〔大〕经云∶膀胱不利为癃，不约为遗尿者，乃心肾之气传送失度之所为也。故有小
便涩而遗者，有失禁而出不自知者。又妇人产蓐产理不顺，致伤膀胱，遗尿无时。又有
脬寒脏冷而遗尿不禁，治之各有方。
〔薛〕《内经》曰∶胞移热于膀胱则癃、溺血，膀胱不利为癃，不约为遗溺。注曰∶膀
胱为津液之腑，水注由之，然足三焦脉实，约下焦而不通，则不得小便。足三焦脉虚，不
约下焦，则遗溺也。《灵枢经》曰∶足三焦者，太阳之别也，并太阳之正，入络膀胱，约下
焦，实则闭癃，虚则遗溺。窃谓前证若肝肾虚热，挺孔痿痹，用六味丸，如不应，用加
减八味丸。阳气虚惫，膀胱积冷，用鹿茸丸，如不应，用八味丸。若脾气虚弱不能禁止，用
补中益气汤加山药、山萸、五味。若肺气虚寒，前汤加桂、附。此证属虚热者多，真寒
者少，治宜审察。一妇人小便自遗，或时不利，日晡益甚，此肝热阴挺不能约制，用
六味丸料加白术、酒炒黑黄柏七分、知母五分，数剂诸证悉愈。若误用分利之剂，愈损
真阴，必致不起。一老妇患前证，恶寒体倦，四肢逆冷，余以为阳气虚寒，用补中益
气加附子三剂，不应，遂以参附汤四剂稍应，仍以前药而安。附子计用四枚，人参三斤许。
一妇人病愈后，小便出屎，此阴阳失于传送，名大小肠交也。先用五苓散二剂而愈，又
用补中益气汤而安。
〔大〕鹿茸丸 治妇人久积虚冷，小便白浊，滑数不禁。
鹿茸（炙） 椒红 桂心 附子（炮） 牡蛎（ ） 补骨脂（炒） 石斛 肉苁蓉（酒浸）
鸡 （炙） 沉香（各一两） 桑螵蛸（炙，半两）
上为细末，酒煮面糊，丸梧桐子大。空心，温酒下三十丸。
又方 鹿角屑炒令黄，为细末，空心温酒调二钱。
又方 雄鸡 炙为末，空心酒调服二钱。
治妇人遗尿，不知出时。《千金翼》方。
白薇 白芍药（各等分）
上为末，酒服方寸匕，日三服，空心。
又方 以桑螵蛸酒炒，为细末，每服二钱，生姜汤调下。
又方
白矾 牡蛎（各等分）
为细末，饮服方寸匕。亦治丈夫遗尿。
疗妇人遗尿不禁 雄鸡翎烧灰为末，酒服方寸匕。
补遗秘元丸 治内虚自汗，小便不禁。
白龙骨（三两） 诃子（十个，去核） 缩砂仁（一两）
为末，糯米粥丸梧子大。每服五十丸，空心盐油吞下。
又治小便不禁，用猪脬洗净，铁铲上炙熟食之，以酒咽下。
【王冰注】《黄帝内经》说：膀胱气化不利称为“癃”（小便不通），约束无力称为“遗尿”，这是心肾之气传输失常所致。因此，有小便涩滞而遗出的，有失禁而出且自己不知晓的。另外，妇女在产褥期因产理不顺，损伤膀胱，导致随时遗尿。又有因膀胱寒冷、脏腑虚寒而导致遗尿不禁的，治疗各有相应的方剂。
【薛己按】《黄帝内经》说：胞宫的热邪转移至膀胱则导致“癃”或尿血，膀胱气化不利为“癃”，约束无力为“遗溺”。注释说：膀胱是津液之腑，水液由此通过。如果足三焦脉实，约束下焦但气机不通，则不能排尿；如果足三焦脉虚，不能约束下焦，则发生遗尿。《灵枢经》说：足三焦是太阳经的别络，与太阳经的正脉并行，进入联络膀胱，约束下焦。实证则闭阻成“癃”，虚证则发生遗尿。我认为前述病证如果是肝肾虚热，导致阴挺痿痹，使用六味丸（Liuwei Wan, Six-Ingredient Pill with Rehmannia）；如果无效，使用加减八味丸（Jiajian Bawei Wan, Modified Eight-Ingredient Pill）。如果是阳气虚衰，膀胱积冷，使用鹿茸丸（Lurong Wan, Deer Antler Pill）；如果无效，使用八味丸（Bawei Wan, Eight-Ingredient Pill）。如果是脾气虚弱不能固摄，使用补中益气汤（Buzhong Yiqi Tang, Tonify the Middle and Augment the Qi Decoction）加山药、山萸肉、五味子。如果是肺气虚寒，在前一方基础上加桂枝、附子。此证属于虚热的较多，真寒的较少，治疗应当仔细审察。