经义
三焦者，决渎之官，水道出焉。○膀胱者，州都之官，津液藏焉，气化则能出矣。○膀胱不利为癃，不约
为遗溺。○水泉不止者，是膀胱不藏也。○有癃者一日数十溲，此不足也。○督脉起于小腹下骨中央，女子入系
廷孔，生病癃、痔、遗溺。○胞痹者，少腹膀胱按之内痛，若沃以汤，涩于小便。○脾痹者，夜卧则惊，多饮数
小便。○中气不足，溲便为之变。（《素问》）
三焦者，足少阴、太阳之所将，实则闭癃，虚则遗溺。（《灵枢》）
哲言
小便秘∶小水全不出，少腹满，膀胱燥也。小便少∶小水出而不多，津液少也。小便难∶小水点滴难出，
茎中不痛。小便淋沥∶小水点滴而淋沥，或痛。（《医阶辨证》）
闭者，小便不出，塞而不通是也；癃者，罢弱而气不充，淋
淋沥沥，点滴而出，或涩而疼，一日数十次或百次，俗名淋病是也。闭是急病，癃是缓病。遗溺者，睡梦中溺
出，醒后方知是也；不禁者，日夜无度，频频而溺是也。（《赤水玄珠》）
小便热则不通，冷则不禁。热甚者闭而绝无，热微者难而仅有。（《仁斋直指》）
有心肾不交，阴阳不通而内关外格者；有热结下焦，壅塞胞内而气道涩滞者；有肺中伏热，不能生水而气
化不施者；有脾经湿热，清气郁滞而浊气不降者；有痰涎阻结，气道不通者；有久病汗多，津液枯耗者；有肝
经恚怒，气闭不通者；有脾虚气弱，通调失宜者。（《证治汇补》）
不能小便一证，非寒结膀胱，即热逼膀胱，辨证全在少腹；如不能便而痛者为热，不痛者为寒。（《己任编》）
小肠有气，小便胀；小肠有血，小便涩；小肠有热，小便痛。俱禁用补药，盖气得补而愈胀，血得补而愈
涩，热得补而愈盛。（《医统》）
膀胱虽曰津液之腑，至于受盛津液，则又有脬而居膀胱之中焉。故《内经》曰∶脬移热于膀胱。（《灵枢》）
曰∶膀胱之脬薄以濡。《类纂》曰∶膀胱者，脬之室也。夫脬之居于膀胱，有上口无下口，津液既盛于脬，无
由自出，必因气化而后渐渍浸润于脬外，积于脬下之空处，遂为尿，以出于前阴也。若曰脬下无空处，则人尿
急时，至厕安能即出？惟积滞脬下之空处，而不可再容，故急，急则至厕即出矣。（李东垣）
气为水母，必太阳之气化，而膀胱之溺始出，是水道固藉无形之气化，不专责有形之州都矣。然水者阴也，
气者阳也，气为阳之根源，而火为阳之征兆，所以气有余便成壮火而为邪热。壮火上行三焦，则伤太阳之气；
邪热下入膀胱，则涸州都之津。火胜则水亏，理固然也。夫五脏之水火皆生于气，故少火生气，而气即为水，
水精四布，下输膀胱，源清则流洁矣。如壮火食气，
则化源无藉，乃成癃闭、淋涩、膏淋、豆汁、砂石、脓血，而水道为之不利矣。总由化源之不清，非关决渎之
失职，若以八正、舟车、禹功、浚川等剂治之，五脏之阴虚，太阳之气化绝矣。（柯韵伯）
《经》曰∶膀胱者，州都之官，气化出焉。又曰∶通调水道，下输膀胱。盖人身所化之物，惟溺为多，
以其为湿蒸之气酝酿而成。若大肠所出，则物之渣滓耳，非所化也。若肾之精，肝之泪，肺之涕，心之汗，则
又各乘所感而出，非气化所出者也。是以化物独属膀胱之溺。余常深察之，膀胱一脏，不独化和气为物而溺出，
亦化病气为物而溺出之。凡病气重，则小便必涩；病气苏，则便溺渐通。人之一身，能泄病气，无如膀胱也。
膀胱之水泄，则脾土实，脾土实，则肺金清而心火降，百骸自理矣。是故养生则以实脾为枢，治病则疏膀胱为枢。
癃闭
小便不利有三，不可概论。若津液偏渗于肠胃，大便泄泻而小便涩少者一也，治宜分利。若热搏下焦，
津液因而不行者二也，渗泄则愈。若脾胃气涩，不能通利水道下输膀胱而化者三也，可顺其气，令施化而出。
（罗谦甫）
治秘之道有三∶一曰肺燥不能生水，故用二苓、泽泻之甘淡以泄肺而生水；一曰脾湿不能升精，故用白
术之苦温以燥脾而升精；一曰膀胱无阳不能化气，故用肉桂之辛热以温膀胱而化气。使水道通利，则上可以止
渴，中可以去湿，下可以泄邪热也。有真阴虚者，须六味汤以补肾水；真阳虚者，须八味丸以补肾火。至于转
胞喘急欲死，不问男女孕妇产后，急用八味丸料煎饮，缓则不救。或疑桂、附辛热，不敢轻用，岂知肾气虚寒，
水寒冰冻之义，得热则流通，舍此更有何物能直达膀胱，而使雪消春水来耶？（陈来章）
热在上焦气分，便闭而渴，乃肺中伏热不能生水，膀胱绝其
化源，宜用淡渗之药，泻火清金，滋水之化源。热在下焦血分，便闭而不渴，乃真水不足，膀胱干涸，无阴则
阳无以化，宜用苦寒之药，滋肾与膀胱之阴，而阳自化，小便自通。（李东垣）
凡癃闭之证，其因有四，最当辨其虚实。有因火邪结聚小肠膀胱者，此以水泉干涸，而气门热闭不通也。
有因热居肝肾者，则或以败精，或以槁血，阻塞水道而不通也。若此者，本非无水之证，不过壅闭而然。病因
有余，可清可利，是皆癃闭之轻证也。惟是气闭之证，则为危候。然气闭之义有二∶有气实而闭者，有气虚
而闭者。夫膀胱为藏水之腑，而水之入也由气以化水，故有气斯有水；水之出也由水以达气，故有水始有溺。
《经》曰∶气化则能出矣。盖有化而入，而后有化而出，无化而出，必无化而入也，是以其入其出，皆由气化，
此即本《经》气化之义，非单以出者言气化也。然则水中有气，气即水也；气中有水，水即气也。凡病气虚而
闭者，必以真阳下竭，元海无根，水火不交，阴阳痞隔。所以气自气而气不化水，水自水而水蓄不行。气不化
水，则水腑枯竭者有之；水蓄不行，则浸渍腐败者有之。气既不能化，而欲强为通利，果能行乎？阴中已无阳，
而再用苦寒，能无甚乎？至若气实而闭者，不过肝强气逆，移碍膀胱，或破其气，或通其滞，或提其陷而壅者
自去。此治实者无难，而治虚者必得其化，为不易也。（《景岳全书》）
主五液者，肾也。肾气虚而受扰，则无力以化液，而邪火遂乘袭之，以致溲少涩滞。标热虽由膀胱，本虚
实在于肾。宜补肾以益其虚，而从温以化其气，则肾源有滋，小水自利，以此验肾气之来复也。○水虽渗于膀胱，
而泌别之者小肠也。小肠有热，能移及膀胱，小肠为火腑，而本之于心，但使心气通，则小肠之火自降，无热
可移，源澄而流自清也。（程郊倩）
阴虚小便短少，涩滞癃闭，不可见有实势，便用利药，此由下焦元阴之气衰弱，不能运化故也。宜大补元
阴，其溺自通。若
气虚与痰隔中焦，气滞于下及湿热而然者，不在此例。（罗赤诚）
用补中益气汤，小便不利加牛膝。用六味地黄丸，小便不利加车前。（周慎斋）
膀胱者，州都之官，津液藏焉，气化则能出矣。何谓气化？津液乃气所化也。盖饮入于胃，游溢精气，上
输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五经并行。譬之蒸物，汤气上熏釜甑，遂有
液而下滴，此脾气熏蒸肺叶，所以遂能通调水道而输膀胱也。故小便不通之证，审系气虚而水涸者，利之益甚，
须以大剂人参少佐升麻，则阳升阴降，地气上为云，天气下为雨，自然通利矣。○丹溪云∶小便不通，有属气虚、
血虚，有属实热、痰气闭塞，皆宜吐之以提其气，气升则水自降。盖气承载其水者也。气虚用参、术、升麻等，
先服后吐；血虚用四物汤，或芎归汤，先服后吐；痰多用二陈汤，先服后探吐之；痰气闭塞，用二陈汤加香附、
木通，先服后探吐之。或问以吐法通小便，理将安在？曰∶取其气化而已。（《证治准绳》）
《经》云∶至阴虚，天气绝；至阳盛，地气不足。夫肾肝在下，地道也；心肺在上，天道也；脾胃居中，
气交之分也。故天之阳绝而不安于地者，则白露不下；在上之阳不交于阴，则在下之阴无以为化，水道其能出
乎？此上焦之气化也。仲景曰∶卫气行，则小便宣通。又曰∶脾病则九窍不通，此中焦之气化也。东垣云∶在
下之阴虚，在上之阳盛，致肾气不化，必宣其阳而举之，则阴可得而平也。故丹溪曰∶吾以吐法通小便，譬如
滴水之器，上窍闭则下窍无以自通，必上窍开而下窍之水出焉。然升提止可施于涓滴不通者，若溺涩短少，或
淋漓作痛者，非所宜也。由《经》言及诸论观之，未有不主于气化者，不审乎此，转行疏利之剂求功，多见其
不知量也。（《张氏医通》）
气虚而小便不通者∶《经》曰∶膀胱者，津液藏焉，气化则能出矣。气虚则不能化，故不通也。血虚而小
便不通者∶盖血即
津液之属，血虚即津液干燥而溺道不利，故不通也。此与痰气闭结于下者，虚实之情不同。丹溪皆用吐法，乃
急则治其标也。然气虚血虚，以虚为本，虚则必补之而后可。夫以参、术、四物调其真气而吐之，诚可以通其
溺，而其本之虚，岂参、术、四物顷刻下咽，遂能补益之耶？吾恐病根犹在，不久必复作矣。愚意以为若果气
虚血虚，必用补气补血之药，使其气盛而施化，血生而津润，其便自通，不必探吐可也。果宜吐者，必须先吐，
俟其溺通，继服补剂，庶可平复，非如痰气闭结者但吐之而可已。此丹溪未尽之意，予故表而出之。（《医学统旨》）
不禁频数
《灵枢》言∶手太阴之别名曰列缺，其病虚则欠缺，小便遗数。肺为上焦，通调水道，下输膀胱，肾上
连肺，两脏是子母也，母虚子亦虚。东垣云∶小便遗失，肺金虚也。以参、 补之，不愈，当责之肾。《经》
曰∶膀胱不约为遗溺。仲景云∶下焦不归则遗溲。盖下焦在膀胱上口，主分别清浊。下焦不归，其部不能约制
溲便，故遗溺。大抵天暖衣浓则多汗，天冷衣薄则多溺。至于不禁，虚寒之甚，非八味丸不效，如菟丝子丸、
鹿茸散、二气丸，俱可选用。（《赵氏医贯》）
小便频数者，只是里气不守，频而复少，五液虚而注下，此精气、津液、血脉内夺之病，莫谓点滴无多，
不成脏腑之漏卮也，其责不仅玉关。直从十全大补汤，补气还神，补神还精。固知断鳌以补地者，须是炼石以
补天也。（程郊倩）
人之漩溺，藉心肾二气之传送。盖心与小肠为表里，肾与膀胱为表里，若心肾气衰，阳道不运，则传送
失度，必有遗溺失禁之患，治宜温补下元，清心寡欲。（薛立斋）
按∶遗溺，遗失也。梦中遗失，醒而后觉，童稚多有之，大人少有也。夫童稚阳气尚微，不甚约束，好
动而魂游，故夜多遗失。古方多用暖药，乃温养阳气之意。曾见数人，二、三十岁犹遗
失不止，后皆无子，洵非下元虚寒所至与？（孙一奎）
睡则遗尿，责之肾虚。所以婴儿脬气未固，老人下元不足，多有此证。在婴儿挟热者居多，在老人挟寒者
居多。治宜大菟丝子丸，猪脬煎汤送下。（《医学六要》）
热甚，客于足厥阴之经，廷孔郁结，则神无所根据，故漩溺遗失，不能收禁也。（《原病式》）
凡人患阴虚之病而小便频数者，此由相火暗动故也，勿以为虚寒而用参、 、桂、附，只宜大补真阴，其便自
调。（罗赤诚）
小便不禁或频数，古方多以为寒，而用温涩之药，殊不知此证阴虚属热者居多。盖火邪妄动，水不得安，
故不能收禁而频数也。是以老人多频数者，由于膀胱血少，阳火偏旺也。治法宜滋肾之真阴，补膀胱津液为主，
佐以收涩之剂，六味丸加麦冬、五味子之类，不可用温药也。（王节斋）
按∶节斋此论，亦是概言老人下元虚惫，气弱不能乘载其水，故频数不禁。必如河间、节斋所云，癃闭已
