朱丹溪治一人，因服分利之药太过，遂致秘塞，点滴不出，谓其胃气陷于下焦，用补中益气汤一服而通。
因前多用利药损其肾，遂致通后遗溺，一夜不止，急补其肾然后已。凡医之治是症者，未有不用泄利之剂，谁
能顾其肾气之虚哉？（《医说续编》。）
盛用敬治文学姚汝明，内伤新愈，又病食伤。他医皆用下药，病益甚，小便闭，中满，腹坚如石。（三阴受伤
所致。）盛诊之，曰∶此不可用分理药也。（理当作利。）宜以参、 运其气，升、柴提其气，气升则水自下矣。加以
益肾之剂，数服霍然。（《吴江志》。）
钟大延治徐大理，病小便秘，肿胀，面赤发喘。众医皆从热症治，愈甚。大延诊之，曰∶是无火也。急煮
附子汤，一服而愈。（雄按∶亦须以脉参之。）
钱塘有人小便常秘，百方通之不效。有一道人钱宗元视之，反下缩小便药，俄尔遂通。人皆怪之，以问宗
元。曰∶以其秘故，医者骤通之，则小便大至，水道愈溢，而小便愈不得通矣。今吾缩之，使水道稍宽，此所
以得流也。此一治殊为特见。（《北窗炙 》。）
黄氏小便不通，陈雁麓用芒硝一钱，研细，龙眼肉包之，细嚼咽下，立愈。（《续金陵琐事》。）
竹镇有人病溺不下，求于乩仙，判云∶牛膝、车前子，三钱共五钱，同锉为粗末，将来白水煎。空心服之
果愈。（《居易录》。）
龚子才治一人，小便不通，服凉药过多，胀满几死，以附子理中汤加琥珀末，调服立通。
一人小便不通，已经七八日，遍身手足肿满，诸药罔效。以紫苏煎汤入大盆内，令病患坐上熏蒸，冷则添
滚汤，外用盐炒热，熨脐上及遍身肿处，良久便通肿消而愈。
李士材治王郡守，痰火喘盛，咳正甚时，忽然小便不通，自服车前、木通、茯苓、泽泻等药，小腹胀闷，
点滴不出。李曰∶右寸数大，是金燥不能生水之故，惟用紫菀五钱，麦冬三钱，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。
先兄念山，以谪官郁怒之余，又当盛夏，小便不通，气高而喘。以自知医，服胃苓汤四帖，不效。李曰∶
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。
俞孝廉修府志劳神，忽然如丧神守，小便不通。李诊之曰∶寸微而尺鼓，是水涸而神伤也。用地黄、知母
各二钱，人参、丹参各三钱，茯苓一钱五分，黄柏一钱，二剂减，十剂乃全安。
冯楚瞻治王氏女，年十三，小便不通，甚危。初二三岁时，乳母恐其溺床，切戒之，由是寤寐刻刻在心。
（二三岁时事安能记忆？雄按∶此真俗名尿梗病也。往往起于幼时，习惯自然，不可谓二三岁时，不能记忆
也。）数年以来，日中七八次，夜中七八次，习以为常，渐有淋状，近来益甚。或以导赤利水之剂投之，初服
稍应，久则增剧，点滴不通。脉之，六部洪数，久按无神，知为过于矜持，勉强忍小便，心肾久虚，又服利水
之剂，真阴益槁，脏涸津枯，气何能化？以八味汤加五味、麦冬，取秋降白露生之意也。每剂纳熟地二两，连
进两服，使重浊以滋之，为小便张本。再以其渣探吐之，上窍既开，下气自通，数服而愈。一月后症复发，其
家照前方令服，亦令探吐，不惟不效，反胀闷难堪。张曰∶前者气伤未甚，故以滋腴之药济之足矣。今当盛夏，
气伤已甚，虽有滋水良药，若无中气营运，岂能济乎？今六脉洪大而空，中枯已极，二剂滋润，断不可少。然
必继以助中气之药，则中焦气得升降，前药始能营运。令连服加减八味汤二剂，果胀闷益甚。乃以人参一两、
