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Sun Wenyuan treated a man who, due to excessive sexual activity, suffered from nocturnal emission and spermatorrhea. Initially, he took herbs to clear ministerial fire without effect, and subsequently used astringent remedies for spermatorrhea with no success. Seeking Sun's treatment, he was given Yuhua Bai Dan (Jade White Pill), administered with two qian of thickly decocted Ginseng Decoction. (Xu Lingtai notes: This pill should only be temporarily used when the pulse is weak and there are no other signs of excess heat.) After two doses, the condition stabilized slightly. Concurrently, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) was taken with added Lotus Stamens (Lianxu), Euryale Seed (Qianshi), Polygala Root (Yuanzhi), and Schisandra Berry (Wuweizi). The patient recovered after one month. Composition of Yuhua Bai Dan: Gypsum Fibrosum (Zhongru Fen), Kaolin (Baishi Zhi), Yangqishi, and Oyster Shell (Muli) facing left.

A courtesan surnamed Li had short and choppy pulses at both cun positions, surging and slippery pulses at both chi positions, and a wiry pulse at the guan position. Upon examination, Sun asked if her menstruation was regular. She replied that it lasted only one day and was scanty, merely spotting. Sun stated, "This pulse pattern causing nocturnal emission in a virtuous woman is abnormal." She agreed, adding that even during intercourse, emission would occur, accompanied by profuse cold sweat, extreme fatigue, and inability to support herself. Sun prescribed no medicine. When asked why, he explained, "Metal and Wood are overcoming each other, and the Heart Spirit lacks mastery; according to medical principles, this is incurable." Someone argued that since she appeared healthy, the prognosis seemed too severe. Sun replied, "The wiry pulse corresponds to Spring (Wood prosperity), yet it remains rampant when Metal is dominant (Autumn). If it were the Mao month (February, when Wood is prosperous and Fire is secondary), Lung Metal would wither, and the upper source of Water would dry up. Moreover, the Kidney pulse is surging and slippery. (Xu Lingtai notes: A surging pulse indicates Fire, but a slippery pulse does not necessarily indicate Yin deficiency. If this is indeed the pulse, it merely indicates Blood Heat. If it were Yin deficiency with internal blazing desire fire, the chi pulse would be surging and rapid; combined with a wiry guan pulse, death would occur in Spring or Summer.) This courtesan, due to excessive desire, has depleted her Yin Blood, causing淫火 (libidinous fire) to blaze further. Yin deficiency leads to disease; Yin exhaustion leads to death. Coughing has already appeared, signaling impending death. How can it be treated?" She indeed died in February of the following year.

Xue Lizai treated Supervisor Zhu, who suffered from spermatorrhea upon exertion and toothache immediately thereafter. He was treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Pinellia Tuber (Banxia), Poria (Fuling), and White Peony Root (Baishao). (Xu Lingtai notes: Spermatorrhea upon exertion indicates floating fire causing loose teeth; how can Buzhong Yiqi Tang be appropriate? Although supplemented with Yin-nourishing herbs, it serves as a poor example.) He also took Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Later, Shiquan Dabu Tang (Ten Complete Tonifying Decoction) added with Ophiopogon Tuber (Maidong) and Schisandra Berry (Wuweizi) led to his recovery.

A male patient suffered from white turbidity and nocturnal emission, accompanied by heel pain, dry mouth with thirst, constipation, and severe afternoon fever. He was cured using Buzhong Yiqi Tang added with White Peony Root (Baishao) and Scrophularia Root (Yuanshen), along with Jiajian Bawei Wan (Modified Eight-Ingredient Pill).

Gong Zicai treated Scholar Chen Guilin of Guilin, who suffered from nocturnal emission once or twice, or three to five times per month. After emission, he felt mentally dull and physically exhausted. Examination revealed faint, choppy, and powerless pulses in all six positions. This was a syndrome of Yin deficiency with moving fire. He was treated with Chensha Jiji Wan (Cinnabar Equilibration Pill) added with Placenta Humanum (Ziheche) and Dragon Bone (Longgu). After several months, efficacy was observed. However, due to repeated illnesses and failure to strictly adhere to advice, Gong composed a colloquial verse to warn him: "Nurture spirit and essence, valuing sexual restraint; dispel worldly thoughts, guarding against distractions. Eat until half-full, favor bland diet; limit wine to three parts, avoid overindulgence. Take medicine when hungry, advance as needed; fame and fortune have their share, do not rush. If you can savor these few lines, it is the prescription for immortality."

