Urinary retention

　　1, Damp-heat accumulation due to overeating of spicy, greasy, and rich foods, generating dampness and heat, damp-heat not resolved, flowing downwards to the bladder, or inherent damp-heat in the kidney flowing downwards to the bladder, or uncleanness in the lower genital area, invasion of damp-heat, damp-heat obstruction in the bladder, Qi transformation not smooth, urine not passing, or extremely small urine volume, leading to urinary retention.

　　2, Heat and dampness accumulation due to overeating of spicy, greasy, and rich foods, generating dampness and heat, the heat and dampness not resolved, flowing downwards to the bladder, or inherent heat in the kidney flowing downwards to the bladder, or uncleanness in the lower genital area, invasion of heat and dampness, obstruction of bladder heat and dampness, Qi transformation not smooth, urine not passing, or extremely small urine volume, leading to urinary retention.

　　3, Spleen Qi not rising due to overwork, injury to the spleen, irregular diet, or prolonged illness, leading to spleen deficiency and the inability of Qi to rise, then turbidity is difficult to descend, and urine is blocked, leading to urinary retention. As said in 'Ling Shu: Questions on the Oral Canon': 'Insufficiency of middle Qi leads to changes in urination.'

　　4, Deficiency of kidney essence due to aging, physical weakness, or prolonged illness, kidney Yang deficiency, gate of life fire衰, Qi fails to transform water, thus 'without Yang, Yin cannot transform', leading to the inability to urinate; or due to the heat in the lower Jiao, not healing for a long time, consuming body fluids, leading to kidney Yin deficiency, depletion of the water palace, and the formation of urinary retention.

　　5, Liver depression and Qi stagnation due to emotional injury, causing liver Qi stagnation, insufficient release, thus affecting the circulation and Qi transformation of body fluids in the Sanjiao, leading to obstruction of waterway coordination and the formation of urinary retention. Moreover, the meridian of the liver circulates around the genitals and reaches the lower abdomen, which is also a reason why liver disease can lead to urinary retention. Therefore, 'Ling Shu: Treatise on the Channels' proposes: 'The foot Jueyin meridian of the liver, …… is the channel that governs the diseases of the liver, ……enuresis, urinary retention.'

　　6, Urinary tract obstruction due to blood stasis and败精, or mass and calculi blocking the urethra, making it difficult to urinate, thus forming urinary retention. As said in 'Jingyue Quanshu: Urinary Retention': 'Or due to败精, or with dry blood, blocking the waterway and not flowing.'

　　The 'Su Wen: Treatise on Miraculous Efficacy of the Spiritual Canon' says: 'The bladder is the official of the state, where body fluids are stored, and when transformed, they can be excreted.' The smooth flow of urine depends on the Qi transformation of the bladder, so the location of this disease is in the bladder. The 'Su Wen: Treatise on the Differentiation of Channels' also says: 'When liquid food enters the stomach, it spreads its essence and Qi, which is then transported to the spleen. The spleen disseminates the essence, which rises to return to the lung, coordinates the waterways, and transports the water downwards to the bladder. The essence spreads in all directions, and the five meridians function concurrently.'

　　The absorption, circulation, and excretion of body fluids also depend on the transformation of the Sanjiao, and the coordination, transformation, and evaporation of the lungs, spleen, and kidneys. Therefore, the location of urinary retention is closely related to the Sanjiao, lungs, spleen, and kidneys. When the Qi of the upper Jiao does not transform, it should be attributed to the lung. If the lung fails in its function, it cannot coordinate the waterways and transport the water downwards to the bladder. When the Qi of the middle Jiao does not transform, it should be attributed to the spleen. If the spleen Qi is deficient, it cannot rise to clear and descend turbidity. When the Qi of the lower Jiao does not transform, it should be attributed to the kidney. Deficiency of kidney Yang, failure of Qi to transform water, deficiency of kidney Yin, depletion of the water palace, can all lead to urinary retention. Liver depression and Qi stagnation can also lead to urinary retention as the Qi transformation of the Sanjiao is not smooth. In addition, urinary tract obstruction caused by various reasons can also lead to urinary retention. The basic pathogenesis can be summarized as the malcoordination of Sanjiao Qi transformation or urinary tract obstruction, leading to the failure of kidney and bladder Qi transformation.

