肾主五液，开窍于二阴。至前后不通，气机闭窒，胀满不食，气逆喘急，危候也。揆病所由，有因
三焦热结者，宜黄连、黄芩、
山栀、郁金、枳实、海金沙、槟榔。有因三焦湿滞者，宜薏苡、通草、浓朴、茯苓、广皮、泽泻、大腹皮。
有因湿热阻气者，宜石膏、滑石、知母、莱菔子、郁李仁、车前子、木通。有痰隔中脘，气痹上焦者，二陈
汤加木通探吐。有肺气不降者，麦冬、杏仁、通草、枳壳、知母、赤茯。有胃实燥结者，小承气汤、大厘清饮，
或凉膈散。有小肠气痹者，小温中丸。有火腑热结者，有厥阴热秘者，火腑用更衣丸，厥阴用龙荟丸。有腑阳
不行者，玉壶丹、半硫丸，热药多秘，惟硫黄性缓而通。玉壶丹、半硫丸，皆取通阳之义。有血液枯燥者，
通幽汤。有气虚血热者。人参固本丸。有阴囊肿胀，热蕴便闭者，三白散。按经云∶女子督脉入系廷孔，男子
循茎下至篡，所生病不得前后。据此则二便不通，又宜通奇络。如桂心、川楝子、小茴、香附、当归、五灵脂、
桃仁、麻仁等。热蕴腹胀，或用田螺加盐，和壳捣碎，帛系脐下一寸三分，前后皆通。有因膀胱溺满，支撑回
肠，阻大便者，五苓散加木通、车前。溺行便自出，亦有先通大便，水道自利者。圆机活法，在乎审症而施治
焉。
〔大便不通〕有实秘、虚秘、热秘、冷秘、风秘、气秘。有阳结、阴结。仲景云∶脉浮数，能食不大便，
为阳结。脉沉迟、不能食，身重，大便反硬为阴结。东垣云∶实秘、热秘，即阳结也，宜散。虚秘、冷秘，
即阴结也，宜温。气燥，以杏仁、枳实行之。血燥，以桃仁、大黄通之。风燥，以麻仁、大黄利之。气涩不通，
以郁李仁、皂角子润之。气壅便秘，以参、归、麻仁、大黄开之。叶氏治肠痹，必开降肺胃。如杏仁、栝蒌、
冬葵子、枇杷叶、郁金汁、紫菀以降肺。半夏、花粉、竹茹、橘红、枳实汁、姜汁以和胃。即丹溪开上窍以
通下窍之微旨也。今即其症分别言之，由胃实者，善饮食，小水赤，七宣丸。由胃虚者，不能食，小便清利，
浓朴汤。由热秘者，面赤，脉实数，胀闷欲得冷，四顺清凉饮、润肠丸。由冷秘者，面白，脉沉迟，欲得热，
正气散加官桂、枳壳吞半硫丸，或木香顺气散。由风秘者，风搏肺脏，传入大肠，润肠丸加防风、皂角，或
去大黄，加煨阿胶。妇人风秘，大麻仁丸。由气秘者，气不升降，谷气不行，善噫，苏子降
气汤加枳壳。由肺气不通降，失于传送者，杏、蒌、枳、桔、栀、豉、郁金、橘白。由三焦不和，胸膈痞满者，
搜风顺气丸加栝蒌、广皮。由大肠实者，腹满便硬，麻仁丸。由肾虚液少便燥者，六味汤去茯苓，加苁蓉、
白蜜。由血热便难者，当归润燥汤。由风热郁滞者，疏风润肠丸。由血燥兼气秘者，润麻丸。由血虚秘结者，
益血润肠丸。由津液枯涸者，苁蓉丸，五仁丸。由幽门不通者，通幽汤。由素有风病而便秘者，皂角丸。由
病后气血未复，及老人津液衰少，产后去血多者，八珍汤、倍当归、加苁蓉、苏子、杏仁、阿胶、黑芝麻。
由久病气虚下陷，致便难者，补中益气汤，加杏仁、苏梗。老人阳虚风秘者，半硫丸。老人气秘，橘杏丸、
二仁丸。老人血秘，苏麻粥、三仁粥。又有脾约症，伤寒阳明症，自汗出小便数，津液内竭，其脾为约。用
脾约丸。攻荡为治，然亦滋其阴血为稳，宜当归润燥汤主之。如阴寒秘结，当用温药，须略加清润以去结秘。
若病本虚寒，标现躁热，亦宜于通阳药中，稍佐苦寒以去躁热，躁止勿加。如阴躁刻欲就冷，两尺虚，或沉细
迟，勿用寒剂，理中汤冷服。或不效，用外导法。蜜煎入盐五分，皂角烧灰研五分，和捻尖，热纳肛中。冷
秘者，蜜煎中加草乌头末，和捻如上。热秘者。猪胆汁导之。又有求通努力，虚气迫注肛门，里急后重，
气逆呕恶，不堪通利，不堪升提，宜人参、枳壳、当归、陈香橼。或用川芎、当归煎汤。入秽桶，乘热坐熏之，
亦效。风秘发寒热，生何首乌两许煎，加蜜服。或用固本丸熬膏服。失血后，烦渴便结，一味生地黄汁煎服。
血液燥结，熟地蒸热，每服五钱效。若轻用硝黄利药，则秘愈甚。
〔小便不通〕经云∶膀胱者，州都之官，津液藏焉，气化则能出矣。三焦者决渎之官，水道出焉。是
知膀胱主藏溺，必待三焦气化，乃能出水也。详列所由，有肺燥不能生水者，用清润法，生脉散加沙参、茯苓、
桑皮，车前。有气闭不能通调水道以下输者，用探吐法，以沉香、木香、陈皮、枳壳、小茴、木通，煎汤探吐。
有气虚下陷，升降不利者，用升举法，补中益气汤。孕妇胎重压胞，小水闭者，用补中汤探吐。气升则水降，
如滴水之器，开其上则下自通矣。有火郁小肠，溺短而痛者，用清降法，导赤
散加滑石。有湿壅三焦，致闭癃者，用厘清法，通草、滑石、芦根、薏苡、茯苓、车前。有暑湿泄泻，气不化
水者，用化气法，五苓散。有湿胜而渴，小水不利者，用分利法，四苓散。有湿热闭阻经府气分，致便不通者，
用宣通法，石膏、杏仁、浓朴、防己、大腹皮、海金沙、合六一散。由肾水燥热，致不利者，用滋清法，知母、黄
柏、黄芩、泽泻、通草。有阳亢阴衰，孤阳不化者，用补阴抑阳法，化阴煎。若火不甚亢，但由水亏者，用
补水法，大剂六味汤。经言无阳则阴无以生，无阴则阳无以化。热在下焦而不渴，服淡渗药，腹胀不通益甚者，
滋肾丸。其阴阳大亏，气不化者，肾气汤。溺闭转筋，喘急欲死者，八味丸料大剂煎服，缓则不及。其血结而
