一 一童子痘后，余热未除，服滋肾等剂，半载无功，骨蒸消瘦，颈顶生核，肚腹胀大，午后发寒
热。忽左胁大痛，手不可按。余用左金丸，加青皮、楂肉等药，痛止。数日忽发肿大痛，意其胁内生痈，
用夏枯草〔五两煎汤代
水〕连翘、贝母。〔各三钱。〕除热散结，生甘菊、〔二两。〕金银花〔五钱。〕紫花地丁、〔一
两。〕甘草节〔三钱。〕除热解毒；地榆〔五钱。〕凉血泻热∶牛蒡〔二钱。〕白芷〔一钱五分。〕散
结消肿；当归〔一钱五分。〕赤芍〔三钱。〕活血破瘀；皂刺〔一钱五分。〕宣壅通滞；穿三甲〔三
钱。〕破血逐痰；二味均能直达疮所，排毒散肿。服二剂果肿消痛止，寒热亦不作，诸症亦渐愈。
小便不通，匪细故也。少腹急痛，状如复碗。奔迫难禁。期朝不通，便令人呕，数日不通则死。一
见呕逆，便不可救。故内经论二便不通，最急之候。无分标本，宜先治之。经云∶胞〔即子宫。男为
精室，女为血海。〕移热于膀胱则癃。〔屡出而短少也，闭则热极可知。〕《金匮》云∶热在下焦则
淋闭不通，故滋肾水，泻膀胱，名为正治。经又言∶胱膀为津液之府。气化则出。盖水出高原，肺气运
行，水随而注，故清金润燥，名为隔二之治。又言∶脾气散精，上归于肺，通调水道，下输膀胱。故健
脾利水，名为隔三之治。又有因气滞，因胞转，因肝热，因瘀血，致闭不同，治亦各异。丹溪云∶余尝
用吐法通小便，譬如滴水之器，必上窍开，而下窍之水乃出。又有补中益气汤，升举其气，而使之通者。
虽皆是良法，但未可混施。按赵氏云∶益气、四苓、二香、黄连解毒等剂，皆治有余之症，谓膀胱原有
水积，或为热结，或为气闭，有水可通而通之也。至于不足之症，因汗多，五内枯燥，膀胱原无水积，
强欲通之，如向乞人而求食，岂能得
乎？故东垣分在气在血，渴与不渴而辨之。如渴而小便闭者，此属上焦气分受热，治宜清金；〔二冬、二
母、桑皮、茅根之属〕如不渴而小便闭者，此属下焦血分受热，治宜滋阴〔地、冬、知柏、牛膝、车前之
属〕至于真。阴真阳虚者，未之论及。经言∶肾主二便。又言∶肾司开合。又言∶肾开窍于二阴。故火盛
则水衰，津液干枯，而为热闭，宜六味〔去萸肉。〕加二冬、牛膝、车前，滋其阴，而水自来。阳虚则无
气。清浊不化，而为寒闭，宜济生肾气，〔去萸肉。〕直达膀胱，如冻河得太阳而水自通。然世人之患阴
虚者多，阳虚者少，桂、附之药，必察之明，审之当，而后可以用之。若模糊混投，几何不以人命
为戏耶！
猪苓汤〔见伤寒。〕
导赤散〔见火。〕热在下焦，小便淋闭者，随宜采用。〔或合或分
皆可。〕宜加知柏〔滋肾水，泻阴火。肾热既除，膀胱之热自清。〕麦冬〔肺清、财气化下
行，心清、则肺热自除。〕
此皆滋阴润燥荡热利水之剂，燥肾水，泻膀胱，乃正治之法也。
二冬二母散 治肺金躁热，气化不行，小便癃闭。
二冬 二母 加生鸡子〔皆清金润燥之品。〕紫菀〔虽人至高，善于趋下，肺金气化，小
便自利。〕茅根〔清肺、除热、利水。〕茯苓 车前〔利小便而下走气。〕
此方清金润燥，以通小便，乃隔二治法也。
黄连解毒汤〔见伤寒。〕治小便癃闭，因过啖辛热，伤其肺阴者。
原方〔清三焦之热，解辛热之毒。〕宜加二冬 生鸡子白〔急救肺阴。〕茯苓 车前 木
通〔通窍利水。〕便秘加大黄。
此清热解毒，急救肺阴，以通小便之方也。
四苓散〔见湿。〕治小便癃闭，因脾湿不运，而精不上升。以致肺不通调者。
宜加米仁〔健脾燥湿，补肺清热。〕桑皮〔清肺降气，除热利水。〕生象牙屑〔甘寒淡
滑利窍。〕此方健脾燥湿，以通小便，乃隔三之治法也。
