膀胱余热小便涩。火毒如何消散得。无分初潮与收后。三苓导赤为定格。
小便赤涩。此里热甚之症也。在初热正出之时见之。乃热邪下渗。是为正候。麻出现时。小便
赤涩或淋者。以三苓散（见三十七条）加灯心、石膏、葶苈、射干治之。若热甚。小便赤涩、谵语惊
恐者。以导赤散（见二十六条）去甘草。合三苓散（见二十七条）加辰砂主之。夏月以辰砂益元散
（见六十三条）去甘草。加石膏主之。若小便不利而呕吐者。以三苓散（见三十三条）加藿香、竹
茹、枇杷叶治之。一二日不通者。以加味导赤散（见四十九条）主之。若于正收及收后、而见小
便不通者。是内有热毒。不得消散。而余热下匿膀胱。用导赤散（见二十六条）加麦冬。或用加味
导赤散（见四十九条）以滋气化。导利而小便仍不通者。必因大便秘郁之故。速宜通利大便。以
通幽汤（见六十八条）去升麻、熟地、甘草、加枳壳、丑牛、合导赤散（见二十六条）治之。大便一
通。而小便自利矣。
麻疹二便闭不通。邪火炽甚在其中。通关凉膈利脏腑。管取一服见奇功。
麻疹自出至收。总宜大小便滑利。二便俱不宜秘。秘则急宜通利。若麻症有大小便俱不通
者。是火邪内炽之极。宜以河间凉膈散（见二十六条）去甘草。加牛蒡、车前、木通治之。甚则以通
关散去甘草、人参。八正散去甘草治之。
通关散 通心经、利小便、良方。
栀仁（炒） 大黄（酒蒸各一钱） 木通 赤茯苓 车前子（炒） 瞿麦 滑石 蓄（炒）
人参 甘草（各三五分） 灯心十根引。
八正散 治湿热下注。口渴咽干。淋痛尿血。小腹急满。
木通 瞿麦 车前子 栀仁 大黄 滑石 蓄 甘草梢 灯心引。木通、瞿麦、灯心、
入小肠而降心火。车前、入膀胱而泻肝火。山栀仁、泻三焦之郁火。大黄、滑石、乃泻火利水
之捷药。 蓄、利水止痛。甘草梢、入茎止痛。虽治下焦。而不专治下焦。必三焦通利。水方能
下行也。一书加木香。
Residual heat in the Bladder causes difficult and painful urination. How can the fire-toxin be dissipated? Regardless of whether it is during the initial eruption or after resolution, Sanling San (Three-Ingredent Powder) combined with Daochi San (Guiding Out Redness Decoction) serves as the fixed therapeutic regimen.
Reddish and difficult urination indicates a severe internal heat syndrome. When observed during the initial fever stage when the rash first appears, it results from pathogenic heat sinking downward, which is considered a normal manifestation. When the measles rash is visible, if accompanied by reddish, difficult urination or strangury, treat with Sanling San (see Article 37) added with Dengxincao (Juncus Effusus Spike), Shigao (Gypsum Fibrosum), Tinglizi (Descurainiae Semen), and Shegan (Belamcandae Rhizoma). If the heat is extreme, presenting with reddish difficult urination, delirium, and fearfulness, use Daochi San (see Article 26) removing Gancao (Licorice Root), combined with Sanling San (see Article 27), and add Chensha (Cinnabar) as the principal agent. In summer months, use Chensha Yiyuan San (see Article 63) removing Gancao, added with Shigao (Gypsum Fibrosum) as the principal agent. If there is difficulty in urination accompanied by vomiting, treat with Sanling San (see Article 33) added with Huoxiang (Pogostemonis Herba), Zhuru (Bambusae Caulis in Taeniam), and Pipaye (Eriobotryae Folium). For cases where urination and defecation are obstructed within one to two days, JiaWei Daochi San (Modified Guiding Out Redness Decoction, see Article 49) is indicated. If complete urinary retention occurs during the resolution phase or after resolution, it signifies that internal heat-toxins cannot dissipate, and residual heat hides in the Bladder. Apply Daochi San (see Article 26) added with Maidong (Ophiopogonis Radix), or use JiaWei Daochi San (see Article 49) to nourish Qi transformation and guide diuresis. If urination remains obstructed despite these measures, it must be due to constipation and fecal impaction. Rapidly promote bowel movement using Tongyou Tang (Unblocking the Dark Decoction, see Article 68) removing Shengma (Cimicifugae Rhizoma), Shudi (Rehmanniae Radix Praeparata), and Gancao (Licorice Root), added with Zhiqiao (Aurantii Fructus) and Chouniu (Pharbitidis Semen), combined with Daochi San (see Article 26). Once the stool is unblocked, urination will naturally flow freely.
