膀胱不约为遗溺。
小便不禁韭子丸 出《三因方》,治肾冷。
韭子(六两) 苁蓉 鹿茸 牛膝 菟丝子 巴戟 石斛 杜仲 川归 地黄 桂
上随分酌用为丸。
阿胶散 治失禁。
阿胶(炒二两) 牡蛎( ) 鹿茸(酥炙四两任下)
茯苓丸 治心肾虚淋沥。
赤白茯苓(各二两) 地黄汁 好酒熬成膏丸,盐酒任下。
大小便闭者,外有骨热不同。
关格者,外有肝实热、心实热。
便利不禁,外有中风湿、肝脾不同。
结燥便闭 火邪伏于血中,耗散真阴,津液亏少。夫肾主大便为津液,津液
润则大便润。热燥,脾脉沉数,下连于尺,藏中有热。亦有吐泻后,肠胃虚,服
热药多者,宜承气下之。
又大便秘,小便数者,谓之脾约。脾血耗燥,肺金受邪,无所摄脾津液枯竭,治宜养血润燥。
风燥 肺受风邪入肠中,右尺脉浮,宜麻仁丸。
阴结 阴燥欲坐井中,两尺脉按之虚,或沉细而迟者是。
如有阴证,脉坚实,汤药中亦少加苦寒,以去燥热,宜黄柏、知母、附子。
气燥 尺脉伏也,宜温补之。
老人产妇 气弱津液不足而结者,并宜地黄丸。
治法 肾恶燥,以辛润之。脾结燥,以苦泻之,如食伤腹满、腹响是
也。
阳结者,散之。阴结者,热之。
如能食,小便赤,为实,有物秘也,宜麻仁丸、七宣等主之。如不能食者,
小便清,为虚,乃气秘也,宜用浓朴汤主之。
润肠丸
麻仁 桃仁(一两) 羌活 归尾 大黄(煨各半两)
上蜜丸梧子大。
如大便全秘,加酒制大黄;如血燥大便干燥,加桃仁、大黄;如风结大便不
行,加麻仁、大黄;如风湿,加皂角仁、秦艽、大黄;如脉涩身觉气短,加
郁李仁、大黄;如阴结,加姜附。
浓朴汤 治气。
浓朴 半夏 甘草(三两) 白术(五两) 枳实 陈皮(一两)
外有香港脚虚寒,气实亦大便不通。
肾脏风 湿也。阴茎痒痛不忍。
苦参 大黄 荆芥 皂角 洗熏。 海螵蛸末敷。
阴包痒虫蚀
狗脊 黄连 黄柏 水银 光粉 赤石脂 为末敷 又加黄丹
膀胱约束功能失常导致遗尿。
小便不禁韭子丸,出自《三因方》,治疗肾寒证。
韭菜子(六两) 肉苁蓉 鹿茸 牛膝 菟丝子 巴戟天 石斛 杜仲 川当归 地黄 桂枝
以上药物根据分量斟酌,制成丸剂。
阿胶散,治疗失禁。
阿胶(炒制二两) 牡蛎 鹿茸(酥炙四两,可替换上述部分药材)
茯苓丸,治疗心肾虚损导致的淋沥不尽。
赤茯苓、白茯苓(各二两) 地黄汁 优质酒熬制成膏状丸剂,用盐酒送服。
大便秘结和小便不通的情况,外部表现有骨蒸热的不同。
关格证,外部表现有肝实热、心实热。
大小便失禁,外部表现有中风湿邪、肝脾失调的不同。
【结燥便闭】火邪潜伏在血分中,耗散真阴,导致津液亏少。肾主管大便,依赖津液滋润,津液充足则大便润泽。若出现热燥,脾脉沉数,脉象下连尺部,说明脏腑中有热。也有在吐泻之后,肠胃虚弱,服用过多热性药物的情况,适宜用承气汤类攻下。
另外,大便秘结且小便频数的,称为脾约。这是由于脾血耗伤干燥,肺金受邪,无法统摄脾的津液,导致津液枯竭,治疗宜养血润燥。
阴结:阴寒燥结,患者想坐在井中降温,两尺脉按之虚软,或沉细而迟涩的是此证。
如果伴有阴证,脉象坚实,在汤药中也应少量加入苦寒药,以去除燥热,适宜用黄柏、知母、附子。
治法:肾厌恶燥,应用辛味药来润养。脾脏结燥,应用苦味药来泻下,例如饮食损伤导致的腹满、肠鸣就是这种情况。
阳结证,用发散法治疗。阴结证,用温热法治疗。
如果能进食,小便色赤,属于实证,是有形之物秘结,适宜用麻仁丸、七宣汤等主治。如果不能进食,小便清长,属于虚证,是气机秘结,适宜用浓朴汤主治。
润肠丸
火麻仁 桃仁(一两) 羌活 当归尾 大黄(煨制,各半两)
以上药物用蜂蜜制成梧桐子大小的丸剂。
如果大便完全秘结,加酒制大黄;如果是血燥导致大便干燥,加桃仁、大黄;如果是风结导致大便不行,加火麻仁、大黄;如果是风湿,加皂角仁、秦艽、大黄;如果脉涩且身体感觉气短,加郁李仁、大黄;如果是阴结,加干姜、附子。
浓朴汤,治疗气滞。
厚朴 半夏 甘草(三两) 白术(五两) 枳实 陈皮(一两)
此外还有脚气虚寒,气实也会导致大便不通。
Bladder failure to constrain leads to enuresis.
Jiu Zi Wan (Leek Seed Pill) for Incontinence of Urine, from *San Yin Fang*, treats Kidney Cold syndrome.
