治以肾肝为主。经曰。阴阳之要。阳密乃固。阳强不能密。阴气乃绝。阴平阳秘。精神乃治。阴阳离决。
精气乃绝。夫所谓阳强者。乃肝肾所寄之相火强也。所谓阴绝者。乃肾中所藏之真阴绝也。肾为阴。主藏精。
肝为阳。主疏泄。是故肾之阴虚。则精不藏。肝之阳强。则火不秘。以不秘之火。加临不藏之精。除不梦。梦
即泄矣。或问曰。何故不为他梦。而偏多淫梦耶。曰灵枢经淫邪发梦篇云。厥气客于阴器。则梦接内。盖阴器
者。泄精之窍。主宗筋。足太阴阳明少阴厥阴之筋。与夫冲任督三脉之所会。诸筋皆结聚于阴器。而其中有相
火寄焉。凡平人入房。而强于作用者。皆此相火充其力也。若不接内。不与阴气合。则精不泄。一接内。与阴
相合。则三焦上下内外之火。翕然而下从。百体玄府悉开。其滋生之精。尽趋于阴器以泄。而肾不藏矣。若
其人元精坚固者。淫气不能摇。久战而尚不泄。况于梦乎。纵相火动而成宵梦。梦亦不遗。此谓阴平阳秘。无
病患也。今人先天禀赋原虚。兼之色欲过度。以致肾阴衰惫。阴虚则相火动。相火之系。上系于心为君火。感
物而动。动则相火翕然而随。虽不交会。而精已离其位。即客于阴器间矣。夜卧时。当所寄之相火一
遇。与接内时与阴气相协议。故卧而即梦。梦而即遗也。若肾不虚。则无复是梦。梦亦不遗矣。故治是证者。
先以肾肝为主。或问曰。阴虚火动而梦遗。服丹溪补阴丸。以滋阴降火。则证与药相对。每根据法服之。而不
效何也。曰。此未得丹溪滋阴之本意也。盖丹溪心法第一方。原以肾气丸为滋阴之要药也。今人不
会其意。以黄柏知母为君。概用坎离丸固本之类。凡此俱是沉寒泻火之剂。苦寒极能泻水。肾有补而无泻。焉
能有裨于阴哉。独薛立斋发明丹溪之所未发。专用六味地黄以补肾。而治梦遗
屡效。纵有相火。水能滋木。水升而木火自息矣。倘有脾胃不足。湿热下流者。以前丸为主。煎服补中益气汤
以升提之。有用心过度。心不能主令。而相火代事者。亦以前丸为主。而兼用归脾汤。有命门火衰。元精脱
陷。玉关不闭者。急用八味丸。或用金锁正元丹。以壮真阳。使之涵乎阴精而不泄。此其大略也。
归脾汤
人参 茯神 黄 白术 龙眼肉 酸枣仁（炒研各二钱半） 木香 炙甘草（各五分） 用水二钟。生姜
二钱。大红枣一枚。煎一钟服。薛新甫加当归远志。各一钱。亦妙。
昔赵以德云。予治郑鲁叔二十余岁。攻举子业。四鼓犹不卧。遂成此病。卧间玉茎但着被与腿。便梦交
接脱精。惟悬空不着则不梦。饮食日减。倦怠少气。此用心太过。二火俱起。夜不得睡。血不归肝。肾水不
足。火乘阴虚。入客下焦。鼓其精房。则精不得聚藏而欲走。因玉茎着物。犹厥气客之。故作接内之梦。
于是上补心安神。中调脾胃升其阳。下用益精生阴固阳之剂。近三月乃痊。
昔吴茭山有治遗精得法论治。一男子。因病后用心过度。遂梦遗多痰瘦削。诸医以清心莲子饮。久服
无效。吴诊其脉紧涩。知冷药利水之剂太过。致使肾气独降。服此愈剧矣。随用升提之法。升坎水而济离火。
降阳气而滋阴血。次用鹿角胶人乳填补精血。逾月全愈。因思梦遗多端。难作一途施治。有因用心
积热而泄者。有因多服门冬茯苓车前知母黄柏冷利之药而泄者。有久泄玉门不闭而泄者。治疗之法。积热者。
当清心降火。冷利者。温补下元。肾气独降者。当升提。使水火交而坎离定位。
上二案。皆以肾为主。而兼治心脾者也。独有一等。肾不虚而肝经湿热火旺者。茎中作痛。筋急缩。或
作痒。或肿。或挺纵不收。白物如精。随溺而下。此筋疝也。宜用龙胆泻肝汤。张子
和曰。遗溺闭癃阴痿脬肿精滑白淫。皆男子之疝也。若血涸不月。月罢腰膝上热。足 嗌干癃闭。而小腹有
块。或定或移。前阴突出。后阴痔漏。此女子之疝也。惟女子不曰疝而曰瘕。
Treatment focuses primarily on the Kidney and Liver. The Classics state: "The essence of Yin and Yang lies in the density of Yang; when Yang is dense, Essence is secured. If Yang becomes excessive and fails to be dense, Yin Qi will perish. When Yin is peaceful and Yang is secure, Spirit and Essence are regulated. If Yin and Yang separate and break apart, Spirit and Essence will perish." What is meant by "Yang excess" is the hyperactivity of Ministerial Fire (Xiang Huo) residing in the Liver and Kidney. What is meant by "Yin perishing" is the depletion of True Yin (Zhen Yin) stored within the Kidney. The Kidney belongs to Yin and governs the storage of Essence (Jing). The Liver belongs to Yang and governs the free flow of Qi (Shu Xie). Therefore, if Kidney Yin is deficient, Essence cannot be stored; if Liver Yang is hyperactive, Ministerial Fire cannot be secured. Subjecting unsecured Ministerial Fire to unstored Essence inevitably leads to dreams, and once dreaming occurs, emission follows. One might ask: "Why do other dreams not occur, but rather frequent erotic dreams?" The answer is found in the *Ling Shu* chapter "Dreams Caused by Pathogenic Factors": "When Jue Qi invades the genitalia, one dreams of sexual intercourse." The genitalia are the orifice for semen discharge, governing the Zong Jin (Tendons), where the tendons of the Foot Taiyin, Yangming, Shaoyin, and Jueyin meridians, along with the Chong, Ren, and Du vessels, converge. All tendons cluster at the genitalia, where Ministerial Fire resides. In healthy individuals engaging in sexual activity, strength and potency are derived from this Ministerial Fire. Without sexual contact and without combining with Yin Qi, semen will not be discharged. Once contact is made and Yin Qi combines, the fire of the San Jiao (Triple Burner) throughout the