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Nocturnal enuresis in children is caused by deficiency of both the Kidney and Bladder, allowing cold pathogenic factors to invade. Consequently, urine transmission lacks restraint. Some cases arise from congenital insufficiency of Yang Qi, leading to a cold bladder that cannot control urination, resulting in involuntary leakage. Others result from internal deficiency combined with damp-heat, causing dribbling enuresis. Urine that is red indicates blood heat; white urine indicates Qi deficiency. Additionally, involuntary urination during sleep is called bedwetting. This is also due to Kidney deficiency and coldness of the Bladder; since night belongs to Yin, urinary incontinence occurs spontaneously during sleep. White turbidity (Bai Zhuo) refers to urine as cloudy as rice washings, caused by irregular breastfeeding or diet damaging the Spleen, leading to failure in separating clear from turbid substances, which may eventually develop into infantile malnutrition (Gan syndrome). Turbidity that is initially red then becomes white indicates Heart heat. Purely white discharge indicates Gan syndrome. If an older child presents with both red and white turbidity, although the colors differ, they generally stem from Fire pathogens. Red turbidity results from damp-heat invading the Blood level; white turbidity results from damp-phlegm sinking downward. Another type involves Kidney Qi deficiency and coldness, failing to secure essence, causing urine to be white like oil, with unstable luster, coagulating like paste; prolonged cases lead to Kidney exhaustion and consumption disease. For deficiency with accompanying heat, draining and separating methods should be used first; for deficiency with accompanying cold, warming and tonifying are appropriate. Pulse diagnosis should guide treatment.

Treatment for nocturnal enuresis:
Chicken gizzard (one piece, female chicken for males, male chicken for females, burnt until carbonized but retaining efficacy) Oyster Shell (Mu Li), Poria (Fu Ling), Mantis Egg Case (Sang Piao Xiao, stir-fried, 5 qian), Cinnamon Twig (Gui Zhi, bark removed), Dragon Bone (Long Gu) (each 2.5 qian). Grind into powder. Also burn one chicken gizzard and one chicken intestine until carbonized, grind into fine powder. Take 1 qian of the previous powder each time, dissolve in warm wine, taken after meals.

Zhu Danxi specifically emphasizes treating based on "Heat," believing that heat promotes circulation, thus using Anemarrhena Rhizome (Zhi Mu), Phellodendron Bark (Huang Bai), Trichosanthes Powder (Ge Fen), and Indigo Naturalis (Qing Dai). If internal injury causes dual deficiency of Qi and Blood, unable to maintain retention, substantial tonification of Qi and Blood with astringents is required. If illness arises from excessive thinking, located in the Heart, use An Shen Wan combined with tonics. Slippage of semen is primarily due to damp-heat; Huang Bai and Zhi Mu descend Fire, while Mu Li and Ge Fen dry dampness. When the Chi pulse at both wrists is surging and rapid, it indicates Fire agitation causing Water instability, leading to turbid urine and seminal emission. A short and small Xin Mai indicates Heart Blood deficiency, where the Heart fails to control the Kidney. Emission occurring once every few weeks, unresponsive to clearing heat, turns into deficiency-cold; emission occurring less than ten days apart, worsening with astringents, indicates stagnation. Emission associated with sexual dreams is called dream emission (Meng Yi); spontaneous emission without dreams is called seminal slippage (Jing Hua). Spontaneous ejaculation upon hearing or seeing stimuli is called white yin (Bai Yin). All are caused by ministerial Fire agitation; long-term cases involve only deficiency without cold. In summary, seminal emission and strangury/turbidity stem from Heart deficiency with heat; reckless Heart Fire fails to descend to interact with the Kidney, causing loss of primordial essence. Excessive Liver Fire causing persistent erection and continuous emission is called strong middle (Qiang Zhong), often accompanied by wasting-thirst (Xiao Ke) and carbuncles. The left Kidney stores Jing (Essence), which is True Water; the right Kidney stores Qi, which is Ministerial Fire. Dream emission and seminal slippage result from excessive thinking agitating Heart Fire. Heart Fire is Sovereign Fire; when Sovereign Fire moves, Ministerial Fire follows, stirring True Water and causing leakage. Using drying-hot herbs here is like adding wood to fire. One should calm the Spirit and nourish Qi so Essence and Spirit adhere naturally. Astringent herbs are considered "plundering agents"; stop them when the disease resolves, do not overuse. Long Gu dries fluids excessively; chronic use causes late-life dryness and heat. Some argue prolonged leakage leads to cold, but Essence is Yin, Fire is Yang; Yin deficiency exacerbates Yang Fire. The Classic states: "Yin deficiency generates internal heat," not cold. Ancient formulas for dream emission often address stagnation. Quacks use astringents for collapse, worsening stagnation. Treatment principles: Treat the Heart for dream emission; secure the True Essence for seminal slippage; regulate emotions for overflow; harmonize meridians for red turbidity; nourish the Spirit. When Heart is calm and Spirit peaceful, Water and Fire interact, clearing turbidity. Unfulfilled desires damaging Yuan Yin cause dream emission via hidden Fire movement in thoughts. Follow desires to clear mental Fire. Assess Yuan Qi strength. For Yuan Yang weakness and insecure spirit causing slippage, add Deer Antler Frost (Lu Jiao Shuang), Oyster Shell (Mu Li), Deer Antler (Lu Rong), Cynomorium (Suo Yang), plus Ginseng (Ren Shen) and Aconite (Fu Zi) to secure.

