治下焦蕴蓄实热，膀胱肿胀，溺管闭塞，小便滴沥不通。
滑石（一两） 生杭芍（一两） 知母（八钱） 黄柏（八钱）
一人，年六十余，溺血数日，小便忽然不通，两日之间滴沥全无。病患不能支持，自以手揉挤，流出血
水少许，稍较轻松。揉挤数次，疼痛不堪揉挤。 徨无措，求为延医。其脉沉而有力，时当仲夏，身复浓被，
犹觉寒凉。知其实热郁于下焦，溺管因热而肿胀不通也。为拟此汤，一剂稍通，又加木通、海金沙各二钱，服
两剂全愈。
治小便滴沥不通。偶因呕吐咳逆，或侧卧欠伸，可通少许，此转胞也。用升提药，提其胞而转正之，胞
系不了戾，小便自利。
生黄 （五钱） 当归（四钱） 升麻（二钱） 柴胡（二钱）
一妇人，产后小便不利，遣人询方。俾用生化汤加白芍，治之不效，复来询方。言有时恶心呕吐，小便
可通少许。愚恍悟曰，此必因产时努力太过，或撑挤太甚，以致胞系了戾，是以小便不通。恶心呕吐，则气机
上逆，胞系有提转之势，故小便可以稍通也。遂为拟此汤，一剂而愈。
三焦之气化不升则不降。小便不利者，往往因气化下陷，郁于下焦，滞其升降流行之机也。故用一切利
小便之药不效，而投以升提之药恒多奇效。是以拙拟此汤，不但能治转胞，并能治小便癃闭也。
古方有但重用黄 ，治小便不利，积成水肿者（参阅陆定圃《冷庐医话》）。
水肿之证，有虚有实，实者似不宜用黄 。然其证实者甚少，而虚者居多。至其证属虚矣，又当详辨其
为阴虚阳虚，或阴阳俱虚。阳虚者气分亏损，可单用、重用黄 。阴虚者其血分枯耗，宜重用滋阴之药，兼取
阳生阴长之义，而以黄 辅之。至阴阳俱虚者，黄 与滋阴之药，可参半用之。医者不究病因，痛诋为不可用，
固属卤莽，至其连用除湿猛剂，其卤莽尤甚。盖病至
积成水肿，即病因实者，其气血至此，亦有亏损。猛悍药，或一再用犹可。若不得已而用至数次，亦宜以补气
血之药辅之。况其证原属重用黄 治愈之虚证乎。至今之医者，对于此证，纵不用除湿猛剂，亦恒多用利水之
品。不知阴虚者，多用利水之药则伤阴；阳虚者，多用利水之药亦伤阳。夫利水之药，非不可用，然贵深究其
病因，而为根本之调治，利水之药，不过用作向导而已。
【附方】葛稚川《肘后方》治小便不通，用大蝼蛄二枚，取下体，以水一升渍饮，须臾即通。
又《寿域方》用土狗后半，焙研调服半钱，小便即通，生研亦可。
又《唐氏经验方》用土狗后截和麝香捣，纳脐中缚定，即通。
按∶土狗即蝼蛄，《日华诸家本草》谓其治水肿，头面肿。李时珍谓其通大小便，治石淋，诚为利小便
要药。凡小便不通者，无论凉热虚实，皆可加于药中以为向导。即单服之，亦甚有效验。然观古方，皆用其后
半截。盖其前半，开破之力多，后半利水力多。若治二便皆不通者，当全用之。
俗传∶治小便不通闻药方。用明雄黄一钱，蟾酥五分（焙发），麝香六厘，共研细，鼻闻之，小便即通。
治疗下焦蕴蓄实热，膀胱肿胀，尿道闭塞，小便点滴不通。
滑石（一两） 生杭芍（一两） 知母（八钱） 黄柏（八钱）
有一人，六十多岁，尿血数日，小便突然不通，两天之间点滴全无。病人无法支撑，自己用手揉挤，流出少许血水，稍微轻松一些。揉挤多次后，疼痛难忍，不能再揉。惊慌无措，请求我为他请医生。其脉象沉而有力，时值仲夏，身上盖着厚被子，仍然觉得寒冷。我知道这是实热郁结在下焦，尿道因热而肿胀不通。于是为他拟定此汤，服用一剂后稍通，又加入木通、海金沙各二钱，服用两剂后完全痊愈。
治疗小便点滴不通。偶尔因为呕吐咳逆，或者侧卧伸懒腰，可以通出少许，这是转胞病。使用升提药，提升膀胱使其转正，膀胱系带扭转复位，小便自然通畅。
生黄芪（五钱） 当归（四钱） 升麻（二钱） 柴胡（二钱）
有一位妇人，产后小便不利，派人来询问方子。让她用生化汤加白芍治疗，无效，又来询问方子。她说有时恶心呕吐，小便可以通出少许。我恍然大悟说，这一定是因为生产时用力太过，或撑挤太甚，导致膀胱系带扭转，所以小便不通。恶心呕吐，则气机上逆，膀胱系带有被提起扭转的趋势，所以小便可以稍通。于是为她拟定此汤，服用一剂就痊愈了。
三焦的气化功能如果不升，就不能降。小便不利者，往往是因为气化下陷，郁结在下焦，阻滞了其升降流行的机制。所以使用一切利小便的药物无效，而投以升提药物往往有奇效。因此我拟定的此汤，不仅能治疗转胞，也能治疗小便癃闭。
古方中有只重用黄芪，治疗小便不利，积成水肿的（参阅陆定圃《冷庐医话》）。
水肿的病证，有虚有实，实证似乎不宜用黄芪。然而其实证很少，虚证居多。至于证属虚了，又应当详细辨别是阴虚还是阳虚，或是阴阳俱虚。阳虚者是气分亏损，可以单用、重用黄芪。阴虚者是血分枯耗，宜重用滋阴药物，兼取阳生阴长的意义，而以黄芪辅助。至于阴阳俱虚者，黄芪与滋阴药物，可以参半使用。医者不探究病因，痛斥为不可用，固然属于鲁莽，至于连续使用除湿猛剂，其鲁莽尤其严重。大概病至积成水肿，即使是实证，其气血至此，也有亏损。猛悍的药，或许一两次还可以。如果不得已用到数次，也应当以补气血的药物辅助。何况这个证原本是属于重用黄芪治愈的虚证呢。如今的医者，对于此证，纵然不用除湿猛剂，也常常多用利水的药物。不知道阴虚者，多用利水药物则伤阴；阳虚者，多用利水药物亦伤阳。利水的药物，并非不可用，但贵在深究其病因，进行根本性的调治，利水的药物，不过用作向导罢了。