主于热，不禁又主于热，是无虚寒之证也，何古有温补之法，《经》有寒虚之文耶？不若以小便频而清白长者
为寒，频而黄赤涩者为热，及脉之洪数、有力无力、或滑或涩而参验之，始无差误。○不禁，谓无禁约，小便
多而频，不计遍数也。按∶《经》云∶水泉不止者，膀胱不藏也。其证有湿热，有下元虚惫。数而少者为热，
数而多者为虚，老人多有此证。盖因阳气衰微，不能约束。历见数人，卒皆不救，由其不能摄养而神气耗散故
也。古谓不通为热，不禁为寒，乃心肾气弱，阳道衰冷而传化失度，法当温补，养其神，坚其肾，神完肾固，
膀胱气充，自可约束矣。（《赤水玄珠》）
遗溺，因上焦虚者∶宜补肺气；下焦虚者，宜固膀胱；挟寒者∶壮命门阳气，兼以固涩，挟热者∶补肾膀
胱阴血，佐以泻火。（《证治汇补》）
溺黄赤
小便黄赤，有寒、热、虚、实之别。《经》云∶诸病水液混浊，皆属于热。宜黄柏、知母治之。此热证也。
又云∶尺涩，足胫逆冷，小便赤。宜服附子四逆汤。此寒证也。又云∶胃足阳明之脉盛，则身已前皆热，消谷
善饥，溺色黄。宜降胃火。又云∶肝热病者，小便先黄。宜降肝火。此实证也。又云∶肺手太阴之脉气虚，则
【经文义理】
三焦，是负责疏通水道的官职，人体水道由此而出。○膀胱，是州都之官，津液在此储藏，经过气化作用才能排出体外。○膀胱功能不利称为癃（排尿困难），约束无力称为遗溺（尿失禁）。○水泉穴处尿液不止，说明膀胱不能固藏津液。○患有癃病的人一天小便数十次，这是正气不足的表现。○督脉起于小腹下骨中央，女子进入系连廷孔（尿道口附近），生病时会出现癃、痔疮、遗尿等症状。○胞痹证，表现为少腹膀胱部位按压内部疼痛，感觉像被热水浇灌一样，小便涩滞不畅。○脾痹证，夜间睡眠易惊，饮水多且小便频数。○中气不足，会导致大小便异常。（出自《素问》）
三焦，由足少阴肾经和足太阳膀胱经所统摄，实证则出现闭癃（排尿不通），虚证则出现遗溺。（出自《灵枢》）
【哲人言论】
小便秘：小便完全排不出，少腹胀满，是膀胱干燥所致。小便少：小便能排出但量少，是津液不足所致。小便难：小便点滴难出，但尿道不痛。小便淋沥：小便点滴而下呈淋沥状，有时伴有疼痛。（出自《医阶辨证》）
闭证，指小便排不出，堵塞不通；癃证，指身体疲弱、气力不足，小便淋漓不尽，点滴而出，或涩痛，一天数十次甚至上百次，俗称淋病。闭证属于急症，癃证属于缓症。遗溺，指睡梦中排尿，醒来才知道；不禁，指日夜无节制，频繁排尿。（出自《赤水玄珠》）
小便热则排泄不通，冷则无法控制。热势严重则完全闭塞，热势轻微则排尿困难且仅有少量。（出自《仁斋直指》）
有心肾不交，阴阳不通导致内关外格的情况；有热结在下焦，壅塞胞内导致气道涩滞的情况；有肺中伏热，不能生水导致气化功能不施的情况；有脾经湿热，清气郁滞导致浊气不降的情况；有痰涎阻结，气道不通的情况；有久病汗出过多，津液枯耗的情况；有肝经愤怒，气机闭塞不通的情况；有脾虚气弱，通调功能失常的情况。（出自《证治汇补》）
不能小便这一症状，不是寒邪结聚膀胱，就是热邪逼迫膀胱，辨证的关键全在少腹部；如果小便不通且疼痛的是热证，不疼痛的是寒证。（出自《己任编》）
小肠有气，小便胀满；小肠有血，小便涩滞；小肠有热，小便疼痛。这些都禁用补药，因为气得补则胀更甚，血得补则涩更重，热得补则热更盛。（出自《医统》）
膀胱虽然被称为津液之腑，但在承受和盛纳津液方面，还有一个“脬”位于膀胱之中。所以《内经》说：“脬移热于膀胱。”又说：“膀胱的脬壁薄而湿润。”《类纂》说：“膀胱是脬的居室。”脬居于膀胱之中，只有上口没有下口，津液充满脬后，无法自行排出，必须依靠气化作用逐渐浸润到脬外，积聚在脬下的空处，从而形成尿液，从前阴排出。如果说脬下没有空处，那么人尿急时，到了厕所怎么能立即排出呢？正是因为尿液积聚在脬下的空处，满了不能再容，所以感到急迫，急了到了厕所就排出了。（李东垣）
气是水的母体，必须依靠太阳经的气化作用，膀胱的小便才能排出，这说明水道固然依赖无形的气化，不仅仅责成于有形的州都（膀胱）。然而水是阴，气是阳，气是阳的根源，火是阳的征兆，所以气有余就会变成壮火成为邪热。壮火上行的三焦，就会损伤太阳经的气；邪热下入膀胱，就会枯竭州都的津液。火胜则水亏，道理本来如此。五脏的水火都生于气，所以少火生气，气即为水，水精四布，下输膀胱，源头清澈则水流洁净。如果壮火食气，化源失去依托，就会形成癃闭、淋涩、膏淋、豆汁样尿、砂石、脓血，导致水道不利。总归是因为化源不清，并非决渎（三焦）失职，如果用八正散、舟车丸、禹功散、浚川散等药剂治疗，五脏的阴虚和太阳经的气化就会断绝。（柯韵伯）
《内经》说：“膀胱是州都之官，气化则能出。”又说：“通调水道，下输膀胱。”大概人身所化的物质，只有尿液最多，因为它是湿蒸之气酝酿而成的。至于大肠排出的，只是食物的渣滓，并非气化所生。至于肾之精、肝之泪、肺之涕、心之汗，则是各自随感受而排出，并非气化所出。因此，化物独属膀胱的尿液。我常深入考察，膀胱这一脏腑，不仅将和气化为物而排出尿液，也将病气化为物而排出。凡是病气重的，小便必然涩滞；病气缓解，大小便逐渐通畅。人一身中，能泄病气的，没有比得上膀胱的了。膀胱之水泄出，则脾土充实，脾土充实，则肺金清肃而心火下降，全身百骸自然理顺。所以养生以实脾为枢纽，治病以疏利膀胱为枢纽。
癃闭
小便不利有三种情况，不可一概而论。如果是津液偏渗于肠胃，大便泄泻而小便涩少的，是一类，治疗宜分利。如果是热邪搏结于下焦，津液因此不行的，是二类，渗泄即可痊愈。如果是脾胃气涩，不能通利水道下输膀胱而化生的，是三类，可顺其气机，令其施化而出。（罗谦甫）
治疗秘结之道有三：一是肺燥不能生水，所以用茯苓、泽泻的甘淡之性来泄肺而生水；二是脾湿不能升精，所以用白术的苦温之性来燥脾而升精；三是膀胱无阳不能化气，所以用肉桂的辛热之性来温膀胱而化气。使水道通利，向上可以止渴，中间可以去湿，向下可以泄邪热。有真阴虚的，需用六味地黄汤补肾水；真阳虚的，需用八味丸补肾火。至于转胞（妊娠或产后因胎气压迫膀胱）喘急欲死，不问男女孕妇产后，急用八味丸料煎服，迟缓则无法挽救。有人怀疑桂枝、附子辛热，不敢轻用，岂不知肾气虚寒，如水寒冰冻之意，得热则流通，除了这些还有什么药能直达膀胱，使雪消春水来呢？（陈来章）
热在上焦气分，便闭且口渴，是肺中伏热不能生水，膀胱断绝了其化源，宜用淡渗药物，泻火清金，滋补水之化源。热在下焦血分，便闭且不口渴，是真水不足，膀胱干涸，无阴则阳无以化，宜用苦寒药物，滋补肾与膀胱之阴，而阳自能化，小便自通。（李东垣）
凡是癃闭之证，原因有四，最应当辨别虚实。有因火邪结聚在小肠膀胱的，这是水泉干涸，气门热闭不通。有因热邪居于肝肾的，则或因败精，或因干枯之血，阻塞水道而不通。像这种情况，本不是无水之证，不过是壅闭而已。病因属于有余，可清可利，这些都是癃闭的轻证。唯有气闭之证，则是危候。然而气闭的含义有二：有气实而闭的，有气虚而闭的。膀胱是藏水之腑，而水的进入是由气来化水，所以有气才有水；水的排出是由水来达气，所以有水才有尿。《内经》说：“气化则能出矣。”大概有化而入，然后有化而出，无化而出，必无化而入，所以其入其出，都由气化，这就是依据《内经》气化的本义，不仅仅是指出者而言气化。既然这样，水中有气，气即水也；气中有水，水即气也。凡是病气虚而闭的，必定是真阳下竭，元海无根，水火不交，阴阳痞隔。所以气自气而气不化水，水自水而水蓄不行。气不化水，则水腑枯竭的有之；水蓄不行，则浸渍腐败的有之。气既不能化，而想要强行通利，果真能行吗？阴中已无阳，再用苦寒药，能不严重吗？至于气实而闭的，不过是肝强气逆，移碍膀胱，或破其气，或通其滞，或提其陷而壅者自去。治疗实证不难，而治疗虚证必须得其气化之理，是不容易的。（《景岳全书》）
主管五液的，是肾。肾气虚而受扰，则无力化液，邪火遂乘袭之，以致尿少涩滞。标热虽由膀胱引起，本虚实则在于肾。宜补肾以益其虚，并从温以化其气，则肾源有滋，小水自利，以此验证肾气之恢复。○水虽渗入膀胱，而泌别清浊的是小肠。小肠有热，能移及膀胱，小肠为火腑，而本之于心，只要心气通，则小肠之火自降，无热可移，源澄而流自清。（程郊倩）
阴虚导致小便短少，涩滞癃闭，不可见有实势，就用利水药，这是由于下焦元阴之气衰弱，不能运化所致。宜大补元阴，其溺自通。若是气虚与痰隔阻中焦，气滞于下及湿热所致者，不在此例。（罗赤诚）
用补中益气汤，小便不利加牛膝。用六味地黄丸，小便不利加车前子。（周慎斋）
膀胱是州都之官，津液藏焉，气化则能出矣。什么叫气化？津液乃气所化也。大概饮食入胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五经并行。譬如蒸物，汤气上熏釜甑，遂有液而下滴，这是脾气熏蒸肺叶，所以遂能通调水道而输膀胱。故小便不通之证，审系气虚而水涸者，利之益甚，须以大剂人参少佐升麻，则阳升阴降，地气上为云，天气下为雨，自然通利矣。○丹溪说：小便不通，有属气虚、血虚，有属实热、痰气闭塞，皆宜吐之以提其气，气升则水自降。盖气承载其水者也。气虚用参、术、升麻等，先服后吐；血虚用四物汤，或芎归汤，先服后吐；痰多用二陈汤，先服后探吐之；痰气闭塞，用二陈汤加香附、木通，先服后探吐之。有人问用吐法通小便，道理何在？回答说：取其气化而已。（《证治准绳》）
《内经》说：至阴虚，天气绝；至阳盛，地气不足。肾肝在下，地道也；心肺在上，天道也；脾胃居中，气交之分也。故天之阳绝而不安于地者，则白露不下；在上之阳不交于阴，则在下之阴无以为化，水道其能出乎？此上焦之气化也。仲景说：卫气行，则小便宣通。又说：脾病则九窍不通，此中焦之气化也。东垣说：在下之阴虚，在上之阳盛，致肾气不化，必宣其阳而举之，则阴可得而平也。故丹溪说：吾以吐法通小便，譬如滴水之器，上窍闭则下窍无以自通，必上窍开而下窍之水出焉。然升提止可施于涓滴不通者，若溺涩短少，或淋漓作痛者，非所宜也。由《经》言及诸论观之，未有不主于气化者，不审乎此，转行疏利之剂求功，多见其不知量也。（《张氏医通》）
气虚而小便不通者：《内经》说：膀胱者，津液藏焉，气化则能出矣。气虚则不能化，故不通也。血虚而小便不通者：盖血即津液之属，血虚即津液干燥而溺道不利，故不通也。此与痰气闭结于下者，虚实之情不同。丹溪皆用吐法，乃急则治其标也。然气虚血虚，以虚为本，虚则必补之而后可。夫以参、术、四物调其真气而吐之，诚可以通其溺，而其本之虚，岂参、术、四物顷刻下咽，遂能补益之耶？吾恐病根犹在，不久必复作矣。愚意以为若果气虚血虚，必用补气补血之药，使其气盛而施化，血生而津润，其便自通，不必探吐可也。果宜吐者，必须先吐，俟其溺通，继服补剂，庶可平复，非如痰气闭结者但吐之而可已。此丹溪未尽之意，予故表而出之。（《医学统旨》）
