有下焦蓄热者，《内经》所谓膀胱不利为癃也，巢氏云∶膀胱与肾为表里，而俱主水，
热气
太盛，故令结涩，小便不通，腹胀气急，甚者水气上逆，令主腹痛呕，乃至于死，其脉紧而
滑直者是也。
广济方
冬葵子 滑石 茯苓 通草（各三两） 茅根（四两） 芒硝（二两，汤成下）
水煮分温三服，相去如人行六七里。若不得溺，急闷欲绝者，以盐二升，大铛中熬，以
布绵裹脐下 之，小盒饭渐通也。曾试有验。
《圣济总录》方
独颗大蒜一枚，栀子仁三匕枚，盐花少许，三味捣摊纸上，贴脐良久即通，未通涂阴囊
上立通。
掩脐法
连根葱勿洗，带土生姜一块，淡豆豉二十一粒，盐二匙，同研烂，捍饼烘热掩脐中，以
帛扎定，良久气透自通，不然再换一剂。
有肺热不降者，东垣曰∶小便闭而不渴者，热在下焦血分，真水不足，膀胱干涸，乃无
阳无以化，法宜苦寒之属，以补肾与膀胱，使阴气行而阳自化，则小便自通。其渴者，热在
上焦气分，肺中伏火，不能生水，膀胱绝其化源，宜气味俱薄淡渗之药，以泻肺火，清肺金
而滋水之化源。
百合饮子（《外台》）
桑白皮（六分） 通草 百合（各八分） 白茅根（一分）
水四升，煮取二升，去滓温服。
有下焦阳虚不化者，夫肾开窍于二阴，肾中阳虚，则二阴之窍闭，闭则大小便俱不得出
，如重阴冱寒，地道闭塞，惟与白通汤多加葱白，阳气一至，二便立通矣。
白通汤
葱白（四茎） 干姜（一两） 附子（一枚）
上三味，以水三升，煮取一升，去滓，分温再服，加入尿五合尤佳。伤寒并用猪胆者，
所以从上焦格拒之阴，此病独加人尿者，所以通阴中闭塞之阳也。
有下焦阴虚而阳不化者，其状脚膝软弱无力，阴汗阴痿，足热不能履地，不渴而小便闭
，是
不可以淡渗之剂利之，利之则阴愈竭，而水益不行矣。宜苦寒之属以补肾与膀胱，所云使阴
气行而阳自化也。
滋肾丸
黄柏（酒洗，焙，二两） 知母（酒洗，焙，一两） 肉桂（一钱）
上为细末，熟水丸芡实大，每服百丸，加至二百丸，百沸汤空心下。
《内经》曰∶热者寒之。又云∶肾苦燥，急食辛以润之。以黄柏之苦寒，泻热补水润燥
，故以为君；以知母苦寒泻肾火，故以为佐；肉桂辛热，寒因热用也。
丹溪云∶诸淋皆属于热，余每用滋肾丸，每百丸，可用四物汤加甘草梢、杜牛膝、木通
、桃仁、滑石、木香煎汤，空心吞服。兼灸三阴交，如鼓应桴，累试累验。
有转胞不得小便者，由胞为热所迫，或强忍小便，俱令水气迫于胞，屈辟不得充张，外
水应
入不得入，内水应出不得出，小腹急痛，不得小便，不治害人。亦有虚人下焦气冷不治，胞
系了戾者，宜分而治之。
滑石散
寒水石（二两） 葵子（一合） 滑石（一两） 乱发灰 车前子 木通（各一两）
上锉散，水一斗，煮取五升，时时服一剂即利。
八味丸 治肾虚小便不通，或过服凉药而闭涩愈甚者，及虚人下元冷，胞转不得
小便，膨急切痛，经四五日困笃欲死者，每服五十丸，温盐汤下。
小便闭尿满方
小青菜子 炒枳壳 不拘分两，煎汤薰洗即通。
【下焦蓄热证】
存在下焦蓄积热邪的情况，《黄帝内经》中称之为“膀胱气化不利导致癃闭”。巢元方在《诸病源候论》中指出：膀胱与肾互为表里，且都主管水液代谢。如果体内热气过于旺盛，就会导致尿液凝结涩滞，小便不通，腹部胀满、气息急促；严重时水气上逆，引起腹痛、呕吐，甚至死亡，其脉象表现为紧而滑直。
《广济方》方剂：
冬葵子、滑石、茯苓、通草（各三两），白茅根（四两），芒硝（二两，待药汤煮成后加入）。
用水煎煮，分三次温服，两次服药间隔时间约为行人步行六七里的路程。如果仍然无法排尿，感到极度憋闷几乎要窒息时，用盐二升，在大锅中炒热，用布绵包裹敷于脐下，小便逐渐就能通畅。我曾尝试过，确有疗效。
《圣济总录》方剂：
独头蒜一枚，栀子仁三枚，少许盐花。将这三味药捣碎摊在纸上，贴敷于脐部良久即可通畅；若未通，则涂敷于阴囊上，立即可通。
掩脐法：
带根的葱不要清洗，带土生姜一块，淡豆豉二十一粒，盐两匙。一同研烂，做成饼状烘热后敷于脐中，用布带扎紧固定。良久之后，气机透达，小便自通；如果不行，再更换一剂。
【肺热不降证】
存在肺热不能肃降的情况。李东垣说：小便闭塞但不口渴的，是热在下焦血分，真阴不足，导致膀胱干涸，因为没有阳气就无法气化，治法适宜用苦寒性质的药物，来补肾与膀胱，使阴气运行而阳气自然气化，则小便自通。如果口渴的，是热在上焦气分，肺中有伏火，不能生水，导致膀胱失去化源，适宜使用气味淡薄、具有淡渗作用的药物，以泻肺火，清肺金从而滋补水液的化源。
