遗尿者，溺出不自知也。闭癃者，溺闭不通而淋沥滴点也。唯肝与督脉、三焦、膀胱主之。肝脉、
督脉主之者。经云∶肝足厥阴之脉，过阴器，所生病者，遗溺闭癃。又云∶督脉者，女子入系廷孔，
其孔溺孔之端也。其男子循茎下至篡，与女子等，其生病癃痔遗溺。故遗溺闭癃，皆取厥阴俞穴、及
督脉俞穴也。三焦主之者。经云∶三焦下脉在于足太阳之前，少阳之后，出于 中外廉，名曰委阳，
足太阳络也。三焦者，足太阳、少阳之所将，太阳之别也，上踝五寸，别入贯 肠，出于委阳，并太
阳之正，入络膀胱，约下焦，实则闭癃，虚则遗溺。遗溺则补之，闭癃则泻之是也。膀胱主之者。经
云∶膀胱不利为癃，不约为遗溺是也。然遗溺闭癃，不取膀胱俞穴者，盖膀胱但脏溺，其出溺，皆从
三焦及肝、督脉也。闭癃，合而言之，一病也。分而言之，有暴久之殊。盖闭者暴病，为溺闭点滴不
出，俗名小便不通是
也。癃者久病，为溺癃淋沥点滴而出，一日数十次，或百次，名淋病是也。今分其病立为二门。
丹溪大法，小便不通，有热、有湿、有气结于下。宜清、宜燥、宜升，有隔二隔三之治。如因肺
燥不能生水，则清金，此隔二。如不因肺燥，但膀胱有热，则宜泻膀胱，此正治也。如因脾湿不运而
精不升，故肺不能生水，则当燥脾健胃，此隔三。车前子、茯苓清肺也。黄柏、知母泻膀胱也。苍术、
白术健胃燥脾也。《宝鉴》小便不利有三，不可一概而论。若津液偏渗于肠胃，大便泄泻而小便涩少，
一也，宜分利而已。若热搏下焦津液，则热湿而不行，二也，必渗泄则愈。若脾胃气涩，不能通调水
道，下输膀胱而化者，三也，可顺气，令施化而出也。东垣大法，小便不通，皆邪热为病，分在气在
血而治之。以渴与不渴而辨之。如渴而不利者，热在上焦肺分故也。夫小便者，是足太阳膀胱经所主
也。肺合生水，若肺热不能生
水，是绝其水之源。经云∶虚则补其母，宜清肺而滋其化源，故当从肺之分，助其秋令，水自生焉。
又如雨如雾如霜，皆从天而降下也。且药有气之薄者，乃阳中之阴，是感秋清肃杀之气而生，可以补
肺之不足，淡味渗泄之药是也。茯苓、泽泻、琥珀、灯心、通草、车前子、木通、瞿麦、 蓄之类，
以清肺之气，泄其火，滋水之上源也。如不渴而小便不通者，热在下焦血分，故不渴而小便不通也。
热闭于下焦者，肾也、膀胱也，乃阴中之阴，阴受热邪，闭塞其流。易老云∶寒在胸中遏塞不入，热
在下焦填塞不便，须用感北方寒水之化，气味俱阴之药，以除其热，泄其闭塞。《内经》云∶无阳则
阴无以生，无阴则阳无以化。若服淡渗之药，其性乃阳中之阴，非纯阴之剂，阳无以化，何以补重阴
之不足也。须用感地之水运而生大苦之味，感天之寒气而生大寒之药，此气味俱阴，乃阴中之阴也。
大寒之气，人感之生膀胱。寒水之运，人感之生肾。此药能补肾与膀胱。受阳中之阳热火之邪，而闭
其下焦，使小便不通也。夫用大苦寒之药，治法当寒因热用。又云∶必伏其所主，而先其所因，其始
则气同，其终则气异也。如热在上焦，以栀子、黄芩。热在中焦，
以黄连、芍药。热在下焦，以黄柏。热在气分，渴而小便闭，清肺散、猪苓汤、五苓散、茯苓琥珀汤、
红秫散。热在血分，不渴而小便闭，滋肾丸、黄连丸、导气除燥汤。东垣治一人病小便不利，目睛突
出，腹胀如鼓，膝以上坚硬，皮肤欲裂，饮食不下，服甘淡渗泄之药皆不效。曰疾急矣。非精思不能
处，思之半夜，曰吾得之矣。经云∶膀胱者，津液之腑，必气化而能出焉。多服淡渗之药而病益甚，
是气不化也。启玄子云∶无阳则阴无以生，无阴则阳无以化。甘淡气搏皆阳药，独阳无阴，欲化得乎。
遂以滋肾丸群阴之剂投服，再服即愈。渴而腹冷，水气也。《金匮》云∶小便不利者，有水气，其人
苦渴，栝蒌瞿麦丸主之。以小便利，腹中温为度。小便不通，腹下痛，状如覆碗，痛闷难忍者，乃肠
胃干涸，膻中气不下。经云∶膀胱者，州都之官，津液藏焉，气化则能出矣。膻中者，臣使之官，三
焦相火，肾为气海也。王注曰∶膀胱津液之腑，胞内居之，少腹处间毛五内胞器，若得气海之气施化，
则溲便注下，气海之气不及，则隐秘不通，故不得便利也。先用木香、沉香各三钱，酒调下，或八正
散，甚则宜上涌之，令气通达，便自通利，经所谓病在下，上取之。王注曰∶热攻于上，不利于下，
气盛于上，则温辛散之，苦以利之。一方，煎橘红、
茯苓汤，调木香、沉香末服之，空心下。丹溪云∶小便不通，属气虚、血虚、有实热、痰气闭塞，皆
宜吐之，以提其气，气升则水自降，盖气承载其水者也。气虚用参、术、升麻等，先服后吐，或就参、
药中调理吐之。血虚用四物汤，先服后吐，或就芎归汤探吐之。痰多，二陈汤，先服后探吐之。痰
气闭塞，二陈加香附、木通探吐之。实热当利之，或用八正散，盖大便动则小便自通矣。或问以吐法
