脉∶小便不通，浮弦而涩；芤则便红，数则黄赤；便难为癃，实见左尺。
小便不通者，多是热结也。
猪苓汤 治热结小便不通。
木通 猪苓 泽泻 滑石 枳壳（炒） 黄柏（酒浸） 牛膝（去芦） 麦门冬（去心） 瞿麦
车前子（各等分） 甘草稍（减半） 蓄叶（十片）
上锉一剂。灯心一团，水煎，空心服。
不渴而小便闭者，热在下焦血分也。
通关丸 治不渴而小便闭，热在下焦血分，兼治淋癃，神效。
黄柏（酒洗焙干） 知母（酒洗焙干，一两） 肉桂（一钱）
上俱为细末，熟水和丸，如梧桐子大。每服百丸，空心白滚汤下。服后须顿两足，令药
易下行也。如小便已利，茎中如刀刺痛，当有恶物下为验。
若渴而小便闭者，热在上焦气分也。
清肺饮子 治渴而小便不利者，是热邪在上焦肺之分，故不利也。肺者，金也，金合生
水。若肺中有热，不能生水，是绝其水源。治宜淡渗之剂，以清肺之气，泄其火邪，滋水之
上源也。
赤茯苓（去皮，钱半） 猪苓（二钱） 泽泻（一钱） 通草（二钱） 灯草（一钱） 车前子（炒，另研，一
钱） 琥珀（另研，五分） 蓄（七分） 木通（七分） 瞿麦（七分）
上锉一剂。水煎，空心，稍热服。
虚寒小便不通者，是寒结也。
加味五苓散 治虚寒小便不通。
猪苓 泽泻 白术（去芦） 赤茯苓（去皮） 肉桂 当归 枳壳 牛膝（去芦） 木通（各等
分） 甘草（稍减半）
上锉一剂。灯心一团，水煎，空心服。
虚热小便不通者，是热结也。
参归升麻汤 治虚人小便不通。
人参（去芦） 当归 生地黄 赤茯苓（去皮） 猪苓 泽泻 山栀 枳壳（去穣） 牛膝（
去芦，酒洗） 黄柏（酒炒） 知母（酒炒，各等分） 升麻（少许） 甘草（减半）
上锉一剂。灯心一团，水煎，空心服。
年老之人，小便不通者，多是气短血虚也。四物汤加黄 煎汤，送下通关丸，空心服。
咳喘小便不通者，是痰气塞也。
二陈汤 治痰气闭塞，小便不通。
陈皮 半夏（姜汁炒） 茯苓 枳壳（麸炒） 牛膝（去芦） 猪苓 木通 山栀 麦门冬（
去心） 车前子 黄柏（酒炒，各等分） 甘草（减半）
上锉一剂。灯心一团，水煎，空心服。
元气虚而不能输化者，宜补中益气汤（方见补益）。阴虚而小便不通者，是火盛也，滋阴
降火汤，治虚怯人阴虚火动，小便不通（方见虚劳）；六味丸尤效，根据本方加猪苓、泽泻、木
通、牛膝。大抵小便不通，用利水药不效者，此积痰在肺。肺为上焦，膀胱为下焦，上焦闭
则下焦塞，如滴水之器，上窍通而下窍之水出焉。若泻痢小便不通者，因后去多而前去少，
泻止后而尿自长也。若呕哕小便不通者，难治也。若中满臌胀，病小便不通者，亦难治也。
治老人下元虚冷，转胞不得小便，膨急切痛，四、五日困笃欲死者，六味丸倍泽泻，效
（方见补益）。
补遗秘方
治小便不通 麝香、半夏末填脐中，上用葱白、螺蛳二味捣成饼封脐上，用布帛缚定
。下用皂角烟入阴中自通，女人用皂角煎汤洗阴户内。
导赤汤 治溺如米泔色，不过二服即愈。
木通 滑石 甘草稍 黄柏 茯苓 生地黄 枳壳 白术 栀子
水煎，空心服。
治小便下坠 好麻三两，扯碎，火焙，用新盆一个盖在上，升作灰。黄酒调下，被盖出
汗，即愈。
治小便不通 用皮硝一合、连须葱一根，捣为一处，用青布摊在上，似膏药样，用热瓦
熨之，即出。
脉象：小便不通利，脉象浮弦而涩；若见芤脉，则尿中带血；脉数则尿液黄赤；排尿困难称为癃闭，实证多见于左尺部。
小便不通利，多是由于热邪结聚所致。
猪苓汤治疗热邪结聚导致的小便不通。
药材：木通、猪苓、泽泻、滑石、枳壳（炒制）、黄柏（酒浸）、牛膝（去芦头）、麦门冬（去心）、瞿麦、车前子（各等分）、甘草梢（减半用量）、蓄叶（十片）。
以上药物锉碎为一剂药量。用灯心草一团，加水煎煮，空腹服用。
通关丸治疗口不渴而小便闭塞，病机为热在下焦血分，兼治淋证和癃闭，疗效神奇。
药材：黄柏（酒洗后焙干）、知母（酒洗后焙干，一两）、肉桂（一钱）。
以上药物都研成细末，用熟水调和制成丸药，大小如梧桐子。每次服用一百丸，空腹时用白开水送服。服药后必须跺脚两次，以使药力容易下行。如果小便已经通畅，尿道中有如刀割般的刺痛感，这是体内有恶浊之物排出的征象。
清肺饮子治疗口渴且小便不利的情况，这是因为热邪位于上焦肺脏部分，所以导致小便不利。肺属金，金能生水。如果肺中有热，不能化生肾水，这就断绝了水源。治疗宜用淡渗利湿的药物，以清肃肺气，泄除火邪，滋补水之上源。
