小便不禁或频数，古方多以为寒，而用温涩之药，殊不知属热者，盖膀胱火邪妄动，水不得宁，故
不能禁而频数来也。故年老人多频数者，是膀胱血少，阳火偏旺也。治法当补膀胱阴血、泻火邪为主，
而佐以收涩之剂，如牡蛎、山茱萸、五味子之类，不可用温药也。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、泻火治其本也，收之、涩之治其标也。
愚按经云膀胱不约为遗溺。小便不禁，常常出而不觉也。人之旋溺，赖心、肾二气之所传送，盖心与
小肠为表里，肾与膀胱为表里。若心肾气亏，传送失度，故有此症，治宜温暖下元，清心寡欲。又有产
褥不顺，致伤膀胱，若内虚寒者，秘元丹、韭子丸之类；若内虚湿热者，六味地黄丸，或加五味、杜
仲、补骨脂，年老者，八味丸；产褥收生不谨，损破尿胞者，参术补胞汤加猪羊胞煎之。窃谓肝主小便，
若肝经血虚，用四物、山栀；若小便涩滞，或茎中作痛，属肝经湿热，用龙胆泻肝汤；若小便频数，或劳
而益甚，属脾气虚弱，用补中益气汤加山药、五味子；若小便无度，或淋沥不禁，乃阴挺痿痹也，用六
味地黄丸；若小便涩滞，或补而益甚，乃膀胱热结也，用五淋散，其脾肺燥不能化生者，黄芩清肺饮；膀胱
阴虚，阳无所生者，滋肾丸；膀胱阳虚，阴无所化者，六味丸；若阴痿，思色精不出，茎道涩痛如淋，
用加减八味丸料加车前、牛膝；若老人精竭复耗，大小便牵痛如淋，亦用前药，不应，急加附子，多有
生者。
刘大参，年逾六旬，形气瘦弱，小便不禁或频数，内热口干，或咳痰喘晕。余以为肺肾气虚，用六味
丸、益气汤以滋化源。彼不信，反服补阴、降火、涩精之剂，阴窍作痛，或小便不利。仍服前药，不两月
而愈。
大尹刘天锡，内有湿热，大便滑利，小便涩滞，服淡渗之剂，愈加滴沥，小腹腿膝皆肿，两眼胀痛。
此肾经虚热在下，反服淡渗，导损阳气，阴无以化。遂用地黄、滋肾二丸，小便如故，更以补中益气汤加
麦门、五味兼服而愈。
州守王用之，肚腹膨胀，饮食少思，服二陈、枳实及淡渗之类，小便不利，大便不实，咳嗽，腹胀，
手足俱冷。余谓足三阴虚寒，用金匮肾气丸而康。
小便失禁或次数频繁，古代医方多认为是寒证，因而使用温补固涩的药物。殊不知也有属于热证的，这是因为膀胱内有火邪妄动，导致水液不得安宁，所以不能控制而频繁排尿。因此，老年人出现尿频的情况，是因为膀胱阴血不足，阳气之火偏旺所致。治疗方法应当以滋补膀胱阴血、清泻火邪为主，并辅以收涩的药物，如牡蛎、山茱萸、五味子等，不可使用温性药物。因为病本属热，所以适宜清泻火邪。由于肾水不足，导致虚火妄动从而引起小便频多；小便既已频多，津液更加亏虚，所以应当通过补血、泻火来治其根本，通过收敛、固涩来治其标症。
我按：《内经》记载：“膀胱不约则遗溺。”小便失禁，是指尿液常常流出而患者自己不觉察。人排尿的过程，依赖心和肾二气的传导输送。心与小肠互为表里，肾与膀胱互为表里。如果心肾之气亏虚，传导功能失常，就会出现这种症状，治疗宜温暖下元，清心寡欲。又有因产褥期护理不当，损伤膀胱者，若体内虚寒，可用秘元丹、韭子丸之类；若体内虚兼湿热，可用六味地黄丸，或者加入五味子、杜仲、补骨脂；老年人可用八味丸（金匮肾气丸）；若是产褥期接生不慎，破损尿胞者，可用参术补胞汤加猪羊胞煎服。
我认为肝主司小便。若肝经血虚，用四物汤加山栀；若小便涩滞不畅，或尿道中疼痛，属于肝经湿热，用龙胆泻肝汤；若小便频数，或劳累后加重，属于脾气虚弱，用补中益气汤加山药、五味子；若小便无度，或淋漓不尽，这是阴挺痿痹之症，用六味地黄丸；若小便涩滞，或进补后反而加重，这是膀胱热结，用五淋散；若是脾肺燥热不能化生津液者，用黄芩清肺饮；膀胱阴虚，阳气无所生化者，用滋肾丸；膀胱阳虚，阴液无所气化者，用六味地黄丸；若出现阳痿，思色而精不出，尿道涩痛如淋证，用加减八味丸料加车前子、牛膝；若是老人精气枯竭又加耗损，大小便牵拉疼痛如淋证，也用上述药物，若无效，急加附子，多有治愈者。
刘大参，年龄超过六十岁，形体瘦弱，气息微弱，小便失禁或频数，伴有内热口干，有时咳嗽痰喘头晕。我认为这是肺肾气虚，使用六味地黄丸和补中益气汤以滋养化源。他不相信我的诊断，反而服用滋阴、降火、固精的药物，导致阴部窍道疼痛，或小便不利。后来仍服用我之前开的药物，不到两个月就痊愈了。
大尹刘天锡，体内有湿热，大便滑利，小便涩滞，服用淡渗利湿的药物后，病情加重，滴沥不尽，小腹、腿部及膝盖均肿胀，双眼胀痛。这是肾经虚热在下焦，反而服用淡渗药物，损伤了阳气，导致阴液无法气化。于是用地黄丸、滋肾丸，小便恢复正常，再配合补中益气汤加麦冬、五味子同服而痊愈。
州守王用之，肚腹膨胀，饮食减少且缺乏食欲，服用二陈汤、枳实及淡渗类药物后，出现小便不利，大便不成形，咳嗽，腹胀，手足俱冷。我认为这是足三阴经虚寒，使用金匮肾气丸而康复。
Urinary incontinence or frequency was traditionally considered a cold syndrome by ancient physicians, who often employed warming and astringent herbs. However, it is not uncommon for this condition to stem from heat. This occurs when pathogenic fire in the Bladder (Bladder) moves recklessly, disturbing the water metabolism, thereby causing an inability to retain urine and resulting in frequent urination. Consequently, elderly individuals often experience frequency due to insufficient blood and yin in the Bladder, leading to an excess of yang fire. The treatment principle should primarily focus on tonifying the yin and blood of the Bladder and clearing pathogenic fire, assisted by astringent agents such as Oyster Shell (Muli), Cornus Fruit (Shanzhuyu), and Schisandra Berry (Wuweizi). Warming herbs should be avoided. Since the root cause is heat, clearing fire is appropriate. Due to insufficient kidney water, fire becomes active, causing polyuria; as urine volume increases, body fluids become further depleted. Therefore, one must treat the root by nourishing blood and clearing fire, while treating the branch by astringing and consolidating.
