经义
肾者主水，受五脏六腑之精而藏之。五脏盛，乃能泻。○丈夫二八肾气盛，天癸至，精气溢泻，阴阳和，
故能有子。○肾者主蛰，封藏之本，精之处也。（《素问》）
人始生，先成精，精成而脑髓生。○故生之来谓之精；两精相搏谓之神；随神往来谓之魂；并精而出入者
谓之魄。○怵惕思虑则伤神；神伤，则恐惧流淫而不止。○恐惧不解则伤精；精伤，则骨酸痿厥，精时自下。（《灵枢》）
哲言
有谓生来之精者，先身生之精也。有谓食气入胃，散精于五脏者；有谓水饮自脾肺输肾而四布，五经并行
之精者；此水谷日生之精也。然饮食日生之精，皆从生来元精之所化，而后分布，其藏盈溢，则输之于肾，肾
乃元气之本，生成之根，以始终化之养之之道也。（《证治准绳》）
精藏于肾，人尽知之，至精何以生？何以藏？何以出？则人不知也。夫精，即肾中之脂膏也，有长存者，
有日生者。肾中有藏精之处，充满不缺，如井中之水日夜充盈，此长存者也；其欲动交媾所出之精，及有病而
滑脱之精，乃日生者也。其精旋去旋生，不去亦不生，犹井中之水，日日汲之，不见其亏，终年不汲，不见其
溢。《易》云∶井道不可不革。故受之以革，其理然也。曰∶然则纵欲可无害乎？曰∶是又不然。盖天下之理，
总归自然，有肾气盛者，多欲无伤；肾气衰者，自当节养。《左传》云∶女不可近乎？对曰∶节之。若纵欲不
节，如浅狭之井，汲之无度，则枯竭矣。曰∶然则强壮之人，绝欲何如？曰∶但必浮火不动，阴阳相守则可；
若浮火日动而强制之，则反有害。盖精因火动而离其位，则必有头眩、目赤、身痒、腰疼、遗泄、偏坠等证，
甚者或发痈疽，此强制之害也。故精之为物，欲动则生，不动则不生，能自然不动则有益，强制则有害，过用
则衰竭，任其自然而无所勉强，则保精之良法也。（徐灵胎）
五脏皆有精，精者人之本也。然肾为藏精之都会，听命于心君，若能遣欲澄心，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∶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。治法∶因肾病而遗者治其肾；由他脏而致者，则以他脏与肾两治之。如心病而遗
者，血脉空虚，本纵不收；肺病而遗者，皮革毛焦，喘急不利；脾病而遗者，色黄肉消，四肢懈惰；肝病而遗
者，色青而筋痿；肾病而遗者，色黑而髓空。更当以六脉参详，昭然可辨。（《医宗必读》）
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，故目 不明。精不内固，水不济火，
故遗泄而精愈耗也。然百病皆生于心，皆根于肾，肾水不升，心火不降，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；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。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
以泄也，总由心虚不能入肾阴以藏，肾虚不能延心气以纳，心失拱默之德，肾失封藏之功，而为不交不固之患
矣。有梦而遗者，思想所致，心气不足而不摄也；无梦而遗者，多欲所致，肾精滑泄而不固也。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；有痰火湿热扰动精腑者。治惟养心滋肾，因湿、因热、因寒兼而治之，更须补其中气，以使元气升
举，不可轻服涩药。（《冯氏锦囊》）
肾主闭藏，肝主疏泄，二脏皆有相火，而其系上属于心。心，君火也，为物所感，则易于动，心动则相火
翕然随之，虽不交会，精亦暗流而渗漏矣。所以圣人教人收心养心，其旨微矣。○或问∶夜梦交接之理何如？
曰∶《灵枢·淫邪发梦篇》云∶厥气客于阴器，则梦接内。盖阴器者，宗筋之所系也，而足太阴、阳明、少
阴、厥阴之筋，皆结聚于阴器，与冲、任、督三脉之所会。厥阴主筋，故诸筋皆统属于厥阴也。肾为阴，主藏
精；肝为阳，主疏泄。阴器乃泄精之窍，是故肾之阴虚，则精不藏；肝之阳强，则气不固。若遇阴邪客于其窍，
与所强之阳相感，则精脱出而成梦矣。所谓阳强者，非肾脏之真阳强也，乃肝脏所寄之相火强耳。曰∶如子所
言，梦遗则从肝肾得之乎？曰∶不然。病之初起，亦有不在肝肾，而在心脾胃之不足者，然必传于肝肾而后精
方走也。故精脱之后，其气未能卒复，未免形体衰惫，不比平人接内之后，其气一、二时便可复也。曰∶治当
何如？曰∶病从他脏而起，则以初感病者为本，肾肝聚病处为标；若由肾肝二脏自得者，独治肾肝；由阴阳离
决，水火不交者，则既济之；阴阳不相抱负者，则因而和之；阳虚者，补其气；阴虚者，补其血；阳强者，泻
其火。火有正治反治，从多从少，随其攸利。（《推求师意》）
梦遗有数种∶有下元虚惫，精元不禁者；有年壮气盛久旷，经络壅滞者；有情欲淫动，所愿不遂者。如
瓶煎汤，气盛盈溢者；如瓶中汤沸而溢，欲动心邪者；如瓶倾倒而出，虚惫不禁者；如瓶有罅而漏。不可一概
用药。（《赤水玄珠》）
遗精证状，亦复不同∶或小便后出多不可禁者；或不小便而自出者；或茎中痛痒，常如欲小便者；或睡
中无梦，流出不自觉者。太抵夜睡自遗者轻，昼觉自遗者重。（《证治汇补》）
遗精之证有九∶凡有所注恋而梦者，此精为神动也，其因在心；有欲事不遂而梦者，此精失其位也，其
因在肾；有值劳倦即遗者，此筋力不胜，肝脾之气弱也；有因用心思索过度辄遗者，此中气不足，心脾之虚陷
也；有因湿热下流，或相火妄动而遗者，此脾肾之火不清也；有无故滑而不禁者，此下元之虚，肺肾之不固也；
有素禀不足，而精易滑者，此先天元气之单薄也；有久服冷利等剂，以致元气失守而滑泄者，此误药之所致也；
有壮年气盛，久节房欲而遗者，此满而溢者也。凡此之类，是皆遗精之病。
然心主神，肺主气，脾主湿，肝主疏泄，肾主闭藏，凡此诸病，五脏皆有所主，治当各求所因。至若满而溢者，
则去者自去，生者自生，势出自然，无足虑也。○因梦而出精者，谓之梦遗；不因梦而精自出者，谓之滑精。梦
遗者，有情，有火，有虚，有溢，有因情动而梦者，有因精动而梦者。情动者，清其心；精动者，固其肾。滑
精者，无非肾气不守而然；若暴滑而兼痛者，则当从赤白浊门论治。（张景岳）
久病而忽梦遗，是湿热注于膀胱而泄，火气得以下行，犹为佳兆。若房劳，则心之相火动，真精一泄，祸
将滔天矣。（查了吾）
补编
遗精一证，不越乎有梦、无梦、湿热三者范围。有梦为心病，无梦为肾病，湿热为小肠膀胱病。夫精之藏
制虽在肾，而精之主宰则在心。其精血下注，湿热混淆而遗滑者，责任在小肠膀胱；其治，不外养心益肾，填
精固摄，清热利湿诸法。如肾精亏乏，相火易动，阴虚阳冒而为遗精者，治用浓味填精，介类潜阳，养阴固涩；
如无梦而肾关不固，精窍滑脱者，治用桑螵蛸散，填阴固摄及滑涩互施；如有梦而遗，烦劳过度，及脾胃受伤，
心肾不交，上下交损者，用归脾汤、妙香散、参术膏、补心丹等方，心脾肾兼治；如阴虚不摄，湿热下注而遗
滑者，用黄柏、萆 、黄连、苓、泽等味，苦泄厥阴郁热，兼通腑气为主；如下虚上实，火风震动，脾肾液枯
而为遗滑者，用二至、百补丸及通摄下焦之法；如龙相交炽，阴精走泄者，用三才封髓丹、滋肾丸、大补阴丸，
峻补真阴，承制相火，以泻阴中伏热为主；又有房劳过度，精竭阳虚，寐则阳陷而精道不禁，随触随泄，不梦
而遗者，当用固精丸，升固八脉之气；又有膏粱酒肉，饮醇浓味，脾胃酿成湿热，留伏阴中而为梦泄者，当用
猪肚丸，清其脾胃蕴蓄之湿热。（《临证指南》）
梦遗者，治其心；精滑者，固其精；满而溢者，舒其情；浊
而赤者，调其经，养其神。心安神定，火来坎户，水利离宫，水火交养，遗浊皆清。（《冯氏锦囊》）
遗精之源有三∶有斫丧太过，肾气不藏，无梦而遗者，当益精以壮火，如鹿茸丸、安肾丸、聚精丸、金
锁玉关丸。有劳心太过，心肾不交，酣卧而遗者，当实土以堤水，如归脾汤、妙香散、远志丸、补中益气汤、
朱砂安神丸。有思想无穷，所愿不得，妄梦而遗者，当泻火以益水，如滋肾丸、威喜丸、本事猪苓丸、清心莲
子饮。三者其源各异，若当清利而反补涩，滋患愈甚；当补涩而反清利，阳气愈微；当升阳而反滋阴，元气愈
陷。不可不求其故而为施治也。（陆丽京）
