人有夜卧遗尿者，其人畏寒喜热，面黄体怯，大便溏泄，小水必勤，人以为小肠之
虚，谁知肾气之虚乎。夫肾与膀胱为表里，膀胱之开阖，乃肾主之也。盖膀胱奉令于肾，
肾寒则膀胱自不尊肾之令，故肾不闭而膀胱亦不闭也。治法约肾之水而水寒，不若温肾之水而
水缩也。方用温泉饮∶
白术（一两） 巴戟天（一两） 益智仁（三钱） 肉桂（一钱）水煎服。一剂即
止遗，连服四剂，不再遗矣。
此方脾肾两补之法。肉桂温命门之寒，益智断膀胱之漏，且白术通腰脐之气，自然病与
药宜。盖遗尿之病，虽成于肾寒，亦由腰脐之气不通，则水不走于小肠，而竟走于膀胱也。
通其腰脐之气，则水迂 其途，自走小肠。小肠与心为表里，而心气能摄之而不遽遗也。且
白术又上能补心之气，心气虚则水泻，心气旺而水又难泻矣。心肾交而泉温，亦心肾交而
泉缩矣。
此症可用萸术益桂汤治之。
山茱萸（五钱） 白术（一两） 肉桂（一钱） 益智仁（一钱）水煎服。
人有年老遗尿者，不必夜卧而遗也，虽日间不睡而自遗，较前症更重，此命门寒极不能
制水也。夫老人孤阳，何至寒极而自遗乎？盖人有偏阴偏阳之分，阳旺则有阴虚火动之忧，
阳衰则有阴冷水沉之患。少年时，过泄其精，水去而火又何存。水火必两相制者也，火无水
制则火上炎，水无火制则水下泄。老人寒极而遗，正坐水中之无火耳。惟是补老人之火，必
须于水中补之，以老人火衰，而水亦不能甚旺
也。方用八味地黄汤∶
熟地（一两） 山茱萸（一两） 山药（五钱） 茯苓（二钱） 泽泻（一钱） 丹
皮（一钱） 附子（一钱） 肉桂（一钱）水煎服。连服二剂，溺即止矣，服十日全愈。
约照此方分两，修合丸散，每日服一两，永不再遗。
八味地黄汤正水中补火之圣药。水中火旺，则肾中阳气自能通于小肠之内，下达于膀胱。
膀胱得肾之气，能开能阖，一奉令于肾，何敢私自开关，听水之自出乎？气化能出，即气化
能闭也。惟是八味汤中，茯苓、泽泻过于利水，老人少似非宜，丹皮清骨中之热，遗尿之病
助热而不可助寒，故皆略减其分量，以制桂附之横，斟酌得宜，愈见八味汤之妙。然此方但
可加减，而不可去留，加减则奏功，去留则寡效也。
此症亦可用助老汤治之。
熟地（一两） 山茱萸（一两） 益智（一钱） 肉桂（二钱） 远志（一钱） 炒
枣仁（五钱） 人参（三钱） 北五味（二钱）水煎服。
人有憎热喜寒，面红耳热，大便燥结，小便艰涩作痛，夜卧反至遗尿，人以为膀胱之热
也，谁知是心火之炎亢乎。夫心与小肠为表里，心热而小肠亦热。然小肠
主下行者也。因心火太盛，小肠之水不敢下行，反上走而顾心，及至夜卧，则心气趋于
肾，小肠之水不能到肾，只可到膀胱，以膀胱与肾为表里，到膀胱即是到肾矣。然而膀胱
见小肠之水，原欲趋肾，意不相合，且其火又盛，自能化气而外越，听其自行，全无约束，
故遗尿而勿顾也。治法将泻膀胱，而膀胱无邪，将补膀胱，而膀胱又未损正。然则奈
何？泻心火之有余，而遗尿自止矣。方用清心莲子饮加减治之。
茯苓（三钱） 麦冬（三钱） 竹叶（三十片） 莲子心（三钱） 黄连（二钱） 白
芍（五钱） 陈皮（五分） 丹皮（二钱） 天门冬（三钱） 紫菀（一钱） 玄参（三
钱）水煎服。一剂少利，再剂大利，三剂全愈。
此方专清心火，不去止小肠之水，盖此等遗尿，愈止而愈遗也。
此症亦可用加减逍遥散治之。
茯苓 白芍 当归 车前子（各五钱） 山药 丹皮（各三钱） 柴胡 黄连（各一钱）
人参（五分） 陈皮（三分） 甘草（五分）水煎服。
有一位夜间睡眠时遗尿的人，他怕冷喜欢温暖，面色发黄且身体虚弱，大便稀溏，小便次数频繁。人们认为这是小肠虚寒所致，却不知这其实是肾气虚弱的缘故。肾脏与膀胱互为表里，膀胱的开合功能是由肾脏主导的。因为膀胱受命于肾，如果肾阳寒冷，膀胱自然就不听从肾脏的命令，所以肾脏不能固摄，膀胱也就无法闭合。治疗原则如果是试图通过收敛肾水来消除水寒，不如温补肾阳之水使水液自缩。方剂使用温泉饮：白术（一两）、巴戟天（一两）、益智仁（三钱）、肉桂（一钱），水煎服。服用一剂后遗尿即止，连续服用四剂，不再遗尿。
这个方子是脾肾双补的方法。肉桂能温补命门之火以驱散寒邪，益智仁能阻断膀胱的漏泄，而且白术能疏通腰部和脐部的气机，这样病情与药物自然契合。大概遗尿这种病，虽然起因于肾寒，但也由于腰脐部位的气机不通畅，导致水液不流向小肠，反而直接流入膀胱。疏通了腰脐的气机，水液就会改变路径，自然流向小肠。小肠与心脏互为表里，心气能够统摄水液而不使其突然遗出。而且白术又能向上补益心气，心气虚弱则水液下泻，心气旺盛则水液难以下泻。心肾相交则泉源温暖，心肾相交也能使水液收敛。
此症也可以使用萸术益桂汤治疗。山茱萸（五钱）、白术（一两）、肉桂（一钱）、益智仁（一钱），水煎服。
有老年人出现遗尿症状，不一定是在夜间睡觉时遗尿，即使白天不睡觉也会自行遗尿，比前面的病症更严重，这是因为命门寒气极盛，不能制约水液。老年人阳气孤弱，怎么会达到寒气极盛而自行遗尿呢？大概人有偏阴或偏阳的区别，阳气旺盛则有阴虚火动的忧虑，阳气衰弱则有阴冷水沉的祸患。少年时期，过度耗泄精气，精水亏去，阳气又怎能存在？水和火必然是相互制约的，火没有水的制约就会向上炎升，水没有火的制约就会向下泄漏。老年人寒气极盛而遗尿，正是由于水中无火所致。只是要补益老年人的阳气，必须从水中进行补益，因为老年人阳气衰微，水液也不能过于旺盛。方剂使用八味地黄汤：熟地黄（一两）、山茱萸（一两）、山药（五钱）、茯苓（二钱）、泽泻（一钱）、牡丹皮（一钱）、附子（一钱）、肉桂（一钱），水煎服。连续服用两剂，溺尿即止，服用十天完全痊愈。大约按照此方的分量比例，制作成丸药或散剂，每天服用一两，永远不再遗尿。
八味地黄汤正是从水中补火的圣药。水中的阳气旺盛，肾中的阳气自然能通达于小肠内部，下达至膀胱。膀胱得到肾气的支持，就能正常开合，一切听命于肾，怎敢私自开关，任由水液自行流出呢？气化功能能控制排泄，也就意味着能控制闭藏。只是八味汤中，茯苓、泽泻利水作用过于强烈，对于老年人来说似乎不太适宜；牡丹皮清解骨中之热，遗尿之病助热而不可助寒，因此都略微减少其分量，以制约肉桂和附子的燥烈之性，斟酌得宜，更显八味汤的精妙。然而此方只能加减，不能随意去除或增加药物，加减才能奏效，随意去留则效果甚微。
