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Jing (Essence) is the supreme treasure of the body, originating from congenital endowment and formed through postnatal nourishment. (Jing belongs to Water; Heaven generates One Water, originating at the beginning of life and growing through the nourishment of food and water.) Jing resides in all five Zang organs but is governed by the Kidney. In a state of stillness, it is stored; in a state of movement, it is discharged. Stillness is the virtue of Water, while movement is the function of Fire. If Fire does not overcome Water, then in a healthy person, even with physiological arousal, as long as there is no external sexual intercourse, leakage will not occur. However, if Kidney Water is extremely deficient and Heart Fire is extremely blazing, then upon mental stimulation, leakage may occur even without sexual intercourse. It is evident that leakage occurring only through intercourse must also require sleep and dreams of sexual union to result in seminal emission. Conversely, leakage occurring without intercourse implies that it happens without dreams or sleep. Therefore, emissions occurring without sleep, those occurring during sleep without dreams, and those occurring during sleep with dreams of sexual union should be discussed separately.

Why do dreams of sexual union occur? The answer is: Ministerial Fire (Xiang Huo) lodges in the Yin organ (genitals). When the Yin organ is disturbed by this lodging fire, it becomes aroused and erect, leading to a desire for intercourse, thus resulting in sexual acts within dreams. If Fire does not lodge in the Yin organ, other types of dreams would occur. However, there is a distinction between dreams with and without sexual desire. Dreams of sexual union without conscious desire arise because Qi agitation moves the Will (Zhi); dreams with conscious desire arise because Will agitation moves Qi. When Qi moves Will, dreaming does not necessarily lead to emission; when Will moves Qi, dreaming invariably leads to emission. Does Ministerial Fire exist only in the Liver and Kidney? The answer is no: The tendons of the three Yin and three Yang meridities of the foot converge with the Chong, Ren, and Du vessels, and all tendons cluster around the genitals. Therefore, Fire from various meridians can lodge there, not just those of the Liver and Kidney. Since the Kidney governs storing Essence and the Liver governs discharge, treatment focuses heavily on these two organs, and physicians should carefully examine the cause.

For cases where Kidney Water is deficient and Fire blazes, the primary treatment is Nourishing Yin and Descending Fire. For cases where Liver Qi is stagnant and Fire is abundant, the primary treatment is Dispersing Stagnation and Raising Yang. For cases where Damp-Heat from the Spleen and Stomach flows downward, the primary treatment is Draining Dampness, Clearing Heat, and Raising Clear Qi. For cases where excessive mental effort causes Heart Fire to blaze, the primary treatment is Clearing the Heart and Nourishing Blood. For cases where the Lung is affected by external pathogens or sorrow-induced Fire, the primary treatment is Dispersing Pathogens and Clearing the Lung. These are relatively easy to treat. For individuals who have abstained from sex for a long time, causing Essence to become full and overflow, no treatment is needed. The most difficult cases involve those obsessed with sexual desires; unless they sever emotional roots and cleanse delusional thoughts, medication will be ineffective.

Emissions occurring without sleep (leakage begins as soon as desire arises) and emissions occurring immediately upon falling asleep without waiting for dreams represent severe essence slipping. This may result from excessive sexual activity, chronic seminal emission, or deficiency-cold failing to secure Essence (Qi failing to hold Essence), which is more severe than simple dream emission. However, the treatment methods are similar, utilizing Suojing Wan (Locking Essence Pill), Guben Wan (Root-Securing Pill), Jinying Wan (Cherokee Rose Pill), Fengsui Dan (Phoenix Marrow Elixir), or Guzhen San (Securing True Powder). For cases of excessive mental effort where the Heart fails to control the Kidney, use Yuanzhi Wan (Polygala Pill), taken with Jiaogan Tang (Interacting Decoction) augmented with Lotus Seed and Schisandra Berry, assisted by Lingsha Dan (Cinnabar Elixir). (See Vomiting section.) For cases of unfulfilled sexual longing where Essence leaves its proper position and lodges in the genitals, causing emission during dreams, use Siqi Tang (Four Seven Decoction) (see Qi section) taken with Baiwan Zi (White Pill) (see Stroke section). In severe cases where hearing or seeing objects of desire causes immediate emission, known as "White Impurity" (Bai Yin), use Miaoxiang San (Wonderful Fragrance Powder) (see Red and White Turbidity section) taken with Yuhua Bai Dan (Jade Flower White Elixir).