《经》曰∶思想无穷，所愿不得，意淫于外，入房太甚，宗筋弛纵，发为白淫、梦遗等证。昔贤治法有
五∶其一，意淫于外者，用辰砂、磁石、龙骨之类，镇坠神之浮游是也。其二，思想结成痰饮，迷于心窍者，
许学士用猪苓丸，导利其痰是也。其三，思想伤阴者，洁古用珍珠粉丸，降火补阴是也。其四，思想伤阳
者，谦甫用鹿茸、苁蓉、菟丝等补阳是也。其五，阴阳俱虚者，丹溪治一人形瘦便浊梦遗，作心虚治，用定志丸
是也。○遗精，治作肾虚，补涩罔效，不知此因脾胃湿热所乘，饮酒浓味，痰火之人，多有此疾。肾虽藏精，其
精本于脾胃饮食生化而输于肾，若脾胃受伤，湿热内郁，使中气淆而不清，则所输皆浊气，邪火扰动，水不得
安，故令遗滑。治以苍白二陈，加黄柏、升、柴，俾清升浊降，脾胃健运，则自止矣。○尝谓治遗滑以涩剂不
能止，不若泻心火；泻心火不能止，不若用升阳之剂。非此能止之也，举其气上而不下也。（《证治准绳》）
童男阳盛，情动于中，志有所慕而不得遂，以致夜梦遗精，不可补涩，清心乃安，朝服清心莲子饮，
暮服定志丸。（龚云林）
梦遗属郁滞者居多，庸医不知，但用固涩，愈涩愈郁，其病反甚。（娄全善）
大抵梦遗多是阴亏、火气用事，苟非确系阳虚，桂、附助阳之药慎勿轻用；非确系气虚，参、术益气之味
不可漫施。试观梦遗必在黎明，阳气发动之时，其为阴虚阳扰可知矣。（《张氏医通》）
脉候
男子脉浮弱而涩，为无子，精气清冷。○夫失精家，少腹弦急，阴头寒，目眩发落。脉极虚芤迟，为清谷、
亡血、失精；脉得诸芤动紧，男子失精，女子梦交。（《金匮》）
选案
一人因劳心太过患梦遗，数日一发，发过则虚火上炎，面赤烘热，手足逆冷，终夜不寐，服补心肾及涩药
不效。予用黄柏为君，佐以地黄、枸杞、莲须、膘胶、山萸、五味子、车前、麦冬，治之而痊。人疑黄柏大寒，
讵知肾欲坚，急食苦以坚之。肾得坚，则心经虽有火而精自固。○一人患遗精，闻妇人声即泄，瘠瘦欲死。予用
远志为君，莲须、石莲为臣，龙骨、茯神、沙苑、牡蛎为佐，服药虽止，然终不断，于前方内加膘胶一味即愈。（缪仲淳）
郑鲁叔攻举子业，四鼓犹不卧，遂成此病，卧间玉茎但着被与腿，便梦交接脱精，食减倦怠。此由用心太
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，鼓起精房，则精不得聚藏，因玉茎着
物，厥气客之，故作接内之梦。上用补心安神，中用调脾升阳，下用益精生阴，三月乃痊。（《推求师意》）
萧方来子，天资聪敏，十岁时即患梦遗、盗汗。余用六味丸加龟版、龙骨潜藏灵物，久服渐止。毕姻后，
竟以损证早逝。（许宣治）
一男子病后用心过度，遂患梦遗，多痰瘦削，久服清心莲子饮无效。诊脉紧涩，知其冷药利水太过，致使
肾气独降。初以升提之法，升坎水而济离火，降阳气而滋阴血；次用鹿胶、人乳填补精血，逾月而愈。（吴茭山）
一人常患梦遗，诊其关中有动脉如大豆圆，此痰凝中焦，幸
梦遗，免致鼓胀。但尺寸俱不起。方用补中益气汤加茯苓、半夏、菖蒲，一升一降之道。（查了吾）
一人夏感伤寒五、六日，左寸脉浮紧，他部洪数，外证头疼、目痛，鼻干口渴，体汗寒热，闭目则遗精。
医曰∶闭目遗精，虚之极也。予思头痛未止，表证未罢；目痛鼻干口渴，阳明证也；寒热往来，又兼少阳。梦
【经文义理】
肾脏主管水液代谢，接受并贮藏来自五脏六腑的精微物质。只有当五脏精气充盛时，才能将多余的精气排泄出来。○男子到了十六岁（二八），肾气旺盛，天癸（促进生殖机能成熟的物质）到来，精气满溢而排出，阴阳交合，因此能够生育子女。○肾脏主蛰伏闭藏，是封藏的根本所在，也是精气汇聚的地方。（出自《素问》）
人初生时，先形成精，精形成后脑髓随之产生。○所以生命的本源称为精；父母两精结合产生神；伴随神往来活动的是魂；与精一起出入的是魄。○惊恐思虑会损伤神；神受损，就会出现恐惧、滑精且不止的症状。○长期恐惧不解会损伤精；精受损，就会骨骼酸痛、肢体痿软厥冷，精气自行滑脱。（出自《灵枢》）
【哲人言论】
有一种说法认为“先天之精”，是先于身体形成的精。有一种说法认为“后天之精”，是饮食之气进入胃中，散布到五脏的精微物质；还有一种说法认为是水饮从脾肺输送到肾，进而布散全身，运行于五经的精微物质；这些都属于随饮食每日生成的“后天之精”。然而，每日由饮食生成的后天之精，都是由先天元精转化而来，然后分布全身，其储藏充盈后，再输送给肾脏。肾是元气的根本，生成的根源，以此作为始终化生和滋养的途径。（出自《证治准绳》）
人们都知道精藏在肾里，但至于精是如何生成的？如何贮藏的？如何排出的？人们就不了解了。所谓精，就是肾中的脂膏，其中有长存不变的，也有每日新生的。肾中有贮藏精气的地方，充满不缺，就像井里的水日夜充盈，这是长存的精；而那些因性欲冲动性交排出的精，以及生病时滑脱流失的精，则是每日新生的。这种精是去多少生多少，不去也不生，就像井里的水，每天汲取它，看不出亏损；整年不汲取，也看不出溢出。《易经》说：井道不能不革新。所以接着讲“革”卦，道理就是这样。有人问：那么纵欲无害吗？回答说：这又不对了。天下的道理，总归自然，肾气旺盛的人，多欲也无妨；肾气衰弱的人，自然应当节制保养。《左传》中说：女子不可亲近吗？回答说：要有所节制。如果纵欲无度，就像浅窄的井，汲取没有限度，就会枯竭。有人问：那么强壮的人，完全禁欲怎么样？回答说：只要虚火不动，阴阳相守就可以；如果虚火天天躁动却强行抑制，反而有害。因为精因火动而离开原位，就必然会出现头晕、眼红、身痒、腰痛、遗泄、睾丸偏坠等症状，严重的甚至发生痈疽，这是强行抑制的危害。所以精这种东西，欲望动则生，不动则不生，能自然不动则有益，强行抑制则有害，过度使用则衰竭，顺应自然而不勉强，才是保精的好方法。（徐灵胎）
五脏都有精，精是人的根本。但肾是藏精的总汇，听从心君（心脏）的指挥。如果能遣除欲望、澄清心境，精气内守，阴平阳秘，精元就能固密。如果纵欲劳神，就会导致心肾不交，关键不固。《内经》说：惊恐思虑会损伤神；神受损，就会恐惧、滑精不止。又说：肾脏主管水液，接受五脏六腑的精而贮藏它。又说：厥逆之气客居在生殖器，就会梦见性交。无奈古今方论，都把遗精当作肾病，好像与其他脏腑没有干涉，却不知道《内经》说五脏六腑各有精，肾则接受并贮藏它们。对于不梦而自遗的，多是心肾受伤；做梦后遗精的，多是相火过强为害。如果五脏各尽其职，则精能藏而病愈；假如某一脏不得其正，严重时必定会移害到主持藏精的心肾。治疗方法：因肾病而遗的，治疗肾；由其他脏腑导致的，则同时治疗该脏与肾。如心病导致遗精的，血脉空虚，松弛不收；肺病导致遗精的，皮毛枯焦，喘急不利；脾病导致遗精的，面色黄、肌肉消瘦，四肢懈怠；肝病导致遗精的，面色青、筋脉痿软；肾病导致遗精的，面色黑、骨髓空虚。更应当结合六脉详查，就能清楚辨别。（《医宗必读》）
精能生气，气能生神，精伤就不能生气，所以身体瘦弱、气短；气弱就不能生神，所以视力不明。精不能内固，肾水不能上济心火，所以遗泄且精更加耗损。然而百病都生于心，根源于肾，肾水不升，心火不降，这就是梦遗产生的原因。肾水不上行，则气不固而阴虚；心火不下行，则妄动而相火随之；阳旺阴虚，则水火不交。《内经》说：阴阳分离决裂，精气就会断绝。说的就是这个道理。梦遗本是由心火引起的疾病，但肝肾二经之火相互挟持而成。因为心藏神，肝藏魂，肾藏精。梦中产生的，就是心的神；梦中见到的，就是肝的魂；梦中泄出的，就是肾的精。心是君主，肝肾是宰相，梦中神游，魂化为形，相火突然鼓动。这就是精之所以泄出的原因，总归于心虚不能入肾阴以藏，肾虚不能延引心气以纳，心失去了拱默辅佐的德行，肾失去了封藏的功能，从而造成不交不固的祸患。有梦而遗的，是思想所致，心气不足而不能摄持；无梦而遗的，多是纵欲所致，肾精滑泄而不固。有因醉饱劳倦，清气不升，脾精不运而遗的；有因肾水不足，淫火熏蒸，精离其位而遗的；有因相火旺而脾胃受伤，水谷每日生成的精，不能进入与元精共同贮藏而遗的；有因火炎上而水下趋，心肾不交而滑脱的；有因年轻气盛，久节房事，精满而溢的；有因脾虚下陷的；有因痰火湿热扰动精室而遗的。治疗唯有养心滋肾，根据湿、热、寒兼而治之，更须补益中气，以使元气升举，不可轻易服用涩药。（《冯氏锦囊》）