此症也可以使用助老汤治疗。熟地黄（一两）、山茱萸（一两）、益智仁（一钱）、肉桂（二钱）、远志（一钱）、炒酸枣仁（五钱）、人参（三钱）、北五味子（二钱），水煎服。
有人厌恶炎热喜欢寒冷，面色发红耳朵发热，大便干燥结硬，小便艰涩且伴有疼痛，夜间睡觉反而出现遗尿，人们认为是膀胱有热，却不知这是心火亢盛的原因。心脏与小肠互为表里，心热则小肠也热。然而小肠主要功能是向下传导。因为心火太盛，小肠中的水液不敢向下行，反而向上流去顾护心脏，等到夜间卧床时，心气趋向于肾，小肠的水液不能到达肾脏，只能到达膀胱，因为膀胱与肾脏互为表里，到达膀胱即是到达肾脏了。然而膀胱见到来自小肠的水液，原本想要趋向肾脏，心意不相符合，况且其中的火势又盛，自然能化气向外发散，听任其自行流动，完全没有约束，所以发生遗尿而不予顾惜。治疗方法如果要清泻膀胱，但膀胱并无邪气；如果要补益膀胱，但膀胱正气并未受损。那么该怎么办呢？清泻心火之有余，遗尿自然就会停止。方剂使用清心莲子饮加减治疗。茯苓（三钱）、麦冬（三钱）、竹叶（三十片）、莲子心（三钱）、黄连（二钱）、白芍（五钱）、陈皮（五分）、牡丹皮（二钱）、天门冬（三钱）、紫菀（一钱）、玄参（三钱），水煎服。服用一剂后小便稍通利，服用两剂后通利明显，服用三剂后完全痊愈。
这个方子专门清泻心火，不去强行止住小肠的水液，因为这类遗尿，越止泻反而遗尿越严重。
此症也可以使用加减逍遥散治疗。茯苓、白芍、当归、车前子（各五钱）、山药、牡丹皮（各三钱）、柴胡、黄连（各一钱）、人参（五分）、陈皮（三分）、甘草（五分），水煎服。
There is a person who suffers from nocturnal enuresis (bedwetting) during sleep. This individual fears cold and prefers warmth, has a sallow complexion with a frail constitution, loose stools, and frequent urination. People attribute this to deficiency of the Small Intestine, but little do they know it is actually due to deficiency of Kidney Qi (Kidney Energy). The Kidneys and Bladder are exterior-interiorly related; the opening and closing of the Bladder are governed by the Kidneys. Since the Bladder receives orders from the Kidneys, if the Kidneys are cold, the Bladder naturally disobeys the Kidney's commands. Thus, when the Kidneys fail to consolidate, the Bladder also fails to close. The treatment principle is that attempting to restrain kidney water to eliminate cold water is inferior to warming the kidney water so that the fluid naturally contracts. Use the formula Wenquan Yin (Hot Spring Drink): Baizhu (Atractylodis Rhizoma, 1 liang), Bajitian (Morindae Officinalis Radix, 1 liang), Yizhiren (Alpiniae Oxyphyllae Semen, 3 qian), Rougui (Cinnamomi Cortex, 1 qian). Decoct in water and take orally. Enuresis stops after one dose; after four consecutive doses, it does not recur.
This formula employs a method of tonifying both the Spleen and Kidneys. Rougui warms the Mingmen Fire (Gate of Vitality) to dispel cold, Yizhiren stops bladder leakage, and Baizhu unblocks qi in the waist and umbilical region, ensuring the disease and medicine are mutually suitable. Generally, enuresis originates from Kidney cold but is also caused by blocked qi in the waist and umbilical area, preventing water from flowing into the Small Intestine and causing it to flow directly into the Bladder. By