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According to *Yuan Bing Shi* (Treatise on the Origin of Diseases): When pathogenic heat is excessive and invades the Kidney region, interfering with the Foot Jueyin Liver Meridian, it causes extreme stagnation and knotting at the external urethral orifice (Ting Kong). Consequently, Qi and Blood cannot circulate freely, leading to flaccidity and numbness. The Spirit loses its function, causing body fluids to seep into the Bladder, resulting in involuntary urination that cannot be controlled. Examining the *Nei Jing* (Inner Canon), it states that disease of the Du Mai (Governing Vessel) leads to urinary incontinence. The *Ling Shu* (Spiritual Pivot) states that diseases generated by the Liver include urinary incontinence. This is because these two meridians traverse the genitalia and connect to the external urethral orifice; when diseased, Ying and Wei (Nutritive and Defensive Qi) fail to reach these areas, and Qi and Blood become deficient and weak, unable to constrain the orifices of the water passages, thus causing involuntary leakage. Liu Hejian can be said to have grasped this principle. However, the *Nei Jing* also states that if the Bladder fails to maintain restraint, it results in urinary incontinence. The *Ling Shu* mentions that the Luo-connecting vessel of the Hand Taiyin Lung Meridian is named Lieque (LU-7); its deficiency symptoms include yawning and frequent, involuntary urination. From this, we see that the pathology is not limited solely to the genitalia and the external urethral orifice. Such cases arise internally due to dysfunction in the Sanjiao's (Triple Burner) regulation of water pathways. Why? The Hand Shaoyang Sanjiao Meridian originates from the Quepen (LI-15) area, spreads to the Shanzhong (CV-17), descends through the diaphragm, and connects to the Sanjiao. The Foot Taiyang Bladder Meridian runs from the shoulder blades, medial to the spine, down to the waist, enters the muscular tissue, and connects to the Bladder. Deficiency of the Sanjiao leads to deficiency of the Bladder, hence a lack of restraint. The Lung regulates water pathways from the Upper Jiao and transports them downward to the Bladder. The Kidney connects upward to the Lung, linking the two organs as mother and child. If the Mother organ is deficient, the Child organ will also be deficient. Thus, Qi deficiency in the Upper, Middle, and Lower Jiao can all lead to urinary incontinence. From this, we understand that pathogens transforming into the Five Evils within the regions governed by the Sanjiao can invade the excretory orifices of the Lower Jiao (Kidney, Liver, and Bladder), causing incontinence, far exceeding mere heat-induced stagnation and flaccidity in the Kidney region. Furthermore, considering the *Nei Jing*'s statement: "When Taiyin is in authority, if the invading pathogen prevails, dampness occupies the Lower Jiao, causing irregular urination," and "In the recurrence of Taiyin, if severe, it enters the Kidney, causing uncontrolled discharge from the orifices," we know that dampness primarily causes obstruction. Since this is an overacting pathogen, does it not cause stagnation and flaccidity? Reflecting further, the Sage's words allow one to infer the whole from a part. The previous discussion on Liver, Kidney, and Bladder diseases did not specify the pathogen, implying that all types of pathogens can cause disease. The subsequent mention of deficiency in the Hand Taiyin Lieque point highlights the critical relationship between mother and child organ Qi. It shows that the Five Evils arising from generation, restriction, and non-restriction can all attack this point. Regarding the excess and recurrence of Taiyin, dampness is the predominant overacting pathogen. Other pathogens like Wind, Cold, Dryness, and Heat, though not explicitly mentioned, are implied to be included.

