巢氏云∶肾主水,与足太阳相为表里。经曰∶膀胱者,州都之官,津液藏焉。卧则阳气内收
,肾与膀胱之气虚寒不能约制,故睡中遗出,《内经》谓膀胱不约为遗是也。用破故纸散、
益智散、鸡肠散之类主之。亦有热客于肾,干于足厥阴之经,廷孔郁结,而气血不能宣通,
则痿痹而无所用,故液渗入膀胱,而漩溺遗失者,用六味地黄丸;虚热亦用前丸。脾肺气虚
者,用补中益气汤加补骨脂、山茱萸。
治验
一小儿眼胞微肿,咳嗽恶心,小便泔白,余谓脾疳食积也,用五味异功散,佐以四味肥儿丸
而愈。后不节饮食,视物不明。余曰∶目为五脏之精,脾胃复伤,须补养为主。不信,乃复
峻厉之剂,变慢脾风,竟为不起。
一小儿三岁,素遗尿,余视其两颏微赤,此禀父肾与膀胱二经阴虚也,与六味丸服之,赤色
渐退,而遗尿亦愈。
一小儿四岁,饮食少思,便泄腹痛,素遗尿,额颏青黑,虽盛暑而恶风寒,余谓∶经云∶热
之不热,是无火也。用八味丸治之,诸症悉愈。
破故纸散 治膀胱虚冷,夜间遗尿,或小便不禁。
破故纸
为末,每服一钱,热汤调下。
汤氏鸡肠散 治小便不禁,睡中遗出。
鸡肠草(一两) 牡蛎粉(三钱) 龙骨( ) 麦门冬(去心) 白茯苓 桑螵蛸(炙。各半两)
上为散,每服一钱,枣水煎。
又方 五倍子炒焦为末,每服半钱,白汤调下,或糊丸米汤送下。
益智散(方见潮热,即益智丸)
异功散(方见内钓)
补中益气汤(方见虚羸)
四味肥儿散(方见寒吐)
六味地黄丸
加减八味丸(二方见肾脏,即六味丸加五味子、肉桂)
巢元方说:肾主管水液代谢,与足太阳膀胱经互为表里。医经记载:膀胱是州都之官,负责贮藏津液。睡眠时阳气内收,若肾与膀胱之气虚寒,不能制约水液,就会导致睡中遗尿,《内经》称之为“膀胱不约”导致的遗尿。治疗可用破故纸散、益智散、鸡肠散等方剂。也有因热邪客居肾脏,干扰足厥阴肝经,导致前阴部位郁结,气血不能宣通,从而出现痿痹而无用,致使液体渗入膀胱,造成小便遗失的情况,这种情况用六味地黄丸治疗;若是虚热所致,也使用前方。若是脾肺气虚者,用补中益气汤加补骨脂、山茱萸。
治验案例:
有一个小儿眼睑微肿,咳嗽恶心,小便浑浊如米泔水,我认为是脾疳食积,于是使用五味异功散,配合四味肥儿丸,病就好了。后来因为饮食不节制,导致视物不明。我说:眼睛是五脏精华所在,脾胃再次受伤,必须以补养为主。家属不信,反而使用峻烈猛烈的药物,导致病情演变为慢脾风,最终孩子死亡。
有一个三岁小儿,平时有遗尿症状,我看他两颏部微微发红,这是禀受父亲肾与膀胱二经阴虚所致,给予六味地黄丸服用,红色逐渐消退,遗尿也随之痊愈。
有一个四岁小儿,饮食减少且思食不佳,大便泄泻并腹痛,平时有遗尿症状,额头和下巴青黑,即使在盛夏也怕冷怕风。我说:医经云:加热后仍不发热,这是无火(肾阳虚衰)的表现。用八味丸治疗,各种症状全部痊愈。
破故纸散:治疗膀胱虚冷,夜间遗尿,或小便失禁。
破故纸(补骨脂),研为细末,每次服用一钱,用热开水调服。
汤氏鸡肠散:治疗小便失禁,睡中遗尿。
鸡肠草(一两)、牡蛎粉(三钱)、龙骨(未注明剂量)、麦门冬(去心)、白茯苓、桑螵蛸(炙。各半两)。
以上药材研为散剂,每次服用一钱,用枣子煎的水送服。
又一方:五倍子炒焦后研为细末,每次服用半钱,用白开水调服,或者制成糊丸用米汤送服。
益智散(方剂见潮热章节,即益智丸)
异功散(方剂见内钓章节)
补中益气汤(方剂见虚羸章节)
四味肥儿散(方剂见寒吐章节)
六味地黄丸
加减八味丸(两个方剂见肾脏章节,即六味地黄丸加五味子、肉桂)
Chao Yuanfang stated: The Kidney governs water metabolism and stands in a exterior-interior relationship with the Foot-Taiyang Bladder Meridian. The Classics state: The Bladder is the official of the Zhou Du, responsible for storing body fluids. During sleep, Yang Qi withdraws inward. If the Qi of the Kidney and Bladder is deficient and cold, failing to constrain the fluids, nocturnal enuresis occurs. This is referred to in the *Nei Jing* as "enuresis due to the Bladder's failure to constrain." Treatment may involve formulas such as Pogostemon Powder (Pogostemon San), Yi Zhi Powder (Yi Zhi San), or Chicken Intestine Powder (Ji Chang San). Alternatively, heat pathogens may lodge in the Kidney, interfering with the Foot-Jueyin Liver Meridian, causing stagnation at the anterior aperture, leading to impotence and dysfunction, resulting in fluids seeping into the Bladder and urinary incontinence; this is treated with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia); if caused by deficiency-heat, the same formula is used. For cases of Spleen and Lung Qi deficiency, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is administered with added Psoralea Fruit (Buguzhi) and Cornus Fruit (Shanzhuyu).
Clinical Cases:
