文仲当归大黄汤，方见《胁痛》。）
小便总说 胞囊者，肾膀胱候也，贮津液并尿。若脏中热病者，胞涩，小便不通，尿黄赤。若腑有寒
病，则胞滑，小便数而多白。若至夜则尿偏甚者，夜则内阴气生故。热则泻之，寒则补之，不寒不热，
根据经调之，则病不生矣。（《千金》）
肾主水，膀胱为之腑，水潴于膀胱而泄于小肠（按∶当云水潴于小肠而泄于膀胱，此误错），实相通
也。然小肠独应于心者何哉？盖阴不可以无阳，水不可以无火，水火既济，上下相交，此荣卫所以流行，而水
窦开阖所以不失其司耳。惟夫心肾不济，阴阳不调，故内外关格而水道涩，传送失度而水道滑。热则不通，冷
则不禁。其热盛者，小便闭而绝无；其热微者，小便难而仅有。肾与膀胱俱虚，客热乘之，故不能制水，水挟热
而行涩焉，是以数起而溺有余沥。肾与膀胱俱冷，内气不充，故胞中自滑，所出多而色白焉。是以
遇夜阴盛愈多云云。故或冷或热而滑涩随之矣。（《直指》）
病由肾膀胱有热 小便不通，由膀胱与肾俱有热故也。肾主水，膀胱为津液之府，此二经为表里，而
水行于小肠入胞者为小便。肾与膀胱俱热，热入于胞，热气太盛故结涩，令小
便不通，小腹胀满，气急甚者，水气上逆，令心急腹满，乃
至于死。诊其脉紧而滑直者，不得小便也。（病源论）
热气在于脏腑（按∶此上数句，与不通候同，脏腑即肾、膀胱），水气则涩，其热势极微，故但小便难
也。诊其尺脉浮，小便难。尺脉濡，小便难。尺脉缓，小便有余沥也。（《同上》）（按∶此诊候本出《脉
经》。）
病有数端 尝记小便不利者有三，不可一概而论也。若津液偏渗于肠胃，大便泄泻而小便涩少，一
也，宜分利而已。若热搏下焦津液，则热湿而不行，二也，必渗泄则愈。若脾胃气涩，不能通利水道下输膀
胱而化者，三也，可顺气，令施化而出也。（《宝鉴》）
凡癃闭之证，其因有四，最当辨其虚实。有因火邪结聚小肠膀胱者，此以水泉干涸，而气门热闭不通
也。有因热居肝肾者，则或以败精，或以槁血，阻塞水道而不通也。若此者，本非无水之证，不过壅闭而然，
病因有余，可清可利，或用法以通之，是皆癃闭之轻证也。惟是气闭之证则尤为危候，然气闭之义有二焉，
有气实而闭者，有气虚而闭者。夫膀胱为藏水之腑，而水之入也，由气以化水，故有气斯有水；水之出也，由水
以达气，故有水始有溺。经曰∶气化则能出矣。盖有化而入，而后有化而出，无化而出，必其无化而入。是以
其入其出皆由气化，此即本经气化之义，非单以出者言气化也。然则水中有气，气即水也，气中有水，水即气
也。今凡病气虚而闭者，必以真阳下竭，元海无根，水火不交，阴阳否隔，所以气自气而气不化水，水自水而水
蓄不行。气不化水，则水腑枯竭者有之；水蓄不行，则浸渍腐败者有之。气既不能化，而欲强为通利，果能行乎
。阴中已无阳，而再用苦寒之剂，能无甚乎。理本甚明，何知之者之不多见也。至若气实而闭者，不
过肝强气逆，移碍膀
胱，或破其气，或通其滞，或提其陷，而壅者自无不去，此治实者无难，而治虚者必得其化为不易也。故凡临
此证，不可不详辨其虚实。（《景岳》）
转胞 胞转者，由是胞屈辟小便不通，名为胞转。其病状，脐下急痛，小便不通是也。此病或由小便应
下便强忍之，或为寒热所迫，此二者俱令水气还上，气迫于胞，使胞屈辟，不得充张，外水应入不得入，内
溲应出不得出，外内相壅塞，故令不通，此病至四五日乃有致死者。饱食讫应小便而忍之，或饱食讫而走马，
或小便急因疾走，或忍尿入房，亦皆令胞转或胞落，并致死。（《病源论》）
转胞证候，孕妇多有之，患在忍缩小便，或喜食煎爆，故饱后为热所迫，遂使小肠之气逆而不通，大肠之
气与之俱滞，外水不能入膀胱，内水不能出膀胱，淋沥急数，每欲尿时，痛不可言，大便亦里急频并，似痢非
痢。必以手从胸间按至脐下，庶可立出小便，否则逆上出而不禁，甚者因此腹胀浮肿。治法用凉药疏利小肠中
热，仍与通泄大肠，迨其腹中搅痛，大便大下，则溺胞随即归正，于是小便顺流。葵子
散，见附《妇人摘奇方》。（《直指》）（按∶葵子散方未考，或者葵子茯苓散。）
男子亦有转胞，妇人转胞不必尽由胎压，多因尿急脬胀，而骤马驰车，飞跑急走，致脬颠翻，或水溢中
焦，食满肠胃，下压膀胱，无处退避，以致闪侧翻转（热攻气迫者可推），并须吐法。（《医碥》）
病变不一 小水不通，是为癃闭，此最危最急证也。水道不通，则上侵脾胃而为胀，外侵肌肉而
为肿，泛及中焦则为呕，再及上焦则为喘，数日不通，则奔迫难堪，必致危
殆。今人一见此证，但知利水，或用田螺罨脐之法，而不辨
其所致之本，无怪其多不治也。（《景岳》）
证治总例 （禁渗利证）气闭证，当分虚实寒热而治之。凡气实者，气结于小肠膀胱之间，而壅闭不
通，多属肝强气逆之证，惟暴怒郁结者多有之，宜以破气行气为主，如香附、枳壳、乌药、沉香、茴香之属，
兼四苓散而用之。若气陷于下，药力不能骤及者，当即以此药多服探吐，以提其气，使气升则水自降也。凡气虚
而小便闭者，必以素多斫丧，或年衰气竭者，方有此证，正以气有不化，最为危候，不易治也。然凡病此者必
其有渐，但觉小便短少，或便时费力，盒饭留心速治。若待其剧，恐无及也。但治此者，亦当
辨其脏气之寒热。（《景岳》）
老人及虚弱人小便不通，当服八味丸之属，不宜服凉心经疏导之药。暑月多误以为伏热，尤宜详审。（《魏氏》）