I note: The *Classic of Internal Medicine* states, "When the Bladder fails to constrain, enuresis occurs." Urinary incontinence refers to the involuntary leakage of urine without the patient's awareness. The act of urination relies on the transmission and transportation of Qi from the Heart and Kidney. The Heart and Small Intestine are exteriorly-interiorly related, as are the Kidney and Bladder. If Qi of the Heart and Kidney is deficient, leading to impaired transmission, this symptom arises. Treatment should involve warming the lower origin and calming the mind while reducing desires. Additionally, improper care during the postpartum period may injure the Bladder. If there is internal deficiency-cold, formulas such as Mi Yuan Dan or Jiu Zi Wan may be used; if there is internal deficiency with damp-heat, Liu Wei Di Huang Wan may be used, potentially supplemented with Wuweizi, Duzhong, or Buguzhi; for the elderly, Ba Wei Wan (Jin Gui Shen Qi Wan) is suitable. If the bladder wall is damaged due to careless midwifery, Shen Zhu Bao Bao Tang decocted with pig or sheep bladders can be administered.
In my opinion, the Liver governs urinary functions. If Liver channel blood is deficient, Si Wu Tang combined with Gardenia (Shanzhi) is indicated. If urination is obstructed or painful in the urethra, it belongs to Liver channel damp-heat, treated with Long Dan Xie Gan Tang. If urination is frequent or worsens with exertion, it indicates Spleen Qi deficiency, treated with Bu Zhong Yi Qi Tang supplemented with Yam (Shanyao) and Wuweizi. If urination is uncontrolled or dribbling, it signifies prolapse and flaccidity (Yin Ting Wei Bi), treated with Liu Wei Di Huang Wan. If urination is obstructed or worsens after tonification, it indicates Bladder heat accumulation, treated with Wu Lin San. If Spleen and Lung dryness prevents fluid transformation, Huang Qin Qing Fei Yin is used. For Bladder yin deficiency where yang lacks generation, Zi Shen Wan is prescribed. For Bladder yang deficiency where yin lacks transformation, Liu Wei Di Huang Wan is used. In cases of impotence, where sexual desire exists but ejaculation does not occur, accompanied by urethral pain resembling strangury, Jia Jian Ba Wei Wan material with Plantago Seed (Cheqianzi) and Achyranthes Root (Niuxi) is applied. For elderly patients whose essence is exhausted and further depleted, presenting with pulling pain in both bowel and bladder movements resembling strangury, the aforementioned formula is used; if ineffective, Aconite Root (Fuzi) should be added urgently, often resulting in recovery.
Official Liu Dashan, over sixty years old, presented with emaciation and weak constitution, urinary incontinence or frequency, internal heat, dry mouth, occasional cough with sputum, wheezing, and dizziness. I diagnosed Lung and Kidney Qi deficiency and prescribed Liu Wei Di Huang Wan and Bu Zhong Yi Qi Tang to nourish the source of transformation. He did not trust this diagnosis and instead took yin-nourishing, fire-clearing, and essence-astringing agents, which caused pain in the genital orifices and dysuria. Upon resuming my original prescription, he recovered within two months.
Official Liu Tianxi had internal damp-heat, loose stools, and obstructed urination. After taking diuretic and leaching herbs, his condition worsened with dribbling, swelling of the lower abdomen, legs, and knees, and distending pain in the eyes. This was due to deficiency-heat in the Kidney channel located in the lower jiao. The use of leaching herbs further damaged yang qi, preventing the transformation of yin. Subsequently, Di Huang Wan and Zi Shen Wan were administered, restoring normal urination. Further treatment with Bu Zhong Yi Qi Tang supplemented with Ophiopogon Tuber (Maidong) and Wuweizi led to full recovery.
Prefect Wang Yongzhi suffered from abdominal distension, poor appetite, and lack of desire for food. After taking Er Chen Tang, Zhi Shi, and diuretic herbs, he developed dysuria, loose stools, cough, abdominal distension, and cold limbs. I diagnosed deficiency-cold of the three foot yin meridians and prescribed Jin Gui Shen Qi Wan, resulting in his recovery.