For cases of excessive sexual indulgence leading to deficiency and exhaustion of the Lower Origin, with uncontrollable slippery emissions, use Lurong Wan (Deer Antler Pill) (see Blood section), Shanyao Wan (Dioscorea Pill) (see Lower Back Pain section), Datuzisi Wan (Large Cuscuta Pill) (see Cough section), or Guyang Wan (Consolidating Yang Pill). (Note: These are mostly hot-natured formulas; do not use lightly unless there is deficiency-cold.) Wuweizi (Myrica Waxberry) secures Essence more effectively than Longgu (Dragon Bone) and Muli (Oyster Shell). To facilitate communication between Heart and Kidney, Shichangpu (Acorus), Yuanzhi (Polygala), and Lianzi (Lotus Seed) are indispensable. Ancient formulas often treated stagnation, but quack doctors mistakenly used astringents. A young man suffered from turbid emissions with Qi rushing upward from the lower abdomen (Liver Qi rebellion) and daily heat in the lower back (Kidney Fire stagnation). Recognizing internal stagnation, he was first given Untan Wan (Rolling Phlegm Pill) for strong purgation, followed by Jiaban Bawu Tang (Modified Eight Substance Decoction) taken with Zishen Wan (Nourishing Kidney Pill) 100 pills. Had astringents like Ge Fen (Clam Powder) been used initially, emissions would have worsened. Instead, Daochi San (Guiding Heat Outward Powder) was prescribed in large doses, stopping the emissions. Another male patient had worsening dream emissions after taking astringents; he was given Shenxiong Wan (Spiritual Xiong Pill) for strong purgation, then cured with Zhuling Wan (Polyporus Pill). For Spleen-Stomach Damp-Heat flowing downward, Cangbai Erchen Tang (Atractylodes and Pinellia Two-Chen Decoction) (see Dampness section) with Huangbo (Phellodendron), Shengma (Cimicifuga), and Chaihu (Bupleurum) is used. For intense sexual fire, clearing the Heart prevents erratic Fire; use Yuanzhi Wan or Fushen Tang (Poria Spirit Decoction).

One case involved a scholar whose excessive mental labor caused his genitals to emit semen during dreams whenever they touched bedding or legs, but not when suspended. This was due to excessive mental effort causing Blood deficiency and Fire blazing, exhausting Kidney Water, with Fire lodging in the Lower Jiao, agitating the genital chamber so Essence could not be stored. Contact with objects simulated intercourse, triggering淫梦 (lustful dreams). Treatment involved tonifying the Heart and calming the Spirit above, regulating the Spleen and Stomach and raising Yang in the middle, and benefiting Yin and securing Essence below. (Such cases should primarily use Liuwei Dihuang Wan, Guipi Tang, or Buzhong Yiqi Tang.) A sixty-year-old patient with malaria and cough was mistreated, leading to excessive Damp-Heat below and a rapid, forceful pulse. He was given Buzhong Yiqi Tang (see Qi section) with cooling agents, followed by Huangbo Wan. The Chi pulse weakened significantly. Upon asking if he had dreamed of sex, he replied yes, but did not ejaculate. The physician noted that although old age implies depleted Essence, the Fire lodged in the Essence Chamber had dispersed into the genital orifices due to the medicine, reducing pathology. After two more days, another dream occurred, but the malaria and cough were fully resolved. There are also cases influenced by demonic entities, characterized by aversion to people, talking to oneself, laughing or crying inexplicably, resembling dementia, with irregular pulses. Treatment uses Zhusha (Cinnabar), Xionghuang (Realgar), Shexiang (Musk), Guijianyu (Arrowwood Twig), and Hutou Gu (Tiger Skull Bone). Yu Jiayan’s formula for treating such afflictions is also excellent. (See Middle Evil section.) If astringents fail to stop collapse, draining the Heart is better; if draining the Heart fails, raising Yang is best. Raising Yang is suitable for sinking Kidney Qi, downward-flowing Spleen Dampness, and Liver stagnation. Phlegm formed by emotional Qi stagnation confusing the Heart orifice requires Zhuling Wan to drain phlegm. Heat in the meridians mistaken for deficiency-cold worsens the condition; use Qingxin Wan (Clear Heart Pill). A patient with night-time spinal heat and dream emissions was cured of emissions using Zhenzhu Fen Wan (Pearl Powder Pill) and Zhuling Wan, with final resolution of spinal heat after taking Zixue (Purple Snow). Another patient with lower back heat and emissions was treated with Untan Wan for purgation and Daochi San to clear Fire. Emissions accompanied by body heat are usually due to Heat.

