A nocturnal emission is an involuntary discharge of
semen during sleep, usually accompanied by spiritlessness, soreness and weakness
of lumbus and knees, dizziness, tinnitus, palpitation, insomnia, etc. This
disorder, occurring in cases of neurasthenia, prostatitis, spermatocystitis and
other chronic diseases in modern medicine, may be differentiated and treated as
mentioned in this section.
Etiology and Pathogenesis
The weakening of kidney-qi is considered as the major pathogenesis of nocturnal
emissions, which may result from the following causes:
A. Emotional upsets, sexual indulgence, overstrain and masturbation, causing
imbalance of the heart-fire and kidney-fluid.
B. Immoderate diet and drinking, impairing the spleen and stomach with the
production of dampness-heat and phlegm-fire.
C. Congenital insufficiency of acquired malnutrition, resulting in the
deficiency of spleen and kidney.
Syndrome Differentiation and Therapeutic Principles
A. Syndrome differentiation
(a) Differentiation between the physiological emission and the pathologic
emission: Nocturnal emission occurring once during a period of 15-30 days is
considered physiological, while that occurring twice a week or more and
associated with symptoms such as dizziness, listlessness, soreness and weakness
of lumbus and knees, insomnia, etc., is considered pathologic.
(b) Identification of the diseased position: Generally speaking, the case due to
overthinking or hyperactivity of prime-minister fire mostly involves the heart,
while that due to the failure of holding the semen and not associated with
dreams suggests the involvement of the kidneys.
(c) Differentiation between asthenia and sthenia syndromes: An incipient case
accompanied by hyperactivity of prime-minister fire and dampness-heat attacking
the lower jiao usually manifests as asthenia-syndrome, while a longstanding case
associated with yin-deficiency and fire hyperactivity reveals an
d) Differentiation between yin-deficiency and yang-deficiency: The case with
dizziness, tinnitus, lumbago, red tongue and thready, rapid pulse is attributed
to deficiency of kidney-yin, while that with pale complexion, aversion to cold,
coldness of limbs, pale tongue and deep, thready and weak pulse to deficiency of
B. Therapeutic principles
Clearing and purgating therapy is recommended for sthenia-syndrome, and
tonifying therapy for asthenia-syndrome. In cases of asthenia-syndrome
complicated with heat, the therapy of nourishing yin and keeping fire downward
should be adopted. It is not advisable to apply the therapy of strengthening the
kidneys and preserving essence indiscriminately, and the treatment should be
based on the syndrome differentiation.
Classification and Treatment
A. Hyperactivity of monarch and prime-minister fires and imbalance between heart
Manifestations: Dreamfulness, sleeplessness, nocturnal emission occurring with
dreams, chest distress, dizziness, palpitations, poor memory, spiritlessness,
fatigue, red tongue and thready and rapid pulse.
Therapeutic principles: Clear heart-fire, nourish kidney-fluid, and restore the
equilibrium between the heart and kidneys.
Prescription: The Pill of Sancaifengshui
Radix Rehmanniae 10 g
Radix Rehmanniae Praeparata 10 g
Radix Ophiopogonis 10 g
Rhizoma Coptidis 10 g
Cortex Phellodendri 10 g
Semen Ziziphi Spinosae (fried) 15 g
Radix Polygalae 10 g
Lignum Pini Poriaferum 10 g
Rhizoma Anemarrhenae 10 g
Fructus Corni 10 g
B. Attack of dampness-heat to lower jiao, disturbing the semen house.
Manifestations: Frequent emissions or discharge of seminal fluid during
urination, bitter taste in the mouth, thirst, vexation, sleeplessness, aphthae,
reddish urine, yellow greasy tongue coating and soft-floating and rapid pulse.
Therapeutic principles: Clear away heat and dampness.
