治证同前。
白茯苓（去皮） 鹿角霜（各等分）
上为细末，酒煮糊为丸，如梧桐子大，每服三十丸，空心用盐汤送下。
夫以方论，其小便遗失者，为肾与膀胱虚冷，不能约其水也。今乃以为热，有所据乎？
曰∶此刘河间深得其旨，乃作《原病式》云∶热客膀胱，郁结不能渗泄故也。或曰∶小便涩
而不通者为热，遗溺不禁者为寒，岂知热甚而气血不能宣通，则痿痹而神无所用，故液渗入
膀胱，漩溺遗失不能收禁也。《内经》则谓督脉生病为遗溺。又曰∶膀胱不禁为遗溺。《灵
枢》谓肝所生病亦遗溺。盖因二经循阴器，系廷孔，病则劳卫不至，气血虚劳，莫能约束水
道之窍，故遗失不禁也。又曰∶水谷入于口，其味有五，各注其海，津液各走其道。故三焦
出气，以温肌肉，充皮肤，为其津液，流而不行者为液。天热衣浓，则腠理开，故汗出也。
寒气留于分肉，聚沫则为痛。天寒衣薄，则腠理闭，气湿不行，水下留于膀胱，则为溺与气
也。《灵枢》又云∶手太阳虚，小便遗，遗者观之，则人不独病在阴廷孔而已。人如是者，
乃是三焦决渎之失常，何以足三焦之手少阳，从足上入络膀胱，故不约也。肺手太阴，从上
焦通调水道，下输膀胱。肾又上连肺，故将两脏更是子母脏也。母虚子亦虚，此非上下三焦
气虚，皆足以致其遗溺乎？肺属金，肾与膀胱属水，所以金乃水之源，膀胱者乃渗泄之府。
肾者水之窍，今患不禁，病何止于热极郁结，痿痹肾部而已？又自《内经》所谓太阴在泉，
客胜，湿客下焦，溲便不时，太阴之复綦则入肾窍，泄无度者观之，但湿主于否，况是所胜
之邪，其不为郁结痿痹者乎？从而思之，圣人之言，举一隅盒饭以三隅反。前谓肺肾膀胱之
病，不言其邪，可见诸邪尽能病之也。故言手太阴别之虚者，为子母藏气者之安也。可见所
生所复不胜之五邪，亦是能挟之也。大抵人之漩溺，盖心属火，与小肠为表里，二气所以受
盛，是为传送。又肾属水，合膀胱为表里，膀胱为之腑，水注于膀胱，而泄于小肠，实相交
通也。若心肾气弱，阳道衰冷，传送失度，必遗尿失禁。经云∶膀胱不利为癃，不约为遗矣
。夫水火不济，阴阳不调，下焦蓄冷，肾与膀胱受克，故不能制水。水道滑则因水挟寒而不
禁也。又曰∶下焦蓄血，虚劳内损，则便溺自遗，而不知下焦虚寒，不能温制水液，则便溺
欲出而不禁，乃心不与肾交通，或冷或热，而滑涩随之也。不然，若不观于色，不辨于脉，
不审所兼之病状，独指为冷，指为热，独务涩水道之窍，不求邪所自之本者，五味所从也。
《伤寒论·脉法》有曰∶寸口脉微而涩，微者胃气不行，涩者荣气不足。荣卫不能调，则三
焦无所伸而归其部。上焦不归，嗳而吞酸，中焦不归者，不能消谷引饮，下焦不归者，则遗
溺失禁也。治之之法，当温补下元，清心寡欲，宜用秘元丹家韭子丸厘清饮之类。又有产后
所伤，及小儿胞冷，皆有遗溺失禁者，临证察脉，究其所因，度其遗禁，对病用药服饵，决
效矣。
症状表现与前文所述相同。
白茯苓（去皮） 鹿角霜（各等分）
以上两味药研成细末，用酒煮糊作为丸剂，大小如梧桐子，每次服用三十丸，空腹时用盐汤送服。
从方论的角度来看，小便失禁的病症，是由于肾与膀胱虚寒，不能约束尿液所致。现在却认为这是热证，有什么依据吗？
回答说：这是刘河间深刻领悟了其中的旨意，他在《原病式》中说：热邪客居膀胱，郁结导致不能正常渗泄。有人问：小便涩滞不通的是热证，遗尿不禁的是寒证，难道不知道热邪极盛导致气血不能宣通，从而出现痿痹而神志功能丧失，致使津液渗入膀胱，尿液流失无法控制吗？《内经》说督脉生病会导致遗尿。又说：膀胱不固摄会导致遗尿。《灵枢》说肝所生的疾病也包括遗尿。这是因为这两条经脉循行经过阴器，联系廷孔（尿道口），发病时卫气不至，气血虚损劳伤，不能约束水道的窍道，所以导致遗尿不禁。又说：食物进入口中，味道有五种，分别注入相应的“海”（指脏腑汇聚之处），津液各自走其通道。