上灶屠 屡有遗滑，脉弦细，气滞，腹中不和，呛咳，舌微灰。宜清肺胃为主。
北沙参（三钱） 光杏仁（三钱） 生牡蛎（四钱） 预知子（三钱，即八月札） 怀山药（四
钱） 川贝（二钱，不杵） 茯神（四钱） 绿萼梅（钱半） 石莲子（三钱，杵） 砂壳（钱半） 谷芽（
四钱）
清煎五帖。
介按∶肾阴久亏，阳升无制，冲肺则呛，精滑则遗。治法于摄固之中，参以补脾养胃而
清肺，乃是上损从阳，下损从阴之义。
某 咳嗽较减，脉虚细，心肾并亏，湿未净，屡次滑精。宜清养肝肾，佐清肺渗湿。（
四月十八日。）
钗斛（三钱） 桑寄生（三钱） 甜杏仁（三钱） 冬瓜子（三钱） 生牡蛎（四钱） 怀药（三
钱） 川贝（钱半） 草（三钱） 炒杜仲（三钱） 生米仁（四钱） 丝瓜络（三钱）
清煎四帖。
介按∶邹滋九曰∶遗精一症，前贤各有明辨，其义各载本门，兹不复赘。大抵此症变幻
虽多
，不越乎有梦、无梦、湿热三者之范围而已。古人以有梦为心病，无梦为肾病，湿热为小肠
膀胱病。夫精之藏制虽在肾，而精之主宰则在心，其精血下注，湿热混摇遗滑者，责在小肠
膀胱。今此案病在心肾，阴虚不摄，而兼湿热留着，若阳升无制，乘肺则咳，肾精不固，下
注则遗。如用固摄，决难应病。清肺渗湿，兼以养心补肾，庶克有济。
安昌高 痰红已除，脉形小数，溺白，精关不固，溺后有淫。宜固补心肾为妥。（七月
十八日。）
东洋参（一钱） 桑螵蛸（三钱） 远志肉（八分） 莲须（一钱） 怀药（三钱） 抱木茯神（
四钱） 生牡蛎（四钱） 新会皮（钱半） 生地（四钱） 炒驴胶（钱半） 炒杜仲（三钱）
清煎五帖。
介按∶汪昂曰∶心君火也，君火一动，相火随之。相火寄于肝胆，肾之阴虚则精不藏，
肾之
阳强则气不固。今此案是肝阳上冒，故致痰中兼红，肾虚不摄，则溺后有淫，治以固摄助纳
，又佐安神宁气，气固则精自守矣。
渔庄沈（湘记） 阴火已敛，脉虚细，心肾不交则精滑，舌白稍润。宜补心丹加减。（五
月十九日）
丹参（三钱） 生地（三钱） 金樱子（三钱） 生牡蛎（四钱） 茯神（四钱） 远志肉（八分）
怀药（三钱） 柏子仁（三钱） 西洋参（一钱） 炒枣仁（三钱） 新会皮（钱半）
清煎四帖。
又 精滑未除，脉细劲，舌微白，大便难，有血。宜补益润肠。（五月二十八日。）
太子参（一钱） 龟版（四钱） 麻子仁（三钱） 新会皮（钱半） 茯神（四钱） 丹皮（三钱）
金樱子（三钱） 生牡蛎（四钱） 生地（三钱） 远志肉（八分） 豆衣（三钱）
清煎四帖。
介按∶经云∶神气舍心，精神毕具。又曰∶心者生之本，神之舍也。今以肾液未能上承
于心
，而心不藏神，心神一动，肾精遗泄，故治以补心丹加减，藉滋肾液而安心神。但其阴液已
虚，未能腴润于大肠，肠中宿垢，因致秘结不通。传导之官，失其常度，故次方于滋阴潜阳
之中，参用麻仁、生地以润肠通便，俾得肾液渐充，则便自通畅，而精固神安。
Shangzao Tu frequently experienced nocturnal emission and seminal leakage. The pulse was wiry and thin, qi stagnation was present, abdominal discomfort occurred, accompanied by choking cough, and the tongue coating was slightly gray. Treatment should primarily focus on clearing the Lung and Stomach.
