《原病式》曰∶遗尿不禁者为冷。《内经》曰∶膀胱不约为遗溺。仁斋曰∶小便者，津液之余也。肾主水，膀胱为
津液之腑，肾与膀胱俱虚而冷气乘之，故不能拘制其水，出而不禁，此谓遗尿；睡里自出者，谓之尿床。此皆肾与膀胱，
虚而挟冷所致也，以鸡肠散主之，然益智、破故纸之类，亦不可缺。
亦有热客于肾部及膀胱，火邪妄动，水不得宁，故不能禁而频数来也，治当补膀胱阴血，泻火邪为主，而佐以收涩
之剂，如牡蛎、山茱萸、五味之类。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，故宜补
血泻火。补血治其本也；收之、涩之，治其标也。
〔附方〕
鸡肠散 桂（一钱五分） 龙骨（二钱五分） 牡蛎（ 灰） 茯苓 桑螵蛸（炒，各五钱） 鸡肠一具（烧
存性，男用雌，女用雄）上为极细末，仍以鸡肫皮一具，鸡肠一具，烧存性，研为极细末，每用前药一钱，以温酒调化，
食前服。
又方 鸡肫皮（一具） 鸡肠（一具，烧） 猪胞（炙焦，男用雌、女用雄）为末，酒调服。
总括 木本湿热死血因，手麻原属气家虚；忽然十指麻木也，湿痰死血胃中虚。
脉法 脉浮而濡属气虚，关前得之麻在上体，关后得之麻在下体也。脉浮而缓属湿，为麻痹；脉紧而浮属寒，为痛
痹；脉涩而芤属死血，为木，不知痛痒。
《内经》曰∶风寒湿三气合而为痹。故风气胜为行痹，寒气胜者为痛痹，湿气胜者为着痹。（自批∶《内经》注虽合
为痹，发起亦殊也。风则阳受之，故为痹行；寒则阴受之，故为痹痛；湿则皮肉筋受之，故为皮着而不去也。）河间曰∶
留着不去，四肢麻木拘挛也。
岐伯曰∶痛者，寒气多也，有寒故痛也。其不痛不仁者，病久入深，荣卫之行湿，经络时疏故不痛，皮肤不荣故不
仁。夫所谓不仁者或周身或四肢唧唧然，麻木不知痛痒，如绳扎缚初解之状，古方名为麻痹是也。
丹溪曰∶麻是气虚，木是湿痰、死血，然则曰麻曰木者，以不仁中而分三也。虽然亦有气血俱虚，但麻而不木者，
亦有虚而感湿；麻木兼作者，又有因虚而风寒湿三气乘之。故周身掣痛，并麻木并作者，古方谓之周痹，治法宜先汗后
补也，然当以类推而治之，不可执一见也。
如十指麻木是胃中有湿痰死血，宜二陈汤加苍术、桃仁、红花，少加附子行经，又宜四物汤加苍术、白术、陈皮、
茯苓、羌活、红花、苏木之类。
如手足俱麻木，并指尖麻者，皆痰滞经络也，宜二陈汤加竹沥、姜汁、白芥子，以祛痰火散风气。
麻用补中益气汤加当归、木香、香附、青皮、川芎，少加桂枝行经。
木用四物汤，并二陈汤加桃仁、红花，二方俱宜。用竹沥、姜汁、白芥子，以行经至胁肋，达痰之所在也。
〔附方〕
二陈汤 见诸吐症内。
四物汤 见痢疾症内。
补中益气汤 见脱肛症内。
《原病式》中说：遗尿且无法控制是由于寒邪所致。《内经》指出：膀胱约束功能失常会导致遗尿。仁斋说：小便，是津液的剩余部分。肾主管水液代谢，膀胱是储存津液的腑，如果肾与膀胱都虚弱，寒气趁机侵袭，因此不能制约水液，导致尿液流出而失控，这称为遗尿；在睡眠中不自觉排尿的，称为尿床。这些情况都是由于肾与膀胱虚弱并夹杂寒邪所导致的，治疗应以鸡肠散为主方，然而益智仁、破故纸（补骨脂）等药物也不可缺少。
也有热邪客居于肾部及膀胱，火邪妄动，使水液不得安宁，因此无法控制且尿频频繁，治疗应当以补益膀胱阴血、清泻火邪为主，并辅以收涩的药物，如牡蛎、山茱萸、五味子等。病本属于热证，所以适宜清泻火邪；因为水液不足，所以火动而导致小便增多，小便既多，水液更加虚弱，所以适宜补血并清泻火邪。补血是治其根本；收敛、固涩，是治其标症。
〔附方〕
鸡肠散：桂枝（一钱五分）、龙骨（二钱五分）、牡蛎（煅灰）、茯苓、桑螵蛸（炒，各五钱）、鸡肠一条（烧至存性，男性用雌鸡肠，女性用雄鸡肠）。以上药物研成极细末，另外取鸡肫皮一条、鸡肠一条，烧至存性，研为极细末。每次服用前药一钱，用温酒调服化开，饭前服用。
又一方：鸡肫皮（一条）、鸡肠（一条，烧制）、猪膀胱（炙焦，男性用雌性猪膀胱，女性用雄性猪膀胱），研为细末，用酒调服。
总括：木本湿热死血因，手麻原属气家虚；忽然十指麻木也，湿痰死血胃中虚。
脉法：脉象浮而濡软属于气虚，关前出现此脉则麻木在上半身，关后出现此脉则麻木在下半身。脉象浮而缓属于湿邪，表现为麻痹；脉象紧而浮属于寒邪，表现为痛痹；脉象涩而芤属于瘀血，表现为木，即不知痛痒。
《内经》说：风、寒、湿三种邪气结合而形成痹证。所以风气偏胜的为行痹，寒气偏胜的为痛痹，湿气偏胜的为着痹。（自批：《内经》注解说三者合而为痹，但发起原因各不相同。风邪侵犯阳分，所以表现为行痹；寒邪侵犯阴分，所以表现为痛痹；湿邪侵犯皮肉筋，所以表现为留着不去的着痹。）河间说：邪气留着不去，导致四肢麻木拘挛。
岐伯说：疼痛是因为寒气多，有寒所以疼痛。不痛且不感觉知觉的是因为病程久深入体内，营卫运行涩滞，经络时常空虚所以不痛，皮肤得不到滋养所以不仁。所谓不仁，或者是全身或者是四肢唧唧作响，麻木不知痛痒，像绳子捆绑后刚解开时的状态，古方称之为麻痹。
丹溪说：麻是气虚，木是湿痰和瘀血，所以说麻和木，是在不仁的基础上分为三类。虽然也有气血都虚，只有麻而没有木的情况，也有因虚而感受湿邪的情况；麻木同时出现的，又有因虚而风、寒、湿三气乘虚而入的情况。所以全身掣痛并伴有麻木的，古方称为周痹，治疗方法适宜先发汗后补益，但应当类推而治，不可固执己见。
如果是十个手指麻木，这是胃中有湿痰和瘀血，适宜用二陈汤加苍术、桃仁、红花，少量加入附子以通行经络，又适宜用四物汤加苍术、白术、陈皮、茯苓、羌活、红花、苏木等药物。
如果是手足都麻木，并且指尖麻木的，都是痰滞留在经络中，适宜用二陈汤加竹沥、姜汁、白芥子，以祛除痰火、疏散风邪。
对于“麻”的症状，使用补中益气汤加当归、木香、香附、青皮、川芎，少量加入桂枝以通行经络。
