bubble_chart Concept

Seminal emission refers to the involuntary discharge of semen without sexual intercourse.

Neijing. Shanggu Tianzhen Lun states: "At the age of sixteen, a man's kidney qi is in excess, the reproduction-stimulating essence arrives, and the essential qi overflows." Shoushi Baoyuan says: "In the prime of youth, prolonged celibacy and forced suppression of sexual desire can lead to unconscious seminal emission, like a full bottle overflowing. This is not a disease and does not require medication." It is said that when the essence is full, it overflows; the overflow is a natural discharge, and new essence is generated. For generally healthy males, seminal emission occurring 1-2 times a month is a normal physiological phenomenon.

The so-called seminal emission syndrome refers to frequent seminal emission accompanied by systemic symptoms, which is considered a pathological condition. Throughout history, medical practitioners have classified it under the category of "deficiency fatigue." Neijing. Benshen chapter mentions "spontaneous discharge of essence," Jingui Yaolue, Zhubing Yuanhou Lun refer to it as "seminal emission." If it occurs with dreams, Jingui Yaolue calls it "nocturnal emission," Zhubing Yuanhou Lun calls it "dream emission of essence," Qianjin Fang calls it "dream emission." Since Jingui Yaolue, medical practitioners throughout history have generally divided seminal emission into two categories based on whether it occurs with or without dreams: emission with dreams is called nocturnal emission, and emission without dreams is called spermatorrhea. Generally, emission with dreams is considered mild, while emission without dreams is considered severe.