*Allii Tuberosi Semen* (six liang), *Cistanche Herba* (Rou Cong Rong), *Deer Antler* (Lu Rong), *Achyranthes Root* (Niu Xi), *Cuscuta Seed* (Tu Si Zi), *Morinda Root* (Ba Ji), *Dendrobium Stem* (Shi Hu), *Eucommia Bark* (Du Zhong), *Angelica Sinensis Root* (Chuan Gui), *Rehmannia Root* (Di Huang), *Cinnamon Twig* (Gui Zhi).
Process the above ingredients according to their proportions and form into pills.
E Jiao San (Donkey-hide Gelatin Powder) for Incontinence.
*Colla Corii Asini* (fried, two liang), *Concha Ostreae* (Mu Li), *Deer Antler* (Su Zhi Lu Rong, four liang; can replace some of the above herbs).
Fu Ling Wan (Poria Pill) for dribbling due to Heart and Kidney deficiency.
*Red Poria* (Chi Fu Ling) and *White Poria* (Bai Fu Ling) (two liang each), *Rehmannia Juice*, boiled with fine wine into a paste to form pills; take with salted wine.
In cases of constipation and urinary retention, external manifestations differ regarding bone-steaming heat.
Guan Ge syndrome presents externally with Liver Excess Heat and Heart Excess Heat.
Incontinence of stool and urine presents externally with differences between Wind-Dampness invasion and Liver-Spleen dysfunction.
[Constipation due to Dryness] Fire pathogen hides in the blood level, consuming True Yin, leading to a deficiency of body fluids. The Kidney governs defecation via body fluids; when fluids are sufficient, stools are moist. If there is dryness-heat, the Spleen pulse is deep and rapid, extending to the Chi position, indicating heat within the zang organs. There are also cases after vomiting or diarrhea where the intestines and stomach are weak, and excessive intake of hot medicines has occurred; these should be treated with Cheng Qi Tang to purge downwards.
Furthermore, when constipation accompanies frequent urination, it is called Pi Yue (Spleen Restriction). This is caused by consumption and drying of Spleen blood, pathogenic invasion of Lung Metal, inability to control Spleen fluids, leading to fluid exhaustion. Treatment should focus on nourishing blood and moistening dryness.
