成 不能言及语言难出有二证其一则太阳风温其一则少阳咽中生疮是皆传经之邪热气壅闭所致非阴寒之证气血通行则关节开张语言出矣
太阳 发汗已身犹灼热名风温脉尺寸俱浮自汗身重多眠鼻鼾语言难出（详风温）
少阴 病咽中伤生疮不能言语声不出者苦酒汤
吴 凡喑哑不言有六一者少阴病咽中伤生疮不能言语者以鸡子苦汤酒主之二者狐惑伤寒上唇有疮咽干声哑者治见
本条三者痉证口噤不能言者亦见本条四者热病音哑不言三四日不得汗出者死五者热甚火伤肺金不能言者宜清肺降火则
愈六者风热壅盛咳嗽声哑者以消风降痰火治又有失于发散风邪伏于肺中者当发散之
成 风温则鼻鼾太阳中风则鼻鸣由风气壅塞卫气不利所致阳明少阴三阳虽亦有中风然邪不在表故鼻不鸣而不鼾也
太阳 中风阳浮阴弱阳浮热自发阴弱汗自出啬啬恶寒淅淅恶风翕翕发热鼻鸣干呕者桂枝汤汗已身犹灼热脉浮自汗
身重多眠鼻鼾语言难出不可下不可火
（小便难）
成 小便不利有数种被下而小便不利者津液耗于内也因汗而小便不利者津液亡于外也发黄与痞及夫热病小便不利
者热郁所致风湿相搏与夫阳明风中其小便不利寒邪所乘其小便难者亦多由汗下而然宜详辨之
太阳 伤寒表不解心下有水气干呕发热而咳或渴或利或噎或小便不利少腹满或喘者小青龙汤去麻黄加茯苓（方见
咳）太阳病大发汗后胃干烦躁不得眠欲饮水小便不利者脉浮五苓散不浮者猪苓汤本以下之心下痞与泻心汤痞不解渴而口
躁烦小便不利者五苓散服桂枝汤或汗或下之仍头项强痛翕翕发热无汗心满微痛小便不利者桂枝去桂加茯苓白术汤太阳
病饮水多必心下悸小便少者茯苓甘草汤（方见厥）若兼身黄而小腹硬脉沉结者茵陈汤（方见黄）若表未解反下之不结胸
但头汗出小便不利者必发黄亦茵陈汤（栀子柏皮汤）
阳明 病面合赤色不可攻之必发热色黄小便不利也阳明病小便不利若中寒不能食手足 然汗出大便初硬后溏者此
欲作固瘕若能食大便自调其人骨节疼翕翕如有热状奄然发狂 然汗出而解者此水不胜谷气与汗共并脉紧则愈或无汗心
中懊 或被火额上微汗出或头汗出身无汗剂颈而还渴引水浆皆欲发黄之候若脉浮发热渴欲饮水小便不利者猪苓汤主之
（此浮字误也活人云脉浮者五苓散脉沉者猪苓汤则知此证若脉字下脱一不字也按太阳病内五苓散乃猪苓泽泻茯苓三味
中加桂白术也阳明篇内猪苓汤乃猪苓泽泻茯苓三味中加阿胶滑石也桂与白术味甘辛为阳主外阿胶滑石味甘寒为阴主内
南阳之言亦可谓不失仲景之旨矣第南阳欲区别二药分晓不觉笔下以沉对浮遂使后人致疑三阳证中不当言脉沉更不复致
疑经文之有阙也更详太阳证固当脉浮而阳明为表之里故其脉不曰浮而曰长盖长者不浮不沉之中脉也成氏直以脉浮释之
而朱氏却以脉沉言之胥失之矣若曰脉浮者五苓散不浮者猪苓汤则得仲景之意矣又详少阴病下利六七日咳而呕渴心烦不
得眠者猪苓汤一条虽不言脉沉然少阳之脉必沉也岂活人以少阴对太阳一证而言与以此推之成氏随文误释明矣）病患小便
不利大便乍难乍易时有微热喘冒不能卧者有燥屎也宜大承气汤得病二三日脉弱无太阳柴胡证烦躁心下硬至四五日虽能
食以小承气汤少少与微和之若不大便六七日小便少者虽不能食但初头硬后必溏须小便利屎定硬乃可用大承气攻之
少阳 伤寒五六日中风往来寒热胸胁痛不欲食心烦喜呕或心下悸小便不利者小柴胡汤伤寒五六日已汗复下胸胁满
微结小便不利渴而不呕但头汗心烦往来寒热为未解柴胡桂姜汤伤寒八九日下之胸满烦惊小便不利谵语身重不可转侧柴
胡加龙骨牡蛎汤
