频数无度，似淋而茎中不痛，故另分一篇。（数而少且涩，则似淋，以不痛故异。多且不
涩，又似不禁，然可忍为异。）证由肾虚有火，火动欲出，水不得藏，（肾虚六味丸，有火五苓散。）数
而少者，茯苓琥珀汤利之，免致涩痛成淋。数而多者，薯蓣、莲肉、益智仁之属收
之。然此证固属有火，亦有下元虚冷，肾不摄水者，菟丝子丸、八味丸。（见虚损）、鹿
茸丸（见血）。中气不足，数而多，补中益气汤（见气）。夜多小便、益智仁二十个为末，盐
五分，水一碗煎，临卧温服，或苁蓉丸。小便毕，少顷，谓已尽，忽再出些少，或
尿后又急者，多由忍尿行房所致，（忍尿则水不下行，行房则火炎，气升而不降，水不
下而气不降，后虽
便亦不畅，其去未尽，故情状如此。）宜生料五苓散（见伤湿）加阿胶，吞加减八味丸（见虚损）。心
移热于小肠，致小便数，（大喜动心火多有之。）厘清散（见赤白浊）、四七汤（见气），
仍以辰砂妙
香散（见心痛）煎吞小菟丝子丸（见赤白浊）。大便硬，小便数者，名脾约，麻仁丸。（见大便不通。
说详《伤寒·阳明篇》。）天暖衣浓，则气上升而外泄，故多汗。天寒衣薄，则气内敛而下降，
故多尿，不在病论。
不知而出为遗，知而不能忍为不禁，比小便数为甚，故另为一篇。多由肺肾
虚寒，气不能摄，补中益气汤（见气）送肾气丸。（见虚损。）大抵上虚补气，下虚固脱。睡着
遗尿，大菟丝子丸（见咳嗽），猪脬炙碎煎汤下。韭子丸、六味丸（见虚损）去泽泻，加故纸四
两，益智仁、人参各三两、肉桂一两。老人尿不节，山茱萸一味最妙。产后不禁，
血气兼虚，八珍汤（见虚损）。以上皆言虚寒之证，亦有热甚神昏，尿出不知者，即
《伤寒论》所谓直视失溲也，此为死证。热甚，阳邪盛也，失溲，阴失守也，故
死。河间谓热甚客于肾部，干于肝经，廷孔郁结之极，气血不能宣通，神无所用，
故遗尿不禁。（肝主疏泄，郁极则泄愈甚。）后人又推展之，谓各脏腑之热，皆能令小便不禁，
皆热证也。实热者，神芎导水丸，（见肿胀。）每服百丸，空心白汤下，一服利，即止后
服。
薛立斋治因劳发热作渴，小便自遗，（肝火疏泄。）或时闭涩，（肝血虚故涩，气郁故闭也。）作
肝火血虚，阴挺不能约制，午前服补中益气汤，（见气。升散其郁。）加山茱、山药，午后
服六味丸。（见虚损。滋阴养血。）月余悉退，此虚热也。有洗手足，尿即急，不能忍者，岂
房劳伤肾，尿为火持不下，得水则阳得阴化，故尿出乎？又岂肾冷不摄，得水则益
其冷，而即出乎？然阴性迟，火性急，似当以前说为是。（大抵内水与外水相感应之理。）
小便频数而无节制，症状类似淋证但尿道中不疼痛，因此单独分出一篇论述。（若尿频且尿量少、排尿涩滞，则类似淋证，但因无疼痛而有所不同；若尿量多且不涩滞，又类似小便失禁，但因患者尚能忍受而有所区别。）此证多因肾虚有火，火热扰动导致尿液欲出，肾气虚弱无法固摄藏水。（治疗肾虚用六味丸，治有火用五苓散。）若尿频且尿量少，可用茯苓琥珀汤利水通淋，以免导致涩痛演变为淋证。若尿频且尿量多，可用山药、莲子肉、益智仁等药物收敛固涩。然而此证固然属于有火，也有下元虚冷、肾气不能摄纳水液的情况，可用菟丝子丸、八味丸（见虚损篇）、鹿茸丸（见血证篇）。若因中气不足导致尿频且尿量多，可用补中益气汤（见气证篇）。夜间小便多者，可将益智仁二十枚研为末，加盐五分，用水一碗煎煮，睡前温服，或服用苁蓉丸。小便结束后，片刻后自以为已排尽，忽又流出少量尿液，或排尿后又感急迫的，多由忍尿行房所致。（忍尿则尿液不能下行，行房则相火炎上，气机上升而不下降，尿液不下行且气机不降，虽然后面虽有便意但排泄不畅，体内余尿未尽，所以出现这种情状。）宜用生料五苓散（见伤湿篇）加阿胶，吞服加减八味丸（见虚损篇）。心火移热于小肠，导致小便频数，（大喜动用心火者多有此症。）可用厘清散（见赤白浊篇）、四七汤（见气证篇），仍以辰砂妙香散（见心痛篇）煎汤送服小菟丝子丸（见赤白浊篇）。大便干硬，小便频数的，名为脾约，用麻仁丸（见大便不通篇。详细说明见《伤寒论·阳明篇》）。天气温暖衣着厚重时，气机上升向外宣泄，所以多汗。天气寒冷衣着单薄时，气机内敛向下沉降，所以多尿，这不属于病理论述范围。
意识丧失而出尿为遗尿，有意识但不能忍耐而出尿为不禁，比小便频数更为严重，因此单独分为一篇。多由肺肾虚寒，气机不能摄纳所致，可用补中益气汤（见气证篇）送服肾气丸（见虚损篇）。大抵上焦虚损当补气，下焦虚损当固脱止遗。睡着时遗尿，可用大菟丝子丸（见咳嗽篇），或用猪脬炙碎后煎汤送服。韭子丸、六味丸（见虚损篇）去掉泽泻，加入故纸（补骨脂）四两、益智仁和人参各三两、肉桂一两。老人小便不节制的，单用山茱萸一味药最为奇妙。产后小便不禁，属气血兼虚，用八珍汤（见虚损篇）。以上皆言虚寒之证，也有热邪极盛导致神志昏迷、尿出不知的，即《伤寒论》所谓“直视失溲”，此为死证。热邪极盛，是阳邪亢盛；失溲，是阴气失守，所以致死。刘河间认为热邪客居于肾部，干扰肝经，导致前阴郁结至极，气血不能宣通，神志无所主使，所以遗尿不禁。（肝主疏泄，郁结至极则疏泄过度。）后人又进一步推演，认为各脏腑的热邪，都能导致小便不禁，都属于热证。实热证者，用神芎导水丸（见肿胀篇），每次服用一百丸，空腹用白开水送下，一次服药后若见效即停止后续服药。薛立斋治疗因劳累发热口渴、小便自遗的病症，（这是肝火疏泄太过所致。）有时闭塞涩滞，（肝血虚故涩滞，气郁故闭塞。）辨作肝火与血虚，阴挺不能制约，午前服用补中益气汤（见气证篇。升散其郁结之气），加山茱萸、山药，午后服用六味丸（见虚损篇。滋阴养血）。月余后症状全部消退，此为虚热证。有洗手洗脚时，尿意即急迫，不能忍耐的，难道是房劳损伤肾气，尿液被火邪挟持而不能下行，遇到外水则阳气得阴气化育，所以尿液排出吗？难道是肾冷不能摄纳，遇到外水则更加加重其寒冷，从而立即排出吗？然而水性迟缓，火性急迫，似乎应当以第一种说法为是。（大抵内在水液与外在水液相互感应的道理。）
Frequent urination without restraint, resembling strangury (Lin syndrome) but without pain in the urethra, is therefore discussed in a separate chapter. (If frequency is accompanied by scanty volume and dysuria, it resembles strangury, but differs due to the absence of pain; if the volume is abundant and not obstructed, it resembles incontinence, but differs because the patient can still endure it.) This condition arises from Kidney deficiency with fire, where