【附方】葛稚川《肘后方》治疗小便不通，用大蝼蛄两只，取下体，用水一升浸泡饮用，片刻即通。
又《寿域方》用土狗后半段，焙干研末调服半钱，小便即通，生研也可以。
又《唐氏经验方》用土狗后半截和麝香捣碎，纳入脐中缚定，即通。
按：土狗即蝼蛄，《日华诸家本草》谓其治疗水肿，头面肿。李时珍谓其通大小便，治疗石淋，确实是利小便的要药。凡小便不通者，无论凉热虚实，都可以加入药中作为向导。即使单服，也很有疗效。然而看古方，都用其后半截。大概其前半部分，开破之力多，后半部分利水力多。如果治疗二便皆不通者，应当全用之。
俗传：治疗小便不通闻药方。用明雄黄一钱，蟾酥五分（焙发），麝香六厘，共研细，鼻闻之，小便即通。
Treats the accumulation of excess heat in the lower jiao, swelling of the bladder, obstruction of the urethra, and urinary retention with only a few drops.
Hua Shi (Talcum, 1 liang) Sheng Hang Shao (Raw Paeoniae Radix Alba, 1 liang) Zhi Mu (Anemarrhenae Rhizoma, 8 qian) Huang Bo (Phellodendri Cortex, 8 qian)
A patient, over sixty years old, had hematuria for several days, followed by sudden urinary retention, with no urine output at all for two days. The patient was unable to bear it and rubbed/squeezed the area with his hands, expelling a small amount of bloody water, which provided slight relief. After repeated squeezing, the pain became unbearable. In panic and helplessness, he asked me to find a doctor for him. His pulse was deep and forceful. It was mid-summer, and although he was covered with thick quilts, he still felt cold. I determined that excess heat was stagnating in the lower jiao, causing the urethra to swell and become obstructed due to heat. I prescribed this decoction. After one dose, urination slightly improved. Then, Mu Tong (Akebiae Caulis) and Hai Jin Sha (Lygodii Spora), each 2 qian, were added. After two doses, he was completely cured.
To treat urinary retention with only a few drops. Occasionally, due to vomiting or hiccups, or when lying on the side and stretching, a small amount of urine can pass; this is called "Zhuan Bao" (Cystoptosis/Bladder Displacement). Using lifting herbs to raise the bladder and restore its normal position, once the ligamentous attachments are untwisted, urination will naturally resume.
