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.
07 Dysuria 小便不通 소변이 나오지 않는 것
① As heat moves from the placenta to bladder, difficulty in urination or hematuria appears.
② Difficulty in urination and anuria means a blocked bladder. Add Aucklandiae Radix (木香) to Eight Ingredient Rectify Powder (八正散).
③ The liver meridian passes the external genitals. The diseases from that place would be enuresis, difficulty in urination, and hematuria. For a woman, the governor vessel enters into the external genitals and the orifice exists at the end of the urethra. If this area catches a disease, there will be difficulty in urination, hemorrhoids, and enuresis. The foot triple energizer is branched from the bladder meridian. It enters the bladder in the continuum and moves around the lower energizer. Therefore, uroschesis and ischuria are caused by the excess foot triple energizer, while enuresis is caused by a deficient one.
④ Difficulty in urination and anuria may be the same thing, but there is the difference of acute and chronic disease. Blockage of urination involves acute dribbling of urination. Outside the medical field, it is called dysuria. Difficult urination is a chronic disease involving the dribbling of urination so one urinates ten to a hundred times a day. This is called strangury disease.
⑤ One cannot urinate when heat obstructs the lower energizer. Symptoms include blockage of urination, lack of thirst, and agitation.
⑥ There is a difference between qi and blood when considering dysuria. Dysuria with thirst means heat in the qi aspect of the upper energizer, so use Clear Lungs Powder. Dysuria with no thirst means heat in the blood aspect of the lower energizer, so use a Nourish Kidneys Pill.
⑦ In the case of dysuria, the part below the umbilicus looks like a turned-over bowl and it is hard for one to endure the pain and oppression. There are two treatments. For dysuria by malfunction of qi transformation, use a Tangerine Peel and Poria Decoction with the powder of Aucklandiae Radix (木香) and Aquillariae Lignum (沈香) 2 dons each, take it on an empty stomach, and make qi come up by vomiting. For dysuria caused by static blood in the lower energizer, use a Peach Pit Order Qi Decoction [the prescription is mentioned in the chapter on Cold Damage] to break the static blood.
⑧ Heat causes dysuria while cold causes urinary incontinence. If the heat is severe, there will be anuria; if the heat is mild, there will be dysuria.
⑨ Dysuria means rough blood and qi not being able to flow well, blocking the orifices. Use a Guide Qi to Eliminate Dryness Decoction.
⑩ Use Five Ingredients Powder with Poria [the prescription is mentioned in the chapter on Cold Damage], Guide Out Red Formula, Broom Cypress Decoction, Qi Diffusion Powder, Unblock Barriers Pill, Polyporus Decoction, Augmented Five Ingredients Poria Powder, or Penetrate Wellspring Powder for dysuria.
- Eight Ingredient Rectify Powder 八正散 팔정산: Used for difficult urination and anuria caused by heat accumulating in the bladder. Rhei Radix et Rhizoma (大黃), Akebiae Caulis (木通), Dianthi Herba (瞿麥), Polygoni Avicularis Herba (萹蓄), Talcum (滑石), Gardeniae Fructus (梔子), Plantaginis Semen (車前子), and Glycyrrhizae Radix (甘草) 1 don each. Chop these into 1 package, add Junci Medulla (燈心) 1 don, steep it with water, and take it on an empty stomach.
- Clear Lungs Powder 淸肺散 청폐산: Used for blockage of urination with thirst. Polyporus (猪苓), Tetrapanacis Medulla (通草) 1.5 don each, Poria Sclerotium Rubra (赤茯苓), Alismatis Rhizoma (澤瀉), Junci Medulla (燈心), Plantaginis Semen (車前子) 1 don each, Polygoni Avicularis Herba (萹蓄), Akebiae Caulis (木通), Dianthi Herba (瞿麥) 7 pun each, and Succinum (琥珀) 5 pun. Chop these into 1 package, steep it with water, and take it on an empty stomach.
