【纲】仲景曰。三阳合病。腹满身重。难以转侧。口中不仁。面垢。谵语遗尿。自汗者。不可
汗。不可下。宜少与白虎汤。风温病。脉浮。自汗出。体重多眠。若下之。则小便不利。直视失溲。
寸口脉微而涩。微者卫气不行。涩者营气不逮。荣卫不能相将。三焦无所仰。身体痹不仁。荣
气不足。则烦疼。口难言。卫气虚。则恶寒。数欠。三焦不归其部。上焦不归者。噫而吞酸。中焦
不归者。不能消谷。下焦不归者。则遗溲。
【目】杨士瀛曰。膀胱潴水。下焦不摄。则亦遗溺。经云。邪中下焦。阴气为栗。足膝逆冷。
便溺妄出。合用四逆汤。下焦蓄血。小腹结急。小便自利不禁。轻者。桃仁承气汤。重者。抵当汤。
【纲】仲景曰。咳而小便利。若失小便者。不可发汗。汗出则四肢厥冷。太阳病。火熨其背。
大汗出。谵语。十余日。振栗下利。欲小便不利。反呕而失溲者。此为欲解也。遗溲狂言。目反直视者。此为肾绝。
【目】吴绶曰。遗尿者。小便自出不知也。其热盛神昏。遗尿者。为可治。若阴症下寒。逆冷。
遗尿。脉沉微者。难治。宜附子汤加干姜、益智以温其下。若厥阴囊缩。逆冷。脉微。遗尿者。
四逆加吴萸汤温之。阳不回者死。凡伤寒汗下后。热不解。阴虚火动而遗尿者。人参三白汤加知、
柏。或补中益气汤加知、柏、麦冬、生地、五味之类。若狂言直视。谵语遗尿。此为肾绝。内经言。
膀胱不利为癃。不约则遗溺。又曰。水泉不止者。膀胱不藏也。言肾与膀胱为表里。肾虚。则膀
胱之气不约。故遗尿也。要在滋补膀胱之气。东垣谓溲便遗失。为肺金虚。又当补肺气也。大抵肺
虚肾虚热甚者。皆可治。惟肾绝遗尿。则不可治。此下焦气绝。不归其部故也。
[Outline] Zhang Zhongjing stated: In San-Yang He-Bing (simultaneous involvement of the Yang-Wei, Yang-Ming, and Shao-Yang channels), symptoms include abdominal fullness, heaviness of the body, difficulty in turning over, numbness in the mouth, a greasy appearance on the face, delirium, and urinary incontinence. If there is spontaneous sweating, diaphoresis therapy (sweating method) and purgation therapy should not be used. It is appropriate to administer Baihu Tang (White Tiger Decoction) in small amounts. In Feng-Wen Bing (Wind-Warmth disease), the pulse is floating, there is spontaneous sweating, body heaviness, and excessive sleepiness. If purgation is mistakenly applied, it leads to difficult urination, fixed gaze, and loss of control over both urine and stool. The Cun-Kou (radial artery at the wrist) pulse is faint and choppy. Faintness indicates that Wei-Qi (Defensive Qi) cannot circulate; choppiness indicates that Ying-Qi (Nutritive Qi) cannot reach its destination. When Ying-Qi and Wei-Qi cannot coordinate with each other, the San-Jiao (Triple Burner) loses its support, resulting in physical numbness and insensitivity. Deficiency of Ying-Qi causes irritability and pain, and difficulty in speaking; deficiency of Wei-Qi causes aversion to cold and frequent yawning. When the Qi of the San-Jiao fails to return to its proper location: if the Upper Jiao does not return, belching and acid regurgitation occur; if the Middle Jiao does not return, the inability to digest grains occurs; if the Lower Jiao does not return, urinary and fecal incontinence occurs.
[Commentary] Yang Shiying stated: Accumulation of water in the Bladder and failure of the Lower Jiao to secure will also lead to urinary incontinence. The Classics state: When pathogenic factors attack the Lower Jiao, Yin Qi trembles, leading to cold feet and knees, and involuntary discharge of urine and feces. In such cases, Sini Tang (Frigid Extremities Decoction) should be used. For Blood Stasis accumulation in the Lower Jiao, characterized by urgency and tightness in the lower abdomen with free urination and incontinence, Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) is used for mild cases, and Didang Tang (Arriving There Decoction) for severe cases.
[Outline] Zhang Zhongjing stated: Cough accompanied by free urination, or cases of urinary incontinence, should not be treated with diaphoresis therapy. If sweating is induced, it leads to cold extremities. In Tai-Yang Bing (Tai-Yang Disease), if the back is ironed with heat causing profuse sweating, followed by delirium, and after more than ten days, shivering, diarrhea, desire to urinate but inability to do so, vomiting, and loss of control over urine and stool occur, this indicates that the disease is about to resolve. However, if urinary incontinence, wild talk, and eyes staring straight back occur, this is a sign of Kidney Qi exhaustion.
[Commentary] Wu Shou stated: Urinary incontinence refers to the involuntary leakage of urine without the patient's awareness. If caused by intense heat and confused spirit, it is treatable. If caused by Yin Syndrome with lower cold, cold extremities, urinary incontinence, and a deep, faint pulse, it is difficult to treat. It is appropriate to use Fuzi Tang (Aconite Decoction) added with Gan Jiang (Dried Ginger) and Yi Zhi Ren (Alpinia Oxyphylla Fruit) to warm the lower burner. If Jue-Yin disease presents with retraction of the scrotum, cold extremities, faint pulse, and urinary incontinence, Sini Tang added with Wu Zhu Yu (Evodia Fruit) should be used to warm the body. If Yang Qi does not return, death ensues. Generally, after sweating or purgation in Shang-Han (Cold Damage), if heat persists and urinary incontinence occurs due to Yin deficiency with hyperactive fire, Renshen Sanbai Tang (Ginseng Three Whites Decoction) added with Zhi Mu (Anemarrhena Rhizome) and Huang Bo (Phellodendron Bark), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Zhi Mu, Huang Bo, Mai Dong (Ophiopogon Tuber), Sheng Di Huang (Rehmannia Root), and Wu Wei Zi (Schisandra Berry) should be used. If wild talk, fixed gaze, delirium, and urinary incontinence occur, this indicates Kidney Qi exhaustion. The Neijing states: "Inability of the Bladder to promote transformation is called Long (urinary retention); lack of restraint leads to Yi Niao (urinary incontinence)." It also states: "Unceasing flow of water indicates that the Bladder cannot store." This implies that the Kidney and Bladder are exterior-interior partners. Kidney deficiency leads to lack of restraint in Bladder Qi, causing urinary incontinence. The key lies in tonifying Bladder Qi. Li Dongyuan stated that loss of urine and stool is due to deficiency of Lung Metal, and thus Lung Qi should be supplemented. Generally, Lung deficiency, Kidney deficiency, and severe heat are all treatable. Only urinary incontinence caused by Kidney Qi exhaustion is untreatable, because the Qi of the Lower Jiao has exhausted and failed to return to its proper location.