大意
遗精之主宰在心。精之藏制在肾。凡人酒色过度。思虑无穷。（直指）致真元下渗。虚火流行。精气滑脱（指掌）
内因
有思想无穷。相火妄动而精走者。有用心过度。心不摄肾而失精者。有饮酒浓味。痰火湿热。扰动精府者。
有淫欲太过。闭藏失职。精窍清脱者。有脾虚下陷者。有肝火炽强者。（汇补）
外候
其为证状。亦复不同。或小便后。出多不可禁者。或不小便而自出者。或茎中痛痒常欲如小便者。（丹溪）或
睡中无梦。流出不自觉者。大抵夜睡而自遗者轻。昼觉而自遗重。（汇补）
五脏遗精
五脏各有精。肾则受而藏之。故遗精之病。五脏皆有。不独肾也。如心病而遗者。必血脉空虚。本纵不收。肺
病而遗者。必皮革毛焦。喘急不利。脾病而遗者。必色黄肉脱。四肢懈惰。肝病而遗者。色青筋痿。肾病而遗
者。色黑髓枯。更当以六脉参详。昭然可辨。若肾脏自病者。专治其肾。如他脏移病者。则他脏与肾两治之。（汇补）
脉法
遗精之脉。当验于尺。结芤动紧。二症之的。微涩阴伤。洪数火逼。（紫虚）
治法
治宜抑火清心。安脾实肾。则水火既济。坎离协议。何病之有。（玉策）
用药
心火妄动者。茯神汤。心肾不交者。炒香散。脾胃湿热者。二陈汤。加苍术、黄柏、升麻、柴胡。肾元不固者。
山药丸。加牡蛎、龙骨、鹿茸、韭子。脾气下陷者。补中益气汤。肝火炽盛者。加味逍遥散。（汇补）
【附梦遗】
昼之所思。为夜之所见。凡男女性淫者。则心肝与肾之相火。无时不动。故劳怯之症。多梦鬼交。（正传）盖心
藏神。肝藏魂。梦中所主之心。即心之神也。所见之形。即肝之魂也。所泄之精。即肾之精也。故心为君。肾为
相。未有君火动。而相火不随之者。（指掌）所以寐则神游于外。魂化为形。神魂相感。俾君相二火。吸撮三焦
之气。尽趋阴窍而跃出。（准绳）故治此病者。当先求其心。非君不能动其相。非相不能使其精。故宁心益肾
为要药也。（绳墨）若寡欲之人。亦患此者。当作脾湿治。盖脾湿则气化不清。而分注于膀胱者。亦混浊而稠
浓。由是扰动阴火。精随火泄。（指掌）治宜定志丸、珍珠丸、水陆二仙丹之类。
【附鬼交】
鬼魅相感者。其状不欲见人。如有人晤对。时独言笑悲泣。脉来乍大乍小。乍有乍无。及脉绵绵不知度数。
而颜色不常。乃其候也。（必读）治以苏合香丸。或朱砂、雄黄、麝香、鬼箭、虎骨之类。或灸鬼哭穴二三十壮良
瘥。（汇补）
遗精选方
茯苓汤 治欲火太盛。君火妄动而遗精。
茯苓 远志 枣仁 菖蒲 人参 茯神
黄连 生地 当归 甘草
妙香散（荆公） 治心虚神弱。不能摄肾而精遗。
龙骨 益智 人参（各一两） 茯苓 远志 茯神（各五钱）
朱砂 甘草（各二钱）
为末。每服二钱。空心温酒下。
山药丸（子和） 治肾气虚脱。腰痛体瘦。目暗耳鸣而遗精者。
赤石脂（ ） 茯神 山萸肉 熟地 巴戟 牛膝
泽泻（各一两） 杜仲 菟丝子 山药（各三两） 五味（六两） 肉苁蓉（四两）
为末。炼蜜丸。空心。温酒或盐汤下。
二陈汤 治膏粱太过。脾胃湿热遗精。（方见痰症）
补中益气汤 治脾元下陷。精气不统而精遗。
加味逍遥散 治肝火妄动。疏泄太过而精遗。（二方俱见中风）
水陆二仙丹 治相火动而精遗。以致烦躁者。与补阴药同用。
金樱子入粗袋。擦去刺。捣碎。水浸二宿。滤去渣。又将汁澄清。入锅熬成膏。芡实去壳为末。入金樱膏内。
和为丸。如梧子大。每服百丸。淡盐汤下。
珍珠粉丸（洁古） 治虚热遗精。
黄柏（瓦上炒） 真蛤粉（各一斤）
为末。滴水丸。温酒下。
内补鹿茸丸（宝鉴） 治虚寒遗精。
鹿茸（酥炙） 菟丝 白蒺藜 沙蒺藜 肉苁蓉 紫菀
蛇床子（酒浸蒸） 黄 桑螵蛸 阳起石 附子 肉桂（各等分）
为末。蜜丸。温酒下。
[General Principle]
The governing factor of spermatorrhea (Spermatorrhea) lies in the Heart. The storage and control of essence lie in the Kidney. For those who indulge excessively in alcohol and sexual activity, or engage in endless mental worry, it leads to the seepage of True Yuan (True Primal Qi) downwards, the prevalence of Deficiency Fire (Deficient Heat), and the slipping and loss of Essence (Jing).
[Internal Causes]
Some cases arise from endless mental worry, causing Ministerial Fire (Ministerial Fire) to move recklessly and lead to seminal emission; some from excessive mental exertion, where Heart Qi fails to control Kidney Qi, resulting in loss of essence; some from excessive drinking and rich, greasy diets, leading to Phlegm-Fire (Phlegm-Heat) and Damp-Heat disturbing the Essence Mansion (Seminal Vesicles); some from excessive lust, causing failure of closure and storage functions, leading to clear leakage from the essence orifice; some from Spleen Qi deficiency with sinking; some from blazing Liver Fire. (From *Zhengzhi Huibu*)
[External Manifestations]