- Nourish Kidneys Pill 滋腎丸 자신환: ① Used for blockage of urination with no thirst. Phellodendri Cortex (黃柏), Anemarrhenae Rhizoma (知母) (washed with wine and baked) 1 nyang, and Cinnamomi Cortex Spissus (肉桂) 0.5 don. Grind, make into paste with water, and make it into pills as big as a seed of the royal foxglove tree. Take 100 pills with boiled water on an empty stomach. It is also called Seolsinhwan, the pill discharging the kidneys. ② Someone had suffered from dysuria, abdominal distension, edema of the feet, protrusion of both eyes and insomnia. It was too painful for the person to say a word. Dongyuan said, “The bladder is the house of fluid and humor. When qi transformation is completed, urine may come out. Difficulty in urination and anuria are what happens when there is neither the transformation of yin qi nor of yang qi. This person has eaten too much fat, sweet and greasy food, and accumulated heat. Therefore, the bladder, namely the house of the kidneys, has been dried for a long time, unable to make urine. Now, the person has blockage and repulsion and is soon to die, but can be cured with treatment on the lower energizer.” After taking the medicine, the person urinated easily and recovered.
- Guide Qi to Eliminate Dryness Decoction 導氣除燥湯 도기제조탕: Used for dysuria. Poria Sclerotium Rubra (赤茯苓) 1.5 don, Phellodendri Cortex (黃柏) 1.2 don, Talcum (滑石), Anemarrhenae Rhizoma (知母), and Alismatis Rhizoma (澤瀉) 1 don each. Chop these into 1 package, add Junci Medulla (燈心) 1 don, steep with water, and take it on an empty stomach.
- Guide Out Red Formula 導赤元 도적원: Used for dysuria caused by heat in the bladder. Rhei Radix et Rhizoma (大黃) (stir-baked) 1.5 nyang, Gardeniae Fructus (梔子) 1.2 nyang, Akebiae Caulis (木通), Rehmanniae Radix (生乾地黃) 8 don each, Paeoniae Radix (赤芍藥), Poria Sclerotium Rubra (赤茯苓), and Talcum (滑石) 4 don each. Grind, make into paste with honey and make it into pills as big as a seed of the royal foxglove tree. Take 30 to 50 pills with water steeped with a Guide Out Red Formula (導赤散) [the prescription is mentioned in the chapter on Five Viscera] on an empty stomach. Used for dysuria due to heat accumulation in the lower energizer. Kochiae Fructus (地膚子) 1 don, Anemarrhenae Rhizoma (知母), Scutellariae Radix (黃芩), Polyporus (猪苓), Dianthi Herba (瞿麥), Ponciri Fructus Immaturus (枳實), Cimicifugae Rhizoma (升麻), Tetrapanacis Medulla (通草), Malvae Semen (冬葵子), Sargassum (海藻) 7 pun [unit of weight] each. Chop these into 1 package, steep it with water, and take it on an empty stomach. ② When a woman has dysuria with a sunken and fine pulse after sexual intercourse, steep this with a half kidney of a pig and take it.
- Qi Diffusion Powder 宣氣散 선기산: Used for acute pain with difficulty in urination and anuria. Glycyrrhizae Radix (甘草) (small roots) and Akebiae Caulis (木通) 3 don each, Gardeniae Fructus (梔子) 2 don, Malvae Semen (葵子), and Talcum (滑石) 1 don each. Grind these into powder and take it each 2 don with Junci Medulla (燈心)-steeped water.
- Unblock Barriers Pill 通關丸 통관환: Used for dysuria. Phellodendri Cortex (黃柏) and Anemarrhenae Rhizoma (知母) (soaked in wine and stir-baked together), Talcum (滑石) 2 nyang each, Akebiae Caulis (木通) 1 nyang, and Cinnamomi Cortex Spissus (肉桂) 3 don. Grind, make into paste with water, and make it into pills as big as a seed of the royal foxglove tree. Take each 100 pills on an empty stomach.
