王海藏云∶余尝治脱精不止者，以涩剂止之不能，不若泻心火。泻心火不能止之，不若
用升阳
之剂。如风药之类止之。(风药善升，使阳气上举，而不下降也。)非能止之也，举其气上而
不下
也。《药要或问》云∶郑叔鲁，年二十余，攻举业，夜读书至四鼓犹未已，忽发病，卧间但
阴
着物，便梦交接脱精，悬空则无悬，饮食日减，倦怠少气。盖以用心太过，二火俱起，夜
不得眠
，血不归经，肾水不足，火乘阴虚。(阴虚火炎，鼓灼精房，失于退藏而外泄也。)入客下焦
，
鼓其精房，则精不得聚藏而欲走，因阴着物，由厥气客之，故作接内之梦，于是上补心安神
，中调脾胃升举其阳，下用益精生阴固阳之剂，不三月而病安矣。《医学集成》记江单医云
∶遗泄一症，寻常只治心肾，未有别治。以《素问》、仲景考之，当服此屡效。丸方∶浓
朴(姜
制二两)，羊胫(三两)，炭火 通红窨杀，别研细如粉，上二味，陈黄米糊丸，桐子大，每
服百丸至三百丸，米汤下。
《九灵山房集》云∶浙省平章左答纳失理在帅阃时，病无睡，睡则心悸神慑，如处孤垒
，而
四面受敌，达旦目眵眵无所见，耳 无所闻，虽坚卧密室，睫未尝交也，即选医之良者，
处剂
累月勿瘳。后召元膺翁诊视，翁切其脉，左关之阳浮而虚，察其色，少阳之支溢于目 ，即
告
之曰∶此得之胆虚而风上，独治其心而不祛其胆之风，非法也。因投药方，乌梅汤、抱胆丸
。日再服，遂熟睡。一方∶治多疑不得眠如狂，用温胆汤加酸枣仁一两，炒研煎。
从来不寐之证，前人皆以心肾不交治也，投剂无效。窃思阴阳违和，二气亦不交。椿田
每用
制半夏、夏枯草各五钱，取阴阳相配之义，浓煎长流水，竟覆杯而卧。治病切勿执着，拘泥
古方，妙在随症用药，变通化裁，精思过人，是为良工。
王海藏说：我曾经治疗精气滑脱不止的患者，使用固涩剂止住精液无效，不如清泻心火。如果清泻心火也不能止住，不如使用升阳的方剂。例如用风药之类来止住。（风药善于升散，能使阳气上升举扬，而不向下沉降。）这并不是直接止住它，而是提升气机向上而不使其下降。《药要或问》记载：郑叔鲁，二十多岁，攻读科举学业，夜间读书到四更天还不停止，忽然发病，睡觉时只要身体接触到物体，就会梦见男女交合而遗精，如果是悬空则不会，饮食日渐减少，疲倦乏力、气短。这是因为用心过度，导致心火与相火同时亢盛，夜晚不能安眠，血液不能正常归经，肾水不足，火热之邪乘阴虚之时侵袭。（阴虚导致虚火上炎，鼓动灼烧精室，失去封藏功能而外泄。）火热侵入下焦，鼓动精室，使得精气不能聚积收藏而想要外泄，因为身体接触物体，加之厥逆之气客居体内，所以产生性交之梦。于是上部补益心神以安神，中部调理脾胃以升举阳气，下部使用益精生阴、固护阳气的方剂，不到三个月病就好了。《医学集成》记载江单医说：遗精滑泄这一病症，平常只治疗心和肾，没有别的治法。参照《素问》和张仲景的著作，应当服用此方多次有效。丸方配方：厚朴（姜制二两），羊胫骨（三两），用炭火烧红后埋入土中冷却灭尽火星，另研细如粉末，以上两味药，用陈年黄米糊制作成丸，大小如梧桐子，每次服用一百丸至三百丸，米汤送服。
《九灵山房集》记载：浙江省平章左答纳失理在担任帅府职务时，患失眠症，睡着就心悸惊恐，如同身处孤立堡垒，四面受敌，直到天亮眼睛昏花看不见东西，耳朵听不见声音，虽然坚决躺在密室中，但睫毛从未闭合过，即选拔医术高明的医生，开具药剂长达数月也未痊愈。后来召见元膺翁诊治，元膺翁切按其脉象，左手关部脉阳浮而虚弱，观察其面色，少阳经脉分支溢于眼部，便告诉他说：这是胆气虚弱而风邪上扰所致，只治疗心脏而不祛除胆腑的风邪，不是正确的治疗方法。于是投予乌梅汤、抱胆丸。每天服用两次，随即熟睡。另一个方子：治疗多疑且失眠如狂的症状，使用温胆汤加酸枣仁一两，炒研后煎煮。
从来失眠的证候，前人都认为是心肾不交所致进行治疗，投药无效。我私下思考阴阳失调，二气也不能相交。椿田（人名）经常使用制半夏、夏枯草各五钱，取阴阳相配的含义，浓煎长流水，喝完药立刻就能入睡。治病千万不要执着拘泥，死守古方，妙处在于根据症状用药，灵活变通化裁，深思熟虑超过常人，这才是良医。
Wang Haicang said: I once treated a patient with continuous seminal emission. Using astringent agents to stop the leakage was ineffective; it is better to clear and drain Heart Fire. If clearing and draining Heart Fire also fails to stop it, it is better to use an agent that raises Yang. For example, using wind-dispelling herbs can achieve this. (Wind-dispelling herbs are good at ascending and dispersing, causing Yang Qi to rise and lift, rather than descend.) This does not directly stop the emission but lifts the Qi upward so it does not sink downward. *Yao Yao Huo Wen* records: Zheng Shulu, in his early twenties, studied for the imperial examinations, reading late into the night until the fourth watch without stopping. He suddenly fell ill; whenever he slept and his body touched objects, he dreamed of sexual intercourse and experienced seminal emission, whereas if he slept in mid-air, no emission occurred. His diet decreased daily, and he felt fatigued with shortness of breath. This was due to excessive mental exertion, causing both Ministerial Fire and Heart Fire to arise. At night, he could not sleep, blood failed to return to its vessels, Kidney Water was insufficient, and Fire invaded during Yin deficiency. (Yin deficiency leads to flaming up of deficient Fire, which agitates and scorches the Essence Chamber, leading to loss of retention and external leakage.) The Fire entered the Lower Jiao, agitating the Essence Chamber, so that Essence could not gather and store but desired to escape. Because his body touched objects, and rebellious Qi lodged within, he thus had dreams of internal sexual activity. Therefore, the upper part was treated by tonifying the Heart Spirit to calm the mind, the middle part by regulating the Spleen and Stomach to raise and lift Yang, and the lower part by using agents to benefit Essence, generate Yin, and secure Yang. Within three months, the illness resolved.
