Can’t Urinate? Doctor Zhu Danxi’s Five Approaches to Urinary Retention and Scanty Urine
Patient search words: can’t urinate / urinary retention / scanty urine / urine blocked / urine very yellow / urination not smooth
Corresponding medical terms: lin bi (urinary retention) · xiao bian bu li (scanty, difficult urination) · tan ge zhong jiao (phlegm blocking the middle jiao) · damp-heat in the lower jiao · yang deficiency · yin deficiency
Opening scene: this whole chapter is case records
Doctor Luo Dalun says he especially loves the chapter in Doctor Zhu Danxi’s book about urinary retention — the chapter is almost entirely case records, one after another, laying every treatment approach right in front of you.
💬 Note from Doctor Luo: This style of writing is precious. Most medical books explain a disease by discussing principles and listing formulas; Doctor Zhu Danxi is different — he lets the patients speak, and he writes out every kind of situation. So please don’t hear “urinary retention” and think, “I don’t have that problem, this has nothing to do with me” — Chinese medicine rarely works by matching a single disease name. If you simply look up the name and try to fit your own symptoms to it, you’ll be wrong. Chances are we treat many other illnesses with exactly this same way of thinking. What you are learning is the thinking of Chinese medicine — Doctor Zhu Danxi’s understanding and analysis of the human body and of qi movement. I find that extremely valuable.
So let’s follow Doctor Luo Dalun and go through these case records one by one.
A little background: why did Doctor Zhu Danxi study medicine?
Before the cases, Doctor Luo Dalun tells a background story — a word keeps appearing in Doctor Zhu Danxi’s book: spleen pain (pi teng). It turns out that Doctor Zhu Danxi’s own mother once suffered from spleen pain.
💬 Note from Doctor Luo: Doctor Zhu Danxi began studying the Huangdi Neijing (Yellow Emperor’s Inner Canon) in earnest because his mother was in such suffering — and after he studied it, he really did cure her spleen pain. So what exactly is this “spleen pain”? Today we don’t use that term anymore. Some people say it should be arm pain or joint pain, but in fact it was very likely what we now call pain in the spleen and stomach region.
A mother’s illness produced a great physician. And the first case Doctor Zhu Danxi recorded on urinary retention is connected to that very spleen pain.
Case one: first spleen pain, then both urine and stool stopped
There was a woman who first suffered spleen pain, and then a new problem appeared — both urine and stool stopped coming out. The urine wouldn’t pass, and the bowels wouldn’t move either.
💬 Note from Doctor Luo: Doctor Zhu Danxi judged that the problem lay in “phlegm blocking the middle jiao” — phlegm obstructing the middle region, so that the qi mechanism could no longer flow freely up and down. The qi then became congested and sank downward, gathering in the lower jiao, and as a result neither urine nor stool could pass smoothly — the qi movement was simply blocked. So his approach was: transform phlegm. How? With Er Chen Tang — as you know, Er Chen Tang (Two Aged Ingredients Decoction) is the principal formula for transforming phlegm. Inside it are chen pi (tangerine peel), fu ling (poria), and ban xia (pinellia), plus zhi gan cao (honey-fried licorice) — these four herbs transform phlegm extremely well.
Doctor Zhu Danxi used Er Chen Tang to transform phlegm, and added one more herb — mu tong (akebia stem), which guides out damp-heat and promotes urination. But the interesting part comes after: after the medicine was decocted, the patient drank the first extraction — don’t throw away the dregs. Decoct the dregs a second time, drink that too, and then what? Induce vomiting.
Induced vomiting: sending the phlegm out from above
What is “induced vomiting” (tan tu)? It means touching the back of the throat to make the person nauseous and vomit — in the old days doctors swept the throat with a goose feather, or used a finger, and sometimes gently touched it with a chopstick (a chopstick is hard and can easily injure the throat, so soft implements were preferred). The touch makes the person gag, and up comes what was in the stomach.
