DONGUIBOGAM; Internal Bodily Elements 34. Urine 小便 소변 (4) Block and Repulse/ Incurable and Obstinate Cases

Written By Jun Heo(許浚, 1539~1615), Translated by Namil Kim, Wung Seok Cha et al., Published by Ministry of Health & Welfare (Korea)Buy vitamins and supplements.

09 Block and Repulse 關格證 관격증

1. When pathogenic qi is in the six bowels, yang pulse becomes uneven, making qi stagnant, which in turn makes the yang pulse exuberant. When pathogenic qi is in the five viscera, the yin pulse becomes uneven, making blood stagnant which in turn makes the yin pulse exuberant. It is called Gyeok (格, repulse) when yang qi cannot grow due to too much exuberant yin qi; it is called Gwan (關, block) when yin qi cannot grow due to too much exuberant yang qi. Finally, it is called Gwangyeok (關格, block and repulse) when too much yin and yang cannot look after each other. Then, one may not fill one’s natural life span.
2. Gwan (關, block) means dysuria and Gyeok (格, repulse) means vomiting. Blockage is due to excess heat qi, while repulsion is due to excess cold qi. Being unable to send out is called Gwan (關, block), while being unable to send down is called Gyeok (格, repulse). When cold qi is in the chest, blockage, and obstruction occur. When heat qi is in the lower energizer, dysuria occurs.
3. Yin and yang switching sides is called Gwangyeok (關格, block and repulse). It is called gyeok (格, repulse) when water cannot descend because of cold qi in the chest and gwan (關, block), when urine cannot come out because of heat qi in the cinnabar field.
4. Blockage means dysuria and repulse means vomiting; both up and down result in illness.
5. The Inner Classic (內經) says, “The carotid pulse fourfold the wrist pulse is called gyeok (格, repulse), and wrist pulse fourfold the carotid pulse is gwan (關, block).”
6. Both chon (寸) pulses being exuberant is called Gwangyeok (關格, block and repulse). The symptoms would be vomiting and dysuria
7. Most cases of blockage and repulse result in death; it’s because the upper side is cold and lower side is hot.[B073] ⑧ Difficulties in urination and defecation are also called Yinyang Gwangyeok (陰陽關格, block and repulse on yin and yang) or Samchoyak (三焦約, stagnation on the triple energizer). The Inner Classic (內經) says that Samchoyak (三焦約) and yak (約, stagnation) mean stagnation. Steep Eight Ingredient Rectify Powder (八正散) with running water from a distant place and take it.
8. Blockage and repulse indicate dysphagia. It feels like something is stuck and one is unable to lift it up, send it down, or feed oneself. It is caused by the blockage of qi.
9. Use a Mirabilite Decoction or Great qi Coordinating Decoction [the prescriptions are mentioned in the chapter on Cold Damage] for blockage and repulsion. Use a Tonify the Center to Augment the qi Decoction with Arecae Semen (檳榔) to lift qi up for the middle qi deficiency and an Unripe Bitter Orange and Syzygii Flos Relieve Stomach Decoction for blockage by phlegm.

