诸小便病，除淋浊不通外，下焦失约证并载于此，析而列之。但其方则宜相通用，故不随证为别。
小便利多 小便利多者，由膀胱虚寒胞滑故也。肾为脏，膀胱肾之腑也，其为表里，俱主水，肾气下
通于阴。腑既虚寒，不能温其脏，故小便白而多。其至夜尿偏甚者，则内阴气生是也。（《病源论》）
小便多者，乃下元虚冷，肾不摄水，以致渗泄，宜菟丝子丸、八味丸、玄菟丹、生料鹿茸丸。（《要
诀》）（按∶《六要》此下曰∶余按肾气不能摄水，降多升少，非大补莫能，参、 佐桂、附可也。）
小便数 小便数者，膀胱与肾俱虚，而有客热乘之故也。肾与膀胱为表里，俱主水，肾气下通于阴。
此二经既虚，致受于客热，虚则不能制水，故令数。小便热则水行涩，涩则小便不快，故令数起也。（《病源论》）
许仁则论此病有二种∶一者小便多而渴，饮食渐加，肌肉渐减，乏气力，少颜色，此是消渴。一者小便虽
数而不至多，又不渴，食饮亦不异常，或不至多，能食，但稍遇天寒冷，即小便多，更无别候，此是
虚冷所致。大都两种俱缘肾气膀胱冷，不瘥便能杀人。肾虚腰冷，无所为害。（《外台》）
若小便常急，遍数虽多，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，多因自忍尿，或忍尿行房事而然。宜生料五苓散，减泽泻之半，加阿胶一钱，吞八味丸，此丸须用
五味子者。（《要诀》）
数而少，热也，茯苓琥珀汤利之；数而多，虚也，薯蓣、莲肉、益智仁之属收之。（《六要》）
小便频而清白长者为虚寒，频而少黄赤涩者为热，及脉洪数、有力无力、或滑或涩参验之，始无差误。凡
热天小便少，寒天小便多，寒热之理，亦易见尔。（《赤水》）（按∶《灵枢·五癃津液别论》当参。）
小便不禁 小便不禁者，肾气虚，下焦受冷也。肾主水，其气下通于阴。肾虚下焦冷，不能温制其
水液，故小便不禁也。（《病源论》）
下焦蓄血，其与虚劳内损，则便溺自遗而不知；下焦虚寒，不能温制水液，则便溺欲出而不禁。是皆心不
与肾交通。（《直指》）
溲溺惟宜形气治也，溲溺不禁，形气病也，轻者脬中有痹，重者大气虚而且绝尔。（《方考》）
不禁谓无禁约，小便多而频，不计遍数。按经云∶水泉不止者，是膀胱不藏也。有湿热，有下元虚惫，
数而少为热，数而多为虚，老人多有此，盖阳气衰微，不能约束，历见数人，卒皆不救，由其不能摄养，
而神气耗散故也。古人有谓不通为热，不禁为寒，乃心肾气弱，阳道衰冷而传化失度。法当温补，温存以养
其神，药石以坚其肾，神完肾固，膀胱气充，自可约束，然必调治及早，庶或十全三五。（《赤水》）
古方书论小便不禁，有属热属寒之辨。不知不禁之谓，乃以小水太利为言，皆属虚寒，何有热症。若因热
而小便频数，则淋沥点滴不能禁止，而又出之不快，或多痛涩，非遗失不禁之谓矣。倘以虚寒误认为热，而
妄投泻火之剂，岂不殆哉。（《金匮翼》）（按∶遗尿不禁为热客肾经，《原病式》有其说，而王氏《杂着》
亦谓为属热。《赤水》、《景岳》既斥其非，而尤氏此言最为约核，故拈出之。又《必读》有肝家郁热，小便
不禁，得温补转炽者，用龙胆泻肝汤加黄鸡肠治验，盖是证之变者也。）
凡治小便不禁者，古方多用固涩，此固宜然，然固涩之剂，不过固其门户，此亦治标之意，而非塞源之道
也。盖小水虽利于肾，而肾上连肺，若肺气无权，则肾水终不能摄，故治水者必须治气，治肾者必须治肺。宜
以参、 、归、术、桂、附、干姜之属为之主，然后相机加以固涩之剂为之佐，庶得治水之道，而源流如度，
否则徒障狂澜，终无益也。余制有巩堤丸方治，无论心脾肺肾之属，皆宜以此为主治。（《景岳》）（按∶
巩堤丸用熟地、菟丝、白术、五味、益智、故纸、附子、茯苓、韭子，山药糊为丸。）
因先病淋，服利药太多，致溺不禁者，参、 大补为主，少佐熟附子。（《六要》）
又有女人下关无闭，遇寒则便数，遇咳嗽则小便适来，亦为不禁者也。（《绳墨》）
遗尿尿床 遗尿者，此由膀胱虚冷，不能约于水故也。膀胱为足太阳，肾为足少阴，二经为表里。
肾主水，肾气下通于阴，小便者水液之余也。膀胱为津液之府，府既虚冷，阳气衰弱，不能约于水，故令遗尿
也。诊其脉来过寸口入鱼际，遗尿。肝脉微滑，遗尿。左手关上脉沉为阴，阴绝者无
肝脉也，苦遗尿，尺脉实，小腹牢痛，小便不禁。尺中虚，小便不禁。肾病小便不禁，脉当沉滑而反浮大。其
色当黑反黄，此土之克水为逆，不治。（《病源论》）（按∶此说脉，肝脉微滑出《灵枢》，其他皆出《
脉经》，但尺中虚未考。）
尿床候，夫人有于眠睡不觉尿出者，是其禀质阴气偏盛，阳气偏虚者，则膀胱肾气俱冷，不能温制于水，
则小便多，或不禁而遗尿。膀胱足太阳也，为肾之腑，肾为足少阴为脏，与膀胱合，俱主水。凡人之阴阳，日
入而阳气尽则阴受气，至夜半阴阳大会，气交则卧睡。小便者水液之余也，从膀胱入于胞为小便。夜卧则
阳气衰伏，不能制于阴，所以阴气独发，水下不禁，故于眠睡而不觉尿出也。（同上）
出而不禁，谓之遗尿。睡里自出，谓之尿床。（《直指·小儿》）
睡着遗尿者，此亦下元冷、小便无禁而然，宜大菟丝子丸，猪胞炙碎煎汤下。凡遗尿皆属虚，古书云∶实
则失气，虚则遗尿。有盛喜致小便多，日夜无度，乃喜极伤心，心与小肠为表里，宜厘清饮、四七汤各半帖和
煎，仍以辰砂妙香散，吞小菟丝子丸或玄菟丹。（《要诀》）
少壮遗尿，下元热也。热则有动其火，故梦遗也。遗虽失而阳热盛，然必有力。治之宜清。（《绳墨》）
（按∶遗尿属热，《原病式》语意不了，丹溪亦有按。难为准，并不录。）
