《灵枢。本输篇》说：“少阳属肾，肾上连肺，故将两脏。”心火居上，不断下交于肾水，使肾能得火之助而阳气旺；肾水居下，不断上升而滋肺心，使心火得肾水之滋养。若肝气不疏，三焦郁滞，心火不能下交肾水，肾水不能上滋心火，则下焦寒甚，而上焦火炎，所以但补其火，则冰炭难温；清其火则寒更甚，因此必与疏肝气，理三焦，交心肾，才能使上焦之火下降而下焦之寒冷消失。例如：焦××，男，成。小腹冰冷7—8年，前医与大剂附、桂、硫黄、干姜、小茴、大茴、沉香、荜茇、良姜之剂数年不效。细视其证：头晕心烦，口苦咽干，脉见弦滑。与柴胡加龙骨牡蛎汤去铅丹，6剂后，腹冷顿消，20剂而愈。郝××，男，25岁。少腹、阴茎冰冷4年多，阳痿2年多，前医以温肾壮阳之剂200多剂，丸剂数百丸不效。细审其证，心烦心悸，便秘尿赤，面赤有神，口苦苔黄，脉见沉弦。为拟柴胡加龙骨牡蛎汤：柴胡、半夏、黄芩、党参、桂枝、茯苓各10克，干姜3克，川军4克，甘草6克，大枣5枚，龙骨15克，牡蛎15克。3剂诸证大减，少腹温和，20剂诸证消失而愈。郭××，男，40岁。五年来遗精，有时2—3天一次，有时连续4—5天中午、晚上均遗精，小腹阴茎冰冷，头晕失眠，胸胁苦满，有时窜痛，四肢厥冷，疲乏无力，前医予温肾之剂遗精加重，固涩之剂烦躁顿加。邀余诊视。审其舌苔黄白，脉沉而弦，且服补益固涩无功，乃予苦辛通降、补泻同施、疏理三焦、交通心肾之柴胡加龙骨牡蛎汤去铅丹加甘草花粉方，10剂诸证减，80剂诸证除而愈。
二便不通
二便俱闭大多以通利为急务，惟正气不足者用之非但不解，反见正气更伤，而便溲更加不利。曾治患者赵××，女，成。骨盆骨折，膀胱破裂术后，30多天来，二便一直不通，非导尿、灌肠不得解。审其身热多汗，疲乏无力，咳嗽多痰，纳呆食减，口苦口干，舌质嫩红，舌苔白厚，脉虚大滑数，寸脉为盛。急予黄芪15克、升麻6克、柴胡6克以益气升阳，天门冬10克、麦门冬10克以滋阴润肺，桔梗12克、枳壳12克、紫菀10克、知母10克以开宣肺气，使清阳升，浊阴降，营卫行，三焦决渎之职得复。3剂后，大便通，并微有排尿之感；再审其舌苔水滑，故加肉桂4克、青皮9克以温阳化水，2剂溲通而愈。若瘀血阻滞，外伤较久，活血伤气，正气难支者．可用局部敷贴药物。
例如：患者张××，男，成。一年前摔伤，腰椎畸形，下肢瘫痪之后，二便一直不通，每曰全靠导尿、灌肠来通大小便，且近来日渐严重。患者为了减轻此项痛苦，不得已采用短期禁食来减轻腹胀。予血竭、儿茶、三七、自然铜、补骨脂、当归、木瓜、赤芍、乳香、栀子、桃仁、山甲珠、牛膝、牙皂各15克，金果榄18克。共研细末，热醋调合，装口袋内，放置腰部1小时。一日1次，1剂后，腹胀略减，2剂后二便正常而愈。
内服药、外用药均为治疗疾病的重要方法，若内科疾病之因局部病变为主者，外用药饵效果宏大而不伤正，此辨证论治过程中之不可不予注意也。
癃闭
《证治准绳》说：“三焦者，决渎之官，水道出焉。膀胱者，州都之官，津液藏焉，气化则能出矣，故上中下三焦之气有一不化，则不得如决渎之水而出矣，岂独下焦膀胱气塞而已哉。上焦肺者，主行营卫，通调水道。下输膀胱，而肾之合足三焦下输又上连肺，此岂非小便从上焦之气化者乎?”又说：“脾胃气滞不能转输，加以痰饮食积阻碍清道，大小便秘涩不快，升麻二术二陈汤数服能令大便润小便长。”余宗上方之意治癃闭而愈者不少，然予肾气不足，湿热蕴结者，则无功。
曾治患者孙××，男，70岁。7天前突然尿闭不通，腹胀难忍，急至某院泌尿科诊治，云：“前列腺肥大，尿潴留。”予导尿及其他药物治疗腹胀稍减，然取掉导尿管后即腹胀难忍，尿闭不出。医欲手术治疗，因患者拒绝而不得不请中医治疗。某医以利尿之剂治之不效，以补气养阴之剂无功，乃改求予进行治疗。审其脉弦而尺大，舌苔黄腻。云：“脉弦者，寒也，尺脉大者，肾之阳气不足也，肾阳不足化水不能，郁而生热，尿闭而痛，法宜八味地黄丸加肉苁蓉以补肾气，知母、黄柏以除湿热。药进3剂，排尿稍利。15剂，小便通畅而愈。至若肾阳不足，燥火独聚于上之癃闭，非温肾而润上不能解。
例如：耿××，男，70岁。小便不利20多天，先用西药治疗效果不著，改请中医治疗。审其神佳体健，而口微干，指冷，苔薄黄，脉沉弦细。脉证合参，诊为肾阳不足，燥火独聚于上，源匮而化气不能，治以温阳益肾，除热生津，瓜蒌瞿麦丸加减：天花粉15克，山药30克，瞿麦15克，茯苓10克，附子3克。连服6剂，小便较前畅利，继进14剂排尿恢复正常。
便秘
便秘一证，仲景分为阴结、阳结、脾约三种，后世医家分为风秘、气秘、热秘、寒秘、风燥五类。但这种分类方法往往不被临床医生所重视，加以近年的一些著作，或者单纯追求少而简，或者过于强调中西医结合，致使一些医者仅仅知道攻下、润下两法，至于1964年版《中医内科学讲义》所述之“忧愁思虑，情志不舒，或多坐少动，每致气机郁滞，不能宣达，于是通降失常，传导失职，使糟粕内停，不得下行，因而大便秘”者，则很少给予应有的注意。
例如：郭××，男，54岁。3年来经常便秘不通，先用中、西药物攻下、润下，尚能暂时缓解，但近1个月来，虽把泻下药增加1倍也无济于事，特别是近7天来，频用承气、西药及灌肠等一直未能排便，并见头晕头痛，心烦失眠，口苦口干。急邀余诊，视之舌苔薄白，脉象沉弦。乃云：此少阳气郁，三焦不利，津液不下之证耳。为拟柴胡加龙骨牡蛎汤：柴胡6克，黄芩、党参、半夏、桂枝、茯苓、陈皮各9克，大黄3克，甘草6克，生姜3片，大枣5枚，龙骨、牡蛎各15克。莫医云：患者三年经常大便秘结，先用果导、灌肠和中药大承气汤、麻子仁丸等，虽然能暂时通便，尔后便秘越来越重，而你用大黄仅仅3克，并有龙骨、牡蛎之固涩，其能效吗?答曰．“本病证脉合参，为三焦郁滞，不能宣达，通降失职，糟粕内停之便秘，前医之不效者，在于频用攻伐，阳气匮乏，腑气不行，故不再予大剂以事攻伐。柴胡加龙骨牡蛎汤，既有小柴胡汤的疏肝胆理三焦，又有党参、桂枝、生姜、甘草、大枣的助脾温阳，半夏、陈皮、生姜的辛温，龙骨、牡蛎的潜阳镇纳，其虽有收敛之弊，然清气可升，浊气可降。又患者阳气上冲，头晕头痛者，非重镇降逆便难通下，龙骨、牡蛎虽有收涩之害，而却有潜阳之益，故佐大黄少许，大便自解。”药后大便果通，继服6剂数年之便秘得解。其后该医又云：古医遍用朱砂、代赭石、石决明、草决明以通便，余久久不解其意，其理原来在此耳。
大便秘结，二三天或五六天排便一次者，燥热内结，津液干枯，传导失常所致者恒多，故承气诸方尤为常用；老人津枯，产后亡血，病后正衰，血少津枯，肠道失润者，养血润便，多所喜用；而阴寒内结，阳气不行，传导失职者，常多忽略，致使久久不愈者常多。
