Incontinence of urine refers to the symptom of losing control over urination, resulting in involuntary leakage. This also includes cases where urination occurs involuntarily during the night while the person is fully conscious.

This condition is conceptually different from enuresis. The "Neijing" collectively refers to it as "qian ni" (遣溺), and it was only after the Ming and Qing dynasties that it began to be discussed separately. The "Leizheng Zhicai" states: "Enuresis is a condition where urination occurs involuntarily during sleep, or where frequent urination is uncontrollable due to lack of control." Currently, it is generally believed that enuresis refers to the involuntary discharge of urine during normal sleep, while incontinence of urine refers to the loss of control over urination while conscious. Incontinence of urine during unconsciousness is not discussed in this section.

Residual dribbling refers to the condition where urination is still controllable, but a small amount of urine leaks out after urination, which is also not within the scope of this condition.

bubble_chart Modern Research

Incontinence of urine occurs due to lesions in the central nervous system or spinal cord damage, which disrupts the functional connection between the sacral spinal cord's primary micturition reflex center and the cerebral cortex. This results in the loss of conscious control over urination. The bladder, no longer governed by sensory and motor nerves, becomes an autonomous organ, leading to involuntary urination.

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1. Kidney Qi Deficiency︰Urinary incontinence, involuntary leakage at any time, frequent and clear profuse urine, accompanied by pale complexion, fatigue and lack of strength, soreness and weakness in the lower back, cold limbs, or spermatorrhea and premature ejaculation, erectile dysfunction, pale and swollen tongue with tooth marks, thin white coating, deep and thin weak pulse. Mostly caused by prolonged illness damaging yang, decline of life-gate fire, failure in qi transformation, and loss of regulatory function, accompanied by clear profuse urine, cold body and limbs, soreness and weakness in the lower back, erectile dysfunction, commonly seen in the elderly. Treatment involves warming the kidney and reinforcing astringency, with the prescription selection of Gongdi Wan.
2. Lung-spleen Qi Deficiency︰Urinary incontinence and frequent urination, accompanied by cough, panting, and timidity, mental fatigue, physical exhaustion, reduced appetite, loose stool, abdominal distension and fullness after meals, pale tongue with thin white coating, and weak pulse. Due to chronic cough disease damaging the lungs, lung qi deficiency impairing regulation, combined with spleen deficiency and qi sinking, leading to abnormal bladder qi transformation. Concurrent symptoms include frequent urination with scant output, resulting from lung qi failing to disperse and dysfunction of the spleen in transportation, manifesting as cough, panting, reduced appetite, loose stool, and abdominal distension and fullness after meals. Treatment should focus on warming the lungs and strengthening the spleen, tonifying the middle and replenishing qi, using Middle-Tonifying Qi-Replenishing Decoction combined with Liquorice and Dried Ginger Decoction with modifications.
3. Bladder Dampness-heat︰Urinary incontinence, short and yellow urine, dribbling discharge, burning sensation in the urethra, stabbing pain, lower abdominal heaviness and discomfort, bitter taste in the mouth, dry mouth, red tongue with yellow coating, wiry and rapid pulse. Dampness-heathexternal pathogens invading the interior, or excessive consumption of spicy, hot, and greasy foods leading to dampness-heat pouring downward, resulting in dysfunction of bladder qi transformation and impaired restraint; this is an excess heat pattern due to internal accumulation of dampness-heat, hence the red and yellow urine, often accompanied by frequent, urgent, and painful urination, dribbling discharge, and acute onset. Treatment should aim to clear and drain damp-heat, using the formula Eight-Ingredient Rectification Powder.
4. Liver-kidney Yin Deficiency︰Urinary incontinence, scanty and yellow urine, often accompanied by dizziness, tinnitus, flushed cheeks, hypochondriac region dull pain, soreness and weakness in the lower back and legs, steaming bone fever, night sweats, vexing heat in the chest, palms, and soles, unsmooth bowel movements, a red tongue with scant coating, and a wiry, thin, and rapid pulse. This is due to liver and kidney yin deficiency, with yin deficiency leading to internal heat, and deficient heat disturbing internally, resulting in bladder incontinence. It is a yin deficiency pattern, with a relatively slow onset, and may also present with dizziness, tinnitus, blurred vision, hypochondriac region dull pain, soreness and weakness in the lower back and legs, and vexing heat in the chest, palms, and soles. Treatment involves nourishing water to moisten wood, supplemented with astringent therapy. The recommended formula is Major Yin-Tonifying Pill with modifications.

Kidney qi deficiency cold and lung-spleen qi deficiency both belong to deficiency pattern. Bladder heat retention and liver-kidney yin deficiency, one is excess heat, the other is deficiency heat.

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1. Zhangshi Yitong．incontinence of urine: "incontinence of urine with dribbling and painful urination is due to the leakage of true yang, use Gupiao Pill. If ineffective, use modified Mantis Egg-Case Powder. If symptoms are worse during the day, it is due to yang deficiency, tonify the middle and replenish qi with cooked Aconite Lateral Root; if worse at night, it is due to yin deficiency, use Eight-Ingredient Pill."
2. Leizheng Zhicai．retention of urine and enuresis: "Some cases are due to fear leading to enuresis, this is due to insufficiency of heart qi and deficiency of the liver and kidney, use Returning to Spleen Decoction, or Five Gentlemen Decoction."