小便不利者，可与导赤丸、导赤散、五淋散（并见《淋》）、五苓散，加滑石细研，用海金沙、车前子、
灯心煎汤调服。（《管见》）
大便小便，脉络相贯也。人有多日小便不通，但用神保丸、北亭丸辈（神保丸见《胁痛》，北亭丸见《和
剂》），大泻数行，小肠自利。（《直指》）
小腹痛胀如覆碗为实，其法有二∶气壅塞于下者，用吐法以提之，血污于下者，用桃仁之类以破之。（《
纲目》）
小便不通，腹中痛闷难忍，如覆碗者为实，亦分在气在血。气壅于下者，四磨、六磨选用；血污于下者，
代抵当丸。小便不利，审是气虚，独参汤少加广皮如神。（《医通》）
盖小便不通，有全秘者，有涩少者云云。有元气下坠不
通者，宜吐以提其气，气升则水降而自利矣，盖气承载其水
故也。有大便泄泻而小便涩少者，乃津液偏渗肠胃也，宜分利而已。有热搏下焦，津液被涸不通者，须清热生
津则愈。有脾胃气弱，不能通调水道下输膀胱而化者，可益元气，令施化而出也。有汗多而津液竭少涩秘者，
有亡血致虚涩秘者，有劳伤气虚涩秘者，有痰饮阻滞气道不通者，有忿气闭
遏不通者，有诸疮脓血去多涩少者，各随所因施治。（《病源集》）
汗出过多，小便赤涩，此五内枯燥，慎勿用利水之剂，只宜十全大补汤去桂，或养荣汤，滋血生津，或疮
疾去脓血多而赤涩者，治法亦然。（同上）
服分利既多而小水愈不通者，此必下竭之证，察其水亏者，必须大补真阴，火虚者，必须峻补阳气，气达
水行，其便自调。不可见其假实，恣意疏通，此与榨干汁、 枯油者何异，致令竭者愈竭，鲜不危矣。（《景岳》）
膀胱无水等证，有因泄泻，水归大肠，而小水不通者，此当但治泄泻，泄泻止而水自利也。有因大汗多汗，气从汗
泄，而小水不利者，此当调治营卫，表气收而小便自利也。有虚劳亡血伤精，水随液去，五内枯燥，而小水不
利者，此当调补真阴，血气渐充而小水渐利也。凡此数者，皆膀胱无水枯涸之证，水泉既涸，故不可再加
分利。内惟泄泻证亦有可分利者，然亦不过十之三耳。诸如此者，当于各门详察治之，皆非有水不通而为
癃闭之证也。（同上）
湿邪在表证 一妇年五十，患小便涩，治以八正散等剂，小肠胀急不通，身如芒刺。余以所感霖淫
雨滋，邪尚在表，因用苍术为君，附子佐之发表，一服即汗，小便随通。（《推求师意》）（按∶此亦出《准绳》。）
湿热内蓄证 中书右丞合刺合孙，病小便数而欠，日夜
约去二十余行，脐腹胀满，腰脚沉重，不得安卧。至元癸未季春下旬，予往诊视，脉得沉缓。时时带数。（
按∶此下说小便不利有三，见上。）今右丞平素膏粱，湿热内蓄，不得施化，膀胱窍涩，是以起数而见少也，
非渗泄分利，则不能快利。遂处一方，名曰茯苓琥珀汤云云。两服减半，旬日良愈。（《宝鉴》）
气闭证 其在仪真，御史中丞亦家焉。其内人病，艰于小溲，中满喘渴。门僧宝颇知医，投以瞿麦、
栀、芩诸滑利药，而闷益甚。召寿，候其脉三部皆弦而涩。寿曰∶经云∶膀胱者州都之官，津液藏焉，气化则
能出矣。所谓水出高源者也，膻中之气不化，则水液不行，病因于气，徒行水无益也，法当治上焦。乃制朱雀
汤（按∶魏氏校本，举其方，用雄雀肉、赤豆、参、苓、枣、小麦、紫石英、紫菀、远志、丹参、甘草。又附
朱雀丸方），倍以枳、桔，煎用长流水，一饮而溲，再饮气平，数服病已。（《医史·撄宁生传》）
先兄念山，谪官浙江按察，郁怒之余，又当盛夏，小便不通，气高而喘。以自知医，服胃苓汤四帖不效。
余曰∶六脉见结，此气滞也。但用枳壳八钱，生姜五片，急火煎服，一剂稍通，四剂霍然矣。（《必读》）
或有气闭而小便不通，至脐下气 结痛，以五香散，间服独味琥珀末，以灯心汤下，甚效。女人
多有此证。（《要诀》）
热在下焦证 北京人王善甫，为京兆酒官，病小便不利，目精凸出，腹胀如鼓，膝以上坚硬，皮肤
欲裂，饮食不下，甘淡渗泄之药皆不效。先师曰∶疾急矣，尚非精思不能处，我归而思之。夜参半，忽揽衣
而起曰∶吾得之矣。《内经》有云∶膀胱者津液之府，必气化而能出焉。渠辈已用渗
泄之药而病益甚，是气不化也。启玄子云∶无阳则阴无以生，无阴则阳无以化。甘淡气薄皆阳药，独阳无阴，
欲化得乎。明日以群阴之药投之，不再服而愈。（《试效》）（按∶群阴之药即滋肾丸，方见后。）
端君宝母，六十余，亦病小便 ，若淋状，小腹胀，口吻渴。邀寿诊其脉，沉且涩。曰∶此病在下焦血
分，阴火盛而水不足，法当治血，血与水同，血有形而气无形，有形之
疾当以有形法治之。即以东垣家滋肾丸服之而愈。（《撄宁生传》）
肺燥证 郡守王镜如，痰火喘嗽正甚时，忽然小便不通，自服车前、木通、茯苓、泽泻等药，小肠
胀满，点滴不通。余曰∶右寸数大，是金燥不能生水之故。惟用紫菀五钱，麦门冬三钱，北五味十粒，人参
二钱，一剂而小便涌出如泉。若淡渗之药愈多，则反致燥急之苦，不可不察也。（《必读》）
积痰证 一男子病小便不通，医治以利药益甚。翁诊之，寸口颇弦滑。曰∶此积痰病也，积痰在肺，
肺为上焦而膀胱为下焦，上焦闭则下焦塞。譬如滴水之器，必上窍通而后下窍之水出焉。乃以法大吐之，吐已
病如失。（《医史·丹溪翁传》）（按∶《金匮翼》曰∶必痰实气闭者乃可用之，未可以之概治气虚、血虚等症。）
病有宜缩小便 钱塘有人小肠秘，百方通之不效。有一，道人钱宗元视之，反下缩小便药，俄而遂
