证在危急，韭地中蚯蚓泥捣，和水澄清饮之，立通。又方，大黄、滑石、皂角
各三钱为末，如小便势急，倍滑石，大便势急，倍大黄。又推车子七个，土狗七个，
新瓦上焙干为末，以虎目树（即虎杖）。皮向东南者，煎浓汤调服。又皂角末、葱白连须，
加麝香二分，蜜少许，捣贴脐下至毛际。湿热痰火结滞，脉洪盛，肢节烦疼，（湿热也。）
凉膈散（见发热）、通圣散（见中风）。吐逆，二便不通，导气清利汤。痰隔中焦，气聚上焦不
下，二陈（见痰）加木通，先服后吐。烧皂角灰为末，粥清调服。皂角去皮弦、琥珀各一
钱，麝少许，神曲为丸，作二次服，用升提分利药送下之，立通。少顷未通，探吐
之，无不通者。
点滴不出，小腹胀痛，由气道闭塞。（六淫七情，痰食血气，内外诸邪，皆能闭气。）
气分上中
下三焦。上焦之气肺主之，肺热则气不下行，治宜清降。中焦之气脾胃主之，湿盛
或热盛，而气滞不行，须治湿热。若气虚而下陷不运，须升清以降浊。下焦之气肝
肾主之，肾移热于膀胱，无阴则阳无以化，须纯阴之剂，滋肾丸。肝脉过阴器，肝
火郁不伸，则癃闭，肝火疏泄，则为遗溺，治取肝经俞穴。又下焦脉在膀胱经前，
胆经后，出于 中外廉，曰委阳，膀胱经络也。下焦火盛则癃闭，虚则遗溺。
又督脉，女子入系廷孔，男子循茎下至篡，其病癃闭遗溺，治取督脉俞穴。（不取膀胱俞
穴者，以膀胱但脏溺，其出溺皆从三焦督脉及肝也。）丹溪云∶肺热不生水清金，
乃隔二之治也。脾
湿不运，清不升，浊不降，故肺气壅闭不下行，燥湿健脾，乃隔三之治也。若不关
脾肺，但膀胱有热，直泻膀胱，乃正治也。东垣分在气在血，以渴不渴为辨。渴者
热在肺，属气分，用淡渗之药，茯苓、猪苓、泽泻、琥珀、灯心、通草、车前、
瞿麦、扁蓄等气薄之品，气薄为阳中之阴，从阳而下降者也。不渴者热在下焦，属
血分，须用纯阴之剂，无阴则阳无以化，黄连、黄柏、知母、滑石之类。（淡渗之品，
乃阳中之阴，非阴中之阳，勿用。）热实者，八正散（见淋）加木香。腹痛不可忍，
木通汤。上喘，
红秫散。肾虚寒，气不化者，甚而转筋，不救，肾气丸（见虚损）。此为下元冷秘，常有
用桂附乃通者。气虚不化，而不急满，惟倦怠懒言，春泽汤（见伤湿）。津液藏于膀胱，
气化乃能出，故用沉香、橘红之属。或用吐法，以提其气，气升则水自降，如滴水
之器，上窍开，下窍乃通也。（气虚而不升化，用参、 等药，先服后吐之，痰多闭气，
用二陈，先服后
吐之，更推类，以尽其余。）或由大便不通，而小便渐闭者，通大便则小便自行。瘀血闭气
者，宜多用牛膝，实者桃仁煎、代抵当丸、（见血。）牛膝膏。（见淋。）渴而腹冷，水气也，
（水蓄腹中故冷，停蓄不运，清气不升，津液不生，故渴。不降，故小便闭。）
栝蒌瞿麦丸主之，便利腹温
为度。小便不通，及转胞危急，诸药不效，用猪尿脬一个，底头穿一小孔，贯一通
透翎筒，线扎紧，翎筒口塞以蜡，从脬口吹气，满七分，线扎紧，再用手捻紧
翎筒根，令不泄气，乃去筒口之蜡，将筒口插入茎物窍内，放手，（放开捻筒根之手也。）却
捻猪脬，使气透入膀胱，小便即出。小便不通，呕逆，饮食不得入，名关格。若头
汗出者（阳脱）死，脉细涩者（知阴亦竭）亦死。葱白一斤，碎切，入麝香五分，拌匀，分二包，
先用一包置脐上，以炭火熨斗熨之，半炷香久，换一包，以熨斗盛冷水熨之，
互相换熨，以通为度。或以木通、老葱煎汤服，顷时探吐，再服再吐，以通为度。
或身无汗，以葱汤入木桶内，令病者坐杌上，没脐为度，匝腰系裙以覆之，少
时汗出尿亦出，即于桶中溺之，勿出桶，恐气收而尿又回也。孕妇胎满，逼压尿脬，
胞转翻倾侧，胞系了戾，不得小便，名转胞。须举其胎，令稳婆香油抹手，入产户
托起其胎，溺出如注。次以人参、白术、陈皮、升麻，加入四物汤（见血）内煎服，顷时
以指探吐，如此三四次，则胎举矣。一法令孕妇卧榻上，连榻倒竖起，尿自出，胜
手托。男子亦有转胞。妇人转胞，不必尽由胎压，多因尿急脬胀。而骤马驰车，飞
跑疾走，致脬 翻，或水溢中焦，食满肠胃，下压膀胱，无处退避，以致闪侧翻转，
（热攻气迫者可推。）并须吐法。滑石散。《金匮》，妇人病，饮食如故，（病不在胃。）烦热不得卧，
倚息，（喘也，不下通则上干，故烦喘不得卧，阳被迫浮越，故热。）此转胞不得溺也，（
此由虚寒，气不化，
溺急胞胀，重坠翻转。）肾气丸。（即八味丸，见虚损。）
证候处于危急状态时，取韭菜地中的蚯蚓泥捣烂，加水澄清后饮用，小便立即通畅。另一方，大黄、滑石、皂角各三钱研为细末，如果小便不通的症状急迫，加倍使用滑石；如果大便不通的症状急迫，加倍使用大黄。又一方，取推车子七个、土狗（蝼蛄）七个，在新瓦上焙干研为细末，用虎目树（即虎杖）的皮（选取朝向东南方向的），煎煮浓汤调服。又一方，用皂角末、带须的葱白，加入麝香二分、少许蜂蜜，捣烂后贴敷于脐下至阴毛际处。若是湿热、痰火结滞所致，脉象洪大旺盛，肢体关节烦痛（这是湿热的表现），可用凉膈散（见发热章节）、通圣散（见中风章节）。若出现呕吐逆气，大小便均不通利，用导气清利汤。若是痰邪阻隔中焦，气机聚集在上焦不能下行，用二陈汤（见痰章节）加木通，先服用然后催吐。将皂角烧成灰研为细末，用米粥的清液调服。皂角去皮弦、琥珀各一钱，少许麝香，神曲为丸，分两次服用，用具有升提和分利作用的药物送服，小便立即通畅。过了一会儿仍不通，采用探吐法，没有不通的。
点滴尿不出，小腹胀痛，这是由于气道闭塞。（六淫、七情、痰食、血气以及内外各种邪气，都能导致气机闭塞。）气分涉及上、中、下三焦。上焦的气由肺所主，肺热则气不能下行，治疗宜清降。中焦的气由脾胃所主，湿气盛或热气盛导致气机阻滞不行，必须治疗湿热。如果是气虚而下陷不能运化，必须升举清气以降浊阴。下焦的气由肝肾所主，肾将热移于膀胱，无阴则阳无法气化，需用纯阴的药物，如滋肾丸。肝经脉络经过阴器，肝火郁结不得舒展，则导致小便癃闭；肝火疏泄太过，则导致遗尿，治疗应选取肝经的俞穴。另外下焦的脉在膀胱经之前，胆经之后，出于中外廉穴，名为委阳，是膀胱经的络穴。下焦火盛则导致癃闭，虚则导致遗尿。还有督脉，女子进入廷孔，男子沿阴茎下行至会阴，其病证为癃闭、遗尿，治疗应选取督脉的俞穴。（不选取膀胱俞穴的原因，是因为膀胱只是贮存尿液，排出尿液都通过三焦、督脉及肝经来完成。）丹溪说：肺热不生水，清金（清肺），这是隔二之治。脾湿不运，清阳不升，浊阴不降，导致肺气壅闭不能下行，燥湿健脾，这是隔三之治。