附子三钱，浓煎温服，自胸次以至小腹漉漉有声，小便行数次而愈。
张隐庵治一书吏患癃闭，诸治无效，以补中益气汤投之，一剂而愈。或问曰∶此症人皆以通利治之不效，
今以升提治而效，其故何也？曰∶君不见夫水注子乎？闭其上而倒悬之，点滴不能下矣，去其上之闭，而水自
通流，非其验耶？
薛立斋治一妇人，患小便淋沥不通，面青胁胀，诸药不应。此肝经滞而血伤，用山栀、川芎，煎服而愈。
一妇人小便不利，小腹并水道秘闷，或时腹胁胀痛。此肝火，用加味逍遥散加龙胆草，四剂稍愈。乃去胆
草，佐以八珍散加炒黑山栀，兼服而愈。
郑奠一曰∶木瓜乃酸涩之品，世用治水肿胀误矣。时有大寮舟过金陵，爱其芬馥购数百颗置之舟中，举舟
人皆病溺不得出。医用通利药罔效，迎余视之，闻四面皆木瓜香，笑谓诸人曰∶撤去此物，溺即出矣，不必用
药也。于是尽投江中倾之，溺皆如旧。（《本草备要》。）
汪 庵曰∶家母舅童时病溺塞，服通淋药罔效。老医黄五聚视之曰∶此乃外皮窍小，故溺时艰难，非淋症
也。以牛骨为楔，塞于皮端，窍渐展开，不药而愈。使重服通利药，得不更变他症乎？乃知医理非一端也。（同上。）
一人燥热伤下焦，至小便不利，当养阴，当归、地黄、知母、黄柏、牛膝、茯苓、生甘草、白术、陈皮之
类。（治法。）
绍兴刘驻泊汝翼云∶魏KT 知明州时，宅库之妻患腹胀，小便不通，垂殆。随行御医某人治此药，令服遂愈。
栝蒌不拘多少，焙干，碾为细末，每服三钱重，热酒调下。不能饮者，米饮调下。频进数服，以通为度。（《是
斋方》。）
吴孚先治曹庶常，小便不通，多服分利之药，遗尿一夜不止，既而仍复秘塞，点滴不行。此利药太过，肾
气亏极，急用补中益气汤，送肾气丸，遂痊。
黄履素曰∶予家有仆妇，患小便不通之症，时师药以丸节汤，腹渐满而终不通，几殆矣。有草泽医人，以
白萝卜子炒香，白汤吞下数钱，小便立通。此予亲见之者。
孙文垣治倪二南内人，小水不禁，一日二十余。脉之，右寸洪而有力，左寸虚，右尺沉微，此心肾不交也。
以当归、远志之类，五日而安。后凡遇辛苦则发，以此服之立效。
薛立斋治一妇人，小便自遗，有时不利，日晡益甚。此肝热阴挺不能约制，用六味丸料加白术酒炒黑，
黄柏七分，知母五分，数剂诸症悉愈。若误用分利之剂，愈损真阴，必致不起矣。
一老妇患前症，恶寒体倦，四肢逆冷。薛以为阳气虚寒，用补中益气加附子三剂不应，遂以参附汤四剂稍
应，仍以前药而安。附子计用四枚，人参斤许。
小便不通，由于气闭。若用泽泻、木通、车前、茯苓之类，反不效。宜用归身一两，川芎五钱，柴胡二钱
五分，升麻二钱五分，一服即通。年老人可以加参。
Zhu Danxi treated a patient who, due to excessive use of diuretic (fenli) medicines, developed urinary retention with no drops passing. He diagnosed this as stomach qi sinking into the lower jiao and prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). After one dose, urination resumed.
