治脾气虚极下陷，小便不禁。
生箭 （四钱） 白术（四钱） 桑寄生（三钱） 川续断（三钱） 萸肉（四钱，去净核） 龙骨
（四钱， 捣） 牡蛎（四钱， 捣） 川萆 （二钱） 甘草（二钱，蜜炙）
《内经》曰∶“饮入于胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱。”是
脾也者，原位居中焦，为水
饮上达下输之枢机，枢机不旺，则不待上达而即下输，此小便之所以不禁也。然水饮降下之路不一，《内经》
又谓“肝热病者，小便先黄”，又谓“肝壅两 （胁也）满，卧则惊悸，不得小便。”且芍药为理肝之主药，
而善利小便。由斯观之，是水饮又由胃入肝，而下达膀胱也。至胃中所余水饮，传至小肠渗出，此又人所共知。
故方中用黄 、白术、甘草以升补脾气，即用黄 同寄生、续断以升补肝气，更用龙骨、牡蛎、萸肉、萆 以
固涩小肠也。又人之胸中大气旺，自能吸摄全身气化，不使下陷，黄 与寄生并用，又为填补大气之要药也。
或问∶黄 为补肺脾之药，今谓其能补肝气何也？答曰∶肝属木而应春令，其气温而性喜条达，黄 性
温而升，以之补肝，原有同气相求之妙用。愚自临证以来，凡遇肝气虚弱，不能条达，一切补肝之药不效者，
重用黄 为主，而少佐以理气之品，服之，复杯之顷，即见效验（治验详黄 解）。是知谓肝虚无补法者，非
见道之言也。
或问∶《神农本草经》谓桑寄生能治腰疼、坚齿发、长须眉，是当为补肝肾之药，而谓其能补胸中大气
何也？答曰∶寄生根不着土，寄生树上，最善吸空中之气，以自滋生，故其所含之气化，实与胸中大气为同类。
尝见有以补肝肾，而多服久服，胸中恒觉满闷，无他，因其胸中大气不虚，故不受寄生之补也。且《神农本草
经》不又谓其治痈肿乎？然痈肿初起，服之必无效，惟痈肿溃后，生肌不速，则用之甚效。如此而言，又与黄
之主痈疽败证者相同，则其性近黄 ，更可知矣。
或问∶萆 世医多用以治淋，夫淋以通利为主，盖取萆 能利小便也。此方中用之以固小便，其性果固
小便乎，抑利小便乎？答曰∶萆 为固涩下焦之要药，其能治失溺，《名医别录》原有明文。时医因古方有萆
解厘清饮，遂误认萆 为利小便之要
药，而于小便不利、淋涩诸证多用之。尝见有以利小便，而小便转癃闭者，以治淋证，竟致小便滴沥不通者，
其误人可胜道哉！盖萆 厘清饮之君萆 ，原治小便频数，溺出旋白如油，乃下焦虚寒，气化不固之证，观其
佐以缩小便之益智，温下焦之乌药，其用意可知。特当日命名时，少欠斟酌，遂致庸俗医辈，错有会心，贻害
无穷，可不慎哉！
治疗脾气极度虚弱且下陷，导致小便失禁。
生黄芪（四钱） 白术（四钱） 桑寄生（三钱） 川续断（三钱） 山茱萸肉（四钱，去净核） 龙骨（四钱，捣碎） 牡蛎（四钱，捣碎） 川萆薢（二钱） 甘草（二钱，蜜炙）
《黄帝内经》说：“饮食进入胃中，游溢精气，向上输送给脾，脾气散布精微物质，向上归于肺，通调水道，向下输送到膀胱。”这说明脾脏原本位居中焦，是水饮上达和下输的枢纽。如果枢纽功能不旺盛，水饮就不待上达而直接下输，这就是小便不禁的原因。然而，水饮下降的途径不止一条，《黄帝内经》又说“患肝热病的人，小便先变黄”，又说“肝气壅滞导致两胁胀满，睡觉时惊悸，不能排尿”。而且芍药是调理肝脏的主要药物，却善于通利小便。由此看来，水饮又是从胃进入肝脏，然后下达膀胱的。至于胃中剩余的水饮，传导至小肠渗出，这也是人所共知的常识。
因此，本方中使用黄芪、白术、甘草来升提补益脾气；同时用黄芪配合桑寄生、续断来升提补益肝气；更使用龙骨、牡蛎、山茱萸肉、川萆薢来固涩小肠。另外，人的胸中大气旺盛，自然能吸摄全身的气化功能，防止其下陷，黄芪与桑寄生并用，又是填补大气的关键药物。
有人问：黄芪是补益肺脾的药物，现在说它能补益肝气，为什么呢？回答说：肝属木而对应春季的气候，其气温和且性质喜欢条达舒畅，黄芪性温而主升，用它来补肝，原本就有同气相求的奇妙作用。我自临证以来，凡是遇到肝气虚弱，不能条达舒畅，所有补肝的药物都不见效的情况，重用黄芪为主药，并少量佐以理气的药物，服用后，片刻之间就能见效（治疗案例详见黄芪条目解析）。由此可知，说肝虚无补法的人，不是真正懂得医道的话。
有人问：《神农本草经》说桑寄生能治疗腰痛、坚固牙齿头发、生长胡须眉毛，这应当是补益肝肾的药物，为什么说它能补益胸中大气呢？回答说：桑寄生的根不着于泥土，而是寄生在树上，最善于吸收空中的清气来滋养自身，所以它所蕴含的气化功能，实际上与胸中的大气属于同类。曾经见到有人服用补肝肾的药物，多服久服后，胸中常常觉得满闷，没有其他原因，是因为他的胸中大气不虚，所以不接受桑寄生的补益。而且《神农本草经》不又提到它治疗痈肿吗？然而痈肿初起时，服用它必然无效，只有当痈肿溃破后，肌肉生长缓慢时，使用它才非常有效。这样说来，它与黄芪主治痈疽败证的情况相同，那么它的药性与黄芪相近，也就可想而知了。
