〔大〕经云∶膀胱不利为癃，不约为遗尿者，乃心肾之气传送失度之所为也。故有小
便涩而遗者，有失禁而出不自知者。又妇人产蓐产理不顺，致伤膀胱，遗尿无时。又有
脬寒脏冷而遗尿不禁，治之各有方。
〔薛〕《内经》曰∶胞移热于膀胱则癃、溺血，膀胱不利为癃，不约为遗溺。注曰∶膀
胱为津液之腑，水注由之，然足三焦脉实，约下焦而不通，则不得小便。足三焦脉虚，不
约下焦，则遗溺也。《灵枢经》曰∶足三焦者，太阳之别也，并太阳之正，入络膀胱，约下
焦，实则闭癃，虚则遗溺。窃谓前证若肝肾虚热，挺孔痿痹，用六味丸，如不应，用加
减八味丸。阳气虚惫，膀胱积冷，用鹿茸丸，如不应，用八味丸。若脾气虚弱不能禁止，用
补中益气汤加山药、山萸、五味。若肺气虚寒，前汤加桂、附。此证属虚热者多，真寒
者少，治宜审察。一妇人小便自遗，或时不利，日晡益甚，此肝热阴挺不能约制，用
六味丸料加白术、酒炒黑黄柏七分、知母五分，数剂诸证悉愈。若误用分利之剂，愈损
真阴，必致不起。一老妇患前证，恶寒体倦，四肢逆冷，余以为阳气虚寒，用补中益
气加附子三剂，不应，遂以参附汤四剂稍应，仍以前药而安。附子计用四枚，人参三斤许。
一妇人病愈后，小便出屎，此阴阳失于传送，名大小肠交也。先用五苓散二剂而愈，又
用补中益气汤而安。
〔大〕鹿茸丸 治妇人久积虚冷，小便白浊，滑数不禁。
鹿茸（炙） 椒红 桂心 附子（炮） 牡蛎（ ） 补骨脂（炒） 石斛 肉苁蓉（酒浸）
鸡 （炙） 沉香（各一两） 桑螵蛸（炙，半两）
上为细末，酒煮面糊，丸梧桐子大。空心，温酒下三十丸。
又方 鹿角屑炒令黄，为细末，空心温酒调二钱。
又方 雄鸡 炙为末，空心酒调服二钱。
治妇人遗尿，不知出时。《千金翼》方。
白薇 白芍药（各等分）
上为末，酒服方寸匕，日三服，空心。
又方 以桑螵蛸酒炒，为细末，每服二钱，生姜汤调下。
又方
白矾 牡蛎（各等分）
为细末，饮服方寸匕。亦治丈夫遗尿。
疗妇人遗尿不禁 雄鸡翎烧灰为末，酒服方寸匕。
补遗秘元丸 治内虚自汗，小便不禁。
白龙骨（三两） 诃子（十个，去核） 缩砂仁（一两）
为末，糯米粥丸梧子大。每服五十丸，空心盐油吞下。
又治小便不禁，用猪脬洗净，铁铲上炙熟食之，以酒咽下。
【丹溪】《黄帝内经》说：膀胱气化不利称为“癃”（小便不通），约束无力称为遗尿，这是心肾之气传输失常所致。因此有小便涩滞而遗尿的，也有失禁而出、自己不知晓的。另外，妇女在产褥期因产理不顺，损伤了膀胱，导致随时遗尿。又有因膀胱寒冷、脏腑虚寒而导致遗尿不禁的，治疗各有相应的方剂。
【薛己】《黄帝内经》说：胞宫的热邪转移至膀胱则导致癃闭、尿血；膀胱气化不利称为癃，约束无力称为遗溺。注释说：膀胱是津液之腑，水液由此通过。如果足三焦脉象实盛，约束下焦但气机不通，则不能排尿。如果足三焦脉象虚弱，不能约束下焦，则发生遗溺。《灵枢经》说：足三焦经，是足太阳膀胱经的别络，与足太阳经的正脉并行，进入联络膀胱，约束下焦。脉实则导致闭癃，脉虚则导致遗溺。我认为前述证候如果是肝肾虚热，导致阴挺痿痹，使用六味丸；如果无效，使用加减八味丸。如果是阳气虚衰疲惫，膀胱积冷，使用鹿茸丸；如果无效，使用八味丸。如果是脾气虚弱不能固摄，使用补中益气汤加山药、山萸肉、五味子。如果是肺气虚寒，在前方的基础上加桂枝、附子。