肾主闭脏，肾虚则不能约，以故不时而遗出也，中年人凿丧太过，多有此症。亦有下部湿热太盛，迫水
妄行者，其人必嗜酒。夜遗，少壮责之火，中年责之虚。热则清之，栀
子、木通、茯苓等，虚则补之。（《六要》）
遗溺，遗失也，睡梦中遗失，醒而后觉，童稚多有此，大人少有也。夫童稚阳气尚微，不甚约束，好动而
魂游，故夜多遗失也。古方多用暖药，乃温养阳气之意，经谓虚则遗溺，不约为遗溺，从可知矣。曾见数人二
三十岁，仍遗失不止，后皆无子，得非下元虚寒所致欤。（《赤水》）（按∶又曰。刘河间、丹溪、《千金翼
方》有认为热者，必以脉症相参看，庶无偏热偏寒之弊。予前论寒者，以大概而言也。诸病皆
有寒热虚实，多有始同终异，故治法不能执一而无权也。此引《千金翼方》，当考。）
遗溺一证，有自遗者，以睡中而遗失也。有不禁者，以气门不固而频数不能禁也。又有气脱于上，则下
焦不约而遗失不觉者。此虚极之候也。总之三者皆属虚证，但有轻重之辨耳。若梦中自遗者，惟幼稚多有之，俟
其气壮而固，或少加调理可愈，无足疑也。（《景岳》）
有睡则遗尿，皆责之虚，所以婴儿脾气未固，老人下元不足，多有此证。在婴儿挟热者十居七八，在老人
挟寒者十居七八，此又不可不辨也。（《必读》）
午前数尿 有人每日从早至午前定尿四次，一日之间又自无事，此肾虚所致，亦犹脾肾泄，早泄而
晚愈，次日又复然者也。（《要诀》）
小便余沥 肾主水。劳伤之人，肾气虚弱，不能藏水，胞内虚冷，故小便后水液不止而有余沥。尺脉
缓细者，小便余沥也。（《病源论》）（按∶《脉经》曰∶尺脉缓，脚弱下肿，小便难，有余沥。》
固涩诸方 《范汪方》治人喜遗尿方。
矾石、牡蛎，分等治合，以黍粥服方寸匕，日三。（《医心》）
《录验方》治遗尿，龙骨散方。
桑耳（三两） 矾石（二两） 牡蛎（二两） 龙骨（三两）
凡四物，合治下筛，服方寸匕，日三。（同上）《外台》无牡蛎，有阿胶。
《古今录验》牡蛎汤，治遗尿小便涩方。
牡蛎（四两熬） 鹿茸（炙四两） 阿胶（炙，各二两） 桑螵蛸（二两）
上四味切，以水五升，煮取二升，分再服。（《外台》）《千金》于本方去桑螵蛸，加桑耳。《圣惠》
治妇人虚冷，小便数，桑螵蛸散，于本方去阿胶，加甘草、黄 ，捣细罗为散，生姜汤调下。（《必读》治阳
气虚弱，小便不禁，去甘草，加人参、赤石脂。）《奇效》泽泻散（主治同），于
本方加泽泻、牡丹皮、赤茯苓，为细末，酒调服。
治不渴而小便大利，遂至于死者方。
牡蛎五两，以患人尿三升，煎取二升，分再服，神验。（《千金》）
治小肠虚冷，小便数多，鹿茸丸方。
鹿茸（二两去毛涂酥炙令黄色） 白龙骨（一两） 山茱萸（三分微炒）
上件药三味，捣罗为末，炼蜜和丸，如梧桐子大，每服二十丸，空心盐汤下，晚食前再服。（《简要济众》）
治小便数方。
上取纯糯米 一手大，临卧炙令软熟啖之，以温酒送下，不饮酒人温汤下，多啖弥佳，行坐良久，待心
间空便睡，一夜十余行者当夜便止。予尝以为戏术，与人赌物，用之如有神圣。或言假火气温水送，不然
也。太多糯稻主缩水，凡人夜饮酒者，是夜辄不尿，此糯米之力也。（苏沈）（原更载糯稻秆治渴，宜考。）
邻家有一男子，小便日数十次，如稠米泔，色亦白，心
神恍惚，瘦瘁食减，以女劳得之，令服此桑螵蛸散，未终一剂而愈。安神魂，定心志，治健忘、小便数，补心
气。桑螵蛸、远志、菖蒲、龙骨、人参、茯神、当归、龟甲醋炙，以上各一两为末，夜卧人参汤调下二钱。
如无桑上者，即用余者。（《本草衍义》）
固真丹，治肾与膀胱虚冷，真气不固，小便滑数。
韭子（四两） 舶上茴香（炒） 补骨脂（炒） 益智子（炒） 鹿角霜（各二两） 白龙骨
（三两 别研细如粉）
上为细末，以青盐、鹿角胶各一两，同煮酒糊为丸，如梧桐子大，每服五十丸，空心温酒送下，盐汤亦
得。（《魏氏》）又破故纸丸，治肾气虚冷，小便无度。破故纸、茴香（并盐炒）等分，酒糊为丸。
缩泉丸，治丈夫小便频。（《史越王氏》）
乌药 川椒（去目并合口者出汗） 吴茱萸（九蒸九曝） 益智（炒）
上等分为细末，酒煮面糊丸，如梧桐子大，每服五六十丸，临卧盐汤下。（同上）《济生续》去川椒、吴
茱，酒煮山药糊为丸。（《得效》名三仙丸。又《白浊》萆 厘清散盖此祖方。）
六味地黄丸，治内虚热者，小便频数不禁。
本方加牡蛎、五味子。（《丹溪附余》）
固脬丸，治小便不禁。
菟丝子（二两制） 茴香（一两） 附子（炮去皮脐） 桑螵蛸（炙焦各半两） 戎盐（一分）
上为细末，酒煮面糊为丸，如梧桐子大，每服三十丸，空心用米饮送下。（《奇效》）《医通》山药末
糊丸，酒下十五丸。
姜附赤石脂朱砂丹，治小便数而不禁，怔忡多忘，魇梦
不已，下元虚冷，遗尿精滑，或阳虚精漏不止。
附子（生） 干姜（各半两） 赤石脂（一两半水飞）
上为细末，酒糊丸，绿豆大，每服十五至二三十丸，大便不和米饮下，小便不禁茯苓汤下。（《准绳》）
黄 束气汤，治气虚遗溺。
黄 （一钱二分） 白芍（一钱） 人参 破故纸（各七分） 升麻 益智仁（各五分） 北五味
子（三分） 薄桂（二分）
水姜煎服，（《儿科方要》）
清凉和温诸方 《范汪方》治小便一日一夜数十行方。
菖蒲、黄连二物，分等治筛，酒服方寸匕。
又方，石膏半斤 咀，以水一斗，煮取五升，稍热服。（以上《葛氏方》同之）（《医心》）
《究原方》醉仙丸，治因劳心，肾经寒，小便多。
