Dongui Bogam_25_Nocturnal Emission Pertains to the Heart

[遺泄精屬心]
[Nocturnal Emission Pertains to the Heart]

丹溪曰, 主閉藏者, 腎也, 司疏泄者, 肝也. 二藏皆有相火, 而其系上屬於心. 心君火也. 爲物所感則易動, 心動則相火亦動, 動則精自走, 相火翕然而起, 雖不交會, 亦暗流而疏泄矣. 所以聖人只是敎人收心養心, 其旨微矣.
Danxi said, "Storing and protecting is controlled by the kidneys, and opening and flowing is controlled by the liver. The two viscera both have ministerial Fire, and the liver system and kidney system are both connected upwards to the heart. The heart is the sovereign Fire, and it reacts easily when it is stimulated. The ministerial Fire reacts when the heart reacts; the essence moves when the ministerial Fire moves. Essence leaks even without intercourse when the ministerial Fire moves. This is why the wise taught to collect one's mind and train oneself, the meaning of the teaching is mysterious."

精之主宰在心, 精之藏制在腎. 心腎氣虛不能管攝, 因小便而出者曰尿精, 因見聞而出者曰漏精. 《直指》
The heart governs essence, and the kidneys store and control essence. Essence leaks during urination when the qi of the heart and kidneys are so weak that they cannot control the essence very well. This is what is called urine with semen. Leakage after seeing or hearing something is called leaking semen.

初因君火不寧, 久則相火擅權, 精元一於走而不固, 甚則夜失連連, 日亦滑流不已, 宜服坎离丸ㆍ黃連淸心飮. 《入門》
The foremost reason is the uncomfortable state of the sovereign Fire. The ministerial Fire moves on its own if this lasts, and the essence shakes that it cannot keep its place safely. When it gets worse, it leaks continuously at night and day. A Water and Fire Pill or Coptis Clear Heart Drink should be prescribed.

[夢泄屬心]
[Dream Emission Pertains to the Heart]

直指曰, 邪客於陰, 神不守舍, 故心有所感, 夢而後泄也. 其候有三. 年少氣盛, 鰥曠矜持, 强制情慾, 不自覺知. 此泄如甁之滿而溢者, 人或有之, 勿藥可也. 心家氣虛, 不能主宰, 或心受熱邪, 陽氣不收. 此泄如甁之側而出者, 人多有之, 其病猶輕, 合用和平之劑. 藏府積弱, 眞元久虧, 心不攝念, 腎不攝精. 此泄如甁之罅而出者, 人少有之, 其病最重, 須當大作補湯.
It is said in the Renghai's Straight-forward Directions on Formulas (直指), "When pathogenic qi enters yin, the spirit does not remain in its place. Therefore, when the heart is stimulated, one will emit semen while dreaming. There are three cases to this occasion: in the case of a young person with strong qi, a widower controlling his desire with all his will, or when one controls desires against one's will, the essence leaks without one's notice. This is the same as the overflowing of water in a bottle. Such a case happens at times, and there is no need for medication. When a person with a weak heart qi is not able to control his essence, or when yang qi is not collected due to a heat pathogen in the heart, the essence leaks. This is the same as the flowing water from a tilted bottle. It happens to many men, and the symptoms are mild, so harmonizing and placid medicines should be used. When the viscera and bowels gradually get weak and the genuine foundation is harmed for a long time, the heart is not able to think well and the kidneys are not able to store essence so the essence leaks. This is the same as water leaking from a broken bottle through a crack. Such a case does not happen often, but it is very severe. Medicines that tonify greatly must be used for the cure." 

夢遺不可作虛冷, 亦有經絡熱而得之. 嘗治一人, 至夜脊心熱, 夢遺, 用珍珠粉丸, 猪苓丸, 遺止, 而終服紫雪, 脊熱始除. 淸心丸亦佳. 《本事》
Dream emissions happen not only to the weak and cold but also to those with heat in the meridians. I once treated a patient with dream emission who felt heat in the middle of the spine. I prescribed a Pearl Powder Pill and Polyporus Pill, and his dream emissions stopped; after taking Purple Snow (紫雪), the heat in the middle of the spine vanished. A Clear Heart Pill is also good in this case. 

