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Nocturnal Emission

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 asthenia-syndrome.

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 kidney-yang.

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 and kidneys

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 Turbid Urine

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 semen

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 the Heart

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 Anxiety and 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.

Experiential Prescriptions

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.

Appendix I

EJACULATIO PRAECOX

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 employed.

 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.

Appendix II

IMPOTENCE

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 Plantaginis, etc.

Experiential Prescriptions

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

 


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