- Polyporus Decoction 猪苓湯 저령탕: Used for dysuria due to the heat accumulation. Polyporus (豬苓), Akebiae Caulis (木通), Alismatis Rhizoma (澤瀉), Talcum (滑石), Aruantii Fructus Immaturus (枳殼), Phellodendri Cortex (黃柏) (soaked in wine), Achyranthis Radix (牛膝), Liriopis Tuber (麥門冬), Dianthi Herba (瞿麥), Polygoni Avicularis Herba (萹蓄), Plantaginis Semen (車前子) 7 pun each, and Glycyrrhizae Radix (甘草) 3 pun. Chop these into 1 package, add Junci Medulla (燈心) 1 don, steep it with water, and take it on an empty stomach.
- Augmented Five Ingredients Poria Powder 加味五苓散 가미오령산: Used for dysuria owing to deficiency cold. Add Angelica Gigantis Radix (當歸), Aruantii Fructus Immaturus (枳殼), Achyranthis Radix (牛膝), Akebiae Caulis (木通), and Glycyrrhizae Radix (甘草) (small roots) all same amount to Five Ingredients Powder with Poria (五苓散) (all same amounts of the herbal ingredients). Chop these, add 1 handful of Junci Medulla (燈心), steep, and take it on an empty stomach.
- Penetrate Wellspring Powder 透泉散 투천산: Used for hematuria and dysuria. Talcum (滑石) 1 nyang, Natrii Sulfas (芒硝), Glycyrrhizae Radix (甘草) 5 don each, and Succinum (琥珀) 2.5 don. Grind these into powder, take 2 don each with Junci Medulla (燈心)-steeped water on an empty stomach.
07-1 Difficulty in Urination for the Old and the Weak 老虛人癃閉 노인이나 허약한 사람의 융폐
① Dysuria of a senile person is mostly due to shortness of breath or blood deficiency. Take a Nourish Kidneys Pill with water steeped with a Four Substances Decoction and Astragali Radix (黃芪) on an empty stomach.
② In the case of dysuria of senile persons caused by qi deficiency, take a Nourish Kidneys Pill with water steeped with Astragali Radix (黃芪), Ginseng Radix (人參) and a Four Substances Decoction.
③ In the case of dysuria of the senile or weak persons, take powder of Succinum (琥珀) with steeped Ginseng Radix (人參) and Poria Sclerotium Rubra (赤茯苓) on an empty stomach.
07-2 Vomiting Must be Induced for Difficulty in Urination and Anuria 癃閉宜吐 융폐는 토하게 해야 한다
① Dysuria belongs to qi and blood deficiencies. When there is blockage caused by excess heat or phlegm qi, make qi ascend by inducing regurgitation. Use Ginseng Radix (人參), Atractylodis Rhizoma Alba (白朮), and Cimicifugae Rhizoma (升麻) for a qi deficiency, a Four Substances Decoction for a blood deficiency, and a Syzygii Flos Relieve Stomach Decoction for phlegm. After taking them, massage the throat to induce vomiting. Use Eight Ingredient Rectify Powder to relieve excess heat. [The prescription is mentioned later in the chapter].
② Someone had suffered from dysuria and no medicine worked. Danxi said, “This disease is formed by accumulated phlegm in the lungs. The lungs belong to the upper energizer and the bladder belongs to the lower. As the upper energizer is blocked, so is the lower one. When using a medicine dropper, make sure the upper hole is opened to let water fall down through the lower hole.” After taking a Syzygii Flos Relieve Stomach Decoction and vomiting much, the person could be cured.
③ In case of urine blockage by much phlegm, steep a Syzygii Flos Relieve Stomach Decoction with Cyperi Rhizoma (香附子), Aucklandiae Radix (木香) and Akebiae Caulis (木通), take one glass first, then massage the throat with the residue to vomit and lift qi. As qi ascends, water descends. ④ In the case of dysuria caused by heat access, add Pharbitidis Semen (黑丑) powder 1 to 2 don to sugar water, take it, then massage the throat to induce vomiting.
