Part 4: Damp-Heat, Blood Stasis, and Qi Deficiency Syndromes in Middle-Aged and Elderly Men with Decreased Sexual Function
III. Damp-heat
This syndrome is generally characterized by penile weakness and inability to achieve an erection or easy erection but premature ejaculation during intercourse, damp heat and itching or swelling and pain in the scrotum, frequent nocturnal emissions, accompanied by a dirty complexion, lower back pain and weakness, dry or sticky stools, scanty dark urine, red tongue, yellow and greasy tongue coating, and slippery and rapid pulse.
When damp heat is present, the tendons of the penis are damaged and become loose and difficult to lift; when damp heat disturbs the interior, the ministerial fire runs rampant and fails to function properly, resulting in easy erection but premature ejaculation; when damp heat accumulates and flows down the meridians, itching, swelling and pain in the scrotum, constipation and dark urine occur; when damp heat disturbs the seminal vesicle, the seminal vesicle is not sealed, so frequent seminal emission occurs; the waist is the residence of the kidneys, and when damp heat stagnates in the liver and kidneys, it causes soreness and weakness in the waist.
This condition is commonly seen in benign prostatic hyperplasia. Its characteristics include scanty, dark urine that is dribbling down and ending in cloudy urine. White mucus may also be discharged from the urethra during defecation. The condition is diagnosed as damp-heat in the bladder. Treatment should focus on clearing heat and dampness, and promoting bladder function. The formula used is Bazheng San with modifications.
IV. Blood stasis
This condition is generally manifested as penile inability to achieve or maintain an erection for a short period of time, or inability to ejaculate during intercourse, postcoital ejaculation, intermittent pain in the genital area, purplish-dark glans penis, varicose veins, accompanied by emaciation, dark and sallow complexion, rough and dry skin, dry mouth without thirst, chest tightness and discomfort, purplish-dark tongue with petechiae and ecchymosis, and a deep, wiry or thready and intermittent pulse.
When the seminal vessels are obstructed, the flow of seminal blood is disrupted, and the tendons of the penis are not nourished, resulting in erectile dysfunction or short duration of erection. When qi and blood are not flowing smoothly, and seminal blood stagnates, the seminal vessels become varicose. When blood stasis obstructs the seminal gate, it fails to open during intercourse, or opens but does not flow smoothly after intercourse, thus causing inability to ejaculate or nocturnal emission. When blood stasis obstructs the flow, there is intermittent pain in the genital area and a purplish-dark glans penis. When qi cannot flow, it is obstructed in the chest, thus causing chest tightness and discomfort. When qi cannot distribute body fluids, there is dry mouth and no desire to drink. When qi and blood circulation is not smooth, the muscles and skin are not nourished, thus causing emaciation, a dull complexion, and rough, dry skin.
This condition is commonly seen in the following diseases:
(1) Benign prostatic hyperplasia is characterized by urinary obstruction or thinning of the urine stream, dribbling, enlarged and hard prostate with tenderness. The syndrome is due to turbidity and blood stasis obstruction. The treatment should promote blood circulation, remove turbidity and clear the water passages. The prescription is modified Daidi Dang Wan.
(2) Atherosclerosis is characterized by headaches that feel like stabbing or piercing, dizziness and palpitations, chest tightness and chest pain, and numbness in the limbs and fingers. The syndrome is due to blood stasis and qi stagnation. The treatment should focus on removing blood stasis, promoting qi circulation and unblocking the meridians. The prescription is modified Huoxue Tongmai Pian.
(3) Sequelae of cerebrovascular accident, characterized by hemiplegia, slurred speech, numbness in the hands and feet, and muscle weakness. The syndrome is due to qi deficiency and blood stasis. The treatment should be to replenish qi and blood, promote blood circulation and remove blood stasis. The prescription is Buyang Huanwu Decoction with modifications.
5. Qi deficiency
This syndrome is generally characterized by decreased libido, weak erection, excessive sweating and fatigue after intercourse, premature ejaculation and seminal emission, accompanied by dizziness and tinnitus, shortness of breath and reluctance to speak, fatigue and weakness, poor appetite, spontaneous sweating, clear and copious urine, dribbling after urination, frequent urination at night, pale tongue with white coating, and weak pulse.