bubble_chart Pattern Analysis

1. Essence-Qi Overflow︰The body is generally strong, with frequent nocturnal emissions more than usual, feeling fatigued after emission, and the tongue and pulse may be normal. Apart from slightly more frequent seminal emissions than normal, there may be mild discomfort such as mental fatigue. Treatment may not be necessary, or clearing the heart and tranquilizing the spirit can be applied, using Clearing Heart Pills.
2. Exuberance of Heart Fire︰During the day, there is palpitation and restlessness; at night, dreamfulness and seminal emission, susceptibility to fright, forgetfulness, or accompanied by dark urine, a red tongue tip, and a rapid pulse. This is due to prolonged longing that injures the heart, causing the heart channel's fire-heat to blaze and the spirit to fail to remain within. During the day, the heart-mind is unsettled, with palpitation and restlessness, and unfulfilled desires; at night, there are chaotic dreams and nocturnal emission of essence. Additionally, there are symptoms of heart channel fire-heat, such as a red tongue, dark urine, and a rapid pulse. In the early stages, the deficiency signs are not yet obvious, but over time, insufficiency of heart blood will inevitably appear, manifesting as palpitation, severe palpitation, susceptibility to fright, forgetfulness, and other symptoms. Therefore, treatment should focus on clearing the heart and reducing fire, calming the spirit and astringing essence. Formulas such as Two-Yin Decoction, Heart-Nourishing Decoction, Heart-Clearing Lotus Seed Decoction, and others can be modified accordingly. For chronic conditions, it is appropriate to include herbs such as Chinese Angelica, Rehmannia, Peony Root, Fleeceflower Root, and Donkey-hide Gelatin to nourish yin and tonify blood.
3. Deficiency of Both Heart and Spleen︰Frequent nocturnal emissions, emaciation, mental fatigue, pale complexion, shortness of breath upon exertion, spontaneous sweating, poor appetite, palpitations, insomnia, forgetfulness, pale lips and a bland taste in the mouth, pale tongue texture, and weak, thin pulse. This condition is often caused by excessive mental strain, prolonged overthinking, and the gradual depletion of the heart and spleen. It commonly occurs in individuals engaged in prolonged and demanding mental work, often accompanied by dreams during emission. The *Medical Records of Three Generations of the Lu Family* states: "Excessive contemplation depletes the heart blood, leaving nothing to nourish the spirit, causing the mind to wander and leading to dreams of intercourse. When the mind fails to remain in its abode, the will is also unsteady, and kidney essence is lost downward." Insufficiency of heart qi and blood manifests as a pale complexion, palpitations, shortness of breath, spontaneous sweating, insomnia, dreamfulness, and forgetfulness. Spleen qi deficiency results in emaciation, fatigue, and anorexia. Deficiency of both the heart and spleen leads to a pale tongue and thin pulse. Treatment should focus on tonifying and replenishing the heart and spleen, supplementing qi to secure essence. Prescriptions such as Heart-Nourishing Decoction, Mind-Calming Pill, and Wonderful Scent Powder may be modified and applied.
4. Deficiency of Both Heart and Kidney︰Frequent dreaming with nocturnal emissions, soreness or pain in the waist, and mental fatigue. Palpitation, insomnia, forgetfulness. If accompanied by yellow urine, dry stool, virtual heat, night sweat, red tongue with scant coating, and thin rapid pulse, it indicates the pattern of yin deficiency in heart and kidney due to insufficiency of heart blood and kidney yin deficiency. If accompanied by a pale complexion, shortness of breath, pale tongue with white coating, and thin weak pulse, it suggests the pattern of heart and kidney qi deficiency due to insufficiency of heart qi and kidney deficiency (without signs of kidney yin or kidney yang deficiency). It may manifest as the pattern of yin deficiency and effulgent fire due to insufficiency of heart blood and kidney yin. Heart blood deficiency leads to palpitation, insomnia, dreamfulness, and forgetfulness, while kidney yin deficiency causes soreness and weakness in the waist and knees, tinnitus, vertigo, dry throat and tongue, or even tidal fever, flushed face, night sweat, red tongue with scant coating, and thin pulse. Nocturnal emissions occur during dreams. Alternatively, spermatorrhea may occur without dreams. Treatment should focus on tonifying heart blood and nourishing kidney yin, using formulas such as Heart-Nourishing Elixir and Subduing Yang and Marrow-Filling Pill with modifications. The dual deficiency of heart and kidney may also present as the pattern of heart and kidney qi deficiency, often resulting from excessive mental exertion and prolonged contemplation, initially depleting heart and spleen and eventually leading to deficiency of all three organs—heart, spleen, and kidney. The main manifestations are symptoms of heart and kidney qi deficiency. Seminal emission may occur with or without dreams. Heart qi deficiency causes palpitation, shortness of breath, spontaneous sweating, pale complexion, pale tongue, and thin pulse. Kidney qi deficiency leads to soreness and weakness in the waist and knees, physical fatigue, mental fatigue, shortness of breath, tinnitus, alopecia areata, or even impotence. Treatment should aim at tonifying and replenishing the heart and kidney, stopping emissions, and securing essence, using Mantis Egg-Case Powder with modifications.