通小便，方论中未尝有之，理将安在？曰∶取其气化而已。何则？《内经》谓三焦者，决渎之官，水
道出焉。膀胱者，州都之官，津液藏焉，气化则能出矣。故上中下三焦之气，有一不化，则不得如决
渎之水而出矣，岂独下焦膀胱气塞而已哉。上焦肺者，主行荣卫，通调水道，下输膀胱，而肾之合足
三焦，下输又上连肺，此岂非小便从上焦之气化者乎。张仲景有言，卫气行则小便宣通，其义亦在是
矣。《内经》又谓脾病则九窍不通，小便不利，是其一也。此岂非小便从中焦之气化者乎。由是而言
之，三焦所伤之邪不一，气之变化无穷，故当随处治邪行水，求其气化，亦无穷也。然而大要在乎阴
与阳无相偏负，然后气得以化。若方盛衰论曰∶至阴虚，天气绝，至阳盛，地气不足。夫肾肝在下，
地道也。心肺在上，天道也。脾胃居中，气交之分也。故
天之阳绝而不交于地者，尚且白露不下。况人同乎天，其在上之阳不交于阴，则在下之阴无以为化，
而水道其能出乎。东垣引《八十一难经》谓，有阴阳相乘，有覆有溢，而为内关，不得小便者。有或
在下之阴虚，在上之阳盛，不务其德而乘之，致肾气之不化者，必泻其阳而举之，则阴可得而平也。
若此条所叙之证，皆用吐法，盖因气道闭塞，升降不前者而用耳。何尝舍众法而独施是哉。丹溪尝曰，
吾以吐通小便，譬如滴水之器，上窍闭则下窍无以自通，必上窍开而下窍之水出焉。予尝推是开窍之
法，用之多验，姑书一二证以明之。甲午秋，治一妇人，年五十，初患小便涩，医以八止散等剂，展
转小便不通，身如芒刺加于体。予以所感霖淫雨湿，邪尚在表，因用苍术为君，附子佐之，发其表，
一服即汗，小便实时便通。又治马参政父，年八旬，初患小便短涩，因服药分利太过，遂致闭塞，涓
滴不出。予以饮食太过，伤其胃气，陷于下焦，用补中益气汤，一服小便通。因先多利药，损其肾气，
遂致通后遗尿，一夜不止，急补其肾，然后已。凡医之治是证，未有不用泄利之剂者，安能顾其肾气
之虚哉。表而出之，以为世戒。有瘀血而小便闭者，宜多用牛膝。《本事方》云∶顷在 陵，有一贵
官妻外家，小便不通，脐腹胀痛不可忍，众医皆作淋
治，如八正散之类，数种皆治不通，病愈甚。予诊之曰，此血瘕也。非瞑眩药不可去。乃用桃仁煎，
初服至日午，大痛不可忍，卧少顷，下血块如拳者数枚，小便如黑豆汁一二升，痛止得愈。此药猛峻，
气虚血弱者，宜斟酌之。大抵小腹痛胀如覆碗者为实，亦分在气在血，气壅塞于下者，木香流气饮。
血污于下者，桃仁煎、代抵当丸、牛膝膏。经云∶肾合膀胱，膀胱者，津液之腑也。小肠属肾，肾上
连肺，故将两脏。三焦者，中渎之腑也，水液出焉。是属膀胱，乃肾之腑也。又云∶膀胱者，州都之官，
津液藏焉，气化则能出矣。由是言之，膀胱藏水，三焦出水。治小便不利，故刺灸法但取三焦穴，不
取膀胱也。小肠属肾、肺，故东垣用清肺饮子、滋肾丸利小便也。运气小便不利有三∶其一，属湿邪
攻三焦。经云∶太阴在泉，湿淫所胜，病小腹痛肿，不得小便。又云∶水不及曰涸流，涸流之纪，上
宫与正宫同，其病癃闭是也。其二，属风邪攻脾。经云∶厥阴司天，风淫所胜，病溏瘕泄、水闭是也。
其三，属燥热。经云∶阳明司天之政，天气急，地气明，民病癃闭。初之气，其病小便黄赤，甚则淋。
又云∶少阴司天之政，地气肃，天气明。二之气，其病淋是也。良法治小便不通，诸药不效，或转胞
至死危困，用猪尿胞一个，底头出一小
眼子，翎筒通过，放在眼儿内，根底以细线系定，翎筒子口细杖子堵定，上用黄蜡封尿胞口，吹满气
七分，系定了，再用手捻定翎筒根头，放了黄蜡，塞其翎筒在小便出里头，放开翎筒根头，手捻其气
透于里，小便即出，神效。
【妊娠小便不通】妊娠胎满逼胞，多致小便不利，若胞系了戾，小便不通，名曰转胞。丹溪以为
多因胎妇虚弱，忧闷性躁，食味浓。古方用滑利疏导药鲜效，若脬为胎所坠而不通，但升举其胎，胞
系疏而小便自行。若脐腹作胀而小便淋 ，此脾胃气虚，胎压尿胞，四物、二陈、参、术，空心服后
探吐，数次自安。薛氏云∶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；
亦有金为火燥，脾土湿热甚而不利者。更当详审施治。《金匮要略》问曰∶妇人病饮食如故，烦热不
得卧，而反倚息者，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，酒下十五丸至三十丸，日再服。）又云∶妊娠有水气，身重小便不利，洒
淅恶寒，起即头眩，葵子茯苓散主之。又云∶妊娠小便难，饮食如故，归母苦参丸主之。丹溪治一妇
转胞，小便闭，脉似涩，重取则弦，
左稍和，此得之忧患。涩为血少气多，弦为有饮。血少则胞不举，气多有饮，中焦不清而溢，则胞知
