（附∶遗溺尿床）
总括 膀胱不利称邪热，清肺资源是所宜；多尿遗溺为虚冷，温补收湿任所施。
脉法 小便闭者，其脉盛大而实者生，虚涩而细者死。
《内经》曰∶膀胱不利为癃闭。夫小便闭而不通者，皆邪热为病也。分在气在血而治之，以渴与不渴而辨之。如渴
而小便不利者，热在上焦肺之分，故渴而小便不利也。夫小便者，是足太阳膀胱经所主也，长生于申，申者西方金也，
肺金生水。若肺中有热，不能生水，是绝其水之源。《经》云，虚则补其母，宜清肺而资其化源，须用茯苓、泽泻、琥
珀、灯心、通草、车前子、木通、瞿麦、 蓄之类，以清肺气，泻其火，资水之上源也。如不渴，小便不通者，热在下
焦血之分，故不渴而大便燥，小便不通也。热闭于下焦者，肾也、膀胱也，乃阴中之阴，阴受热邪，闭塞其流。易老云∶
寒在胸中，则遏绝不入；热在下焦，则填塞不便。须用感北方寒水之化，气味俱阴之药，以除其热，泄其闭塞，如黄柏、
知母、肉桂之类，以补肾与膀胱，而资其化源。若服淡渗之药，何能补重阴之不足哉！夫用大苦寒之药者，治法当寒因
热用耳。曾氏曰∶小便闭而不通，有阴阳二症。阴闭者为冷湿乘虚入里，因而不通，名曰阴闭，以白芍药汤，加南木香
及用炒盐，以绢包熨脐四围，并投五苓散，入灵砂末，温盐汤空心服。阳闭者，因暴热所逼，涩而不通，名曰阳闭，以
五苓散加车前子、灯心煎服，及益元散、木通散。
又癃闭与淋闭不同。盖癃者乃五内气虚受热壅滞，宣化不行，非涩非痛，但闭不通，腹胀紧满，亦用五苓散加车前、
木通服，或贴姜饼于脐上，取效。不拘阴阳二症，悉能疗之。
小儿初生无尿者，因母食糟酒炙 辛毒之物，热气流于胎中，儿因食血，故生下肚胀、膨脐、肾肿，如觉脐四旁有
青黑色及撮口，即不可救矣。如无青黑色，不饮乳者，用葱白头寸大者，分作四服，用乳汁半小盏同煎，片时分作四次
服即通，不饮乳服之即吃。
杨氏曰∶肾主水，膀胱为之腑，水满膀胱，通泄于小肠也。然小肠应于心，盖阴不可无阳，水不可无火。水火既济，
上下相交，荣卫流行，水道开合，不失所司矣。若心肾不济，阴阳不调，故内外关膈，而水道涩，传送失道，则水道滑。
热则不通，冷则不禁。其热甚者，小便闭而全无，热微者小便难而 。有肾与膀胱俱虚，客热乘之，水道涩焉，自令心
气旺甚，小便壅遏，用赤茯苓、车前、麦冬、灯心之类清利之。
〔附方〕
白芍药汤 见腹痛症内。
五苓散 见惊风症内。
益元散 见霍乱症内。
木通散 见大便症内。
姜豉饼 生姜（一两，切细） 生葱（五根，切碎） 淡豆豉（七钱，润） 生盐（二钱） 生蒜（七个，切
碎） 穿山甲（五钱，制） 酒麸糟（一灯盏），如无，以好酒代用，杵捣烂，捻作饼子二寸间，用微火烘热，带热贴
脐上，以绢兜住，如冷根据前法，再以火烘暖亦好。
总括：膀胱气化不利称为邪热，清肺生津是适宜的治疗方法；多尿、遗尿属于虚寒证，温补固涩任其施治。
脉法：小便闭塞不通的患者，如果脉象盛大而实，预后良好可生；如果脉象虚弱、涩滞且细弱，则预后不良主死。
《内经》说：膀胱气化不利导致癃闭。凡是小便闭塞不通的，都是邪热致病。需要分辨病在气分还是血分来治疗，通过观察患者是否口渴来进行辨别。如果口渴且小便不利，说明热邪在上焦肺的部位，所以既口渴又小便不利。小便由足太阳膀胱经所主管，膀胱经之气长生于申时，申时对应西方金，肺属金，金生水。如果肺中有热，不能生水，这就断绝了水的源头。《内经》说：“虚则补其母”，应当清肺以资助化源，需要使用茯苓、泽泻、琥珀、灯心草、通草、车前子、木通、瞿麦、萹蓄等药物，以清肺气，泻火邪，资助水之上源。如果不口渴但小便不通，说明热邪在下焦血分的部位，所以不口渴但大便干燥，小便不通。