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Zhu Danxi treated a woman. She felt heat in her heart as if burning, which then entered the Small Intestine channel. When she urgently went to urinate, stool would also be discharged simultaneously. This condition persisted for three years. Upon seeking treatment, her pulse was slippery and rapid. This was caused by Minister Fire (Minister Fire refers to the fire of the Mingmen residing in the Liver and Kidney) transmitting into the Small Intestine channel. He prescribed Si Wu Tang (Four Substances Decoction) added with stir-fried Huang Lian (Coptidis Rhizoma), Huang Bai (Phellodendri Cortex), Xiao Hui Xiang (Foeniculi Fructus), and Mu Tong (Akebiae Caulis). After four doses, the condition stabilized.

Li Shicai treated the wife of Fangbo Zhang Qize. She had loss of appetite and urinary incontinence. Li stated: The six pulses are deep and slow; the "Water Spring" (urine) cannot be contained, indicating a lack of Fire (Kidney Yang deficiency). He administered Ba Wei Wan (Eight-Ingredient Pill) ingredients. Concurrently, he prescribed Liu Jun Zi Tang (Six-Gentlemen Decoction) added with Yi Zhi Ren (Alpiniae Oxyphyllae Fructus) and Rou Gui (Cinnamomi Cortex). After three doses, symptoms decreased; after several doses, the condition stabilized.

Yu Yuanqian, a scholar, suffered from worry and indignation for over a week, suddenly developing urinary incontinence. Physicians all treated him with formulas to tonify the bladder and secure the kidneys. After a full month, the condition worsened. Li stated: The six pulses are soft upon light palpation but firm upon heavy pressure. This indicates latent Heat (hidden pathogenic heat) within the Yin of the Kidney and Liver. He used Mu Dan Pi (Moutan Cortex), Fu Ling (Poria), each 2 qian; Ku Shen (Sophorae Flavescentis Radix) 8 fen; Gan Cao Gao (Glycyrrhizae Radix et Rhizoma tip) 6 fen; Huang Lian (Coptidis Rhizoma) 1 qian. Decocted and taken with Huang Ji Chang (Yellow Chicken Intestine) mixed in. After six doses, the condition stabilized. A physician remarked that since he recovered, he should undergo strong tonification. Days later, incontinence recurred. Upon re-consultation, Li said: The Liver has inherent stagnant Heat, which flared up due to warm tonification. Thus, he prescribed Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver) added with Huang Ji Chang. After four doses, it stopped. Subsequently, he used Si Jun Zi Tang (Four Gentlemen Decoction) added with Huang Lian and Shan Zhi (Gardeniae Fructus). He recovered after one month.

Yu Zhen’s commentary: Zhu Danxi’s case involved Minister Fire entering the Small Intestine; this case involves latent Heat in the Yin of the Liver and Kidney. The pathology differs slightly, and consequently, the medication also differs slightly. One must observe these nuances.

Zhang Luzhu treated Min Shaojiang from Wuxing. He was elderly, obese, and did not abstain from sexual activity. He suffered from this disease for thirteen years. Overexertion or anger, or improper diet, caused frequent urination with dribbling and painful dysuria. At night, when he briefly slept, urine would leak out; upon waking, obstruction returned. He had consumed countless amounts of Ren Shen (Ginseng Radix), Lu Rong (Cervi Cornu Pantotrichum), and He Che Da Xia (Placenta Humana), yet remained stable. However, touching Mu Dan Pi or Bai Zhu (Atractylodis Macrocephalae Rhizoma) caused unbearable distension and pain. Zhang said: This disease is named Bao Bi (Bladder Obstruction). It arises from accumulated Heat from rich foods above, and injury to essence from excessive sexual activity below, causing Damp-Heat to gather vacuously within the inner bladder capsule. He used Shen Li Tang (Kidney Filtration Decoction), which was quite effective. However, analyzing his inability to sleep and nocturnal enuresis, it is known that Liver deficiency with Fire disturbance causes restless dreams and failure of the Shu-Xie (dispersing and draining) function. Those who experience distension after taking Mu Dan Pi (a Liver-soothing herb) cannot tolerate the Qi movement striking the Minister Fire; those who experience distension after taking Bai Zhu (a Spleen-tonifying herb) cannot tolerate the turbid nature obstructing Damp-Heat; those who take Ren Shen, Lu Rong, and He Che Da Xia (warm tonics) without adverse effects do so because deficiency can accept heat, though the tonification does not address the root cause. He further proposed Jia Jian Sang Piao Xiao San (Modified Mulberry Mantis Egg Case Powder), made into pills using Sheep Kidney decoction. He advised strict abstinence from sex, after which he stabilized.

Yu Zhen’s commentary: Dysuria while awake and enuresis while asleep originally differ from simple incontinence. Therefore, treatment focuses on Bladder and Spleen syndromes. His discussion on the mismatch between drugs and pathology is precise in principle and accurate in meaning. Later, Ye Tianshi’s prescriptions emphasized this principle greatly. Looking at the following two cases, the pathology is the same but the treatment methods differ, and the medication choices have subtle explanations. Careful study prevents the ridicule of "grabbing any prescription that comes to hand."

Huang Yuanji, over sixty years old, suffered from painful dysuria after losing his wife and keeping a mistress. In spring, after falling and becoming unconscious, he experienced enuresis. Since then, he suffered from intermittent enuresis. After the Winter Solstice (when Yang begins to rise), the condition worsened significantly. During the day, urine was obstructed and could not flow; unless sitting in hot water, not a drop would come out. As soon as he closed his eyes to sleep, incontinence occurred. Zhang diagnosed his pulse as sometimes empty and large, sometimes fine and rapid, but the left Guan and Chi positions always showed a String-like (Xian) image. This indicated severe depletion of Kidney Qi, a sign of sinking/collapse below. He administered Di Huang Yin Zi (Rehmannia Drink) for several doses; dysuria improved slightly, and enuresis intervals lengthened. Later, he used Ba Wei Wan (Eight-Ingredient Pill) removing Mu Dan Pi and Ze Xie (Alismatis Rhizoma), adding Lu Rong, Wu Wei Zi (Schisandrae Fructus), Ba Ji Tian (Morindae Officinalis Radix), and Yuan Zhi (Polygalae Radix) for conditioning, leading to recovery.