Dream emission and seminal slippage are often treated as Kidney deficiency, but if tonifying/astringing fails, consider Spleen/Stomach issues from alcohol and rich foods causing phlegm-fire damp-heat. Kidney stores Essence, generated by Spleen/Stomach transformation of food and transported to Kidney. Damp-heat damaging Spleen/Stomach causes mid-Jiao Qi stagnation and turbidity; transformed Essence becomes turbid. Kidney governs closure; Yin stillness brings peace. Turbid Essence disturbs with evil Fire, preventing Kidney Water from resting, causing emission/slippage, similar to white turbidity. Danxi states white turbidity is turbid Qi from Stomach sinking into Bladder. Those with excessive lust and wild imagination should be treated from Heart and Kidney.

Dream emission treatment focuses on Kidney and Liver. *Zhun Sheng* notes early stages may involve Heart/Lung/Spleen/Stomach deficiency, but must transmit to Kidney/Liver for essence to leak. Heart and Kidney are Water/Fire organs, storing Spirit and Essence, masters of the Five Viscera. If other organs cause Kidney leakage, examine all four aspects for treatment. The Classic says: "The key to Yin-Yang is dense Yang ensuring solidity. If Yang is strong but not dense, Yin Qi perishes. If Yin is flat and Yang is secret, Spirit thrives. If Yin-Yang separate, Spirit dies." Strong Yang refers to vigorous Ministerial Fire in Liver/Kidney. Yin perishing refers to depletion of True Yin in Kidney. Kidney (Yin) stores; Liver (Yang) excretes. Kidney Yin deficiency means Essence is not stored; Liver Yang excess means Fire is not contained. Uncontained Fire over unstored Essence leads to emission even without dreams. Why erotic dreams? The Classic says: "Jue Qi invades the genitalia, leading to dreams of intercourse." Genitalia are the orifice for semen, governing sinews, meeting channels of Foot Taiyin, Yangming, Shaoyin, Jueyin, Chong, Ren, and Du. Sinews gather there, housing Ministerial Fire. Sexual activity relies on this Fire. When active, Fire from Sanjiao descends, pores open, Essence flows to genitals. Only those with solid Yuan Jing resist this. Weak constitution, excessive lust, depleted Kidney Yin allows Sovereign Fire to move, dragging Ministerial Fire. Essence leaves its position. Sleepers with balance have no disease; weak ones dream and emit. Liver Fire excess causes leakage; Kidney Qi weakness fails to store. Liver Fire excess stems from Kidney Yin deficiency. Thus, treat Kidney/Liver. Question: Why does Danxi's Bu Yin Wan fail for Yin-deficiency Fire-agitation? Misunderstanding of nourishing Yin. Danxi used Shen Qi Wan as the base; modern practitioners wrongly use Zhi Mu/Huang Bai as sovereign, employing Kan Li Gu Ben types, which are cold-draining. Kidney needs tonification, not draining. Li Dongyuan clarified Danxi, using Liu Wei Di Huang Wan exclusively, effective because Water nourishes Wood, extinguishing Fire. For Spleen/Stomach deficiency with damp-heat sinking, use Liu Wei plus Bu Zhong Yi Qi Tang to raise. For excessive mental work causing Heart deficiency and unchecked Ministerial Fire, use Liu Wei plus Gui Pi Tang. For Ming Men Fire decline and essence collapse, use Ba Wei Wan or Jin Suo Zheng Yuan Dan to strengthen True Yang and secure Essence.

