《内经》治痿取阳明，专主宗筋关节行，古有虎潜丸守服，淫羊术柏佐功成。
遗精宜分有梦无梦。有梦而遗为相火之炽，宜封髓丹；无梦而遗为心肾之虚，宜白术八
两，莲须、菟丝子、五味子各四两，蜜丸，间服二加龙骨汤。然肝主疏泄，宜兼治肝，用温
胆汤加人参、茯神、枣仁、莲须主之。精之蓄泄，皆听命于心，宜兼治心，用四君子汤加远
志、龙骨、生牡蛎、莲须主之。如久泄不愈，必用附子以司北门之锁钥，时医未之知也。此
证为肾脏之病，故列于虚证。
（经解）《上古天真论》曰∶“肾者主水，受五脏六腑之精而藏之，故五脏盛乃为泻。”《经
脉篇》曰∶“人始生，先成精，精成而脑髓生。”《六节气象论》曰∶“心者生之本，神之
变也。肾者，主蛰，封藏之本，精之处也。”
（长孙男心典）按∶此言五脏和而精足，自无梦遗、自遗之患。及夫妇交媾而泻之，则有子
，故称之曰“能”。盖精虽藏之于肾，而阳之动与不动，精之泄与不泄，无非听命于心，推
之“恐伤肾”而亦通于心。凡阳事不壮之人，临事时若存一“恐”不能举之心，即偶动而随
有梦而遗封髓丹，若还无梦术莲飧。肝司疏泄邪休（忧），心主纲维令必端。温胆（汤加）茯神
清得法，四君（子汤加）远志补斯安。病如日久须加附（子），锁钥权归（于肾）岂（是以热）去寒。
遗溺者，小便不禁是也，主肾虚。余每用附子、人参各三钱，山萸肉一两，或加益智仁
二钱，水煮，入盐少许服，多效。亦有脾肺气虚，不能约束水道，《金匮》所谓∶“上虚不
能制下者也。”宜补中益气汤之类加减治之。巢氏谓∶“人睡中尿出者，是其素禀阴气偏盛
，阳气偏虚，膀胱与肾气俱冷。而夜卧阳气衰伏，不能制阴，阴气独盛，则小便多，而或不
禁遗尿。治宜雄鸡冠，桂心二味等分，捣为丸，如小豆大，日三服。”
（经义）《宣明五气篇》曰∶“膀胱不利为癃，不约为遗溺。”《骨空论》曰∶“督脉为病
，癃痔遗溺。”《痹论》曰∶“淫气遗溺，痹聚在肾。”《厥气论》曰∶“心移热于肺，肺
消，肺消者，饮一溲二，死不治。”《脉要精微论》曰∶“仓廪不藏者，是门户不要也。水
泉不止者，是膀胱不藏也。得守者生，失守者死。”《本输篇》曰∶“三焦者，足少阴、
太阳之所将，实则闭癃，虚则遗溺。”
《黄帝内经》治疗痿证取用阳明经，专门针对宗筋和关节的功能运行。古代有服用虎潜丸的方法，配合淫羊藿、白术、黄柏等药物辅助，从而取得功效。
遗精应当区分有梦和无梦两种情况。有梦而遗精属于相火炽盛，适宜使用封髓丹；无梦而遗精属于心肾两虚，适宜使用白术八两，莲须、菟丝子、五味子各四两，制成蜜丸，间隔服用，并配合二加龙骨汤。然而肝主疏泄功能，治疗时应当兼顾肝脏，使用温胆汤加入人参、茯神、酸枣仁、莲须来主治。精液的蓄积与排泄，都听从心脏的指挥，治疗时应当兼顾心脏，使用四君子汤加入远志、龙骨、生牡蛎、莲须来主治。如果久治不愈，必须使用附子来掌管“北门”（指肾脏固摄精气的作用）的锁钥，当时的医生往往不了解这一点。此病证属于肾脏的疾病，因此将其列在虚证之中。
（经文解析）《上古天真论》说：“肾主水液代谢，接受五脏六腑的精微物质并加以贮藏，所以只有当五脏精气充盛时，才会进行正常的排泄。”《经脉篇》说：“人初生成时，先形成精，精形成后脑髓随之产生。”《六节藏象论》说：“心是生命的根本，是精神变化的所在。肾主蛰伏，是封藏的根本，也是精液储存的地方。”
（长孙男陈修园按语：心典）按：这里说的是五脏调和则精气充足，自然没有梦遗、滑精的祸患。等到夫妇交合时射精，就能生育子女，所以称之为“能”。虽然精藏在肾中，但阳气的动与不动，精液的泄与不泄，无不听从心脏的指挥，推究“恐伤肾”的理论，也与心脏相通。凡是阳气不壮的人，在行房事时如果存有“恐惧”导致不能勃起的心理，即使偶尔勃起也会随即疲软。
有梦而遗精用封髓丹，若无梦遗精则用白术、莲须等药。肝主管疏泄，邪气不要引起忧虑；心主管纲维，命令必须端正。温胆汤加入茯神，清热方法得当；四君子汤加入远志，补益得以安宁。病情如果日久，需要加入附子；锁钥的权力归于肾脏，难道是用清热法去寒吗？
遗尿，是指小便失禁，主要病机为肾虚。我每次使用附子、人参各三钱，山茱萸一两，或者加入益智仁二钱，用水煎煮，加入少许盐服用，大多有效。也有因脾肺气虚，不能约束水道，《金匮要略》所说的：“上焦虚弱不能制约下焦。”适宜用补中益气汤之类加减治疗。巢元方说：“人在睡梦中尿出的，是因为他素来禀赋阴气偏盛，阳气偏虚，膀胱与肾气都寒冷。夜间卧睡时阳气衰伏，不能制约阴气，阴气独盛，则小便多，或者不禁遗尿。治疗适宜用雄鸡冠、桂心两味药等分，捣碎制成丸药，如小豆大小，每日服用三次。”
（经文义理）《宣明五气篇》说：“膀胱气化不利称为癃闭，约束无力称为遗尿。”《骨空论》说：“督脉发生病变，会出现癃闭、痔疮、遗尿。”《痹论》说：“淫气导致遗尿，痹症聚集在肾。”《厥气论》说：“心将热邪移于肺，导致肺消渴，肺消渴病，喝一份水排两份尿，属于死证无法治疗。”《脉要精微论》说：“仓廪（脾胃）不能收藏，是因为门户不坚固。水泉（尿液）不止，是因为膀胱不能贮藏。能够固守者生，失去固守者死。”《本输篇》说：“三焦，由足少阴肾经和足太阳膀胱经所统领，实证表现为闭癃，虚证表现为遗尿。”