• Mirabilite Decoction 芒硝湯 망초탕: Used for dysuria caused by blockage and repulsion. Natrii Sulfas (芒硝) 2.5 nyang, Talcum (滑石) 3 nyang and Malvae Semen (冬葵子) (stir-baked) 3 hop. Steep coarse Talcum (滑石) and Malvae Semen (冬葵子) powder 5 don with water until half remains, boil this with Natrii Sulfas (芒硝) 1 don one more time, and take it on an empty stomach.
• Unripe Bitter Orange and Syzygii Flos Relieve Stomach Decoction 枳縮二陳湯 지축이진탕: Used when blockage and repulsion cause stagnation in the upper and lower areas. It is for phlegm blocking the middle enerziger. Phlegm may come out by taking it. Ponciri Fructus Immaturus (枳實) 1 don, Cnidii Rhizoma (川芎) 8 pun, Amomi Fructus (砂仁), Poria Sclerotium (白茯苓), Bulbus Fritillariae Cirrhosae (貝母), Citrus Unshius Pericarpium (陳皮), Perillae Semen (蘇子), Trichosanthis Semen (瓜蔞仁), Magnoliae Cortex (厚朴), and Cyperi Rhizoma (便香附子) 7 pun each, Aucklandiae Radix (木香) and Aquillariae Lignum (沈香) 5 pun each, and Glycyrrhizae Radix (甘草) 3 pun. Chop these except Aucklandiae Radix (木香) and Aquillariae Lignum (沈香) into 1 package and steep with 3 pieces of Zingiberis Rhizoma (生薑). Mix these with dark juice, ground Bambusae Caulis in Liquamen (竹瀝), Aquillariae Lignum (沈香) and Aucklandiae Radix (木香) with water.

09-1 For Blockage and Repulsion Vomiting or Diarrhea Should be Induced 關格宜吐瀉 관격에는 토하거나 설사시켜야 한다

1. Regurgitation must be used for blockage and repulsion. There is no need to take phlegm out; lifting blocked qi up is enough. When there is phlegm, prescribe a Syzygii Flos Relieve Stomach Decoction [the prescription is mentioned in the chapter on Phlegm], tickle the inner side of throat, and induce vomitting. For stagnation caused by the middle qi deficiency, add Aucklandiae Radix (木香) and Arecae Semen (檳榔) to a Tonify the Center to Augment the qi Decoction to make qi flow up and down.
2. For difficulties in urination and defecation caused by yin yang blockage and repulsion, inducing defecation makes urine come out by itself.
3. Blockage and repulsion mean death is imminent but can be cured by treating the lower energizer. Use a Great qi Coordinating Decoction. [The prescription is mentioned in the chapter on Cold Damage].
4. One woman suddenly vomited and had difficulty in urination and defecation, felt oppression, dizziness, cold limbs, and no sense of her pulse beating. After taking a package of Great qi Coordinating Decoction, she could defecate around midnight with the pulse getting even and was at ease the next day. It is so hard to treat blockages and repulsion. This is the only patient who was almost dead and survived.
5. For blockage and repulsion, never use bland tastes to let urine permeate out.
6. One child cried out loud, was raving mad and rolling over because of dysruia. He had sand in urine, constipation, and the anus was protruding 1 to 2 chon. Someone said, “That is blockage in the lower energizer. How can the lower energizer be opened if regurgitation and diarrhea are not induced? How can urine come out if water is not drunk?” He added Pharbitidis Semen (牽牛子) (use the first coming powder after ground and sifted) 3 don to a Regulate Stomach and Coordinate Qi Decoction 1 nyang, steeped it with river water and gave it to the patient. Also, he pasted Melonis Pedicellus (瓜蔕) powder down with starch and made these into pills as big as the size of a Brassicae Junceae Semen (芥子). Then, the patient threw up and had loose bowels sending out all at once including pus and blood. After the vomiting and diarrhea stopped, he took 30 to 40 glasses of newly-brought water, 1 glass at a time, and was cured completely.