Huang Lvsu stated: "In my thirties, I suffered from spermatorrhea, with slight leakage from the glans penis constantly day and night. Initially, I was terrified, wondering how much essence and blood the body possessed to withstand such continuous loss. Highly skilled physicians deemed it harmless, advising against astringents. (Xu Lingtai notes: Because it was a Fire syndrome, astringents were contraindicated. For deficiency-cold spermatorrhea, what harm is there in using them? Physicians must first examine the syndrome and not adhere rigidly to one method.) Through taking Aconite Root (Fuzi), I realized it was a Fire syndrome; thus, cooling tonification rather than warming tonification was required. I used Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) added with Astragalus Complanatus Seed (Shawen Jili), Dodder Seed (Tusizi), and a small amount of stir-fried Phellodendron Bark (Huangbai). I set the illness aside, did not dwell on it, and regulated life normally, recovering fully after two years. Dragon Bone (Longgu) and Oyster Shell (Muli) were never ingested, as only free circulation of Qi and Blood brings comfort; how can astringents cause stagnation? Though temporary relief might be gained, the harm is profound; patients must deliberate carefully. I initially feared, but throughout the two years, social engagements continued normally without fatigue. Could this semen differ from the primordial essence of intercourse, thus posing no great harm?"

Zhang Luyu treated the youngest son of Han Mulu, who had a delicate constitution and a chronic history of uncontrollable spermatorrhea. Examination revealed a faint, wiry, and rapid pulse, with a slight discontinuity in the chi position. This indicated not only insufficient Kidney Qi but also stagnant and unregulated Qi mechanism, failing to perform the function of sealing and storing. He was given Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) with Alisma Rhizome (Zexie) removed, added with Fish Maw (Biao Jiao) and Schisandra Berry (Wuweizi), with a touch of Aquilaria Wood (Chenxiang), embodying dissemination within tonification. Although this method was sound, long-term slipping leads to lax orifices, making rapid recovery difficult.

Li Shicai treated a man whose mental exertion from examinations caused spermatorrhea, with leakage after urination and during dreams. He had self-administered Jin Ying Gao (Cherokee Rose Fruit Paste) for a month without effect. Li diagnosed, "Qi deficiency with agitated Spirit requires Yuanzhi Wan (Polygala Pill)." After ten doses, symptoms halved; after one month, full recovery occurred.

Wang Shuquan stated: "A young scholar sought moxibustion for nocturnal emission. Points on the Kidney channel were selected, and moxibustion cured him. Regardless of age, this is due to Kidney deficiency. Ancients said: 'All diseases arise from the Heart.' Also: 'All diseases arise from the Kidney.' Everyone knows Heart labor causes myriad diseases; few know Kidney deficiency does so as well. Heaven generates Water (One), Earth generates Fire (Two). If Kidney Water does not ascend, Heart Fire does not descend; this is the origin of disease. One must nourish the Heart and protect the Kidney." (From *Zisheng Jing*.)

Physician Tan from Pingjiang said: "For emission, usually only the Heart and Kidney are treated, with no other approaches. Examining *Suwen* and Zhang Zhongjing's works, the Spleen should be treated, yielding frequent success. Prescription: Magnolia Bark (Noumu) two liang, processed with Ginger Juice; Sheep Tibia bone one liang, burned red-hot in charcoal, then ground to powder. These two ingredients formed into pills the size of Sophora seeds using wheat flour paste. Take 100 to 300 pills per dose, washed down with rice soup." (*Jicheng*. Xu Lingtai notes: Suitable for damp-heat in the middle jiao, functioning similarly to Songshi Zhudu Wan, but not applicable to all cases of emission.)