Because previous overuse of diuretics had damaged kidney qi, the patient experienced enuresis (involuntary urination) for a whole night after urination initially resumed. Urgent treatment to tonify the kidney stopped it. In treating such cases, physicians invariably use purgative or draining agents; who can attend to the deficiency of kidney qi? (From *Yishuo Xubian*.)
Sheng Yongjing treated Scholar Yao Ruming, whose internal injury had just healed but was complicated by food stagnation. Other physicians used purgatives, worsening the condition, leading to urinary retention, abdominal fullness, and an abdomen hard as stone (caused by injury to the three yin meridians). Sheng examined him and said: "This cannot be treated with draining medicines." ("Li" should be read as "Li," meaning drain.) It is appropriate to use Ginseng Radix et Rhizoma (Renshen) to move the qi, and Cimicifugae Rhizoma (Shengma) and Bupleuri Radix (Chaihu) to raise the qi. When qi rises, water flows downward naturally. Added with kidney-tonifying herbs, the illness resolved after several doses. (From *Wujiang Zhi*.)
Zhong Dayan treated Xu Dali, who suffered from urinary retention accompanied by swelling, flushed face, and asthma. Physicians treated it as a heat syndrome, exacerbating the condition. Zhong diagnosed: "There is no fire [yang deficiency]." He urgently prepared Fuzi Tang (Aconite Decoction), which cured the patient after one dose. (Note by Xiong: Pulse diagnosis must also be considered.)
A person in Qiantang frequently suffered from urinary retention, unresponsive to various treatments. A Daoist priest named Qian Zongyuan treated him by administering herbs that constrict urine flow, after which urination resumed shortly. People were puzzled and asked for the reason. Qian explained: "Because of the retention, if physicians force rapid passage, urine floods out, overflowing the channels, making flow even more obstructed. By contracting the channel slightly, I create space for flow." This treatment showed unique insight. (From *Beichuang Zhige*.)
Huang suffered from urinary retention. Chen Yanlu used Magnitio Nitratis (Mangxiao), one qian, finely ground, wrapped in Longan Arillus (Longyanrou), chewed slowly and swallowed, resulting in immediate cure. (From *Xu Jinling Suoshi*.)
A person in Zhu zhen could not urinate and consulted a spirit-writing medium. The verdict prescribed: Achyranthis Bidentatae Radix (Niuxi) and Plantaginis Semen (Cheqianzi), 3 qian each totaling 5 qian, coarsely powdered, decocted in plain water, taken on an empty stomach. The patient recovered. (From *Juyi Lu*.)
Gong Zicai treated a patient with urinary retention who had taken too many cooling herbs, leading to severe distension nearly causing death. Using Fuzi Lizhong Tang (Aconite and Ginger Decoction to Warm the Middle) added with Succinum (Hupo), mixed and taken, resulted in immediate relief.
Another patient had been unable to urinate for seven or eight days, with generalized edema of the body and limbs, unresponsive to all drugs. Purple Perilla Leaf (Zisu) was decocted in a large basin for fumigation. The patient sat in the steam, adding boiling water as it cooled. Salt was heated externally and applied to the navel and swollen areas. After some time, urination resumed and swelling subsided.
Li Shicai treated Governor Wang, who had severe phlegm-fire asthma and coughing. Suddenly, he developed urinary retention. Self-medicating with Plantaginis Semen (Cheqianzi), Akebiae Caulis (Mutong), Poria (Fuling), and Alisma Rhizoma (Zexie) caused lower abdominal distension and inability to pass any urine. Li stated: "The right cun pulse is rapid and large, indicating lung metal dryness failing to generate kidney water." He prescribed Asterae Tataricae Radix (Zewan) 5 qian, Ophiopogonis Radix (Maidong) 3 qian, Schisandrae Fructus (Wuweizi) 10 berries, and Ginseng Radix et Rhizoma (Renshen) 2 qian. One dose produced a gushing stream of urine. Excessive use of bland-draining herbs causes dryness and urgency; this must be noted.
