乃大小肠、膀胱三经之实热也。多由暴感惊忧，忿怒郁遏之气，无可伸发，触动心肺之火，
传于三经。卒然气乘，致大小便闭，迫小腹急胀，逆上冲心，甚则闷绝欲死，脉多沉数。
主方 大黄 滑石（研） 皂角（各三钱）上为末，煮酒，调作四服。
大便不通加大黄（三钱），小便不通加滑石（三钱）。
丁香散 脏腑实热，大小便不通，兼服八正散（方见淋门）。
苦丁香（五分） 川乌（炮） 草乌（炮） 白芷 皂荚（炮） 细辛（各三钱） 胡椒（
一分） 麝香（少许）
上为末，用竹管吹入肛门即通。
简便方 皂荚炙去皮子为末，酒糊丸，桐子大，每三十丸酒下。
又 木通为末，酒下。掩脐法（见秘结），更以朴硝同蜜汤调下。
（附∶不禁）
经曰∶膀胱不约为遗溺。又曰∶督脉主病为遗溺。夫人之游溺，藉心肾二经传送。盖心与小
肠为表里，肾与膀胱为表里。若心肾气衰，阳道不固，传送失度，必成遗溺不禁之愆。亦有因三
焦气虚而作者；肺从上焦，通调水道，下输膀胱，肾上连肺，母子相关，肾与膀胱亏损则子能令
母虚。肺金水源渗流，膀胱无能藏摄，尤致斯患。或热病时过用寒凉药，或立夏前多服白虎汤，
并宜温药升阳。然二证大同小异，遗溺较甚。遗溺者，睡中遗出而不自知；不禁者，时常欲溺而
不能制。左尺微涩，皆宜补肾滋阴，调荣益卫，少佐升提。
主方 人参 黄 当归 白术 熟地黄 石斛 益智（研。各一钱） 陈皮（七分）
肉桂（五分） 升麻末（效，倍加） 柴胡（各三分）
虚、老加附子（制）。姜三片，枣一枚，水煎，空心服。
体虚加山药、山萸、枣仁、五味；或六味地黄丸合补中益气汤煎服（方见虚损）。
家韭丸 治少、长遗尿不禁，白浊，梦遗，精滑，补元进食。
鹿茸（一对，制） 韭子（炒） 肉苁蓉 菟丝子（煮饼） 熟地黄 当归 牛膝（各二两）
杜仲（姜炒断丝） 巴戟天（去骨） 石斛 肉桂 干姜（各一两）
上各根据法制度，除鹿、地外，共为细末，制鹿、地（法见前）。入好酒，糊和丸，桐子大，
每服五十丸，空心，盐汤或酒下。
秘元丹 治小便不禁、自汗。
龙骨（另研，三两） 灵砂（水飞，二两） 诃子肉 砂仁（各一两）
上为细末，煮糯米糊丸，桐子大，每服五十丸，空心盐汤下。
缩泉丸 治频数不禁。
益智仁 乌药（天台者） 等分为末，山药糊丸，桐子大。每五十丸，盐汤送下。
益血固元汤 治阴虚血少，火盛不禁。
黄柏 知母（俱盐水炒） 当归 白芍 生地 熟地 天门冬 麦门冬 白术 栀子（炒）
益智（各一钱） 姜、枣煎。
六味地黄丸 久患不愈，去泽泻，加益智，多合久服，见效。
简便方 遗溺不禁。
鸡肫内黄皮（火炙为末，男用雌，女用雄），空心酒下。
又 牡蛎（入小砂罐，上下安盐，瓦盖外盐泥溏，炭火 红取用） 赤石脂（研细，拌醋，铁
铫内慢火炒干）
上各研极细末，等分，酒糊丸，桐子大。每五十丸，空心盐汤下。
又 茯苓为末，同面 饼，空心米汤下（忌茶）。或猪脬烧研，酒下。
又 小茴香（一钱），川椒（七粒），盐（一撮），炒研，晚间糯食蘸吃，温酒送下。
又 猪脬（糯米泔洗），入椒盐煮，蘸茴香食，酒下。或羊脬盛水，两头扎紧，煮食。
又 鹿肉霜为末，酒糊丸，酒下。或益智（两半），酒煎。或乌药为末，酒下。
老人夜溺多∶白芷（一两） 糯米（五钱） 炒黑为末，糯糊丸，木馒头或根煎汤下。
小儿遗尿∶肉桂为末，雄鸡肝捣丸，每寸丸，酒下。或燕去后窝内草，烧研末，水调下。
这是大肠、小肠和膀胱这三条经络的实热证。多由突然感受惊恐忧愁，或愤怒导致的气机郁结阻滞，气无法舒展发泄，从而触动心火和肺火，传变至这三条经络。忽然气机逆乱，导致大小便闭塞，逼迫小腹急迫胀满，气逆向上冲撞心脏，严重时甚至胸闷窒息欲死，脉象多为沉而数。
主方：大黄、滑石（研碎）、皂角（各三钱）。以上药物研为细末，用酒煮开，调匀分四次服用。大便不通加大黄（三钱），小便不通加滑石（三钱）。