有人问：川萆薢被世间的医生多用来治疗淋证，淋证以通利为主，大概是取川萆薢能通利小便的作用。这个方子中用它来固涩小便，它的药性究竟是固涩小便还是通利小便呢？回答说：川萆薢是固涩下焦的重要药物，它能治疗遗尿失禁，《名医别录》中原本就有明文记载。当时的医生因为古方中有萆薢分清饮，于是错误地认为川萆薢是通利小便的重要药物，而在小便不利、淋涩等各种证候中多用它。曾经见到有用它来通利小便，结果反而导致小便癃闭不通的；用它来治疗淋证，竟然导致小便滴沥不通的，这种误人害人的情况难道能说尽吗！大概萆薢分清饮中的君药川萆薢，原本是治疗小便频数，尿液排出后迅速变白如油的症状，这是下焦虚寒、气化不固的证候，观察其中佐以缩小便的益智仁、温下焦的乌药，其用意就可以知道了。只是当时命名时，稍微缺乏斟酌，致使平庸庸俗的医生们产生了错误的理解，遗留祸害无穷，能不谨慎吗！
Treats extreme deficiency and sinking of Spleen Qi (Spleen Qi), resulting in incontinence of urine.
Raw Astragali Radix (Sheng Huangqi, 4 qian) Atractylodis Macrocephalae Rhizoma (Baizhu, 4 qian) Taxilli Herba (Sangjisheng, 3 qian) Datiscae Radix (Chuan Xuduan, 3 qian) Corni Fructus (Yurou, 4 qian, seeds removed completely) Dragon Bone (Longgu, 4 qian, crushed) Oyster Shell (Muli, 4 qian, crushed) Dioscoreae Hypoglaucae Rhizoma (Chuan Bixie, 2 qian) Glycyrrhizae Radix et Rhizoma (Gancao, 2 qian, honey-fried)
The *Neijing* (Yellow Emperor's Inner Canon) states: "When drink enters the stomach, its essence floats and overflows, is transported upward to the Spleen; the Spleen scatters the essence, sending it upward to return to the Lung, which regulates the water passages and transports them downward to the Bladder." This indicates that the Spleen, originally situated in the Middle Jiao, serves as the pivot for the ascending and descending of fluids. If this pivot function is not vigorous, fluids will descend directly without ascending first; this is the reason for incontinence of urine. However, there are multiple pathways for the descent of fluids. The *Neijing* also states: "In cases of Liver Heat disease, the urine turns yellow first," and again: "Liver congestion causes fullness in both hypochondria; lying down leads to palpitations and fright, and an inability to urinate." Furthermore, Paeoniae Radix (Shaoyao) is the primary herb for regulating the Liver, yet it is excellent at promoting urination. From this perspective, fluids enter the Liver from the Stomach and then descend to the Bladder. As for the remaining fluids in the Stomach, they are transmitted to the Small Intestine where they exude; this is common knowledge.
