Library

This is the principal formula for treating difficulty in urination; it regulates the water passages of the Sanjiao (Triple Burner), rather than being a medicine for the Taiyang (Greater Yang) channel. The *Suwen: Jingmai Bie Lun* states: "When drink enters the stomach, its essence floats and overflows, moving upward to be transported by the Spleen; the Spleen scatters the essence, sending it upward to return to the Lung; the Lung regulates and smooths the water passages, transmitting them downward to the Bladder; the water essence distributes throughout the four directions, and the five meridians run in parallel." This formula uses Cinnamon Twig (*Guizhi*) to assist the fire of the Mingmen (Gate of Life), akin to adding fuel to the bottom of a pot, thereby causing the essence and qi of the Stomach to ascend; then using Atractodis Rhizoma (*Baizhu*) to strengthen the Spleen and transport essence to the Lung; subsequently employing Poria (*Fuling*), Polyporus (*Zeling*), and Alisma Rhizome (*Zexie*) to facilitate the ascending and then descending movement of the water passages. This method of first ascending and then descending aligns perfectly with the principles of the *Neijing*, returning every drop to its source, and has no relation to the Taiyang channel. In the *Shanghan Lun*, regarding difficulty in urination: "If there is sweating and thirst, Wuling San (Five-Ingredient Powder with Poria) should govern it; if there is no thirst, Lingcao Ganjiang Tang (Poria, Licorice, and Dried Ginger Decoction) should govern it." Generally, thirst indicates insufficient Yang Qi, preventing water from ascending; without ascending, there can be no descending. Therefore, Cinnamon Twig (*Guizhi*) is used to raise it, while Poria (*Fuling*), Polyporus (*Zeling*), and Alisma Rhizome (*Zexie*) are used to lower it, with Atractodis Rhizoma (*Baizhu*) serving as the central pivot. However, commentators have universally attributed thirst to heat entering the Bladder, causing fluid depletion. If heat had truly entered, using Cinnamon Twig (*Guizhi*) and Atractodis Rhizoma (*Baizhu*) to warm would consume fluids, and combined with the draining action of Poria (*Fuling*) and Alisma Rhizome (*Zexie*), this would be heat upon heat and consumption upon consumption, hastening death. Moreover, those without thirst do not use Wuling San but instead use Lingcao Ganjiang Tang. This shows that without thirst, there is no need for Cinnamon Twig (*Guizhi*) and Atractodis Rhizoma (*Baizhu*) to vaporize fluids, further proving that these herbs treat the Sanjiao rather than the Taiyang, which goes without saying. In cases of urinary obstruction where Cinnamon Twig (*Guizhi*) is substituted for Cinnamon Bark (*Rougui*), it is likely because the fire of the Mingmen (Gate of Life) is not deficient, but there is an exterior Taiyang syndrome. Because pathogenic factors injured the Taiyang channel and transmitted to the Sanjiao, the exterior pathogen remains unresolved while the water passages of the Sanjiao are obstructed. This corresponds to what the *Shanghan Lun* calls: "Wind-strike with fever, unresolved after six or seven days, accompanied by irritability, presenting both exterior and interior syndromes, thirst with desire to drink, but vomiting immediately after drinking, named Shuini (Water Reversal), governed by Wuling San (Five-Ingredient Powder with Poria)." The exterior syndrome stems from Taiyang deficiency, so Cinnamon Twig (*Guizhi*) is used to disseminate Yang Qi and circulate fluids throughout the body, adhering to the principle in the classics: "Water essence distributes throughout the four directions, and the five meridians run in parallel," not to promote urination downward. The interior syndrome results from the failure of Sanjiao Qi transformation to unblock, so the draining actions of Poria (*Fuling*) and Polyporus (*Zeling*) are used to open Sanjiao blockage, not to open the urethral orifice of the Bladder. When Qi transformation in the Lower Jiao fails to unblock, abdominal distension and difficulty in urination occur; water accumulates outside the Bladder because it cannot transform into the Bladder. Thus, Wuling San (Five-Ingredient Powder with Poria) is used to resolve it. There are also cases where Cinnamon Twig (*Guizhi*) is effective because Wei Qi (Defensive Qi) originates from the Lower Jiao, assisting Taiyang Qi transformation to move water, not to treat water accumulation within the Taiyang Fu organ. If the Sanjiao has transported water qi into the Bladder but it cannot exit, this is true Bi (Obstruction) within the Taiyang Fu organ, known as Baobi (Bladder Bi). The *Suwen: Bilun* states: "Baobi presents as internal pain upon pressing the lower abdomen and Bladder area, feeling as if soaked in hot water, with difficult and scanty urination, and clear nasal discharge above." Water inside the Bladder causes Bladder fullness rather than abdominal distension, hence internal pain upon pressing; feeling as if soaked in hot water indicates the urinary passage is blocked and unpatent, leading to difficult urination; the Bi Qi of the Bladder follows the Taiyang meridian pathway from the vertex into the brain, causing clear nasal discharge above. This is true water binding within the Taiyang Fu organ, distinct from urinary difficulty accompanied by abdominal distension. In summary, only when water enters the interior of the Bladder does it belong to the Taiyang category; if water is outside the Bladder, causing abdominal distension and difficult urination, this is governed by the Sanjiao, located outside the Zang-Fu organs and within the body shell. Yu Damin stated: The Sanjiao refers to the body cavity. Therefore, in treating abdominal fullness and swelling, if one uses only diuretic herbs, the Qi of the Sanjiao will fail to transform and distribute, and the fluids of the Bladder will be exhausted below. This contradicts the intent of Zhongjing's Wuling San (Five-Ingredient Powder with Poria).