少阴 小便不利而大便自利腹痛为少阴病兼四肢沉重有水气者真武汤兼便脓血者桃花汤兼四逆者四逆散加茯苓
厥阴 伤寒哕而腹满视其前后知何部不利利之则愈前部为小便小便不利脉浮者五苓散不浮者猪苓汤小便不利关节
疼痛若痛不得屈伸汗出恶风身肿者属风湿宜甘草附子汤（方见身痛）若脉沉缓大便反快者属湿痹活人用五苓散（方见湿）
附
活 阴证小便不利手足厥冷脉微细者不宜服利小便冷滑药但服返阴丹并取脐下石门穴灸之（方论见阴毒）
集 伤寒小便不通取阴谷 阴陵泉
吴 凡伤寒小便不通刺任脉二穴在脐下一寸用长针入八分又次支沟二穴在手腕后三寸两骨之间陷中针入二分凡伤
寒小便不利当分六经治之太阴少阴详见本条太阴腹满自利小便不利无热脉沉者理中汤合五苓散更加浓朴木香分利其小
便而大便自止厥阴寒闭厥冷脉伏囊缩入腹小便不利宜四逆汤通草茯苓或灸气海石门穴或以葱熨法治之若阴虚火动小便
赤涩不利者加木通生地知母黄柏丸内热甚大便不通小便赤涩不利者八正散治之凡不渴小便不利者热在血分也宜知母黄
柏生地之类夫膀胱为津液之府气化而能出也若汗多者津液外泄小便因少不可利之恐重亡津液待汗止小便自行又小便自
利不可妄利之恐引热入膀胱则变蓄血又为害也
小便难
汗后小便难若太阳发汗遂漏不止者则恶风小便难四肢难屈伸宜桂枝附子汤（方论见自汗）若太阳证中风以火
劫发汗则邪风被火热血气流溢身黄阳盛阴虚欲衄小便难也（方论见头汗）若少阴以火劫汗者则咳而下利谵语小便难也（论
见胁痛）
下后小便难有二若脉迟浮弱恶风寒下之者则胁满身黄项强小便难也（见胁痛）若阳明胃实发热恶寒脉浮紧下之者则
腹满小便难也（论见胃实）
胁痛身黄小便难若阳明胃实未下者宜小柴胡汤若下后不食项强者忌柴胡（论见胁痛）
赵 伤寒小便难仲景论有发汗漏不止桂枝加附子汤者有阳明中风或脉弦浮大而潮热哕者或脉浮而紧误下而成腹满
者又有阳明脉浮迟饱则微烦头眩者活人问中当以传经邪热与漏风亡阳分作两条其桂枝加附子汤证乃亡阳经虚所致岂得
均谓之阴虚阳凑为有热耶要当以小柴胡证及误下证谷疸证次于阳凑传邪之下却别出一条云外有汗多亡阳津液不足亦有
小便难者还以桂枝加附子汤证属之
成无己：不能言语及语言困难有两种证候。其一是太阳风温，其二是少阳咽中生疮。这些都是传经之邪热气壅闭所致，并非阴寒之证。气血通行则关节开张，语言即可发出。
太阳病：发汗后身体仍然灼热，名为风温。脉象尺寸俱浮，自汗出，身体沉重，多眠睡，鼻鼾，语言难出。（详见风温条）
少阴病：咽喉受伤生疮，不能言语，声音出不来的，用苦酒汤治疗。
吴谦：凡是失音哑默不言有六种情况。第一种是少阴病，咽喉受伤生疮，不能言语的，用鸡子苦汤（即苦酒汤）为主治疗。第二种是狐惑伤寒，上唇有疮，咽干声哑的，治法见本条。第三种是痉证，口噤不能言语的，也见本条。第四种是热病，音哑不言，三四天不得汗出的，预后不良属死证。第五种是热甚火伤肺金导致不能言语的，宜清肺降火则可痊愈。第六种是风热壅盛，咳嗽声哑的，以消风降痰火治疗。又有因失于发散，风邪伏于肺中的，应当发散风邪。
成无己：风温则鼻鼾，太阳中风则鼻鸣，都是由风气壅塞，卫气不利所致。阳明、少阴、三阳虽然也有中风，但邪气不在表，所以鼻不鸣也不鼾。
太阳病：中风，阳脉浮阴脉弱，阳浮则热自发，阴弱则汗自出，啬啬恶寒，淅淅恶风，翕翕发热，鼻鸣干呕的，用桂枝汤。若发汗后身体仍然灼热，脉浮，自汗，身重，多眠，鼻鼾，语言难出，不可用下法，不可用火疗。
