Tongguan Zishen Wan for Dysuria from Prostatic Hyperplasia or Hepatic Ascites
Tongguan Zishen Wan comes from the Lanshi Micang (Secrets of the Orchid Chamber) by Li Dongyuan, one of the four great masters of the Jin-Yuan period. The formula is simple, just three herbs: Huangbai (Phellodendron), Zhimu (Anemarrhena), and Rougui (Cinnamon bark). The original doses: Huangbai one liang, Zhimu one liang, Rougui five fen. Huangbai and Zhimu are wine-processed (skip wine for patients who should not take wine); grind all three finely, form pellets with hot water, the size of a wutong seed. Take 100 pills each time with hot water.
It treats long-qi damp-heat causing linbi (urinary retention)—in TCM, inability to urinate. Besides obstruction, there is urethral stinging or heat.
Why mention it now? Because summer is peak season for long-qi damp-heat urinary retention. Not only prostatitis and prostatic hyperplasia in men but also urethritis in women can cause it; some liver patients have dysuria in summer. Tongguan Zishen Wan works well. If fever and thirst are present, combine with Liuyi San. It is manufactured, though simply called Zishen Wan; many pills carry that name, so check ingredients when buying.
If unavailable, buy the herbs by ratio, have the pharmacy powder them, or use a home blender, and take as powder or fill capsules. This suits patients who should avoid wine, such as those with hepatic ascites. If too troublesome, decoct in the ratio: Huangbai 10 g, Zhimu 10 g, Rougui 0.5 g; add Rougui last, simmering only about 5 minutes after first decocting Huangbai and Zhimu. Though the pill dose seems smaller than the decoction, the pill works better.
Traditional TCM: Huangbai clears lower-jiao damp-heat; Zhimu both clears heat and nourishes kidney yin, so the pair addresses the root. Rougui promotes qi transformation and diuresis while blunting the cold-bitter suppression of Huangbai and Zhimu on spleen-kidney yang. Rougui also improves appetite—Huangbai and Zhimu diminish it—so it is a clever combination that solves the problem without side effects.
This embodies yin-yang mutual rooting. Zhang Jingyue said, 'He who excellently supplements yin seeks yin within yang.' Without warm Rougui to assist, the yin-nourishing heat-clearing herbs could not achieve mutual rooting.