unblocking the qi in the waist and umbilicus, water changes its course and flows naturally into the Small Intestine. The Small Intestine and Heart are exterior-interiorly related, and Heart Qi can control the fluid so it does not suddenly leak. Furthermore, Baizhu tonifies Heart Qi upwards; when Heart Qi is deficient, water flows downward as diarrhea, but when Heart Qi is robust, water is difficult to discharge. When Heart and Kidney interact, the source becomes warm; when Heart and Kidney interact, the fluid also contracts.
This condition can also be treated with Yuzhu Yigui Tang (Cornus and Atractylodes Cinnamon Decoction): Shanzhuyu (Corni Fructus, 5 qian), Baizhu (Atractylodis Rhizoma, 1 liang), Rougui (Cinnamomi Cortex, 1 qian), Yizhiren (Alpiniae Oxyphyllae Semen, 1 qian). Decoct in water and take orally.
Elderly people may suffer from enuresis not only at night but also spontaneously during the day without sleeping, which is more severe than the previous condition. This is due to extreme cold in the Mingmen (Gate of Vitality) failing to control water. How can an elderly person with isolated Yang reach such extreme cold? People have tendencies toward Yin or Yang excess. When Yang is vigorous, there is worry of Yin deficiency with fire stirring; when Yang declines, there is the hazard of Yin excess with cold water sinking. In youth, excessive loss of essence depletes water, leaving no fire remaining. Water and fire must mutually constrain each other; without water to constrain fire, fire flares upward; without fire to constrain water, water leaks downward. The elderly person’s extreme cold and enuresis result precisely from the absence of fire within the water. To tonify the fire of the elderly, it must be done within the water, because as their fire declines, water cannot become overly vigorous. Use the formula Bawei Dihuang Wan/Tang (Eight-Ingredient Rehmannia Pill/Decoction): Shudi (Rehmanniae Radix Praeparata, 1 liang), Shanzhuyu (Corni Fructus, 1 liang), Shanyao (Dioscoreae Rhizoma, 5 qian), Fuling (Poria, 2 qian), Zexie (Alismatis Rhizoma, 1 qian), Danpi (Moutan Cortex, 1 qian), Fuzi (Aconiti Lateralis Radix Praeparata, 1 qian), Rougui (Cinnamomi Cortex, 1 qian). Decoct in water and take orally. After two consecutive doses, urination stops; after ten days, full recovery occurs. Approximately following the proportions of this formula, prepare pills or powders, taking 1 liang daily, to prevent recurrence permanently.
