治以肾肝为主。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。
精气乃绝。夫所谓阳强者。乃肝肾所寄之相火强也。所谓阴绝者。乃肾中所藏之真阴绝也。肾为阴。主藏精。
肝为阳。主疏泄。是故肾之阴虚。则精不藏。肝之阳强。则火不秘。以不秘之火。加临不藏之精。除不梦。梦
即泄矣。或问曰。何故不为他梦。而偏多淫梦耶。曰灵枢经淫邪发梦篇云。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。而其中有相
火寄焉。凡平人入房。而强于作用者。皆此相火充其力也。若不接内。不与阴气合。则精不泄。一接内。与阴
相合。则三焦上下内外之火。翕然而下从。百体玄府悉开。其滋生之精。尽趋于阴器以泄。而肾不藏矣。若
其人元精坚固者。淫气不能摇。久战而尚不泄。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。今人先天禀赋原虚。兼之色欲过度。以致肾阴衰惫。阴虚则相火动。相火之系。上系于心为君火。感
物而动。动则相火翕然而随。虽不交会。而精已离其位。即客于阴器间矣。夜卧时。当所寄之相火一
遇。与接内时与阴气相协议。故卧而即梦。梦而即遗也。若肾不虚。则无复是梦。梦亦不遗矣。故治是证者。
先以肾肝为主。或问曰。阴虚火动而梦遗。服丹溪补阴丸。以滋阴降火。则证与药相对。每根据法服之。而不
效何也。曰。此未得丹溪滋阴之本意也。盖丹溪心法第一方。原以肾气丸为滋阴之要药也。今人不
会其意。以黄柏知母为君。概用坎离丸固本之类。凡此俱是沉寒泻火之剂。苦寒极能泻水。肾有补而无泻。焉
能有裨于阴哉。独薛立斋发明丹溪之所未发。专用六味地黄以补肾。而治梦遗
屡效。纵有相火。水能滋木。水升而木火自息矣。倘有脾胃不足。湿热下流者。以前丸为主。煎服补中益气汤
以升提之。有用心过度。心不能主令。而相火代事者。亦以前丸为主。而兼用归脾汤。有命门火衰。元精脱
陷。玉关不闭者。急用八味丸。或用金锁正元丹。以壮真阳。使之涵乎阴精而不泄。此其大略也。
归脾汤
人参 茯神 黄 白术 龙眼肉 酸枣仁（炒研各二钱半） 木香 炙甘草（各五分） 用水二钟。生姜
二钱。大红枣一枚。煎一钟服。薛新甫加当归远志。各一钱。亦妙。
昔赵以德云。予治郑鲁叔二十余岁。攻举子业。四鼓犹不卧。遂成此病。卧间玉茎但着被与腿。便梦交
接脱精。惟悬空不着则不梦。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。近三月乃痊。
昔吴茭山有治遗精得法论治。一男子。因病后用心过度。遂梦遗多痰瘦削。诸医以清心莲子饮。久服
无效。吴诊其脉紧涩。知冷药利水之剂太过。致使肾气独降。服此愈剧矣。随用升提之法。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。逾月全愈。因思梦遗多端。难作一途施治。有因用心
积热而泄者。有因多服门冬茯苓车前知母黄柏冷利之药而泄者。有久泄玉门不闭而泄者。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。使水火交而坎离定位。
上二案。皆以肾为主。而兼治心脾者也。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。宜用龙胆泻肝汤。张子
和曰。遗溺闭癃阴痿脬肿精滑白淫。皆男子之疝也。若血涸不月。月罢腰膝上热。足 嗌干癃闭。而小腹有
块。或定或移。前阴突出。后阴痔漏。此女子之疝也。惟女子不曰疝而曰瘕。
治疗以肾和肝为主。《内经》说：阴阳的关键，在于阳气致密则阴精固守。如果阳气亢盛而不能致密，阴气就会枯竭。只有阴气平和、阳气秘固，精神才能正常。如果阴阳分离决裂，精气就会断绝。所谓“阳强”，是指寄居于肝肾的相火过旺。所谓“阴绝”，是指肾中所藏的真阴枯竭。肾属阴，主司藏精；肝属阳，主司疏泄。因此，肾阴虚则精液不能固藏，肝阳亢则相火不能秘守。用不能秘守的相火，加临于不能固藏的精液之上，除了做梦之外别无他法，一旦做梦就会射精。有人问：为什么不做其他梦，偏偏多做淫秽之梦呢？回答说：《灵枢经·淫邪发梦篇》说：“厥气客于阴器，则梦接内。”大概阴器是排泄精液的孔窍，主管宗筋，足太阴、阳明、少阴、厥阴的筋脉，以及冲、任、督三条经脉都汇聚于此。所有的筋脉都结聚在阴器，而其中有相火寄居。凡是普通人进行房事，且性功能强劲有力的，都是靠这相火提供力量。如果不进行性交，不与阴气结合，精液就不会泄出。一旦进行性交，与阴气相合，那么三焦上下内外的火气，就会迅速向下从行，全身毛孔全部张开，体内滋生的精液，全都趋向于阴器而泄出，导致肾无法固藏。如果这个人先天元气坚固，淫邪之气不能动摇他，即使长时间交合也不会泄精，何况是在梦中呢？纵然相火妄动形成夜间梦境，梦中也不会遗精。这叫做“阴平阳秘”，没有疾病。现在的人先天禀赋原本虚弱，加上色欲过度，导致肾阴衰败。阴虚则相火妄动，相火的根源上连于心，成为君火，受到外界事物刺激而动，一动则相火随之迅速下趋。虽然不进行性交，但精液已经离开其正常位置，即停留在阴器之间。夜间卧床时，当寄居的相火一遇到这种状态，就像性交时与阴气相合一样。所以睡觉就做梦，做梦就遗精。如果肾不虚，就不会再有这种梦，做梦也不会遗精了。所以治疗这种病症，先以调理肾肝为主。有人问：阴虚火旺导致的梦遗，服用丹溪的补阴丸，以滋阴降火，这样证候与药物相对，每次按照法则服用，却不见效，为什么呢？回答说：这是没有得到朱丹溪滋阴的本意。朱丹溪《心法》中的第一方，原本是以肾气丸作为滋阴的要药。现在的人不理解这个意思，把黄柏、知母作为主药，一概使用坎离丸、固本丸之类的药物。凡此这些都是沉寒泻火的药剂，苦寒之性极能泻水（伤阴）。肾只有补益而没有泻法，怎么能够对阴精有裨益呢？只有薛立斋阐发了朱丹溪未曾阐发的理论，专门使用六味地黄丸来补肾，治疗梦遗屡见疗效。纵然有相火，水能滋养木，水升则木火自然平息。如果有脾胃不足，湿热下注的情况，以前述丸剂为主，煎服补中益气汤以升提清气。如果用脑过度，心神不能主导，而由相火代行其职的，也以前述丸剂为主，兼用归脾汤。如果命门火衰，元气精血脱陷，玉门关不闭合的，急用八味丸，或者用金锁正元丹，以壮真阳，使其涵纳阴精而不外泄。这是大致的治疗方法。
归脾汤
人参、茯神、黄芪、白术、龙眼肉、酸枣仁（炒后研碎，各二钱半）、木香、炙甘草（各五分），用水两钟，生姜二钱，大红枣一枚，煎至一钟服用。薛新甫加入当归、远志，各一钱，也很好。
从前赵以德说：我治疗郑鲁叔，二十多岁，攻读科举学业，凌晨四更天还不睡觉，于是得了这个病。睡觉时阴茎只要碰到被子或腿，就会梦见性交而泄精，只有悬空不接触才不会做梦。饮食日渐减少，倦怠乏力，气短。这是因为用心太过，心火与相火同时兴起，夜晚无法入睡，血液不能归藏于肝，肾水不足，火乘阴虚之机，侵入下焦，鼓动精室，导致精液不能聚藏而想要外走。因为阴茎接触物体，如同厥气客于阴器，所以产生性交之梦。于是采用上补心安神，中调脾胃升举阳气，下用益精生阴固阳的药物，将近三个月才痊愈。
