王中阳治一人。弱冠未婚。病遗沥日久。每作虚寒脱泄治之。愈甚。王诊其六部弦数。
不记至数。人已骨立。不能自支。乃曰苦哉。此三焦不利。膀胱蓄热。五淋病也。患者曰。
膏血砂垢。每溺则痛不可言。遂用局方五淋散加山栀、赤芍、木通、瞿麦、鲜车前、滑石作
大
剂。入灯心二十茎煎服。五七日全愈。无奈频发。一日忽来告急云。九日便溲俱不通。秘闷
将死。王即令用细灰。于患人连脐带丹田作一泥塘。径如碗大。下令用一指浓灰。四围高起
以新汲水调朴硝一两许令化。渐渐倾入灰塘中。勿令漫溢横流。须臾。大小便迸然而出。
溺中血条如指。若非热解气快。其如龟窍之小。何由连出三四日恶物。复得回生。再令服黄
连解毒丸。三载约四斤。乃不复发。
丹溪治一妇。痹疼后。大小便不通。此痰隔中焦。气聚下焦。二陈加木通煎服。再一服
探吐之。
李时珍曰。外甥柳乔。素多酒色。病下极胀痛。二便不通。不能坐卧。立哭呻吟者七昼
夜。医用通利药不效。遣人叩予。予思此乃湿热之邪在精道。壅胀隧路。病在二阴之间。故
前阻小便。后阻大便。病不在大肠膀胱也。乃用楝实、茴香、穿山甲诸药。入牵牛加倍。煎
服。一服减。三服平。牵牛达右肾命门。走精隧。人所不知。
震按二便不通。脉实者。八正散倍大黄。或倒换散亦妙。若形弱及老人。或病后产后有
此。悉从虚秘治。润燥养阴为主。下用导引法。若体健神旺。二便秘涩者。必脾胃气滞不转
输。加以痰饮食积。阻碍浊道。脉沉实者。升、柴、二陈、二术汤。今所选王案。取其外治
之法。及服黄连解毒丸三载为大奇。而李时珍之用甲片、牵牛。走精隧以通淤塞为更奇。直
可与东垣滋肾丸并垂天壤。
王中阳治疗一名男子。该男子二十岁尚未娶妻。患有遗精滑泄日久，每次发作都按虚寒脱泄来治疗，病情反而加重。王中阳诊察其六部脉象均呈弦数之象，未细记至数（脉搏频率），患者已瘦骨嶙峋，身体极度虚弱无法支撑。于是说道：“痛苦啊！这是三焦气化不利，膀胱蓄积热邪，属于五淋病。”患者说：“排出膏脂、血液、砂石和污垢时，每次排尿疼痛难忍。”于是使用局方五淋散，加入山栀、赤芍、木通、瞿麦、鲜车前草、滑石，制成大剂量药剂，加入灯心草二十茎煎服。五到七日后完全痊愈。但无奈病情频繁复发。有一天突然紧急告知说：九天内大小便均不通畅，憋闷得快要死了。王中阳立即让人用细灰，在患者从肚脐到丹田处堆成一个泥塘，直径如碗口大小。下令用一指厚的浓灰，四周堆高，用新汲取的井水调和朴硝一两左右使其溶解，慢慢倒入灰塘中，不要让它漫溢横流。不一会儿，大小便突然迸发而出，尿液中有血条状物如手指粗细。如果不是热邪解除、气机通畅，凭龟窍那样小的开口，怎么能连续三四天排出恶臭污物？从而得以起死回生。再令服用黄连解毒丸，三年累计约四斤，才不再复发。
朱丹溪治疗一名妇女。在痹痛之后，出现大小便不通。这是痰浊阻隔中焦，气机聚结于下焦。使用二陈汤加木通煎服，再服用一次后通过探吐法催吐。
李时珍说：我的外甥柳乔，平时好酒色，患下部极度胀痛，大小便不通，不能坐卧，站立哭泣呻吟了七个昼夜。医生使用通利药物无效，派人来请教我。我思考这乃是湿热邪气在精道，壅塞胀满隧道，病位在二阴之间，所以前面阻碍小便，后面阻碍大便。病不在大肠和膀胱。于是使用楝实、茴香、穿山甲等药，加入牵牛子加倍量，煎服。一服药后症状减轻，三服药后平复。牵牛子能到达右肾命门，行走于精隧之中，这是人们所不知道的。
俞震按语：大小便不通，脉象实者，可用八正散倍加大黄，或者倒换散也很奇妙。如果是形体虚弱及老年人，或病后产后出现这种情况，全部按照虚秘治疗，以润燥养阴为主，下方使用导引法。如果体质健壮精神旺盛，却出现二便秘涩，必定是脾胃气滞不转输，加上痰饮食积，阻碍浊道，脉象沉实者，可用升麻、柴胡、二陈汤、二术汤。本次所选的王中阳医案，取其外治之法，以及服用黄连解毒丸长达三年的奇特之处；而李时珍使用穿山甲片、牵牛子，行走精隧以通淤塞更为奇特。完全可以与东垣的滋肾丸并垂不朽。
Wang Zhongyang treated a man who was twenty years old and unmarried. He had suffered from chronic spermatorrhea and dribbling for a long time. Each episode was treated as deficiency-cold with collapse and leakage, but the condition worsened. Wang examined the pulse at all six positions (three on each wrist) and found them wiry and rapid; he did not record the exact rate. The patient was emaciated to the point of being skeletal and could barely support himself. Wang said, "How bitter! This is due to the dysfunction of the Sanjiao (Triple Burner), with heat accumulating in the Bladder, constituting a case of the Five Types of Strangury (Wu Lin)." The patient said, "When discharging semen, blood, sand, and filth, every urination is accompanied by unbearable pain." Therefore, Ju Fang Wu Lin San (Bureau Formula Decoction for Five Stranguries) was used, added with Gardenia Fruit (Gardeniae Fructus), Red Peony Root (Paeoniae Radix Rubra), Akebia Stem (Akebiae Caulis), Knotgrass Herb (Polygoni Avicularis Herba), fresh Plantago Seed (Plantaginis Semen), and Talcum (Talcum). It was prepared as a large dose, decocted with twenty stalks of Juncus Effusus (Junci Medullam), and administered. After five to seven days, he was completely cured. However, the relapses were frequent. One day, he suddenly came in an emergency stating that for nine days, both stool and urine had been obstructed, causing suffocation and impending death. Wang immediately ordered fine ash to be piled around the patient's navel down to the Dantian (Sea of Qi) to form a mud pond, about the size of a bowl. An instruction was given to use thick ash one finger-width high, raised around the perimeter. About one tael of Mirabilite (Natrii