通。人皆怪之，以问宗元。曰∶以其秘，故医者骤通之，则小便大至，水道愈隘，而小便愈不得通矣。今吾缩
之，使水道稍宽，此所以得流也。此一事殊为特见。（《北窗炙 》）
妊妇尿闭 怀妊之妇，每有小便不通者，此以胎气下
陷、溺孔被压而然，多以气虚不能举胎所致，宜八珍汤、补中益气汤之类主之。若临盆之际，胎压膀胱而小便
不通者，宜以手指托起其胎，则小水自出。（《景岳》）
孕妇胎满，逼压尿胞，胞转侧倾侧，胞系了戾，不得小便，名转胞。须举其胎，令稳婆香油抹手，入
产户托起其胎，溺出如注，次以人参、白术、陈皮、升麻，加入四物内煎服，顷时以指探吐，如此三四次则
胎举矣。一法，令孕妇卧榻上。连榻倒竖起，尿自出，胜手托。（《医碥》）
滑窍淡渗诸方 《古今录验》疗胞转不得小便方。
真琥珀（一两） 葱白（十四茎）
上二味，以水四升，煮取三升，去葱白，末琥珀细筛，下汤中，温服一升，日三服。范汪同。（《外
台》）《千金》于本方（葱白四十七茎，琥珀三两）加阿胶（一两）、车前子（一升）， 咀，以水一斗，
煮取三升，分三服。
又张苗说，有容忍小便令胞转，大小便不得，四五日困笃欲死无脉，服此差方。
滑石（二两） 乱发（三两烧灰）
上二味捣下筛，取生桃白皮一斤熟春，以水合绞，得汁二升，以汁服散方寸匕，日三服即愈。（按∶
Wenzhong Danggui Dahuang Decoction, see the formula in the "Hypochondriac Pain" chapter.)
General Discussion on Urination The bladder (Pangguang) is the external manifestation of the Kidney and Bladder functions, responsible for storing body fluids (Jinye) and urine. If there is a heat pathogen in the zang-fu organs, the bladder becomes obstructed, leading to urinary retention with yellow-red urine. If there is a cold pathogen in the fu organs, the bladder becomes slippery, leading to frequent urination with white urine. If urination is particularly severe at night, it is because yin qi generates internally at night. Heat patterns are treated with purging methods, cold patterns with tonifying methods, and neither heat nor cold patterns are regulated according to meridian theory, thus preventing disease. (From *Qianjin Fang*)
The Kidney governs water, and the Bladder is its fu organ. Water accumulates in the Small Intestine and is excreted into the Bladder (Note: It should be stated that water accumulates in the Small Intestine and is excreted into the Bladder; the original text contains an error). They are indeed connected. However, why does the Small Intestine correspond solely to the Heart? This is because yin cannot exist without yang, and water cannot exist without fire. When water and fire interact harmoniously, upper and lower parts communicate, which allows Ying and Wei Qi to circulate freely, ensuring that the openings and closures of the water passages remain under proper control. Only when the Heart and Kidney do not interact, and yin and yang are imbalanced, will