《原病式》云∶热甚客于肾部，干于足厥阴之经，廷孔郁结极甚，而气血不能宣
通，则痿痹，神无所用，故津液渗入膀胱而旋溺遗失，不能收禁也。考之《内经》则谓督脉生病为遗
溺。《灵枢》谓肝所生病为遗溺。盖因二经循阴器，系廷孔，病则荣卫不至，气血劳劣，莫能约束水
道之窍，故遗失不禁。刘河间可谓得此旨矣。然《内经》复言膀胱不约为遗溺。《灵枢》言手太阴之
别，名曰列缺，其病虚则欠KT ，小便遗数。由此观之，则又不独病在阴器廷孔而已。夫如是者，内由
三焦决渎之失常也。何则？手少阳之脉，从缺盆布膻中，下鬲循属三焦。足太阳之脉，从肩膊内挟脊
抵腰中，入循膂，属膀胱。三焦虚则膀胱虚，故不约也。肺从上焦通调水道，下输膀胱，肾又上连肺，
故将两脏，是子母也。母虚子亦虚，此上中下三焦气虚，皆足以致遗溺矣。由是而知三焦所部，五脏
之淫气变而为五邪者，悉能干于下焦肾肝膀胱出水之窍而为不禁之病，何止于热极郁结痿痹肾部而已
乎。又自《内经》所谓太阴在泉，客胜，湿客下焦，溲便不时。太阴之复，甚则入肾，窍泄无度者观
之，则知湿主于痞，况是所胜之邪，其不为郁结痿痹者乎。从而思之，圣人之言，举一隅盒饭以三隅
反，前所谓肝肾膀胱之病，不言其邪，可见诸邪尽能病之也。次言手太阴列缺虚者，为子母脏气之要
也。可见所生、所胜、不胜之五邪，皆足以乘之也。
其言太阴之胜复，则湿为所胜之重者也。其他风寒燥热，虽不及言，可知在其中矣。治法，上虚补气。
下虚涩脱。东垣云∶小便遗失者，肺金虚也。宜安卧养气，禁劳役，以黄 、人参之类补之。不愈当
责有热，加黄柏、生地。下虚谓膀胱下焦虚。经云∶水泉不止者，是膀胱不藏也。仲景云∶下焦竭则
遗溺失便，其气不能自禁制，不须治，久则愈。又云∶下焦不归则遗溲，世用桑螵蛸、鸡 之类是
也。古方多燥热，如二气丹、家韭子丸、菟丝子丸、固脬丸、白茯苓散、鹿茸散、菟丝子散，内有桂、
附，唯真虚寒者宜之。桑螵蛸散、鹿角霜丸、阿胶饮、鹿茸散，温补而不僭。小便不禁而淋沥涩滞者，
泽泻散、茯苓丸。滑脱者，牡蛎丸。如白薇散、鸡肠散，内俱有寒药，内热者宜之。娄全善治一男子
遗溺不觉，脉洪大盛，以黄柏、知母、杜牛膝为君，青皮、甘草为臣，木香为佐，桂些少反佐，服数
帖大效。此法与《千金》白薇散，皆河间所谓热甚，廷孔郁结，神无所用，不能收禁之意也。遗尿有
实热者，用神芎导水丸，每服百丸，空心白汤下。若一服利，止后服。此谓淫气遗溺，痹聚在肾，痹
谓气血不通宣也。戴云∶睡着遗尿者，此亦下元冷，小便无禁而然。宜大菟丝子丸，猪胞炙碎煎汤下。
凡遗尿皆属虚。通用方，薏苡仁盐炒煎服。
鸡肠一具，以水三升，煮取一升，分三服。一方用雄鸡烧灰为末，用三指撮，温浆水调一钱，向北斗
服之，更良。雄鸡喉咙及矢白， 里黄皮，烧为末，麦粥清调服。羊脬盛水贮令满，系两头煮熟，
开取水顿服之。鸡 一具，并肠洗净烧灰，男用雌，女用雄，为细末。每服二钱，空心温酒调服。
一方加猪脬灰。燕蓐草主眠中遗尿不觉，烧令黑，研，水进方寸匕。膀胱咳者，咳而遗溺。
【妊娠尿出不知】用白薇、芍药为末，酒调下。或白矾、牡蛎为末，酒调二钱。或鸡毛灰末，酒
服一匕。或炙桑螵蛸、益智仁为末，米饮下。薛氏云∶前证若脬中有热，宜加味逍遥散。若脾肺气虚，
宜补中益气汤加益智。若肝肾阴虚，宜六味丸。
【产后小便数】乃气血不能制故也。薛氏曰∶若因稳婆不慎，以致胞损而小便淋沥者，用八珍汤
以补气血，兼进补脬饮。若因膀胱气虚而小便频数，当补脾肺。若膀胱阴虚而小便淋沥，须补肺肾。
妇人产蓐，产理不顺，致伤膀胱，遗尿无时，宜补脬饮、桑螵蛸散、白薇散。薛氏曰∶前证若脾
肺阳虚，用补中益气汤。若肝肾阴虚，用六味地黄丸。若肝肾之气虚寒，用八味地黄丸。若肝脾气血
虚热，用加味逍遥散，佐以六味丸。丹溪云∶
尝见尿胞因收生者不谨，以致破损而得淋沥病，遂为废疾。有妇年壮，难产得此，因思肌肉破伤在外
者，可以补完。胞虽在腹，恐亦可治。诊其脉虚甚，遂与峻补，以参、 为君，芎、归为臣，桃仁、
陈皮、黄 、茯苓为佐，煎以猪羊胞中汤，极饥时饮之。但剂小者，率用一两，至一月而安。盖令气
血骤长，其胞自完。恐稍缓，亦难成功矣。
《原病式》中说：热邪盛极侵袭肾部，干扰足厥阴肝经，导致前阴尿道（廷孔）郁结闭塞至极，气血无法宣通，从而出现痿痹症状，神志功能丧失作用，因此津液渗入膀胱而随即发生遗尿失禁，无法控制。考察《内经》则说督脉生病会导致遗尿。《灵枢》说肝所生的疾病包括遗尿。大概因为这两条经脉循行经过阴器，连接前阴尿道，患病时营卫之气不能到达，气血衰弱，不能约束水道的窍道，所以发生遗尿不禁。刘河间可以说是领悟了这个旨意了。然而《内经》又说膀胱不固约会导致遗尿。《灵枢》说手太阴肺经的别络，名叫列缺，其病症虚证表现为呵欠、小便频数遗溺。由此看来，那么就不只是病在阴器和前阴尿道而已。像这样的情况，内部是由于三焦决渎功能失常所致。为什么呢？手少阳三焦经的脉气，从缺盆布散于膻中，向下穿过横膈，归属于三焦。足太阳膀胱经的脉气，从肩膊内侧挟脊下行抵于腰部，进入肌肉深处，归属于膀胱。三焦虚弱则膀胱也虚弱，所以不能固约。肺从上焦通调水道，向下输送到膀胱，肾又向上连接肺，所以将两脏联系起来，这是母子关系。母脏虚弱子脏也会虚弱，这上、中、下三焦气虚，都足以导致遗尿。由此可知，三焦所辖部位，五脏的淫乱之气变而为五邪的，都能侵犯下焦肾、肝、膀胱出水之窍，从而造成不禁的病证，何止是热极郁结痿痹于肾部而已呢。又从《内经》所谓“太阴在泉，客胜，湿邪客居下焦，小便排泄不时”、“太阴之复，甚则入肾，窍泄无度”来看，就知道湿邪主病痞塞，况且这是所胜之邪，难道不会导致郁结痿痹吗？进而思考，圣人的言论，举一反三，前面所说的肝肾膀胱的病，没有提及具体的邪气，可见各种邪气都能致病。其次提到手太阴列缺虚证，是母子脏气关系的关键所在。可见相生、相克、不胜的五邪，都足以乘虚侵袭。
