Nine Months Pregnant and Suddenly Can’t Urinate?
Patient search terms: pregnant woman can’t urinate / pregnancy urinary retention / urine blocked during pregnancy / swollen feet in pregnancy / pressure in the lower abdomen
Medical terms: zhuan pao (transferred bladder) · pregnancy urinary retention · sinking of middle qi
The opening scene: a woman nine months pregnant, three days without a single drop of urine
The doctor in today’s case is Doctor Zhu Danxi of the Yuan dynasty — one of the Four Great Masters of the Jin–Yuan period. And the disease he faced was a very unusual one: zhuan pao (转胞), the “transferred bladder.”
💬 Note from Doctor Luo: What is zhuan pao? Pao is the same word used for the uterus — the “palace of the child.” Zhuan pao is what happens when a pregnant woman suddenly cannot pass urine, and the urine pools inside her body with no way out. In Chinese medicine this condition is called zhuan pao. The name sounds strange, but it is simply urinary retention in pregnancy — and today, it is the kind of thing that would send a woman straight to the hospital.
Who was the patient? Pregnant at forty — advanced maternal age even back then
The patient was forty years old and pregnant. At forty, a pregnancy is considered “advanced maternal age” even today, needing extra care. In ancient times, it was all the more so.
💬 Note from Doctor Luo: There was no contraception in the old days, so it was common for a woman to bear seven or eight children in a lifetime. But when a pregnancy comes at an older age, the body struggles to cope and problems appear. This woman had reached nine months — about to give birth — and that is exactly when zhuan pao struck.
The symptoms: three days without urinating, and her legs had swollen up
Doctor Zhu Danxi recorded: “xiao bian bu chu san ri” — she had not passed urine for three full days. Even more alarming, her lower limbs suddenly swelled — her legs and feet blew up.
💬 Note from Doctor Luo: Imagine it: three days without passing urine. Her belly was distended, her legs were swollen, and she was nearly at the end of her strength. Everyone around her feared for her life. This was a genuinely critical situation, which is why Doctor Zhu Danxi was called in urgently.
The pulse: choppy on the right, slightly calmer on the left — the right is qi, the left is blood
When Doctor Zhu Danxi took her pulse, the record says “qi mai cui” — the pulse was weak and frail. To be precise: right choppy, left slightly more settled — the right-side pulse was choppy and rough, while the left was a little more even.
💬 Note from Doctor Luo: Here is a basic principle of Chinese medicine: the two sides of the body have a division of labor. The right side represents qi; the left side represents blood. The Huangdi Neijing (Yellow Emperor’s Inner Canon) says “the left and the right are the roads of yin and yang.” When the right-side pulse is weak and choppy, it usually means qi is insufficient and not flowing smoothly.
The cause: it wasn’t a blocked urinary tract — the fetus was crushing the bladder
So where did the qi go wrong? Doctor Zhu Danxi hit the nail on the head with one sentence: “gai you bao shi er qi shang” — the injury came from eating well and injuring the qi.
💬 Note from Doctor Luo: This woman ate richly and well — and that very abundance injured her spleen and stomach. When the spleen and stomach are injured, qi becomes deficient. With sufficient qi, the internal organs are held firmly in place; with deficient qi, there is no strength to lift them, so the organs sag downward — in Chinese medicine, this is called qi sinking (qi xian). This woman was nine months pregnant with a heavy baby, and on top of that, the cord suspending the fetus was weak and could not hold it up (tai xi ruo, bu neng zi ju). With nothing to support it, the fetus sank, and it pressed the bladder to one side, blocking the opening of the urethra. That is why the urine could not come out. Doctor Zhu Danxi said “zhuan pao zhi bing da di ru ci” — this is generally how zhuan pao happens — and his understanding of the human body was remarkably close to what is actually going on.
Different from the ancients: everyone drained downward; Doctor Zhu Danxi lifted upward
Before Doctor Zhu Danxi, physicians of the Tang and Song dynasties and earlier all treated this disease the same way: can’t urinate? Then drain! They used bland, moistening, diuretic herbs to push everything downward and outward.
💬 Note from Doctor Luo: But Doctor Zhu Danxi found that this approach did not work well. He reasoned: if the problem is qi deficiency and the fetus pressing down on the bladder, what good does plain diuresis do? So he proposed a completely new idea: nourish the blood and support the qi, and in doing so straighten the fetal position (bu xue yang qi, ji zheng tai xi) — build the qi up so that the fetus holds itself up and stops sinking. Only then could the disease resolve. This line of thinking was completely different from everything that had come before.
Breaking down the prescription: ginseng and angelica as the foundation, nourishing qi and blood at the same time
The formula Doctor Zhu Danxi wrote was built around tonifying qi and blood: ren shen (ginseng) to build qi, dang gui shen (angelica root body) and dang gui wei (angelica root tail) to nourish blood, together with bai shao (white peony), bai zhu (atractylodes), chen pi (tangerine peel, used with its white pith), zhi gan cao (honey-fried licorice), ban xia (pinellia) and sheng jiang (fresh ginger) — regulating qi, draining dampness, resolving phlegm and harmonizing the middle, clearing the path as they go.
