东垣云∶小便不利，有在气在血之异。夫小便者，足太阳膀胱之所生，长生于申，申者金也
，金能生水，肺中伏热，水不能生，是绝小便之源也。治法∶用清燥金之正化，气薄之药茯
苓、猪苓、泽泻、琥珀、灯心、通草、车前、瞿麦、扁豆之类，皆为淡渗，能泄肺中之热，
而滋水之化源也。若不渴，热在下焦，是热涩其流，而溺不泄也，须用气味俱浓，阴中之阴
药治之。二者之病，一居上焦，在气分而必渴，一居下焦，在血分而不渴，血中有湿，故不
渴也，二者之殊，至易分别耳。窃谓前症，若津液偏渗于肠胃，大便泻利，而小便涩少者，
宜分利。若热蕴于下焦，津液燥而小便不行者宜渗泄。若脾胃气涩不能通调水道者，宜顺气
。若乳母肝心二经有热者，用栀子清肝散。肝经怒火者，用柴胡栀子散。若因父母曾服燥剂
而致者，用四物、麦门、甘草。数而黄者，用四物加山茱萸、黄柏、知母、五味、麦门。肺
虚而短少者，用补中益气加山药、麦门。阴挺痿痹而频数者，用地黄丸。热结膀胱而不利者
，用五淋散。脾肺燥不能化生者，用黄芩清肺饮。膀胱阴虚，阳无以生而淋沥者，用滋肾丸
。若膀胱阳虚，阴无以化而淋沥者，用六味丸。若因乳母浓味酒面积热者，用清胃散、五淋
散。仍参诸淋览之。
治验
一小儿十四岁，肢体倦怠，发热晡热，口干作渴，吐痰如涌，小便淋沥，或面目赤色，身不
欲衣，此禀赋肾虚阴燥也，用补中益气汤、加减八味丸而愈。
一小儿五岁，小便不利，用五苓散分利澹泄之药，益加不通，小便阴囊渐肿，先兄谓前药复
损真阴也，用六味丸料加牛膝、肉桂、车前子，佐以补中益气汤而痊。
一小儿八岁，先小便涩滞，服五苓散益甚，加木通、车前之类腹胀吐痰，加枳壳、海金砂而
胸满阴肿，遍身发浮，余用六味丸煎送滋肾丸而痊。此皆禀父气所致，其作湿热痰气治之，
而殁者多矣。
一小儿八岁，先因小便黄赤，服五苓、导赤等散，后患便血，余以为禀父虚热也，用六味丸
及补中益气汤而痊。
木通散 治小便不通，少腹作痛。
木通 滑石（各一两） 牵牛（半两，炒）
上为末，灯心葱白水煎，空心服。
八正散 治蕴热，咽干口燥，大渴引饮，心忪面热，烦躁不宁，目赤睛疼，或咽舌生疮，小
便赤闭，及热淋血淋。
车前子 瞿麦（炒） 大黄（面裹煨） 山栀 滑石 蓄 木通 甘草（炙。各一两）
上为末，每服二三钱，入灯心水煎，食前服。
栀子仁散 治小便不通，脐腹胀闷，心神烦热。
栀子仁（五枚） 茅根 冬葵子（各半两） 甘草（炙，二钱）
上为末，每服一钱，水煎空心服。
栀子清肝散
柴胡栀子散（二方见发热，即柴胡清肝散）
补中益气汤（方见虚羸）
黄芩清肺饮（方见百 内嗽）
加减滋肾丸（方见腹胀）
清胃散（方见内钓）
四物汤（方见急惊）
五苓散（方见五淋）
六味地黄丸（方见肾脏）
李东垣说：小便不利，有属于气分病变和血分病变的区别。小便，是由足太阳膀胱经所主管的，其气在申时（下午3-5点）处于长生状态，申属金，金能生水，如果肺中有伏热，导致水液不能正常化生，这就是断绝了小便的来源。治疗方法：使用清燥金之正气的药物，气味轻薄的药如茯苓、猪苓、泽泻、琥珀、灯心草、通草、车前子、瞿麦、扁豆等，这些都属于淡味渗湿药，能够泄除肺中的热邪，从而滋养水液的化源。如果不口渴，说明热在下焦，这是热邪涩滞了水道，导致尿液无法排出，必须使用气味浓厚、属于阴中之阴的药物来治疗。这两种病症，一个在上焦，位于气分且必然口渴；一个在下焦，位于血分且不口渴，因为血中有湿，所以不口渴，这两者的区别，非常容易分辨。我认为前述症状，如果津液偏渗于肠胃，导致大便泻利，而小便涩少者，宜用分利法。如果热蕴结于下焦，津液干燥而导致小便不通者，宜用渗泄法。如果脾胃气机涩滞，不能通调水道者，宜用顺气法。如果乳母的心肝二经有热者，用栀子清肝散。如果是肝经怒火者，用柴胡栀子散。如果是因父母曾服用燥剂而导致小儿患病者，用四物汤、麦门冬、甘草。如果脉数且尿黄者，用四物汤加山茱萸、黄柏、知母、五味子、麦门冬。如果肺气虚而尿短少者，用补中益气汤加山药、麦门冬。如果阴挺、痿痹且尿频者，用地黄丸。如果热结膀胱而排尿不利者，用五淋散。如果脾肺燥热不能化生津液者，用黄芩清肺饮。如果膀胱阴虚，阳气无以生发而导致淋沥者，用滋肾丸。如果膀胱阳虚，阴液无以气化而导致淋沥者，用六味丸。如果因乳母食用浓味、酒面食物积热者，用清胃散、五淋散。仍参考各种淋证的内容查阅。
治验案例：
一个十四岁的小儿，肢体倦怠，午后发热，口干作渴，吐痰如涌，小便淋沥，有时面目赤红，身体不想穿衣，这是禀赋肾虚导致的阴燥，用补中益气汤、加减八味丸治愈。
一个五岁的小儿，小便不利，用了五苓散这种分利澹泄的药物后，反而更加不通，小便部位及阴囊逐渐肿胀，我的先兄认为前面的药物进一步损伤了真阴，于是用六味丸料加牛膝、肉桂、车前子，配合补中益气汤治愈。
一个八岁的小儿，起初小便涩滞，服用五苓散后病情加重，加上木通、车前子等药后出现腹胀吐痰，再加枳壳、海金砂后出现胸满阴肿，遍身浮肿，我用六味丸煎汤送服滋肾丸治愈。这些都是禀受父亲之气所致，那些将其当作湿热痰气来治疗的，大多死亡。
另一个八岁的小儿，起初因小便黄赤，服用了五苓散、导赤散等，后来患便血，我认为是禀受父亲的虚热所致，用六味丸及补中益气汤治愈。
木通散：治疗小便不通，小腹部疼痛。
木通、滑石（各一两），牵牛子（半两，炒）。
以上研为末，用灯心草、葱白、水煎煮，空腹服用。
八正散：治疗蕴热，咽干口燥，大渴引饮，心悸面热，烦躁不宁，目赤睛疼，或咽喉舌头生疮，小便赤闭，以及热淋、血淋。
车前子、瞿麦（炒）、大黄（面粉包裹煨制）、山栀、滑石、蓄草、木通、甘草（炙。各一两）。
以上研为末，每次服用二三钱，加入灯心草水煎煮，饭前服用。
栀子仁散：治疗小便不通，脐腹部胀闷，心神烦热。
栀子仁（五枚）、茅根、冬葵子（各半两）、甘草（炙，二钱）。
以上研为末，每次服用一钱，用水煎煮，空腹服用。
栀子清肝散
柴胡栀子散（这两个方剂见“发热”章节，即柴胡清肝散）
补中益气汤（方剂见“虚羸”章节）
黄芩清肺饮（方剂见“百日内嗽”章节）
加减滋肾丸（方剂见“腹胀”章节）
清胃散（方剂见“内钓”章节）
四物汤（方剂见“急惊”章节）
五苓散（方剂见“五淋”章节）
六味地黄丸（方剂见“肾脏”章节）