For floating Heart Spirit and failure of Water-Fire interaction causing slippery emissions, sedation and consolidation are needed, using Mizhen Wan (Secret True Pill) or Baxian Dan (Eight Immortals Elixir). For Mingmen Fire decline, Essence depletion, and inability to close the Jade Gate, urgently use Bawei Wan (Eight Ingredient Pill) or Jin suo Zhengyuan Dan (Golden Lock Correcting Origin Elixir). (Initial seminal emission is rarely not due to excess Fire; prolonged cases lead to Fire decline, Qi deficiency, and slippery Essence. If cold results from overuse of cooling medicines, the pulse is typically tight and choppy, indicating Cold trapping Fire in the Lower Jiao; raise Yang first. If the pulse is deep and slow, it indicates Lower Origin deficiency-cold; urgently warm and tonify, combined with raising Yang to reverse downward flow.) A type of Liver Meridian Damp-Heat causes penile pain or protrusion that does not retract, with white fluid resembling Essence discharging with urine, known as Sin Hernia (Jin Shan), treated with Longdan Xiegan Tang (Gentian Liver-Draining Decoction). (This belongs to the category of White Turbidity.)

Formula for Zixue (Purple Snow): Gold (100 liang), Shi Gao (Gypsum), Han Shui Shi (Calcitum), Ci Shi (Magnetite), Hua Shi (Talcum) (each 3 jin, crushed). Boil in 1 hu (10 dou) of water until reduced to 4 sheng. Strain, add Xi Jiao Xiao (Rhinoceros Horn shaving - substitute with Buffalo Horn), Ling Yang Jiao Xiao (Antelope Horn shaving), Qing Mu Xiang (Aquilaria), Chen Xiang (Agarwood) (each 5 liang), Xuan Shen (Scrophularia), Sheng Ma (Cimicifuga) (each 1 jin), Gan Cao (Licorice) (roasted, 8 liang), Ding Xiang (Clove) (1 liang). Boil to 1.5 dou. Strain, add Po Xiao (Mirabilite, refined 10 jin), Xiao Shi (Niter, 4 sheng; if unavailable, Mang Xiao/Mirabilite works; each sheng weighs 7 liang 7 qian 5 fen). Simmer gently, stirring constantly with a willow stick until reduced to 7 sheng. Pour into a basin of water for half a day. As it begins to solidify, add She Xiang (Musk, 1 liang 2 qian 5 fen) and Fei Zhu Sha (Fly Cinnabar, 3 liang). Stir evenly until cooled to a purple snow-like consistency. Take 1-2 qian mixed with cold water; reduce dose for children. Treats irritability, fever, mania, resolves toxicity of various heat-clearing medicines, and pediatric convulsions. Note: Zixue San in the Throat section is similar; consult both.