世谓上吐血。下遗精。其病不治。谓其上逆下竭。立见消耗也。然病此者。但未沉久。犹可图治。盖遗精失血。
虽是两病。其实一而已矣。精者肾中阳气所化。乃天一所生之癸水也。女子十四。则癸水至于胞中。而冲
任两脉即通。将心火所化之血。转输入胞。与癸水交合。水从血化。是为月信。男子十六。则癸水亦至于胞
中。而冲任两脉。亦输血入胞。与癸水合。血从水化。是谓之精。胞者精之舍。即血之室也。吐衄者。是胞中血
分之病。遗精者。是胞中水分之病。血与水。上下内外。皆相济而行。吾已言之屡矣。故病血者。未尝不病水。
病水者。亦未尝不病血也。是以吐血。多兼痰饮。血亦变水肿。淋秘亦有下鲜血者。以血与水原相倚伏耳。
精者水之所化。遗精者。水病也。而又吐衄。是血亦病也。先吐血而后遗精。是血病。累及于水。先遗精而后
吐血。是水病累及于血。治法无论先后。总以治肝为主。胞宫乃肝之所司。精与血。皆藏于此。治血者必治
胞。治精者亦必治胞。胞为肝所司。故皆以治肝为主。肝寄相火。气主疏泄。火炽气盛。则上吐血而下遗精。
地骨皮散。加柴胡胡黄连知母黄柏牡蛎龙骨茯苓蒲黄血余治之。丹栀逍遥散。加阿胶龙骨牡蛎蒲黄
以平之。吐血甚而遗精轻者。以治吐血为主。生地黄散。加金樱子牡蛎治之。遗精甚而吐血轻者。以遗精
为主。地黄汤。加血余龙骨牡蛎治之。
仲景治遗精。有用天雄附子法。肾气不纳。心火不下交于肾。有用肉桂法。皆阳虚之证也。若失血家。则多
是火遗。即心肾不交。亦是水不济火。其为梦遗。十之八九。盖肝经火旺。则魂不内守。恍惚有见。亦有无梦
而遗。仍属相火之甚者。火甚则神不清。是以昏沉迷闷。不觉精之走失。比较有梦而遗者。其火更甚。毋得
误认为阳虚之证也。大补阴丸。加生枣仁牡蛎龙骨茯神治之。若气不摄精者。其人必见虚寒之状。不徒
以有梦无梦为别也。
世人认为，上部吐血、下部遗精，是难以治愈的病症。这是因为他们认为病机为上逆下竭，会导致身体迅速消耗。然而，患有此病的人，如果病情尚未深沉日久，还是可以设法治疗的。
大概遗精和失血，虽然被视为两种疾病，但其实质是一回事。精，是由肾中的阳气所化生，这是由“天一生水”理论产生的癸水（阴精）。女子到了十四岁，癸水到达胞宫（子宫），冲脉和任脉因此通畅，将心火所化生的血液，转运输入胞宫，与癸水交合，水从血中转化，这就形成了月经。男子到了十六岁，癸水也到达胞宫，冲脉和任脉也将血液输入胞宫，与癸水结合，血从水中转化，这就称之为精。胞宫，是精的居所，也就是血的室舍。吐血和鼻衄（鼻出血），是胞宫中血分的病变；遗精，是胞宫中水分的病变。血与水，在上下内外之间，都是相互资助而运行的，我已经多次讲过这个道理了。所以，患血病的人，没有不兼患水病的；患水病的人，也没有不兼患血病的。因此，吐血往往兼有痰饮，血病也会变成水肿，淋证和小便不通也有排出鲜红血液的情况，因为血与水原本就相互依存潜伏。
精是由水所化生的，遗精就是水的病变；如果再伴有吐血或鼻衄，那就是血也生病了。先吐血而后遗精，是血病牵连及水；先遗精而后吐血，是水病牵连及血。治疗方法无论先后顺序如何，总以治疗肝为主。胞宫是由肝所主管的，精与血都藏于此。治疗血病必须治疗胞宫，治疗精病也必须治疗胞宫。胞宫由肝所主管，所以都以治肝为主要方法。肝寄居相火（命门之火），气主疏泄功能。如果火势炽盛、气机旺盛，就会导致上部吐血、下部遗精。可以用地骨皮散（Ground Bark Powder），加入柴胡（Bupleurum Root）、胡黄连（Picrorhiza Rhizome）、知母（Anemarrhenae Rhizome）、黄柏（Phellodendri Cortex）、牡蛎（Oyster Shell）、龙骨（Dragon Bone）、茯苓（Poria）、蒲黄（Typhae Pollen）、血余炭（Carbonized Human Hair）来治疗。或者用丹栀逍遥散（Moutan and Gardenia Xiaoyao Powder），加入阿胶（Donkey-hide Gelatin）、龙骨、牡蛎、蒲黄来平复病情。如果吐血严重而遗精轻微，就以治疗吐血为主，用生地黄散（Rehmanniae Decoction），加入金樱子（Cherokee Rose Fruit）、牡蛎来治疗。如果遗精严重而吐血轻微，就以治疗遗精为主，用地黄汤（Rehmannia Decoction），加入血余炭、龙骨、牡蛎来治疗。
张仲景治疗遗精，有用天雄附子法，适用于肾气不能内纳，心火不能下行交于肾的情况；有用肉桂法，这些都属于阳虚的证候。如果是失血的患者，则多是因火导致的遗精，即使是心肾不交，也是由于水不能济助火。其中梦遗占十之八九，大概是因为肝经火旺，导致魂不能内守，出现恍惚幻觉。也有无梦而遗精的，仍然属于相火极盛的情况。火邪太盛会使得神志不清，因此昏沉迷闷，不知不觉精液走失。这比起有梦而遗精的人，火邪更甚，千万不要误认为是阳虚的证候。可以用大补阴丸（Great Supplement Yin Pill），加入酸枣仁（Ziziphus Seed）、牡蛎、龙骨、茯神（Poria with Hostwood）来治疗。如果是气不能固摄精液的患者，其人必定表现出虚寒的症状，不仅仅通过是否有梦境来区分。
It is commonly believed that hematemesis (vomiting blood) from above and spermatorrhea (involuntary emission of semen) from below are incurable diseases, on the grounds that the pathogenesis involves upward rebellion and downward depletion, leading to rapid consumption of the body. However, for those suffering from this condition, if the disease has not become deep-seated or chronic, it is still possible to attempt treatment.