所避而就下故坠。以四物汤加参、术、半夏、陈皮、甘草、生姜空心饮，随以指探吐之，俟气定又与，
至八帖而安。此恐偶中，后又治数人皆效。又一妇四十一岁，孕九月转胞小便闭，脚肿形瘁，脉左稍
和而右涩，此饱食气伤胎系，弱不能自举而下坠，压着膀胱，偏在一边，气急为其所闭，所以水窍不
能出也。宜补血养气，气血既正，胎系自举，则不下坠，方有安之理。遂用人参、当归身尾、白芍药、
白术、陈皮、炙甘草、半夏、生姜煎汤，浓与四帖，次早以渣煎，顿服探吐之，小便即通，皆黑水。
后就此方加大腹皮、枳壳、青葱叶、砂仁二十帖与之，而得以安产。一孕妇小便不通，脉细弱，乃气
血俱虚，胎压膀胱下口。用补药升起恐迟，反加急满。令稳婆以香油抹手，入产户托起其胎，溺出如
注。却以参、 、升麻大剂服之。一法将孕妇倒竖起，胎自运，溺自出，胜手托远矣。
【产后小便不通】旧方用陈皮去白为末，空心酒调二钱，外用盐填脐中，却以葱白剥去粗皮，十
余根作一缚，切作一指浓，安盐上，用大艾炷满葱饼上，以火灸之，觉热气入腹内，实时便通。按此
唯气壅不得通者宜之，若气虚源涸与夫热结者，不
可泥也。
遗尿，是指小便排出时自己不知道。闭癃，是指小便闭塞不通，只能淋漓滴沥而出。这些病症主要由肝、督脉、三焦和膀胱所主管。
肝和督脉主管这些病症的原因在于：经典记载：“足厥阴肝经，经过生殖器，其所发生的疾病包括遗尿和闭癃。”又说：“督脉，女子进入系连廷孔（尿道口），这个孔就是溺孔的末端。男子则沿着阴茎下行至会阴部，与女子相同，其发病表现为癃闭、痔疮和遗尿。”因此，治疗遗尿和闭癃，都选取厥阴俞穴以及督脉的俞穴。
三焦主管这些病症的原因在于：经典记载：“三焦的下行经脉位于足太阳膀胱经之前，足少阳胆经之后，出于内外廉之间，名叫委阳穴，这是足太阳膀胱经的络穴。三焦，是足太阳、足少阳所统领的，也是足太阳的别络，上行至踝上五寸处，别行进入并贯穿肠道，出于委阳穴，并入足太阳膀胱经的正脉，进入联络膀胱，约束下焦。实证表现为闭癃，虚证表现为遗尿。遗尿应当用补法，闭癃应当用泻法，说的就是这个道理。”
膀胱主管这些病症的原因在于：经典记载：“膀胱气机不利则发生癃闭，约束无力则发生遗尿。”然而，对于遗尿和闭癃，不直接取膀胱俞穴的原因，大概是因为膀胱只是储存尿液的地方，而尿液的排出，都是通过三焦以及肝、督脉来完成的。
“闭”和“癃”，合起来说是一种病，分开来说，有突发和久病的区别。所谓“闭”，是突发疾病，表现为小便完全闭塞，点滴不出，俗称小便不通。所谓“癃”，是久病，表现为小便淋漓滴沥而出，一天几十次，甚至上百次，称为淋病。现在将这两种病分别设立为两个门类。
朱丹溪的大法认为，小便不通，原因有热、有湿、有气结于下焦。治疗方法宜清热、宜燥湿、宜升提，有“隔二”、“隔三”的治疗策略。如果是因为肺燥不能生水（津液），则清润肺金，这叫隔二治法。如果不是因为肺燥，仅仅是膀胱有热，则适宜直接泻膀胱之火，这叫正治法。如果是因为脾湿不运导致精气不能上升，进而使肺不能生水，则应当燥湿健脾健胃，这叫隔三治法。车前子、茯苓用于清肺；黄柏、知母用于泻膀胱火；苍术、白术用于健胃燥脾。
《宝鉴》指出小便不利有三种情况，不可一概而论。第一种，津液偏渗于肠胃，导致大便泄泻而小便涩少，这种情况适宜分利水湿即可。第二种，热邪搏结于下焦津液，导致湿热停滞不行，这种情况必须通过渗泄湿热才能痊愈。第三种，脾胃气机涩滞，不能通调水道，向下输送到膀胱进行气化，这种情况可以顺气，使气化功能恢复从而排尿。
李东垣的大法认为，小便不通，都是邪热致病，分为在气分和在血分两种情况来治疗。以口渴与否来辨别。如果口渴且小便不利，是因为热在上焦肺分。小便由足太阳膀胱经所主，肺合生水（生成津液），如果肺热不能生水，就是断绝了水的源头。经典说：“虚则补其母”，适宜清肺以滋养化源，所以应当从肺的角度入手，辅助秋令（金生水），水自然能生出来。就像雨、雾、霜一样，都是从天空降下来的。而且药性气味薄弱的，属于阳中之阴，是感应秋天清肃杀之气而生长的，可以补肺之不足，这类淡味渗泄的药物如茯苓、泽泻、琥珀、灯心草、通草、车前子、木通、瞿麦、萹蓄等，用来清肺气，泄火热，滋补水之上源。
