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In the middle of autumn in the Gui Si year, Grand Marshal Yuan Hongxi of Nanjing, who concurrently held the positions of Minister of Works, Censorate, and Commander of the River Operations, traveled daily between various government offices under the scorching sun to handle official duties. This led to fever, dry mouth, and extreme thirst. To relieve the dryness and thirst, he consumed excessive amounts of water-soaked watermelon, pear, and fresh lotus root, which subsequently caused diarrhea and scanty urination. Physicians treated him with Weiling Tang (Stomach and Lingzhi Decoction) added with Huashi (Talcum), Mutong (Akebia Stem), and Cheqianzi (Plantago Seed) to promote diuresis, which stopped the diarrhea. However, this resulted in dry and hard stools, making defecation extremely difficult. Subsequently, Runchang Wan (Moisten Intestines Pill) was administered, but this exacerbated the condition, leading to persistent diarrhea. Previous purgative and diuretic agents were tried again; while the diarrhea ceased, urination became completely obstructed, causing distension and urgency below the umbilicus. When standing to urinate, not a drop could be passed; when lying down, urine flowed incessantly. Due to the frequent need to empty the chamber pot, he suffered from insomnia throughout the night. After more than half a month of treatment, his spirit declined, and both sleep and appetite were lost. Hearing that I resided in the office of Department Minister Cui, he summoned me for treatment. Upon first meeting, I informed him of the origin of his illness and stated that the physicians in the capital did not recognize the syndrome. If it were considered Long Bi (obstructive urinary dysfunction), urine should not flow when lying down; if considered Mi Jie (constipation), there would be no urine leakage; if considered Pi Yue (spleen constraint constipation), the stool would not be dry; if considered Qi Xu Xia Xian (Qi deficiency with sinking) and Xin Xue Bu Zu (Heart blood insufficiency), then Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Anshen Wan (Calm the Spirit Pill) taken for ten days and nights should have been effective. Having heard of your high medical skill, we hope you will diagnose us to resolve the matter. I palpated his pulse: the Cun (inch) positions on both sides were short and weak, the Guan (bar) positions were slow and large, and the Chi (cubit) positions were surging and large. I said to him, "This is residual summerheat unresolved, combined with your habit of drinking alcohol, leading to damp-heat flowing into the lower jiao. It is now afternoon, so my diagnosis may not be precise yet. I will wait until tomorrow morning to examine you carefully before prescribing." The Duke said, "I have long awaited your arrival. What you said is quite accurate. I wish to take a dose immediately to hopefully get some sleep." Reluctantly, I prescribed Yi Yuan San (Benefit Primordial Powder) three qian, decocted in Xiangru Tang (Mosla Decoction). There was little change in symptoms. On the next morning's follow-up, the six pulses remained the same. I pondered and suddenly realized. I told him again, "This syndrome is due to misalignment of the urethral orifice." The Duke asked, "Which book does this term come from?" I replied, "The Nei Jing states: 'The bladder is the chamber of the paodang (urinary bladder/uterus).' Damp-heat in the paodang sinks downward, so when standing, the orifice is misaligned, preventing urination; when lying down, the paodang does not sink, allowing urine to seep out. Because the orifice is still misaligned, although urine flows in drops, it cannot drain smoothly, hence the sensation of incomplete emptying. Treatment requires tonifying the Yuan Qi of the upper and middle jiao, while simultaneously clearing damp-heat from the lower jiao. Another method: since Qi deficiency with sinking has persisted for a long time, one or two doses will not suffice to make you lie down and sleep. Moreover, this insomnia is not due to Heart blood insufficiency, but rather the fear of incomplete emptying prevents sleep. Temporarily line your mat with old clothes or cloth pads. Do not worry; let the urine flow freely. This avoids disturbing the Shen (spirit) by getting up to use the chamber pot, allowing natural deep sleep." I used Buzhong Yiqi Tang to tonify the Yuan Qi of the upper and middle jiao, adding Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) to clear damp-heat from the lower jiao. As clear Yang ascends, turbid Yin naturally descends; without damp-heat in the paodang, it will not sag, the orifice will align, and the disease will heal. The Duke happily accepted the prescription. That night, following the advice to pad the bed, he indeed slept soundly, forgetting whether urine had flowed or not. The next morning, the padding was moist but not soaked. Having not closed his eyes for so long, this sleep restored his Shen Qi instantly, and his chest felt refreshed as if he were healthy. After four days of regulation, he fully recovered. The Duke was overjoyed and wished to keep me staying longer, but due to the urgent invitation from Li Gong of the Grain Transport, I could not stay. A large boat was dispatched, with musicians escorting me back to Qian Pass.