所以三焦发出气，用来温养肌肉，充实皮肤，这就是津液；流动而不停止的称为液。天气炎热衣服穿得厚，腠理就开放，所以出汗。寒气停留在分肉之间，聚集成沫就会疼痛。天气寒冷衣服穿得薄，腠理闭合，气湿运行不畅，水向下流留在膀胱，就成为溺和气体。《灵枢》又说：手太阳经虚弱，会导致小便遗溺。观察遗溺的情况，可知人不仅仅是在阴廷孔部位生病。像这样的人，是三焦决渎功能失常，为什么足三焦的手少阳经，从足部上行入络于膀胱，所以不能约束呢？手太阴肺经，从上焦通调水道，向下输送到膀胱。肾又向上连接肺，所以这两脏是母子关系。母脏虚弱子脏也虚弱，这不仅仅是上中下三焦气虚，都足以导致遗尿吗？肺属金，肾与膀胱属水，所以金是水之源，膀胱是渗泄之府。肾是水之窍，现在患病不能控制，病情哪里仅仅是热极郁结、痿痹肾部而已？再从《内经》所谓太阴在泉，客气胜主气，湿邪客居下焦，小便失时，太阴复气甚则侵入肾窍，泄泻无度的情况来看，湿主要导致闭塞，何况是所胜之邪，难道不会导致郁结痿痹吗？由此思考，圣人的话，举一反三。前面提到肺肾膀胱的病，没有提及具体的邪气，可见各种邪气都能致病。所以说手太阴别经虚弱，是因为母子脏气的安和与否。可见所生、所复不胜的五种邪气，也能挟持致病。大抵人的尿液，心属火，与小肠为表里，二气相互受盛，起到传送作用。肾属水，合膀胱为表里，膀胱为之腑，水注入膀胱，而排泄于小肠，实际上是相互交通的。如果心肾气弱，阳道衰冷，传送失去节制，必然遗尿失禁。经书说：膀胱不利为癃闭，不固摄则为遗尿。水火不相济，阴阳不调和，下焦蓄积寒冷，肾与膀胱受克制，所以不能制约水液。水道滑利则因水挟带寒气而不能控制。又说：下焦蓄血，虚劳内损，则大小便自遗，如果不了解是下焦虚寒，不能温制水液，则大小便欲出而失控，这是心不与肾交通，或冷或热，随之出现滑或涩的情况。不然的话，如果不观察面色，不辨别脉象，不审察兼夹的病状，只指为冷，指为热，只致力于涩水道之窍，不寻求邪气产生的根本原因，这是不明五味来源的表现。《伤寒论·脉法》说：寸口脉微而涩，微者胃气不行，涩者营气不足。营卫不能调和，则三焦无所伸展而归其部位。上焦不归，嗳气吞酸；中焦不归，不能消化谷物饮水；下焦不归，则遗尿失禁。治疗的方法，应当温补下元，清心寡欲，适宜使用秘元丹、家韭子丸、厘清饮之类的方剂。又有产后受伤，以及小儿胞冷，都有遗尿失禁的情况，临证诊察脉象，探究病因，衡量遗禁的程度，对病用药服用，必定有效。
The symptoms are the same as described previously.
Bai Fuling (Poria Cocos, peeled) and Lujiaoshuang (Deer Antler Frost) in equal parts.
Grind the above two herbs into a fine powder, use wine to make a paste for pills, sized like Sophora japonica seeds. Take thirty pills each time, on an empty stomach, with salt water to swallow.
From the perspective of formula theory, urinary incontinence is caused by deficiency-cold of the Kidney and Bladder, failing to constrain the urine. Now, how can it be considered a heat syndrome? What is the basis for this?
