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Zhang Jingyue stated: Enuresis (Urinary Incontinence) includes involuntary urination during sleep, inability to control urine due to insecure Qi gate, and enuresis caused by Qi collapse in the upper Jiao leading to lack of constraint in the lower Jiao. All three belong to deficiency syndromes, but there are distinctions in severity. Sleep-enuresis is common in children; with robust Qi and solid constitution, it often resolves spontaneously. If urine flows like a spring without cessation, and the Bladder fails to store fluids, this indicates Qi deficiency. Since Qi is the mother of Water, water cannot be retained because Qi fails to consolidate. When it progresses to a state of no sensation, this represents extreme deficiency. It also frequently occurs in the elderly or after severe illness. Zhongjing said: "When the Lower Jiao is exhausted, enuresis and incontinence occur." Ancient formulas discuss both excess and deficiency, but one must not know that incontinence mostly belongs to deficiency-cold. If there is dribbling with pain and astringency, only then is it a heat syndrome; do not mistakenly use cooling herbs for enuresis.

Furthermore, ancient formulas often use astringent methods, which are merely symptomatic treatments. Although small water (urine) is governed by the Kidney, the Kidney connects upward to the Lung. If Lung Qi lacks authority (regulatory function), Kidney water cannot be grasped. Therefore, treating water metabolism requires regulating Qi. Suitable main herbs include Ginseng Radix et Rhizoma (Renshen), [missing character], Angelicae Sinensis Radix (Danggui), Atractylodis Macrocephalae Rhizoma (Baizhu), Cinnamomi Ramulus (Guizhi), Aconiti Lateralis Radix Praeparata (Fuzi), and Zingiberis Rhizoma (Ganjiang), supplemented with astringent agents.

Li Shicai stated: Red turbid discharge and white turbid discharge, according to canonical texts and former sages' discussions, indicate that turbid disease is a disorder of essence (Jing), not urine. Patients with turbid discharge experience burning and cutting pain in the urethra while urine remains clear. Only at the orifice does foul matter occasionally appear, resembling pus from sores or eye discharge, dripping continuously, completely distinct from stool and urine. Generally, cases due to corruption of essence account for 60%; those due to damp-heat pouring down and deficiency account for 20-30%. Why is there a distinction between red and white turbidity? Essence is transformed from blood. If turbid qi is excessive and essence transformation lags, the red color fails to turn white, resulting in red turbidity, indicating severe deficiency. Thus, youths whose Tian Gui (menstruation/seminal emission capability) has not yet arrived, engaging in vigorous sexual activity, may expel half essence and half blood; adults who indulge excessively often expel mixed essence and blood. Therefore, Zhu Danxi's view that red belongs to blood and white belongs to Qi is incomplete. His assertion that red turbidity stems from Heart deficiency with heat due to overthinking, and white turbidity from Kidney deficiency with cold due to lust, is also not definitive. In summary, when Heart moves with desire and Kidney is injured by sexual indulgence, or when coitus is forcibly restrained, or when aphrodisiacs are taken excessively, corrupted essence flows out, causing white turbidity. In deficiency-slippery cases where blood fails to transform, red turbidity results. Accompanied by cold, the pulse is deep, slow, and weak, urine is clear and white; treat with Bi Li Qing Yin Decoction, Ba Wei Wan Pill, or Nei Bu Lu Rong Wan Pill. Accompanied by heat, there is thirst and red urine, pulse is slippery, rapid, and forceful; treat with Qing Xin Lian Zi Yin Decoction or Xiang Ling San Powder. For phlegm-dampness pouring down from the Stomach, use Cang Bai Er Chen Tang plus Sheng Ma and Zi Su Ye. For deficiency-consumption patterns, use Liu Wei Di Huang Wan plus Lian Xu, Qian Shi, Tu Si Zi, Wu Wei Zi, Long Gu, and Mu Li. For latent summerheat, use Si Ling San plus Xiang Ru, Mai Dong, Ren Shen, and Shi Lian Zi. For thick, sticky discharge like paste with abnormal astringent pain, this is essence blocking the orifices; use Xiang Ling San to deliver Ba Wei Wan or Jin Gui Shen Qi Wan. For heat patterns, use Bi Li Qing Yin or Fu Tu Wan. For excessive thinking causing Heart agitation, leading to essence corruption in the Lower Jiao, use Jia Wei Qing Xin Yin or Rui Lian Wan. These are the general categories. Injuries to the Five Zang organs and invasions by the Six Excesses are too numerous to list; do not neglect them lightly.