（小便难）
成无己：小便不利有多种情况。被误下后小便不利的，是因为津液耗损于内；因发汗后小便不利的，是因为津液亡失于外。发黄、痞证以及热病导致的小便不利，是由热郁所致；风湿相搏以及阳明风中导致的小便不利，寒邪所乘导致的小便难，也多由汗下之后引起，应当详细辨别。
太阳病：伤寒表不解，心下有水气，干呕发热而咳，或渴，或利，或噎，或小便不利，少腹满，或喘的，用小青龙汤去麻黄加茯苓（方剂见咳条）。太阳病大发汗后，胃干烦躁不得眠，想喝水，小便不利的，脉浮的用五苓散，不浮的用猪苓汤。原本因下法导致的心下痞，与泻心汤后痞证未解，口渴且口燥烦，小便不利的，用五苓散。服用桂枝汤，或经过汗法或下法治疗后，仍然头项强痛，翕翕发热，无汗，心满微痛，小便不利的，用桂枝去桂加茯苓白术汤。太阳病饮水多必心下悸，小便少的，用茯苓甘草汤（方剂见厥条）。如果兼见身黄而小腹硬，脉沉结的，用茵陈汤（方剂见黄条）。如果表证未解反而误下，不结胸，但头汗出，小便不利的，必然发黄，也用茵陈汤（栀子柏皮汤）。
阳明病：面色合赤色，不可攻下，否则必然发热色黄，小便不利。阳明病小便不利，如果中寒不能食，手足濈然汗出，大便初硬后溏的，这是欲作固瘕。如果能食，大便自调，其人骨节疼，翕翕如有热状，奄然发狂，濈然汗出而解的，这是水不胜谷气，与汗共并，脉紧则愈。或者无汗，心中懊憹，或被火疗后额上微汗出，或头汗出，身无汗，齐颈而还，渴引水浆，都是欲发黄的征候。如果脉浮，发热，渴欲饮水，小便不利的，用猪苓汤主治。（此处“浮”字有误，《活人书》说脉浮者用五苓散，脉沉者用猪苓汤，则知此证若在“脉”字下脱一“不”字。按太阳病篇的五苓散乃是在猪苓、泽泻、茯苓三味中加桂枝、白术。阳明病篇的猪苓汤乃是在猪苓、泽泻、茯苓三味中加阿胶、滑石。桂枝与白术味甘辛为阳，主外；阿胶与滑石味甘寒为阴，主内。南阳之言可谓不失仲景之意。只是南阳想要区别这两种药物分明，不觉笔下以“沉”对“浮”，遂使后人产生疑惑：三阳证中不当言脉沉，更不再怀疑经文有缺漏。再详察太阳证固当脉浮，而阳明为表之里，故其脉不曰浮而曰长，盖长是不浮不沉之中的脉。成氏直接用脉浮解释，而朱氏却以脉沉言之，都失之偏颇了。如果说脉浮者用五苓散，不浮者用猪苓汤，就符合仲景之意了。又详察少阴病下利六七日，咳而呕，渴，心烦不得眠的，用猪苓汤一条，虽不言脉沉，然少阳之脉必沉也。岂非《活人书》以少阴对太阳一证而言？以此推之，成氏随文误释明矣。）病患小便不利，大便乍难乍易，时有微热，喘冒不能卧的，是有燥屎，宜用大承气汤。得病二三日，脉弱，无太阳柴胡证，烦躁，心下硬，至四五日，虽能食，以小承气汤少量给予，微微调和之。若不大便六七日，小便少的，虽不能食，但初头硬后必溏，须小便利，屎定硬，乃可用大承气攻之。
少阳病：伤寒五六日，中风，往来寒热，胸胁痛，不欲食，心烦喜呕，或心下悸，小便不利的，用小柴胡汤。伤寒五六日已汗复下，胸胁满微结，小便不利，渴而不呕，但头汗出，心烦，往来寒热，为未解，用柴胡桂姜汤。伤寒八九日下之，胸满烦惊，小便不利，谵语，身重不可转侧，用柴胡加龙骨牡蛎汤。
少阴病：小便不利而大便自利，腹痛为少阴病，兼四肢沉重有水气的，用真武汤；兼便脓血的，用桃花汤；兼四逆的，用四逆散加茯苓。
