某 无梦而遗，劳心辄泄，乃心肾失交症。用茯神丸参六味。人参、熟地、茯神、远志、当归、山药、
莲须、枣仁、五味、龙骨、莲实。糊丸服。数料全愈。
吉 己巳同会试前数日，同寓约观梨圆，座中遗泄如注。归寓后寒热咳嗽吐痰，此阴虚兼外感也。令
服补中汤，寒热退，但脉虚而沉细欲绝，断为肾损难治。粗毕场事，神愈疲乏，劳热喘促，痰嗽食减，乃脾
肺虚而气不归源也。必用人参乃定。彼吝费，一友赠高丽参二钱，予谓代用效减，自须全投，书人参养营汤去
熟地与桂，加茯神、山药、莲实。彼又将高丽参二钱分作四服。予哂之，服后喘热减，饮食颇加。又两服，改
用潞参，而效更减矣。
族某 梦泄。宿 腰痛，新兼脘痛，脉弦细。此伤精候也。妙香散去黄 、麝、辰砂，加砂仁、马料
豆（炒），服效。
吕 少年未室，每十日一梦泄。积久疲乏，面少神采，素服滋阴敛涩等药，不效。改服镇心安神等剂，亦
不效。予谓肝肾脉虚，非相火为害，但精关久滑，气少固摄耳。询之，果有时无梦亦泄，遂重用参、 、佐以五
味，茯神，山药、莲子、菟丝、芡实、杞子（俱炒）。滑泄竟止。更用丸剂，加鱼鳔（炒研）而固。
幼侄 宵读神劳即梦泄，夜热易饥，左关脉搏按。丹溪云∶主闭藏者肾，司疏泄者肝，二脏皆有相火。
而其系上属于心，心君火也，感物而动，君火动则相火随之，虽不交会，精亦暗流矣。又隐庵谓∶肾之阴虚则
精不藏，肝之阳强则气不固，故梦而精脱也。先用六味汤加减，熟地、山药、茯神、丹皮、远志、潞参、
麦冬、芡实、莲心、石斛。数服而效，后加龙骨、白芍、五味、炼蜜为丸，服愈。此补肝肾参养心之剂。君
火安则神魂敛而龙雷不扰矣。
刘 试场受惊，心惕精走于下。延为怔忡悸恐，心君虚不主令，相代其权，乃至有梦无梦皆遗，腰膝酸软
乏力。诊左寸沉数，左关尺沉细如丝，右尺微弦。此心营损极，神不摄精。宜补养心神，固纳肾真。（经言∶
怵惕思虑则伤神，神伤则恐惧流淫不止。又云∶恐惧不解则伤精，精伤则骨酸痿厥，精时自下，大抵怵惕伤心，
恐惧伤肾，心肾失交，精关不固。必精生神，神摄精，乃能却病。）且情志之病，尤在静养善调，勿希速效。
潞参、熟地、茯神（各三钱）、龙骨、山药（各二钱）、枣仁、远志、当归（各钱半） 金樱子（一钱）、
五味子、柏子仁（各六分）、莲子（十粒）。二服甚适。诊左寸绵绵不绝，惟尺泽空，精腑少藏耳。若滋填精
室，旬日内漏卮勿泄，尺脉可起。又夜半易饥便滑，前方去当归、柏子仁、熟地、山药焙用，加鱼鳔（三钱）、
菟丝饼（二钱）。十服神安精固，惟骨节时酸，胁肉时 ，坐卧恍惚，如在波浪中。此病后神未复元，虚阳
浮越也。宜招集散亡，封固管钥，更用潜阳填髓丸∶熟地（八两）、湖莲、芡实（俱炒）、线胶、淡菜、茯神、
山药（各四两）、五味（一两）、龟板、远志、麦冬（朱砂拌炒各二两）、猪脊髓（熬），为丸。又经云∶
精不足补之以味。午用猪心肾海参煨食，晨用牛乳同糯米煮食，调理数月渐安。
某患者：没有梦境却发生遗精，劳累用心时就会泄精，这是心肾不交证。使用茯神丸配合六味地黄丸加减。药物组成：人参、熟地黄、茯神、远志、当归、山药、莲须、酸枣仁、五味子、龙骨、莲子。制成糊丸服用。服用几剂后完全痊愈。
吉姓患者：己巳年参加会试前几天，与同住的人约定一起观看戏曲表演，在座位上突然遗精如注。回到住处后出现寒热往来、咳嗽吐痰的症状，这是阴虚兼有外感病邪。令其服用补中益气汤，寒热症状消退，但脉象虚而沉细几乎摸不到，判断为肾脏损伤，难以治愈。勉强考完试后，精神更加疲乏，劳累发热、气喘急促、咳嗽痰多、食欲减退，这是脾肺虚弱且气不能归根于肾。必须用人参才能安定病情。他吝啬花费，一位朋友赠送两钱高丽参，我认为代用品效果会减弱，应当全量投入使用，于是开具人参养营汤去掉熟地黄和桂枝，加入茯神、山药、莲子。他又将两钱高丽参分成四次服用。我嘲笑这种做法，服药后气喘和发热减轻，饮食略有增加。再服两剂后，改用潞党参，而疗效更差了。
同族某人：有梦而遗精。既往有腰痛病史，新近兼有胃脘疼痛，脉象弦细。这是耗伤精气的征候。使用妙香散去掉黄芩、麝香、辰砂，加入砂仁、马料豆（炒制），服用有效。