Treatment principles: For Upper Jiao deficiency, tonify Qi. For Lower Jiao deficiency, use astringents to stop leakage. Li Dongyuan stated: Urinary incontinence is due to deficiency of Metal (Lung). One should rest quietly to nourish Qi, avoid labor, and tonify with herbs such as Huangqi (Astragali Radix) and Renshen (Ginseng Radix). If there is no improvement, check for heat and add Huangbai (Phellodendri Cortex) and Shengdi (Rehmanniae Radix). "Lower Jiao deficiency" refers to deficiency of the Bladder and Lower Jiao. The Classics state: "Unceasing flow of urine indicates the Bladder fails to store." Zhang Zhongjing stated: "When the Lower Jiao exhausts, urinary incontinence and fecal loss occur; the Qi cannot self-control. No treatment is needed; it will heal after time." He also stated: "When Lower Jiao Qi fails to return, urinary incontinence occurs." Modern practitioners often use Sangpiaoxiao (Mantis Egg Case) and Jineijin (Galli Gigerii Endothelium Corneum). Ancient formulas often used hot and drying herbs, such as Erqi Dan, Jiajiuzi Wan, Tusizi Wan, Gu Pao Wan, Bai Fuling San, Lurong San, and Tusizi San, which contain Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata); these are suitable only for true deficiency-cold patterns. Sangpiaoxiao San, Lujiaoshuang Wan, Ejiao Yin, Lurong San, and Tusizi San provide warming tonification without being overly acrid. For urinary incontinence accompanied by dribbling and obstruction, use Zexie San and Fuling Wan. For sliding and loss of control, use Muli Wan. Baibai San and Jichang San contain cold herbs and are suitable for internal heat patterns. Lou Quanshan treated a man with unconscious urinary incontinence; his pulse was surging and full. He used Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) as Sovereign herbs, Qingpi (Aurantii Fructus Pericarpium) and Gancao (Glycyrrhizae Radix et Rhizoma) as Minister herbs, and Muxiang (Aucklandiae Radix) as Assistant herb, with a small amount of Guizhi (Cinnamomi Ramulus) acting as a counter-agent. After several doses, there was significant effect. This method aligns with the Baibai San from *Qian Jin Fang* and reflects Liu Hejian's concept of extreme heat causing stagnation at the urethral orifice, loss of spiritual control, and inability to restrain urine. For enuresis with excess heat, use Shenxiong Dao Shui Wan, 100 pills per dose, taken on an empty stomach with plain water. If diarrhea occurs after one dose, stop further administration. This describes enuresis caused by rampant Qi and Bi syndrome accumulating in the Kidney, where Bi refers to the obstruction of Qi and Blood circulation. Dai Yun stated: Enuresis during sleep is due to cold in the Lower Yuan, causing loss of bladder control. Use Da Tusizi Wan, administered with decoction of roasted pig bladder. Generally, enuresis belongs to deficiency. A universal formula is Yi Yi Ren (Coicis Semen) stir-fried with salt and decocted.

Take one chicken gizzard/intestine, boil in three sheng of water until reduced to one sheng, divided into three doses. Another method uses powdered ash of a rooster, taken with warm grain water. Or use ash from the chicken throat and white fecal matter, mixed with wheat gruel. Boil a filled sheep bladder tied at both ends, collect the water, and drink it at once. Take one chicken gizzard and intestines, clean and burn to ash; use female chicken for male patients and male chicken for female patients. Take two qian with warm wine on an empty stomach. Another variation adds pig bladder ash. Yanru Cao (Herba Siegesbeckiae) treats unconscious nocturnal enuresis; burn until black, powder, and administer with water. Coughing Bladder (Bladder Cough) presents as coughing with urinary incontinence.

[Pregnancy: Unconscious Urination] Powder Baibai (Baikiaeae Caulis) and Shaoyao (Paeoniae Radix), take with wine. Or powder Bai Fan (Alumen) and Muli (Concha Ostreae), take two qian with wine. Or take chicken feather ash with wine. Or powder roasted Sangpiaoxiao (Mantis Egg Case) and Yizhi Ren (Alpiniae Oxyphyllae Fructus), take with rice water. Xue Ji stated: If the preceding condition involves heat in the bladder, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). If Spleen and Lung Qi are deficient, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Yizhi Ren. If Liver and Kidney Yin are deficient, use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia).

[Postpartum Frequent Urination] This is due to Qi and Blood failing to exert control. Xue Ji stated: If caused by careless midwifery leading to bladder injury and dribbling, use Ba Zhen Tang (Eight Treasure Decoction) to tonify Qi and Blood, combined with Bu Pao Yin (Bladder Tonifying Drink). If due to Bladder Qi deficiency causing frequency, tonify Spleen and Lung. If due to Bladder Yin deficiency causing dribbling, tonify Lung and Kidney. During postpartum confinement, if difficult labor injures the bladder causing intermittent incontinence, use Bu Pao Yin, Sangpiaoxiao San, or Baibai San. Xue Ji stated: If Spleen and Lung Yang are deficient, use Bu Zhong Yi Qi Tang. If Liver and Kidney Yin are deficient, use Liu Wei Di Huang Wan. If Liver and Kidney Qi are deficient and cold, use Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia). If Liver and Spleen Qi and Blood are deficient with heat, use Jia Wei Xiao Yao San assisted by Liu Wei Di Huang Wan. Zhu Danxi stated:
I have seen cases where the bladder was damaged by careless delivery, leading to chronic dribbling and disability. A strong woman suffered this after difficult labor. I reasoned that external muscle wounds can be repaired; perhaps the internal bladder can also be treated. Her pulse was extremely deficient. I prescribed strong tonification: Renshen (Ginseng Radix) and Huangqi (Astragali Radix) as Sovereign herbs, Chuanxiong (Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) as Minister herbs, Taoren (Persicae Semen), Chenpi (Citri Reticulatae Pericarpium), Huangqi (Astragali Radix), and Fuling (Poria) as Assistant herbs. Decocted in pig or sheep bladder soup, taken when extremely hungry. Although doses were small (typically one liang), she recovered in one month. The goal was rapid growth of Qi and Blood so the bladder would repair itself. Delay might hinder success.