有命门阳衰，不能约束水液者，经所谓水泉不止，膀胱不藏，乃失守之死候也。急宜温
固肾气，多有生者。
《济生》菟丝子丸
菟丝子（制，二两） 肉苁蓉（酒浸，二两） 牡蛎（ ） 桑螵蛸（酒炙，五钱） 五味子
鹿茸（酒炙，各二两） 鸡 （炙干，五钱） 附子（炮，二两）
上为末，酒糊丸桐子大，每服七十丸，空心盐汤温酒任下。
有脾肺气虚，不能约束水道而病为不禁者，《金匮》所谓上虚不能制下者也，宜补中益
气之
属为主，而以固涩之剂佐之。张景岳曰∶小便不禁，古方多用固涩，此亦治标之意，而非塞
源之道也。盖水虽主于肾，而肾上连肺，若肺气无权，则肾水终不能摄，故治水者必先治气
，治肾者必先治肺，不然徒障狂澜，无益也。又古方书论小便不禁，有属热属虚之辨，不知
不禁之谓，乃以小水太利为言，皆属虚寒，何有热证。若因热而小便频数，则淋沥点滴，不
能禁止，而又出之不快，或多痛涩，非遗失不禁之谓矣。倘以虚寒误认为热，而妄投泻火之
剂，岂不殆哉。
巢氏云∶人睡中尿出者，是其素禀阴气偏盛，阳气偏虚，膀胱与肾气俱冷，不能制于水
，而夜卧阳气衰状，不能制于阴，阴气独盛，则小便多，或不禁而遗尿也。
治之方
雄鸡肠 桂心
二味等分捣为丸，服如豆大一枚，日三服。
命门阳气衰微，无法约束水液的情况，正如经典所述“水泉不止，膀胱不藏”，这是失守的危重证候。此时急需温补并固摄肾气，多数患者可以痊愈。
《济生方》菟丝子丸
菟丝子（炮制，二两） 肉苁蓉（酒浸，二两） 牡蛎（煅） 桑螵蛸（酒炙，五钱） 五味子 鹿茸（酒炙，各二两） 鸡肠（炙干，五钱） 附子（炮制，二两）
以上药物研为细末，用酒调面糊制成梧桐子大小的丸药，每次服用七十丸，空腹时以淡盐汤或温酒送服。
脾肺之气虚弱，无法约束水道而导致小便不禁的情况，正如《金匮要略》所说“上虚不能制下”，治疗应以补中益气类药物为主，辅以固涩止遗的药物。张景岳说：小便不禁，古方多使用固涩法，这属于治标之意，并非堵塞水源的根本之道。因为水液虽由肾主司，但肾上连于肺，若肺气无权（宣降失职），则肾水最终不能被摄纳，所以治疗水液代谢问题必须先调理气机，治疗肾脏问题必须先调理肺脏，否则如同徒劳地阻挡狂澜，毫无益处。另外，古方书中论述小便不禁，有属热和属虚的辨析，殊不知“不禁”是指小便过于通利，皆属于虚寒证，哪里会有热证？如果是因热导致的小便频数，则是淋沥点滴、不能控制，且排尿不畅，或多疼痛涩滞，这不属于遗失不禁的范畴。倘若将虚寒误认为热证，而妄用泻火药物，岂不是危险吗？
巢元方说：人在睡梦中尿床的，是因为其先天禀赋阴气偏盛，阳气偏虚，膀胱与肾气俱冷，无法制约水液，加之夜间睡眠时阳气更衰，不能制约阴气，导致阴气独盛，从而小便增多，或不禁而遗尿。
治疗此症的方剂：
雄鸡肠 桂心
以上两味药等分捣碎制成丸药，每次服用如豆大一枚，每日三次服用。
In cases where the Yang Qi of the Mingmen (Gate of Life) is deficient and unable to constrain body fluids, as described in the classics as "water springs flowing without cease, the Bladder failing to store," this is a critical sign of loss of control. Urgent treatment should focus on warming and consolidating the Kidney Qi; many patients will recover.
*Tusizi Wan* (Cuscuta Seed Pill) from *Jisheng Fang*
*Cuscutae Semen* (processed, 2 liang), *Cistanche Herba* (soaked in wine, 2 liang), *Ostrea Concha* (calcined), *Mantis Ootheca* (roasted with wine, 5 qian), *Schisandrae Fructus*, *Cervi Cornu Pantotrichum* (roasted with wine, each 2 liang), *Gallus gallus domesticus Intestinum Crassum* (roasted until dry, 5 qian), *Aconiti Lateralis Radix Praeparata* (processed, 2 liang).
Grind the above ingredients into fine powder, mix with wine paste to form pills the size of paulownia seeds. Take 70 pills per dose, administered empty-stomach with light salt water or warm wine.
In cases where the Qi of the Spleen and Lung is deficient, failing to constrain the water passages and resulting in urinary incontinence, as stated in *Jingui Yaolue* ("Upper deficiency cannot control the lower"), treatment should primarily use formulas that tonify the Middle and benefit Qi, assisted by astringent agents. Zhang Jingyue stated: For urinary incontinence, ancient formulas mostly used astringents; this is treating the branch rather than the root. Although water metabolism is governed by the Kidney, the Kidney connects superiorly to the Lung. If Lung Qi lacks authority (fails to regulate descent and diffusion), Kidney water ultimately cannot be secured. Therefore, when treating water metabolism, one must first treat Qi; when treating the Kidney, one must first treat the Lung. Otherwise, it is like vainly attempting to dam a raging torrent, yielding no benefit. Furthermore, ancient texts discuss urinary incontinence with distinctions between heat and deficiency. However, "incontinence" refers to excessive urination, which belongs to deficiency-cold; where is there a heat syndrome? If frequent urination is caused by heat, it presents as dribbling drops, inability to hold urine, slow stream, pain, and astringency; this does not constitute the meaning of involuntary loss. If deficiency-cold is mistaken for heat and purgative-fire medications are recklessly administered, would this not be dangerous?
Chao Yuanfang stated: Those who wet the bed during sleep do so because their innate constitution features excess Yin Qi and deficient Yang Qi. The Bladder and Kidney Qi are both cold and unable to control water. During night sleep, Yang Qi declines further and cannot restrain Yin, causing Yin Qi to dominate exclusively, leading to increased urination or enuresis.
Treatment formula:
*Gallus gallus domesticus Intestinum Crassum* (Rooster intestine), *Cinnamomi Cortex* (Guixin).
Grind these two ingredients in equal parts into pills. Take one pill the size of a bean at a time, three times daily.