不禁频数
《灵枢》说：手太阴之别名曰列缺，其病虚则欠缺，小便遗数。肺为上焦，通调水道，下输膀胱，肾上连肺，两脏是子母也，母虚子亦虚。东垣说：小便遗失，肺金虚也。以人参、黄芪补之，不愈，当责之肾。《内经》说：膀胱不约为遗溺。仲景说：下焦不归则遗溲。盖下焦在膀胱上口，主分别清浊。下焦不归，其部不能约制溲便，故遗溺。大抵天暖衣浓则多汗，天冷衣薄则多溺。至于不禁，虚寒之甚，非八味丸不效，如菟丝子丸、鹿茸散、二气丸，俱可选用。（《赵氏医贯》）
小便频数者，只是里气不守，频而复少，五液虚而注下，此精气、津液、血脉内夺之病，莫谓点滴无多，不成脏腑之漏卮也，其责不仅玉关。直从十全大补汤，补气还神，补神还精。固知断鳌以补地者，须是炼石以补天也。（程郊倩）
人之小便，藉心肾二气之传送。盖心与小肠为表里，肾与膀胱为表里，若心肾气衰，阳道不运，则传送失度，必有遗溺失禁之患，治宜温补下元，清心寡欲。（薛立斋）
按：遗溺，遗失也。梦中遗失，醒而后觉，童稚多有之，大人少有也。夫童稚阳气尚微，不甚约束，好动而魂游，故夜多遗失。古方多用暖药，乃温养阳气之意。曾见数人，二、三十岁犹遗尿不止，后皆无子，洵非下元虚寒所至与？（孙一奎）
睡则遗尿，责之肾虚。所以婴儿脬气未固，老人下元不足，多有此证。在婴儿挟热者居多，在老人挟寒者居多。治宜大菟丝子丸，猪脬煎汤送下。（《医学六要》）
热甚，客于足厥阴之经，廷孔郁结，则神无所根据，故漩溺遗失，不能收禁也。（《原病式》）
凡人患阴虚之病而小便频数者，此由相火暗动故也，勿以为虚寒而用人参、黄芪、桂枝、附子，只宜大补真阴，其便自调。（罗赤诚）
小便不禁或频数，古方多以为寒，而用温涩之药，殊不知此证阴虚属热者居多。盖火邪妄动，水不得安，故不能收禁而频数也。是以老人多频数者，由于膀胱血少，阳火偏旺也。治法宜滋肾之真阴，补膀胱津液为主，佐以收涩之剂，六味丸加麦冬、五味子之类，不可用温药也。（王节斋）
按：节斋此论，亦是概言老人下元虚惫，气弱不能乘载其水，故频数不禁。必如河间、节斋所云，癃闭已主于热，不禁又主于热，是无虚寒之证也，何古有温补之法，《经》有寒虚之文耶？不若以小便频而清白长者为寒，频而黄赤涩者为热，及脉之洪数、有力无力、或滑或涩而参验之，始无差误。○不禁，谓无禁约，小便多而频，不计遍数也。按：《内经》云：水泉不止者，膀胱不藏也。其证有湿热，有下元虚惫。数而少者为热，数而多者为虚，老人多有此证。盖因阳气衰微，不能约束。历见数人，卒皆不救，由其不能摄养而神气耗散故也。古谓不通为热，不禁为寒，乃心肾气弱，阳道衰冷而传化失度，法当温补，养其神，坚其肾，神完肾固，膀胱气充，自可约束矣。（《赤水玄珠》）
遗溺，因上焦虚者：宜补肺气；下焦虚者，宜固膀胱；挟寒者：壮命门阳气，兼以固涩，挟热者：补肾膀胱阴血，佐以泻火。（《证治汇补》）
溺黄赤
小便黄赤，有寒、热、虚、实之别。《内经》说：诸病水液混浊，皆属于热。宜黄柏、知母治之。此热证也。又说：尺脉涩，足胫逆冷，小便赤。宜服附子四逆汤。此寒证也。又说：胃足阳明之脉盛，则身已前皆热，消谷善饥，溺色黄。宜降胃火。又说：肝热病者，小便先黄。宜降肝火。此实证也。又说：肺手太阴之脉气虚，则
[Scriptural Principles]
The Sanjiao (Triple Burner) is the official responsible for dredging waterways, through which water passages emerge. ○ The Bladder is the official of the Zhou Du (State Capital), where body fluids are stored; only through Qi transformation can they be excreted. ○ When the Bladder functions poorly, it is called Long (urinary retention); when it lacks restraint, it is called Yiniao (urinary incontinence). ○ If urine flows incessantly from the Shuiquan point, it indicates that the Bladder fails to store fluids. ○ Those suffering from Long urinate dozens of times a day, which signifies deficiency. ○ The Du Mai (Governing Vessel) originates from the center below the lower abdomen; in women, it enters and connects to the Ting Kong (near the urethral opening); diseases here manifest as Long, hemorrhoids, and urinary incontinence. ○ In Pao Bi (Bladder Bi syndrome), pressing the interior of the lower abdomen at the Bladder location causes pain, feeling as if scalded by hot water, with difficult and scanty urination. ○ In Pi Bi (Spleen Bi syndrome), one startles during sleep, drinks excessively, and urinates frequently. ○ Insufficiency of Middle Qi leads to abnormalities in urination and defecation. (From *Suwen*)
The Sanjiao is governed by the Foot Shaoyin (Kidney) and Foot Taiyang (Bladder) meridians; excess manifests as Bi Long (obstructive urinary retention), while deficiency manifests as Yiniao (urinary incontinence). (From *Lingshu*)
[Philosophical Discourses]
Xiaobianmi (Minor Urinary Constipation): Complete inability to urinate, with fullness in the lower abdomen, caused by dryness of the Bladder. Xiaobiaoshao (Scanty Urine): Urine is excreted but in small amounts, due to insufficient body fluids. Xiaobiaonan (Difficult Urination): Urine comes out drop by drop with difficulty, without pain in the glans. Xiaobiaolinli (Dribbling Urination): Urine drips drop by drop, sometimes accompanied by pain. (From *Yijie Bianzheng*)
Bi (Obstruction) refers to the complete inability to urinate, blocked and unpassable; Long (Retention) refers to physical weakness and insufficient Qi, with urine dripping drop by drop, or being difficult and painful, occurring dozens or even hundreds of times a day, commonly known as Lin disease (strangury). Bi is an acute condition; Long is a chronic condition. Yiniao (Urinary Incontinence) refers to urinating in one's sleep, realizing it only upon waking; Jinb (Incontinence) refers to frequent urination without day or night restraint. (From *Chishui Xuanzhu*)
Heat in urination causes obstruction; cold causes loss of control. Severe heat leads to complete blockage; mild heat leads to difficulty and only scanty output. (From *Renzhai Zhizhi*)
