关格病者，膈中觉有所碍，欲升不升，欲降不降，升降不通，饮食不下，此因气之横格
也，乃是痰格中焦。用枳缩二陈汤加减治之，痰出为要。此病多死，寒在上而热在下也。又
曰∶关者，不得小便。格者，吐逆上下俱病者也。关者，甚热之气无出之由也，热在下焦填
塞不便；格者，甚寒之气无入之理也，寒在胸中遏绝不入。
枳缩二陈汤 治关格上下不通。
枳实（麸炒，一钱） 砂仁（七分） 白茯苓（去皮） 贝母（去心） 陈皮 苏子（炒） 瓜蒌仁
浓朴（姜汁炒） 香附（童便炒，各七分） 抚芎（八分） 木香（五分） 沉香（五分） 甘草（三分）
上锉一剂。生姜三片，水煎，入竹沥磨沉、木香服。
《经》云∶膀胱不约为遗溺，小便不禁，常常出而不觉也。
人之漩溺，赖心肾二气之所传送。盖心与小肠为表里，肾与膀胱为表里。若心肾气亏，
传送失度，故有此症。小便自遗失禁者，溺出而不知也。遗溺失禁者，属气虚，用参 汤加
减；老人溺多者，是虚寒，用参附汤加减；壮人溺多者，是虚热，用滋阴降火汤加减；夏月
因伏暑热，溺必遗也，用人参白虎汤加减；中风症遗尿失禁者，难治也。
参 汤 治气虚遗溺失禁。
人参（去芦） 黄 （蜜水炒） 茯苓（去皮） 当归（酒洗） 熟地黄 白术（去芦） 陈皮（各
一钱） 升麻 肉桂（各五分） 益智仁（八分） 甘草（三分）
上锉一剂。姜三片、枣一枚，水煎，空心服。年老之人，虚寒遗溺者多，加附子，名参
附汤。
治身体虚瘦，夜啼遗溺失禁。
人参（八分） 白术（麸炒） 山茱（酒蒸，去核） 黄 （蜜水炒） 白芍（酒炒，各一钱） 山
药（炒） 酸枣仁（炒，各七分） 甘草（炙，四分）
上锉一剂。水煎，温服。
治小水频数，此症皆下元气虚所致。
人参（五钱） 黄柏（五钱，酒浸） 益智仁（六钱） 甘草（一钱）
上为细末，炼蜜为丸，梧桐子大。五更、临卧每服五十丸，滚水下，酒亦可。
滋阴降火汤，治虚热尿多（方见虚劳）。根据本方加炒山栀子，去五味子。人参白虎汤，治
夏月因伏暑热遗尿者（方见暑症）。根据本方加黄柏、知母，去香薷。若小便频数，或劳而益甚
，属脾气虚弱，用补中益气汤加山药、五味子（方见补益）。若小便无度，或淋沥不禁，乃
阴挺痿痹也，用六味丸去泽泻，用益智仁（方见补益）。
Patients with Guan-Ge disease (Obstruction and Rejection) feel an obstruction in the epigastrium/chest. They desire to ascend but cannot, desire to descend but cannot; the ascending and descending mechanisms are blocked, preventing food and drink from going down. This is caused by the horizontal obstruction of Qi (vital energy), specifically due to Phlegm (Tan, 痰) blocking the Middle Jiao (Middle Burner). Treatment should employ Zhisuo Erchen Tang (Bitter Orange and Amomum Two-Chen Decoction) with modifications, with the expulsion of phlegm being the priority. This disease often results in death, characterized by Cold in the Upper Jiao and Heat in the Lower Jiao. It is also said: "Guan" refers to the inability to urinate. "Ge" refers to vomiting and rebellion, where both upper and lower parts are diseased. "Guan" occurs because extreme Heat Qi has no outlet, causing heat to fill and obstruct the Lower Jiao. "Ge" occurs because extreme Cold Qi has no entry point, causing cold to block and prevent entry into the chest.
Zhisuo Erchen Tang: Treats Guan-Ge causing obstruction in both upper and lower aspects.
Ingredients: Zhishi (Fructus Aurantii, stir-baked with bran, 1 qian), Sharen (Fructus Amomi, 0.7 qian), Baifuling (Poria Cocos, peeled), Beimu (Flos Fritillariae Cirrhosae, heart removed), Chenpi (Pericarpium Citri Reticulatae), Suzi (Fructus Perillae, stir-baked), Gualouren (Semen Benincasae), Houpo (Cortex Magnoliae Officinalis, stir-fried with ginger juice), Xiangfu (Rhizoma Cyperi, stir-fried with child's urine, each 0.7 qian), Fuxiong (Radix Chuanxiong, 0.8 qian), Muxiang (Radix Aucklandiae, 0.5 qian), Chenxiang (Lignum Aquilariae Resinatum, 0.5 qian), Gancao (Radix Glycyrrhizae Uralensis, 0.3 qian).
Preparation and Administration: Coarsely crush the above ingredients for one dose. Add three slices of fresh ginger, decoct in water. Before taking, mix in Zhu Li (Bamboo Sap) and dissolve Chenxiang and Muxiang.
