小儿遗尿者，乃肾与膀胱俱虚，而冷气乘之。是以传送无度，亦有禀受阳气不足，
而胞冷不能约制，其水出而不禁。亦有内虚湿热，是以不禁遗沥者有焉。色赤者为血
热，白者气虚也。更有睡中自出者，谓之尿床。此亦肾虚与膀胱虚冷，至夜属阴，故小
便不禁，睡中自出也。白浊者，其尿白如米泔，由乳哺失节，有伤于脾，致使清浊不
分，久则成疳。先赤后白者，心热也。便下纯白者，疳症也。若小儿长大，而有赤白二
浊者，其色虽殊，总归于火。赤浊者，湿热乘于血分也。白浊者，湿痰流下所致也。又
有肾气虚寒，不能收摄精华，以是尿白如油，光彩不定，凝如膏糊者，久则肾败成
痨。虚而挟热者，先行分利，虚而挟寒者，惟宜温补，当以脉候详之。
治遗尿。
鸡肠（一具，男用雌鸡，女用雄鸡，烧存性） 牡蛎 茯苓 桑螵蛸（炒，五钱） 桂
（去皮） 龙骨（各二钱五分） 为末，仍以鸡肫 一具，鸡肠一具，烧存性，研细末，
每用前药末一钱，温酒调化食。
丹溪专主乎热，以热则流通也，故用知柏、蛤粉、青黛。若内伤气血两虚，不能固
守者，当大补气血以涩之。若思想成病，具病在心，宜安神丸带补药。精滑主乎湿热，
黄柏、知母降火，牡蛎、蛤粉燥湿。凡两尺
洪数者，则火动而水不自安，必便浊精遗。若心脉短小者，乃心血虚损，心不能摄肾
也。数旬一遗，清之不止为虚寒，遗不满旬，涩之反甚为郁滞。因梦交而精出者，谓
之梦遗。不因梦而自泄者，谓之精滑。耳闻目见，其精自出，名曰白淫。皆相火所动，
久则有虚而无寒也。总之，遗精、淋浊，皆心虚而有热，心火妄动则不能下交于肾，故
元精失守也。有肝火强盛，以致茎盛不衰，精出不止，名曰强中，多发消渴、痈疽。
左肾所藏者，精也，真水也。右肾所藏者，气也，相火也。梦遗精滑之症，由人思
想过度，以动心火。心火，君火也。君火出则相火翕然而动，所以激搏真水而疏泄，倘
再用燥热之药，犹积薪救火矣。惟宜安神养气，使精与神气相根据，而自固也。至于收涩
滑脱之味，亦谓劫剂，中病则已，不可过投。况龙骨最能涸津，若过服之，晚年发燥
热之所由也。或曰精泄已久，则为寒矣，殊不知，精属阴也，火属阳也，阴精虚而阳火
愈炽。《经》云∶阴虚生内热。未云阴虚生内寒也。且详古治梦遗方按，属郁滞者，居
大半。庸医不知其郁，但用涩剂固脱，愈涩愈郁，其病反甚矣。故治法曰∶梦遗者治其
心，精滑者固其真，满而溢者疏其情，浊而赤者调其经，养其神，心安神宁，火来坎
户，水到离宫，水火交养，遗浊皆清。慕欲不遂，而伤元阴，以致梦遗者，此神思间之
火暗动故也。则当从其所欲，与清神中之火，梦遗自止。亦须看人之元气强弱何如？
若元阳衰弱，而精神不固，致使精滑自遗者，加鹿角霜、牡蛎、鹿茸、锁阳，多加参
、附子以固之。
梦遗精滑，多作肾虚，而用补涩之药不效，盖有属脾胃，饮酒浓味，痰火湿热者。
夫肾藏精，精之所生，由脾胃饮食化生而输归于肾，今脾胃伤于湿热，内郁中气，浊而
不清，则所化生之精，亦得浊气，肾主闭藏，阴静则宁，所输之精即有浊气，则邪火
扰动，肾中水不得宁静，故遗而滑，此症与白浊同。丹溪论，白浊为胃中浊气，下流渗
入膀胱也。其有色心太重，妄想过用而遗滑者，自从心肾治之。
梦遗者，治以肾肝为主。《准绳》曰∶病之初起，亦有不在肝肾，而在心肺脾胃之
不足者，然必传于肝肾，而精乃走也。故心肾为水火之脏，法天生地施化成之道，藏精
藏神，为五脏之宗主，若由他脏而致肾之泄者，必察四属，以求其治。《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，精神乃
绝。所谓阳强者，肝肾所寄之相火强也。阴绝者，肾中所藏之真阴绝也。肾为阴主藏，
肝为阳主泄，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，有不梦，梦即泄矣。何故不为他梦，而偏多淫梦耶！《经》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，其中有相火寄焉。凡平人入房，强于作用者，皆此火充其
力，于是三焦上下内外之火，翕然下从，百体玄府悉开，其滋生之精，尽趋于阴器以
泄，岂止肾之所藏者而已哉！若人元精坚固者，淫气不能摇，久度不泄，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。今人禀赋原虚，色欲过度，
肾阴衰惫，君火感物而动，动则相火翕然而随，虽不交会，其精已离其位而不固矣。当
卧之时，壮者，阴平阳秘，无是病也。弱者阴不强而阳不秘，故卧而即梦，梦而即遗
也。由于肝火旺而妄行疏泄，肾气弱而不以闭藏，即肝火之旺，亦肾阴之虚，故治以肾
肝为主，或问曰∶阴虚火动而梦遗，服丹溪补阴丸，以滋阴降火而不效何也？此未得滋
阴之本意也。盖丹溪原以肾气丸，为滋阴之要药，今人不会其意，以知柏为君，概用坎
离固本之类，俱是沉寒泻火之剂，苦寒极能
泻水，肾有补而无泻，焉能有神于阴哉！独立斋发明丹溪之未发，专用六味补肾，而治
屡效，纵有相火，水能滋木，水升而木火自息矣。倘脾胃不足，湿热下流者，以前丸为
主，煎服补中益气以升提之，有用心过度，心虚不能主令，而相火夺权太过者，亦以前
丸为主，而兼归脾汤，命门火衰，元精脱陷，玉关不闭者，用八味丸，或金锁正元
丹，以壮真阳，使之涵摄阴精，而不泄，此其治也。
夫精生气，气生神，精伤则无以生气，故瘦弱少气，气弱则不能生神，故曰旺不明
精，气不内固，水不能济火，故遗泄而精愈耗也。然百病皆生于心，百病皆根于肾，天
一生水，地二生火，肾水不上升，心火不下降，梦遗所由来也。夫肾水不上，则气不
固，而阴虚，心火不下则妄动，而相火从之，以阳旺，阳旺阴虚，则水火不交，《经》