致闭者，牛膝汤。痰盛而致闭者，导痰汤。火闭者，七正散。气虚溺不利者，独参汤，少加广皮效。通治小水不
通法，用独囊蒜头数枚，栀子三枚，盐少许，烂捣，摊纸贴脐上，良久即通。或用食盐半斤，炒热，布包熨之。
诸药不效者，用白菊花根捣烂，以生白酒冲和。取酒汁温服神效。又法∶用活田螺一个，连壳捣如泥，入麝香
细研末少许，置脐上，以蛤蜊合之，以帛扎定，效。
The Kidney governs the five fluids and opens into the two lower orifices. When both anterior (urination) and posterior (defecation) passages are obstructed, causing Qi mechanism to be closed and stagnant, resulting in abdominal distension, inability to eat, rebellious Qi, and rapid panting, this is a critical condition. Investigating the etiology, there are cases due to heat accumulation in the Sanjiao (Triple Burner), suitable for treating with Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Yujin (Curcumae Radix), Zhishi (Aurantii Fructus Immaturus), Haijinsha (Lygodii Spora), and Binglang (Arecae Semen). There are cases due to dampness stagnation in the Sanjiao, suitable for treating with Yiyiren (Coicis Semen), Tongcao (Tetrapanacis Medulla), Houpo (Magnoliae Officinalis Cortex), Fuling (Poria), Guangpi (Citri Reticulatae Pericarpium), Zexie (Alismatis Rhizoma), and Dafupi (Arecae Pericarpium). There are cases due to damp-heat obstructing Qi mechanism, suitable for treating with Shigao (Gypsum Fibrosum), Huashi (Kaolin), Zhimu (Anemarrhenae Rhizoma), Laifuzi (Raphani Semen), Yuliren (Pruni Semen), Cheqianzi (Plantaginis Semen), and Mutong (Akebiae Caulis). There are cases where phlegm blocks the middle Jiao and Qi is bi-syndrome in the Upper Jiao, suitable for inducing vomiting using Erchen Tang (Two-Cured Decoction) added with Mutong. There are cases of Lung Qi failing to descend, suitable for treating with Maidong (Ophiopogonis Radix), Xingren (Armeniacae Semen Amarum), Tongcao, Zhike (Aurantii Fructus), Zhimu, and Chifu Ling (Poria cum Rubro). There are cases of Stomach excess with dry accumulation, suitable for treating with Xiao Chengqi Tang (Minor Order the Qi Decoction), Da Li Qing Yin (Great Clear the Turbid Infusion), or Liangge San (Cool the Diaphragm Powder). There are cases of Small Intestine Qi bi-syndrome, suitable for treating with Xiao Wenzhong Wan (Small Warm the Middle Pill). There