*Yixue Jicheng* records Jiang Dan Yi saying: In cases of seminal emission and leakage, ordinary practice only treats the Heart and Kidney, with no other approaches. Examining *Suwen* and Zhang Zhongjing's works, one should take this formula, which has been effective repeatedly. Pill Formula: Houpo (Cortex Magnoliae Officinalis, processed with ginger, 2 liang), Yangjinggu (Os Calcaneus, 3 liang). Burn the calcaneus red-hot over charcoal, bury it to extinguish the fire, then grind separately into a fine powder like dust. Mix these two ingredients with paste made from aged yellow millet to form pills the size of paulownia seeds. Take 100 to 300 pills per dose, washed down with rice soup.
*Jiuling Shanfang Ji* records: When Zuo Dana Shili, the Pingzhang of Zhejiang Province, served in his military headquarters, he suffered from insomnia. Whenever he slept, he palpitated and felt terrified, as if located in an isolated fortress under attack from all sides. Until dawn, his eyes were dim and unable to see, and his ears unable to hear. Although he lay firmly in a secret room, his eyelids never closed. Excellent physicians were selected, and prescriptions were administered for months without cure. Later, Yuan Ying Weng was summoned to diagnose him. Yuan Ying Weng palpated the pulse and found the Yang aspect of the Left Guan position floating and deficient. Observing his complexion, he saw the branch vessels of Shaoyang overflowing into the eyes. He informed the patient: "This condition arises from Gallbladder Deficiency with Wind rising upwards. Treating only the Heart without dispelling the Wind from the Gallbladder is not the correct method." Consequently, he prescribed Wumei Tang (Mume Decoction) and Baodan Wan (Gallbladder-Securing Pill). Taken twice daily, the patient subsequently slept soundly. Another formula: To treat suspicion-induced insomnia resembling madness, use Wendan Tang (Warm the Gallbladder Decoction) plus Suanzao Ren (Semen Ziziphi Spinosae, 1 liang), stir-fried, ground, and decocted.
Historically, insomnia has always been treated by predecessors as resulting from the failure of communication between the Heart and Kidney, yet prescriptions proved ineffective. I privately ponder that when Yin and Yang are disharmonious, the two Qi cannot interact. Chuntian (a person's name) often used Zhi Banxia (Rhizoma Pinelliae Preparata) and Xiakucao (Herba Prunellae Spicae), each 5 qian, taking the meaning of Yin-Yang pairing. Decocted strongly in long-flowing water, the patient would fall asleep immediately after finishing the cup. In treating diseases, one must not be stubborn or rigidly adhere to ancient formulas. The subtlety lies in prescribing according to symptoms, adapting and modifying flexibly. Deep thinking surpassing others defines a skilled physician.