曰∶阴阳离决，精气乃绝此也。梦遗本心火为病，然肝肾二经之火，相挟以成之，盖心
藏神，肝藏魂，肾藏精，梦中所生，即心之神，梦中所见，即肝之魂，梦中所泄，即肾
之精也。心为君主，肝肾为相，梦中神游，则魂化为形，相火翕然鼓之，此精之所以
泄，总由心气虚，不能入肾阴以藏，肾气虚，不能延心气以纳，心失拱默，君主之
德，肾失封蛰闭藏之功，而为不交不固之患矣。有梦而遗者，由思想所致，心虚不足，
而不能摄肾也。无梦而遗者，多欲所致肾精滑泄而不能禁固，相火妄动所致也。有醉饱
劳倦，清气不升，脾精不运而遗者。有肾水不足，淫火熏蒸，精离其位而遗者。有相火
旺，而脾胃有伤水谷日生之精，不得入，与元精俱藏而遗者。有火炎上，而水下趋，心
肾不交而滑者。有年壮气盛，久无色欲，精满而溢者。有脾虚下陷者，有痰火湿热扰动
精府者，然治惟宜保心滋肾，因湿因热因寒而治之，更补中气，以使元阳升举，久服自
愈，不可轻服涩药，盖人身气血，周流乃畅，岂可涩之使滞耶！，若夫白浊者，其原
在于脾胃之虚，其标在于膀胱之寒，初浊则属湿热，久浊则为气脱，气脱则下焦无火，
而水不温暴病非阴，久病非阳，大抵白浊伤于气，赤浊伤于血也。但阴窍有二，一窍通
精，属肾，一窍通溺，属膀胱。两窍不并开者，入房则精窍开，而溺窍闭，溲溺则溺窍
开，而精窍闭，故凡梦遗滑精，均从精窍而出，为肾经相火虚热之病，凡白浊五淋，
均主溺窍而出，为膀胱湿热下流之病，然玩《经》曰∶思想无穷，所愿不得，意淫于外，
入房太甚，宗筋驰纵，发为筋痿，及为白淫。又考前哲诸论，则知浊病即精病，仍在
精窍，与淋病之在溺窍者不同也。每见时医治浊，多以淋法治之，五苓八正，不惟不
效，反增沉困矣。
五脏皆有精，精者人之本，然肾为藏精之都会，听命于心君，若能遗欲澄心，精气
内守，阴平阳秘，精元固密矣。或纵欲劳神，则心肾不交，关键不固。《经》曰∶怵
惕思虑则伤神，神伤则恐惧流淫而不止；又曰∶恐惧不解则伤精，精伤则骨酸痿厥，精
时自下；又曰∶五脏主藏精，伤则失守；又曰∶肾者主水，受五脏六腑之精，而藏之；
又曰∶厥气客于阴器，则梦接内，奈古今方论皆以遗精为肾气衰弱之病，若与他脏不相
干涉，不知《内经》言五脏六腑各有精，肾则受而藏之，以不梦而自遗者，心肾之伤居
多，梦而后遗者，相火之强为害，若五脏各得其职，则精藏而治，苟一脏不得其正，甚
则必移害心肾之主精者焉。治之之法，独因肾病而遗者，治其肾，由他脏而致者，则以
他脏与肾两治之，当以六脉参详，昭然可辨矣。
壮年未偶，时时梦遗者，为精气溢泄，不必过治，盖心有所思，夜见于梦，乃心火
动，而相火随之也。过为补益，则助其火，过为敛涩，则增其郁。
大智禅师云∶梦遗不可全作虚冷治，亦
有经络热而得之者。尝治一男子，至夜脊心热梦遗，用珍珠粉丸，猪苓丸，而遗止，脊
热始除。又一男子，脉洪腰热，遗精，沉香和中丸下之，导赤散治其火而愈，故精滑多
因寒，梦遗多因热也。
赵以德云∶予治郑鲁叔二十余岁，攻举子业，四鼓犹未卧，遂成此病，卧间玉茎但
着被与腿，便梦交接脱精，悬空则不梦，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，不三月而安。
心肾为水火之脏，心神伤则火动，火动不已，则肾水受伤，肾主藏精，所受五脏六
腑，输至之精，皆不得藏，而时下矣，故为遗精梦泄。昔吴茭山有治遗精得法论，治一
男子因病后用心过度，遂成梦遗之患，多痰瘦削，诸医以清心莲子饮，久服无效，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。以升提之法，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，不逾月而愈。因思梦遗多端，难
作一途而治，有因用心积热而泄者，有因多服冷利之药而泄者，有久泄玉关不闭而泄
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
火自交，而坎离定位矣。
已上二按，皆以肾为主，而兼治心脾者，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。用
龙胆泻肝汤主之，张子和曰∶遗溺闭癃，阴痿脬痹精滑白淫，皆男子之疝也。若血涸不
月，月罢腰膝上热，足 嗌干癃闭，小腹有块，或定或移，前阴突出，后阴痔漏，皆
女子疝也，惟女子不曰疝而曰瘕。
浊病在精窍，与淋病之在溺窍者不同，故患浊者，茎中如刀割火灼，而溺自清，惟
窍端时有秽物如疮之脓，淋漓不断，与溺道绝不相混，大抵由精败而腐者，十之七八，
由湿热流注与虚者十之二三，其伤精耗血，总属一也。然有赤白之分者，盖精为血之所
化，浊去太多，精化不及，赤未变白，名曰赤浊，此虚之甚者也。譬如少年天癸未足，
强力行房，所泄半精半血，壮年施泄无度，亦多精血杂出耳。有分赤白为气血，又以心
虚有热，因思虑而得为赤，肾虚有寒，由嗜欲而得为白，然当以脉之滑数，而口渴便赤
为热，脉之沉迟，而便清白为寒。总之心动于欲，肾伤于色，强忍房事，多服淫方，败
精流溢，湿热郁滞，而为患也。亦有胃中湿痰流注者，有属虚劳者，有因伏暑者，有思
想太过，心动烦扰而精败下焦也。总五脏之伤，六淫之变，难以言尽，脉候凿详，自无
遁情矣。
张每见咳嗽肺虚之人，梦魂怪异，甚至户外之事，皆能闻见者何与？盖魄强者魂
安，夫木性虽浮，肝则藏血藏魂，而隶于下焦，金性虽沉，肺则主气藏魄，而居乎至
高，若肺燥而失其相传治节之权，则肝为将军之官，无所畏制，遂飞扬而上越不能自藏
其魂耳。魄强魂安，今魄弱而魂不肯退藏，乃逐虚阳而放荡，此名离魂，魂既离矣。则
