经云。三焦者。决渎之官。水道出焉。膀胱者。州都之官。津液藏焉。气化则能出矣。下焦
者。别回肠。注于膀胱而渗入焉。故水谷者。常并居于胃中。成糟粕。俱下于大肠。而成下焦。
渗而俱下。济泌别汁。循下焦而渗入膀胱焉。膀胱之胞薄以懦。得酸则缩蜷。约而不通。水道不
行。故癃。阴者。积筋之所终也。故酸入而走筋矣。饮食入胃。游溢精气。上输于脾。脾气散精。
上归于肺。通调水道。下输膀胱。
经云。至阴虚。天气绝。至阳盛。地气不足。夫肾肝在下。地道也。心肺在上。天道也。脾
胃居中。气交之分也。故天之阳绝而不安于地者。则白露不下。在上之阳不交于阴。则在下之阴
无以为化。水道其能出乎。此上焦之气化也。仲景曰。卫气行。则小便宣通。又曰。脾病则九窍
不通。此中焦之气化也。东垣云。在下之阴虚。在上之阳盛。致肾气不化。必宣其阳而举之。则
阴可得而平也。故丹溪云。以吐法通小便。上窍通而下窍之水出焉。然升提止可施于涓滴不通者。
若溺涩短少。或淋漓作痛者。非所宜也。由经言及诸论观之。未有不主于气化者。不审乎此。转
行疏利之剂求功。多见其不知量也。
东垣云。小便不通。皆邪热为病。分在气在血而治之。以渴与不渴而辨之。渴而不利。或黄
或涩者。热在上焦气分也。小便者膀胱所主。若肺热不能生水。是绝其寒水生化之源。宜清肺而
滋化源。故当从肺分助其秋令。宜茯苓、泽泻、车前、木通之类淡味渗泄之药。水自生焉。如不
渴而小便不通者。热在下焦血分。肾与膀胱受热。闭塞其流。须知、柏
之类苦寒气味俱阴之药以除其热。稍兼肉桂辛温散结之阳药以泄其闭。若服淡渗之味。则阳无以
化。而阴愈闭塞不通矣。气分热。渴而小便闭。或黄或涩者。黄芩清肺饮。血分热。小便闭而不
渴者。滋肾丸。不应。并中焦亦有热也。加连、柏、甘草。等分煎服。阴虚血热人。渴而小便不
通。或涩痛淋沥者。切禁五苓燥剂。宜导赤散。津液偏渗于大肠。大便泄泻。小便涩少。或水停
心下。不能下输膀胱者。五苓散渗泄之。若六腑客热转于下焦而不通者。用益元散以清之。若气
迫闭塞。升降不通者。二陈汤去半夏。加木通、滑石、柴胡、升麻以提之。汗出过多。小便赤涩。
此五内枯燥。慎勿用利水之剂。生脉散加黄 、当归。若右寸独数大。小便点滴而下者。此金燥
不能生水。气化不及州都。生脉散去五味子。易大剂紫菀。可一服而愈。小便不通。腹下痛闷难
忍如覆碗者为实。亦分在气在血。气壅于下者。四磨、六磨选用。血污于下者。代抵当丸。有火
虚者。非与温补之剂则水不能行。如金匮肾气丸。元气下陷而水道不通者。补中益气汤加木通、
车前。升清以降浊也。小便不利。审是气虚。独参汤少加广皮如神。凡小便不通。用独蒜涂脐法。
以独囊蒜一枚。栀子三枚。盐少许。捣烂。摊纸贴脐。良久即通。未通。涂阴囊上立效。或用食
盐半斤。炒热布包熨之。天行热病。小便不通。用蚯蚓泥升许。以水浸澄清。渴即与饮。不应。
用地龙数枚。同芦根。捣汁饮之。
闭癃 闭癃者。溺闭不通。淋沥点滴也。惟肝与督脉三焦膀胱主之。经云。膀胱之胞薄以懦。
得酸则缩蜷。约而不通。水道不行。故癃。又云。膀胱不利为癃。不约为遗溺。盖实则闭癃。虚
则遗溺。遗溺则补之。闭癃则泻之。然遗溺闭癃。不取膀胱俞者。盖膀胱但藏溺。其主出溺者。
皆从三焦及肝与督脉也。闭癃者。合而言之。一病也。分而言之。有暴久之殊。盖闭者。暴病。
为溺点滴不出。俗名小便不通是也。可用疏通利窍之剂。甚则用吐法以提其气自通。若补中益
气、二陈、五苓。俱可探吐也。癃者。久病。为溺癃淋沥。点滴而出。一日数十次。名淋病是也。
惟宜滋养真阴。兼资气化。如六味、生脉之类。亦可合用。若疏泄利气之药。皆为戈戟矣。夏秋
热伤癃闭。以滑石调水饮之即通。但阴虚泉竭者禁用。
《黄帝内经》说：三焦，是决渎之官，水道由此而出。膀胱，是州都之官，津液在此储藏，经过气化作用才能排出。下焦，分别回肠，注入膀胱并渗入其中。所以水谷，常常共同居住在胃中，消化后成为糟粕，一起下行到大肠，从而形成下焦的功能状态。通过渗滤和分别汁液，循着下焦渗入膀胱。膀胱的胞壁薄而柔弱，遇到酸味就会收缩蜷曲，约束不通，导致水道不行，所以发生癃闭。阴部，是筋脉汇聚终结的地方，所以酸味入胃后走向筋脉。饮食进入胃中，游溢精气，向上输送到脾脏，脾气散布精微，向上归于肺脏，通调水道，向下输送到膀胱。
《黄帝内经》又说：至阴之气虚衰，天气（阳气）就会隔绝；至阳之气过盛，地气（阴气）就会不足。肾和肝位于下部，属于地道；心和肺位于上部，属于天道；脾和胃居于中部，属于气机交合的分野。所以，如果天之阳气隔绝而不能安于地下，那么白露就不会下降；在上部的阳气不能与在下部的阴气相交，那么在下的阴气就无法得到化生，水道怎么能排出呢？这是上焦的气化功能。张仲景说：卫气运行，则小便宣通。又说：脾病则九窍不通。这是中焦的气化功能。李东垣说：在下部的阴虚，在上部的阳盛，导致肾气不化，必须宣发阳气并提升它，那么阴气就可以平和了。所以朱丹溪说：用吐法来通利小便，上窍通畅，下窍的水液自然流出。然而升提之法只适用于点滴不通的情况，如果是尿涩短少，或者淋漓作痛，就不适宜使用。从经文及诸家论述来看，无不主张以气化为主。如果不审察这一点，转而使用疏利之剂以求功效，多见其不知轻重深浅啊。