二香散 治郁怒气滞，小便不通。又治强忍房事，或过忍小便，致转胞不通。
木香、真沉香。宜加滑石、〔为末等分。以橘红、茯苓车前，煎汤，空心调服四、五钱，以
通为度。一方治男妇转胞，但用寒水石、滑石、各二两，冬葵子五钱，煎服。〕
此化气之剂，气化则胞转如常，而小便自利。故曰∶治其气则愈。愚意仍加利水清热之药，以相助
为理更妙。
龙胆泻肝汤〔见胁痛。〕
此泻肝火以通小便之方也。
琥珀益元散 治小便不通，因血结者。〔血蓄膀胱。本小便自利，今反不利，是膀胱气分，亦因热
结，乃气血交病也。〕
益元加真琥珀末。〔均利小便。能逐瘀血。〕可加牛膝、〔茎中痛甚者，生用至两许。〕瞿
麦〔利水破血。〕郁金〔治血积气壅。〕连翅仁〔散血结气聚，二味皆辛苦寒，并汤调服。〕
此驱膀胱瘀血，以通小便之方也。
敷脐法 溺秘因热者多，此方最效。
大田螺〔性寒而善厘清浊，故浊水中置之，便能澄彻。二枚捣烂去壳。〕盐〔润
下。〕麝香〔通窍，各少许。〕〔同螺肉，敷脐中及少腹，软帛系之，即通。一法用猪胆连汁，笼
阴头，少顷汁入，亦即通。〕
葱熨法 气闭不通者宜之。〔因热者大忌之。〕
葱白〔三斤切细。〕盐〔一斤同炒热。绢包更换熨脐下。或再加紫苏、皂荚煎汤，坐浸水
中，亦效。〕
一、一个少年在出痘疹之后，余热尚未清除，服用滋补肾阴等药剂，半年没有疗效，出现骨蒸潮热、身体消瘦，颈部和头顶长出肿块，腹部胀大，午后发冷发热。忽然左侧胁部剧烈疼痛，手不能触碰。我用左金丸，加入青皮、山楂肉等药物，疼痛停止。几天后忽然发作肿胀剧痛，我推测是胁内生痈，使用夏枯草（五两煎汤代水）连翘、贝母（各三钱），以清热散结；生甘菊（二两）、金银花（五钱）、紫花地丁（一两）、甘草节（三钱），以清热解毒；地榆（五钱）凉血泻热；牛蒡子（二钱）、白芷（一钱五分），以散结消肿；当归（一钱五分）、赤芍（三钱），以活血破瘀；皂角刺（一钱五分），以宣通壅滞；穿山甲、鳖甲、龟板（各三钱），以破血逐痰；这两味药均能直达疮疡部位，排毒散肿。服用两剂后果然肿胀消退、疼痛停止，寒热也不再发作，各种症状也逐渐痊愈。
小便不通，不是小毛病。少腹拘急疼痛，形状像倒扣的碗。尿意紧迫难以控制。一天不通，就会令人呕吐，几天不通就会死亡。一见呕吐逆气，就不可救治。所以《内经》论述二便不通，是最危急的症状。不分标本，应当先治疗它。经书说：胞（即子宫。男性为精室，女性为血海。）移热于膀胱则导致癃闭。（屡出而短少也，闭则热极可知。）《金匮要略》说：热在下焦则淋闭不通，所以滋肾水，泻膀胱，名为正治。经书又说：膀胱为津液之府。气化则出。盖水出高原，肺气运行，水随而注，所以清金润燥，名为隔二之治。又言：脾气散精，上归于肺，通调水道，下输膀胱。所以健脾利水，名为隔三之治。又有因气滞，因胞转，因肝热，因瘀血，导致闭不同，治亦各异。丹溪说：我曾经用吐法通小便，譬如滴水之器，必上窍开，而下窍之水乃出。又有补中益气汤，升举其气，而使之通者。虽皆是良法，但未可混施。按赵氏说：益气、四苓、二香、黄连解毒等剂，皆治有余之症，谓膀胱原有水积，或为热结，或为气闭，有水可通而通之也。至于不足之症，因汗多，五内枯燥，膀胱原无水积，强欲通之，如向乞人而求食，岂能得乎？故东垣分在气在血，渴与不渴而辨之。如渴而小便闭者，此属上焦气分受热，治宜清金；（二冬、二母、桑皮、茅根之属）如不渴而小便闭者，此属下焦血分受热，治宜滋阴（地、冬、知柏、牛膝、车前之属）至于真阴真阳虚者，未之论及。经言：肾主二便。又言：肾司开合。又言：肾开窍于二阴。故火盛则水衰，津液干枯，而为热闭，宜六味（去萸肉。）加二冬、牛膝、车前，滋其阴，而水自来。阳虚则无气。清浊不化，而为寒闭，宜济生肾气（去萸肉。）直达膀胱，如冻河得太阳而水自通。然世人之患阴虚者多，阳虚者少，桂、附之药，必察之明，审之当，而后可以用之。若模糊混投，几何不以人命为戏耶！