如果不关乎脾肺，仅是膀胱有热，直接泻膀胱之火，这是正治。东垣区分在气在血，以口渴与否作为辨别标准。口渴的是热在肺，属于气分，用淡渗的药物，如茯苓、猪苓、泽泻、琥珀、灯心草、通草、车前子、瞿麦、扁蓄等气薄之品，气薄属于阳中之阴，从阳而下降。不口渴的是热在下焦，属于血分，需用纯阴的药物，无阴则阳无法气化，如黄连、黄柏、知母、滑石之类。（淡渗之品，乃阳中之阴，并非阴中之阳，不要误用。）热实证，用八正散（见淋证章节）加木香。腹痛难以忍受，用木通汤。上气喘促，用红秫散。肾虚寒，气不化者，甚至出现转筋，预后不良，用肾气丸（见虚损章节）。这属于下元冷秘，常有使用桂枝、附子而通利的情况。气虚不化，且腹部不紧急胀满，只有倦怠懒言，用春泽汤（见伤湿章节）。津液藏于膀胱，气化后才能排出，所以用沉香、橘红之类的药物。或者用吐法，以提举气机，气升则水自降，如同滴水之器，上窍开则下窍通。（气虚而不能升化，用人参、[原文缺字，推测为黄芪等补气药]等药，先服用然后催吐；痰多闭气，用二陈汤，先服用然后催吐，以此类推，穷尽其理。）或者由于大便不通，导致小便逐渐闭塞，通利大便则小便自行通畅。瘀血闭气者，宜多用牛膝，实证用桃仁煎、代抵当丸（见血证章节）、牛膝膏（见淋证章节）。口渴而腹部发冷，是水气病，（水蓄积在腹中故寒冷，停蓄不运，清气不升，津液不生，故口渴；水不降，故小便闭），用栝蒌瞿麦丸主治，以二便通利、腹部温暖为度。小便不通，以及转胞危急，诸药无效，用一个猪膀胱，底部穿一个小孔，插入一根通透的羽毛管，线扎紧，羽毛管口用蜡塞住，从膀胱口吹气，充满七分，线扎紧，再用手捏紧羽毛管根部，令不漏气，然后去掉筒口的蜡，将筒口插入尿道内，放手，（放开捏管根的手），再捏猪膀胱，使气透入膀胱，小便即出。小便不通，呕吐逆气，饮食不能入口，称为关格。如果头汗出（阳气脱失），死；脉细涩（阴液亦竭尽），也死。葱白一斤，切碎，加入麝香五分，拌匀，分两包，先用一包放在脐上，用炭火熨斗熨烫，约半炷香时间，换一包，用熨斗盛冷水熨烫，互相交替熨烫，以通利为度。或者用木通、老葱煎汤服用，一会儿后催吐，再服再吐，以通利为度。或者身体无汗，用葱汤倒入木桶内，让病人坐在凳子上，没至肚脐为度，腰间系裙以覆盖，一会儿出汗，尿也会出来，就在桶中小便，不要出桶，恐怕气收而尿又回去。孕妇胎满，压迫膀胱，胞转翻倾侧，胞系了戾，不得小便，称为转胞。须举起胎儿，令稳婆香油抹手，进入产户托起胎儿，溺出如注。随后用人参、白术、陈皮、升麻，加入四物汤（见血证章节）内煎服，一会儿后用手指催吐，如此三四次，则胎儿举起来了。另一法让孕妇卧床，连床倒竖起，尿自然流出，胜过手托。男子也有转胞。妇人转胞，不一定全由胎压引起，多因尿急膀胱胀。突然骑马乘车，飞跑疾走，导致膀胱翻转，或者水溢中焦，食物充满肠胃，下压膀胱，无处退避，以致闪侧翻转，（热攻气迫者可推断），都必须用吐法。滑石散。《金匮要略》记载，妇人病，饮食如常，（病不在胃），烦热不得卧，倚息（喘，不下通则上干，故烦喘不得卧，阳被迫浮越，故热），这是转胞不得溺，（此由虚寒，气不化，溺急胞胀，重坠翻转），用肾气丸。（即八味丸，见虚损章节）。
When the condition is critical, earthworm mud from leek fields is mashed, mixed with water, clarified, and drunk, resulting in immediate urination. Another prescription consists of Rhizoma et Radix Rhei (Dahuang), Talcum (Huashi), and Fructus Gleditsiae Sinensis (Zaojiao), each three qian, ground into powder. If urinary urgency is severe, double the amount of Talcum; if defecatory urgency is severe, double the amount of Rhizoma et Radix Rhei. Another method involves using seven chariots' wheels and seven mole crickets (Lougu), baked on new tiles until dry, then ground into powder, taken with a strong decoction of Cortex Polygoni Cuspidati (Huzhang) bark (specifically that facing southeast). Another method uses powder of Fructus Gleditsiae Sinensis, green onion whites with roots, two fen of Moschus (Shexiang), and a little honey, mashed and applied to the area below the navel down to the pubic region. For urinary retention due to damp-heat or phlegm-fire stagnation, with a surging pulse and painful limbs/joints (indicative of damp-heat), use Liangge San (see Fever) or Tongsheng San (see Stroke). For vomiting and reversal of qi with both urinary and fecal obstruction, use Daoqi Qingli Tang. For phlegm obstructing the Middle Jiao and qi accumulating in the Upper Jiao failing to descend, use Erchen Tang (see Phlegm) added with