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Zhong Dayan treated a pregnant woman from a noble family. The patient suffered from urinary retention accompanied by swelling and pain, flushed face, and panting. Other physicians failed to achieve any effect. After diagnosis, Zhong Dayan said, "Medication is not necessary; this is caused by the fetus pressing on the bladder." He instructed her to move her whole body, and she recovered. (From *Gazetteer of Ningbo Prefecture*.)

Sun Zhuo, a native of Fuliang, was well-versed in traditional Chinese medicine. During the Zhengde reign, due to the rebellion of Chen Hao, the county magistrate first sent his wife away in a sedan chair to Zhongshan. She fell ill with urinary retention for five days, her abdomen distended like a drum, eyes staring upward, and breath faint. Sun Zhuo was urgently summoned. He said, "This resulted from rushing in the intense heat, drinking excessive water, and holding urine due to shame, leading to *Zhuan Pao* (urinary retention)." The treatment method involved inflating a pig's bladder with air until full, then having a female servant throw it against the patient. Urine then flowed freely, and she recovered. (From *Gazetteer of Jiangxi*.)

Sun Wen Yuan treated a wealthy woman who had been unable to urinate or defecate for three days. A quack doctor administered two doses of *Radix Crotonis Tiglii* pills. Although she had a bowel movement, her urinary retention worsened. Her abdomen became bloated and stifling, with the umbilicus protruding over two inches. The external genitalia swelled and cracked, making sitting or lying down impossible. She cried, groaned, and wished to end her life. Sun Wen Yuan diagnosed, "This is *Zhuan Pao* disease." He prescribed one cun of root bark from the east side of a tree, three qian of *Talcum* (Hua Shi), and one qian each of *Rhizoma Corydalis Yanhu Suo* (Yan Hu Suo), *Peach Kernel* (Tao Ren), *Angelica Sinensis* (Dang Gui), and *Herba Diantherae* (Qu Mai). Half a cup of chive juice was added just before administration. After about the time it takes to eat a meal, urination slightly resumed, but urethral pain was severe, requiring extreme straining to pass urine. The prescription was changed to *Cimicifugae Rhizoma* (Sheng Ma), *Platycodon Root* (Jie Geng), *Aurantii Fructus Immaturus* (Zhi Ke), and *Rhizoma Corydalis Yanhu Suo*, decocted and mixed with two qian of *Mirabilite* (Yuan Ming Fen). This aimed to raise clear qi and descend turbid qi. After administration, both urination and defecation resumed, and abdominal distension subsided. The next day, it was reported that abdominal pain preceded urination, with pale bloody fluid discharge and scanty urine. A new prescription of *Salvia Miltiorrhiza* (Dan Shen), *Moutan Bark* (Dan Pi), *Angelica Sinensis*, *White Peony Root* (Bai Shao), *Licorice Root* (Gan Cao), *Green Tangerina Peel* (Qing Pi), *Cyperi Rhizoma* (Xiang Fu), *Rhizoma Corydalis Yanhu Suo*, *Poria* (Fu Ling), *Gardenia Fruit* (Shan Zhi), and *Hawthorn Fruit* (Shan Zha) was given for two doses, after which the condition stabilized.

Mr. Sun had another case record in Volume 4, page 77, also involving *Zhuan Pao*. The treatment was largely similar, except the patient was instructed to lie horizontally while a strong woman supported her legs bent at the knees on her shoulders, lifting the lower body into the air and shaking it several times to invert the bladder, then slowly lowering it. Before the patient could dress, urine shot out like an arrow, hot as boiling water and black as ink, filling a basin instantly. (Note: For *Zhuan Pao*, ancients simply had patients lie horizontally with their lower body elevated for a long time until urine passed naturally, without much effort.)

