治心肾有热，小便不通。
赤茯苓 木通 车前子 桑白皮（炒） 荆芥 灯草 赤芍药 甘草（微炒）
蒲黄（生） 滑石（各等分） 为末，每服二钱，葱白柴苏煎汤，食前调下。
治肾虚蒸热，下焦邪热，口不渴，而小便秘。
黄柏（酒炒，二两） 知母（酒炒，一两） 桂（一钱） 蜜丸。
治小便闭，小肠胀，不急治，杀人。
用葱白三斤，切细炒熟，绢包分两袋，更替熨脐下，气透即通。又法炒盐半斤，囊
盛熨小腹。又法以自爪甲烧灰米饮下。
治小便不通。
大蒜独颗者（一枚） 栀子（七枚） 盐花（少许） 上捣烂绵纸上贴脐，良久即通，未通涂
阴囊上立通。
治大人小儿，小便不利或不通。
大黄 木通（去皮） 滑石 粉草 瞿麦 山栀 荆芥（各等分） 为末，每一钱，
薄荷汤调，食前服。
小便不禁频数，古方多以为寒，而用温涩之药，殊不知属热者多。盖膀胱火邪妄
动，水不得宁，故不能禁而频数来也。故年老人多频数，是膀胱血少，阳火偏旺也。治
法当补膀胱阴血，泻火邪为主，佐以收涩之剂，如牡蛎山茱五味之类，不可用温药也。
盖病本属热，故宜泻火，因水不足故火动，而致小便多，小便既多，水益虚矣。故宜补
血泻火以治本，收之涩之以治标，至于小便不禁，出而不觉者，属虚属寒，赤者是阴不
足，白者是气虚，而元阳亏极。
丹溪治一老人，患小便不利，因服分利之药太过，遂致闭塞，点滴不出，此因分
降，而清阳之胃气下陷也。用补中益气汤，一服而通，但因先多用利药，损其肾气，遂
致通后，遗尿一夜不止，复急温补其肾而后已。凡医之治是证者，未有不用渗利之剂，
谁能固其肾气之虚哉！若有善法丹溪者，已明知其肺虚也，乃以补中益气汤，送肾气
丸，岂不上下相须，子母并益耶！《灵枢》言∶手太阴之别，名曰列缺，其病虚则欠
缺，小便遗失，肺为上焦通调水道，下输膀胱，而肾又上连于肺，为子母也。母虚子亦
虚，自然之理。东垣云∶小便遗失，肺金虚也。宜禁劳役，安卧养气，以黄 人参之类
大补之，不愈当责之肾。《经》曰∶膀胱不约为遗溺。仲景云∶下焦渴则遗溺失便；又
云∶下焦不归，则遗溲，盖下焦在膀胱上口，主分别清浊溲便，下焦不归其部，不能
约制溲便，故遗溺，如天暖衣浓，则多汗，天冷衣薄则多溺，多溺者寒也。至于不禁，
虚寒之甚，非八味九不效。古方如菟丝子丸，鹿茸散，二气丸俱可选用。戴氏云∶睡
着遗尿者，此亦下元虚冷，小便无禁而然，宜大冤丝子丸，猪胞灸碎煎汤下。凡遗尿皆
属虚，刘河间为热甚客于肾部，干于足厥阴之经，挺孔郁结，甚而气血不能宣通，则痿
痹，神无所用，故津液渗入膀胱，而漩溺遗失，不能收禁也。即《内经》淫气遗溺，痹
聚在肾，此系热症，不可不知。考之薛按∶有因劳发热作渴，小便自遗，或时闭涩者，
作肝火血虚，阴挺不能约制为治，午前补中益气汤，加山药山茱，午后六味丸，月余悉
退，故不禁之病，虽有热症亦虚火多而实热少，倘以虚症误投泻火，顷刻危殆；慎之，
大抵频数，尚有虚热，不禁纯属虚寒也。世治遗失，但知补涩，不知荣卫不调，而使其
正气冲和，连用各行其道，遽以敛剂投之，虽暂止而必复作，要知肺者，主气以下降，
生水以下输，膀胱者，津液藏焉。气化则能出，水泉不止者，膀胱不能约束也，此两经
者，实为总习，肺虚者为上虚，当补气，惟补中益气而已，此治肺虚而救其上源也。不
愈，当分以治之。若膀胱虚，则为下虚，当涩脱挟寒者，当温补，滑脱者，当收涩，挟
热者当清利。有因病淋，多服利药太过，致溺不禁者，大剂参 少佐熟附。妇人生产，
因稳婆损胞，而致小便不禁者，须以参 为君，芎归为臣，桃仁、陈皮、茯苓为佐，煎
