治以吐法何也？曰∶取其气化而已。经曰∶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。故上、中、下三焦之气，有一不化，则不得如决渎之水而出矣。岂独下焦膀胱气塞
而已！上焦肺者，主行荣卫，通调水道，下输膀胱，而肾又上连肺，岂非小便从上焦之气化者乎？仲景谓
胃气行则小
便宣通。《内经》谓脾病则九窍不通。小便不利者，其病一也。由是三焦所伤之邪不一，气之变化
无穷，故当随处治邪行水，大要在乎阴阳无相偏负，然后气得以化。若方盛衰论曰∶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。
故天之阳绝而不下交于地者，尚且白露不下，况人同乎天，其上之阳不下交于阴，则下之阴虚；在上
之阳盛不务其德而乘之，致肾气之不化，必泻其阳而举之，则阴可得而平也。若此条所叙之症，皆用吐法
，盖因气道闭塞，升降不前者而用耳！其他众法，何尝舍之而独施是哉？先生尝曰∶吾以吐
法通小便，譬如滴水之器，开其上窍则下窍水自出焉！
一妇年五十，患小便涩，治以八正散等剂，小肠胀急不通，身如芒刺。余以所感霖淫雨，湿邪尚
在表，因用苍术为君，附子佐之发表，一服即汗，小便随通。
一人年八旬，小便短涩，分利太过，致涓滴不出。盖饮食过伤，其胃气陷于下焦。用补中益气汤，
一服即通。
为什么要用吐法来治疗？回答说：这是为了利用气化的原理。《内经》说：三焦是决渎之官，水道由此而出。膀胱是州都之官，津液藏于此，经过气化作用才能排出。所以上、中、下三焦的气机，只要有一个不能气化，就不能像决渎之水那样顺畅流出。这难道仅仅是下焦膀胱气机闭塞吗？上焦的肺，主管运行营卫之气，通调水道，向下输送到膀胱，而肾又向上连接肺，这难道不是说明小便的排泄依赖于上焦的气化作用吗？张仲景说胃气通畅则小便宣通。《内经》说脾病则九窍不通。小便不利，其病机是一致的。因此，三焦所受的邪气不一，气的变化无穷，所以应当根据具体情况祛除邪气、通利水道，关键在于阴阳平衡不偏颇，然后气才能正常气化。《素问·方盛衰论》说：至阴之气虚竭，则天气（阳气）断绝；至阳之气过盛，则地气（阴气）不足。肾、肝位于下部，属于地道；心、肺位于上部，属于天道；脾胃居于中部，是气机升降交会的部位。所以天之阳气断绝而不能下行与地气相交，尚且会导致白露不下，何况人同于天，如果上部的阳气不能下行与阴气相交，就会导致下部阴虚；如果上部的阳气过盛而不守其德，反而乘袭下部，导致肾气不能气化，必须泻其阳热并升举阳气，那么阴气就可以恢复平衡了。像本条所述的症状，都用吐法，是因为气道闭塞，气机升降停滞不前才使用的！其他各种方法，何尝不是舍弃它们而单独使用这种方法呢？先生曾经说：我用吐法来通利小便，就像滴水之器，打开上面的孔窍，下面的水自然就会流出！
有一位五十岁的妇女，患小便涩滞，用八正散等方剂治疗，小肠胀急不通，身体感觉如芒刺在背。我考虑到当时正值连绵阴雨，湿邪尚在体表，因此用苍术作为君药，附子作为佐药以发表祛湿，服一次即出汗，小便随即通畅。
有一位八十岁的老人，小便短少涩滞，因过度分利（利尿），导致点滴不出。这是因为饮食过度损伤，导致胃气下陷于下焦。使用补中益气汤，服一次即通畅。
Why is the vomiting method used for treatment? The answer is: to utilize the principle of Qi transformation. The Classics state: The Sanjiao (Triple Burner) is the official in charge of irrigation, and the water passages emerge from it. The Bladder is the official of the capital, where body fluids are stored; only through Qi transformation can they be excreted. Therefore, if the Qi of the Upper, Middle, or Lower Sanjiao fails to transform in any one aspect, the water cannot flow out smoothly as if from an irrigated channel. Is it merely due to Qi obstruction in the Lower Jiao Bladder alone! The Lung, located in the Upper Jiao, governs the circulation of Ying (Nutritive) and Wei (Defensive) Qi, regulates the water passages, and transmits them downward to the Bladder. Moreover, the Kidney connects upward with the Lung. Does this not indicate that urination depends on the Qi transformation of the Upper Jiao? Zhang Zhongjing stated that when Stomach Qi moves freely, urination becomes unobstructed. The *Neijing* states that when the Spleen is diseased, the nine orifices become blocked. Urinary difficulty shares the same pathological mechanism. Thus, the pathogenic factors affecting the Sanjiao vary, and the changes of Qi are infinite. Therefore, one must treat the pathogen and promote water metabolism according to the specific situation. The key lies in ensuring Yin and Yang do not bear an imbalance, so that Qi can undergo transformation. As stated in the *Fang Sheng Lun* (Treatise on the Balance of Excess and Deficiency): When Yin reaches its extreme deficiency, Heavenly Qi (Yang) is cut off; when Yang reaches its extreme excess, Earthly Qi (Yin) is insufficient. The Kidney and Liver are located below, belonging to Earthly Qi; the Heart and Lung are located above, belonging to Heavenly Qi; the Spleen and Stomach reside in the center, at the junction where Qi interacts. Therefore, if Heavenly Yang is cut off and fails to descend to interact with Earth, even white dew will not fall. How much more so for humans who correspond to Heaven! If the Yang above fails to descend and interact with Yin, the Yin below becomes deficient. If the excessive Yang above fails to maintain its virtue and instead attacks the lower part, causing the Kidney Qi to fail in transformation, one must drain the excess Yang and raise it, so that Yin can be balanced. For the symptoms described in this section, the vomiting method is employed because the Qi pathway is blocked, and the ascending and descending movements are stagnant! Other methods are not abandoned solely to use this one. The Master once said: "My use of the vomiting method to promote urination is like a vessel dripping water; if you open the upper aperture, the water naturally flows out from the lower aperture!"
A fifty-year-old woman suffered from difficult and scanty urination. She was treated with formulas such as Bazen San (Eight-Right Decoction), resulting in distension and urgency of the Small Intestine with no relief, and her body felt as if pierced by thorns. Considering that she had been exposed to continuous heavy rain, with dampness still lingering in the exterior, I used Cangzhu (Rhizoma Atractylodis Macrocephalae) as the sovereign herb, assisted by Fuzi (Radix Aconiti Lateralis Preparata) to release the exterior. After one dose, she sweated, and urination immediately became free.
An eighty-year-old man suffered from short and scanty urination. Due to excessive use of diuretic methods, he produced not a single drop. This was caused by dietary injury leading to the sinking of Stomach Qi into the Lower Jiao. He was administered Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi), and after one dose, urination was restored.