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A patient presents with complete inability to urinate, unable to pass even a drop, suffering from urgent distension as if about to die, mental restlessness, thirst desiring drink, yet drinking exacerbates the urgency. People assume this is extreme heat in the Small Intestine (Small Intestine), but little do they know it is hyperactivity of Heart Fire (Heart Fire). The Heart and Small Intestine are exterior-interiorly related; when the Small Intestine suffers from extreme heat leading to retention of urine (Ling Bi), it is actually heat in the Heart causing the retention. The opening and closing of the Small Intestine rely entirely on the communication between Qi of the Heart and Kidney. Now, with hyperactive and scorching Heart Fire, clear Qi cannot interact with the Small Intestine; only fierce fire presses upon it. The Small Intestine has Yang without Yin, how can it transmit and transform? Since the Small Intestine cannot transmit and transform, how could the Bladder (Bladder) substitute for it? Moreover, since Qi of the Heart and Kidney does not enter the Small Intestine, how can it enter the Bladder to transform water? The treatment method is to drain Heart Fire while promoting diuresis in the Bladder, so that Qi of the Heart and Kidney becomes unobstructed, and urination resumes. Use Liang Xin Li Shui Tang (Cool the Heart and Promote Water Decoction): Radix Ophiopogonis (Mai Dong, 1 liang), Poria Cocos (Fu Shen, 5 qian), Lotus Plumule (Lian Zi Xin, 1 qian), Semen Plantaginis (Che Qian Zi, 3 qian). Decoct in water and take orally. After two doses, urine flows like a stream; after four doses, full recovery occurs.

This formula uses herbs that tonify the Heart, which are also cooling herbs. With the Heart no longer at risk of excessive hyperactivity, how could the Small Intestine suffer major interference? Furthermore, with slippery and leaching flavors to unblock the water pathways, Heart Qi naturally interacts with Kidney Qi, and Kidney Qi naturally interacts with Bladder Qi. Qi transformation easily expels water; where would there be the distress of obstruction?

Another patient presents with Small Intestine obstruction, protruding eyes, red face, hot ears, thirst with desire to drink, and irritability. People attribute this to excess fire in the Upper Jiao (Upper Jiao), but little do they know it is exuberant fire in the Bladder. The Bladder and Kidney are exterior-interiorly related; the Bladder must communicate with Kidney Qi to transform water. Thus, Bladder fire is the Fire of Ming Men (Gate of Life) within the Kidney. Without fire, the Bladder cannot transform water; why does excess fire cause blockage? It is unknown that when the Bladder receives proper fire, water disperses easily; when it receives pathogenic fire, water flow is difficult. The Bladder belongs to the Taiyang (Greater Yang) channel, which is most susceptible to pathogens. Once invaded by pathogens, cold transforms into heat. Heat accumulation in the Bladder indicates pathogens are about to dissipate. If pathogens are dissipating, fire should exit with urine; why does it form a blockage symptom? Because as pathogens prepare to leave, fearing their route will be cut off, they pretend to be strong and lodge in the Bladder. The treatment need not drain Kidney fire; simply promote diuresis in the Bladder, and pathogens will be removed as easily as sweeping. Use Dao Shui San (Guide Water Powder): Herba Centellae Asiaticae (Wang Bu Liu Xing, 5 qian), Rhizoma Alismatis (Ze Xie, 3 qian), Rhizoma Atractylodis Macrocephalae (Bai Zhu, 3 qian). Decoct in water and take orally. After one dose, normal passage is restored; a second dose is unnecessary.

This formula is miraculous in driving out water because Wang Bu Liu Xing acts swiftly and travels well, thus used to expel pathogens. The root of blockage lies in the Bladder; promoting diuresis in the Bladder opens the blockage naturally. Why panic and rashly administer rapid and potent agents?

