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
王海藏曰因有卢氏医镜见姜附石脂朱砂丹一药味数分两皆同惟丹砂一味用伏火者及治病
有瘥
所治者小便数而不禁怔忡多忘魇梦不已之不同耳其不同者审而详之乃得此之治决不瘥耳泛举
之言肾主大便肝主小便淋溲难经云小肠为赤肠是面赤色及便溺赤色者皆出心与小肠南方赤色
显于外也经言下焦如渎者正谓大小便也大便为阴为有形乃下焦之下者也肾脏为病主大便不言
大肠者明矣子行父之道小便为气所化乃下焦之高者也谓肝主小便淋溲亦是子行父道为腑病诸
气化者皆腑诸有形血化者皆脏病所主此腑言膀胱病此二证俱在下焦则同药有形无形及在脏在
腑
有殊俱是丹田衰惫不言心火者以其相火化行君之令故也细分之则膀胱壬水胜丙小肠者是不传
阴则阴不病何为有形病此为阴之体也为腑之用也天地阴阳反为体用以斯可见是明五脏者为六
腑所用六腑者为五脏所用明矣是有形皆为传阴也夫小便不禁是膀胱不约为遗溺此不传阴也是
丹田胞络受寒为壬所克大抵诸腑皆盛有形物有形病皆在腑责其所来皆在脏也用伏火朱砂者去
其寒邪耳治法同者以其俱在下焦补诸无形同在胞络耳以其胞与肾相对有时相连故也肾主大便
肝主小便所治安得不殊
按此论遗溺为经虚之本病也然亦有误服凉剂太过而致者如东垣曰立夏前误用白虎汤过多
致遗溺者宜温药升阳以解之是也故用药者当审诛罚无过之戒
谨按丹溪先生曰淋证多主于气虚亦有死血作淋者小便不通实热者当利之因气者宜吐之以
提其
气气升则水自下盖气承载其水也痰多者用二陈汤先服后吐痰气闭塞者二陈加木通香附探吐一
男子病小便不通医用利药而加剧先生曰此积痰病也积痰在肺肺为上焦膀胱为下焦上焦闭则下
焦塞譬如滴水之器必上窍通而后下窍之水出焉乃以法大吐之吐已病如失然此可见癃淋又不独
主于经病也
淋 治法(小便不禁附)
《黄帝内经》说：胞中的热邪转移至膀胱，就会导致小便不通（癃）和尿血；膀胱气机不利则导致小便不通，约束无力则导致遗尿。注释说：膀胱是贮存津液的腑，水液代谢由此经过。如果足三焦脉象实盛，约束下焦功能过强导致不通畅，就会小便不通；如果足三焦脉象虚弱，不能约束下焦，就会遗尿。《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，入里联络膀胱。如果下焦实证，就会闭阻导致小便不通；如果下焦虚证，就会遗尿。
王海藏说：因为看到卢氏的《医镜》，其中姜、附子、赤石脂、朱砂、丹参这五味药的剂量都相同，只有丹砂一味使用了经过伏火处理的，以及治疗疾病痊愈后，所治疗的病症是小便频数且不禁控、心悸怔忡、多梦易惊不止等不同之处罢了。这些不同之处仔细审察并详细分析，才能找到这种治法，否则决不会痊愈。泛泛而谈地说：肾主管大便，肝主管小便。《难经》说小肠为“赤肠”，是指面色赤红以及大小便颜色赤红，这些都出自心与小肠，南方红色显现在外部。经文说“下焦如渎”，正是指大小便。大便是阴，是有形之物，属于下焦的下部。肾脏生病主要影响大便，而不提大肠，这是很明显的。小便是由气化而成，属于下焦的上部。说肝主管小便、淋涩不通，也是子行父之道。对于腑病，凡是涉及气化的都是腑病，凡是涉及有形血液化生的都是脏病所主。这里说的是膀胱的病，这两个证候都在下焦，所以相同；但药物涉及有形无形，以及在脏在腑，却有差异。都说是丹田衰惫，不说心火，是因为相火执行君火的命令。细分来说，膀胱属壬水，胜过丙火的小肠，是不传阴，所以阴不生病。为什么是有形病？这是因为它是阴的形体，作为腑的功能。天地的阴阳反过来体现体用关系，由此可见，明确五脏被六腑所用，六腑被五脏所用，是很清楚的。所以凡是有形之物都属于传阴。至于小便不禁，是膀胱约束无力导致的遗尿，这是不传阴。这是因为丹田和胞络受寒，被壬水所克。大体上诸腑都盛，有形之物、有形之病都在腑，追究来源都在脏。使用伏火朱砂是为了去除寒邪。治法相同，是因为它们都在下焦，补益诸无形之气同在胞络的缘故。因为胞与肾相对，有时相连，所以如此。肾主管大便，肝主管小便，所安定的方面怎能没有差异呢？