吕姓患者：少年未婚，每十天做一次梦遗精。日久导致身体疲乏，面色缺少神采，平时服用滋阴收敛固涩等药物，无效。改服镇心安神等方剂，也无效。我认为肝肾脉象虚弱，并非相火为害，只是精关长期滑脱，气缺乏固摄能力罢了。询问之下，果然有时没有梦境也会泄精，于是重用参、黄芪，辅以五味子、茯神、山药、莲子、菟丝子、芡实、枸杞子（全部炒制）。滑泄竟然停止。后来改用丸剂，加入鱼鳔（炒研）以加强固摄作用。
年幼的侄子：夜间读书精神疲劳就做梦遗精，夜间发热容易饥饿，左关脉搏动有力。丹溪说：主司闭藏的是肾，主司疏泄的是肝，这两脏都有相火。而其联系上属于心，心是君火，感受外界事物而动，君火一动则相火随之，即使不进行性交，精气也会暗中流失。又隐庵说：肾阴不足则精不内藏，肝阳过强则气不固摄，所以做梦而精气脱失。先用六味地黄汤加减，药物包括：熟地黄、山药、茯神、牡丹皮、远志、潞党参、麦冬、芡实、莲心、石斛。服用几剂后见效，后来加入龙骨、白芍、五味子，炼蜜为丸，服用痊愈。这是补益肝肾并参入养心的方剂。君火安宁则神魂收敛，龙雷之火不再扰动。
刘某：在考场受到惊吓，心神惊恐导致精气下行流失。随后发展为怔忡心悸恐惧，心君虚弱不能主导功能，相火代替行使职权，以至于有梦无梦都发生遗精，腰膝酸软乏力。诊察左寸脉沉数，左关尺脉沉细如丝，右尺脉微弦。这是心营受损极重，神不能摄持精气。应当补养心神，固纳肾中真元。（《内经》说：惊惧思虑会损伤神，神受伤则恐惧流淫不止。又说：恐惧不解会损伤精，精受伤则骨酸痿厥，精气时常自下。大抵惊惧伤心，恐惧伤肾，心肾不交，精关不固。必须精能生神，神能摄精，才能去除疾病。）况且情志方面的疾病，尤其在于静养善于调摄，不要期望速效。药物组成：潞党参、熟地黄、茯神（各三钱）、龙骨、山药（各二钱）、酸枣仁、远志、当归（各一钱半）、金樱子（一钱）、五味子、柏子仁（各六分）、莲子（十粒）。服用两剂非常舒适。诊察左寸脉绵绵不绝，只有尺部脉空，说明精腑稍微缺乏藏蓄。如果滋填精室，十日内不漏泄，尺脉可以恢复。又有半夜易饥、大便滑泄，前方去掉当归、柏子仁、熟地黄、山药焙干使用，加入鱼鳔（三钱）、菟丝饼（二钱）。服用十剂后神安精固，只有骨节时常酸痛，胁肋肌肉不时跳动，坐卧恍惚，像在波浪中一样。这是病后神气未恢复元气，虚阳浮越所致。应当招集散亡之气，封固管钥，更用潜阳填髓丸：熟地黄（八两）、湖莲子、芡实（全部炒制）、线胶、淡菜、茯神、山药（各四两）、五味子（一两）、龟板、远志、麦冬（朱砂拌炒各二两）、猪脊髓（熬制），制成丸剂。又经云：精不足用厚味来补。中午吃猪心、肾、海参煨食，早晨喝牛奶同糯米煮食，调理数月逐渐安稳。
Patient Mou: Nocturnal emission occurs without dreams; mental exertion triggers seminal discharge. This is a syndrome of Heart-Kidney non-interaction (Xin-Shen Shi-Jiao). Treatment employed Fushen Wan (Fuling and Poria Pill) combined with modifications of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Formula ingredients: Ren Shen (Ginseng Radix), Shu Di Huang (Prepared Rehmanniae Radix), Fu Shen (Poria with Hostwood), Yuan Zhi (Polygalae Radix), Dang Gui (Angelicae Sinensis Radix), Shan Yao (Dioscoreae Rhizoma), Lian Xu (Nelumbinis Stamen), Suan Zao Ren (Ziziphi Spinosi Semen), Wu Wei Zi (Schisandrae Fructus), Long Gu (Fossilia Ossis Mastodi), Lian Shi (Nelumbinis Semen). Prepared as paste pills. Several doses resulted in complete recovery.
