（转胞）
大全云∶妊娠小便不通，为小肠有热，传于胞而不通耳。若兼心肺气滞，则致喘急。陈
无择云∶妊娠胎满逼胞，多致小便不利。若心肾气虚，清浊相干，则为诸淋；若胞系了戾，小
便不通，名曰转胞；若胎满尿出，名曰遗尿。
丹溪云∶转胞病，胎妇禀受弱者，忧闷多者，性躁急者，食味浓者，大率有之。古方皆用
滑利疏导药，鲜有应效，因思胞为胎所压，转在一旁，胞系了戾不通耳。胎若举起，悬在中
央，胞系得疏，水道自行。然胎之坠下，必有其由。一日吴宅宠人患此，脉之两手似涩，重取
则弦，左手稍和。予曰∶此得之忧患，涩为血少气多，弦为有饮。血少则胞弱而不能自举，气
多有饮，中焦不清而隘，则胞知所避而就下，故喜坠。遂以四物汤加参、术、半夏、陈皮、生
甘草、生姜空心饮，随以指探喉中，吐出药汁，候少顷，气定，又与一帖，次日亦然，如是八帖
而安。此法果为的确，恐偶中耳，后有数人，历历有效，未知果何如耶？仲景云∶妇人本肌盛，
头举身满，今反羸瘦，头举中空减，胞系了戾，亦致胞转，其义未详，必有能知之者。一妇
人四十一岁，妊孕九个月，转胞，小便不出三日矣，下急脚肿，不堪存活。来告急，予往视
之，见其形瘁，脉之右涩，而左稍和，此饱食而气伤，胎系弱不能自举而下坠，压着膀胱，偏
在一旁，气急为其所闭，所以水窍不能出也，转胞之病，大率如此。予遂制一方，补血养气，
血气既正，胎系自举，则不下坠，方有安之理，遂作人参、当归身尾、白芍药、白术、陈皮、炙
甘草、半夏、生姜煎浓汤，与四帖，任其叫啖。至次早，又与四帖，药渣作一帖，煎令顿饮之，
探喉，令吐出次药汤，小便立通，皆黑水，后就此方加大腹皮、枳壳、青葱叶、缩砂仁，二十帖
与之，以防产前后之虚，果得就蓐平安，产后亦健。一妇人妊娠七八个月，患小便不通，
百医不能利，转加急胀，诊其脉细弱。予意其
血气虚弱，不能承载其胎，故胎重坠下，压住膀胱下口，因此溺不得出，若服补药升扶，胎
起则自下，药力未至，愈加急满，遂令一老妇，用香油涂手，自产门入，托起其胎，溺出如注，
胀急顿解。一面却以人参、黄 、升麻大剂煮服，或少有急满，仍用手托放取溺，如此三日
后，胎渐起，小便如故。（又一法，以健人同病妇皆仰卧，将两足直伸相对，其健人以双足抵
病患足，频频细耸，令病患身亦细细频耸，则胎自随耸而上，胞不了戾，而小便自通矣。其
无妊妇人亦有胞系了戾，溺不出者，可令伶俐收生妇人，以手法转其胞，溺亦随出矣。又有
将病妇两足倒提向上，如是数次，溺亦随通。并附之）
薛氏曰∶前证亦有脾肺气虚，不能下输膀胱者；亦有气热郁结膀胱，津液不利者；亦有
金为火烁，脾土湿热甚而不利者。更当详审施治。
司徒李杏冈仲子室孕五月，小便不利，诸药不应。余曰∶非八味丸不能救。不信，别用
分利之药，肚腹肿胀，以致不起。
儒者王文远室患此，小腹肿胀，几至于殆，用八味丸一服，小便滴沥，再以前丸料加
车前子一剂即利，肚腹顿空而安。
仲景云∶问曰妇人病，饮食如故，烦热不卧而反得倚息者，何也？师曰∶此名转胞不得
溺也，以胞系了戾，故致此病，但利小便则愈，宜肾气丸主之。（即八味丸，方见虚劳，每以酒下十五丸
至二十丸，日再服。）
冬葵子散 治孕妇转胞，小便不通，及男子小便不通，皆效。
冬葵子 山栀子（炒） 滑石（各半两） 木通（三钱）
上锉，一剂，水煎，空心温服。外以冬葵子、滑石、栀子为末，田螺肉捣膏，或葱汁调膏
贴脐中立通。
全生茯苓散 治妊娠小便不通。
赤茯苓 冬葵子（各等分）
上 咀，每服五钱，水煎，空心服。济生方加发灰少许，极效。
葵榆汤 治妊娠小便不通，脐下妨闷，心神烦乱。
葵子（研） 榆白皮（切，各一两）
上水煎，分三服。
独圣散 治妊娠小便不通。
