Seminal emission is a pattern in which the semen of a man emits frequently without making sexual activities. This disease usually results from insecure seminal gate due to kidney deficiency, or blazing fire of the monarch (heart) and minister (kidneys), downrush of damp and heat, etc., which can disturb the seminal chamber. When the semen emits in sleep without dreaming, it is called non-dream emission. When the semen emits in dreaming, or even in being sleepless, it is called slip emission. However, in clinical practice of TCM, doctors tend to call all these two conditions seminal emission.

The record of this disease was first seen in Huangdi Neijing (The Medical Classic of the Yellow Emperor). One of its articles, Root Spirit in the volume Divine Pivot (Ling Shu), describes this condition that ¡°the semen itself emits downward frequently.¡± The Simultaneous Treatment of the Pulse and Patterns of Blood Qi-Impediment Disease and Deficiency Exhaustion Disease, an article in the medical masterpiece Jin Gui Yao Yue (Synopsis of Golden Chamber), describes seminal emission as semen loss.

The Symptoms of Semen Loss due to Deficiency Exhaustion, an article in the Etiology of Various Diseases, says that ¡°the kidney qi is enfeebled and incapable of storing semen, so the semen leaks and loses.¡± Based on this description, the major pathomechanism of seminal emission is elucidated.

In western medicine, seminal emission caused by prostatitis, neurasthenia, etc., can be diagnosed and coped with in reference to the contents of this section.                                                 

Characteristics of Pattern

Seminal emission occurs more than twice a week. The semen emits when one is dreaming or sober, accompanied by dizziness, tinitus, forgetfulness, palpitation, insomnia, lumbar aching pains, soft legs, spiritlessness, and such other symptoms. If the patient overworks mentally, it usually exhibits dizziness, palpitation, forgetfulness, devitalized spirit, fatigue, lack of strength, reddish tongue, thready and rapid pulse. If the patient indulges in sexual activities, it is often seen as dizziness, blurred vision, lumbar aching pains, tinnitus, spiritlessness, lack of strength, and reddish tongue with few fluids, string-like and thready and rapid pulse. If the disease originates from the inborn shortage of endowment, it is characterized by wan complexion, devitalized spirit, pale tongue, deep and weak pulse. If the disease is due to intemperate diet, a bitter taste in the mouth or thirst, hot and yellowish urine, yellow and slimy tongue coating, sloppy and rapid pulse, etc., are always displayed.

Pathogen and Pathomechanism

1. Deficient kidneys failing to store essence

a. Indulgence in sex: early marriage, excessive sexual activities, or frequent masturbation due to ignorance, may result in the depletion of the kidney essence. If the kidney yin is deficient, the deficient yin may cause blazing vacuous fire; the minister (kidneys) fire prevails and disturbs the seminal chamber, evoking its failed duty to store essence. If the kidney qi is insufficient, it would be incapable of astringing essence, thus the seminal gate would fail to secure and seminal emission will arise. Dream Emission and Slip Emission in the book Medical Piercing says, ¡°If the kidney yin is deficient, the essence will not be stored. If the liver yang is much too strong, the fire would not be harmonious. Therefore, the inharmonious fire along with the semen that cannot be stored would ultimately result in its emission with dream or without dream.¡± An article Seminal Emission in the book Gists of Patterns and Treatments says, ¡°There are people who get unstopped seminal emission because of excessive sexual desires.¡± The former condition is related to deficient yin and prevailing yang, while the next is related to the dual deficiencies of the yin and yang, and the devitalized lower original qi as well.

b. Shortage of the inborn endowment: The inborn endowment is so short and weak that the lower original qi is debilitated and the seminal pass is not secure. So, this man is apt to suffer from seminal emission. An article Seminal Emission in the book The Complete Works of Jingyue (an ancient doctor) notes, ¡°There are those who have insufficient endowment and the semen tends to emit easily. This condition is just due to the weak and fragile inborn original qi.¡±

2. Effulgent fire of the monarch (heart) and minister (kidneys)

a. Overwork of the heart: If one uses his heart (mind) excessively, the heart yin is exhausted in an undercovered way. Thus the heart yang becomes overwhelming solely, and the heart fire cannot associate downward with the kidney water, while the kidney water cannot moisten the heart. Therefore, the heart and kidneys fail to associate each other. The water is deficient, yet the fire is effulgent, disturbing the room of the semen and causing seminal emission.

b. Excessive sexual desires which cannot be realized: In this condition, the heart and spirit are restless, the monarch (heart) fire prevails and the minister (kidneys) fire stirs frenetically, evoking the seminal emission.

3. Downrush of damp and heat, or phlegm and fire

Intemperate diet, such as too much wine, pungent and fatty foods, etc., may damage the spleen and stomach. The damp and heat are produced, or the phlegm is produced which can transform to fire. Therefore, the damp and heat or phlegm and fire would rush downward to perturb the seminal chamber, causing seminal emission ultimately.

To generalize it, the major pathomechonism of seminal emission is related to the heart, liver, and kidneys. In clinical practice, seminal emission is usually due to indulgence in sexual activities, weak inborn endowment, mental overwork, excessive sexual desires which cannot be realized, intemperate diet, etc., which could influence the normal storage of the kidneys.

