大意
三焦者。中渎之府。水道出焉。属膀胱。是孤之府也。故上焦脉虚则不约。下焦则遗溺。（内经）
内因
水潴于膀胱。而泄于小肠。若心肾亏损。阳气衰冷。传送失度。必具遗尿之患。（大全）又有挟热者。因膀胱火
邪妄动。水不得宁。故不禁而频来。（王纶）可见遗尿一症。有寒有热之不同也。（汇补）
外候
色白者。虚寒也。色赤者。虚热也。（戴氏）大抵患热者。频数而绝少。寒者。不觉而恒多。（汇补）
脉法
尺中脉虚。小便不禁。凡遗溺者。脉当沉滑而反浮大。其色当黑而反现黄。此土克水为逆。不治。（汇补）
治法
上焦虚者。宜补肺气。下焦虚者。宜固膀胱。挟寒者。壮命门阳气。兼以固涩之剂。挟热者。补肾膀阴血。佐以
泻火之品。（汇补）
睡中遗尿
睡则遗尿。此为虚症。所以婴儿脬气未固。老人下元不足。皆有此患。但小儿挟热者多。老人挟寒者多。不
可不辨。（六要）
用药
虚寒。主以四君子汤。加益智、山药、五味、破故纸、肉桂、升麻。虚热。主以四物汤。加丹皮、山栀、黄柏、知
母、麦冬、桔梗。如欲止涩。加牡蛎、赤石脂、桑螵蛸、鸡 。久不愈。属下元虚极。十全大补汤、补中益气汤、
缩泉丸、秘元丹、肾气丸等。加减选用。（汇补）
遗溺选方
家韭子丸（三因）治肾寒。阳气不能闭藏而遗尿。
家韭子 鹿角 肉苁蓉 熟地 当归 菟丝子
巴戟 杜仲 石斛 肉桂 山萸肉 干姜
桑螵蛸散 治心不摄肾遗尿。
桑螵蛸（盐炒） 远志 龙骨 菖蒲 人参 茯神 龟甲 当归（等分）
为末。参汤服。
又方
桑螵蛸 鹿茸（酥炙） 黄 （各三两） 牡蛎 人参 赤石脂 杜仲（各二两）
为末。米饮调下。
秘真丹（河间） 能固精止溺。
龙骨（三两） 砂仁（一两） 诃子（十枚） 灵砂（二两）
加味逍遥散 治肝火疏泄。
补中益气汤 治脾气不升。（二方俱见中风）
[General Principle]
The Sanjiao (Triple Burner) is the Fu-organ of middle conduits, through which water passages emerge. It is associated with the Bladder and is known as the "solitary Fu-organ." Therefore, when the pulse of the Upper Jiao is deficient, there is a failure to constrain; when the Lower Jiao is deficient, enuresis occurs. (From *Neijing*)
[Etiology]
Water accumulates in the Bladder but leaks into the Small Intestine. If the Heart and Kidney are deficient, and Yang Qi is weak and cold, leading to impaired transmission, enuresis will inevitably occur. (From *Daquan*) There are also cases complicated by Heat, where Fire pathogenic factors in the Bladder move recklessly, causing the water to be unsettled, resulting in incontinence and frequent urination. (Wang Lun) Thus, it can be seen that enuresis presents differently as either Cold or Heat patterns. (From *Huibuzhengzhi*)
[External Manifestations]
A pale complexion indicates Deficient-Cold; a red complexion indicates Deficient-Heat. (Dai Shi) Generally, those with Heat patterns have frequent but scanty urination, while those with Cold patterns have involuntary and abundant urination. (From *Huibuzhengzhi*)
[Pulse Diagnosis]
If the Chi position pulse is deficient, there is incontinence of urine. For patients with enuresis, if the pulse should be deep and slippery but is instead floating and large, and the complexion should be black but appears yellow, this represents Earth overcoming Water, an adverse sign indicating untreatability. (From *Huibuzhengzhi*)
[Therapeutic Principles]
For deficiency in the Upper Jiao, benefit the Lung Qi; for deficiency in the Lower Jiao, consolidate the Bladder. For patterns complicated by Cold, strengthen the Yang Qi of the Gate of Vitality (Mingmen), combined with astringent agents. For patterns complicated by Heat, nourish the Yin and Blood of the Kidney and Bladder, assisted by heat-clearing agents. (From *Huibuzhengzhi*)
[Enuresis During Sleep]
Enuresis during sleep is a deficiency pattern. Infants suffer from this because their Bladder Qi is not yet solidified; the elderly suffer from it due to insufficiency of the Lower Yuan. However, infants more often have patterns complicated by Heat, while the elderly more often have patterns complicated by Cold. This must be distinguished. (From *Liuyao*)