白茯苓去皮，不计多少，用黑豆同水煮半日，去豆，出焙为细末，用薏苡仁炒碾为细末，煮糊为丸，如桐
子大，每服五七十丸，以枣汤服下，空腹临睡服。（《万安》）（按∶此《苏沈》梦泄茯苓散之意。）
四君子汤，诸急病遗尿不禁者，此方主之。诸急病，谓卒然暴仆诸疾也。遗尿不禁者，形气将脱，无形之
气不足以固有形之溺也。甘温为阳，可使益气，故人参、白术、茯苓、甘草皆甘温也，可以用之。（《方
考》）（按∶此方何能堪急病不禁，但缓证或有相适，姑存之。）
治肾虚小便多，阿胶汤方。
阿胶（炙令燥别捣末） 人参（各一两） 干姜（炮二两 远志（去心） 附子（一枚炮制去皮脐） 甘
草（炙锉三两） 大麻仁（烂研一两）
上七味，粗捣筛五味，与麻仁拌匀，每服六钱匕，水二
盏，煎至一盏，去滓入阿胶末半钱匕，更煎两沸，食前温
服，日三。（《圣济》）（按∶此方本出《千金·消渴》中。今加入人参、甘草。）
治气牵腰背，及胁内痛，小腹坚，小便不禁，当归汤。（同上）（按∶即张
Various diseases of urination, excluding those involving strangury (Strangury) and turbid urine causing obstruction, are recorded here under the category of lower jiao (Lower Jiao) failure to control. They are analyzed and listed separately. However, the formulas used can be generally applicable, so they are not differentiated by specific syndromes.
**Excessive Urination Frequency and Volume:** Excessive urination frequency and volume is caused by deficiency-cold of the bladder and slipperiness of the urinary bladder organ. The Kidney is a Zang organ, and the Bladder is its Fu organ; they are exterior-interior pairs, both governing water metabolism, with Kidney Qi extending downward to the external genitalia. Since the Fu organ is deficient and cold, it cannot warm its corresponding Zang organ, resulting in white and abundant urine. If nocturia is particularly severe at night, it is due to the generation of internal Yin pathogenic factors. (*Zhu Bing Yuan Hou Lun*)
Excessive urination frequency and volume results from deficiency-cold of the lower origin (Lower Origin), where the Kidney fails to secure water, leading to leakage and excretion. Suitable formulas include Tusizi Wan (Cuscuta Seed Pill), Bawei Wan (Eight-Ingredient Pill), Xuantu Dan (Black Cuscuta Elixir), and Shengliao Lurong Wan (Unprocessed Deer Antler Pill). (*Jisheng Baci*) [Note: *Liuyao* adds: I observe that if Kidney Qi cannot secure water, descending exceeds ascending; only major tonification can help, and Ginseng, Cinnamon Twig, and Aconite Root are appropriate.]
