王节斋曰。小便不禁。或频数。古方多以为寒。而用温涩之药。殊不知阴虚属热者多。盖火
邪妄动。水不得宁。故不能禁而频数也。是以老年人多频数者。是膀胱血少。阳火偏旺也。治法
宜滋肾水真阴。补膀胱津液为主。而佐以收涩之剂。六味丸加麦冬、五味之类。不可用温药也。
戴氏云。小便多者。乃下元虚冷。肾不摄水。以致渗泄。宜八味丸、生料鹿茸丸。若小便常
急偏数。虽多而所出常少。放了复急。不涩痛。却非淋证。亦有小便毕。少顷将谓已尽。忽再出
些少者。多因从忍尿行房事而然。宜生料五苓散加阿胶。吞加减八味丸。小便不禁而淋沥涩痛者。
此真阳不固而下渗也。固脬丸。不应。用加减桑螵蛸散。昼甚者。为阳虚。补中益气加熟附子。
夜甚者。为阴虚。八味丸。脬气不足。小便频数。昼甚于夜者。缩泉丸。或时清利过多。或时频
数赤涩者。旧用萆 厘清饮。多不应。改用加减八味丸效。若夜起小便多者。八味丸加五味子。
数而少为实热。宜渗之。五苓减桂加滑石、甘草。数而色黄。虚热也。宜滋阴六味丸。数而多。
色白体羸。为真阳虚。升气少而降气多。须补右肾相火。八味丸加补骨脂、鹿茸。病后服苦寒泄
利药太过。小水不禁。或如稠泔色者。加减八味丸。
小便频数。劳而益甚者。属脾气虚弱。补中益气汤加山药、五味。若小便涩滞。补之益甚者。乃膀胱热结也。
赤芍、赤茯苓、黑山栀、生甘草、木通、滑石、淡竹叶。目白睛黄。加茵陈。有血。加当归、延胡索。脉滑
数盛。加大黄二钱。芒硝一钱。大便通。小便亦利也。其脾肺气燥不能化生者。黄芩清肺饮。膀
胱阴虚阳无以生者。滋肾丸。肾与膀胱俱虚。或肺气不化。水泉涩数者。六味丸加麦冬、五味。
若小便涩滞。或茎中痛。属肝肾湿热。龙胆泻肝汤。
遗溺 经云。督脉生病为遗溺。肝所生病为遗溺。膀胱不约为遗溺。仲景云。下焦不归则遗
溺。天寒则腠理闭。气湿不行。水下流于膀胱。则为溺与气。故多溺而寒也。至于不禁。虚寒之
甚。非八味丸、固脬丸、加减桑螵蛸散不效。然亦有热客肾部而遗尿者。经曰。淫气遗溺。痹聚
在肾。此系热证。其证发热作渴。或时闭涩。或时自遗。或阴挺不能约制。午前小剂补中益气加
黑山栀。午后大剂生料六味丸加五味子。常服自效。夏月暑病遗尿者。白虎加人参汤。一服即应。
有先因病淋。服利药太多。致溺不禁者。补中益气少佐熟附子。有所伤损。污血蓄于胞中。亦令
遗失。鹿角屑炙黄为末。和桃仁泥等分。酒调三钱。咳而遗溺属膀胱。茯苓甘草汤。不应。五苓
散。小儿胎中受冷遗尿。一味补骨脂炒研。临卧红酒调服。即不遗。孕妇及产后遗尿。见妇人门。
石顽治吴兴闵少江。年高体丰。患胞痹一十三年。历治罔效。一日偶述其证于张涵高。涵高
曰。此病隐曲难明。非请正于石顽张子。不能测识也。少江素忝交知。因是延余。备陈所患。凡
遇劳心嗔恚。或饮食失宜。则小便频数。滴沥涩痛不已。至夜略得交睫。溺即渗漉而遗。觉则阻
滞如前。十三年来。服人参、鹿茸、紫河车无算。然皆平稳无碍。独犯牡丹、白术。即胀痛不禁。
五犯五剧。究竟此属何疾。余曰。病名胞痹。惟见之于内经。其他方书不载。是以医不加察。并
未闻其病名。此皆膏粱积热于上。作强伤精于下。湿热乘虚。结聚于膀胱之内胞也。素问云。胞痹者。小腹
膀胱按之内痛。若沃以汤。涩于小便。上为清涕。详此节经文。则知膀胱虚滞。不能上吸肺气。
肺气不清。不能下通水道。所以涩滞不利。得汤热之助。则小便涩涩微通。其气循经蒸发。肺气
暂开。则清涕得以上泄也。因举肾沥汤方。服之其效颇捷。但原其不得宁寝。寝则遗溺。知肝虚
火扰。而致魂梦不宁。疏泄失职。所以服牡丹疏肝之药则胀者。不胜其气之窜。以击动阴火也。
服白术补脾之药亦胀者。不胜其味之浊。以壅滞湿热也服。人参、鹿茸、河车温补之药。平稳无
碍者。虚能受热。但补而不切于治也。更拟加减桑螵蛸散。用羊肾汤泛丸服。庶有合于病情。然
八秩年高。犹恃体丰。不远房室。药虽中 。难保前证不复也。