upper, lower, interior, and exterior rapidly descends. The pores of the entire body open, and all generated Essence rushes toward the genitalia for discharge, causing the Kidney to fail in its storing function. If a person's primordial Essence is solid and strong, pathogenic Qi cannot disturb them; even after prolonged intercourse, they do not ejaculate, let alone during sleep. Even if Ministerial Fire moves and causes nocturnal dreams, no emission occurs. This is called "Yin Peaceful and Yang Secure," indicating a state of health without disease. However, modern people often have congenital deficiency combined with excessive sexual indulgence, leading to exhaustion of Kidney Yin. Yin deficiency causes Ministerial Fire to flare up. The root of Ministerial Fire connects upward to the Heart, becoming Sovereign Fire (Jun Huo); stimulated by external objects, it moves, causing Ministerial Fire to descend rapidly. Although actual intercourse does not take place, the Essence has already left its proper position and lingers in the genitalia. During sleep, when the resident Ministerial Fire encounters this state, it acts similarly to the combination with Yin Qi during intercourse. Thus, one dreams while sleeping and emits while dreaming. If the Kidney is not deficient, such dreams will not recur, and no emission will occur during dreams. Therefore, treating this condition prioritizes regulating the Liver and Kidney. One might ask: "For dream emission caused by Yin deficiency and Fire hyperactivity, taking Danxi's Pill to Nourish Yin (Buyin Wan) aims to nourish Yin and descend Fire, matching the syndrome and treatment. Why does it fail when taken according to the method?" The answer is that one has not grasped the original intent of Danxi's Yin-nourishing theory. The primary formula in Danxi's *Xin Fa* is actually Shenqi Wan (Kidney Qi Pill) as the essential medicine for nourishing Yin. Modern practitioners misunderstand this, using Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) as chief ingredients, indiscriminately using formulas like Kanli Wan or Guben Wan. These are all cold and purgative agents that strongly drain Water (Yin). The Kidney is only supplemented, never drained; how can such drugs benefit Yin? Only Xue Lizhai elucidated aspects of Danxi's theory that were previously unexpressed, specifically using Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to tonify the Kidney, achieving frequent success in treating dream emission. Even if Ministerial Fire exists, Water nourishes Wood; as Water ascends, Wood-Fire naturally subsides. If there is Spleen-Stomach insufficiency with Damp-Heat flowing downward, use the aforementioned pill as the base, decocted with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise the clear Qi. If mental overexertion causes the Heart to lose its command, allowing Ministerial Fire to take over, use the aforementioned pill as the base, combined with Guipi Tang (Restore the Spleen Decoction). If Mingmen Fire (Gate of Life Fire) is declined, with primordial Essence sinking and the Jade Gate failing to close, urgently use Bawei Wan (Eight-Ingredient Pill) or Jin Suo Zhengyuan Dan (Golden Lock Stabilizing Primordial Elixir Pill) to strengthen True Yang, enabling it to contain Yin Essence and prevent leakage. This outlines the general approach.