药材：赤茯苓（去皮，一钱半）、猪苓（二钱）、泽泻（一钱）、通草（二钱）、灯心草（一钱）、车前子（炒制，另研，一钱）、琥珀（另研，五分）、蓄（七分）、木通（七分）、瞿麦（七分）。
以上药物锉碎为一剂药量。加水煎煮，空腹时稍温热服用。
加味五苓散治疗虚寒引起的小便不通。
药材：猪苓、泽泻、白术（去芦头）、赤茯苓（去皮）、肉桂、当归、枳壳、牛膝（去芦头）、木通（各等分）、甘草（稍减量）。
以上药物锉碎为一剂药量。用灯心草一团，加水煎煮，空腹服用。
参归升麻汤治疗体质虚弱者的小便不通。
药材：人参（去芦头）、当归、生地黄、赤茯苓（去皮）、猪苓、泽泻、山栀、枳壳（去瓤）、牛膝（去芦头，酒洗）、黄柏（酒炒）、知母（酒炒，各等分）、升麻（少许）、甘草（减半）。
以上药物锉碎为一剂药量。用灯心草一团，加水煎煮，空腹服用。
年老之人出现小便不通，多是因为气短血虚。可用四物汤加黄芩煎汤，送服通关丸，空腹服用。
二陈汤治疗痰气闭塞导致的小便不通。
药材：陈皮、半夏（姜汁炒）、茯苓、枳壳（麸炒）、牛膝（去芦头）、猪苓、木通、山栀、麦门冬（去心）、车前子、黄柏（酒炒，各等分）、甘草（减半）。
以上药物锉碎为一剂药量。用灯心草一团，加水煎煮，空腹服用。
元气虚弱而不能输布气化的人，适宜使用补中益气汤（方剂见补益篇）。阴虚导致小便不通的，是火盛所致，滋阴降火汤治疗虚怯之人阴虚火动引起的小便不通（方剂见虚劳篇）；六味丸尤为有效，可根据本方加入猪苓、泽泻、木通、牛膝。大抵而言，小便不通，使用利水药无效的情况，是因为肺部有积痰。肺为上焦，膀胱为下焦，上焦闭塞则下焦阻塞，就像滴水之器，上窍通畅而下窍的水才能流出。如果是泻痢导致小便不通，是因为失水过多而进水过少，待泻痢停止后，小便自然会恢复。如果是呕吐呃逆导致小便不通，则难以治疗。如果是中满臌胀导致小便不通，也难以治疗。
治疗老人下元虚冷，导致转胞无法小便，腹部膨隆急迫疼痛，持续四五天困顿危重欲死者，可用六味丸加倍泽泻用量，疗效显著（方剂见补益篇）。
补遗秘方
治疗小便不通：将麝香、半夏末填入肚脐中，上面用葱白、螺蛳两味药捣成饼状封在脐上，用布帛绑紧。下面用皂角烟熏入阴户，自然通畅，女性用皂角煎汤清洗阴户内部。
导赤汤治疗小便颜色如米泔水色，不超过两服即可痊愈。
药材：木通、滑石、甘草梢、黄柏、茯苓、生地黄、枳壳、白术、栀子。
加水煎煮，空腹服用。
Pulse: In cases of urinary retention, the pulse is floating, wiry, and choppy; a knotted pulse indicates hematuria; a rapid pulse indicates yellow-red urine; difficulty in urination is termed "long" (strangury/retention), and excess patterns are commonly seen at the left chi position.
Urinary retention is mostly caused by heat accumulation.
Zhuling Tang (Polyporus Decoction) treats urinary retention due to heat accumulation.
Ingredients: Tongcao (Tetrapanacis Medulla), Polyporus (Polypori Umbellati Sclerotium), Alisma Rhizoma (Alismatis Rhizoma), Talcum (Talcum), Aurantium Fructus (Aurantii Fructus, stir-fried), Phellodendri Cortex (Phellodendri Chinensis Cortex, wine-soaked), Achyranthis Bidentatae Radix (Achyranthis Bidentatae Radix, remove rhizome), Ophiopogonis Radix (Ophiopogonis Radix, remove heart), Dianthi Herba (Dianthi Herba), Plantaginis Semen (Plantaginis Semen) (all equal parts), Glycyrrhizae Radix et Rhizoma (Glycyrrhizae Radix et Rhizoma, tip used, reduced by half), Artemisiae Scopariae Herba (Artemisiae Scopariae Herba, ten leaves).