There are cases of Heart-Kidney non-interaction, with Yin and Yang not communicating, leading to internal closure and external rejection; there are cases of Heat binding in the Lower Jiao, blocking the interior of the Pao and causing stagnation of the Qi pathway; there are cases of latent Heat in the Lung, failing to generate Water and thus failing to execute Qi transformation; there are cases of Damp-Heat in the Spleen meridian, with stagnant Clear Qi and failure of Turbid Qi to descend; there are cases of Phlegm-Saliva obstruction, blocking the Qi pathway; there are cases of prolonged illness with excessive sweating, depleting body fluids; there are cases of Liver meridian anger, causing Qi closure and blockage; there are cases of Spleen deficiency and Qi weakness, leading to improper regulation. (From *Zhengzhi Huibu*)
The symptom of inability to urinate is either Cold binding in the Bladder or Heat forcing the Bladder; differentiation relies entirely on the lower abdomen: if urination is obstructed and painful, it is Heat; if not painful, it is Cold. (From *Jiren Bian*)
If there is Qi in the Small Intestine, the urine feels distended; if there is Blood, urination is difficult/astringent; if there is Heat, urination is painful. All these conditions contraindicate the use of tonifying herbs, because tonifying Qi worsens distension, tonifying Blood worsens astringency, and tonifying Heat worsens the heat. (From *Yitong*)
Although the Bladder is called the organ of body fluids, regarding the reception and storage of fluids, there is a "Pao" (bladder sac) located within the Bladder. Thus, *Neijing* states: "Heat shifts from the Pao to the Bladder." It also states: "The Pao of the Bladder is thin and moist." *Leizan* states: "The Bladder is the chamber of the Pao." The Pao resides within the Bladder, having an upper opening but no lower opening. When fluids fill the Pao, they cannot exit spontaneously; they must rely on Qi transformation to gradually infiltrate outside the Pao, accumulating in the empty space below the Pao, thereby forming urine to exit via the anterior yin. If there were no empty space below the Pao, how could urine be expelled immediately upon reaching the toilet? It is precisely because urine accumulates in this empty space until it cannot hold more, causing urgency, and when urgent, it is expelled immediately upon reaching the toilet. (Li Dongyuan)
Qi is the mother of Water; only through the Qi transformation of the Taiyang meridian can bladder urine be excreted. This shows that water pathways rely on formless Qi transformation, not solely on the有形 (form) of the Zhou Du (Bladder). However, Water is Yin, and Qi is Yang. Qi is the root of Yang, and Fire is the manifestation of Yang. Therefore, excess Qi becomes Zhuang Huo (Fierce Fire) and turns into pathogenic Heat. When Fierce Fire ascends to the Sanjiao, it damages the Qi of the Taiyang; when pathogenic Heat descends into the Bladder, it dries up the fluids of the Zhou Du. When Fire prevails, Water is deficient; this is natural law. The Water and Fire of the Five Zang organs all originate from Qi; thus, Shao Huo (Mild Fire) generates Qi, and Qi becomes Water. When Water Essence spreads throughout, descending to the Bladder, a clear source yields clean flow. If Fierce Fire consumes Qi, the source of transformation loses its support, leading to Long/Bi (retention/obstruction), Linse (strangury/difficulty), Gaolin (gurry strangury), bean-water urine, stones, and pus-blood, causing obstruction of the water pathways. Ultimately, this is due to a turbid source of transformation, not a failure of the Duodu (Sanjiao). Using formulas like Bazheng San, Zhouche Wan, Yugong San, or Junchuan San would exhaust the Yin deficiency of the Five Zang and cut off the Qi transformation of the Taiyang. (Ke Yunbo)
*Neijing* states: "The Bladder is the official of the Zhou Du; Qi transformation allows it to exit." It also states: "Regulate the water pathways, transporting downward to the Bladder." Generally, among substances transformed in the human body, urine is the most abundant, as it is formed by the fermentation of damp-evaporated Qi. What exits the Large Intestine is merely food residue, not a product of transformation. As for Kidney essence, Liver tears, Lung mucus, and Heart sweat, they are discharged according to specific stimuli, not through Qi transformation. Therefore, transformation products belong uniquely to bladder urine. I have often observed deeply that the Bladder, besides transforming harmonious Qi into urine, also transforms pathogenic Qi into urine. When pathogenic Qi is heavy, urination becomes difficult; when pathogenic Qi subsides, urination gradually clears. Among all organs in the body, none can expel pathogenic Qi better than the Bladder. When Bladder water is excreted, Spleen Earth becomes solid; when Spleen Earth is solid, Lung Metal becomes clear and Heart Fire descends, allowing the whole body to regulate itself. Thus, in health preservation, strengthening the Spleen is the pivot; in treating disease, draining the Bladder is the pivot.