猪苓汤（见伤寒。）
导赤散（见火。）热在下焦，小便淋闭者，随宜采用。（或合或分皆可。）宜加知柏（滋肾水，泻阴火。肾热既除，膀胱之热自清。）麦冬（肺清、财气化下行，心清、则肺热自除。）
此皆滋阴润燥荡热利水之剂，燥肾水，泻膀胱，乃正治之法也。
二冬二母散 治肺金躁热，气化不行，小便癃闭。
二冬 二母 加生鸡子（皆清金润燥之品。）紫菀（虽人至高，善于趋下，肺金气化，小便自利。）茅根（清肺、除热、利水。）茯苓 车前（利小便而下走气。）
此方清金润燥，以通小便，乃隔二治法也。
黄连解毒汤（见伤寒。）治小便癃闭，因过啖辛热，伤其肺阴者。
原方（清三焦之热，解辛热之毒。）宜加二冬 生鸡子白（急救肺阴。）茯苓 车前 木通（通窍利水。）便秘加大黄。
此清热解毒，急救肺阴，以通小便之方也。
四苓散（见湿。）治小便癃闭，因脾湿不运，而精不上升。以致肺不通调者。
宜加米仁（健脾燥湿，补肺清热。）桑皮（清肺降气，除热利水。）生象牙屑（甘寒淡滑利窍。）此方健脾燥湿，以通小便，乃隔三之治法也。
二香散 治郁怒气滞，小便不通。又治强忍房事，或过忍小便，致转胞不通。
木香、真沉香。宜加滑石、（为末等分。以橘红、茯苓车前，煎汤，空心调服四、五钱，以通为度。一方治男妇转胞，但用寒水石、滑石、各二两，冬葵子五钱，煎服。）
此化气之剂，气化则胞转如常，而小便自利。故曰∶治其气则愈。愚意仍加利水清热之药，以相助为理更妙。
琥珀益元散 治小便不通，因血结者。（血蓄膀胱。本小便自利，今反不利，是膀胱气分，亦因热结，乃气血交病也。）
益元加真琥珀末。（均利小便。能逐瘀血。）可加牛膝、（茎中痛甚者，生用至两许。）瞿麦（利水破血。）郁金（治血积气壅。）连翅仁（散血结气聚，二味皆辛苦寒，并汤调服。）
此驱膀胱瘀血，以通小便之方也。
敷脐法 溺秘因热者多，此方最效。
大田螺（性寒而善厘清浊，故浊水中置之，便能澄彻。二枚捣烂去壳。）盐（润下。）麝香（通窍，各少许。）（同螺肉，敷脐中及少腹，软帛系之，即通。一法用猪胆连汁，笼阴头，少顷汁入，亦即通。）
葱熨法 气闭不通者宜之。（因热者大忌之。）
葱白（三斤切细。）盐（一斤同炒热。绢包更换熨脐下。或再加紫苏、皂荚煎汤，坐浸水中，亦效。）
1. A young boy, after suffering from smallpox, still had residual heat that was not cleared. He took kidney-nourishing prescriptions for half a year without effect, resulting in bone-steaming fever and emaciation, lumps on the neck and crown, abdominal distension, and alternating chills and fever in the afternoon. Suddenly, he experienced severe pain in the left hypochondrium, which could not