热邪闭塞于下焦的是肾和膀胱，它们属于阴中之阴，阴分受热邪侵袭，闭塞了水流通道。易老（李东垣）说：“寒邪在胸中，就会遏制隔绝阳气不入；热邪在下焦，就会填塞导致不便。”必须使用感应北方寒水之气、气味均属阴的药物，以清除热邪，泄去闭塞，如黄柏、知母、肉桂等药物，以补肾与膀胱，资助其化源。如果服用淡渗利湿的药物，怎么能补益重阴之不足呢！使用大苦寒药物的治疗方法，应当采用“寒因热用”的原则。曾氏说：小便闭塞不通，有阴阳两种证候。阴闭是由于冷湿乘虚侵入体内，因而导致不通，名叫阴闭，用白芍药汤，加入南木香，并用炒盐装在绢袋里熨烫肚脐四周，同时内服五苓散，加入灵砂末，空腹用温盐水送服。阳闭是由于暴热逼迫所致，尿道涩滞不通，名叫阳闭，用五苓散加车前子、灯心草煎服，以及益元散、木通散。
另外，癃闭与淋闭不同。癃证是由于五脏气虚受热邪壅滞，宣发肃降功能不行，并非尿道涩痛，只是闭塞不通，伴有腹胀紧满，也用五苓散加车前子、木通服用，或者将姜饼贴在肚脐上，可以取得疗效。不论阴阳两种证候，都能治疗。
小儿出生后立即无尿，是因为母亲食用了糟粕、酒、炙烤、辛辣有毒的食物，热气流入胎中，胎儿因摄入血液，所以出生后肚子胀、肚脐膨出、肾脏肿胀，如果发现肚脐周围有青黑色以及出现撮口风症状，就不可救治了。如果没有青黑色，但不吃奶的，用一寸长的葱白头，分成四份，用半小盏乳汁同煎，片刻后分四次服用，尿液即可通畅，不吃奶的孩子服用后就会吃奶。
杨氏说：肾主水，膀胱是其腑，水充满膀胱后，通泄到小肠。然而小肠对应于心，因为阴不可没有阳，水不可没有火。水火既济，上下相交，营卫气血流行，水道开合正常，不失其职。如果心肾不济，阴阳不调，就会导致内外关膈，水道涩滞，传送失常，那么水道就会滑利失控。热盛则不通，寒冷则不禁固。热邪严重的，小便完全闭塞全无；热邪轻微的，小便困难且量少。如果有肾与膀胱俱虚，客热乘虚而入，水道涩滞，自然会让心气旺盛，小便壅遏，可用赤茯苓、车前子、麦冬、灯心草等药物清利之。
〔附方〕
白芍药汤 见腹痛症内。
五苓散 见惊风症内。
益元散 见霍乱症内。
木通散 见大便症内。
姜豉饼 生姜（一两，切细） 生葱（五根，切碎） 淡豆豉（七钱，润湿） 生盐（二钱） 生蒜（七个，切碎） 穿山甲（五钱，炮制） 酒麸糟（一灯盏），如果没有，用好酒代替，捣烂，捏成直径两寸的饼子，用微火烘热，趁热贴在肚脐上，用绢带兜住，如果冷了按前述方法再用火烘暖也可以。
(Attachment: Enuresis and Bedwetting)
General Principles: Bladder Qi transformation dysfunction is termed pathogenic heat; clearing the Lung and generating fluids is the appropriate treatment. Frequent urination and enuresis belong to deficiency-cold patterns, where warming, tonifying, and astringing dampness can be applied.
Pulse Diagnosis: In cases of urinary retention, if the pulse is large and excess, the prognosis is favorable (survival); if the pulse is deficient, choppy, and thin, the prognosis is poor (death).