厥阴病：伤寒哕而腹满，视其前后，知何部不利，利之则愈。前部为小便，小便不利脉浮的，用五苓散；不浮的，用猪苓汤。小便不利，关节疼痛，若痛不得屈伸，汗出恶风，身肿的，属风湿，宜甘草附子汤（方剂见身痛条）。若脉沉缓，大便反快的，属湿痹，《活人书》用五苓散（方剂见湿条）。
附录：
活人书：阴证小便不利，手足厥冷，脉微细的，不宜服利小便冷滑药，只服返阴丹，并灸脐下石门穴（方论见阴毒条）。
集注：伤寒小便不通，取阴谷、阴陵泉穴。
吴谦：凡伤寒小便不通，刺任脉二穴，在脐下一寸，用长针入八分。又次支沟二穴，在手腕后三寸两骨之间陷中，针入二分。凡伤寒小便不利，当分六经治之。太阴、少阴详见本条。太阴腹满自利，小便不利，无热脉沉的，用理中汤合五苓散，更加浓朴、木香，分利其小便而大便自止。厥阴寒闭，厥冷脉伏，囊缩入腹，小便不利的，宜四逆汤、通草、茯苓，或灸气海、石门穴，或以葱熨法治之。若阴虚火动，小便赤涩不利的，加木通、生地、知母、黄柏丸。内热甚，大便不通，小便赤涩不利的，用八正散治之。凡不渴，小便不利的，热在血分也，宜知母、黄柏、生地之类。夫膀胱为津液之府，气化而能出也。若汗多者，津液外泄，小便因少，不可利之，恐重亡津液，待汗止小便自行。又小便自利，不可妄利之，恐引热入膀胱则变蓄血，又为害也。
小便难
汗后小便难：若太阳发汗遂漏不止的，则恶风，小便难，四肢难屈伸，宜桂枝附子汤（方论见自汗条）。若太阳证中风，以火劫发汗，则邪风被火热血气流溢，身黄，阳盛阴虚，欲衄，小便难也（方论见头汗条）。若少阴以火劫汗的，则咳而下利，谵语，小便难也（论见胁痛条）。
下后小便难有二：若脉迟浮弱，恶风寒，下之的，则胁满身黄，项强，小便难也（见胁痛条）。若阳明胃实，发热恶寒，脉浮紧，下之的，则腹满，小便难也（论见胃实条）。
胁痛身黄小便难：若阳明胃实未下的，宜小柴胡汤。若下后不食，项强的，忌柴胡（论见胁痛条）。
赵献可：伤寒小便难，仲景论中有发汗漏不止，用桂枝加附子汤者；有阳明中风，或脉弦浮大而潮热哕者；或脉浮而紧，误下而成腹满者；又有阳明脉浮迟，饱则微烦头眩者。《活人书》问中，当以传经邪热与漏风亡阳分作两条。其桂枝加附子汤证乃亡阳经虚所致，岂得均谓之阴虚阳凑为有热耶？要当以小柴胡证及误下证、谷疸证次于阳凑传邪之下，却别出一条云：“外有汗多亡阳，津液不足，亦有小便难者”，还以桂枝加附子汤证属之。
Cheng Wuji: Inability to speak and difficulty in speech manifest as two syndromes. One is Taiyang Wind-Warmth (Taiyang Fengwen), and the other is sores arising in the throat of Shaoyin. Both are caused by pathogenic heat qi obstructing and closing due to transmitted disease, not by Yin-cold syndromes. When Qi and Blood circulate freely, joints open up, and speech can be produced.