Another patient presents with urinary retention, unable to pass drops, lower abdominal distension but no pain, no signs of irritability in the Upper Jiao, no feeling of oppression in the chest, no thirst, and a dry tongue. People believe it is water closure in the Bladder, but little do they know it is obstruction of Ming Men Fire. The Bladder is the official of drainage; it empties through Qi transformation of the Kidney, which is Ming Men Fire. When Ming Men Fire is vigorous, Bladder water flows freely; when Ming Men Fire declines, Bladder water becomes obstructed. One might ask: Frequent urination results from declining Ming Men Fire. If fire declines, urine should flow abundantly; why does it become blocked? It is unknown that Ming Men Fire must be nourished by Kidney Water. When Kidney Water declines, fire appears vigorous because water lacks strength to restrain it. Fire without water, though appearing vigorous, is actually deficient; water without fire, though wanting to flow, becomes blocked. Declining Ming Men Fire causes frequent urination; extreme decline leads to extreme frequency; extreme frequency leads to extreme blockage. Seeing the blockage, people mistakenly suspect Bladder fire and use cold medicines, further damaging Ming Men Fire and weakening Bladder Qi, making water transformation impossible. Switching to diuretics only increases deficiency. The treatment must assist Ming Men Fire. However, merely assisting Ming Men Fire risks excessive Yang consuming Yin. One must tonify fire within water, so fire is born in water, and water flows within fire. Use Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill): Prepared Radix Rehmanniae (Shu Di Huang, 1 liang), Fructus Corni (Shan Zhu Yu, 5 qian), Cortex Moutan (Dan Pi, 3 qian), Rhizoma Dioscoreae (Shan Yao, 5 qian), Rhizoma Alismatis (Ze Xie, 3 qian), Poria Cocos (Fu Ling, 5 qian), Cortex Cinnamomi (Rou Gui, 3 qian), Radix Aconiti Lateralis Preparata (Fu Zi, 1 qian). Decoct in water and take orally. After one dose, urine flows like a stream.

Ba Wei Di Huang Wan is the supreme medicine for tonifying fire within water. Tonifying fire within water avoids the fear of excessive burning; facilitating water within fire avoids the fear of water exhaustion. Even in cases of long-term retention leading to bladder torsion, this formula yields immediate results, let alone simple blockages.

Using Xing Shui Tang (Move Water Decoction) for this condition is also very effective: Prepared Radix Rehmanniae (2 liang), Radix Morindae Officinalis (Ba Ji Tian), Poria Cocos (Fu Shen), Semen Euryales (Qian Shi) (each 1 liang), Cortex Cinnamomi (Rou Gui, 2 qian). Decoct in water and take orally.

Another patient presents with urinary obstruction, protruding eyes, abdominal distension like a drum, hardness above the knees, skin tight as if cracking, inability to eat or drink, yet no thirst. Medicines with sweet, bland, and leaching properties have no effect. People assume extreme Yang excess, but little do they know it is extreme Yin deficiency. Yin and Yang cannot be separated. Sweet, bland, and leaching medicines are Yang medicines. In a disease of Yin deficiency, using Yang medicines should theoretically allow Yin to arise from Yang. However, "Yin deficiency" here refers to the ultimate Yin within Yin. The ultimate Yin requires the ultimate Yang within Yang to transform. Urinary obstruction is a Bladder disease. The Bladder is the mansion of fluids, requiring Qi transformation to empty. This Qi is the ultimate Yang within Yang. Originally stored within the ultimate Yin, without the Qi of ultimate Yin, ultimate Yang becomes solitary and Yin-less, unable to transform water. The treatment is to tonify the ultimate Yin, and Yang will naturally transform. Use Chun Yin Hua Yang Tang (Pure Yin Transforms Yang Decoction): Prepared Radix Rehmanniae (1 liang), Radix Scrophulariae (Xuan Shen, 3 liang), Cortex Cinnamomi (Rou Gui, 2 fen), Semen Plantaginis (Che Qian Zi, 3 qian). Decoct in water and take orally. After one dose, urine flows like a spring; after two doses, obstruction disappears.

This formula surpasses Zi Shen Wan (Nourish Kidney Pill) because Zi Shen Wan uses bitter-cold herbs like Cortex Phellodendri (Huang Bo) and Radix Anemarrhenae (Zhi Mu) to transform water, whereas this formula uses slightly cold herbs. Critics argue that in critical conditions, tonification to unblock the Kidney is inappropriate, and that Prepared Radix Rehmanniae is cloying and may worsen obstruction. They fail to realize that the Kidney is only suitable for tonification, not purging; using Zhi Mu and Huang Bo purges the Kidney, increasing deficiency. How does it compare to using Pure Yin Prepared Radix Rehmanniae aided by moistening Radix Scrophulariae? This combination generates Yin and descends fire, combining attack and tonification. Ultimate Yang receiving this is like fish in water, transforming hyperactive heat into coolness, ensuring discharge. Some ask: If Prepared Radix Rehmanniae and Radix Scrophulariae generate Yin, allowing ultimate Yang to transform, why add Cortex Cinnamomi and Semen Plantaginis? The medicine is pure Yin, requiring ultimate Yang agents to guide it into the ultimate Yang, along with water-guiding flavors to work together, entering and exiting Yang. Moreover, Cortex Cinnamomi is used only for its aromatic qi to enter Yang, not its flavor to tonify Yang, demonstrating subtle efficacy.