蔓荆子为末，每服二钱，食前，浓煎葱白汤调下。（蔓荆子凉诸经之血，其性轻扬，有升
一之义）
归母苦参丸 治妊娠小便难，饮食如故。
当归 贝母 苦参（各四两）
上为末，炼蜜为丸，如小豆大，每服三丸，加至十丸。男子加滑石半两。
杂方治妊娠卒不得小便。
杏仁去皮尖，炒黄，捣丸如绿豆大，灯心汤吞七粒。一方捣杏仁入滑石末，饭丸小豆
大，每服二十丸，白汤下。一方滑石为末，水和涂脐下。一方车前子捣汁，调滑石末涂脐
周遭四寸，热易之。一方紫菀为丸，井华水调下二钱。一方桑螵蛸捣末，米饮服方寸
匕，日三服。
（转胞）
《大全》记载：妊娠期间小便不通，是因为小肠有热，热邪传入膀胱导致不通畅。如果同时伴有心肺气机阻滞，就会导致气喘急促。陈无择说：妊娠时胎儿增大压迫膀胱，多导致小便不利。如果心肾气虚，清浊之气相互干扰，就会形成各种淋证；如果膀胱系带扭曲，小便不通，称为“转胞”；如果因胎满而尿液流出，称为“遗尿”。
朱丹溪说：患转胞病的孕妇，大多是体质虚弱、忧愁郁闷多、性情急躁、饮食口味浓厚的人。古方都用滑利疏导的药物，很少见效。我思考这是因为膀胱被胎儿压迫，偏转在一侧，膀胱系带扭曲不通。如果胎儿能举起，悬在中央，膀胱系带得以疏通，水道自然通畅。然而胎儿下坠必有其原因。有一天吴家宠妾患此病，诊脉两手脉象似涩，重按则弦，左手稍和缓。我说：这是由忧患引起的，涩脉代表血少气多，弦脉代表体内有水饮。血少则膀胱虚弱不能自行举起，气多有水饮，中焦不清且狭窄，膀胱知道避开而上行受阻就向下，所以喜欢下坠。于是用四物汤加入人参、白术、半夏、陈皮、生甘草、生姜，空腹服用，随即用手指探喉催吐药汁，等片刻气定后，再服一帖，第二天也这样做，如此共服八帖而痊愈。这个方法确实有效，恐怕是偶然中的，后来又有几个人，效果明显，不知究竟是何道理？张仲景说：妇人原本肌肉丰盛，头部抬起身体丰满，现在反而消瘦，头部抬起中间空虚减少，膀胱系带扭曲，也会导致膀胱扭转，其中的含义不详，一定有能懂得的人。一位41岁的妇女，怀孕九个月，患转胞，三天不出小便，小腹急迫脚肿，痛苦不堪无法生存。来告急，我去诊治，见她形体憔悴，诊脉右脉涩，左脉稍和缓，这是饱食后伤气，胎系虚弱不能自行举起而下坠，压着膀胱，偏在一侧，气机急迫被其闭塞，所以尿道不能排出，转胞的病，大抵都是这样。于是我制定一方，补血养气，气血既正，胎系自然举起，就不下坠，方子才有安胎的道理，于是用人参、当归身尾、白芍药、白术、陈皮、炙甘草、半夏、生姜煎浓汤，给她服四帖，任凭她呕吐。到第二天早上，又给四帖，药渣再作一帖，煎好后顿服，探喉令吐出次药汤，小便立即通畅，排出的都是黑水，后来在此方中加入大腹皮、枳壳、青葱叶、缩砂仁，共二十帖给她，以防产前产后之虚，果然临产平安，产后也很健康。另一位妇女怀孕七八个月，患小便不通，众多医生治疗无效，转加急胀，诊其脉细弱。我推测她是气血虚弱，不能承载胎儿，所以胎儿沉重下坠，压住膀胱下口，因此溺不得出，如果服用补药升提扶持，胎儿起来则自然下行，但药力未到，更加急满，于是让一位老妇，用香油涂手，从产门进入，托起其胎儿，溺出如注，胀急顿时解除。一面却让人用人参、黄芪、升麻大剂量煮服，如果稍有急满，仍用手托放取溺，如此三日后，胎儿渐渐升起，小便恢复正常。（又一法，让健康人和患病孕妇都仰卧，将两足直伸相对，健康人用双足抵住病患足，频频轻轻耸动，令病患身体也细细频繁耸动，则胎儿自然随耸动而上，膀胱系带不扭曲，而小便自然通畅了。没有怀孕的妇女也有膀胱系带扭曲，溺不出者，可以让灵巧的接生婆，用手法治转其膀胱，溺也随即而出。又有将病患两足倒提向上，如此数次，溺也随即通畅。一并附记于此）