Sheng Huang Qi (Astragali Radix, 5 qian) Dang Gui (Angelicae Sinensis Radix, 4 qian) Sheng Ma (Cimicifugae Rhizoma, 2 qian) Chai Hu (Bupleuri Radix, 2 qian)
A woman suffered from difficult urination after childbirth and sent someone to ask for a prescription. She was advised to use Sheng Hua Tang (Decoction for Generating Blood) with added Bai Shao (Paeoniae Radix Alba), but it was ineffective. She returned asking for another prescription. She stated that she sometimes experienced nausea and vomiting, during which a small amount of urine could pass. I suddenly realized: this must be caused by excessive effort or pushing during delivery, leading to torsion of the bladder's ligamentous attachments, thus causing urinary retention. Nausea and vomiting cause the qi mechanism to rebel upwards, creating a tendency for the bladder ligaments to be lifted and twisted, allowing a small amount of urine to pass. Therefore, I prescribed this decoction, and she was cured after one dose.
When the qi transformation of the San Jiao (Triple Burner) fails to ascend, it cannot descend. Difficult urination often results from qi sinking and stagnating in the lower jiao, blocking the mechanism of ascending and descending circulation. Therefore, using all kinds of diuretic herbs is ineffective, while using lifting herbs often yields miraculous effects. Thus, my proposed decoction not only treats Zhuan Bao but also treats Long Bi (Urinary Retention).
Ancient formulas exist that use a heavy dose of Huang Qi alone to treat difficult urination accumulating into edema (see Lu Dingpu's *Leng Lu Yi Hua*).
Edema syndromes can be either deficiency or excess. Excess patterns seem unsuitable for Huang Qi. However, true excess patterns are rare, while deficiency patterns are common. Once the pattern is identified as deficiency, one must carefully distinguish between Yin deficiency, Yang deficiency, or combined Yin-Yang deficiency. Yang deficiency involves depletion of the Qi aspect and can be treated with single or heavy doses of Huang Qi. Yin deficiency involves exhaustion of the Blood aspect; it is appropriate to heavily use Yin-nourishing herbs, taking advantage of the principle that "Yang generates Yin," assisted by Huang Qi. For combined Yin-Yang deficiency, Huang Qi and Yin-nourishing herbs can be used in equal parts. Physicians who do not investigate the etiology and vehemently condemn its use are certainly reckless. Those who continuously use strong damp-draining agents are even more reckless. Generally, when the disease progresses to edema, even if the etiology is excess, the Qi and Blood have already been depleted by this stage. Potent and harsh drugs may be used once or twice. If unavoidable usage extends to several times, they should be assisted by Qi- and Blood-tonifying herbs. Moreover, these cases originally belong to deficiency patterns curable by heavy doses of Huang Qi. Today's physicians, regarding this condition, even if they do not use strong damp-draining agents, often excessively use diuretics. They fail to realize that for Yin deficiency, excessive use of diuretics damages Yin; for Yang deficiency, excessive use of diuretics also damages Yang. Diuretic herbs are not unusable, but it is crucial to deeply investigate the etiology and provide fundamental treatment; diuretic herbs serve merely as guides.
[Attached Formulas] Ge Zhichuan's *Zhou Hou Fang* treats urinary retention using two large earthworms (Lou Gu). Remove the posterior half, soak in one sheng of water, and drink. Urination clears shortly after.
Also, *Shou Yu Fang* uses the posterior half of the earthworm, dried and powdered, taken with liquid (half qian). Urination clears immediately; raw powder is also acceptable.
Also, *Tang Shi Jing Yan Fang* uses the posterior half of the earthworm mixed with Moschus (She Xiang), pounded, applied into the umbilicus and bound securely. Urination clears immediately.
Note: Tu Gou refers to Lou Gu (Earthworm/Antlion larva). *Ri Hua Zhu Jia Ben Cao* states it treats edema and facial swelling. Li Shizhen states it unblocks both large and small intestines/bladder and treats Stone Lin (Calculus). It is indeed an essential herb for promoting urination. For any case of urinary retention, regardless of cold, heat, deficiency, or excess, it can be added to prescriptions as a guide. Even taken alone, it is very effective. However, observing ancient formulas, only the posterior half is used. This is because the anterior half has stronger breaking/purging power, while the posterior half has stronger diuretic power. If treating blockage of both stool and urine, the whole insect should be used.
Folk tradition: A method to treat urinary retention by smelling a herbal powder. Use Ming Xiong Huang (Realgar, 1 qian), Chan Su (Toad Venom, 5 fen, dried until brittle), and She Xiang (Moschus, 6 li). Grind finely together. Inhale through the nose; urination clears immediately.