出入无时，故户外事，皆能闻且见也。当急救肺之燥。则肝木有所制，而魂魄俱宁，且
金能生水，肾更得有闭藏禁固之义，由此观之，肺弱肝强为遗者，亦比比矣，然肝之
强，必由于肾水之水足，肺之弱，必由于心火之有余。
更有久旷之人，与女交合，泄而不止，谓之走阳，其女须抱定，勿使阴茎出户
急呵热气于口中，以指捻住尾闾即救矣。若女人惊而脱去者，十有九死，亟令童女，以
口对口，补接其气，再灌以大剂独参汤，亦有活者。
小儿遗尿，是由于肾与膀胱都虚弱，寒气侵袭所致。因此尿液排泄没有节制，也有的是因为先天禀赋阳气不足，导致胞宫寒冷不能约束，使尿液流出而失控。也有因体内虚弱兼有湿热，导致尿液淋漓不禁的情况。尿液颜色发赤的属于血热，发白的属于气虚。还有在睡眠中自行排尿的，称为尿床。这也是肾虚和膀胱虚冷，夜间属阴，所以小便失禁，在睡梦中自行排出。白浊症，是指尿液像米泔水一样浑浊，这是由于哺乳喂养不当，损伤了脾胃，致使清浊之气不分，时间久了会形成疳积病。先红后白的，是心热所致。完全排出的白色浑浊物，是疳症的表现。如果小儿长大后，出现红色和白色的两种浊症，虽然颜色不同，但总归都属于火邪。赤浊，是湿热侵入血分所致。白浊，是湿痰下注所致。又有因肾气虚寒，不能收摄精华，导致尿液像油一样白，光泽不定，凝结如膏糊状，时间久了会导致肾败坏而成痨病。体质虚弱兼有热的，应先采用分利的方法；体质虚弱兼有寒的，只宜温补，应当通过脉象详细辨别。
治疗遗尿。
鸡肠（一根，男用雌鸡肠，女用雄鸡肠，烧至存性） 牡蛎 茯苓 桑螵蛸（炒，五钱） 桂枝（去皮） 龙骨（各二钱五分）。研为细末，再用鸡肫一个、鸡肠一根，烧至存性，研成细末。每次取前药末一钱，用温酒调服，饭后服用。
朱丹溪专门主张从“热”论治，认为热则气血流通，所以使用知母、黄柏、蛤粉、青黛。如果是内伤导致气血两虚，不能固守精气，应当大补气血以收敛固涩。如果是因思虑过度致病，病位在心，宜用安神丸配合补益药物。精液滑泄主要由于湿热，用黄柏、知母降火，牡蛎、蛤粉燥湿。凡是尺脉洪数的，说明火动而水不安定，必然导致小便浑浊、精液遗泄。如果心脉短小，是心血虚损，心不能制约肾。每隔几十天遗精一次，清热不止反而转为虚寒；遗精不满十天，用收敛药反而加重，这是郁滞所致。因做梦交合而射精的，称为梦遗。不因做梦而自行泄精的，称为精滑。听到或看到异性，精液自行流出，称为白淫。这些都是相火妄动所致，时间久了只有虚证而没有寒证。总之，遗精、淋浊，都是心虚而有热，心火妄动不能下行交于肾，导致元精失守。有肝火强盛，导致阴茎勃起不衰，精液流出不止，称为强中，多并发消渴、痈疽。左肾所藏的是精，即真水；右肾所藏的是气，即相火。梦遗精滑的病证，是由于人思虑过度，引动心火。心火是君火，君火一出，相火便随之而动，从而激荡真水使其疏泄，如果再使用燥热药物，如同在柴堆上救火。只宜安神养气，使精与神气相依附，自然坚固。至于那些收敛固涩的药物，也称为劫剂，病愈即止，不可过量投用。况且龙骨最能耗伤津液，如果长期服用，是晚年发生燥热的原因。有人说精液泄漏久了就会变寒，殊不知，精属阴，火属阳，阴精虚则阳火更炽。《内经》说：“阴虚生内热”，没说阴虚生内寒。且详细考察古代治疗梦遗的方案，属于郁滞的占大半。庸医不知道是郁滞，只用涩剂固脱，越涩越郁，病情反而加重。所以治疗方法说：梦遗者治其心，精滑者固其真，满而溢者疏导其情志，浊而赤者调理其经脉，养护其神，心神安宁，水火既济，遗浊自清。慕欲不得满足而损伤元阴，导致梦遗的，这是神思间之火暗动所致。则应当顺从其欲望，清解神中之火，梦遗自然停止。也必须看人的元气强弱如何？如果元阳衰弱，精神不固，导致精滑自遗的，加鹿角霜、牡蛎、鹿茸、锁阳，多加人参、附子以固摄。
梦遗精滑，多认为是肾虚，而用补涩药无效，大概有属于脾胃，因饮酒厚味，痰火湿热所致。肾藏精，精的产生，由脾胃饮食化生而输送归于肾，现在脾胃被湿热所伤，中气郁结，浊而不清，那么所化生的精也带有浊气，肾主闭藏，阴静则安宁，所输送的精如果有浊气，则邪火扰动，肾中水不得宁静，所以遗而滑，此症与白浊相同。丹溪论述，白浊是胃中浊气，下流渗入膀胱。那些色欲太重，妄想过用而遗滑的，自然从心肾论治。
梦遗的治疗，以肾肝为主。《准绳》说：病之初起，也有不在肝肾，而在心肺脾胃不足的，但必然传变到肝肾，精才会走泄。所以心肾是水火之脏，效法天地施化成之道，藏精藏神，为五脏宗主，如果由其他脏腑导致肾泄，必须察验四属，以求治法。《内经》说：阴阳的要领，阳气致密才能固守，阳气过强不能致密，阴气就会枯竭，阴平阳秘，精神才能正常，阴阳离决，精神就会绝灭。所谓阳强，是肝肾所寄的相火强盛。阴绝，是肾中所藏的真阴枯竭。肾为阴主藏，肝为阳主泄，肾阴虚则精不藏，肝阳强则火不秘，以不秘之火，加临不藏之精，不做梦也会如此，做梦就会泄精。为什么不别的梦，偏偏多是淫梦呢！《内经》说：厥气客于阴器，则梦接内，盖阴器是泄精之窍，主宗筋，足太阴、阳明、少阴、厥阴之筋，以及冲任督三脉都会聚于此，诸筋都结聚于阴器，其中有相火寄居。凡普通人房事，强力作用者，都是此火充其力，于是三焦上下内外之火，一起下行，全身玄府悉开，滋生的精，尽趋于阴器以泄，岂止是肾所藏的呢！如果人元精坚固，淫气不能动摇，久战不泄，何况做梦呢，纵使相火动，而成宵梦，梦也不遗，这叫阴平阳秘，无病患。现在人禀赋原虚，色欲过度，肾阴衰惫，君火感物而动，动则相火随之，虽不交会，其精已离其位而不固了。当卧之时，强者阴平阳秘，无此病。弱者阴不强而阳不秘，所以卧而即梦，梦而即遗。由于肝火旺而妄行疏泄，肾气弱而不能闭藏，即肝火之旺，也是肾阴之虚，所以治疗以肾肝为主。有人问：阴虚火动而梦遗，服用丹溪补阴丸，滋阴降火却无效，为什么？这是未得滋阴的本意。丹溪原本以肾气丸为滋阴要药，今人不会其意，以知母、黄柏为君药，一概使用坎离固本之类，都是沉寒泻火之剂，苦寒极能泻水，肾有补而无泻，怎么能有神于阴呢！李东垣发明丹溪未发之意，专用六味地黄丸补肾，治疗屡效，纵有相火，水能滋木，水升而木火自息矣。如果脾胃不足，湿热下流的，以前丸为主，煎服补中益气汤以升提之；有用心过度，心虚不能主令，而相火夺权太过的，也以前丸为主，兼用归脾汤；命门火衰，元精脱陷，玉关不闭的，用八味丸，或金锁正元丹，以壮真阳，使之涵摄阴精，而不泄，这是其治法。
