大小便之闭塞不通也人皆谓之火然火亦有阴阳之别阳火而成闭结人易知阴火而成闭结人
难识
也先言大便之闭寒邪火逼迫于大肠之中烧干大肠以致肠结而痛手按之不可近者必须用祛荡之
品而大泻之否则邪留于腹中必变为谵语发狂之症矣此等之病乃阳火作崇也若夫肾水亏损不能
滋润于大肠以致粪如羊屎者往往有经月而尚未便者虽觉急迫而终亦不甚忍至二三日而如前不
相异老人多有此症乃阴火作崇也阴火者相火乃虚火也肾火之有余实肾水之不足也若
亦
以下药下之是因其阴虚而复虚之也去死不远矣吾今定二方一治阳火一治阴火治阳火方名利火
下
导汤此方虽有大黄之行火麻之润而仍以当归为君则补多于下亦止因势利导而终非过下亡阴
也治阴火方名为升阳下阴汤此方之妙妙在熟地纯阴之药为君而佐之地榆苁蓉火麻之润尤妙用
升麻升提清气则秽浊自然下行又何必加入大黄之多事哉再言小便之闭塞小便之通在于膀胱
之气化膀胱乘于火邪 则小便必点滴不通其症必气急面红心欲呕而胃作酸腹欲胀而肠欲断两
目双赤狂燥不宁此阳症也苟或小便虽急而非点滴之不通气不急面不红目不痛腹胀而喜按胃安
而难餐此阴症也设不辨其阴阳而轻用开关之剂亦半死半生之道也夫阳症易治而阴症难治者何
也亦不取阴症而一辨明之耳盖小便之通虽本于膀胱之气化然膀胱畏火而又未尝不喜火也多火
则膀胱之气化不及行无火则膀胱之气化又不能行也膀胱之阴虚则水道已成水冻之窟又何
能通阴寒之水哉故小便亦闭塞而不通也吾今亦立二方一治阳症一治阴症阳症方名清水至神汤
一剂即通车前利水而不走气寄奴逐水而不伤阴升麻升提而反得下降之宜白果引入任督之路以
泻水之气直入膀胱实有妙用也阴症用益火济水汤此方之妙妙在纯是补阴而不去利水用肉桂
之
一味以转阳和自然雪消春水冰泮而沟壑皆通也倘止去通水则膀胱愈寒必成牢不可破之坚城矣
利火下导汤
大黄（三钱） 当归（一两） 红花（二钱） 赤芍药（三钱） 浓朴（二钱） 枳实（一钱） 柴胡（八
分） 火麻子（三钱）水煎服
升阳下阴汤
熟地（一两） 当归（五钱） 地榆（一钱） 火麻子（一钱） 升麻（一钱） 生地（五钱） 麦冬（五
钱） 肉苁蓉（五钱洗去盐水）水煎好加入人乳半碗服
清水至神汤
薏仁（五钱） 白果（十个） 升麻（五分） 车前子（一两） 泽泻（三钱） 刘寄奴（五钱）水煎服
益火济水汤
熟地（一两） 山药（五钱） 茯苓（五钱） 山茱萸（五钱） 牛膝（三钱） 肉桂（二钱） 麦冬（五
钱） 车前子（三钱） 薏仁（五钱）水煎服
大小便闭塞不通，人们都认为是火邪所致。然而，火邪也有阴火和阳火的分别。阳火导致的闭结，人们容易识别；阴火导致的闭结，人们难以辨识。
先说大便的闭结。如果是寒邪与火邪逼迫于大肠之中，烧干大肠津液，导致肠道干枯而疼痛，手按压时痛感剧烈、不可靠近，必须使用具有祛荡作用的药物进行猛烈泻下。否则，邪气留滞于腹中，必然演变为胡言乱语、发狂的症状。这类疾病是阳火在作祟。
如果是肾水亏损，不能滋润大肠，导致粪便像羊屎一样干燥，往往有长达一个月尚未排便的情况。虽然感觉急迫，但终究不是那种极度忍耐的痛苦，过了两三天后情况与之前没有太大差异。老年人多有此症，这是阴火在作祟。所谓的阴火，就是相火，属于虚火。肾火有余，实际上是肾水不足的表现。如果此时再用下药攻下，就是使其阴虚更加虚弱，离死不远了。
我现在制定两个方子：一个治疗阳火，一个治疗阴火。
治疗阳火的方子名为“利火下导汤”。此方虽然有大黄的行火作用、火麻仁的润燥作用，但仍以当归为君药，则补益多于泻下。这也是顺应病势加以引导，最终不会因过度泻下而亡失阴液。
治疗阴火的方子名为“升阳下阴汤”。此方的妙处在于：以熟地黄这一纯阴之药为君药，佐以地榆、肉苁蓉、火麻仁的润燥之性。尤其妙用升麻提升清气，则秽浊之气自然下行。又何必多此一举加入大黄呢？
再说小便的闭结。小便的通利在于膀胱的气化功能。如果膀胱遭受火邪侵袭，则小便必定点滴不通。其症状表现为气促、面红、心中想呕吐且胃部泛酸、腹部胀满且肠道似欲断裂、双眼通红、狂躁不安。这是阳证。
倘若小便虽然急迫，但并非点滴不通，气息不急、面色不红、眼睛不痛、腹部胀满但喜欢按压、胃气安宁但食欲不振，这是阴证。如果不辨别阴阳而轻易使用开关通利的药剂，也是半死半生的危险之道。
为什么阳证容易治疗而阴证难治呢？是因为不重视对阴证的辨析并明确其机理罢了。大概小便的通利虽然根本在于膀胱的气化，但膀胱既畏惧火邪，又未尝不喜欢火（指阳气）。火邪过多，则膀胱的气化功能无法正常运行；如果没有火（阳气），膀胱的气化功能又不能运行。膀胱阴虚，则水道已成如冰冻之窟，又怎能通利阴寒之水呢？因此小便也闭塞不通。
我现在也设立两个方子：一个治疗阳证，一个治疗阴证。
治疗阳证的方子名为“清水至神汤”。一剂即可通车前子利水而不耗气，刘寄奴逐水而不伤阴，升麻提升反而获得下降的适宜效果，白果引入任督二脉之路以泻水气直入膀胱，实有妙用。
治疗阴证的方子名为“益火济水汤”。此方的妙处在于：完全是补阴而不直接利水，只用一味肉桂来转化阳气，自然如同雪消春水、冰泮沟壑皆通。如果只去除通水的药物，则膀胱更加寒冷，必然成为牢不可破的坚城。
利火下导汤
大黄（三钱） 当归（一两） 红花（二钱） 赤芍药（三钱） 浓朴（二钱） 枳实（一钱） 柴胡（八分） 火麻子（三钱） 水煎服