When the spleen is deficient, its function of transformation and transportation is impaired, resulting in poor appetite. When the production of qi and blood is insufficient, the muscles of the limbs are not adequately nourished, leading to shortness of breath, reluctance to speak, fatigue, and weakness. When the spleen is deficient, it cannot retain body fluids, resulting in excessive sweating. When the kidney qi is deficient, it cannot retain semen, resulting in premature ejaculation and spermatorrhea. When the spleen's function of transformation and transportation is impaired, the kidney's essence and qi become weak, resulting in decreased libido and impotence. When the kidney essence is depleted, the marrow sea is not replenished, resulting in dizziness and tinnitus. Since the kidney and bladder are internally and externally related, when the kidney qi is weak, the bladder loses its control, resulting in clear and copious urine, dribbling after urination, and frequent urination at night.
This condition is commonly seen in the following diseases:
(1) Benign prostatic hyperplasia is characterized by frequent urination, frequent nighttime urination, weak urination, incomplete emptying, or urinary incontinence due to abdominal distension. The syndrome is due to spleen and kidney qi deficiency. The treatment should be to warm and tonify the spleen and kidney, and to replenish qi and open the orifices. The prescription is Jisheng Shenqi Wan with modifications.
(2) Emphysema is characterized by shortness of breath, more exhalation than inhalation, inability to sustain breath, and worsening of shortness of breath with exertion. The syndrome is due to deficiency of lung and kidney qi. The treatment should be to warm and tonify the lung and kidney, and relieve shortness of breath. The prescription is modified Jin Kui Shen Qi Wan.
(3) Liver cirrhosis is characterized by fatigue, loss of appetite, abdominal distension and pain, diarrhea, pain relief after defecation, stool containing mucus or coarse particles that are not digested, and edema of the limbs. The syndrome is due to spleen deficiency. The treatment should focus on soothing the liver and stomach, tonifying the spleen and strengthening the kidneys. The prescription is Tongxie Yaofang with modifications.
(4) Neurasthenia is characterized by dizziness, tinnitus, forgetfulness, palpitations, dreaminess and insomnia. The syndrome is due to deficiency of both heart and spleen. The treatment should be to invigorate qi and spleen, nourish blood and calm the mind. The prescription is Gui Pi Tang with modifications.
(5) Diabetes mellitus is characterized by dry mouth and tongue, thirst but not drinking much, emaciation, fatigue and weakness. The syndrome is due to deficiency of both qi and yin. The treatment should be to tonify the spleen and replenish qi, nourish yin and generate fluids. The formula is Ziqiang Yin with modifications.
VI. Deficiency of essence
This syndrome is mainly characterized by decreased libido, impotence, thin and watery semen, low sperm count, and infertility. It is also accompanied by symptoms such as lethargy, haggard appearance, back pain, weakness in the waist and knees, hair loss and loose teeth, tinnitus and deafness, forgetfulness and confusion, slow movements, pale tongue, and weak pulse.
Kidney essence is the foundation of sexuality and reproduction. When kidney essence is deficient, the essence cannot transform into yang, the essence and qi are weak and cold, the yang function is weak, resulting in decreased libido, impotence, low sperm count and infertility. Insufficient essence cannot nourish the bone marrow, and the bone marrow is not nourished, resulting in soreness and weakness in the lower back. When the mind is empty, there will be tinnitus, deafness, forgetfulness, confusion and slow movements. When essence is deficient and premature aging occurs, there will be mental fatigue, haggard appearance, hair loss and loose teeth.
This condition is commonly seen in the following diseases:
(1) Gonadal dysfunction is characterized by thin semen, reduced sperm count, infertility, low libido, inability to achieve erection, and unclear diurnal rhythm. The syndrome is due to kidney essence deficiency. The treatment should focus on tonifying the kidney and nourishing essence. The prescription is modified Guilu Erxian Jiao.
(2) Male menopausal syndrome is characterized by physical decline, decreased libido, impotence and erectile dysfunction in men around 60 years old, accompanied by abnormal psychological state. The syndrome is attributed to deficiency of essence and yang. The treatment should be to warm the kidneys and replenish essence, regulate yin and yang, and use Huanshao Dan with modifications.