fire agitates causing urine to desire to exit, while the deficient Kidney cannot store water. (For Kidney deficiency, use Liuwei Wan [Six-Ingredient Rehmannia Pill]; for fire, use Wuling San [Five-Ingredient Powder].) If frequent and scanty, Fuling Hupo Tang [Poria and Amber Decoction] should be used to promote diuresis, preventing obstruction and pain from developing into strangury. If frequent and abundant, herbs such as Dioscoreae Rhizoma (Shuyu), Nelumbinis Semen (Lianrou), and Alpiniae Oxyphyllae Fructus (Yizhiren) should be used to astringe and consolidate. However, this condition certainly belongs to having fire, but there are also cases of lower origin deficiency-cold where the Kidney fails to control water, treated with Tusizi Wan [Cuscuta Pill], Bawei Wan [Eight-Ingredient Pill] (see Deficiency Damage), and Lurong Wan [Deer Antler Pill] (see Blood disorders). If due to Middle Qi deficiency resulting in frequent and abundant urination, use Buzhong Yiqi Tang [Middle-Boosting and Qi-Invigorating Decoction] (see Qi disorders). For frequent nocturnal urination, grind twenty Alpiniae Oxyphyllae Fructus (Yizhiren) into powder, add five fen of salt, decoct in one bowl of water, and take warm before retiring, or consume Congrong Wan [Cistanche Pill]. After urination, after a short while believing it to be finished, suddenly a small amount emerges again, or urgency arises again after voiding, this is mostly caused by holding urine during sexual intercourse. (Holding urine prevents downward flow; intercourse causes ministerial fire to flare up, causing Qi to ascend rather than descend. With urine not descending and Qi not descending, although there is a sensation of defecation/voiding later, the flow is unsmooth, and residual urine remains, hence such symptoms.) Use Shengliao Wuling San [Raw Material Five-Ingredient Powder] (see Injury by Dampness) plus E-Jiao [Donkey-Hide Gelatin], swallowed with Jiabian Bawei Wan [Modified Eight-Ingredient Pill] (see Deficiency Damage). Heart transferring heat to the Small Intestine causes frequent urination (often seen in cases of excessive joy stirring Heart fire). Use Liqing San [Clearing and Purifying Powder] (see Red and White Turbidity), Sqi Tang [Seven-Word Decoction] (see Qi disorders), still using Chensha Miaoxiang San [Cinnabar and Fragrant Incense Powder] (see Heartache) decocted to swallow Xiaotusizi Wan [Small Cuscuta Pill] (see Red and White Turbidity). When stool is hard and urination is frequent, it is named Pi Yue [Spleen Constriction], treated with Maren Wan [Hemp Seed Pill] (see Constipation. Detailed explanation in *Shanghan Lun · Yangming Chapter*). In warm weather with thick clothing, Qi ascends and leaks outward, thus causing much sweating. In cold weather with thin clothing, Qi turns inward and descends, thus causing much urination; this is not discussed under pathological conditions.