以猪羊胞中汤，极饥时饮之，大剂连服，切不可缓，须令气血骤长，迟则难以成功矣。
妊妇尿出不知，用炙桑螵蛸，益智仁为末，米饮二钱。若脾肺气虚，补中益气汤加益智
仁。肝肾阴虚，六味丸，若脬中有热者，加
味逍遥散，在老人多由下元不足，婴儿多由阳气尚微，不能约束，并宜温补。
有妇人病后，小便出屎者，此阴阳失于传送，名大小肠交也。先调阴阳，次为补中益气。
治疗心肾有热，导致小便不通。
赤茯苓、木通、车前子、桑白皮（炒）、荆芥、灯草、赤芍药、甘草（微炒）
蒲黄（生用）、滑石（以上药材各等分），研为细末，每次服用二钱，用葱白和紫苏煎汤，在饭前调服。
治疗肾虚引起的蒸蒸发热，下焦邪热，口不渴，但小便闭塞不通。
黄柏（酒炒，二两）、知母（酒炒，一两）、桂枝（一钱），制成蜜丸。
治疗小便闭塞，小肠胀满，如果不紧急治疗，会危及生命。
用葱白三斤，切碎后炒熟，用绢布包成分成两袋，交替熨烫脐下部位，待热气透入则小便通畅。另一种方法是用半斤炒盐，装在袋中熨烫小腹。还有一种方法是将自己的指甲烧成灰，用米饮送服。
治疗小便不通。
独头大蒜（一枚）、栀子（七枚）、盐花（少许），将上述药物捣烂，贴在绵纸上敷于脐部，过一段时间即可通畅；如果未通，涂在阴囊上立即通畅。
治疗成人和小儿，小便不利或完全不通。
大黄、木通（去皮）、滑石、粉草、瞿麦、山栀、荆芥（以上药材各等分），研为细末，每次服用一钱，用薄荷汤调服，饭前服用。
小便不禁且频数，古方多认为是寒证，而使用温涩的药物，殊不知属于热证的居多。这是因为膀胱火邪妄动，水液不得安宁，所以不能控制而频繁排尿。因此老年人多出现频数，是因为膀胱血少，阳火偏旺所致。治疗方法应当以补益膀胱阴血、泻火邪为主，辅以收涩的药物，如牡蛎、山茱萸、五味子之类，不可使用温药。因为病本属热，所以宜泻火；因水不足导致火动，从而引起小便多，小便既多，水更加虚弱。所以宜补血泻火以治本，收涩以治标。至于小便不禁，流出而不觉察的，属于虚证、寒证；尿色赤的是阴不足，尿色白的是气虚，且元阳亏损至极。
丹溪治疗一位老人，患小便不利，因为服用分利药物太过，导致闭塞，点滴不出，这是由于过度分降，导致清阳胃气下陷。用补中益气汤，服用一次即通，但因为先前多用利药，损伤了肾气，导致通后遗尿一夜不止，再次急用温补肾气的药物才停止。凡是医生治疗这种病症，没有不用渗利药物的，谁能固护其肾气之虚呢！如果有像丹溪那样高明的医生，既然已经知道其肺虚，就用补中益气汤送服肾气丸，岂不是上下相须，子母并益吗？《灵枢》说：手太阴肺经的别络，名叫列缺，其病虚则呵欠，小便遗失。肺为上焦通调水道，下输膀胱，而肾又上连于肺，为子母关系。母虚子亦虚，这是自然之理。东垣说：小便遗失，是肺金虚损。应当禁止劳役，安卧养气，用人参之类大补之，如果不愈应当责之于肾。《内经》说：膀胱不约则遗溺。仲景说：下焦渴则遗溺失便；又说：下焦不归其部，则遗溲，盖下焦位于膀胱上口，主分别清浊溲便，下焦不归其部，不能约束溲便，故遗溺，就像天暖衣厚则多汗，天冷衣薄则多溺，多溺者是寒证。至于小便不禁，是虚寒之甚，非八味丸无效。古方如菟丝子丸、鹿茸散、二气丸都可选用。戴氏说：睡着遗尿，这也是下元虚冷，小便无禁所致，宜用菟丝子丸，猪胞灸碎煎汤送服。凡遗尿皆属虚证，刘河间认为是热甚客于肾部，干犯足厥阴肝经，挺孔郁结，甚则气血不能宣通，则痿痹，神无所用，故津液渗入膀胱，而漩溺遗失，不能收禁。即《内经》所说淫气遗溺，痹聚在肾，这是热症，不可不知。