be touched by hand. I used Zuojin Wan (Left Metal Pill), adding Qingpi (Green Tangerine Peel) and Zharen (Hawthorn Flesh). The pain stopped. A few days later, swelling and severe pain suddenly erupted. Suspecting an abscess within the hypochondrium, I used Xiakucao (Prunella Vulgaris) [five taels decocted as water substitute], Lianqiao (Forsythia Fruit), and Beimu (Fritillaria Bulb) [each three qian] to clear heat and dissipate nodules; Sheng Ganju (Chrysanthemum Indicum), Jinyinhua (Lonicera Japonica), Zihuadiding (Viola Yedoensis), and Gancaojie (Licorice Joint) [three qian] to clear heat and resolve toxicity; Diyu (Sanguisorba Officinalis) [five qian] to cool blood and purge heat; Niubangzi (Arctium Lappa Seed) and Baizhi (Angelica Dahurica Root) [one qian five fen each] to dissipate nodules and reduce swelling; Danggui (Angelica Sinensis Root) and Chishao (Red Peony Root) [one qian five fen and three qian respectively] to invigorate blood and break stasis; Zaocis Spina (Gleditsia Sinensis Thorn) [one qian five fen] to unblock congestion and promote stagnation; Chuanshanjia (Pangolin Scales) and Biejia (Trionyx Carapace) and Guiban (Testudinis Carapax et Plastrum) [each three qian] to break blood and expel phlegm; these two ingredients can reach the lesion directly, detoxifying and reducing swelling. After taking two doses, the swelling subsided, pain ceased, chills and fever did not recur, and all symptoms gradually improved.