Patient Ji: In the year Jisi, several days before the metropolitan examination, while watching an opera performance with co-residents, he experienced profuse nocturnal emission. Upon returning to his lodging, he developed alternating chills and fever, cough, and expectoration. This indicated Yin deficiency complicated by external pathogenic invasion. He was prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); the chills and fever subsided. However, the pulse was deficient, deep, fine, and nearly imperceptible, leading to the prognosis that Kidney damage was severe and difficult to treat. After barely completing the examination, his spirit became increasingly fatigued, accompanied by劳热 (fatigue-heat), panting, rapid breathing, cough with phlegm, and reduced appetite. This signified Spleen-Lung Qi deficiency with Qi failing to root in the Kidney. Only Ren Shen (Ginseng Radix) could stabilize the condition. Due to his stinginess, a friend gifted him 2 qian of Gao Li Shen (Korean Ginseng). I stated that using a substitute would reduce efficacy and insisted on full dosage, prescribing Renshen Yangying Tang (Ginseng Nourishing the Ying Decoction) minus Shu Di Huang (Prepared Rehmanniae Radix) and Gui Zhi (Cinnamon Twig), adding Fu Shen (Poria with Hostwood), Shan Yao (Dioscoreae Rhizoma), and Lian Shi (Nelumbinis Semen). He further divided the 2 qian of Korean Ginseng into four doses. I ridiculed this approach. After administration, panting and heat decreased, and dietary intake improved slightly. After two more doses, he switched to Lu Shen (Codonopsis Radix), resulting in diminished efficacy.
Relative Mou: Nocturnal emission with dreams. History of chronic lower back pain; new onset of epigastric pain. Pulse is wiry and fine. This is a manifestation of Jing (Essence) injury. Miaoxiang San (Wonderful Fragrance Powder) was used, removing Huang Qin (Scutellariae Radix), She Xiang (Musk), and Chen Sha (Cinnabar), and adding Sha Ren (Amomi Fructus) and Ma Liao Dou (Vigna angularis var. angularis, roasted). Effective.
Patient Lv: A young unmarried man experiencing nocturnal emission every ten days. Chronic fatigue and lackluster complexion. Previous treatments with Yin-nourishing and astringent herbs were ineffective. Subsequent use of formulas for calming the Heart and tranquilizing the Spirit also failed. I diagnosed Liver and Kidney pulse deficiency, ruling out Minister Fire pathology. The issue was long-term sliding of the Essence Gate due to insufficient Qi securing ability. Inquiry confirmed emissions even without dreams. Heavy dosages of Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) were used, assisted by Wu Wei Zi (Schisandrae Fructus), Fu Shen (Poria with Hostwood), Shan Yao (Dioscoreae Rhizoma), Lian Zi (Nelumbinis Semen), Tu Si Zi (Cuscutae Semen), Qian Shi (Euryales Semen), and Qi Zi (Lycii Fructus), all roasted. Sliding emissions ceased. Later, a pill formula was prepared adding Yu Biao (Swim Bladder, roasted and ground) to strengthen consolidation.
