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Enuresis refers to the involuntary discharge of urine without awareness. Bi-long (obstruction and dribbling) refers to the blockage of urination with only scanty, dripping drops. These conditions are primarily governed by the Liver, Du Mai (Governing Vessel), Sanjiao (Triple Burner), and Bladder.

The reason the Liver and Du Mai govern these conditions is stated in the classics: "The Foot Jueyin Liver Meridian passes through the genitalia; diseases it generates include enuresis and bi-long." It also states: "The Du Mai enters and connects to the Ting Kong (urethral opening) in women, which is the end of the urinary pore. In men, it follows the penis down to the perineum, identical to women; its diseases include long-term obstruction, hemorrhoids, and enuresis." Therefore, for treating enuresis and bi-long, one selects acupoints on the Jueyin and Du Mai meridians.

The reason the Sanjiao governs these conditions is stated in the classics: "The descending channel of the Sanjiao lies anterior to the Foot Taiyang Bladder Meridian and posterior to the Foot Shaoyang Gallbladder Meridian, emerging between the inner and outer condyles, named Weiyang (BL34), which is the collateral of the Foot Taiyang Bladder Meridian. The Sanjiao is commanded by the Foot Taiyang and Foot Shaoyang, and is a branch of the Foot Taiyang. It ascends five cun above the ankle, branches off, penetrates the intestines, emerges at Weiyang, joins the main channel of the Taiyang, enters and connects to the Bladder, and regulates the Lower Jiao. Excess manifests as bi-long (obstruction), deficiency manifests as enuresis. Enuresis should be treated with tonification, and bi-long with sedation."

The reason the Bladder governs these conditions is stated in the classics: "Bladder dysfunction leads to long-term obstruction (long); lack of restraint leads to enuresis." However, for enuresis and bi-long, one does not directly select the Bladder Shu point because the Bladder merely stores urine; the discharge of urine is accomplished through the Sanjiao, Liver, and Du Mai.

"Bi" and "Long," when combined, refer to one disease; when distinguished, they differ in onset duration. "Bi" refers to acute onset, characterized by complete retention of urine with no drops passing, commonly known as urinary retention. "Long" refers to chronic onset, characterized by scanty, dripping urination occurring dozens or even hundreds of times a day, known as strangury (Lin syndrome). Currently, these two conditions are classified into separate categories.

Zhu Danxi's general principle holds that urinary obstruction arises from Heat, Dampness, or Qi stagnation in the Lower Jiao. Treatment may involve clearing Heat, drying Dampness, or raising Qi, employing strategies of "indirect treatment via two organs" (Ge Er) and "indirect treatment via three organs" (Ge San). If caused by Lung Dryness failing to generate fluids (Jin Ye), one clears and moistens the Metal (Lung); this is Ge Er. If not due to Lung Dryness but solely Bladder Heat, one directly purges the Bladder; this is direct treatment. If caused by Spleen Dampness failing to transport essence upward, thereby preventing the Lung from generating fluids, one dries the Spleen and strengthens the Stomach; this is Ge San. Qianhenzi (Plantaginis Semen) and Fuling (Poria) clear the Lung; Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) purge Bladder heat; Cangzhu (Atractylodis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) strengthen the Stomach and dry Spleen Dampness.

*Baojian* states there are three types of difficult urination, which cannot be treated uniformly. First, if body fluids leak excessively into the Intestines and Stomach, causing diarrhea and scanty urine, diuresis is appropriate. Second, if Heat combats fluids in the Lower Jiao, causing Heat-Damp stagnation, permeating and draining is necessary for cure. Third, if Stomach-Spleen Qi is stagnant and fails to regulate water pathways to transmit to the Bladder for transformation, regulating Qi to restore transformation is suitable.

Li Dongyuan's general principle holds that urinary obstruction is caused by pathogenic Heat, differentiated into Qi level and Blood level treatments, distinguished by thirst. If thirsty with difficulty urinating, Heat is in the Upper Jiao Lung. Urine is governed by the Foot Taiyang Bladder Meridian; the Lung generates fluids. If Lung Heat prevents fluid generation, the source of water is cut off. The classics state: "Deficiency tonifies its mother"; thus, clearing the Lung to nourish the source of transformation is appropriate, assisting the Autumn (Metal) function so Water generates naturally. Just as rain, mist, and frost descend from heaven, drugs with thin Qi and flavor belong to Yang within Yin, generated by the crisp, killing Qi of Autumn, capable of supplementing Lung deficiency. Such bland-draining drugs include Fuling (Poria), Zexie (Alismatis Rhizoma), Hupo (Fossilia Os Costatum), Dengxincao (Junci Medulla), Tongcao (Tetrapanacis Medulla), Qianhenzi (Plantaginis Semen), Mutong (Akebiae Caulis), Qumai (Dianthi Herba), and Pianfu (Persicariae Herba), used to clear Lung Qi, drain fire, and nourish the upper source of Water.