考证薛己按语：有因劳发热作渴，小便自遗，或时闭涩者，作肝火血虚，阴挺不能约制来治疗，午前服补中益气汤，加山药、山茱萸，午后服六味丸，月余悉退，所以不禁之病，虽有热症也是虚火多而实热少，倘若以虚症误投泻火药，顷刻危殆；慎重啊，大抵频数，尚有虚热，不禁纯属虚寒也。世治遗失，只知补涩，不知荣卫不调，而使其正气冲和，连用各行其道，遽以敛剂投之，虽暂止而必复作，要知肺者，主气以下降，生水以下输，膀胱者，津液藏焉。气化则能出，水泉不止者，膀胱不能约束也，此两经者，实为总习，肺虚者为上虚，当补气，惟补中益气而已，此治肺虚而救其上源也。不愈，当分以治之。若膀胱虚，则为下虚，当涩脱挟寒者，当温补，滑脱者，当收涩，挟热者当清利。有因病淋，多服利药太过，致溺不禁者，大剂参 少佐熟附。妇人生产，因稳婆损胞，而致小便不禁者，须以参 为君，芎归为臣，桃仁、陈皮、茯苓为佐，煎以猪羊胞中汤，极饥时饮之，大剂连服，切不可缓，须令气血骤长，迟则难以成功矣。 妊妇尿出不知，用炙桑螵蛸，益智仁为末，米饮二钱。若脾肺气虚，补中益气汤加益智仁。肝肾阴虚，六味丸，若脬中有热者，加味逍遥散，在老人多由下元不足，婴儿多由阳气尚微，不能约束，并宜温补。 有妇人病后，小便出屎者，此阴阳失于传送，名大小肠交也。先调阴阳，次为补中益气。
Treats heat in the Heart and Kidney causing urinary retention.
Chi Fuling (Polyporus), Mutong (Akebia Caulis), Cheqianzi (Plantaginis Semen), Sangbaipi (Mori Cortex, stir-fried), Jingjie (Schizonepetae Herba), Dengcao (Junci Medulla), Chishaoyao (Paeoniae Radix Rubra), Gancao (Glycyrrhizae Radix et Rhizoma, lightly stir-fried).
Puhuang (Typhae Pollen, raw), Huashi (Talcum) (all in equal proportions), ground into powder. Take two qian each time, mixed with decoction of Congbai (Allii Fistulosi Bulbus) and Zisu (Perillae Folium), taken before meals.
Treats steaming heat due to Kidney deficiency, pathogenic heat in the Lower Jiao, no thirst, but urinary obstruction.
Huangbai (Phellodendri Cortex, wine-fried, two liang), Zhimu (Anemarrhenae Rhizoma, wine-fried, one liang), Gui (Cinnamomi Ramulus, one qian), made into honey pills.
Treats urinary closure, distension of the Small Intestine; if not treated urgently, it can be fatal.