Using Jia Shen Hua Shen Tang (Add Spirit Transform Kidney Decoction) for this condition is also miraculous: Prepared Radix Rehmanniae (4 liang), Raw Radix Rehmanniae (Sheng Di Huang, 2 liang), Cortex Cinnamomi (Rou Gui, 3 fen). Decoct in water and take orally.

Another patient presents with inability to urinate, middle jiao fullness and distension, severe thirst. Diuretics fail. People attribute this to exuberant Bladder fire, but little do they know it is Dryness of Lung Qi. The Bladder is the capital official, storing fluids, which are expelled through Qi transformation. Failure of Upper Jiao Qi transformation is due to Lung Heat. Lung heat causes Metal dryness, failing to generate Water. Using diuretics consumes Lung Qi further, so the more water is moved, the less water is generated. The treatment should tonify Lung Qi and support Autumn functions, so Water is naturally generated. Use Sheng Mai San (Generate Pulse Powder): Radix Ginseng (Ren Shen, 1 liang), Radix Ophiopogonis (Mai Dong, 2 liang), Fructus Schisandrae (Bei Wu Wei Zi, 1 qian), Radix Scutellariae (Huang Qin, 1 qian). Decoct in water and take orally. After two doses, water flows freely.

Sheng Mai San tonifies Lung Qi to generate Metal, which is equivalent to tonifying Lung Qi to generate Water. Why add Huang Qin to clear Lung heat, risking damage to Metal and Lung? It is known that in autumn, white dew falls; heaven uses cold to generate water. In the human body, Lung Metal heat requires cold-clearing agents to benefit the Lung and generate water. Thus, Huang Qin is necessary in Sheng Mai San to assist the Lung Metal's clearing and descending function.

Using Mai Dong Fu Ling Tang (Ophiopogon and Poria Decoction) for this condition: Radix Ophiopogonis (3 liang), Poria Cocos (5 qian). Decoct in water and take orally.

Another patient presents with urinary obstruction due to irregular diet injuring Stomach Qi. People attribute this to Lung Qi deficiency, but little do they know it is Sinking of Stomach Qi into the Lower Jiao, unable to ascend. The Bladder requires Qi transformation to empty; ascending Qi is the evidence of Qi transformation. The rising and falling of Qi depends on its strength. Strong Qi leads to rising of Clear Qi and falling of Turbid Qi; weak Qi leads to neither rising nor falling. The Stomach is the mansion of abundant Qi, governing all Qi. The strength of Stomach Qi is crucial for the strength of all Qi. Therefore, when Stomach Qi is deficient, Qi of all meridians often fails to rise. Thus, Spleen and Stomach deficiency causes obstruction of all nine orifices, not just anterior water retention. The treatment must lift the Supreme Yang Qi, starting from the Stomach. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction): Radix Ginseng (2 qian), Radix Astragali (Huang Qi, 3 qian), Rhizoma Atractylodis Macrocephalae (Bai Zhu, 3 qian), Radix Angelicae Sinensis (Dang Gui, 2 qian), Radix Glycyrrhizae (Gan Cao, 1 qian), Pericarpium Citri Reticulatae (Chen Pi, 2 fen), Radix Bupleuri (Chai Hu, 1 qian), Rhizoma Cimicifugae (Sheng Ma, 5 fen). Decoct in water and take orally. After one dose, urination resumes; after two doses, full recovery occurs.

This formula uses the sweet-warm properties of Ren Shen and Huang Qi to tonify Stomach Qi; Sheng Ma and Chai Hu lift from below the source of Yuan Qi. Thus, Clear rises and Turbid falls, Lung Qi is not deficient, and naturally performs its clearing and descending function, avoiding blockage.