李东垣治长安王善夫。病小便不通。渐成中满腹大。坚硬如石。腿脚亦胀裂出水。双睛
凸出。昼夜不得眠。饮食不下。痛苦不可名状。服甘淡渗泄之药皆不效。李曰。病深矣。非
精思不能处。因记素问有云。无阳则阴无以生。无阴则阳无以化。又云。膀胱者。州都之官
津液藏焉。气化则能出矣。此病小便癃闭。是无阴而阳气不化也。凡利小便之药。皆淡味
渗泄为阳。止是气药。阳中之阴。非北方寒水阴中之阴所化者也。此乃奉养太过。膏粱积热
损北方之阴。肾水不足。膀胱肾之室。久而干涸。小便不化。火又逆上而为呕哕。非膈上
所生也。独为关。非格病也。洁古云。热在下焦。填塞不便。是关格之法。今病者内关外格
之病悉具。死在旦夕。但治下焦可愈。随处以禀北方寒水所化大苦寒之味者。黄柏、知母。
桂为引用。丸如桐子大。沸汤下二百丸。少时来报。服药须臾。前阴如刀刺火烧之痛。溺如
瀑泉涌出。卧具皆湿。床下成流。顾盼之间。肿胀消散。李惊喜曰。大哉圣人之言。岂不可
遍览而执一者乎。其证小便闭塞而不渴。时见躁者是也。凡诸病居下焦。皆不渴也。二者之
病。一居上焦。在气分而必渴。一居下焦。在血分而不渴。血中有湿。故不渴也。二者之殊
至易别耳。
震按前贤之不可及者。以其善悟经旨而创立治法耳。若今人不过寻章摘句。即旧时成法
尚未通晓。岂能另标新义。恰合病情乎。
朱丹溪治一人。小便不通。医用利药益甚。脉右寸颇弦滑。此积痰在肺。肺为上焦。膀
胱为下焦。上焦闭则下焦塞。如滴水之器。必上窍通而后下窍之水出焉。以药大吐之。病如
失。
李士材治郡守王镜如。痰火喘嗽正甚时。忽然小便不通。自服车前、木通、茯苓、泽泻
等药。小腹胀闷。点滴不通。李曰。右寸数大。是金燥不能生水之故。惟用紫菀五钱。麦
冬三钱。北五味十粒。人参二钱。一剂而小便涌出如泉。若淡渗之药愈多。反致燥急之苦。
不可不察也。
江右袁启莘。平素劳心。处事沉滞。时当二气。小便不通。用六一散。不效。再用苓、
泻、木通、车前等。又不效。李诊两寸洪数。知为心火刑金。故气化不及州都也。用黄连、
茯神、牛膝、人参、麦冬、五味。一剂而愈。
士材曰。先兄念山。谪官浙江按察。郁怒之余。又当盛夏。小便不通。气高而喘。服胃
苓汤四帖。不效。余曰。六脉见结。此气滞也。但用枳壳八钱。生姜五片。急火煎服。一剂
稍通。四剂霍然矣。
孝廉俞彦直。修府志劳神。忽然如丧神守。小便不通。士材曰。寸微而尺鼓。是水涸而
神伤也。用地黄、知母各二钱。人参。丹参各三钱。茯苓一钱五分。黄柏一钱。二剂稍减。
十剂而安。
王金 曰。一妇人年五十。初患小便涩。医以八正散等剂。展转小便不通。身如芒刺加
于体。予以所感霖淫雨湿。邪尚在表。因用苍术为君。附子佐之。发其表。一服得汗。小便
实时便通。
又治马参政父。年八旬。初患小便短涩。因服药分利太过。遂致闭塞。涓滴不出。予以
饮食太过。伤其胃气。陷于下焦。用补中益气汤。一服小便通。因先多用利药。损其肾气。
遂致通后遗尿一夜不止。急补其肾然后已。凡医之治是证者。未有不用泄利之剂。安能顾其
肾气之虚哉。
〔附〕本事方云。顷在毗陵。一贵官妻。小便不通。脐腹胀痛不可忍。众医皆作淋治。
如八正散之类。皆治不通。病益甚。许曰。此血瘕也。非瞑眩药不可去。乃用桃仁煎。初服
至日午。大痛不可忍。卧少顷。下血块如拳者数枚。小便如黑豆汁一二升。痛止得愈。此药
猛峻。气虚血弱者。宜斟酌之。
震按仲景云。小便利者为有血。小便不利者为无血。乃辨伤寒蓄血之规矩也。此却因蓄
血而小便闭。岂非规矩又贵变通乎。
孙东宿治一富家妇。当仲秋。大小便秘者三日。医以巴豆丸二服。大便泻而小便愈秘。
胀闷。脐突二寸余。前阴胀裂。不能坐卧。啼泣欲尽。此转脬病也。 树东行根皮一寸。滑
石三钱。延胡、桃仁、当归、瞿麦各一钱。水煎。入韭菜汁半杯。服后食顷而小便稍行。玉
户痛甚。小便非极力努之则不出。改用升麻、桔梗、枳壳、延胡。煎成。调元明粉二钱。乃
提清降浊之意。大小便俱行而愈。
僧慎柔治一妇。年五十。小便时。常有雪白寒冰一块。塞其阴户。欲小便。须以手抠出
方溺。否则难。慎柔曰。此胃家寒湿。因脾胃虚寒。凝结而下坠。至阴户口而不即出者。脾
胃之气。尚未虚脱。但陷下耳。用六君加姜、桂。二十剂全愈。
震按小便不通。乃至危至急之候。此集所选仅十一条。似乎简略。然诸法毕备。并不重
复。学人苟能触类引伸。定有无穷变化。