Essence generates Qi; Qi generates Shen. Essence damage reduces Qi generation, causing emaciation and fatigue. Qi weakness fails to generate Shen. If Qi is not secured internally, Water cannot control Fire, leading to emission and further Essence loss. Diseases originate in Heart, root in Kidney. Heaven generates Water (Kidney), Earth generates Fire (Heart). If Kidney Water doesn't rise and Heart Fire doesn't descend, dream emission occurs. Rising Kidney Water secures Qi; descending Heart Fire prevents reckless movement. Imbalance leads to non-interaction of Water/Fire. Dream emission originates in Heart Fire, aided by Liver/Kidney Fire. Heart stores Shen, Liver stores Hun, Kidney stores Jing. Dreams involve Shen, visions involve Hun, emission involves Jing. Heart is Monarch, Liver/Kidney are Ministers. In dreams, Hun takes form, driven by Ministerial Fire, causing emission. Root cause: Heart Qi deficiency fails to enter Kidney Yin; Kidney Qi deficiency fails to receive Heart Qi. Heart loses quietude; Kidney loses storage. Dream emission stems from thoughts/Heart deficiency; non-dream emission stems from lust/Kidney essence slippage/ministerial Fire. Other causes: drunkenness/fatigue failing to raise clear Qi; Kidney Yin deficiency with淫火 steaming essence; Ministerial Fire excess with damaged Spleen/Stomach failing to transform daily Essence; Fire flaming up, Water sinking, Heart-Kidney non-interaction; robust youth with abstinence causing fullness overflow; Spleen deficiency sinking; Phlegm-fire damp-heat disturbing the Essence Mansion. Treatment: Protect Heart, nourish Kidney, address damp/heat/cold, tonify Middle Qi to raise Yuan Yang. Avoid astringents as they stagnate Qi/Blood flow. White turbidity originates in Spleen/Stomach deficiency, manifests as Bladder cold. Initial turbidity is damp-heat; chronic is Qi collapse. Collapse means lower Jiao lacks Fire/warmth. Acute is not purely Yin; chronic is not purely Yang. Generally, white turbidity damages Qi; red turbidity damages Blood. There are two yin orifices: one for essence (Kidney), one for urine (Bladder). They do not open simultaneously. During sex, essence orifice opens, urine closes; during urination, urine orifice opens, essence closes. Thus, emission/slippage exits via essence orifice (Kidney Ministerial Fire deficiency-heat); turbidity/strangury exits via urine orifice (Bladder damp-heat). The Classic states: "Endless thoughts, unfulfilled wishes, external lust, excessive sex cause sinew flaccidity and white yin." Ancient theories confirm turbidity is an essence disease in the essence orifice, distinct from strangury in the urine orifice. Treating turbidity as strangury with Wu Ling San or Ba Zheng San is ineffective and worsens condition.

All five viscera possess Essence, the root of life. Kidney is the gathering place, obeying the Heart Monarch. Restrain desires, clarify mind, secure Essence, balance Yin-Yang. Indulgence damages Heart-Kidney interaction. The Classic says: "Fear and worry injure Shen... Fear unresolved injures Jing... Five viscera store Essence; injury leads to loss of control... Kidney governs Water, receiving Essence from all viscera... Jue Qi in genitalia causes dreams of intercourse." Yet ancient texts often attribute emission solely to Kidney Qi weakness, ignoring other viscera. The Classic states all viscera have Essence, Kidney stores it. Non-dream emission often involves Heart-Kidney injury; dream emission involves strong Ministerial Fire. If all viscera function correctly, Essence is stored. If one viscus is abnormal, it harms Heart/Kidney. Treatment: If solely Kidney, treat Kidney; if from other viscera, treat both. Six-pulse diagnosis clarifies this.

Young unmarried men with frequent dream emission experience natural overflow; do not over-treat. Thoughts appear in dreams, agitating Heart and Ministerial Fire. Over-tonification aids Fire; over-astringency increases stagnation.

Chan Master Da Zhi said: Do not treat all dream emission as deficiency-cold; some arise from channel heat. Treated a man with spinal heat and dream emission using Zhen Zhu Fen Wan and Zhu Ling Wan, stopping emission and removing heat. Another man with surging pulse and waist heat used Chen Xiang He Zhong Wan and Dao Chi San to clear Fire. Thus, slippage is often cold-related; dream emission is often heat-related.