从前吴茭山有关于治疗遗精得法的论述。有一个男子，因病后用心过度，于是梦遗，多痰，身体消瘦。各位医生使用清心莲子饮，长期服用无效。吴诊察他的脉搏紧涩，知道是因为冷药利水的药剂使用过度，致使肾气独自下降，服用这些药物病情更加严重。随即使用升提的方法，升坎水以济离火，降阳气以滋阴血。其次使用鹿角胶、人乳填补精血，过了一个月完全痊愈。因而想到梦遗原因繁多，难以用一种方法施治。有的因用心积热而泄精，有的因多服麦冬、茯苓、车前子、知母、黄柏等寒凉通利药物而泄精，有的因久泄导致玉门不闭而泄精。治疗的方法：积热的，应当清心降火；寒凉的，温补下元；肾气独降的，应当升提，使水火相交，坎离定位。
以上两个医案，都是以肾为主，兼治心脾。唯独有一类情况，肾不虚而肝经湿热火旺的，阴茎中疼痛，筋脉拘急收缩，或者作痒，或者肿胀，或者挺纵不收，白色分泌物像精液一样，随小便而下，这叫筋疝。张子和说：遗尿、闭癃、阳痿、膀胱肿、滑精、白淫，都是男子的疝病。如果妇女血枯不来月经，月经停止后腰膝上部发热，足胫咽喉干燥，小便不通，小腹有肿块，或固定或移动，前阴突出，后阴痔疮漏下，这是女子的疝病。只是女子不叫疝而叫瘕。
Treatment focuses primarily on the Kidney and Liver. The Classics state: "The essence of Yin and Yang lies in the density of Yang; when Yang is dense, Essence is secured. If Yang becomes excessive and fails to be dense, Yin Qi will perish. When Yin is peaceful and Yang is secure, Spirit and Essence are regulated. If Yin and Yang separate and break apart, Spirit and Essence will perish." What is meant by "Yang excess" is the hyperactivity of Ministerial Fire (Xiang Huo) residing in the Liver and Kidney. What is meant by "Yin perishing" is the depletion of True Yin (Zhen Yin) stored within the Kidney. The Kidney belongs to Yin and governs the storage of Essence (Jing). The Liver belongs to Yang and governs the free flow of Qi (Shu Xie). Therefore, if Kidney Yin is deficient, Essence cannot be stored; if Liver Yang is hyperactive, Ministerial Fire cannot be secured. Subjecting unsecured Ministerial Fire to unstored Essence inevitably leads to dreams, and once dreaming occurs, emission follows. One might ask: "Why do other dreams not occur, but rather frequent erotic dreams?" The answer is found in the *Ling Shu* chapter "Dreams Caused by Pathogenic Factors": "When Jue Qi invades the genitalia, one dreams of sexual intercourse." The genitalia are the orifice for semen discharge, governing the Zong Jin (Tendons), where the tendons of the Foot Taiyin, Yangming, Shaoyin, and Jueyin meridians, along with the Chong, Ren, and Du vessels, converge. All tendons cluster at the genitalia, where Ministerial Fire resides. In healthy individuals engaging in sexual activity, strength and potency are derived from this Ministerial Fire. Without sexual contact and without combining with Yin Qi, semen will not be discharged. Once contact is made and Yin Qi combines, the fire of the San Jiao (Triple Burner) throughout the upper, lower, interior, and exterior rapidly descends. The pores of the entire body open, and all generated Essence rushes toward the genitalia for discharge, causing the Kidney to fail in its storing function. If a person's primordial Essence is solid and strong, pathogenic Qi cannot disturb them; even after prolonged intercourse, they do not ejaculate, let alone during sleep. Even if Ministerial Fire moves and causes nocturnal dreams, no emission occurs. This