동의보감- 내경편 권1-25[精] 遺泄精屬心: 유정은 심에 속한다

遺泄精屬心: 유정은 심에 속한다
[동의보감 원문 링크]

단계가, "굳게 간직하는 것은 신(腎)이 주관하고 막힌 것을 터서 내보내는 것은 간(肝)이 맡는다. 두 장기에는 모두 상화가 있고 간계(肝系)와 신계(腎系)는 위로 올라가 심(心)에 닿는다. 심(心)은 군화인데 대상에 자극을 받으면 쉽게 움직인다. 심(心)이 움직이면 상화도 움직이고, 상화가 움직이면 정(精)이 흔들린다. 상화가 일어나면 성교를 하지 않더라도 저절로 흘러나온다. 그래서 성인께서 단지 마음을 거두어들이고 수양하라고 가르치신 것이니 그 뜻이 오묘하다"고 하였다.

정(精)을 다스리는 것은 심(心)이고, 정(精)을 저장하고 조절하는 것은 신(腎)이다. 심신(心腎)의 기(氣)가 허하여 제대로 조절하지 못하기 때문에 소변을 볼 때 정(精)이 새어 나온다. 이것을 요정(尿精)이라 한다. 무언가를 보거나 들었을 때 새어 나오는 것은 누정(漏精)이라 한다. 《직지》

처음에는 군화가 편안하지 않은 것이 원인이 된다. 그런데 오래되면 상화도 제멋대로 움직여 정(精)이 흔들리게 되어 제자리를 든든히 지키지 못한다. 심해지면 밤에 계속 새어 나오고 낮에도 줄줄 흘러나와 멈추지 않는다. 감리환ㆍ황련청심음을 복용해야 한다. 《입문》

夢泄屬心: 몽설은 심에 속한다

《직지》에, "사기(邪氣)가 음분에 들어오면 신(神)이 제자리를 지키지 못하기 때문에 심(心)에 자극이 오면 꿈을 꾸면서 정(精)을 내보내게 된다. 이렇게 되는 상황은 3가지가 있다. 젊어서 기(氣)가 왕성할 때, 홀아비가 온 힘을 다하여 성욕을 참을 때, 정욕을 억지로 참을 때는 자기도 모르는 사이에 정(精)이 새나가는데 이것은 물이 병에 가득 차서 넘치는 경우와 비슷하다. 간혹 이런 때가 있는데, 이 때는 약을 쓰지 않아도 된다. 심기(心氣)가 허한 사람이 정(精)을 다스릴 수 없거나 심(心)이 열사(熱邪)를 받아서 양기가 수렴되지 못하면 정(精)이 새어 나간다. 이는 병이 기울어져 물이 흘러내리는 경우와 유사하다. 많은 사람에게 나타나는데 그 병은 가벼운 편이니 화평한 약을 합하여 쓴다. 장부가 점차 약해지고 진원(眞元)이 오랫동안 상하면 심(心)이 생각을 잘 하지 못하고 신(腎)이 정(精)을 담을 수 없게 되어 정(精)이 새어 나온다. 이것은 병이 깨져 그 틈으로 물이 새어 나오는 경우와 같다. 이 경우는 드물지만 가장 중한 것이니 반드시 크게 보하는 탕약을 지어먹어야 한다"고 하였다.

몽유는 허랭(虛冷)한 것 뿐 아니라 경락에 열이 있어도 생긴다. 예전에 밤이면 척추 가운데에서 열이 나고 몽유가 있는 사람을 치료했었다. 진주분환과 저령환을 복용하니 몽유가 그쳤고 나중에 자설을 복용한 후에는 척추의 열이 사라졌다. 청심환도 좋다. 《본사》

몽유는 전적으로 심(心)에 속한다. 성교할 때 나오는 정(精)은 늘 조그만 흰 막에 싸여 신(腎)에 저장되어 있지만, 이 정(精)의 근본이 되는 원정(元精)은 사실 심(心)에 있다. 낮에 그리워하던 것을 밤에 꿈꾸면서 정(精)을 잃게 되는 것이다. 황련청심음을 써야 한다. 《입문》

꿈에 귀신과 교접하여 정(精)이 새는 것을 몽유라고 한다. 이것은 오로지 열 때문이므로 황백ㆍ지모ㆍ모려ㆍ합분을 사용한다. 만약 안으로 기혈이 상하여 정(精)을 굳게 지키지 못하여 몽유하는 경우는 보해야 하므로 팔물탕을 가감한 것에 저근피환을 먹는다. 팔물탕은 허로문에 나온다