Guipi Tang (Restore the Spleen Decoction):
Renshen (Ginseng Radix), Fushen (Poria with Hostwood), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Longyanrou (Longan Aril), Suanzaoren (Ziziphi Spinosae Semen, stir-fried and crushed, 2.5 qian each), Muxiang ( Aucklandiae Radix), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum, 0.5 qian each). Decoct with 2 zhong of water, 2 qian of fresh ginger, and 1 large red date, until 1 zhong remains. Take orally. Xue Xinpu added Danggui (Angelicae Sinensis Radix) and Yuanzhi (Polygalae Radix), 1 qian each, which is also excellent.
Zhao Yi-de once stated: "I treated Zheng Lushu, who was in his twenties, studying for imperial examinations, staying awake until the fourth watch (midnight to 2 AM). He developed this condition. While lying down, if his penis touched the blanket or his legs, he would dream of sexual intercourse and emit semen. Only when suspended in air without contact did he avoid dreams. His diet decreased daily, and he suffered from fatigue and shortness of breath. This was due to excessive mental exertion, causing both Heart Fire and Ministerial Fire to arise, preventing sleep at night. Blood failed to return to the Liver, Kidney Water became insufficient, and Fire exploited the Yin deficiency, invading the Lower Jiao, stirring the Essence Chamber. Consequently, Essence could not gather and store, but tended to escape. Because the penis touched objects, it was akin to Jue Qi invading the genitalia, thus generating dreams of intercourse. I employed methods to tonify the Heart and calm the Spirit above, regulate the Spleen and Stomach to raise Yang in the middle, and use herbs to benefit Essence, generate Yin, and secure Yang below. After nearly three months, he recovered."
Wu Jiaoshan once discussed effective methods for treating spermatorrhea. A man, after recovering from illness, exerted himself mentally excessively, resulting in frequent dream emissions, profuse phlegm, and emaciation. Various physicians prescribed Qingxin Lianzi Yin (Clear the Heart and Lotus Seed Infusion), which proved ineffective after long-term use. Wu palpated his pulse as tight and choppy, realizing that excessive use of cold-draining and diuretic medicines had caused Kidney Qi to sink exclusively. Continued use of these drugs worsened the condition. Wu immediately employed a lifting method to raise Kan Water to nourish Li Fire, descending Yang Qi to nourish Yin Blood. Subsequently, he used Deer Antler Glue (Cervi Cornus Colla) and Human Milk to replenish Essence and Blood. Over a month, the patient fully recovered. This led him to reflect that dream emission has diverse causes and cannot be treated uniformly. Some cases result from accumulated heat due to mental exertion; others from excessive intake of cold-purgative herbs like Dongchong Xiacao (Ophiocordyceps), Fuling (Poria), Cheqianzi (Plantaginis Semen), Zhimu, and Huangbai; still others from chronic emission leading to laxity of the urethral orifice. Treatment principles vary: for accumulated heat, clear the Heart and descend Fire; for cold-purgative damage, warm and tonify the Lower Yuan; for sinking Kidney Qi, employ lifting methods to ensure Water and Fire interact, stabilizing Kan and Li.
The above two cases both prioritize the Kidney while simultaneously treating the Heart and Spleen. However, there is another category where the Kidney is not deficient, but the Liver Meridian suffers from Damp-Heat and Fire Hyperactivity. Symptoms include pain in the penis, tendon contraction and retraction, itching, swelling, or flaccidity without retraction, with white discharge resembling semen passing with urine. This is termed "Jin Shan" (Sinew Hernia). Zhang Zihe stated: "Enuresis, strangury, impotence, bladder swelling, seminal slip, and leukorrhea are all forms of hernia in men. In women, blood dryness with amenorrhea, heat above the waist and knees after menstruation ceases, dryness of the feet and throat, strangury, abdominal masses that move or remain fixed, protrusion of the anterior orifice, and hemorrhoids/fistulas at the posterior orifice constitute hernia in women. Women's conditions are not called 'Shan' (Hernia) but 'Jia' (Mass)."