💬 Note from Doctor Luo: Doctor Zhu Danxi’s method here is very clever: I send in phlegm-transforming herbs to break up the phlegm, and then induce vomiting so the phlegm is expelled from above. But the vomiting isn’t simply to get rid of the phlegm — more importantly, it adjusts the qi mechanism upward. As we discussed yesterday, in diseases where the qi mechanism of the lower jiao is congested, he makes the qi move upward; once the qi moves upward, water and dampness have no choice but to move downward. This is the relationship between sheng qing (lifting the clear) and jiang zhuo (lowering the turbid) — there is real subtlety here. That is why Doctor Zhu Danxi often used the vomiting method for this kind of illness — especially when phlegm is involved: the phlegm-transforming herbs go in, then vomiting is induced, and where does the dissolved phlegm go? It comes out from above.
This case record is very short — Doctor Zhu Danxi simply wrote down the treatment. Of course the patient was cured, otherwise he would not have recorded it as a case.
The second pattern: damp-heat in the lower jiao — Ba Zheng San
So one type of urinary retention is phlegm blocking the middle jiao, with heavy phlegm-dampness obstructing the movement of qi — treated with Er Chen Tang plus induced vomiting. But what if there is heat in the lower jiao? Heat stored in the lower jiao blocks the qi mechanism and stops the urine — what is the orthodox treatment then?
💬 Note from Doctor Luo: This is the most common situation — damp-heat binding in the lower jiao — and the formula is Ba Zheng San (Eight Corrections Powder), which clears out the damp-heat. Doctor Zhu Danxi’s case records have a special quality: he writes out every pattern. It is absolutely not what people imagine — that Doctor Zhu Danxi only nourishes yin and clears heat. Not at all! He wrote out every disease. It is you who carry the prejudice and look only at the yin-nourishing, heat-clearing side of him. Look at this phlegm case: there is no yin-nourishing or heat-clearing at all — he simply transforms phlegm. And when there is a genuine heat pattern, damp-heat binding in the lower jiao, Doctor Zhu Danxi uses Ba Zheng San to clear it outward. Even today we use it the same way. You cannot say, “Oh, I won’t use bitter-cold herbs — you have damp-heat binding in the lower jiao, but I’m afraid of injuring yang.” If you refuse all bitter-cold herbs, refuse Ba Zheng San, then the disease can only get worse and worse. So Doctor Zhu Danxi set out every syndrome clearly and completely.
The third pattern: yang deficiency — fennel applied to the lower belly
And sometimes there really is yang deficiency. Doctor Zhu Danxi wrote: after a cold-damage illness, “tuo yang” (yang collapsing) — urinary retention. Some people have had their yang qi injured; yang is deficient, the urine won’t pass — what to do?
💬 Note from Doctor Luo: Use hui xiang (fennel) mixed with fresh ginger juice — squeeze the ginger into juice and mix it with fennel, then apply it to the lower belly. This warms the yang. At the same time take internally Hui Xiang Wan (Fennel Pill) or a similar warming patent medicine — also warming the yang — and then guide the dampness outward. Do you see? When Doctor Zhu Danxi met someone with yang deficiency, he warmed the yang — he wrote it down perfectly clearly.
The fourth pattern: yin deficiency — nourishing blood is nourishing yin
The next case record: what was wrong with this patient? Yin deficiency — a man whose dry heat had injured the lower jiao, causing scanty urination. Dry heat injured what? It injured the yin, so the yin had to be nourished.
💬 Note from Doctor Luo: Which herbs were used? Dang gui (angelica), di huang (rehmannia), zhi mu (anemarrhena), huang bai (phellodendron), niu xi (achyranthes), fu ling (poria), sheng gan cao (raw licorice), bai zhu (atractylodes), and chen pi (tangerine peel) — herbs to nourish yin and nourish blood. Here you must understand something important: in Doctor Zhu Danxi’s language, nourishing blood is also nourishing yin. So sometimes when he says “yin deficiency,” he is actually talking about blood deficiency — yin and blood were always considered together. When he speaks of nourishing yin, nourishing the blood is usually included in it.