If not thirsty but unable to urinate, Heat is in the Lower Jiao Blood level, hence no thirst but obstruction. Heat blocking the Lower Jiao involves the Kidney and Bladder, which are Yin within Yin. Yin suffering Heat evil blocks the flow. Zhang Yishou said: "Cold obstructing the chest prevents entry; Heat filling the Lower Jiao causes inconvenience. One must use drugs sensing the transformation of Northern Cold Water, with both Qi and flavor being Yin, to remove Heat and unblock obstruction." *Neijing* states: "Without Yang, Yin cannot generate; without Yin, Yang cannot transform." If bland-draining drugs (Yang within Yin) are taken, they are not pure Yin agents; without Yang, transformation cannot occur, so how can they supplement severe Yin deficiency? One must use drugs sensing Earth's water movement producing bitter flavors, and Heaven's cold air producing cold drugs—both Qi and flavor Yin, i.e., Yin within Yin. Great Cold Qi generates Bladder function; Cold Water movement generates Kidney function. These drugs tonify Kidney and Bladder. For cases where Yang-Heat evil blocks the Lower Jiao causing obstruction, using great bitter-cold drugs requires the method of "treating cold with heat" (Han Yin Re Yong). It is also said: "Subdue the ruling pathogen and address the cause first; initially the Qi is similar, finally it differs." For Heat in Upper Jiao, use Zhizi (Gardeniae Fructus) and Huangqin (Scutellariae Radix). For Heat in Middle Jiao, use Huanglian (Coptidis Rhizoma) and Shaoyao (Paeoniae Radix). For Heat in Lower Jiao, use Huangbai (Phellodendri Cortex). For Heat in Qi level with thirst and obstruction, use Qingfei San, Zhuling Tang, Wuling San, Fuling Hupo Tang, or Hongshu San. For Heat in Blood level without thirst and obstruction, use Zishen Wan, Huanglian Wan, or Daoqi Chuzao Tang.

Li Dongyuan treated a patient with difficult urination, protruding eyes, drum-like abdominal distension, hardness above the knees, skin tight as if cracking, and inability to eat. Bland-draining drugs failed. He said: "The condition is urgent. It requires deep thought. The classics say: 'The Bladder is the mansion of fluids, requiring Qi transformation to excrete.' Taking many bland-draining drugs worsened the condition because Qi did not transform. Wang Bing noted: 'Without Yang, Yin cannot generate; without Yin, Yang cannot transform.' Bland-sweet drugs are Yang; alone, Yang cannot transform without Yin." He prescribed Zishen Wan (a group of Yin herbs), and the patient recovered after two doses.

If thirsty with cold abdomen, it is Water Qi. *Jingui Yaolue* states: "For difficult urination with Water Qi and extreme thirst, use Gualou Qumai Wan." The goal is smooth urination and warmth in the abdomen. If urinary obstruction with lower abdominal pain shaped like an inverted bowl, unbearable and stifling, it is dryness of Intestines and Stomach with failure of Danzhong Qi to descend. The classics say: "The Bladder is the official of the metropolis, storing fluids, transforming by Qi to excrete." Danzhong is the official of the minister, Sanjiao houses Ministerial Fire, and Kidney is the Sea of Qi. Wang's commentary notes: "The Bladder, mansion of fluids, resides in the Bao (uterus/bladder). If Qi Sea transforms, urine flows; if Qi Sea is insufficient, secretion stops." Initially, use Muxiang (Aucklandiae Radix) and Chenxiang (Aquilariae Lignum Resinatum), 3 qian each, mixed with wine, or Bazheng San. Severe cases require emesis to open Qi, following the principle "treat lower by accessing upper." Wang notes: "Heat attacking upper hinders lower; excess Qi above requires warm-acrid dispersal and bitter draining." One formula decocts Juhong (Citri Reticulatae Pericarpium) and Fuling (Poria), mixed with Muxiang and Chenxiang powder, taken fasting.

