大意
膀胱者。州都之官。津液藏焉。气化则能出矣。故膀胱不利为癃。三焦者。决渎之官。水道出焉。故三焦实则
闭癃。（内经）癃与闭。二症也。暴病为溺闭。小便点滴。内急。胀满而难通。久病为溺癃。欲解不解。屡出而短
少。（必读）
内因
有心肾不交。阴阳不通。而内外关格者。有热结下焦。壅塞胞内。而气道涩滞者。有肺中伏热。不能生水。而
气化不施者。有脾经湿热。清气郁滞。而浊气不降者。有痰涎阻结。气道不通者。有久病多汗。津液枯耗者。
有肝经忿怒。气闭不通者。有脾虚气弱。通调失宜者。（汇补）
外候
凡人鼻色黄。小便必难。热微则小便难而仅有。热甚则小便闭而绝无。（入门）小便胀满。气急上逆。心腹俱
闷。叫痛欲死。（巢氏）甚有肺气壅极。横行脐中。小肠为之突出。外肾为之挺长。（寓意草）
脉法
脉紧而滑直者。不得小便也。又尺脉或浮或涩或缓。皆小便难。溺有余沥也。右寸关滑实者。痰滞上焦。细
微者。中气不运。左尺脉洪数者。热结下焦。虚浮者。肾气不足。（汇补）
治法
一身之气关于肺。肺清则气行。肺浊则气壅。故小便不通。由肺气不能宣布者居多。宜清金降气为主。并
参他症治之。若肺燥不能生水。当滋肾涤热。夫滋肾涤热。名为正治。清金润燥。名为隔二之治。燥脾健胃。
名为隔三之治。又有水液只渗大肠。小肠因而燥竭者。分利而已。有气滞不通。水道因而闭塞者。顺气为
急。实热者。非咸寒则阳无以化。虚寒者。非温补则阴无以生。痰闭者。吐提可法。瘀血者。疏导兼行。脾虚气
陷者。升提中气。下焦阳虚者。温补命门。（汇补）
用药
肺气受热。清肺饮。膀胱热结。八正散。气滞于内者。利气散。阴虚者。地黄汤。阳虚者。八味丸。脾虚不运者。
补中益气汤。气虚不化者。六君子汤。血瘀者。牛膝汤。痰闭者。导痰汤。先服后吐。又有因小便不通。过服寒凉
渗利诸剂。致气闭于下。寒郁于中。阴翳否隔。不能气化而不通者。用干姜、升麻。煎服而愈。于此可悟夫天
地升降之道。阴阳消长之理。故志之。（汇补）
【附转胞】
转脬者。胞系转戾。脐下并急而痛。小便不通者是也。（巢氏）凡强忍小便而疾走。或饱食大怒而入房。使水
气逆上。并迫于胞。故屈戾而不舒张也。治以甘遂末。水调。敷脐下。内饮甘草汤。其药汁至脐。二药相反。胞
必自转。小便自通。或用甘遂末一钱。猪苓汤下即愈。若妊妇小便不通。因胎肥压胞。宜升举其胎。胞转而
水道自利。不可专用淡渗。宜补中益气汤探吐以提其气。或外用稳婆手托法。亦可。（汇补）
【附胞痹】
胞痹者。小腹膀胱。按之内痛。若沃以汤。涩于小便。上为清涕。（内经）盖因风寒湿气客于胞中。则气不能化。
故胞满而小便不通。其为清涕者。以膀胱之脉。络脑而下贯鼻中。宜散胞中之邪。调下焦之气。肾沥汤主之。（医统）
【附关格】
关格者。脉名也。左手人迎脉。大于右手四倍。曰关。关者。热在下焦。必下绝小便。右手气口脉。大于左手四
倍。曰格。格者。寒在上焦。必上为呕逆。若脉象既关且格。必小便不通。旦夕之间。陡增呕恶。此因浊邪壅塞。
三焦正气不得升降。所以关应下而小便闭。格应上而生吐呕。阴阳闭绝。一日即死。最为危候。宜二陈汤
加防风、桔梗芦探吐。若吐不出。以二陈汤加槟榔、大黄、枳壳、浓朴、木香、木通、杏仁、泽泻降之。古法。治虚人
关格。有用补中益气汤加槟榔者。若上不得吐。下不得通。愦愦无奈。头汗不止者死。至于寻常腹痛二便
不通而呕吐。其脉沉静不紧盛倍大者。非关格也。乃痰食之症。宜二陈汤加白芥子、山楂、枳实、青皮治之。（汇补）
癃闭选方
清肺饮（东垣） 治肺热口渴。小便不通。
茯苓 黄芩 桑皮 麦冬 车前 山栀 木通（等分）
水煎。
八正散（宝鉴） 治膀胱热郁。小便不行。
瞿麦 蓄 车前 滑石 甘草 山栀
木通 大黄（等分）
每服二钱。加灯心。水煎。
导赤散 治心经客热溺闭。
生地 木通 甘草 加连翘、黄连。
五苓散 治清浊混行于大肠。致泄泻小便不通者。
白术 茯苓 猪苓 泽泻 肉桂
利气散 治气壅小便不通。
枳壳 陈皮 木通 甘草
通闭散 可与前方合用。
香附 陈皮 赤苓
牛膝汤 治血瘀小便不通。
牛膝 归尾 黄芩 加琥珀末少许。
地黄汤 治阴虚小便不通。（方见中风）
即地黄汤去萸肉。加麦冬、牛膝、车前。
肾气丸（金匮） 治阳虚小便不通。（方见湿症）
补中益气汤 六君子汤（二方俱见中风） 导痰汤（方见似中风）
外治法
葱头二十茎。紫苏二两。煎汤熏洗外肾小腹。或以盐炒热。绢包熨脐上下。或姜渣、枳壳亦可。或葱饼灸
脐亦效。 又法。取田螺泥涂脐中。法见淋症。加麝香一二厘。或盐半匙填脐中扎紧更效。又法。独颗
蒜一枚。栀子三十。盐花少许。研烂摊纸上。贴脐。甚者连阴囊涂之。即通。又小便不通欲死者。用桃枝、
柳枝、木通、枯矾、旱莲子、汉椒各一两、葱白一握。灯心一束。细锉。入水三斗煎。耗一半。用瓷瓶盛汁。熏外
肾。周遭以被围绕。不得入风。冷则换汁。再熏即通。（一方无旱莲子）
[General Principle]
The Bladder is the official of the State Capital (Zhou Du), where body fluids are stored. Through Qi transformation, urine is able to be discharged. Therefore, if the Bladder's Qi mechanism is obstructed, it leads to Lin and Bi (difficulty in urination). The San Jiao (Triple Burner) is the official of irrigation, through which water passages flow. Thus, if the San Jiao is affected by excess heat, it results in Bi and Lin (urinary retention). According to the *Neijing* (*Classic of Internal Medicine*), Lin and Bi are two distinct symptoms. Acute onset is called "Niao Bi" (acute urinary retention), characterized by drops of urine, internal urgency, distension, and difficulty in passage. Chronic onset is called "Niao Long" (chronic dribbling), characterized by the urge to void but inability to do so, frequent urination with small amounts. (From *Jingyue Quanshu*)
[Etiology (Internal)]