**Frequent Urination:** Frequent urination occurs because both the Bladder and Kidney are deficient, allowing guest-heat (Guest Heat) to take advantage of this weakness. The Kidney and Bladder are exterior-interior pairs, both governing water, with Kidney Qi extending downward to the external genitalia. Having become deficient, these two meridians are susceptible to guest-heat. Deficiency leads to an inability to control water, causing frequency. Heat in the urine causes sluggish flow; sluggishness leads to discomfort during urination, resulting in frequent urges. (*Zhu Bing Yuan Hou Lun*)
Xu Renze discusses two types of this disease: First, frequent urination accompanied by thirst, increased appetite, gradual muscle wasting, fatigue, and poor complexion; this is Xiao Ke (Wasting and Thirsting Syndrome). Second, frequent urination but not necessarily excessive volume, no thirst, normal diet, or slightly increased urination upon exposure to cold weather, with no other symptoms; this is caused by deficiency-cold. Generally, both conditions stem from Cold of Kidney Qi and the Bladder. If untreated, they can be fatal. Kidney deficiency with cold waist poses less danger. (*Waitai Miyao*)
If there is constant urgency with frequent voiding but small volumes each time, followed by renewed urgency without dysuria or pain, it is not Strangury. Sometimes, shortly after finishing urination, one feels empty but then passes a small amount again; this is often due to holding urine or engaging in sexual activity while holding urine. Suitable treatment is Shengliao Wuling San (Raw Five-Ling Powder), reducing Ze Xie by half, adding one qian of Ejiao (Donkey-Hide Gelatin), taken with Bawei Wan. This pill must contain Wuweizi (Schisandra Berry). (*Jisheng Baci*)
Frequency with small volume indicates Heat; treat with Fuling Hupo Tang (Poria and Amber Decoction) to promote diuresis. Frequency with large volume indicates Deficiency; treat with herbs like Shanyao (Dioscorea Rhizome), Lianrou (Lotus Seed Endosperm), and Yizhiren (Bitter Apricot Seed) to astringe. (*Liuyao*)
Frequent urination with clear, long stream indicates Deficiency-Cold; frequent urination with small volume, yellow-red color, and dysuria indicates Heat. Corroborate with pulse diagnosis (surging and rapid, forceful or forceless, slippery or choppy) to avoid errors. Generally, summer has less urine, winter has more; this reflects the principles of Cold and Heat. (*Chishui Xuanzhu*) [Note: Refer to *Ling Shu: Wu Long Jin Ye Bie Lun*.]