例如：高××，女，12岁。11年来，先是三四天，后是七八天排便一次，每次排便都用中、西药才可暂通，患者为了促进排便，每日经常服食大量水果、蜂蜜。但近一年来便秘却更加严重，腹胀腹痛，纳呆乏力，每次排便都用大承气汤、开塞露才能排便。但近4个月来，虽用大剂攻下、润便，以及开塞露、肥皂水灌肠等，亦难于排出，为了减轻痛苦，每天都得蹲厕2小时左右。细审其证：面色萎黄，少气寡言，腹满腹帐，隐隐作痛，舌苔薄白，质淡微黯，脉沉弦而细。思之，病虽少年之躯，而久用寒凉攻伐，滋阴润燥，戕害阳气，经云：“大肠者，传道之官，变化出焉。小肠者，受盛之官，化物出焉。，’阳虚传化不能，大便怎通?乃拟温阳理气，化湿和中。厚朴温中汤加减：厚朴10克，陈皮10克，甘草6克，草蔻10克，木香6克，干姜6克，肉桂6克，大黄1克。药进1剂，大便二行，且腹满胀痛亦减，继进3剂大便正常。后思其阳气大衰，改予附桂理中汤加减：附子10克，肉桂10克，党参10克，白术10克，干姜10克，甘草10克，枳实10克，厚朴10克，大黄2克。药进3剂，腹满胀痛又剧，大便三日一行而干，反复琢磨，景岳曾云：沉脉为阳郁之脉，弦为寒，寒郁者不理其气，反助其阳，必使寒结于内，便秘加甚。乃再改予厚朴温中汤加减治之，服药30余剂，治疗40多天，大便正常而愈。
又如：郭××，女，43岁。经常3—5天大便一次，已30多年。为了减轻排便时的痛苦，每曰除吃各种水果、蜂蜜以外，几乎每天都吃西药缓泻剂，如此这般，仍然经常七八天才能排便。近两年来，每次排便都得服用承气汤、蜂蜜，外用开塞露或灌肠才能排出。审之，面色萎黄，舌苔薄白，舌质淡而暗，脉弦大而紧，乃云：病已三十余载，又频用攻伐，戕害元气，润燥生津，阴气用事，仲景云：“脉弦而紧，弦则卫气不行，即恶寒，紧则不欲食，邪正相搏。”“脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚，虚寒相搏，此名为革。”虚寒阴结，法宜附桂理中温阳散寒，佐以理气通下：附子10克，肉桂10克，党参10克，白术10克，甘草10克，干姜10克，枳实6克，厚朴6克，大黄2克。服药1剂，大便三行，微溏，继服4剂，大便一直保持在一日2次。患者云：前医诸方均用大黄30克，芒硝10克，且配以开塞露而便难通，你用大黄2克反泻下者何也?答曰：大黄、芒硝虽系攻下圣药，然其用于实热者尚可，用于津枯者不可，用于虚寒者更不可，因大黄、芒硝苦咸而寒，泻热通腑，津伤液耗者反伤其津，津枯则不润，水枯则舟停，舟停则便不通。阳虚者用之，必更伐生生夕阳气，阳不生则气不行，气不行则便不通。本方所以用附桂理中大补中下二焦之阳，稍佐小承气以取效者，在于行其阳气耳、继服一月，诸证消失而愈。
遗尿
遗尿一证，《内经》阐述较为详尽。它说：“膀胱……不约为遗溺”，“督脉为病……遗溺”，“脉所生病者遗溺”，“淫气遗溺，痹聚在肾”，“三焦者，足少阴少阳之所将……虚则遗溺”。
曾治一男性患者，43岁。遗尿40年，经多方检查除隐性骶椎裂外，余无异常发现。前医用针灸，中、西药物治疗数十载无功，审其诸方多为补肾固涩之品；察其证，除一至三夜遗尿一次外，腰不痛，小腹不胀，神色正常，舌苔薄白，脉虚大而缓，并无肾虚膀胱不约之表现。反复思考始得其解。《素问·经脉别论》说：“食气入胃，浊气归心，淫精于脉，脉气流经，经气归于肺，肺朝百脉，输精于皮毛，毛脉合精，行气于府。府精神明，留于四脏，气归于权衡。权衡以平，气口成寸，以决死生”。《素问·脉要精微论》说：“微妙在脉，不可不察。”证不具备者，应求之于脉，此病脉虚大缓，乃脾肺俱虚，清阳不升所致．沈金鳌说：“肺主气以下降生水，输于膀胱。肺虚则不能为气化之主，故溺不禁也。”乃子补气升阳，佐以固涩之法，补中益气汤、缩泉丸加减：黄芪15克，党参9克，白术9克，陈皮9克，当归9克，白果9克，乌药9克，升麻6克，柴胡6克，甘草6克。连进12剂，遗尿延至一周1次；服药20剂后，40天内除有一天因过度劳累而发生1次遗尿外，未再遗尿，乃按原方为丸调理一年而愈。
恩师李翰卿先生告诫我说：治病的关键在于认清证候的性质，认清阴阳表里虚实寒热，认清脏腑经络．辨证的关键在于四诊合参，其中急性病要重证候，慢性病要重脉象，重望色，否则辨证难明，药非治其病之所在，即使经方验方，也取不到应有效果。
尿失禁
尿失禁，祖国医学中论述颇多，但对手术和脊髓损伤后的尿失禁却很少明确的提到，所以给中药治疗带来了困难。
1974年6月10日，曾治一男性患者，于某某，74岁。前列腺肥大手术后半年来小便一直不能控制，曾用针灸、中、西药物治疗无效，细审其方均为补肾固涩缩泉固脬之药。证见神疲乏力，气短，舌苔白、脉弦大，尺脉尤甚。久思不得其解，乃求教于恩师李翰卿先生，说：《素问》云：“微妙在脉，不可不察”；朱丹溪说：“大脉为洪之别名、病内伤者，阴虚为阳所乘故脉大，当作虚治。”仲景说：“脉大为劳”，可见大脉为虚，尺脉属肾，尺大为肾虚，故此病当为肺肾俱虚。前医用补肾固脬遗尿不减者，在于未补脾肺，肺为水之上源，脾主水液之运化，肺脾肾俱虚则阳气不升，水液不固，所以本证必须肺脾肾三脏同治，升阳益阴方能奏效。余宗其论，予补中益气汤补脾肺，升清阳，六味地黄丸滋肾水敛精气，缩泉丸固脬止遗。处方：黄芪15克，党参9克，白术9克，陈皮9克，当归9克，熟地9克，山药9克，五味子9克，益智仁9克，乌药9克，茯苓9克，泽泻9克，丹皮9克，升麻6克，柴胡6克。4剂减，8剂竟豁然而愈。
《灵枢·本输篇》说：“少阳经隶属于肾，肾向上连接肺，所以能统摄这两个脏腑。”心火位于上部，不断向下与肾水相交，使肾得到火的帮助而阳气旺盛；肾水位于下部，不断上升以滋润肺和心，使心火得到肾水的滋养。如果肝气不疏泄，三焦气机郁滞，心火不能下交于肾水，肾水不能上滋于心火，就会导致下焦寒气极盛，而上焦火热炎上。因此，单纯补火，就像冰炭难以调和一样无法温煦；单纯清火，则寒气会更重。所以必须配合疏理肝气、调理三焦、交通心肾的方法，才能使上焦的火下降，下焦的寒冷消失。例如：患者焦某某，男性，成年。小腹冰冷7-8年，前医使用大剂量的附子、桂枝、硫黄、干姜、小茴香、大茴香、沉香、荜茇、高良姜等药物治疗数年无效。仔细审视其证候：头晕心烦，口苦咽干，脉象弦滑。给予柴胡加龙骨牡蛎汤去掉铅丹，服用6剂后，腹冷顿时消除，20剂后痊愈。郝某某，男性，25岁。少腹、阴茎冰冷4年多，阳痿2年多，前医使用温肾壮阳的药物200多剂，丸剂数百丸无效。仔细审查其证候，心烦心悸，便秘尿赤，面色红而有神，口苦苔黄，脉象沉弦。为此拟定柴胡加龙骨牡蛎汤：柴胡、半夏、黄芩、党参、桂枝、茯苓各10克，干姜3克，大黄4克，甘草6克，大枣5枚，龙骨15克，牡蛎15克。服用3剂后诸证大减，少腹转温，20剂后诸证消失而愈。郭某某，男性，40岁。五年来遗精，有时2-3天一次，有时连续4-5天中午、晚上均遗精，小腹阴茎冰冷，头晕失眠，胸胁苦满，有时窜痛，四肢厥冷，疲乏无力，前医给予温肾药物导致遗精加重，固涩药物导致烦躁顿增。邀请我诊治。审视其舌苔黄白，脉象沉而弦，且服用补益固涩药物无效，于是给予苦辛通降、补泻同施、疏理三焦、交通心肾的柴胡加龙骨牡蛎汤去掉铅丹加上甘草、天花粉的方子，10剂后诸证减轻，80剂后诸证消除而痊愈。