如果不口渴而小便不通，是因为热在下焦血分，所以不渴而小便不通。热邪闭塞于下焦的是肾和膀胱，这属于阴中之阴，阴分受热邪侵袭，闭塞了水流通道。易老（张元素）说：“寒邪在胸中遏塞不入，热邪在下焦填塞不便，必须使用感应北方寒水之化的药物，气味俱阴的药，来清除热邪，泄去闭塞。”《内经》说：“无阳则阴无以生，无阴则阳无以化。”如果服用淡渗的药物，其性质是阳中之阴，并非纯阴之剂，没有阳气就无法气化，怎么能补充重阴的不足呢？必须使用感应大地水运而生大苦之味的药物，感应天之寒气而生大寒之药，这类气味俱阴，乃阴中之阴。大寒之气，人感受它产生膀胱的功能；寒水之运，人感受它产生肾的功能。这种药能补肾与膀胱。针对受阳中之阳热火之邪侵袭，闭塞下焦导致小便不通的情况，使用大苦寒药物治疗，治法应当“寒因热用”。又说：“必须制服其主治的病邪，先找出病因，开始用药时气性相同，最终气性则不同。”例如热在上焦，用栀子、黄芩；热在中焦，用黄连、芍药；热在下焦，用黄柏。热在气分，口渴而小便闭，用清肺散、猪苓汤、五苓散、茯苓琥珀汤、红秫散。热在血分，不渴而小便闭，用滋肾丸、黄连丸、导气除燥汤。
李东垣曾治疗一个人患小便不利，眼睛突出，腹胀如鼓，膝盖以上坚硬，皮肤紧绷欲裂，饮食不下，服用甘淡渗泄的药物都没有效果。他说：“病情危急啊。不是精心思考不能处理，思考到半夜，说：‘我找到原因了。’经典说：‘膀胱是津液之腑，必须气化才能排出。’多服淡渗药物而病情加重，这是因为气不化。启玄子（王冰）说：‘无阳则阴无以生，无阴则阳无以化。’甘淡气味都属于阳药，独阳无阴，想要气化怎么可能呢？”于是给予滋肾丸这一群阴之剂服用，再服即愈。
如果口渴且腹部冷，是水气病。《金匮要略》说：“小便不利者，有水气，其人苦于口渴，用栝蒌瞿麦丸主治。”以小便利、腹中温暖为标准。如果小便不通，小腹疼痛，形状像倒扣的碗，痛闷难忍，这是肠胃干涸，膻中气机不下行。经典说：“膀胱是州都之官，津液藏焉，气化则能出矣。”膻中是臣使之官，三焦相火，肾为气海。王注曰：“膀胱是津液之腑，居于胞内，位于少腹毛际之内，若得气海之气施化，则溲便注下；气海之气不及，则隐秘不通，所以不得便利。”先用木香、沉香各三钱，酒调下，或者用八正散，严重时宜用涌吐法，使气机通达，小便自然通利，这就是经典所说的“病在下，上取之”。王注曰：“热攻于上，不利于下，气盛于上，则用温辛药发散，苦味药通利。”一方，煎橘红、茯苓汤，调木香、沉香末空腹服用。
朱丹溪说：“小便不通，属于气虚、血虚、有实热、痰气闭塞，都适宜用吐法，以提举气机，气升则水自降，因为气承载水。”气虚用人参、白术、升麻等，先服药后催吐，或者就在人参药中调理后催吐。血虚用四物汤，先服药后催吐，或者就在芎归汤中探吐。痰多，用二陈汤，先服药后探吐。痰气闭塞，用二陈汤加香附、木通探吐。实热当利尿，或者用八正散，因为大便动则小便自通。有人问用吐法通小便，方论中未曾有过，道理在哪里？回答说：取其气化而已。为什么呢？《内经》说三焦是决渎之官，水道出焉；膀胱是州都之官，津液藏焉，气化则能出矣。所以上中下三焦的气，只要有一个不化，就不能像决渎之水那样流出，难道只是下焦膀胱气塞吗？上焦肺，主行营卫，通调水道，下输膀胱，而肾合足三焦，下输又上连肺，这难道不是小便从上焦的气化而来吗？张仲景有言，卫气行则小便宣通，其义也在此。《内经》又说脾病则九窍不通，小便不利，这是一方面。这难道不是小便从中焦的气化而来吗？由此而言，三焦所伤的邪气不一，气的变化无穷，所以应当随处治邪行水，求其气化，也是无穷的。然而大要在乎阴与阳无相偏负，然后气得以化。如果像《方盛衰论》所说：“至阴虚，天气绝，至阳盛，地气不足。”肾肝在下，是地道；心肺在上，是天道；脾胃居中，是气交之分。所以天的阳绝而不交于地，尚且白露不下。何况人同乎天，其在上的阳不交于阴，则在下的阴无法气化，水道怎么能流出呢？李东垣引用《八十一难经》说，有阴阳相乘，有覆有溢，而为内关，不得小便。有的在下阴虚，在上阳盛，不务其德而乘之，导致肾气不化，必须泻其阳而举之，则阴可得而平。像本条所述的证候，都用吐法，是因为气道闭塞，升降不前才用的。何尝舍弃众法而独施此法呢？朱丹溪曾说：“我用吐法通小便，譬如滴水之器，上窍闭则下窍无以自通，必上窍开而下窍之水出焉。”我曾推演这种开窍之法，用之多验，姑且记录一二病例以说明。甲午年秋，治疗一妇人，五十岁，初患小便涩，医生用八正散等剂，辗转导致小便不通，身如芒刺加于体。我认为这是由于感受霖淫雨湿，邪尚在表，因此用苍术为君药，附子佐之，发其表邪，一服即汗，小便实时便通。又治疗马参政的父亲，八十岁，初患小便短涩，因服药分利太过，遂致闭塞，涓滴不出。我认为这是由于饮食太过，伤其胃气，陷于下焦，用补中益气汤，一服小便通。因为先前多用利药，损其肾气，遂致通后遗尿，一夜不止，急补其肾，然后停止。凡医生治疗此证，未有不用泄利剂的，怎能顾及其肾气之虚呢？特此列出，以为世人警戒。
