1.膀胱热结为癃闭, 寒虚遗尿与不禁, 闭即尿闭无滴出, 少腹胀满
痛难伸, 癃即淋沥点滴出, 茎中涩痛数而勤, 不知为遗知不禁, 石血
膏劳气淋分. 膀胱热结, 轻者为癃, 重者为闭. 膀胱寒虚, 轻者为遗
尿,重者为不禁. 闭者, 即小便闭无点滴下出, 故少腹满胀痛也. 癃
者,即淋沥点滴而出, 一日数十次, 或勤出无度, 故茎中涩痛也. 不
知而尿出, 谓之遗尿. 知而不能固, 谓之小便不禁.
2.呕哕尿闭为关格, 若出头汗命将倾, 伤寒狂冒遗尿死, 尿闭细涩
不能生.
【注】上为呕哕不入, 下为小便不通, 则阴阳之气关格, 若出头汗,
则为阳绝, 故命倾也. 伤寒狂冒属阳邪盛, 遗尿属阴不守, 若尿闭脉
细涩, 知阴亦竭, 故俱死也.
3.阴阳熨脐葱白麝, 冷热互熨尿自行, 宣上木通葱探吐, 达外葱汤
熏汗通.
【注】用葱白一斤细锉, 入麝香五分拌匀, 分二包置脐上, 先以炭火
熨斗熨之, 半炷香时换一包, 以冷水熨斗熨之, 互相递熨, 以尿通为
度. 服诸药不效, 或服药实时吐出, 或服攻下药不利, 宜用宣上法:
以木通, 老葱煎汤服, 顷时探吐, 再服再吐, 以尿通为度. 服诸药不
效,或身无汗, 宜用达外法: 以葱汤入木桶内, 令病人坐于杌上, 没
脐为度, 匝腰系裙以覆之, 少时汗出, 其尿自出. 欲尿时不可出桶 ,
即于桶内溺之, 恐出桶气收, 而尿又回也.
1. 膀胱热结导致癃闭,膀胱寒虚导致遗尿与小便失禁。所谓“闭”,是指尿液完全闭塞,一滴也排不出来,少腹部胀满疼痛,难以伸展;所谓“癃”,是指尿液淋沥不尽,仅能点滴排出,尿道中有涩痛感,且排尿次数频繁而急迫。不知道在排尿称为“遗尿”,知道想控制却控制不住称为“不禁”。根据病情的轻重和性质不同:膀胱热结较轻者表现为癃,较重者表现为闭;膀胱寒虚较轻者表现为遗尿,较重者表现为不禁。所谓“闭”,就是小便完全闭塞,没有点滴流出,因此少腹部出现胀满疼痛的症状。所谓“癃”,就是尿液淋沥点滴而出,一天可能要排尿几十次,或者频繁无度,因此尿道中会有涩痛的感觉。不知不觉地尿液流出,这叫做遗尿。虽然意识清醒却无法固摄尿液,这叫做小便不禁。
2. 呕吐呃逆伴小便不通称为“关格”证,如果此时头部出汗,则生命危在旦夕。伤寒病中出现神志狂乱、头目昏眩并伴有遗尿的,属于死证;小便闭塞且脉象细涩的,也是死证。
【注】上面是呕吐呃逆无法进食,下面是小便不通,这标志着阴阳之气相互格拒(关格)。如果此时只有头部出汗,说明阳气即将断绝,所以生命垂危。伤寒病中的神志狂乱、头目昏眩属于阳邪亢盛,遗尿属于阴气不能内守,如果小便闭塞且脉象细涩,说明阴液也已枯竭,因此这些情况都属于死证。
3. 使用阴阳熨法,配合葱白和麝香敷脐,通过冷热交替熨烫可使尿液自行排出。采用宣上法,用木通和葱白煎汤服用后探吐;采用达外法,用葱汤熏蒸发汗以通利小便。
【注】取一斤葱白切碎,加入五分麝香拌匀,分成两包放在肚脐上。先用炭火加热的熨斗熨烫,约半炷香的时间换一包,再用冷水冷却的熨斗熨烫,两者交替熨烫,直到尿液通畅为止。如果服用各种药物无效,或者服药后立即吐出,或者服用攻下药后大便仍不通利,适宜使用宣上法:用木通和老葱煎汤服用,过了一会儿进行探吐,再服药再探吐,直到尿液通畅为止。如果服用各种药物无效,或者身体没有出汗,适宜使用达外法:将葱汤倒入木桶中,让病人坐在矮凳上,使液面没过肚脐,腰部系上围裙以覆盖住桶口,过一会儿病人出汗,尿液自然就会排出。想要排尿时不要离开木桶,就在桶内解决,恐怕离开木桶后寒气收敛,尿液又会回去(即再次潴留)。
1. Heat accumulation in the Bladder (Bladder) causes *Long-Bi* (difficulty in urination); cold deficiency of the Bladder causes *Yiniao* (enuresis/involuntary urination) and *Bujin* (incontinence). "Bi" refers to complete urinary retention with no drops passing, accompanied by distension, fullness, pain, and difficulty extending the lower abdomen. "Long" refers to dribbling urine that passes only drop by drop, with astringent pain in the urethra and frequent, urgent voiding. Urination without awareness is called *Yiniao*; awareness of the need to urinate but inability to control it is called *Bujin*. Regarding severity: mild heat accumulation in the Bladder manifests as *Long*, while severe cases manifest as *Bi*. Mild cold deficiency of the Bladder manifests as *Yiniao*, while severe cases manifest as *Bujin*. In "Bi", urine is completely retained with no drops passing, hence the distension and painful fullness of the lower abdomen. In "Long", urine dribbles out drop by drop, occurring dozens of times a day or frequently without limit, hence the astringent pain in the urethra. Unconscious urination is termed *Yiniao*. Consciousness present but inability to retain urine is termed *Bujin*.