关于太阴的胜复，湿是所胜之邪中的重者。其他风寒燥热，虽然未言及，可知包含在其中了。治疗方法：上焦虚损补气。下焦虚损涩脱止遗。李东垣说：小便遗失，是肺金虚损。应当安卧养气，禁止劳累役使，用黄芪、人参之类补益。如果不好转应当责求有热，加黄柏、生地。下虚是指膀胱和下焦虚损。经书说：水泉不止（小便失禁），是膀胱不能藏纳。张仲景说：下焦精气枯竭则遗尿失便，其气不能自我控制，不需要治疗，时间久了会自愈。又说：下焦之气不归元则遗尿，世医常用桑螵蛸、鸡内金之类。古方多用燥热药，如二气丹、家韭子丸、菟丝子丸、固脬丸、白茯苓散、鹿茸散、菟丝子散，内含桂枝、附子，只有真正虚寒者适宜。桑螵蛸散、鹿角霜丸、阿胶饮、鹿茸散，温补而不峻猛。小便不禁且淋沥涩滞的，用泽泻散、茯苓丸。滑脱不固的，用牡蛎丸。如白薇散、鸡肠散，内俱有寒凉药，内热者适宜。娄全善治疗一名男子遗尿不觉，脉象洪大盛实，以黄柏、知母、杜牛膝为君药，青皮、甘草为臣药，木香为佐药，少量桂枝反佐，服用几帖后大效。此法与《千金方》的白薇散，都是刘河间所谓热邪盛极，前阴尿道郁结，神志功能丧失，不能收摄禁固的意思。遗尿有实热的，用神芎导水丸，每次服用一百丸，空腹白开水送下。如果服一次后腹泻，就停止后续服药。这叫淫气遗尿，痹阻聚积在肾，痹指气血不通畅。戴云说：睡着后遗尿，这也是下元寒冷，小便失去禁固所致。宜用大菟丝子丸，猪膀胱炙碎煎汤送下。凡是遗尿都属于虚证。通用方：薏苡仁盐炒后煎服。
取鸡肠一条，用水三升，煮取一升，分三次服用。另一方法用雄鸡烧成灰研末，用三指撮的量，温浆水调服一钱，面向北斗星服用，效果更好。雄鸡喉咙及粪便中的白色部分，里面的黄色内膜，烧成灰，用麦粥清汁调服。羊膀胱盛水使其充满，系住两头煮熟，打开取水一次性服下。鸡肫一条，连同肠洗净烧成灰，男患者用雌鸡，女患者用雄鸡，研为细末。每次服用二钱，空腹温酒调服。另一方加猪膀胱灰。燕蓐草主治睡梦中遗尿不觉，烧黑研末，用水进服一方寸匕。膀胱咳，即咳嗽时遗尿。
【妊娠期间尿出不知】用白薇、芍药研末，酒调下。或用白矾、牡蛎研末，酒调服二钱。或用鸡毛灰末，酒服一方寸匕。或炙桑螵蛸、益智仁研末，米饮送下。薛己说：前述证候若膀胱中有热，宜用加味逍遥散。若脾肺气虚，宜用补中益气汤加益智仁。若肝肾阴虚，宜用六味地黄丸。
【产后小便频数】是因为气血不能制约的缘故。薛己说：如果因接生婆不慎，导致胞宫损伤而小便淋沥的，用八珍汤补益气血，兼服补脬饮。若因膀胱气虚而小便频数，当补脾肺。若膀胱阴虚而小便淋沥，须补肺肾。妇女产褥期，产理不顺，致伤膀胱，遗尿无时，宜用补脬饮、桑螵蛸散、白薇散。薛己说：前述证候若脾肺阳虚，用补中益气汤。若肝肾阴虚，用六味地黄丸。若肝肾之气虚寒，用八味地黄丸。若肝脾气血虚热，用加味逍遥散，佐以六味地黄丸。朱丹溪说：
我曾见到尿胞因接生者不谨慎，以致破损而得淋沥病，遂成为废疾。有妇人年壮，难产得此病，因思肌肉破伤在外者，可以修补完整。胞虽在腹中，恐怕也可治疗。诊其脉象非常虚弱，于是给予峻补，以人参、黄芪为君药，川芎、当归为臣药，桃仁、陈皮、黄芪、茯苓为佐药，用猪羊膀胱汤煎药，在极度饥饿时饮用。但剂量小的，通常用一两，至一个月而痊愈。大概是让气血迅速生长，其胞自然修复。恐怕稍缓慢，也难以成功。
According to *Yuan Bing Shi* (Treatise on the Origin of Diseases): When pathogenic heat is excessive and invades the Kidney region, interfering with the Foot Jueyin Liver Meridian, it causes extreme stagnation and knotting at the external urethral orifice (Ting Kong). Consequently, Qi and Blood cannot circulate freely, leading to flaccidity and numbness. The Spirit loses its function, causing body fluids to seep into the Bladder, resulting in involuntary urination that cannot be controlled. Examining the *Nei Jing* (Inner Canon), it states that disease of the Du Mai (Governing Vessel) leads to urinary incontinence. The *Ling Shu* (Spiritual Pivot) states that diseases generated by the Liver include urinary incontinence. This is because these two meridians traverse the genitalia and connect to the external urethral orifice; when diseased, Ying and Wei (Nutritive and Defensive Qi) fail to reach these areas, and Qi and Blood become deficient and weak, unable to constrain the orifices of the water passages, thus causing involuntary leakage. Liu Hejian can be said to have grasped this principle. However, the *Nei Jing* also states that if the Bladder fails to maintain restraint, it results in urinary incontinence. The *Ling Shu* mentions that the Luo-connecting vessel of the Hand Taiyin Lung Meridian is named Lieque (LU-7); its deficiency symptoms include yawning and frequent, involuntary urination. From this, we see that the pathology is not limited solely to the genitalia and the