按语：此论述认为遗尿是经脉虚损的根本病证。然而也有误服凉药太过而导致的，比如李东垣说：立夏前误用白虎汤过多导致遗尿的，适宜用温药升阳来解除它，就是这个道理。所以用药者应当审慎，警惕诛伐无过的戒律。
谨按：朱丹溪先生说：淋证多主于气虚，也有因死血导致淋证的。小便不通属实热的应当通利，因气滞的应当用吐法以提举其气，气上升则水自下行，盖因为气承载水。痰多的先用二陈汤，先服药后催吐。痰气闭塞的，用二陈汤加木通、香附探吐。有一个男子患小便不通，医生用利尿药反而加重病情。朱先生說：这是积痰病。积痰在肺，肺为上焦，膀胱为下焦，上焦闭塞则下焦堵塞，譬如滴水之器，必须上窍通畅然后下窍的水才能流出。于是用吐法，吐完后病如失。然而这可见癃淋又不独主于经脉病变。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When heat from the bladder organ (Baopao, 胞) transfers to the Urinary Bladder (Pangguang, 膀胱), it results in urinary retention (Long, 癃) and hematuria (Nixue, 溺血); if the Qi mechanism of the Urinary Bladder is obstructed, it causes urinary retention; if its constraining function is weak, it leads to enuresis (Yiniao, 遗溺). The annotation explains: The Urinary Bladder is the Fu organ responsible for storing body fluids (Jinye, 津液), through which water metabolism passes. If the pulse of the Foot Sanjiao (Zusanli channel context implies Taiyang/Sanjiao relationship here, specifically referring to the meridian dynamics) is excess, over-constraining the Lower Jiao (Xiajiao, 下焦) leads to obstruction and inability to urinate; if the pulse is deficient, failing to constrain the Lower Jiao, it leads to enuresis. The *Lingshu Jing* (Spiritual Pivot) states: The Foot Sanjiao meridian is a collateral branch of the Foot Taiyang Bladder meridian. It runs parallel with the main pathway of the Foot Taiyang, enters and connects with the Urinary Bladder. If there is an Excess syndrome in the Lower Jiao, it causes closure and urinary retention; if there is a Deficiency syndrome in the Lower Jiao, it causes enuresis.