肾主闭藏，肝主疏泄，这两脏都有相火，而其联系上属于心。心，是君火，容易被外物感应而动，心动则相火随之突然鼓动，即使不进行性交，精也会暗中流渗漏出。所以圣人教导人收心养心，用意深远。○有人问：夜间梦境交接的道理是怎样的？回答说：《灵枢·淫邪发梦篇》说：厥逆之气客居在生殖器，就会梦见性交。大概生殖器，是宗筋所系结的地方，而足太阴、阳明、少阴、厥阴的筋，都结聚在生殖器，与冲、任、督三脉交会。厥阴主筋，所以诸筋都统属于厥阴。肾属阴，主藏精；肝属阳，主疏泄。生殖器是泄精的窍道，所以肾阴虚，则精不藏；肝阳强，则气不固。如果遇到阴邪客居在窍道，与所强的阳气相感，则精脱出而形成梦遗。所谓的阳强，不是肾脏的真阳强，而是肝脏所寄寓的相火强罢了。有人问：像您所说的，梦遗是从肝肾得来的吗？回答说：不对。病初起时，也有不在肝肾，而在心脾胃不足的，但必须传到肝肾之后精才会走泄。所以精脱失之后，气不能立刻恢复，难免形体衰惫，不像正常人性交后，一两个小时气就能恢复一样。有人问：治疗应当怎样？回答说：病从他脏而起，则以初感病的脏腑为本，肾肝聚集病变处为标；若由肾肝二脏自身得病，单独治疗肾肝；若由阴阳离决，水火不交引起，则用既济法调和；阴阳不相抱持的，则顺势调和；阳虚的，补气；阴虚的，补血；阳强的，泻火。火有正治反治，从多从少，随其便利而定。（《推求师意》）
梦遗有好几种：有因下元虚惫，精元不禁的；有因年轻气盛久旷，经络壅滞的；有情欲淫动，愿望未遂的。就像瓶子里煎汤，气盛盈溢的；像瓶中汤沸腾而溢出，欲望触动心邪的；像瓶子倾倒而出，虚惫不禁的；像瓶子有裂缝而漏水的。不可一概用药。（《赤水玄珠》）
遗精的症状表现也各不相同：有的在小便后流出很多且不可控制；有的不小便而自行流出；有的阴茎中痛痒，常想小便；有的在睡中没有梦，流出而自己不知道。大抵夜里睡觉自遗的较轻，白天清醒时自遗的较重。（《证治汇补》）
遗精的病证有九种：凡是有所眷恋而做梦的，这是精被神动，病因在心；有因欲望之事未遂而做梦的，这是精失其位，病因在肾；有因劳累疲倦即遗精的，这是筋力不胜，肝脾之气虚弱；有因用心思索过度就遗精的，这是中气不足，心脾虚陷；有因湿热下流，或相火妄动而遗精的，这是脾肾之火不清；有无故滑脱不禁的，这是下元虚，肺肾不固；有素体禀赋不足，而精易滑的，这是先天元气单薄；有久服冷利等药物，以致元气失守而滑泄的，这是误药所致；有壮年气盛，久节房事而遗精的，这是满而溢。凡此之类，都是遗精的病。
然而心主神，肺主气，脾主湿，肝主疏泄，肾主闭藏，凡这些病，五脏都各有主治，治疗应当各自探究病因。至于满而溢的，则去的自去，生的自生，势出自然，无需担忧。○因梦而出精的，叫作梦遗；不因梦而精自出的，叫作滑精。梦遗的，有情志因素，有火，有虚，有溢。因情动而梦的，清其心；因精动而梦的，固其肾。滑精的，无非是肾气不守所致；如果暴滑且兼疼痛的，则应当从赤白浊的门类来论治。（张景岳）
久病忽然梦遗，是湿热注于膀胱而泄，火气得以下行，还是好兆头。如果是房劳过度，则心之相火动，真精一泄，祸患将滔天。（查了吾）
【补编】
遗精这一证候，不出乎有梦、无梦、湿热三者范围。有梦为心病，无梦为肾病，湿热为小肠膀胱病。精的藏制虽在肾，但精的主宰在心。其精血下注，湿热混淆而遗滑的，责任在小肠膀胱；其治疗，不外乎养心益肾、填精固摄、清热利湿等方法。如肾精亏乏，相火易动，阴虚阳冒而为遗精的，治疗用浓味填精，介类潜阳，养阴固涩；如无梦而肾关不固，精窍滑脱的，治疗用桑螵蛸散，填阴固摄及滑涩互施；如有梦而遗，烦劳过度，及脾胃受伤，心肾不交，上下交损的，用归脾汤、妙香散、参术膏、补心丹等方，心脾肾兼治；如阴虚不摄，湿热下注而遗滑的，用黄柏、萆薢、黄连、茯苓、泽泻等味，苦泄厥阴郁热，兼通腑气为主；如下虚上实，火风震动，脾肾液枯而为遗滑的，用二至丸、百补丸及通摄下焦之法；如龙雷之火相交炽，阴精走泄的，用三才封髓丹、滋肾丸、大补阴丸，峻补真阴，承制相火，以泻阴中伏热为主；又有房劳过度，精竭阳虚，寐则阳陷而精道不禁，随触随泄，不梦而遗的，当用固精丸，升固八脉之气；又有膏粱酒肉，饮醇浓味，脾胃酿成湿热，留伏阴中而为梦泄的，当用猪肚丸，清其脾胃蕴蓄之湿热。（《临证指南》）
梦遗者，治其心；精滑者，固其精；满而溢者，舒其情；浊而赤者，调其经，养其神。心安神定，火来坎户，水利离宫，水火交养，遗浊皆清。（《冯氏锦囊》）
遗精的来源有三：有因斫丧太过，肾气不藏，无梦而遗的，当益精以壮火，如鹿茸丸、安肾丸、聚精丸、金锁玉关丸。有因劳心太过，心肾不交，酣卧而遗的，当实土以堤水，如归脾汤、妙香散、远志丸、补中益气汤、朱砂安神丸。有因思想无穷，所愿不得，妄梦而遗的，当泻火以益水，如滋肾丸、威喜丸、本事猪苓丸、清心莲子饮。三者来源各异，若当清利而反补涩，滋患愈甚；当补涩而反清利，阳气愈微；当升阳而反滋阴，元气愈陷。不可不求其故因而施治。（陆丽京）
《内经》说：思想无穷，所愿不得，意淫于外，入房太甚，宗筋弛纵，发为白淫、梦遗等证。昔贤治法有五：其一，意淫于外的，用辰砂、磁石、龙骨之类，镇坠神之浮游是也。其二，思想结成痰饮，迷于心窍的，许学士用猪苓丸，导利其痰是也。其三，思想伤阴的，洁古用珍珠粉丸，降火补阴是也。其四，思想伤阳的，谦甫用鹿茸、苁蓉、菟丝等补阳是也。其五，阴阳俱虚的，丹溪治一人形瘦便浊梦遗，作心虚治，用定志丸是也。○遗精，若按肾虚治，补涩无效，不知这是因为脾胃湿热所乘，饮酒浓味，痰火之人，多有此疾。肾虽藏精，但其精本于脾胃饮食生化而输于肾，若脾胃受伤，湿热内郁，使中气淆而不清，则所输皆浊气，邪火扰动，水不得安，故令遗滑。治疗用苍白二陈汤，加黄柏、升麻、柴胡，俾清升浊降，脾胃健运，则自止矣。○我曾说治疗遗滑用涩剂不能止，不如泻心火；泻心火不能止，不如用升阳之剂。这不是靠它能止住，而是提升其气上达而不下降。（《证治准绳》）
童男阳气盛，情动于中，志有所慕而不得遂，以致夜梦遗精，不可补涩，清心乃安，朝服清心莲子饮，暮服定志丸。（龚云林）
梦遗属郁滞者居多，庸医不知，只用固涩，愈涩愈郁，其病反而加重。（娄全善）
大抵梦遗多是阴亏、火气用事，如果不是确系阳虚，桂枝、附子助阳之药慎勿轻用；如果不是确系气虚，人参、白术益气之味不可漫施。试看梦遗必在黎明，阳气发动之时，其为阴虚阳扰可知矣。（《张氏医通》）
【脉候】
男子脉浮弱而涩，为无子，精气清冷。○夫失精家，少腹弦急，阴头寒，目眩发落。脉极虚芤迟，为清谷、亡血、失精；脉得诸芤动紧，男子失精，女子梦交。（《金匮要略》）
【选案】
一人因劳心太过患梦遗，数日一发，发过则虚火上炎，面赤烘热，手足逆冷，终夜不寐，服补心肾及涩药不效。我用黄柏为君药，佐以地黄、枸杞、莲须、阿胶、山萸肉、五味子、车前子、麦冬，治之而痊愈。有人怀疑黄柏大寒，岂知肾欲坚，急食苦以坚之。肾得坚，则心经虽有火而精自固。○一人患遗精，闻妇人声即泄，瘦弱欲死。我用远志为君药，莲须、石莲为臣药，龙骨、茯神、沙苑子、牡蛎为佐药，服药虽止，然终不断，于前方内加阿胶一味即愈。（缪仲淳）
郑鲁叔攻读举子业，四更天还不睡，遂成此病，卧间阴茎但只要着被与腿，便梦交接脱精，食减倦怠。这是由于用心太过，二火俱起，夜不得睡，血不归肝，肾水不足，火乘阴虚，入客下焦，鼓起精房，则精不得聚藏，因阴茎着物，厥气客之，故作接内之梦。上用补心安神，中用调脾升阳，下用益精生阴，三月乃痊愈。（《推求师意》）
萧方来的儿子，天资聪敏，十岁时即患梦遗、盗汗。我用六味丸加龟版、龙骨等潜藏灵物，久服渐止。结婚后，竟因虚损证早逝。（许宣治）
一男子病后用心过度，遂患梦遗，多痰瘦削，久服清心莲子饮无效。诊脉紧涩，知其冷药利水太过，致使肾气独降。初以升提之法，升坎水而济离火，降阳气而滋阴血；次用鹿胶、人乳填补精血，逾月而愈。（吴茭山）
一人常患梦遗，诊其关中有动脉如大豆圆，此痰凝中焦，幸好梦遗，免致鼓胀。但尺寸俱不起。方用补中益气汤加茯苓、半夏、菖蒲，取一升一降之道。（查了吾）
一人夏感伤寒五、六日，左寸脉浮紧，他部洪数，外证头疼、目痛，鼻干口渴，体汗寒热，闭目则遗精。医生说：闭目遗精，虚之极也。我思考：头痛未止，表证未罢；目痛鼻干口渴，阳明证也；寒热往来，又兼少阳。梦
[Scriptural Principles]