external urethral orifice. Such cases arise internally due to dysfunction in the Sanjiao's (Triple Burner) regulation of water pathways. Why? The Hand Shaoyang Sanjiao Meridian originates from the Quepen (LI-15) area, spreads to the Shanzhong (CV-17), descends through the diaphragm, and connects to the Sanjiao. The Foot Taiyang Bladder Meridian runs from the shoulder blades, medial to the spine, down to the waist, enters the muscular tissue, and connects to the Bladder. Deficiency of the Sanjiao leads to deficiency of the Bladder, hence a lack of restraint. The Lung regulates water pathways from the Upper Jiao and transports them downward to the Bladder. The Kidney connects upward to the Lung, linking the two organs as mother and child. If the Mother organ is deficient, the Child organ will also be deficient. Thus, Qi deficiency in the Upper, Middle, and Lower Jiao can all lead to urinary incontinence. From this, we understand that pathogens transforming into the Five Evils within the regions governed by the Sanjiao can invade the excretory orifices of the Lower Jiao (Kidney, Liver, and Bladder), causing incontinence, far exceeding mere heat-induced stagnation and flaccidity in the Kidney region. Furthermore, considering the *Nei Jing*'s statement: "When Taiyin is in authority, if the invading pathogen prevails, dampness occupies the Lower Jiao, causing irregular urination," and "In the recurrence of Taiyin, if severe, it enters the Kidney, causing uncontrolled discharge from the orifices," we know that dampness primarily causes obstruction. Since this is an overacting pathogen, does it not cause stagnation and flaccidity? Reflecting further, the Sage's words allow one to infer the whole from a part. The previous discussion on Liver, Kidney, and Bladder diseases did not specify the pathogen, implying that all types of pathogens can cause disease. The subsequent mention of deficiency in the Hand Taiyin Lieque point highlights the critical relationship between mother and child organ Qi. It shows that the Five Evils arising from generation, restriction, and non-restriction can all attack this point. Regarding the excess and recurrence of Taiyin, dampness is the predominant overacting pathogen. Other pathogens like Wind, Cold, Dryness, and Heat, though not explicitly mentioned, are implied to be included.