The Classic states: When the Bladder fails to maintain restraint, it leads to Yini (Enuresis/Urinary Incontinence), where urine flows out constantly without the patient's awareness.
The generation and excretion of urine rely on the transmission and delivery of Qi from the Heart and Kidney. The Heart and Small Intestine are exterior-interiorly related; the Kidney and Bladder are exterior-interiorly related. If the Qi of the Heart and Kidney is deficient, and transmission loses its regulation, this symptom arises. Spontaneous loss of urine control, where urine flows out without awareness, indicates Enuresis and Incontinence. This belongs to Qi Deficiency; treat with Shen Tang with modifications. For the elderly with polyuria, it is Deficient-Cold; treat with Shenfu Tang (Ginseng and Aconite Decoction) with modifications. For robust individuals with polyuria, it is Deficient-Heat; treat with Ziyin Jianghuo Tang (Nourish Yin and Descend Fire Decoction) with modifications. In summer, due to latent Summerheat-Heat, enuresis will occur; treat with Renshen Baitu Tang (Ginseng and White Tiger Decoction) with modifications. Enuresis and incontinence occurring in Stroke syndromes are difficult to treat.
Shen Tang: Treats enuresis and incontinence due to Qi deficiency.
Ingredients: Renshen (Radix Ginseng, rhizome removed), Huangqi (Radix Astragali Membranacei, stir-fried with honey water), Fuling (Poria Cocos, peeled), Danggui (Radix Angelicae Sinensis, washed with wine), Shudihuang (Radix Rehmanniae Preparata), Baizhu (Rhizoma Atractylodis Macrocephalae, rhizome removed), Chenpi (Pericarpium Citri Reticulatae, each 1 qian), Shengma (Rhizoma Cimicifugae Foetidae), Rougui (Cortex Cinnamomi, each 0.5 qian), Yizhiren (Semen Alpiniae Oxyphyllae, 0.8 qian), Gancao (Radix Glycyrrhizae Uralensis, 0.3 qian).
Preparation and Administration: Coarsely crush the above ingredients for one dose. Add three slices of ginger and one date, decoct in water, and take on an empty stomach. Elderly people often suffer from enuresis due to Deficient-Cold; if Fuzi (Radix Aconiti Lateralis Preparata) is added, it is named Shenfu Tang.
Formula for treating physical weakness and emaciation, night crying, and enuresis/incontinence:
Ingredients: Renshen (Radix Ginseng, 0.8 qian), Baizhu (Rhizoma Atractylodis Macrocephalae, stir-baked with bran), Shanzhuyu (Fructus Corni Officinalis, steamed with wine, pips removed), Huangqi (Radix Astragali Membranacei, stir-fried with honey water), Baishao (Radix Paeoniae Alba, stir-fried with wine, each 1 qian), Shanyao (Rhizoma Dioscoreae Oppositae, stir-fried), Szaoren (Semen Ziziphi Spinosae, stir-fried, each 0.7 qian), Gancao (Radix Glycyrrhizae Uralensis, honey-roasted, 0.4 qian).
Preparation and Administration: Coarsely crush the above ingredients for one dose. Decoct in water and take warm.
For treating frequent urination, a condition caused by deficiency of Yuan Qi (Original Qi) in the Lower Origin:
Ingredients: Renshen (Radix Ginseng, 5 qian), Huangbai (Cortex Phellodendri Amurensis, 5 qian, soaked in wine), Yizhiren (Semen Alpiniae Oxyphyllae, 6 qian), Gancao (Radix Glycyrrhizae Uralensis, 1 qian).
Preparation and Administration: Grind the above ingredients into fine powder. Form pills using refined honey, sized like wutong seeds. Take 50 pills at dawn (wugeng) and before bed, swallowed with boiling water or wine.
Ziyin Jianghuo Tang (Nourish Yin and Descend Fire Decoction): Treats polyuria due to Deficient-Heat (see "Xu Lao" chapter). Add Chao Shanzhizi (Stir-fried Fructus Gardeniae Jasminoidis) and remove Wuweizi (Fructus Schisandrae Chinensis) based on this formula.
Renshen Baitu Tang (Ginseng and White Tiger Decoction): Treats enuresis due to latent Summerheat-Heat in summer (see "Shu Zheng" chapter). Add Huangbai (Cortex Phellodendri Amurensis) and Zhimu (Rhizoma Anemarrhenae Asphodeloidis), and remove Xiangru (Herba Elsholtziae) based on this formula.
If urination is frequent or worsens with fatigue, it belongs to Spleen Qi Weakness; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Shanyao (Rhizoma Dioscoreae Oppositae) and Wuweizi (Fructus Schisandrae Chinensis) added (see "Bu Yi" chapter).
If urination is uncontrolled or dribbles without inhibition, it is Yin Ting Wei Bi (Yin prolapse and flaccidity-obstruction); use Liuwei Wan (Six-Ingredient Pill) removing Zexie (Rhizoma Alismatis Orientals) and adding Yizhiren (Semen Alpiniae Oxyphyllae) (see "Bu Yi" chapter).