经曰∶膀胱者，州都之官，津液藏焉，气化则能出矣。又曰∶膀胱不利为癃，不约为遗溺。又曰∶肝有热则
小便先赤。凡小便赤涩为热，小便自遗为寒。热者火有余，水不足，治宜泻心火、滋肾水，加味导赤散；寒者火
不足，水有余，治宜温肾水、益心火，益智散。
小便不通，乃由脏气虚，受热壅滞，宣化不行，非塞非痛，但闭而不通，腹胀紧满。宜五苓散加车前、灯芯。
大病之后，气虚津液不足，而小便闭者，不可利之。利则中气日虚，津液愈涸。宜人参散。
小儿患淋，小便淋沥作痛，不必分五种，然皆属火热。宜清利之，海金砂散。
小儿久病气虚而淋病者，不可利小便，宜六味地黄丸，滋其化源。
小便自出而不禁者，谓之遗尿；睡中自出者，谓之尿床。此皆肾与膀胱虚寒也。益智散加附、桂、龙骨。
小儿初便黄赤，落地良久，凝如白膏者，谓之尿白。伤脾所致，久而成疳。胃苓丸，盐
汤下。
小儿小便出时，色白混浊，随尿而来，谓之白浊。此心经虚热，宜清心莲子饮。
加味导赤散 治心热肝热，小便赤涩。
淮木通 怀生地 炙草 枯黄芩 黑栀仁 泽泻 北柴胡（以上各一钱）
淡竹叶七片灯芯十茎
水煎，空心热服。
益智散 治水有余，火不足而遗溺。
益智仁（五钱，盐水炒） 补骨脂（三钱，盐水炒） 白云苓（五钱，酒炒）
共为细末，每服一钱，盐汤调下。
五苓散 方见卷二暑证门。
人参散 治气虚津液不足，小便不通。
官拣参（一钱） 大麦冬（二钱） 川黄柏（五分） 炙甘草（一钱）
生姜三片，水煎服。
海金砂散 治小儿诸淋，皆属于热。
香附米（酒炒） 正川芎（酒炒） 赤茯苓（屑炒，以上各五钱） 白滑石（水飞，一钱） 陈枳壳（炒）
宣泽泻（焙） 陈石苇（焙） 尖槟榔（炒，以上各一钱五分）
共为细末，每服一钱，淡盐汤调下。
胃苓丸 方见卷二湿证门。
清心莲子饮 专治白浊。
建莲子（二钱） 白云苓（一钱五分） 益智仁（一钱） 远志肉（五分） 大麦冬（一钱） 官拣参（五分）
石菖蒲（五分） 车前子（五分） 漂白术（六分） 宣泽泻（四分） 生甘草（三分）
灯芯十茎，水煎，空心服。
《黄帝内经》说：膀胱是州都之官，负责贮藏津液，经过气化作用才能排出尿液。又说：膀胱气机不利会导致癃闭（小便不通），约束无力则导致遗尿（小便失禁）。还说：肝脏有热邪时，小便会先变红赤。凡是小便颜色红赤、排尿涩痛属于热证；小便自行遗出属于寒证。热证是心火有余、肾水不足，治疗应当清泻心火、滋补肾水，使用加味导赤散；寒证是心火不足、肾水有余，治疗应当温补肾水、补益心火，使用益智散。
小便不通，是由于脏腑之气虚弱，受热邪壅滞，宣发和化气功能不行，并非堵塞或疼痛，只是闭塞而不通，伴有腹部胀满紧绷感。适宜用五苓散加入车前子、灯芯草。
大病之后，因气虚津液不足而导致小便闭阻的，不可使用利尿药。如果利尿，会使中气日益虚弱，津液更加枯竭。适宜用人参散。
小儿患淋证，小便淋漓不尽且作痛，不必区分五种淋证，但都属于火热之邪。适宜清热利湿，使用海金砂散。
小儿久病导致气虚而患淋证的，不可利尿，适宜用六味地黄丸，以滋生化之源。
小便自行流出且不受控制的，称为遗尿；睡眠中小便自出的，称为尿床。这都是肾与膀胱虚寒所致。可用益智散加入附子、肉桂、龙骨。
小儿初次排出的小便黄赤，落地良久后，凝结如白膏样的，称为尿白。这是损伤脾脏所致，日久会发展为疳积。可用胃苓丸，用盐汤送服。
小儿小便排出时，颜色白且混浊，随尿而来，称为白浊。这是心经虚热所致，适宜用清心莲子饮。
加味导赤散 治疗心热肝热引起的小便红赤涩痛。
淮木通、怀生地、炙甘草、枯黄芩、黑栀子仁、泽泻、北柴胡（以上各一钱）
淡竹叶七片，灯芯草十茎
加水煎煮，空腹温热服用。
益智散 治疗肾水有余、心火不足导致的遗尿。
益智仁（五钱，盐水炒）、补骨脂（三钱，盐水炒）、白云苓（五钱，酒炒）
共研为细末，每次服用一钱，用盐汤调下。
五苓散 方剂见卷二暑证门。
人参散 治疗气虚津液不足导致的小便不通。
官拣参（一钱）、大麦冬（二钱）、川黄柏（五分）、炙甘草（一钱）
生姜三片，加水煎服。
海金砂散 治疗小儿各种淋证，皆属于热。
香附米（酒炒）、正川芎（酒炒）、赤茯苓（屑炒，以上各五钱）、白滑石（水飞，一钱）、陈枳壳（炒）、宣泽泻（焙）、陈石苇（焙）、尖槟榔（炒，以上各一钱五分）
共研为细末，每次服用一钱，用淡盐汤调下。
胃苓丸 方剂见卷二湿证门。
清心莲子饮 专门治疗白浊。
建莲子（二钱）、白云苓（一钱五分）、益智仁（一钱）、远志肉（五分）、大麦冬（一钱）、官拣参（五分）、石菖蒲（五分）、车前子（五分）、漂白术（六分）、宣泽泻（四分）、生甘草（三分）
灯芯草十茎，加水煎煮，空腹服用。