丁香散：适用于脏腑实热，大小便不通，兼服八正散（方剂见淋证门）。苦丁香（五分）、川乌（炮制）、草乌（炮制）、白芷、皂荚（炮制）、细辛（各三钱）、胡椒（一分）、麝香（少许）。以上药物研为细末，用竹管吹入肛门即可通畅。
简便方：皂荚炙烤后去皮去子研为细末，用酒糊制成丸药，如梧桐子大，每次三十丸，用酒送服。
又方：木通研为细末，用酒送服。掩脐法（见便秘条），再用朴硝同蜂蜜水调下。
（附注：不禁）
《内经》说：膀胱约束无力导致遗尿。又说：督脉病变表现为遗尿。人的小便排泄，依靠心和肾两条经络的传导。因为心与小肠互为表里，肾与膀胱互为表里。如果心肾之气衰弱，阳气不固，传导失去节制，必然造成遗尿不禁的过失。也有因三焦气虚引起的；肺位于上焦，通调水道，向下输送到膀胱，肾向上连接肺，母子相关，肾与膀胱亏损则子病及母导致肺气虚。肺金与水液源头渗流失常，膀胱无法藏摄尿液，尤其导致这种病患。或者在热病期间过度使用寒凉药物，或在立夏前多服用白虎汤，都适宜用温药升发阳气。然而这两种证候大同小异，遗尿症状较重。遗尿是指睡中排尿而不自知；不禁是指时常想排尿但无法控制。左尺脉微涩，都适宜补肾滋阴，调和营卫，稍加升提药物。
主方：人参、黄芪、当归、白术、熟地黄、石斛、益智仁（研碎，各一钱）、陈皮（七分）、肉桂（五分）、升麻末（效佳，加倍加入）、柴胡（各三分）。体质虚弱、年老者加附子（炮制）。生姜三片，大枣一枚，水煎，空腹服用。
身体虚弱加山药、山茱萸、酸枣仁、五味子；或者六味地黄丸合补中益气汤煎服（方剂见虚损门）。
家韭丸：治疗少年、老年遗尿不禁，白浊，梦遗，精滑，补元气增进饮食。鹿茸（一对，炮制）、韭菜子（炒）、肉苁蓉、菟丝子（煮饼制）、熟地黄、当归、牛膝（各二两）、杜仲（姜炒断丝）、巴戟天（去骨）、石斛、肉桂、干姜（各一两）。以上各药根据法制处理，除鹿茸、熟地黄外，共研为细末，单独制作鹿茸和熟地黄（方法见前文）。加入好酒，用糊状物调和成丸，如梧桐子大，每次服用五十丸，空腹，用盐汤或酒送服。
秘元丹：治疗小便不禁、自汗。龙骨（另研，三两）、灵砂（水飞法，二两）、诃子肉、砂仁（各一两）。以上研为细末，用糯米煮糊制成丸药，如梧桐子大，每次服用五十丸，空腹，用盐汤送服。
缩泉丸：治疗尿频不禁。益智仁、乌药（天台产者）等分为细末，用山药糊制成丸药，如梧桐子大。每次五十丸，用盐汤送服。
益血固元汤：治疗阴虚血少，火盛导致的不禁。黄柏、知母（均用盐水炒）、当归、白芍、生地黄、熟地黄、天门冬、麦门冬、白术、栀子（炒）、益智仁（各一钱）。生姜、大枣煎服。
六味地黄丸：久患不愈，去掉泽泻，加入益智仁，长期配合服用，见效。
简便方：遗尿不禁。鸡肫内的黄皮（火烤研为细末，男性用雌鸡，女性用雄鸡），空腹用酒送服。
又方：牡蛎（放入小砂罐，上下铺盐，瓦盖外用盐泥封固，炭火烧红取用）、赤石脂（研细，拌醋，在铁锅中慢火炒干）。以上各药研成极细末，等分，用酒糊制成丸药，如梧桐子大。每次五十丸，空腹，用盐汤送服。
又方：茯苓研为细末，同面粉做成饼，空腹用米汤送服（忌茶）。或者猪膀胱烧研，用酒送服。
又方：小茴香（一钱），川椒（七粒），盐（一撮），炒后研细，晚间用糯米饭蘸着吃，温酒送下。
又方：猪膀胱（用糯米泔水清洗），加入椒盐煮熟，蘸茴香吃，用酒送服。或者羊膀胱盛水，两头扎紧，煮熟食用。
又方：鹿肉霜研为细末，用酒糊制成丸药，用酒送服。或者益智仁（半两），用酒煎服。或者乌药研为细末，用酒送服。