Crush the above ingredients for one dose. Boil with a bundle of Juncus effusus (Junci Medulla) in water, take on an empty stomach.
In cases where there is no thirst but urinary retention exists, the heat is accumulated in the blood aspect of the lower jiao.
Tongguan Wan (Passage-Opening Pill) treats urinary retention without thirst, where heat is in the blood aspect of the lower jiao, and also effectively treats strangury and retention.
Ingredients: Phellodendri Cortex (Phellodendri Chinensis Cortex, washed with wine and dried), Anemarrhenae Rhizoma (Anemarrhenae Rhizoma, washed with wine and dried, 1 liang), Cinnamomi Cortex (Cinnamomi Cortex, 1 qian).
Grind all into fine powder, mix with cooked water to form pills the size of sophora seeds. Take 100 pills per dose, swallow with plain warm water on an empty stomach. After taking the medicine, stomp the feet twice to facilitate the downward movement of the medicinal effect. If urination becomes smooth and there is a stabbing pain in the urethra like a knife cut, it indicates that pathogenic turbid matter is being expelled.
If there is thirst accompanied by urinary retention, the heat is in the qi aspect of the upper jiao.
Qingfei Yinzi (Lung-Clearing Decoction) treats thirst with difficult urination, which is due to heat pathogen in the lung portion of the upper jiao. The lung belongs to metal, and metal generates water. If there is heat in the lung, it cannot generate kidney water, thus cutting off the water source. Treatment should employ bland-draining agents to clear lung qi, drain fire pathogen, and nourish the upper source of water.