百合饮子（出自《外台秘要》）：
桑白皮（六分），通草、百合（各八分），白茅根（一分）。
用水四升，煮取二升，去渣，温服。
【下焦阳虚不化证】
存在下焦阳气虚弱无法气化的情况。肾开窍于前后二阴，肾中阳气虚弱，则二阴之窍闭塞，闭塞则大小便都不得排出，如同重阴冻结寒冷，大地通道闭塞，只需用白通汤多加葱白，阳气一到，二便立即通畅。
白通汤：
葱白（四茎），干姜（一两），附子（一枚）。
以上三味药，用水三升，煮取一升，去渣，分两次温服，加入人尿五合效果更佳。治疗伤寒时使用猪胆汁，是为了从上焦格拒阴寒之气；此病唯独加入人尿，是为了通达阴中闭塞的阳气。
【下焦阴虚而阳不化证】
存在下焦阴虚而阳气无法气化的情况。症状表现为脚膝软弱无力，阴部出汗、阳痿，足心发热不能踩地，口不渴但小便闭塞。这种情况不可以用淡渗利尿的药剂来利水，因为利水会使阴液更加枯竭，而水液更无法运行。适宜用苦寒性质的药物来补肾与膀胱，所谓“使阴气运行而阳气自然气化”。
滋肾丸：
黄柏（酒洗，焙干，二两），知母（酒洗，焙干，一两），肉桂（一钱）。
以上制成细末，用熟水泛丸如芡实大小，每次服用一百丸，加至二百丸，空腹时用滚开水送服。
《黄帝内经》说：“热者寒之。”又说：“肾恶燥，急食辛以润之。”用黄柏的苦寒，泻热补水润燥，所以作为君药；用知母的苦寒泻肾火，所以作为佐药；肉桂辛热，这是利用热性药来引导寒性药发挥作用（寒因热用）。
朱丹溪说：各种淋证都属于热，我每次使用滋肾丸，每次一百丸，可以用四物汤加甘草梢、杜牛膝、木通、桃仁、滑石、木香煎汤，空腹吞服滋肾丸。同时艾灸三阴交穴，效果如鼓应桴般迅速，多次尝试多次验证有效。
【转胞证】
存在转胞导致无法小便的情况，这是由于胞宫被热邪逼迫，或者强忍小便，都导致水气压迫胞宫，使其屈曲偏斜不能充盈扩张，外面的水应该进入却进不去，里面的水应该排出却排不出，小腹急痛，无法小便，不及时治疗会害人性命。也有虚人下焦气冷不治，导致胞系扭转错乱的，应当分别进行治疗。
滑石散：
寒水石（二两），葵子（一合），滑石（一两），乱发灰，车前子，木通（各一两）。
以上锉散，用水一斗，煮取五升，时时服用一剂即可通利。
八味丸：治疗肾虚导致的小便不通，或者过服凉药而导致闭涩更严重的，以及虚人下元寒冷，胞转导致无法小便，腹部膨隆急切疼痛，经过四五日困顿危急想要死亡的，每次服用五十丸，用温盐水送下。
[Accumulation of Heat in the Lower Jiao]
There is a condition of heat accumulation in the Lower Jiao (Lower Burner). As stated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon), this is referred to as "bladder dysfunction leading to strangury" (Lóng). Chao Yuanfang noted in *Zhubing Yuanhou Lun* (General Treatise on the Origins and Manifestations of All Diseases): The Bladder and Kidney are exterior-interiorly related and both govern water metabolism. If excessive heat prevails, it causes urine to coagulate and become涩滞 (obstructed), resulting in urinary retention, abdominal distension, and shortness of breath. In severe cases, water qi rebels upward, causing abdominal pain and vomiting, potentially leading to death; the pulse is tight and slippery and straight.