有一位妇人小便自遗，有时排尿不畅，傍晚时分加重，这是肝热导致阴挺，不能约制，使用六味丸料加白术、酒炒黑黄柏七分、知母五分，服用数剂后诸证痊愈。如果误用分利（利尿通淋）的药物，会进一步损伤真阴，必然导致死亡。一位老妇人患上述病证，恶寒体倦，四肢逆冷，我认为是阳气虚寒，使用补中益气汤加附子，服用三剂无效，于是改用参附汤（Shenfu Tang, Ginseng and Aconite Decoction）四剂稍见成效，随后仍用前药而安定。附子共计用了四枚，人参大约三斤。一位妇人在病愈后，小便中排出粪便，这是阴阳失去传输协调，名为“大小肠交”（Small and Large Intestines Intermingling）。先用五苓散（Wuling San, Five-Ingredient Powder with Poria）二剂而愈，又用补中益气汤而安。
【王冰注】鹿茸丸：治疗妇人久积虚冷，小便白浊，滑数不禁。
鹿茸（炙）、椒红、桂心、附子（炮）、牡蛎（煅）、补骨脂（炒）、石斛、肉苁蓉（酒浸）、鸡内金（炙）、沉香（各一两）、桑螵蛸（炙，半两）。
以上药物研为细末，用酒煮面糊，制成梧桐子大小的丸剂。空腹时，温酒送服三十丸。
又一方：鹿角屑炒至黄色，研为细末，空腹时用温酒调服二钱。
又一方：雄鸡内金炙后研为末，空腹时用酒调服二钱。
治疗妇人遗尿，不知何时流出。出自《千金翼方》。
白薇、白芍药（各等分）。
以上研为末，用酒送服方寸匕，每日三次，空腹服用。
又一方：将桑螵蛸用酒炒，研为细末，每次服用二钱，生姜汤调下。
又一方：
白矾、牡蛎（各等分）。
研为细末，饮水送服方寸匕。也治疗男子遗尿。
治疗妇人遗尿不禁：雄鸡翎烧灰为末，用酒送服方寸匕。
补遗秘元丸：治疗内虚自汗，小便不禁。
白龙骨（三两）、诃子（十个，去核）、缩砂仁（一两）。
研为末，糯米粥泛丸如梧子大。每次服用五十丸，空腹时用盐油吞下。
又治小便不禁：用猪脬（猪膀胱）洗净，在铁铲上烤熟食用，以酒咽下。
[Wang Bing's Note] The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Impaired urination due to bladder dysfunction is termed "Long" (癃, difficulty in urination), while loss of control is termed "Yiniao" (遗尿, urinary incontinence). These conditions result from the disordered transmission of Qi between the Heart and Kidney. Therefore, there are cases where urine dribbles out with a涩感 (astringent sensation/difficulty), and cases of incontinence where the patient is unaware of the leakage. Furthermore, women may suffer from urinary incontinence at any time due to injury to the bladder caused by improper labor processes during the postpartum period. There are also cases of incontinence due to cold in the bladder and coldness of the viscera, each requiring specific formulas for treatment.