　　1, Characterized by difficulty in urination, a significant decrease in total urine output throughout the day, dripping out, or urine retention, with no dripping at all.

　　2, Common in elderly males, postpartum women, or patients after surgery. They often have a history of stranguria and edema disease.

　　3. If there is a feeling of fullness in the lower abdomen, the desire to urinate cannot be satisfied, and the bladder area in the lower abdomen is obviously distended when palpated and percussed, it is urinary retention. If the total daily urine volume is significantly reduced or not passed, without the desire to urinate, without the feeling of fullness in the lower abdomen, and there is no obvious distension sign in the bladder area when palpated and percussed, it is more likely to be kidney failure.

　　4. Appropriate selection of digital rectal examination, ultrasound, abdominal X-ray film, cystoscopy, renal function examination, to clarify whether the urinary retention is caused by kidney, bladder, urethra, or prostate disease.

　　The main clinical manifestations of this disease are difficulty in urination, a significant decrease in total daily urine output, even complete blockage of urine with no droplets at all. The onset may be sudden or gradual. Generally, in the stage of urinary retention, the manifestation is difficulty in urination, dribbling, weak urination, narrowing of the urine stream, or sudden interruption of the urine stream, with a significant decrease in total daily urine output; in the stage of closure, the manifestation is urinary retention, with very little total daily urine output, or even no droplets at all, or the desire to urinate cannot be satisfied, with a full and bloated lower abdomen, resembling a bowl. Urinary retention can occur suddenly or develop gradually from urinary retention. In severe cases, symptoms such as dizziness, chest tightness and shortness of breath, nausea and vomiting, foul breath, edema, and even irritability, confusion, may occur. There is no pain sensation in the urethra.

　　Exercise the body, enhance resistance, maintain a pleasant mood, and avoid worry, anger, and frustration; eliminate factors related to external pathogenic invasion and endogenous damp-heat, such as holding urine, pressing the perineal area, unclean vulva, overeating of rich, sweet, spicy foods, excessive alcohol consumption, desire for cold, overindulgence in desire and overwork; actively treat diseases such as stranguria, edema, urinary tract and surrounding tumors, which are of great significance for the prevention and treatment of urinary retention.

　　Urinary retention is a type of disease characterized by difficulty in urination, a significant decrease in total daily urine output, dripping out, and even complete blockage of urine, with no droplets at all as clinical features. The diagnosis of urinary retention should determine whether it is hydroureter or urinary retention. If it is hydroureter, then the daily urine output should be accurately measured. This disease needs to be differentiated from stranguria, Guige syndrome. The location of urinary retention is in the bladder, but it is closely related to the kidney, spleen, lung, and Sanjiao. Its main pathological mechanism is the failure of lung Qi in the upper焦 to transform, leading to the failure of the lung to regulate the waterway and the downward transfer to the bladder; the failure of spleen Qi in the middle焦 to transform, leading to deficiency of the spleen and inability to raise the clear and lower the turbid; the failure of kidney Qi in the lower焦 to transform, leading to kidney Yang deficiency, failure of Qi to transform into water, or kidney Yin deficiency, depletion of the water palace; liver Qi stagnation, causing the Qi transformation of Sanjiao to be不利; urinary tract obstruction, urinary retention. The differentiation of symptoms for urinary retention focuses on differentiation of deficiency and excess, and its treatment should be based on the principle of 'the six bowels are used for their function of being open', focusing on opening. However, the method of opening varies according to the excess or deficiency of the syndrome. Excess syndrome is treated with clearing damp-heat, dissipating blood stasis, promoting Qi movement, and opening the waterway; deficiency syndrome is treated with tonifying the spleen and kidney, assisting Qi transformation, so that Qi transformation can occur, and urination will naturally occur. At the same time, according to the etiology and pathogenesis, and the different locations of the disease in the lung, spleen, and kidney, differentiation and treatment should be performed, and it should not be used recklessly. When internal medication is slow to relieve urgency, it should be combined with catheterization or acupuncture to urgently open the urine.