二便不通
大小便俱闭大多以通利为紧急任务，但对于正气不足者，使用通利之法不仅不能解决，反而会使正气更伤，导致大小便更加不利。曾治疗患者赵某某，女性，成年。骨盆骨折，膀胱破裂术后，30多天来，大小便一直不通，非导尿、灌肠不能解决。审视其身热多汗，疲乏无力，咳嗽多痰，食欲不振，口苦口干，舌质嫩红，舌苔白厚，脉象虚大滑数，寸脉偏盛。急予黄芪15克、升麻6克、柴胡6克以益气升阳，天门冬10克、麦门冬10克以滋阴润肺，桔梗12克、枳壳12克、紫菀10克、知母10克以开宣肺气，使清阳上升，浊阴下降，营卫运行，三焦决渎的功能得以恢复。3剂后，大便通畅，并有微弱的排尿感；再审视其舌苔水滑，故加肉桂4克、青皮9克以温阳化水，2剂后小便通利而痊愈。如果是瘀血阻滞，外伤时间较长，活血伤气，正气难支的情况，可以使用局部敷贴药物。
例如：患者张某某，男性，成年。一年前摔伤，腰椎畸形，下肢瘫痪之后，大小便一直不通，每天全靠导尿、灌肠来通大小便，且近来日渐严重。患者为了减轻此项痛苦，不得已采用短期禁食来减轻腹胀。给予血竭、儿茶、三七、自然铜、补骨脂、当归、木瓜、赤芍、乳香、栀子、桃仁、穿山甲珠、牛膝、牙皂各15克，金果榄18克。共研细末，用热醋调合，装入口袋内，放置在腰部1小时。一日1次，1剂后，腹胀略减，2剂后大小便正常而痊愈。
内服药、外用药均为治疗疾病的重要方法，若内科疾病以局部病变为主者，外用药饵效果宏大且不伤正气，这是辨证论治过程中不可不予注意的。
癃闭（小便不通）
《证治准绳》说：“三焦是决渎之官，水道由此而出。膀胱是州都之官，津液藏于此，气化后才能排出，所以上中下三焦的气有一处不化，就不能像决渎之水那样流出，难道仅仅是下焦膀胱气塞而已吗？上焦肺，主行营卫，通调水道，下输膀胱，而肾与足三焦相合，下输又上连肺，这难道不是小便从上焦的气化而来吗？”又说：“脾胃气滞不能转输，加上痰饮食积阻碍清道，大小便秘涩不快，服用升麻二术二陈汤几剂就能令大便润、小便长。”我遵循上方之意治疗癃闭而痊愈者不少，然而对于肾气不足，湿热蕴结者，则无效。
曾治疗患者孙某某，男性，70岁。7天前突然尿闭不通，腹胀难忍，急至某院泌尿科诊治，诊断为：“前列腺肥大，尿潴留。”给予导尿及其他药物治疗后腹胀稍减，但取掉导尿管后即腹胀难忍，尿闭不出。医生欲手术治疗，因患者拒绝而不得不请中医治疗。某医以利尿之剂治疗无效，以补气养阴之剂无功，于是改求我进行治疗。审视其脉弦而尺部大，舌苔黄腻。他说：“脉弦者，寒也，尺脉大者，肾之阳气不足也，肾阳不足化水不能，郁而生热，尿闭而痛，法宜八味地黄丸加肉苁蓉以补肾气，知母、黄柏以除湿热。”药进3剂，排尿稍利。15剂，小便通畅而痊愈。至于肾阳不足，燥火独聚于上的癃闭，非温肾而润上不能解。
例如：耿某某，男性，70岁。小便不利20多天，先用西药治疗效果不显著，改请中医治疗。审视其精神佳体健，而口微干，手指冷，苔薄黄，脉沉弦细。脉证合参，诊为肾阳不足，燥火独聚于上，源匮而化气不能，治以温阳益肾，除热生津，瓜蒌瞿麦丸加减：天花粉15克，山药30克，瞿麦15克，茯苓10克，附子3克。连服6剂，小便较前畅利，继进14剂排尿恢复正常。
便秘
便秘一证，张仲景分为阴结、阳结、脾约三种，后世医家分为风秘、气秘、热秘、寒秘、风燥五类。但这种分类方法往往不被临床医生所重视，加以近年的一些著作，或者单纯追求少而简，或者过于强调中西医结合，致使一些医者仅仅知道攻下、润下两法，至于1964年版《中医内科学讲义》所述之“忧愁思虑，情志不舒，或多坐少动，每致气机郁滞，不能宣达，于是通降失常，传导失职，使糟粕内停，不得下行，因而大便秘”者，则很少给予应有的注意。
例如：郭某某，男性，54岁。3年来经常便秘不通，先用中、西药物攻下、润下，尚能暂时缓解，但近1个月来，虽把泻下药增加1倍也无济于事，特别是近7天来，频用承气汤、西药及灌肠等一直未能排便，并见头晕头痛，心烦失眠，口苦口干。急邀我诊，视之舌苔薄白，脉象沉弦。于是说：此少阳气郁，三焦不利，津液不下之证耳。为此拟定柴胡加龙骨牡蛎汤：柴胡6克，黄芩、党参、半夏、桂枝、茯苓、陈皮各9克，大黄3克，甘草6克，生姜3片，大枣5枚，龙骨、牡蛎各15克。那位医生说：患者三年经常大便秘结，先用果导、灌肠和中药大承气汤、麻子仁丸等，虽然能暂时通便，尔后便秘越来越重，而你用大黄仅仅3克，并有龙骨、牡蛎之固涩，其能效吗?我回答说：“本病证脉合参，为三焦郁滞，不能宣达，通降失职，糟粕内停之便秘，前医之不效者，在于频用攻伐，阳气匮乏，腑气不行，故不再予大剂以事攻伐。柴胡加龙骨牡蛎汤，既有小柴胡汤的疏肝胆理三焦，又有党参、桂枝、生姜、甘草、大枣的助脾温阳，半夏、陈皮、生姜的辛温，龙骨、牡蛎的潜阳镇纳，其虽有收敛之弊，然清气可升，浊气可降。又患者阳气上冲，头晕头痛者，非重镇降逆便难通下，龙骨、牡蛎虽有收涩之害，而却有潜阳之益，故佐大黄少许，大便自解。”药后大便果然通畅，继服6剂数年之便秘得解。其后该医又说：古医遍用朱砂、代赭石、石决明、草决明以通便，我久久不解其意，其理原来在此耳。
大便秘结，二三天或五六天排便一次者，燥热内结，津液干枯，传导失常所致者恒多，故承气诸方尤为常用；老人津枯，产后亡血，病后正衰，血少津枯，肠道失润者，养血润便，多所喜用；而阴寒内结，阳气不行，传导失职者，常多忽略，致使久久不愈者常多。
例如：高某某，女性，12岁。11年来，先是三四天，后是七八天排便一次，每次排便都用中、西药才可暂通，患者为了促进排便，每日经常服食大量水果、蜂蜜。但近一年来便秘却更加严重，腹胀腹痛，纳呆乏力，每次排便都用大承气汤、开塞露才能排便。但近4个月来，虽用大剂攻下、润便，以及开塞露、肥皂水灌肠等，亦难于排出，为了减轻痛苦，每天都得蹲厕2小时左右。仔细审视其证候：面色萎黄，少气寡言，腹满腹胀，隐隐作痛，舌苔薄白，质淡微黯，脉沉弦而细。思考之，病虽少年之躯，而久用寒凉攻伐，滋阴润燥，戕害阳气，经云：“大肠者，传道之官，变化出焉。小肠者，受盛之官，化物出焉。”阳虚传化不能，大便怎通?于是拟定温阳理气，化湿和中。厚朴温中汤加减：厚朴10克，陈皮10克，甘草6克，草蔻10克，木香6克，干姜6克，肉桂6克，大黄1克。药进1剂，大便二行，且腹满胀痛亦减，继进3剂大便正常。后思其阳气大衰，改予附桂理中汤加减：附子10克，肉桂10克，党参10克，白术10克，干姜10克，甘草10克，枳实10克，厚朴10克，大黄2克。药进3剂，腹满胀痛又剧，大便三日一行而干，反复琢磨，景岳曾云：沉脉为阳郁之脉，弦为寒，寒郁者不理其气，反助其阳，必使寒结于内，便秘加甚。于是再改予厚朴温中汤加减治之，服药30余剂，治疗40多天，大便正常而痊愈。