[Xue Ji's Commentary] The *Huangdi Neijing* states: When heat from the Bao Organ (uterus/bladder area) shifts to the Bladder, it causes "Long" or hematuria; bladder dysfunction leads to "Long," and lack of restraint leads to "Yiniao" (urinary incontinence). The annotation explains: The Bladder is the Fu organ of Jin-Ye (body fluids), through which water passes. If the Foot-Sanjiao (Triple Burner) pulse is excess, constraining the Lower Jiao but blocking flow, urination is impossible. If the Foot-Sanjiao pulse is deficient, failing to constrain the Lower Jiao, urinary incontinence occurs. The *Lingshu Jing* (Spiritual Pivot) states: The Foot-Sanjiao is an extra channel of the Taiyang meridian, running parallel to its main pathway, entering and connecting with the Bladder to constrain the Lower Jiao. In excess patterns, obstruction and "Long" occur; in deficiency patterns, urinary incontinence occurs. I believe that if the aforementioned symptoms are due to Deficient-Heat in the Liver and Kidney causing prolapse and flaccidity, use Liuwei Wan (Six-Ingredient Pill with Rehmannia); if ineffective, use Jiajian Bawei Wan (Modified Eight-Ingredient Pill). If due to Yang Qi deficiency and exhaustion with cold accumulation in the Bladder, use Lurong Wan (Deer Antler Pill); if ineffective, use Bawei Wan (Eight-Ingredient Pill). If due to Spleen Qi deficiency failing to hold, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Dioscoreae Rhizoma (Shanyao), Corni Fructus (Shanzhuyu), and Schisandrae Fructus (Wuweizi). If due to Lung Qi deficiency and cold, add Cinnamomi Ramulus (Guizhi) and Aconiti Lateralis Radix Praeparata (Fuzi) to the previous formula. Most cases of this condition belong to Deficient-Heat, with few being True Cold; treatment requires careful examination. One woman suffered from spontaneous urinary leakage, sometimes with difficult urination, worsening in the late afternoon. This was due to Liver Heat causing vaginal prolapse, unable to restrain urine. She was treated with Liuwei Wan ingredients added with Atractylodis Macrocephalae Rhizoma (Baizhu), Phellodendri Cortex (Huangbai) stir-fried with wine until blackened (7 fen), and Anemarrhenae Rhizoma (Zhimu) (5 fen). After several doses, all symptoms resolved. If diuretic agents (Fenli) were mistakenly used, it would further damage True Yin, inevitably leading to death. An elderly woman suffered from the aforementioned condition, with aversion to cold, fatigue, and cold limbs. I diagnosed it as Yang Qi deficiency and cold. She was treated with Buzhong Yiqi Tang added with Fuzi for three doses without effect. Subsequently, Shenfu Tang (Ginseng and Aconite Decoction) was administered for four doses, showing slight improvement, after which she stabilized on the previous medication. Approximately four pieces of Fuzi and three jin of Ren Shen (Ginseng) were used in total. Another woman, after recovering from illness, passed feces through her urethra. This indicates a failure of Yin and Yang transmission coordination, named "Intertwining of Small and Large Intestines." She was first cured with Wuling San (Five-Ingredient Powder with Poria) for two doses, then stabilized with Buzhong Yiqi Tang.
[Wang Bing's Note] Lurong Wan (Deer Antler Pill): Treats chronic deficiency-cold in women, cloudy white urine, and uncontrollable frequent slipping of urine.
Prepared Deer Antler (Lurong), Sichuan Pepper Red (Jiaohong), Cinnamon Heart (Guixin), Prepared Aconite Root (Fuzi), Calcined Oyster Shell (Muli), Stir-fried Psoralea Fruit (Buguzhi), Dendrobium Stem (Shihu), Wine-soaked Cistanche Stem (Roucongrou), Roasted Chicken Gizzard Lining (Jineijin), Agarwood (Chenxiang) (each 1 liang), Mummified Locust Egg Pod (Sangpiaoxiao) (roasted, 0.5 liang).
Grind these into fine powder, mix with rice paste boiled in wine, and form pills the size of paulownia seeds. Take 30 pills with warm wine on an empty stomach.
Another prescription: Stir-fry Deer Horn Scrapings (Lujiaoxie) until yellow, grind into fine powder, and take 2 qian mixed with warm wine on an empty stomach.
Another prescription: Roast Male Chicken Gizzard Lining (Xiongji Nei-Jin), grind into powder, and take 2 qian mixed with wine on an empty stomach.
Treats female urinary incontinence where the patient is unaware of the leakage. From *Qianjin Yi Fang*.
Baiwei (Cynanchum Atratum Root) and Baishaoyao (White Peony Root) (equal parts).
Grind into powder, take one fangcun bi (a square-inch measure) with wine, three times daily, on an empty stomach.
Another prescription: Stir-fry Sangpiaoxiao (Locust Egg Pod) with wine, grind into powder, take 2 qian per dose, mixed with Ginger Decoction.
Another prescription:
Baimfan (Alumen) and Muli (Oyster Shell) (equal parts).
Grind into powder, take one fangcun bi with water. Also treats male urinary incontinence.
Treats female urinary incontinence: Burn Male Chicken Feathers (Xiongji Ling) to ash, grind into powder, and take one fangcun bi with wine.
Buyi Miyuan Wan (Secret Origin Pill): Treats internal deficiency with spontaneous sweating and urinary incontinence.
Bailonggu (Dragon Bone) (3 liang), Hezi (Chebula Fruit) (10 pieces, pitted), Suosharen (Amomum Fruit) (1 liang).
Grind into powder, make pills with glutinous rice porridge the size of paulownia seeds. Take 50 pills per dose, swallowed with salted oil on an empty stomach.
Another treatment for urinary incontinence: Wash a Pig Bladder (Zhupao), roast it thoroughly on an iron spatula, eat it cooked, and wash it down with wine.