李东垣治疗长安人王善夫。患者小便不通畅，逐渐发展成腹部胀满、肚子变大，坚硬如石头，腿脚也肿胀破裂流出水液，双眼突出，昼夜无法入睡，饮食无法进入，痛苦难以言表。服用甘淡渗泄的药物均无效。李东垣说：“病势深重了，不精心思考不能处方。”于是想起《素问》中说：“没有阳气，阴气就无法生成；没有阴气，阳气就无法化生。”又说：“膀胱是州都之官，津液在此储藏，经过气化作用才能排出。”此病小便癃闭，是因为无阴导致阳气无法气化。凡是通利小便的药物，都是淡味渗泄属阳，只是气药，属于阳中之阴，并非北方寒水阴中之阴所化生的。这是由于供养太过，膏粱厚味积热损伤了北方的阴气，肾水不足。膀胱是肾的居室，时间久了就会干涸，导致小便无法化出。火气又逆向上冲引起呕吐呃逆，这并非膈上产生的病症。这只是“关”证，不是“格”病。张洁古说：“热在下焦，填塞不便”，这是关格的治法。现在病人具备内关外格的病症，死期就在旦夕之间。但只要治疗下焦就可以痊愈。选取禀受北方寒水之气所化的大苦寒味的药物：黄柏、知母，以桂枝为引经药，制成梧桐子大小的丸剂，用沸水送服二百丸。过了一会儿来报告，服药不久后，前阴像刀刺火烧一样的疼痛，尿液像瀑布泉水一样涌出，卧具都湿了，床下形成水流。转眼间，肿胀消散。李东垣惊喜地说：“圣人的言论多么伟大啊！怎么能只浏览一遍就固执己见呢？”这种证候是小便闭塞但不口渴，偶尔出现烦躁。各种疾病位于下焦的，都不口渴。这两种病的区别在于：一种位于上焦，在气分，必然口渴；一种位于下焦，在血分，不口渴。因为血中有湿，所以不口渴。这两种病的差异非常容易辨别。
俞震按语：前辈们不可企及的地方，在于他们善于领悟经典旨意并创立治疗方法。如果现代人只是寻章摘句，连旧时的成法都尚未通晓，怎么能另标新义，恰好符合病情呢？
朱丹溪治疗一个人，小便不通，医生使用利尿药后病情更加严重。脉象右寸颇显弦滑，这是痰积在肺。肺为上焦，膀胱为下焦，上焦闭塞则下焦堵塞，就像滴水之器，必须上窍通畅然后下窍的水才能流出。于是用药催吐，病像丢失了一样好了。
李士材治疗郡守王镜如。在痰火喘嗽正严重时，忽然小便不通，自己服用车前子、木通、茯苓、泽泻等药，小腹胀闷，点滴不通。李士材说：“右寸脉数大，这是金燥不能生水的缘故。”只用紫菀五钱，麦冬三钱，北五味子十粒，人参二钱，一剂药后小便像泉水一样涌出。如果淡渗利尿的药用得越多，反而会导致燥急的痛苦，不可不仔细考察。
江西袁启莘，平时劳心，处事沉滞，时值二气（指阴阳之气交替之时），小便不通。用六一散，无效。再用茯苓、泽泻、木通、车前子等，又无效。李士材诊察两寸脉洪数，知道是心火刑克肺金，所以气化功能达不到州都（膀胱）。用黄连、茯神、牛膝、人参、麦冬、五味子，一剂药就好了。
李士材说：“我的兄长念山，被贬官到浙江按察司，在郁怒之余，又正值盛夏，小便不通，气高而喘。服用胃苓汤四帖，无效。我说：‘六脉见结脉，这是气滞。’只用枳壳八钱，生姜五片，急火煎服，一剂后稍微通畅，四剂后完全康复。”
孝廉俞彦直，修撰府志劳神，忽然像丢了魂魄一样，小便不通。李士材说：“寸脉微而尺脉鼓动，这是水涸而神伤。”用地黄、知母各二钱，人参、丹参各三钱，茯苓一钱五分，黄柏一钱，两剂后症状稍减，十剂后安稳。
王金曰：一位五十岁的妇人，起初患小便涩滞，医生用八正散等方剂，辗转导致小便不通，身体像有芒刺加在身上。我认为是感受了霖雨湿气，邪气尚在体表，因此用苍术为君药，附子佐之，发散表邪。一服药后出汗，小便随即通畅。
又治疗马参政的父亲，八十岁，起初患小便短涩，因服药分利太过，导致闭塞，涓滴不出。我认为是饮食太过，伤了胃气，陷于下焦。用补中益气汤，一服后小便通。因为先前多用利药，损伤了肾气，导致通尿后遗尿一夜不止。急忙补肾后才停止。凡是医生治疗这个证候，没有不用泄利剂的，怎么能顾及其肾气的虚弱呢？
〔附〕《本事方》记载：以前在毗陵，一位贵官的妻子，小便不通，脐腹胀痛不可忍受。众医都当作淋证治疗，如八正散之类，都治不好，病情加重。许叔微说：“这是血瘕，非瞑眩药不能去除。”于是用桃仁煎。初服到中午，大痛不可忍受，躺了一会儿，排出拳头大小的血块数个，小便像黑豆汁一二升，痛止痊愈。此药猛峻，气虚血弱者，宜斟酌使用。
俞震按语：张仲景说：“小便利者为有血，小便不利者为无血”，这是辨别伤寒蓄血的规矩。这里却是因蓄血而小便闭，难道规矩还需要变通吗？