**Urinary Incontinence:** Urinary incontinence is caused by Kidney Qi deficiency and Cold in the lower jiao. The Kidney governs water, with its Qi extending downward to the external genitalia. Kidney deficiency and lower jiao cold prevent the warming and controlling of fluids, leading to incontinence. (*Zhu Bing Yuan Hou Lun*)
Blood stasis in the lower jiao, combined with chronic deficiency damage, leads to involuntary passage of urine and feces without awareness. Lower jiao deficiency-cold, failing to warm and control fluids, leads to inability to restrain the urge to urinate. Both result from the Heart and Kidney failing to communicate. (*Zhizhi Fang*)
Treatment of urination disorders should focus on form and Qi. Incontinence is a disorder of form and Qi: mild cases involve Bi obstruction in the bladder; severe cases involve collapse of Great Qi. (*Fangkao*)
"Incontinence" means lack of restraint, with frequent and abundant urination regardless of count. The classics state: "Unceasing urine indicates the Bladder fails to store." Causes include Damp-Heat and exhaustion of the lower origin. Frequency with small volume is Heat; frequency with large volume is Deficiency. Elderly people often suffer from this due to declining Yang Qi and inability to constrain. I have seen several cases ending fatally due to lack of self-care and dissipation of Shen (Spirit). Ancients said: "Obstruction is Heat; Incontinence is Cold." This stems from weak Heart-Kidney Qi, declining Yang Dao, and loss of transformation rules. Treatment requires warming and tonifying, nurturing Shen gently, and using medicine to strengthen the Kidney. When Shen is complete and Kidney solid, Bladder Qi fills and restraint returns. Early treatment is crucial for any chance of recovery. (*Chishui Xuanzhu*)
Ancient texts debate whether incontinence is Heat or Cold. However, "incontinence" implies excessive free passage, belonging to Deficiency-Cold, not Heat. If Heat causes frequency, it presents as dribbling, difficulty passing, pain, or dysuria, which differs from incontinence. Mistaking Deficiency-Cold for Heat and using fire-draining formulas is dangerous. (*Jinkui Yi*) [Note: *Yuanbing Shi* and Wang Shi's *Zazhe* attribute incontinence to Heat. *Chishui* and Jingyue refute this. You Shi's view is concise and accurate, so it is cited. *Bidu* mentions Liver Depression-Heat causing incontinence worsening with warming tonics, treated successfully with Longdan Xiegan Tang plus Huangjichang, representing a variant syndrome.]
Generally, ancient formulas use astringents for incontinence, which is appropriate but treats the branch, not the root. Astringents merely close the gate. Water metabolism involves the Kidney and Lung; if Lung Qi lacks authority, Kidney Water cannot be secured. Thus, treating water requires treating Qi, and treating the Kidney requires treating the Lung. Use Ginseng, Danggui (Angelica Sinensis), Baizhu (Atractylodes Macrocephala), Guizhi (Cinnamon Twig), Fuzi (Aconite Root), Ganjiang (Dried Ginger) as main ingredients, then add astringents as auxiliaries according to circumstances. Otherwise, trying to stop the flood is futile. My Gongdi Wan (Gongdi Pill) is suitable for all cases involving Heart, Spleen, Lung, or Kidney. (*Jingyue Quanshu*) [Note: Gongdi Wan contains Shudihuang (Rehmannia Root), Tusizi (Cuscuta Seed), Baizhu (Atractylodes Macrocephala), Wuweizi (Schisandra Berry), Yizhiren (Bitter Apricot Seed), Poguozhi (Psoralea Fruit), Fuzi (Aconite Root), Fuling (Poria), Jiucai Zi (Leek Seed), formed into pills with Yam paste.]