are cases of Fire Fu organ heat accumulation, and cases of Jueyin channel heat constipation; for Fire Fu heat, use Gengyi Wan (Change Garments Pill), and for Jueyin heat constipation, use Longhui Wan (Dragon Gallbladder Pill). There are cases of Fu Yang not functioning, suitable for treating with Yu Hu Dan (Jade Pot Elixir) and Banshu Wan (Half-Sulfur Pill); hot-natured herbs often cause constipation, only Sulfur has a mild nature and promotes unblocking. Both Yu Hu Dan and Banshu Wan take the meaning of promoting Yang unblocking. There are cases of blood dryness, suitable for treating with Tongyou Tang (Unblock the Lower Orifice Decoction). There are cases of Qi deficiency with Blood heat, suitable for treating with Renshen Guben Wan (Ginseng Solidify the Root Pill). There are cases of scrotal swelling with heat accumulation causing constipation, suitable for treating with Sanbai San (Three Whites Powder). According to the Classics: The Du vessel enters and connects to the Ting Kong in women, and in men it follows the penis down to the perineum; the diseases produced here are inability to pass urine and stool. Based on this, for obstruction of both anterior and posterior passages, it is also suitable to unblock the extraordinary vessels. Such as Guixin (Cinnamomi Cortex), Chuanlianzi (Meliae Fructus), Xiaohui (Foeniculi Fructus), Xiangfu (Cyperi Rhizoma), Danggui (Angelicae Sinensis Radix), Wulingzhi (Trogopterori Faeces), Taoren (Persicae Semen), and Maren (Cannabis Semen). If heat accumulates causing abdominal distension, one may use field snails mixed with salt, crushed together with shells, tied with cloth below the umbilicus at 1 cun 3 fen, which can unblock both passages. There are cases where bladder urine is full, pressing against the ileum and obstructing defecation, suitable for treating with Wuling San (Five-Ling Powder) added with Mutong and Cheqianzi. Once urination proceeds, defecation naturally occurs; there are also cases where defecation is cleared first, and the water pathway naturally benefits. Flexible methods depend on examining symptoms to apply treatment.