internal-external obstruction occur, causing the water passages to become sluggish or overly slippery due to loss of transmission regulation. Excessive heat leads to urinary obstruction, while cold leads to urinary incontinence. In cases of intense heat, urine is completely blocked; in cases of mild heat, urination is difficult with only scant amounts. When both the Kidney and Bladder are deficient, and exogenous heat invades, they fail to control water, so water moves sluggishly with heat, resulting in frequent urination with post-void dribbling. When both the Kidney and Bladder are cold, internal qi is insufficient, causing the bladder to become naturally slippery, resulting in copious white discharge. Therefore, during the night when yin qi is abundant, symptoms worsen. Thus, depending on whether the condition is cold or hot, slipperiness or obstruction follows. (From *Zhizhi Fang*)
Urinary retention caused by heat in the Kidney and Blader results from heat present in both organs. The Kidney governs water, and the Bladder is the mansion of body fluids. These two meridians are exterior-interior partners. Water travels through the Small Intestine into the Bladder to become urine. When both the Kidney and Bladder have heat, and heat enters the bladder, excessive heat causes stagnation and obstruction, leading to urinary retention, lower abdominal distension and fullness. In severe cases of qi urgency, water qi rebels upward, causing heart irritability and abdominal fullness, potentially leading to death. Palpating a tight, smooth, and straight pulse indicates inability to urinate. (From *Zhubing Yuanhou Lun*)
Heat residing in the zang-fu organs (Note: The preceding sentences are identical to those describing urinary retention; "zang-fu" here refers specifically to the Kidney and Bladder). Water qi becomes sluggish. If the heat is extremely mild, only difficulty in urination occurs. A floating chi pulse indicates difficulty in urination. A soggy chi pulse indicates difficulty in urination. A slow chi pulse indicates post-void dribbling. (From *Ibid.*) (Note: This diagnostic pattern originates from *Mai Jing*.)