Prescription: The Modification of Dioscoreae Hypoglaucae Decoction for Clearing
Rhizoma Dioscoreae Hypoglaucae 15 g
Poria 12 g
Cortex Phellodendri 10 g
Semen Plantaginis (wrapped in cloth) 10 g
Plumula Nelumbinis 0.5 g
Radix Salviae Miltiorrhizae 15 g
Rhizoma Acori Graminei 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Concha Ostreae Praeparata 30 g
Remarks: Add Radix Gentianae, Fructus Gardeniae, Radix Bupleuri and Radix
Paeoniae Rubra for cases with dizziness, redness of eyes and irritability due to
retention of dampness-heat in the liver meridian. Add Fructus Ligustri Lucidi,
Radix Polygoni Multiflori and Radix Paeoniae Alba for cases with dizziness,
dryness of eyes, and soreness and weakness of lumbus and knees due to deficiency
of liver-yin and kidney-yin.
C. Impairment of heat and spleen by overstrain, with failure of qi to control
Manifestations: Palpitations, sleeplessness, poor memory, sallow complexion,
fatigue, loss of appetite, loose stool, emission induced by overstrain, pale
tongue with thin coating and feeble pulse.
Therapeutic principles: Regulate and tonify the heart and spleen, benefit qi,
and preserve essence.
Prescription: The Modified Decoction for Invigorating the Spleen and Nourishing
Radix Codonopsis Pilosulae 12 g
Radix Astragali Praeparata 12 g
Lignum Pini Poriaferum 10 g
Radix Polygalae 10 g
Radix Angelicae Sinensis 10 g
Rhizoma Dioscoreae 12 g
Semen Euryales 10 g
Pericarpium Citri Reticulatae 10 g
Fructus Schisandrae 9 g
Semen Ziziphi Spinosae (fried) 12 g
Remarks: For cases with frequent emissions, spiritlessness, shortness of breath,
diarrhea and prolapse of rectum due to damage of spleen by
consumption of qi by overstrain (leading to the deficiency of middle-jiao qi and
the failure of lucid yang to ascend), use the Modified Decoction for
Strengthening Middle Jiao and Benefiting Qi which contains Radix Codonopsis
Pilosulae, Rhizoma Atractylodis Macrocephalae, Radix Astragali, Rhizoma
Cimicifugae, Radix Bupleuri, Rhizoma Chuanxiong and Radix Angelicae Sinensis to
lift up the middle-jiao qi.
D. Deficiency of kidney-yin with failure to store semen
Manifestations: Nocturnal emissions, dizziness, tinnitus, lumbago, fatigue,
debility, red tongue with little coating and wiry, thready and rapid pulse.
herapeutic principles: Tonify kidney-yin, and strengthen the astringent
function of the kidneys.
Prescription: The Modified Bolus of Six Drugs Containing Rehmanniae Praeparata
and Pill of Two Gods from Land and Sea
Radix Rehmanniae 12 g
Radix Rehmanniae Praeparata 12 g
Fructus Corni 10 g
Fructus lycii 10 g
Semen Cuscutae 10 g
Colla Cornus Cervi (dissolved in water) 10 g
Radix Aconiti Lateralis Praeparata 6 g
Semen Euryales 12 g
Fructus Rosae Laevigatae 12 g
Os Draconis Usta (decocted first) 30 g
Concha Ostreae Usta (decocted first) 30 g
Aside from medication, mental care, limitation of sexual activity, abstinence
from masturbation and dietetic therapy should be adopted at the same time.
A. Semen Allii Tuberosi (6 g), and Semen Juglandis (1 piece); decocted with a
small amount of yellow rice wine, one dose daily for several days; applicable to
cases attributed to deficiency of kidney-qi.
B. Fructus Rosae Laevigatae (30 g) and herba Polygoni Avicularis (30 g) prepared
as decoction; half of which taken in two doses daily.
C. Fructus Schisandrae (30 g) and Endothelium Corneum Gigeriae Galli (30 g)
prepared as powder; 3 grams thrice daily. D. Equal amount of Galla Chinensis and
fructus Foeniculi prepared as powder and mixed with vinegar to form a paste;
applied on the umbilicus.