又治徽友黄元吉。年六十余。因丧明蓄外家。而患小便淋涩。春间因颠仆昏愦遗尿。此后遂不
时遗溺。或发或止。至一阳后。其证大剧。昼日苦于溺涩不通。非坐于热汤。则涓滴不出。交睫
便遗之不禁。因求治于石顽。其脉或时虚大。或时细数。而左关尺必显弦象。此肾气大亏。而为
下脱之兆也。乃与地黄饮子数服。溺涩稍可。遗亦少间。后与八味丸去丹皮、泽泻。加鹿茸、五
味、巴戟、远志。调理而痊。
又治陕客亢仁轩。年壮色苍。体丰善啖。患胞痹十余年。诸省名医。俱药之不应。亦未有识
其病名者。癸丑夏。泊吴求治。其脉软大而涩涩不调。不时蹲踞于地。以手揉其茎囊则溲从谷道
点滴而渗。必以热汤沃之始得稍通。寐则有时而遗其。最苦者。中有结块如橘核之状。外裹红丝。
内包黄水。杂于脂腻之中。与向所治高参议田孟先无异。此因恣饮不禁。酒湿乘虚袭入髓窍。故
有是患。因令坚戒烟草火酒。湿面椒蒜。糟醋鸡豕。炙爆等味。与半夏、茯苓、猪苓、泽泻、萆
、犀角、竹茹作汤。四剂不应。省其故。以西北人惯食等味。不能戒口。所以不效。乃令其坚守勿犯。
方与调治。仍用前药四剂。势减二三。次与肾沥汤加萆 数服。水道遂通。溲亦不痛。但觉食不
甘美。后以补中益气加车前、木通。调之而安。此与高参议田孟先证虽同而治稍异。高则因远游。
恣乐妓馆致病。故用肾沥汤、加减八味丸收功。田由阴虚多火。故用肾沥汤、生脉散合六味丸收
功。若萆 厘清渗水伤精之味。咸为切禁。此则肥盛多湿。故先与清胃豁痰之药。然后理肾调脾。
为治不得不异耳。
又治御前侍卫金汉光。年逾花甲。初夏误饮新酒致病。前有淋沥涩痛。后有四痔肿突。此阴
虚热陷膀胱也。先与导赤散。次进补中益气。势渐向安。惟庭孔涩痛未除。或令服益元散三服。
遂致遗溺不能自主。投剂不应。直至新秋。脉渐 弱。因采肾沥之义。以羯羊肾制补骨脂。羊脬
制菟丝子。浓煎桑根皮汁制螵蛸。甫进三日。得终夜安寝。涓滴靡遗矣。
Wang Jiezhai stated: Incontinence of urine, or frequent urination. Ancient prescriptions often considered this a cold syndrome and used warming and astringent medicines. However, it is unknown that cases due to yin deficiency with heat are numerous. This is because pathogenic fire moves recklessly, causing the water (urine) to be unsettled, thus unable to be controlled, resulting in frequent urination. Therefore, elderly people who frequently urinate do so because the bladder lacks blood, and yang fire is excessively active. The treatment method should focus on nourishing kidney water and true yin, and replenishing bladder fluids, assisted by astringent agents. For example, Liuwei Wan (Six-Ingredient Pill with Rehmannia) added with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Fruit). Warming medicines should not be used.