09-2 How to Wash and Foment 洗熨法 씻는 법과 찜질법

1. The yin yang foment method is also called the cold heat foment; it treats a shifted urinary bladder or difficulties in urination and defecation. First, foment the lower abdomen with a cold object, then repeat with a hot object. Also, fomenting with cold leads to defecation and makes urine to come out itself.
2. To treat a shifted urinary bladder or dysuria, fumigate and wash the lower abdomen, the outer kidney and anus with water steeped with 1 handful of Zingiberis Rhizoma (生薑), Allii Fistulosi Bulbus (葱白), and Perillae Folium (紫蘇葉) each. Again, after getting warm, washing, wiping, and drying, make the patient sit on a cotton blanket while looking up with the legs spread comfortably; this will make qi spread. Then chop Poria Sclerotium Rubra (赤茯苓), Paeoniae Radix (赤芍藥), Paeoniae Radix Alba (白芍藥) 5 don each, and Althaeae Semen (蜀葵子) 2.5 don, steep with water 1 nyang, add Liquid Styrax Pill [the prescription is mentioned in the chapter on Qi] 3 pills and powder of Sal (靑鹽) 0.5 don and take it on an empty stomach. It would be efficacious.
3. One might die if difficulty in urination and the swollen lower abdomen are not treated immediately. Slicing 3 geun of Allii Fistulosi Bulbus (葱白) stir-baked hot, wrapping with towels, making it into 2 bundles, and fomenting below the umbilicus by turns may make urine come out.[B090] ④ Filling a pouch with a half geun of stir-baked salt may also be efficacious.[B090] ⑤ After childbirth, having dysuria, an abdomen swelling like a drum, oppression, dizziness, and an absent mind is due to unfavorable motility of the urinary bladder on delivery. Fill the umbilicus with salt, slicing tens of Allii Fistulosi Bulbus (葱白) roots, put them on the salt, and burn moxa with a large moxa handle. After feeling heat qi entering into the abdomen directly, one can urinate. This has a wondrous effect.

09-3 Navel-compressing Therapy 掩臍法 엄제법

1. If no medicine works for a shifted urinary bladder and a certain amount of time has passed, one may die. Mix Euphorbiae Kansui Radix (甘遂) powder with water, attach it under the umbilicus, and take the steeped water with Glycyrrhizae Radix (甘草). When the juice arrives at the umbilicus, the two medicines are contrary to each other so the urinary bladder moves itself. Then, urine comes out little by little like a spring; this is a good emergency therapy. However, the two must be bought and made separately by two people. Never put these together in one site. This is critical.
2. For the blockage of urine, pound a large river snail alive finely and attach it to the umbilicus for urinating.
3. For dysuria, make urine come out by itself by filling the umbilicus with Moschus (麝香) and Pinelliae Tuber (半夏) powder, piling rice cake up high pounded with Allii Fistulosi Bulbus (葱白) and a river snail, binding it with a thread and burning the pieces under external genitals to put the smoke inside. For women, wash the vaginal orifice with water steeped with Gleditsiae Spina (皂角).
4. For dysuria, use prescriptions mobilizing the umbilicus. Fill a white porcelain bottle with water, fold a sheet of paper with words in 7 folds, block the entrance of the bottle with this paper, fill the patient’s umbilicus with 1 handful of salt, stand the bottle upside down, and cover the umbilicus with it. After feeling cold while lying down, one may urinate.
5. For difficulties in urination and anuria, use Umbilicus Plaster (貼臍膏) [the prescription is mentioned in the chapter on Feces] and Unblock Barriers Powder (通關散).

• Unblock Barriers Powder 通關散 통관산: Used for dysuria. Alumen (礬石) (crude), Natrii Chloridum (白鹽) 2.5 don each. Grind them into fine powder. Roll up some paper, encircle the umbilicus with it, and then pour this medicine there and drop cold water on it; urine will come out.

10 Incurable and Obstinate Cases 難治不治證 난치증과 불치증

1. Dysuria with vomiting and hiccups is hard to cure, so is fullness in the middle and tympanites.
2. Dysuria of a senile person due to qi deficiency [also shortness of breath in other parts] is caused by dried blood qi in the lower energizer. In this case, one may die.
3. In the case of dysuria caused by blockage and repulsion, one may be cured when there is no sweating on the head but die if there is.
4. Sweating on the head and dysuria caused by blockage and repulsion are due to exhausted yang. In this case, it may be incurable.
5. In the case of blockage and repulsion, one may die, if there is sweating on the head.
6. In the case of Cold Damage fever disease or wind-warmth, saying mad things, raising one’s eyes up and enuresis mean death.