It is said: This is Liu Hejian's deep understanding of the essence. In his *Yuan Bing Shi* (Original Treatise on Disease Causes), he stated: Heat pathogens lodging in the Bladder, causing stagnation and failure to secrete normally. Some ask: Urinary difficulty and obstruction are due to heat, while urinary incontinence is due to cold. Do they not know that extreme heat causes Qi and Blood to fail to circulate freely, leading to flaccidity and paralysis where the spirit loses its function, causing fluids to seep into the Bladder, resulting in uncontrolled leakage of urine? The *Nei Jing* states that diseases of the Du Mai (Governing Vessel) cause urinary incontinence. It also says: Failure of the Bladder to control leads to urinary incontinence. The *Ling Shu* states that diseases generated by the Liver also include urinary incontinence. This is because these two meridians circulate through the genital organs and connect to the Ting Kong (urethral orifice). When diseased, Wei Qi does not reach there, and Qi and Blood are deficient and exhausted, unable to constrain the orifices of the water pathways, thus causing uncontrollable urinary incontinence. It further states: Food enters the mouth, its flavors fall into five categories, each pouring into its respective "Sea" (accumulation point of Zang-Fu organs), and body fluids travel their own paths. Thus, Qi emitted by the San Jiao (Triple Burner) warms the muscles and fills the skin; this is Jin Ye (thin body fluid); that which flows without stopping is called Ye (thick body fluid). When the weather is hot and clothes are thick, the Cou Li (pores) open, so sweat is produced. When cold Qi remains between the muscle layers, gathering into foam, it causes pain. When the weather is cold and clothes are thin, the Cou Li close, Qi and dampness do not move, water flows down and stays in the Bladder, becoming urine and gas. The *Ling Shu* also says: Deficiency of the Hand Taiyang Meridian causes urinary incontinence. Observing urinary incontinence, one sees that illness is not confined only to the genital orifice. Such cases indicate dysfunction of the San Jiao's drainage system. Why does the Hand Shaoyang of Foot San Jiao, ascending from the foot to connect with the Bladder, fail to constrain? The Hand Taiyin Lung Meridian regulates water passages from the Upper Jiao and transports them downward to the Bladder. The Kidney connects upward to the Lung, making these two Zang organs mother and child. If the Mother is deficient, the Child is also deficient. Is it not true that Qi deficiency in the Upper, Middle, and Lower Jiao all contribute to urinary incontinence? The Lung belongs to Metal, while the Kidney and Bladder belong to Water; thus, Metal is the source of Water, and the Bladder is the mansion of secretion and excretion. The Kidney is the orifice of Water. Now, if one suffers from inability to control, is the disease limited only to extreme heat stagnation and Kidney flaccidity/paralysis? Furthermore, considering the *Nei Jing*'s statement: When Taiyin is in authority, if the pathogenic factor overcomes, dampness lodges in the Lower Jiao, causing irregular urination; if the reaction of Taiyin is severe, it invades the Kidney orifice, causing excessive discharge. Observing this, dampness primarily causes blockage. How much more so for the overcoming pathogen, could it not lead to stagnation and flaccidity? Reflecting on this, the words of the Sages allow one to infer other instances from one example. Previously, mentioning diseases of the Lung, Kidney, and Bladder without specifying the pathogen implies that all pathogens can cause disease. Therefore, stating that deficiency of the Hand Taiyin branch relates to the harmony of mother-child organ Qi indicates that the five types of pathogens, whether generated or reacted, which cannot be overcome, can also accompany the disease. Generally speaking, regarding urine: The Heart belongs to Fire and is exterior-interior with the Small Intestine; the two Qi mutually receive and hold, serving as transmission. The Kidney belongs to Water and is exterior-interior with the Bladder; the Bladder is its Fu organ. Water pours into the Bladder but excretes via the Small Intestine; this is actually mutual communication. If Heart and Kidney Qi are weak, and Yang Dao (Yang pathway) is cold and declining, transmission loses regulation, inevitably leading to urinary incontinence. The Classics say: Obstruction of the Bladder is Cong (retention); lack of constraint is Yi Niao (incontinence). When Water and Fire do not interact, and Yin and Yang are disharmonious, cold accumulates in the Lower Jiao, and the Kidney and Bladder are constrained, thus failing to control water. If the water pathway is slippery, it is due to water carrying cold and failing to be controlled. It is also said: Blood stasis in the Lower Jiao, deficiency-heat and internal damage, lead to spontaneous loss of urine and stool. If one does not realize that Lower Jiao deficiency-cold fails to warm and control body fluids, causing urine and stool to want to exit uncontrollably, this is because the Heart does not communicate with the Kidney, or due to cold or heat, followed by slipperiness or astringency. Otherwise, if one does not observe complexion, distinguish pulse, examine accompanying symptoms, and solely attribute it to cold or heat, merely striving to astringe the water orifice without seeking the root of the pathogen, this is ignorance of the origin of the Five Flavors. The *Mai Fa* (Pulse Methods) of *Shang Han Lun* states: Cun Kou pulse is faint and choppy. Faint means Stomach Qi does not move; choppy means Ying Qi (Nutritive Qi) is insufficient. If Ying and Wei Qi (Defensive Qi) are not harmonized, the San Jiao has no extension and returns to its sector. If the Upper Jiao does not return, there is belching and acid regurgitation; if the Middle Jiao does not return, one cannot digest grains and drink; if the Lower Jiao does not return, there is urinary incontinence. The treatment method should be to warm and tonify the Lower Yuan (Lower Origin), clear the Heart and reduce desires. Suitable formulas include Mi Yuan Dan (Secret Essence Pill), Jia Jiu Zi Wan (Leek Seed Pill), and Li Qing Yin (Clear Separation Decoction). There are also cases of postpartum injury and cold womb in children, all presenting with urinary incontinence. Upon clinical observation of the pulse, investigating the cause, assessing the degree of incontinence, and prescribing medicine according to the disease, efficacy will surely be achieved.