Taiyang Disease: After sweating therapy, if the body remains burning hot, it is named Wind-Warmth (Fengwen). The pulse at both Cun and Chi positions is floating; there is spontaneous sweating, heaviness of the body, excessive sleepiness, snoring, and difficulty in speech. (See detailed discussion under Wind-Warmth).
Shaoyin Disease: If the throat is injured with sores, leading to inability to speak and voice loss, treat with Kujiu Tang (Bitter Wine Decoction).
Wu Qian: There are six types of aphonia and muteness. First, Shaoyin disease where throat injury causes sores and inability to speak; treat primarily with Jizi Kujiu Tang (Egg Yolk Bitter Wine Decoction, i.e., Kujiu Tang). Second, Huhu (Fox-Confusion) Cold Damage affecting the upper lip with sores, dry throat, and hoarseness; treatment is found in that section. Third, Spasm syndrome (Jingzheng) with locked jaw preventing speech; also found in that section. Fourth, Heat disease causing aphonia without sweat for three to four days indicates a fatal prognosis. Fifth, extreme heat injuring Lung Metal causing inability to speak; clear Lung heat and descend fire to cure. Sixth, excess Wind-Heat obstructing causing cough and hoarseness; treat by dispelling Wind and descending Phlegm-Fire. Additionally, cases where failure to disperse allows Wind pathogen to lodge in the Lungs require dispersing Wind pathogen.
Cheng Wuji: Wind-Warmth presents with snoring, while Taiyang Wind Strike presents with nasal humming. Both result from Wind Qi obstruction impairing Wei-Qi circulation. Although Yangming, Shaoyin, and the Three Yang meridians may experience Wind Strike, since the pathogen is not on the exterior, there is no nasal humming or snoring.
Taiyang Disease: Wind Strike characterized by floating Yang pulse and weak Yin pulse. Floating Yang leads to spontaneous heat generation; weak Yin leads to spontaneous sweating. Symptoms include aversion to cold (Se-se), shivering aversion to wind (Xi-xi), mild fever (Xi-xi), nasal humming, and dry retching. Treat with Guizhi Tang (Cinnamon Twig Decoction). If after sweating the body remains burning hot, with floating pulse, spontaneous sweating, body heaviness, somnolence, snoring, and speech difficulty, do not use purgation or fire therapy.
(Urination Difficulty)
Cheng Wuji: Impaired urination has several types. Post-mistaken-purgation impairment results from internal fluid depletion. Post-sweating impairment results from external fluid loss. Jaundice, Pi (Glomus) syndrome, and Heat diseases causing impaired urination stem from Heat stagnation. Rheumatism interaction and Yangming Wind invasion causing impaired urination, or Cold pathogen assault causing difficult urination, often arise post-sweat/purge and must be differentiated carefully.