The symptoms vary. Some experience uncontrollable seminal discharge after urination; some have spontaneous discharge without urinating; some feel pain and itching in the penis, often desiring to urinate. (From *Danxi Xinfa*) Some have spontaneous, unconscious discharge during sleep without dreams. Generally, nocturnal emissions during sleep are mild, while diurnal emissions while awake are severe. (From *Zhengzhi Huibu*)
[Spermatorrhea Involving the Five Zang Organs]
Each of the Five Zang organs possesses its own essence, but the Kidney receives and stores it. Therefore, spermatorrhea can involve all five Zang organs, not just the Kidney. If caused by Heart disease, there must be emptiness of blood vessels and laxity/failure of contraction; if caused by Lung disease, there must be dry skin, withered hair, panting, and difficulty in breathing; if caused by Spleen disease, there must be sallow complexion, emaciation, and flaccidity/lethargy of the four limbs; if caused by Liver disease, there must be bluish complexion and sinew atrophy; if caused by Kidney disease, there must be dark complexion and marrow depletion. One must further examine the six pulse positions to clearly distinguish them. If the disease originates in the Kidney itself, treat the Kidney specifically; if the disease transfers from other Zang organs, treat both the affected organ and the Kidney simultaneously. (From *Zhengzhi Huibu*)
[Pulse Diagnosis]
For spermatorrhea, the pulse should be examined at the Chi (Cun-Kuan-Chi) position. Knotted, hollow, moving, or tight pulses are definitive signs for these conditions; a fine and choppy pulse indicates Yin injury, while a flooding and rapid pulse indicates fire forcing. (From *Zixu Maijue*)
[Therapeutic Methods]
Treatment should focus on suppressing fire, clearing the Heart, calming the Spleen, and solidifying the Kidney. Thus, Water and Fire will interact harmoniously, Kan and Li (Water and Fire trigrams) will coordinate, and what disease would remain incurable? (From *Yuce*)
[Medication]
For reckless movement of Heart Fire, use Fushen Tang (Poria Decoction); for disharmony between Heart and Kidney, use Chaoxiang San (Fragrant Powder); for Spleen-Stomach Damp-Heat, use Erchen Tang (Two-Cured Decoction) added with Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), Shengma (Cimicifugae Rhizoma), and Chaihu (Bupleuri Radix); for insecurity of Kidney Yuan, use Shanyao Wan (Dioscorea Pill) added with Muli (Ostreae Concha), Longgu (Fossilia Ossis Mastodi), Lurong (Cornu Cervi Pantotrichum), and Jiuizi (Trichosanthis Fructus Seed - note: likely refers to Allii Tuberosi Semen); for Spleen Qi sinking, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); for blazing Liver Fire, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). (From *Zhengzhi Huibu*)
[Appendix: Dream Emission]