(3) Atherosclerosis is characterized by blurred vision, dizziness, palpitations, leg pain, unsteady gait, and cold hands and feet. The syndrome is due to deficiency of kidney essence. The treatment should focus on replenishing qi and blood, nourishing the kidney and replenishing essence. The formula is Sanhuang Pill with modifications.
(4) Hypertension is characterized by severe dizziness, palpitations, forgetfulness, weakness in the limbs, unsteady gait, and puffy face. The syndrome is due to kidney essence deficiency. The treatment should focus on strengthening the kidney and nourishing yin, warming yang and transforming qi. The formula is Zuogui Wan with modifications.
(5) Diabetes mellitus is characterized by urine that is like paste or fat, or urine that is like urination after drinking, significant weight loss, fatigue and weakness. The syndrome is due to kidney essence deficiency. The treatment should be to tonify the kidney and replenish essence, nourish yin and warm yang. The prescription is Deer Antler Pill with modifications.
VII. Yin Deficiency
This syndrome is generally characterized by hypersexuality, easy erection but difficulty in maintaining an erection, easy ejaculation during intercourse, or nocturnal emission. It is also accompanied by emaciation, flushed cheeks, dry mouth and throat, dizziness, insomnia, palpitations, forgetfulness, fever, night sweats, weakness of muscles and bones, soreness and weakness of the lower back and knees, red tongue with little coating, and a thready and rapid pulse.
When Yin essence is depleted, the head and eyes are not nourished, hence dizziness, forgetfulness, dry mouth and throat; Yin deficiency leads to internal heat, hence irritability, flushed cheeks, and night sweats; heat disturbs the mind, hence palpitations and insomnia; heat disturbs the seminal chamber, hence easy arousal, premature ejaculation and seminal emission; however, when Yin essence is depleted, the tendons and bones are not nourished, hence difficulty in achieving an erection, weakness of tendons and bones, soreness and weakness of the lower back and knees, emaciation and weakness.
This condition is commonly seen in the following diseases:
(1) Atherosclerosis is characterized by dizziness, headache, tinnitus, blurred vision, palpitations or pain, and numbness and weakness in the limbs. The syndrome is due to liver and kidney yin deficiency. The treatment should nourish the liver and kidney, nourish yin and subdue yang. The prescription is Qibao Meiran Dan with modifications.
(2) Hypertension is characterized by dizziness, headache, blurred vision, tinnitus, palpitations, easy startling, and flushed cheeks. The syndrome is due to yin deficiency and yang hyperactivity. The treatment should be to nourish the liver and kidneys, nourish yin and reduce fire. The prescription is modified Qi Ju Di Huang Tang.
(3) Sequelae of cerebrovascular accident, characterized by hemiplegia, facial paralysis, and speech impairment, are diagnosed as liver and kidney yin deficiency. The treatment should focus on nourishing the liver and blood, and tonifying the kidney and yin. The prescription is Dihuang Yinzi with modifications.
(4) Chronic renal failure is characterized by headache, dizziness, dry skin, and scanty, yellow urine. The syndrome is due to yin deficiency and yang hyperactivity. The treatment should nourish the liver and kidneys, subdue yang and reduce fire. The prescription is modified Qi Ju Di Huang Tang.
(5) Chronic adrenocortical insufficiency is characterized by dizziness, insomnia, forgetfulness, irritability, pigmentation of the skin and mucous membranes, emaciation, constipation, impotence and premature ejaculation. The syndrome is due to liver and kidney yin deficiency. The treatment should nourish the liver and kidneys, and the formula is Zuogui Wan with modifications.
(6) Hyperthyroidism is characterized by palpitations and irritability, increased appetite, haggard appearance, muscle wasting, and constipation. The syndrome is due to yin deficiency of the heart and kidneys. The treatment should focus on nourishing yin and reducing fire, benefiting the kidneys and calming the mind. The prescription is Tianwang Buxin Dan with modifications.