This is excess heat in the Large Intestine, Small Intestine, and Bladder meridians. It often arises from sudden exposure to fright or sorrow, or from qi stagnation due to anger, where the qi cannot be released, thereby stirring up Heart Fire and Lung Fire, which then transmits to these three meridians. Suddenly, rebellious qi causes obstruction of both urination and defecation, forcing urgency and distension in the lower abdomen, with qi rushing upward to strike the heart; in severe cases, it may cause chest oppression, syncope, or a sensation of impending death. The pulse is typically deep and rapid.
Main Formula: Rhizoma Rhei Preparata (Dahuang), Talcum (Huashi), Fructus Gleditsiae Sinensis (Zaojiao) [each 3 qian]. Grind the above into powder, boil in wine, mix well, and divide into four doses. For constipation, add Rhizoma Rhei Preparata (Dahuang) [3 qian]; for urinary retention, add Talcum (Huashi) [3 qian].
Dingxiang San: Indicated for excess heat in the zang-fu organs causing obstruction of urination and defecation; can be taken concurrently with Bazheng San (see Lin Syndrome section). Bitter Clove (Kuding Xiang) [5 fen], Prepared Aconitum carmichaelii Radix (Chuanwu), Prepared Aconitum kusnezoffii Radix (Caowu), Angelicae Dahuricae Radix (Baizhi), Prepared Fructus Gleditsiae Sinensis (Zaojia), Asari Radix et Rhizoma (Xixin) [each 3 qian], Piperis Nigris Fructus (Hujiao) [1 fen], Moschus (Shexiang) [a small amount]. Grind the above into fine powder, and blow into the anus using a bamboo tube to achieve immediate relief.
Simple Prescription: Roast Fructus Gleditsiae Sinensis (Zaojiao), remove skin and seeds, grind into powder, bind with wine paste into pills the size of Sophora japonica seeds. Take 30 pills per dose with wine.