What is thought about during the day becomes what is seen at night. For men and women with sexual fantasies, the Ministerial Fire of the Heart, Liver, and Kidney is constantly active. Therefore, patients with consumptive weakness often dream of intercourse with ghosts. (From *Jingyue Quanshu*) The Heart houses the Shen (Spirit), and the Liver houses the Hun (Ethereal Soul). The Heart dominating the dream is the Heart's Shen; the form seen is the Liver's Hun; the essence discharged is the Kidney's Jing. Thus, the Heart is the Monarch Fire, and the Kidney is the Minister Fire. It is impossible for Monarch Fire to move without Ministerial Fire following. (From *Yizong Bidu*) Therefore, during sleep, the Shen wanders outside, and the Hun transforms into form. The interaction of Shen and Hun causes the Monarch and Minister fires to attract and gather Qi from the Triple Burner, directing it all towards the yin orifice to leap out. (From *Yixue Gangmu*) Therefore, treating this disease requires first seeking the Heart; without the Monarch, the Minister cannot move; without the Minister, the essence cannot be discharged. Thus, calming the Heart and benefiting the Kidney are essential treatments. (From *Shishi Milu*) For those with few desires who still suffer from this, it should be treated as Spleen Dampness. Because Spleen dampness leads to unclear Qi transformation, and fluids diverted to the Bladder become turbid and thick, thereby stirring up Yin Fire, causing essence to leak with the fire. (From *Yizong Bidu*) Treatment should use Dingzhi Wan (Stabilize Will Pill), Zhenzhu Wan (Pearl Pill), or Shuilu Erxian Dan (Water and Land Two Immortals Pellets).
[Appendix: Ghost Intercourse]
When influenced by malevolent spirits, the patient does not wish to see people, yet seems to converse face-to-face, often speaking, laughing, crying, or weeping alone. The pulse comes alternately large and small, present and absent, or continuous and boundless, accompanied by abnormal facial coloration. These are the signs. (From *Yixue Rumen*) Treat with Suhexiang Wan (Styrax Pill), or drugs such as Zhusha (Cinnabar), Xionghuang (Realgar), Shexiang (Musk), Guijianyu (Spatholobi Caulis), and Hugu (Tiger Bone). Alternatively, moxa application to Guiku Acupoint (Ex-HN 20) for 20-30 moxa cones yields good results. (From *Zhengzhi Huibu*)
[Selected Formulas for Spermatorrhea]
Fuling Tang (Poria Decoction)
Indications: Excessive desire fire, reckless movement of Monarch Fire causing spermatorrhea.
Ingredients: Fuling (Poria), Yuanzhi (Polygalae Radix), Zaoren (Ziziphi Spinosomi Semen), Changpu (Acori Tatarinowii Rhizoma), Renshen (Ginseng Radix), Fushen (Poria with Hostwood), Huanglian (Coptidis Rhizoma), Shengdi (Rehmanniae Radix), Danggui (Angelicae Sinensis Radix), Gancao (Glycyrrhizae Radix et Rhizoma).
