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(Transposition of the Bladder)

The *Daquan* records: In pregnancy, retention of urine is caused by heat in the Small Intestine transmitting to the bladder (Bladder), leading to obstruction. If accompanied by Qi stagnation in the Heart and Lungs, it results in panting and urgency. Chen Wuyue states: During pregnancy, when the full fetus compresses the bladder, it often leads to difficult urination. If there is deficiency of Qi in the Heart and Kidney, causing turbid and clear energies to interfere with each other, various types of strangury (Lin Syndrome) occur; if the ligamentous system of the bladder is twisted, resulting in urinary retention, it is called "Zhuan Bao" (Transposition of the Bladder); if urine leaks out due to fetal fullness, it is called "Yi Niao" (Urinary Incontinence).

Zhu Danxi says: Women suffering from Zhuan Bao are mostly those with weak constitutions, prone to worry and depression, irritable temperaments, or those who consume rich-flavored foods. Ancient prescriptions all used slippery and draining herbs, but rarely achieved efficacy. I reasoned that the bladder was compressed by the fetus, shifted to one side, and its ligamentous system was twisted and obstructed. If the fetus were lifted and suspended centrally, the bladder's ligamentous system would be unblocked, and the water pathway would function naturally. However, the downward displacement of the fetus must have a cause. One day, a concubine in the Wu household suffered from this condition. Her pulse was slightly choppy in both hands, becoming wiry upon heavy pressure, while the left hand was slightly harmonious. I said: This resulted from worry and distress. A choppy pulse indicates blood deficiency and excess Qi; a wiry pulse indicates fluid retention. Blood deficiency makes the bladder weak and unable to lift itself; excess Qi with fluid retention causes the Middle Jiao to be unclear and narrow, so the bladder avoids upward movement and descends, hence preferring to drop. Therefore, I prescribed Siwu Tang (Four Substances Decoction) added with Ginseng (Ren Shen), Atractylodes Macrocephala (Bai Zhu), Pinellia (Ban Xia), Tangerine Peel (Chen Pi), Raw Licorice (Sheng Gan Cao), and Fresh Ginger (Sheng Jiang), taken on an empty stomach. Immediately after, I induced vomiting by probing the throat with a finger. After the Qi settled, another dose was given, repeated the next day. After eight doses, she recovered. This method proved effective, though perhaps by chance. Later, several others showed distinct efficacy; I wonder what the true principle is? Zhang Zhongjing stated: Women originally having abundant flesh, with heads raised and bodies full, now become emaciated, with heads raised but centers hollow and reduced. The bladder's ligamentous system twists, also causing bladder transposition. The meaning is unclear; surely someone knows it. A 41-year-old woman, nine months pregnant, suffered from Zhuan Bao, with no urination for three days. Her lower abdomen was urgent, feet swollen, unbearable suffering. She sought emergency help. Upon examination, her form was emaciated; the right pulse was choppy, the left slightly harmonious. This indicated injury to Qi after overeating, weakness of the fetal ligament preventing self-lifting and causing descent, pressing on the bladder, shifting it to one side. Qi urgency was blocked by this, so the urinary orifice could not open. Zhuan Bao disease is generally like this. Thus, I formulated a prescription to nourish Blood and tonify Qi. Once Blood and Qi are rectified, the fetal ligament lifts naturally, preventing descent, ensuring safety. I prepared a decoction of Ginseng, Angelica Sinensis (Dang Gui) body and tail, White Peony Root (Bai Shao), Atractylodes Macrocephala (Bai Zhu), Tangerine Peel (Chen Pi), Roasted Licorice (Zhi Gan Cao), Pinellia (Ban Xia), and Fresh Ginger (Sheng Jiang), boiled into a thick decoction. She took four doses, allowing herself to vomit. By the next morning, another four doses were given. The dregs were boiled as one dose, taken in one gulp, then inducing vomiting to expel the subsequent medicinal soup. Urination immediately flowed, discharging dark water. Later, adding Large Cardamom Fruit (Da Fu Pi), Bitter Orange (Zhi Ke), Green Onion Leaves (Qing Cong Ye), and Amomum Villosum (Suo Sha Ren) to this formula, she took twenty doses to prevent deficiency before and after delivery. Indeed, she delivered safely and remained healthy postpartum. Another woman, seven to eight months pregnant, suffered from urinary retention. Hundreds of doctors failed to promote urination, worsening distension. Her pulse was fine and weak. I surmised her Qi and Blood were deficient, unable to support the fetus, causing the heavy fetus to descend and press the lower outlet of the bladder, thus preventing urination. If tonic drugs were used to lift, the fetus would rise and descend naturally, but before the drug's effect arrived, distension would worsen. So, I instructed an old woman to apply sesame oil to her hands, insert them into the birth canal, and manually lift the fetus. Urine gushed out, and distension instantly resolved. Simultaneously, large doses of Ginseng, Astragalus (Huang Qi), and Cimicifuga (Sheng Ma) were boiled and administered. If slight urgency occurred, manual lifting was still used to facilitate urination. After three days, the fetus gradually rose, and urination returned to normal. (Another method: Have the healthy person and the pregnant patient lie supine. Extend both legs straight towards each other. The healthy person presses their feet against the patient's feet, frequently and gently thrusting upwards, causing the patient's body to subtly and frequently rise. Thus, the fetus naturally rises with the thrust, the bladder's ligament untwists, and urination flows freely. Non-pregnant women may also suffer from twisted bladder ligaments and inability to urinate. An adept midwife can manually manipulate the bladder to restore flow. Alternatively, holding the patient upside down by the legs several times can also restore urination. These are appended here.)

Xue Ji states: The aforementioned conditions may also result from deficiency of Spleen and Lung Qi, failing to transport downwards to the bladder; or from Qi-heat stagnating in the bladder, impairing fluid metabolism; or from Metal being scorched by Fire, with severe Damp-Heat in Spleen Earth, leading to dysfunction. Treatment must be carefully assessed.

The second son-in-law of Minister Li Xingang, pregnant for five months, had difficult urination. All medicines failed. I said: Only Ba Wei Wan (Eight-Ingredient Pill) can save her. Disbelieving, he used diuretic drugs instead. Abdominal swelling ensued, leading to death.

The wife of Confucian scholar Wang Wenyuan suffered from this, with severe lower abdominal swelling, nearly fatal. One dose of Ba Wei Wan produced dripping urination. A further dose of the previous pill ingredients added with Plantago Seed (Che Qian Zi) promoted free urination, emptying the abdomen and bringing relief.

Zhang Zhongjing asked: Regarding women's diseases, if diet remains normal, yet there is irritability, heat, inability to lie flat, but rather leaning forward for breath, why is this? The Master replied: This is named Zhuan Bao, inability to urinate. Because the bladder's ligamentous system is twisted, this disease arises. Promoting urination alone will cure it. Use Shen Qi Wan (Kidney Qi Pill) as the main treatment. (This is Ba Wei Wan, see Consumption chapter. Take 15-20 pills with wine, twice daily.)

Dong Kui Zi San (Winter Melon Seed Powder) treats Zhuan Bao in pregnant women, urinary retention, and also urinary retention in men, with efficacy in all cases.
Winter Melon Seed (Dong Kui Zi), Gardenia (Shan Zhi Zi) stir-fried, Talcum (Hua Shi) (each half liang), Akebia Stem (Mu Tong) (3 qian).
Crush, one dose, decoct in water, take warm on an empty stomach. Externally, powder Dong Kui Zi, Hua Shi, and Shan Zhi Zi. Mix with paste of River Snail Meat (Tian Luo Rou) or scallion juice, apply to the umbilicus for immediate passage.

Quan Sheng Fu Ling San (Complete Life Poria Powder) treats urinary retention in pregnancy.
Red Poria (Chi Fu Ling), Winter Melon Seed (Dong Kui Zi) (equal parts).
Crumble, take 5 qian per dose, decoct in water, take on an empty stomach. The *Jisheng Fang* adds a small amount of Hair Ash (Fa Hui), extremely effective.

Kui Yu Tang (Malva and Elm Bark Decoction) treats urinary retention in pregnancy, oppression under the umbilicus, and mental restlessness.
Malva Seed (Kui Zi) ground, Elm Bark (Yu Bai Pi) sliced (each 1 liang).
Decoct in water, divide into three doses.

Du Sheng San (Supreme Saint Powder) treats urinary retention in pregnancy.
Vitex Seed (Man Jing Zi) powdered, take 2 qian per dose, before meals, mixed with strong decoction of Scallion White (Cong Bai) soup. (Vitex Seed cools blood in all meridians, its nature is light and ascending, embodying the principle of rising.)

Gui Mu Ku Shen Wan (Angelica and Sophora Pill) treats difficult urination in pregnancy, with normal diet.
Angelica Sinensis (Dang Gui), Fritillaria (Bei Mu), Sophora Root (Ku Shen) (each 4 liang).
Powder, mix with refined honey to make pills the size of small beans. Take 3 pills per dose, increase to 10. For men, add Talcum (Hua Shi) half liang.

Miscellaneous formulas treat sudden urinary retention in pregnancy.
Almond Kernel (Xing Ren) peeled and de-seeded, stir-fried yellow, pounded into pills the size of mung beans. Swallow 7 pills with Centella Decoction (Deng Xin Tang). Another recipe: Pound Almond Kernel, mix with Talcum powder, rice-pill sized, take 20 pills with white soup. Another: Talcum powder mixed with water, applied to below the umbilicus. Another: Plantago Seed juice mixed with Talcum powder, applied around the umbilicus (four cun radius), change when hot. Another: Asters (Zi Wan) made into pills, taken with well-water (Jing Hua Shui), 2 qian. Another: Mantis Egg Case (Sang Piao Xiao) powdered, taken with rice drink, one cun-bi dose, three times daily.