Ingredients: Red Poria (Poria cum Radio, peel removed, 1.5 qian), Polyporus (Polypori Umbellati Sclerotium, 2 qian), Alisma Rhizoma (Alismatis Rhizoma, 1 qian), Tetrapanacis Medulla (Tetrapanacis Medulla, 2 qian), Junci Medulla (Junci Medulla, 1 qian), Plantaginis Semen (Plantaginis Semen, stir-fried, separately ground, 1 qian), Succinum (Succinum, separately ground, 0.5 qian), Artemisiae Scopariae Herba (Artemisiae Scopariae Herba, 0.7 qian), Akebiae Caulis (Akebiae Caulis, 0.7 qian), Dianthi Herba (Dianthi Herba, 0.7 qian).
Crush the above ingredients for one dose. Boil in water, take slightly warm on an empty stomach.
Urinary retention due to deficiency-cold is caused by cold accumulation.
Jiawei Wuling San (Modified Five-Ling Powder) treats urinary retention due to deficiency-cold.
Ingredients: Polyporus (Polypori Umbellati Sclerotium), Alisma Rhizoma (Alismatis Rhizoma), Atractylodis Macrocephalae Rhizoma (Atractylodis Macrocephalae Rhizoma, remove rhizome), Red Poria (Poria cum Radio, peel removed), Cinnamomi Cortex (Cinnamomi Cortex), Angelicae Sinensis Radix (Angelicae Sinensis Radix), Aurantium Fructus (Aurantii Fructus), Achyranthis Bidentatae Radix (Achyranthis Bidentatae Radix, remove rhizome), Akebiae Caulis (Akebiae Caulis) (all equal parts), Glycyrrhizae Radix et Rhizoma (Glycyrrhizae Radix et Rhizoma, slightly reduced).
Crush the above ingredients for one dose. Boil with a bundle of Juncus effusus (Junci Medulla) in water, take on an empty stomach.
Urinary retention due to deficiency-heat is caused by heat accumulation.
Shengma Shengyang Tang (not explicitly named in text, referred to as Shen Gui Shengma Tang) treats urinary retention in deficient persons.
Ingredients: Ginseng Radix (Ginseng Radix, remove rhizome), Angelicae Sinensis Radix (Angelicae Sinensis Radix), Rehmanniae Radix Recens (Rehmanniae Radix Recens), Red Poria (Poria cum Radio, peel removed), Polyporus (Polypori Umbellati Sclerotium), Alisma Rhizoma (Alismatis Rhizoma), Gardeniae Fructus (Gardeniae Fructus), Aurantium Fructus (Aurantii Fructus, remove pith), Achyranthis Bidentatae Radix (Achyranthis Bidentatae Radix, remove rhizome, wine-washed), Phellodendri Cortex (Phellodendri Chinensis Cortex, wine-stir-fried), Anemarrhenae Rhizoma (Anemarrhenae Rhizoma, wine-stir-fried) (all equal parts), Cimicifugae Rhizoma (Cimicifugae Rhizoma, small amount), Glycyrrhizae Radix et Rhizoma (Glycyrrhizae Radix et Rhizoma, reduced by half).
Crush the above ingredients for one dose. Boil with a bundle of Juncus effusus (Junci Medulla) in water, take on an empty stomach.
In elderly people, urinary retention is mostly due to shortness of qi and blood deficiency. Use Siwu Tang (Four-Substance Decoction) plus Huangqin (Scutellariae Radix) decocted as soup, to swallow Tongguan Wan (Passage-Opening Pill), taken on an empty stomach.
Urinary retention accompanied by cough and asthma is due to phlegm-qiu obstruction.
Erchen Tang (Two-Aged Decoction) treats urinary retention due to phlegm-qiu blockage.