07-3 For Difficulty in Urination and Anuria Diarrhea Must Be Induced 癃閉宜瀉 융폐는 설사를 시켜야 한다
① The reason why Eight Ingredient Rectify Powder is used for difficulty in urination and anuria caused by excess heat is because if feces move, urine moves as well.
② The basic source of dysuria is in the kidneys, so use Pharbitidis Semen (牽牛子) and Alismatis Rhizoma (澤瀉). While the minor source is in the lungs, add Drabae Semen (葶藶子) to Mori Cortex (桑白皮). In addition, helping this with Akebiae Caulis (木通) and Talcum (滑石) may make urination easy. However, feces and urine are in touch with each other through vessels and collaterals, so use Spiritual Protection Formula [The prescription is mentioned in the chapter on Qi] to induce diarrhea, so as to cure dysuria that has lasted for some days.
③ Use Guide Out Water Pill, Triple Transformation Spiritual Blessing Pill [all mentioned in the chapter on Purgation] for difficulty in urination caused by excess heat.
08 Shifted Urinary Bladder Syndrome 轉脬證 전포증
① Symptoms of a shifted urinary bladder are contracture and pain below the umbilicus and dysuria. Holding urine by force, running fast when there is an urgency to urinate, holding urine after fully eating, riding a horse after eating full, or having sexual intercourse while holding urine makes water qi ascend reversely, pushing the bladder to be bent and not stretched. When the bladder falls, one may die.
② Symptoms of a shifted urinary bladder appear with a pregnant woman in large numbers. Holding urine or having sexual intercourse while drunk or full makes the small intestine and large intestine qi ascend reversely. Then, water outside cannot enter the bladder and water inside cannot come out from the bladder. Therefore, there is urgent, frequent and dribbling urination and it would be too painful to express in words. There are also urgent and frequent feces like dysentery, but this is not real dysentery and one may urinate only by pressing under the umbilicus. When it gets worse, abdominal distending and edema happen. The treatment is to use cool medicines to relieve heat in the small intestine and the large intestine and send it down. If one has stirring pain in the stomach and diarrhea afterwards, the bladder sets itself straight and urine eases itself.
③ The shifted urinary bladder during pregnancy occurs primarily on someone born weak, having much anxiety and anguish, being tempered or eating greasy food. In ancient prescriptions, it was less efficacious to use medicines to ease urination. The bladder is pressed to one side by the placenta, so the bladder system is bent and dysuria happens. Lifting the placenta and hanging it at the center may set the bladder system straight and urine may come out by itself. One woman had suffered from a shifted urinary bladder. Both pulses seemed rough but were string-like when pressed deep. It was from anxiety. A rough pulse means less blood and more qi, while a string-like pulse means the presence of fluid. Accordingly, I added Ginseng Radix (人參), Atractylodis Rhizoma Alba (白朮), Pinelliae Tuber (半夏), Citrus Unshius Pericarpium (陳皮), Glycyrrhizae Radix (甘草), and Zingiberis Rhizoma (生薑) to a Four Substances Decoction, steeped it, and made her take it on an empty stomach and stick her fingers down her throat to force the vomiting of the medicinal juice. After a moment, I gave her another package and again on the next day. After I gave her 8 package all together this way, she was at ease. As I was worried if this effect were by chance, I prescribed this to many other patients later and it was efficacious.
④ For a shifted urinary bladder, steep Akebiae Caulis (木通), Plantaginis Semen (車前子) and Talcum and Calcitum Powder for the same amounts each, take it and do yin and yang hot treatment.
⑤ For a shifted urinary bladder, use Bulrush Pollen Powder, Talcum Powder, or a Spring Onion Decoction.
⑥ When a senile person suffers from the shifted urinary bladder in a critical condition and is close to death, use a Six Ingredients Rehmannia Pill [the prescription is mentioned in the chapter on Deficiency Vexation] with Alismatis Rhizoma (澤瀉) twice.
⑦ Use a Ginseng and White Atractylodes Drink (參朮飮) for the shifted urinary bladder of a pregnant woman.