此证属于虚热的较多，真寒的较少，治疗应当仔细审察。有一位妇人小便自遗，有时排尿不畅，傍晚时分加重，这是肝热导致阴挺，不能约制，使用六味丸料加白术、酒炒黑黄柏七分、知母五分，数剂后所有症状痊愈。如果误用分利（利尿）的药物，会进一步损伤真阴，必然导致死亡。一位老妇人患前证，恶寒体倦，四肢逆冷，我认为是阳气虚寒，使用补中益气汤加附子，服用三剂无效，于是改用参附汤四剂，稍有反应，仍以前药调理而安。附子共计用了四枚，人参大约三斤。一位妇人在病愈后，小便中排出粪便，这是阴阳失去传输协调，名为大小肠交。先用五苓散二剂而愈，又用补中益气汤调理而安。
【丹溪】鹿茸丸 治疗妇人久积虚冷，小便白浊，滑数不禁。
鹿茸（炙） 椒红 桂心 附子（炮） 牡蛎（煅） 补骨脂（炒） 石斛 肉苁蓉（酒浸） 鸡肫（炙） 沉香（各一两） 桑螵蛸（炙，半两）
以上药物研为细末，用酒煮面糊，制成梧桐子大小的丸剂。空腹时，温酒送服三十丸。
又一方 鹿角屑炒至黄色，研为细末，空腹时用温酒调服二钱。
又一方 雄鸡肫炙烤后研为末，空腹时用酒调服二钱。
治疗妇人遗尿，不知何时流出。出自《千金翼方》。
白薇 白芍药（各等分）
以上研为末，用酒送服方寸匕，每日三次，空腹服用。
又一方 将桑螵蛸用酒炒，研为细末，每次服二钱，生姜汤调下。
又一方
白矾 牡蛎（各等分）
研为细末，饮水送服方寸匕。也治疗男子遗尿。
治疗妇人遗尿不禁 雄鸡翎烧成灰研为末，用酒送服方寸匕。
补遗秘元丸 治疗内虚自汗，小便不禁。
白龙骨（三两） 诃子（十个，去核） 缩砂仁（一两）
研为末，糯米粥为丸，如梧子大。每次服五十丸，空腹时用盐油吞下。
又治小便不禁，用猪脬洗净，在铁铲上炙熟食之，用酒咽下。
[Danxi] The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Bladder dysfunction is termed 'long' (difficulty in urination), and lack of restraint is termed enuresis." This is caused by the disorderly transmission of Qi between the Heart and Kidney. Therefore, there are cases of dribbling with astringent urination, and cases of incontinence where one is unaware of the leakage. Furthermore, women may suffer from bladder injury due to difficult labor during the puerperium, resulting in unpredictable enuresis. There are also cases of enuresis due to cold in the bladder and visceral coldness, each treated with specific formulas.
