太无论小便不利三端∶一者大便泻而小便涩，为津液偏渗，治宜分利而已。二者热搏下
焦，
湿热不行，必通泄则愈。三者脾胃气涩，不能通调水道，下输膀胱，可顺气令施化而出。然
津液偏渗，有脾肺之分；湿热不行，亦有肾与膀胱之别。更当参合脉症而分辨之。东垣以小
便不通，皆邪热为病，分在气在血而治之。如渴而不利者，热在上焦气分，为肺热不能生水
，是绝小便之源也。宜淡味渗泄之药，以清肺泄火，滋水之化源。如不渴者，热在下焦血分
，为阴受热邪，闭塞其流，宜气味俱阴之药，以除其热，泄其闭塞也。此以上下二焦分气血
言。然在下焦，亦有气壅血污之分；即在上焦，亦有气虚气窒之异，不可不察也。
《元珠》论遗溺闭癃，惟肝与督脉、三焦、膀胱主之。经云∶肝足厥阴之脉，环阴器，
所生
病遗溺闭癃。督脉者女子入系廷孔，其孔，溺孔之端也。其男子循茎下至纂，与女子等，其
生病癃痔遗溺。三焦者，足太阳少阴之所将，太阳之别也，上踝五寸，别出贯 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。然刺灸之法，但取厥阴、督脉
、三焦俞穴，而不及膀胱者，以膀胱但藏溺耳。其出溺，皆从三焦及肝、督脉也。按∶经云
肾开窍于二阴；又云肾合膀胱，余常见老医以白通、六味、肾气等药，辨阴阳虚实而治之，
其效捷于桴鼓，而此论独不主肾，故当总统诸家，而参考之，则无遗义矣。
丹溪云∶小便不通，有正治，有隔二隔三之治，如不因他故，但膀胱有热者，则宜黄柏
、知
母之属泻膀胱，此正治也。如因肺燥不能生水者，则宜车前、茯苓之属清肺气，此隔二之治
也。如因脾湿不运，而精不升，以致肺不能生水者，则当苍术、白术之属燥脾利湿，此隔三
之治也。但所谓清肺之法，自宜《外台》百合饮子之类，清润兼行，庶几得理，若车前、茯
苓渗利之品，以求其水，益资其燥矣。
丹溪又谓∶不论气虚、血虚、实热、痰闭，皆宜吐之，以提其气，气升则水自降，譬之滴
水之
器，必使上窍通而后下窍之水出焉。夫病在下，取之上，《内经》之旨也。天地之气不升则
不降，吐亦法之巧耳。然必痰实气闭者，乃可用之，未可以之概治气虚、血虚等症也。
《元珠》闭癃遗溺不禁之辨，谓闭者，小便不出，塞而不通也。癃者，罢弱而气不充，
淋淋
沥沥，点滴而出，或涩而疼，一日数十次，俗名淋病者是也。闭则是急病，癃则是缓病；遗
溺睡梦中溺出，醒而方知是也。不禁者，日夜无遍数，频频而溺也。
太无（宋代医家陈言）论述小便不利，主要有三种情况：一是大便泄泻而小便涩滞，这是由于津液偏渗于大肠所致，治疗应当采用分利的方法。二是热邪搏结于下焦，湿热阻滞不通，必须通过通泄的方法才能痊愈。三是脾胃气机涩滞，不能通调水道，使水液向下输注到膀胱，可以通过顺气的方法使其气化排出。然而，津液偏渗，有涉及脾和肺的区别；湿热阻滞不通，也有涉及肾与膀胱的不同。更应当结合脉象和症状来加以分辨。李东垣认为小便不通，都是邪热致病，分为在气分和血分两种情况来治疗。如口渴而小便不利的，是热在上焦气分，属于肺热不能生水，这是断绝了小便的源头。适宜使用淡味渗泄的药物，以清肺火，滋补水液的化源。如不口渴的，是热在下焦血分，属于阴分受热邪侵袭，闭塞了水流，适宜使用气味俱属阴的药物，以清除热邪，疏通闭塞。这是以上下二焦区分气血而言。但在下焦，也有气壅和血污的区别；即使在上焦，也有气虚和气窒的不同，不可不仔细考察。
《元珠》（即《医学纲目》或相关古籍，此处指代特定文献观点）论述遗溺（尿失禁）和闭癃（排尿困难），主要与肝、督脉、三焦、膀胱有关。经文说：足厥阴肝经，环绕生殖器，所生的病包括遗溺和闭癃。督脉，女子进入系连廷孔，这个孔就是溺孔的末端。男子则沿阴茎下行至会阴，与女子相同，其发病表现为癃、痔、遗溺。三焦，是足太阳膀胱经和足少阴肾经所统摄的，是太阳经的别络，在外踝上五寸处别出，穿过肠道，出于委阳穴，并与太阳经的正脉并行，入络于膀胱，约束下焦，实证则出现闭癃，虚证则出现遗溺。然而针刺灸法，只取厥阴、督脉、三焦俞穴，而不取膀胱穴的原因，是因为膀胱只是储存尿液的地方，而尿液的排出，都经过三焦以及肝、督脉的作用。按语：经文说肾开窍于前后二阴；又说肾合膀胱。我常见老医生用白通汤、六味地黄丸、肾气丸等药物，辨别阴阳虚实进行治疗，效果迅速如击鼓应声，但这篇论述唯独不强调肾，所以应当综合各家学说，参考比较，就没有遗漏的道理了。
朱丹溪说：小便不通，有正治法，有隔二之治法，有隔三之治法。如不是因其他原因，仅仅是膀胱有热的，适宜用黄柏、知母之类的药泻膀胱之火，这是正治法。如因肺燥不能生水，适宜用车前子、茯苓之类的药清肺气，这是隔二之治法。如因脾湿不运，导致精微物质不能上升，致使肺不能生水，应当用苍术、白术之类的药燥脾利湿，这是隔三之治法。但是所谓清肺的方法，自然适宜用《外台秘要》中的百合饮子之类，清润兼施，才合乎道理，如果用前文提到的车前子、茯苓这些渗利之品来求水，反而更加助长肺燥了。