Miaoxiang San (Wonderful Fragrance Powder) [Formula of Lord Jinggong/Sima Guang]
Indications: Heart deficiency and weak spirit, inability to control Kidney leading to seminal emission.
Ingredients: Longgu (Fossilia Ossis Mastodi), Yizhi (Alpiniae Oxyphyllae Fructus), Renshen (Ginseng Radix) (each 1 liang); Fuling (Poria), Yuanzhi (Polygalae Radix), Fushen (Poria with Hostwood) (each 5 qian); Zhusha (Cinnabar), Gancao (Glycyrrhizae Radix et Rhizoma) (each 2 qian).
Preparation: Grind into powder. Take 2 qian per dose, swallowed with warm wine on an empty stomach.
Shanyao Wan (Dioscorea Pill) [Formula of Zhang Hezi]
Indications: Kidney Qi deficiency and collapse, lower back pain, emaciation, dim vision, tinnitus, and spermatorrhea.
Ingredients: Chishizhi (Halloysit Rubra) (dose missing); Fushen (Poria with Hostwood), Shanzhuyu (Corni Fructus), Shudi (Rehmanniae Radix Preparata), Bajitian (Morinda Officinalis Radix), Niuxi (Achyranthis Bidentatae Radix), Zexie (Alismatis Rhizoma) (each 1 liang); Duzhong (Eucommiae Cortex), Tusizi (Cuscutae Semen), Shanyao (Dioscoreae Rhizoma) (each 3 liang); Wuweizi (Schisandrae Fructus) (6 liang); Roucongrong (Cynomorchii Herba) (4 liang).
Preparation: Grind into powder, make pills with refined honey. Take on an empty stomach with warm wine or salt water.
Erchen Tang (Two-Cured Decoction)
Indications: Spermatorrhea due to excessive rich food and Spleen-Stomach Damp-Heat. (See Phlegm Diseases chapter for formula).
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction)
Indications: Spleen Yuan sinking, failure of Essence to consolidate leading to seminal emission.
Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder)
Indications: Spermatorrhea due to reckless Liver Fire movement and excessive dispersion. (Both formulas above are referenced in Stroke Disease chapter).
Shuilu Erxian Dan (Water and Land Two Immortals Pellets)
Indications: Spermatorrhea and irritability due to Ministerial Fire movement. Use together with Yin-tonifying medicines.
Preparation: Put Jinyingzi (Chrysanthemi Fructus - note: actually Cornus officinalis fruit usually, but text says Jin Ying Zi which is Rosa Laevigata Fructus) into a coarse bag, remove thorns, crush, soak in water for two nights, filter dregs, clarify the juice, and boil into a paste. Remove shells from Qianshi (Euryales Semen), grind into powder, mix into the Jin Yingzi paste, and form pills the size of wutong seeds. Take 100 pills per dose with light salt water.
Zhenzhu Fen Wan (Pearl Powder Pill) [Formula of Jiegu]
Indications: Spermatorrhea due to deficiency heat.
Ingredients: Huangbai (Phellodendri Cortex) (fried on tile), Zhen Gefen (Tridacnidae Testa) (each 1 jin).
Preparation: Grind into powder, make pills with dripping water, take with warm wine.
Neibu Lurong Wan (Internal Tonification with Deer Antler Pill) [From Baojian]
Indications: Spermatorrhea due to deficiency cold.
Ingredients: Lurong (Cornu Cervi Pantotrichum) (roasted with butter), Tusizi (Cuscutae Semen), Bai Jili (Tribuli Fructus), Sha Jili (Tribuli Fructus - different variety), Roucongrong (Cynomorchii Herba), Ziwan (Adenophorae Radix), Shechuangzi (Cnidii Fructus) (steeped in wine and steamed), Huangqi (Astragali Radix), Sangpiaoxiao (Mantidis Oötheca), Yangqishi (Leucogypi Mineral), Fuzi (Aconiti Lateralis Radix Preparata), Rougui (Cinnamomi Cortex) (equal parts).
Preparation: Grind into powder, make pills with honey, take with warm wine.