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) treats Wei syndrome (flaccidity syndrome) by selecting the Yangming channel, specifically focusing on the function of the Zongjin (tendons and joints). In ancient times, there was a method of taking Hujian Wan (Tiger Crouching Pill), assisted by herbs such as Epimedium Herba (Yinyanghuo, 淫羊藿), Atractylodis Rhizoma (Baizhu, 白术), and Phellodendri Cortex (Huangbai, 黄柏), thereby achieving success.
Spermatorrhea should be distinguished into two categories: with dreams and without dreams. Spermatorrhea with dreams is due to the blazing of Ministerial Fire (Xianghuo, 相火), and Fengsui Dan (Seal the Marrow Pill) is appropriate. Spermatorrhea without dreams is due to deficiency of the Heart and Kidney, and a prescription of Baizhu (Atractylodis Rhizoma) eight liang, Lianxu (Lotus Stamen), Tusizi (Cuscutae Semen), and Wuweizi (Schisandrae Fructus) four liang each, made into honeyed pills and taken intermittently, combined with Erjia Longgu Tang (Double-Added Dragon Bone Decoction), is appropriate. However, since the Liver governs Shuxie (free flow and discharge), treatment should also address the Liver, using Wendan Tang (Gallbladder-Warming Decoction) added with Renshen (Ginseng Radix et Rhizoma), Fushen (Poria with Hostwood), Zaoren (Ziziphi Spinosae Semen), and Lianxu (Lotus Stamen). The storage and discharge of essence are all commanded by the Heart, so treatment should also address the Heart, using Sijunzi Tang (Four Gentlemen Decoction) added with Yuanzhi (Polygalae Radix), Longgu (Fossilized Bones), Sheng Muli (Raw Oyster Shell), and Lianxu (Lotus Stamen). If the condition persists for a long time without healing, Fuzi (Aconiti Lateralis Radix Praeparata) must be used to manage the "lock and key" of the North Gate (referring to the Kidney's ability to secure essence); contemporary physicians often fail to understand this. This syndrome is a disease of the Kidney, hence it is listed among deficiency syndromes.