李东垣说：小便不通，都是邪热致病，分为在气分和在血分而进行治疗，通过口渴与否来辨别。口渴且小便不利，颜色黄或排尿涩滞的，是热在上焦气分。小便由膀胱所主，如果肺热不能生水，就是断绝了寒水生化之源，应当清肺以滋生化之源，所以应当从肺分助其秋令，宜用茯苓、泽泻、车前子、木通等淡味渗泄的药物，水液自然生成。如果不口渴而小便不通的，是热在下焦血分，肾与膀胱受热，闭塞了水流，须知知母、黄柏等苦寒气味俱阴的药物可以清除其热，稍加肉桂辛温散结的阳药以泄其闭塞。如果服用淡渗之味，则阳气无法化生，阴气更加闭塞不通。气分热，口渴且小便闭，或黄或涩的，用黄芩清肺饮。血分热，小便闭而不渴的，用滋肾丸。如果无效，说明中焦也有热，加黄连、黄柏、甘草，等分煎服。阴虚血热之人，口渴且小便不通，或涩痛淋沥的，严禁使用五苓散等燥剂，宜用导赤散。津液偏渗于大肠，大便泄泻，小便涩少，或者水停心下，不能下输膀胱的，用五苓散渗泄。如果六腑客热转于下焦而不通的，用益元散清解。如果气迫闭塞，升降不通的，用二陈汤去掉半夏，加木通、滑石、柴胡、升麻以提升气机。汗出过多，小便赤涩，这是五脏内部枯燥，千万不要用利水之剂，用生脉散加黄芪、当归。如果右寸脉独独数大，小便点滴而下，这是金燥不能生水，气化不及州都，用生脉散去五味子，换用大剂量紫菀，可一服而愈。小便不通，腹部下方疼痛闷胀难忍如倒扣碗状的是实证，也分为在气分和血分。气壅于下的，选用四磨汤、六磨汤。血污于下的，用代抵当丸。有火虚的，不用温补之剂则水液不能行，如金匮肾气丸。元气下陷而水道不通的，用补中益气汤加木通、车前子，升清以降浊。小便不利，审察确属气虚的，独参汤少加广陈皮，效如神速。凡小便不通，可用独蒜涂脐法，用独头蒜一枚，栀子三枚，盐少许，捣烂，摊在纸上贴于脐部，良久即通。未通，涂于阴囊上立效。或用食盐半斤，炒热布包熨烫。天行热病，小便不通，用蚯蚓泥约一升，用水浸泡澄清，口渴时给予饮用。无效，用地龙数条，同芦根一起，捣汁饮用。
闭癃：闭癃，是指溺闭不通，淋沥点滴。主要由肝、督脉、三焦、膀胱主管。《黄帝内经》说：膀胱的胞壁薄而柔弱，遇到酸味就会收缩蜷曲，约束不通，水道不行，所以发生癃。又说：膀胱不利为癃，不约为遗溺。大概实证表现为闭癃，虚证表现为遗溺。遗溺则补之，闭癃则泻之。然而治疗遗溺和闭癃，不取膀胱俞穴，因为膀胱只是储藏尿液，其主管排出尿液，都从三焦以及肝与督脉而来。闭癃，合而言之，是一种病；分而言之，有发病急缓的不同。所谓“闭”，是暴病，指尿液点滴不出，俗名小便不通，可用疏通利窍之剂，严重时可用吐法以提其气自通。若补中益气汤、二陈汤、五苓散，均可用于探吐。“癃”，是久病，指尿液癃淋沥，点滴而出，一日数十次，名为淋病，只宜滋养真阴，兼资气化，如六味地黄丸、生脉散之类，也可合用。如果使用疏泄利气之药，就都成了伤害身体的戈戟了。夏秋季节热伤导致的癃闭，用滑石调水饮用即通，但阴虚泉竭者禁用。
The *Classic of Medicine* (Huangdi Neijing) states: The Sanjiao (Triple Burner) is the official responsible for draining and conducting, through which water passages emerge. The Bladder is the official of the reservoir, storing body fluids; only through Qi transformation can they be discharged. The Lower Jiao separates from the ileum, pours into the Bladder, and permeates therein. Thus, food and drink often reside together in the Stomach, transform into dregs, and descend together to the Large Intestine, thereby forming the functional state of the Lower Jiao. Through filtration and separation of juices, following the Lower Jiao, they permeate into the Bladder. The vesical wall is thin and soft; upon encountering sour flavors, it contracts and curls, becoming constrained and obstructed, causing water passages to fail to flow, thus