Wind-Dryness: Wind pathogen invades the intestines via the Lungs; the Right Chi pulse is floating. Ma Ren Wan (Hemp Seed Pill) is appropriate.
Yin Jie (Yin Constipation): Severe cold-dryness makes the patient wish to sit in a well to cool down; the Two Chi pulses feel empty upon pressure, or are deep, thin, and slow.
If Yin syndrome symptoms are present and the pulse is firm, add a small amount of bitter-cold herbs to the decoction to remove dryness-heat; Huang Bo (Phellodendron Bark), Zhi Mu (Anemarrhena Rhizome), and Fu Zi (Prepared Aconite Root) are suitable.
Qi Dryness: The Chi pulse is hidden/faint; warm tonification is appropriate.
For the elderly and postpartum women: Constipation due to weak Qi and insufficient fluids should all be treated with Di Huang Wan (Rehmannia Pill).
Treatment Principles: The Kidney dislikes dryness; use acrid herbs to moisten it. Spleen dryness-stagnation is purged with bitter herbs, such as in cases of abdominal fullness and borborygmi due to dietary injury.
Yang Jie (Yang Constipation) is treated with dispersing methods. Yin Jie (Yin Constipation) is treated with warming methods.
If the patient can eat and has dark urine, it is Excess syndrome with tangible obstruction; treat primarily with Ma Ren Wan or Qi Xuan Tang. If the patient cannot eat and has clear urine, it is Deficiency syndrome with Qi stagnation; treat primarily with Hou Po Tang.
Run Chang Wan (Moisten Intestines Pill)
*Hemp Seed* (Ma Ren), *Peach Kernel* (Tao Ren, one liang), *Notopterygium Rhizome* (Qiang Huo), *Angelica Sinensis Tail* (Gui Wei), *Rhubarb Root* (Da Huang, baked, half liang each).
Process with honey into pills the size of wu zi (Chinese quince seeds).
If stool is completely blocked, add wine-processed Da Huang; if blood dryness causes hard stool, add Tao Ren and Da Huang; if wind constipation prevents passage, add Ma Ren and Da Huang; if Wind-Dampness, add Gleditsia Sinensis Fruit (Zao Jiao Ren), Gentian Root (Qin Jiao), and Da Huang; if the pulse is choppy and the body feels short of breath, add Prunus Armeniaca Seed (Yu Li Ren) and Da Huang; if Yin Jie, add Ginger and Fu Zi.
Hou Po Tang (Magnolia Bark Decoction) treats Qi stagnation.
*Magnolia Bark* (Hou Po), *Pinellia Tuber* (Ban Xia), *Licorice Root* (Gan Cao, three liang), *Atractylodes Macrocephala Rhizome* (Bai Zhu, five liang), *Immature Bitter Orange* (Zhi Shi), *Tangerine Peel* (Chen Pi, one liang).
Additionally, Xu Han (Deficiency-Cold) of Hong Kong Foot (Gouty Arthritis/Jock Itch context) with Excess Qi can also cause constipation.
[Kidney Wind] This is Dampness. The penis itches and hurts unbearably.
*Sophora Root* (Ku Shen), *Rhubarb Root* (Da Huang), *Schizonepeta Spike* (Jing Jie), *Gleditsia Sinensis Fruit* (Zao Jiao), wash and fumigate. Apply powder of *Cuttlebone* (Hai Piao Xiao).
Itching of the Yin Bao (Genital swelling) like insect erosion:
*Cibotium Rhizome* (Gou Ji), *Coptis Rhizome* (Huang Lian), *Phellodendron Bark* (Huang Bo), *Mercury* (Shui Yin), *Glacial Borax* (Guang Fen), *Red Kaolin* (Chi Shi Zhi), grind into powder for application. Another formula adds *Minium* (Huang Dan).