This kind of urinary difficulty is actually a case where the body’s fluids truly are insufficient — yin and blood are deficient, so the urine is very scanty, and very yellow.
💬 Note from Doctor Luo: This is just like the situation we described in summer: sometimes when summer heat is fierce and a person suddenly sweats a great deal, the fluids are badly damaged — especially in someone whose yin blood is already deficient. What happens to the urine then? It turns yellow and very scanty. Why? Because the yin blood inside the body is insufficient. At that point the person easily catches an external contraction — and once they catch one, the throat hurts; this is what we call a warm disease. How to regulate it? Use San Dou Wu Mei Bai Tang (Three Beans, Black Plum and Sugar Decoction) — mainly the black plum and white sugar, sour-sweet to engender yin, nourishing the yin. It is the same principle. So when Doctor Zhu Danxi treated this disease — with dang gui, di huang, zhi mu, huang bai, and so on — he was nourishing the blood and the yin while clearing heat. This is how scanty urination from yin-blood deficiency is treated.
Doctor Luo Dalun adds an important distinction: everything discussed above concerned “urinary retention” (the urine is completely blocked), whereas the yin-blood deficiency type generally does not stop completely — it is what we call xiao bian bu li, scanty and difficult urination — very little urine, short and yellow, never quite satisfying. This kind is regulated with yin-nourishing methods.
Case five: a fifty-year-old woman who got worse the more she was treated
The earlier cases represent treatments we can generally think of ourselves — if there is phlegm, transform the phlegm (only Doctor Zhu Danxi expelled it upward by vomiting while adjusting the qi mechanism); yin deficiency, nourish yin; yang deficiency, warm yang; damp-heat in the lower jiao, clear and drain it — students of Chinese medicine can usually learn these. But the next case will make you stop and think.
There was a woman, fifty years old, suffering from scanty, difficult urination — urine coming out drop by drop, very little, with great effort. She consulted a doctor, who assumed it was damp-heat and prescribed Ba Zheng San (Eight Corrections Powder). And what happened?
💬 Note from Doctor Luo: Her lower abdomen became acutely distended and painful — a pressing, aching, swollen feeling in the belly — and the urine completely stopped, entirely gone. On top of that, her body felt like it was pierced by needles (shen ru mang ci) — a problem appeared on the body surface, prickling pain all over, as if stabbed by thorns. The disease was not cured; it grew worse: what had been merely scanty was now completely blocked, and the skin was prickling everywhere. What was going on?
At that point she came to Doctor Zhu Danxi. He made a judgment and said something no one expected — “it has been raining every day.”
Read the weather first: continuous rain, dampness everywhere
What was Doctor Zhu Danxi’s basis for judgment? The weather.
💬 Note from Doctor Luo: Rain day after day, unbroken rain — the dampness was extremely heavy. This woman had contracted a dampness pathogen. The dampness was at the body surface, in the upper part of the body. What to do about that? You must induce sweating to treat it. So Doctor Zhu Danxi used cang zhu (atractylodes lancea) — which dries dampness — and fu zi (aconite) — which warms yang, here in order to promote sweating. The overall strategy was to open the exterior and bring on sweat. And the result? One dose brought sweating — the moment she drank the medicine she began to sweat, and as soon as the sweat came out, her urine flowed again immediately.
Doctor Zhu Danxi looked first at the surrounding weather, and only then judged what disease the person had — this is what a genuinely good Chinese doctor does. When he treats you, he considers the climate conditions at the time you fell ill; only then can he figure out what the illness is connected to.
💬 Note from Doctor Luo: You see how he looked at the days of continuous rain and judged that the woman was chilled by dampness. What to do? Warm the yang, induce sweating, and release the exterior. This is what we call kai cou li — opening the interstices. We call the skin the cou li (interstices); once you open the interstices and drain off the dampness, the qi mechanism immediately flows freely; and once the qi mechanism flows, the water below comes out too. This is a remarkably clever treatment.