Zhao Yi De treated Zheng Lushu (20s), studying hard, sleeping late. Emission occurred when penis touched bedding/legs, not when suspended. Appetite decreased, fatigue increased. Caused by excessive mental effort, dual Fire rising, insomnia, Blood not returning to Liver, Kidney Water insufficient, Fire exploiting Yin deficiency, invading lower Jiao, stirring essence chamber. Touch acted as Jue Qi, causing dreams. Treatment: Upper: Tonify Heart, calm Spirit; Middle: Regulate Spleen/Stomach, raise Yang; Lower: Nourish Essence, generate Yin, secure Yang. Recovered in three months.

Heart/Kidney are Water/Fire organs. Heart Spirit injury agitates Fire; relentless Fire damages Kidney Water. Kidney stores Essence received from all viscera; if damaged, Essence leaks downward, causing emission. Wu Jiaoshan treated a man with post-illness mental overexertion causing dream emission, phlegm, emaciation. Qing Xin Lian Zi Yin failed. Pulse was tight/raspy; cold/diuretic drugs were excessive, causing Kidney Qi to sink alone. Used lifting method to raise Kan Water to aid Li Fire, descend Yang to nourish Yin Blood, then Deer Antler Glue and Human Milk to fill Essence/Blood. Recovered in a month. Dream emission has many causes: Accumulated heat requires clearing Heart/descending Fire; Cold/drug-induced requires warming/lower Yuan tonification; Sinking Kidney Qi requires lifting to restore Water-Fire interaction.

Previous analyses focused on Kidney with Heart/Spleen support. One exception: Kidney not deficient, but Liver channel damp-heat/fire excess causing penile pain, tendon contraction, itching, swelling, or protrusion, with white fluid like semen in urine. This is Sinew Hernia (Jin Shan). Use Long Dan Xie Gan Tang. Zhang Zihe stated: Enuresis, retention, impotence, bladder paralysis, seminal slippage, white yin are all male hernias. For women: Blood exhaustion amenorrhea, upper waist/knee heat, foot/throat dryness, retention, abdominal masses, anterior prolapse, posterior hemorrhoids/fistulas are female hernias (called Jia in women).

Turbidity affects the essence orifice, distinct from strangury in the urine orifice. Patients feel knife-like/burning pain in penis, urine is clear, but pus-like foul matter drips from orifice tip, mixing not with urine. Mostly due to rotten essence (70-80%), damp-heat sinking or deficiency (20-30%). Both damage Essence/Blood. Red vs. White: Essence transforms from Blood. Too much turbidity loss means Essence transformation lags; red hasn't turned white, called Red Turbidity, severe deficiency. Like youths with incomplete Tian Gui forcing sex, leaking half-essence/half-blood; adults with excessive release also mix essence/blood. Some distinguish red as Qi/Blood, Heart deficiency-heat/thoughts causing red; Kidney deficiency-cold/lust causing white. However, slippery-rapid pulse with thirst/red urine indicates heat; deep-slow pulse with clear/white urine indicates cold. Ultimately, Heart moved by desire, Kidney injured by lust, forced intercourse, aphrodisiacs cause rotten essence overflow, damp-heat stagnation. Also stomach damp-phlegm sinking, consumption disease, latent summerheat, excessive thoughts agitating Heart damaging lower Jiao Essence. All visceral injuries and six climatic changes are complex; detailed pulse diagnosis reveals truth.

Zhang noted coughing Lung-deficient patients having strange dreams, even sensing outdoor events. Why? Strong Po ensures calm Hun. Wood floats, Liver stores Blood/Hun in lower Jiao; Metal sinks, Lung governs Qi/Po in highest region. If Lung dryness loses regulating authority, Liver (General) is unrestrained, Hun flies upward, unable to hide. Strong Po, calm Hun. Now weak Po, Hun refuses to hide, chasing deficient Yang, becoming erratic. Called "Departing Soul" (Li Hun). With departing soul, entry/exit is unregulated, hence sensing outside events. Urgently rescue Lung dryness. Liver Wood will be controlled, Po/Hun calm. Metal generates Water, aiding Kidney storage. Thus, Lung weakness/Liver excess causing emission is common. Liver excess stems from sufficient Kidney Water; Lung weakness stems from excess Heart Fire.

For men abstinent for long periods, intercourse with unstoppable emission is called "Walking Yang" (Zou Yang). Woman must hold firm, prevent penis withdrawal. Blow hot air into mouth, press Weilu point with finger to save. If woman startsle and withdraws, nine out of ten die. Immediately order virgin girl to perform mouth-to-mouth resuscitation to replenish Qi, then administer large dose of Du Shen Tang. Survival possible.