对于“木”的症状，使用四物汤，以及二陈汤加桃仁、红花，两个方剂都适宜。配合使用竹沥、姜汁、白芥子，以通行经络到达胁肋，直达痰邪所在之处。
The *Yuan Bing Shi* states: Enuresis with incontinence is caused by cold. The *Nei Jing* (Inner Canon) says: Incontinence of urine results from the failure of the Bladder to maintain control. Renzhai said: Urine is the surplus of body fluids. The Kidney governs water metabolism, and the Bladder is the fu-organ of body fluids. When both the Kidney and the Bladder are deficient, and cold pathogenic factors take advantage of this deficiency, they cannot restrain the water, leading to uncontrolled outflow; this is called enuresis. When urination occurs involuntarily during sleep, it is called bedwetting. All these conditions are caused by deficiency of the Kidney and Bladder combined with cold. The primary treatment should be Jichang San (Chicken Intestine Powder), yet herbs such as Yizhi Ren (Alpinia Oxyphylla Fruit) and Poguzhi (Psoralea Fructus) should not be omitted.
There are also cases where heat pathogens lodge in the Kidney region and the Bladder, causing fire pathogens to move recklessly, disturbing the water so that it cannot remain tranquil. Consequently, control is lost, and urination becomes frequent. Treatment should focus on tonifying the Yin and blood of the Bladder and purging the fire pathogens, assisted by astringent agents such as Muli (Oyster Shell), Shanzhuyu (Cornus Officinalis Fruit), and Wuweizi (Schisandra Chinensis Fruit). Since the root of the disease belongs to heat, purging fire is appropriate. Because water is insufficient, fire moves, leading to increased urination; as urination increases, water becomes more deficient, so tonifying blood and purging fire is indicated. Tonifying blood treats the root; astringing and consolidating treat the branch.
[Attached Formulas]
Jichang San (Chicken Intestine Powder): Guizhi (Cinnamon Twig, 1.5 qian), Longgu (Dragon Bone, 2.5 qian), Muli (Oyster Shell, calcined to ash), Fuling (Poria), Sangpiaoxiao (Mantis Egg Case, stir-fried, each 5 qian), one Chicken Intestine (burned until carbonized but retaining efficacy; use female intestine for males, male for females). Grind all into an extremely fine powder. Additionally, take one Chicken Gizzard Skin and one Chicken Intestine, burn until carbonized, and grind into an extremely fine powder. Each time, take 1 qian of the previous medicine, dissolve it with warm wine, and administer before meals.