Ti hu jie gai: why treat a lower-body disease from above?
This treatment is so ingenious that it resembles something Doctor Luo Dalun has discussed before — the “lift the pot, open the lid” method (ti hu jie gai).
💬 Note from Doctor Luo: The ancients observed things carefully: a teapot has a small hole in the lid. If you press the hole shut with your finger and try to pour water in, and the pot is airtight, the water will not come out of the spout. Open the hole in the lid, and the water below gushes right out — that is “lifting the pot to open the lid.” Through this perception of everyday objects, the ancients realized that people work the same way: if the lung qi of the upper jiao is closed and congested, and the qi mechanism cannot flow freely, then the water passages of the lower jiao cannot regulate either — because water is managed jointly by the lung, the spleen, and the kidney. The lung is the upper source of water. If the upper jiao is closed, the qi mechanism cannot circulate, and the water below cannot move or distribute properly. So if you open the lung qi above, the urine below often flows. When the ancients treated urinary difficulty, they had this ti hu jie gai method: open the lung qi above, gently regulate the upper body, and once the qi mechanism is unobstructed, the water passage below is unobstructed too.
This method has been used widely in later generations. Doctor Luo Dalun told a story from his own experience — about Doctor Zhao Shaoqin of Beijing University of Chinese Medicine, a founding elder of the school.
💬 Note from Doctor Luo: In fact, it was because of Doctor Zhao that I entered the doctoral program at Beijing University of Chinese Medicine — I admired him enormously and longed to study under his influence. Here is a story about him: an old comrade’s daughter-in-law had given birth in America, and after childbirth she developed urinary retention — she could not urinate. The Americans had no solution, so they turned to Doctor Zhao. Doctor Zhao said: “Here’s what you do — in America you can buy zi su ye (perilla leaf), right? Pair it with pi pa ye (loquat leaf) — both are herbs that open the lung qi. Buy some, decoct them in water, and drink it.” She drank it — and it opened! The urine flowed, smoothly and freely. This is the ti hu jie gai method. I remember this story very clearly. Later, when my own sister gave birth, she also had urinary retention — her belly was hugely distended, the ultrasound showed a great deal of fluid, and the urine would not come out. My mother called me and asked what to do. I said, use ti hu jie gai — also su ye and pi pa ye, decoct them in water, and drink. Her urine came right out, and the flow was unobstructed.
Conclusion: the body is a whole
Combining all of Doctor Zhu Danxi’s case records, what can we take away?
💬 Note from Doctor Luo: The human body is a whole. Qi moves through it, and fluids are constantly being metabolized. Sometimes you see a disease below, but it can be resolved by regulating from above; sometimes you see a disease on the inside, but releasing the exterior solves the problem. If something destroys this wholeness, illness may result. Chinese medicine tends to adjust the whole — freeing the movement of qi up and down, letting each organ recover its own function — and then the local problem often resolves itself. This last case is an unusual one, different from the conventional treatments; it belongs to the higher-level art of Chinese medicine. When such a patient arrives, an ordinary physician of average skill may well be unable to solve it. A true master — someone who genuinely commands the theory — will intuit the underlying principle and work out an approach that looks strange to others. Strange as it looks, it is perfectly reasonable. Doctor Zhu Danxi said “release the exterior,” but there is warming of yang in it too — he used fu zi to warm the yang and change the state of failed qi transformation; at the same time he opened the body surface, and with the yang warmed, cold could be dispersed and fluid metabolism returned to normal. This case is worth studying carefully.
These cases all look like treatments for urinary retention and scanty urination — but what we are really grasping is the treatment principle that the body is a whole: regulate the qi mechanism, free the water passages. Doctor Luo Dalun says that after going through these case records, we should have a real sense of how qi moves and transforms in the body, and how fluids are distributed.
Based on Doctor Luo Dalun’s commentary on Doctor Zhu Danxi’s case records, from Dan Xi Xin Fa · Xiao Bian Bu Tong (The Essential Methods of Dan Xi, “Urinary Retention” chapter).