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The Bladder is the official of the "State Capital" (Zhou Du), responsible for storing body fluids (Jinye); it can discharge them only through Qi transformation. It also states: When the Bladder's Qi mechanism is obstructed, it leads to Long Bi (urinary retention/incomplete voiding); when its constraining function is deficient, it leads to Yi Niao (urinary incontinence). Furthermore, it states: When there is heat in the Liver, the urine will first become red and dark. Generally, urine that is red and scanty with dysuria indicates Heat; spontaneous urinary incontinence indicates Cold. Heat patterns involve excess Heart Fire and deficient Kidney Water; treatment should focus on purging Heart Fire and nourishing Kidney Water, using Jiawei Daochi San (Modified Guide Out Red Decoction). Cold patterns involve deficient Heart Fire and excess Kidney Water; treatment should focus on warming Kidney Water and benefiting Heart Fire, using Yizhi San (Yi Zhi Pill).
Urinary obstruction arises from deficiency of Zang-Fu Qi combined with stagnation due to Heat pathogens, leading to failure of diffusion and Qi transformation. It is not caused by physical blockage or pain, but by closure without passage, accompanied by abdominal distension and tightness. Wuling San (Five-Ingredient Powder with Poria) added with Cheqianzi (Plantago Seed) and Dengxincao (Juncus Effusus) is appropriate.
After a severe illness, if urinary obstruction occurs due to Qi deficiency and insufficient body fluids, diuretics must not be used. Using diuretics will further deplete Middle Jiao Qi and dry up body fluids. Renshen San (Ginseng Decoction) is appropriate.
When children suffer from Lin Syndrome (strangury), characterized by dribbling and painful urination, it is unnecessary to distinguish among the five types of Lin; all belong to Fire-Heat. Clearing Heat and promoting urination is appropriate, using Haijinsha San (Hai Jin Sha Powder).
For children suffering from Lin Syndrome due to Qi deficiency after prolonged illness, diuretics should not be used. Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is appropriate to nourish the source of transformation.
Spontaneous leakage of urine without control is called Yi Niao (enuresis/urinary incontinence); involuntary urination during sleep is called Niao Chuang (bedwetting). These are both caused by deficiency-cold of the Kidney and Bladder. Yizhi San (Yi Zhi Pill) added with Fuzi (Aconite Lateral Root), Rougui (Cinnamon Bark), and Longgu (Fossilized Bones) is appropriate.