💬 Note from Doctor Luo: There is real subtlety here. Angelica root is divided into head, body and tail: dang gui tou (the head) tonifies blood and also stops bleeding; dang gui shen (the body) tonifies blood; dang gui wei (the tail) moves blood and has a mildly breaking action. Ordinarily we use the whole root, which balances tonifying and moving. But Doctor Zhu Danxi deliberately used only the body and the tail, leaving out the head — nourishing the blood while adding just a touch of moving and unblocking. Giving a moving blood herb to a pregnant woman takes real experience and courage; a doctor who is not sure of himself would never dare. Then there is bai shao (white peony): it gathers and softens the liver, and it has a special talent called huan ji — “easing urgency.” When qi and blood are insufficient and local cramping or spasm appears, white peony helps things relax and stretch out. The famous Shao Yao Gan Cao Tang (Peony and Licorice Decoction) is exactly this idea — replenishing fluids and resolving spasm. Adding white peony here was about releasing the local tension and letting the body loosen up.
The signature move: four packages decocted together — drink it, then bring it back up
The way this formula was taken is what makes it truly distinctive. Doctor Zhu Danxi had four packages of the formula decocted together into one concentrated soup, and the patient drank it. Then, at dawn the next day, he said: don’t throw away the dregs of those four packages. Boil them again, make one more serving, and have the patient “qiang ling dun yin” — gulp the whole thing down in one go.
💬 Note from Doctor Luo: Once the medicine was in her stomach and she was full and bloated, Doctor Zhu Danxi had someone tickle her throat to make her vomit it all back up — using a goose feather or something similar. What was this about? The four packages the night before were to support the upright qi. The re-decocted dregs in the morning, drunk and then vomited out, were meant to open up the qi mechanism of the upper and middle burners. Chinese medicine has a famous image for this: ti hu jie gai — lift the pot by the lid. If the lid of a teapot is sealed tight, no water pours from the spout; crack the lid open a sliver and the water flows out in a stream. Once the qi mechanism moves freely and the upper passage is open, the lower passage opens by itself. First build the qi, then open the upper orifice — that was Doctor Zhu Danxi’s method.
The turnaround: urine flowed freely — and out came black water
After she vomited, her urine suddenly flowed freely — a great release! But what came out was black water.
💬 Note from Doctor Luo: Why black? It means there had been bleeding inside. Blood that has pooled for a long time turns black, and it was passing out with the urine. You can see this really was a dangerous situation. Once the urine was flowing, Doctor Zhu Danxi built on the original formula, adding da fu pi (areca peel) — at this point beginning to drain water through urination — plus qing cong (green onion leaves) to warm yang and open the orifices, and suo sha ren (amomum fruit) to move the qi and settle the medicine’s action downward. He gave two more packages of this to guard against deficiency before and after childbirth — the baby was almost due, so he prepared the body’s foundation first.
The ending: a smooth delivery, mother and child strong
How did it turn out? Perfectly safe. The woman gave birth with remarkable ease, and afterward she was strong and healthy — mother and child both well.
💬 Note from Doctor Luo: This case matters because of where it stands in history. Before Doctor Zhu Danxi, in the early development of Chinese medicine, this disease was always treated by draining the urine outward. Doctor Zhu Danxi was the first to propose building qi and lifting upward — once the fetal position is corrected, the lower burner opens on its own. Later generations largely followed his approach. And he was wonderfully modest: in the original text he wrote “wei zhi guo ru he” — his own few cases had all worked, but whether the method suits everyone, and whether other patterns exist, he said, remains to be seen. He did not claim to have the final word; he had a genuine spirit of inquiry. That is a rare and precious quality in a physician.
A bonus lesson: when the lower passage is blocked, don’t rush to drain it
The most valuable thing in this case is that Doctor Zhu Danxi stated the principle clearly: a problem in the lower burner is not necessarily a blockage in the lower burner — very often the qi above simply cannot lift.
💬 Note from Doctor Luo: I see examples like this all the time. I have treated patients with chronic lower-abdominal pain and a heavy, pressing feeling — and they were overweight. Plump people are often qi deficient: the qi cannot hold things up, everything sags, the pressure in the lower burner builds up, and “when there is no flow, there is pain.” For these patients, using the path of Sheng Xian Tang (Lift the Sunken Qi Decoction) or Bu Zhong Yi Qi Tang — lifting the qi upward — holds the organs in place, eases the pressure in the lower belly, and the pain disappears. And think of elderly people with urinary difficulty: everyone immediately blames the prostate, and piles on strong draining herbs, blood-moving stasis-breakers, ze xie, yi yi ren, zhu ling. If there really is damp-heat, fine. But many elderly people have qi deficiency with sinking — the internal organs sag and press on the lower burner. The more you use draining medicines on them, the more deficient the upright qi becomes and the worse it gets. Lift the qi instead, let the organs return to their proper positions, and the urine flows on its own.
Closing thoughts
When qi deficiency goes far enough, it can also cause stomach prolapse, uterine prolapse and rectal prolapse — all of them sinking of middle qi (zhong qi xia xian), the internal organs sagging downward. With gynecological problems and bowel problems alike, always keep in mind that “insufficient middle qi with sinking of the qi mechanism” is one possible pattern.
💬 Note from Doctor Luo: Chinese medicine does not anchor itself to disease names; it anchors itself to mechanisms. Doctor Zhu Danxi treated ordinary urinary retention and zhuan pao with the very same idea. Meet a similar mechanism in some other area of medicine, and you can apply the same method of regulation. Remember: when the lower passage is blocked, first ask whether the answer is to lift upward — that is the wisdom Doctor Zhu Danxi left us.
Compiled from Doctor Luo Dalun’s commentary on Doctor Zhu Danxi’s case records.