孙东宿治疗一个富家妇，正值仲秋，大小便秘三天。医生用巴豆丸两服，大便泻下但小便更加秘结。胀闷，肚脐突出二寸多，前阴肿胀破裂，不能坐卧，啼哭欲绝。这是转脬病。用树东行根皮一寸，滑石三钱，延胡索、桃仁、当归、瞿麦各一钱，水煎，加入韭菜汁半杯，服后食顷时间小便稍行。玉户疼痛剧烈，小便非极力努责则不出。改用升麻、桔梗、枳壳、延胡索，煎成，调元明粉二钱，这是提清降浊的意思。大小便俱行而愈。
僧慎柔治疗一个妇人，五十岁，小便时，常有雪白寒冰一块，塞住阴户，想小便，必须用手抠出才能溺出，否则困难。慎柔说：“这是胃家寒湿，因脾胃虚寒，凝结而下坠，至阴户口而不即出的原因是脾胃之气尚未虚脱，只是陷下罢了。”用六君子汤加生姜、肉桂，二十剂全愈。
俞震按语：小便不通，是乃至危至急的证候。本集所选仅十一条，似乎简略，然而诸法毕备，并不重复。学习者如果能触类旁通，定有无穷变化。
Li Dongyuan treated Wang Shanfu of Chang'an. The patient suffered from urinary retention, which gradually developed into abdominal distension and enlargement, with the abdomen hard as stone. His legs and feet were swollen, cracking and oozing fluid. His eyes protruded, he could not sleep day or night, could not take food or drink, and his suffering was indescribable. He had taken sweet and bland diuretic herbs without effect. Li said, "The disease is deep; it requires careful contemplation to prescribe." He recalled a passage from *Suwen*: "Without Yang, Yin cannot be generated; without Yin, Yang cannot transform." It also states: "The Bladder is the official of the Zhou Du (capital), where body fluids are stored; only through Qi transformation can they be excreted." This case of urinary strangury and retention is due to a lack of Yin, causing Yang to fail in transformation. All herbs that promote urination have a bland taste and promote drainage, belonging to Yang. They are merely Qi-moving herbs, representing Yin within Yang, and are not transformed by the Yin within Yin of the Northern Cold Water. This condition resulted from excessive nourishment, where rich foods accumulated heat and damaged the Yin of the North. Kidney Water was insufficient. The Bladder is the chamber of the Kidney; over time it dried up, leading to an inability to transform urine. Fire rebelled upward, causing vomiting and hiccups; this did not originate above the