If a child's initial urine is yellow and red, and after remaining on the ground for some time, coagulates into a white paste-like substance, it is called Niao Bai (white urine). This is caused by Spleen injury and may develop into Gan Accumulation (pediatric malnutrition syndrome) over time. Weiling Wan (Wei Ling Pill) taken with salt water is appropriate.
If a child's urine is white and turbid upon discharge, coming along with the stream, it is called Bai Zhuo (white turbidity). This is caused by deficiency-heat in the Heart Meridian. Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction) is appropriate.
**Jiawei Daochi San (Modified Guide Out Red Decoction)** treats Heart and Liver Heat causing red, scanty, and dysuric urine.
Huaimutong (Akebia Caulis), Huaishengdi (Rehmanniae Radix Praeparata), Zhigancao (Prepared Licorice Root), Kuhuángqín (Scutellaria Root), Hei Zhiren (Gardeniae Fructus), Zexie (Alisma Rhizome), Beichaihu (Bupleuri Radix) (each 1 qian);
Dan Zhuye (Lophatherum Leaf) 7 pieces, Dengxincao (Junci Medulla) 10 stems.
Decoct in water and take warm on an empty stomach.
**Yizhi San (Yi Zhi Pill)** treats Yi Niao (urinary incontinence) caused by excess Kidney Water and deficient Heart Fire.
Yizhiren (Alpinia Oxyphylla Fruit) (5 qian, stir-fried with salt water), Buguzhi (Psoraleae Fructus) (3 qian, stir-fried with salt water), Bai Yunling (Poria) (5 qian, stir-fried with wine).
Grind into fine powder. Take 1 qian per dose, mixed with salt water.
**Wuling San (Five-Ingredient Powder with Poria)** See Volume II, Section on Summerheat Patterns.
**Renshen San (Ginseng Decoction)** treats urinary obstruction due to Qi deficiency and insufficient body fluids.
Guanjianshen (Ginseng Radix et Rhizoma) (1 qian), Damaidong (Ophiopogonis Radix) (2 qian), Chuan Huangbai (Phellodendri Cortex) (0.5 qian), Zhigancao (Prepared Licorice Root) (1 qian).
Add 3 slices of Shengjiang (Fresh Ginger Root), decoct in water, and take.
**Haijinsha San (Hai Jin Sha Powder)** treats various forms of Lin Syndrome in children, all belonging to Heat.
Xiangfumǐ (Cyperi Rhizoma) (wine-fried), Zheng Chuanxiong (Ligusticum Chuanxiong Rhizoma) (wine-fried), Chi Fuling (Poria with Red Core) (powdered, stir-fried, each 5 qian), Bai Huashi (Talcum) (water-suspended, 1 qian), Chen Zhike (Aurantii Fructus Perfricatus) (stir-fried), Xuan Zexie (Alisma Rhizome) (roasted), Chen Shiwei (Pyrosperma Herba) (roasted), Jian Binglang (Arecae Semen) (stir-fried, each 1.5 qian).
Grind into fine powder. Take 1 qian per dose, mixed with light salt water.
**Weiling Wan (Wei Ling Pill)** See Volume II, Section on Dampness Patterns.
**Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction)** specifically treats Bai Zhuo (white turbidity).
Jian Lianzi (Nelumbinis Semen) (2 qian), Bai Yunling (Poria) (1.5 qian), Yizhiren (Alpinia Oxyphylla Fruit) (1 qian), Yuanzhi Rou (Polygalae Radix) (0.5 qian), Damaidong (Ophiopogonis Radix) (1 qian), Guanjianshen (Ginseng Radix et Rhizoma) (0.5 qian), Shichangpu (Acori Tatarinowii Rhizoma) (0.5 qian), Cheqianzi (Plantago Seed) (0.5 qian), Biaozhuzhu (Atractylodis Macrocephalae Rhizoma) (0.6 qian), Xuan Zexie (Alisma Rhizome) (0.4 qian), Sheng Gancao (Licorice Root) (0.3 qian).
Add 10 stems of Dengxincao (Junci Medulla), decoct in water, and take on an empty stomach.