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Urinary incontinence or frequency was traditionally considered a cold syndrome by ancient physicians, who often employed warming and astringent herbs. However, it is not uncommon for this condition to stem from heat. This occurs when pathogenic fire in the Bladder (Bladder) moves recklessly, disturbing the water metabolism, thereby causing an inability to retain urine and resulting in frequent urination. Consequently, elderly individuals often experience frequency due to insufficient blood and yin in the Bladder, leading to an excess of yang fire. The treatment principle should primarily focus on tonifying the yin and blood of the Bladder and clearing pathogenic fire, assisted by astringent agents such as Oyster Shell (Muli), Cornus Fruit (Shanzhuyu), and Schisandra Berry (Wuweizi). Warming herbs should be avoided. Since the root cause is heat, clearing fire is appropriate. Due to insufficient kidney water, fire becomes active, causing polyuria; as urine volume increases, body fluids become further depleted. Therefore, one must treat the root by nourishing blood and clearing fire, while treating the branch by astringing and consolidating.

I note: The *Classic of Internal Medicine* states, "When the Bladder fails to constrain, enuresis occurs." Urinary incontinence refers to the involuntary leakage of urine without the patient's awareness. The act of urination relies on the transmission and transportation of Qi from the Heart and Kidney. The Heart and Small Intestine are exteriorly-interiorly related, as are the Kidney and Bladder. If Qi of the Heart and Kidney is deficient, leading to impaired transmission, this symptom arises. Treatment should involve warming the lower origin and calming the mind while reducing desires. Additionally, improper care during the postpartum period may injure the Bladder. If there is internal deficiency-cold, formulas such as Mi Yuan Dan or Jiu Zi Wan may be used; if there is internal deficiency with damp-heat, Liu Wei Di Huang Wan may be used, potentially supplemented with Wuweizi, Duzhong, or Buguzhi; for the elderly, Ba Wei Wan (Jin Gui Shen Qi Wan) is suitable. If the bladder wall is damaged due to careless midwifery, Shen Zhu Bao Bao Tang decocted with pig or sheep bladders can be administered.

In my opinion, the Liver governs urinary functions. If Liver channel blood is deficient, Si Wu Tang combined with Gardenia (Shanzhi) is indicated. If urination is obstructed or painful in the urethra, it belongs to Liver channel damp-heat, treated with Long Dan Xie Gan Tang. If urination is frequent or worsens with exertion, it indicates Spleen Qi deficiency, treated with Bu Zhong Yi Qi Tang supplemented with Yam (Shanyao) and Wuweizi. If urination is uncontrolled or dribbling, it signifies prolapse and flaccidity (Yin Ting Wei Bi), treated with Liu Wei Di Huang Wan. If urination is obstructed or worsens after tonification, it indicates Bladder heat accumulation, treated with Wu Lin San. If Spleen and Lung dryness prevents fluid transformation, Huang Qin Qing Fei Yin is used. For Bladder yin deficiency where yang lacks generation, Zi Shen Wan is prescribed. For Bladder yang deficiency where yin lacks transformation, Liu Wei Di Huang Wan is used. In cases of impotence, where sexual desire exists but ejaculation does not occur, accompanied by urethral pain resembling strangury, Jia Jian Ba Wei Wan material with Plantago Seed (Cheqianzi) and Achyranthes Root (Niuxi) is applied. For elderly patients whose essence is exhausted and further depleted, presenting with pulling pain in both bowel and bladder movements resembling strangury, the aforementioned formula is used; if ineffective, Aconite Root (Fuzi) should be added urgently, often resulting in recovery.

Official Liu Dashan, over sixty years old, presented with emaciation and weak constitution, urinary incontinence or frequency, internal heat, dry mouth, occasional cough with sputum, wheezing, and dizziness. I diagnosed Lung and Kidney Qi deficiency and prescribed Liu Wei Di Huang Wan and Bu Zhong Yi Qi Tang to nourish the source of transformation. He did not trust this diagnosis and instead took yin-nourishing, fire-clearing, and essence-astringing agents, which caused pain in the genital orifices and dysuria. Upon resuming my original prescription, he recovered within two months.

Official Liu Tianxi had internal damp-heat, loose stools, and obstructed urination. After taking diuretic and leaching herbs, his condition worsened with dribbling, swelling of the lower abdomen, legs, and knees, and distending pain in the eyes. This was due to deficiency-heat in the Kidney channel located in the lower jiao. The use of leaching herbs further damaged yang qi, preventing the transformation of yin. Subsequently, Di Huang Wan and Zi Shen Wan were administered, restoring normal urination. Further treatment with Bu Zhong Yi Qi Tang supplemented with Ophiopogon Tuber (Maidong) and Wuweizi led to full recovery.

Prefect Wang Yongzhi suffered from abdominal distension, poor appetite, and lack of desire for food. After taking Er Chen Tang, Zhi Shi, and diuretic herbs, he developed dysuria, loose stools, cough, abdominal distension, and cold limbs. I diagnosed deficiency-cold of the three foot yin meridians and prescribed Jin Gui Shen Qi Wan, resulting in his recovery.