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Tai Wu (a Song Dynasty physician) discusses three main aspects of difficulty in urination: First, diarrhea accompanied by scanty or difficult urination is due to the preferential seepage of body fluids into the large intestine; treatment should focus on separating and draining. Second, heat clashing with the Lower Jiao results in stagnant damp-heat, which must be resolved through purgation and drainage to heal. Third, sluggish Qi in the Spleen and Stomach fails to regulate water passages and transport fluids downward to the Bladder; treatment involves regulating Qi to promote transformation and excretion. However, preferential fluid seepage may involve the Spleen or Lung, while stagnant damp-heat may differ between the Kidney and Bladder. One must further differentiate based on pulse and symptoms. Li Dongyuan posits that difficulty in urination is caused by pathogenic heat, distinguishing between involvement of the Qi level and Blood level for treatment. If thirst is present with difficulty in urination, the heat is in the Qi level of the Upper Jiao, indicating Lung Heat failing to generate Water, thus cutting off the source of urine. Light, permeating, and draining herbs should be used to clear Lung Heat and nourish the source of Water generation. If there is no thirst, the heat is in the Blood level of the Lower Jiao, where Yin receives pathogenic heat, blocking the flow; herbs with Yin natures and flavors should be used to eliminate heat and unblock obstruction. This distinguishes Qi and Blood levels by Upper and Lower Jiao. Yet, within the Lower Jiao, there are distinctions between Qi stagnation and Blood turbidity; even in the Upper Jiao, there are differences between Qi deficiency and Qi obstruction, which must not be overlooked.

The *Yuan Zhu* discusses enuresis (involuntary urination) and strangury/obstruction, attributing them primarily to the Liver, Du Mai (Governing Vessel), San Jiao (Triple Burner), and Bladder. The Classic states: The Foot Jueyin Liver Meridian circles the genitalia; diseases arising from it include enuresis and strangury. The Du Mai enters the Ting Kong in women, which is the opening of the urethra. In men, it follows the penis down to the perineum, similar to women; its diseases include strangury, hemorrhoids, and enuresis. The San Jiao is commanded by the Foot Taiyang Bladder Meridian and Foot Shaoyin Kidney Meridian; it is a branch of the Taiyang, emerging five cun above the ankle, passing through the intestines, exiting at Weiyang (BL39), running parallel to the Taiyang proper, entering and connecting with the Bladder, and constraining the Lower Jiao. Excess leads to strangury/obstruction, while deficiency leads to enuresis. However, acupuncture and moxibustion only select points from the Jueyin, Du Mai, and Sanjiaoshu (BL27), omitting the Bladder itself, because the Bladder merely stores urine, whereas the discharge of urine is governed by the San Jiao, Liver, and Du Mai. Note: The Classic states the Kidney opens into the two yin orifices and combines with the Bladder. I have often seen experienced physicians treat with Baotong Decoction, Liuwei Dihuang Wan, or Shenqi Wan, differentiating Yin and Yang excess and deficiency, achieving rapid effects like a drumstick striking a drum. Since this discussion does not emphasize the Kidney, one should synthesize various schools of thought and cross-reference them to avoid omission.

Zhu Danxi stated: Difficulty in urination has direct treatment, treatment separated by two organs, and treatment separated by three organs. If there is no other cause and the Bladder simply has heat, herbs such as Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) should be used to drain Bladder heat; this is direct treatment. If Lung dryness prevents Water generation, herbs such as Cheqianzi (Plantaginis Semen) and Fuling (Poria) should be used to clear Lung Qi; this is treatment separated by two organs. If Spleen dampness fails to transport, preventing essence from ascending and thereby causing the Lung to fail in generating Water, herbs such as Cangzhu (Atractylodis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) should be used to dry the Spleen and promote dampness removal; this is treatment separated by three organs. However, regarding methods to clear the Lung, one should naturally use formulas like Baihe Yinzi (Lily Decoction) from the *Waitai Misha*, combining clearing and moistening properties to align with principles. Using permeating and draining items like Cheqianzi and Fuling to seek water would only exacerbate dryness.

Danxi also stated: Regardless of whether the cause is Qi deficiency, Blood deficiency, excess heat, or phlegm obstruction, vomiting therapy is suitable to lift Qi. When Qi ascends, Water descends, akin to a dripping vessel where the upper aperture must be open for water to flow out from the lower. Treating a disease in the lower part by targeting the upper part is the principle of the *Neijing*. Heaven and Earth Qi do not descend if they do not ascend; vomiting is a clever application of this method. However, it can only be used when there is phlegm-fullness and Qi obstruction, and cannot be applied generally to conditions such as Qi deficiency or Blood deficiency.

The *Yuan Zhu* differentiates Bi (obstruction), Long (strangury), Yini (enuresis), and Jinbun (incontinence). Bi refers to the inability to pass urine, blocked and obstructed. Long refers to weakness and insufficient Qi, resulting in dribbling, drop by drop, possibly with pain and frequency (dozens of times a day); this is commonly known as Lin syndrome (dysuria). Bi is an acute condition, while Long is a chronic condition. Yini refers to urination during sleep, realized only upon waking. Jinbun refers to frequent urination without restriction throughout day and night.