Taiyang Disease: Cold Damage with unresolved exterior and fluid retention below the heart, presenting with dry retching, fever, cough, thirst, diarrhea, dysphagia, impaired urination, hypogastric fullness, or wheezing. Treat with Xiao Qinglong Tang (Minor Blue Dragon Decoction), removing Mahuang (Ephedrae Herba) and adding Fuling (Poria). After excessive sweating in Taiyang disease, stomach dryness causes irritability, insomnia, thirst, and impaired urination. If pulse is floating, use Wuling San (Five-Ingredient Powder with Poria); if not floating, use Zhuling Tang (Polyporus Decoction). For Pi syndrome unrelieved by Xixin Tang (Heart-Piercing Decoctions) following purgation, accompanied by thirst, oral dryness/irritability, and impaired urination, use Wuling San. After Guizhi Tang or post-sweat/purge, if head/neck stiffness, mild fever, anhidrosis, chest fullness/mild pain, and impaired urination persist, use Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction). Excessive drinking in Taiyang disease causing epigastric palpitations and scant urine requires Fuling Gancao Jiangtang (Poria Licoricia Ginger Decoction). If accompanied by jaundice, hard hypogastric region, and sinking/knotted pulse, use Yinchen Tang (Artemisia Capillaris Decoction). If exterior unresolved and mistaken purgation occurs, resulting in no Jie Xiong (Chest Binding) but only head sweating and impaired urination, jaundice will likely develop; treat with Yinchen Tang (Zhi Zi Bai Pi Tang [Gardenia and Phellodendron Bark Decoction]).
Yangming Disease: Facial redness contraindicates purgation; doing so causes fever, yellow complexion, and impaired urination. In Yangming disease with impaired urination, if Cold damages the Stomach preventing eating, with constant hand/foot sweating, initial hard stool followed by loose stool, this suggests impending Gujia (Solid Mass). If eating normally and stools regulate, joint pain, mild fever sensation, sudden madness, constant sweating indicating resolution, implies Water failing to overcome Grain Qi combined with sweat; tight pulse indicates recovery. Anhidrosis, mental restlessness, or post-fire therapy showing slight forehead sweat or head-only sweat with neck-down anhidrosis, thirst for fluids, all indicate impending jaundice. If floating pulse, fever, thirst, and impaired urination occur, use Zhuling Tang. (Note: "Floating" here is likely an error; *Ren Shu* states floating pulse uses Wuling San, sinking pulse uses Zhuling Tang. Thus, "not floating" was likely omitted. Wuling San adds Guizhi and Baizhu to Zhuling, Zexie, Fuling; these are Yang/acrid-sweet acting externally. Zhuling Tang adds Ejiao and Huashi; these are Yin/sweet-cold acting internally. This distinction aligns with Zhang Zhongjing's intent. Cheng Shi interpreted via floating pulse, Zhu Xi via sinking pulse, both deviating. Correctly: floating pulse = Wuling San; non-floating = Zhuling Tang.) Regarding Shaoyin disease with diarrhea, cough, vomiting, thirst, irritability, insomnia for 6-7 days, Zhuling Tang is used despite no mention of sinking pulse, as Shaoyang/Shao Yin pulses are typically sinking. Cheng Shi’s textual interpretation is flawed. Patient with impaired urination, alternating hard/loose stools, occasional mild fever, wheezing/dizziness unable to lie down, indicates Dry Stool; use Dachengqi Tang (Major Order the Qi Decoction). Early stage (2-3 days) with weak pulse, no Taiyang/Shaoyang signs, irritability, epigastric hardness: give Xiaochengqi Tang (Minor Order the Qi Decoction) sparingly to harmonize. If no bowel movement for 6-7 days and scant urine, even if unable to eat, initial hardness suggests later looseness; wait for free urination to confirm hard stool before using Dachengqi Tang.
Shaoyang Disease: Cold Damage/Wind Strike after 5-6 days, with alternating chills/fever, hypochondriac pain, anorexia, irritability, frequent vomiting, epigastric palpitations, or impaired urination. Use Xiaochaihu Tang (Minor Bupleurum Decoction). Post-sweat/purge with hypochondriac fullness/knotting, impaired urination, thirst, no vomiting, head sweat, irritability, alternating chills/fever: use Chaihu Guijiang Tang (Bupleurum and Cinnamon Twig Decoction). Post-purgation after 8-9 days with chest fullness, fright, impaired urination, delirium, body heaviness/inability to turn: use Chaihu Jia Longgu Muli Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction).
Shaoyin Disease: Impaired urination with normal stool and abdominal pain is Shaoyin disease. With heavy limbs/water retention, use Zhenwu Tang (True Warrior Decoction). With pus/blood in stool, use Taohua Tang (Peach Blossom Decoction). With Si Ni (Cold Extremities), use Sini San (Frigid Extremities Powder) plus Fuling.