Sulfas) was dissolved with freshly drawn well water and slowly poured into the ash pond, preventing it from overflowing. Suddenly, both stool and urine gushed out. Blood clots like fingers appeared in the urine. If the heat had not resolved and qi had not moved freely, how could such foul matter have been discharged continuously for three or four days through the small opening of the turtle-like orifice? Thus, life was restored. He was then instructed to take Huanglian Jiedu Wan (Coptis Decoction to Resolve Toxicity Pills). Over three years, consuming approximately four jin (about 2 kg), the condition did not recur.
Zhu Danxi treated a woman who, after suffering from Bi Syndrome (Obstruction Syndrome characterized by pain), experienced obstruction of both stool and urine. This was due to phlegm obstructing the Middle Jiao and qi gathering in the Lower Jiao. Er Chen Tang (Two-Cured Decoction) with Akebia Stem was decocted and taken. After another dose, induced vomiting was performed.
Li Shizhen said: My nephew, Liu Qiao, who indulged in alcohol and sexual activity, suffered from severe distending pain in the lower extremities/genital region, with obstruction of both stool and urine. He could neither sit nor lie down, standing up crying and groaning for seven days and nights. Physicians used purgative and diuretic medicines without effect. They sent someone to ask me. I reasoned that this was damp-heat pathogenic factor in the seminal ducts, causing congestion and swelling of the passages. The disease was located between the two yin openings (urethra and anus), thus blocking urine anteriorly and stool posteriorly. The disease was not in the Large Intestine or Bladder. Therefore, I used Madrone Fruit (Chaenomelis Fructus), Fennel Fruit (Foeniculi Fructus), and Pangolin Scales (Manis Squama), adding doubled quantity of Morning Glory Seed (Pharbitidis Semen). After one dose, symptoms decreased; after three doses, they normalized. Pharbitidis Semen reaches the Mingmen (Gate of Life) of the right Kidney and travels through the seminal passages, which is unknown to most people.
Yu Zhen commented: For obstruction of both stool and urine, if the pulse is excess, Bazheng San (Eight-Herb Rectifying Powder) with doubled Rhubarb (Rhei Radix et Rhizoma), or Daohuan San (Turning Over Powder) are also excellent. If the constitution is weak, or in the elderly, or post-illness/postpartum, these cases should all be treated as deficiency constipation, focusing on moistening dryness and nourishing yin, using guiding methods below. If the physique is robust and spirit vigorous, yet experiencing constipation and difficult urination, it must be due to stagnation of Spleen and Stomach qi failing to transport, compounded by phlegm, food retention, and obstruction of turbid pathways. If the pulse is deep and excess, use Bupleurum (Bupleuri Radix), Cimicifuga (Cimicifugae Rhizoma), Er Chen Tang, and Baizhu-Atractylodes Decoction (Er Zhu Tang). The selected case of Wang Zhongyang herein is valued for its external treatment method and the peculiarity of taking Huanglian Jiedu Wan for three years. Furthermore, Li Shizhen's use of Pangolin Scales and Pharbitidis Seed to travel through seminal passages to unblock stasis is even more peculiar. It can stand alongside Dongyuan's Zishen Wan (Kidney-Nourishing Pill) forever.