Lu Zuyu treated a man who, while writing late at night, leaned on a table to rest, fell asleep, and emitted semen in a dream. The next morning, he coughed up blood several times, repeating days later. From then on, bleeding and emission occurred intermittently or consecutively. Hundreds of doses of Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) were given, varying only slightly within Yin-nourishing and fire-clearing methods, yet ineffective for months. Symptoms included dry mouth, mild cough, aversion to wind and cold, lethargy, loose stools, and scanty dark urine. Pulse was vast and powerless superficially, but rapid and forceful deep down. Lu stated, "This syndrome did not originate from sexual excess but from excessive mental worry damaging Heart Blood. Deficient Heart Blood cannot nourish the Spirit, causing the Spirit to fly away, leading to dream intercourse. With the Spirit unsettled, Will (Zhi) becomes insecure, causing Kidney Essence to leak downward. Kidney deficiency allows Fire to run unchecked, forcing Blood to bleed recklessly causing hemoptysis, and attacking Lung Metal causing cough. Aversion to wind/cold and lethargy occur because Fire is the thief of Original Qi; when Fire is strong, Original Qi becomes deficient. Muscle wasting and loose stools result because worrying damages Heart Blood, which is equivalent to injuring Spleen Yin." He was given Guipi Tang (Restore the Spleen Decoction) for twenty doses, reducing hemoptysis by half. Another twenty doses cured all symptoms; after a hundred doses, spirit doubled.

Miu Zhongchun treated Wang Guanshou from Lou Dong, who suffered from emission, ejaculating upon hearing women's voices, becoming extremely emaciated and near death, with doctors exhausted of methods. Miu's disciple used Polygala Root (Yuanzhi) as the sovereign herb, Lotus Stamens (Lianxu) and Stone Lotus Seeds (Shilianzi) as ministers, Dragon Teeth (Longchi), Poria (Fushen), Astragalus Complanatus Seed (Shawen Jili), and Oyster Shell (Muli) as assistants and guides. Pills stopped the flow slightly but did not cure it completely. Miu added Fish Maw (Biao Jiao) to the previous formula, curing the patient before finishing one dose.

Grand Secretary Zhao Jingzhi, before passing the imperial exams, suffered from nocturnal emission for three to four years due to excessive mental labor from study. Attacks occurred every few days; afterwards, deficient Fire flared upward, causing facial flushing, cold hands and feet, and insomnia. All Heart-Kidney tonics and astringents had been tried. In the spring of Ren Shen year, he invited diagnosis due to a cold. Discussing his suffering, a pill formula was prescribed with Phellodendron Bark (Huangbai) as sovereign, assisted by Rehmannia Root (Dihuang), Goji Berry (Gouqi), Lotus Stamens (Lianxu), Fish Maw (Biao Jiao), Cornus Fruit (Yurou), Schisandra Berry (Wuweizi), Plantago Seed (Cheqian), Asparagus Tuber (Tian Dong), and Ophiopogon Tuber (Maidong). Recovery occurred before finishing one dose. Initially, Zhao doubted Huangbai's extreme coldness. I said, "Your prolonged non-recovery is precisely because this herb was not used. The theory of Five Organs' preferences states: 'Kidney desires firmness; urgently eat bitter to firm it.' Huangbai is such an herb. When the Kidney is firm, even if Heart Fire exists, Essence remains secure, preventing nocturnal emission. Previously, only tonifying and astringing were used, missing this point, hence lack of efficacy."

Xue Lizai treated Supervisor Wang, who suffered from emission worsening with labor, accompanied by axillary nodules. Qingxin Lianzi Yin (Clear Heart Lotus Seed Drink) and Lianqiao Xiaodu San (Forsythia Detoxification Powder) failed. Bazhen Tang (Eight-Treasure Decoction) added with Chinese Yam (Shanyao), Cornus Fruit (Yurou), and Polygala Root (Yuanzhi) showed gradual improvement over ten doses. Subsequent treatment with Fuling Wan (Poria Pill) prevented recurrence. Inspector Ye suffered similarly, claiming all medicines failed; Ludangu cured him with Bawei Wan (Eight-Ingredient Pill).

Xu Lingtai stated: "Treatment of emission essentially involves replenishing Essence and calming the Heart; there are no miraculous methods. Quack doctors often use warming and sticky substances, inevitably harming patients. This syndrome always involves latent pathogens, such as Fire, Phlegm, Dampness, or Wind. It is necessary to search out and eliminate residual pathogens while harmonizing organ Qi, treating tactfully to avoid complications. Merely calming the Spirit and tonifying the Kidney leaves many aspects unresolved."