Diaphragm. It was solely a "Guan" (closure) syndrome, not a "Ge" (regurgitation) syndrome. Zhang Jiegu said, "Heat in the Lower Jiao causes blockage and difficulty," which is the method for Guan-Ge. Now the patient exhibits both internal Guan and external Ge symptoms, and death is imminent. However, treating the Lower Jiao can cure him. Select herbs with a great bitter-cold flavor that embody the transformation of Northern Cold Water: Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma). Use Guizhi (Cinnamon Twig) as a guiding herb. Form pills the size of sesame seeds. Administer 200 pills with boiling water. Shortly after, a report came: shortly after taking the medicine, the anterior orifice felt like being pierced by a knife or burned by fire, and urine gushed out like a waterfall. Bedding became wet, and streams formed under the bed. In the blink of an eye, the swelling and distension dissipated. Li exclaimed in surprise and joy, "How great are the words of the Sages! How can one simply browse them and adhere rigidly?" This syndrome presents as urinary obstruction without thirst, occasionally accompanied by restlessness. Diseases located in the Lower Jiao generally do not cause thirst. The difference between these two types of diseases is easy to distinguish: one is located in the Upper Jiao, involves the Qi level, and necessarily causes thirst; the other is located in the Lower Jiao, involves the Blood level, and does not cause thirst because dampness exists within the Blood.
Yu Zhen commented: What makes the sages of old incomparable is their ability to comprehend the essence of classics and establish treatment methods. If modern practitioners merely pick phrases from texts and have not even mastered established formulas, how can they innovate and precisely match the pathology?