The Kidney governs water metabolism and receives and stores the essence from the five zang and six fu organs. Only when the essence of the five zang organs is abundant can it be discharged. ○ When a man reaches sixteen years of age (2 × 8), his kidney qi becomes vigorous, Tian Gui (substances that promote reproductive maturation) arrives, essence overflows and is discharged, yin and yang interact, thus enabling procreation. ○ The Kidney governs hibernation and storage; it is the root of sealing and storing, and the residence of essence. (From *Su Wen*)
At the beginning of human life, essence forms first; once essence is formed, brain marrow develops. ○ Therefore, the origin of life is called essence; the interaction of paternal and maternal essence gives rise to Shen (Spirit); Hun (Ethereal Soul) follows Shen in its activities; Po (Corporeal Soul) enters and exits with essence. ○ Fear and anxiety injure Shen; when Shen is injured, fear and involuntary seminal emission occur without cessation. ○ Unrelieved chronic fear injures Jing (Essence); when Jing is injured, there is soreness and coldness in the bones, flaccidity and coldness of the limbs, and spontaneous leakage of essence. (From *Ling Shu*)
[Philosophical Discourses]
Some refer to "innate essence," which is the essence generated prior to physical formation. Others refer to "acquired essence," which is the refined material from food and drink entering the stomach and dispersing to the five zang organs; still others refer to fluids transported from the Spleen and Lungs to the Kidneys, spreading throughout the body and circulating through the five meridians; these constitute the daily-generated "acquired essence." However, this daily acquired essence is transformed from innate primordial essence, distributed throughout the body, and when stored abundantly, is further transmitted to the Kidneys. The Kidney is the root of Yuan Qi (Primordial Qi) and the source of generation, serving as the continuous process of transformation and nourishment. (From *Zheng Zhi Zhun Sheng*)
It is widely known that essence is stored in the Kidneys, but few understand how essence is generated, stored, or discharged. Essence refers to the fatty substance within the Kidneys; some parts are long-lasting, while others are generated daily. The place in the Kidney where essence is stored remains full and un-depleted, like water in a well that fills day and night; this represents the long-lasting essence. The essence discharged due to sexual desire or lost during illness represents the daily-generated essence. This essence is replenished as it leaves; if not used, it is not generated, similar to well water: drawing from it daily shows no depletion, while leaving it undisturbed for a year shows no overflow. The *I Ching* states: "The way of the well must not remain unchanged." Hence, it is followed by the hexagram Ge (Revolution). Someone asks: Is indulgence in sex harmless? The answer is: Not so. All principles return to nature. Those with vigorous Kidney qi may indulge without harm; those with declining Kidney qi should naturally practice moderation and nourishment. As stated in *Zuo Zhuan*: "Should one avoid women?" The reply: "One must exercise restraint." Indulgence without restraint is like a shallow, narrow well drawn from excessively; it will dry up. Someone asks: What about strong individuals who abstain completely? The answer: As long as floating fire does not move and yin and yang remain harmonious, it is acceptable. If floating fire agitates daily yet one forces abstinence, it causes harm. Because essence moves away from its position due to fire, symptoms such as dizziness, red eyes, itching, lower back pain, seminal emission, and testicular swelling may occur, and severe cases may develop carbuncles. This is the harm of forced suppression. Thus, essence is generated when desire moves and not generated when it does not. Natural non-movement benefits, forced suppression harms, excessive use leads to exhaustion, and following nature without coercion is the best method for preserving essence. (Xu Lingtai)
All five zang organs contain essence, which is the foundation of human life. However, the Kidney is the repository of essence, obeying the command of the Heart Monarch. If desires are dispelled and the mind clarified, essence remains internal, yin and yang are balanced, and essence is firmly secured. Indulgence in sex and mental labor cause Heart-Kidney non-interaction and insecurity of the key mechanisms. The Classics state: "Fear and anxiety injure Shen; when Shen is injured, fear and involuntary seminal emission occur without cessation." It also states: "The Kidney governs water, receiving and storing essence from the five zang and six fu organs." And: "Jue Qi lodging in the genitalia causes dreams of intercourse." Unfortunately, ancient and modern theories treat seminal emission solely as a Kidney disease, ignoring other organs. Yet the *Nei Jing* teaches that all five zang and six fu organs have their own essence, which the Kidney receives and stores. Non-dream emission usually results from Heart-Kidney injury; dream emission is often caused by hyperactive Ministerial Fire. If the five zang organs function properly, essence is stored and health is maintained; if one organ is dysfunctional, it may eventually damage the Heart and Kidney, which govern essence. Treatment: For Kidney-originated emission, treat the Kidney; for emissions caused by other organs, treat both the affected organ and the Kidney. Heart-related emission involves empty blood vessels and laxity; Lung-related emission involves dry skin and hair, wheezing, and difficulty urinating; Spleen-related emission involves yellow complexion, muscle wasting, and limb fatigue; Liver-related emission involves blue complexion and tendon flaccidity; Kidney-related emission involves black complexion and empty marrow. Pulse diagnosis clarifies differentiation. (From *Yi Zong Bi Du*)
Essence generates Qi, and Qi generates Shen. Injury to essence impairs Qi generation, leading to emaciation and shortness of breath; weak Qi fails to generate Shen, causing blurred vision. If essence is not internally secured and Kidney Water fails to control Heart Fire, seminal emission occurs, further depleting essence. All diseases originate in the Heart and root in the Kidney. When Kidney Water does not ascend and Heart Fire does not descend, dream emission arises. Ascending failure leads to insecure Qi and Yin deficiency; descending failure leads to erratic movement and Ministerial Fire activation. Yang excess and Yin deficiency result in non-interaction of Water and Fire. The Classics state: "When Yin and Yang separate and rupture, Jing and Qi perish." Dream emission is primarily a Heart Fire disorder, exacerbated by Liver and Kidney