Treatment principles: For Upper Jiao deficiency, tonify Qi. For Lower Jiao deficiency, use astringents to stop leakage. Li Dongyuan stated: Urinary incontinence is due to deficiency of Metal (Lung). One should rest quietly to nourish Qi, avoid labor, and tonify with herbs such as Huangqi (Astragali Radix) and Renshen (Ginseng Radix). If there is no improvement, check for heat and add Huangbai (Phellodendri Cortex) and Shengdi (Rehmanniae Radix). "Lower Jiao deficiency" refers to deficiency of the Bladder and Lower Jiao. The Classics state: "Unceasing flow of urine indicates the Bladder fails to store." Zhang Zhongjing stated: "When the Lower Jiao exhausts, urinary incontinence and fecal loss occur; the Qi cannot self-control. No treatment is needed; it will heal after time." He also stated: "When Lower Jiao Qi fails to return, urinary incontinence occurs." Modern practitioners often use Sangpiaoxiao (Mantis Egg Case) and Jineijin (Galli Gigerii Endothelium Corneum). Ancient formulas often used hot and drying herbs, such as Erqi Dan, Jiajiuzi Wan, Tusizi Wan, Gu Pao Wan, Bai Fuling San, Lurong San, and Tusizi San, which contain Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata); these are suitable only for true deficiency-cold patterns. Sangpiaoxiao San, Lujiaoshuang Wan, Ejiao Yin, Lurong San, and Tusizi San provide warming tonification without being overly acrid. For urinary incontinence accompanied by dribbling and obstruction, use Zexie San and Fuling Wan. For sliding and loss of control, use Muli Wan. Baibai San and Jichang San contain cold herbs and are suitable for internal heat patterns. Lou Quanshan treated a man with unconscious urinary incontinence; his pulse was surging and full. He used Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) as Sovereign herbs, Qingpi (Aurantii Fructus Pericarpium) and Gancao (Glycyrrhizae Radix et Rhizoma) as Minister herbs, and Muxiang (Aucklandiae Radix) as Assistant herb, with a small amount of Guizhi (Cinnamomi Ramulus) acting as a counter-agent. After several doses, there was significant effect. This method aligns with the Baibai San from *Qian Jin Fang* and reflects Liu Hejian's concept of extreme heat causing stagnation at the urethral orifice, loss of spiritual control, and inability to restrain urine. For enuresis with excess heat, use Shenxiong Dao Shui Wan, 100 pills per dose, taken on an empty stomach with plain water. If diarrhea occurs after one dose, stop further administration. This describes enuresis caused by rampant Qi and Bi syndrome accumulating in the Kidney, where Bi refers to the obstruction of Qi and Blood circulation. Dai Yun stated: Enuresis during sleep is due to cold in the Lower Yuan, causing loss of bladder control. Use Da Tusizi Wan, administered with decoction of roasted pig bladder. Generally, enuresis belongs to deficiency. A universal formula is Yi Yi Ren (Coicis Semen) stir-fried with salt and decocted.