Zhu Danxi said: "Urinary obstruction due to Qi deficiency, Blood deficiency, Excess Heat, or Phlegm-Qi blockage all benefit from emesis to raise Qi; as Qi rises, Water descends, for Qi carries Water." For Qi deficiency, use Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Shengma (Cimicifugae Rhizoma); take medicine then induce vomiting. For Blood deficiency, use Siwu Tang; take then induce vomiting. For much Phlegm, use Erchen Tang; take then induce vomiting. For Phlegm-Qi blockage, use Erchen Tang plus Xiangfu (Cyperi Rhizoma) and Mutong (Akebiae Caulis) to induce vomiting. For Excess Heat, promote urination with Bazheng San, as moving stool promotes urination. When asked why emesis works for urination, the answer is Qi transformation. *Neijing* says Sanjiao is the official of drainage, and Bladder stores fluids for Qi transformation. If any of Upper, Middle, or Lower Jiao fails to transform, water cannot flow. Upper Jiao Lung governs Ying-Wei and water pathways, transmitting to Bladder; Kidney connects to Sanjiao, which connects up to Lung. Thus, urination depends on Upper Jiao Qi transformation. Zhang Zhongjing said: "When Wei Qi moves, urination is patent." Also, *Neijing* says Spleen disease causes nine orifices to block, including difficult urination, indicating Middle Jiao Qi transformation. Since pathogens injuring Sanjiao vary and Qi changes infinitely, one must treat pathogens and move water everywhere, seeking Qi transformation. The key is balance of Yin and Yang. As *Fang Sheng Shuai Lun* states: "Extreme Yin deficiency cuts off Heavenly Qi; extreme Yang excess leaves Earthly Qi insufficient." Kidney/Liver below are Earth Way; Heart/Lung above are Heaven Way; Spleen/Stomach middle is Qi intersection. If Heaven Yang does not intersect Earth, white dew does not fall. Similarly, if Upper Yang does not intersect Lower Yin, Lower Yin cannot transform, and waterways cannot flow. Li Dongyuan cited *Nan Jing*: Yin-Yang mutual overcoming causes Fu and Yi, leading to Neiguan and inability to urinate. If Lower Yin deficiency and Upper Yang excess overcome virtue, causing Kidney Qi failure, one must purge Yang and raise Yin to balance. The cases described use emesis because Qi pathways are blocked and ascending/descending are halted. Zhu Danxi compared it to a dripping vessel: if the upper orifice closes, the lower cannot flow; opening the upper allows water out. I have applied this successfully.

In autumn of Jiawu year, I treated a 50-year-old woman with initial sluggish urination. Doctors used Bazheng San etc., worsening it to total obstruction with body prickling sensations. Attributing it to dampness from heavy rains still on the surface, I used Cangzhu (Atractylodis Rhizoma) as sovereign and Fuzi (Aconiti Lateralis Radix Preparata) as assistant to release the exterior. After one dose, sweating occurred, and urination immediately cleared. I also treated the father of Official Ma, 80 years old, with short, sluggish urination caused by excessive diuretics leading to total blockage. Attributing it to overeating damaging Stomach Qi sinking to Lower Jiao, I used Buzhong Yiqi Tang. After one dose, urination flowed. However, prior diuretics damaged Kidney Qi, causing post-obstruction enuresis all night. Urgent Kidney tonification stopped it. Physicians rarely protect Kidney Qi when using draining agents; this is recorded as a warning.

For blood stasis causing obstruction, use Niuxi (Achyranthis Bidentatae Radix) frequently. *Benshi Fang* records a noblewoman with unbearable abdominal pain and obstruction. Doctors treated as strangury with Bazheng San etc., worsening the condition. Diagnosing Xue Jia (blood mass), I used Taoren Jian (Peach Kernel Decoction). After taking it until noon, severe pain ensued, followed by passage of fist-sized blood clots and dark urine, curing the pain. This drug is potent; use cautiously in Qi/Blood deficiency. Generally, lower abdominal distension like an inverted bowl indicates Excess. Differentiate Qi vs. Blood. Qi stagnation below uses Muxiang Liuqi Yin. Blood turbidity below uses Taoren Jian, Daididang Wan, or Niuxi Gao. Classics state: "Kidney combines with Bladder... Small Intestine belongs to Kidney, Kidney connects to Lung... Sanjiao is the mid-channel mansion of water." Thus, Bladder stores water, Sanjiao outputs water. For difficult urination, acupuncture targets Sanjiao points, not Bladder. Small Intestine belongs to Kidney/Lung, so Li Dongyuan used Qingfei Yinzi and Zishen Wan.

