邪气聚于下焦，结而不散，甚则小腹硬满而痛，此小便所以不通。大抵有所不利者行之，所以
渗泄也。若饮水过多，下焦蓄热，或中湿发黄，水饮停留，皆以利小便为先。惟汗后亡津液，胃汁
干，与阳明汗多者，则以利小便为戒。设或小便不利而见头汗者，乃为阳脱关格之疾矣。
饮水过多，下焦蓄血热，小便不利，脉浮者，用五苓散；脉沉者，猪苓汤。
太阳病，身黄，脉沉者，猪苓汤。太阳病，身黄，脉沉结，小腹硬，小便不利者，为亡血也，
五苓加茵陈。呕而发热，胸满，心下怔忡，小便不利者，为亡血也，五苓加茵陈、茯苓。
少阴病，四逆，或小便不利，四逆散加茯苓。
阳明病，无汗，小便不利，心下懊 者，身必发黄，五苓散加茵陈。
经曰∶虚则小便难。阴虚者，阳必凑之，由膀胱受热，致小便赤涩而不流利也。又曰∶虽不大
便也，六七日而小便少者，但初硬后溏未定，或硬攻之，必溏。候小便多，屎定硬，方可攻之。乃
胃中水谷不别，虽通而不能也。
阳明中风，脉浮弦大，身黄鼻干，气短腹满，潮热时哕，胸胁痛，小便难，小柴胡加茯苓。
太阳病，小便利者，以饮水多，必有心下悸，茯苓白术甘草汤；小便少者，必里急，猪苓汤。
小便自利者，为津液漏渗，大便必硬，宜以药微下之。其阳明自汗者，复发其汗，使津液内竭，
屎虽硬，尤不可攻，纵使大便难，蜜导煎导之。太阴当发身黄，其小便自利者，则湿热内泄，不能
发黄。惟血证，则腹急而如狂。肾与膀胱虚，则不能约制水液，二者皆小便自利。若肾与膀胱虚而
挟热，热则水道涩，则小便不快，故涩淋而数起也。若自汗而小便数者，虽有表证，又不可用桂枝，
谓亡走津液也。
太阳病，小便自利，以饮水多，心下悸，茯苓桂枝、茯苓甘草汤。
太阳自汗，四肢拘急，心烦，微恶寒，脚挛急，小便数，误服桂枝汤，得之便厥，与甘草干姜
汤、甘草芍药汤。
脉浮自汗，小便数，胃不和，谵语者，少与调胃承气汤。
阳明脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则难，其脾为约，
宜麻仁汤。
少阴四逆，小便自利，或色白，为虚寒，四逆汤，或真武汤去茯苓。既吐且利，小便复利而大
汗出，下利清谷，内寒外热，脉浮欲绝者，四逆汤。
邪气聚集在下焦，凝结而不消散，严重时小腹部坚硬胀满且疼痛，这就是小便不通畅的原因。大抵凡是出现小便不利的情况，应当采用通利的方法，使水湿通过渗泄排出。如果饮水过多，导致下焦蓄积热邪，或者因中湿而发黄，以及水饮停留体内，都应当以通利小便为首要治疗原则。只有在发汗后津液耗伤、胃中津液干燥，以及阳明病出汗过多的情况下，才禁止使用利小便的方法。假如小便不利同时伴有头部出汗，这是阳气脱失、阴阳格拒的危重病症。
饮水过多，导致下焦蓄积血热，小便不利，脉象浮的，使用五苓散；脉象沉的，使用猪苓汤。
太阳病，身体发黄，脉象沉的，使用猪苓汤。太阳病，身体发黄，脉象沉而结滞，小腹部坚硬，小便不利的，属于失血证候，在五苓散基础上加茵陈。呕吐且发热，胸中胀满，心下悸动不安，小便不利的，也属于失血证候，在五苓散基础上加茵陈和茯苓。
阳明病，无汗，小便不利，心中烦闷懊恼的，身体一定会发黄，使用五苓散加茵陈。
医经说：虚证会导致小便困难。阴虚时，阳热之气必会凑合于内，由于膀胱受热，导致小便赤红涩痛且不流利。又说：虽然大便不通，但经过六七天而小便量少的，说明大便只是开头硬后面稀，尚未完全定型，如果此时用攻下法，必然导致腹泻。必须等到小便增多，大便确定变硬后，才可以进行攻下。这是因为胃中水谷分离不清，虽然通畅却无法形成正常大便。
阳明中风，脉象浮弦大，身体发黄，鼻干，气短腹满，潮热时常呃逆，胸胁疼痛，小便困难的，使用小柴胡汤加茯苓。
太阳病，小便通畅的，是因为饮水过多，必定会出现心下悸动，使用茯苓白术甘草汤；小便少的，必定会出现里急后重感，使用猪苓汤。
小便自利的（指频数或失禁），是津液漏泄渗出的表现，大便必然坚硬，适宜用药轻微通便。如果是阳明病自汗，又再次发汗，导致津液在内枯竭，即使大便坚硬，也不可攻下，纵使大便困难，也应使用蜜导煎进行导便。太阴病本应发生身黄，但如果小便自利，则湿热从内部泄出，不会发黄。只有血分病变，才会出现腹部拘急且神志狂乱。肾与膀胱虚弱，就不能制约水液，这两种情况都会导致小便自利。如果肾与膀胱虚弱兼夹热邪，热邪会使水道涩滞，导致小便不畅，所以出现涩痛淋沥且次数频繁。如果自汗且小便频数，虽然有表证，也不可用桂枝汤，因为那会进一步耗亡津液。
太阳病，小便自利，因饮水过多导致心下悸动的，使用茯苓桂枝汤或茯苓甘草汤。
太阳病自汗，四肢拘挛紧急，心烦，微恶寒，脚部抽筋，误服桂枝汤后，导致四肢厥冷，给予甘草干姜汤、甘草芍药汤。