Use three jin of Congbai (Allii Fistulosi Bulbus), cut finely and stir-fried until cooked, wrapped in silk cloth into two bags, alternately applied to moxibustion below the umbilicus. When Qi penetrates, urination will flow freely. Another method: stir-fry half a jin of salt, place in a bag, and apply to the lower abdomen. Another method: burn one's own fingernails to ash, take with rice water.
Treats urinary retention.
One clove of garlic (one piece), Gardenia fruits (seven pieces), salt crystals (a small amount). Pound these into a paste, apply on cotton paper to the umbilicus. After a while, urination will flow freely; if not, apply to the scrotum for immediate relief.
Treats adults and children with difficult urination or complete retention.
Dahuang (Rhei Radix et Rhizoma), Mutong (Akebiae Caulis, peeled), Huashi (Talcum), Fencǎo (Glycyrrhizae Radix et Rhizoma), Qumai (Dianthi Herba), Shanzhi (Gardeniae Fructus), Jingjie (Schizonepetae Herba) (all in equal proportions). Ground into powder. Take one qian each time, mixed with Bohe Tang (Menthae Haplocalycis Decoction), taken before meals.
Urinary incontinence with frequency is often considered cold syndrome in ancient formulas, using warming and astringent drugs. However, it is unknown that most cases belong to heat syndrome. This is because Fire Evil in the Bladder moves recklessly, Water cannot remain tranquil, thus unable to control and frequent urination occurs. Therefore, elderly people often have frequency, which is due to less Blood in the Bladder and hyperactive Yang Fire. The treatment method should primarily tonify Bladder Yin and Blood, and purge Fire Evil, assisted by astringent agents such as Muli (Ostreae Concha), Shanzhuyu (Corni Fructus), and Wuweizi (Schisandrae Fructus). Warming drugs should not be used. Since the root of the disease belongs to Heat, purging Fire is appropriate. Because Water insufficiency causes Fire movement, leading to frequent urination, and frequent urition further depletes Water, one should tonify Blood and purge Fire to treat the root, and use astringents to treat the branch. As for urinary incontinence where urine flows out without awareness, it belongs to Deficiency and Cold. Red urine indicates Yin insufficiency; white urine indicates Qi deficiency and extreme depletion of Primordial Yang.
Danxi treated an elderly man suffering from difficult urination. Due to excessive use of diuretic drugs, he developed complete obstruction with no drops coming out. This was caused by excessive draining, leading to sinking of Clear Yang Stomach Qi. Using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), one dose resulted in free urination. However, because previous use of diuretics damaged Kidney Qi, he suffered nocturnal enuresis for a night after urination resumed. Emergency warming and tonification of the Kidney was required to stop it. Physicians treating this condition invariably use permeating and draining agents; who can secure the deficiency of Kidney Qi? If there were physicians as skilled as Danxi, knowing Lung deficiency, they would use Buzhong Yiqi Tang to deliver Shenqi Wan (Kidney Qi Pill), achieving mutual assistance between Upper and Lower, benefiting both Mother and Child organs! The *Ling Shu* states: The collateral of Hand-Taiyin [Lung] is named Lieque. Its disease when deficient involves yawning and urinary incontinence. The Lung regulates water passages in the Upper Jiao, transmitting downwards to the Bladder. The Kidney connects upwards to the Lung, forming a Mother-Child relationship. Mother deficiency leads to Child deficiency, which is natural law. Dongyuan stated: Urinary incontinence is due to Lung Metal deficiency. One should avoid overwork, rest quietly to nourish Qi, and use large doses of Renshen (Ginseng Radix et Rhizoma) etc. to tonify. If not cured, blame the Kidney. The *Classic* says: When the Bladder fails to constrain, enuresis occurs. Zhang Zhongjing said: Thirst in the Lower Jiao leads to enuresis and loss of stool; also: When the Lower Jiao does not return to its station, dribbling urine occurs. The Lower Jiao is located above the opening of the Bladder, responsible for separating clear and turbid fluids. If the Lower Jiao does not return to its station, it cannot constrain urine, leading to enuresis. Just