Caulis Akebiae (Mutong), administered first followed by inducing vomiting. Burnt powder of Fructus Gleditsiae Sinensis can be taken with rice water. Powder of Fructus Gleditsiae Sinensis (without skin and rind) and Succinum (Hupo), one qian each, with a little Moschus, formed into pills with Massa Medicata Fermentata (Shenqu), taken in two doses, delivered with herbs that promote ascending and separating/drainage, leading to immediate urination. If still obstructed shortly after, induce vomiting; there are no cases of failure.
Inability to pass even drops of urine, with distension and pain in the lower abdomen, is caused by blockage of the qi mechanism. (Six Excesses, Seven Emotions, phlegm-food stasis, blood and qi issues, and various internal/external pathogens can all close the qi mechanism.) Qi distribution involves the Upper, Middle, and Lower Jiao. The Upper Jiao qi is governed by the Lung; lung heat prevents qi from descending, so treatment should clear and descend. The Middle Jiao qi is governed by the Spleen and Stomach; excess dampness or heat causes qi stagnation, requiring treatment of damp-heat. If qi deficiency leads to sinking and failure to transport, clearing the upper and descending the turbid must be promoted. The Lower Jiao qi is governed by the Liver and Kidney; kidney heat transferring to the Bladder without yin fluid means yang cannot transform, requiring pure yin formulas like Zishen Wan. The Liver meridian passes through the genitalia; liver fire stagnating causes urinary retention (Longbi), while excessive liver fire dispersion causes enuresis; treatment should select acupoints from the Liver meridian. Additionally, the lower jiao pulse is located anterior to the Bladder meridian and posterior to the Gallbladder meridian, emerging at the Zhongwai Lian point, named Weiyang, which is the Luo-connecting point of the Bladder meridian. Excess fire in the lower jiao causes Longbi, while deficiency causes enuresis. The Du Meridian enters the Ting Kong in women and runs along the penis to the perineum in men; its diseases include Longbi and enuresis, treated by selecting acupoints from the Du Meridian. (Bladder Shu points are not selected because the Bladder merely stores urine, while the process of voiding is directed by the Sanjiao, Du Meridian, and Liver.) Danxi stated: Lung heat failing to generate water and clear metal (Lung) is a "two-steps away" treatment. Spleen dampness failing to transport, preventing clear ascent and turbid descent, causing Lung qi congestion and failure to descend, treating with drying dampness and strengthening the spleen is a "three-steps away" treatment. If