薛己说：前证也有脾肺气虚，不能下输膀胱的；也有气热郁结膀胱，津液不利的；也有金为火烁，脾土湿热甚而不利的。更应当详细审察施治。
司徒李杏冈的二儿媳怀孕五个月，小便不利，诸药无效。我说：非八味丸不能救。不信，另用分利之药，肚腹肿胀，以致不起。
儒者王文远的妻子患此病，小腹肿胀，几乎危及生命，用八味丸一服，小便滴沥，再用以前丸料加入车前子一剂即通利，肚腹顿时空而安。
张仲景说：问曰妇人病，饮食如故，烦热不卧而反得倚息者，何也？师曰：此名转胞不得溺也，以胞系了戾，故致此病，但利小便则愈，宜肾气丸主之。（即八味丸，方见虚劳，每以酒下十五丸至二十丸，日再服。）
冬葵子散 治疗孕妇转胞，小便不通，以及男子小便不通，都有效。
冬葵子 山栀子（炒） 滑石（各半两） 木通（三钱）
上锉，一剂，水煎，空心温服。外以冬葵子、滑石、栀子为末，田螺肉捣膏，或葱汁调膏贴脐中立通。
全生茯苓散 治疗妊娠小便不通。
赤茯苓 冬葵子（各等分）
上咀，每服五钱，水煎，空心服。济生方加发灰少许，极效。
葵榆汤 治疗妊娠小便不通，脐下妨闷，心神烦乱。
葵子（研） 榆白皮（切，各一两）
上水煎，分三服。
独圣散 治疗妊娠小便不通。
蔓荆子为末，每服二钱，食前，浓煎葱白汤调下。（蔓荆子凉诸经之血，其性轻扬，有升一之义）
归母苦参丸 治疗妊娠小便难，饮食如故。
当归 贝母 苦参（各四两）
上为末，炼蜜为丸，如小豆大，每服三丸，加至十丸。男子加滑石半两。
杂方治疗妊娠突然不得小便。
杏仁去皮尖，炒黄，捣丸如绿豆大，灯心汤吞七粒。一方捣杏仁入滑石末，饭丸小豆大，每服二十丸，白汤下。一方滑石为末，水和涂脐下。一方车前子捣汁，调滑石末涂脐周遭四寸，热易之。一方紫菀为丸，井华水调下二钱。一方桑螵蛸捣末，米饮服方寸匕，日三服。
(Transposition of the Bladder)
The *Daquan* records: In pregnancy, retention of urine is caused by heat in the Small Intestine transmitting to the bladder (Bladder), leading to obstruction. If accompanied by Qi stagnation in the Heart and Lungs, it results in panting and urgency. Chen Wuyue states: During pregnancy, when the full fetus compresses the bladder, it often leads to difficult urination. If there is deficiency of Qi in the Heart and Kidney, causing turbid and clear energies to interfere with each other, various types of strangury (Lin Syndrome) occur; if the ligamentous system of the bladder is twisted, resulting in urinary retention, it is called "Zhuan Bao" (Transposition of the Bladder); if urine leaks out due to fetal fullness, it is called "Yi Niao" (Urinary Incontinence).