Dai stated: Frequent urination is caused by deficiency-cold in the lower origin, where the kidney fails to control water, leading to leakage. Bawei Wan (Eight-Ingredient Pill) or Shengliao Lurong Wan (Deer Horn Pill with Raw Ingredients) are suitable. If urination is often urgent and frequent, although the total volume is large, each voiding is small, and urgency returns immediately after voiding without dysuria, this is not strangury (Lin syndrome). There are also cases where, after finishing urination, a small amount comes out suddenly after a while; this is often due to sexual intercourse while holding urine. Shengliao Wuling San (Five-Ingredient Powder with Poria Decoction with Raw Ingredients) added with Ejiao (Donkey-Hide Gelatin), taken with Jiajian Bawei Wan (Modified Eight-Ingredient Pill), is suitable. Incontinence accompanied by dribbling and dysuria indicates failure of true yang to secure, leading to leakage. Gupao Wan (Bladder-Securing Pill) is used; if ineffective, Jiajian Sangpiaoxiao San (Modified Mantis Egg Case Powder) is used. Severe symptoms during the day indicate yang deficiency, treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shu Fuzi (Prepared Aconite Root). Severe symptoms at night indicate yin deficiency, treated with Bawei Wan (Eight-Ingredient Pill). Insufficiency of bladder qi causes frequent urination, worse during the day than at night, treated with Suoquan Wan (Retain Water Pill). Occasional excessive diuresis or occasional frequency with redness and dysuria was traditionally treated with Bixie Fenqing Yin (Grass Leaf Sedge Clearing Separation Infusion), but this was mostly ineffective; Jiajian Bawei Wan (Modified Eight-Ingredient Pill) is effective now. Frequent nocturia is treated with Bawei Wan (Eight-Ingredient Pill) added with Wuweizi (Schisandra Fruit). Frequency with small volume indicates excess heat, requiring draining; Wuling San (Five-Ingredient Powder) minus Guizhi (Cinnamon Twig) added with Huashi (Talcum) and Gancao (Licorice Root). Frequency with yellow color indicates deficient heat, requiring yin nourishment; Liuwei Wan (Six-Ingredient Pill with Rehmannia) is used. Frequency with large volume, white color, and emaciation indicates true yang deficiency, with less ascending qi and more descending qi; the ministerial fire of the right kidney must be tonified using Bawei Wan (Eight-Ingredient Pill) added with Buguzhi (Psoralea Fruit) and Lurong (Deer Antler). Excessive use of bitter-cold purgatives after illness leads to incontinence or urine resembling thick rice washings; Jiajian Bawei Wan (Modified Eight-Ingredient Pill) is used.
Frequent urination worsening with fatigue belongs to spleen qi deficiency, treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shanyao (Chinese Yam) and Wuweizi (Schisandra Fruit). If urinary retention worsens with tonification, it is bladder heat accumulation. Chishao (Red Peony Root), Chifuling (Red Poria), Heishanzhi (Black Gardenia Fruit), Sheng Gancao (Raw Licorice Root), Mutong (Akebia Stem), Huashi (Talcum), and Danzhuye (Light Bamboo Leaf) are used. Yellow sclera adds Yinchen (Artemisia Capillaris). Blood presence adds Danggui (Angelica Sinensis) and Yanhusuo (Corydalis Rhizome). Slippery, rapid, and full pulse adds Dahuang (Rhubarb Root) 2 qian and Mangxiao (Mirabilite) 1 qian. Once bowel movements are unblocked, urination also becomes smooth. Dryness of spleen and lung qi failing to transform is treated with Huangqin Qingfei Yin (Scutellaria Lung-Clearing Infusion). Bladder yin deficiency failing to generate yang is treated with Zishen Wan (Kidney-Nourishing Pill). Deficiency of both kidney and bladder, or lung qi failing to transform, with rough and frequent urination, is treated with Liuwei Wan (Six-Ingredient Pill with Rehmannia) added with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Fruit). Urinary retention or penile pain belongs to liver-kidney damp-heat, treated with Longdan Xiegan Tang (Gentian Liver-Draining Decoction).
