During intercourse, premature ejaculation occurs when ejaculation happens too early, causing the penis to become soft and preventing normal sexual activity. This is referred to as premature ejaculation. As described in "Shen's Treatise on Life Preservation": "Ejaculation occurs before intercourse or immediately upon intercourse."

Premature ejaculation is closely related to erectile dysfunction. Both share similarities in terms of disease causes, mechanisms, and treatment methods, but their clinical manifestations differ. Premature ejaculation results in the penis becoming soft due to early ejaculation, preventing normal intercourse, while erectile dysfunction involves the inability to achieve or maintain an erection sufficient for intercourse. Premature ejaculation may be an early symptom of erectile dysfunction, and erectile dysfunction is often the result of the further progression of premature ejaculation.

Premature ejaculation differs from seminal emission. Seminal emission refers to the involuntary release of semen without intercourse, whereas premature ejaculation occurs at the beginning of intercourse, leading to ejaculation before normal intercourse can take place.

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1. Kidney Qi Deficiency︰premature ejaculation, lumbago, weak knees, alopecia areata, loose teeth, and weak pulse at the chi position. If accompanied by kidney yang deficiency, symptoms may include fear of cold, cold limbs, shortness of breath, pale complexion, clear and profuse urine or frequent urination, loose stools, a swollen and moist tongue or with tooth marks, and a deep pulse. If accompanied by kidney yin deficiency, symptoms may include vexing heat in the chest, palms, and soles, night sweats, dry mouth, dizziness, tinnitus, dark yellow urine, dry stools, a red tongue with little coating, and a thin, rapid, and weak pulse. Premature ejaculation is one of the main clinical manifestations of insufficient kidney qi. The kidneys store essence and are the "root of sealing and storing." If kidney qi is damaged due to excessive sexual activity, overindulgence in desires, or frequent masturbation in youth, it may initially lead to premature ejaculation and, in severe cases, even impotence. Insufficient essential qi of the kidneys can manifest as lumbago or pain, weak knees, alopecia areata, loose teeth, and a weak pulse. "When essence is full, qi is strong; when qi is strong, the spirit is vigorous; when the spirit is vigorous, the body is healthy and free from illness" (Shen's Book of Life Preservation). Due to the depletion of kidney essence, the essential qi of other organs also becomes insufficient, leading to symptoms such as qi deficiency, fatigue, listlessness, and a dull complexion. This is what is meant by "essence damage leads to qi deficiency, and qi deficiency leads to spirit decline." Treatment should focus on tonifying the kidneys and strengthening yang, supplemented with heart-clearing and astringent herbs. Since this condition is often caused by "decline of the life gate fire," Jingyue Quanshu advocates warming and tonifying, emphasizing both warming yang to tonify the kidneys and enriching yin to replenish essence. Jingyue Quanshu·Miscellaneous Syndromes states: "Those skilled in tonifying yang must treat yin for yang, so that yang is aided by yin, and generation and transformation are endless." Gezhi Yulun believes that "yin is often insufficient" and strongly advocates enriching yin. However, this condition is not an overnight ailment but often develops over time. Although it mostly presents as yang deficiency, using drying and heat-inducing yang-tonifying herbs may yield temporary results but cannot sustain long-term effects and may risk depleting yin. On the other hand, enriching yin with bitter and cold herbs may damage kidney yang, and excessive use may lead to cold stagnation. Therefore, clinically, mild warming and balanced tonifying formulas are preferred. Patients with this condition often experience significant anxiety and fear during intercourse and seek quick results. In addition to medication, it is essential to alleviate their psychological concerns, advise them to clear the heart and reduce desires, and practice moderation in sexual activity for gradual improvement. The formula Deer Horn Powder with modifications can be used. Those with yang deficiency may take Zanyu Dan or Zhufeng Wan. For milder symptoms, balanced tonifying and astringent formulas such as Gordon Euryale Seed Pill or Songaria Cynomorium Herb Dan with modifications can be selected.
2. Dampness-heat in Liver Meridian︰Premature ejaculation accompanied by dampness-heat manifestations, presenting symptoms such as restlessness, bitter taste in the mouth, dark urine, turbid urine, painful urination, or swelling of the vulva, pruritus vulvae, yellow tongue coating, and wiry, forceful pulse, etc. This is because "the Liver Meridian of Foot-Jueyin... passes around the external genitalia," and "its branch... connects with the penis" (Lingshu.Jingmai). The liver governs the tendons and regulates free flow, while the external genitalia are the convergence of all tendons. When dampness-heat in the liver meridian flows downward to the external genitalia, it disrupts the free flow and weakens containment, leading to premature ejaculation. Since this condition is caused by dampness-heat, it must be accompanied by symptoms of dampness-heat in the liver meridian (restlessness, bitter taste in the mouth, dark urine, turbid urine, pruritus vulvae, yellow tongue coating, wiry or rapid pulse). Treatment should focus on clearing and draining dampness-heat in the liver meridian, using the Modified Heaven, Human, and Earth Marrow-Retaining Pill. For severe cases of dampness-heat, the Gentian Liver-Draining Decoction may be temporarily employed, but treatment should cease once the condition improves, avoiding excessive dosage.
3. Deficiency of Heart and Spleen︰Premature ejaculation accompanied by symptoms of spleen qi and blood deficiency, such as emaciation, dull complexion, qi deficiency fatigue, limb fatigue, anorexia, loose stool, palpitation, shortness of breath, spontaneous sweating, dreamfulness, forgetfulness, pale tongue, and thin pulse. It often occurs in individuals with mental overstrain or excessive contemplation, inevitably manifesting symptoms of heart and spleen qi and blood deficiency (emaciation, dull complexion, qi deficiency fatigue, anorexia, loose stool, palpitation, spontaneous sweating, dreamfulness, insomnia, forgetfulness, pale tongue, thin pulse). Treatment should focus on tonifying and replenishing the heart and spleen, consolidating essence to stop leakage, using Returning to Spleen Decoction plus Fossil Bone, Gordon Euryale Seed, Cervi Deer-Horn Glue, etc.
   • If the condition persists and fails to heal, due to insufficient spleen transformation, it may lead to deficiency of heart blood and kidney yin, presenting symptoms of heart and kidney yin deficiency (tidal fever, night sweat, vexing heat in the chest, palms, and soles, dry mouth, sore waist, dizziness, blurred vision, tinnitus, yellow urine, red tongue, thin and rapid pulse). Treatment should focus on enriching yin and clearing heat, tonifying the kidney and astringing essence, using Great Phoenix Marrow Pill with modifications, or Celestial Emperor Heart-Tonifying Pill.
   • If premature ejaculation due to heart and spleen deficiency persists and leads to kidney qi deficiency, manifesting symptoms of deficiency in all three organs—heart, spleen, and kidney (palpitation, shortness of breath, spontaneous sweating, pale complexion, fatigue and lack of strength, abdominal distension, anorexia, loose stool, tinnitus, alopecia areata, pale tongue, thin pulse), treatment should focus on tonifying and replenishing the heart and spleen, tonifying qi and consolidating essence, using Mantis Egg-Case Powder with modifications.