*Guangji Fang* Prescription:
*Dongkuizi* (Seed of Malva Verticillata), *Shishi* (Talcum), *Fuling* (Poria), *Tongcao* (Akebia Stem) (each 3 liang); *Magen* (Rhizoma Imperatae) (4 liang); *Mangxiao* (Natrii Sulfas) (2 liang, added when the decoction is ready).
Decoct with water, divide into three warm doses. The interval between doses should be approximately the time it takes for a person to walk six or seven *li*. If urination does not occur and there is extreme憋闷 (distress/urgency) approaching suffocation, take 2 *liang* of salt, roast it in a large pot, wrap it in cloth and cotton, and apply it below the umbilicus. Urination will gradually resume. I have tested this, and it is effective.
*Shengji Zonglu* Prescription:
One bulb of garlic (single-clove), three seeds of *Zhizi* (Fructus Gardeniae), and a small amount of salt crystals. Pound these three ingredients, spread them on paper, and apply to the umbilicus for a long time until urination resumes. If it does not work, apply to the scrotum, and urination will immediately resume.
Umbilical Covering Method:
Green onions with roots (do not wash), a piece of ginger with soil, 21 grains of *Dandouchi* (Fermented Soybean), and two spoons of salt. Grind together until paste-like, form into a cake, heat it, and apply to the umbilicus. Secure tightly with a cloth band. After a while, qi will penetrate, and urination will resume naturally. If not, replace with another dose.
[Failure of Lung Heat to Descend]
There is a condition where lung heat fails to descend. Li Dongyuan stated: When urinary obstruction occurs without thirst, the heat is in the blood level of the Lower Jiao. True yin is insufficient, causing the bladder to dry up. Without yang, transformation cannot occur. The treatment method should employ bitter-cold herbs to tonify the Kidney and Bladder, allowing yin qi to circulate so that yang transforms naturally, and urination will resume. If thirst is present, the heat is in the qi level of the Upper Jiao. Hidden fire in the lungs fails to generate water, cutting off the source of transformation for the bladder. It is appropriate to use herbs with thin aroma and flavor that are light and diuretic to drain lung fire, clear lung metal, and nourish the source of water transformation.
*Baihe Yinzi* (Lily Decoction) (from *Waitai Misha*):
*Sangbaipi* (Cortex Mori Radicis) (6 fen), *Tongcao* (Akebia Caulis) and *Baihe* (Bulbus Lilii) (each 8 fen), *Baimaogen* (Rhizoma Imperatae) (1 fen).
Add four sheng of water, boil down to two sheng, remove dregs, and take warm.
[Yang Deficiency in the Lower Jiao Failing to Transform]
There is a condition of yang deficiency in the Lower Jiao failing to transform. The Kidney opens into the two yin passages (anterior and posterior). If kidney yang is deficient, the orifices of the two yin passages close. Closure results in the inability to pass both stool and urine, similar to heavy yin freezing cold where the earth's pathways are blocked. One should use *Baitong Tang* with increased amounts of *Congbai* (Scallion White). Once yang qi arrives, bowel and bladder movements will immediately resume.
*Baitong Tang*:
*Congbai* (Scallion White) (4 stems), *Ganjiang* (Rhizoma Zingiberis Preparatum) (1 liang), *Fuzi* (Radix Aconiti Lateralis Preparata) (1 piece).
