凡人下焦如渎，所以主潴泄也。产后气血虚脱，沟渎决裂，潴蓄不固，水泉不止，故数而遗而不
禁耳。治法∶下者举之，脱者涩之，宜用升阳调元汤，合桑螵蛸散主之。《医通》云∶产后小便数，
乃气虚不能制水，补中益气加车前、茯苓。遗尿不知，补中益气汤。然有肾气不固者，宜六味丸加益智。
若因膀胱气虚，小便频数，
当补脾肺，补中益气加山萸、山药为主，佐以人参螵蛸散。如系虚寒以致数遗，益心汤最妙。冯氏云∶
小便不禁，若脾肾虚弱，补中汤送还少丹。若脾肾虚寒，用八味丸、四神丸佐之。然世有新产之妇，
廷孔未敛，故溺出不知。此恒有之，至六七朝自止，不必治也。又有临产损破尿胞遗尿者，已于前淋
证门中论治矣。
升阳调元汤 治产后小便数，及遗尿不禁。
人参 益智仁 黄 （蜜炙。各一钱五分） 升麻 炙草（各一钱）
姜枣煎，调桑螵蛸散服。原方药通用一钱五分，予谓升麻、炙草宜减，故各录用一钱。
桑螵蛸散
真桑螵蛸（炒） 白龙骨（ ） 牡蛎（各等分。取左顾者， ）
为细末，每服调服三钱。
人参螵蛸散 治产后阳气虚弱，小便频数及遗尿。
桑螵蛸（二三十个，炒） 人参（二两） 黄 （三两，蜜炙） 鹿茸（酥炙） 牡蛎（ ） 赤石
脂（ ） 浓朴（姜汁制。各二两）
上为末，每服二钱。空心粥饮调下。《外台方》无浓朴、石脂，有甘草、生姜。
益心汤 治产后小便数及遗尿。
益智仁（二十七粒）
为细末，每服二钱，米饮调服。
还少丹 治脾肾虚寒，血气羸乏，不思饮食，发热盗汗等证。
熟地（二两） 山药 牛膝（酒浸。各一两五钱） 山萸肉 茯苓（乳拌） 杜仲（姜汁炒断
丝） 远志（制，去心，取净肉） 五味子（炒） 楮实子（酒蒸） 小茴香（炒） 巴戟天（酒浸，去骨
）肉苁蓉（酒浸，洗去泥甲。各一两） 石菖蒲（五钱）
枣肉加蜜为丸，每服三四钱。白汤、淡盐汤俱可送下。
补中益气汤（见上卷诸痛门。） 六味丸 八味丸（俱见上卷诸痛门，附六味地黄汤下。）
四神丸（见本卷腹痛门。）
凡是人的下焦如同沟渠，主要负责储存和排泄水液。产后气血虚弱耗脱，导致沟渠决裂，蓄水固摄无力，尿液不断流出，所以出现小便频数且遗尿失禁的情况。治疗方法：对于下陷的病证应当升举，对于滑脱的病证应当固涩，适宜使用升阳调元汤，配合桑螵蛸散主治。《医通》说：产后小便频数，是由于气虚不能制约水液，可用补中益气汤加入车前子、茯苓。遗尿不知者，用补中益气汤。然而有肾气不坚固的，适宜用六味丸加入益智仁。如果是因为膀胱气虚，小便频繁，应当补益脾肺，以补中益气汤加入山茱萸、山药为主，佐以人参螵蛸散。如果是由于虚寒导致的小便频数遗尿，益心汤最为巧妙。冯氏说：小便不禁，如果是脾肾虚弱，用补中汤送服还少丹。如果是脾肾虚寒，用八味丸、四神丸辅助治疗。然而世间有新产后的妇女，产道（廷孔）尚未闭合，所以尿液流出而不自知。这是经常有的情况，到了六七天后自然停止，不需要治疗。又有临产时损伤破裂膀胱导致遗尿的，已经在前面淋证章节中论述过治疗方法了。
升阳调元汤 治疗产后小便频数，以及遗尿失禁。
人参 益智仁 黄芪（蜜炙。各一钱五分） 升麻 炙甘草（各一钱）
用生姜、大枣煎煮，调和桑螵蛸散服用。原方药物通用一钱五分，我认为升麻、炙甘草应当减量，所以各自选用一钱。
桑螵蛸散
真桑螵蛸（炒） 白龙骨（煅） 牡蛎（煅，各等分。选取向左顾视的，）
研为细末，每次服用三钱，调服。
人参螵蛸散 治疗产后阳气虚弱，小便频繁及遗尿。
桑螵蛸（二三十个，炒） 人参（二两） 黄芪（三两，蜜炙） 鹿茸（酥炙） 牡蛎（煅） 赤石脂（煅） 厚朴（姜汁制。各二两）
以上研为末，每次服用二钱。空腹时用米粥饮调下。《外台秘要》方中没有厚朴、石脂，有甘草、生姜。
益心汤 治疗产后小便频数及遗尿。
益智仁（二十七粒）
研为细末，每次服用二钱，用米饮调服。
还少丹 治疗脾肾虚寒，血气衰弱缺乏，不思饮食，发热盗汗等症状。
熟地黄（二两） 山药 牛膝（酒浸。各一两五钱） 山茱萸肉 茯苓（乳拌） 杜仲（姜汁炒断丝） 远志（制，去心，取净肉） 五味子（炒） 楮实子（酒蒸） 小茴香（炒） 巴戟天（酒浸，去骨） 肉苁蓉（酒浸，洗去泥甲。各一两） 石菖蒲（五钱）
枣肉加蜂蜜制成丸药，每次服用三四钱。白开水、淡盐汤均可送服。
The lower jiao (Lower Burner) in the human body is like a drainage ditch, primarily responsible for storing and excreting fluids. After childbirth, when qi and blood are deficient and depleted, the "ditches" rupture, causing the stored fluids to be unsecured and urine to flow incessantly; thus, frequent urination and urinary incontinence occur. The treatment principle is: for sinking conditions, lift them up; for slipping/loose conditions, astringe them. It is appropriate to use Shengyang Tiaoyuan Decoction (Ascending Yang and Regulating Primordial Decoction), combined with Sangpiaoxiao San (Mantis Egg-case Powder). *Yitong* states: Frequent urination after childbirth is due to qi deficiency failing to control water; Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Cheqianzi (Plantago Seed) and Fuling (Poria) should be used. For urinary incontinence without awareness, Buzhong Yiqi Tang alone is indicated. However, for cases where kidney qi is not secure, Liuwei Wan (Six-Ingredient Pill with Rehmannia) added with Yizhiren (Bitter Apricot Seed) is suitable. If the cause is bladder qi deficiency leading to frequent urination, one should tonify the spleen and lungs, using Buzhong Yiqi Tang added with Shanzhuyu (Cornus Fruit) and Shanyao (Dioscorea Rhizome) as the main formula, assisted by Ren Shen Piaoxiao San (Ginseng and Mantis Egg-case Powder). If the condition arises from deficiency-cold causing frequent urination and incontinence, Yixin Tang (Benefit Heart Decoction) is most excellent. Feng Shi states: For urinary incontinence due to spleen and kidney weakness, Buyin Tang (Tonify Spleen Decoction) administered with Huanshao Dan (Return to Youth Pill) is used. For spleen and kidney deficiency-cold, Bawei Wan (Eight-Ingredient Pill) and Sishen Wan (Four Spirits Pill) are used as adjuncts. However, among women who have just given birth, if the vaginal opening (Tingkong) has not yet closed, urine may flow out without their knowledge. This is a common occurrence and will cease naturally after six or seven days; no treatment is necessary. As for cases of urinary incontinence due to damage and rupture of the bladder during labor, these have already been discussed in the preceding section on strangury syndromes.