The key points to differentiate between kidney qi deficiency and heart-spleen deficiency are: the former is caused by excessive sexual activity and should be treated by tonifying kidney qi; the latter is caused by overthinking and overstrain and should be treated by nourishing the heart and spleen.

Premature ejaculation can also be caused by fear damaging the kidney, leading to an insecure essence gate; or by emotional distress and liver depression, causing the liver to lose its free-flowing function. The former should be treated by tranquilizing the spirit and calming the mind, while the latter should be treated by soothing the liver and relieving depression. Whether due to kidney qi deficiency, heart-spleen insufficiency, or dampness-heat in the liver meridian, deficiency syndromes are more common, while excess syndromes are less common. Treating deficiency with tonification is the main principle for treating premature ejaculation, whether by tonifying the liver and kidney or by tonifying the heart and spleen. However, medication should avoid dryness-heat and bitter-cold properties, and the method of warming the kidney with mild tonification is most appropriate to avoid bias. For patients with premature ejaculation but no obvious symptoms of liver, kidney, heart, or spleen deficiency, it is better to treat by clearing the heart and securing the essence, using modified prescriptions such as the Secret Essence Pill and the Heart-Clearing Pill.

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1. "Secret Records of the Stone Chamber" Volume 1: "Those who see colors and retreat, with the gates unguarded, the kidneys have lost their power of opening and closing. Who would have thought that it is all due to the deficiency of the heart ruler, and the ministerial fire seizing power, leading to such a state. ... For the fire in the kidneys is deficient because the water in the heart is first deficient. Therefore, to replenish the kidney fire, one must first replenish the heart fire." The prescription uses Prepared Rehmannia Root, Chinese Yam, Asiatic Cornelian Cherry Fruit, Poria, Cassia Bark, Aconite Lateral Root, Ginseng, White Atractylodes Rhizome, Schisandra Fruit, Ophiopogon Tuber, Milkwort Root, Pilose Antler, Morinda, Desertliving Cistanche, Platycladi Seed, Villous Amomum Fruit, human placenta, Eucommia Bark, malaytea scurfpea fruit.