Zhu Danxi says: Women suffering from Zhuan Bao are mostly those with weak constitutions, prone to worry and depression, irritable temperaments, or those who consume rich-flavored foods. Ancient prescriptions all used slippery and draining herbs, but rarely achieved efficacy. I reasoned that the bladder was compressed by the fetus, shifted to one side, and its ligamentous system was twisted and obstructed. If the fetus were lifted and suspended centrally, the bladder's ligamentous system would be unblocked, and the water pathway would function naturally. However, the downward displacement of the fetus must have a cause. One day, a concubine in the Wu household suffered from this condition. Her pulse was slightly choppy in both hands, becoming wiry upon heavy pressure, while the left hand was slightly harmonious. I said: This resulted from worry and distress. A choppy pulse indicates blood deficiency and excess Qi; a wiry pulse indicates fluid retention. Blood deficiency makes the bladder weak and unable to lift itself; excess Qi with fluid retention causes the Middle Jiao to be unclear and narrow, so the bladder avoids upward movement and descends, hence preferring to drop. Therefore, I prescribed Siwu Tang (Four Substances Decoction) added with Ginseng (Ren Shen), Atractylodes Macrocephala (Bai Zhu), Pinellia (Ban Xia), Tangerine Peel (Chen Pi), Raw Licorice (Sheng Gan Cao), and Fresh Ginger (Sheng Jiang), taken on an empty stomach. Immediately after, I induced vomiting by probing the throat with a finger. After the Qi settled, another dose was given, repeated the next day. After eight doses, she recovered. This method proved effective, though perhaps by chance. Later, several others showed distinct efficacy; I wonder what the true principle is? Zhang Zhongjing stated: Women originally having abundant flesh, with heads raised and bodies full, now become emaciated, with heads raised but centers hollow and reduced. The bladder's ligamentous system twists, also causing bladder transposition. The meaning is unclear; surely someone knows it. A 41-year-old woman, nine months pregnant, suffered from Zhuan Bao, with no urination for three days. Her lower abdomen was urgent, feet swollen, unbearable suffering. She sought emergency help. Upon examination, her form was emaciated; the right pulse was choppy, the left slightly harmonious. This indicated injury to Qi after overeating, weakness of the fetal ligament preventing self-lifting and causing descent, pressing on the bladder, shifting it to one side. Qi urgency was blocked by this, so the urinary orifice could not open. Zhuan Bao disease is generally like this. Thus, I formulated a prescription to nourish Blood and tonify Qi. Once Blood and Qi are rectified, the fetal ligament lifts naturally, preventing descent, ensuring safety. I prepared a decoction of Ginseng, Angelica Sinensis (Dang Gui) body and tail, White Peony Root (Bai Shao), Atractylodes Macrocephala (Bai Zhu), Tangerine Peel (Chen Pi), Roasted Licorice (Zhi Gan Cao), Pinellia (Ban Xia), and Fresh Ginger (Sheng Jiang), boiled into a thick decoction. She took four doses, allowing herself to vomit. By the next morning, another four doses were given. The dregs were boiled as one dose, taken in one gulp, then inducing vomiting to expel the subsequent medicinal soup. Urination immediately flowed, discharging dark water. Later, adding Large Cardamom Fruit (Da Fu Pi), Bitter Orange (Zhi Ke), Green Onion Leaves (Qing Cong Ye), and Amomum Villosum (Suo Sha Ren) to this formula, she took twenty doses to prevent deficiency before and after delivery. Indeed, she delivered safely and remained healthy postpartum. Another woman, seven to eight months pregnant, suffered from urinary retention. Hundreds of doctors failed to promote urination, worsening distension. Her pulse was fine and weak. I surmised her Qi and Blood were deficient, unable to support the fetus, causing the heavy fetus to descend and press the lower outlet of the bladder, thus preventing urination. If tonic drugs were used to lift, the fetus would rise and descend naturally, but before the drug's effect arrived, distension would worsen. So, I instructed an old woman to apply sesame oil to her hands, insert them into the birth canal, and manually lift the fetus. Urine gushed out, and distension instantly resolved. Simultaneously, large doses of Ginseng, Astragalus (Huang Qi), and Cimicifuga (Sheng Ma) were boiled and administered. If slight urgency occurred, manual lifting was still used to facilitate urination. After three days, the fetus gradually rose, and urination returned to normal. (Another method: Have the healthy person and the pregnant patient lie supine. Extend both legs straight towards each other. The healthy person presses their feet against the patient's feet, frequently and gently thrusting upwards, causing the patient's body to subtly and frequently rise. Thus, the fetus naturally rises with the thrust, the bladder's ligament untwists, and urination flows freely. Non-pregnant women may also suffer from twisted bladder ligaments and inability to urinate. An adept midwife can manually manipulate the bladder to restore flow. Alternatively, holding the patient upside down by the legs several times can also restore urination. These are appended here.)