A child presented with slightly swollen eyelids, coughing, nausea, and cloudy urine resembling rice washings. I diagnosed this as Spleen-type malnutrition (Pi Gan) with food retention, and prescribed Wu Wei Yi Gong San (Five-Ingredient Extraordinary Power Powder), assisted by Si Wei Fei Er Wan (Four-Ingredient Fat-Enriching Pill), resulting in recovery. Later, due to irregular diet, the child suffered from blurred vision. I stated: "The eyes are the essence of the five Zang organs; since the Spleen and Stomach were injured again, nourishment and tonification must be the primary approach." The family did not believe this and instead used harsh, drastic medicines, which transformed the condition into Slow Spleen Wind (Man Pi Feng), leading to the child's death.
A three-year-old child, who habitually suffered from nocturnal enuresis, had slightly reddish chins upon examination. This indicated congenital Yin deficiency of the Father's Kidney and Bladder meridians. Administration of Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) gradually reduced the redness and cured the enuresis.
A four-year-old child exhibited poor appetite, diarrhea with abdominal pain, habitual nocturnal enuresis, and bluish-black discoloration on the forehead and chin. Despite the height of summer, the child feared wind and cold. I stated: "The Classics say: 'If heating does not produce warmth, it indicates absence of Fire' (Kidney Yang deficiency)." Treatment with Ba Wei Wan (Eight-Ingredient Pill) resulted in the complete resolution of all symptoms.
Pogostemon Powder (Pogostemon San): Treats Bladder deficiency-cold, nocturnal enuresis, or urinary incontinence.
Psoralea Fruit (Pogostemon cablin), ground into powder. Take one qian per dose, mixed with hot water.
Tang Shi Chicken Intestine Powder (Tang Shi Ji Chang San): Treats urinary incontinence and nocturnal enuresis.
Commelina communis Herb (Ji Chang Cao, 1 liang), Oyster Shell Powder (Muli Fen, 3 qian), Dragon Bone (Long Gu, dosage unspecified), Ophiopogon Tuber (Mendong, heart removed), Poria (Fuling), and Mantis Egg Case (Sangpiaoxiao, processed. Each 0.5 liang).
Grind into powder. Take one qian per dose, decocted with jujube water.
Another Prescription: Koelreuteria Seed (Wubeizi) roasted until charred, ground into powder. Take half a qian per dose, mixed with plain water, or made into paste pills and taken with rice soup.
Yi Zhi Powder (Yi Zhi San) (See Fever Chapter, i.e., Yi Zhi Wan).
Yi Gong Powder (Yi Gong San) (See Internal Hook Chapter).
Bu Zhong Yi Qi Decoction (Bu Zhong Yi Qi Tang) (See Emaciation Chapter).
Si Wei Fei Er Powder (Si Wei Fei Er San) (See Cold Vomiting Chapter).
Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia).
Modified Ba Wei Wan (Jia Jian Ba Wei Wan) (See Kidney Chapter, i.e., Liu Wei Di Huang Wan plus Schisandra Berry (Wuweizi) and Cinnamon Bark (Rougui)).