Wang Haicang stated: Regarding Lu Shi's *Yi Jing* (Medical Mirror), the dosages of Ginger (Shengjiang, 生姜/干姜), Aconite (Fuzi, 附子), Red Kaolin (Chishizhi, 赤石脂), Cinnabar (Zhusha, 朱砂), and Salvia Miltiorrhiza (Danshen, 丹参) are identical. The only difference is that the Cinnabar used was processed by "Fu Huo" (buried fire processing). Furthermore, although the prescriptions were similar, the treated conditions differed significantly: one involved frequent and incontinent urination, palpitations (Zhentong, 怔忡), excessive forgetfulness, and persistent nightmare sleep. By carefully examining and detailing these differences, one can arrive at the correct treatment; otherwise, recovery will not occur. Broadly speaking: The Kidney (Shen, 肾) governs large bowel movements, while the Liver (Gan, 肝) governs urination. The *Nanjing* (Classic of Difficult Issues) states that the Small Intestine (Xiaochang, 小肠) is the "Red Intestine," indicating that a red complexion and red urine/stool originate from the Heart (Xin, 心) and Small Intestine, corresponding to the Southern element Fire manifesting externally. The classic text says "The Lower Jiao is like a ditch," referring precisely to both stool and urine. Stool is Yin and has form, belonging to the lower part of the Lower Jiao. When the Kidney is diseased, it primarily affects stool, not explicitly mentioning the Large Intestine, which is clear. Urine is transformed by Qi and belongs to the upper part of the Lower Jiao. Saying the Liver governs urination and dysuria is also an example of the "Son following the Father's way" (Wood generating Fire, or Liver influencing Bladder function via Qi transformation). For Fu organ diseases, those involving Qi transformation are Fu organ diseases; those involving the transformation of有形 (form/blood) are Zang organ diseases. This passage discusses Bladder disease. Both syndromes reside in the Lower Jiao, hence they are similar; however, the medicines involve distinctions between formless (Qi) and formed (Substance), and between Zang and Fu organs. Both are described as depletion of the Dantian (Elixir Field). The reason Heart Fire is not mentioned is because the Ministerial Fire (Xianghuo, 相火) executes the orders of the Sovereign Fire (Junhuo, 君火). Analyzed in detail: The Bladder is Ren Water, overcoming Bing Fire of the Small Intestine; this does not transmit to Yin, so Yin does not become diseased. Why is it a Formed disease? Because it is the substance of Yin, serving the function of the Fu organ. Heaven and Earth's Yin and Yang reverse to demonstrate Substance (Ti, 体) and Function (Yong, 用). Thus, it is clear that the Five Zang organs are utilized by the Six Fu organs, and the Six Fu organs are utilized by the Five Zang organs. Therefore, all formed substances belong to the transmission of Yin. As for urinary incontinence, it is enuresis caused by the Bladder's failure to constrain; this is non-transmission of Yin. It occurs because the Dantian and Baoluo (Uterus/Membranes) are affected by Cold, overcome by Ren Water. Generally, all Fu organs are abundant; formed substances and formed diseases reside in the Fu organs, but their origin lies in the Zang organs. Using Fu Huo-processed Cinnabar is to dispel Cold pathogenic factors. The treatments are similar because they both reside in the Lower Jiao and tonify formless Qi within the Baoluo. Since the Baoluo is opposite to and sometimes connected with the Kidney, this is the case. The Kidney governs stool, the Liver governs urination; how can their governance not differ?
Commentary: This discussion considers enuresis as a fundamental disease of meridian deficiency. However, it can also be caused by excessive intake of cooling agents. For instance, Li Dongyuan stated: Enuresis caused by excessive use of Baihu Tang (White Tiger Decoction) before the Start of Summer should be treated with warming herbs to raise Yang and resolve the condition. Therefore, practitioners must exercise caution against unnecessary purgation (Zhu Fa Wu Guo, 诛罚无过).
According to Master Zhu Danxi: Lin syndrome (Lin Zheng, 淋证) is mostly due to Qi deficiency, but can also be caused by static blood. Urinary retention due to Excess Heat should be treated with draining methods; retention due to Qi stagnation should be treated with emesis to lift the Qi. When Qi rises, water flows down naturally, as Qi carries water. For cases with excessive phlegm, Er Chen Tang (Two-Cured Decoction) should be administered first, followed by emesis. For phlegm-Qi blockage, Er Chen Tang added with Tong Cao (Akebia Caulis) and Cyperi Rhizoma should be used for induced vomiting. A male patient suffered from urinary retention. The physician used diuretics, which worsened the condition. Master Zhu said: This is a disease of accumulated phlegm. The accumulated phlegm is in the Lung. The Lung is the Upper Jiao, and the Bladder is the Lower Jiao. If the Upper Jiao is closed, the Lower Jiao is blocked. It is like a vessel for dripping water; the upper aperture must be open for water to flow out of the lower aperture. He therefore used the emetic method. After vomiting, the illness disappeared. This demonstrates that Long and Lin syndromes are not solely determined by meridian pathology.
Treatment Methods for Lin Syndrome (Including Urinary Incontinence)