There are several types of etiology. I recall three types of impaired urination that cannot be generalized. First, if body fluids leak excessively into the intestines and stomach, causing diarrhea and scanty, sluggish urine, this is one type, treatable by separating and draining. Second, if heat binds with fluids in the lower jiao, causing damp-heat stagnation, this is the second type, curable only by渗泄 (seeping and draining). Third, if spleen and stomach qi is stagnant, failing to regulate water passages to transport downward to the bladder for transformation, this is the third type, treatable by regulating qi to facilitate transformation and excretion. (From *Weisheng Baojian*)
In cases of longbi (urinary retention), there are four causes, and distinguishing deficiency from excess is paramount. One cause is fire pathogens accumulating in the Small Intestine and Bladder, where the source of water is dried up, and the qi gate is heat-closed and obstructed. Another cause is heat residing in the Liver and Kidney, where either residual essence or stasis blocks the water passages. Such cases are not truly devoid of water but are obstructed due to excess pathogens; they can be cleared or drained, or treated with methods to unblock them. These are mild forms of longbi. However, qi-blockage patterns are particularly critical. There are two meanings of qi-blockage: excess qi-blockage and deficiency qi-blockage. The Bladder is the mansion storing water. Water enters via qi transforming water, so having qi means having water. Water exits via water reaching qi, so having water means having urine. The Classic states: "Qi transformation allows for excretion." Essentially, there must be transformation-in before there is transformation-out. Without transformation-out, there is likely no transformation-in. Thus, entry and exit both depend on qi transformation. This is the meaning of qi transformation in the Classic, not merely referring to excretion. Water contains qi, so qi is water; air contains water, so water is qi. In cases of deficiency qi-blockage, true yang has exhausted downwards, the root sea lacks foundation, water and fire do not interact, and yin and yang are blocked. Thus, qi remains qi and fails to transform water, while water remains water and accumulates without moving. Failure of qi to transform water may lead to dryness of the water mansion; accumulation of unmoving water may lead to putrefaction. If qi cannot transform, forcing diuresis is futile. If yang is absent within yin, using bitter-cold agents will only worsen the condition. The principle is clear, yet few understand it. Regarding excess qi-blockage, it is merely strong Liver qi rebelling and obstructing the Bladder. Breaking qi, unblocking stagnation, or lifting sinking can remove obstruction. Treating excess is easy, but treating deficiency requires mastering transformation, which is difficult. Therefore, upon encountering such conditions, one must carefully distinguish between deficiency and excess. (From *Jingyue Quanshu*)
Zhuanbao (Bladder Torsion) Zhuanbao occurs when the bladder twists or tilts, causing urinary retention. Symptoms include acute pain below the umbilicus and inability to urinate. This condition arises from forcibly holding back urine or being compelled by cold/heat pathogens. Both scenarios cause water qi to rebel upward, pressing on the bladder, causing it to twist and preventing expansion. External fluids cannot enter, and internal urine cannot exit, leading to mutual blockage. This condition can be fatal after four to five days. Holding urine after a full meal, riding a horse quickly after eating, running fast when the urge to urinate is strong, or engaging in sexual activity while holding urine can all cause bladder torsion or prolapse, potentially leading to death. (From *Zhubing Yuanhou Lun*)
Zhuanbao patterns are common in pregnant women, often caused by holding back urine or consuming fried/spicy foods. After a full meal, heat compels the qi of the Small Intestine to rebel and stagnate, along with the Large Intestine qi. External water cannot enter the Bladder, and internal water cannot exit. Symptoms include dribbling, urgency, severe pain upon attempting to urinate, tenesmus, and stool frequency resembling dysentery but not quite. Pressing from the chest down to the umbilicus may immediately release urine; otherwise, urine may regurgitate uncontrollably, leading to abdominal distension and edema. Treatment involves cooling herbs to drain heat from the Small Intestine and unblocking the Large Intestine. Once abdominal cramping occurs and stool passes profusely, the bladder returns to its normal position, and urine flows smoothly. Kuizi San, see attached *Furen Zhai Qifang*. (From *Zhizhi Fang*) (Note: Kuizi San formula is unverified; possibly Guazi Fuling San.)