又如：郭某某，女性，43岁。经常3—5天大便一次，已30多年。为了减轻排便时的痛苦，每日除吃各种水果、蜂蜜以外，几乎每天都吃西药缓泻剂，如此这般，仍然经常七八天才能排便。近两年来，每次排便都得服用承气汤、蜂蜜，外用开塞露或灌肠才能排出。审视之，面色萎黄，舌苔薄白，舌质淡而暗，脉弦大而紧，于是说：病已三十余载，又频用攻伐，戕害元气，润燥生津，阴气用事，仲景云：“脉弦而紧，弦则卫气不行，即恶寒，紧则不欲食，邪正相搏。”“脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚，虚寒相搏，此名为革。”虚寒阴结，法宜附桂理中温阳散寒，佐以理气通下：附子10克，肉桂10克，党参10克，白术10克，甘草10克，干姜10克，枳实6克，厚朴6克，大黄2克。服药1剂，大便三行，微溏，继服4剂，大便一直保持在一日2次。患者说：前医诸方均用大黄30克，芒硝10克，且配以开塞露而便难通，你用大黄2克反泻下者何也?我回答说：大黄、芒硝虽系攻下圣药，然其用于实热者尚可，用于津枯者不可，用于虚寒者更不可，因大黄、芒硝苦咸而寒，泻热通腑，津伤液耗者反伤其津，津枯则不润，水枯则舟停，舟停则便不通。阳虚者用之，必更伐生生夕阳气，阳不生则气不行，气不行则便不通。本方所以用附桂理中大补中下二焦之阳，稍佐小承气以取效者，在于行其阳气耳、继服一月，诸证消失而痊愈。
遗尿
遗尿一证，《内经》阐述较为详尽。它说：“膀胱……不约为遗溺”，“督脉为病……遗溺”，“脉所生病者遗溺”，“淫气遗溺，痹聚在肾”，“三焦者，足少阴少阳之所将……虚则遗溺”。
曾治一男性患者，43岁。遗尿40年，经多方检查除隐性骶椎裂外，余无异常发现。前医用针灸，中、西药物治疗数十载无功，审视其诸方多为补肾固涩之品；察其证，除一至三夜遗尿一次外，腰不痛，小腹不胀，神色正常，舌苔薄白，脉虚大而缓，并无肾虚膀胱不约之表现。反复思考始得其解。《素问·经脉别论》说：“食气入胃，浊气归心，淫精于脉，脉气流经，经气归于肺，肺朝百脉，输精于皮毛，毛脉合精，行气于府。府精神明，留于四脏，气归于权衡。权衡以平，气口成寸，以决死生”。《素问·脉要精微论》说：“微妙在脉，不可不察。”证不具备者，应求之于脉，此病脉虚大缓，乃脾肺俱虚，清阳不升所致．沈金鳌说：“肺主气以下降生水，输于膀胱。肺虚则不能为气化之主，故溺不禁也。”于是予补气升阳，佐以固涩之法，补中益气汤、缩泉丸加减：黄芪15克，党参9克，白术9克，陈皮9克，当归9克，白果9克，乌药9克，升麻6克，柴胡6克，甘草6克。连进12剂，遗尿延至一周1次；服药20剂后，40天内除有一天因过度劳累而发生1次遗尿外，未再遗尿，于是按原方为丸调理一年而痊愈。
恩师李翰卿先生告诫我说：治病的关键在于认清证候的性质，认清阴阳表里虚实寒热，认清脏腑经络．辨证的关键在于四诊合参，其中急性病要重证候，慢性病要重脉象，重望色，否则辨证难明，药非治其病之所在，即使经方验方，也取不到应有效果。
尿失禁
尿失禁，祖国医学中论述颇多，但对手术和脊髓损伤后的尿失禁却很少明确的提到，所以给中药治疗带来了困难。
1974年6月10日，曾治一男性患者，于某某，74岁。前列腺肥大手术后半年来小便一直不能控制，曾用针灸、中、西药物治疗无效，仔细审视其方均为补肾固涩缩泉固脬之药。证见神疲乏力，气短，舌苔白、脉弦大，尺脉尤甚。久思不得其解，于是求教于恩师李翰卿先生，他说：《素问》云：“微妙在脉，不可不察”；朱丹溪说：“大脉为洪之别名、病内伤者，阴虚为阳所乘故脉大，当作虚治。”仲景说：“脉大为劳”，可见大脉为虚，尺脉属肾，尺大为肾虚，故此病当为肺肾俱虚。前医用补肾固脬遗尿不减者，在于未补脾肺，肺为水之上源，脾主水液之运化，肺脾肾俱虚则阳气不升，水液不固，所以本证必须肺脾肾三脏同治，升阳益阴方能奏效。我遵循其论，予补中益气汤补脾肺，升清阳，六味地黄丸滋肾水敛精气，缩泉丸固脬止遗。处方：黄芪15克，党参9克，白术9克，陈皮9克，当归9克，熟地9克，山药9克，五味子9克，益智仁9克，乌药9克，茯苓9克，泽泻9克，丹皮9克，升麻6克，柴胡6克。4剂减，8剂竟豁然痊愈。
The *Ling Shu: Ben Shu Chapter* states: "Shaoyang is affiliated with the Kidney, and the Kidney connects upward to the Lung; thus, it governs these two Zang organs." Heart Fire resides in the upper part and constantly descends to interact with Kidney Water, enabling the Kidney to receive assistance from Fire, thereby strengthening Yang Qi. Kidney Water resides in the lower part and constantly ascends to nourish the Lung and Heart, allowing Heart Fire to be moistened by Kidney Water. If Liver Qi fails to disperse and the San Jiao (Triple Burner) becomes stagnant, Heart Fire cannot descend to interact with Kidney Water, and Kidney Water cannot ascend to nourish Heart Fire. This results in severe cold in the Lower Jiao and blazing fire in the Upper Jiao. Therefore, simply tonifying Fire makes it difficult to harmonize like ice and charcoal; clearing Fire exacerbates the cold. Thus, one must combine methods to