Take the above three ingredients, add three sheng of water, boil down to one sheng, remove dregs, and divide into two warm doses. Adding five he of human urine is especially beneficial. In treating Cold Damage (*Shanghan*), pig bile is used to repel yin from the Upper Jiao. This disease uniquely adds human urine to unblock yang obstructed within the yin.
[Yin Deficiency in the Lower Jiao with Failure of Yang to Transform]
There is a condition of yin deficiency in the Lower Jiao with failure of yang to transform. Symptoms include weakness and lack of strength in the feet and knees, sweating in the genital area, impotence, heat in the feet preventing walking, no thirst but urinary closure. In this case, diuretic agents with light and penetrating properties should not be used to promote urination, as this would further deplete yin and prevent water from flowing. It is appropriate to use bitter-cold herbs to tonify the Kidney and Bladder, as stated: "allow yin qi to circulate so that yang transforms naturally."
*Zishen Wan* (Kidney-Nourishing Pill):
*Huangbai* (Cortex Phellodendri) (washed with wine, dried, 2 liang), *Zhimu* (Rhizoma Anemarrhenae) (washed with wine, dried, 1 liang), *Rougui* (Cortex Cinnamomi) (1 qian).
Grind into fine powder, make pills with cooked water the size of *Qianshi* (Euryale Seed). Take 100 pills per dose, increasing to 200 pills. Take on an empty stomach with boiling water.
The *Huangdi Neijing* states: "For heat, use cold." It also says: "The Kidney dislikes dryness; quickly eat pungent substances to moisten it." Using the bitter-cold *Huangbai* to drain heat, replenish water, and moisten dryness makes it the Sovereign herb. Using the bitter-cold *Zhimu* to drain kidney fire makes it the Assistant herb. *Rougui* is pungent and hot, utilizing heat to facilitate the action of cold (using heat due to cold nature/heat pathogenesis context).
Zhu Danxi said: All types of Lin syndrome belong to heat. I often use *Zishen Wan*, 100 pills each time, taken with a decoction of *Sini Tang* (Four Substances Decoction) plus *Gancao Shao* (Radix Glycyrrhizae Preparata tip), *Duniuxi* (Radix Achyranthis Bidentatae), *Mutong* (Caulis Akebiae), *Taoren* (Semen Persicae), *Shishi* (Talcum), and *Muxiang* (Radix Aucklandiae). Swallow the pill with the decoction on an empty stomach. Additionally moxa the *Sanyinjiao* (SP6) acupoint. The effect is as immediate as a drum responding to a beat; repeated trials have proven effective.
[Reversed Bladder Syndrome]
There is a condition of reversed bladder (*Zhuanbao*) causing inability to urinate. This is caused by the bladder being forced by heat, or by forcibly holding urine, both leading to water qi pressing against the bladder, causing it to twist and fail to expand. External water cannot enter, and internal water cannot exit. There is urgent pain in the lower abdomen and inability to urinate. If untreated, it can be fatal. There are also cases of deficient individuals with cold qi in the lower jiao untreated, leading to twisting of the bladder ligaments. These should be treated separately.
*Shishi San*:
*Hanshui Shi* (Halloysitum Rubrum), *Kui Zi* (Seed of Malva Verticillata), *Shishi* (Talcum), *Luancha Hui* (Ash of Human Hair), *Cheqian Zi* (Seed Plantaginis), *Mutong* (Caulis Akebiae) (each 1 liang).
Cut into pieces, add ten dou of water, boil down to five sheng. Take one dose frequently until urination resumes.
*Ba Wei Wan* (Eight-Ingredient Pill):
Treats urinary retention due to kidney deficiency, or worsening obstruction due to overuse of cooling medicines, as well as cold in the lower origin of deficient individuals causing reversed bladder and inability to urinate, with abdominal distension, urgency, and pain, becoming critical after four or five days. Take 50 pills per dose, with warm salt water.
Prescription for Urinary Retention with Fullness:
*Xiao Qingcai Zi* (Seed of Brassica Chinensis), *Chao Zhiqiao* (Fried Aurantium Fructus). Do not fix the dosage. Decoct and use for fumigation and washing; urination will resume.