梦遗者，因梦交而精始出，精滑者，不因梦而精自泻，症状不同。有小便后出多不禁者，有不小
便而自出者，茎中痒痛，常欲如小便者，皆由肾水虚哀，相火妄动所致。然亦有数者之不同。有因用心
过度，不摄肾而致失精者∶有因房劳太过，精窍虚滑而致失精者，有中气虚损下陷，使精不宁而失者；
有脾胃湿热下流，使精扰动而失者；亦有命门火衰，不能涵乎阴精而失者，各宜分别施治。有鳏居独宿，
精满而出者，此非为病，不须服药。沈氏云∶遗病多端，治法大要总不越乎补肾水，敛元精，安心神，清
相火为主。
六味汤丸 左归丸饮〔俱见虚劳。〕
原方〔补肾壮水。〕加莲须、五味、龙骨、牡蛎、鳔胶〔敛精填髓，〕远志、莲肉〔安心神。〕黄
柏。〔清相火。〕
此方因肾虚火旺失精者用之。虚滑甚者，以金樱子煎膏，代蜜为丸。
天王补心丹 归脾汤〔俱见虚劳。〕
此二方，前方补心兼肾，后方心脾俱补。用心过度，心肾不交者，神志不宁，怔忡惊悸，宜朝服六味
之属，晚间择前方服之。
补中益气汤〔见泄泻。〕
此方因中气下陷，失精者宜之。其人必现四肢倦怠，食少便泄。余谓仍宜朝服六味诸方，按士材
云∶因肾病而遗者，独治其肾，由他脏而致者，则他脏与肾两治之，以肾为藏精之脏故也。
清热渗湿汤〔见湿。〕
此方因脾湿下流失精者可宗，加减用之，祛其湿热，则肾安而精自固，治病必求其本也。
八味丸〔见不能食。〕
此方因阳不帅阴而失精者宜之。必见畏寒厥冷，小便清长，大便溏泻，食难消化，脉沉小迟者，
投之不误，否则以火济火矣。
梦遗，是指因梦中交合而导致精液射出；滑精，是指没有做梦而精液自行泄出，两者的症状不同。有的在小便之后精液流出且无法控制，有的不在小便时却自行流出，尿道中感到瘙痒疼痛，经常有想小便的感觉，这些情况都是由肾阴亏虚、相火妄动所导致的。然而，病因也有几种不同。有的是因为用心过度，不能固摄肾脏而导致失精；有的是因为房事劳倦太过，导致精窍虚滑而引起失精；有的是因为中气虚损下陷，使得精气不宁而流失；有的是因为脾胃湿热下注，使得精液扰动而流失；还有的是因为命门火衰，不能涵养阴精而导致失精，这些都应当分别辨证施治。有长期独居的鳏夫，因精满自溢而流出，这不属于疾病，不需要服药。沈氏说：遗精的病证多种多样，治疗的大要总离不开补肾水、敛元精、安心神、清相火这几个方面。
六味地黄汤丸、左归丸饮（均见于虚劳章节）。
原方（具有补肾壮水功效）加入莲须、五味子、龙骨、牡蛎、鱼鳔胶（具有收敛精液、填补骨髓功效），远志、莲子肉（具有安心神功效），黄柏（具有清相火功效）。
此方适用于因肾虚火旺导致失精的患者。如果虚滑症状严重，可用金樱子煎膏，代替蜂蜜制成丸药。
天王补心丹、归脾汤（均见于虚劳章节）。
这两个方剂，前方（天王补心丹）是补心兼补肾，后方（归脾汤）是心脾双补。对于因用心过度导致心肾不交，出现神志不宁、怔忡惊悸的患者，适宜早晨服用六味地黄类方剂，晚间选择前方服用。
补中益气汤（见于泄泻章节）。
此方适用于因中气下陷导致失精的患者。这类患者必然表现出四肢倦怠、食欲减少、大便泄泻等症状。我认为仍然适宜早晨服用六味地黄等方剂，参考士材（李中梓）的说法：因肾病导致的遗精，单独治疗肾脏即可；由其他脏腑病变引起的，则需同时治疗其他脏腑和肾脏，这是因为肾是藏精的脏器。
清热渗湿汤（见于湿证章节）。
此方适用于因脾湿下注导致失精的患者可以遵循使用，进行加减化裁，祛除体内的湿热，那么肾脏就能安宁，精液自然固摄，治病必须探究其根本原因。
八味丸（见于不能食章节）。
此方适用于因阳气不能统帅阴精而导致失精的患者。此类患者必然表现出畏寒肢冷、小便清长、大便溏泻、食物难以消化、脉象沉小迟滞等症状，此时投用此方不会出错，否则就会犯以火助火的错误。
Dream emission refers to the ejaculation of semen resulting from sexual intercourse in dreams, whereas spermatorrhea refers to the spontaneous leakage of semen without dreaming; their symptoms differ. Some patients experience uncontrollable seminal discharge after urination, while others have spontaneous discharge unrelated to urination, accompanied by itching and pain in the urethra and a frequent urge to urinate. All these conditions are caused by deficiency of Kidney Yin (Kidney Water) and hyperactivity of Ministerial Fire (Xiang Huo). However, the etiologies vary. Some cases result from excessive mental exertion failing to secure the Kidneys, leading to loss of essence; some arise from excessive sexual fatigue causing deficiency and slipperiness of the seminal orifice; some stem from deficiency and sinking of Middle Qi, causing instability of essence; some are due to Damp-Heat flowing downward from the Spleen and Stomach, disturbing the essence; and some are caused by decline of Mingmen Fire (Gate of Life Fire), failing to nourish