soothe Liver Qi, regulate the San Jiao, and facilitate communication between the Heart and Kidney, so that the fire in the Upper Jiao descends and the cold in the Lower Jiao dissipates. For example: Patient Jiao XX, male, adult. Coldness in the lower abdomen for 7–8 years. Previous physicians prescribed large doses of Fu Zi (Aconite Lateral Root), Gui Zhi (Cinnamon Twig), Liu Huang (Sulfur), Gan Jiang (Dried Ginger), Xiao Hui Xiang (Fennel Fruit), Da Hui Xiang (Aniseed), Chen Xiang (Agarwood), Bi Bo (Long Pepper), and Gao Liang Jiang (Galangal Rhizome) for several years without effect. Careful examination revealed dizziness, irritability, bitter taste in the mouth, dry throat, and a wiry-slippery pulse. Prescribed Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Decoction with Dragon Bone and Oyster Shell) minus Qian Dan (Lead Monoxide). After 6 doses, abdominal coldness disappeared instantly; after 20 doses, the patient recovered. Hao XX, male, 25 years old. Coldness in the lower abdomen and penis for over 4 years, impotence for over 2 years. Previous physicians prescribed over 200 doses of Kidney-warming and Yang-strengthening formulas and hundreds of pills without effect. Careful examination revealed irritability, palpitations, constipation, dark urine, ruddy complexion with spirit, bitter taste, yellow tongue coating, and a deep-wiry pulse. Prescribed Chai Hu Jia Long Gu Mu Li Tang: Chai Hu (Bupleuri Radix), Ban Xia (Pinelliae Tuber), Huang Qin (Scutellariae Radix), Dang Shen (Codonopsis Radix), Gui Zhi (Cinnamomi Ramulus), Fu Ling (Poria) each 10g; Gan Jiang (Zingiberis Rhizoma) 3g; Da Huang (Rhei Radix et Rhizoma) 4g; Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g; Da Zao (Jujubae Fructus) 5 pieces; Long Gu (Fossilia Ossis Mastodi) 15g; Mu Li (Ostreae Concha) 15g. After 3 doses, symptoms greatly reduced and lower abdomen became warm; after 20 doses, all symptoms disappeared and the patient recovered. Guo XX, male, 40 years old. Spermatorrhea for 5 years, occurring every 2–3 days or continuously for 4–5 days at noon and night. Coldness in lower abdomen and penis, dizziness, insomnia, fullness and discomfort in chest and hypochondrium, wandering pain, cold limbs, fatigue. Previous treatment with Kidney-warming agents worsened spermatorrhea, and astringent agents increased irritability. Upon consultation, tongue coating was yellow-white, pulse was deep-wiry. Since tonifying and astringent treatments failed, prescribed Ku Xin Tong Jiang Bu Xie Tong Shi Shu Li San Jiao Jiao Tong Xin Shen Zhi Chai Hu Jia Long Gu Mu Li Tang Qu Qian Dan Jia Gan Cao Hua Fen Fang (Bupleurum Decoction with Dragon Bone and Oyster Shell minus Lead Monoxide plus Licorice and Trichosanthes Root). After 10 doses, symptoms reduced; after 80 doses, all symptoms resolved.