夢泄亦屬鬱: 몽설은 울증에도 속한다

《본사》에, "신기(腎氣)가 막히면 정(精)이 새어 나온다"고 하였다. 《소문》에, "신(腎)은 강력함을 내는 기관[作强之官]이니 기교가 거기서 나온다"고 하였다. 또, "신(腎)은 정을 저장한다"고 하였다. 신(腎)은 정기(精氣)를 모아 사람을 낳고 기른다. 정기를 모으는 것과 흩는 것은 모두 신(腎)에 달려 있다. 신기(腎氣)가 쇠하면 몸의 정기(精氣)를 모으지 못하기 때문에 함부로 흘러 다니며 아무 때나 정(精)이 나오게 된다. 저령환은 바로 이것을 치료하기 위해 만들어진 것이다.

《강목》에, "몽유는 울체로 인한 것이 거의 태반이다. 우매한 의사들은 울체 때문이라는 것을 알지 못하고 삽제(澁劑)를 써서 틀어막으려고만 한다. 그러나 막으려고 하면 할수록 더욱 더 울체되어 그 병이 도리어 심해지게 된다. 어떤 남자가 몽유로 소변이 뿌옇고 아랫배에서 치밀어오르는 기가 있으며, 매일 묘시(卯時)가 되면 허리에서 열이 나다가 유시(酉時)가 되면 서늘해졌다. 허리에서 열이 날 때는 손발이 차고 전음이 무기력하며, 허리의 열이 내리면 전음에 기가 생기고 손발이 따뜻해졌다. 또, 아침에는 방귀가 많이 나오고 저녁에는 트림이 많이 나오며 10-20일에 한 번씩 반드시 몽유가 있었다. 맥은 현활(弦滑)하면서 대(大)하고 낮에는 홍대(洪大)해졌다. 나는 그 사람이 울체가 있다는 것을 알고 먼저 침향화중환처방은 담음문에 나온다으로 설사시킨 다음, 가감팔미탕처방은 오장문에 나온다에 자신환처방은 소변문에 나온다 100알을 썼다. 만약 삽제를 주면 몽유와 소변이 뿌연 것이 도리어 심해져서 간혹 하룻밤에 몽유를 2번 하는 경우도 있다. 이 때는 약을 바꾸어 도적산처방은 오장문에 나온다의 양을 늘려 달여 먹이면 몽유와 소변이 뿌연 것이 모두 사라진다.

또 한 남자가 몽유가 있었는데 의사가 삽제(澁劑)를 주어 더 심해졌다. 먼저 신궁환처방은 《의학입문》에 나온다으로 크게 설사시킨 후 저령환을 복용하게 하였더니 역시 나았다. 이 두 사례를 통해 울체에 속하는 몽유가 많다는 것을 알 수 있다.


精滑脫屬虛: 정이 새어 나가는 것은 허증이다

《영추》에, "두려움이 풀리지 않으면 정(精)이 상한다. 정이 상하면 뼈가 시리고 손발이 차고 다리에 힘이 빠지며 정이 때때로 저절로 흘러내린다"고 하였다. 또, "정(精)이 몹시 부족하면 귀가 먹는다"고 하였다.

《내경》에, "생각은 끝이 없는데 원하는 것을 하지 못하여 음란한 생각을 지나치게 하거나, 성생활을 너무 심하게 하여 종근이 늘어지면 근위가 되고 백음이 된다"고 하였다. 신장의 정은 소중히 여겨야 하는데 마음이 잘 다스려지면 정이 보존되어 새지 않는다. 만약 생각이 밖으로 지나치거나 성생활을 너무 심하게 하면 든든히 지킬 수 없어 저도 모르게 소변을 따라 나오게 된다. 그러므로 근위의 원인은 종근이 늘어진 것이다. 《겸보》

여자와 성교하지 않고도 정이 나오는 것은 음탕한 얘기를 듣거나 예쁜 부인을 보거나 생각은 끝이 없지만 원하는 것을 하지 못하거나 성생활을 너무 심하게 하여 종근이 늘어졌기 때문이다. 이렇게 근위가 되어 정이 저절로 나오는 것을 백음이라 한다. 정이 계속 새나가기 때문에 가감진주분환처방은 소변문에 나온다을 써야 한다.