Li Dongyuan stated: Impaired urination differs in whether it resides in the Qi level or the Blood level. Urination is governed by the Foot-Taiyang Bladder channel, which enters its "Chang Sheng" (Long Life) phase at Shen hour (3-5 PM). Shen corresponds to Metal; Metal generates Water. If latent heat resides in the Lung, water cannot be generated properly, thus cutting off the source of urine. Treatment method: Use drugs that clear and dry the Zheng Hua (normal transformation) of Metal, specifically those with thin aromas such as Poria (Fuling), Polyporus (Zhuling), Alisma (Zexie), Amber (Hupo), Juncus effusus (Dengxin), Tongcao, Plantago seed (Cheqian), and Dianthus superbus (Qumai), among others. These all possess a light and penetrating nature, capable of draining heat from the Lung and nourishing the source of water transformation. If there is no thirst, the heat is in the Lower Jiao, meaning heat has obstructed the flow, preventing urine discharge. In this case, one must use drugs with strong aroma and flavor, belonging to Yin within Yin. The disease in the former case resides in the Upper Jiao, involves the Qi level, and necessarily presents with thirst; the latter resides in the Lower Jiao, involves the Blood level, and presents without thirst because dampness exists in the Blood. The distinction between these two is very easy to identify. I suggest that for the aforementioned symptoms, if body fluids leak excessively into the intestines and stomach causing diarrhea while urination is scanty and difficult, one should employ separation and leaching methods. If heat accumulates in the Lower Jiao, drying body fluids and stopping urination, one should employ permeating and draining methods. If Spleen and Stomach Qi is stagnant and unable to regulate water passages, one should promote Qi movement. If the nursing mother has heat in the Liver and Heart channels, use Zhizi Qinggan San (Gardenia Clearing Liver Powder). If caused by Liver fire anger, use Chaihu Zhizi San (Bupleurum and Gardenia Powder). If caused by parents having previously taken drying agents, use Siwu Tang (Four Substances Decoction), Ophiopogon (Maimen), and Licorice (Gancao). If the pulse is rapid and urine yellow, use Siwu Tang plus Cornus officinalis (Shanzhuyu), Phellodendron (Huangbai), Anemarrhena (Zhimu), Schisandra (Wuweizi), and Ophiopogon (Maimen). If Lung deficiency causes short and scanty urine, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Dioscorea (Shanyao) and Ophiopogon (Maimen). If prolapse, flaccidity, numbness, and frequent urination occur, use Dihuang Wan (Rehmannia Pill). If heat binds in the Bladder causing difficulty in urination, use Wulin San (Five Dampnesses Powder). If Spleen and Lung dryness prevents fluid generation, use Huangqin Qingfei Yin (Scutellaria Clearing Lung Drink). If Bladder Yin deficiency leads to Yang failing to generate, causing dribbling, use Zishen Wan (Nourish Kidney Pill). If Bladder Yang deficiency leads to Yin failing to transform, causing dribbling, use Liuwei Wan (Six-Ingredient Pill). If caused by the nursing mother consuming rich flavors, alcohol, and wheat products accumulating heat, use Qingwei San (Clear Stomach Powder) and Wulin San. Refer to the section on various types of strangury for further details.