Zhu Danxi treated a man with urinary retention. After physicians used diuretics, the condition worsened. The pulse at the right Cun position was slightly wiry and slippery, indicating phlegm accumulation in the Lung. The Lung is the Upper Jiao, and the Bladder is the Lower Jiao. When the Upper Jiao is closed, the Lower Jiao becomes blocked, similar to a vessel for dripping water: the upper aperture must open before the water flows from the lower aperture. He induced vomiting with medication, and the illness vanished as if lost.
Li Shicai treated Wang Jingru, Prefect of a Commandery. While suffering severely from phlegm-fire, wheezing, and coughing, he suddenly experienced urinary retention. He self-administered Cheqianzi (Plantaginis Semen), Mutong (Akebiae Caulis), Fuling (Poria), and Zexie (Alismatis Rhizoma), resulting in lower abdominal distension and fullness with no urine output. Li said, "The rapid and large pulse at the right Cun indicates Dryness of Metal failing to generate Water." He prescribed Ziwan (Asternatis Radix) 5 qian, Maidong (Ophiopogonis Radix) 3 qian, Beiwuweizi (Schisandrae Fructus) 10 grains, and Renshen (Ginseng Radix et Rhizoma) 2 qian. After one dose, urine gushed out like a spring. If bland diuretic herbs are used excessively, they反而 (instead) cause dryness and urgency; this must be carefully observed.
Yuan Qixin of Jiangxi usually exerted his mind and was sluggish in handling affairs. During the transition of Yin and Yang energies, he suffered urinary retention. Liu Yi San (Six-One Powder) was ineffective. Subsequently, Fuling (Poria), Zexie (Alismatis Rhizoma), Mutong (Akebiae Caulis), and Cheqianzi (Plantaginis Semen) were used, also without effect. Li palpated the two Cun positions and found them flooding and rapid, determining that Heart Fire was punishing Lung Metal, thus preventing Qi transformation from reaching the Zhou Du (Bladder). He prescribed Huanglian (Coptidis Rhizoma), Fushen (Poria with Hostwood), Niuxi (Achyranthis Bidentatae Radix), Renshen (Ginseng Radix et Rhizoma), Maidong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus). One dose cured him.
Li Shicai stated: "My elder brother Nianshan was demoted to the Surveillance Commissioner of Zhejiang. Amidst depression and anger, and during midsummer, he suffered urinary retention, with high Qi and wheezing. He took Weiling Tang (Stomach-Cooling Decoction) for four doses without effect. I said, 'The six pulses show knotted qualities, indicating Qi stagnation.' I prescribed only Zhike (Aurantii Fructus) 8 qian and Shengjiang (Zingiberis Rhizoma Recens) 5 slices, decocted rapidly. After one dose, there was slight patency; after four doses, he recovered completely."
Xiaolian Yu Yanzhi, while compiling local gazetteers and exhausting his spirit, suddenly appeared disoriented, accompanied by urinary retention. Li Shicai said, "The Cun pulse is faint while the Chi pulse is drum-like, indicating exhaustion of Water and injury to Spirit." He used Dihuang (Rehmanniae Radix) and Zhimu (Anemarrhenae Rhizoma) each 2 qian, Renshen (Ginseng Radix et Rhizoma) and Danshen (Salviae Miltiorrhizae Radix) each 3 qian, Fuling (Poria) 1.5 qian, and Huangbai (Phellodendri Cortex) 1 qian. Symptoms decreased slightly after two doses and stabilized after ten doses.
Wang Jin stated: A fifty-year-old woman initially suffered from scanty and difficult urination. Physicians prescribed Bazheng San (Eight-Herb Powder for Unblocking Damp-Heat), which eventually led to complete urinary retention. Her body felt as if covered in thorns. I attributed it to exposure to prolonged rain and dampness, with pathogenic factors still on the exterior. Therefore, I used Cangzhu (Atractylodis Rhizoma) as the sovereign herb and Fuzi (Aconiti Lateralis Radix Praeparata) as an assistant to release the exterior. After one dose, she sweated, and urination immediately resumed.