is called "Yin Peaceful and Yang Secure," indicating a state of health without disease. However, modern people often have congenital deficiency combined with excessive sexual indulgence, leading to exhaustion of Kidney Yin. Yin deficiency causes Ministerial Fire to flare up. The root of Ministerial Fire connects upward to the Heart, becoming Sovereign Fire (Jun Huo); stimulated by external objects, it moves, causing Ministerial Fire to descend rapidly. Although actual intercourse does not take place, the Essence has already left its proper position and lingers in the genitalia. During sleep, when the resident Ministerial Fire encounters this state, it acts similarly to the combination with Yin Qi during intercourse. Thus, one dreams while sleeping and emits while dreaming. If the Kidney is not deficient, such dreams will not recur, and no emission will occur during dreams. Therefore, treating this condition prioritizes regulating the Liver and Kidney. One might ask: "For dream emission caused by Yin deficiency and Fire hyperactivity, taking Danxi's Pill to Nourish Yin (Buyin Wan) aims to nourish Yin and descend Fire, matching the syndrome and treatment. Why does it fail when taken according to the method?" The answer is that one has not grasped the original intent of Danxi's Yin-nourishing theory. The primary formula in Danxi's *Xin Fa* is actually Shenqi Wan (Kidney Qi Pill) as the essential medicine for nourishing Yin. Modern practitioners misunderstand this, using Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) as chief ingredients, indiscriminately using formulas like Kanli Wan or Guben Wan. These are all cold and purgative agents that strongly drain Water (Yin). The Kidney is only supplemented, never drained; how can such drugs benefit Yin? Only Xue Lizhai elucidated aspects of Danxi's theory that were previously unexpressed, specifically using Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to tonify the Kidney, achieving frequent success in treating dream emission. Even if Ministerial Fire exists, Water nourishes Wood; as Water ascends, Wood-Fire naturally subsides. If there is Spleen-Stomach insufficiency with Damp-Heat flowing downward, use the aforementioned pill as the base, decocted with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise the clear Qi. If mental overexertion causes the Heart to lose its command, allowing Ministerial Fire to take over, use the aforementioned pill as the base, combined with Guipi Tang (Restore the Spleen Decoction). If Mingmen Fire (Gate of Life Fire) is declined, with primordial Essence sinking and the Jade Gate failing to close, urgently use Bawei Wan (Eight-Ingredient Pill) or Jin Suo Zhengyuan Dan (Golden Lock Stabilizing Primordial Elixir Pill) to strengthen True Yang, enabling it to contain Yin Essence and prevent leakage. This outlines the general approach.