5. Frenetic Stirring of Ministerial Fire︰Priapism, nocturnal emission, or involuntary seminal efflux with diarrhea. At the initial stage, bitter taste in the mouth, dark urine, yellow tongue coating, and wiry-strong pulse indicate liver channel fire-heat; further progression may manifest as dry mouth, red tongue, rapid pulse, and other signs of yin deficiency. For exuberant heart fire, it is a heart channel heat pattern; for frenetic stirring of ministerial fire, it is a pattern of heat in the liver and kidney. Heart fire is monarch fire, which governs stillness and is an intangible, dynamic qi, while liver-kidney fire is ministerial fire, which is reckless movement of tangible fire. Whenever the heart is stimulated, monarch fire stirs, and ministerial fire follows recklessly. Thus, Gezhi Yulun states: "The kidney governs hiding and storing, while the liver governs free coursing and discharge. Both organs contain ministerial fire, and their connections ascend to the heart. The heart is monarch fire, easily stirred by external stimuli. When the heart stirs, ministerial fire also stirs, and when it stirs, essence flows out spontaneously." Therefore, seminal emission due to frenetic stirring of ministerial fire is a further progression of seminal emission caused by exuberant heart fire. The former is milder, while the latter is more severe. Treatment should focus on draining liver fire and securing the essence gate. For pronounced liver channel fire-heat (priapism, dampness or itching in the genital area, bitter taste in the mouth, yellow tongue coating, dark urine, wiry or rapid pulse), directly drain liver fire using Gentian Liver-Draining Decoction. Seminal emission due to frenetic stirring of ministerial fire arises from liver channel heat, which over time may be accompanied by yin deficiency. If accompanied by yin deficiency with effulgent fire (dry mouth, red tongue, thin and rapid pulse), nourish yin and reduce fire using Yin-Nourishing and Fire-Reducing Decoction.
6. Insecurity of Kidney Qi︰Nocturnal emission without dreams, or even slight thoughts, or slight fatigue leading to involuntary seminal emission, occurring several times a day and night. Emaciation, mental fatigue, dizziness, tinnitus, bodily exhaustion, soreness and weakness of the waist and knees, shortness of breath insufficient for respiration. If kidney yang deficiency is present, there may be cold hands and feet, fear of cold, lethargy, clear breath from the mouth and nose, pale tongue, and deep, thin pulse. If kidney yin deficiency is present, there may be tidal fever, steaming bone fever, night sweat, flushed cheeks, sore throat, dry mouth, red tongue with scant coating, and thin, rapid, weak pulse. Often, there is nocturnal emission without dreams, or even efflux diarrhea that cannot be controlled. Zhubing Yuanhou Lun states: "The kidney stores essence, but now it is weak and unable to control the essence, hence the essence overflows due to sensory stimulation." Or it may be due to "marrying too early, when the essence and blood are not yet full, chronic diarrhea must involve the failure of the gate to restrain" (Linzheng Zhinan Yi'an). Alternatively, it may be caused by congenital insufficiency, inherent weakness, unregulated sexual activity, excessive lust, or engaging in sexual activity too soon after recovering from a serious or prolonged illness. The kidney stores essence and is the root of sealing and storing. When kidney qi is severely damaged, the gate of essence cannot firmly restrain, leading to uncontrolled seminal emission, hence the appearance of various deficiency symptoms. "Injury to essence leads to depletion of qi, and depletion of qi leads to dispersion of spirit" (Shen Shi Zunsheng Shu), manifesting as emaciation, weak qi, sore waist, lumbago, bodily exhaustion, shortness of breath upon exertion, spontaneous sweating, tinnitus, dizziness, listlessness, deep, thin, weak pulse, etc. Treatment should focus on consolidating the kidney and astringing essence, using Golden-Lock Semen-Securing Pill with modifications. In severe cases, tonifying the kidney and replenishing essence, nourishing yin and tonifying yang are necessary, using Great Life-Endowing Pill with modifications. If kidney yin is insufficient, there may be uncontrolled seminal emission, cold sperm, thin semen, cold limbs, fear of cold, lethargy, listlessness, clear breath from the mouth and nose, pale lips, bland taste in the mouth, pale, swollen, moist tongue, and six pulse conditions deep and thin to the point of fading—all signs of yang deficiency. Treatment should involve warming and tonifying the kidney, stopping emission and astringing essence, using Jia Cao Zi Wan, Pilose Antler Essence-Boosting Pill, Golden-Lock Zhengyuan Dan, etc., with modifications. If kidney water is insufficient and true yin is depleted, there may be involuntary efflux diarrhea, tidal fever, steaming bone fever, restlessness and insomnia, vexing heat in the chest, palms, and soles, bone weakness, emaciation, sore waist, lumbago, flushed cheeks and face, dry mouth, sore throat, dark urine, dry stool, red tongue with scant coating, and thin, rapid, weak pulse. Yizong Jinjian, Volume 27, states: "Zhu Zhenheng said: Yin is often insufficient, yang is often excessive. One should always nourish yin, so that yin and yang are balanced, then water can control fire, and there will be no disease. People nowadays often have excessive desires, leading to depletion of essence and blood, and ministerial fire becoming hyperactive. True yin is further exhausted, and solitary yang runs rampant, resulting in pulmonary tuberculosis, tidal fever, night sweat, steaming bone fever, cough, hemoptysis, hematemesis, and other symptoms." Treatment should focus on nourishing kidney yin and subduing deficient fire, as the saying goes: "Strengthen the ruler of water to control the sunlight." Use Six-Ingredient Rehmannia Pill and Anemarrhena, Phelloendron and Rehmannia Pill with modifications. In severe cases, use Major Yin-Tonifying Pill to "suddenly replenish true yin and restrain ministerial fire, achieving faster results than the Six-Ingredient Pill."
7. Dampness-heat︰Frequent nocturnal emissions, occasionally spermatorrhea without dreams, sometimes accompanied by irritability and fever, dampness or itching in the genital area, dark urine, thick or yellow tongue coating, slippery or rapid pulse. Due to excessive consumption of rich and greasy food, "dampness-heat of spleen and stomach, impaired qi transformation, which then flows downward to the bladder... When yin fire is stirred, semen follows and is discharged, occurring even without dreams" (Shen's Comprehensive Treatise on Life Preservation), or emissions with dreams. Because of spleen-stomach weakness and bladder dampness-heat, the tongue coating is yellow or thick, and the urine is dark. Ye Tian-shi once said: "For seminal emission disorders, when tonifying and astringing methods fail, most cases are caused by dampness-heat of spleen and stomach" (quoted from Introduction to Clinical Experience in Chinese Medicine, (3), Ren Ying-qiu, Seminal Emission). Treatment should focus on eliminating dampness and strengthening the spleen, ascending lucidity and descending turbidity, and seminal emission will naturally cease. Formulas such as Modified Cang Bai Two Old Ingredients Decoction or Chun Gen Bai Pi Wan can be used with modifications.