resulting in Lin syndrome (difficulty in urination). The Yin region is where sinews converge and terminate; therefore, sour flavors enter the Stomach and travel to the sinews. Food and drink entering the Stomach, their essence and Qi overflow and are transported upward to the Spleen. The Spleen scatters essences, transporting them upward to return to the Lung. The Lung regulates water passages, transporting them downward to the Bladder.
The *Classic of Medicine* further states: When Yin Qi reaches its deficiency, Heaven Qi (Yang) is severed; when Yang Qi reaches its excess, Earth Qi (Yin) is insufficient. The Kidney and Liver are located below, belonging to Earth Dao; the Heart and Lung are located above, belonging to Heaven Dao; the Spleen and Stomach reside in the center, belonging to the zone of Qi intersection. Therefore, if Heaven's Yang is severed and cannot settle in the Earth, white dew will not descend. If Yang above does not interact with Yin below, then Yin below has no basis for transformation; how can water passages discharge? This refers to the Qi transformation of the Upper Jiao. Zhang Zhongjing stated: When Wei Qi (Defensive Qi) circulates, urination is unobstructed. He also stated: When the Spleen is diseased, the nine orifices become obstructed. This refers to the Qi transformation of the Middle Jiao. Li Dongyuan stated: When there is Yin deficiency below and Yang excess above, leading to failure of Kidney Qi transformation, one must vent Yang Qi and lift it, so that Yin may become balanced. Thus, Zhu Danxi stated: Using emesis to promote urination, once the upper orifice is open, water from the lower orifice flows out. However, lifting methods are only applicable to cases of complete retention with no drops passing. For cases with scanty, astringent urine, or painful dribbling, this method is inappropriate. From the classics and various discussions, all emphasize Qi transformation as the primary principle. Failing to examine this and instead using diuretic agents to seek efficacy demonstrates a lack of judgment regarding severity and depth.