2. Vomiting and hiccups accompanied by urinary retention constitute *Guan-Ge* (Obstruction and Rejection syndrome); if sweating occurs only on the head, life is imminent peril. In *Shanghan* (Cold Damage), mania and dizziness accompanied by enuresis indicate a fatal prognosis; urinary retention with a fine and choppy pulse also indicates fatality.
[Note]: Upper vomiting and hiccups preventing intake, and lower urinary obstruction, signify the mutual rejection of Yin and Yang Qi (*Guan-Ge*). If sweating is confined to the head, it indicates the exhaustion of Yang Qi, hence the peril to life. Mania and dizziness in *Shanghan* belong to excessive Yang pathogenic factors; enuresis belongs to Yin failing to hold fast. If urinary retention is accompanied by a fine and choppy pulse, it indicates the exhaustion of Yin fluids as well; thus, all these conditions are fatal.
3. Use the Yin-Yang moxibustion/ironing method on the navel with scallion white and musk; alternating hot and cold ironing allows urine to flow spontaneously. To promote upper release, use Tongcao (Akebia Caulis) and scallion decoction followed by induced vomiting; to promote external release, use scallion steam to induce sweating and unblock urination.
[Note]: Take one jin (approx. 500g) of scallion white, finely chopped, mix with five fen (approx. 1.8g) of Moschus (Musk), divide into two bags, and place on the navel. First, iron with a charcoal-heated iron for half an incense stick's duration, then replace with one bag and iron with a cold-water-cooled iron. Alternate ironing until urination resumes. If various oral medications fail, or if taken medicine is immediately vomited, or if purgatives fail to relieve constipation, use the "Promote Upper Release" method: Decoct Akebia Caulis (Tongcao) and old scallion, drink the soup, wait a moment, then induce vomiting. Repeat medication and vomiting until urination resumes. If various oral medications fail, or if there is no sweating, use the "Promote External Release" method: Pour scallion decoction into a wooden tub, have the patient sit on a stool inside, submerging up to the navel. Tie a skirt around the waist to cover the tub opening. After a short time, when sweating occurs, urine will discharge spontaneously. Do not leave the tub when the urge to urinate arises; urinate within the tub, lest leaving exposes the body to cold air which may cause the urine to retreat (retention again).