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When epidemic pestilence (Shi Yi) initially occurs and the pathogen is in the exterior, if symptoms such as headache, fever, and dysuria (difficult or painful urination) appear, this indicates heat entering the Bladder. The primary treatment is Yiyuan San (Benefit the Origin Powder); Siling San (Four-Ingredient Powder for Leaching Out Dampness) and Zhuling Tang (Polyporus Decoction) are also applicable. Li Dongyuan stated: When dysuria is accompanied by thirst, the heat is in the Upper Jiao (Upper Burner), and the method should be light and permeating to leach out dampness; when dysuria occurs without thirst, the heat is in the Lower Jiao (Lower Burner), and the method should be bitter and cold to clear heat. This serves as a reliable basis.

When epidemic pestilence transmits inward, resulting in constipation and dysuria, one must first unblock the stool; once the stool is unblocked, urination will naturally become free. This phenomenon is specific to epidemic pestilence and does not apply to other diseases. If dysuria persists after repeated sweating and purging treatments for epidemic pestilence, it indicates exhaustion of Yin fluids, which is difficult to treat. It can be managed with herbs such as Anemarrhenae Rhizoma (Zhimu), Phellodendri Cortex (Huangbai), Rehmanniae Radix Recens (Shengdi), and Ophiopogonis Radix (Maidong), or formulas such as Shengmai San (Generate the Pulse Powder) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). However, patients often present with a distended abdomen like a drum and may prove incurable.

In cases of chronic dysuria where the lower orifices remain blocked for a long time, the pathological qi inevitably rebels upward. This often manifests as vomiting, hiccups, inability to swallow even small amounts of liquid, and eventually the inability to take any decoction. In such situations, an umbilical application method should be used: Take one large river snail, mash it thoroughly, add 3 li (approx. 0.15g) of Moschus (Shexiang), and apply it to the umbilicus, securing it with silk bandages. Urination will likely resume immediately; once drops of urine appear, oral decoctions can be administered. Ancient methods also include warming the area with scallions or applying mud from the bottom of a well to the lower abdomen, which can be referenced, but these are not suitable for patients with Yin exhaustion and deficiency.

Before the transmission of epidemic pestilence, urination is usually normal. Once heat transmits inward, the urine becomes yellow; with severe heat, it turns red; if heat enters the Blood level causing blood stasis accumulation, the urine turns black. Urine observation can verify the presence, depth, and quantity of interior heat, but it should not be used as a sole diagnostic criterion. If the epidemic pathogen is in the exterior and urine is yellow, cooling herbs should be added to exterior-resolving formulas. If the pathogen has entered the interior and urine is yellow-red, even if there is cold extremities (cold hands and feet), interior purging to remove heat is still required. After the epidemic pathogen has receded and the exterior and interior are harmonized, if yellow-red urine persists, residual pathogens should still be cleared and diuresis promoted. Only when urine is black should the primary treatment focus on dispelling stasis and clearing heat, using formulas such as Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) with added Rhubarb. If repeated sweating and purging, along with excessive use of cooling herbs, have eliminated all heat from the exterior and interior, yet diarrhea with abdominal pain and yellow-red urine persist, the treatment should focus on regulating the Spleen and raising Yang Qi. This situation arises from improper medication rather than the disease itself.