Young Nephew: Mental fatigue from night reading triggered dream-emissions; night-time heat and increased hunger. Left Guan pulse was forceful upon pressing. Danxi stated: The Kidney governs closure and storage; the Liver governs dispersion and excretion. Both organs contain Minister Fire. Their connection extends upward to the Heart, which houses Sovereign Fire. External stimuli move Sovereign Fire, which then moves Minister Fire. Even without sexual intercourse, Essence flows secretly. Yin'an stated: When Kidney Yin is deficient, Essence is not stored; when Liver Yang is excessive, Qi is not secured. Thus, dreaming leads to Essence loss. Initially, Liuwei Tang (Six-Ingredient Decoction) was modified with Shu Di Huang (Prepared Rehmanniae Radix), Shan Yao (Dioscoreae Rhizoma), Fu Shen (Poria with Hostwood), Mu Dan Pi (Moutan Cortex), Yuan Zhi (Polygalae Radix), Lu Shen (Codonopsis Radix), Mai Dong (Ophiopogonis Radix), Qian Shi (Euryales Semen), Lian Xin (Nelumbinis Plumula), and Shi Hu (Dendrobii Caulis). Effective after several doses. Later, Long Gu (Fossilia Ossis Mastodi), Bai Shao (Paeoniae Radix Alba), and Wu Wei Zi (Schisandrae Fructus) were added, processed with refined honey into pills. Cured. This is a formula tonifying Liver and Kidney while nourishing the Heart. When Sovereign Fire is calm, Soul and Spirit are contained, and Dragon-Fire does not disturb.
Patient Liu: Frightened during the examination, causing Heart fright and Essence descending. Developed palpitations and fear. Heart Sovereign was deficient and unable to command, allowing Minister Fire to usurp authority. Resulted in emissions with or without dreams, soreness and weakness of waist and knees. Left Cun pulse was deep and rapid; Left Guan and Chi pulses were deep, fine, and thread-like; Right Chi pulse was slightly wiry. This indicated extreme depletion of Heart Ying (Nutritive Qi) and Spirit’s failure to secure Essence. Treatment should tonify Heart Spirit and consolidate Kidney True Yuan. *Jing* states: "Fear and anxiety injure Spirit; injured Spirit leads to uncontrolled fear and seminal leakage." Also: "Unresolved fear injures Essence; injured Essence leads to bone ache, flaccidity, cold limbs, and spontaneous seminal emission." Generally, fear injures Heart, terror injures Kidney; Heart-Kidney non-interaction leads to insecure Essence Gate. Essence must generate Spirit, and Spirit must secure Essence to cure disease. Emotional disorders require quiet rest and proper regulation, not expecting quick results. Formula: Lu Shen (Codonopsis Radix), Shu Di Huang (Prepared Rehmanniae Radix), Fu Shen (Poria with Hostwood) [each 3 qian], Long Gu (Fossilia Ossis Mastodi), Shan Yao (Dioscoreae Rhizoma) [each 2 qian], Suan Zao Ren (Ziziphi Spinosi Semen), Yuan Zhi (Polygalae Radix), Dang Gui (Angelicae Sinensis Radix) [each 1.5 qian], Jin Ying Zi (Chrysanthemi Fructus? No, Rubi Fructus), Wu Wei Zi (Schisandrae Fructus), Bai Zi Ren (Platycladi Semen) [each 6 fen], Lian Zi (Nelumbinis Semen) [10 grains]. Two doses felt very comfortable. Pulse check: Left Cun pulse was continuous, but Chi position was empty, indicating slight lack of Essence storage. If Essence chambers are filled, within ten days leakage will stop, and Chi pulse will recover. Symptoms of midnight hunger and loose stools led to modifying the previous formula: removing Dang Gui, Bai Zi Ren, Shu Di Huang, and Shan Yao (stir-baked); adding Yu Biao (Swim Bladder, 3 qian) and Tu Si Bing (Cuscutae Cake, 2 qian). Ten doses stabilized Spirit and secured Essence. Remaining symptoms: occasional joint soreness, twitching of hypochondriac muscles, restlessness, feeling like floating on waves. This indicates post-illness Spirit has not recovered, with Floating Deficient Yang. Treatment: Gather scattered Qi, seal the gates. Prescribed Qianyang Tiansui Wan (Subduing Yang and Filling Marrow Pill): Shu Di Huang (Prepared Rehmanniae Radix, 8 liang), Hu Lian (Lake Lotus Seeds), Qian Shi (Euryales Semen) [both roasted], Xian Jiao (Donkey-hide Gelatin), Dan Cai (Edible Sea Squirt), Fu Shen (Poria with Hostwood), Shan Yao (Dioscoreae Rhizoma) [each 4 liang], Wu Wei Zi (Schisandrae Fructus, 1 liang), Gui Ban (Testudinis Carapax et Plastrum), Yuan Zhi (Polygalae Radix), Mai Dong (Ophiopogonis Radix) [all stir-fried with Zhu Sha/Cinnabar, 2 liang each], Zhu Ji Sui (Porcine Spinal Cord, boiled). Processed into pills. *Jing* states: "Deficiency of Essence is treated with rich flavors." Lunch: Pork heart, kidney, and sea cucumber stewed. Breakfast: Milk cooked with glutinous rice. Regulated over several months until stable.