膀胱余热小便涩。火毒如何消散得。无分初潮与收后。三苓导赤为定格。
小便赤涩。此里热甚之症也。在初热正出之时见之。乃热邪下渗。是为正候。麻出现时。小便
赤涩或淋者。以三苓散（见三十七条）加灯心、石膏、葶苈、射干治之。若热甚。小便赤涩、谵语惊
恐者。以导赤散（见二十六条）去甘草。合三苓散（见二十七条）加辰砂主之。夏月以辰砂益元散
（见六十三条）去甘草。加石膏主之。若小便不利而呕吐者。以三苓散（见三十三条）加藿香、竹
茹、枇杷叶治之。一二日不通者。以加味导赤散（见四十九条）主之。若于正收及收后、而见小
便不通者。是内有热毒。不得消散。而余热下匿膀胱。用导赤散（见二十六条）加麦冬。或用加味
导赤散（见四十九条）以滋气化。导利而小便仍不通者。必因大便秘郁之故。速宜通利大便。以
通幽汤（见六十八条）去升麻、熟地、甘草、加枳壳、丑牛、合导赤散（见二十六条）治之。大便一
通。而小便自利矣。
麻疹二便闭不通。邪火炽甚在其中。通关凉膈利脏腑。管取一服见奇功。
麻疹自出至收。总宜大小便滑利。二便俱不宜秘。秘则急宜通利。若麻症有大小便俱不通
者。是火邪内炽之极。宜以河间凉膈散（见二十六条）去甘草。加牛蒡、车前、木通治之。甚则以通
关散去甘草、人参。八正散去甘草治之。
通关散 通心经、利小便、良方。
栀仁（炒） 大黄（酒蒸各一钱） 木通 赤茯苓 车前子（炒） 瞿麦 滑石 蓄（炒）
人参 甘草（各三五分） 灯心十根引。
八正散 治湿热下注。口渴咽干。淋痛尿血。小腹急满。
木通 瞿麦 车前子 栀仁 大黄 滑石 蓄 甘草梢 灯心引。木通、瞿麦、灯心、
入小肠而降心火。车前、入膀胱而泻肝火。山栀仁、泻三焦之郁火。大黄、滑石、乃泻火利水
之捷药。 蓄、利水止痛。甘草梢、入茎止痛。虽治下焦。而不专治下焦。必三焦通利。水方能
下行也。一书加木香。
膀胱内有残余热邪导致小便涩滞不畅。体内的火毒应当如何消散呢？无论是在麻疹初发阶段还是收没之后，使用三苓散配合导赤散是固定的治疗法则。
小便颜色红赤且排尿涩滞，这是体内热邪严重的症状表现。如果在发热初期、疹子刚发出时出现这种情况，属于热邪向下渗透所致，是正常的病候。当麻疹显现时，若出现小便红赤涩滞或淋沥不尽的症状，用三苓散（见第三十七条）加入灯心草、石膏、葶苈子、射干来治疗。如果热势极盛，出现小便红赤涩滞、胡言乱语及惊恐不安的症状，用导赤散（见第二十六条）去掉甘草，合用三苓散（见第二十七条），并加入辰砂为主药进行治疗。夏季则使用辰砂益元散（见第六十三条）去掉甘草，加入石膏为主药治疗。如果出现小便不通利同时伴有呕吐的症状，用三苓散（见第三十三条）加入藿香、竹茹、枇杷叶来治疗。发病一两天内大小便不通的，用加味导赤散（见第四十九条）主治。如果在疹子正收没或收没后，出现小便完全不通的情况，这是因为体内有热毒无法消散，余热潜伏在膀胱。此时应用导赤散（见第二十六条）加入麦冬，或者使用加味导赤散（见第四十九条）以滋养气化功能，引导利尿。如果经过上述处理，小便仍然不通，那一定是因为大便秘结郁滞的缘故。必须迅速通利大便，使用通幽汤（见第六十八条）去掉升麻、熟地黄、甘草，加入枳壳、牵牛子，并合用导赤散（见第二十六条）进行治疗。一旦大便通畅，小便自然就会通利了。
麻疹期间大小便闭塞不通，是因为体内的邪火极其炽盛。通过通关、清利脏腑的方法，保证服用一剂就能见到奇效。
从麻疹发出到收没的全过程，总宜保持大小便滑利通畅。大小便都不宜秘结，一旦秘结就急需通利。如果麻疹病症中出现大小便全部不通的情况，说明火邪在内极度炽盛。适宜使用河间凉膈散（见第二十六条）去掉甘草，加入牛蒡子、车前子、木通进行治疗。病情严重的，使用通关散去甘草、人参；或使用八正散去甘草进行治疗。
通关散：能疏通心经、通利小便，是良方。
配方：栀子仁（炒制）、大黄（酒蒸，各一钱）、木通、赤茯苓、车前子（炒制）、瞿麦、滑石、萹蓄（炒制）、人参、甘草（各三五分）。以灯心草十根为引。
八正散：治疗湿热下注引起的口渴咽干、淋痛尿血、小腹部急迫胀满。
配方：木通、瞿麦、车前子、栀子仁、大黄、滑石、萹蓄、甘草梢。以灯心草为引。
解析：木通、瞿麦、灯心草入小肠经而下降心火；车前子入膀胱经而泻肝火；山栀子仁泻三焦的郁积之火；大黄、滑石是泻火利水的快捷药物；萹蓄利水止痛；甘草梢入尿道止痛。虽然此方主要治疗下焦疾病，但并不局限于下焦，必须使三焦气机通利，水液才能下行。另一本书中在此方基础上加入了木香。
Residual heat in the Bladder causes difficult and painful urination. How can the fire-toxin be dissipated? Regardless of whether it is during the initial eruption or after resolution, Sanling San (Three-Ingredent Powder) combined with Daochi San (Guiding Out Redness Decoction) serves as the fixed therapeutic regimen.