丹溪又说：不论气虚、血虚、实热、痰闭引起的小便不通，都适宜用吐法，以提举气机，气升则水自降，好比滴水之器，必须使上窍通畅，然后下窍的水才能流出。病在下部，取上部穴位，《内经》的宗旨就是这样。天地之气如果不升就不能降，吐法也是巧妙的治疗方法。但是必须是痰实气闭的情况，才可以使用这种方法，不可以用它来概括治疗气虚、血虚等症状。
《元珠》对闭、癃、遗溺、不禁的辨别，说闭，是小便排不出，堵塞不通。癃，是身体疲弱而气不充足，淋淋漓漓，点滴而出，或者涩痛，一天几十次，俗称淋病的就是这种情况。闭属于急病，癃属于缓病。遗溺，是在睡梦中小便流出，醒来才知道。不禁，是日夜没有次数限制，频繁地小便。
Tai Wu (a Song Dynasty physician) discusses three main aspects of difficulty in urination: First, diarrhea accompanied by scanty or difficult urination is due to the preferential seepage of body fluids into the large intestine; treatment should focus on separating and draining. Second, heat clashing with the Lower Jiao results in stagnant damp-heat, which must be resolved through purgation and drainage to heal. Third, sluggish Qi in the Spleen and Stomach fails to regulate water passages and transport fluids downward to the Bladder; treatment involves regulating Qi to promote transformation and excretion. However, preferential fluid seepage may involve the Spleen or Lung, while stagnant damp-heat may differ between the Kidney and Bladder. One must further differentiate based on pulse and symptoms. Li Dongyuan posits that difficulty in urination is caused by pathogenic heat, distinguishing between involvement of the Qi level and Blood level for treatment. If thirst is present with difficulty in urination, the heat is in the Qi level of the Upper Jiao, indicating Lung Heat failing to generate Water, thus cutting off the source of urine. Light, permeating, and draining herbs should be used to clear Lung Heat and nourish the source of Water generation. If there is no thirst, the heat is in the Blood level of the Lower Jiao, where Yin receives pathogenic heat, blocking the flow; herbs with Yin natures and flavors should be used to eliminate heat and unblock obstruction. This distinguishes Qi and Blood levels by Upper and Lower Jiao. Yet, within the Lower Jiao, there are distinctions between Qi stagnation and Blood turbidity; even in the Upper Jiao, there are differences between Qi deficiency and Qi obstruction, which must not be overlooked.