精生气，气生神，精伤则无以生气，所以瘦弱少气，气弱则不能生神，所以说精旺不明，气不内固，水不能济火，所以遗泄而精愈耗。然而百病皆生于心，百病皆根于肾，天一生水，地二生火，肾水不上升，心火不下降，梦遗由此产生。肾水不上，则气不固而阴虚，心火不下则妄动，而相火从之，以阳旺，阳旺阴虚，则水火不交，《内经》说：阴阳离决，精气乃绝，就是这个道理。梦遗本是心火为病，然肝肾二经之火，相挟以成之，盖心藏神，肝藏魂，肾藏精，梦中所生，即心之神，梦中所见，即肝之魂，梦中所泄，即肾之精也。心为君主，肝肾为相，梦中神游，则魂化为形，相火翕然鼓之，此精之所以泄，总由心气虚，不能入肾阴以藏，肾气虚，不能延心气以纳，心失拱默，君主之德，肾失封蛰闭藏之功，而为不交不固之患矣。有梦而遗者，由思想所致，心虚不足，而不能摄肾也。无梦而遗者，多欲所致肾精滑泄而不能禁固，相火妄动所致也。有醉饱劳倦，清气不升，脾精不运而遗者。有肾水不足，淫火熏蒸，精离其位而遗者。有相火旺，而脾胃有伤水谷日生之精，不得入，与元精俱藏而遗者。有火炎上，而水下趋，心肾不交而滑者。有年壮气盛，久无色欲，精满而溢者。有脾虚下陷者，有痰火湿热扰动精府者，然治惟宜保心滋肾，因湿因热因寒而治之，更补中气，以使元阳升举，久服自愈，不可轻服涩药，盖人身气血，周流乃畅，岂可涩之使滞耶！，若夫白浊者，其原在于脾胃之虚，其标在于膀胱之寒，初浊则属湿热，久浊则为气脱，气脱则下焦无火，而水不温暴病非阴，久病非阳，大抵白浊伤于气，赤浊伤于血也。但阴窍有二，一窍通精，属肾，一窍通溺，属膀胱。两窍不并开者，入房则精窍开，而溺窍闭，溲溺则溺窍开，而精窍闭，故凡梦遗滑精，均从精窍而出，为肾经相火虚热之病，凡白浊五淋，均主溺窍而出，为膀胱湿热下流之病，然玩《经》曰∶思想无穷，所愿不得，意淫于外，入房太甚，宗筋驰纵，发为筋痿，及为白淫。又考前哲诸论，则知浊病即精病，仍在精窍，与淋病之在溺窍者不同也。每见时医治浊，多以淋法治之，五苓八正，不惟不效，反增沉困矣。
五脏皆有精，精者人之本，然肾为藏精之都会，听命于心君，若能遗欲澄心，精气内守，阴平阳秘，精元固密矣。或纵欲劳神，则心肾不交，关键不固。《经》曰∶怵惕思虑则伤神，神伤则恐惧流淫而不止；又曰∶恐惧不解则伤精，精伤则骨酸痿厥，精时自下；又曰∶五脏主藏精，伤则失守；又曰∶肾者主水，受五脏六腑之精，而藏之；又曰∶厥气客于阴器，则梦接内，奈古今方论皆以遗精为肾气衰弱之病，若与他脏不相干涉，不知《内经》言五脏六腑各有精，肾则受而藏之，以不梦而自遗者，心肾之伤居多，梦而后遗者，相火之强为害，若五脏各得其职，则精藏而治，苟一脏不得其正，甚则必移害心肾之主精者焉。治之之法，独因肾病而遗者，治其肾，由他脏而致者，则以他脏与肾两治之，当以六脉参详，昭然可辨矣。
壮年未偶，时时梦遗者，为精气溢泄，不必过治，盖心有所思，夜见于梦，乃心火动，而相火随之也。过为补益，则助其火，过为敛涩，则增其郁。
大智禅师云∶梦遗不可全作虚冷治，亦有经络热而得之者。尝治一男子，至夜脊心热梦遗，用珍珠粉丸，猪苓丸，而遗止，脊热始除。又一男子，脉洪腰热，遗精，沉香和中丸下之，导赤散治其火而愈，故精滑多因寒，梦遗多因热也。
赵以德云∶予治郑鲁叔二十余岁，攻举子业，四鼓犹未卧，遂成此病，卧间玉茎但着被与腿，便梦交接脱精，悬空则不梦，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，不三月而安。
心肾为水火之脏，心神伤则火动，火动不已，则肾水受伤，肾主藏精，所受五脏六腑，输至之精，皆不得藏，而时下矣，故为遗精梦泄。昔吴茭山有治遗精得法论，治一男子因病后用心过度，遂成梦遗之患，多痰瘦削，诸医以清心莲子饮，久服无效，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。以升提之法，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，不逾月而愈。因思梦遗多端，难作一途而治，有因用心积热而泄者，有因多服冷利之药而泄者，有久泄玉关不闭而泄者，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，使水火自交，而坎离定位矣。
已上二按，皆以肾为主，而兼治心脾者，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。用龙胆泻肝汤主之，张子和曰∶遗溺闭癃，阴痿脬痹精滑白淫，皆男子之疝也。若血涸不月，月罢腰膝上热，足 嗌干癃闭，小腹有块，或定或移，前阴突出，后阴痔漏，皆女子疝也，惟女子不曰疝而曰瘕。