Reddish and difficult urination indicates a severe internal heat syndrome. When observed during the initial fever stage when the rash first appears, it results from pathogenic heat sinking downward, which is considered a normal manifestation. When the measles rash is visible, if accompanied by reddish, difficult urination or strangury, treat with Sanling San (see Article 37) added with Dengxincao (Juncus Effusus Spike), Shigao (Gypsum Fibrosum), Tinglizi (Descurainiae Semen), and Shegan (Belamcandae Rhizoma). If the heat is extreme, presenting with reddish difficult urination, delirium, and fearfulness, use Daochi San (see Article 26) removing Gancao (Licorice Root), combined with Sanling San (see Article 27), and add Chensha (Cinnabar) as the principal agent. In summer months, use Chensha Yiyuan San (see Article 63) removing Gancao, added with Shigao (Gypsum Fibrosum) as the principal agent. If there is difficulty in urination accompanied by vomiting, treat with Sanling San (see Article 33) added with Huoxiang (Pogostemonis Herba), Zhuru (Bambusae Caulis in Taeniam), and Pipaye (Eriobotryae Folium). For cases where urination and defecation are obstructed within one to two days, JiaWei Daochi San (Modified Guiding Out Redness Decoction, see Article 49) is indicated. If complete urinary retention occurs during the resolution phase or after resolution, it signifies that internal heat-toxins cannot dissipate, and residual heat hides in the Bladder. Apply Daochi San (see Article 26) added with Maidong (Ophiopogonis Radix), or use JiaWei Daochi San (see Article 49) to nourish Qi transformation and guide diuresis. If urination remains obstructed despite these measures, it must be due to constipation and fecal impaction. Rapidly promote bowel movement using Tongyou Tang (Unblocking the Dark Decoction, see Article 68) removing Shengma (Cimicifugae Rhizoma), Shudi (Rehmanniae Radix Praeparata), and Gancao (Licorice Root), added with Zhiqiao (Aurantii Fructus) and Chouniu (Pharbitidis Semen), combined with Daochi San (see Article 26). Once the stool is unblocked, urination will naturally flow freely.
Obstruction of both urine and stool during measles is caused by extreme proliferation of pathogenic fire within. Through methods of opening the passages and clearing the Liao organs, one dose can yield miraculous results.
Throughout the process from the eruption to the resolution of measles, it is essential to maintain smooth and free passage of both urine and stool. Neither should be constipated; if they are, urgent promotion of flow is required. If both urine and stool are completely obstructed in measles cases, it indicates that fire-pathogens are extremely intense internally. It is appropriate to use Hejian Liangge San (Liangge San from Liu Wansu, see Article 26) removing Gancao (Licorice Root), added with Niubangzi (Arctii Fructus), Cheqianzi (Plantaginis Semen), and Mutong (Akebiae Caulis). For severe cases, use Tongguan San (Opening the Passages Powder) removing Gancao (Licorice Root) and Renshen (Ginseng Radix et Rhizoma); or use Bazheng San (Eight-Righteousness Decoction) removing Gancao (Licorice Root).
Tongguan San: Effectively unblocks the Heart meridian and promotes urination; a fine prescription.
Ingredients: Zhiren (Gardeniae Semen, stir-fried), Dahuang (Rhei Radix et Rhizoma, steamed with wine, each 1 qian), Mutong (Akebiae Caulis), Chi Fuling (Polyporus with Hostwood, stir-fried), Cheqianzi (Plantaginis Semen, stir-fried), Qumai (Dianthi Herba), Huashi (Talcum), Pianxu (Polygoni Avicularis Herba, stir-fried), Renshen (Ginseng Radix et Rhizoma), Gancao (Licorice Root, each 3-5 fen). Use Dengxincao (Juncus Effusus Spike, 10 spikes) as an guiding agent.
Bazheng San: Treats damp-heat pouring downward, manifesting as thirst, dry throat, painful strangury, hematuria, and acute fullness in the lower abdomen.
Ingredients: Mutong (Akebiae Caulis), Qumai (Dianthi Herba), Cheqianzi (Plantaginis Semen), Zhiren (Gardeniae Semen), Dahuang (Rhei Radix et Rhizoma), Huashi (Talcum), Pianxu (Polygoni Avicularis Herba), Gancao Shao (Radix Glycyrrhizae with caudex), Dengxincao (Juncus Effusus Spike) as guiding agent.
Analysis: Mutong (Akebiae Caulis), Qumai (Dianthi Herba), and Dengxincao (Juncus Effusus Spike) enter the Small Intestine to descend Heart fire; Cheqianzi (Plantaginis Semen) enters the Bladder to drain Liver fire; Gardeniae Semen drains stagnant fire from the Triple Burner; Dahuang (Rhei Radix et Rhizoma) and Huashi (Talcum) are swift agents for draining fire and promoting urination; Pianxu (Polygoni Avicularis Herba) promotes urination and relieves pain; Gancao Shao (Radix Glycyrrhizae with caudex) enters the urethra to relieve pain. Although this formula treats the Lower Burner, it does not focus exclusively on it; the Triple Burner must be unblocked for water to flow downward. Another text adds Muxiang (Aucklandiae Radix).