　　1. History of urinary retention

　　Inquire about the history of severe pain in the lower abdomen and perineal area, to understand the presence or absence of calculi; inquire about the speed of onset and course of disease of urinary retention, prostatic diseases have a slow onset and long course, while bleeding from the posterior urethra and abscesses have a rapid onset and short course.

　　2, Examination

　　Digital rectal examination can determine the size, texture, smoothness, tenderness, and tumor of the prostate.

　　3, Laboratory examination

　　Routine examination of prostatic fluid is important for diagnosing prostatitis.

　　4, Instrument examination

　　Cystoscopy is helpful for diagnosing narrowing, stones, and tumors at the neck of the bladder.

　　1, Dangshen and Huangqi Dongguazao Soup

　　Dangshen (Codonopsis pilosula) 15 grams, raw Huangqi (Astragalus membranaceus) 20 grams, Dongguazao (Benincasa hispida) 50 grams. First place Dangshen and Huangqi in a pot, add water and boil for 15 minutes, remove the dregs and keep the juice, then add Dongguazao and cook until soft, add seasonings (monosodium glutamate, sesame oil, salt) and it is ready, it can be eaten with meals. It has the effect of invigorating the spleen and Qi, and promoting Yang and diuresis.

　　2, Cinnamon and Herba Cheqiancao Porridge

　　Cinnamon 3 grams, Cheqiancao 30 grams, Jiangmi (Glutinous Rice) 50 grams. First decoct cinnamon and Cheqiancao, remove the dregs and take the juice, then add Jiangmi and cook until done, take it on an empty stomach. It has the effect of warming Yang and promoting diuresis.

　　3, Almond Pear Shiwai Drink

　　Bitter almonds 10 grams, Shiwai (Herba Pteris multifida Poir.) 12 grams, Cheqiancao (Herba Plantaginis) 15 grams, a large pear. Grind the almonds, cut the pear into pieces after removing the core, and cook with Shiwai and Cheqiancao with water. After boiling, take the juice to drink as tea. It has the effect of nourishing yin and promoting diuresis.

　　4, Diuretic Cucumber Soup

　　Cucumber 1 root, Shechuang (Herba Saginae Spp.) and Qumai (Equisetum hyemale L.) each 10 grams. First decoct Shechuang and Qumai, remove the dregs and take the juice, then boil it again and add cucumber slices, then add seasonings (monosodium glutamate, salt, sesame oil), and eat it when warm. It has the effect of clearing heat and promoting diuresis.

　　The treatment of enuresis should be based on the principle of 'the six bowels should be used for their function', focusing on opening up, that is, promoting urination. However, the method of opening up can be direct or indirect, depending on the虚实 of the symptoms. For实证, treatment should be for clearing damp-heat, dissipating blood stasis, promoting Qi movement, and opening up the waterway; for 虚证, treatment should be for strengthening the spleen and kidneys, assisting Qi transformation, so that Qi transformation can be carried out, and urination will naturally occur. At the same time, according to the etiology and pathogenesis, the differentiation and treatment should be carried out according to the condition of the lung, spleen, and kidney, and it is not allowed to滥用 diuretics. In addition, according to the theory of 'if the upper orifice is opened, the lower orifice will naturally open', the method of opening the lung Qi to open the upper and lower parts, known as the method of 'lifting the pot and removing the cover', can be used for treatment.

　　If there is an urgent need for urination and the internal medicine is not effective, it should be accompanied by catheterization or acupuncture to quickly relieve the difficulty in urination.