For incontinence caused by overuse of diuretics for prior strangury, use Ginseng and Huangqi (Astragalus Root) for major tonification, with a little Shufuzi (Prepared Aconite Root). (*Liuyao*)
In women, laxity of the lower orifice causes frequency when cold and sudden urination when coughing, also classified as incontinence. (*Yizong Shengmo*)
**Enuresis and Bedwetting:** Enuresis is caused by deficiency-cold of the Bladder, unable to constrain water. The Bladder is the Foot-Taiyang Meridian, and the Kidney is the Foot-Shaoyin Meridian; they are exterior-interior pairs. The Kidney governs water, with Qi extending to the external genitalia; urine is the residue of body fluids. The Bladder is the repository of fluids. Deficiency-cold and weak Yang Qi lead to enuresis. Pulse diagnosis: Pulse exceeding Cun entering Yuji indicates enuresis. Slightly slippery Liver pulse indicates enuresis. Deep Yin pulse at Left Guan indicates absence of Liver pulse, suffering from enuresis. Solid Chi pulse with lower abdominal pain indicates incontinence. Deficient Chi pulse indicates incontinence. Kidney disease with incontinence should show deep-slippery pulse but shows floating-large instead. Complexion should be black but appears yellow; this is Earth overcoming Water, a counter-indication, untreatable. (*Zhu Bing Yuan Hou Lun*) [Note: Pulse descriptions: Liver pulse slightly slippery from *Ling Shu*, others from *Mai Jing*. Chi deficiency unverified.]
Bedwetting symptom: Individuals sleeping and unknowingly wetting themselves have constitutionally excess Yin and deficient Yang. Bladder and Kidney Qi are cold, failing to warm/control water, leading to abundance or incontinence. Bladder (Foot-Taiyang) is the Fu of Kidney (Foot-Shaoyin); together they govern water. At sunset, Yang ends, Yin receives Qi. At midnight, Yin and Yang meet, Qi intersects, inducing sleep. Urine is fluid residue entering the bladder. During sleep, Yang declines, failing to control Yin, so Yin dominates, water flows uncontrollably, causing bedwetting. (*Ibid.*)
Loss of control is called Enuresis. Self-discharge during sleep is called Bedwetting. (*Zhizhi Fang · Pediatrics*)
Sleeping enuresis is due to lower origin cold and lack of constraint. Treat with Da Tusizi Wan (Large Cuscuta Seed Pill), taken with decoction of roasted pig bladder. All enuresis belongs to Deficiency. Classics say: "Excess leads to flatus; Deficiency leads to enuresis." Extreme joy damages the Heart; Heart and Small Intestine are exterior-interior. Treat with Liqing Yin and Siqi Tang mixed, taken with Chen Sha Miaoxiang San and Xiaotusizi Wan or Xuantu Dan. (*Jisheng Baci*)
Enuresis in young adults indicates lower origin Heat. Heat agitates Fire, causing nocturnal emission. Although loss occurs, Yang-Heat is strong and pulse is forceful. Treatment requires clearing Heat. (*Yizong Shengmo*) [Note: *Yuanbing Shi* and Danxi have unclear views on Heat-type enuresis; not recorded as standard.]
Kidney governs closure. Kidney deficiency leads to lack of constraint and spontaneous leakage. Middle-aged people with excessive sexual activity often have this. Also, excessive Damp-Heat in the lower jiao forcing water to flow recklessly occurs in alcoholics. Nocturnal enuresis in youth is blamed on Fire; in middle age, on Deficiency. Clear Heat with Zhizi (Gardenia Fruit), Mutong (Akebia Stem), Fuling (Poria); Tonify Deficiency. (*Liuyao*)
Enuresis is loss during sleep, realized upon waking. Common in children, rare in adults. Children have weak Yang and poor constraint, active spirits, leading to night losses. Ancient formulas use warming herbs to nourish Yang. Classics say: "Deficiency leads to enuresis, lack of constraint leads to enuresis." I saw adults aged 20-30 with persistent enuresis who had no children; likely due to lower origin deficiency-cold. (*Chishui Xuanzhu*) [Note: Liu Hejian, Danxi, and *Qianjin Yifang* attribute some cases to Heat. Pulse and symptoms must be correlated to avoid bias. My previous discussion focused on Cold as the general rule. Diseases vary in Cold/Heat/Deficiency/Excess and start/end differently; treatments must be flexible. Reference *Qianjin Yifang* for verification.]
