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The unobstructed flow of urine primarily depends on Qi transformation (Qi Hua), as the Bladder is the reservoir where fluids gather and from which fluids are excreted through the process of Qi transformation. If urinary retention occurs accompanied by thirst, it indicates that heat has damaged the Qi level of the Upper Jiao; in this case, one should regulate the transformation of Lung Qi, using Shengmai San (Generate the Pulse Powder) with added Jiegeng (Platycodon Root). If urinary retention occurs without thirst, it indicates that heat has damaged the Blood level of the Lower Jiao; Zishen Wan (Kidney-Nourishing Pill) should be used. If damp-heat exists within the body, it may also present as non-thirsty urinary retention. For cases of Wuling San syndrome presenting with difficult urination and abdominal distension, this is due to Fire located in the Lower Jiao; blood transformed into water by heat inevitably leads to fullness in the middle abdomen. In such instances, use Xixin (Asarum Root) to raise the Kidney Water of Shaoyin to descend the Fire, and subsequently assist with diuretic herbs; the distension will naturally subside.

Case Record 1
After a person wept loudly, they experienced difficult urination and lower abdominal pain. This was caused by grief injuring the Lung Qi. The Lung is the source of fluid transformation, and the Bladder is the fu-organ of fluids; when the source is injured, the fluids in the Bladder also dry up, causing the Ministerial Fire to become pathological, leading to difficult urination and pain. Treatment involved regulating with sweet-cold herbs that nourish the Lung and generate fluids.

Case Record 2
A patient suffered from urinary retention, gradually developing abdominal fullness. The abdomen became hard and swollen like stone, legs swelled with yellow fluid oozing out, eyes protruded, sleep was impossible day or night, and food intake ceased. This occurred because without Yang, Yin cannot grow; without Yin, Yang cannot transform. Zishen Wan (Kidney-Nourishing Pill) was administered. After a short while, a burning sensation arose at the anterior yin, followed by urine gushing forth like a spring, and the swelling subsided.

Case Record 3
An elderly person suffered from difficult urination after holding back ejaculation during sexual intercourse. Various medicines were ineffective. This was due to Kidney deficiency, Qi stagnation, and Blood coagulation. Juice extracted from crushed Tu Niuxi (Achyranthes Bidentata Root) was taken orally with wine, two bowls per dose. Subsequently, an object three cun long was discharged, along with two worms each six cun long, and the condition resolved.

Case Record 4
Another patient suffered from urinary retention, unresponsive to various medicines. Wu Zhu Yu (Evodia Fruit) and Niuxi (Achyranthes Root) were decocted and taken orally, resulting in immediate urination.

Case Record 5
A patient who overused their mind and lacked moderation in sexual activity experienced painful, difficult urination. The Heart pulse was floating and scattered, and the left Chi pulse was choppy and sharp like a knife cut. This indicated Heart fire transmitting heat to the Small Intestine, causing Kidney Water to dry up, resulting in Yin deficiency with hyperactive Fire. Ren Shen (Ginseng Root) 5 qian, Shan Yao (Dioscorea Rhizome) 3 liang, Fu Ling (Poria), Sheng Di Huang (Rehmannia Root), and Suan Zao Ren (Ziziphus Seed) 2 liang each were processed into Yuan Rou Wan (Longan Pill). Taken on an empty stomach with plain boiled water.

The black color of the North corresponds to the Kidney, communicating with it and opening into the two yin openings (anterior and posterior orifices). The two yin openings refer to urination and defecation; thus, the Kidney governs both. If both urination and defecation are obstructed, Kidney Water is exhausted; when Water is exhausted, Fire becomes dry and hot. Elderly people often suffer from dry stools due to this mechanism.

Case Record 6
A patient presented with swelling and pain in the Jueyin channel region and lower abdominal distension. Physicians mistakenly used Chengqi Tang (Bowel-Unblocking Decoction) for purgation and Wuling San (Five-Ingredient Powder with Poria) for diuresis, leading to complete obstruction of both urination and defecation. Upon diagnosis, I determined the disease was in the Jueyin channel and constituted a True Cold pattern. The erroneous use of purgatives and diuretics led to extreme Yin cold repelling Yang. Although the stool appeared empty, urination was free-flowing. Gan Jiang (Dried Ginger), Rou Gui (Cinnamon Bark), and Zhi Qiao (Aurantium Fructus) 1 qian each, plus Sheng Ma (Cimicifuga Rhizome) and Chai Hu (Bupleurum Root) 0.5 fen each, and Wu Zhu Yu (Evodia Fruit) 0.3 fen were decocted and taken orally, resulting in bowel movement. Subsequently, Sheng Ma (Cimicifuga Rhizome) and Gan Cao Gao (Licorice Tip) 0.3 fen each, Wu Zhu Yu (Evodia Fruit) 0.2 fen, Ge Gen (Kudzu Root), Chi Shao (Red Peony Root), Pao Jiang (Prepared Ginger), Rou Gui (Cinnamon Bark), Bing Lang (Areca Seed), and Mu Tong (Akebia Stem) 1 qian each were used, leading to patent urination and recovery.

Case Record 7
A patient had a bowel movement only once every ten days, scanty urination, and tinea on the face. This was due to sinking of Yang Qi and dryness-fire generation in the Lower Jiao. Buzhong Yiqi Tang (Middle-Supplementing Qi-Boosting Decoction) with doubled Dang Gui Shen (Angelica Sinensis Root tip) was used, adding Hong Hua (Safflower), Dan Pi (Moutan Cortex), and Hei Zhi Zi (Black Gardenia Fruit) to raise Yang, moisten dryness, and clear Lower Jiao heat, resulting in recovery. (Zhang Dongfu commented: Treating the anterior and posterior orifices separately to promote unobstruction is also a valid method. Modern physicians often apply chaotic and erroneous treatments; this case should serve as a standard.)