有瘀血而小便闭者，宜多用牛膝。《本事方》说：“前不久在陵州，有一位贵官的妻子，小便不通，脐腹胀痛不可忍受，众医都当作淋病治疗，如八正散之类，数种药都治不通，病更重。我诊察说，这是血瘕。非瞑眩药不可去除。于是用桃仁煎，初服到中午，大痛不可忍，躺了一会儿，下血块如拳头大小数枚，小便如黑豆汁一二升，痛止得愈。此药猛峻，气虚血弱者，宜斟酌使用。”大抵小腹痛胀如倒扣的碗者为实证，也分在气在血，气壅塞于下者，用木香流气饮。血污于下者，用桃仁煎、代抵当丸、牛膝膏。经典说：“肾合膀胱，膀胱是津液之腑。小肠属肾，肾上连肺，故将两脏。三焦是中渎之腑，水液出焉。这是属膀胱，乃肾之腑。”又说：“膀胱是州都之官，津液藏焉，气化则能出矣。”由此言之，膀胱藏水，三焦出水。治疗小便不利，所以刺灸法只取三焦穴，不取膀胱穴。小肠属肾、肺，所以李东垣用清肺饮子、滋肾丸利小便。
运气学说中小便不利有三种：其一，属湿邪攻三焦。经典说：“太阴在泉，湿淫所胜，病小腹痛肿，不得小便。”又说：“水不及曰涸流，涸流之纪，上宫与正宫同，其病癃闭是也。”其二，属风邪攻脾。经典说：“厥阴司天，风淫所胜，病溏瘕泄、水闭是也。”其三，属燥热。经典说：“阳明司天之政，天气急，地气明，民病癃闭。初之气，其病小便黄赤，甚则淋。”又说：“少阴司天之政，地气肃，天气明。二之气，其病淋是也。”
良法治小便不通，诸药不效，或转胞至死危困，用一个猪尿胞，底头出一小眼子，翎筒通过，放在眼儿内，根底以细线系定，翎筒子口用细杖子堵定，上用黄蜡封尿胞口，吹满气七分，系定了，再用手捻定翎筒根头，放了黄蜡，塞其翎筒在小便出里头，放开翎筒根头，手捻其气透于里，小便即出，神效。
【妊娠小便不通】妊娠胎满逼胞，多致小便不利，若胞系了戾（扭曲），小便不通，名曰转胞。朱丹溪认为多因胎妇虚弱，忧闷性躁，食味浓。古方用滑利疏导药鲜效，若胞为胎所坠而不通，但升举其胎，胞系疏而小便自行。如果脐腹作胀而小便淋沥，这是脾胃气虚，胎压尿胞，用四物汤、二陈汤、人参、白术，空心服后探吐，数次自安。薛氏说：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；也有金为火燥，脾土湿热甚而不利的。更当详审施治。《金匮要略》问曰：“妇人病饮食如故，烦热不得卧，而反倚息者，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，酒下十五丸至三十丸，日再服。）”又说：“妊娠有水气，身重小便不利，洒淅恶寒，起即头眩，葵子茯苓散主之。”又说：“妊娠小便难，饮食如故，归母苦参丸主之。”
朱丹溪治疗一妇人转胞，小便闭，脉似涩，重取则弦，左稍和，这是得之忧患所致。涩为血少气多，弦为有饮。血少则胞不举，气多有饮，中焦不清而溢，则胞知所避而就下故坠。用四物汤加人参、白术、半夏、陈皮、甘草、生姜空心饮，随即用手指探吐，待气定再给，至八帖而安。这恐怕是偶然中的，后又治疗数人都有效。又一妇人四十一岁，孕九月转胞小便闭，脚肿形瘁，脉左稍和而右涩，这是饱食气伤胎系，弱不能自举而下坠，压着膀胱，偏在一边，气急为其所闭，所以水窍不能出也。宜补血养气，气血既正，胎系自举，则不下坠，方有安之理。遂用人参、当归身尾、白芍药、白术、陈皮、炙甘草、半夏、生姜煎汤，浓煎四帖，次早以渣煎，顿服探吐之，小便即通，皆黑水。后就此方加大腹皮、枳壳、青葱叶、砂仁二十帖与之，而得以安产。一孕妇小便不通，脉细弱，乃气血俱虚，胎压膀胱下口。用补药升起恐迟，反加急满。令稳婆以香油抹手，入产户托起其胎，溺出如注。却以人参、黄芪、升麻大剂服之。一法将孕妇倒竖起，胎自运，溺自出，胜手托远矣。
【产后小便不通】旧方用陈皮去白为末，空心酒调二钱，外用盐填脐中，却以葱白剥去粗皮，十余根作一缚，切作一指厚，安盐上，用大艾炷满葱饼上，以火灸之，觉热气入腹内，实时便通。按此唯气壅不得通者宜之，若气虚源涸与夫热结者，不可泥也。
Enuresis refers to the involuntary discharge of urine without awareness. Bi-long (obstruction and dribbling) refers to the blockage of urination with only scanty, dripping drops. These conditions are primarily governed by the Liver, Du Mai (Governing Vessel), Sanjiao (Triple Burner), and Bladder.