There are cases of Heart-Kidney non-interaction and Yin-Yang obstruction, leading to internal-external rejection; cases of heat accumulation in the Lower Jiao, blocking the interior of the Bao (uterus/bladder), causing stagnation of the Qi pathway; cases of latent heat in the Lung, failing to generate fluids, resulting in failure of Qi transformation; cases of damp-heat in the Spleen channel, with stagnation of clear Qi and failure of turbid Qi to descend; cases of phlegm-saliva obstruction blocking the Qi pathway; cases of prolonged illness with excessive sweating leading to depletion of body fluids; cases of Liver channel anger causing Qi closure and obstruction; and cases of Spleen deficiency and Qi weakness leading to dysfunction of regulation and communication. (From *Zhengzhi Huibu*)
[External Manifestations]
In individuals whose nasal color is yellow, urination is invariably difficult. If heat is mild, urination is difficult with only scant output; if heat is severe, urination is completely blocked with no output. (From *Yixue Rumen*) Urinary distension,急促 breathing with upward reversal of Qi, fullness and pain in the heart and abdomen, crying out in pain as if dying. (From *Zhubing Yuanhou Lun*) In extreme cases, Lung Qi is extremely congested, spreading horizontally across the umbilicus, causing the Small Intestine to protrude and the external genitalia to become erect and elongated. (From *Yuyi Cao*)
[Pulse Diagnosis]
A pulse that is tight, slippery, and straight indicates inability to urinate. Additionally, a Chi (Cun Guan Chi position, specifically Chi) pulse that is floating, choppy, or slow all indicate difficult urination and residual dripping after voiding. A Hua Shi (slippery and solid) pulse at the Right Cun and Guan positions indicates phlegm stagnation in the Upper Jiao; a Xi Wei (fine and minute) pulse indicates failure of Middle Qi to transport; a Hong Shu (surging and rapid) pulse at the Left Chi position indicates heat accumulation in the Lower Jiao; a Xu Fu (deficient and floating) pulse indicates insufficiency of Kidney Qi. (From *Zhengzhi Huibu*)
[Therapeutic Principles]
The Qi of the entire body is related to the Lung. When the Lung is clear, Qi moves; when the Lung is turbid, Qi becomes congested. Therefore, most cases of urinary obstruction are due to the Lung's inability to disseminate and descend. Treatment should primarily focus on clearing Metal (Lung) and descending Qi, while considering other symptoms. If Lung dryness fails to generate fluids, one should nourish the Kidney and purge heat. Nourishing the Kidney and purging heat is termed "Direct Treatment" (Zheng Zhi); clearing Metal and moistening dryness is termed "Treatment of the Second Remove" (Ge Er Zhi Zhi, treating the organ separated by one from the diseased organ); drying the Spleen and strengthening the Stomach is termed "Treatment of the Third Remove" (Ge San