脉象浮、自汗、小便频数，胃气不和，出现谵语的，少量给予调胃承气汤。
阳明病脉象浮而涩，浮表示胃气强盛，涩表示小便频数，浮与涩相互搏结，大便就会困难，这是脾为胃所约束的病证，适宜使用麻仁汤。
少阴病四肢厥冷，小便自利，或者尿色清白，属于虚寒证，使用四逆汤，或者真武汤去掉茯苓。既呕吐又腹泻，小便反而通利且大汗出，下利清谷（完谷不化），内寒外热，脉象浮而欲绝的，使用四逆汤。
Pathogenic factors gather in the Lower Jiao (Lower Burner), condensing and failing to disperse. In severe cases, this leads to hardness, fullness, and pain in the lower abdomen, which is the reason for urinary obstruction. Generally, when there is any difficulty in urination, one should employ methods to promote flow, thereby allowing water dampness to be excreted via seepage and drainage. If excessive water intake causes heat accumulation in the Lower Jiao, or if dampness obstructs leading to jaundice, or if fluid retention remains, promoting urination should be the primary treatment principle. However, only after sweating has depleted body fluids and dried up stomach juices, or in Yangming disease with excessive sweating, should the use of diuretics be strictly avoided. If urinary obstruction is accompanied by sweating only on the head, it indicates a critical condition of Yang collapse and Yin-Yang separation (Guan Ge).
If excessive water intake leads to blood-heat accumulation in the Lower Jiao, causing urinary obstruction with a floating pulse, Wuling San (Five-Ling Powder) is used; if the pulse is deep, Zhuling Tang (Polyporus Decoction) is used.
In Taiyang disease, if the body is yellow and the pulse is deep, Zhuling Tang (Polyporus Decoction) is used. In Taiyang disease, if the body is yellow, the pulse is deep and knotted, the lower abdomen is hard, and urination is difficult, it is a syndrome of blood loss; add Yichen (Artemisiae Scopariae Herba) to Wuling San (Five-Ling Powder). If there is vomiting and fever, chest fullness, palpitations in the epigastrium, and urinary difficulty, it is also a syndrome of blood loss; add Yichen (Artemisiae Scopariae Herba) and Fuling (Poria) to Wuling San (Five-Ling Powder).