또, "욕심을 한 번 품을 때마다 정이 그 생각을 따라 나온다. 이것이 오랫동안 배출되지 못하면 음경 속이 가렵고 아프며 늘 소변을 보고 싶다. 소변으로 정액이 나오거나 소변을 따라 나오지 않고 저절로 새어 나오는데, 이것을 유정이라 한다. 몽유보다 더욱 심한 것이니 팔물탕을 가감한 것에 진주분환처방은 앞에 나온다을 복용해야 한다"고 하였다.

어린 사내아이가 양성(陽盛)하여 정욕이 동하였으나 원하는 것을 하지 못하여 밤에 몽유하는 때에는 보해서는 안 된다. 심(心)을 맑게 해야 편안해진다. 아침에는 청심연자음처방을 복용하고 저녁에는 정지환을 복용해야 한다. 《의감》


[遺泄精屬心]
[Nocturnal Emission Pertains to the Heart]

丹溪曰, 主閉藏者, 腎也, 司疏泄者, 肝也. 二藏皆有相火, 而其系上屬於心. 心君火也. 爲物所感則易動, 心動則相火亦動, 動則精自走, 相火翕然而起, 雖不交會, 亦暗流而疏泄矣. 所以聖人只是敎人收心養心, 其旨微矣.
Danxi said, "Storing and protecting is controlled by the kidneys, and opening and flowing is controlled by the liver. The two viscera both have ministerial Fire, and the liver system and kidney system are both connected upwards to the heart. The heart is the sovereign Fire, and it reacts easily when it is stimulated. The ministerial Fire reacts when the heart reacts; the essence moves when the ministerial Fire moves. Essence leaks even without intercourse when the ministerial Fire moves. This is why the wise taught to collect one's mind and train oneself, the meaning of the teaching is mysterious."

精之主宰在心, 精之藏制在腎. 心腎氣虛不能管攝, 因小便而出者曰尿精, 因見聞而出者曰漏精. 《直指》
The heart governs essence, and the kidneys store and control essence. Essence leaks during urination when the qi of the heart and kidneys are so weak that they cannot control the essence very well. This is what is called urine with semen. Leakage after seeing or hearing something is called leaking semen.

初因君火不寧, 久則相火擅權, 精元一於走而不固, 甚則夜失連連, 日亦滑流不已, 宜服坎离丸ㆍ黃連淸心飮. 《入門》
The foremost reason is the uncomfortable state of the sovereign Fire. The ministerial Fire moves on its own if this lasts, and the essence shakes that it cannot keep its place safely. When it gets worse, it leaks continuously at night and day. A Water and Fire Pill or Coptis Clear Heart Drink should be prescribed.

[夢泄屬心]
[Dream Emission Pertains to the Heart]

直指曰, 邪客於陰, 神不守舍, 故心有所感, 夢而後泄也. 其候有三. 年少氣盛, 鰥曠矜持, 强制情慾, 不自覺知. 此泄如甁之滿而溢者, 人或有之, 勿藥可也. 心家氣虛, 不能主宰, 或心受熱邪, 陽氣不收. 此泄如甁之側而出者, 人多有之, 其病猶輕, 合用和平之劑. 藏府積弱, 眞元久虧, 心不攝念, 腎不攝精. 此泄如甁之罅而出者, 人少有之, 其病最重, 須當大作補湯.
It is said in the Renghai's Straight-forward Directions on Formulas (#), "When pathogenic qi enters yin, the spirit does not remain in its place. Therefore, when the heart is stimulated, one will emit semen while dreaming. There are three cases to this occasion: in the case of a young person with strong qi, a widower controlling his desire with all his will, or when one controls desires against one's will, the essence leaks without one's notice. This is the same as the overflowing of water in a bottle. Such a case happens at times, and there is no need for medication. When a person with a weak heart qi is not able to control his essence, or when yang qi is not collected due to a heat pathogen in the heart, the essence leaks. This is the same as the flowing water from a tilted bottle. It happens to many men, and the symptoms are mild, so harmonizing and placid medicines should be used. When the viscera and bowels gradually get weak and the genuine foundation is harmed for a long time, the heart is not able to think well and the kidneys are not able to store essence so the essence leaks. This is the same as water leaking from a broken bottle through a crack. Such a case does not happen often, but it is very severe. Medicines that tonify greatly must be used for the cure." 