- Talcum and Calcitum Powder 二石散 이석산: Used to treat dysuria that has continued for eight to nine days due to a shifted urinary bladder. Decoct Steep Talcum (滑石), Glauberite (寒水石), and Malvae Semen (冬葵子) 1 don each with 10 glasses of water until 5 glasses remain and take it twice on an empty stomach.
- Bulrush Pollen Powder 蒲黃散 포황산: Used to treat dysuria caused by a shifted urinary bladder. Grind Typhae Pollen (蒲黃) and Talcum (滑石) both the same amounts, steep each 2 don with the white of an egg and take it.
- Talcum Powder 滑石散 활석산: Used to treat dysuria caused by a shifted urinary bladder. Glauberite (寒水石) 2 nyang, Talcum (滑石), Carbonisatus Crinis (亂髮灰), Plantaginis Semen (車前子), and Akebiae Caulis (木通) one nyang each, and Malvae Semen (冬葵子) 1 hop. Chop, steep it with 1 mal of water until 5 doe remains, take it 1 doe three times a day until urination is possible.
- Spring Onion Decoction 葱白湯 총백탕: Used for sudden dysuria, distended lower abdomen, an oppressed and about to faint feeling caused by qi rushing up to the heart. This is because fright, anxiety or sudden anger makes qi press the bladder, and obstruct it; the urinary bladder system will be in the wrong position. Citrus Unshius Pericarpium (陳皮) 3 nyang, Malvae Semen (冬葵子) 1 nyang, and 3 stems of Allii Fistulosi Bulbus (葱白) (葱白). Chop, steep it with 5 doe water until 2 doe remain, and take it three times.
- Ginseng and White Atractylodes Drink 參朮飮 삼출음: ① Used for dysuria of a pregnant woman caused by a shifted urinary bladder. Add Ginseng Radix (人參), Atractylodis Rhizoma Alba (白朮), Pinelliae Tuber (半夏), Citrus Unshius Pericarpium (陳皮), and Glycyrrhizae Radix (甘草) 1 don each to a Four Substances Decoction (四物湯). Chop into 1 package, add 3 pieces of Zingiberis Rhizoma (生薑), and two pieces of Zizyphi Fructus (大棗), steep with water, take it on an empty stomach, and massage the throat to induce vomiting. ② Or chop Malvae Semen (冬葵子), Gardeniae Fructus (梔子) (stir-baked) and Talcum (滑石) 5 don each, and Akebiae Caulis (木通) 3 don into 1 package, steep with water, and take it on an empty stomach. Grind Malvae Semen (冬葵子), Gardeniae Fructus (梔子), and Talcum (滑石) into fine powder, pound with a river snail’s flesh to make an ointment. Or add the juice of Allii Fistulosi Bulbus (葱白) and attach this to the umbilicus to make urine come out soon. ③ Because of the shifted urinary bladder, a nine-month pregnant woman had suffered from blockage of urine, edema of legs, and weight loss. The left pulse was in harmony and the right one was rough. This is surely caused by a qi injury due to overeating. As the weak placenta system could not lift the bladder up and press it down, blockage of urine and dysuria happened. Steeping Ginseng Radix (人參), Atractylodis Rhizoma Alba (白朮), Angelica Gigantis Radix (當歸), Paeoniae Radix (芍藥), Citrus Unshius Pericarpium (陳皮), Pinelliae Tuber (半夏), and Glycyrrhizae Radix (甘草), taking 4 packages, steeping the residuum, taking it once on the next day, and massaging the throat to induce vomiting makes her urinate all black urine pleasantly. ④ One pregnant woman had a fine pulse with weakened qi and the placenta pressing the lower entrance of the bladder by the shifted urinary bladder. I was worried that using medicine to tonify might aggravate contracture and fullness. As I made a midwife apply Sesami Semen (香油) to her hands, put one hand into the vagina and lift the placenta, urine came out like flowing water. ⑤ Making the pregnant woman to stand upside down may set the placenta upright and result in urination. This would be better than pushing with the hands.