Men also suffer from Zhuanbao. In women, it is not always caused by fetal pressure. It often results from urgent urination and bladder distension combined with sudden horseback riding or running, causing the bladder to invert. Or, water overflows into the middle jiao, food fills the intestines, pressing down on the bladder, leaving no room for retreat, causing it to flip sideways (caused by heat attacking and qi forcing). Emetic therapy is required. (From *Yi Que*)
Pathological variations vary. Impaired urination is called longbi, a critical and urgent condition. If water passages are blocked, it invades the Spleen and Stomach causing distension, invades muscles causing swelling, reaches the middle jiao causing vomiting, and reaches the upper jiao causing asthma. If untreated for days, the distress is unbearable and life-threatening. Modern practitioners, seeing this condition, only know to promote diuresis or apply apple snails to the navel, without identifying the root cause. No wonder many cases are untreatable. (From *Jingyue Quanshu*)
General Principles of Syndrome Differentiation and Treatment (Contraindication for Diuretics) For qi-blockage patterns, differentiate deficiency/excess and cold/heat. Excess qi patterns involve qi knotting in the Small Intestine and Bladder, causing obstruction, often due to strong Liver qi rebellion, commonly seen in sudden anger and depression. Treat primarily with qi-breaking and qi-moving herbs like Xiangfu, Zhike, Wuyao, Chenxiang, Huixiang, combined with Siling San. If qi sinks low and medicinal force cannot reach quickly, use these herbs in large doses to induce vomiting, lifting qi so that water descends. Deficiency qi patterns causing urinary retention occur in those with chronic depletion or elderly qi exhaustion. Because qi fails to transform, this is a critical and difficult-to-treat condition. Patients usually experience gradual onset; notice short urine volume or effort during urination and treat promptly. Waiting until severe stages is too late. Differentiate cold/heat of the zang qi. (From *Jingyue Quanshu*)
Elderly and weak patients with urinary retention should take Bawei Wan (Eight-Ingredient Pill) and avoid cooling Heart meridian draining herbs. In summer months, this is often mistaken for latent heat, requiring careful examination. (From *Wei Shi Jiacang Fang*)
For impaired urination, administer Daochi Wan, Daochi San, Wulin San (see "Lin Zheng" chapter), or Wuling San. Add finely ground Huashi, mixed with Haijinsha, Cheqianzi, and Dengxin decoction. (From *Yixue Guan Jian*)
Large and small bowel channels are interconnected. For multi-day urinary retention, using Shenbao Wan or Beiting Wan (Shenbao Wan see "Hypochondriac Pain"; Beiting Wan see *Heji Jufang*) to induce heavy diarrhea can benefit the Small Intestine. (From *Zhizhi Fang*)
Lower abdominal pain and distension like an inverted bowl indicate excess. Two methods apply: if qi stagnates below, use emesis to lift it; if blood turbidity stagnates below, use Taoren to break it. (From *Bencao Gangmu*)
Urinary retention with unbearable abdominal pain, feeling like an inverted bowl, indicates excess, differentiating between qi and blood. If qi stagnates below, choose Simo Tang or Liumo Tang; if blood turbidity stagnates below, use Daididang Wan. For impaired urination due to qi deficiency, Dushen Tang with a little Guangpi is miraculous. (From *Yixue Rumen*)
Generally, urinary retention includes complete obstruction or scanty/sluggish flow. For qi sinking causing obstruction, use emesis to lift qi; as qi rises, water descends and flows naturally, because qi carries water. For diarrhea with scanty urine due to fluid leakage into intestines, use separation and drainage. For lower jiao heat drying up fluids, clear heat and generate fluids. For weak Spleen/Stomach qi failing to regulate water passages, tonify yuan qi to facilitate transformation. For excessive sweating depleting fluids, for blood loss causing deficiency, for劳伤 (labor injury) causing qi deficiency, for phlegm-fluid blocking airways, for anger causing closure, for excessive pus/blood loss from sores—treat according to the specific cause. (From *Bingyuan Ji*)
Excessive sweating with red-sluggish urine indicates internal dryness; absolutely avoid diuretics. Use Shiquan Dabu Tang minus Rougui, or Yangrong Tang, to nourish blood and generate fluids. Similarly for sores with excessive pus/blood loss. (Ibid.)