as warm weather and thick clothes cause sweating, cold weather and thin clothes cause frequent urination; frequent urination indicates Cold. As for incontinence, it is extreme Deficiency-Cold, effective only with Bajun Wan (Eight-Ingredient Pill). Ancient formulas such as Tusizi Wan (Cuscutae Seed Pill), Lurong San (Deer Antler Powder), and Erqi Wan are all selectable. Dai Shi said: Nocturnal enuresis during sleep is due to deficiency-cold of the Lower Yuan, causing uncontrolled urination. Use Tusizi Wan, with roasted pig bladder crushed and decocted to take. All enuresis belongs to Deficiency. Liu Hejian attributed it to severe Heat lodging in the Kidney region, affecting the Foot-Jueyin Liver Meridian, causing congestion in the genital aperture. Severe cases lead to Qi and Blood stagnation, resulting in flaccidity and numbness, Spirit having no function, so body fluids seep into the Bladder, causing dribbling and loss of urine, unable to constrain. This corresponds to the *Nei Jing* saying: Pathogenic factors causing enuresis gather in the Kidney. This is a Heat syndrome, which must be known. Examining Xue Ji's notes: There are cases where labor-induced fever and thirst accompany spontaneous enuresis or intermittent obstruction. These are treated as Liver Fire and Blood Deficiency, with Yin protrusion failing to constrain. Morning: Buzhong Yiqi Tang added with Shanyao (Dioscoreae Rhizoma) and Shanzhuyu (Corni Fructus); Afternoon: Liuwei Wan (Six-Ingredient Pill). After a month, symptoms resolved. Thus, incontinence diseases, even if presenting with Heat syndromes, mostly involve Deficient Heat rather than Excess Heat. Mistakenly using Fire-purging drugs for Deficiency syndromes can lead to critical danger in an instant; be cautious. Generally, frequency may still involve Deficient Heat, but incontinence is purely Deficiency-Cold. In treating loss of urine, people only know to tonify and astringe, ignoring disharmony of Ying and Wei. Letting Righteous Qi harmonize naturally, using various methods sequentially, then suddenly administering astringents may temporarily stop it but it will recur. Know that the Lung governs Qi descending and generating Water transmitting downwards; the Bladder stores fluids. Qi transformation allows excretion. Continuous flow of water indicates the Bladder's failure to constrain. These two meridians are indeed the masters. Lung deficiency is Upper Deficiency, requiring Qi tonification, specifically Buzhong Yiqi Tang, treating Lung deficiency by saving its upper source. If not cured, differentiate and treat separately. If Bladder deficiency, it is Lower Deficiency, requiring astringency. With Cold, use warming tonification; with slipping, use astringency; with Heat, use clearing and draining. For those who took too many diuretics for strangury, leading to incontinence, use large doses of Renshen (Ginseng Radix et Rhizoma) with a little Shufu (Aconiti Lateralis Radix Praeparata). For women whose bladders were damaged by midwives during childbirth, causing incontinence, use Renshen (Ginseng Radix et Rhizoma) as Sovereign, Xionggui (Chuanxiong Rhizoma and Angelicae Sinensis Radix) as Minister, Tao Ren (Persicae Semen), Chenpi (Citri Reticulatae Pericarpium), and Fuling (Poria) as Assistants. Decoct in soup made from pig or sheep bladder. Drink at extreme hunger. Take large doses continuously without delay. Qi and Blood must grow rapidly; delay makes success difficult. Pregnant women leaking urine unknowingly: Use roasted Sangpiaoxiao (Mantis Ootheca) and Yizhiren (Alpiniae Oxyphyllae Fructus) ground into powder, taken with rice water, two qian. If Spleen and Lung Qi deficiency, use Buzhong Yiqi Tang added with Yizhiren (Alpiniae Oxyphyllae Fructus). If Liver and Kidney Yin deficiency, use Liuwei Wan (Six-Ingredient Pill). If Heat in the Pao (Bladder), use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). In the elderly, it is mostly due to insufficiency of the Lower Yuan; in infants, due to slight Yang Qi unable to constrain. Both suit warming tonification. Women who, after illness, pass feces with urine: This is loss of transmission between Yin and Yang, named Intersection of Large and Small Intestines. First regulate Yin and Yang, then use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).