(7) Diabetes mellitus is characterized by thirst and a desire to drink, hunger and a strong appetite, and dark yellow urine. The syndrome is due to dryness and heat damaging Yin. The treatment should focus on nourishing Yin, clearing heat, moistening dryness and reducing fire. The formula is Yu Nu Jian with modifications.
(8) Neurasthenia is characterized by headache, dizziness, tinnitus, blurred vision, insomnia, dreaminess, forgetfulness, anxiety, palpitations, easy startling, impotence and premature ejaculation. The syndrome is due to disharmony between the heart and kidneys. The treatment should focus on nourishing yin and reducing fire, and harmonizing the heart and kidneys. The prescription is Tianwang Buxin Dan with modifications.
(9) Emphysema is characterized by shortness of breath, which worsens with exertion, cough, and difficulty expectorating phlegm. The syndrome is due to lung and kidney yin deficiency. The treatment should nourish the lung and kidney, and nourish yin to resolve phlegm. The prescription is Baxian Longevity Pill with modifications.
(10) Benign prostatic hyperplasia is characterized by frequent or dribbling urination, which occurs intermittently and is yellow or reddish in color. The syndrome is due to kidney yin deficiency. The treatment should nourish the liver and kidneys and clear the water passages. The prescription is Zhi Bai Di Huang Wan with modifications.
8. Yang deficiency
This syndrome is generally characterized by low libido, impotence, premature ejaculation, and spermatorrhea, accompanied by a pale complexion, premature graying of hair, cold limbs, fatigue, cold pain in the lower back, knees, and lower abdomen, poor appetite, diarrhea at dawn, facial and limb edema, a pale and tender tongue with a white and slippery coating, and a deep and weak pulse.
The kidneys are the foundation of innate constitution, while the spleen is the foundation of acquired constitution. When the spleen and kidneys are deficient in yang, they cannot warm and nourish the limbs and bones, resulting in a pale complexion, cold limbs, and fatigue. Yang deficiency and internal coldness cause stagnation in the meridians, leading to cold pain in the lower back, knees, and lower abdomen. Food and water cannot be properly digested and transported, resulting in poor appetite and diarrhea before dawn. Weak yang qi cannot transport and transform water and dampness, resulting in facial and limb edema. Spleen and kidney yang deficiency and weak qi lead to deficiency and coldness of essence and qi, resulting in low libido, impotence, and premature graying of hair. Kidney deficiency cannot retain semen, resulting in premature ejaculation and spermatorrhea.
This condition is commonly seen in the following diseases:
(1) Gonadal dysfunction is characterized by a significant decrease in libido, or even no libido, penile flaccidity, inability to erect, loss of diurnal rhythm, clear and cold semen, and infertility. The syndrome is kidney yang deficiency. The treatment should be to tonify the kidney and warm the yang. The formula is Yougui Wan with modifications.
(2) Chronic adrenocortical insufficiency is characterized by skin and mucous membrane pigmentation, fatigue, loss of appetite, nausea and vomiting, abdominal pain, lethargy, sparse pubic and axillary hair, and impotence. The syndrome is due to spleen and kidney yang deficiency. The treatment should be to warm and tonify the spleen and kidney, and the formula is Yougui Wan with modifications.
(3) Hypothyroidism is characterized by pale complexion, apathy, aversion to cold, forgetfulness, dry, sparse and easily falling hair, pale, edematous and cold skin, poor appetite and constipation. The syndrome is due to spleen and kidney yang deficiency. The treatment should be to warm and tonify the spleen and kidney, and to help yang and replenish qi. The prescription is Yougui Wan with modifications.
(4) Neurasthenia is characterized by dizziness, blurred vision, tinnitus, deafness, insomnia, dreaminess, impotence and premature ejaculation. The syndrome is due to kidney yang deficiency. The treatment should be to warm yang and dispel cold, and to benefit essence and strengthen the kidney. The formula is Yougui Wan with modifications.
(5) Chronic renal failure is characterized by general weakness, loss of appetite, nausea and vomiting, decreased urination, or even anuria. The syndrome is due to yang deficiency and yin excess. The treatment should be to warm and tonify the spleen and kidneys, and to descend the rebellious qi and eliminate turbidity. The formula is Zhenwu Decoction with modifications.