（胞痹附）
闭者，小便不通。癃者，小便不利。遗溺者，小便不禁。虽膀胱见症，实肝与督脉三焦主病也。经云∶
膀胱之胞薄以濡，得酸则蜷缩，约而不通，水道不行。又云∶膀胱不利为癃，不约为
遗溺，此但主膀胱言之也。夫膀胱仅主藏溺。主出溺者，三焦之气化耳。故经云∶三焦下 ，并太阳正脉，
入络膀胱，约下焦，实则闭癃，虚则遗溺。又云∶肝脉过阴器，其病闭癃。又云∶女子督脉入系廷孔，男子
循茎下至篡。病不得前后，此闭癃遗溺，所由兼责诸经也。分言之，闭癃为实，遗溺为虚。闭为暴病，癃为久
病。闭则点滴难通，全资气化，或疏通利窍，或用丹溪吐法，以升提其气。诸溺闭治法，已见小便不通论中。
此特详溺癃治法。癃为滴沥不爽，惟滋养真阴，清热化气，升提非所宜矣。仲景云∶阴虚则小便难。经曰∶阳入阴
分，则膀胱热而小便难。东垣云∶小便不通，皆邪热为病。治分在气在血。以渴与不渴辨之，渴而不利，或黄
或涩，热在上焦气分也。宜清肺气而滋水源，黄芩清肺饮。闭而不渴，热在下焦血分也。宜润肾燥以导其流，
滋肾丸。若服淡渗之味，则阳无以化，而阴愈闭窒矣。其阴虚血热，渴而涩痛淋沥者，导赤散，切忌用五苓。
或大便水泻，小便涩少，五苓散渗泄之。若湿热传于下焦，水道不利，益元散清利之。若气机闭塞，升降不通，
二陈汤去半夏，加木通、滑石、升麻以提之。若右寸数大，肺燥不能生水，是气化不及州都。生脉散去五味，
加紫菀、车前子、茯苓。左寸数大，心火盛，移热于小肠，天冬、麦冬、犀角、黄连、赤茯、白芍。或肾火衰，
水不能化，金匮肾气丸。或元气下陷，宜升清降浊，补中益气汤加木通、车前。或血瘀下焦，小便闭涩，代抵
当汤。此治闭癃大概也。若遗溺一症，有睡中自遗者，有气不摄而频数不禁者，有气脱于上，则下焦不约，
而遗失不知者，睡中自遗，幼稚多有，俟其气壮乃固，或调补心肾自愈。寇氏桑螵蛸散。惟水泉不止，膀胱不
藏，多是年衰气弱，以气为水母，水不能蓄，由气不固摄也。宜参、 、归、术、益智、五味、补骨脂、升麻。
甚至气脱而遗失不知，惟类中风症，及大病后有之。宜独参汤。大抵遗溺失禁，由肺肾膀胱气虚。肺虚，补中益
气汤加五味、牡蛎。肾虚，菟丝子散。膀胱虚，固脬丸。夹寒，家韭子丸。夹热，白薇散。滑脱，秘元丹、牡
蛎丸。命火衰，右归饮、巩堤丸。治水必先治气，治肾必先治肺，惟巩堤丸一方，凡心脾肺肾之属皆宜。有
因恐惧辄遗者，此心气
不足，下及肝肾而然，宜归脾汤或五君子煎。下元亏损，固精丸。睡中自遗，多属下元虚冷，宜螵蛸丸。
然遗失不知，必交通心肾，寇氏桑螵蛸散。小儿自遗多属热，沈氏 泉丸。间或因寒， 泉丸去山栀，加山萸、
补骨脂。老人不禁，多虚寒，大菟丝子丸加减。间亦有热，萆 厘清饮。节斋谓∶老人溺频数者，由膀胱血
少，阳火偏旺。宜滋肾中真阴，补膀胱津液。六味丸加麦冬、五味。戴氏云∶老人溺多者，由下元虚寒、
肾不摄水，以致渗泄，宜八味丸、生料鹿茸丸。其滴沥不禁者，为真阳不固，宜固脬散，若不效，加减桑螵
蛸散。昼甚为阳虚，补中益气汤。夜甚为阴虚，八味丸。脬气不足，溺频昼甚者，缩泉丸。夜间溺多者，八
味丸加五味。溺频而少为热，宜渗之，四苓散加滑石、甘草。频数久而益甚者，属脾虚气弱，补中益气汤
加五味、山药。若溺涩得补益甚者，为膀胱热结，宜山栀、茯苓、木通、滑石、甘草、竹叶、灯芯。溺涩而茎
中痛者，属肝肾湿热，龙胆泻肝汤。溺后余沥，属肾气虚，茯菟丸加覆盆子、益智仁。咳而遗溺，属膀胱急，
茯苓甘草汤。不应，五苓散可效。妊妇溺出不知，或由脬热，加味逍遥散。或由脾肺气虚，补中益气汤。或由
肝肾阴虚，六味丸。产后小便不禁，或脬损，固脬丸、八珍汤，补脬饮加参、术或猪羊脬煎。俟饥时大剂
饮之，令气血骤长，迟则难效。产育不顺，致伤膀胱，或收生不谨，损破尿脬，皆能致小水失禁也。或由膀
胱气虚，加味补中汤。此治遗溺大概也。
〔胞痹〕胞居膀胱之中，受气化以藏溺出溺者也。经曰∶胞移热于膀胱，盖膀胱内别有胞，得气化而
为溺以出也。若气痹不通，必由膏粱积热于上，作强伤精于下，湿热乘虚，结于胞中，故痹也。经曰∶胞痹者，
小腹膀胱，按之内痛。若沃以汤，涩于小便，上为清涕。盖以膀胱既虚，不能上吸肺气，肺气不清，不能下通
水道，所以痹塞不利。得热汤之助，则小便涩涩微通，其气循经蒸发，肺乃暂开，清涕亦得上泄矣。条其治法∶
由膀胱伤湿，致痹而溺涩者，肾着汤加萆 。由实热致痹而溺痛者，葵子丸。由湿热致痹而溺不利者，肾沥汤。
由虚寒致痹而溺闭者，巴戟丸。其艰涩如淋不痛者，非胞病，属肾阴虚，六味丸加肉苁蓉、
鹿茸。其老人精气已衰，犹不绝欲，小便涩痛，少腹胀闭，牵引谷道者，肾气丸。昼苦溺涩，夜则遗溺者，
属肾气大亏，地黄饮子。其膀胱气坠，溺道不爽者，补中益气汤。石顽有治胞痹案数则，医者忽之，今特标为
论焉。
(Attached to Bladder Bi Syndrome)
Bi (obstruction) refers to the complete inability to urinate. Long (stagnation) refers to difficult, dribbling urination. Yi Niao (enuresis/incontinence) refers to involuntary loss of urine. Although these symptoms manifest in the Bladder, they are essentially diseases governed by the Liver, Du Mai (Governing Vessel), and San Jiao (Triple Burner). The Classics state: "The sac of the Bladder is thin and moist; upon encountering sour flavors, it contracts and curls, becoming too tight and obstructed, so that the water pathway cannot flow." It also states: "When the Bladder is not free-flowing, it becomes Long; when it lacks restraint, it becomes Yi Niao." This discusses only from the perspective of the Bladder. In fact, the Bladder merely stores urine; what governs the discharge of urine is the Qi transformation of the San Jiao. Therefore, the Classics say: "The lower part of the San Jiao runs parallel with the principal