[Constipation] includes Excess Constipation, Deficiency Constipation, Heat Constipation, Cold Constipation, Wind Constipation, and Qi Constipation. There are also Yang Knotting and Yin Knotting. Zhang Zhongjing said: Pulse floating and rapid, able to eat but unable to defecate, is called Yang Knotting. Pulse deep and slow, unable to eat, body heavy, stool reversely hard, is called Yin Knotting. Li Dongyuan said: Excess Constipation and Heat Constipation are Yang Knotting, suitable for dispersing. Deficiency Constipation and Cold Constipation are Yin Knotting, suitable for warming. For Qi dryness, use Xingren and Zhishi to move it. For Blood dryness, use Taoren and Dahuang to unblock it. For Wind dryness, use Maren and Dahuang to lubricate and promote. For Qi涩 (astringency/obstruction) without passage, use Yuliren and Zhaojiaozizi to moisten. For Qi congestion and constipation, use Renshen, Danggui, Maren, and Dahuang to open it. Ye Tianshi treats Chang Bi (Intestinal Obstruction) by necessarily descending Lung and Stomach. Such as using Xingren, Gualou, Dongkuizi, Pipaye, Yujin juice, and Ziwan to descend Lung Qi; using Banxia, Huafen, Zhuru, Juhong, Zhishi juice, and Jiangzhi to harmonize Stomach Qi. This is the subtle purport of Zhu Danxi's "opening the upper orifice to unblock the lower orifice." Now, speaking separately according to symptoms: Caused by Stomach excess, good appetite, red urine, use Qixuan Wan. Caused by Stomach deficiency, poor appetite, clear and free urination, use Houpo Tang. Caused by Heat Constipation, red face, solid and rapid pulse, distension and oppression desiring cold drinks, use Sishun Qingliang Yin and Runchang Wan. Caused by Cold Constipation, pale face, deep and slow pulse, desiring heat, use Zhengqi San added with Guigui and Zhike taken with Banshu Wan, or Muxiang Shunqi San. Caused by Wind Constipation, wind combats Lung organ, transmitting to Large Intestine, use Runchang Wan added with Fangfeng and Zhaojiao, or remove Dahuang and add Wei Ejiao. Women's Wind Constipation, use Dama Ren Wan. Caused by Qi Constipation, Qi does not ascend and descend, grain Qi does not move, frequent belching, use Suzi Jiangqi Tang added with Zhike. Caused by Lung Qi not descending and losing transmission function, use Xingren, Gualou, Zhike, Jiegeng, Zhizi, Chidou, Yujin, Ju Bai. Caused by Sanjiao disharmony, chest and diaphragm fullness, use Soushun Fengqi Wan added with Gualou and Guangpi. Caused by Large Intestine excess, abdominal fullness and hard stool, use Maren Wan. Caused by Kidney deficiency and fluid scarcity leading to dry stool, use Liuwei Tang removing Fuling, adding Congrong and Baimi. Caused by Blood heat leading to difficult defecation, use Danggui Runzao Tang. Caused by Wind-heat stagnation, use Shufeng Runchang Wan. Caused by Blood dryness combined with Qi constipation, use Runma Wan. Caused by Blood deficiency and knotting, use Yixue Runchang Wan. Caused by fluid exhaustion, use Congrong Wan and Wuren Wan. Ca caused by幽门 (Pylorus) obstruction, use Tongyou Tang. Caused by pre-existing wind disease and constipation, use Zhaojiao Wan. Caused by post-illness Qi and Blood not recovered, elderly fluid decline, or postpartum excessive blood loss, use Bazhen Tang, doubling Danggui, adding Congrong, Suzi, Xingren, Ejiao, and Heimaazi. Caused by long-term illness Qi deficiency sinking, leading to difficulty defecating, use Buzhong Yiqi Tang added with Xingren and Sugeng. Elderly Yang deficiency Wind Constipation, use Banshu Wan. Elderly Qi Constipation, use Juxing Wan and Eren Wan. Elderly Blood Constipation, use Suma Zhou and Saren Zhou. There is also Pi Yue syndrome, belonging to Taiyang Yangming syndrome, spontaneous sweating and frequent urination, internal exhaustion of fluids, the Spleen is constrained. Use Pi Yue Wan. Although purging is the treatment, nourishing Yin and Blood is more stable, primarily using Danggui Runzao Tang. If Yin-cold knotting, warm herbs should be used, slightly adding clearing and moistening agents to remove knotting. If the root is deficiency-cold but branch shows restlessness-heat, it is also appropriate to slightly assist bitter-cold herbs among Yang-unblocking drugs to remove restlessness-heat; stop adding once restlessness ceases. If Yin-restlessness desires cold constantly, two Chi pulses are deficient, or deep, fine, and slow, do not use cold agents; use Lizhong Tang taken cold. If ineffective, use external guidance method. Honey suppository with 5 fen salt, soap horn ash ground 5 fen, mixed and shaped into a point, heated and inserted into anus. For Cold Constipation, add Aconitum Kusnezoffii powder to honey suppository, mix and shape as above. For Heat Constipation, use pig bile for guidance. There are also cases of straining to defecate, empty Qi forcing into anus, tenesmus, rebellious Qi and vomiting, intolerant to purgatives and intolerant to lifting, suitable for using Renshen, Zhike, Danggui, and Chen Xiangyuan. Or use Chuanxiong and Danggui decoction, pour into chamber pot, sit and fumigate while hot, also effective. Wind Constipation with chills and fever, boil raw Hemshouwu (Polygoni Multiflori Radix) approx. 1 liang, take with honey. Or use Guben Wan boiled into paste. After blood loss, irritability, thirst, and constipation, decoct and take single herb Sheng Dihuang (Rehmanniae Radix) juice. Blood dryness and knotting, steam cooked Dihuang (Rehmanniae Radix Preparata), take 5 qian each time, effective. If lightly using Xiaoming and Dahuang purgatives, constipation will worsen.