Urinary retention is no trivial matter. There is urgency and pain in the lower abdomen, resembling an inverted bowl. The urge to urinate is pressing and uncontrollable. If urine does not pass for one day, vomiting ensues; if it does not pass for several days, death occurs. Once vomiting appears, it is incurable. Therefore, the *Neijing* states that urinary and fecal retention are the most critical conditions. Regardless of root or branch, treatment should focus on this first. The classics state: "If heat shifts from the Bao (uterus. In males, it is the essence chamber; in females, it is the sea of blood) to the Bladder, it causes long (difficulty in urination with frequent but scanty voiding)." [Long implies extreme heat when closed.] The *Jinkui Yaolue* states: "Heat in the lower jiao causes lin syndrome and urinary retention." Thus, nourishing Kidney water and purging Bladder heat is called the direct treatment method. The classics also say: "The Bladder is the mansion of body fluids. When qi transforms, they exit." Since water originates from the high source (lungs), and Lung qi circulates, water follows and flows downward. Therefore, clearing Lung metal and moistening dryness is called the indirect treatment via the second organ (Lung). It is also stated: "Spleen qi scatters essence, sending it up to the Lung, which regulates water passages and transports them down to the Bladder." Thus, strengthening the Spleen and promoting diuresis is called the indirect treatment via the third organ (Spleen). There are also cases where retention is caused by qi stagnation, Bao turning, Liver heat, or blood stasis, leading to different treatments. Danxi said: "I once used emesis to promote urination, like a dripping vessel; only when the upper orifice opens does water flow from the lower orifice." There is also Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), which raises qi to facilitate passage. Although these are good methods, they should not be mixed indiscriminately. According to Zhao, formulas such as those tonifying qi, Si Ling San (Four-Ingredient Poria Powder), Er Xiang San (Two-Aromatic Powder), and Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) treat excess conditions, where there is originally water accumulation in the Bladder, or heat knot, or qi closure, allowing water to be passed through. For deficiency conditions, however, due to excessive sweating and dryness of the five zang organs, there is no water accumulation in the Bladder. Forcing diuresis is like begging a beggar for food—how can it succeed? Therefore, Dongyuan distinguishes between qi and blood levels, and thirst or no thirst. If thirsty with urinary retention, it belongs to heat in the qi level of the upper jiao, treated by clearing Lung metal (using Dongguamu, Mutuhu, Sangbaipi, Baigen); if not thirsty with urinary retention, it belongs to heat in the blood level of the lower jiao, treated by nourishing yin (using Dihuang, Maidong, Zhimu, Huangbai, Niuxi, Cheqiancao). Cases of true yin or true yang deficiency were not discussed. The classics state: "The Kidney governs both urination and defecation," "The Kidney controls opening and closing," and "The Kidney opens into the two yin orifices." Thus, when fire is excessive, water declines, body fluids dry up, causing heat-closure; Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) [remove Cornus officinalis] added with Dongguamu, Niuxi, and Cheqiancao nourishes yin, and water returns naturally. When yang is deficient, there is no qi transformation, clear and turbid do not separate, causing cold-closure; Jisheng Shenqi Wan (Shenqi Pill for Saving Life) [remove Cornus officinalis] reaches the Bladder directly, like ice melting under the sun. However, people today mostly suffer from yin deficiency rather than yang deficiency. Cinnamon and Aconite must be used with clear observation and careful judgment. Otherwise, treating human life as a game is inevitable!
Zhuling Tang (See Shanghan Lun.)
Daochi San (See Fire Syndrome.) For heat in the lower jiao causing lin and urinary retention, adopt as appropriate. [Can be combined or used separately.] Add Zhimu and Huangbai [to nourish Kidney water and purge ministerial fire. Once Kidney heat is removed, Bladder heat clears itself.] Maidong [Clears Lung, facilitates qi transformation descending; clears Heart, removes Lung heat.]
These are all agents that nourish yin, moisten dryness, purge heat, and promote diuresis, drying Kidney water and purging Bladder heat, which is the direct treatment method.
Erdong Ermu San (Two Winter Two Mother Powder) treats Lung metal dryness-heat, failure of qi transformation, and urinary long/retention.
Erdong (Dongguamu and Maidong), Ermu (Zhemu and Fumu), add raw chicken egg [all are agents that clear Lung metal and moisten dryness]. Ziwan (Aster Tataricus Root) [Although reaching high, it tends downward; when Lung metal qi transforms, urination becomes free.] Baogen (Imperata Rhizome) [Clears Lung, removes heat, promotes diuresis]. Fuling (Poria), Cheqiancao (Plantago Seed) [Promotes urination and directs qi downward].
This formula clears Lung metal and moistens dryness to promote urination, representing the indirect treatment via the second organ (Lung).
Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) (See Shanghan Lun.) Treats urinary long/retention caused by excessive consumption of pungent-hot foods damaging Lung yin.
Original formula [Clears heat of the three jiao, resolves pungent-hot toxicity.] Add Erdong (Dongguamu and Maidong), raw egg white [urgently rescue Lung yin], Fuling, Cheqiancao, Mutong (Akebia Caulis) [Open orifices and promote diuresis]. Add Dahuang (Rhubarb Root) for constipation.
This is a formula for clearing heat and resolving toxicity, urgently rescuing Lung yin, to promote urination.
Siling San (Four-Poria Powder) (See Dampness Syndrome.) Treats urinary long/retention caused by Spleen dampness failing to transport, essence failing to ascend, leading to Lung failure to regulate.
Add Yiyiren (Coix Seed) [Strengthen Spleen, dry dampness, tonify Lung, clear heat]. Sangbaipi (Morus Bark) [Clear Lung, descend qi, remove heat, promote diuresis]. Sheng Xiangya Xie (Raw Ivory Chip) [Sweet, cold, bland, slippery, opens orifices]. This formula strengthens the Spleen and dries dampness to promote urination, representing the indirect treatment via the third organ (Spleen).
Er Xiang San (Two-Aromatic Powder) treats qi stagnation from pent-up anger causing urinary retention. Also treats Bao turning caused by forced sexual restraint or holding urine too long.
Muxiang (Aucklandia Root), Zhen Chenxiang (Aquilaria Wood). Add Huashi (Talcum) [Grind into powder in equal parts. Decoct Juhong (Citrus Reticulata Peel), Fuling, and Cheqiancao in soup, take four to five qian on an empty stomach, until passage is achieved. Another prescription for male/female Bao turning uses Hanshuishi (Halloysitum Rubrum) and Huashi, two taels each, and Dongkuizi (Abutilon Seed), five qian, decocted and taken orally.]
This is an agent that transforms qi. When qi transforms, the Bao turns normally, and urination becomes free. Hence it is said: "Treating the qi leads to recovery." My opinion is that adding diuretic and heat-clearing herbs to assist would be even better.
Longdan Xiegan Tang (Gentian Liver-Draining Decoction) (See Hypochondriac Pain.)
This is a formula for draining Liver fire to promote urination.
Hupo Yiyuan San (Amber Crystal-Glory Powder) treats urinary retention due to blood knotting. [Blood accumulates in the Bladder. Normally urination is free; now it is obstructed, indicating qi level heat knot in the Bladder, a simultaneous disease of qi and blood.]
Yiyuan San plus real Amber powder [Both promote urination and expel blood stasis]. Can add Niuxi (Achyranthes Root) [For severe pain in the urethra, use raw up to one liang]. Qumai (Dianthus Herb) [Promotes diuresis and breaks blood]. Yujin (Curcuma Rhizome) [Treats blood accumulation and qi congestion]. Lianqiren (Forsythia Seed) [Dissipates blood knots and qi gatherings; both are pungent, bitter, and cold, taken with soup].
This is a formula for driving out Bladder blood stasis to promote urination.
Umbilical Application Method Most urinary retention is due to heat; this formula is most effective.
Large river snail [Cold nature, good at separating clear and turbid; placed in turbid water, it clarifies it. Two snails, pounded and shell removed.] Salt [Moistens and directs downward]. Moschus (Musk) [Opens orifices, small amounts of each.] [Mix with snail meat, apply to umbilicus and lower abdomen, tie with soft cloth, passage ensues. Another method uses pig gallbladder juice applied to the glans penis; shortly after, juice enters, and passage occurs.]
Scallion Moxibustion Method Suitable for qi-closure obstruction. [Greatly contraindicated for heat cases.]
Scallion white (three jin cut finely). Salt (one jin stir-fried hot together. Wrap in silk, replace and apply heat to below umbilicus. Or add Perilla and Gleditsia pod decoction, sit and soak in water, also effective.)