Enuresis: The Classic states that disease of the Du Mai (Governor Vessel) causes enuresis; diseases of the liver cause enuresis; failure of the bladder to constrain causes enuresis. Zhang Zhongjing stated that failure of the lower jiao to return causes enuresis. Cold weather closes the pores, moisture does not circulate, water flows down to the bladder, causing urine and gas, hence frequent urination with cold sensations. Incontinence represents severe deficiency-cold, effective only with Bawei Wan (Eight-Ingredient Pill), Gupao Wan (Bladder-Securing Pill), or Jiajian Sangpiaoxiao San (Modified Mantis Egg Case Powder). However, there are cases of enuresis due to heat lodging in the kidney region. The Classic states: "Excessive fluids cause enuresis; bi syndrome gathers in the kidney." This is a heat syndrome, characterized by fever and thirst, sometimes retention, sometimes spontaneous leakage, sometimes prolapse of the yin unable to be constrained. Small dose of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Heishanzhi (Black Gardenia Fruit) in the morning; large dose of Shengliao Liuwei Wan (Raw Six-Ingredient Pill with Rehmannia) added with Wuweizi (Schisandra Fruit) in the afternoon; regular use yields effect. Summer heat disease causing enuresis is treated with Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), effective after one dose. Enuresis caused by excessive use of diuretics for prior strangury is treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with a little Shu Fuzi (Prepared Aconite Root). Injury causing stagnant blood in the uterus also causes leakage. Lu Jiaoxie (Deer Horn Fragment) roasted yellow and powdered, mixed equally with Tao Ren paste (Peach Kernel Paste), taken with wine, 3 qian. Cough with enuresis belongs to the bladder, treated with Fuling Gancao Tang (Poria and Licorice Decoction); if ineffective, Wuling San (Five-Ingredient Powder) is used. Enuresis in children due to cold received in the womb is treated with single ingredient Buguzhi (Psoralea Fruit) roasted and ground, taken with red wine before sleep, stopping enuresis. Enuresis in pregnant women and postpartum women is seen in the Women's Section.
Shiwang treated Min Shaojiang from Wuxing, an elderly man with a robust physique, suffering from Bao Bi (Bladder Bi Syndrome) for thirteen years with no effect from various treatments. One day he recounted his condition to Zhang Hangao, who said, "This disease is obscure and difficult to clarify; only by consulting Shiwan Zhangzi can its nature be determined." Since Shaojiang was a friend, I was invited to treat him. He described his condition: whenever mental labor or anger occurred, or diet was improper, urination became frequent, dribbling with dysuria. At night, upon falling asleep, urine leaked spontaneously; upon waking, obstruction returned as before. For thirteen years, he took countless doses of Renshen (Ginseng Root), Lurong (Deer Antler), and Ziheche (Placenta Humanus), all stable without adverse effects. However, taking Mudan (Tree Peony Bark) or Baizhu (Atractylodes Rhizome) caused distension and uncontrollable pain, worsening with each occurrence. What disease is this? I said: The disease name is Bao Bi (Bladder Bi Syndrome), found only in the Neijing, not recorded in other medical books, hence physicians failed to observe it and did not know its name. This is due to accumulated heat from rich foods above, and injury to essence from excessive sexual activity below, allowing damp-heat to enter deficiency and accumulate in the inner bladder. The Suwen states: "In Bao Bi, pressing the lower abdomen and bladder causes internal pain, feeling like pouring hot water, with difficult urination, and clear nasal discharge above." Examining this text reveals that bladder deficiency and stagnation fail to absorb lung qi; unclear lung qi fails to descend to regulate water passages, causing roughness and obstruction. Heat helps slightly open the urine flow; qi evaporates along the meridian, lung qi temporarily opens, allowing clear nasal discharge to exit above. I prescribed Shenli Tang (Kidney Drip Decoction), which was quite effective. However, his inability to rest peacefully and enuresis during sleep indicated liver deficiency with fire disturbing the soul, causing restless dreams and failure of dispersion and transformation. Hence, Mudan (Tree Peony Bark), a liver-soothing herb, caused distension because it could not withstand the wandering qi, stirring yin fire. Baizhu (Atractylodes Rhizoe), a spleen-tonifying herb, also caused distension because it could not withstand the turbid flavor, obstructing damp-heat. Renshen (Ginseng Root), Lurong (Deer Antler), and Heche (Placenta Humanus), warming tonics, were stable because deficiency can accept heat, but they did not address the root cause. I then proposed Jiajian Sangpiaoxiao San (Modified Mantis Egg Case Powder), made into pills with sheep kidney decoction, to better match the condition. However, at eighty years old, relying on his robust physique and not abstaining from sex, although the medicine hit the pathology, recurrence cannot be guaranteed.