夢遺全屬心. 盖交感之精, 雖常有一點白膜裹藏於腎, 而元精以爲此精之本者, 實在乎心. 日有所思, 夜夢而失之矣. 宜黃連淸心飮. 《入門》
Dream emissions are solely related to the heart. The semen from intercourse is always stored in the kidneys under a small white membrane, but the genuine essence which is the origin of the semen is in the heart. A person dreams at night what he is longing for during the day and loses essence. A Coptis Clear Heart Drink must be prescribed.

夢與鬼交而泄精, 名曰夢遺. 專主於熱, 用黃柏ㆍ知母ㆍ牡蠣ㆍ蛤粉. 若內傷氣血, 不能固守, 而夢遺者當補, 以八物湯加減, 呑樗根皮丸. 八物湯方見虛勞
Dream emission is the leakage of semen from interacting with a ghost in the dream. This happens solely from the heat, so Phellodendri Cortex (黃柏), Anemarrhenae Rhizoma (知母), Ostreae Testa (牡蠣), and Anodontae Caro Pulvis (蛤粉) should be used. When the dream emission results from damaged qi and blood not protecting the essence well modified, an Eight Substances Decoction should be prescribed with a Euonymi Cortex Pill. [The Eight Substances Decoction is found in the chapter Deficiency Vexation].

[夢泄亦屬鬱]
[Dream Emissions also Pertain to Stagnation]

本事曰, 腎氣閉, 卽泄精. 素問曰, 腎者, 作强之官, 伎巧出焉. 又曰, 腎藏精. 盖腎能攝精氣, 以生育人倫者也. 或育或散, 皆主於腎. 今腎氣衰, 則一身之精氣, 無所管攝, 故妄行而出不時, 猪苓丸一方, 正爲此設.
It is said in the Formulas for Universal Relief (本事), "Essence leaks when kidney qi is blocked." It is also said in the Basic Questionss (素問), "Kidneys are the office of labor, and convergencies of vital energy come from them." Also, it said, "kidneys store essence." The kidneys collect the essence-qi, give birth, and nurture. The collecting and dispersing of essence-qi all depends on the kidneys. When kidney qi is weak, essence-qi in the body is not collected well; this leads essence-qi to flow haplessly, and essence leaks at any time. A Polyporus Pill is used to treat such symptoms. 

綱目曰, 夢遺屬鬱滯者, 居太半, 庸醫不知其鬱, 但用澁劑固脫, 殊不知愈澁愈鬱, 其病反甚. 嘗治一男子, 夢遺白濁, 小腹有氣衝上, 每日腰熱, 卯作酉涼, 腰熱作則手足冷, 前陰無氣, 腰熱退則前陰氣耕, 手足溫. 又朝多下氣, 暮多噫氣, 一旬二旬必遺. 脉且弦滑而大, 午則洪大. 予知其有鬱滯, 先用沈香和中丸下之方見痰飮, 次用加減八味湯方見五藏, 呑滋腎丸方見小便百丸. 若與澁藥則遺與濁反甚, 或一夜再遺, 改用導赤散方見五藏大劑煎服, 遺濁皆止.
It is said in the Compendium of Medicine (綱目), "More than half of the dream emissions are due to gi stagnation. Foolish doctors do not know that it is from qi stagnation and keep on using astringing medicines to stop the leakage. However, the more medication is applied to stop the leakage, the more severe the stagnation symptoms become. The diseases get worse by the minute. Once a man had murky urine and upsurging qi from the lower abdomen due to dream emissions and felt heat along the waist every day at the time of Myo (5:00 am 7:00 am) and cooling down at the time of yu (5:00 pm - 7:00 pm). When heat is felt along the waist, the hands and feet become cold with a weak penis, and as the heat subsides the hands and feet warm up and the penis gathers qi. Also, he passed gas often in the morning and belched often in the evening, and had dream emissions every 10-20 days. The pulse was slippery, string-like, and large, and became surging and large during the day. I figured he had qi stagnation and prescribed an Aquilaria Pill to Harmonise the Center [The prescription is in the chapter Phlegm]. To induce diarrhea and prescribed a Modified Eight Ingredient Decoction [The prescription is in the chapter Five Viscera] with 100 pills of Nourish Kidneys Pill [The prescription is in the chapter Urine]. If astringing medicines are used, the urine gets even murkier and the dream emissions appear as often as twice a night. If this happens, prescribe concentrated Guide Out Red Powder [The prescription is in chapter Five Viscera] to treat the dream emissions and murky urine at the same time. 