Another Prescription: Stem Lycopodium (Mutong) ground into powder, taken with wine. Apply the Umbilical Covering Method (see Constipation section), and additionally take Natrii Sulfas (Puxiao) mixed with honey water orally.
(Attachment: Incontinence)
The Classic states: "Incontinence of urine results from the failure of the Bladder to constrain." It also states: "Diseases of the Du Mai manifest as incontinence of urine." Urination relies on the transmission of the Heart and Kidney meridians. Since the Heart and Small Intestine are exterior-interior pairs, and the Kidney and Bladder are exterior-interior pairs, if Qi of the Heart and Kidney declines and Yang fails to secure, transmission loses regulation, inevitably leading to incontinence. Some cases arise from deficiency of Qi in the Triple Burner; the Lung resides in the Upper Jiao, regulates water passages, and transports fluids downward to the Bladder. The Kidney connects upward to the Lung, and as mother and child, deficiency in the Kidney and Bladder causes the child to weaken the mother. If Lung Metal and Water sources flow abnormally, the Bladder loses its ability to store and control, exacerbating this condition. Alternatively, excessive use of cold-cooling medicines during febrile diseases, or frequent consumption of Baihu Tang before Start of Summer, should be treated with warm medicines to raise Yang. Although these two conditions are largely similar, incontinence (Yiniao) is more severe. Yiniao refers to involuntary urination during sleep without awareness; incontinence (Bujin) refers to frequent urge to urinate but inability to control. With a faint and choppy pulse at the left Chi position, treatment should focus on tonifying the Kidney and nourishing Yin, harmonizing Ying and Wei, with slight addition of lifting herbs.
Main Formula: Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), Angelicae Sinensis Radix (Danggui), Atractylodis Macrocephalae Rhizoma (Baizhu), Rehmanniae Radix Praeparata (Shudihuang), Dendrobii Caulis (Shihu), Semen Alpiniae Oxyphyllae (Yizhi) [ground, each 1 qian], Chenpi [7 fen], Cinnamomi Cortex (Rougui) [5 fen], Cimicifugae Rhizoma Powder (Shengma) [use effective quality, double dose], Bupleuri Radix (Chaihu) [each 3 fen]. For deficiency or elderly patients, add Prepared Aconiti Lateralis Radix (Fuzi). Add 3 slices of Zingiberis Rhizoma Recens (Jiang) and 1 Jujubae Fructus (Zao), decoct in water, and take on an empty stomach.
For physical weakness, add Dioscoreae Rhizoma (Shanyao), Corni Fructus (Shanzhuyu), Ziziphi Spinosae Semen (Suanzaoren), Schisandrae Fructus (Wuweizi); or combine Liuwei Dihuang Wan with Buzhong Yiqi Tang (see Deficiency Damage section).
Jiajiu Wan: Treats incontinence in youth and elderly, white turbid discharge, nocturnal emission, seminal leakage, tonifies Yuan Qi and promotes appetite. Prepared Antler Cornu Cervi (Lurong) [one pair], Fried Allii Tuberosi Semen (Jiu Zi), Morus Cinnamon Bark (Roucongrou), Dodder Seed (Tusizi) [boiled with wheat cake], Rehmanniae Radix Praeparata (Shudihuang), Angelicae Sinensis Radix (Danggui), Achyranthis Bidentatae Radix (Niuxi) [each 2 liang], Eucommiae Cortex (Duzhong) [stir-fried with ginger until fibers break], Morinda Officinalis Radix (Bajitian) [bone removed], Dendrobii Caulis (Shihu), Cinnamomi Cortex (Rougui), Zingiberis Rhizoma (Ganjiang) [each 1 liang]. Process each herb according to method, except for Deer Antler and Rehmannia. Grind the rest into fine powder. Prepare Deer Antler and Rehmannia separately (method seen previously). Mix with good wine and paste to form pills the size of Sophora japonica seeds. Take 50 pills per dose on an empty stomach, with salt water or wine.