Obstruction of both urine and stool during measles is caused by extreme proliferation of pathogenic fire within. Through methods of opening the passages and clearing the Liao organs, one dose can yield miraculous results.
Throughout the process from the eruption to the resolution of measles, it is essential to maintain smooth and free passage of both urine and stool. Neither should be constipated; if they are, urgent promotion of flow is required. If both urine and stool are completely obstructed in measles cases, it indicates that fire-pathogens are extremely intense internally. It is appropriate to use Hejian Liangge San (Liangge San from Liu Wansu, see Article 26) removing Gancao (Licorice Root), added with Niubangzi (Arctii Fructus), Cheqianzi (Plantaginis Semen), and Mutong (Akebiae Caulis). For severe cases, use Tongguan San (Opening the Passages Powder) removing Gancao (Licorice Root) and Renshen (Ginseng Radix et Rhizoma); or use Bazheng San (Eight-Righteousness Decoction) removing Gancao (Licorice Root).
Tongguan San: Effectively unblocks the Heart meridian and promotes urination; a fine prescription.
Ingredients: Zhiren (Gardeniae Semen, stir-fried), Dahuang (Rhei Radix et Rhizoma, steamed with wine, each 1 qian), Mutong (Akebiae Caulis), Chi Fuling (Polyporus with Hostwood, stir-fried), Cheqianzi (Plantaginis Semen, stir-fried), Qumai (Dianthi Herba), Huashi (Talcum), Pianxu (Polygoni Avicularis Herba, stir-fried), Renshen (Ginseng Radix et Rhizoma), Gancao (Licorice Root, each 3-5 fen). Use Dengxincao (Juncus Effusus Spike, 10 spikes) as an guiding agent.
Bazheng San: Treats damp-heat pouring downward, manifesting as thirst, dry throat, painful strangury, hematuria, and acute fullness in the lower abdomen.
Ingredients: Mutong (Akebiae Caulis), Qumai (Dianthi Herba), Cheqianzi (Plantaginis Semen), Zhiren (Gardeniae Semen), Dahuang (Rhei Radix et Rhizoma), Huashi (Talcum), Pianxu (Polygoni Avicularis Herba), Gancao Shao (Radix Glycyrrhizae with caudex), Dengxincao (Juncus Effusus Spike) as guiding agent.
Analysis: Mutong (Akebiae Caulis), Qumai (Dianthi Herba), and Dengxincao (Juncus Effusus Spike) enter the Small Intestine to descend Heart fire; Cheqianzi (Plantaginis Semen) enters the Bladder to drain Liver fire; Gardeniae Semen drains stagnant fire from the Triple Burner; Dahuang (Rhei Radix et Rhizoma) and Huashi (Talcum) are swift agents for draining fire and promoting urination; Pianxu (Polygoni Avicularis Herba) promotes urination and relieves pain; Gancao Shao (Radix Glycyrrhizae with caudex) enters the urethra to relieve pain. Although this formula treats the Lower Burner, it does not focus exclusively on it; the Triple Burner must be unblocked for water to flow downward. Another text adds Muxiang (Aucklandiae Radix).