The *Yuan Zhu* discusses enuresis (involuntary urination) and strangury/obstruction, attributing them primarily to the Liver, Du Mai (Governing Vessel), San Jiao (Triple Burner), and Bladder. The Classic states: The Foot Jueyin Liver Meridian circles the genitalia; diseases arising from it include enuresis and strangury. The Du Mai enters the Ting Kong in women, which is the opening of the urethra. In men, it follows the penis down to the perineum, similar to women; its diseases include strangury, hemorrhoids, and enuresis. The San Jiao is commanded by the Foot Taiyang Bladder Meridian and Foot Shaoyin Kidney Meridian; it is a branch of the Taiyang, emerging five cun above the ankle, passing through the intestines, exiting at Weiyang (BL39), running parallel to the Taiyang proper, entering and connecting with the Bladder, and constraining the Lower Jiao. Excess leads to strangury/obstruction, while deficiency leads to enuresis. However, acupuncture and moxibustion only select points from the Jueyin, Du Mai, and Sanjiaoshu (BL27), omitting the Bladder itself, because the Bladder merely stores urine, whereas the discharge of urine is governed by the San Jiao, Liver, and Du Mai. Note: The Classic states the Kidney opens into the two yin orifices and combines with the Bladder. I have often seen experienced physicians treat with Baotong Decoction, Liuwei Dihuang Wan, or Shenqi Wan, differentiating Yin and Yang excess and deficiency, achieving rapid effects like a drumstick striking a drum. Since this discussion does not emphasize the Kidney, one should synthesize various schools of thought and cross-reference them to avoid omission.
Zhu Danxi stated: Difficulty in urination has direct treatment, treatment separated by two organs, and treatment separated by three organs. If there is no other cause and the Bladder simply has heat, herbs such as Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) should be used to drain Bladder heat; this is direct treatment. If Lung dryness prevents Water generation, herbs such as Cheqianzi (Plantaginis Semen) and Fuling (Poria) should be used to clear Lung Qi; this is treatment separated by two organs. If Spleen dampness fails to transport, preventing essence from ascending and thereby causing the Lung to fail in generating Water, herbs such as Cangzhu (Atractylodis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) should be used to dry the Spleen and promote dampness removal; this is treatment separated by three organs. However, regarding methods to clear the Lung, one should naturally use formulas like Baihe Yinzi (Lily Decoction) from the *Waitai Misha*, combining clearing and moistening properties to align with principles. Using permeating and draining items like Cheqianzi and Fuling to seek water would only exacerbate dryness.
Danxi also stated: Regardless of whether the cause is Qi deficiency, Blood deficiency, excess heat, or phlegm obstruction, vomiting therapy is suitable to lift Qi. When Qi ascends, Water descends, akin to a dripping vessel where the upper aperture must be open for water to flow out from the lower. Treating a disease in the lower part by targeting the upper part is the principle of the *Neijing*. Heaven and Earth Qi do not descend if they do not ascend; vomiting is a clever application of this method. However, it can only be used when there is phlegm-fullness and Qi obstruction, and cannot be applied generally to conditions such as Qi deficiency or Blood deficiency.
The *Yuan Zhu* differentiates Bi (obstruction), Long (strangury), Yini (enuresis), and Jinbun (incontinence). Bi refers to the inability to pass urine, blocked and obstructed. Long refers to weakness and insufficient Qi, resulting in dribbling, drop by drop, possibly with pain and frequency (dozens of times a day); this is commonly known as Lin syndrome (dysuria). Bi is an acute condition, while Long is a chronic condition. Yini refers to urination during sleep, realized only upon waking. Jinbun refers to frequent urination without restriction throughout day and night.