男子阴痿不起，古方多云命门火衰。精气虚冷固有之矣，然亦有郁火甚而致痿者，经云壮火食气。譬
如人在暑热而倦怠痿弱，遇冬寒而坚强也。予尝亲见一二人，肾经郁火而有此症，令服黄柏、知母清火坚
肾之药而效，故须审察，不可偏认作火衰也。
愚按阴茎属肝之经络。盖肝者木也，如木得湛露则森立，遇酷热则萎悴。若因肝经湿热而患者，用龙
胆泻肝汤以清肝火、导湿热；若因肝经燥热而患者，用六味丸以滋肾水、养肝血而自安。
学士徐崦西，口干有痰，欲服琼玉膏。余曰∶此沉阴降火之剂，君面白、口干而有痰，属脾肺气虚也，
当用温补之剂。不信，仍服两月余，大便不实，饮食少思，且兼阴痿，始信余言。先用补中益气加茯苓、
半夏二味，以温补脾胃，饮食渐加，大便渐实，乃去二味，服月余而痊，更服六味丸三月余，阴道如常。
矧琼玉膏、固本丸、坎离丸，此辈俱是沉寒泻火之剂，非肠胃有燥热者不宜服。若足三阴经阴虚发热
者，久而服之，令人无子。盖谓损其阳气，则阴血无所生故也。屡验。
梦遗、精滑，世人多作肾虚治，而用补肾涩精之药不效，殊不知此症多属脾胃，饮酒浓味痰火湿热之
人多有之。盖肾藏精，精之所生，由脾胃饮食化生，而输归于肾。今脾胃伤于浓浓，湿热内郁，中气浊而
不清，则其所化生之精，亦得浊气。肾主闭藏，阴静则宁。今所输之精，既有浊气，则邪火动于肾中，而
水不得宁静，故遗而滑也。此症与白浊同。丹溪论白浊，为胃中浊气下流，渗入膀胱，而云无人知此也。
其有色心太重，妄想过用而致遗滑者，自从心肾治，但兼脾胃者，多须要审察。
愚按遗精有四∶有用心过度，心不摄肾而致者；有因色欲不遂；精气失位输精而出者，有色欲太过，
滑泄不禁者；有年壮气盛，久无色欲，精气满溢者。有小便出多不禁者，或不出小便而自出，或茎中出而
痒痛常如欲小便者，宜辰砂妙香散，或威喜丸。大抵调补元气为主。圣人教人收心养性，厥有旨哉！
少宰汪涵斋，白浊，用补中益气汤加茯苓、半夏，倍白术，愈而复作，肌体消瘦，不时眩晕，用
八味丸而痊。
司厅陈石镜，属脾虚，用补中益气、六味地黄而愈。
光禄柴黼庵，因劳，赤白浊如注，用归脾汤而愈。
司厅张检斋，小腹不时作痛，茎出白淫，用小柴胡加山栀、龙胆草、山茱、芎、归而愈。
男子阴茎勃起功能障碍（阴痿）不能勃起，古代医方大多认为是命门火衰所致。精气虚冷确实存在这种情况，然而也有因为郁结之火严重而导致阳痿的，《内经》说“壮火食气”。譬如人在暑热天气中会感到倦怠、身体痿弱无力，遇到冬季寒冷时反而变得坚硬有力。我曾经亲眼见过一两个人，是因为肾经有郁结之火而出现这种症状，让他们服用黄柏、知母等清火坚肾的药物而见效，所以必须仔细审察，不可片面地认定为火衰。
我按：阴茎属于肝的经络。肝在五行中属木，就像树木得到露水滋润就会挺拔耸立，遇到酷热就会枯萎憔悴。如果是因为肝经湿热导致的患者，使用龙胆泻肝汤来清肝火、疏导湿热；如果是因为肝经燥热导致的患者，使用六味地黄丸来滋补肾水、滋养肝血从而使病情安宁。
学士徐崦西，口干且有痰，想要服用琼玉膏。我说：“这是性质沉寒、降火的药剂，你面色白、口干且有痰，属于脾肺气虚，应当使用温补的药剂。”他不相信，仍然服用了两个多月，导致大便不成形，饮食减少且没有食欲，并且兼有阳痿的症状，这才相信我的话。先用补中益气汤加入茯苓、半夏两味药，以温补脾胃，饮食逐渐增加，大便逐渐成形，然后去掉这两味药，继续服药一个多月后痊愈，又服用六味地黄丸三个多月，性功能恢复正常。
况且琼玉膏、固本丸、坎离丸，这类药物都是性质沉寒、泻火的药剂，如果不是肠胃有燥热的人不宜服用。如果是足三阴经阴虚发热的患者，长期服用这些药物，会导致人无法生育。这是因为损伤了阳气，阴血就无法化生缘故。这经过多次验证。
梦遗、精液滑泄，世人多当作肾虚治疗，而使用补肾涩精的药物无效，殊不知这种症状多与脾胃有关，饮酒过多、食用浓味食物以及痰火湿热体质的人常有此症。肾藏精，精的产生，是由脾胃运化饮食而生成的，然后输送归藏于肾。现在脾胃被浓烈厚味的食物所伤，湿热内郁，中气浑浊而不清明，那么它所化生的精液，也会带有浊气。肾主闭藏，阴静则安宁。现在输送进来的精液既有浊气，那么邪火就会在肾中躁动，使肾水不得宁静，所以出现遗精和滑精。这种症状与白浊相同。朱丹溪论述白浊，认为是胃中浊气下流，渗入膀胱，并说没有人知道这个道理。那些因为色欲心太重，妄自幻想过度而导致遗精滑精的，自然要从心和肾来治疗，但凡是兼有脾胃问题的，大多需要仔细审察。
我按：遗精有四种情况：有用心过度，心神不能统摄肾精而导致的；有因色欲不遂意，精气失位而输精外出的；有色欲太过，滑泄不禁的；有年轻气盛，久无性生活，精气满溢而出的。有小便排出多且不禁的，或者不出小便而精液自出，或者从尿道口流出且瘙痒疼痛常像要小便的感觉，适宜用辰砂妙香散，或威喜丸。大抵以调补元气为主。圣人教导人们收心养性，其中深意深远啊！
In cases of erectile dysfunction (Yin Wei) in men, ancient prescriptions often attribute it to the decline of Mingmen fire. Although deficiency cold of essence and qi is indeed a cause, there are also cases where severe stagnant fire leads to impotence. The Classics state that "vigorous fire consumes qi." For instance, people feel fatigued and physically weak in hot summer weather, whereas they become firm and strong in winter cold. I have personally observed one or two cases where this symptom was caused by stagnant fire in the Kidney meridian; administering herbs such as Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) to clear heat and strengthen the kidney proved effective. Therefore, careful examination is required, and one must not unilaterally diagnose it as fire deficiency.