In climatic factors, difficult urination has three types: 1. Dampness attacking Sanjiao: "Taiyin in泉, excessive dampness causes lower abdominal pain/swelling and inability to urinate." "Water deficiency called Hedou... diseases include long-term obstruction." 2. Wind attacking Spleen: "Jueyin ruling heaven, excessive wind causes loose stools/masses/diarrhea and water closure." 3. Dryness-Heat: "Yangming ruling heaven... people suffer long-term obstruction. First phase: yellow-red urine, severe strangury." "Shaoyin ruling heaven... second phase: strangury."

For refractory cases or severe Tuo Bao (displaced bladder/uterus), a clever method uses a pig bladder. Pierce a small hole at the base, insert a feather quill, secure with thread, plug quill end with stick, seal bladder mouth with beeswax. Blow air into bladder to 70% full, tie securely, press quill root, remove wax, insert quill into urethra, release pressure, massage air inside. Urine flows instantly.

[Pregnancy Urinary Obstruction] Full fetus pressing on Bladder often causes difficult urination. If Bao Xi (bladder ligaments) are twisted, causing obstruction, it is called Tuo Bao. Zhu Danxi attributes this to maternal weakness, worry/irritability, and rich diet. Ancient slippery/dredging drugs fail. If Bladder is depressed by fetus, lifting the fetus loosens ligaments and urination resumes. If abdominal distension with dribbling occurs due to Spleen-Stomach Qi deficiency and fetal pressure, use Siwu Tang, Erchen Tang, Renshen, Baizhu, taken fasting then induced vomiting. Xue notes: Also consider Spleen-Lung Qi deficiency failing to transmit to Bladder; Qi-Heat stagnation blocking Bladder fluids; or Metal dried by Fire with Spleen-Damp-Heat. *Jingui Yaolue* asks: "Woman eats well, feels hot/restless, leans back to breathe—why?" Master answers: "This is Tuo Bao, inability to urinate due to twisted Bao Xi. Promote urination to cure; use Shenqi Wan (Eight-Ingredient Pill, 15-30 pills with wine, twice daily)." Also: "Pregnancy with Water Qi, heavy body, difficult urination, chills, dizziness on rising; use Kuizi Fuling San." Also: "Pregnancy difficult urination, eating well; use Guimu Kushen Wan."

Zhu Danxi treated a woman with Tuo Bao, obstruction, pulse slightly choppy, deep stringy, left slightly harmonious, caused by worry. Choppy indicates low Blood/excess Qi; Stringy indicates Fluid retention. Low Blood fails to lift Bao; excess Qi with Fluids clouds Middle Jiao, causing Bao to sag. Used Siwu Tang plus Renshen, Baizhu, Banxia, Chenpi, Gancao, Shengjiang, taken fasting then induced vomiting. After eight doses, resolved. Treated several others successfully. Another 41-year-old pregnant woman, 9 months, Tuo Bao, swollen legs, emaciated, pulse left harmonious/right choppy. Caused by overeating injuring fetal suspension, weak to lift, pressing Bladder sideways, closing Qi, blocking water outlet. Tonify Blood/Qi; once balanced, suspension lifts, no sagging, safety achieved. Used Renshen, Danggui, Shaoyao, Baizhu, Chenpi, Zhigancao, Banxia, Shengjiang decoction, four thick doses, next morning dregs decocted and taken to induce vomiting. Urine flowed, dark water passed. Added Dafupi, Zhiqiao, Congbai, Sharen for twenty doses, resulting in safe delivery. Another pregnant woman, weak fine pulse, Qi/Blood deficiency, fetal pressure on bladder outlet. Tonics too slow, risk worsening fullness. Midwife oiled hand, inserted into vagina to lift fetus, urine gushed. Then gave large dose of Renshen, Huangqi, Shengma. Another method: invert pregnant woman vertically; fetus moves, urine flows, superior to manual lifting.

[Postpartum Urinary Obstruction] Old formula: Chenpi (Citri Reticulatae Pericarpium) powder, 2 qian with wine fasting. Apply salt to umbilicus, bundle ten+ scallion whites, slice finger-thick, place on salt, cover with large moxa cone, moxa until heat enters abdomen, urination follows immediately. Note: Only suitable for Qi stagnation. Not for Qi deficiency/dryness or Heat binding.