Generally speaking, although spermatorrhea and hemorrhage are considered two different diseases, their essence is actually one. Jing (Essence) is transformed by the Yang Qi in the Kidney; it is the Gui Water (Yin Essence) generated by "Heaven generates One." When a girl reaches fourteen years of age, Gui Water arrives in the Bao Gong (Uterus), causing the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel) to become unobstructed. The blood transformed by Heart Fire is then transported into the Bao Gong to combine with Gui Water. Water transforms from blood, which becomes menstruation. When a boy reaches sixteen years of age, Gui Water also arrives in the Bao Gong, and the Chong Mai and Ren Mai transport blood into the Bao Gong to combine with Gui Water. Blood transforms from water, which is called Jing (Essence). The Bao Gong is the residence of Jing and the chamber of blood. Hematemesis and epistaxis (nosebleed) are disorders of the blood aspect within the Bao Gong, while spermatorrhea is a disorder of the water aspect within the Bao Gong. Blood and water nourish each other in the upper/lower and internal/external aspects, as I have stated many times before. Therefore, those suffering from blood disorders invariably suffer from water disorders, and those suffering from water disorders invariably suffer from blood disorders. Thus, hematemesis often accompanies phlegm-fluid retention, and blood disorders can transform into edema; stranguria (dysuria) and urinary retention may also involve passing fresh red blood, because blood and water originally rely on and conceal each other.
Jing is transformed from water; spermatorrhea is a disorder of water. If accompanied by hematemesis or epistaxis, it indicates that blood is also diseased. If hematemesis occurs first followed by spermatorrhea, the blood disorder affects the water. If spermatorrhea occurs first followed by hematemesis, the water disorder affects the blood. Regardless of the sequence, the treatment method always prioritizes treating the Liver. The Bao Gong is governed by the Liver, and both Jing and blood are stored therein. To treat blood disorders, one must treat the Bao Gong; to treat Jing disorders, one must also treat the Bao Gong. Since the Bao Gong is governed by the Liver, the primary approach is always to treat the Liver. The Liver houses Xiang Huo (Ministerial Fire) and its Qi governs free flow and discharge. If Fire is blazing and Qi is excessive, it leads to hematemesis above and spermatorrhea below. This can be treated with Digupi San (Ground Bark Powder), added with Chai Hu (Bupleuri Radix), Huhuanglian (Picrorhizae Rhizoma), Zhimu (Anemarrhenae Rhizoma), Huangbai (Phellodendri Cortex), Muli (Concha Ostreae), Longgu (Os Draconis), Fuling (Poria), Puhuang (Pollinis Typhae), and Xuyurou (Cortex Capitis Humanus Carbonisatus). Alternatively, Danzhi Xiaoyao San (Xiaoyao Powder with Moutan and Gardenia) can be used, added with Ejiao (Colla Corii Asini), Longgu, Muli, and Puhuang to calm the condition. If hematemesis is severe but spermatorrhea is mild, prioritize treating hematemesis using Shengdi Huang San (Rehmanniae Decoction), added with Jinyingzi (Fructus Rosae Laevigatae) and Muli. If spermatorrhea is severe but hematemesis is mild, prioritize treating spermatorrhea using Dihuang Tang (Rehmannia Decoction), added with Xuyurou, Longgu, and Muli.
Zhang Zhongjing treated spermatorrhea using Tianxiong and Fuzi methods when Kidney Qi failed to grasp inwardly and Heart Fire failed to descend to communicate with the Kidney; he also used Rougui (Cinnamon Bark) methods. These all belong to deficiency-cold patterns. However, patients who have suffered from hemorrhage mostly experience fire-induced spermatorrhea. Even if it is Heart-Kidney non-interaction, it is due to Water failing to moisten Fire. Among these cases, dream-erection spermatorrhea accounts for eight or nine out of ten. This is generally because Liver Meridian Fire is hyperactive, causing Hun (Ethereal Soul) to fail to remain internally, resulting in hallucinations and confusion. There are also cases of spermatorrhea without dreams, which still belong to extreme Ministerial Fire. Excessive Fire causes mental clarity to be lost, leading to drowsiness and depression, so that one is unaware of the loss of essence. Compared to dream-erection spermatorrhea, the Fire here is even more severe; do not mistakenly identify this as a deficiency-cold pattern. Treat this with Dabu Yin Wan (Great Supplement Yin Pill), added with Suanzaoren (Ziziphi Spinosae Semen), Muli, Longgu, and Fushen (Poria cum Radice). If it is Qi failing to secure essence, the patient will necessarily exhibit signs of deficiency-cold, and differentiation cannot rely solely on the presence or absence of dreams.