Long Bi (Retention and Obstruction)
There are three types of difficult urination, which cannot be generalized. First, if body fluids leak preferentially into the intestines and stomach, causing diarrhea and scanty, difficult urination, treatment should focus on separating and draining. Second, if Heat combats the Lower Jiao, preventing fluid movement, treatment with渗泄 (percolating and draining) will cure it. Third, if Spleen-Stomach Qi is stagnant, unable to regulate water pathways and transport them downward to the Bladder for transformation, treatment should follow the Qi mechanism to allow transformation and excretion. (Luo Qianfu)
There are three approaches to treating constipation/obstruction: 1. Lung dryness fails to generate Water, so use the sweet and bland properties of Fu Ling (Poria) and Ze Xie (Alisma) to drain the Lung and generate Water; 2. Spleen dampness fails to ascend Jing Essence, so use the bitter and warm property of Bai Zhu (Atractylodes Macrocephala) to dry the Spleen and ascend Jing Essence; 3. The Bladder lacks Yang and cannot transform Qi, so use the acrid and hot property of Rou Gui (Cinnamon Bark) to warm the Bladder and transform Qi. This makes the water pathways smooth: upward it stops thirst, middle it removes dampness, and downward it drains pathogenic Heat. For True Yin deficiency, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) is needed to tonify Kidney Water; for True Yang deficiency, Bawei Wan (Eight-Ingredient Pill) is needed to tonify Kidney Fire. For Zhuanbao (displaced bladder) with asthma and urgency threatening death, regardless of gender, pregnancy, or postpartum status, urgently decoct Bawei Wan ingredients; delay means no rescue. Some doubt the acrid-hot nature of Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite) and dare not use them lightly. Do they not know that Kidney Qi deficiency and cold resemble frozen water; heat makes it flow. Besides these, what else can reach the Bladder directly to melt snow and bring spring water? (Chen Laizhang)
Heat in the Upper Jiao Qi level causes obstruction and thirst; this is latent Heat in the Lung failing to generate Water, cutting off the Bladder's transformation source. Use bland-draining herbs to drain Fire, clear Metal, and nourish the Water source. Heat in the Lower Jiao Blood level causes obstruction without thirst; this is insufficiency of True Water, leaving the Bladder dry. Without Yin, Yang cannot transform. Use bitter-cold herbs to nourish the Yin of the Kidney and Bladder, allowing Yang to transform naturally and urination to clear. (Li Dongyuan)
For all Long/Bi syndromes, there are four causes, and distinguishing excess from deficiency is paramount. One cause is Fire-Evil aggregating in the Small Intestine and Bladder, where water springs are dried up and the Qi gate is heat-blocked. Another cause is Heat residing in the Liver and Kidneys, where stale semen or dried blood blocks the water pathways. These are not cases of absolute lack of water, but rather blockage. Since the etiology is excess, it can be cleared or drained; these are mild forms of Long/Bi. Only Qi Blockade is a critical condition. Qi Blockade has two meanings: Qi Excess Blockage and Qi Deficiency Blockage. The Bladder is the organ storing Water, but water enters via Qi transforming into Water, so Qi produces Water; water exits via Water reaching Qi, so Water produces Urine. *Neijing* states: "Qi transformation allows it to exit." There must be transformation-in before there is transformation-out; without transformation-out, there is no transformation-in. Thus, both entry and exit depend on Qi transformation. This follows the *Neijing*'s meaning of Qi transformation, not just referring to the act of exiting. Therefore, Water contains Qi, so Qi is Water; Qi contains Water, so Water is Qi. For cases of Qi Deficiency Blockage, there is inevitably depletion of True Yang at the lower extremities, rootlessness of the Yuan