【歌】实热溲便故不通，下焦气结号为癃。气虚血弱兼痰闭，一吐提时便有功。虚热故令便不禁，虚寒
遗溺在温中。
【论】夫肾水潴于膀胱而泄于小肠，此上下相通，故水火既济，则荣卫流行，水窦开阖，便溺通畅，岂有
不禁、不利者欤？夫惟心肾不交，水火未济，阴阳不调，则内外关水道窒塞，而有小便癃闭、遗溺之病生焉。
盖膀胱与肾为表里，虚则客热乘之，故不能制水，水挟热而行，故数而不通，溺有余沥。肾与膀胱皆冷，内气
不充，胞中自滑，故出多而色白。所以热则不通，冷则不禁，理之自然。亦有虚热而遗沥，气虚而不通者，不
可不知。
【脉】鼻头色黄，小便必难。脉浮弦涩，为不小便。
虚闭
气虚不能施化，小水不通者，四君子汤加升麻，先服后吐之。（方见脾胃。）血虚而小水不通者，四物汤
加升麻，先服后吐之。（方见血虚。）气血两虚，二方合用加升麻。
痰闭
痰气闭涩于下焦，小水不通者，二陈汤加木通、香附，先服后吐，或蒲黄汤。痰盛肥胖之人，导痰汤取吐
即通。（二陈汤、导痰汤二方俱见痰证内。）
蒲黄汤
治小便不通。
赤茯苓（五分） 木通（五分） 车前子（五分） 桑白皮（八分） 荆芥（四分） 灯心（三分） 赤芍
药（五分） 蒲黄（生用，八分） 滑石（一钱，研） 甘草梢（七分） 紫苏（五分）
上锉，加葱白三个，水煎服。
热闭
下焦实热，小便不通者，八正散，再用通小便法。茎中痛，热盛闷涩者，导赤散加山栀、大黄。
八正散
治热闭。
车前子（一钱） 瞿麦（一钱） 蓄（一钱） 滑石（一钱） 甘草（一钱） 山栀仁（一钱） 木通（一
钱） 大黄（一钱，面裹煨）
灯心二十茎，水煎，空心服。
导赤散
治小便不通。
木通（二两） 生地黄（二两） 甘草（一两）
水煎服。
通小便法
用活田螺一个，连壳捣如泥，入麝少许，置脐内，以蛤蜊壳合之，绢帛扎定，少时即通，治噤口痢亦用此法。
小便不禁
小水不禁，出而不觉，赤者为热，白者气虚。又有虚热、虚寒之不同。内虚湿热，小便不禁，遗沥者，六
味地黄丸加牛膝、杜仲、破故纸。（方见前劳瘵证。）三因韭子丸乃治虚寒遗溺之要药。自汗脉弱者，秘元丹。
若虚热不禁，补阴丸加益智、人参、干山药。（方见火证。）
三因韭子丸
韭子（六两，炒） 鹿茸（四两，酥炙） 肉苁蓉（酒浸，二两） 牛膝（二两） 熟地黄（二两） 当归
（二两） 巴戟（两半，去心） 菟丝子（两半） 杜仲（一两） 石斛（一两） 干姜（一两） 桂心（一两）
末之，丸梧子大，每服百丸，空心酒下。
秘元丹
固精止溺。
龙骨（三两， ） 砂仁（二两） 诃子（十个，泡去核） 灵砂（二两）
末之，煮糯米粥，丸如麻子大，空心临卧各用酒下五十丸。
[Song]
Excess heat causes obstruction of urination and defecation; qi stagnation in the Lower Jiao is termed *Long* (癃, difficulty in urination). Qi deficiency and blood weakness combined with phlegm obstruction: using emesis to raise clear Yang can be effective. Deficient heat causes urinary incontinence; deficient cold causing enuresis requires warming the Middle Jiao.
[Discussion]
Kidney water accumulates in the Bladder and drains into the Small Intestine; this connection between upper and lower allows for the mutual interaction of Water and Fire (*Shui Huo Ji Ji*), enabling the smooth circulation of Ying and Wei (Nutritive and Defensive Qi). With the proper opening and closing of water passages, urination and defecation are unobstructed. How could there be incontinence or obstruction? Only when Heart and Kidney fail to interact, Water and Fire do not harmonize, and Yin and Yang are imbalanced, do internal and external barriers cause blockage of water passages, leading to diseases such as urinary retention (*Long*) and enuresis.
The Bladder and Kidney are exterior-interior pairs. When deficient, pathogenic heat invades, so it cannot control water. Water carries heat and flows rapidly, resulting in frequent but obstructed urination with residual drops. If both Kidney and Bladder are cold, and internal Qi is insufficient, the Bladder becomes slippery, resulting in large volumes of pale urine. Thus, heat causes obstruction, and cold causes incontinence; this is the natural principle. There are also cases of residual drops due to deficient heat, or obstruction due to Qi deficiency, which must be understood.
[Pulse Diagnosis]
Yellow color on the tip of the nose indicates difficult urination. A floating, wiry, and choppy pulse indicates urinary retention.
[Deficient Obstruction]
When Qi deficiency fails to promote transformation, causing urinary retention, administer Si Jun Zi Tang (Four Gentlemen Decoction) with Sheng Ma (Cimicifugae Rhizoma), followed by emesis. (Formula see Spleen-Stomach section.) When Blood deficiency causes urinary retention, administer Si Wu Tang (Four Substances Decoction) with Sheng Ma, followed by emesis. (Formula see Blood Deficiency section.) For dual Qi and Blood deficiency, combine both formulas with Sheng Ma.