Obstruction of Urine and Stool
When both urine and stool are obstructed, promoting unblocking is usually the urgent priority. However, for patients with deficient Zheng Qi (Upright Qi), using such methods not only fails to resolve the issue but further injures Zheng Qi, making urination and defecation more difficult. I once treated patient Zhao XX, female, adult. Following pelvic fracture surgery and bladder rupture repair, she had been unable to pass urine or stool for over 30 days, requiring catheterization and enemas. Examination showed fever, excessive sweating, fatigue, cough with profuse sputum, poor appetite, bitter taste, dry mouth, tender-red tongue body, thick white tongue coating, and a deficiency-large-slippery-rapid pulse, with the Cun (Inch) position being prominent. Urgently prescribed Huang Qi (Astragali Radix) 15g, Sheng Ma (Cimicifugae Rhizoma) 6g, Chai Hu (Bupleuri Radix) 6g to benefit Qi and raise Yang; Tian Men Dong (Asparagi Radix) 10g, Mai Men Dong (Ophiopogonis Radix) 10g to nourish Yin and moisten the Lung; Jie Geng (Platycodonis Radix), Zhi Ke (Aurantii Fructus Immaturus) 12g, Zi Wan (Asteris Radix), Zhi Mu (Anemarrhenae Rhizoma) 10g to open and diffuse Lung Qi, allowing Clear Yang to rise and Turbid Yin to descend, Ying and Wei (Nutritive and Defensive Qi) to circulate, and the San Jiao's function of water passage to recover. After 3 doses, stool passed, and there was a slight sensation of urination. Re-examination showed a slippery-water tongue coating, so Rou Gui (Cinnamomi Cortex) 4g and Qing Pi (Aurantii Fructus Pericarpium Viride) 9g were added to warm Yang and transform water. After 2 doses, urination resumed and the patient recovered. In cases of blood stasis obstruction due to long-term trauma where invigorating blood injures Qi and Zheng Qi is insufficient, local external applications can be used.
For example: Patient Zhang XX, male, adult. One year ago, he fell, resulting in lumbar spine deformity and lower limb paralysis. Since then, he has been unable to pass urine or stool, relying daily on catheterization and enemas, with worsening condition recently. To alleviate suffering, he resorted to short-term fasting to reduce abdominal distension. Prescribed Xue Jie (Dragon's Blood), Er Cha (Catechu), San Qi (Notoginseng Radix et Rhizoma), Zi Ran Tong (Natural Pyrite), Bu Gu Zhi (Psoraleae Fructus), Dang Gui (Angelicae Sinensis Radix), Mu Gua (Chaenomelis Fructus), Chi Shao (Paeoniae Radix Rubra), Ru Xiang (Olibanum), Zhi Zi (Gardeniae Fructus), Tao Ren (Persicae Semen), Shan Jia Zhu (Manis Squama), Niu Xi (Achyranthis Bidentatae Radix), Ya Zao (Gleditsiae Spina) each 15g, Jin Guo Lan (Tinosporae Rhizoma) 18g. Ground into fine powder, mixed with hot vinegar, placed in a bag, and applied to the waist for 1 hour. Once daily. After 1 dose, abdominal distension slightly decreased; after 2 doses, normal urination and defecation resumed.
Internal and external medications are both important methods for treating diseases. For internal medicine conditions primarily caused by local lesions, external medicaments can be highly effective without injuring Zheng Qi. This must be noted during syndrome differentiation and treatment.
Liong Bi (Difficulty in Urination)
*Zheng Zhi Zhun Sheng* states: "The San Jiao is the official of irrigation, through which water passages flow. The Bladder is the official of the capital, storing fluids; only through Qi transformation can they be excreted. Therefore, if Qi transformation fails in any of the Upper, Middle, or Lower Jiao, water cannot flow freely as in irrigation channels. Is it merely an obstruction of Qi in the Lower Jiao Bladder? The Upper Jiao Lung governs the circulation of Ying and Wei Qi and regulates water passages, transmitting them downward to the Bladder. The Kidney pairs with the Foot Shaoyang San Jiao, which transmits downward and connects upward to the Lung. Does this not indicate that urination originates from Qi transformation in the Upper Jiao?" It also states: "Stagnation of Spleen and Stomach Qi prevents transportation and distribution. Combined with phlegm, food stagnation blocking the clear pathways, causing constipation and dysuria, several doses of Sheng Ma Er Zhu Er Chen Tang can moisten the stool and increase urine output." I have successfully treated many cases of Liong Bi following this principle, but it is ineffective for patterns of Kidney Qi deficiency and damp-heat accumulation.
I once treated patient Sun XX, male, 70 years old. Suddenly developed urinary retention 7 days ago, with unbearable abdominal distension. He went to the Urology Department of a certain hospital, diagnosed with "Benign Prostatic Hyperplasia, Urinary Retention." Catheterization and other medications provided slight relief from distension, but upon removal of the catheter, distension returned severely with no urine output. Surgery was proposed, but the patient refused, seeking Traditional Chinese Medicine (TCM) treatment. A previous physician's diuretic formula failed, as did a Qi-tonifying and Yin-nourishing formula. Upon examination, the pulse was wiry with a large Chi (Cubit) position, and the tongue coating was yellow-greasy. The physician stated: "A wiry pulse indicates cold; a large Chi pulse indicates insufficiency of Kidney Yang. Insufficient Kidney Yang fails to transform water, leading to stagnation and heat generation, causing urinary retention and pain. The method should be Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) plus Rou Cong Rong (Cistanche Caulis) to tonify Kidney Qi, and Zhi Mu (Anemarrhenae Rhizoma), Huang Bai (Phellodendri Cortex) to drain damp-heat." After 3 doses, urination improved slightly. After 15 doses, urination was smooth and the patient recovered. For Liong Bi caused by Kidney Yang deficiency with dry fire accumulating exclusively in the upper part, warming the Kidney and moistening the upper part is necessary.
For example: Geng XX, male, 70 years old. Difficulty in urination for over 20 days. Western medicine was initially ineffective. Upon examination, mental state was good, body healthy, slight dry mouth, cold fingers, thin-yellow tongue coating, deep-wiry-thin pulse. Correlating pulse and symptoms, diagnosed as Kidney Yang deficiency with dry fire accumulating in the upper part, source depletion failing Qi transformation. Treatment aimed to warm Yang, benefit the Kidney, clear heat, and generate fluids. Gua Lou Qu Mai Wan (Trichosanthes and Knotweed Decoction) modified: Hua Fen (Trichosanthis Radix) 15g, Shan Yao (Dioscoreae Rhizoma) 30g, Qu Mai (Polygoni Avicularis Herba) 15g, Fu Ling (Poria) 10g, Fu Zi (Aconiti Lateralis Radix Praeparata) 3g. Taken continuously for 6 doses, urination became smoother; continued for 14 doses until normal urination resumed.
Constipation
Zhang Zhongjing classified constipation into Yin Constipation, Yang Constipation, and Spleen Restriction. Later physicians classified it into Wind, Qi, Heat, Cold, and Wind-Dryness types. However, this classification is often overlooked by clinicians. Recent works either pursue brevity or emphasize integration with Western medicine, leading some physicians to know only purgative and moistening methods. They rarely pay attention to the description in the 1964 edition of *TCM Internal Medicine Lecture Notes*: "Worry and overthinking, emotional depression, or prolonged sitting and lack of movement often cause Qi mechanism stagnation, preventing diffusion. Consequently, descending and unblocking functions fail, transmission duties are lost, waste remains inside, cannot move downward, resulting in fecal constipation."