Zhi Zhi, treating the organ separated by two from the diseased organ). In cases where fluids only seep into the Large Intestine, causing the Small Intestine to become dry and exhausted, separation and diuresis suffice. In cases of Qi stagnation blocking the water passages, promoting Qi movement is urgent. For excess heat, salty-cold herbs are required for Yang to transform; for deficiency cold, warm-tonifying herbs are required for Yin to generate. For phlegm closure, emesis can be used to lift Qi; for blood stasis, dredging and guiding should be combined; for Spleen deficiency with Qi sinking, lifting Middle Qi is indicated; for Lower Jiao Yang deficiency, warming and tonifying the Mingmen (Gate of Life) is indicated. (From *Zhengzhi Huibu*)
[Prescriptions]
For Lung Qi affected by heat: Qingfei Yin (Clear the Lung Drink). For Bladder heat accumulation: Bazheng San (Eight Corrects Powder). For internal Qi stagnation: Liqi San (Promote Qi Powder). For Yin deficiency: Dihuang Tang (Rehmannia Decoction). For Yang deficiency: Bawei Wan (Eight-Ingredient Pill). For Spleen deficiency with failure of transport: Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For Qi deficiency with failure of transformation: Liu Junzi Tang (Six Gentlemen Decoction). For blood stasis: Niuxi Tang (Achyranthes Decoction). For phlegm closure: Daotan Tang (Resolve Phlegm Decoction), taken first followed by emesis. There are also cases where urinary obstruction, caused by overuse of cold and draining agents, leads to Qi closure below and cold depression in the middle, creating Yin obscurity and blockage preventing Qi transformation. These are cured by decocting and taking Ganjiang (Dried Ginger) and Shengma (Cimicifuga Rhizome). From this, one can comprehend the principles of Heaven and Earth's ascending and descending, and the waxing and waning of Yin and Yang. Hence recorded. (From *Zhengzhi Huibu*)
[Appendix: Zhuan Pao (Twisted Bladder)]
Zhuan Pao refers to the twisting and inversion of the Bao system, accompanied by urgency and pain in the lower abdomen and urinary obstruction. (From *Zhubing Yuanhou Lun*) It occurs when one holds urine forcibly while walking quickly, or engages in intercourse after a full meal and great anger, causing Water Qi to reverse upwards and press upon the Bao, leading to twisting and inability to expand. Treatment involves applying Gansui powder mixed with water to the lower abdomen, and internally drinking Gancao Tang (Licorice Decoction). When the medicinal juice reaches the umbilicus, the opposing properties of the two drugs cause the Bao to untwist naturally, and urination resumes. Alternatively, administer one qian of Gansui powder with Zhu Ling Tang (Polyporus Decoction). In pregnant women with urinary obstruction due to a large fetus pressing on the Bao, the fetus should be lifted; once the Bao returns to position, the water passages open. Do not use only bland-draining diuretics; instead, use Buzhong Yiqi Tang to induce vomiting to lift Qi, or use an external method where an attendant manually lifts the uterus. (From *Zhengzhi Huibu*)