My elder brother Nianshan, suffering from depression due to demotion during midsummer, developed urinary retention with upward rushing qi and asthma. Knowing medicine himself, he took four doses of Weiling Tang without effect. Li said: "The six pulses show knotted qualities, indicating qi stagnation." He prescribed Zhiqiao (Bitter Orange Peel) 8 qian and Zingiberis Rhizoma Recens (Shengjiang) 5 slices, decocted rapidly. One dose brought slight relief; four doses led to complete recovery.
Yu Xiaolian, exhausted from compiling local gazetteers, suddenly felt disoriented with urinary retention. Li diagnosed: "Cun pulse is faint, chi pulse is drum-like, indicating exhaustion of water and damage to spirit." He used Rehmanniae Radix (Dihuang) and Anemarrhenae Rhizoma (Zhimu) 2 qian each, Ginseng Radix et Rhizoma (Renshen) and Salviae Miltiorrhizae Radix (Danshen) 3 qian each, Poria (Fuling) 1.5 qian, and Phellodendri Cortex (Huangbai) 1 qian. Symptoms reduced after two doses and resolved after ten.
Feng Chuzhan treated a 13-year-old girl with critical urinary retention. Since age two or three, her wet nurse had strictly forbidden bed-wetting, causing her to constantly suppress urination consciously and unconsciously. Over years, she voided 7-8 times day and night, developing symptoms resembling strangury. Treating with Daochi San (Drain the Heart Powder) and diuretics initially helped but later worsened to total obstruction. Pulses were flooding and rapid in all positions but empty upon deep pressure. Feng knew this was due to excessive holding back of urine, chronic heart-kidney deficiency, and further depletion of true yin by diuretics. He used Bajia Wan (Eight-Ingredient Pill) plus Schisandrae Fructus (Wuweizi) and Ophiopogonis Radix (Maidong), following the principle of autumn dew generation. Each dose included 2 liang of Shudihuang (Prepared Rehmannia Root) to nourish with heavy/turbid substances, preparing the foundation for urine. He then induced vomiting with the dregs to open the upper orifice, allowing lower qi to flow freely. She recovered after several doses. One month later, symptoms recurred. Family repeated the formula and induced vomiting, but she became severely distended. Zhang Jingyue remarked: "Previously, qi injury was mild, so nourishing herbs sufficed. Now, in midsummer, qi injury is severe. Without middle jiao transport, nourishing herbs cannot work. The pulses are flooding yet empty, indicating extreme middle jiao depletion. Two doses of moistening herbs are essential, but must be followed by herbs supporting middle qi to enable transport. Prescribe modified Bajia Wan for two doses." Distension worsened. Then, Ginseng Radix et Rhizoma (Renshen) 1 liang and Aconiti Lateralis Radix Praeparata (Fuzi) 3 qian were decocted strongly and taken warm. Gurgling sounds were heard from chest to lower abdomen, and urination resumed after several times.
Zhang Yin'an treated a scribe with strangury (longbi) unresponsive to other treatments. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) cured him in one dose. Asked why lifting worked when draining failed, he replied: "Have you not seen a water vessel? If sealed at the top and inverted, no water flows. Remove the seal, and water flows naturally. Is this not proof?"
Xue Lizhai treated a woman with dribbling urinary retention, blue complexion, and hypochondriac distension, unresponsive to drugs. This was liver meridian stagnation with blood injury. Gardeniae Fructus (Shanzhi) and Ligusticum Chuanxiong Rhizoma (Chuanxiong) decocted and taken cured her.
Another woman had difficult urination, lower abdominal and urethral tightness, and intermittent abdominal/hypochondriac pain. This was liver fire. Jia Wei Xiaoyao San (Modified Free and Easy Wanderer Powder) plus Gentianae Radix (Longdancao) improved her in four doses. Longdancao was removed, and Bazhen San (Eight-Treasure Powder) plus charred Shanzhi was added, curing her.