Therefore, in this formula, Astragalus (Huangqi), Atractylodes (Baizhu), and Licorice (Gancao) are used to raise and tonify Spleen Qi; simultaneously, Astragalus is combined with Taxillus (Sangjisheng) and Datisc Root (Xuduan) to raise and tonify Liver Qi; additionally, Dragon Bone (Longgu), Oyster Shell (Muli), Cornus Fruit (Yurou), and Dioscorea Hypoglauca Rhizome (Bixie) are used to astringe the Small Intestine. Moreover, when the Great Qi (Daqi) in the chest is vigorous, it naturally absorbs and controls the Qi transformation of the whole body, preventing it from sinking. The combination of Astragalus and Taxillus is also a key remedy for replenishing the Great Qi.
One might ask: Astragalus is an herb that tonifies the Lung and Spleen; why is it said to tonify Liver Qi? The answer is: The Liver belongs to Wood and corresponds to the Spring season; its nature is warm and it prefers free flow and unobstructedness. Astragalus is warm in nature and has an ascending property. Using it to tonify the Liver possesses the subtle efficacy of seeking resonance between similar energies. Since I began clinical practice, whenever I encounter cases of weak Liver Qi unable to flow freely, where all other Liver-tonifying herbs fail, I heavily rely on Astragalus as the main ingredient, assisted by a small amount of Qi-regulating herbs. Upon ingestion, effects are seen within moments (for detailed case records, see the analysis under Astragalus). Thus, those who claim there is no method to tonify Liver Deficiency have not truly understood the Dao of medicine.
One might ask: The *Shennong Bencao Jing* (Divine Farmer's Materia Medica) states that Taxillus can treat lower back pain, strengthen teeth and hair, and promote the growth of beard and eyebrows; thus, it should be considered a herb for tonifying the Liver and Kidneys. Why is it said to tonify the Great Qi in the chest? The answer is: Taxillus roots do not touch the soil but grow on trees, making it most adept at absorbing the clear Qi of the air to nourish itself. Therefore, its Qi transformation properties are actually of the same category as the Great Qi in the chest. I have observed that some people take herbs to tonify the Liver and Kidneys; after prolonged use, they often feel chest fullness and oppression. There is no other reason than their Great Qi in the chest being sufficient, so they cannot accept the tonification from Taxillus. Furthermore, does the *Shennong Bencao Jing* not mention its treatment of carbuncles and swellings? However, when a carbuncle or swelling first arises, taking it is invariably ineffective. Only after the carbuncle ulcerates and tissue regeneration is slow does its use become very effective. In this regard, it is similar to Astragalus, which treats severe cases of carbuncles and ulcers; thus, its nature being close to that of Astragalus can be inferred.
One might ask: Physicians of the world often use Dioscorea Hypoglauca Rhizome (Bixie) to treat Lin syndrome (dysuria), which primarily focuses on promoting free flow, presumably because Bixie promotes urination. In this formula, it is used to astringe urine. Is its nature indeed astringent for urine, or is it diuretic? The answer is: Bixie is a crucial herb for astringing the Lower Jiao. Its ability to treat urinary incontinence is explicitly recorded in the *Mingyi Bielu* (Record of Famous Physicians). Contemporary physicians, due to the ancient formula *Bixie Fenqing Yin* (Dioscorea Hypoglauca Rhizome Decoction for Separating the Clear), mistakenly believe Bixie is a key herb for promoting urination, and thus use it frequently for conditions such as difficult urination and dysuria. I have seen cases where using it to promote urination resulted in urinary retention (longbi); using it to treat Lin syndrome led to点滴不通 (scanty dripping or complete obstruction). How can such errors harming patients be fully recounted! Originally, the chief herb Bixie in *Bixie Fenqing Yin* was intended to treat frequent urination where the urine turns white like oil immediately upon exiting; this is a pattern of Lower Jiao deficiency-cold and failure of Qi transformation to secure. Observing the accompanying herbs—Alpinia Oxyphylla Fruit (Yizhi) to reduce urination frequency and Lindera Aggregate Root (Wuyao) to warm the Lower Jiao—its intent is clear. It was merely a lack of careful consideration in naming at that time that led mediocre physicians to misunderstand, causing endless harm. Can one not be cautious?