Li Dongyuan's Zishen Tongguan Wan for Urinary Retention
In Lan Shi Mi Cang (Secrets from the Orchid Chamber), there is an empirical formula of Li Dongyuan for treating urinary retention called Zishen Tongguan Wan (Kidney-Nourishing Passage-Restoring Pill). It is composed of Huangbai (Phellodendri Cortex, peeled) 1 liang (30g), Zhimu (Anemarrhenae Rhizoma, washed in wine and dried) 1 liang (30g), and Rougui (Cinnamomi Cortex) 5 fen (1.5g). Preparation: grind the three herbs into a fine powder, bind with water into pills the size of a parasol tree seed. Take 100 pills each time, on an empty stomach, washed down with rice soup.This formula treats longbi (urinary retention or difficult, dribbling urination) due to insufficiency of kidney yin combined with decline of kidney yang. Longbi means obstruction of urine or difficult, dripping urination. This pattern is commonly seen in prostatic diseases of elderly men, including prostatic hyperplasia and prostate cancer. It is usually caused by kidney yin deficiency with damp-heat pouring downward.Treatment therefore uses the bitter-cold Huangbai to drain damp-heat from the lower burner, and Zhimu to nourish yin and downbear fire. Both herbs, however, are excessively bitter and cold, so a small amount of Rougui is used as a counter-assistant (fanzuo) to moderate their bitter-cold nature. Moreover, Rougui itself promotes urination; it appears in Zhang Zhongjing's famous diuretic formula Wuling San (Five-Ingredient Powder).Li Dongyuan used this formula to treat a patient named Wang Shanfu, who could not urinate. His abdomen was swollen and hard as a stone, his legs were so distended that they split and oozed fluid, and his life was in danger. With so simple a formula as Zishen Tongguan Wan, Li Dongyuan brought the patient back from the brink of death.The patient Li Dongyuan treated may have had urinary retention caused by prostatic hyperplasia, or possibly by prostate cancer. Li Dongyuan lived in the Jin-Yuan period; limited by the conditions of his time, he could not truly determine the cause of the disease and could only treat the patient symptomatically based on clinical manifestations.Using Zhimu and Huangbai to treat this condition does have remarkable effects. Not long ago I advised a prostate cancer patient presenting with hot sensations in the hands and feet, night sweats, and depression to take the patent medicine Zhibai Dihuang Wan (Anemarrhena-Phellodendron Rehmannia Pill). After taking it, most of the patient's clinical symptoms disappeared, and his energy and spirit recovered markedly.That Zhibai Dihuang Wan should have this effect in prostate cancer was also somewhat beyond my expectation. Zhibai Dihuang Wan is very cheap; compared with expensive targeted drugs, its price is almost negligible.Zhibai Dihuang Wan is composed of Zhimu, Huangbai, Shudihuang (Rehmanniae Radix Praeparata), Shanzhuyu (Corni Fructus, processed), Mudanpi (Moutan Cortex), Shanyao (Dioscoreae Rhizoma), Fuling (Poria), and Zexie (Alismatis Rhizoma). It has the action of nourishing yin and downbearing fire, and is mainly used for tidal fever and night sweats, dry mouth and sore throat, tinnitus and seminal emission, and scanty dark urine due to yin deficiency with effulgent fire. Zhibai Dihuang Wan is also dominated by Zhimu and Huangbai.Compared with Zhibai Dihuang Wan, Li Dongyuan's Zishen Tongguan Wan has a simpler composition and acts more directly. Unfortunately, no reputable manufacturer currently produces a patent version of this formula. Patients who wish to use it must themselves follow Li Dongyuan's recipe and ask a pharmacy to process it into pills.