unrelated to Spleen/Lung but involving Bladder heat, directly draining Bladder heat is the direct treatment. Dongyuan distinguished between Qi and Blood levels based on thirst. Thirst indicates heat in the Lung, belonging to the Qi level, treated with light diuretic herbs such as Poria (Fuling), Polyporus (Zhuling), Alisma (Zexie), Succinum (Hupo), Juncus Effusus (Dengxin), Tinosporae Caulis (Tongcao), Plantaginis Semen (Cheqian), Dianthus Superbus (Qumai), and Polygoni Cuspidati Herba (Bianfu). These are thin-qi substances, Yang within Yin, descending from Yang. No thirst indicates heat in the Lower Jiao, belonging to the Blood level, requiring pure yin agents like Coptidis Rhizoma (Huanglian), Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu), and Talcum (Huashi). (Light diuretics are Yang within Yin, not Yin within Yang, do not use them for this purpose.) For heat-excess patterns, use Bazheng San (see Strangury) added with Aucklandiae Radix (Muxiang). For unbearable abdominal pain, use Mutong Tang. For upper asthma, use Hongshu San. For Kidney deficiency-cold with failure of qi transformation, potentially leading to muscle spasms and poor prognosis, use Shenqi Wan (see Deficiency Damage). This is cold constipation of the lower origin, often treated with Cinnamomi Ramulus (Guizhi) and Aconiti Lateralis Radix Praeparata (Fuzi) to achieve flow. For qi deficiency failing to transform without urgent fullness, only fatigue and reluctance to speak, use Chunze Tang (see Injury from Dampness). Fluids are stored in the Bladder and exit via qi transformation; thus, Aquilariae Lignum Resinatum (Chenxiang) and Citri Reticulatae Pericarpium (Juhong) are used. Vomiting methods may be used to lift qi; when qi ascends, water descends, like a dripping vessel where opening the upper orifice opens the lower. (For qi deficiency failing to ascend and transform, use Ginseng [and other tonics], administer first then induce vomiting; for phlegm blocking qi, use Erchen Tang, administer first then induce vomiting; extend this logic exhaustively.) Sometimes, fecal obstruction leads to gradual urinary closure; unblocking stool allows spontaneous urination. For blood stasis blocking qi, use more Achyranthis Bidentatae Radix (Niuxi); for excess patterns, use Taoren Jian, Daidi Dang Wan (see Blood Stasis), or Niuxi Gao (see Strangury). Thirst with cold abdomen indicates Water Qi (water accumulation in abdomen causes cold; stagnation prevents clear ascent and fluid generation, causing thirst; turbid descent fails, causing urinary closure). Treat with Gualou Qumai Wan, aiming for free bowel/bladder movements and warm