If repeated diuretic use worsens urinary retention, this indicates lower exhaustion. If yin/fluid deficient, strongly tonify true yin; if fire/yang deficient, strongly tonify yang qi. When qi reaches, water moves, and urination regulates. Do not mistake false excess for real excess and blindly unblock; this is like squeezing dry juice or burnt oil, worsening depletion and endangering life. (From *Jingyue Quanshu*)
Conditions of "Bladder without Water": Caused by diarrhea where water goes to the Large Intestine, stopping urine; treat diarrhea, and urine will flow. Caused by excessive sweating where qi escapes with sweat; regulate Ying and Wei, and when exterior qi consolidates, urine flows. Caused by consumptive disease, blood loss, and essence injury where water leaves with fluids, causing internal dryness; tonify true yin, and as blood/qi replenishes, urine flows. All these are cases of bladder dryness/depletion. Since the spring is dried up, do not add more draining herbs. Even in diarrhea, only 30% may benefit from draining. Investigate each case carefully; these are not longbi caused by water obstruction. (Ibid.)
Damp Pathogen in Exterior Pattern A 50-year-old woman suffered from sluggish urination. Treated with Bazheng San etc., her Small Intestine became distended and urgent, body felt like prickles. I reasoned she was affected by prolonged rain, pathogen still in exterior. Used Cangzhu as sovereign, Fuzi as assistant to release exterior. One dose induced sweating, and urination followed. (From *Tuiqiu Shiyi*) (Note: Also from *Zhunsheng*.)
Damp-Heat Internal Accumulation Pattern Helehesun, Right Chancellor of Secretariat, suffered from frequent urination with incomplete emptying, approx. 20 times day/night, abdominal distension, heavy waist/legs, unable to sleep. In late spring of Guiwei year, I diagnosed deep-slow pulse, occasionally rapid. (Note: See above discussion on three types of impaired urination.) The Chancellor usually consumes rich food, leading to internal damp-heat accumulation, failing to transform, causing bladder orifice sluggishness, hence frequency with scant output. Non-draining methods cannot relieve it. Prescribed Fuling Hupo Tang. Two doses halved symptoms; cured in ten days. (From *Weisheng Baojian*)
Qi-Blockage Pattern In Yizhen, the Censor-in-Chief lived. His wife suffered from difficult urination, abdominal fullness, asthma, thirst. Monk Bao, knowledgeable in medicine, gave Qumai, Zhizi, Huangqin, and other slippery/draining herbs, worsening oppression. Summoned Shou (Zhu Zhenheng/Wang Lü context implies expert diagnosis). Pulse was wiry and choppy in all three positions. Doctor said: The Classic states: Bladder is the official of the reservoir, storing fluids, transforming via qi allows excretion. This is 'water issuing from high source'. If Pericardium/Shanzhong qi fails to transform, water fluids do not move. Disease stems from qi; merely moving water is useless. Method: Treat Upper Jiao. Prepared Zhuque Tang (Note: Wei edition lists ingredients: Male Sparrow Meat, Red Bean, Ginseng, Poria, Jujube, Wheat, Purple Quartz, Ziwan, Yuanzhi, Danshen, Gancao. Also Zhuque Wan). Added extra Zhike and Jiegeng, decocted with long-flowing water. One drink released urine, second drink calmed qi, several doses cured. (From *Yishi: Yingningsheng Zhuan*)
My elder brother Nianshan, demoted to Zhejiang Surveillance Commissioner, suffered from郁怒 (depression/anger) in midsummer, urinary retention, high qi and asthma. Self-medicating with Weiping Tang for four doses failed. I said: Six pulses show knotted quality, indicating qi stagnation. Used Zhike 8 qian, Shengjiang 5 slices, boiled rapidly. One dose slightly improved, four doses cured. (From *Bidu*)
Sometimes qi-blockage causes urinary retention with qi knotting/pain below umbilicus. Use Wuxiang San, alternating with pure Hupo powder taken with Dengxin decoction, very effective. Common in women. (From *Yaojue*)
Heat in Lower Jiao Pattern Wang Shanfu from Beijing, Wine Official of Jingzhao, suffered from impaired urination, protruding eyes, drum-like abdominal distension, hard knees upwards, skin cracking, inability to eat. Sweet/light draining herbs failed. My teacher said: Disease is urgent, requires deep thought. Returned home to ponder. At midnight, rose suddenly saying: I have found it! *Neijing* says: Bladder is mansion of fluids, must transform via qi to excrete. They used draining herbs but disease worsened; this is failure of qi transformation. Qixuanzi said: Without yang, yin cannot generate; without yin, yang cannot transform. Sweet/light/thin-qi are yang herbs. Pure yang without yin, how can transformation occur? Next day, administered group of yin herbs. Cured after less than one dose. (From *Shixiao*) (Note: Group of yin herbs refers to Zishen Wan, see formula later.)
