膀胱者，州都之官，津液藏焉，气化则能出矣。何谓气化，津液乃气所化也。(小便不
通，是气化不行也。经谓膀胱者，津液之府，气化则能出矣。)《经脉别论》云∶饮入于胃
，游溢精气
，
上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五经并行。盖譬之蒸物
然，汤气上熏釜甑，遂有液而下滴，此脾气熏蒸肺叶，所以遂能调水道而输膀胱也。故小便
不通
之症，审系所虚而水涸者，利之益甚，须以大补。人参少佐升麻，煎汤饮之，则阳升阴降，
是
地气上为云，天气下为雨也。自然通利矣。丹溪尝治一人伤寒，得汗热退后，脉尚洪，(伤
寒
得汗脉，必洪而无力。)此洪脉作虚论，与人参、黄 、白术、炙甘草、当归、芍药、陈皮
，数日，其脉仍
大，又小便不通，小腹下妨闷，颇为所苦，但仰卧则点滴而出，日以补药服之未效，于前药
内
倍加黄 、人参，大剂与服，两日而小便方利。强力入房，过忍小便而不通者，小菟丝子丸
、六味
丸治之，多服取效，下焦有热者，凤髓丹、滋肾丸之属。杨仁斋云∶大凡水道不行，其本在
肾
，其末在肺。合用牵牛、泽泻、便自通。虚人老人，又不在此例。王海藏云∶年老人虚秘，
是下亡津
液也。以升麻汤举之，阳升阴降，是地气上为云，天气下为雨也，所以通利。又云∶小便不
通，
非小肠膀胱厥阴也，强力房劳，过忍小便之过也。一男子病小便不通，他医治以利药益甚，
丹溪诊之，右寸颇弦滑，曰∶此积痰也。积痰在脉，脉为上焦，而膀胱为下焦，上焦闭则下
焦塞，譬如滴水之器，必上窍通而后下窍之水出，乃以法大吐，吐已病如失。经云∶膀胱
者，津
液之府，气化则能出矣。又云∶肺气通调水道，下泄膀胱。《脉诀》云∶肝胆同归津液府，
所以太阳厥阴同为一治。又云∶膀胱肾合为精府。此肾主大小二便难也。
着眼在肺气通调，水津四布二语。
膀胱，是州都之官（指汇聚水液的器官），津液在此储藏，经过气化作用才能排出体外。什么叫气化？津液是由气所化生的。（小便不通，是因为气化功能不行。经文说膀胱是津液之府，气化正常则尿液能排出。）《经脉别论》说：饮水进入胃中，精气游溢散布，向上输送给脾，脾气散精，向上归于肺，通调水道，向下输送到膀胱，水精四布全身，五行经脉并行。这就像蒸东西一样，汤气向上熏蒸釜甑，于是有液体滴下，这是脾气熏蒸肺叶，所以能够通调水道而输注到膀胱。因此，对于小便不通的症状，如果审查是由于虚损导致津液枯竭的，使用利水药会使情况更严重，必须用大补之法。用人参少佐升麻，煎汤饮用，那么阳气上升阴气下降，就像地气上升为云，天气下降为雨一样，自然就会通利了。丹溪曾经治疗一个伤寒患者，发汗热退后，脉象仍然洪大，（伤寒发汗后的脉象，必定是洪大但无力。）将此洪脉作为虚证来论述，给予人参、黄芩、白术、炙甘草、当归、芍药、陈皮，数日后，脉象仍然很大，又出现小便不通，小腹下方胀闷，非常痛苦，只有仰卧时才能点滴流出，每天服用补药没有效果，在前药基础上加倍加入黄芩、人参，大剂量服用，两天后小便才通利。因强力行房事，强忍小便而不通的，用小菟丝子丸、六味丸治疗，多服见效，下焦有热的，用凤髓丹、滋肾丸之类。杨仁斋说：大凡水道不通，根本在肾，末梢在肺。合用牵牛子、泽泻，小便自然通畅。体虚的老人，不在此例。王海藏说：老年人虚秘，是下焦津液亡失。用升麻汤提升阳气，阳气上升阴气下降，就像地气上升为云，天气下降为雨，所以能通利。又说：小便不通，不是小肠、膀胱、厥阴经的问题，而是强力房劳、强忍小便造成的过失。一个男子患小便不通，其他医生用利水药治疗反而加重，丹溪诊察，右寸脉颇弦滑，说：这是积痰。积痰在脉，脉属上焦，而膀胱属下焦，上焦闭塞则下焦堵塞，就像滴水之器，必须上窍通畅然后下窍的水才能流出，于是用催吐法，吐完后病如失。经文说：膀胱是津液之府，气化则能排出。又说：肺气通调水道，向下排泄到膀胱。《脉诀》说：肝胆同归津液府，所以太阳经和厥阴经同为一治。又说：膀胱与肾合为精府。这是肾主管大小便困难的原因。着眼点在“肺气通调，水津四布”这两句话。
The Bladder is the official of the "Zhou Du" (a metaphor for the reservoir of fluids), where body fluids are stored; only through Qi transformation can they be excreted. What is meant by Qi transformation? Body fluids are transformed by Qi. (Impaired urination results from the failure of Qi transformation. The Classic states that the Bladder is the mansion of body fluids, and when Qi transforms, excretion occurs.) The *Treatise on Differences in Meridians* says: When drink enters the stomach, its essence floats and overflows, moving upward to the Spleen. The Spleen scatters the essence, sending it upward to return to the Lung. The Lung regulates and directs the water passages, transmitting them downward to the Bladder. Water essence distributes throughout the four directions, and the five meridians proceed together. This is like steaming food: the steam from the broth rises to熏 (smoke/steam) the cauldron and steamer, causing liquid to drip down. Similarly, the Spleen's steaming action warms the Lung leaves, thereby regulating the water passages and transmitting fluids to the Bladder. Therefore, regarding the symptom of impaired urination, if it is examined to be due to deficiency leading to fluid depletion, using diuretics will worsen it; one must use major tonification. Using Ren Shen (Ginseng Root) with a small amount of Sheng Ma (Cimicifugae Rhizome), decocted and drunk, causes Yang to rise and Yin to descend, just as earthy qi rises to form clouds and heavenly qi descends to form rain. Naturally, flow becomes smooth. Danxi once treated a patient with Shang