Part 3: General Discussion of Syndromes of Male Sexual Dysfunction in Middle-Aged and Elderly Men and Qi Stagnation Syndrome

Traditional Chinese medicine believes that the causes of decreased sexual function in middle-aged and elderly men are nothing more than two aspects: deficiency and excess. It may be due to the decline of organs with age, resulting in deficiency of qi, blood, yin and yang, leading to functional decline; or it may be due to the invasion of phlegm, dampness, cold and heat, causing stagnation of qi and blood in the body, leading to functional disorders. The former forms deficiency syndromes, such as qi deficiency, essence deficiency, yin deficiency, and yang deficiency; the latter forms excess syndromes, such as qi stagnation, phlegm dampness, damp heat, and blood stasis.

However, the two are not entirely separate; they often influence each other, are mutually causal, and are intricately intertwined, forming a complex syndrome involving both deficiency and excess. In clinical treatment, the location and nature of the disease should be clearly distinguished first to determine its syndrome type.

However, based on the author's clinical experience, decreased sexual function in middle-aged and elderly men is often not an independent disease, but rather a symptom of many geriatric diseases during the aging process. Satisfactory results can only be achieved by combining treatment with these primary geriatric diseases.

Therefore, in clinical treatment, while determining the syndrome type, it is also necessary to combine it with Western medicine's disease differentiation, and select appropriate treatment methods and prescriptions based on the primary geriatric disease, that is, to adopt a treatment method that combines syndrome differentiation and disease differentiation.

The syndrome types introduced in this section specifically refer to those of sexual dysfunction in middle-aged and elderly individuals, and the listed diseases are also common geriatric diseases that can lead to sexual dysfunction. However, younger patients with sexual dysfunction can also be treated in accordance with these syndrome types, which reflects the characteristic of traditional Chinese medicine of "treating different diseases with the same method and treating the same disease with different methods."

I. Qi stagnation

This syndrome is generally characterized by low libido, weak erection, premature ejaculation, accompanied by depression, a sorrowful expression, taciturnity, irritability, dizziness, chest and rib distension, bitter taste in the mouth, dry throat, abdominal distension, poor appetite, dark red tongue, white or slightly yellow coating, and wiry pulse.

The liver governs the free flow of Qi. When liver Qi is stagnant and fails to rise, one becomes depressed, taciturn, and unhappy. When liver Qi is stagnant and obstructed, one's will is not fulfilled, hence one's libido is weak. The liver governs the tendons. When liver Qi is not smooth, the Qi mechanism is obstructed, and blood circulation is disrupted, resulting in the tendons being malnourished and becoming weak. When the Jueyin wind Qi is obstructed, the Shaoyang fire rises excessively in the lower body, leading to premature ejaculation. When liver Qi is stagnant and the meridians are obstructed, one experiences chest and rib distension. When liver Qi is stagnant and fails to ascend, one experiences dizziness. When liver Qi invades the spleen and its digestive function is disrupted, one experiences abdominal distension and poor appetite. When Qi stagnation transforms into fire, one becomes irritable and easily angered. When body fluids are depleted and fail to ascend, one experiences a bitter taste in the mouth and a dry throat.

This condition is commonly seen in the following diseases:

(1) Neurasthenia is characterized by headache, dizziness, anxiety, chest tightness, belching, nausea, and a feeling of obstruction in the throat. The syndrome is due to liver qi stagnation. The treatment should focus on soothing the liver, regulating qi, relieving depression, and relieving chest tightness. The formula is Yueju Pill with modifications.

(2) Liver cirrhosis is characterized by fatigue, loss of appetite, abdominal distension, and dull pain in the right hypochondrium. The syndrome is due to stagnation of liver qi. The treatment should focus on soothing the liver and regulating qi, strengthening the spleen and stomach. The formula is modified Chaihu Shugan San.

(3) Hyperthyroidism is characterized by goiter, exophthalmos, irritability, palpitations, emaciation, and high blood pressure. The syndrome is due to qi stagnation and phlegm accumulation. The treatment should focus on relieving stagnation and dispersing stagnation. The prescription is Xiao Chai Hu Tang with modifications.

(4) Hypertension is characterized by dizziness, headache, flushed face and red eyes, irritability and anger, and a red tongue. The syndrome is liver stagnation and fire transformation. The treatment should be to soothe the liver and relieve stagnation, clear fire and heat. The prescription is modified Longdan Xiegan Tang.

(5) Male menopausal syndrome is characterized by palpitations, irritability, mood swings, insomnia, impotence and premature ejaculation in men around 60 years old. The syndrome is attributed to liver stagnation and fire. The treatment should focus on soothing the liver and relieving stagnation, clearing liver fire, and using modified Chaihu Qinggan Decoction.

II. Phlegm and Dampness

This syndrome is generally characterized by decreased libido, impotence or weak erection, scrotal dampness, and is accompanied by obesity, heaviness and discomfort in the body, drowsiness and fatigue, sticky phlegm in the mouth, abdominal distension and poor appetite, pale and swollen tongue with white and greasy coating, and wiry and slippery pulse.

Phlegm and dampness impair the spleen's function, leading to dysfunction in its transport and transformation. If phlegm and dampness are not eliminated, abdominal distension, poor appetite, sticky mouth with excessive phlegm, and obesity will result. In obese individuals, phlegm and dampness stagnate, preventing the free flow of Yang Qi, thus reducing libido. Phlegm and dampness obstruct the middle Jiao, impairing the spleen and stomach, and preventing the distribution of clear Yang, resulting in heaviness, discomfort, drowsiness, and fatigue. When the spleen is not functioning properly, the production of Qi and blood is insufficient, leading to malnourishment of the tendons and muscles, resulting in insufficient penile fertility and impotence. Phlegm and dampness obstruct the lower Jiao, leading to scrotal dampness.

This condition is commonly seen in the following diseases:

(1) Emphysema is characterized by cough, wheezing and shortness of breath, and expectoration of white sticky sputum. The syndrome is due to spleen deficiency and phlegm obstruction. The treatment should focus on strengthening the spleen and replenishing qi, eliminating phlegm and relieving asthma. The prescription is modified Woxue Decoction.

(2) Atherosclerosis is characterized by obesity, dizziness, drowsiness, palpitations and chest tightness, or epileptic-like seizures. The syndrome is due to spleen deficiency and phlegm dampness. The treatment should focus on strengthening the spleen and stomach, eliminating dampness and resolving phlegm. The prescription is modified Xianshu Fuling Wan.

(3) Hypertension is characterized by obesity, headache and dizziness, tremors of the mouth and eyes, stiff neck, numbness of the hands and feet. The syndrome is caused by wind and phlegm disturbing the upper body. The treatment should be to calm the liver and extinguish wind, dry dampness and resolve phlegm. The prescription is modified Banxia Baizhu Tianma Decoction.