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There is a person who suffers from nocturnal enuresis (bedwetting) during sleep. This individual fears cold and prefers warmth, has a sallow complexion with a frail constitution, loose stools, and frequent urination. People attribute this to deficiency of the Small Intestine, but little do they know it is actually due to deficiency of Kidney Qi (Kidney Energy). The Kidneys and Bladder are exterior-interiorly related; the opening and closing of the Bladder are governed by the Kidneys. Since the Bladder receives orders from the Kidneys, if the Kidneys are cold, the Bladder naturally disobeys the Kidney's commands. Thus, when the Kidneys fail to consolidate, the Bladder also fails to close. The treatment principle is that attempting to restrain kidney water to eliminate cold water is inferior to warming the kidney water so that the fluid naturally contracts. Use the formula Wenquan Yin (Hot Spring Drink): Baizhu (Atractylodis Rhizoma, 1 liang), Bajitian (Morindae Officinalis Radix, 1 liang), Yizhiren (Alpiniae Oxyphyllae Semen, 3 qian), Rougui (Cinnamomi Cortex, 1 qian). Decoct in water and take orally. Enuresis stops after one dose; after four consecutive doses, it does not recur.

This formula employs a method of tonifying both the Spleen and Kidneys. Rougui warms the Mingmen Fire (Gate of Vitality) to dispel cold, Yizhiren stops bladder leakage, and Baizhu unblocks qi in the waist and umbilical region, ensuring the disease and medicine are mutually suitable. Generally, enuresis originates from Kidney cold but is also caused by blocked qi in the waist and umbilical area, preventing water from flowing into the Small Intestine and causing it to flow directly into the Bladder. By unblocking the qi in the waist and umbilicus, water changes its course and flows naturally into the Small Intestine. The Small Intestine and Heart are exterior-interiorly related, and Heart Qi can control the fluid so it does not suddenly leak. Furthermore, Baizhu tonifies Heart Qi upwards; when Heart Qi is deficient, water flows downward as diarrhea, but when Heart Qi is robust, water is difficult to discharge. When Heart and Kidney interact, the source becomes warm; when Heart and Kidney interact, the fluid also contracts.

This condition can also be treated with Yuzhu Yigui Tang (Cornus and Atractylodes Cinnamon Decoction): Shanzhuyu (Corni Fructus, 5 qian), Baizhu (Atractylodis Rhizoma, 1 liang), Rougui (Cinnamomi Cortex, 1 qian), Yizhiren (Alpiniae Oxyphyllae Semen, 1 qian). Decoct in water and take orally.

Elderly people may suffer from enuresis not only at night but also spontaneously during the day without sleeping, which is more severe than the previous condition. This is due to extreme cold in the Mingmen (Gate of Vitality) failing to control water. How can an elderly person with isolated Yang reach such extreme cold? People have tendencies toward Yin or Yang excess. When Yang is vigorous, there is worry of Yin deficiency with fire stirring; when Yang declines, there is the hazard of Yin excess with cold water sinking. In youth, excessive loss of essence depletes water, leaving no fire remaining. Water and fire must mutually constrain each other; without water to constrain fire, fire flares upward; without fire to constrain water, water leaks downward. The elderly person’s extreme cold and enuresis result precisely from the absence of fire within the water. To tonify the fire of the elderly, it must be done within the water, because as their fire declines, water cannot become overly vigorous. Use the formula Bawei Dihuang Wan/Tang (Eight-Ingredient Rehmannia Pill/Decoction): Shudi (Rehmanniae Radix Praeparata, 1 liang), Shanzhuyu (Corni Fructus, 1 liang), Shanyao (Dioscoreae Rhizoma, 5 qian), Fuling (Poria, 2 qian), Zexie (Alismatis Rhizoma, 1 qian), Danpi (Moutan Cortex, 1 qian), Fuzi (Aconiti Lateralis Radix Praeparata, 1 qian), Rougui (Cinnamomi Cortex, 1 qian). Decoct in water and take orally. After two consecutive doses, urination stops; after ten days, full recovery occurs. Approximately following the proportions of this formula, prepare pills or powders, taking 1 liang daily, to prevent recurrence permanently.