浊病在精窍，与淋病之在溺窍者不同，故患浊者，茎中如刀割火灼，而溺自清，惟窍端时有秽物如疮之脓，淋漓不断，与溺道绝不相混，大抵由精败而腐者，十之七八，由湿热流注与虚者十之二三，其伤精耗血，总属一也。然有赤白之分者，盖精为血之所化，浊去太多，精化不及，赤未变白，名曰赤浊，此虚之甚者也。譬如少年天癸未足，强力行房，所泄半精半血，壮年施泄无度，亦多精血杂出耳。有分赤白为气血，又以心虚有热，因思虑而得为赤，肾虚有寒，由嗜欲而得为白，然当以脉之滑数，而口渴便赤为热，脉之沉迟，而便清白为寒。总之心动于欲，肾伤于色，强忍房事，多服淫方，败精流溢，湿热郁滞，而为患也。亦有胃中湿痰流注者，有属虚劳者，有因伏暑者，有思想太过，心动烦扰而精败下焦也。总五脏之伤，六淫之变，难以言尽，脉候凿详，自无遁情矣。
张每见咳嗽肺虚之人，梦魂怪异，甚至户外之事，皆能闻见者何与？盖魄强者魂安，夫木性虽浮，肝则藏血藏魂，而隶于下焦，金性虽沉，肺则主气藏魄，而居乎至高，若肺燥而失其相传治节之权，则肝为将军之官，无所畏制，遂飞扬而上越不能自藏其魂耳。魄强魂安，今魄弱而魂不肯退藏，乃逐虚阳而放荡，此名离魂，魂既离矣。则出入无时，故户外事，皆能闻且见也。当急救肺之燥。则肝木有所制，而魂魄俱宁，且金能生水，肾更得有闭藏禁固之义，由此观之，肺弱肝强为遗者，亦比比矣，然肝之强，必由于肾水之水足，肺之弱，必由于心火之有余。
更有久旷之人，与女交合，泄而不止，谓之走阳，其女须抱定，勿使阴茎出户急呵热气于口中，以指捻住尾闾即救矣。若女人惊而脱去者，十有九死，亟令童女，以口对口，补接其气，再灌以大剂独参汤，亦有活者。
Nocturnal enuresis in children is caused by deficiency of both the Kidney and Bladder, allowing cold pathogenic factors to invade. Consequently, urine transmission lacks restraint. Some cases arise from congenital insufficiency of Yang Qi, leading to a cold bladder that cannot control urination, resulting in involuntary leakage. Others result from internal deficiency combined with damp-heat, causing dribbling enuresis. Urine that is red indicates blood heat; white urine indicates Qi deficiency. Additionally, involuntary urination during sleep is called bedwetting. This is also due to Kidney deficiency and coldness of the Bladder; since night belongs to Yin, urinary incontinence occurs spontaneously during sleep. White turbidity (Bai Zhuo) refers to urine as cloudy as rice washings, caused by irregular breastfeeding or diet damaging the Spleen, leading to failure in separating clear from turbid substances, which may eventually develop into infantile malnutrition (Gan syndrome). Turbidity that is initially red then becomes white indicates Heart heat. Purely white discharge indicates Gan syndrome. If an older child presents with both red and white turbidity, although the colors differ, they generally stem from Fire pathogens. Red turbidity results from damp-heat invading the Blood level; white turbidity results from damp-phlegm sinking downward. Another type involves Kidney Qi deficiency and coldness, failing to secure essence, causing urine to be white like oil, with unstable luster, coagulating like paste; prolonged cases lead to Kidney exhaustion and consumption disease. For deficiency with accompanying heat, draining and separating methods should be used first; for deficiency with accompanying cold, warming and tonifying are appropriate. Pulse diagnosis should guide treatment.