Clinical Cases:
A fourteen-year-old child presented with limb fatigue, afternoon fever, dry mouth with thirst, profuse expectoration, dribbling urination, sometimes red face and eyes, and aversion to clothing. This was due to congenital Kidney deficiency causing Yin dryness. He was cured using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Jiajian Bawei Wan (Modified Eight-Ingredient Pill).
A five-year-old child had impaired urination. After taking Wuling San (Five-Poria Powder), a diuretic and leaching drug, the obstruction worsened, and the perineum and scrotum gradually swelled. My elder brother stated that the previous medicine further damaged the True Yin. He treated him with Liuwei Wan material plus Achyranthes bidentata (Niuxi), Cinnamon bark (Rougui), and Plantago seed (Cheqianzi), assisted by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), resulting in recovery.
An eight-year-old child initially had sluggish urination. Taking Wuling San exacerbated the condition. Adding Akebia stem (Mutong) and Plantago seed (Cheqian) led to abdominal distension and phlegm vomiting. Adding Magnolia bark (Zhiqiao) and Gold sand (Haijinsha) led to chest fullness, genital swelling, and generalized edema. I treated him with Liuwei Wan (Six-Ingredient Pill) decoction administered with Zishen Wan (Nourish Kidney Pill), leading to recovery. All these cases were due to inheriting the father's constitution. Those who treated them as damp-heat-phlegm-Qi stagnation mostly died.
Another eight-year-old child initially had yellow-red urine. After taking Wuling San and Daochi San (Guide Out Red Powder), he developed hematochezia. I attributed this to inheriting the father's deficient heat. He was cured using Liuwei Wan (Six-Ingredient Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
Mutong San (Akebia Powder): Treats urinary retention with lower abdominal pain.
Akebia stem (Mutong), Talcum (Huashi) (each 1 liang); Sesame bean (Qianniu) (0.5 liang, stir-fried).
Grind into powder. Decoct with Juncus effusus (Dengxin), Scallion white (Congbai), and water. Take on an empty stomach.
Bazheng San (Eight-Upright Powder): Treats accumulated heat, dry throat and mouth, excessive thirst with desire to drink, palpitations and facial heat, restlessness, red eyes and eye pain, sores in the throat and tongue, red and obstructed urination, as well as heat strangury and blood strangury.
Plantago seed (Cheqianzi), Dianthus superbus (Qumai, stir-fried), Rhubarb (Dahuang, baked in flour), Gardenia (Shanzhi), Talcum (Huashi), Knotweed (Qiancaosu), Akebia stem (Mutong), Licorice root (Gancao, honey-fried) (each 1 liang).
Grind into powder. Take 2-3 qian per dose. Decoct with Juncus effusus (Dengxin) and water. Take before meals.
Zhizi Ren San (Gardenia Kernel Powder): Treats urinary retention, umbilical and abdominal distension and stuffiness, and mental restlessness with heat.
Gardenia kernel (Zhizi Ren) (5 kernels), Imperata rhizome (Maogen), Malva seed (Dongkuizi) (each 0.5 liang), Licorice root (Gancao, honey-fried) (2 qian).
Grind into powder. Take 1 qian per dose. Decoct with water. Take on an empty stomach.
Zhizi Qinggan San (Gardenia Clearing Liver Powder)
Chaihu Zhizi San (Bupleurum and Gardenia Powder) (Both formulas are found in the "Febrile Disease" chapter, also known as Chaihu Qinggan San)
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (Formula found in the "Emaciation" chapter)
Huangqin Qingfei Yin (Scutellaria Clearing Lung Drink) (Formula found in the "Infantile Cough" chapter)
Jiajian Zishen Wan (Modified Nourish Kidney Pill) (Formula found in the "Abdominal Distension" chapter)
Qingwei San (Clear Stomach Powder) (Formula found in the "Internal Hook" chapter)
Siwu Tang (Four Substances Decoction) (Formula found in the "Acute Convulsion" chapter)
Wuling San (Five-Poria Powder) (Formula found in the "Five Stranguries" chapter)
Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (Formula found in the "Kidney" chapter)