升阳下阴汤
熟地（一两） 当归（五钱） 地榆（一钱） 火麻子（一钱） 升麻（一钱） 生地（五钱） 麦冬（五钱） 肉苁蓉（五钱，洗去盐水） 水煎好后加入人乳半碗服用
清水至神汤
薏仁（五钱） 白果（十个） 升麻（五分） 车前子（一两） 泽泻（三钱） 刘寄奴（五钱） 水煎服
益火济水汤
熟地（一两） 山药（五钱） 茯苓（五钱） 山茱萸（五钱） 牛膝（三钱） 肉桂（二钱） 麦冬（五钱） 车前子（三钱） 薏仁（五钱） 水煎服
Obstruction and blockage of urination and defecation are generally attributed to Fire. However, Fire is distinguished into Yin Fire and Yang Fire. Obstructions caused by Yang Fire are easily recognized by people, whereas those caused by Yin Fire are difficult to identify.
First, regarding the obstruction of defecation: If cold pathogens and Fire force their way into the Large Intestine, burning up its fluids and causing dryness leading to intestinal knotting and pain that cannot be touched by hand, it is necessary to use purgative agents for vigorous evacuation. Otherwise, the pathogen remaining in the abdomen will inevitably transform into symptoms of delirium and madness. Such diseases are caused by Yang Fire.
If Kidney Water is deficient and fails to moisten the Large Intestine, resulting in feces as hard as sheep dung, cases where there has been no bowel movement for a month often occur. Although there may be a sense of urgency, it is not the unbearable type of pain; after two or three days, the condition remains similar to before. This symptom is common in the elderly and is caused by Yin Fire. The so-called Yin Fire refers to Ministerial Fire, which is Deficient Fire. Excess Kidney Fire is actually due to insufficiency of Kidney Water. If one were to use purgatives in such cases, it would further deplete the already deficient Yin, bringing death closer.
I have now established two formulas: one for treating Yang Fire and one for treating Yin Fire.
The formula for treating Yang Fire is named *Li Huo Xia Dao Tang* (Fire-Draining Downward-Guiding Decoction). Although this formula contains Da Huang (Rhubarb Rhizome) for moving Fire and Huo Ma Ren (Hemp Seed) for moistening, it takes Dang Gui (Angelica Sinensis Root) as the sovereign herb. Thus, tonification outweighs purgation. This follows the momentum of the disease to guide it out, ultimately avoiding the loss of Yin through excessive purging.