I note: The penis belongs to the Liver meridian. In the Five Elements, the Liver corresponds to Wood. Just as trees stand tall when nourished by dew, they wither under scorching heat. If the patient suffers from damp-heat in the Liver meridian, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) should be used to clear Liver fire and drain damp-heat. If the cause is dry-heat in the Liver meridian, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) should be used to nourish Kidney water and Liver blood, thereby restoring peace.
Scholar Xu Yanxi suffered from dry mouth and phlegm, and wished to take Qiongyu Gao (Jade Dew Paste). I said, "This is a heavy, cold preparation that descends and clears heat. Your pale complexion, dry mouth, and phlegm indicate deficiency of Spleen and Lung qi; you should use warming and tonifying preparations." He did not believe me and continued taking it for over two months, resulting in loose stools, loss of appetite, and concurrent erectile dysfunction. Only then did he accept my advice. We first used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinelliae Rhizoma) to warm and tonify the Spleen and Stomach. His diet gradually improved, and his stools became solid. Then we removed those two herbs, and after another month of treatment, he recovered. He subsequently took Liuwei Dihuang Wan for over three months, and his sexual function returned to normal.
Moreover, Qiongyu Gao, Guben Wan (Solidify the Root Pill), and Kanli Wan (Kan-Li Pill) are all heavy, cold, and heat-clearing preparations. They are unsuitable for those without dry-heat in the intestines and stomach. If patients with Yin deficiency and fever in the Foot Three Yin meridians take them for a long time, it may lead to infertility. This is because damaging Yang qi prevents the generation of Yin blood. This has been verified repeatedly.
Nocturnal emission and spermatorrhea are often treated by laypeople as Kidney deficiency, leading to ineffective use of Kidney-tonifying and astringent herbs. However, these symptoms are frequently related to the Spleen and Stomach, commonly occurring in individuals who consume excessive alcohol, rich flavors, or have constitutions of phlegm-fire and damp-heat. The Kidneys store essence; essence is generated by the digestion and transformation of food by the Spleen and Stomach, and then transported to the Kidneys. When the Spleen and Stomach are damaged by rich and greasy foods, damp-heat becomes internally stagnant, and the Middle Qi becomes turbid and unclear. Consequently, the essence produced also carries turbidity. The Kidneys govern retention; stillness brings peace. Since the transported essence contains turbidity, pathogenic fire stirs within the Kidneys, preventing the Water from remaining tranquil, thus causing nocturnal emission and spermatorrhea. This condition is similar to Bai Zhuo (White Turbidity). Danxi discussed Bai Zhuo, attributing it to turbid Qi from the Stomach flowing downward into the Bladder, noting that few understand this principle. Cases caused by excessive lustful thoughts should be treated from the perspective of the Heart and Kidneys. However, when Spleen and Stomach involvement is present, careful examination is essential.
I note: There are four types of seminal emission: 1) Caused by excessive mental exertion, where the Heart fails to control the Kidney; 2) Due to unfulfilled sexual desire, causing essence to lose its position and leak out; 3) Excessive sexual activity leading to uncontrollable sliding emission; 4) In young men with vigorous Qi, after prolonged abstinence, causing fullness and overflow of essence. Some present with excessive urination and incontinence, while others have spontaneous emission without urination, or discharge from the urethra accompanied by itching and pain resembling the urge to urinate. In such cases, Chensha Miaoxiang San (Cinnabar Wonderful Fragrance Powder) or Weixi Wan (Weixi Pill) are appropriate. Generally, the primary approach is to regulate and tonify Yuan Qi. As the Sages taught, gathering the mind and nurturing nature holds profound significance!
Vice Minister Wang Hanzhai suffered from Bai Zhuo. Treatment with Buzhong Yiqi Tang added with Fuling and Banxia, with doubled Baizhu (Atractylodis Macrocephalae Rhizoma), cured him initially, but the condition recurred. He became emaciated and experienced frequent dizziness. He was cured using Bawei Dihuang Wan (Eight-Ingredient Pill with Rehmannia).
Director Chen Shijing, suffering from Spleen deficiency, was cured using Buzhong Yiqi Tang and Liuwei Dihuang Wan.
Guanglu Chai Fu'an, due to fatigue, suffered from profuse red and white turbidity. He was cured using Guipi Tang (Restore the Spleen Decoction).
Director Zhang Jianzhai experienced intermittent lower abdominal pain and discharge of white turbidity from the penis. He was cured using Xiaochaihu Tang (Minor Bupleurum Decoction) added with Zhizi (Gardeniae Fructus), Longdancao (Gentianae Radix), Shanzhuyu (Corni Fructus), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Danggui (Angelicae Sinensis Radix).