Ingredients: Citri Reticulatae Pericarpium (Citri Reticulatae Pericarpium), Pinelliae Rhizoma (Pinelliae Rhizoma, stir-fried with ginger juice), Poria (Poria), Aurantium Fructus (Aurantii Fructus, bran-stir-fried), Achyranthis Bidentatae Radix (Achyranthis Bidentatae Radix, remove rhizome), Polyporus (Polypori Umbellati Sclerotium), Akebiae Caulis (Akebiae Caulis), Gardeniae Fructus (Gardeniae Fructus), Ophiopogonis Radix (Ophiopogonis Radix, remove heart), Plantaginis Semen (Plantaginis Semen), Phellodendri Cortex (Phellodendri Chinensis Cortex, wine-stir-fried) (all equal parts), Glycyrrhizae Radix et Rhizoma (Glycyrrhizae Radix et Rhizoma, reduced by half).
Crush the above ingredients for one dose. Boil with a bundle of Juncus effusus (Junci Medulla) in water, take on an empty stomach.
For those with deficient yuan qi unable to transform and transport, Buchong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is suitable (formula see Tonification section). For urinary retention due to yin deficiency, this is due to excessive fire; Ziyin Jianghuo Tang (Nourish Yin and Descend Fire Decoction) treats urinary retention in frail persons with yin deficiency and hyperactive fire (formula see Deficiency Labor section); Liuwei Wan (Six-Ingredient Pill) is particularly effective, based on the original formula adding Polyporus, Alisma Rhizoma, Akebiae Caulis, and Achyranthis Bidentatae Radix. Generally speaking, when urinary retention does not respond to diuretic herbs, it is because accumulated phlegm is in the lung. The lung is the upper jiao, and the bladder is the lower jiao; if the upper jiao is closed, the lower jiao is blocked, similar to a dripping vessel where water flows out from the lower spout only if the upper opening is open. If urinary retention occurs during diarrhea or dysentery, it is due to excessive fluid loss and insufficient intake; after diarrhea stops, urination will naturally resume. If urinary retention occurs with vomiting or hiccups, it is difficult to treat. If urinary retention occurs with abdominal fullness and distension (鼓胀), it is also difficult to treat.
To treat elderly patients with deficiency-cold in the lower origin, resulting in "zhuanbao" (bladder displacement/retention) preventing urination, with abdominal distension, urgency, pain, and critical condition lasting four to five days, use Liuwei Wan (Six-Ingredient Pill) with doubled Alisma Rhizoma dosage, which is effective (formula see Tonification section).
Supplementary Secret Prescriptions
Treating urinary retention: Fill the umbilicus with powder of Moschus (Moschus) and Pinelliae Rhizoma (Pinelliae Rhizoma). Cover the umbilicus with a paste made from Scallion White (Allii Fistulosi Bulbus) and Snail (Cochleae Concha), and bind tightly with cloth. Below, use smoke from Sophora Flower (Sophorae Flos) introduced into the vagina for natural passage; for women, wash the vaginal interior with decoction of Sophora Flower.
Daochi Tang (Directing Red Decoction) treats urine resembling rice-water color, cured within two doses.
Ingredients: Akebiae Caulis (Akebiae Caulis), Talcum (Talcum), Glycyrrhizae Radix et Rhizoma (Glycyrrhizae Radix et Rhizoma, tip), Phellodendri Cortex (Phellodendri Chinensis Cortex), Poria (Poria), Rehmanniae Radix Recens (Rehmanniae Radix Recens), Aurantium Fructus (Aurantii Fructus), Atractylodis Macrocephalae Rhizoma (Atractylodis Macrocephalae Rhizoma), Gardeniae Fructus (Gardeniae Fructus).
Boil in water, take on an empty stomach.
Treating sensation of urinary dragging/heaviness: Take 3 liang of high-quality Hemp Stem (Cannabis Sativae Caulis), tear it up, roast it over fire, cover with a new basin to collect the ash produced. Mix with yellow wine and take orally. Cover with blankets to induce sweating, then recover.
Treating urinary retention: Mix 1 he of Natrii Sulfas (Natrii Sulfas) with one green onion including roots, pound into a mixture. Spread on green cloth like a plaster, apply hot tile to iron/warm it, and urine will flow out.