Regarding spermatorrhea, ancient and modern theories regard it as a disease of Kidney Qi decline, unrelated to other Zang organs. However, the *Nei Jing* states that all Five Zang and Six Fu organs possess essence, which the Kidney receives and stores. Non-dream spontaneous emission usually involves injury to the Heart and Kidney; emission after dreams is caused by hyperactive Minister Fire. If the Five Zang perform their duties, essence is stored and regulated. If one Zang loses its proper function, it severely harms the Heart and Kidney, which govern essence. Treatment depends on the cause: if solely due to Kidney disease, treat the Kidney; if caused by other Zang, treat both the affected Zang and the Kidney. For Heart disease causing emission, there is emptiness of blood vessels and laxity; for Lung disease, dry skin/hair and panting; for Spleen disease, yellow complexion, muscle wasting, and limb lethargy; for Liver disease, blue complexion and tendon flaccidity; for Kidney disease, dark complexion and empty marrow. Pulse diagnosis of the six positions is essential. Causes vary: overwork damaging Heart's control over Kidney suggests Yuan Zhi Wan assisted by Ling Sha Dan. Unfulfilled sexual desire causing leakage suggests Si Qi Tang with Bai Wan Zi. Severe cases of auditory/visual triggers causing spontaneous emission, named Bai Yin (White Pollution), suggest Miao Xiang San with Yu Hua Bai Dan. Excessive sexual activity causing porous orifices suggests Zheng Yuan San with Mu Li Fen and Rou Cong Rong, swallowed with Ling Sha Dan, assisted by Lu Rong Wan, Shan Yao Wan, Da Tu Si Zi Wan, or Gu Yang Wan. Vigorous adults abstaining long enough to have full essence overflowing suggest Qing Xin Wan. Alcohol and rich foods causing phlegm-fire-damp-heat disturbing the Essence Mansion suggest Cang Zhu, Bai Zhu, Er Chen Tang, Sheng Ma, and Chai Hu to raise clear Qi and descend turbid Qi, strengthening Spleen/Stomach to stop emission. Spleen Qi sinking suggests Bu Zhong Yi Qi Tang. Kidney insecurity suggests Wubeizi (two liang) and Fu Ling (four liang) pills. Variations include post-urination emission, spontaneous emission without urination, urethral itching/pain mimicking urge to urinate, or dream-coitus; treat accordingly. Generally, slippery essence requires astringents; if ineffective, drain Heart Fire; if still ineffective, use Bu Zhong Yi Qi Tang to raise Qi upward.

Wang Jiezhai stated: Dream-emission and slippery sperm are often treated as Kidney deficiency with astringents, but fail. This condition often belongs to the Spleen and Stomach, common in those with rich diets, phlegm-fire, and damp-heat. The Kidney stores essence, but essence is generated by the Spleen/Stomach from food and transported to the Kidney. If Spleen/Stomach are damaged by damp-heat, middle Qi stagnates, becoming turbid. The generated essence becomes turbid. The Kidney governs closure; when quiet, it is peaceful. But with turbid essence arriving, evil fire moves in the Kidney, water loses peace, causing emission. This matches white turbidity. Danxi described white turbidity as turbid Qi from Kidney flowing down into the Bladder. Those with heavy lust and excessive fantasy should be treated via Heart/Kidney. Often involving Lung/Stomach, careful examination is needed.

Zhang Jianbin stated: Dream-emission and slippery sperm are all loss-of-essence diseases, originating in the Heart. Heart is Sovereign Fire, Kidney is Minister Fire; Heart movement triggers Kidney response. Youthful lust and fantasies often cause this. Essence is stored in Kidney but governed by Heart; emission obeys Heart. Treatment prioritizes calming the Heart. There are nine types of emission: 1. Obsession causing dreams (Heart); 2. Unfulfilled desire causing dreams (Kidney); 3. Fatigue-induced emission (Liver/Spleen weakness); 4. Overthinking-induced emission (Heart/Spleen sinking); 5. Damp-heat pouring down, Minister Fire moving recklessly (Lung/Kidney fire unclear); 6. Spontaneous slippery emission without inhibition (Lower Yuan deficiency, Kidney/Lung insecurity); 7. Constitutional insufficiency causing slipperiness (Congenital Qi thin); 8. Long-term use of cold/purgative drugs causing Yang loss and slipperiness; 9. Young adults practicing moderation yet emitting (Essence full and overflowing). Each symptom is governed by a Zang: Heart governs Spirit, Lung governs Qi, Spleen governs Dampness, Liver governs Dispersing/Descending, Kidney governs Closure. Treat according to cause.