He also treated Huang Yuanji, a friend from Hui, over sixty years old, who suffered from urinary strangury and roughness after losing sight and keeping a mistress. In spring, he fell, fainted, and experienced enuresis, thereafter suffering intermittent enuresis. After the Winter Solstice, symptoms worsened significantly. During the day, he suffered from urinary obstruction, not excreting a drop unless sitting in hot water; upon sleeping, enuresis was uncontrollable. Seeking treatment from Shiwang, his pulse was sometimes empty and large, sometimes fine and rapid, but the left Guan and Chi positions always showed a wiry image, indicating severe kidney qi deficiency and signs of sinking/depletion. He was given Dihuang Yinzi (Rehmannia Decoction) for several doses; urinary roughness improved slightly, and enuresis decreased. Later, Bawei Wan (Eight-Ingredient Pill) minus Mudanpi (Tree Peony Bark) and Zexie (Alisma Rhizome), added with Lurong (Deer Antler), Wuweizi (Schisandra Fruit), Bajitian (Morinda Root), and Yuanzhi (Polygala Root), was used for conditioning until recovery.
He also treated Kang Renxuan, a traveler from Shaanxi, a young man with dark complexion, robust physique, and good appetite, suffering from Bao Bi (Bladder Bi Syndrome) for over ten years. Famous doctors in various provinces failed to treat him, and no one recognized the disease name. In summer of Gui Chou year, he sought treatment in Wu. His pulse was soft, large, and irregularly rough. He frequently squatted on the ground, rubbing his penis and scrotum, causing urine to seep drop by drop from the anus, requiring hot water to achieve slight passage. He sometimes leaked urine during sleep. Most distressingly, there was a lump inside like an orange seed, wrapped in red filaments externally, containing yellow fluid internally, mixed with fatty tissue, identical to the case of Counselor Tian Mengxian previously treated. This was due to uncontrolled drinking, where alcohol-dampness invaded the marrow orifices due to deficiency. He was strictly ordered to avoid tobacco, strong wine, wet noodles, pepper, garlic, pickles, vinegar, chicken, pork, and fried foods. Banxia (Pinellia Tuber), Fuling (Poria), Zhuling (Polyporus), Zexie (Alisma Rhizome), Bixie (Grass Leaf Sedge), Xijiao (Rhino Horn - *note: substitute with alternative in modern practice*), and Zhuru (Bamboo Shavings) were made into a decoction. Four doses had no effect. Investigating the cause, since Northwest people are accustomed to these foods and could not abstain, it was ineffective. He was ordered to strictly adhere to the diet before further treatment. Still using the previous medicine for four doses, severity reduced by two or three parts. Next, Shenli Tang (Kidney Drip Decoction) added with Bixie (Grass Leaf Sedge) was taken for several doses, water passages opened, and urination became painless, though food tasted bland. Later, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Cheqianzi (Plantago Seed) and Mutong (Akebia Stem) was used for regulation until peace. Although this case was similar to Counselor Tian Mengxian, treatment differed slightly. Gao contracted the disease from traveling and frequenting brothels, so Shenli Tang (Kidney Drip Decoction) and Jiajian Bawei Wan (Modified Eight-Ingredient Pill) concluded the cure. Tian had yin deficiency with much fire, so Shenli Tang (Kidney Drip Decoction), Shengmai San (Generate the Pulse Powder), and Liuwei Wan (Six-Ingredient Pill with Rehmannia) concluded the cure. Ingredients in Bixie Fenqing Yin that drain water and injure essence are strictly prohibited. This patient was obese with much dampness, so stomach-clearing and phlegm-resolving medicines were given first, then kidney-regulating and spleen-adjusting methods followed, necessitating different treatment.
He also treated Jin Hanguang, an Imperial Guard, over sixty years old, who fell ill in early summer after mistakenly drinking new wine. Initially, he had dribbling and dysuria, later developing four swollen hemorrhoids. This was yin deficiency with heat sinking into the bladder. Daochi San (Guide Out Red Powder) was given first, followed by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), with symptoms gradually improving. Only the urethral roughness and pain remained. Someone suggested taking Yiyuan San (Benefit Origin Powder) for three doses, which led to uncontrollable enuresis. Prescriptions were ineffective until early autumn, when the pulse became weak. Adopting the principle of Shenli Tang (Kidney Drip Decoction), Buguzhi (Psoralea Fruit) was processed with ram kidney, Tusizi (Cuscuta Seed) with sheep bladder, and Piaoxiao (Mantis Egg Case) with mulberry root bark decoction. After just three doses, he slept through the night without any leakage.