Enuresis includes spontaneous loss during sleep, incontinence due to insecure Qi gates, and loss due to upper Qi collapse causing lower jiao unconstraint. These are extreme Deficiency signs. Spontaneous dream loss is mostly in children; resolve with growth and minor regulation. (*Jingyue Quanshu*)
Bedwetting is always blamed on Deficiency. Infants have unstable Spleen Qi; elderly have insufficient lower origin. Infants often have accompanying Heat (70-80%); elderly often have accompanying Cold (70-80%). Differentiation is essential. (*Yizong Bidu*)
**Morning Frequent Urination:** Some individuals urinate four times daily until noon, otherwise asymptomatic. This is due to Kidney Deficiency, similar to Spleen-Kidney diarrhea occurring early and resolving late, recurring the next day. (*Jisheng Baci*)
**Post-void Dribbling:** The Kidney governs water. Fatigue injury weakens Kidney Qi, preventing water storage. Cold in the bladder organ causes post-void dribbling. Slow and fine Chi pulse indicates post-void dribbling. (*Zhu Bing Yuan Hou Lun*) [Note: *Mai Jing*: "Slow Chi pulse, weak legs, lower edema, difficult urination, dribbling."]
**Astringent Formulas**
*Fan Wang Fang* for frequent enuresis:
Alum (Mingfan) and Oyster Shell (Muli), equal parts, mix. Take one cun bi with millet porridge, three times daily. (*Yixin Fang*)
*Luyuan Fang* Longgu San for enuresis:
Sang'er (Auditory Fungus, 3 liang), Mingfan (2 liang), Muli (2 liang), Longgu (Dragon Bone, 3 liang).
Process four items, sieve, take one cun bi, three times daily. (*Ibid.* *Waitai* omits Muli, adds Ejiao.)
*Gujin Luyan* Muli Tang for enuresis with dysuria:
Muli (Oyster Shell, 4 liang calcined), Lurong (Deer Antler, 4 liang roasted), Ejiao (Donkey-Hide Gelatin, 2 liang roasted), Sangpiaoxiao (Mantis Egg Case, 2 liang).
Cut four items, boil in 5 sheng water to 2 sheng, divide into two doses. (*Waitai*). *Qianjin* removes Sangpiaoxiao, adds Sang'er. *Shenghui* formula for female deficiency-cold frequency removes Ejiao, adds Gancao (Licorice) and Huangqin (Scutellaria), taken with Ginger decoction. (*Bidu* for Yang deficiency incontinence removes Gancao, adds Renshen (Ginseng) and Chishizhi (Red Halloysite). *Qixiao* Zexie San adds Zexie (Alisma), Mudanpi (Tree Peony Bark), Chifuling (Red Poria), taken with wine.)
Formula for non-thirsty excessive urination leading to death:
Muli (5 liang), boiled in 3 sheng of patient's urine to 2 sheng, divided into two doses. Miraculous. (*Qianjin*)
Lurong Wan for Small Intestine deficiency-cold with frequent urination:
Lurong (2 liang, hair removed, butter-roasted), Baigulong (White Dragon Bone, 1 liang), Shanzhuyu (Cornus Fruit, 0.3 liang lightly roasted).
Grind to powder, honey pills, wutong seed size. Take 20 pills fasting with salt water, repeat before evening meal. (*Jianyao Jizhong*)
Formula for frequent urination:
Take pure glutinous rice, hand-sized, roast until soft, eat before bed, wash down with warm wine (or warm water if non-drinker). Eat more if possible. Walk/sit for a while, sleep when stomach is empty. Stops nocturia immediately. Glutinous rice retains water. (*Su Shen Liangfang*)
Neighbor's man with frequent urination, cloudy white urine, mental confusion, emaciation, due to female labor strain. Treated with Sangpiaoxiao San (Mantis Egg Case Powder): Sangpiaoxiao, Yuanzhi (Polygala Root), Changpu (Acorus Rhizome), Longgu, Renshen, Fushen (Poria with Hostwood), Danggui (Angelica Sinensis), Guijia (Turtle Shell vinegar-roasted), 1 liang each. Powder. Take 2 qian with Ginseng decoction at night. (*Bencao Yan yi*)
Guzhen Dan for Kidney/Bladder deficiency-cold, insecure True Qi, slippery frequent urination:
Jiu Zi (Leek Seed, 4 liang), Bo Shang Huixiang (Fennel, stir-fried), Buguzhi (Psoralea Fruit, stir-fried), Yizhi Zi (Bitter Apricot Seed, stir-fried), Lu Jiaoshuang (Deer Antler Glue Frost, 2 liang each), Baigulong (White Dragon Bone, 3 liang finely ground).
Powder. Boil Qingyan (Green Salt) and Lu Jiaojiao (Deer Antler Glue, 1 liang each) in wine to make paste pills, wutong seed size. Take 50 pills fasting with warm wine or salt water. (*Wei Shi*)
Poguozhi Wan for Kidney Qi deficiency-cold, unlimited urination: Poguozhi, Huixiang (salt-roasted), equal parts, wine paste pills.