Huang Lvsu stated: "My friend, Fangbo He Li'an, often spoke of his uncle, He Yue, who was skilled in medicine. He once treated a pregnant woman near delivery who suffered from urinary retention. All medicines failed; the more she drank, the fuller she felt, leaving them helpless awaiting death. He Yue diagnosed, 'This is spleen qi deficiency failing to support the uterus, causing uterine prolapse compressing the bladder and blocking the water passages. Greatly tonifying the spleen will lift the uterus, and urination will resume.' He used two liang of earth-fried *Atractylodes Macrocephala Rhizome* (Bai Zhu), plus a few qian of fried *Amomum Villosum Fruit* (Sha Ren), along with one or two auxiliary herbs. One dose resulted in immediate urination. Its efficacy was miraculous, and I often kept this in mind. In the winter of the Year of Wang Yin, my wife, pregnant and nearing term, suffered the same illness. Medical treatments were ineffective, and the situation was critical. I informed the attending physician of this method. The physician accepted it humbly and applied it, resulting in immediate efficacy, and our eldest son, Yin Xi, was born. Had I not heard these words, both mother and child would have perished. (Note: This summer, the wife of Qian Ximin suffered severely from this illness. I was summoned urgently. Her pulse was slippery and rapid, eyes red, and mouth dry. I administered a large dose of *Plantago Seed* (Che Qian Zi), *Talcum*, *Scorched Human Hair* (Xue Yu Tan), *Trichosanthes Fruit* (Gua Lou), *Anemarrhena Rhizome* (Zhi Mu), *Gardenia Fruit*, *Achyranthes Root* (Niu Xi), *Arnebia Root* (Zi Cao), and *Astragalus Complanatus Seed* (Sha Yuan Zi). Urine still did not pass, and she eventually delivered a male infant. Subsequently, the placenta detached, and urine filled the cavity. It seems the child had already exited the womb, and frequent drinking of fluids accumulated in the center. Although I did not initially anticipate this, if I had not used draining and guiding methods, the fetus would not have been expelled quickly. If I had additionally used spleen-tonifying and drying/astringent herbs, the outcome would have been unpredictable. Is clinical practice not difficult?)

Li Shizhen once treated several cases of urinary retention and critical *Zhuan Pao*. He instructed blowing salt into the urethra through a scallion tube, achieving very rapid effects. For infants not urinating due to fetal heat, he sliced four pieces of large white scallion stalks, boiled them with half a cup of milk for a short while, divided into four doses, which restored urination. Those with urinary retention urinated immediately upon ingestion. Infants refusing breast milk began nursing after ingestion. However, if there were dark blue-black skin around the navel and puckering of the lips, the condition was incurable. (From *Compendium of Materia Medica*.)

Xue Lizhai treated the second daughter-in-law of Situ Li Xingang, who was five months pregnant and suffering from difficult urination. Various medicines failed. Xue Lizhai stated, "Only *Eight-Ingredient Pill with Rehmannia* (Ba Wei Wan) can save her." The family did not believe him and used diuretic drugs instead, leading to abdominal swelling and death.

The wife of scholar Wang Wenyuan suffered from urinary retention and abdominal distension, nearly dying. One dose of *Eight-Ingredient Pill with Rehmannia* resulted in dripping urination. A subsequent dose of the same formula added with *Plantago Seed* brought free urination, and the abdomen relaxed and comfort returned.