Kang Renxuan, a merchant from Shaanxi, was young, dark-complexioned, obese, and had a hearty appetite. He suffered from Bao Bi for over ten years. His pulse was soft, large, and irregularly choppy. He would frequently squat on the ground and rub his penis and scrotum with his hands, causing urine to seep drop by drop from the anus. Only washing with hot water provided slight relief. He occasionally experienced enuresis during sleep. In the most severe cases, there were nodules in the middle resembling tangerine seeds, wrapped in red filaments externally and containing yellow fluid internally, mixed with fatty tissue. This was caused by indulging in alcohol without restraint, allowing Wine-Dampness to invade the marrow orifices vacuously. He was strictly ordered to avoid tobacco, liquor, damp noodles, pepper, garlic, pickles, chicken, pork, and fried foods. He was given a decoction of Ban Xia (Pinelliae Rhizoma), Fu Ling, Zhu Ling (Polyporus), Ze Xie, Bi Xie (Dioscoreae Hypoglaucae Rhizoma), Xi Jiao (Rhinocerotis Cornu - note: now substituted with Buffalo Horn), and Zhu Ru (Bambusae Caulis in Taenia). After four doses, the condition reduced by two or three parts. Next, Shen Li Tang added with Bi Xie was taken for several doses; the water pathway cleared, and urination became painless. However, food tasted bland. Later, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Che Qian Zi (Plantaginis Semen) and Mu Tong was used for regulation, leading to stability. Shi Wen noted: There are two types of Bao Bi. One results from visiting prostitutes, treated with Shen Li Tang and Jia Jian Ba Wei Wan. The other results from Yin deficiency with excess Fire, treated with Shen Li Tang, Sheng Mai San (Generate the Pulse Powder) combined with Liu Wei Wan (Six-Ingredient Pill). Drugs like Bi Xie that clear turbidity and drain water damaging essence are strictly prohibited. This patient was obese and damp-heavy, so clearing Stomach Heat and resolving Phlegm was done first, followed by regulating Kidney and Spleen. Treatments vary according to suitability.

Sun Dongsu treated Yuan Hongxi, Grand Commandant of Nanjing. Working under summer heat led to fever, dryness, and thirst. Eating ice-chilled melons, pears, and fresh lotus roots caused diarrhea. Urine volume decreased. Physicians used Wei Ling Tang (Stomach Regulating Decoction) added with Hua Shi (Talcum), Mu Tong, and Che Qian Zi to promote diuresis, stopping the diarrhea. Consequently, stool became dry and hard, difficult to pass. Run Chang Wan (Moisten Intestines Pill) was used, but diarrhea continued. Previous diuretic agents were readministered; diarrhea stopped, but urine could not flow freely. Distension and urgency occurred below the umbilicus. Standing to urinate yielded no drops; lying down resulted in continuous flow. Frequent changing of urinals prevented sleep throughout the night. After more than half a month of treatment, spirit waned, and eating/sleeping ceased. All physicians failed to diagnose. Some suspected Long (difficulty urinating) because standing yielded no drops; others suspected Bi (complete retention) because lying down yielded flow. They attributed it to Qi deficiency sinking and Heart Blood insufficiency, but Bu Zhong Yi Qi Tang and An Shen Wan (Calming Spirit Pill) were ineffective. Sun diagnosed the pulse: Cun positions short and weak, Guan position slow and large, Chi positions surging and large. He said: Residual Summer-Heat has not resolved, and since the Commandant loves drinking, Damp-Heat flows to the lower part. It is now afternoon; the pulse may not be accurate. I will examine carefully tomorrow morning to finalize the prescription. The Commandant said: I have awaited you for a long time; please give me one dose just to sleep tonight. Reluctantly, Sun gave Yi Yuan San (Benefit Primordial Powder) 3 qian, decocted in Xiang Ru (Moslae Herba) soup. There was no improvement. Next morning, the six pulses were the same. Thinking deeply, he suddenly realized: This syndrome is "Urinary Orifice Misalignment." The Commandant asked: Which book mentions this? Sun said: The *Nei Jing* states, "The Bladder is the chamber of the Paopao (bladder sac)." Damp-Heat in the Paopao sinks downward, so when standing, the orifice misaligns, preventing urine exit. When lying down, the Paopao does not sink, and urine seeps out, also due to orifice misalignment. Although flowing drop by drop, it cannot reach directly, hence "finished but not finished." Treatment requires lifting and tonifying Yuan Qi of the Upper and Middle Jiao, while clearing Damp-Heat in the Lower Jiao. Another method: Qi deficiency has sunk for a long time; one or two doses won't work, so how can he sleep? This insomnia is not due to Heart Blood insufficiency, but fear of leaking urine preventing sleep. Temporarily place a cloth bag on the mat, allow leakage without worry, avoiding the need for urinals, ensuring natural sleep. The formula was Bu Zhong Yi Qi Tang added with Huang Bai and Zhi Mu (Anemarrhenae Rhizoma). Following this method, he recovered.

Yu Zhen’s commentary: Incontinence when standing and retention when sleeping differs from Zhang’s case. The concept of "Urinary Orifice Misalignment" was derived from Tang Yuzheng’s treatment of Patrol Officer Wu.