[Medication]
For Deficient-Cold, the main formula is Sijunzi Tang (Four Gentlemen Decoction), added with Yizhi Ren (Alpinia Oxyphylla Fruit), Shanyao (Chinese Yam), Wuweizi (Schisandra Berry), Pogostemon Cablin (Gu Zhi/Bu Gu Zhi), Rougui (Cinnamon Bark), and Shengma (Cimicifuga Rhizome). For Deficient-Heat, the main formula is Siwu Tang (Four Substances Decoction), added with Mudanpi (Tree Peony Bark), Shanzhi (Gardenia Fruit), Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome), Maidong (Ophiopogon Tuber), and Jiegeng (Platycodon Root). To achieve astringency, add Muli (Oyster Shell), Chishizhi (Red Kaolin), Sangpiaoxiao (Mantis Egg Case), and Jin Guaji (Chicken Gizzard Lining). For chronic cases unresponsive to treatment, indicating extreme deficiency of the Lower Yuan, select from Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Suoquan Wan (Lock the Spring Pill), Miyuan Dan (Secret True Pill), or Shenqi Wan (Kidney Qi Pill), adjusting according to the condition. (From *Huibuzhengzhi*)
[Selected Formulas for Enuresis]
Jiajiuzi Wan (Family Leek Seed Pill) (From *Sanyin Fang*): Treats Kidney Cold where Yang Qi fails to secure and store, causing enuresis.
Ingredients: Jiajiuzi (Allium Tuberosum Seed), Lujiao (Deer Antler), Rouburong (Cistanche Stem), Shudi (Prepared Rehmannia Root), Danggui (Angelica Sinensis Root), Tusizi (Dodder Seed), Bajitian (Morinda Officinalis Root), Duzhong (Eucommia Bark), Shihu (Dendrobium Stem), Rougui (Cinnamon Bark), Shanyurou (Cornus Fruit), Ganjiang (Dried Ginger).
Sangpiaoxiao San (Mantis Egg Case Powder): Treats enuresis caused by the Heart failing to control the Kidney.
Ingredients: Sangpiaoxiao (Mantis Egg Case, stir-fried with salt), Yuanzhi (Polygala Root), Longgu (Fossilized Bone), Changpu (Acorus Rhizome), Renshen (Ginseng Root), Fushen (Poria with Hostwood), Guijia (Turtle Shell), Danggui (Angelica Sinensis Root) (equal parts).
Usage: Grind into powder, take with Ginseng decoction.
Another Prescription:
Ingredients: Sangpiaoxiao (Mantis Egg Case), Lurong (Deer Antler, roasted with butter), Huangqi (Astragalus Root) (each 3 liang), Muli (Oyster Shell), Renshen (Ginseng Root), Chishizhi (Red Kaolin), Duzhong (Eucommia Bark) (each 2 liang).
Usage: Grind into powder, mix with rice water and take orally.
Mizhen Dan (Secret True Pill) (From Liu Hejian): Can secure essence and stop urination.
Ingredients: Longgu (Fossilized Bone, 3 liang), Sharen (Amomum Fruit, 1 liang), Hezi (Chebula Fruit, 10 pieces), Lingsha (Spiritual Cinnabar, 2 liang).
Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder): Treats enuresis due to Liver Fire dispersing excessively.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction): Treats enuresis due to Spleen Qi failing to ascend. (Both formulas are also found in the Stroke chapter.)