又一男子夢遺, 醫與澁藥反甚, 先與神芎丸方見五藏大下之, 却服此猪苓丸亦痊. 可見夢遺屬鬱滯者多矣.
Another man also had dream emissions, which were aggravated after taking astringing medicine. I first prescribed a Spiritual Chuanxiong Pill [The prescription is in chapter Five Viscera] to induce diarrhea and then prescribed Polyporus Pill. The two cases show that many cases of dream emissions result from stagnation.

[精滑脫屬虛]
[Spermatorrhea Belongs to Deficiency]

靈樞曰, 恐懼而不解則傷精, 精傷則骨痠痿厥, 精時自下. 又曰, 精脫者耳聾.
In the Divine Pivot (靈樞), it says "Essence is harmed if fear is not resolved. When essence is harmed, bones get chilly, hands and feet cold, legs weak, and essence spontaneously leaks from time to time." Also, it says "If essence lacks greatly, hearing loss will follow." 

內經曰, 思想無窮, 所願不得, 意淫於外, 入房太甚, 宗筋弛縱, 發爲筋痿, 及爲白淫. 夫腎藏天一, 以慳爲事, 志意內治, 則精全而澁. 若思想外淫, 房室太甚, 則固有淫泆不守, 輒隨溲尿而下. 然本於筋痿者, 以宗筋弛縱也. 《謙甫》
It is said in the Inner Classic (內經), "The penis gets weak when a man keeps on thinking and yet does not achieve what one wants, has too many obscene thoughts, or has excessive intercourse, which all wilt the penis and leads to muscular flaccidity and white ooze." The essence in the kidneys must be treasured; if the mind is controlled well, the essence is stored well and does not leak. If the thoughts are too many or one has excessive intercourse, the essence cannot be protected well and leaks along with urine without notice. Therefore, the wilting of the penis results from muscular flaccidity.

其不御女漏者, 或聞淫事, 或見美色, 或思想無窮, 所願不得, 或入房太甚, 宗筋弛縱, 發爲筋痿而精自出者, 謂之白淫. 宜乎滲漏而不止也. 宜加減珍珠粉丸方見小便.
When a man's essence leaks without intercourse, it is from the weakness of the penis. This muscular flaccidity results when an obscene story is heard, a beautiful woman is seen, many thoughts do not result in achievements, or when intercourse is excessive. White ooze is spontaneously leaking semen due to muscular flaccidity. Since essence is continuously leaking, Modified Pinctada Powder Pill. [The prescription is in the chapter Urine] must be prescribed. it is said, "Essence leaks along with one's desire. When it is not ejected for a long time, there will be itching and pain inside the penis, and the person will have an urge to urinate all the time. If essence is urinated or leaks, it is called seminal emission. This is a worse symptom than dream emission, so a modified Eight Substances Decoction should be taken with a Pearl Powder Pill. [The prescription was mentioned previously] must be prescribed. 

又曰, 慾心一動, 精隨念去, 凝滯久則莖中痒痛, 常如欲小便, 然或從小便而出, 或不從便出而自流者, 謂之遺精. 比之夢遺尤甚, 八物湯加減, 呑珍珠粉丸方見上.
Also, it is said, "Essence leaks along with one's desire. When it is not ejected for a long time, there will be itching and pain inside the penis, and the person will have an urge to urinate all the time. If essence is urinated or leaks, it is called seminal emission. This is a worse symptom than dream emission, so a modified Eight Substances Decoction should be taken with a Pearl Powder Pill. [The prescription was mentioned previously]."