[Appendix: Bao Bi (Bladder Obstruction)]
Bao Bi is characterized by internal pain upon pressure in the lower abdomen and Bladder area, a sensation as if scalded with hot water, difficult urination, and clear nasal discharge above. (From *Neijing*) This is caused by Wind-Cold-Damp pathogens lodging in the Bao, preventing Qi transformation, leading to fullness of the Bao and urinary obstruction. The clear nasal discharge occurs because the Bladder meridian connects to the brain and descends through the nose. Treatment should dispel pathogens in the Bao and regulate Qi in the Lower Jiao, primarily using Shenli Tang (Kidney Drip Decoction). (From *Yitong*)
[Appendix: Guan Ge (Obstruction and Rejection)]
Guan Ge is a pulse name. If the Renying pulse on the left hand is four times larger than the right hand, it is called Guan (Closed). Guan indicates heat in the Lower Jiao, necessarily leading to cessation of urination. If the Qikou pulse on the right hand is four times larger than the left hand, it is called Ge (Rejecting). Ge indicates cold in the Upper Jiao, necessarily leading to vomiting and reflux. If the pulse exhibits both Guan and Ge, there will be urinary obstruction, and sudden increase in vomiting and nausea within a day or night. This is due to turbid pathogens blocking the San Jiao, preventing the ascent and descent of righteous Qi. Thus, Guan corresponds to the lower part causing urinary closure, and Ge corresponds to the upper part causing vomiting. Closure of Yin and Yang leads to death within a day; it is the most critical condition. Treatment involves using Erchen Tang (Two-Aged Decoction) with Fangfeng (Saposhnikovia Root) and Jiegeng Lu (Platycodon Stem Tip) to induce vomiting. If vomiting does not occur, use Erchen Tang with Binglang (Areca Seed), Dahuang (Rhubarb Root), Zhike (Aurantii Fructus), Houpo (Magnolia Bark), Muxiang (Aucklandiae Radix), Mutong (Akebia Caulis), Xingren (Apricot Seed), and Zexie (Alisma Rhizome) to descend Qi. Ancient methods for treating Guan Ge in deficient persons involve using Buzhong Yiqi Tang with Binglang. If one cannot vomit above nor pass stool/urine below, feeling confused and helpless, with continuous head sweating, death ensues. As for ordinary abdominal pain with obstruction of stool and urine accompanied by vomiting, if the pulse is calm and not tight or excessively large, it is not Guan Ge, but rather a Phlegm-Food stagnation syndrome, treated with Erchen Tang plus Baijiezi (White Mustard Seed), Shanzha (Hawthorn Fruit), Zhishi (Immature Bitter Orange), and Qingpi (Green Tangerina Peel). (From *Zhengzhi Huibu*)
Selected Formulas for Long-Bi
Qingfei Yin (Li Dongyuan) Treats Lung heat with thirst and urinary obstruction.