Loss of consciousness with urine emission is called Enuresis (Yin); awareness with inability to restrain is called Incontinence (Bujin), which is more severe than frequent urination, so it is separated into another chapter. It mostly results from Lung and Kidney deficiency-cold, where Qi cannot control, treated with Buzhong Yiqi Tang [Middle-Boosting and Qi-Invigorating Decoction] (see Qi disorders) delivering Shenqi Wan [Kidney Qi Pill] (see Deficiency Damage). Generally, upper deficiency requires tonifying Qi, lower deficiency requires consolidating and arresting leakage. Nocturnal enuresis during sleep is treated with Datusizi Wan [Large Cuscuta Pill] (see Cough), or Zhu Pao Zhi Sui Jian Tang [Pig Bladder Roasted and Crushed Decoction] for delivery. Jiu Zi Wan [Leek Seed Pill], Liuwei Wan [Six-Ingredient Pill] (see Deficiency Damage) minus Ze Xie [Alisma Rhizome], plus Gubai [Psoralea Fruit/Bu Gu Zhi] four liang, Yizhiren and Renshen [Ginseng Radix] three liang each, Rougui [Cinnamon Bark] one liang. For elderly people with uncontrolled urination, Shan Zhuyu [Cornus Fruit] alone is most excellent. Postpartum incontinence involves both blood and Qi deficiency, treated with Bazhen Tang [Eight-Treasure Decoction] (see Deficiency Damage). All above discuss deficiency-cold syndromes. There are also cases of extreme heat causing coma and unawareness of urination, known in *Shanghan Lun* as "fixed gaze and loss of urine," which is a fatal syndrome. Extreme heat indicates flourishing Yang pathogen; loss of urine indicates Yin failing to hold, hence death. He Jian [Liu Wansu] stated that extreme heat lodging in the Kidney region interferes with the Liver meridian, causing extreme stagnation at the anterior aperture, blocking Qi and Blood circulation, leaving the Spirit without function, thus causing enuresis and incontinence. (The Liver governs dispersion and drainage; extreme stagnation leads to excessive drainage.) Later scholars expanded this, stating that heat in any organ can cause urinary incontinence, all being heat syndromes. For excess heat, use Shenxiong Dao Shui Wan [God Celery and Ligusticum Water-Guiding Pill] (see Swelling), taking one hundred pills per dose, with plain water on an empty stomach; stop subsequent doses once effective. Xue Lizhai treated fever and thirst caused by labor with spontaneous enuresis (Liver fire causing excessive drainage), sometimes with obstruction and dysuria (Liver blood deficiency causing stasis, Qi stagnation causing obstruction), diagnosing Liver fire and blood deficiency, with Yin protruding and unable to constrain. Morning: Buzhong Yiqi Tang [Middle-Boosting and Qi-Invigorating Decoction] (see Qi disorders. Ascending and dispersing stagnation) plus Shan Zhuyu and Shanyao [Dioscorea Rhizome]; Afternoon: Liuwei Wan [Six-Ingredient Pill] (see Deficiency Damage. Nourishing Yin and nourishing blood). After more than a month, all symptoms receded, indicating deficiency-heat. Some experience immediate urgency and inability to restrain when washing hands and feet. Could this be due to sexual exhaustion injuring the Kidney, where urine is held back by fire and cannot descend, but upon contact with external water, Yang obtains Yin transformation, thus emitting urine? Or could it be Kidney cold failing to control, where external water increases the cold, causing immediate emission? However, water nature is slow, fire nature is urgent, suggesting the former explanation is likely. (Generally, the principle of mutual感应 [induction/response] between internal water and external water.)