Treatment for nocturnal enuresis:
Chicken gizzard (one piece, female chicken for males, male chicken for females, burnt until carbonized but retaining efficacy) Oyster Shell (Mu Li), Poria (Fu Ling), Mantis Egg Case (Sang Piao Xiao, stir-fried, 5 qian), Cinnamon Twig (Gui Zhi, bark removed), Dragon Bone (Long Gu) (each 2.5 qian). Grind into powder. Also burn one chicken gizzard and one chicken intestine until carbonized, grind into fine powder. Take 1 qian of the previous powder each time, dissolve in warm wine, taken after meals.
Zhu Danxi specifically emphasizes treating based on "Heat," believing that heat promotes circulation, thus using Anemarrhena Rhizome (Zhi Mu), Phellodendron Bark (Huang Bai), Trichosanthes Powder (Ge Fen), and Indigo Naturalis (Qing Dai). If internal injury causes dual deficiency of Qi and Blood, unable to maintain retention, substantial tonification of Qi and Blood with astringents is required. If illness arises from excessive thinking, located in the Heart, use An Shen Wan combined with tonics. Slippage of semen is primarily due to damp-heat; Huang Bai and Zhi Mu descend Fire, while Mu Li and Ge Fen dry dampness. When the Chi pulse at both wrists is surging and rapid, it indicates Fire agitation causing Water instability, leading to turbid urine and seminal emission. A short and small Xin Mai indicates Heart Blood deficiency, where the Heart fails to control the Kidney. Emission occurring once every few weeks, unresponsive to clearing heat, turns into deficiency-cold; emission occurring less than ten days apart, worsening with astringents, indicates stagnation. Emission associated with sexual dreams is called dream emission (Meng Yi); spontaneous emission without dreams is called seminal slippage (Jing Hua). Spontaneous ejaculation upon hearing or seeing stimuli is called white yin (Bai Yin). All are caused by ministerial Fire agitation; long-term cases involve only deficiency without cold. In summary, seminal emission and strangury/turbidity stem from Heart deficiency with heat; reckless Heart Fire fails to descend to interact with the Kidney, causing loss of primordial essence. Excessive Liver Fire causing persistent erection and continuous emission is called strong middle (Qiang Zhong), often accompanied by wasting-thirst (Xiao Ke) and carbuncles. The left Kidney stores Jing (Essence), which is True Water; the right Kidney stores Qi, which is Ministerial Fire. Dream emission and seminal slippage result from excessive thinking agitating Heart Fire. Heart Fire is Sovereign Fire; when Sovereign Fire moves, Ministerial Fire follows, stirring True Water and causing leakage. Using drying-hot herbs here is like adding wood to fire. One should calm the Spirit and nourish Qi so Essence and Spirit adhere naturally. Astringent herbs are considered "plundering agents"; stop them when the disease resolves, do not overuse. Long Gu dries fluids excessively; chronic use causes late-life dryness and heat. Some argue prolonged leakage leads to cold, but Essence is Yin, Fire is Yang; Yin deficiency exacerbates Yang Fire. The Classic states: "Yin deficiency generates internal heat," not cold. Ancient formulas for dream emission often address stagnation. Quacks use astringents for collapse, worsening stagnation. Treatment principles: Treat the Heart for dream emission; secure the True Essence for seminal slippage; regulate emotions for overflow; harmonize meridians for red turbidity; nourish the Spirit. When Heart is calm and Spirit peaceful, Water and Fire interact, clearing turbidity. Unfulfilled desires damaging Yuan Yin cause dream emission via hidden Fire movement in thoughts. Follow desires to clear mental Fire. Assess Yuan Qi strength. For Yuan Yang weakness and insecure spirit causing slippage, add Deer Antler Frost (Lu Jiao Shuang), Oyster Shell (Mu Li), Deer Antler (Lu Rong), Cynomorium (Suo Yang), plus Ginseng (Ren Shen) and Aconite (Fu Zi) to secure.
Dream emission and seminal slippage are often treated as Kidney deficiency, but if tonifying/astringing fails, consider Spleen/Stomach issues from alcohol and rich foods causing phlegm-fire damp-heat. Kidney stores Essence, generated by Spleen/Stomach transformation of food and transported to Kidney. Damp-heat damaging Spleen/Stomach causes mid-Jiao Qi stagnation and turbidity; transformed Essence becomes turbid. Kidney governs closure; Yin stillness brings peace. Turbid Essence disturbs with evil Fire, preventing Kidney Water from resting, causing emission/slippage, similar to white turbidity. Danxi states white turbidity is turbid Qi from Stomach sinking into Bladder. Those with excessive lust and wild imagination should be treated from Heart and Kidney.