Suoquan Wan for male frequent urination (*Shi Yue Wang Shi*):
Wuyao (Lindera Root), Chuanjiao (Sichuan Pepper), Wuzhuyu (Evodia Fruit), Yizhi (Bitter Apricot Seed).
Powder. Wine-boiled wheat paste pills, wutong seed size. Take 50-60 pills before bed with salt water. (*Ibid.* *Jisheng Xu* removes Chuanjiao/Wuzhuyu, uses Yam paste. *Defang* calls it Sanxian Wan. *Baizhuo* Bixie Qingfen San derives from this.)
Liuwei Dihuang Wan for internal deficiency-heat, frequent incontinent urination:
Base formula + Muli (Oyster Shell), Wuweizi (Schisandra Berry). (*Danxi Fuyu*)
Guobao Wan for urinary incontinence:
Tusizi (Cuscuta Seed, processed, 2 liang), Huixiang (Fennel, 1 liang), Fuzi (Aconite Root, prepared, peeled), Sangpiaoxiao (Mantis Egg Case, roasted, 0.5 liang each), Rongyan (Rock Salt, 0.1 fen).
Powder. Wine-boiled wheat paste pills, wutong seed size. Take 30 pills fasting with rice drink. (*Qixiao*). *Yitong* uses Yam powder paste, 15 pills with wine.
Jiangfu Chishizhi Zhusha Dan for frequent incontinent uritation, palpitations, forgetfulness, nightmares, lower origin cold, enuresis, spermatorrhea, or Yang deficiency seminal leakage:
Fuzi (Raw, 0.5 liang), Ganjiang (Dried Ginger, 0.5 liang), Chishizhi (Red Halloysite, water-washed, 1.5 liang).
Powder. Wine paste pills, mung bean size. Take 15-30 pills. For bowel issues, rice drink; for incontinence, Fuling Tang. (*Zhunseng*)
Huangqi Shuqi Tang for Qi-deficiency enuresis:
Huangqi (Astragalus Root, 1.2 qian), Baishao (White Peony Root, 1 qian), Renshen (Ginseng), Poguozhi (Psoralea Fruit, 0.7 qian each), Shengma (Cimicifuga Rhizome), Yizhiren (Bitter Apricot Seed, 0.5 qian each), Bei Wuweizi (Schisandra Berry, 0.3 qian), Bao Gui (Thin Cinnamon Twig, 0.2 fen).
Decoct with water and Ginger. (*Erke Fangyao*)
**Cooling and Warming Formulas**
*Fan Wang Fang* for dozens of voidings per day:
Changpu (Acorus Rhizome), Huanglian (Coptis Rhizome), equal parts, sieve. Take one cun bi with wine.
Another formula: Shigao (Gypsum, 0.5 jin), crushed, boil in 10 dou water to 5 sheng, take warm. (*Ge Shi Fang*). (*Yixin Fang*)
*Jiuyuan Fang* Zuixian Wan for Heart-labor, Kidney meridian cold, frequent urination:
Baifuling (Poria, peeled, any amount), boil with Black Soybeans for half a day, remove beans, dry, grind. Mix with fried/coarse-ground Coix Seed (Yiyiren) paste. Pills, wutong seed size. Take 50-70 pills with Jujube decoction, fasting before bed. (*Wan'an*) [Note: Based on *Su Shen* Mengxie Fuling San.]
Sijunzi Tang (Four Gentlemen Decoction) for acute enuresis/incontinence. Acute diseases refer to sudden collapse. Incontinence here indicates impending Qi collapse, where formless Qi cannot hold formed urine. Sweet-Warm herbs tonify Qi. Renshen, Baizhu, Fuling, Gancao are sweet-warm. (*Fangkao*) [Note: May not suit acute cases, but fits chronic ones. Retained for reference.]
Ejiao Tang for Kidney deficiency frequent urination:
Ejiao (Roasted, powdered), Renshen (1 liang each), Ganjiang (Dried Ginger, 2 liang roasted), Yuanzhi (Polygala Root, heart removed), Fuzi (Aconite Root, 1 piece prepared), Gancao (Licorice Root, 3 liang roasted/crushed), Dama Ren (Hemp Seed, mashed, 1 liang).
Coarsely grind five items, mix with Hemp Seed. Take 6 qian bi, boil in 2 zhan water to 1 zhan, strain, add Ejiao powder (0.5 qian bi), boil twice more. Warm take before meals, three times daily. (*Shengji Zonglu*) [Note: Originally from *Qianjin · Xiao Ke*, now added Ginseng/Gancao.]
Danggui Tang for Qi pulling back/waist/flank pain, hard lower abdomen, incontinence. (*Shengji Zonglu*) [Note: i.e., Zhang Zhongjing...]