The reason the Liver and Du Mai govern these conditions is stated in the classics: "The Foot Jueyin Liver Meridian passes through the genitalia; diseases it generates include enuresis and bi-long." It also states: "The Du Mai enters and connects to the Ting Kong (urethral opening) in women, which is the end of the urinary pore. In men, it follows the penis down to the perineum, identical to women; its diseases include long-term obstruction, hemorrhoids, and enuresis." Therefore, for treating enuresis and bi-long, one selects acupoints on the Jueyin and Du Mai meridians.
The reason the Sanjiao governs these conditions is stated in the classics: "The descending channel of the Sanjiao lies anterior to the Foot Taiyang Bladder Meridian and posterior to the Foot Shaoyang Gallbladder Meridian, emerging between the inner and outer condyles, named Weiyang (BL34), which is the collateral of the Foot Taiyang Bladder Meridian. The Sanjiao is commanded by the Foot Taiyang and Foot Shaoyang, and is a branch of the Foot Taiyang. It ascends five cun above the ankle, branches off, penetrates the intestines, emerges at Weiyang, joins the main channel of the Taiyang, enters and connects to the Bladder, and regulates the Lower Jiao. Excess manifests as bi-long (obstruction), deficiency manifests as enuresis. Enuresis should be treated with tonification, and bi-long with sedation."
The reason the Bladder governs these conditions is stated in the classics: "Bladder dysfunction leads to long-term obstruction (long); lack of restraint leads to enuresis." However, for enuresis and bi-long, one does not directly select the Bladder Shu point because the Bladder merely stores urine; the discharge of urine is accomplished through the Sanjiao, Liver, and Du Mai.
"Bi" and "Long," when combined, refer to one disease; when distinguished, they differ in onset duration. "Bi" refers to acute onset, characterized by complete retention of urine with no drops passing, commonly known as urinary retention. "Long" refers to chronic onset, characterized by scanty, dripping urination occurring dozens or even hundreds of times a day, known as strangury (Lin syndrome). Currently, these two conditions are classified into separate categories.
Zhu Danxi's general principle holds that urinary obstruction arises from Heat, Dampness, or Qi stagnation in the Lower Jiao. Treatment may involve clearing Heat, drying Dampness, or raising Qi, employing strategies of "indirect treatment via two organs" (Ge Er) and "indirect treatment via three organs" (Ge San). If caused by Lung Dryness failing to generate fluids (Jin Ye), one clears and moistens the Metal (Lung); this is Ge Er. If not due to Lung Dryness but solely Bladder Heat, one directly purges the Bladder; this is direct treatment. If caused by Spleen Dampness failing to transport essence upward, thereby preventing the Lung from generating fluids, one dries the Spleen and strengthens the Stomach; this is Ge San. Qianhenzi (Plantaginis Semen) and Fuling (Poria) clear the Lung; Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) purge Bladder heat; Cangzhu (Atractylodis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) strengthen the Stomach and dry Spleen Dampness.
*Baojian* states there are three types of difficult urination, which cannot be treated uniformly. First, if body fluids leak excessively into the Intestines and Stomach, causing diarrhea and scanty urine, diuresis is appropriate. Second, if Heat combats fluids in the Lower Jiao, causing Heat-Damp stagnation, permeating and draining is necessary for cure. Third, if Stomach-Spleen Qi is stagnant and fails to regulate water pathways to transmit to the Bladder for transformation, regulating Qi to restore transformation is suitable.
Li Dongyuan's general principle holds that urinary obstruction is caused by pathogenic Heat, differentiated into Qi level and Blood level treatments, distinguished by thirst. If thirsty with difficulty urinating, Heat is in the Upper Jiao Lung. Urine is governed by the Foot Taiyang Bladder Meridian; the Lung generates fluids. If Lung Heat prevents fluid generation, the source of water is cut off. The classics state: "Deficiency tonifies its mother"; thus, clearing the Lung to nourish the source of transformation is appropriate, assisting the Autumn (Metal) function so Water generates naturally. Just as rain, mist, and frost descend from heaven, drugs with thin Qi and flavor belong to Yang within Yin, generated by the crisp, killing Qi of Autumn, capable of supplementing Lung deficiency. Such bland-draining drugs include Fuling (Poria), Zexie (Alismatis Rhizoma), Hupo (Fossilia Os Costatum), Dengxincao (Junci Medulla), Tongcao (Tetrapanacis Medulla), Qianhenzi (Plantaginis Semen), Mutong (Akebiae Caulis), Qumai (Dianthi Herba), and Pianfu (Persicariae Herba), used to clear Lung Qi, drain fire, and nourish the upper source of Water.
If not thirsty but unable to urinate, Heat is in the Lower Jiao Blood level, hence no thirst but obstruction. Heat blocking the Lower Jiao involves the Kidney and Bladder, which are Yin within Yin. Yin suffering Heat evil blocks the flow. Zhang Yishou said: "Cold obstructing the chest prevents entry; Heat filling the Lower Jiao causes inconvenience. One must use drugs sensing the transformation of Northern Cold Water, with both Qi and flavor being Yin, to remove Heat and unblock obstruction." *Neijing* states: "Without Yang, Yin cannot generate; without Yin, Yang cannot transform." If bland-draining drugs (Yang within Yin) are taken, they are not pure Yin agents; without Yang, transformation cannot occur, so how can they supplement severe Yin deficiency? One must use drugs sensing Earth's water movement producing bitter flavors, and Heaven's cold air producing cold drugs—both Qi and flavor Yin, i.e., Yin within Yin. Great Cold Qi generates Bladder function; Cold Water movement generates Kidney function. These drugs tonify Kidney and Bladder. For cases where Yang-Heat evil blocks the Lower Jiao causing obstruction, using great bitter-cold drugs requires the method of "treating cold with heat" (Han Yin Re Yong). It is also said: "Subdue the ruling pathogen and address the cause first; initially the Qi is similar, finally it differs." For Heat in Upper Jiao, use Zhizi (Gardeniae Fructus) and Huangqin (Scutellariae Radix). For Heat in Middle Jiao, use Huanglian (Coptidis Rhizoma) and Shaoyao (Paeoniae Radix). For Heat in Lower Jiao, use Huangbai (Phellodendri Cortex). For Heat in Qi level with thirst and obstruction, use Qingfei San, Zhuling Tang, Wuling San, Fuling Hupo Tang, or Hongshu San. For Heat in Blood level without thirst and obstruction, use Zishen Wan, Huanglian Wan, or Daoqi Chuzao Tang.