Lu Yang Yu treated the daughter of Fang Sigui, aged fourteen, who had not urinated or defecated for three days. A village doctor gave dozens of sesame-sized pills. While bowel movements resumed with diarrhea, urinary retention persisted. Two days later, abdominal distension increased, the area below the umbilicus protruded, cramping pain occurred, making sitting or lying impossible. She cried and wished to die. Her pulse was deep and rapid, especially in the chi positions. Lu said, "This is *Zhuan Pao* disease." Given the hot weather, he administered *Liu Yi San* (Six-to-One Powder) mixed with well water. Urination slightly resumed but was extremely painful in the vagina, followed by only drops. Straining for stool yielded no feces. Abdominal pain came in waves, feeling like knife stabs. Re-examination showed a deep, rapid pulse. He prescribed three fen of *Cimicifugae Rhizoma* and one qian each of *Bupleurum Root* (Chai Hu), *Kudzu Root* (Ge Gen), *Licorice Root*, and *Platycodon Root* to raise clear qi and descend turbid qi. After administration, both urination and defecation resumed. Urine was pure blood, and stool contained bloody fluid. The family remained worried. Lu said, "She is now safe. The previous pills must have contained *Radix Crotonis Tiglii*. The disease was originally heat stagnation, but extreme heat-inducing drugs were used. The previous stabbing pain and current hematuria are due to *Radix Crotonis Tiglii* toxicity." He cured her with *Xi Jiao Di Huang Tang* (Rhinoceros Horn and Rehmannia Decoction) added with *Coptis Rhizome* (Huang Lian) and *Gardenia Fruit*.

Wan Mizhai treated a pregnant woman with dribbling urinary retention. Physicians treated it as *Zhuan Bao* (uterine inversion/compression) without success. He used powdered *Areca Seed* (Bing Lang) and *Red Peony Root* (Chi Shao), decocted in flowing river water, which was effective. This formula treats all types of bloody strangury in men and women, as well as painful, obstructed urinary flow, with miraculous results.

Ma Yuanyi treated a relative of the Shen family, who was eight months pregnant. She had suffered diarrhea for over twenty days. Post-diarrhea, she developed urinary retention and strangury, thirst with desire to drink, yet vomiting small amounts after drinking, with abnormal涩 (astringent/painful) sensation for three days and nights. Her lung pulse was distinctly large, while other pulses were deficient and choppy. He said, "Prolonged diarrhea consumes spleen yin, allowing dryness-fire to flourish. The isolated large lung pulse indicates fire occupying the lung position, controlling metal. Qi transformation fails to reach the bladder (Zhou Du); how can urine be excreted? The Classics state: treat upper disorders for lower diseases. Opening the upper orifices allows the lower orifices to function. Moreover, the deficient and choppy pulse in pregnancy indicates insufficient qi and blood to nourish the fetus. Further downward-draining methods would fail to cure the disease and risk fetal movement." He prescribed five qian of *Aster Root* (Zi Wan) to regulate lung qi descending to the bladder; one qian of *Kudzu Root* (Gan Ge) to raise stomach qi and distribute fluids; *Apricot Seed* (Xing Ren) and *Perilla Fruit* (Su Zi) to moisten dryness caused by fire stagnation; *Mint* (Bo He) to clear wind generated by dryness; and *Aurantii Fructus Immaturus* and *Platycodon Root* to open and lift san jiao qi. One dose resulted in urine flowing like a spring; a second dose stopped the diarrhea.

Wu Qiao treated Mrs. Zhao, who was constitutionally weak and seven months pregnant, suffering from inability to urinate or defecate. Physicians sequentially used *Si Ling San* (Four-Poria Powder) to promote urination, but to no avail. Eventually, severe abdominal distension and pain occurred, with restlessness and confusion, nearly unbearable. Wu Qiao diagnosed and prescribed *Bu Zhong Yi Qi Tang* (Tonify the Middle and Augment the Qi Decoction) added with *Coptis Rhizome*. One dose allowed slight urination. The next day, he prepared five dou of liquid medicine, fed it orally via a flask spout. He had the patient sit over a basin and poured the warm liquid over her abdomen. Then, instructing the midwife to lift and support the uterus manually, both urination and defecation resumed, and she recovered. The illness originated from incomplete expulsion of arsenic poison after vomiting, which irritated the fetus. The patient's internal deficiency caused the fetus to descend and press on the bladder. Someone asked, "If fetal pressure causes urinary retention, why is defecation also blocked?" Wu Qiao replied, "Urinary blockage distends the bladder, which obstructs the large intestine, causing its qi mechanism to become unfavorable as well." The listener agreed. (From *Tai Han Ji*.)