Bawei Dihuang Tang is the supreme medicine for tonifying fire within water. When fire within water is vigorous, Kidney Yang naturally communicates into the interior of the Small Intestine and descends to the Bladder. With Kidney Qi supporting the Bladder, it can open and close properly, obeying the Kidney’s command. How would it dare to open or close privately, allowing water to escape on its own? If qi transformation can control excretion, it implies it can also control retention. However, in Bawei Tang, Fuling and Zexie are too diuretic, which may not be suitable for the elderly; Danpi clears heat from the bones; since enuresis involves assisting heat rather than cold, these ingredients should be slightly reduced in dosage to moderate the harshness of Rougui and Fuzi. Such careful adjustment highlights the efficacy of Bawei Tang. Nevertheless, this formula allows for modification but not removal or addition of core herbs; modifications yield results, while arbitrary changes lead to poor efficacy.

This condition can also be treated with Zhulao Tang (Assisting the Elderly Decoction): Shudi (Rehmanniae Radix Praeparata, 1 liang), Shanzhuyu (Corni Fructus, 1 liang), Yizhi (Alpiniae Oxyphyllae Semen, 1 qian), Rougui (Cinnamomi Cortex, 2 qian), Yuanzhi (Polygalae Radix, 1 qian), Chao Zaoren (Ziziphi Spinosae Semen Fried, 5 qian), Renshen (Ginseng Radix et Rhizoma, 3 qian), Bei Wuwei (Schisandrae Chinensis Fructus, 2 qian). Decoct in water and take orally.

There is a person who dislikes heat and prefers cold, has a red face and hot ears, dry and constipated stools, and painful, difficult urination, yet suffers from enuresis at night. People attribute this to Heat in the Bladder, but little do they know it is due to Hyperactive Heart Fire. The Heart and Small Intestine are exterior-interiorly related; Heart Heat causes Small Intestine Heat. However, the Small Intestine primarily governs downward movement. Because Heart Fire is too excessive, water in the Small Intestine dares not move downward and instead flows upward to attend to the Heart. At night, when lying down, Heart Qi tends toward the Kidneys; thus, water from the Small Intestine cannot reach the Kidneys and only reaches the Bladder. Since the Bladder and Kidneys are exterior-interiorly related, reaching the Bladder is equivalent to reaching the Kidneys. However, upon seeing water from the Small Intestine, the Bladder originally intended to move toward the Kidneys, but the intentions did not align. Moreover, the fire was intense, naturally transforming qi and dispersing outward, acting without constraint, leading to enuresis without regard. Treatment requires neither purging the Bladder (as there is no pathogen) nor tonifying the Bladder (as its righteous qi is undamaged). So what should be done? Purge the excess of Heart Fire, and enuresis will stop naturally. Use modified Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction): Fuling (Poria, 3 qian), Maidong (Ophiopogonis Tuber, 3 qian), Zhuye (Bambusae Folium, 30 leaves), Lianzixin (Nelumbinis Plumula, 3 qian), Huanglian (Coptidis Rhizoma, 2 qian), Baishao (Paeoniae Radix Alba, 5 qian), Chenpi (Citri Reticulatae Pericarpium, 5 fen), Danpi (Moutan Cortex, 2 qian), Tiandong (Asparagi Radix, 3 qian), Ziwan (Asterae Radix, 1 qian), Xuanshen (Scrophulariae Radix, 3 qian). Decoct in water and take orally. After one dose, urination becomes slightly freer; after two doses, significantly freer; after three doses, fully recovered.

This formula specifically clears Heart Fire and does not attempt to stop Small Intestine water directly, because for this type of enuresis, stopping it further exacerbates the leakage.

This condition can also be treated with Jiajian Xiaoyao San (Modified Free and Easy Wanderer Powder): Fuling (Poria), Baishao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix), Cheqianzi (Plantaginis Semen) (each 5 qian), Shanyao (Dioscoreae Rhizoma), Danpi (Moutan Cortex) (each 3 qian), Chaihu (Bupleuri Radix), Huanglian (Coptidis Rhizoma) (each 1 qian), Renshen (Ginseng Radix et Rhizoma, 5 fen), Chenpi (Citri Reticulatae Pericarpium, 3 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 5 fen). Decoct in water and take orally.