Essential qi overflow and heart fire exuberance both result in dreaming and seminal emission. The heart stores the spirit, and when the eyes see something, the heart thinks about it. If the thoughts are not fulfilled, the spirit is injured. When the spirit is injured above, the essence is shaken below, leading to dreamfulness at night and seminal emission. The key points for differentiating these two conditions are that both involve dreaming and emission, with the former being mild and the latter severe, but neither shows obvious signs of deficiency. In treatment, the former only requires clearing the heart, while the latter requires draining heart fire, calming the spirit, and astringing essence, along with supplementing heart blood.

Frenetic stirring of ministerial fire and heart-kidney yin deficiency with yin deficiency and effulgent fire are compared, with the former being mild and the latter severe. Frenetic stirring of ministerial fire can further develop into heart-kidney yin deficiency with yin deficiency and effulgent fire, leading to seminal emission.

Generally, the condition of seminal emission, "though it varies greatly, does not go beyond the scope of dreaming, non-dreaming, and dampness-heat" (Linzheng Zhinan Yi'an). The treatment methods are simply to differentiate whether there is fire or not, and whether it is deficiency or excess. For those with dreams, the responsibility lies with the strength of ministerial fire, and clearing heart and liver fire will cure the disease. For those without dreams, it is entirely due to kidney deficiency and lack of consolidation, and should be treated with tonification and astringency to secure the collapse" (Chengfang Biandu). If dampness-heat is the cause, it should be cleared and drained.

bubble_chart Documentation

1. Jingui Yaolue-Blood Bi-Syndrome and Deficiency Fatigue: " For those who suffer from seminal loss, there is lower abdominal tension, coldness in the glans, dizziness, hair loss, and extremely weak, hollow, and slow pulses... Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell is prescribed."
2. Shiyi Dexiao Fang Volume 7 records: " For any condition involving uncontrollable seminal discharge, spontaneous sweating, dizziness, extreme deficiency, alternating chills and fever, when astringent tonics prove ineffective, and the pulse is floating, soft, and scattered—this is neither pure deficiency nor excessive sexual activity. The cause lies elsewhere: seeing something, longing for it, delighting in the thought, desires arising but unfulfilled, thus leading to this ailment. Since tonics and consolidation fail, what treatment remains? When the heart harbors love, the spirit does not return; when the mind entertains thoughts, the will is unsettled. First harmonize the nutritive and defensive qi—when these are balanced, the heart calms. Next regulate the spleen—when spleen qi harmonizes, the will stabilizes. When heart and kidney interact, essence and spirit are preserved within, and the illness naturally resolves."
3. Jingyue Quanshu- Miscellaneous Syndromes: " There are nine types of seminal emission: 1) Dreams due to fixation—essence stirred by the spirit, rooted in the heart; 2) Dreams from unfulfilled desires—essence displaced, rooted in the kidney; 3) Emission after exertion—physical weakness, liver-spleen deficiency; 4) Emission from overthinking—middle qi insufficiency, heart-spleen collapse; 5) Emission from damp-heat or ministerial fire—spleen-kidney fire unresolved; 6) Spontaneous seminal slippage—lower origin deficiency, lung-kidney insecurity; 7) Congenital weakness with easy slippage—innate qi frailty; 8) Slippage from prolonged cold medications—yang collapse due to mistaken treatment; 9) Emission in vigorous youth after prolonged abstinence—overflow from fullness... What departs departs, what regenerates regenerates—a natural process unworthy of concern."
4. Gujin Yian An- Seminal Emission: " Medical texts universally state: dream-induced emission blames heart fire, dreamless emission blames kidney deficiency—these two statements are indeed comprehensive. Yet in my observation, both dream and dreamless cases stem from deficiency... Thus in treatment, only damp-heat stagnation and depression should avoid deficiency approaches. These two further divide: 1) Alcohol-damp heat—treat with Duanyuan Pill; 2) Rich-food damp-heat—treat with Pig Stomach Pill; 3) Phlegm accumulation depression—treat with Rolling Phlegm Pill or Shenxiong Pill; 4) Latent fire depression—treat with Kidney-Nourishing Pill or Polyporus Pill."