meridians of Taiyang, enters and connects with the Bladder, and restrains the Lower Jiao. When excess, it causes Bi and Long; when deficiency, it causes Yi Niao." It also says: "The Liver meridian passes through the genitalia, and its disease manifests as Bi and Long." It further says: "In women, the Du Mai enters and connects to Ting Kong (the external genital opening); in men, it follows the penis down to the perineum. If both anterior and posterior passages are blocked..." This explains why Bi, Long, and Yi Niao must be investigated across multiple meridians. Separately speaking, Bi and Long belong to Excess patterns, while Yi Niao belongs to Deficiency patterns. Bi is an acute condition, whereas Long is a chronic condition. In Bi syndrome, where drops are difficult to pass, treatment relies entirely on Qi transformation, using either methods to unblock orifices or Zhu Danxi's vomiting method to raise and lift the Qi. The treatments for various urinary obstructions have already been discussed in the section on "Incomplete Urination." Here, we specifically detail the treatment for Long. Long presents as dribbling without smoothness; it is suitable to nourish True Yin and clear heat to transform Qi, but raising/lifting methods are inappropriate. Zhang Zhongjing said: "Yin deficiency leads to difficulty in urination." The Classics state: "When Yang Qi enters the Yin level, there is heat in the Bladder leading to difficulty in urination." Li Dongyuan said: "Urinary obstruction is always caused by pathogenic heat." Treatment must distinguish between involvement of the Qi level or Blood level. Differentiate by thirst: if thirsty and urination is difficult, with yellow or astringent urine, the heat is in the Upper Jiao Qi level. It is appropriate to clear Lung Qi to nourish the water source, using Huang Qin Qing Fei Yin (Scutellaria Decoction to Clear the Lungs). If obstructed but not thirsty, the heat is in the Lower Jiao Blood level. It is appropriate to moisten Kidney dryness to guide the flow, using Zi Shen Wan (Nourish the Kidney Pill). If bland diuretics are taken, Yang has no means to transform, and Yin becomes more closed and stagnant. For those with Yin deficiency and blood heat, presenting with thirst, astringency, pain, and dribbling, use Dao Chi San (Guide Out the Red Powder); strictly avoid Wu Ling San (Five-Ingredient Powder with Poria). Or, if accompanied by watery diarrhea and scanty, astringent urination, use Wu Ling San for leaching and draining. If damp-heat transmits to the Lower Jiao causing poor water passage, use Yi Yuan San (Benefit the Origin Powder) to clear and promote urination. If Qi mechanism is blocked and ascending/descending functions are impeded, use Er Chen Tang (Two-Aged Decoction) removing Ban Xia (Pinelliae Rhizoma), adding Mu Tong (Akebiae Caulis), Hua Shi (Talcum), and Sheng Ma (Cimicifugae Rhizoma) to lift. If the Right Cun pulse is rapid and