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Frequent urination without restraint, resembling strangury (Lin syndrome) but without pain in the urethra, is therefore discussed in a separate chapter. (If frequency is accompanied by scanty volume and dysuria, it resembles strangury, but differs due to the absence of pain; if the volume is abundant and not obstructed, it resembles incontinence, but differs because the patient can still endure it.) This condition arises from Kidney deficiency with fire, where fire agitates causing urine to desire to exit, while the deficient Kidney cannot store water. (For Kidney deficiency, use Liuwei Wan [Six-Ingredient Rehmannia Pill]; for fire, use Wuling San [Five-Ingredient Powder].) If frequent and scanty, Fuling Hupo Tang [Poria and Amber Decoction] should be used to promote diuresis, preventing obstruction and pain from developing into strangury. If frequent and abundant, herbs such as Dioscoreae Rhizoma (Shuyu), Nelumbinis Semen (Lianrou), and Alpiniae Oxyphyllae Fructus (Yizhiren) should be used to astringe and consolidate. However, this condition certainly belongs to having fire, but there are also cases of lower origin deficiency-cold where the Kidney fails to control water, treated with Tusizi Wan [Cuscuta Pill], Bawei Wan [Eight-Ingredient Pill] (see Deficiency Damage), and Lurong Wan [Deer Antler Pill] (see Blood disorders). If due to Middle Qi deficiency resulting in frequent and abundant urination, use Buzhong Yiqi Tang [Middle-Boosting and Qi-Invigorating Decoction] (see Qi disorders). For frequent nocturnal urination, grind twenty Alpiniae Oxyphyllae Fructus (Yizhiren) into powder, add five fen of salt, decoct in one bowl of water, and take warm before retiring, or consume Congrong Wan [Cistanche Pill]. After urination, after a short while believing it to be finished, suddenly a small amount emerges again, or urgency arises again after voiding, this is mostly caused by holding urine during sexual intercourse. (Holding urine prevents downward flow; intercourse causes ministerial fire to flare up, causing Qi to ascend rather than descend. With urine not descending and Qi not descending, although there is a sensation of defecation/voiding later, the flow is unsmooth, and residual urine remains, hence such symptoms.) Use Shengliao Wuling San [Raw Material Five-Ingredient Powder] (see Injury by Dampness) plus E-Jiao [Donkey-Hide Gelatin], swallowed with Jiabian Bawei Wan [Modified Eight-Ingredient Pill] (see Deficiency Damage). Heart transferring heat to the Small Intestine causes frequent urination (often seen in cases of excessive joy stirring Heart fire). Use Liqing San [Clearing and Purifying Powder] (see Red and White Turbidity), Sqi Tang [Seven-Word Decoction] (see Qi disorders), still using Chensha Miaoxiang San [Cinnabar and Fragrant Incense Powder] (see Heartache) decocted to swallow Xiaotusizi Wan [Small Cuscuta Pill] (see Red and White Turbidity). When stool is hard and urination is frequent, it is named Pi Yue [Spleen Constriction], treated with Maren Wan [Hemp Seed Pill] (see Constipation. Detailed explanation in *Shanghan Lun · Yangming Chapter*). In warm weather with thick clothing, Qi ascends and leaks outward, thus causing much sweating. In cold weather with thin clothing, Qi turns inward and descends, thus causing much urination; this is not discussed under pathological conditions.

Loss of consciousness with urine emission is called Enuresis (Yin); awareness with inability to restrain is called Incontinence (Bujin), which is more severe than frequent urination, so it is separated into another chapter. It mostly results from Lung and Kidney deficiency-cold, where Qi cannot control, treated with Buzhong Yiqi Tang [Middle-Boosting and Qi-Invigorating Decoction] (see Qi disorders) delivering Shenqi Wan [Kidney Qi Pill] (see Deficiency Damage). Generally, upper deficiency requires tonifying Qi, lower deficiency requires consolidating and arresting leakage. Nocturnal enuresis during sleep is treated with Datusizi Wan [Large Cuscuta Pill] (see Cough), or Zhu Pao Zhi Sui Jian Tang [Pig Bladder Roasted and Crushed Decoction] for delivery. Jiu Zi Wan [Leek Seed Pill], Liuwei Wan [Six-Ingredient Pill] (see Deficiency Damage) minus Ze Xie [Alisma Rhizome], plus Gubai [Psoralea Fruit/Bu Gu Zhi] four liang, Yizhiren and Renshen [Ginseng Radix] three liang each, Rougui [Cinnamon Bark] one liang. For elderly people with uncontrolled urination, Shan Zhuyu [Cornus Fruit] alone is most excellent. Postpartum incontinence involves both blood and Qi deficiency, treated with Bazhen Tang [Eight-Treasure Decoction] (see Deficiency Damage). All above discuss deficiency-cold syndromes. There are also cases of extreme heat causing coma and unawareness of urination, known in *Shanghan Lun* as "fixed gaze and loss of urine," which is a fatal syndrome. Extreme heat indicates flourishing Yang pathogen; loss of urine indicates Yin failing to hold, hence death. He Jian [Liu Wansu] stated that extreme heat lodging in the Kidney region interferes with the Liver meridian, causing extreme stagnation at the anterior aperture, blocking Qi and Blood circulation, leaving the Spirit without function, thus causing enuresis and incontinence. (The Liver governs dispersion and drainage; extreme stagnation leads to excessive drainage.) Later scholars expanded this, stating that heat in any organ can cause urinary incontinence, all being heat syndromes. For excess heat, use Shenxiong Dao Shui Wan [God Celery and Ligusticum Water-Guiding Pill] (see Swelling), taking one hundred pills per dose, with plain water on an empty stomach; stop subsequent doses once effective. Xue Lizhai treated fever and thirst caused by labor with spontaneous enuresis (Liver fire causing excessive drainage), sometimes with obstruction and dysuria (Liver blood deficiency causing stasis, Qi stagnation causing obstruction), diagnosing Liver fire and blood deficiency, with Yin protruding and unable to constrain. Morning: Buzhong Yiqi Tang [Middle-Boosting and Qi-Invigorating Decoction] (see Qi disorders. Ascending and dispersing stagnation) plus Shan Zhuyu and Shanyao [Dioscorea Rhizome]; Afternoon: Liuwei Wan [Six-Ingredient Pill] (see Deficiency Damage. Nourishing Yin and nourishing blood). After more than a month, all symptoms receded, indicating deficiency-heat. Some experience immediate urgency and inability to restrain when washing hands and feet. Could this be due to sexual exhaustion injuring the Kidney, where urine is held back by fire and cannot descend, but upon contact with external water, Yang obtains Yin transformation, thus emitting urine? Or could it be Kidney cold failing to control, where external water increases the cold, causing immediate emission? However, water nature is slow, fire nature is urgent, suggesting the former explanation is likely. (Generally, the principle of mutual感应 [induction/response] between internal water and external water.)