Sea, non-interaction of Water and Fire, and Yin-Yang obstruction. Thus, Qi remains Qi and does not transform Water; Water remains Water and accumulates without moving. If Qi does not transform Water, the Water Organ may become depleted; if Water accumulates without moving, it may rot and corrupt. If Qi cannot transform, can forced drainage work? If there is no Yang in Yin, can bitter-cold herbs be used without harm? As for Qi Excess Blockage, it is merely strong Liver Qi reversing and obstructing the Bladder; breaking the Qi, unblocking stagnation, or lifting sinking obstruction will remove the blockage. Treating excess is easy, but treating deficiency requires mastering Qi transformation, which is difficult. (*Jingyue Quanshu*)
The organ governing the Five Fluids is the Kidney. When Kidney Qi is deficient and disturbed, it lacks strength to transform fluids, allowing Evil Fire to attack, resulting in scanty, difficult urination. Although superficial Heat arises from the Bladder, the root deficiency/excess lies in the Kidney. Tonify the Kidney to benefit deficiency, and warm to transform Qi; then the Kidney source is nourished, and urination becomes free, verifying the recovery of Kidney Qi. ○ Although water seeps into the Bladder, separation is performed by the Small Intestine. Heat in the Small Intestine can shift to the Bladder. The Small Intestine is the Fire Organ, rooted in the Heart. If Heart Qi is unblocked, Small Intestine Fire descends naturally, leaving no Heat to shift; the source clarifies, and the flow clears. (Cheng Jiaoqian)
Yin Deficiency causing short, difficult, obstructed urination: do not see apparent excess signs and use diuretics. This is due to weakness of the Original Yin Qi in the Lower Jiao, unable to transport and transform. Greatly tonify Original Yin, and urination will naturally clear. Cases of Qi Deficiency with Phlegm obstructing the Middle Jiao, Qi stagnation in the Lower Jiao, or Damp-Heat are not included here. (Luo Chicheng)
Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); add Xu Duan (or Niu Xi/Achyranthes) for difficult urination. Use Liujun Dihuang Wan (Six-Ingredient Rehmannia Pill); add Che Qian Zi (Plantago Seed) for difficult urination. (Zhou Shenzhai)
The Bladder is the official of the Zhou Du, storing fluids; Qi transformation allows them to exit. What is Qi transformation? Body fluids are transformed by Qi. Food enters the Stomach, overflowing with Essence-Qi, transported upward to the Spleen. The Spleen disperses Essence, sending it upward to the Lung. The Lung regulates water pathways, transporting downward to the Bladder. Water Essence spreads everywhere, running through the Five Meridians. It is like steaming food: soup vapor rises to steam the pot, creating liquid that drips down. This is the Spleen Qi steaming the Lung lobes, enabling regulation of water pathways and transport to the Bladder. Therefore, for obstruction of urination due to Qi Deficiency and water depletion, using diuretics worsens it. One must use a large dose of Ren Shen (Ginseng) with a little Sheng Ma (Cimicifuga); then Yang rises and Yin descends, earth qi becomes clouds, heaven rain falls, and natural clearance occurs. ○ Danxi said: Obstruction of urination can be due to Qi Deficiency, Blood Deficiency, Excess Heat, or Phlegm-Qi blockage. All should be treated with vomiting to lift Qi; when Qi rises, Water descends. Qi carries Water. For Qi Deficiency, use Ren Shen, Bai Zhu, Sheng Ma, etc., take first, then induce vomiting; for Blood Deficiency, use Siwu Tang or Xionggui Tang, take first, then induce vomiting; for much Phlegm, use Erchen Tang, take first, then induce vomiting; for Phlegm-Qi blockage, use Erchen Tang plus Xiang Fu (Cyperus) and Mu Tong (Akebia), take first, then induce vomiting. Someone asked: What is the rationale for using vomiting to clear urination? Answer: To utilize Qi transformation. (*Zhengzhi Zhunsheng*)