fire. The Heart houses Shen, the Liver houses Hun, and the Kidney houses Jing. In dreams, Shen arises, Hun is perceived, and Jing is discharged. The Heart is the monarch, and Liver/Kidney are ministers. During dream travel, Hun takes form, and Ministerial Fire surges, causing discharge. This results from Heart deficiency failing to enter Kidney Yin for storage, and Kidney deficiency failing to receive Heart Qi. With loss of Heart's supportive virtue and Kidney's sealing function, non-interaction and insecurity occur. Dream emission stems from thoughts and insufficient Heart Qi control; non-dream emission stems from excessive desire and insecure Kidney essence. Emission can result from drunkenness/fatigue with failing clear Qi and Spleen essence transport; Kidney Yin deficiency with flaming fire displacing essence; hyperactive Ministerial Fire damaging Spleen/Stomach, preventing daily essence from storing with primordial essence; fire rising and water sinking causing Heart-Kidney non-interaction; youthful vigor with prolonged abstinence causing overflow; Spleen Qi deficiency with sinking; or Phlegm-Fire-Dampness disturbing the essence chamber. Treatment requires nourishing Heart and moistening Kidney, addressing dampness, heat, or cold, tonifying Middle Qi to raise Yuan Qi, and avoiding astringents. (From *Feng Shi Jin Nang*)
The Kidney governs storage, and the Liver governs dispersion; both contain Ministerial Fire connected to the Heart. The Heart, as Sovereign Fire, is easily moved by external stimuli. When the Heart moves, Ministerial Fire surges, causing secret leakage even without intercourse. Thus, sages taught restraining and nourishing the Heart. Regarding nocturnal emissions: *Ling Shu* states that Jue Qi lodging in the genitalia causes dreams of intercourse. The genitalia are the site of Zong Jin (confluence of sinews), where foot Taiyin, Yangming, Shaoyin, and Jueyin sinews converge with the Chong, Ren, and Du vessels. Jueyin governs sinews. Kidney (Yin) stores essence; Liver (Yang) governs dispersion. The genitalia are the aperture for ejaculation. Kidney Yin deficiency leads to insecure essence; Liver Yang excess leads to insecure Qi. If Yin pathogens lodge in the aperture and interact with strong Yang, essence escapes, causing dreams. This "Yang excess" refers not to true Kidney Yang, but to hyperactive Ministerial Fire in the Liver. While disease may start in Heart, Spleen, or Stomach, it must transmit to Liver and Kidney for essence loss. After essence loss, Qi cannot recover immediately, causing debility unlike normal recovery after intercourse. Treatment depends on origin: if from other organs, treat the primary organ as root and Liver/Kidney as branch; if from Liver/Kidney alone, treat them directly; if from Yin-Yang separation and Water-Fire non-interaction, use Ji Ji (Mutual Completion) methods; if Yin/Yang do not embrace, harmonize them; tonify Qi for Yang deficiency, Blood for Yin deficiency, and drain fire for Yang excess. (From *Tui Qiu Shi Yi*)
Dream emission types include: lower yuan deficiency with uncontrollable essence; youthful vigor with prolonged abstinence causing meridian stagnation; sexual desire unfulfilled. Analogies: boiling water overflowing (excess Qi); pouring out from a tilted bottle (deficiency); leaking from a cracked bottle. Medication must not be uniform. (From *Chi Shui Xuan Zhu*)