Glehniae Radix (Beishashen, 3 qian) Semen Armeniacae Amarum (Guangxingren, 3 qian) Ostrea Concha (Shengmuli, 4 qian) Tetrastigmatis Fructus (Yuzhizi, 3 qian, i.e., Bayue Zha) Dioscoreae Hypoglaucae Rhizoma (Huai shanyao, 4 qian) Fritillariae Cirrhosae Bulbus (Chuanbei, 2 qian, not crushed) Poria Cum Radix Pini (Fushen, 4 qian) Pruni Mume Flos (Lvemei, 1.5 qian) Nelumbinis Semen (Shilianzi, 3 qian, crushed) Citri Reticulatae Pericarpium Viride (Shake, 1.5 qian) Oryza Germ (Guya, 4 qian)
Decocted in water for five doses.
Commentary by Shao Jie: Long-term deficiency of Kidney Yin causes Yang to ascend without restraint; when it rushes to the Lung, it causes choking cough; seminal leakage results from instability of essence. The treatment method involves solidification and consolidation, supplemented by tonifying the Spleen and nourishing the Stomach while clearing the Lung. This embodies the principle that "upper damage follows Yang, lower damage follows Yin."
Patient Mou: Cough has decreased compared to before. The pulse is deficient and thin. Both Heart and Kidney are deficient, and dampness has not been fully cleared. There have been repeated episodes of seminal slip. Treatment should clear and nourish the Liver and Kidney, assisted by clearing the Lung and promoting diuresis to drain dampness. (April 18)
Dendrobii Caulis (Chihuo, 3 qian) Taxilli Herba (Sangjisheng, 3 qian) Semen Armeniacae Dulce (Tianxingren, 3 qian) Benincasae Semen Excoecatum (Dongguazi, 3 qian) Ostrea Concha (Shengmuli, 4 qian) Dioscoreae Hypoglaucae Rhizoma (Huaiyao, 3 qian) Fritillariae Cirrhosae Bulbus (Chuanbei, 1.5 qian) Glycyrrhizae Radix et Rhizoma (Cao, 3 qian) Eucommiae Cortex Ustus (Chao Duzhong, 3 qian) Coicis Semen (Sheng Yiren, 4 qian) Luffae Fructus Retinervus (Sigualuo, 3 qian)
Decocted in water for four doses.
Commentary by Shao Jie: Zou Zijiu stated: Regarding the syndrome of nocturnal emission, past sages have provided clear distinctions, their meanings recorded in their respective schools; I will not elaborate here. Generally, although this syndrome presents with many variations, it does not exceed the scope of having dreams, lacking dreams, and damp-heat. Ancients considered having dreams as a Heart disease, lacking dreams as a Kidney disease, and damp-heat as a Small Intestine and Bladder disease. Although the storage and control of essence reside in the Kidney, the mastery of essence lies in the Heart. If essence and blood flow downward, mixed with damp-heat causing shaking and slipping, the responsibility lies with the Small Intestine and Bladder. In this case, the pathology is in the Heart and Kidney; Yin deficiency fails to secure, accompanied by lingering damp-heat. If Yang ascends without restraint and attacks the Lung, it causes cough; if Kidney essence is insecure and flows downward, it causes emission. Using only securing methods would hardly be effective. Clearing the Lung and draining dampness, combined with nourishing the Heart and tonifying the Kidney, may yield results.
Gao from Anchang: Hemoptysis in phlegm has been eliminated. The pulse form is slightly rapid. Urine is white/cloudy. The essence gate is insecure, with seminal overflow after urination. Treatment should appropriately focus on securing and tonifying the Heart and Kidney. (July 18)
Codonopsis Radix (Dongyangshen, 1 qian) Sangxiao's Sac (Sangpiaoxiao, 3 qian) Polygalae Radix (Yuanzhi Rou, 0.8 fen) Nelumbinis Stamen (Lianxu, 1 qian) Dioscoreae Hypoglaucae Rhizoma (Huaiyao, 3 qian) Poria Cum Radix Pini Baomu (Baomu Fushen, 4 qian) Ostrea Concha (Shengmuli, 4 qian) Citri Reticulatae Pericarpium (Xinhui Pi, 1.5 qian) Rehmanniae Radix (Shengdi, 4 qian) Asini Corii Colla Ustus (Chao Lvjiao, 1.5 qian) Eucommiae Cortex Ustus (Chao Duzhong, 3 qian)
Decocted in water for five doses.