(Commentary on the Classics): The *Shanggu Tianzhen Lun* (Treatise on the Natural Truth of Antiquity) states: "The Kidney governs water, receiving the essence of the five zang and six fu organs to store it; therefore, only when the essence of the five zang is abundant is there discharge." The *Jingmai Pian* (Chapter on Channels and Vessels) states: "When humans begin to form, essence is formed first; when essence is formed, brain marrow arises." The *Liujie Qixiang Lun* (Treatise on the Six Jie and Meteorological Phenomena) states: "The Heart is the root of life and the place of spiritual transformation. The Kidney governs hibernation, is the root of sealing and storing, and is the residence of essence."
(Annotation by Changsun Nan Xindian [Chen Xiuyuan]): Note: This passage indicates that when the five zang are harmonious and essence is sufficient, there will naturally be no worries of nocturnal emission or spontaneous leakage. When ejaculation occurs during sexual intercourse between husband and wife, offspring can be produced, hence it is called "ability." Although essence is stored in the Kidney, the movement or stillness of Yang, and the release or retention of essence, are all commanded by the Heart. Extending this logic, "fear injures the Kidney" also connects to the Heart. For those whose Yang energy is not robust, if they harbor a mind of "fear" that they cannot achieve erection during sexual activity, even if they occasionally become erect, it will immediately subside.
For spermatorrhea with dreams, use Fengsui Dan (Seal the Marrow Pill); for spermatorrhea without dreams, use Baizhu (Atractylodis Rhizoma) and Lianxu (Lotus Stamen). The Liver governs free flow and discharge, so evil qi should not cause worry; the Heart governs the綱维 (guiding principles), so its commands must be upright. Wendan Tang (Gallbladder-Warming Decoction) added with Fushen (Poria with Hostwood) clears heat appropriately; Sijunzi Tang (Four Gentlemen Decoction) added with Yuanzhi (Polygalae Radix) provides nourishment and peace. If the illness has lasted for a long time, Fuzi (Aconiti Lateralis Radix Praeparata) must be added; the power of the lock and key returns to the Kidney, so how could one dispel cold by clearing heat?
Enuresis refers to the involuntary urination, primarily caused by Kidney deficiency. I frequently use Fuzi (Aconiti Lateralis Radix Praeparata) and Renshen (Ginseng Radix et Rhizoma) three qian each, Shanzhuyu (Corni Fructus) one liang, or add Yizhiren (Bletillae Rhizoma) two qian, decocted in water with a small amount of salt, which yields good results. There are also cases of Spleen and Lung Qi deficiency, unable to constrain the water passages, as described in the *Jinkui Yaolue*: "Upper deficiency cannot control lower deficiency." Such cases should be treated with modifications of Buzhong Yiqi Tang (Decoction for Boosting the Middle and Augmenting Qi). Chao Yuanfang stated: "Those who urinate in their sleep have an innate constitution where Yin qi is excessive and Yang qi is deficient, causing both the Bladder and Kidney qi to be cold. During night sleep, Yang qi declines and fails to control Yin, leaving Yin qi dominant, resulting in frequent urination or enuresis. Treatment is suitable for using Rooster Comb (Gallus gallus domesticus cristacarnosa) and Rougui (Cinnamomi Cortex) in equal parts, pounded into pills the size of small beans, taken three times daily."
(Principles of the Classics): The *Xuanming Wuqi Pian* (Chapter on the Five Qi Manifestations) states: "Bladder dysfunction leads to Gongbi (difficulty in urination); lack of constraint leads to Yiniao (enuresis)." The *Gukong Lun* (Treatise on Empty Bones) states: "Disease of the Du Mai (Governing Vessel) manifests as Gongbi (difficulty in urination), hemorrhoids, and enuresis." The *Bi Lun* (Treatise on Bi Syndrome) states: "Excessive pathogenic qi causes enuresis; Bi syndrome gathers in the Kidney." The *Jueqi Lun* (Treatise on Rebellious Qi) states: "Heart transfers heat to the Lung, causing Feixiao (Lung Wasting-Thirst); in Feixiao, drinking one part results in urinating two parts, which is incurable and fatal." The *Maiyao Jingwei Lun* (Treatise on the Essence and Subtleties of Pulse Diagnosis) states: "When the granaries cannot store, it is because the gates are not secure. When the water springs do not cease, it is because the Bladder cannot store. Those who maintain security live; those who lose security die." The *Benshu Pian* (Chapter on Primary Acupoints) states: "The Sanjiao (Triple Burner) is led by the Foot Shaoyin (Kidney) and Foot Taiyang (Bladder) channels; excess manifests as Gongbi (difficulty in urination), deficiency manifests as Yiniao (enuresis)."