Dream emission treatment focuses on Kidney and Liver. *Zhun Sheng* notes early stages may involve Heart/Lung/Spleen/Stomach deficiency, but must transmit to Kidney/Liver for essence to leak. Heart and Kidney are Water/Fire organs, storing Spirit and Essence, masters of the Five Viscera. If other organs cause Kidney leakage, examine all four aspects for treatment. The Classic says: "The key to Yin-Yang is dense Yang ensuring solidity. If Yang is strong but not dense, Yin Qi perishes. If Yin is flat and Yang is secret, Spirit thrives. If Yin-Yang separate, Spirit dies." Strong Yang refers to vigorous Ministerial Fire in Liver/Kidney. Yin perishing refers to depletion of True Yin in Kidney. Kidney (Yin) stores; Liver (Yang) excretes. Kidney Yin deficiency means Essence is not stored; Liver Yang excess means Fire is not contained. Uncontained Fire over unstored Essence leads to emission even without dreams. Why erotic dreams? The Classic says: "Jue Qi invades the genitalia, leading to dreams of intercourse." Genitalia are the orifice for semen, governing sinews, meeting channels of Foot Taiyin, Yangming, Shaoyin, Jueyin, Chong, Ren, and Du. Sinews gather there, housing Ministerial Fire. Sexual activity relies on this Fire. When active, Fire from Sanjiao descends, pores open, Essence flows to genitals. Only those with solid Yuan Jing resist this. Weak constitution, excessive lust, depleted Kidney Yin allows Sovereign Fire to move, dragging Ministerial Fire. Essence leaves its position. Sleepers with balance have no disease; weak ones dream and emit. Liver Fire excess causes leakage; Kidney Qi weakness fails to store. Liver Fire excess stems from Kidney Yin deficiency. Thus, treat Kidney/Liver. Question: Why does Danxi's Bu Yin Wan fail for Yin-deficiency Fire-agitation? Misunderstanding of nourishing Yin. Danxi used Shen Qi Wan as the base; modern practitioners wrongly use Zhi Mu/Huang Bai as sovereign, employing Kan Li Gu Ben types, which are cold-draining. Kidney needs tonification, not draining. Li Dongyuan clarified Danxi, using Liu Wei Di Huang Wan exclusively, effective because Water nourishes Wood, extinguishing Fire. For Spleen/Stomach deficiency with damp-heat sinking, use Liu Wei plus Bu Zhong Yi Qi Tang to raise. For excessive mental work causing Heart deficiency and unchecked Ministerial Fire, use Liu Wei plus Gui Pi Tang. For Ming Men Fire decline and essence collapse, use Ba Wei Wan or Jin Suo Zheng Yuan Dan to strengthen True Yang and secure Essence.
Essence generates Qi; Qi generates Shen. Essence damage reduces Qi generation, causing emaciation and fatigue. Qi weakness fails to generate Shen. If Qi is not secured internally, Water cannot control Fire, leading to emission and further Essence loss. Diseases originate in Heart, root in Kidney. Heaven generates Water (Kidney), Earth generates Fire (Heart). If Kidney Water doesn't rise and Heart Fire doesn't descend, dream emission occurs. Rising Kidney Water secures Qi; descending Heart Fire prevents reckless movement. Imbalance leads to non-interaction of Water/Fire. Dream emission originates in Heart Fire, aided by Liver/Kidney Fire. Heart stores Shen, Liver stores Hun, Kidney stores Jing. Dreams involve Shen, visions involve Hun, emission involves Jing. Heart is Monarch, Liver/Kidney are Ministers. In dreams, Hun takes form, driven by Ministerial Fire, causing emission. Root cause: Heart Qi deficiency fails to enter Kidney Yin; Kidney Qi deficiency fails to receive Heart Qi. Heart loses quietude; Kidney loses storage. Dream emission stems from thoughts/Heart deficiency; non-dream emission stems from lust/Kidney essence slippage/ministerial Fire. Other causes: drunkenness/fatigue failing to raise clear Qi; Kidney Yin deficiency with淫火 steaming essence; Ministerial Fire excess with damaged Spleen/Stomach failing to transform daily Essence; Fire flaming up, Water sinking, Heart-Kidney non-interaction; robust youth with abstinence causing fullness overflow; Spleen deficiency sinking; Phlegm-fire damp-heat disturbing the Essence Mansion. Treatment: Protect Heart, nourish Kidney, address damp/heat/cold, tonify Middle Qi to raise Yuan Yang. Avoid astringents as they stagnate Qi/Blood flow. White turbidity originates in Spleen/Stomach deficiency, manifests as Bladder cold. Initial turbidity is damp-heat; chronic is Qi collapse. Collapse means lower Jiao lacks Fire/warmth. Acute is not purely Yin; chronic is not purely Yang. Generally, white turbidity damages Qi; red turbidity damages Blood. There are two yin orifices: one for essence (Kidney), one for urine (Bladder). They do not open simultaneously. During sex, essence orifice opens, urine closes; during urination, urine orifice opens, essence closes. Thus, emission/slippage exits via essence orifice (Kidney Ministerial Fire deficiency-heat); turbidity/strangury exits via urine orifice (Bladder damp-heat). The Classic states: "Endless thoughts, unfulfilled wishes, external lust, excessive sex cause sinew flaccidity and white yin." Ancient theories confirm turbidity is an essence disease in the essence orifice, distinct from strangury in the urine orifice. Treating turbidity as strangury with Wu Ling San or Ba Zheng San is ineffective and worsens condition.