For example: Guo XX, male, 54 years old. Frequent constipation for 3 years. Initially relieved temporarily by Chinese and Western purgatives and moisteners. In the past month, even doubling the laxative dose was ineffective. For the past 7 days, frequent use of Cheng Qi Tang (Order the Qi Decoction), Western medicines, and enemas failed to produce stool, accompanied by dizziness, headache, irritability, insomnia, bitter taste, and dry mouth. Upon examination, tongue coating was thin-white, pulse was deep-wiry. Diagnosed as Shaoyang Qi stagnation, San Jiao dysfunction, and failure of fluids to descend. Prescribed Chai Hu Jia Long Gu Mu Li Tang: Chai Hu (Bupleuri Radix) 6g; Huang Qin (Scutellariae Radix), Dang Shen (Codonopsis Radix), Ban Xia (Pinelliae Tuber), Gui Zhi (Cinnamomi Ramulus), Fu Ling (Poria), Chen Pi (Citri Reticulatae Pericarpium) each 9g; Da Huang (Rhei Radix et Rhizoma) 3g; Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g; Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices; Da Zao (Jujubae Fructus) 5 pieces; Long Gu (Fossilia Ossis Mastodi), Mu Li (Ostreae Concha) each 15g. The referring doctor asked: "The patient has had chronic constipation for three years. Initial treatments with phenolphthalein, enemas, Da Cheng Qi Tang (Major Order the Qi Decoction), and Ma Zi Ren Wan (Hemp Seed Pill) provided temporary relief, but constipation worsened. You use only 3g of Da Huang, along with astringents like Long Gu and Mu Li. Can this be effective?" I replied: "Correlating symptoms and pulse, this is constipation due to San Jiao stagnation, failure of diffusion, loss of descending/unblocking function, and accumulation of waste. Previous treatments failed due to frequent purging, depleting Yang Qi and hindering Fu organ Qi movement. Therefore, large doses of purgatives are no longer appropriate. Chai Hu Jia Long Gu Mu Li Tang contains Xiao Chai Hu Tang (Minor Bupleurum Decoction) to soothe Liver/Gallbladder and regulate San Jiao; Dang Shen, Gui Zhi, Sheng Jiang, Gan Cao, Da Zao to assist Spleen and warm Yang; Ban Xia, Chen Pi, Sheng Jiang for acrid-warm properties; Long Gu, Mu Li to anchor Yang and calm spirit. Although it has astringent properties, it allows Clear Qi to rise and Turbid Qi to descend. Furthermore, the patient's ascending Yang causes dizziness and headache; heavy sedatives are needed to direct Qi downward. While Long Gu and Mu Li have astringent drawbacks, their ability to anchor Yang is beneficial. Thus, a small amount of Da Huang assists in bowel movement." After medication, stool passed. Continued for 6 doses, resolving years of constipation. The doctor later remarked: "Ancient physicians used Zhu Sha (Cinnabar), Dai Zhe Shi (Haematitum), Shi Jue Ming (Haliotidis Concha), Jue Ming Zi (Cassiae Semen) to promote bowel movements. I never understood why until now."
For constipation occurring every 2–3 or 5–6 days, caused by internal dry-heat binding, fluid exhaustion, and transmission dysfunction, Cheng Qi formulas are commonly used. For elderly patients with fluid exhaustion, postpartum blood loss, or post-illness weakness with blood/fluid deficiency and intestinal dryness, blood-nourishing and bowel-moistening methods are preferred. However, patterns of internal Yin-cold binding, Yang non-movement, and transmission failure are often ignored, leading to chronic persistence.
For example: Gao XX, female, 12 years old. For 11 years, bowel movements occurred every 3–4 days, later every 7–8 days. Temporary relief required Chinese and Western medicines. To promote defecation, she consumed large amounts of fruit and honey daily. However, constipation worsened over the past year, with abdominal distension/pain, poor appetite, and fatigue. Previously, Da Cheng Qi Tang and Kaiselu (glycerin enema) were required. For the past 4 months, despite large doses of purgatives, moisteners, and soap suds enemas, expulsion was difficult, requiring 2 hours of squatting per day to alleviate suffering. Examination revealed sallow complexion, sparse speech, abdominal fullness/distension, dull pain, thin-white tongue coating, pale-dusky tongue body, deep-wiry-thin pulse. Considering her young age but long-term use of cold-purgatives and yin-nourishing/drying agents damaging Yang Qi, and recalling the Classic: "The Large Intestine is the official of transmission, where changes occur. The Small Intestine is the official of reception, where transformations occur." With Yang deficiency, transmission fails, how can stool pass? Prescribed Wen Yang Li Qi, Hua Shi He Zhong (Warm Yang, Regulate Qi, Transform Dampness, Harmonize Middle) formula: Hou Po Wen Zhong Tang (Magnolia Bark Decoction to Warm the Middle) modified: Hou Po (Magnoliae Officinalis Cortex) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Cao Kou (Amomi Fructus Rotundus) 10g, Mu Xiang (Aucklandiae Radix) 6g, Gan Jiang (Zingiberis Rhizoma) 6g, Rou Gui (Cinnamomi Cortex) 6g, Da Huang (Rhei Radix et Rhizoma) 1g. After 1 dose, two bowel movements occurred, and abdominal distension/pain decreased. After 3 doses, normal bowel movements resumed. Suspecting severe Yang deficiency, switched to Fu Gui Li Zhong Tang (Aconite and Cinnamon Decoction to Warm the Middle) modified: Fu Zi (Aconiti Lateralis Radix Praeparata) 10g, Rou Gui (Cinnamomi Cortex) 10g, Dang Shen (Codonopsis Radix) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Gan Jiang (Zingiberis Rhizoma) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Hou Po (Magnoliae Officinalis Cortex) 10g, Da Huang (Rhei Radix et Rhizoma) 2g. After 3 doses, abdominal distension/pain worsened, stool became dry and occurred every 3 days. Reflecting on Jing Yue's statement: "Deep pulse indicates Yang stagnation; wiry indicates cold. For cold stagnation, regulating Qi is essential; assisting Yang directly may cause cold binding internally, worsening constipation." Switched back to Hou Po Wen Zhong Tang modified. After 30+ doses over 40+ days, normal bowel movements resumed.