Symptoms vary: emission after urination uncontrollably; spontaneous emission without urination; penile pain/itching resembling urge to urinate; unconscious emission during sleep without dreams. Nocturnal emission is mild; diurnal emission is severe. (From *Zheng Zhi Hui Bu*)
Nine causes of emission: attachment causing dreams (Heart); unfulfilled desire causing dreams (Kidney); fatigue-induced emission (weak Liver/Spleen Qi); overthinking-induced emission (insufficient Middle Qi, Heart/Spleen deficiency); damp-heat or Ministerial Fire-induced emission (unclear Spleen/Kidney fire); spontaneous sliding (lower yuan deficiency, Lung/Kidney insecurity); congenital weakness (thin primordial Qi); misuse of cold/purgative drugs (Qi loss); youthful vigor with abstinence (overflow). All are emission diseases. Heart governs Shen, Lung Qi, Spleen Damp, Liver dispersion, Kidney storage. Treatment seeks specific causes. Overflow is natural and harmless. Dream emission involves emotion, fire, deficiency, or overflow; regulate Heart for emotional triggers, secure Kidney for essence triggers. Sliding emission is Kidney Qi insecurity; acute sliding with pain treats as Red/White Turbidity. (Zhang Jingyue)
Sudden emission after chronic illness indicates damp-heat draining via Bladder, allowing fire to descend—a good sign. Sexual exhaustion moves Ministerial Fire, losing true essence—a catastrophic outcome. (Cha Liaowu)
[Supplement]
Emission falls into three categories: dream (Heart disease), non-dream (Kidney disease), damp-heat (Small Intestine/Bladder disease). Though stored in Kidney, governed by Heart. Damp-heat confusion involves Small Intestine/Bladder; treatment includes nourishing Heart/Kidney, filling essence, securing, clearing heat, and promoting diuresis. For Kidney essence deficiency with floating Yang, use rich flavors to fill essence, shell substances to anchor Yang, and Yin-nourishing astringents. For non-dream insecurity, use Sang Piao Xiao San. For dream emission with mental labor and Spleen/Stomach injury, use Gui Pi Tang, Miao Xiang San, Shen Zhu Gao, or Xin Dan. For Yin deficiency with damp-heat, use Huang Bo, Bi Xie, Huang Lian, Fu Ling, Ze Xie. For lower deficiency with upper excess, use Er Zhi Wan or Bai Bu Wan. For Dragon/Tiger fire agitation, use San Cai Feng Sui Dan or Zi Shen Wan. For sexual exhaustion with Yang deficiency, use Gu Jing Wan. For diet-induced damp-heat, use Zhu Du Wan. (From *Lin Zheng Zhi Nan*)
Treat dream emission by calming the Heart; sliding emission by securing essence; overflow by soothing emotions; turbid/red discharge by regulating meridians and nourishing Shen. A calm Heart stabilizes Shen, allowing Water and Fire to nourish each other, clearing turbidity. (From *Feng Shi Jin Nang*)
Three sources: excessive depletion causing non-dream emission (tonify essence/fire with Lu Rong Wan, etc.); mental labor causing Heart-Kidney non-interaction (strengthen Earth to dam Water with Gui Pi Tang, etc.); endless longing causing dream emission (drain fire/nourish water with Zi Shen Wan, etc.). Do not confuse clearing/drying with tonifying/astringing. (Lu Lijing)