In Shaoyin disease, with cold extremities or urinary difficulty, Sini San (Frigid Extremities Powder) plus Fuling (Poria) is used.
In Yangming disease, with no sweating, urinary difficulty, and mental restlessness (Ao Nao) in the epigastrium, the body will certainly develop jaundice; add Yichen (Artemisiae Scopariae Herba) to Wuling San (Five-Ling Powder).
The Classic states: Deficiency leads to difficult urination. In Yin deficiency, Yang heat inevitably converges internally. Due to heat affecting the Bladder, urine becomes red, astringent, and non-smooth. It also states: Although there is constipation, if after six or seven days the urine volume is low, it indicates that the stool is only hard at the beginning and loose at the end, not yet definitively formed. If purgatives are applied prematurely, diarrhea will result. One must wait until urine volume increases and the stool is confirmed to be hard before applying purgation. This occurs because water and grain in the Stomach fail to separate properly, so although passage exists, normal defecation cannot occur.
In Yangming Wind Strike, with a floating, wiry, and large pulse, jaundice, dry nose, shortness of breath, abdominal fullness, tidal fever with occasional hiccups, chest and hypochondriac pain, and difficult urination, Xiaochaihu Tang (Minor Bupleurum Decoction) plus Fuling (Poria) is used.
In Taiyang disease, if urination is free, it is due to excessive water intake, which inevitably causes palpitations in the epigastrium; Lingzhi Baizhu Gancao Tang (Poria, Atractylodes, and Licorice Decoction) is used. If urination is scanty, there will likely be tenesmus; Zhuling Tang (Polyporus Decoction) is used.
When urination is frequent or involuntary (Zi Li), it indicates leakage and seepage of body fluids, leading to hard stools. Mild laxatives should be used. In Yangming disease with spontaneous sweating, if sweating is induced again, internal fluids become exhausted. Even if stools are hard, purgation is contraindicated. If defecation is difficult, Honey Suppositories (Mi Dao Jian) should be used for guidance. In Taiyin disease, jaundice is expected; however, if urination is frequent, damp-heat is drained internally, preventing jaundice. Only in blood disorders does one see abdominal urgency and manic behavior. Deficiency of the Kidney and Bladder fails to control fluids, resulting in frequent urination. If Kidney and Bladder deficiency is combined with heat, the water pathways become astringent, causing dysuria, strangury, and frequency. If there is spontaneous sweating with frequent urination, even if exterior symptoms exist, Guizhi Tang (Cinnamon Twig Decoction) is contraindicated, as it would further deplete fluids.
In Taiyang disease, with frequent urition due to excessive water intake causing epigastric palpitations, Lingzhi Guizhi Tang (Poria and Cinnamon Twig Decoction) or Lingzhi Gancao Tang (Poria and Licorice Decoction) is used.
In Taiyang disease with spontaneous sweating, limb stiffness, irritability, slight aversion to cold, and foot cramps, if Guizhi Tang (Cinnamon Twig Decoction) is mistakenly administered, leading to cold extremities, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) and Gancao Shaoyao Tang (Licorice and Peony Decoction) are given.
With a floating pulse, spontaneous sweating, frequent urination, disharmony of the Stomach, and delirious speech, a small dose of Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction) is given.
In Yangming disease, a floating and choppy pulse indicates strong Stomach Qi (floating) and frequent urination (choppy). The interaction of floating and choppy pulses leads to difficult defecation, known as "Spleen Constriction" (Pi Yue); Maren Tang (Hemp Seed Decoction) is appropriate.
In Shaoyin disease with cold extremities and frequent urination, or white urine, it is a deficiency-cold pattern; Sini Tang (Frigid Extremities Decoction) is used, or Zhenwu Tang (True Warrior Decoction) with Fuling (Poria) removed. If there is both vomiting and diarrhea, with frequent urination, profuse sweating, diarrhea of undigested food, interior cold with exterior heat, and a floating pulse nearly imperceptible, Sini Tang (Frigid Extremities Decoction) is used.