[Phlegm Obstruction]
When Phlegm-Qi blocks the Lower Jiao, causing urinary retention, administer Er Chen Tang (Two-Cured Decoction) with Mutong (Akebiae Caulis) and Xiang Fu (Cyperi Rhizoma), followed by emesis, or use Pu Huang Tang. For individuals with excessive phlegm and obesity, Dao Tan Tang (Phlegm-Resolving Decoction) inducing emesis will immediately restore flow. (Er Chen Tang and Dao Tan Tang formulas are found in the Phlegm Syndrome section.)
[Pu Huang Tang]
Treats urinary retention.
Chi Fu Ling (Poria Cocos with Red Skin, 5 fen) Mutong (Akebiae Caulis, 5 fen) Che Qian Zi (Plantaginis Semen, 5 fen) Sang Bai Pi (Mori Cortex, 8 fen) Jing Jie (Schizonepetae Spica, 4 fen) Deng Xin Cao (Junci Medulla, 3 fen) Chi Shao Yao (Paeoniae Radix Rubra, 5 fen) Pu Huang (Typhae Pollen, raw, 8 fen) Hua Shi (Talcum, 1 qian, crushed) Gan Cao Gao (Glycyrrhizae Radix et Rhizoma tip, 7 fen) Zi Su (Perillae Folium, 5 fen)
Chop the ingredients, add three stalks of Cong Bai (Allii Fistulosi Bulbus), decoct in water, and take orally.
[Heat Obstruction]
For excess heat in the Lower Jiao causing urinary retention, use Ba Zheng San (Eight-Utensils Powder), followed by external methods to promote urination. For pain in the urethra and severe heat causing stifling and astringency, use Dao Chi San (Directing Fire Outward Powder) with Shan Zhi (Gardeniae Fructus) and Da Huang (Rhei Radix et Rhizoma).
[Ba Zheng San]
Treats heat obstruction.
Che Qian Zi (Plantaginis Semen, 1 qian) Qu Mai (Dianthi Herba, 1 qian) Bian Xu (Polygoni Avicularis Herba, 1 qian) Hua Shi (Talcum, 1 qian) Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 qian) Shan Zhi Ren (Gardeniae Fructus, 1 qian) Mutong (Akebiae Caulis, 1 qian) Da Huang (Rhei Radix et Rhizoma, 1 qian, baked in flour dough)
Decoct with 20 stems of Deng Xin Cao (Junci Medulla) in water; take on an empty stomach.
[Dao Chi San]
Treats urinary retention.
Mutong (Akebiae Caulis, 2 liang) Sheng Di Huang (Rehmanniae Radix, 2 liang) Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 liang)
Decoct in water and take orally.
[Method to Promote Urination]
Take one live field snail, crush it whole with its shell into a paste, add a small amount of She Xiang (Moschus), apply to the umbilicus, cover with a clam shell, and secure tightly with silk cloth. Urination will resume shortly. This method is also used for treating Jin Kou Li (Throat-lock Dysentery).
[Urinary Incontinence]
Involuntary urination without sensation: red urine indicates Heat; white urine indicates Qi deficiency. Differentiate between deficient Heat and deficient Cold. For internal deficiency with damp-heat causing incontinence and residual drops, use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Niu Xi (Achyranthis Bidentatae Radix), Du Zhong (Eucommiae Cortex), and Po Gu Zhi (Psoraleae Fructus). (Formula see preceding Lao Zhai [Consumption] section.) San Yin Jiu Zi Wan (Three Causes Leek Seed Pill) is a key remedy for deficient cold enuresis. For spontaneous sweating and weak pulse, use Mi Yuan Dan. For incontinence due to deficient heat, use Bu Yin Wan (Yin-Nourishing Pill) plus Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Ren Shen (Ginseng Radix et Rhizoma), and Gan Shan Yao (Dioscoreae Rhizoma). (Formula see Fire Syndrome section.)
[San Yin Jiu Zi Wan]
Jiu Zi (Leek Seed, 6 liang, stir-fried) Lu Rong (Deer Antler Glue, 4 liang, fried with butter) Rou Cong Rong (Cistanche Deserticola, 2 liang, soaked in wine) Niu Xi (Achyranthis Bidentatae Radix, 2 liang) Shu Di Huang (Prepared Rehmanniae Radix, 2 liang) Dang Gui (Angelicae Sinensis Radix, 2 liang) Ba Ji Tian (Morinda Officinalis, 1.5 liang, heart removed) Tu Si Zi (Cuscutae Semen, 1.5 liang) Du Zhong (Eucommiae Cortex, 1 liang) Shi Hu (Dendrobii Caulis, 1 liang) Gan Jiang (Zingiberis Rhizoma, 1 liang) Gui Xin (Cinnamomi Ramulus, 1 liang)
Grind into powder, make pills the size of wutong seeds. Take 100 pills per dose with wine on an empty stomach.
[Mi Yuan Dan]
Consolidates essence and stops urination.
Long Gu (Fossilized Bones, 3 liang, calcined) Sha Ren (Amomi Fructus Rotundus, 2 liang) He Zi (Terminalia Chebula, 10 pieces, soaked and pitted) Ling Sha (Spiritual Cinnabar, 2 liang)
Grind into powder, mix with cooked glutinous rice porridge, make pills the size of hemp seeds. Take 50 pills with wine on an empty stomach and before bed.