[Xue Ji] The *Huangdi Neijing* states: "If heat shifts from the Bao (uterus/bladder) to the Bladder, it causes long and hematuria; bladder dysfunction is termed long, and lack of restraint is termed enuresis." The commentary notes: "The Bladder is the Fu organ of Jin-Ye (body fluids), through which water passes. If the Foot Sanjiao meridian is excess, constraining the Lower Jiao but blocking flow, urination is impossible. If the Foot Sanjiao meridian is deficient, failing to constrain the Lower Jiao, enuresis occurs." The *Lingshu Jing* (Spiritual Pivot) states: "The Foot Sanjiao meridian is a collateral branch of the Foot-Taiyang Bladder meridian. It runs parallel to the main channel of Taiyang, enters and connects with the Bladder, and constrains the Lower Jiao. Excess leads to closure and long; deficiency leads to enuresis." I believe that for the aforementioned conditions, if they are due to Deficiency-Heat in the Liver and Kidney causing prolapse and flaccidity, use Liuwei Wan (Six-Ingredient Pill with Rehmannia). If ineffective, use Jiajian Bawei Wan (Modified Eight-Ingredient Pill). If due to Yang Qi deficiency and exhaustion with cold accumulation in the Bladder, use Lurong Wan (Deer Antler Pill). If ineffective, use Bawei Wan (Eight-Ingredient Pill). If due to Spleen Qi deficiency failing to hold, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shanyao (Dioscoreae Rhizoma), Shanzhuyu (Corni Fructus), and Wuweizi (Schisandrae Fructus). If due to Lung Qi deficiency and cold, add Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata) to the previous formula. Most cases of this condition belong to Deficiency-Heat, while true Cold is rare; treatment requires careful examination. One woman had spontaneous enuresis, sometimes with difficulty urinating, worsening in the late afternoon. This was due to Liver Heat causing genital prolapse and loss of control. I used Liuwei Wan material added with Baizhu (Atractylodis Macrocephalae Rhizoma), Jiuchao Hei Huangbai (Alcohol-fried and charred Phellodendri Cortex) 7 fen, and Zhimu (Anemarrhenae Rhizoma) 5 fen. After several doses, all symptoms resolved. If diuretic agents were mistakenly used, it would further damage True Yin, inevitably leading to death. An elderly woman suffered from the aforementioned condition, with aversion to cold, fatigue, and cold limbs. I diagnosed it as Yang Qi deficiency and cold, using Buzhong Yiqi Tang added with Fuzi. After three doses, there was no improvement, so I switched to Shenfu Tang (Ginseng and Aconite Decoction) for four doses, showing slight response, then returned to the previous medication for stabilization. A total of four pieces of Fuzi and approximately three jin of Renshen (Ginseng Radix et Rhizoma) were used. Another woman, after recovering from illness, passed feces with urine. This is a loss of coordinated transmission between Yin and Yang, named Da Xiaochang Jiao (Intertwining of Large and Small Intestines). She was cured with two doses of Wuling San (Five-Ingredient Powder with Poria), and subsequently stabilized with Buzhong Yiqi Tang.
[Danxi] Lurong Wan treats chronic internal cold in women, turbid white urine, and uncontrollable slippery frequency.
Lurong (Roasted), Jiaohong (Zanthoxyli Pericarpium), Guixin (Cinnamomi Cortex), Fuzi (Prepared), Musli (Calcined), Buguzhi (Psoraleae Fructus), Shihu (Dendrobii Caulis), Roucongrong (Cistanches Herba soaked in wine), Jizhong (Roasted), Chenxiang (Aquilariae Lignum Resinatum) (each 1 liang), Sangpiaoxiao (Mantis Ootheca roasted, 0.5 liang).
Grind into fine powder, make pills with wine-boiled wheat paste, size of Sophora seeds. Take 30 pills on an empty stomach with warm wine.
Another prescription: Roast Lu Jiaoxie (Cornu Cervi Pantotrichum) until yellow, grind into fine powder. Take 2 qian on an empty stomach mixed with warm wine.
Another prescription: Roast Xiongji Zhong (Rooster Gizzard), grind into powder. Take 2 qian mixed with wine on an empty stomach.
Treats female enuresis where the patient is unaware of the leakage. From *Qianjin Yi Fang*.
Baiwei (Cynanchi Atrati Radix), Baishaoyao (Paeoniae Radix Alba) (equal parts).
Grind into powder. Take one fangcunbi with wine, three times daily, on an empty stomach.
Another prescription: Stir-fry Sangpiaoxiao with wine, grind into powder. Take 2 qian per dose, mixed with Ginger Decoction.
Another prescription:
Baifan (Alumen), Musli (equal parts).
Grind into powder. Take one fangcunbi with water. Also treats male enuresis.
Treats female uncontrollable enuresis: Burn Xiongji Ling (Rooster Feather) to ash, grind into powder. Take one fangcunbi with wine.
Buyi Miyuan Wan treats internal deficiency with spontaneous sweating and urinary incontinence.
Bailonggu (Fossilia Ossis Mastodi et Frontis, 3 liang), Hezi (Terminalia Chebula Retusa, 10 fruits, pit removed), Suosharen (Amomi Fructus Rotundus, 1 liang).
Grind into powder. Make pills with glutinous rice porridge, size of Sophora seeds. Take 50 pills per dose, swallow on an empty stomach with salted oil.
Another method for urinary incontinence: Clean the Zhu Pao (Porcine Urinary Bladder), roast thoroughly on an iron spatula until cooked, eat it, and wash down with wine.