large, indicating Lung dryness failing to generate water, this is Qi transformation failing to reach Zhou Du (Bladder). Use Sheng Mai San (Generate the Pulse Powder) removing Wu Wei Zi (Schisandrae Fructus), adding Zi Wan (Asteris Radix), Che Qian Zi (Plantaginis Semen), and Fu Ling (Poria). If the Left Cun pulse is rapid and large, indicating excessive Heart Fire transferring heat to the Small Intestine, use Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Xi Jiao (Rhinocerotis Cornu - *note: substitute with Buffalo Horn in modern practice*), Huang Lian (Coptidis Rhizoma), Chi Fu Ling (Red Poria), and Bai Shao (Paeoniae Radix Alba). Or, if Kidney Fire is weak and water cannot transform, use Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet). Or, if Yuan Qi sinks, it is appropriate to raise the clear and descend the turbid, using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) adding Mu Tong and Che Qian Zi. Or, if blood stasis is in the Lower Jiao causing urinary closure and astringency, use Dai Di Dang Tang (Substitute for Dang Dang Decoction). These are the general treatments for Bi and Long. Regarding Yi Niao, some occur during sleep (nocturnal enuresis), some due to Qi failing to control resulting in frequency and incontinence, and some due to Qi collapse in the upper body causing the Lower Jiao to lack restraint, leading to unaware leakage. Nocturnal enuresis is common in children; wait until Qi and Blood are robust to solidify, or regulate and tonify Heart and Kidney for self-healing. Kou Zhi's Sang Piao Xiao San (Mantis Egg Case Powder) may be used. Only when urine flows like a spring without cessation, and the Bladder fails to store, is it mostly due to aging and weak Qi. Since Qi is the mother of Water, water cannot accumulate because Qi fails to secure. It is appropriate to use Ren Shen (Ginseng Radix), [Missing Character], Dang Gui (Angelicae Sinensis Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Wu Wei Zi (Schisandrae Fructus), Gu Pu Zhi (Psoraleae Fructus), and Sheng Ma (Cimicifugae Rhizoma). Even in cases of Qi collapse with unaware leakage, seen mainly in stroke-like syndromes or after severe illness, use Du Shen Tang (Single Ginseng Decoction). Generally, enuresis and incontinence result from Qi deficiency of the Lung, Kidney, and Bladder. Lung deficiency: Bu Zhong Yi Qi Tang adding Wu Wei Zi and Mu Li (Ostreae Concha). Kidney deficiency: Tu Si Zi San (Dodder Seed Powder). Bladder deficiency: Gu Pao Wan (Secure the Sac Pill). With Cold: Jia Jiu Zi Wan (Leek Seed Pill). With Heat: Bai Wei San (Cynanchum Atratum Powder). Slippage: Mi Yuan Dan (Secret Essence Elixir) or Mu Li Wan (Oyster Shell Pill). Decline of Ming Men Fire: You Gui Yin (Right Restoration Decoction) or Gong Di Wan (Fortify the Dam Pill). Treating water requires first treating Qi; treating the Kidney requires first treating the Lung. Only Gong Di Wan is suitable for all aspects