Ejaculatio praecox refers to the ejaculation of semen prior to or immediately
after the beginning of the sexual act. It is usually caused by sexual indulgence
or frequent masturbation, which leads to the consumption of kidney-essence,
deficiency of kidney-yin and hyperactivity of the prime-minister fire. The
disorder may be differentiated and treated as follows:
A. Yin deficiency and fire hyperactivity: Manifested by frequent occurrence and
incompleteness of penial erection, nocturnal emissions associated with dreams,
dizziness, palpitations, tinnitus, dryness of mouth and throat, red tongue and
thready and rapid pulse. The therapy of tonifying yin and suppressing fire is
recommended, and Bolus of Anemarrhenae, Phellodendri and Rehmanniae should be
B. Deficiency of both yin and yang: manifested by aversion to cold,
coldness of limbs, listlessness, shortness of breath, soreness and weakness of
lumbus and knees, impotence, pale tongue and deep and thready pulse. The
therapeutic principle is to tonify kidney-yang and kidney-yin. The Pill for
Invigorating Kidney-Qi should be applied.
Impotence is the inability to have an erection of the penis or lack of
copulative power in the male before climax. It is usually due to sexual
indulgence, masturbation, emotional upset or an attack of dampness-heat on the
lower jiao. The disorder may be differentiated and treated as follows:
A. Hypofunction of the life-gate: Manifested by impotence, pale complexion,
dizziness, spiritlessness, soreness and weakness of lumbus and knees, pale
tongue with white coating and deep and thready pulse. The therapeutic principle
is to tonify kidney-yang. The Five Seeds Bolus or Pill for Supporting
Reproductivity should be used, which is composed of Fructus Lycii, Semen
Cuscutae, Fructus Schisandrae, Radix Rehmanniae Praeparata, Herba Cistanchis,
Fructus Cnidii, Semen Allii Tuberosi, Herba Epimedii, etc.
B. Impairment of heart and spleen: Manifested by impotence, mental fatigue,
restlessness at night, poor appetite, lusterless complexion, pale tongue with
thin greasy coating and thready pulse. The therapeutic principle is to
invigorate the heart and spleen. The prescription of Modified Decoction for
Invigorating the Spleen and Nourishing the Heart should be used, which is
composed of Radix Codonopsis Pilosulae, Radix Astragali, Rhizoma Atractylodis
Macrocephalae, Radix Angelicae Sinensis, Lignum Pini Poriaferum, Radix
Polygalae, Semen Ziziphi Spinosae, etc.
C. Impairment of kidneys after terror: Manifested by impotence, mental
depression, timidness, doubtfulness, palpitations, insomnia, thin greasy tongue
coating and wiry and thready pulse. The therapeutic principle is to tranquilize
the mind and invigorate the kidneys. The prescription of the Decoction for
Invigorating yang-Qi should be used, which is composed of Radix Rehmanniae
Praeparata, Fructus Corni, Rhizoma Dioscoreae, Radix Angelicae Sinensis, Cortex
Eucommiae, Fructus Lycii, Lignum Pini Poriaferum, Radix Polygalae, etc.
D. Attack of dampness-heat to lower jiao: Manifested by impotence, dampness of
scrotum, soreness of lower limbs, oliguria, yellow tongue coating and deep and
smooth or soft-floating and rapid pulse. The therapeutic principle is to clear
away dampness-heat. The prescription of the Modified Decoction of Gentianae for
Purging Liver-Fire should be applied, which is composed of Radix Gentianae,
Radix Scutellariae, Fructus Gardeniae, Radix Bupleuri, Caulis Akebiae, Semen
A. Scolopendra (30 pieces), Radix Angelicae Sinensis (45 g), Radix Paeoniae Alba
(45 g) and Radix Glycyrrhizae (45 g); dried and prepared as fine powder, and
divided into 30 packages; taken twice daily for 15 days.
B. Two pieces of sheep's testis, steamed with a small amount of old-wine; taken
daily for one month.
Copyright 1995 Hopkins Technology