Dream-emission involves emotion or fire; emotional movement calms the Heart, essence movement secures the Kidney. Slippery sperm is due to Kidney Qi failing to hold. Sudden slippery emission with pain should be treated as red/white turbidity. Frequent emission triggered by fatigue/thinking requires tonifying Heart/Spleen using Gui Pi Tang removing Mu Xiang. If Qi stagnation prevents heavy tonification, use Ren Shen swallowed with Fu Ling, Bai Zhu, Tu Si Zi pills. Excessive Heart Fire requires clearing fire; excessive Minister Fire requires nourishing Water; rising Qi requires lifting; slippery leakage requires astringing; damp-heat invasion requires separating/draining; deficiency-cold requires warming Lower Yuan; insufficient Yuan Yang with dual essence/Qi deficiency requires rooting the foundation. Using Kan Li Wan indiscriminately harms the Kidney with bitter-cold herbs.

Turbid disease distinguishes red, white, essence, and urine: Red is mostly due to fire; White can be cold or heat; Essence-related involves Heart/Kidney; Urine-related involves Bladder/Liver/Spleen. Turbidity in urine, white like rice washings, caused by rich/sweet/spicy/hot foods, indicates internal damp-heat; treat with clearing methods.

Ke Yunbo stated: Red/white turbidity involves injury to essence or blood, caused by stirring of Kidney/Liver Minister Fire. The Kidney is the official of strength; if one fantasizes or engages in excessive intercourse, Kidney fire blazes internally, failing to store essence. Forced retention causes essence to rebel. Before ejaculation, essence leaves its place and does not return to Kidney, but seeps into the water pathway, exiting with urine. Though corrupt essence exits, Kidney fire remains internal, orifices remain open, heat and deficiency interact, new essence responds vacuously, causing continuous dribbling, named White Turbidity. The Liver is the root of endurance; labor or anger injures internally, Liver fire flows down, failing to store blood. Heat damages Yin collaterals, blood overflows. Before normal flow, blood leaves meridians, does not return to Liver, seeps into water pathway, exits with urine. Though corrupt blood exits, Yin collaterals are incomplete, Liver fails to grasp,郁火 (stagnant fire) stays internal, new blood follows, causing continuous oozing, named Red Turbidity. White turbidity differs from spermatorrhea and gao lin; red turbidity differs from xue lin and hematuria. Treatment must address the source. The source is Supreme Yin. Spleen is Supreme Yin among Yin, source of essence/blood. Kidney is Taiyin among Yin, essence is Yin within Yin. Liver is Shaoyang among Yin, blood is Yang within Yin. Thus, white turbidity requires regulating Spleen/Kidney Yin, method: nourish Yin and descend fire. First use Dao Chi San plus Zhi Mu and Huang Bai to clear, then Liu Wei Di Huang Wan plus Wu Wei Zi to collect, so essence is stored. Red turbidity requires regulating Spleen/Liver Yin, method: raise Yang and scatter fire. First use Xiao Yao San plus Mu Dan Pi to clear, then Bu Zhong Yi Qi Tang plus Bai Shao to collect, so blood is stored. For sinking conditions, use lifting. If Bu Zhong Yi Qi Tang fails for white turbidity, it indicates Yin deficiency, unsuitable for lifting; aiding Yang worsens Yin deficiency. If Liu Wei Di Huang Wan succeeds for red turbidity, it is the method of tonifying the Mother for deficiency; Gui and Yi share one treatment. For Spleen deficiency failing to scatter essence to Lung, causing damp-heat pouring down, known as "Middle Qi insufficient causing urinary changes," common in infants. Use Si Jun Zi Tang doubling Fu Ling, adding Sheng Ma and Sha Ren, so water essence distributes four directions, Bladder achieves Qi transformation and clears out.