involving Heart, Spleen, Lung, and Kidney. Those who leak urine upon fear have insufficient Heart Qi affecting the Liver and Kidney; Gui Pi Tang (Restore the Spleen Decoction) or Wu Jun Zi Jian (Five Gentlemen Decoction) is appropriate. Lower Yuan depletion: Gu Jing Wan (Secure Essence Pill). Nocturnal enuresis often indicates cold in the Lower Yuan; Sang Piao Xiao Wan (Mantis Egg Case Pill) is suitable. However, unaware leakage requires communicating Heart and Kidney; Kou Zhi's Sang Piao Xiao San is used. Pediatric nocturnal enuresis is often due to heat; Shen Shi [Missing Character] Quan Wan is used. Occasionally due to cold, remove Zhi Zi (Gardeniae Fructus) from [Missing Character] Quan Wan, add Shan Yu Rou (Corni Fructus) and Gu Pu Zhi. Elderly incontinence is mostly deficiency-cold; Da Tu Si Zi Wan (Large Dodder Seed Pill) modified is used. Occasionally due to heat, Bi Xie Fen Qing Yin (Dioscorea Hypoglauca Decoction to Separate the Turbid) is used. Jie Zhai stated: Frequent urination in the elderly is due to scanty Bladder blood and dominant Yang fire. It is appropriate to nourish True Yin in the Kidney and replenish Bladder fluids; Liu Wei Wan (Six-Ingredient Pill) adding Mai Dong and Wu Wei Zi. Dai Shi stated: Excessive urination in the elderly is due to deficiency-cold in the Lower Yuan and Kidney failing to control water, leading to seepage; Ba Wei Wan (Eight-Ingredient Pill) or Sheng Lu Rong Wan (Raw Deer Antler Pill) are suitable. Dribbling incontinence indicates insecure True Yang; Gu Pao San (Secure the Sac Powder) is used. If ineffective, modify Sang Piao Xiao San. Worse during the day indicates Yang deficiency; Bu Zhong Yi Qi Tang is used. Worse at night indicates Yin deficiency; Ba Wei Wan is used. Insufficient Qi of the Sac with frequent daytime urination: Suo Quan Wan (Retain the Fountain Pill). Frequent nighttime urination: Ba Wei Wan adding Wu Wei Zi. Frequent but scanty urination indicates heat; promote leaching with Si Ling San (Four-Poria Powder) adding Hua Shi and Gan Cao (Licorice Root). Frequency worsening over time indicates Spleen deficiency and weak Qi; Bu Zhong Yi Qi Tang adding Wu Wei Zi and Shan Yao (Dioscoreae Rhizoma). If astringency worsens after taking tonics, it indicates Bladder heat accumulation; use Zhi Zi, Fu Ling, Mu Tong, Hua Shi, Gan Cao, Zhu Ye (Bambusae Folium), and Deng Xin Cao (Junci Medulla). Astringency with penile pain indicates Damp-Heat in Liver and Kidney; Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver) is used. Post-void dribbling indicates Kidney Qi deficiency; Fu Tu Wan (Poria and Dodder Pill) adding Fu Pen Zi (Rubiae Fructus) and Yi Zhi Ren. Coughing with enuresis indicates Bladder tension; Fu Ling Gan Cao Tang (Poria and Licorice Decoction). If ineffective, Wu Ling San can be effective. Pregnant women leaking urine may have Sac heat; Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) is used. Or Spleen/Lung