Li Dongyuan treated a patient with difficult urination, protruding eyes, drum-like abdominal distension, hardness above the knees, skin tight as if cracking, and inability to eat. Bland-draining drugs failed. He said: "The condition is urgent. It requires deep thought. The classics say: 'The Bladder is the mansion of fluids, requiring Qi transformation to excrete.' Taking many bland-draining drugs worsened the condition because Qi did not transform. Wang Bing noted: 'Without Yang, Yin cannot generate; without Yin, Yang cannot transform.' Bland-sweet drugs are Yang; alone, Yang cannot transform without Yin." He prescribed Zishen Wan (a group of Yin herbs), and the patient recovered after two doses.
If thirsty with cold abdomen, it is Water Qi. *Jingui Yaolue* states: "For difficult urination with Water Qi and extreme thirst, use Gualou Qumai Wan." The goal is smooth urination and warmth in the abdomen. If urinary obstruction with lower abdominal pain shaped like an inverted bowl, unbearable and stifling, it is dryness of Intestines and Stomach with failure of Danzhong Qi to descend. The classics say: "The Bladder is the official of the metropolis, storing fluids, transforming by Qi to excrete." Danzhong is the official of the minister, Sanjiao houses Ministerial Fire, and Kidney is the Sea of Qi. Wang's commentary notes: "The Bladder, mansion of fluids, resides in the Bao (uterus/bladder). If Qi Sea transforms, urine flows; if Qi Sea is insufficient, secretion stops." Initially, use Muxiang (Aucklandiae Radix) and Chenxiang (Aquilariae Lignum Resinatum), 3 qian each, mixed with wine, or Bazheng San. Severe cases require emesis to open Qi, following the principle "treat lower by accessing upper." Wang notes: "Heat attacking upper hinders lower; excess Qi above requires warm-acrid dispersal and bitter draining." One formula decocts Juhong (Citri Reticulatae Pericarpium) and Fuling (Poria), mixed with Muxiang and Chenxiang powder, taken fasting.
Zhu Danxi said: "Urinary obstruction due to Qi deficiency, Blood deficiency, Excess Heat, or Phlegm-Qi blockage all benefit from emesis to raise Qi; as Qi rises, Water descends, for Qi carries Water." For Qi deficiency, use Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Shengma (Cimicifugae Rhizoma); take medicine then induce vomiting. For Blood deficiency, use Siwu Tang; take then induce vomiting. For much Phlegm, use Erchen Tang; take then induce vomiting. For Phlegm-Qi blockage, use Erchen Tang plus Xiangfu (Cyperi Rhizoma) and Mutong (Akebiae Caulis) to induce vomiting. For Excess Heat, promote urination with Bazheng San, as moving stool promotes urination. When asked why emesis works for urination, the answer is Qi transformation. *Neijing* says Sanjiao is the official of drainage, and Bladder stores fluids for Qi transformation. If any of Upper, Middle, or Lower Jiao fails to transform, water cannot flow. Upper Jiao Lung governs Ying-Wei and water pathways, transmitting to Bladder; Kidney connects to Sanjiao, which connects up to Lung. Thus, urination depends on Upper Jiao Qi transformation. Zhang Zhongjing said: "When Wei Qi moves, urination is patent." Also, *Neijing* says Spleen disease causes nine orifices to block, including difficult urination, indicating Middle Jiao Qi transformation. Since pathogens injuring Sanjiao vary and Qi changes infinitely, one must treat pathogens and move water everywhere, seeking Qi transformation. The key is balance of Yin and Yang. As *Fang Sheng Shuai Lun* states: "Extreme Yin deficiency cuts off Heavenly Qi; extreme Yang excess leaves Earthly Qi insufficient." Kidney/Liver below are Earth Way; Heart/Lung above are Heaven Way; Spleen/Stomach middle is Qi intersection. If Heaven Yang does not intersect Earth, white dew does not fall. Similarly, if Upper Yang does not intersect Lower Yin, Lower Yin cannot transform, and waterways cannot flow. Li Dongyuan cited *Nan Jing*: Yin-Yang mutual overcoming causes Fu and Yi, leading to Neiguan and inability to urinate. If Lower Yin deficiency and Upper Yang excess overcome virtue, causing Kidney Qi failure, one must purge Yang and raise Yin to balance. The cases described use emesis because Qi pathways are blocked and ascending/descending are halted. Zhu Danxi compared it to a dripping vessel: if the upper orifice closes, the lower cannot flow; opening the upper allows water out. I have applied this successfully.
In autumn of Jiawu year, I treated a 50-year-old woman with initial sluggish urination. Doctors used Bazheng San etc., worsening it to total obstruction with body prickling sensations. Attributing it to dampness from heavy rains still on the surface, I used Cangzhu (Atractylodis Rhizoma) as sovereign and Fuzi (Aconiti Lateralis Radix Preparata) as assistant to release the exterior. After one dose, sweating occurred, and urination immediately cleared. I also treated the father of Official Ma, 80 years old, with short, sluggish urination caused by excessive diuretics leading to total blockage. Attributing it to overeating damaging Stomach Qi sinking to Lower Jiao, I used Buzhong Yiqi Tang. After one dose, urination flowed. However, prior diuretics damaged Kidney Qi, causing post-obstruction enuresis all night. Urgent Kidney tonification stopped it. Physicians rarely protect Kidney Qi when using draining agents; this is recorded as a warning.