Commentary by Shao Jie: Wang Ang stated: The Heart is the Sovereign Fire; when the Sovereign Fire moves, the Ministerial Fire follows. Ministerial Fire resides in the Liver and Gallbladder. When Kidney Yin is deficient, essence is not stored; when Kidney Yang is strong, Qi is not secured. In this case, Liver Yang is rising upward, causing redness in the phlegm. Kidney deficiency fails to secure, leading to seminal overflow after urination. Treatment focuses on securing and assisting reception, aided by calming the Spirit and soothing Qi. When Qi is secured, essence naturally remains.
Shen from Yuzhuang (Xiangji): Yin fire has been敛 (contained). The pulse is deficient and thin. Non-interaction between Heart and Kidney leads to seminal slip. The tongue coating is white and slightly moist. Treatment should use Xin Shen Bu Nao Wan (Heart-Nourishing Pill) with modifications. (May 19)
Salviae Miltiorrhizae Radix (Danshen, 3 qian) Rehmanniae Radix (Shengdi, 3 qian) Rubi Chingii Fructus (Jinyingzi, 3 qian) Ostrea Concha (Shengmuli, 4 qian) Poria Cum Radix Pini (Fushen, 4 qian) Polygalae Radix (Yuanzhi Rou, 0.8 fen) Dioscoreae Hypoglaucae Rhizoma (Huaiyao, 3 qian) Platycladi Semen (Baiziren, 3 qian) Panax Ginseng var. Americanus (Xiyangshen, 1 qian) Ziziphi Spinosae Semen Ustus (Chao Zaoren, 3 qian) Citri Reticulatae Pericarpium (Xinhui Pi, 1.5 qian)
Decocted in water for four doses.
Follow-up: Seminal slip persists. The pulse is fine and tense. The tongue coating is slightly white. Defecation is difficult, with blood present. Treatment should tonify and moisten the intestines. (May 28)
Pseudoginseng Radix (Taizishen, 1 qian) Testudinis Carapax et Plastrum (Guiban, 4 qian) Cannabis Semen (Maziren, 3 qian) Citri Reticulatae Pericarpium (Xinhui Pi, 1.5 qian) Poria Cum Radix Pini (Fushen, 4 qian) Moutan Cortex (Danpi, 3 qian) Rubi Chingii Fructus (Jinyingzi, 3 qian) Ostrea Concha (Shengmuli, 4 qian) Rehmanniae Radix (Shengdi, 3 qian) Polygalae Radix (Yuanzhi Rou, 0.8 fen) Sojae Semen Album Preparatum (Douyi, 3 qian)
Decocted in water for four doses.
Commentary by Shao Jie: The Classic states: Spirit resides in the Heart, and spirit and mind are complete. It also says: The Heart is the root of life and the residence of the Spirit. Currently, because Kidney fluids fail to ascend to the Heart, and the Heart fails to store the Spirit, once the Heart Spirit moves, Kidney essence leaks. Therefore, treatment uses Xin Shen Bu Nao Wan (Heart-Nourishing Pill) with modifications to nourish Kidney fluids and calm the Heart Spirit. However, since Yin fluids are already deficient, they fail to moisten the Large Intestine. Old fecal matter in the intestines causes constipation. The official of transmission loses its normal function. Thus, in the second prescription, within the context of nourishing Yin and subduing Yang, Hemp Seed and Rehmannia Root are used to moisten the intestines and promote bowel movement. This allows Kidney fluids to gradually replenish, resulting in smooth defecation, secure essence, and an安定 (calm) Spirit.