Xue Ji states: The aforementioned conditions may also result from deficiency of Spleen and Lung Qi, failing to transport downwards to the bladder; or from Qi-heat stagnating in the bladder, impairing fluid metabolism; or from Metal being scorched by Fire, with severe Damp-Heat in Spleen Earth, leading to dysfunction. Treatment must be carefully assessed.
The second son-in-law of Minister Li Xingang, pregnant for five months, had difficult urination. All medicines failed. I said: Only Ba Wei Wan (Eight-Ingredient Pill) can save her. Disbelieving, he used diuretic drugs instead. Abdominal swelling ensued, leading to death.
The wife of Confucian scholar Wang Wenyuan suffered from this, with severe lower abdominal swelling, nearly fatal. One dose of Ba Wei Wan produced dripping urination. A further dose of the previous pill ingredients added with Plantago Seed (Che Qian Zi) promoted free urination, emptying the abdomen and bringing relief.
Zhang Zhongjing asked: Regarding women's diseases, if diet remains normal, yet there is irritability, heat, inability to lie flat, but rather leaning forward for breath, why is this? The Master replied: This is named Zhuan Bao, inability to urinate. Because the bladder's ligamentous system is twisted, this disease arises. Promoting urination alone will cure it. Use Shen Qi Wan (Kidney Qi Pill) as the main treatment. (This is Ba Wei Wan, see Consumption chapter. Take 15-20 pills with wine, twice daily.)
Dong Kui Zi San (Winter Melon Seed Powder) treats Zhuan Bao in pregnant women, urinary retention, and also urinary retention in men, with efficacy in all cases.
Winter Melon Seed (Dong Kui Zi), Gardenia (Shan Zhi Zi) stir-fried, Talcum (Hua Shi) (each half liang), Akebia Stem (Mu Tong) (3 qian).
Crush, one dose, decoct in water, take warm on an empty stomach. Externally, powder Dong Kui Zi, Hua Shi, and Shan Zhi Zi. Mix with paste of River Snail Meat (Tian Luo Rou) or scallion juice, apply to the umbilicus for immediate passage.
Quan Sheng Fu Ling San (Complete Life Poria Powder) treats urinary retention in pregnancy.
Red Poria (Chi Fu Ling), Winter Melon Seed (Dong Kui Zi) (equal parts).
Crumble, take 5 qian per dose, decoct in water, take on an empty stomach. The *Jisheng Fang* adds a small amount of Hair Ash (Fa Hui), extremely effective.
Kui Yu Tang (Malva and Elm Bark Decoction) treats urinary retention in pregnancy, oppression under the umbilicus, and mental restlessness.
Malva Seed (Kui Zi) ground, Elm Bark (Yu Bai Pi) sliced (each 1 liang).
Decoct in water, divide into three doses.
Du Sheng San (Supreme Saint Powder) treats urinary retention in pregnancy.
Vitex Seed (Man Jing Zi) powdered, take 2 qian per dose, before meals, mixed with strong decoction of Scallion White (Cong Bai) soup. (Vitex Seed cools blood in all meridians, its nature is light and ascending, embodying the principle of rising.)
Gui Mu Ku Shen Wan (Angelica and Sophora Pill) treats difficult urination in pregnancy, with normal diet.
Angelica Sinensis (Dang Gui), Fritillaria (Bei Mu), Sophora Root (Ku Shen) (each 4 liang).
Powder, mix with refined honey to make pills the size of small beans. Take 3 pills per dose, increase to 10. For men, add Talcum (Hua Shi) half liang.
Miscellaneous formulas treat sudden urinary retention in pregnancy.
Almond Kernel (Xing Ren) peeled and de-seeded, stir-fried yellow, pounded into pills the size of mung beans. Swallow 7 pills with Centella Decoction (Deng Xin Tang). Another recipe: Pound Almond Kernel, mix with Talcum powder, rice-pill sized, take 20 pills with white soup. Another: Talcum powder mixed with water, applied to below the umbilicus. Another: Plantago Seed juice mixed with Talcum powder, applied around the umbilicus (four cun radius), change when hot. Another: Asters (Zi Wan) made into pills, taken with well-water (Jing Hua Shui), 2 qian. Another: Mantis Egg Case (Sang Piao Xiao) powdered, taken with rice drink, one cun-bi dose, three times daily.