Mi Yuan Dan: Treats urinary incontinence and spontaneous sweating. Dragon Bone (Longgu) [separately ground, 3 liang], Ling Sha [water-flown, 2 liang], Chebulae Fructus (Hezi Rou), Amomi Fructus Rotundus (Sharen) [each 1 liang]. Grind into fine powder, bind with glutinous rice paste into pills the size of Sophora japonica seeds. Take 50 pills per dose on an empty stomach, with salt water.
Suoquan Wan: Treats frequent urination and incontinence. Semen Alpiniae Oxyphyllae (Yizhiren), Linderae Radix (Wuyao) [from Tiantai] in equal parts, ground into powder, bound with Yam paste into pills the size of Sophora japonica seeds. Take 50 pills per dose with salt water.
Yixue Guoyuan Tang: Treats Yin deficiency with blood scarcity and hyperactive fire causing incontinence. Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu) [both stir-fried with salt water], Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Rehmanniae Radix (Shengdi), Rehmanniae Radix Praeparata (Shudi), Asparagi Radix (Tianmendong), Ophiopogonis Radix (Maimendong), Atractylodis Macrocephalae Rhizoma (Baizhu), Gardeniae Fructus (Zhizi) [fried], Semen Alpiniae Oxyphyllae (Yizhi) [each 1 qian]. Decoct with Ginger and Jujube.
Liuwei Dihuang Wan: For chronic cases unresponsive to treatment, remove Alisma Rhizoma (Zexie), add Semen Alpiniae Oxyphyllae (Yizhi), and take long-term for efficacy.
Simple Prescription: For urinary incontinence. Yellow membrane inside Chicken Gizzard (Jizhumen Huangpi) [roasted and ground, males use female chicken, females use male chicken], taken with wine on an empty stomach.
Another Prescription: Oyster Concha (Muli) [placed in small clay pot, salt placed top and bottom, covered with tile, sealed with salt mud, roasted over charcoal until red], Red Kaolin (Chishizhi) [ground fine, mixed with vinegar, slow-fired in iron wok until dry]. Grind both into extremely fine powder, mix in equal parts, bind with wine paste into pills the size of Sophora japonica seeds. Take 50 pills per dose on an empty stomach, with salt water.
Another Prescription: Poria (Fuling) ground into powder, made into cakes with flour, taken with rice gruel on an empty stomach (avoid tea). Or burn Pig Bladder (Zhupao), grind, and take with wine.
Another Prescription: Fennel Fructus (Xiaohuixiang) [1 qian], Sichuan Pepper (Chuanjiao) [7 grains], Salt [a pinch], stir-fry and grind. Eat with glutinous rice at night, wash down with warm wine.
Another Prescription: Pig Bladder (Zhupao) [washed with rice water], boiled with pepper and salt, eat dipped in fennel, wash down with wine. Or fill Sheep Bladder (Yangpao) with water, tie both ends tightly, boil and eat.
Another Prescription: Venison Frost (Lurou Shuang) ground into powder, bound with wine paste into pills, taken with wine. Or Semen Alpiniae Oxyphyllae (Yizhi) [half liang], decocted in wine. Or Linderae Radix (Wuyao) ground into powder, taken with wine.
Elderly with frequent nocturia: Angelicae Dahuricae Radix (Baizhi) [1 liang], Glutinous Rice (Nuomi) [5 qian], stir-fry until black and grind into powder, bind with glutinous rice paste into pills, take with decoction of Wood Mantis Eggcase (Mutouteng) or its root.
Pediatric enuresis: Cinnamomi Cortex (Rougui) ground into powder, mixed with Male Chicken Liver (Xiongji Gan) pounded into pills, each about one cun in size, taken with wine. Or burn grass from behind the swallow's nest, grind into powder, mix with water and take.