[Urinary Retention] The Classics say: The Bladder is the official of the capital, storing fluids; Qi transformation allows them to exit. The Sanjiao is the official of drainage, the water pathway exits from it. Thus we know the Bladder stores urine, waiting for Sanjiao Qi transformation to release water. Detailing causes: Lung dryness failing to generate water, use clearing and moistening method, Shengmai San added with Shashen, Fuling, Sangpiao, and Cheqianzi. Qi closure failing to regulate water pathways to transport downward, use induced vomiting method, decoct Chenxiang, Muxiang, Chenpi, Zhike, Xiaohui, and Mutong to induce vomiting. Qi deficiency sinking, ascending and descending unfavorable, use lifting method, Buzhong Yiqi Tang. Pregnant women, fetal weight compressing bladder, urinary closure, use Buzhong Tang to induce vomiting. Qi ascends then water descends, like a dripping vessel, opening the top makes the bottom flow freely. Fire stagnation in Small Intestine, short and painful urine, use clearing and descending method, Daochi San added with Huashi. Dampness congesting Sanjiao, causing retention and dribbling, use clarifying method, Tongcao, Huashi, Lugeng, Yiyiren, Fuling, Cheqianzi. Summer-dampness diarrhea, Qi failing to transform water, use Qi-transforming method, Wuling San. Dampness excess with thirst, urinary difficulty, use separating and draining method, Siling San. Damp-heat blocking meridians and Fu organs Qi level, causing urinary obstruction, use promoting and unblocking method, Shigao, Xingren, Houpo, Fangji, Dafupi, Haijinsha, combined with Liuyi San. Kidney water dryness and heat causing difficulty, use nourishing and clearing method, Zhimu, Huangbai, Huangqin, Zexie, Tongcao. Yang hyperactivity and Yin decline, solitary Yang failing to transform, use nourishing Yin suppressing Yang method, Huayin Jian. If fire is not very hyperactive, merely due to Water deficiency, use replenishing Water method, large dose of Liuwei Tang. The Classics state: Without Yang, Yin cannot be generated; without Yin, Yang cannot be transformed. Heat in Lower Jiao without thirst, taking bland-draining herbs causes increased abdominal distension and obstruction, use Zishen Wan. Great deficiency of Yin and Yang, Qi failing to transform, use Shenqi Tang. Urinary closure with convulsions, panting and near death, use large dose of Bawei Wan ingredients decocted; delay is too late. Blood stasis causing closure, use Niuxi Tang. Phlegm abundance causing closure, use Daotan Tang. Fire closure, use Qizheng San. Qi deficiency urinary difficulty, use Dushen Tang, adding small amount of Guangpi is effective. General method for urinary obstruction: use several bulbs of Allium Sativum (single bulb garlic), three Gardeniae, little salt, mash thoroughly, spread on paper, stick on umbilicus, after a long time it flows. Or use half jin of salt, stir-fry hot, wrap in cloth, moxa/iron over area. If all medicines fail, use white chrysanthemum root mashed, mixed with raw Baijiu. Take wine juice warm, miraculous effect. Another method: use one live field snail, crush shell and flesh into mud, add a little musk powder finely ground, place on umbilicus, cover with clam shell, tie firmly with cloth, effective.