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According to *Yuan Bing Shi* (Treatise on the Original Causes of Disease), enuresis with incontinence is caused by cold. *Nei Jing* (The Inner Canon) states that inability to restrain urination is called "yi ni" (involuntary urination). Ren Zhai stated: Urine is the residue of body fluids. The Kidney governs water metabolism, and the Bladder is the mansion storing body fluids. When both the Kidney and Bladder are deficient, and cold pathogenic factors invade them, they cannot control the water, leading to uncontrolled outflow of urine, which is termed "yi niao" (enuresis); when it occurs spontaneously during sleep, it is called "chuang" (bedwetting). These conditions are all caused by deficiency of both the Kidney and Bladder accompanied by cold. They should be treated primarily with Jichang San (Chicken Intestine Powder). There are also cases where heat pathogens lodge in the Kidney region, affecting the Foot-Jueyin Liver Channel, causing extreme stagnation and obstruction in the genital area. As a result, Qi and Blood cannot circulate freely, leading to flaccidity and paralysis where spiritual consciousness loses its function; thus, fluids seep into the Bladder, resulting in immediate leakage of urine that cannot be retained. Xue Shi used Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). For those with deficiency of Spleen and Lung Qi, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used with added Gubuzhi (Fructus Psoraleae) and Shanzhuyu (Fructus Corni). Zeng Shi believed that this condition arises from a loss of coordination in the transmission between the Heart and Kidney, and the constraining mechanisms of the Small Intestine and Bladder fail to hold. Cases of bedwetting during dreams are all due to deficiency-cold of the Lower Yuan (Lower Burner/Kidney system), often stemming from insufficient innate Yang Qi. Treatment involves Jiuzi Wan (Leek Seed Pill) from *San Yin Fang*, as well as Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) and Bushen Dihuang Wan (Kidney-Nourishing Rehmannia Pill). However, one must also strengthen the Earth (Spleen) to preserve Water (Kidney), thereby avoiding the hazard of leakage. This aligns with the principle that "tonifying the Kidney is inferior to tonifying the Spleen." Pingwei San (Calm the Stomach Powder) with doubled Yizhiren (Fructus Alpiniae Oxyphyllae), crushed, decocted with fresh ginger, jujube, and burnt salt, should be taken warm on an empty stomach.

Jichang San (Chicken Intestine Powder)
Chicken intestine (one piece; for male patients, use hen intestines; for female patients, use rooster intestines; calcined to retain efficacy) Ostreae Concha (Oyster Shell) Poria (with skin removed) Sangpiaoxiao (Mantispidae Ootheca) (stir-fried. Each 5 qian) Cinnamomi Ramulus (bark removed) Longgu (Fossilized Bones) (Each 2.5 qian)
Grind the above ingredients into an extremely fine powder. Additionally, take one chicken or rooster intestine, calcine it to retain efficacy, and grind it into an extremely fine powder. Each time, take 1 qian of the aforementioned powder, dissolve it using warm wine, and administer before meals.

[Zhang's] Jichang San Treats conditions where heat exists in the Bladder, excessive intake of cold medicines leads to inability to restrain urination, or enuresis.
Jichangcao (Herba Desmodii Styraacifolii) Longgu (Fossilized Bones) Ophiopogonis Radix (heart removed, baked) Bai Fuling (Poria) Sangpiaoxiao (Mantispidae Ootheca) (Each half liang) Muli Fen (Oyster Shell Powder) (7.5 qian)
Crush the listed herbs into a coarse powder. Each dose consists of 1 qian, decocted with one small cup of water, adding a little fresh ginger and two jujubes. Simmer until reduced to 60%, strain, and take warm. Adjust dosage according to the child's age and size.

Note: This formula and the previous one are likely variants of the same prescription with transcription errors. Upon careful examination, the use of chicken intestine seems more appropriate, whereas Zhang Shi, Lou Shi, and Xue Shi all advocated using Jichangcao. Both versions are preserved here.

Yizhi Wan (Alpinia Seed Pill) Treats deficiency-heat of the Spleen and Kidney, insufficiency of Heart Qi, enuresis, and leukorrhea/cloudy urine.
Yizhiren (Fructus Alpiniae Oxyphyllae) Fuling (Poria) Fushen (Poria with Hostwood) (Equal parts)
Grind into powder, mix with refined honey to form pills the size of tung tree seeds. Take 50–60 pills each time, on an empty stomach, washed down with plain boiled water.

Poguzhi San (Psoralea Powder) Treats deficiency-cold of the Bladder, nocturnal enuresis, or urinary incontinence. Use Poguzhi (Fructus Psoraleae) ground into powder. Take 1 qian each time, mixed with hot water.
Another Prescription: Poguzhi (Fructus Psoraleae), stir-fried and ground into powder, mixed with Huangbai Tang (Phellodendron Bark Decoction).

*Waitai Mi Yao* (Essential Prescriptions Worth a Thousand Gold for Emergencies) treats children who wet the bed during sleep without awareness. Equal parts of Guixin (Cinnamon Twig Powder) and Xiongji Gan (Rooster Liver) are pounded together and formed into pills the size of mung beans. Taken with warm water, three times daily.

Chu Yushi treated pediatric enuresis with Yiyiren (Coix Seed) one he, keeping the heart and shell intact, cracked open, stir-fried with a pinch of salt until yellow. Decocted with two zhong of water until reduced to half a zhong. Taken on an empty stomach. Repeatedly effective.

Jiuzi Wan (Leek Seed Pill) from *San Yin Fang* (see section on Incontinence in Miscellaneous Diseases)