The formula for treating Yin Fire is named *Sheng Yang Xia Yin Tang* (Ascending Yang and Descending Yin Decoction). The brilliance of this formula lies in using Shu Di Huang (Prepared Rehmannia Root), a purely Yin herb, as the sovereign agent, assisted by the moistening properties of Di Yu (Sanguisorba Root), Rong Rong (Cistanche Stem), and Huo Ma Ren (Hemp Seed). Particularly ingenious is the use of Sheng Ma (Cimicifuga Rhizome) to ascend clear Qi, thereby naturally causing turbid matter to descend. Why add Da Huang unnecessarily?
Regarding the obstruction of urination: The free flow of urine depends on the Qi transformation of the Bladder. If the Bladder is affected by Fire pathogen, urine will pass drop by drop or not at all. Symptoms include rapid breathing, red face, nausea with sour regurgitation, abdominal distension with sensation of intestinal rupture, red eyes, restlessness, and mania. This is a Yang syndrome.
Conversely, if urine is urgent but not completely obstructed, breathing is normal, face is not red, eyes are not painful, abdominal distension is relieved by pressure, stomach comfort is present but appetite is poor, this is a Yin syndrome. If one fails to distinguish between Yin and Yang and lightly uses opening and unblocking agents, it leads to a half-dead, half-alive state.
Why is Yang syndrome easy to treat while Yin syndrome is difficult? It is because Yin syndromes are not sufficiently analyzed and clarified. Generally, the free flow of urine originates from the Qi transformation of the Bladder. The Bladder fears Fire yet also relies on Fire (Yang Qi). Excessive Fire hinders Bladder Qi transformation; absence of Fire prevents Bladder Qi transformation. When Bladder Yin is deficient, the water passages become like frozen pools, unable to conduct Yin-cold water. Thus, urination becomes obstructed.
I have also established two formulas: one for Yang syndrome and one for Yin syndrome.
The formula for Yang syndrome is named *Qing Shui Zhi Shen Tang* (Clearing Water Reaching Divine Effect Decoction). One dose can facilitate Che Qian Zi (Plantago Seed) to promote diuresis without depleting Qi, Liu Ji Nu (Artemisia Annua Herb) to remove water without damaging Yin, Sheng Ma (Cimicifuga Rhizome) to ascend and thereby achieve the appropriate effect of descending, and Bai Guo (Ginkgo Seed) to enter the Ren and Du meridians to drain water Qi directly into the Bladder. This has truly miraculous effects.
The formula for Yin syndrome is named *Yi Huo Ji Shui Tang* (Benefiting Fire to Aid Water Decoction). The brilliance of this formula lies in purely tonifying Yin without directly promoting diuresis. Using only Rou Gui (Cinnamon Bark) to transform Yang allows nature to melt snow like spring water, thawing ice and clearing all channels. If one merely removes water-draining herbs, the Bladder becomes colder, forming an impregnable fortress.
**Li Huo Xia Dao Tang**
Da Huang (3 qian), Dang Gui (1 liang), Hong Hua (2 qian), Chi Shao Yao (3 qian), Nong Po (2 qian), Zhi Shi (1 qian), Chai Hu (8 fen), Huo Ma Zi (3 qian). Decoct in water and take orally.
**Sheng Yang Xia Yin Tang**
Shu Di (1 liang), Dang Gui (5 qian), Di Yu (1 qian), Huo Ma Zi (1 qian), Sheng Ma (1 qian), Sheng Di (5 qian), Mai Dong (5 qian), Rou Cong Rong (5 qian, washed to remove salt). Decoct in water, add half a bowl of human milk when ready, and take orally.
**Qing Shui Zhi Shen Tang**
Yi Yi Ren (5 qian), Bai Guo (10 pieces), Sheng Ma (5 fen), Che Qian Zi (1 liang), Ze Xie (3 qian), Liu Ji Nu (5 qian). Decoct in water and take orally.
**Yi Huo Ji Shui Tang**
Shu Di (1 liang), Shan Yao (5 qian), Fu Ling (5 qian), Shan Zhu Yu (5 qian), Niu Xi (3 qian), Rou Gui (2 qian), Mai Dong (5 qian), Che Qian Zi (3 qian), Yi Yi Ren (5 qian). Decoct in water and take orally.