Fuling (Poria), Huangqin (Scutellaria Root), Sangpi (Mulberry Bark), Maidong (Ophiopogon Tuber), Cheqian (Plantago Seed), Shanzhi (Gardenia Fruit), Mutong (Akebia Caulis) (equal parts)
Decoct in water.
Bazheng San (*Baodian*) Treats Bladder heat stagnation with urinary retention.
Qumai (Dianthus Herb), Lvxu (Polygonum Aviculare Herb), Cheqian (Plantago Seed), Huashi (Talcum), Gancao (Licorice Root), Shanzhi (Gardenia Fruit), Mutong (Akebia Caulis), Dahuang (Rhubarb Root) (equal parts)
Take 2 qian per dose, add Dengxincao (Juncus Medulla), decoct in water.
Daochi San Treats urinary obstruction due to guest heat in the Heart channel.
Shengdi (Rehmannia Root), Mutong (Akebia Caulis), Gancao (Licorice Root), add Lianqiao (Forsythia Fruit) and Huanglian (Coptis Rhizome).
Wuling San Treats mixing of clear and turbid in the Large Intestine causing diarrhea and urinary obstruction.
Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Zhuling (Polyporus), Zexie (Alisma Rhizome), Rougui (Cinnamon Bark)
Liqi San Treats Qi congestion causing urinary obstruction.
Zhike (Aurantii Fructus), Chenpi (Citrus Reticulata Peel), Mutong (Akebia Caulis), Gancao (Licorice Root)
Tongbi San Can be used in combination with the above formulas.
Xiangfu (Cyperi Rhizoma), Chenpi (Citrus Reticulata Peel), Chiling (Red Poria)
Niuxi Treats blood stasis causing urinary obstruction.
Niuxi (Achyranthes Root), Guiwei (Angelica Sinensis Tail), Huangqin (Scutellaria Root), add a small amount of Hupo (Amber)
Dihuang Tang Treats Yin deficiency causing urinary obstruction. (Formula seen in Stroke chapter)
That is Dihuang Tang removing Shanzhuyu (Cornus Fruit), adding Maidong (Ophiopogon Tuber), Niuxi (Achyranthes Root), and Cheqian (Plantago Seed).
Shenqi Wan (*Jingui Yaolue*) Treats Yang deficiency causing urinary obstruction. (Formula seen in Dampness chapter)
Buzhong Yiqi Tang, Liu Junzi Tang (Both formulas seen in Stroke chapter), Daotan Tang (Formula seen in Stroke-like Syndrome chapter)
External Therapies
Twenty stalks of Congtou (Scallion Head) and two liang of Zisu (Perilla Leaf), decoct in water to fumigate and wash the external genitalia and lower abdomen. Or stir-fry salt until hot, wrap in silk cloth, and apply moxibustion-like heat to above and below the umbilicus. Ginger residue or Zhike (Aurantii Fructus) can also be used. Or apply Congbing (Scallion Cake) moxibustion to the umbilicus, which is also effective.
Another method: Apply Tianluoni mud (Field Snail Mud) to the umbilicus, see the method for Lin syndrome, add 1-2 li of Shexiang (Musk). Or fill the umbilicus with half a spoon of salt and tie tightly, which is more effective.
Another method: One whole garlic clove, thirty Gardenias, and a little salt flower, grind into a paste, spread on paper, and apply to the umbilicus. For severe cases, apply to the scrotum as well, which immediately resolves.
Another method: For urinary obstruction nearly causing death, use Taozhi (Peach Twig), Liuzhi (Willow Twig), Mutong (Akebia Caulis), Kufan (Alum), Hanlianzi (Elaeagnus Fruit), Hanjiao (Zanthoxylum Fruit), each one liang, one handful of Congbai (Scallion White), and one bundle of Dengxincao (Juncus Medulla). Finely chop. Add three dou of water and decoct until half is consumed. Store the juice in a porcelain bottle, fumigate the external genitalia, surround with blankets to keep out wind. Replace juice when cold, fumigate again, and it will resolve. (One formula excludes Hanlianzi)