Shengyang Tiaoyuan Decoction (Ascending Yang and Regulating Primordial Decoction): Treats frequent urination after childbirth, as well as urinary incontinence.
Renshen (Ginseng Root), Yizhiren (Bitter Apricot Seed), Huangqi (Astragalus Root, honey-fried) [1.5 qian each], Shengma (Cimicifuga Rhizome), Zhigancao (Licorice Root, roasted) [1 qian each].
Decoct with Jiang (Fresh Ginger) and Zao (Jujube), and take mixed with Sangpiaoxiao San. In the original formula, all herbs were used at 1.5 qian; I believe Shengma and Zhigancao should be reduced, so I prescribe 1 qian for each.
Sangpiaoxiao San (Mantis Egg-case Powder):
Zhen Sangpiaoxiao (True Mantis Egg-case, stir-fried), Bailonggu (White Dragon Bone, calcined), Muli (Oyster Shell, calcined) [equal parts. Select those facing left].
Grind into fine powder. Take 3 qian per dose, mixed with water.
Ren Shen Piaoxiao San (Ginseng and Mantis Egg-case Powder): Treats postpartum yang qi deficiency, frequent urination, and urinary incontinence.
Sangpiaoxiao (Mantis Egg-case, 20-30 pieces, stir-fried), Renshen (Ginseng Root, 2 liang), Huangqi (Astragalus Root, 3 liang, honey-fried), Lurong (Deer Antler, prepared with butter), Muli (Oyster Shell, calcined), Chishizhi (Red Halloysite, calcined), Houpo (Magnolia Bark, processed with ginger juice) [2 liang each].
Grind all into powder. Take 2 qian per dose, swallowed with millet gruel drink on an empty stomach. The *Waitai Fang* (External Cabinet Formulas) does not contain Houpo or Chishizhi, but includes Gancao (Licorice Root) and Shengjiang (Fresh Ginger).
Yixin Tang (Benefit Heart Decoction): Treats postpartum frequent urination and urinary incontinence.
Yizhiren (Bitter Apricot Seed, 27 grains).
Grind into fine powder. Take 2 qian per dose, mixed with rice water.
Huanshao Dan (Return to Youth Pill): Treats spleen and kidney deficiency-cold, depletion of blood and qi, loss of appetite, fever, and night sweats.
Shudi (Prepared Rehmannia Root, 2 liang), Shanyao (Dioscorea Rhizome), Niuxi (Achyranthes Root, soaked in wine) [1.5 liang each], Shanzhuyrou (Cornus Fruit Flesh), Fuling (Poria, mixed with milk), Duzhong (Eucommia Bark, stir-fried with ginger juice until fibers break), Yuanzhi (Polygala Root, processed, heart removed, pure flesh taken), Wuweizi (Schisandra Berry, stir-fried), Chushizi (Cudrania Fruit, steamed in wine), Xiaohuixiang (Fennel Fruit, stir-fried), Bajitian (Morinda Root, soaked in wine, bone removed), Roucongrong (Cistanche Stem, soaked in wine, washed clean) [1 liang each], Shichangpu (Acorus Rhizome, 5 qian).
Make pills with date paste and honey. Take 3-4 qian per dose. Can be taken with plain warm water or light salt water.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See Volume 1, Section on Various Pains). Liuwei Wan (Six-Ingredient Pill with Rehmannia) Bawei Wan (Eight-Ingredient Pill) (Both see Volume 1, Section on Various Pains, attached under Liuhuangdi Wan). Sishen Wan (Four Spirits Pill) (See this volume, Section on Abdominal Pain).