Another case: Guo XX, female, 43 years old. Bowel movements every 3–5 days for over 30 years. To reduce pain, she ate fruits, honey, and almost daily Western laxatives, yet still waited 7–8 days. For the past 2 years, required Cheng Qi Tang, honey, Kaiselu, or enemas. Examination showed sallow complexion, thin-white tongue coating, pale-dusky tongue body, large-tight-wiry pulse. Diagnosed: Chronic illness for 30+ years, frequent purging damaged Yuan Qi, moistening/drying strategies favored Yin. As Zhang Zhongjing stated: "Wiry and tight pulse: wiry means Wei Qi does not move, causing aversion to cold; tight means poor appetite, struggle between pathogen and righteous Qi." "Wiry and large pulse: wiry indicates decline (cold); large indicates hollow (deficiency). Deficiency and cold intertwining is called Ge Pulse." For deficiency-cold Yin constipation, prescribed Fu Gui Li Zhong Tang to warm Yang and scatter cold, assisted by Qi-regulating and unblocking agents: Fu Zi (Aconiti Lateralis Radix Praeparata) 10g, Rou Gui (Cinnamomi Cortex) 10g, Dang Shen (Codonopsis Radix) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Gan Jiang (Zingiberis Rhizoma) 10g, Zhi Shi (Aurantii Fructus Immaturus) 6g, Hou Po (Magnoliae Officinalis Cortex) 6g, Da Huang (Rhei Radix et Rhizoma) 2g. After 1 dose, three bowel movements, slightly loose. Continued for 4 doses, maintaining twice-daily bowel movements. The patient asked: "Previous doctors used 30g Da Huang and 10g Mang Xiao (Mirabilite) with enemas, yet stool was hard to pass. Why did your 2g Da Huang work?" I answered: "Da Huang and Mang Xiao are holy medicines for purging, suitable for excess-heat, but contraindicated for fluid exhaustion and deficiency-cold. Their bitter-salty-cold nature clears heat and unblocks bowels, but damages fluids in those already depleted. Dry fluids mean no lubrication; dry water means the boat stops; stopped boat means no stool. Using them in Yang deficiency further destroys life-giving Yang Qi. Without Yang, Qi does not move; without Qi movement, stool does not pass. This formula uses Fu Gui Li Zhong to strongly tonify Middle/Lower Jiao Yang, with a small amount of Xiao Cheng Qi Tang to facilitate action by moving Yang Qi." After one month, all symptoms resolved.
Enuresis
The *Nei Jing* elaborates extensively on enuresis. It states: "If the Bladder... fails to restrain, it leads to enuresis"; "Disease of the Du Mai... leads to enuresis"; "Diseases of the meridians... lead to enuresis"; "Excessive pathogenic qi causes enuresis, bi-syndrome gathers in the Kidney"; "The San Jiao is governed by Foot Shaoyin and Shaoyang... deficiency leads to enuresis."
I once treated a 43-year-old male with 40 years of enuresis. Extensive examinations revealed only occult sacral spina bifida, with no other abnormalities. Decades of acupuncture and Chinese/Western medicines failed. Previous prescriptions were mostly Kidney-tonifying and astringent. Examination showed enuresis once every 1–3 nights, no lower back pain, no lower abdominal distension, normal demeanor, thin-white tongue coating, deficiency-large-slow pulse. There were no signs of Kidney deficiency or Bladder failure to restrain. After careful reflection, I found the explanation. *Su Wen: Jing Mai Bie Lun* states: "Food qi enters the Stomach, turbid qi returns to the Heart, essence floods into the vessels, vessel qi flows through meridians, meridian qi returns to the Lung. The Lung receives all vessels, transports essence to skin/hair, hair and vessel essence combine, Qi moves to the Fu organs. Fu organ Qi is bright and spiritual, remaining in the four Zang organs, Qi returns to balance. Balance creates the Cun inch pulse, determining life and death." *Su Wen: Mai Yao Jing Wei Lun* states: "Subtlety lies in the pulse, which must not be neglected." When symptoms are absent, seek the pulse. This patient's deficiency-large-slow pulse indicated combined Spleen and Lung deficiency, with failure of Clear Yang to rise. Shen Jin'ao stated: "The Lung governs Qi, descending to generate water, transmitting to the Bladder. Lung deficiency fails to be the master of Qi transformation, hence uncontrollable urination." Prescribed Bu Qi Sheng Yang (Benefit Qi and Raise Yang) with astringents: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Suo Quan Wan (Lock the Spring Pill) modified: Huang Qi (Astragali Radix) 15g, Dang Shen (Codonopsis Radix) 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Dang Gui (Angelicae Sinensis Radix) 9g, Bai Guo (Ginkgonis Semen) 9g, Wu Yao (Linderae Radix) 9g, Sheng Ma (Cimicifugae Rhizoma) 6g, Chai Hu (Bupleuri Radix) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g. After 12 doses, frequency reduced to once a week. After 20 doses, except for one episode due to overexertion within 40 days, no enuresis occurred. Prepared as pills for one year of regulation, resulting in recovery.
My mentor, Mr. Li Hanqing, warned me: The key to treating disease is recognizing the nature of the syndrome, distinguishing Yin/Yang, Exterior/Interior, Deficiency/Excess, Cold/Heat, and identifying Zang-Fu and meridians. The key to differentiation is integrating Four Diagnostic Methods. For acute diseases, focus on symptoms; for chronic diseases, focus on pulse and complexion observation. Otherwise, differentiation is unclear, and medicines will not target the disease location. Even classic and verified formulas will not yield expected effects.
Urinary Incontinence
Traditional Chinese Medicine discusses urinary incontinence extensively but rarely mentions it explicitly after surgery or spinal cord injury, posing difficulties for herbal treatment.
On June 10, 1974, I treated a 74-year-old male, Yu XX. For six months post-BPH surgery, he could not control urination. Acupuncture and Chinese/Western medicines were ineffective. Previous prescriptions were all Kidney-tonifying and astringent (Suo Quan Gu Pao). Symptoms included fatigue, shortness of breath, white tongue coating, wiry-large pulse, especially at the Chi position. After prolonged reflection without solution, I consulted my mentor Li Hanqing. He said: "*Su Wen* states: 'Subtlety lies in the pulse, which must not be neglected.' Zhu Danxi said: 'Large pulse is another name for Hong (Surging) pulse. In internal injury, Yin deficiency allows Yang to invade, causing a large pulse; treat as deficiency.' Zhang Zhongjing said: 'Large pulse indicates劳 (consumption/exhaustion).' Thus, large pulse indicates deficiency. Chi position belongs to Kidney; large Chi indicates Kidney deficiency. Therefore, this disease involves both Lung and Kidney deficiency. Previous treatments failed because they did not tonify Spleen and Lung. The Lung is the upper source of water; the Spleen governs water transport. Deficiency in Lung, Spleen, and Kidney leads to failure of Yang rising and water securing. Thus, treating all three Zang organs together, raising Yang and benefiting Yin, is necessary." Following his theory, I prescribed Bu Zhong Yi Qi Tang to tonify Spleen/Lung and raise Clear Yang; Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to nourish Kidney water and consolidate essence; Suo Quan Wan to secure the Bladder and stop enuresis. Prescription: Huang Qi (Astragali Radix) 15g, Dang Shen (Codonopsis Radix) 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Dang Gui (Angelicae Sinensis Radix) 9g, Shu Di (Rehmanniae Radix Praeparata) 9g, Shan Yao (Dioscoreae Rhizoma) 9g, Wu Wei Zi (Schisandrae Chinensis Fructus) 9g, Yi Zhi Ren (Alpiniae Oxyphyllae Fructus) 9g, Wu Yao (Linderae Radix) 9g, Fu Ling (Poria) 9g, Ze Xie (Alismatis Rhizoma) 9g, Dan Pi (Moutan Cortex) 9g, Sheng Ma (Cimicifugae Rhizoma) 6g, Chai Hu (Bupleuri Radix) 6g. Reduced after 4 doses; completely cured after 8 doses.