abdomen. For urinary retention and acute Zhuantao (retention due to bladder torsion) where drugs fail, use one pig bladder, pierce a small hole in the base, insert a hollow feather quill, tie tightly, seal quill end with wax, blow air into the bladder until 70% full, tie tight, pinch quill root to prevent leakage, remove wax, insert quill into urethra, release hand, then squeeze bladder to force air into bladder, causing urination. Urinary retention with vomiting and inability to eat is called Guange (Closed and Reversed). Head sweating indicates Yang collapse (death); fine and choppy pulse indicates Yin exhaustion (death). One jin of green onion white, chopped, mixed with five fen of Moschus, divided into two packs. Place one pack on the navel, iron with charcoal iron for half an incense stick time, switch to the second pack, iron with cold water-filled iron, alternate until urination resumes. Alternatively, drink Mutong and old green onion decoction, induce vomiting after a moment, repeat until passage. Or, if no sweat, sit in a wooden tub filled with green onion water up to the navel, wrap waist with skirt, wait for sweat and urination, remain in tub to prevent qi retraction. In pregnant women, fetal pressure on the bladder causes Zhuantao (torsion/flipping of the bladder sac), named Zhuantao. The fetus must be lifted; a midwife with oiled hands inserts into the vagina to lift the fetus, allowing urine to gush out. Then administer Ren Shen, Bai Zhu, Chen Pi, Sheng Ma added to Siwu Tang (see Blood Stasis), boil and drink, induce vomiting with finger after a short while, repeat 3-4 times to lift the fetus. Another method: have the pregnant woman lie on a bed, tilt the bed vertically upside down, urine flows naturally, superior to manual lifting. Men also suffer from Zhuantao. Women's Zhuantao is not always due to fetal pressure, often due to urgent urination and bladder distension. Sudden riding or running causes bladder flipping, or water overflowing to Middle Jiao, food filling intestines pressing on Bladder, leaving no room to retreat, causing twisting/flipping (pushable by heat attacking and qi forcing). All require vomiting methods. Huashi San. *Jinkui Yaolue* states: Women's disease, normal diet (disease not in Stomach), irritability, heat, inability to lie flat, orthopnea (asthma, upward disturbance due to downward blockage causes irritability/asthma, forced floating of Yang causes heat), this is Zhuantao with inability to urinate (due to deficiency-cold, qi failure to transform, urgent urine causing bladder distension and heavy twisting). Use Shenqi Wan (i.e., Babawei Wan, see Deficiency Damage).