The *Neijing* states: "Bladder Qi transformation dysfunction leads to strangury and retention." All cases of urinary obstruction are caused by pathogenic heat. Treatment should distinguish whether the pathology lies in the Qi level or Blood level, differentiated by the presence or absence of thirst. If there is thirst accompanied by difficult urination, the heat is located in the Upper Jiao (Lung region), causing both thirst and urinary difficulty. Urine is governed by the Foot-Taiyang Bladder Meridian. The Bladder Meridian Qi is born at Shen hour, which corresponds to West Metal. Lung belongs to Metal, and Metal generates Water. If there is heat in the Lung preventing it from generating Water, the source of water is cut off. The Classics state: "When deficient, tonify its mother." It is advisable to clear the Lung to nourish the source of transformation. Herbs such as Poria (*Fuling*), Alisma (*Zexie*), Amber (*Hupo*), Juncus (*Dengxin*), Talcum (*Tongcao*), Plantago Seed (*Cheqianzi*), Akebia Stem (*Mutong*), Dianthus Flower (*Qumai*), and Polygonum Aviculare (*Bianxu*) should be used to clear Lung Qi, drain fire, and support the upper source of water. If there is no thirst but urinary obstruction, the heat is located in the Lower Jiao (Blood level), resulting in dry stools and urinary obstruction without thirst. Heat blocking the Lower Jiao affects the Kidney and Bladder, which are Yin within Yin. When Yin receives pathogenic heat, the flow is blocked. Li Dongyuan (Yi Lao) stated: "Cold in the chest obstructs Yang from entering; heat in the Lower Jiao causes blockage and difficulty." One must use herbs with Yin nature and aroma that resonate with the Northern Cold Water phase to eliminate heat and relieve obstruction, such as Phellodendron Bark (*Huangbai*), Anemarrhena Rhizome (*Zhimu*), and Cinnamon Twig (*Rougui*), to tonify the Kidney and Bladder and support their transformation source. How can diuretic drugs replenish the insufficiency of heavy Yin! When using bitter-cold drugs, the treatment method should follow "treating heat with cold" (administering cold-natured herbs for heat conditions). Zeng Shi stated: Urinary obstruction has two types: Yin and Yang. Yin obstruction occurs when cold-dampness enters the interior due to deficiency, causing obstruction, named Yin Obstruction. It is treated with Baishao Decoction (*Baishaoyao Tang*), added with Southern Costus Root (*Nanmuxiang*), and external application of fried salt wrapped in silk around the umbilicus, combined with internal administration of Wuling Powder (*Wuling San*) mixed with Lingsha powder, taken on an empty stomach with warm salt water. Yang obstruction is caused by sudden intense heat forcing the urine to become涩 (astringent/stagnant) and obstructed, named Yang Obstruction. It is treated with Wuling Powder (*Wuling San*) added with Plantago Seed (*Cheqianzi*) and Juncus (*Dengxin*) decocted and taken, along with Yi Yuan Powder (*Yiyuan San*) and Mutong Powder (*Mutong San*).
Furthermore, Strangury/Retention (*Longbi*) differs from painful urinary frequency (*Linbi*). *Long* refers to visceral Qi deficiency with heat stagnation, where dissemination and transformation fail. It is not characterized by astringency or pain, but merely by obstruction, abdominal distension, and tight fullness. It is also treated with Wuling Powder (*Wuling San*) added with Plantago Seed (*Cheqianzi*) and Akebia Stem (*Mutong*), or by applying Ginger Cake (*Jiangbing*) to the umbilicus for effect. This treats both Yin and Yang types.
Infants born without urine result from the mother consuming fermented grains, alcohol, roasted foods, spicy, or toxic substances during pregnancy. Heat qi flows into the fetus, and upon ingesting blood, the infant is born with abdominal distension, protruding umbilicus, and swollen kidneys. If bluish-black discoloration appears around the umbilicus or signs of Opisthotonos/Closed Mouth (*Cuekou*) appear, it is incurable. If there is no bluish-black discoloration but the infant refuses milk, use one-inch segments of white onion bulb (*Congbaitou*), divided into four doses. Decoct with half a small cup of breast milk, divide into four parts, and administer over a short period to induce urination. If the infant does not suckle, administering this will stimulate feeding.
Yang Shi stated: The Kidney governs water, and the Bladder is its Fu organ. When water fills the Bladder, it drains into the Small Intestine. The Small Intestine corresponds to the Heart. Yin cannot exist without Yang, and water cannot exist without fire. When Water and Fire interact harmoniously, Upper and Lower intersect, Ying and Wei circulate, and the opening and closing of the water passages function correctly. If Heart and Kidney do not interact, and Yin and Yang are imbalanced, it leads to internal-external blockage, making water passages sluggish. Transmission becomes disordered, leading to uncontrolled slippery discharge. Excessive heat causes obstruction; cold causes incontinence. Severe heat results in complete urinary retention; mild heat causes difficult and scanty urination. If Kidney and Bladder are both deficient, and guest heat attacks, the water passages become sluggish. Naturally, Heart Qi becomes excessive, causing urinary stasis. This is treated with Red Poria (*Chifuling*), Plantago Seed (*Cheqian*), Ophiopogon (*Maidong*), and Juncus (*Dengxin*) to clear and promote urination.
[Attached Formulas]
Baishao Decoction (*Baishaoyao Tang*) See under Abdominal Pain Syndrome.
Wuling Powder (*Wuling San*) See under Convulsive Wind Syndrome.
Yi Yuan Powder (*Yiyuan San*) See under Cholera Syndrome.
Mutong Powder (*Mutong San*) See under Defecation Disorders.
Ginger and Fermented Soybean Cake (*Jiangchibing*) Fresh Ginger (1 liang, sliced finely), Raw Scallion (5 stalks, chopped), Lightly Fermented Soybeans (*Danshidou*, 7 qian, moistened), Raw Salt (2 qian), Raw Garlic (7 cloves, chopped), Pangolin Scales (*Chuanshanjia*, 5 qian, processed), Wine Bran Lees (1 lamp cup; substitute with good wine if unavailable). Pound until paste-like, shape into cakes 2 cun in diameter. Warm gently over low fire, apply hot to the umbilicus, secure with silk bandage. If it cools, re-warm according to the previous method.