Take one chicken gizzard/intestine, boil in three sheng of water until reduced to one sheng, divided into three doses. Another method uses powdered ash of a rooster, taken with warm grain water. Or use ash from the chicken throat and white fecal matter, mixed with wheat gruel. Boil a filled sheep bladder tied at both ends, collect the water, and drink it at once. Take one chicken gizzard and intestines, clean and burn to ash; use female chicken for male patients and male chicken for female patients. Take two qian with warm wine on an empty stomach. Another variation adds pig bladder ash. Yanru Cao (Herba Siegesbeckiae) treats unconscious nocturnal enuresis; burn until black, powder, and administer with water. Coughing Bladder (Bladder Cough) presents as coughing with urinary incontinence.
[Pregnancy: Unconscious Urination] Powder Baibai (Baikiaeae Caulis) and Shaoyao (Paeoniae Radix), take with wine. Or powder Bai Fan (Alumen) and Muli (Concha Ostreae), take two qian with wine. Or take chicken feather ash with wine. Or powder roasted Sangpiaoxiao (Mantis Egg Case) and Yizhi Ren (Alpiniae Oxyphyllae Fructus), take with rice water. Xue Ji stated: If the preceding condition involves heat in the bladder, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). If Spleen and Lung Qi are deficient, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Yizhi Ren. If Liver and Kidney Yin are deficient, use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia).
[Postpartum Frequent Urination] This is due to Qi and Blood failing to exert control. Xue Ji stated: If caused by careless midwifery leading to bladder injury and dribbling, use Ba Zhen Tang (Eight Treasure Decoction) to tonify Qi and Blood, combined with Bu Pao Yin (Bladder Tonifying Drink). If due to Bladder Qi deficiency causing frequency, tonify Spleen and Lung. If due to Bladder Yin deficiency causing dribbling, tonify Lung and Kidney. During postpartum confinement, if difficult labor injures the bladder causing intermittent incontinence, use Bu Pao Yin, Sangpiaoxiao San, or Baibai San. Xue Ji stated: If Spleen and Lung Yang are deficient, use Bu Zhong Yi Qi Tang. If Liver and Kidney Yin are deficient, use Liu Wei Di Huang Wan. If Liver and Kidney Qi are deficient and cold, use Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia). If Liver and Spleen Qi and Blood are deficient with heat, use Jia Wei Xiao Yao San assisted by Liu Wei Di Huang Wan. Zhu Danxi stated:
I have seen cases where the bladder was damaged by careless delivery, leading to chronic dribbling and disability. A strong woman suffered this after difficult labor. I reasoned that external muscle wounds can be repaired; perhaps the internal bladder can also be treated. Her pulse was extremely deficient. I prescribed strong tonification: Renshen (Ginseng Radix) and Huangqi (Astragali Radix) as Sovereign herbs, Chuanxiong (Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) as Minister herbs, Taoren (Persicae Semen), Chenpi (Citri Reticulatae Pericarpium), Huangqi (Astragali Radix), and Fuling (Poria) as Assistant herbs. Decocted in pig or sheep bladder soup, taken when extremely hungry. Although doses were small (typically one liang), she recovered in one month. The goal was rapid growth of Qi and Blood so the bladder would repair itself. Delay might hinder success.