All five viscera possess Essence, the root of life. Kidney is the gathering place, obeying the Heart Monarch. Restrain desires, clarify mind, secure Essence, balance Yin-Yang. Indulgence damages Heart-Kidney interaction. The Classic says: "Fear and worry injure Shen... Fear unresolved injures Jing... Five viscera store Essence; injury leads to loss of control... Kidney governs Water, receiving Essence from all viscera... Jue Qi in genitalia causes dreams of intercourse." Yet ancient texts often attribute emission solely to Kidney Qi weakness, ignoring other viscera. The Classic states all viscera have Essence, Kidney stores it. Non-dream emission often involves Heart-Kidney injury; dream emission involves strong Ministerial Fire. If all viscera function correctly, Essence is stored. If one viscus is abnormal, it harms Heart/Kidney. Treatment: If solely Kidney, treat Kidney; if from other viscera, treat both. Six-pulse diagnosis clarifies this.
Young unmarried men with frequent dream emission experience natural overflow; do not over-treat. Thoughts appear in dreams, agitating Heart and Ministerial Fire. Over-tonification aids Fire; over-astringency increases stagnation.
Chan Master Da Zhi said: Do not treat all dream emission as deficiency-cold; some arise from channel heat. Treated a man with spinal heat and dream emission using Zhen Zhu Fen Wan and Zhu Ling Wan, stopping emission and removing heat. Another man with surging pulse and waist heat used Chen Xiang He Zhong Wan and Dao Chi San to clear Fire. Thus, slippage is often cold-related; dream emission is often heat-related.
Zhao Yi De treated Zheng Lushu (20s), studying hard, sleeping late. Emission occurred when penis touched bedding/legs, not when suspended. Appetite decreased, fatigue increased. Caused by excessive mental effort, dual Fire rising, insomnia, Blood not returning to Liver, Kidney Water insufficient, Fire exploiting Yin deficiency, invading lower Jiao, stirring essence chamber. Touch acted as Jue Qi, causing dreams. Treatment: Upper: Tonify Heart, calm Spirit; Middle: Regulate Spleen/Stomach, raise Yang; Lower: Nourish Essence, generate Yin, secure Yang. Recovered in three months.
Heart/Kidney are Water/Fire organs. Heart Spirit injury agitates Fire; relentless Fire damages Kidney Water. Kidney stores Essence received from all viscera; if damaged, Essence leaks downward, causing emission. Wu Jiaoshan treated a man with post-illness mental overexertion causing dream emission, phlegm, emaciation. Qing Xin Lian Zi Yin failed. Pulse was tight/raspy; cold/diuretic drugs were excessive, causing Kidney Qi to sink alone. Used lifting method to raise Kan Water to aid Li Fire, descend Yang to nourish Yin Blood, then Deer Antler Glue and Human Milk to fill Essence/Blood. Recovered in a month. Dream emission has many causes: Accumulated heat requires clearing Heart/descending Fire; Cold/drug-induced requires warming/lower Yuan tonification; Sinking Kidney Qi requires lifting to restore Water-Fire interaction.
Previous analyses focused on Kidney with Heart/Spleen support. One exception: Kidney not deficient, but Liver channel damp-heat/fire excess causing penile pain, tendon contraction, itching, swelling, or protrusion, with white fluid like semen in urine. This is Sinew Hernia (Jin Shan). Use Long Dan Xie Gan Tang. Zhang Zihe stated: Enuresis, retention, impotence, bladder paralysis, seminal slippage, white yin are all male hernias. For women: Blood exhaustion amenorrhea, upper waist/knee heat, foot/throat dryness, retention, abdominal masses, anterior prolapse, posterior hemorrhoids/fistulas are female hernias (called Jia in women).
Turbidity affects the essence orifice, distinct from strangury in the urine orifice. Patients feel knife-like/burning pain in penis, urine is clear, but pus-like foul matter drips from orifice tip, mixing not with urine. Mostly due to rotten essence (70-80%), damp-heat sinking or deficiency (20-30%). Both damage Essence/Blood. Red vs. White: Essence transforms from Blood. Too much turbidity loss means Essence transformation lags; red hasn't turned white, called Red Turbidity, severe deficiency. Like youths with incomplete Tian Gui forcing sex, leaking half-essence/half-blood; adults with excessive release also mix essence/blood. Some distinguish red as Qi/Blood, Heart deficiency-heat/thoughts causing red; Kidney deficiency-cold/lust causing white. However, slippery-rapid pulse with thirst/red urine indicates heat; deep-slow pulse with clear/white urine indicates cold. Ultimately, Heart moved by desire, Kidney injured by lust, forced intercourse, aphrodisiacs cause rotten essence overflow, damp-heat stagnation. Also stomach damp-phlegm sinking, consumption disease, latent summerheat, excessive thoughts agitating Heart damaging lower Jiao Essence. All visceral injuries and six climatic changes are complex; detailed pulse diagnosis reveals truth.
Zhang noted coughing Lung-deficient patients having strange dreams, even sensing outdoor events. Why? Strong Po ensures calm Hun. Wood floats, Liver stores Blood/Hun in lower Jiao; Metal sinks, Lung governs Qi/Po in highest region. If Lung dryness loses regulating authority, Liver (General) is unrestrained, Hun flies upward, unable to hide. Strong Po, calm Hun. Now weak Po, Hun refuses to hide, chasing deficient Yang, becoming erratic. Called "Departing Soul" (Li Hun). With departing soul, entry/exit is unregulated, hence sensing outside events. Urgently rescue Lung dryness. Liver Wood will be controlled, Po/Hun calm. Metal generates Water, aiding Kidney storage. Thus, Lung weakness/Liver excess causing emission is common. Liver excess stems from sufficient Kidney Water; Lung weakness stems from excess Heart Fire.
For men abstinent for long periods, intercourse with unstoppable emission is called "Walking Yang" (Zou Yang). Woman must hold firm, prevent penis withdrawal. Blow hot air into mouth, press Weilu point with finger to save. If woman startsle and withdraws, nine out of ten die. Immediately order virgin girl to perform mouth-to-mouth resuscitation to replenish Qi, then administer large dose of Du Shen Tang. Survival possible.