Qi deficiency; Bu Zhong Yi Qi Tang. Or Liver/Kidney Yin deficiency; Liu Wei Wan. Postpartum urinary incontinence may be due to Sac damage; Gu Pao Wan, Ba Zhen Tang (Eight-Treasure Decoction), or Bu Pao Yin (Tonify the Sac Decoction) adding Ren Shen and Bai Zhu, or pig/sheep bladder decoction. Drink heavily when hungry to rapidly grow Qi and Blood; delay makes it difficult to be effective. Difficult childbirth injuring the Bladder, or careless midwifery damaging the urethral sac, can cause urinary incontinence. Or Bladder Qi deficiency; Jia Wei Bu Zhong Tang (Modified Tonify Middle Decoction). These are the general treatments for Yi Niao.
[Bladder Bi Syndrome]
The Bao (Sac/Bladder) resides within the Bladder, receiving Qi transformation to store and excrete urine. The Classics state: "If the Bao transfers heat to the Bladder," implying there is another Bao inside the Bladder that transforms into urine for excretion via Qi transformation. If Qi Bi (obstruction) occurs, it is necessarily due to accumulated heat from rich foods above, and injury to essence from excessive sexual activity below, allowing damp-heat to enter via deficiency and knot in the Bao, thus causing Bi. The Classics state: "Symptoms of Bao Bi include pain in the lower abdomen and Bladder upon pressure. It feels as if scalded by hot water, with astringent urination, and clear nasal discharge above." This is because the Bladder, being deficient, cannot absorb Lung Qi upward; since Lung Qi is not clear, it cannot descend to open the water pathways, resulting in Bi obstruction and dysfunction. Assistance from hot liquids allows slight relief of astringency; Qi evaporates along the meridians, temporarily opening the Lung, allowing clear nasal discharge to vent upwards. Summarizing the treatments: Due to Bladder dampness causing Bi and astringent urination, use Shen Zhuo Tang (Sinking Dampness Decoction) adding Bi Xie (Dioscoreae Hypoglaucae Rhizoma). Due to excess heat causing Bi and painful urination, use Kui Zi Wan (Hibiscus Seed Pill). Due to damp-heat causing Bi and difficult urination, use Shen Li Tang (Kidney Filtrate Decoction). Due to deficiency-cold causing Bi and urinary closure, use Ba Ji Wan (Morinda Root Pill). Difficulty resembling strangury but without pain is not a Bao disease, but Kidney Yin deficiency; use Liu Wei Wan adding Rou Cong Rong (Cistanche Herba) and Lu Rong (Deer Antler). For the elderly with depleted essence who continue sexual activity, presenting with astringent/painful urination, lower abdominal distension/closure, and traction to the anus, use Shen Qi Wan (Kidney Qi Pill). Suffering from astringent urination by day and enuresis by night indicates severe Kidney Qi deficiency; use Di Huang Yin Zi (Rehmannia Decoction). Bladder Qi sinking with poor urinary flow: Bu Zhong Yi Qi Tang. Shi Wen had several cases of treating Bao Bi which physicians ignored; now specially marked as a discussion.