Mother of Duanjunbao, over 60, suffered from urinary issues resembling Lin syndrome, lower abdominal distension, mouth/throat thirst. Pulse was deep and choppy. Said: Disease is in Lower Jiao blood level, yin-fire excess and water deficiency. Method: Treat blood. Blood and water are same; blood is substantial, qi is insubstantial. Substantial disease requires substantial treatment. Prescribed Dongyuan's Zishen Wan. Cured. (From *Yingsheng Zhuan*)
Lung Dryness Pattern Governor Wang Jingru, during severe phlegm-fire asthma/cough, suddenly developed urinary retention. Self-medicated with Cheqian, Mutong, Fuling, Zexie etc., causing Small Intestine distension, zero output. I said: Right Cun pulse is rapid and large, indicating Metal dryness failing to generate Water. Used Ziwan 5 qian, Maidong 3 qian, Beiweizi 10 grains, Renshen 2 qian. One dose produced urine gushing like a spring. More draining herbs would only increase dryness/agony. Must observe this. (From *Bidu*)
Accumulated Phlegm Pattern A man suffered from urinary retention. Treatment with draining herbs worsened it. Master (Danxi) palpated Cun kou, slightly wiry and slippery. Said: This is accumulated phlegm disease. Phlegm accumulates in Lung (Upper Jiao), Bladder is Lower Jiao. Upper Jiao closed causes Lower Jiao blocked. Like a dripping vessel, upper orifice must open for lower water to flow. Induced massive vomiting. After vomiting, disease vanished. (From *Yishi: Danxi Weng Zhuan*) (Note: *Jingui Yi* says: Only usable for phlegm-excess qi-blockage, not for general qi-blood deficiency.)
Disease Suiting Urine Contraction Someone in Qiantang had Small Intestine constipation. Hundred remedies failed to open it. Daoist Qian Zongyuan examined him and surprisingly prescribed urine-contracting herbs. Soon, urination opened. People were surprised. Asked Zongyuan. He said: Because of constipation, doctors rushed to open it, causing huge urine influx, narrowing waterway further, making passage harder. Now I contract it, widening the waterway slightly, allowing flow. This insight is unique. (From *Beichuang Zhegu Lu*)
Pregnant Women Urinary Retention Pregnant women often suffer urinary retention due to fetal qi sinking and compression of the urethra, mostly caused by qi deficiency failing to support the fetus. Use Bazhen Tang or Buzhong Yiqi Tang. At delivery, if fetal pressure causes retention, use fingers to lift the fetus, and urine will flow. (From *Jingyue Quanshu*)
When pregnancy is full, fetal pressure compresses the bladder, causing torsion/tilting, bladder ligaments twisted, unable to urinate, named Zhuanbao. Must lift the fetus. Have midwife apply sesame oil to hands, insert into birth canal to lift fetus, urine flows like a stream. Then decoct Renshen, Baizhu, Chenpi, Shengma added to Siwu Tang. Shortly after, induce vomiting with finger. Repeat 3-4 times to lift fetus. Alternative method: Lay pregnant woman on bed. Lift bed vertically upside down, urine flows out, better than manual lifting. (From *Yi Que*)
Slippery Orifice and Light Draining Formulas *Gujin Luyan* treats bladder torsion with urinary retention.
True Hupo (1 liang) Congbai (14 stalks)
These two, boil in 4 sheng water to obtain 3 sheng. Remove Congbai. Powder Hupo, sift fine, add to decoction. Warm drink 1 sheng, 3 times daily. Fan Wang agrees. (From *Waitai Miyao*) *Qianjin Fang* adds Ejiao (1 liang), Cheqianzi (1 sheng) to this formula (Congbai 47 stalks, Hupo 3 liang). Chop, boil in 1 dou water to obtain 3 sheng, divide into 3 doses.
Also Zhang Miao said: Enduring urine retention causes bladder torsion, inability to pass large/small stool, dying without pulse after 4-5 days. Take this curative formula.
Huashi (2 liang) Luafa (3 liang burned to ash)
Pound and sieve these two. Take 1 jin raw peach white skin, pound熟 (cooked/mature). Mix with water, squeeze juice to get 2 sheng. Take powder with juice, 1 cun bi dose, 3 times daily, cured. (Note: