秦子曰∶小便不通，非一例也。在外感五运中，则有运气加临，伤寒门，则有热结膀胱
，混热发黄，汗下亡津。阴症中，则有寒湿内结。内伤门，则有肺热，心热，肾热，水液
偏渗，气化不及，真阴不足诸症，今立外感三条，内伤五条，虽或未尽治法，然亦可以为准绳
【运气小便不利之症】阳明司政，躁热加临，发热烦渴，小便不利，少阴司政。君火
行令，发热舌赤，小便不利。太阴在泉，不得小便，病癃闭。厥阴司天。大便泻，小便闭，此
运气小便不利之症也。
【运气小便不利之因】《内经》云∶阳明司天，天气急，地气明，则民病癃闭。少阴司
天，地气肃，天气明，则病淋闭。太阴在泉，湿淫所胜，则小便不利，不及则亦病癃闭。厥阴
司天，风湿所胜，风邪入土，水谷偏走大肠，则病溏泄水闭。凡此运气加临，则小便不利矣
【运气小便不利之脉】右脉数大。阳明燥热，左脉数大。少阴之别，右脉濡缓，太阴湿
淫，左脉浮弦，厥阴风邪。
【运气小便不利之治】阳明燥热，知母石膏汤、清燥汤。少阴君火，导赤各半汤。太阴
湿胜，苍术防风汤。水不及，清燥汤。厥阴风湿，防风汤。水谷偏渗大肠，防风四苓散。
知母石膏汤
知母 石膏 竹叶 麦冬
清燥汤
桑叶 石膏 人参 麦门冬 枇杷叶 杏仁 甘草 真阿胶
导赤各半汤
生地 木通 甘草 川连 麦门冬 山栀 犀角 黄芩 知母 滑石
苍术防风汤
熟苍术 防风
防风汤 见腹痛。
防风四苓散 即四苓散加防风。
Qin Zi said: Obstruction of urination is not a single condition. In the context of external contraction and the changes of the Five Movements (Wu Yun), there are influences from the superimposition of Qi movements (Yun Qi Jia Lin). In the category of Cold Damage (Shang Han), there are cases of heat binding in the Bladder, yellowing caused by mixed damp-heat, and loss of body fluids due to sweating or purging. In the category of Yin syndromes, there is internal binding of cold-dampness. In the category of internal injury, there are symptoms such as Lung heat, Heart heat, Kidney heat, abnormal leakage of fluids (Shui Pian Shen), failure of Qi transformation (Qi Hua Bu Ji), and deficiency of True Yin. Currently, three categories for external contraction and five categories for internal injury are established. Although they may not exhaust all treatment methods, they can serve as a standard.
[Symptoms of Urinary Difficulty Caused by Qi Movements] When Yangming governs, dry-heat superimposes, causing fever, irritability, thirst, and difficulty in urination. When Shaoyin governs, Minister Fire exercises its command, causing fever, red tongue, and difficulty in urination. When Taiyin is in the lower position (Zai Quan), inability to urinate occurs, manifesting as Long-Bi (strangury with obstruction). When Jueyin governs from above (Si Tian), diarrhea occurs alongside urinary closure. These are symptoms of urinary difficulty caused by Qi movements.
[Etiology of Urinary Difficulty Caused by Qi Movements] The *Neijing* states: When Yangming governs from above, the heavenly Qi is urgent and the earthly Qi is bright, people suffer from Long-Bi. When Shaoyin governs from above, the earthly Qi is solemn and the heavenly Qi is bright, people suffer from Lin syndrome and Bi syndrome. When Taiyin is in the lower position, if dampness overcomes, urination becomes difficult; if it is insufficient, Long-Bi also occurs. When Jueyin governs from above, if wind-dampness overcomes, wind pathogen enters the Earth element (Spleen/Stomach), causing water and grain to deviate to the Large Intestine, resulting in loose stools and water closure. All these superimpositions of Qi movements lead to difficulty in urination.
[Pulse Patterns of Urinary Difficulty Caused by Qi Movements] A rapid and large pulse on the right indicates Yangming dry-heat. A rapid and large pulse on the left indicates the branch pulse of Shaoyin. A soggy and slow pulse on the right indicates Taiyin dampness invasion. A floating and wiry pulse on the left indicates Jueyin wind pathogen.
[Treatment of Urinary Difficulty Caused by Qi Movements] For Yangming dry-heat, use Zhimu Shigao Tang (Anemarrhena and Gypsum Decoction) and Qingzao Tang (Clear Dryness Decoction). For Shaoyin Minister Fire, use Daochi Geban Tang (Half-Combination Decoction for Guiding Out Redness). For Taiyin dampness excess, use Cangzhu Fangfeng Tang (Atractylodes and Saposhnikovia Decoction). For insufficiency of moisture, use Qingzao Tang. For Jueyin wind-dampness, use Fangfeng Tang. For water and grain deviating to the Large Intestine, use Fangfeng Siling San (Saposhnikovia and Four-Poria Powder).
Zhimu Shigao Tang (Anemarrhena and Gypsum Decoction)
Ingredients: Anemarrhenae Rhizoma (Zhimu), Gypsum Fibrosum (Shigao), Bambusae Folium (Zhuye), Ophiopogonis Radix (Maidong).
Qingzao Tang (Clear Dryness Decoction)
Ingredients: Mori Cortex Folium (Sangye), Gypsum Fibrosum (Shigao), Ginseng Radix et Rhizoma (Renshen), Ophiopogonis Radix (Mendong), Eriobotryae Folium (Pipaye), Armeniacae Semen Amarum (Xingren), Glycyrrhizae Radix et Rhizoma (Gancao), Eudemonis Semen (Ejiao).
Daochi Geban Tang (Half-Combination Decoction for Guiding Out Redness)
Ingredients: Rehmanniae Radix (Shengdi), Akebiae Caulis (Mutong), Glycyrrhizae Radix et Rhizoma (Gancao), Coptidis Rhizoma (Chuanlian), Ophiopogonis Radix (Mendong), Gardeniae Fructus (Shanzhi), Cornu Bubali (Xijiao), Scutellariae Radix (Huangqin), Anemarrhenae Rhizoma (Zhimu), Talcum (Huashi).
Cangzhu Fangfeng Tang (Atractylodes and Saposhnikovia Decoction)
Ingredients: Prepared Atractylodis Macrocephalae Rhizoma (Shu Cangzhu), Saposhnikoviae Radix (Fangfeng).
Fangfeng Tang (Saposhnikovia Decoction) See Abdominal Pain section.
Fangfeng Siling San (Saposhnikovia and Four-Poria Powder)
This is Siling San (Four-Poria Powder) added with Saposhnikoviae Radix (Fangfeng).