Can’t Urinate? Doctor Zhu Danxi Cured an 80-Year-Old Man’s Blocked Urine with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction)

Patient search words: urinary retention / want to urinate but can’t / elderly person can’t urinate / urine getting less and less / the more diuretics you take, the less urine comes out

Corresponding medical terms: lin bi (urinary retention) · zhong qi xia xian (sinking of the middle qi) · qi xu bu hua (qi deficiency failing to transform fluids)

Opening scene: trying to “open the channel” — and blocking it instead

Today’s story has a title that already sounds suspicious — the patient wanted to “open the channel,” and instead it got completely blocked. We’re talking about urinary retention — the inability to urinate. It sounds rare, but it is actually very common, especially in elderly people: difficult urination, urine that won’t flow freely — it has almost become a routine complaint of old age.

💬 Note from Doctor Luo: Today we continue with Doctor Zhu Danxi’s case records, on the theme of urinary retention and difficult urination. This illness carries great depth in Chinese medicine, and Doctor Zhu Danxi wrote about it in detail — and every single pattern he described, he paired with a case record to explain it. Very classic material.

Doctor Zhu Danxi lays out the causes: qi deficiency, blood deficiency, damp-heat, and phlegm

When Doctor Zhu Danxi discussed urinary retention, he first sorted out the causes: there is the type caused by qi deficiency, the type caused by blood deficiency, the type caused by damp-heat binding and obstructing, and the type caused by phlegm blocking the movement of qi.

💬 Note from Doctor Luo: You see — even though the symptom is the same, “can’t urinate,” the causes are completely different. Deficiency has a deficiency treatment, dampness has a dampness treatment, phlegm has a phlegm treatment. Doctor Zhu Danxi split one disease into several patterns, and used a case record to argue for each one — that is his style of teaching medicine.

The patient arrives: an eighty-year-old man

The patient who came in that day was an elderly man already eighty years old. In ancient times, living to eighty was a genuinely great age. His complaint was scanty, difficult urination — urinating without ease, without smooth flow. This is terribly common among the elderly. The family called in a doctor, and the doctor thought: difficult urination? Easy. He prescribed diuretic herbs — the ancients called them “fen li” (separating and draining) medicines, the kind that drain dampness and promote urination.

And what happened? The medicine overshot and backfired — the water passage became blocked, and the urine stopped coming out completely. In the end, not a single drop.

💬 Note from Doctor Luo: This situation really is common among elderly people. The urine doesn’t flow well, so they take diuretics — and the more they take, the more blocked it gets, until finally complete urinary retention. Where’s the problem? Doctor Zhu Danxi will tell us in a moment.

Insert a catheter? Treating the branch, not the root

What do you do when someone can’t urinate? Modern medicine’s answer is catheterization — insert a catheter and drain the urine out. But there’s a big problem here: the root of the disease is inside the body. Using an external method like catheterization, the urine does come out — but as soon as the catheter is removed, often it won’t come out again. That’s why many elderly people end up living with a catheter permanently.

💬 Note from Doctor Luo: With a catheter in, you have to carry a drainage bag, urine drips out a little at a time, and it has to be changed regularly. Worse, the tube inside easily causes infection — many elderly people end up with red, inflamed urethras. Actually, the ancient Chinese also had catheterization methods — inserting a tube to drain urine, and we’ve used them too. But Doctor Zhu Danxi’s view was that this is treating the exterior; the problem inside the body remains unsolved. The right way is to regulate the interior.

Doctor Zhu Danxi’s diagnosis: the spleen and stomach are injured, and qi is sinking downward

How did Doctor Zhu Danxi analyze this eighty-year-old man’s illness? He said: the spleen and stomach have been injured. In old people, the spleen and stomach are weak to begin with; if they also eat too much, the qi can’t transform and move it, and the spleen and stomach are hurt even more — and once the spleen and stomach are hurt, qi becomes deficient. When qi is deficient, the qi sinks into the lower burner — the qi mechanism drops and gets stuck down below, and the urine can’t come out.

Going deeper: when upright qi is insufficient and the spleen and stomach qi is weak, all the organs lose their ability to hold things up, and everything tends to sag downward. The internal organs droop, pressure in the lower burner increases, and they press and tangle together — think about it: if all the organs are packed down below, can the qi mechanism of the lower burner stay open? So the lower burner becomes even more congested.

💬 Note from Doctor Luo: You must see this clearly: the illness looks like an excess pattern (something is blocked, after all), but in reality it is a major deficiency pattern — middle qi insufficiency, spleen and stomach qi deficiency, sinking of the qi mechanism. If you only see the “blockage,” you’re wrong.