Jueyin Disease: Cold Damage with hiccups and abdominal fullness: check anterior/posterior obstructions and relieve them. Anterior refers to urination; floating pulse with impaired urination uses Wuling San, non-floating uses Zhuling Tang. Joint pain with impaired urination, inability to flex/extend, sweating, aversion to wind, edema indicates Rheumatism; use Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction). Sinking/slow pulse with rapid stool indicates Damp-Bi; *Ren Shu* recommends Wuling San.
Appendix:
*Ren Shu*: Yin syndrome with impaired urination, cold extremities, faint/thin pulse: avoid diuretic/cold/slippery herbs. Use Fanyin Dan (Return to Yin Pill) and moxa Stone Men (Shimen CV5).
*Ji Zhu*: For Cold Damage urinary obstruction, select Yin Gu (KI10) and Yin Ling Quan (SP9).
Wu Qian: For Cold Damage urinary obstruction, puncture Ren Mai points 1 cun below umbilicus (deep needle 8 fen) and Zhigou (SJ6) 3 cun above wrist between bones (needle 2 fen). Differentiate by Six Meridians. Taiyin: Fullness, diarrhea, impaired urination, no heat, sinking pulse: Lizhong Tang (Regulate the Middle Decoction) combined with Wuling San, plus Houpo and Muxiang to separate fluids/stool. Jueyin Cold Closure: Cold extremities, hidden pulse, scrotal retraction, impaired urination: Sini Tang (Frigid Extremities Decoction), Tongcao, Fuling, or moxa Qihai (CV6)/Shimen (CV5), or Scallion moxibustion. Yin Deficiency with Fire Agitation: Red/astringent impaired urination: add Mutong, Shengdi, Zhimu, Huangbai Wan. Internal Heat with constipation/red urine: Bazheng San (Eight-Herb Powder for Rectification). Non-thirsty impaired urination indicates Heat in Blood level: use Zhimu, Huangbai, Shengdi. Bladder stores fluids; Qi transformation enables excretion. Profuse sweating depletes fluids, reducing urine; do not diurese to avoid further fluid loss. Wait for sweat to stop. Spontaneous frequent urination should not be forcibly stopped to avoid Heat entering Bladder and causing Blood Stasis.
Urination Difficulty
Post-sweat difficulty: Taiyang sweating leading to continuous leakage, aversion to wind, difficulty urinating, stiff limbs: Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction). Fire-induced sweating in Taiyang Wind Strike causes blood/qi overflow, jaundice, Yang excess/Yin deficiency, epistaxis tendency, difficulty urinating. Fire-induced sweating in Shaoyin causes cough, diarrhea, delirium, difficulty urinating.
Post-purgation difficulty: Two types. Pulse slow/floating/weak, aversion to wind/cold, purged: hypochondriac fullness, jaundice, neck stiffness, difficulty urinating. Yangming Excess Heat, fever/chills, floating/tight pulse, purged: abdominal fullness, difficulty urinating.
Hypochondriac Pain, Jaundice, Difficulty Urinating: If Yangming Excess Heat untreated, use Xiaochaihu Tang. Post-purgation anorexia with neck stiffness: contraindicate Chaihu.
Zhao Xianke: Zhang Zhongjing discusses urinary difficulty in Cold Damage: continuous sweating post-treatment uses Guizhi Jia Fuzi Tang (Cinnamon Twig plus Aconite Decoction). Yangming Wind Strike with stringy/large pulse, tidal fever, hiccups, or floating/tight pulse mistaken purgation causing fullness, or floating/slow pulse with fullness-induced vexation/dizziness. *Ren Shu* distinguishes transmitted Heat from Leakage Wind/Yang Collapse. Guizhi Jia Fuzi Tang addresses Yang collapse/meridian deficiency, not merely Yin deficiency with Yang aggregation. It should be listed separately from transmitted Heat, noting "Profuse sweating causes Yang collapse and fluid insufficiency, also leading to urinary difficulty," linking it back to Guizhi Jia Fuzi Tang.