Han (Cold Damage). After sweating and fever subsiding, the pulse remained洪 (Surging). (After sweating in Shang Han, the pulse must be Surging but weak.) Treating this Surging pulse as a sign of deficiency, he administered Ren Shen (Ginseng Root), Huang Qin (Scutellariae Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Zhi Gan Cao (Prepared Licorice Root), Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix), and Chen Pi (Citri Reticulatae Pericarpium). After several days, the pulse remained large, and impaired urination occurred, with distension and stuffiness below the lower abdomen, causing significant distress. Only when lying supine could urine drip out. Daily administration of tonic herbs was ineffective. He doubled the dosage of Huang Qin (Scutellariae Radix) and Ren Shen (Ginseng Root) in the previous prescription and administered it in a large dose. After two days, urination finally became free. For cases caused by strenuous sexual activity or forcibly holding urine, Xiao Tusizi Wan (Small Cuscuta Pill) or Liuwei Wan (Six-Ingredient Pill) should be used; taking them frequently yields results. For heat in the Lower Jiao, Fengsui Dan (Phoenix Marrow Pill) or Zishen Wan (Kidney-Nourishing Pill) are appropriate. Yang Renzhai said: Generally, when water passages do not flow, the root lies in the Kidney, and the branch in the Lung. Using Qian Niu Zi (Pharbitidis Semen) and Ze Xie (Alismatis Rhizoma) allows urine to flow naturally. However, this does not apply to frail or elderly people. Wang Haizang said: Deficiency constipation in the elderly is due to the loss of body fluids in the Lower Jiao. Using Sheng Ma Tang (Cimicifuga Decoction) lifts the Qi. As Yang rises and Yin descends, like earthy qi forming clouds and heavenly qi forming rain, flow is facilitated. He also stated: Impaired urination is not due to disorders of the Small Intestine, Bladder, or Jueyin Meridian, but rather the fault of strenuous sexual activity and forcibly holding urine. A man suffered from impaired urination. Other doctors treated him with diuretics, which worsened his condition. Danxi diagnosed a slightly wiry and slippery pulse at the Right Cun position, stating: This is accumulated phlegm. Accumulated phlegm resides in the vessels; the vessels belong to the Upper Jiao, while the Bladder belongs to the Lower Jiao. If the Upper Jiao is blocked, the Lower Jiao is obstructed. It is like a vessel for dripping water; the upper aperture must be open for water to exit from the lower aperture. Thus, he induced vomiting. After vomiting, the illness disappeared as if lost. The Classic states: The Bladder is the mansion of body fluids; when Qi transforms, excretion occurs. It also states: The Lung regulates and directs the water passages, draining downward into the Bladder. The *Mai Jue* (Pulse Secrets) states: The Liver and Gallbladder both relate to the mansion of body fluids; therefore, the Taiyang and Jueyin meridians are treated together. It also states: The Bladder and Kidney combine to form the mansion of essence. This explains why the Kidney governs difficulties in both large and small bowel movements. The key focus lies in the phrases "Lung Qi regulates and directs" and "water essence distributes throughout."