Zheng Dianyi stated: "Mu Gua (Chaenomeles Fruit) is sour and astringent; using it for edema/distension is erroneous. A large boat passed Jinling carrying hundreds of Mu Gua fruits for their fragrance. All crew members developed urinary retention. Diuretics failed. Upon smelling the Mu Gua aroma, I told them to remove the fruit, and urination resumed without medication." (From *Bencao Beiyao*.)
Wang Ang stated: "My maternal uncle suffered urinary blockage in childhood, unresponsive to stranguary-purging drugs. Old physician Huang Wuju diagnosed small external meatus size, not strangury. He inserted a bone wedge to gradually dilate the opening, curing him without medicine. Repeated diuretics would have caused other disorders. Thus, medical principles vary." (Ibid.)
For lower jiao injury by dryness-heat causing difficult urination, nourish yin with Angelicae Sinensis Radix (Danggui), Rehmanniae Radix (Dihuang), Anemarrhenae Rhizoma (Zhimu), Phellodendri Cortex (Huangbai), Achyranthis Bidentatae Radix (Niuxi), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Gancao), Atractylodis Macrocephalae Rhizoma (Baizhu), and Citri Reticulatae Pericarpium (Chenpi). (Treatment method.)
Liu Zhubo Ruyi of Shaoxing reported: When Wei served as Prefect of Mingzhou, his warehouse keeper's wife suffered abdominal distension and urinary retention, near death. Attending imperial physician prescribed Trichosanthis Fructus (Gualou), dried, powdered. Take 3 qian with hot wine (or rice drink if unable to drink alcohol). Repeat until通畅. (From *Shizhai Fang*.)
Wu Fuxian treated Cao Shuchang with urinary retention. Excessive diuretics caused enuresis for a night, followed by re-retention. This was excessive draining depleting kidney qi. Urgently, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) administered with Shenqi Wan (Kidney Qi Pill) cured him.
Huang Lvsu stated: "A servant in my house suffered urinary retention. Physicians used pills/decoctions, causing abdominal distension without relief, nearly fatal. A folk doctor roasted white radish seeds (Bai Luobozi), swallowed with warm water, and urination resumed immediately. I witnessed this."
Sun Wen yuan treated Ni E'nan's wife with urinary incontinence, voiding 20+ times daily. Pulses: Right cun flooding/forceful, left cun deficient, right chi deep/faint. Diagnosis: Heart-kidney non-interaction. Angelicae Sinensis Radix (Danggui) and Polygalae Radix (Yuanzhi) cured her in five days. Relapses with fatigue responded to this formula.
Xue Lizhai treated a woman with urinary incontinence and occasional difficulty, worsening at dusk. This was liver heat with prolapse preventing control. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) modified with wine-fried Atractylodis Macrocephalae Rhizoma (Baizhu), Phellodendri Cortex (Huangbai), and Anemarrhenae Rhizoma (Zhimu) cured her in several doses. Misusing diuretics would damage true yin fatally.
An elderly woman with similar symptoms had aversion to cold, fatigue, and cold limbs. Xue diagnosed yang deficiency-cold. Buzhong Yiqi Tang plus Fuzi (Aconite) for three doses failed. Shenfu Tang (Ginseng and Aconite Decoction) for four doses showed slight improvement, then returning to previous formula stabilized her. Total Fuzi used: 4 pieces; Renshen: ~1 jin.
Urinary retention due to qi closure does not respond to Alisma Rhizoma (Zexie), Akebiae Caulis (Mutong), Plantaginis Semen (Cheqianzi), or Poria (Fuling). Instead, use Angelicae Sinensis Radix (Danggui) 1 liang, Ligusticum Chuanxiong Rhizoma (Chuanxiong) 5 qian, Bupleuri Radix (Chaihu) 2.5 qian, and Cimicifugae Rhizoma (Shengma) 2.5 qian. One dose restores flow. Elderly patients may add Ginseng Radix et Rhizoma (Renshen).