Classics state: endless thoughts, unfulfilled desires, and excessive sex cause White Yin and dream emission. Five treatments: suppress floating Shen with Chen Sha/Ci Shi/Long Gu; drain phlegm from Heart orifices with Zhu Ling Wan; clear fire/nourish Yin with Zhen Zhu Fen Wan; tonify Yang with Lu Rong/Rong Cao/Tu Si Zi; treat Heart deficiency with Ding Zhi Wan. Emission misdiagnosed as Kidney deficiency often stems from Spleen/Stomach damp-heat and phlegm-fire. Treat with Cang Zhu, Bai Zhu, Er Chen Tang, Huang Bo, Sheng Ma, Chai Hu to clear turbidity and strengthen digestion. Elevating Qi stops emission better than astringents. (From *Zheng Zhi Zhun Sheng*)
Young men with strong Yang and unfulfilled desires should avoid tonification/astringency; clear the Heart. Take Qing Xin Lian Zi Yin in morning, Ding Zhi Wan at night. (Gong Yunlin)
Dream emission is often due to stagnation; astringents worsen it. (Lou Quanshan)
Most dream emission involves Yin deficiency and fire activity; avoid Gui Zhi/Fu Zi unless Yang deficiency is certain; avoid Ren Shen/Bai Zhu unless Qi deficiency is certain. Occurring at dawn when Yang rises indicates Yin deficiency with Yang disturbance. (From *Zhang Shi Yi Tong*)
[Pulse Diagnosis]
Floating, weak, and choppy pulses in men indicate infertility and cold, clear essence. Loss-of-essence patients show tight hypogastrium, cold glans, dizziness, and hair loss. Extreme deficiency, knotted, slow pulses indicate loose stools, blood loss, or essence loss. Knotted, moving, tight pulses indicate male essence loss or female dream intercourse. (From *Jin Gui Yao Lue*)
[Selected Cases]
Case 1: Mental overwork caused dream emission every few days, with false fire rising, red face, hot flashes, cold extremities, and insomnia. Tonics and astringents failed. I used Huang Bo as sovereign, assisted by Di Huang, Gou Qi, Lian Xu, Ejiao, Shan Yu, Wu Wei Zi, Che Qian Zi, Mai Dong. Cure achieved. Some doubted Huang Bo's cold nature, but bitterness hardens the Kidney; hardened Kidney secures essence despite Heart fire.
Case 2: Emission upon hearing women's voices, emaciated. Used Yuan Zhi as sovereign, Lian Xu/Shi Lian as ministers, Long Gu/Fu Shen, Sha Yuan/Mu Li as assistants. Stopped but recurred; adding Ejiao cured. (Miao Zhongchun)
Case 3: Zheng Lushe studied late, causing emission upon touching legs/bedding. Mind overwork raised two fires, blood didn't return to Liver, Kidney Water deficient, fire invaded lower Jiao. Treated with Heart-calming, Spleen-raising, and Kidney-nourishing methods over three months. (From *Tui Qiu Shi Yi*)
Case 4: Xiao Fanglai's son had dream emission and night sweats at age ten. Used Liu Wei Wan plus Gui Ban/Long Gu. Cured initially, but died young after marriage from consumption. (Xu Xuanzhi)
Case 5: Post-illness mental overwork caused emission, phlegm, emaciation. Qing Xin Lian Zi Yin failed. Tight/choppy pulse indicated excessive cold/diuretic drugs lowering Kidney Qi. First raised Kan Water to aid Li Fire, lowered Yang to nourish Yin. Then used Lu Jiao and Human Milk to fill essence/blood. Cured in a month. (Wu Jiaoshan)
Case 6: Frequent dream emission, pulsation at Guan like a bean (phlegm in Middle Jiao). Emission prevented abdominal distension. Chi/Cun pulses weak. Used Bu Zhong Yi Qi Tang plus Fu Ling, Ban Xia, Chang Pu for ascending/descending balance. (Cha Liaowu)
Case 7: Summer cold for 5-6 days, left Cun floating/tight, other positions flooding/fast. Headache, eye pain, dry nose/thirst, sweating/chills. Closing eyes caused emission. Doctor said extreme deficiency. I reasoned: headache means exterior syndrome persists; eye/nose/thirst indicates Yangming; chills/fever indicates Shaoyang. Dream...