Li Dongyuan stated: Urinary obstruction is caused by pathogenic heat, differentiated into involvement of the Qi level or Blood level for treatment, distinguished by the presence or absence of thirst. Thirst accompanied by difficulty in urination, with yellow or astringent urine, indicates heat in the Qi level of the Upper Jiao. Urination is governed by the Bladder; if Lung Heat fails to generate Water, it severs the source of Cold Water generation. One should clear the Lung to nourish the source of transformation, assisting the Autumnal function from the Lung aspect. Suitable herbs include those with bland flavor and draining properties such as Poria (Fuling), Alisma (Zexie), Plantago Seed (Cheqianzi), and Akebia Stem (Mutong), allowing water to generate naturally. If there is no thirst but urinary obstruction occurs, heat resides in the Blood level of the Lower Jiao. The Kidney and Bladder are affected by heat, blocking the flow. One must use bitter-cold, Yin-natured herbs such as Anemarrhena Root (Zhimu) and Phellodendron Bark (Huangbai) to eliminate heat, combined slightly with Cinnamon Twig (Rougui), a pungent-warm, Yang-natured herb to disperse nodules and relieve closure. If bland-draining herbs are used, Yang lacks the means to transform, and Yin becomes more closed and obstructed. For Qi-level heat with thirst and urinary closure, or yellow/astringent urine, use Huangqin Qingfei Yin. For Blood-level heat with urinary closure but no thirst, use Zishen Wan. If ineffective, it indicates heat in the Middle Jiao as well; add Coptis Rhizome (Lian), Phellodendron Bark (Bo), and Licorice Root (Gancao) in equal parts and decoct. For individuals with Yin deficiency and Blood heat, presenting with thirst, urinary obstruction, or painful dribbling, strictly avoid drying agents like Wuling San; use Daochi San instead. When body fluids leak excessively into the Large Intestine, causing diarrhea and scanty, astringent urine, or when water stagnates under the heart and fails to transport to the Bladder, use Wuling San for drainage. If guest-heat from the Six Fu organs shifts to the Lower Jiao causing obstruction, use Yiyuan San to clear it. If Qi pressure causes closure and obstruction of ascending and descending movements, use Erchen Tang removing Pinellia Tuber (Banxia), adding Akebia Stem (Mutong), Talcum (Huashi), Bupleurum Root (Chaihu), and Cimicifuga Rhizome (Shengma) to lift. Excessive sweating leading to red, astringent urine indicates dryness within the five Zang organs; do not use diuretics. Use Shengmai San adding Astragalus Root (Huangqi) and Angelica Sinensis (Danggui). If the Right Cun pulse alone is rapid and large, with urine dripping out, this indicates Metal dryness failing to generate Water, and Qi transformation failing to reach the Reservoir. Use Shengmai San removing Schisandra Berry (Wuweizi), replacing it with a large dose of Aster Root (Ziwan), which can cure in one dose. Urinary obstruction with severe pain and distension in the lower abdomen, resembling an inverted bowl, is an Excess pattern, differentiated into Qi or Blood involvement. Qi stagnation below: select Simo Tang or Limo Tang. Blood turbidity below: use Daididang Wan. In cases of Fire deficiency, water cannot move without warming and tonifying agents, such as Jin Gui Shenqi Wan. When Yuan Qi sinks and water passages are obstructed, use Buzhong Yiqi Tang adding Akebia Stem (Mutong) and Plantago Seed (Cheqian) to raise the Clear and descend the Turbid. For difficult urination confirmed as Qi deficiency, Dushen Tang with a small amount of Tangerine Peel (Guangpi) acts miraculously. For any urinary obstruction, apply the Single Garlic Navel Method: take one bulb of single-clove garlic, three Gardenia fruits (Zhizi), and a little salt, pound into a paste, spread on paper, and apply to the navel; after some time, urination will resume. If not relieved, apply to the scrotum for immediate effect. Alternatively, stir-fry half a jin of table salt until hot, wrap in cloth, and apply as a compress. For epidemic febrile diseases with urinary obstruction, use about one sheng of earthworm mud, soak in water, clarify, and drink when thirsty. If ineffective, use several earthworms (Dilong) with Asparagus Stem (Lugen), pound and juice, and drink.
Bi Long (Urinary Retention): Bi Long refers to complete urinary obstruction with scanty, dribbling drops. It is primarily governed by the Liver, Du Meridian, Sanjiao, and Bladder. The *Classic of Medicine* states: The vesical wall is thin and soft; upon encountering sour flavors, it contracts and curls, becoming constrained and obstructed, causing water passages to fail to flow, thus resulting in Lin. It also states: Bladder dysfunction leads to Bi Long; lack of constraint leads to Enuresis. Generally, Excess patterns manifest as Bi Long, while Deficiency patterns manifest as Enuresis. Enuresis is treated by tonification; Bi Long is treated by purgation. However, for treating enuresis and Bi Long, the Bladder Shu point is not selected because the Bladder only stores urine; the control of urine discharge lies with the Sanjiao, Liver, and Du Meridian. Bi Long, collectively speaking, is one disease; separately, it differs in onset speed. "Bi" refers to acute onset, where urine does not pass even in drops, commonly known as urinary obstruction. It can be treated with herbs that unblock and open orifices; in severe cases, emesis can be used to lift Qi, allowing spontaneous passage. Buzhong Yiqi Tang, Erchen Tang, and Wuling San can all be used to induce vomiting. "Long" refers to chronic onset, where urine dribbles slowly, passing in drops dozens of times a day, named Lin Disease. It requires nourishing True Yin and supporting Qi transformation, such as Liuwei Dihuang Wan or Shengmai San, which can be combined. Using herbs that drain and move Qi would be harmful. For Bi Long caused by summer-autumn heat injury, drinking Slipped Stone (Huashi) mixed with water promotes immediate passage, but it is contraindicated in cases of Yin deficiency and depleted fluids.