*Neijing* says: "Extreme Yin deficiency cuts off Heaven Qi; extreme Yang excess leaves Earth Qi insufficient." Kidney and Liver are below, representing Earth Dao; Heart and Lung are above, representing Heaven Dao; Spleen and Stomach are central, the division of Qi intersection. Thus, if Heaven Yang is cut off and cannot settle in Earth, white dew does not fall; if Yang above does not interact with Yin below, Yin below has nothing to transform, how can water pathways exit? This is Qi transformation of the Upper Jiao. Zhang Zhongjing said: "When Wei Qi circulates, urination is unobstructed." He also said: "Spleen disease causes obstruction of the nine orifices." This is Qi transformation of the Middle Jiao. Li Dongyuan said: "Yin deficiency below and Yang excess above cause Kidney Qi failure to transform; one must promote Yang and lift it, then Yin can be balanced." Thus, Danxi said: "I use vomiting to clear urination, like a dripping vessel; if the upper orifice is closed, the lower orifice cannot open itself; only when the upper orifice opens does water flow from the lower." However, lifting is only suitable for drops that do not pass; for difficult, scanty, or painful dribbling, it is not appropriate. From *Neijing* and various discourses, none do not emphasize Qi transformation. Not examining this, but turning to draining agents for merit, shows much ignorance of measure. (*Zhangshi Yitong*)
Qi Deficiency causing obstruction of urination: *Neijing* says: "The Bladder stores fluids; Qi transformation allows exit." Qi Deficiency means inability to transform, hence obstruction. Blood Deficiency causing obstruction: Blood belongs to body fluids; Blood Deficiency means dry fluids and unfavorable urinary pathways, hence obstruction. This differs from Phlegm-Qi blockage in the Lower Jiao in terms of deficiency/excess. Danxi used vomiting in all cases, treating the branch in emergencies. However, Qi and Blood Deficiency are fundamentally deficient; deficiency must be tonified. Using Ren Shen, Bai Zhu, Siwu to regulate True Qi and then vomiting can indeed clear urine, but can a few moments of swallowing these tonics truly replenish fundamental deficiency? I fear the root cause remains, and relapse will occur soon. My opinion is that if there is true Qi and Blood Deficiency, one must use Qi-tonifying and Blood-nourishing herbs to make Qi vigorous for transformation and Blood generated for moisture, so urination clears naturally, without needing induced vomiting. If vomiting is truly indicated, vomit first, wait for urination to clear, then continue with tonics to achieve recovery, unlike Phlegm-Qi blockage which resolves with vomiting alone. This reveals the incomplete aspect of Danxi's theory, which I hereby highlight. (*Yixue Tongzhi*)
Incontinence and Frequency
*Lingshu* states: The collateral name of Hand Taiyin is Lieque; its disease, when deficient, leads to lack and frequent urinary incontinence. The Lung is the Upper Jiao, regulating water pathways and transporting to the Bladder. The Kidney connects upward to the Lung; the two organs are mother and son. Mother deficiency leads to son deficiency. Dongyuan said: Urinary incontinence is Lung Metal deficiency. Tonify with Ren Shen and Huang Qi; if not cured, blame the Kidney. *Neijing* states: "Bladder lack of restraint causes incontinence." Zhongjing said: "Lower Jiao failing to return causes urinary leakage." The Lower Jiao is at the upper opening of the Bladder, responsible for separating clear and turbid. If the Lower Jiao fails to return, this region cannot restrain urine, causing incontinence. Generally, warm weather and thick clothes cause sweating; cold weather and thin clothes cause urination. As for incontinence, it is severe deficiency-cold; only Bawei Wan (Eight-Ingredient Pill) is effective. Tusizi Wan, Lurong San, and Erqi Wan are also selectable. (*Zhao Shi Yiguan*)
Frequent urination is simply inner Qi failing to hold; frequent yet scanty, due to deficiency of the Five Fluids flowing downward. This is a disease of internal deprivation of Jing Essence, body fluids, and blood vessels. Do not say that because drops are few, it doesn't constitute a leak in the Zang-Fu; the responsibility lies not only in the Jade Gate (Kidney). Directly use Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) to tonify Qi and restore Spirit, restore Spirit and nourish Essence. Indeed, knowing that repairing the earth with turtle legs requires smelting stones to repair heaven. (Cheng Jiaoqian)
Human urine relies on the transmission of Heart and Kidney Qi. The Heart and Small Intestine are exterior-interior; the Kidney and Bladder are exterior-interior. If Heart and Kidney Qi decline and Yang mechanisms fail to operate, transmission becomes irregular, leading to incontinence. Treatment should warm and tonify the Lower Origin, clear the Heart, and reduce desires. (Xue Lizhai)