He also treated the father of Political Counselor Ma, aged eighty. Initially, he suffered from short and scanty urination. Due to excessive use of diuretic drugs, he developed complete obstruction with no drops passing. I diagnosed that excessive food intake had damaged Stomach Qi, causing it to sink into the Lower Jiao. He was given Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi). After one dose, urination resumed. Because previous diuretic use had damaged Kidney Qi, he experienced enuresis for a night after urination resumed. Urgent tonification of the Kidney stopped it. Physicians treating this syndrome invariably use draining and purgative agents; how can they attend to the deficiency of Kidney Qi?
[Appendix] *Ben Shi Fang* records: Previously in Piling, the wife of a noble official suffered urinary retention with unbearable umbilical and abdominal distension and pain. All physicians treated it as Lin syndrome (strangury), using formulas like Bazheng San (Eight-Herb Powder for Unblocking Damp-Heat), but none worked, and the condition worsened. Xu Shuwei said, "This is a Blood Mass (Xue Jia); only a drastic medication causing severe reaction (Mingxuan) can remove it." He used Taoren Jian (Peach Kernel Decoction). By noon after the first dose, severe pain was unbearable. After lying down briefly, several fist-sized blood clots were passed, followed by one to two sheng of urine resembling black bean juice. Pain ceased, and he recovered. This medicine is fierce and harsh; those with Qi deficiency and weak Blood should use it with caution.
Yu Zhen commented: Zhang Zhongjing stated, "If urination is free, there is Blood stasis; if urination is difficult, there is no Blood stasis." This is the rule for distinguishing Blood Accumulation in Shaoyin cold damage. Here, however, urinary closure is caused by Blood Accumulation. Does this not imply that rules require flexibility?
Sunongsu treated the wife of a wealthy family. In mid-autumn, she had constipation of both stool and urine for three days. Physicians administered two doses of Badou Wan (Croton Seed Pills). Although stool was purged, urinary retention worsened. She suffered distension and fullness, with the umbilicus protruding more than two cun, and the anterior orifice swollen and cracked, unable to sit or lie down, weeping bitterly. This was a Zhuanpao (displacement of the bladder) syndrome. He used root bark from the east side of a tree (Shudongxing Genpi) 1 cun, Huashi (Talcum) 3 qian, Yanhusuo (Corydalis Rhizoma), Taoren (Persicae Semen), Danggui (Angelicae Sinensis Radix), and Qumai (Dianthi Herba) each 1 qian. Decocted in water, with half a cup of Jiucail (Chinese Chive Juice) added. After eating for a short while post-medication, urination flowed slightly. The vulva hurt severely, and urine would not come out unless she strained forcefully. He then changed the prescription to Shengma (Cimicifugae Rhizoma), Jiegeng (Platycodonis Radix), Zhike (Aurantii Fructus), and Yanhusuo (Corydalis Rhizoma). Decocted, mixed with Yuanmingfen (Natrii Sulfas Crystallicus) 2 qian. This embodies the intention of raising the clear and descending the turbid. Both stool and urine passed, and she recovered.
Monk Shenrou treated a fifty-year-old woman. During urination, a piece of snow-white ice-like substance would block her vaginal opening. To urinate, she had to manually remove it; otherwise, it was difficult. Shenrou said, "This is Cold-Dampness in the Stomach, caused by deficiency-cold of the Spleen and Stomach, condensing and sinking downward. It reaches the vaginal orifice but does not exit immediately because the Qi of the Spleen and Stomach has not yet collapsed, but has merely sunk." He prescribed Liujun Zi Tang (Six-Gentlemen Decoction) plus Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex). Twenty doses resulted in complete recovery.
Yu Zhen commented: Urinary retention is a critical and urgent condition. This collection selects only eleven cases, seemingly brief, yet all methods are complete and non-repetitive. If learners can apply these principles analogously, they will surely find infinite variations.