夢遺不可作虛冷, 亦有經絡熱而得之. 嘗治一人, 至夜脊心熱, 夢遺, 用珍珠粉丸, 猪苓丸, 遺止, 而終服紫雪, 脊熱始除. 淸心丸亦佳. 《本事》
Dream emissions happen not only to the weak and cold but also to those with heat in the meridians. I once treated a patient with dream emission who felt heat in the middle of the spine. I prescribed a Pearl Powder Pill and Polyporus Pill, and his dream emissions stopped; after taking Purple Snow (紫雪), the heat in the middle of the spine vanished. A Clear Heart Pill is also good in this case. 

夢遺全屬心. 盖交感之精, 雖常有一點白膜裹藏於腎, 而元精以爲此精之本者, 實在乎心. 日有所思, 夜夢而失之矣. 宜黃連淸心飮. 《入門》
Dream emissions are solely related to the heart. The semen from intercourse is always stored in the kidneys under a small white membrane, but the genuine essence which is the origin of the semen is in the heart. A person dreams at night what he is longing for during the day and loses essence. A Coptis Clear Heart Drink must be prescribed.

夢與鬼交而泄精, 名曰夢遺. 專主於熱, 用黃柏ㆍ知母ㆍ牡蠣ㆍ蛤粉. 若內傷氣血, 不能固守, 而夢遺者當補, 以八物湯加減, 呑樗根皮丸. 八物湯方見虛勞
Dream emission is the leakage of semen from interacting with a ghost in the dream. This happens solely from the heat, so Phellodendri Cortex (黃柏), Anemarrhenae Rhizoma (知母), Ostreae Testa (牡蠣), and Anodontae Caro Pulvis (蛤粉) should be used. When the dream emission results from damaged qi and blood not protecting the essence well modified, an Eight Substances Decoction should be prescribed with a Euonymi Cortex Pill. [The Eight Substances Decoction is found in the chapter Deficiency Vexation].

[夢泄亦屬鬱]
[Dream Emissions also Pertain to Stagnation]

本事曰, 腎氣閉, 卽泄精. 素問曰, 腎者, 作强之官, 伎巧出焉. 又曰, 腎藏精. 盖腎能攝精氣, 以生育人倫者也. 或育或散, 皆主於腎. 今腎氣衰, 則一身之精氣, 無所管攝, 故妄行而出不時, 猪苓丸一方, 正爲此設.
It is said in the Formulas for Universal Relief (本事), "Essence leaks when kidney qi is blocked." It is also said in the Basic Questionss (素問), "Kidneys are the office of labor, and convergencies of vital energy come from them." Also, it said, "kidneys store essence." The kidneys collect the essence-qi, give birth, and nurture. The collecting and dispersing of essence-qi all depends on the kidneys. When kidney qi is weak, essence-qi in the body is not collected well; this leads essence-qi to flow haplessly, and essence leaks at any time. A Polyporus Pill is used to treat such symptoms. 

綱目曰, 夢遺屬鬱滯者, 居太半, 庸醫不知其鬱, 但用澁劑固脫, 殊不知愈澁愈鬱, 其病反甚. 嘗治一男子, 夢遺白濁, 小腹有氣衝上, 每日腰熱, 卯作酉涼, 腰熱作則手足冷, 前陰無氣, 腰熱退則前陰氣耕, 手足溫. 又朝多下氣, 暮多噫氣, 一旬二旬必遺. 脉且弦滑而大, 午則洪大. 予知其有鬱滯, 先用沈香和中丸下之方見痰飮, 次用加減八味湯方見五藏, 呑滋腎丸方見小便百丸. 若與澁藥則遺與濁反甚, 或一夜再遺, 改用導赤散方見五藏大劑煎服, 遺濁皆止.
It is said in the Compendium of Medicine (綱目), "More than half of the dream emissions are due to gi stagnation. Foolish doctors do not know that it is from qi stagnation and keep on using astringing medicines to stop the leakage. However, the more medication is applied to stop the leakage, the more severe the stagnation symptoms become. The diseases get worse by the minute. Once a man had murky urine and upsurging qi from the lower abdomen due to dream emissions and felt heat along the waist every day at the time of Myo (5:00 am 7:00 am) and cooling down at the time of yu (5:00 pm - 7:00 pm). When heat is felt along the waist, the hands and feet become cold with a weak penis, and as the heat subsides the hands and feet warm up and the penis gathers qi. Also, he passed gas often in the morning and belched often in the evening, and had dream emissions every 10-20 days. The pulse was slippery, string-like, and large, and became surging and large during the day. I figured he had qi stagnation and prescribed an Aquilaria Pill to Harmonise the Center [The prescription is in the chapter Phlegm]. To induce diarrhea and prescribed a Modified Eight Ingredient Decoction [The prescription is in the chapter Five Viscera] with 100 pills of Nourish Kidneys Pill [The prescription is in the chapter Urine]. If astringing medicines are used, the urine gets even murkier and the dream emissions appear as often as twice a night. If this happens, prescribe concentrated Guide Out Red Powder [The prescription is in chapter Five Viscera] to treat the dream emissions and murky urine at the same time. 