Note: Yiniao means loss. Losing in sleep and realizing upon waking is common in children, rare in adults. Children have weak Yang Qi, lacking restraint, active with wandering Hun (Ethereal Soul), hence frequent nocturnal enuresis. Ancient formulas mostly use warming herbs, intending to warm and nourish Yang Qi. I have seen several people aged twenty or thirty still suffering from continuous enuresis, who later had no children. Is this truly not due to Lower Origin deficiency-cold? (Sun Yikui)
Nocturnal enuresis is blamed on Kidney Deficiency. Infants have unconsolidated Pao Qi; elders have insufficient Lower Origin, both often having this symptom. In infants, it is mostly accompanied by Heat; in elders, mostly by Cold. Treatment should use Da Tusizi Wan (Great Cuscuta Pill), taken with decoction of Pig Bladder. (*Yixue Liuyao*)
Excessive Heat lodging in the Foot Jueyin meridian, causing郁结 (stagnation) in the Ting Kong, leaves the Spirit without foundation, thus causing urinary loss and inability to restrain. (*Yuanbing Shi*)
Anyone suffering from Yin Deficiency disease with frequent urination does so because of hidden movement of Ministerial Fire. Do not mistake it for deficiency-cold and use Ren Shen, Huang Qi, Gui Zhi, or Fu Zi. Only greatly tonify True Yin, and urination will self-regulate. (Luo Chicheng)
Incontinence or frequency of urination was traditionally considered Cold in ancient formulas, treated with warming and astringent herbs. Little did they know that this syndrome is mostly Yin Deficiency with Heat. Because Fire-Evil moves recklessly, Water cannot rest, hence inability to restrain and frequency. Thus, elders often have frequency due to scanty Bladder Blood and predominant Yang Fire. Treatment should primarily nourish Kidney True Yin and replenish Bladder fluids, assisted by astringents, such as Liuwei Wan plus Maidong (Ophiopogon) and Wuweizi (Schisandra). Warming herbs should not be used. (Wang Jiezhai)
Note: Jiezhai's argument generally states that elders have exhausted Lower Origin and weak Qi unable to carry Water, hence frequency and incontinence. If, as Hejian and Jiezhai claim, Long/Bi is mainly Heat and incontinence is also Heat, there would be no deficiency-cold syndromes. Why do ancient texts mention warming/tonifying methods and *Neijing* mention cold/deficiency texts? It is better to consider frequent, clear, long urination as Cold, and frequent, yellow-red, difficult urination as Heat, combined with pulse examination (surging-rapid, forceful-forceless, slippery-slippery) for verification, avoiding error. ○ Jinb means lack of restraint, frequent urination without counting occurrences. Note: *Neijing* says: "If water springs do not stop, the Bladder fails to store." Syndromes include Damp-Heat and Lower Origin exhaustion. Frequent and scanty is Heat; frequent and abundant is Deficiency. Elders often have this due to weak Yang Qi unable to constrain. I have seen several people who died despite treatment, due to failure to nurture and dissipating Shen Qi. Ancients said obstruction is Heat, incontinence is Cold, due to weak Heart-Kidney Qi, cold Yang mechanisms, and irregular transmission. Method should be warming and tonifying, nurturing Shen, strengthening Kidney. When Shen is complete and Kidney solid, Bladder Qi is full, naturally able to constrain. (*Chishui Xuanzhu*)
Enuresis due to Upper Jiao Deficiency: Tonify Lung Qi. Due to Lower Jiao Deficiency: Secure the Bladder. Accompanied by Cold: Strengthen Mingmen Yang Qi, combined with astringents. Accompanied by Heat: Nourish Kidney and Bladder Yin-Blood, assisted by Fire-draining herbs. (*Zhengzhi Huibu*)
Yellow-Red Urine
Yellow-red urine has distinctions of Cold, Heat, Deficiency, and Excess. *Neijing* says: "All turbid body fluids belong to Heat." Treat with Huang Bo (Phellodendron) and Zhi Mu (Anemarrhena). This is a Heat syndrome. It also says: "Chi pulse is choppy, calves are cold, urine is red." Take Fuzi Sini Tang (Aconite Counterflow Decoction). This is a Cold syndrome. It also says: "Excess in the Foot Yangming Stomach meridian causes heat in the front of the body, hunger with good digestion, and yellow urine." Drain Stomach Fire. It also says: "Liver Heat disease presents with yellow urine first." Drain Liver Fire. This is an Excess syndrome. It also says: "Deficiency of Hand Taiyin Lung meridian Qi..."