Bawei Dihuang Tang is the supreme medicine for tonifying fire within water. When fire within water is vigorous, Kidney Yang naturally communicates into the interior of the Small Intestine and descends to the Bladder. With Kidney Qi supporting the Bladder, it can open and close properly, obeying the Kidney’s command. How would it dare to open or close privately, allowing water to escape on its own? If qi transformation can control excretion, it implies it can also control retention. However, in Bawei Tang, Fuling and Zexie are too diuretic, which may not be suitable for the elderly; Danpi clears heat from the bones; since enuresis involves assisting heat rather than cold, these ingredients should be slightly reduced in dosage to moderate the harshness of Rougui and Fuzi. Such careful adjustment highlights the efficacy of Bawei Tang. Nevertheless, this formula allows for modification but not removal or addition of core herbs; modifications yield results, while arbitrary changes lead to poor efficacy.
This condition can also be treated with Zhulao Tang (Assisting the Elderly Decoction): Shudi (Rehmanniae Radix Praeparata, 1 liang), Shanzhuyu (Corni Fructus, 1 liang), Yizhi (Alpiniae Oxyphyllae Semen, 1 qian), Rougui (Cinnamomi Cortex, 2 qian), Yuanzhi (Polygalae Radix, 1 qian), Chao Zaoren (Ziziphi Spinosae Semen Fried, 5 qian), Renshen (Ginseng Radix et Rhizoma, 3 qian), Bei Wuwei (Schisandrae Chinensis Fructus, 2 qian). Decoct in water and take orally.
There is a person who dislikes heat and prefers cold, has a red face and hot ears, dry and constipated stools, and painful, difficult urination, yet suffers from enuresis at night. People attribute this to Heat in the Bladder, but little do they know it is due to Hyperactive Heart Fire. The Heart and Small Intestine are exterior-interiorly related; Heart Heat causes Small Intestine Heat. However, the Small Intestine primarily governs downward movement. Because Heart Fire is too excessive, water in the Small Intestine dares not move downward and instead flows upward to attend to the Heart. At night, when lying down, Heart Qi tends toward the Kidneys; thus, water from the Small Intestine cannot reach the Kidneys and only reaches the Bladder. Since the Bladder and Kidneys are exterior-interiorly related, reaching the Bladder is equivalent to reaching the Kidneys. However, upon seeing water from the Small Intestine, the Bladder originally intended to move toward the Kidneys, but the intentions did not align. Moreover, the fire was intense, naturally transforming qi and dispersing outward, acting without constraint, leading to enuresis without regard. Treatment requires neither purging the Bladder (as there is no pathogen) nor tonifying the Bladder (as its righteous qi is undamaged). So what should be done? Purge the excess of Heart Fire, and enuresis will stop naturally. Use modified Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction): Fuling (Poria, 3 qian), Maidong (Ophiopogonis Tuber, 3 qian), Zhuye (Bambusae Folium, 30 leaves), Lianzixin (Nelumbinis Plumula, 3 qian), Huanglian (Coptidis Rhizoma, 2 qian), Baishao (Paeoniae Radix Alba, 5 qian), Chenpi (Citri Reticulatae Pericarpium, 5 fen), Danpi (Moutan Cortex, 2 qian), Tiandong (Asparagi Radix, 3 qian), Ziwan (Asterae Radix, 1 qian), Xuanshen (Scrophulariae Radix, 3 qian). Decoct in water and take orally. After one dose, urination becomes slightly freer; after two doses, significantly freer; after three doses, fully recovered.
This formula specifically clears Heart Fire and does not attempt to stop Small Intestine water directly, because for this type of enuresis, stopping it further exacerbates the leakage.
This condition can also be treated with Jiajian Xiaoyao San (Modified Free and Easy Wanderer Powder): Fuling (Poria), Baishao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix), Cheqianzi (Plantaginis Semen) (each 5 qian), Shanyao (Dioscoreae Rhizoma), Danpi (Moutan Cortex) (each 3 qian), Chaihu (Bupleuri Radix), Huanglian (Coptidis Rhizoma) (each 1 qian), Renshen (Ginseng Radix et Rhizoma, 5 fen), Chenpi (Citri Reticulatae Pericarpium, 3 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 5 fen). Decoct in water and take orally.