Yin Essence. Each type requires distinct treatment. For widowers living alone, seminal discharge due to fullness is not a disease and requires no medication. Shen stated: Although there are many types of emission disorders, the general principles of treatment always revolve around tonifying Kidney Water, consolidating Primordial Essence, calming the Spirit, and clearing Ministerial Fire.
Liuwei Dihuang Wan/Pill and Zuo Gui Wan/Decoction [See Xu Lao].
Original formula [Tonifies Kidney and strengthens Water] added with Lotus Stamens (Lian Xu), Schisandra Berry (Wu Wei Zi), Dragon Bone (Long Gu), Oyster Shell (Mu Li), Fish Maw (Biao Jiao) [to consolidate essence and fill marrow], Polygala Root (Yuan Zhi), Lotus Seed Meat (Lian Rou) [to calm the Spirit], and Phellodendron Bark (Huang Bo) [to clear Ministerial Fire].
This formula is used for seminal loss due to Kidney Deficiency with Hyperactive Fire. For severe deficiency and slipperiness, prepare an extract of Cherokee Rose Fruit (Jin Ying Zi) and use it instead of honey to make pills.
Tianwang Buxin Dan and Guipi Tang [See Xu Lao].
The former formula tonifies both Heart and Kidney, while the latter tonifies both Heart and Spleen. For patients with excessive mental exertion leading to Disharmony between Heart and Kidney, manifesting as restless spirit, palpitations, and fright, it is advisable to take Liuwei Dihuang formulas in the morning and choose the former formula at night.
Buzhong Yiqi Tang [See Xie Xie].
This formula is suitable for seminal loss due to Sinking of Middle Qi. Such patients typically present with fatigue of the four limbs, poor appetite, and loose stools. I suggest continuing to take Liuwei Dihuang formulas in the morning. Referring to Shicai (Li Zhongzi): For emissions caused by Kidney disease, treat the Kidney alone; for those caused by other organs, treat both the affected organ and the Kidney, because the Kidney is the organ that stores essence.
Qingre Shen Shi Tang [See Shi Zheng].
This formula can be adopted and modified for seminal loss due to Spleen Dampness flowing downward. By dispelling Damp-Heat, the Kidneys will be tranquil, and essence will naturally consolidate. Treating disease requires seeking its root cause.
Ba Wei Wan [See Bu Neng Shi].
This formula is suitable for seminal loss due to Yang failing to guide Yin. Patients must present with aversion to cold, cold extremities, clear and profuse urination, loose stools, indigestion, and a deep, small, and slow pulse. Administering this formula will not lead to error; otherwise, one would be adding fire to fire.