Syndrome Identification and Treatment Determination

1. Fire-stirring of the monarch and minister, dissociation of the heart and kidney

Symptoms: reduced sleep, profuse dreaming, seminal emission once dreaming, accompanied by fretful heat in the heart, dizziness, debilitation, restlessness, forgetfulness, dry mouth, frequent and yellowish urine, reddening of the tongue, thready and rapid pulse.

Therapeutic principle: Clear the heart, calm the spirit, moisten the yin and clear heat.

Formula and ingredients: Coptis Heart-Clearing Decoction combining with Heaven, Human, and Earth Marrow-Retaining Pills

The first formula includes: coptis root (huang lian; clearing and discharging the heart fire), fresh rehmannia root (sheng di; moistening the yin and clearing heat), tangkuei root (dang gui; harmonizing the blood and calming the spirit), spiny jujube kernel (suan zao ren; harmonizing the blood and calming the spirit), root poria (fu ling; calming the spirit and nourishing the heart), polygala root (yuan zhi; calming the spirit and nourishing the heart), ginseng (ren shen; enriching the qi and harmonizing the middle-warmer, i.e., spleen and stomach), licorice root (gan cao; enriching the qi and harmonizing the middle-warmer, i.e., spleen and stomach), lotus seed (lian zi; nourishing the heart and spleen and astringing the essential qi).

The second formula encompasses: asparagus tuber (tian dong; moistening the water and nourishing the yin), cooked rehmannia root (shou di; moistening the water and nourishing the yin), ginseng (ren shen; calming the heart and enriching the qi), licorice root (gan cao; calming the heart and enriching the qi), phellodendron bark (huang bai; clearing the heat and discharging fire to consolidate the yin), amomum fruit (sha ren; moving the stagnation to please the spleen).

2. Downrush of damp-heat, disturbing the seminal chamber

Symptoms: frequent seminal emission, or little semen is seen when urinating, hot, red, turbid urine, or uneven micturation, a bitter taste in the mouth or thirst, vexation, reduced sleep, sores of the tongue and mouth, sloppy and foul stool, or glomus and oppression of the abdomen and stomach, nausea, yellowish and slimy tongue coating, soggy and rapid pulse.

Therapeutic principle: Clear up heat and excrete damp .

Formula and ingredients: Mr. Cheng¡¯s Fish Poison Yam Clear-Turbid Separation Beverage

Fish poison yam (bi xie), phellodendron bark (huang bai), poria (fu ling), plantago seed (che qian zi) can clear heat and damp. Lotus seed (lian zi xin), salvia root (dan shen), acorus root (shi chang pu) can clear the heart and calm the spirit. Ovate atractylodes rhizome (bai zhu) can strengthen the spleen and excrete damp.

3. Damaged heart and spleen by overwork, the failure of the qi to astringe the essence

Symptoms: occurrence of seminal emission when overworking, palpitation, restlessness, insomnia, forgetfulness, sallow yellowish facial complexion, fatigue of the four limbs, reduced intake of food, sloppy stool, pale tongue, thin tongue coating, thready and weak pulse.

Therapeutic principle: Adjust and tonify the heart and spleen, enrich the qi, and astringe the essence.

Formula and ingredients: Marvelous Fragrance Powder

Ginseng (ren shen) and astragalus root (huang qi) can enrich the qi and produce the essence. Chinese yam (shan yao) and poria (fu ling) can support the spleen. Polygala root (ruan zhi) and cinnabar (zhu sha) clear the heart and calm the spirit. Sausurea root (mu xiang) rectifies the qi. Platycodon root (jie gan) lifts the clear qi.

4. Deficiency of the kidneys, insecurity of the seminal pass

Symptoms: frequent dream emissions, even slip emission, aching pains of the loins and knees, dry throat, vexation, dizziness, tinitus, forgetfulness, insomnia, low fever, red cheek, emaciation, night sweating, loss of hair, shaking teeth, red tongue with few coating, thready and rapid pulse. Some patients who suffered from seminal emission long, accompanied by cold limbs, impotence, premature ejaculation, cold semen, profuse night urine or scanty urine, puffy swelling, clear and white urine, or post-voiding dribble, bright white or haggard colorless facial complexion, pale and tender tongue with teeth impressions, white and slippery tongue coating, deep and thready pulse.

Therapeutic principle: Tonify and enrich the kidney essence, secure and astringe to check emission.

Formula and ingredients: Left-Restoring Beverage combining with Golden Lock Essence-Securing Pills.

Cooked rehmannia root (shou di), cornus fruit (shan zhu yu), lycium berry (gou qi zi), complanate astragalus seed (tong ji li) tonify and enrich the kidney essence. Euryale seed (qian shi), lotus stamen (lian xu), Cherokee rose fruit (jin ying zi), dragon bone (long gu), oyster shell (mu li) secure and astringe to stop emission. Chinese yam (shan yao), lotus seed (liang zi rou), poria (fu ling), licorice root (gan cao) strengthen the spleen to assist transportation.    

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