Another Prescription: One Chicken Gizzard Skin, one Chicken Intestine (burned), one Pig Bladder (roasted until scorched; use female bladder for males, male for females). Grind into powder and take with wine.
Summary: Wood originates from damp-heat and stagnant blood; hand numbness originally belongs to Qi deficiency. Sudden numbness of ten fingers indicates damp-phlegm and stagnant blood due to Stomach deficiency.
Pulse Method: A floating and soggy pulse indicates Qi deficiency. If felt at the cun position (front of the guan), numbness is in the upper body; if felt at the chi position (back of the guan), numbness is in the lower body. A floating and moderate pulse indicates dampness, manifesting as paralysis; a tight and floating pulse indicates cold, manifesting as painful bi-syndrome; a choppy and hollow pulse indicates stagnant blood, manifesting as anesthesia (numbness without pain or itch sensation).
The *Nei Jing* says: The combination of wind, cold, and damp pathogens forms bi-syndrome. Therefore, when wind prevails, it is moving bi-syndrome; when cold prevails, it is painful bi-syndrome; when damp prevails, it is fixed bi-syndrome. (Self-commentary: Although the *Nei Jing* commentary notes they combine to form bi, their origins differ. Wind affects yang, thus forming moving bi; cold affects yin, thus forming painful bi; damp affects skin, flesh, and sinews, thus forming fixed bi that does not depart.) Hejian said: Pathogens lingering and not departing cause numbness and spasms in the four limbs.
Qibo said: Pain is due to excessive cold; having cold causes pain. Conditions that are neither painful nor insensible occur because the disease has progressed deeply over a long period, causing the circulation of Ying and Wei to become sluggish, and meridians to be occasionally empty, hence no pain; the skin lacks nourishment, hence insensibility. What is called insensibility involves either the whole body or the four limbs feeling a buzzing sensation, with numbness and loss of pain/itch sensation, resembling the feeling after a rope binding is first untied; ancient formulas call this paralysis (ma bi).
Danxi said: Numbness (ma) is due to Qi deficiency; anesthesia (mu) is due to damp-phlegm and stagnant blood. Thus, ma and mu are distinguished within the category of insensibility. However, there are cases of dual Qi and Blood deficiency presenting only with numbness without anesthesia, and cases of deficiency compounded by dampness. When numbness and anesthesia occur together, it may be due to deficiency allowing wind, cold, and damp pathogens to invade. When general body twitching pain accompanies numbness, ancient formulas call this generalized bi-syndrome (Zhou Bi); the treatment method should prioritize sweating followed by tonification. However, treatment should be applied by analogy, not rigidly adhering to a single view.
If numbness occurs in all ten fingers, it indicates damp-phlegm and stagnant blood in the Stomach. Erchen Tang (Two-Cured Decoction) should be used with Cangzhu (Atractylodes Rhizome), Taoren (Peach Seed), Honghua (Carthamus Flower), and a small amount of Fuzi (Aconite Lateral Root) to promote meridian circulation. Alternatively, Siwu Tang (Four Substance Decoction) with Cangzhu, Baizhu (Atractylodes Macrocephala Rhizome), Chenpi (Tangerine Peel), Fuling, Qianghuo (Notopterygium Rhizome), Honghua, and Sumu (Sappan Wood) is suitable.
If numbness occurs in both hands and feet, including fingertips, it indicates phlegm stagnation in the meridians. Erchen Tang with Zhuli (Bamboo Sap), Jiangzhi (Ginger Juice), and Baijiezi (White Mustard Seed) should be used to dispel phlegm-fire and scatter wind.
For "ma" (numbness), Buyi Zhongyi Tang (Tonify the Middle and Augment the Qi Decoction) with Danggui (Angelica Sinensis Root), Muxiang (Vladimiria Root), Xiangfu (Cyperus Rhizome), Qingpi (Green Tangerine Peel), and Chuanxiong (Ligusticum Rhizome), plus a small amount of Guizhi to promote meridian circulation, is indicated.
For "mu" (anesthesia), Siwu Tang (Four Substance Decoction) and Erchen Tang (Two-Cured Decoction) with Taoren, Honghua, Zhuli, Jiangzhi, and Baijiezi are both suitable. These help promote meridian circulation to the hypochondrium, reaching the location of the phlegm.
[Attached Formulas]
Erchen Tang (Two-Cured Decoction): See section on various vomiting syndromes.
Siwu Tang (Four Substance Decoction): See section on dysentery syndromes.
Buyi Zhongyi Tang (Tonify the Middle and Augment the Qi Decoction): See section on rectal prolapse syndromes.