For blood stasis causing obstruction, use Niuxi (Achyranthis Bidentatae Radix) frequently. *Benshi Fang* records a noblewoman with unbearable abdominal pain and obstruction. Doctors treated as strangury with Bazheng San etc., worsening the condition. Diagnosing Xue Jia (blood mass), I used Taoren Jian (Peach Kernel Decoction). After taking it until noon, severe pain ensued, followed by passage of fist-sized blood clots and dark urine, curing the pain. This drug is potent; use cautiously in Qi/Blood deficiency. Generally, lower abdominal distension like an inverted bowl indicates Excess. Differentiate Qi vs. Blood. Qi stagnation below uses Muxiang Liuqi Yin. Blood turbidity below uses Taoren Jian, Daididang Wan, or Niuxi Gao. Classics state: "Kidney combines with Bladder... Small Intestine belongs to Kidney, Kidney connects to Lung... Sanjiao is the mid-channel mansion of water." Thus, Bladder stores water, Sanjiao outputs water. For difficult urination, acupuncture targets Sanjiao points, not Bladder. Small Intestine belongs to Kidney/Lung, so Li Dongyuan used Qingfei Yinzi and Zishen Wan.
In climatic factors, difficult urination has three types: 1. Dampness attacking Sanjiao: "Taiyin in泉, excessive dampness causes lower abdominal pain/swelling and inability to urinate." "Water deficiency called Hedou... diseases include long-term obstruction." 2. Wind attacking Spleen: "Jueyin ruling heaven, excessive wind causes loose stools/masses/diarrhea and water closure." 3. Dryness-Heat: "Yangming ruling heaven... people suffer long-term obstruction. First phase: yellow-red urine, severe strangury." "Shaoyin ruling heaven... second phase: strangury."
For refractory cases or severe Tuo Bao (displaced bladder/uterus), a clever method uses a pig bladder. Pierce a small hole at the base, insert a feather quill, secure with thread, plug quill end with stick, seal bladder mouth with beeswax. Blow air into bladder to 70% full, tie securely, press quill root, remove wax, insert quill into urethra, release pressure, massage air inside. Urine flows instantly.
[Pregnancy Urinary Obstruction] Full fetus pressing on Bladder often causes difficult urination. If Bao Xi (bladder ligaments) are twisted, causing obstruction, it is called Tuo Bao. Zhu Danxi attributes this to maternal weakness, worry/irritability, and rich diet. Ancient slippery/dredging drugs fail. If Bladder is depressed by fetus, lifting the fetus loosens ligaments and urination resumes. If abdominal distension with dribbling occurs due to Spleen-Stomach Qi deficiency and fetal pressure, use Siwu Tang, Erchen Tang, Renshen, Baizhu, taken fasting then induced vomiting. Xue notes: Also consider Spleen-Lung Qi deficiency failing to transmit to Bladder; Qi-Heat stagnation blocking Bladder fluids; or Metal dried by Fire with Spleen-Damp-Heat. *Jingui Yaolue* asks: "Woman eats well, feels hot/restless, leans back to breathe—why?" Master answers: "This is Tuo Bao, inability to urinate due to twisted Bao Xi. Promote urination to cure; use Shenqi Wan (Eight-Ingredient Pill, 15-30 pills with wine, twice daily)." Also: "Pregnancy with Water Qi, heavy body, difficult urination, chills, dizziness on rising; use Kuizi Fuling San." Also: "Pregnancy difficult urination, eating well; use Guimu Kushen Wan."
Zhu Danxi treated a woman with Tuo Bao, obstruction, pulse slightly choppy, deep stringy, left slightly harmonious, caused by worry. Choppy indicates low Blood/excess Qi; Stringy indicates Fluid retention. Low Blood fails to lift Bao; excess Qi with Fluids clouds Middle Jiao, causing Bao to sag. Used Siwu Tang plus Renshen, Baizhu, Banxia, Chenpi, Gancao, Shengjiang, taken fasting then induced vomiting. After eight doses, resolved. Treated several others successfully. Another 41-year-old pregnant woman, 9 months, Tuo Bao, swollen legs, emaciated, pulse left harmonious/right choppy. Caused by overeating injuring fetal suspension, weak to lift, pressing Bladder sideways, closing Qi, blocking water outlet. Tonify Blood/Qi; once balanced, suspension lifts, no sagging, safety achieved. Used Renshen, Danggui, Shaoyao, Baizhu, Chenpi, Zhigancao, Banxia, Shengjiang decoction, four thick doses, next morning dregs decocted and taken to induce vomiting. Urine flowed, dark water passed. Added Dafupi, Zhiqiao, Congbai, Sharen for twenty doses, resulting in safe delivery. Another pregnant woman, weak fine pulse, Qi/Blood deficiency, fetal pressure on bladder outlet. Tonics too slow, risk worsening fullness. Midwife oiled hand, inserted into vagina to lift fetus, urine gushed. Then gave large dose of Renshen, Huangqi, Shengma. Another method: invert pregnant woman vertically; fetus moves, urine flows, superior to manual lifting.
[Postpartum Urinary Obstruction] Old formula: Chenpi (Citri Reticulatae Pericarpium) powder, 2 qian with wine fasting. Apply salt to umbilicus, bundle ten+ scallion whites, slice finger-thick, place on salt, cover with large moxa cone, moxa until heat enters abdomen, urination follows immediately. Note: Only suitable for Qi stagnation. Not for Qi deficiency/dryness or Heat binding.