A surprising treatment: Li Dongyuan’s Bu Zhong Yi Qi Tang

Deficiency cannot be attacked; it must be tonified. The formula Doctor Zhu Danxi chose is very interesting — Doctor Li Dongyuan’s Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction), which tonifies qi and lifts it upward.

And the result? After one dose, the urine flowed again.

💬 Note from Doctor Luo: Why is it this effective? The moment qi is lifted, the whole body’s qi movement returns to normal, the pressure in the lower burner is relieved, and the urine naturally flows. The treatment looks unusual, but it is actually the orthodox treatment — the correct treatment aimed straight at the root cause.

A metaphor: the plastic bag at the bottom of the pool

To make this clear, Doctor Luo Dalun offers an analogy: imagine a pool with a drain at the bottom. Normally water flows out smoothly. But suppose a plastic bag full of water sinks to the bottom and covers the drain — the water can’t flow out. At that point, no matter how hard you press down or push, it does no good. What you need to do is lift the plastic bag up — clear the drain, and the water whooshes right out.

💬 Note from Doctor Luo: This is only an analogy; in real life it involves how the body’s qi moves: once you tonify qi, the qi mechanism lifts and runs normally, the distribution of fluids returns to normal, and the water down below naturally flows out. The same logic applies to constipation — some elderly people have qi-deficient constipation: when they strain to pass a stool, they have no strength at all (in Chinese medicine, “nu ze wu li,” ineffective straining). The qi mechanism is sunk and the waste can’t be pushed out. In those cases, using Bu Zhong Yi Qi Tang to tonify qi and lift it makes the bowels move instead — I have seen cases like this myself.

Why can’t you always “open” what looks “blocked”?

There’s another important warning in this case: Doctor Li Dongyuan was extremely cautious about using “fen li” (draining and separating) diuretics. Why? Because diuretic herbs send the qi mechanism downward — and when your qi is already sinking, draining it further downward only makes the urine less and less, until, like this old man, it stops completely.

💬 Note from Doctor Luo: Today’s doctors, when they see urine that won’t flow, pile on fu ling (poria), yi mi (coix seed), zhu ling (polyporus) — everything aimed at diuresis. This is exactly what Doctor Li Dongyuan warned against most. The same mistake is common with constipation: as soon as someone is constipated, out come da huang (rhubarb), hei bai chou (morning glory seeds), mang xiao (mirabilite) to purge — eyes fixed only on the “disease,” thinking one herb matches one complaint. That’s wrong. You should look at the whole body: in someone with insufficient upright qi and sinking middle qi, the blockage below is a deficient blockage. Tonifying the middle, lifting the qi — that is the right road.

Conclusion: what we learn is a way of thinking

What this case most wants to teach us is not the formula “urinary retention → Bu Zhong Yi Qi Tang,” but a way of thinking: sometimes you see a blockage below, a channel that won’t open — and the real problem may be insufficient upright qi, sinking middle qi. When qi sinks, the qi mechanism of the lower burner gets stuck, and the whole lower burner function goes into disorder. At that moment, use Bu Zhong Yi Qi Tang to lift the qi upward, relieve the pressure in the lower burner, and things naturally open up again.

💬 Note from Doctor Luo: Doctor Zhu Danxi taught urinary retention through many different treatments, each explained with a case record — truly wonderful material. Over these days we’ve been discussing exactly this approach of his — looking at the qi mechanism as a whole, rather than treating the head when the head hurts and the foot when the foot hurts.

What to take away

• Not every “blockage” should be cleared. When urine won’t come out (or bowels won’t move), ask whether it is a true excess blockage or a deficiency pattern in disguise. If the person is elderly, weak, and the qi is sinking, aggressive draining makes things worse — as it did for this eighty-year-old, who went from difficult urination to not a single drop.
• Look at the whole qi mechanism. Doctor Zhu Danxi treated this “blocked” urine with a formula that lifts qi — Bu Zhong Yi Qi Tang — because the root was middle qi sinking, not excess. When the qi rises and runs normally, fluids are distributed normally and the urine flows.
• The plastic-bag metaphor: when something is covering the drain at the bottom of the pool, pressing down harder never helps — lift the obstruction up. In the body, tonifying and lifting qi is often the way to unblock the lower burner.
• The same lesson applies to constipation: some elderly people can’t pass stool because qi is too weak to push — “nu ze wu li” (ineffective straining). For them, tonifying and lifting qi with Bu Zhong Yi Qi Tang can open the bowels better than any purgative.

Compiled from Doctor Luo Dalun’s explanations of Doctor Zhu Danxi’s case records. The original case comes from the Dan Xi Xin Fa (Teachings of Danxi), chapter on urinary retention (as told by Doctor Luo Dalun).