又一男子夢遺, 醫與澁藥反甚, 先與神芎丸方見五藏大下之, 却服此猪苓丸亦痊. 可見夢遺屬鬱滯者多矣.
Another man also had dream emissions, which were aggravated after taking astringing medicine. I first prescribed a Spiritual Chuanxiong Pill [The prescription is in chapter Five Viscera] to induce diarrhea and then prescribed Polyporus Pill. The two cases show that many cases of dream emissions result from stagnation.

[精滑脫屬虛]
[Spermatorrhea Belongs to Deficiency]

靈樞曰, 恐懼而不解則傷精, 精傷則骨痠痿厥, 精時自下. 又曰, 精脫者耳聾.
In the Divine Pivot (靈樞), it says "Essence is harmed if fear is not resolved. When essence is harmed, bones get chilly, hands and feet cold, legs weak, and essence spontaneously leaks from time to time." Also, it says "If essence lacks greatly, hearing loss will follow." 

內經曰, 思想無窮, 所願不得, 意淫於外, 入房太甚, 宗筋弛縱, 發爲筋痿, 及爲白淫. 夫腎藏天一, 以慳爲事, 志意內治, 則精全而澁. 若思想外淫, 房室太甚, 則固有淫泆不守, 輒隨溲尿而下. 然本於筋痿者, 以宗筋弛縱也. 《謙甫》
It is said in the Inner Classic (內經), "The penis gets weak when a man keeps on thinking and yet does not achieve what one wants, has too many obscene thoughts, or has excessive intercourse, which all wilt the penis and leads to muscular flaccidity and white ooze." The essence in the kidneys must be treasured; if the mind is controlled well, the essence is stored well and does not leak. If the thoughts are too many or one has excessive intercourse, the essence cannot be protected well and leaks along with urine without notice. Therefore, the wilting of the penis results from muscular flaccidity.

其不御女漏者, 或聞淫事, 或見美色, 或思想無窮, 所願不得, 或入房太甚, 宗筋弛縱, 發爲筋痿而精自出者, 謂之白淫. 宜乎滲漏而不止也. 宜加減珍珠粉丸方見小便.
When a man's essence leaks without intercourse, it is from the weakness of the penis. This muscular flaccidity results when an obscene story is heard, a beautiful woman is seen, many thoughts do not result in achievements, or when intercourse is excessive. White ooze is spontaneously leaking semen due to muscular flaccidity. Since essence is continuously leaking, Modified Pinctada Powder Pill. [The prescription is in the chapter Urine] must be prescribed. it is said, "Essence leaks along with one's desire. When it is not ejected for a long time, there will be itching and pain inside the penis, and the person will have an urge to urinate all the time. If essence is urinated or leaks, it is called seminal emission. This is a worse symptom than dream emission, so a modified Eight Substances Decoction should be taken with a Pearl Powder Pill. [The prescription was mentioned previously] must be prescribed. 

又曰, 慾心一動, 精隨念去, 凝滯久則莖中痒痛, 常如欲小便, 然或從小便而出, 或不從便出而自流者, 謂之遺精. 比之夢遺尤甚, 八物湯加減, 呑珍珠粉丸方見上.
Also, it is said, "Essence leaks along with one's desire. When it is not ejected for a long time, there will be itching and pain inside the penis, and the person will have an urge to urinate all the time. If essence is urinated or leaks, it is called seminal emission. This is a worse symptom than dream emission, so a modified Eight Substances Decoction should be taken with a Pearl Powder Pill. [The prescription was mentioned previously]."