Guipi Tang (Restore the Spleen Decoction):
Renshen (Ginseng Radix), Fushen (Poria with Hostwood), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Longyanrou (Longan Aril), Suanzaoren (Ziziphi Spinosae Semen, stir-fried and crushed, 2.5 qian each), Muxiang ( Aucklandiae Radix), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum, 0.5 qian each). Decoct with 2 zhong of water, 2 qian of fresh ginger, and 1 large red date, until 1 zhong remains. Take orally. Xue Xinpu added Danggui (Angelicae Sinensis Radix) and Yuanzhi (Polygalae Radix), 1 qian each, which is also excellent.
Zhao Yi-de once stated: "I treated Zheng Lushu, who was in his twenties, studying for imperial examinations, staying awake until the fourth watch (midnight to 2 AM). He developed this condition. While lying down, if his penis touched the blanket or his legs, he would dream of sexual intercourse and emit semen. Only when suspended in air without contact did he avoid dreams. His diet decreased daily, and he suffered from fatigue and shortness of breath. This was due to excessive mental exertion, causing both Heart Fire and Ministerial Fire to arise, preventing sleep at night. Blood failed to return to the Liver, Kidney Water became insufficient, and Fire exploited the Yin deficiency, invading the Lower Jiao, stirring the Essence Chamber. Consequently, Essence could not gather and store, but tended to escape. Because the penis touched objects, it was akin to Jue Qi invading the genitalia, thus generating dreams of intercourse. I employed methods to tonify the Heart and calm the Spirit above, regulate the Spleen and Stomach to raise Yang in the middle, and use herbs to benefit Essence, generate Yin, and secure Yang below. After nearly three months, he recovered."
Wu Jiaoshan once discussed effective methods for treating spermatorrhea. A man, after recovering from illness, exerted himself mentally excessively, resulting in frequent dream emissions, profuse phlegm, and emaciation. Various physicians prescribed Qingxin Lianzi Yin (Clear the Heart and Lotus Seed Infusion), which proved ineffective after long-term use. Wu palpated his pulse as tight and choppy, realizing that excessive use of cold-draining and diuretic medicines had caused Kidney Qi to sink exclusively. Continued use of these drugs worsened the condition. Wu immediately employed a lifting method to raise Kan Water to nourish Li Fire, descending Yang Qi to nourish Yin Blood. Subsequently, he used Deer Antler Glue (Cervi Cornus Colla) and Human Milk to replenish Essence and Blood. Over a month, the patient fully recovered. This led him to reflect that dream emission has diverse causes and cannot be treated uniformly. Some cases result from accumulated heat due to mental exertion; others from excessive intake of cold-purgative herbs like Dongchong Xiacao (Ophiocordyceps), Fuling (Poria), Cheqianzi (Plantaginis Semen), Zhimu, and Huangbai; still others from chronic emission leading to laxity of the urethral orifice. Treatment principles vary: for accumulated heat, clear the Heart and descend Fire; for cold-purgative damage, warm and tonify the Lower Yuan; for sinking Kidney Qi, employ lifting methods to ensure Water and Fire interact, stabilizing Kan and Li.
The above two cases both prioritize the Kidney while simultaneously treating the Heart and Spleen. However, there is another category where the Kidney is not deficient, but the Liver Meridian suffers from Damp-Heat and Fire Hyperactivity. Symptoms include pain in the penis, tendon contraction and retraction, itching, swelling, or flaccidity without retraction, with white discharge resembling semen passing with urine. This is termed "Jin Shan" (Sinew Hernia). Zhang Zihe stated: "Enuresis, strangury, impotence, bladder swelling, seminal slip, and leukorrhea are all forms of hernia in men. In women, blood dryness with amenorrhea, heat above the waist and knees after menstruation ceases, dryness of the feet and throat, strangury, abdominal masses that move or remain fixed, protrusion of the anterior orifice, and hemorrhoids/fistulas at the posterior orifice constitute hernia in women. Women's conditions are not called 'Shan' (Hernia) but 'Jia' (Mass)."