What are the causes, clinical manifestations, diagnosis and treatment methods of impotence?

Impotence refers to an adult man’s penis that is weak and unable to be lifted, or cannot be lifted firmly, and cannot be inserted into the vagina; or although it can be erect and inserted into the vagina, it becomes weak and weak instantly, so that sexual intercourse cannot be completed satisfactorily or cannot be completed. Sexual dysfunction in men having intercourse.

1. Causes and Pathogenesis Traditional Chinese medicine believes that the onset of impotence is closely related to the overall view of the body, and there are many reasons for it, but deficiency syndrome is often the most common clinical condition.

(1) Kidney Qi deficiency: The kidney stores essence and governs development and reproduction. Jing can transform qi, and the qi metabolized by kidney essence is called "kidney qi". It is produced by the steaming of kidney yang into kidney yin. It is the foundation of human yang and plays a warming and biochemical role in various organs and tissues of the human body. If due to fatigue, internal injuries, old age and frailty; or insufficient congenital endowment; or long-term illness and overwork of the kidneys and chambers, etc., it can lead to insufficient kidney qi and lead to kidney qi deficiency, which in turn can lead to kidney yang deficiency and decreased sexual function. or impotence.

Clinically, it is characterized by infrequent penile erection, inability to hold the penis firmly, and soreness and weakness in the waist and knees.

(2) Mingmen fire decline: Zhang Jiebin's "Jingyue Complete Book·Mingmen Yuyi" says: "Mingmen is the root of vitality and the home of water and fire. The Yin Qi of the five internal organs cannot be nourished otherwise. The Yang Qi of the five internal organs cannot be produced unless it is this, and the spleen and stomach cannot be produced without fire from the soil of Zhongzhou..." From this, we can see that Mingmen is the root of Yang Qi in the human body. If the deficiency of kidney qi develops further, it can lead to the internal growth of yin-cold, the weakening of vitality fire, and impotence with the main symptoms of inability to lift the penis, fear of cold and cold limbs, and soreness and weakness of the waist and knees.

(3) Stomach qi deficiency: People take stomach qi as the basis, mainly to absorb and nourish the essence of cooked water and grains to nourish the whole body. The strength of stomach qi directly affects the functional activities of the organs, as stated in " "The Zhongzang Sutra" says: "If the stomach qi is strong, the five internal organs are strong." Diet is the main source of nutrients needed by the human body after birth, and is also the main material basis for generating qi and blood. The spleen and stomach have the ability to digest and absorb food. and transfer function, so it is said to be "the foundation of acquired nature" and "the source of Qi and blood biochemistry". If the stomach qi is damaged due to hunger and fullness, improper diet, disorder after illness, improper medication; or if the stomach is congenitally weak, the main symptoms of impotence will be Yangming stomach qi deficiency, difficulty in nourishing the zongjin, and lack of yang activity. Therefore, Ye Tianshi said in "Clinical Guide Medical Records·Impotence": "If there is also Yangming deficiency, the Zongjin will be vertical, and the stomach will be like a sea of ??water and grains. Food intake will not be strong, and the essence and Qi will be deficient. In the case of men's external kidneys, their It’s called potential. If the grain energy is not sufficient, isn’t it difficult to achieve a strong and vigorous performance? The only way to cure it is to nourish the Yangming.”

(4) Deficiency of the heart and spleen: the heart governs the blood vessels and can. It supplies the blood required for physiological functions of the whole body to maintain the normal functions of the human body. At the same time, the heart governs the mind and is closely related to people's mental and thinking activities. Therefore, the heart plays an important role in the functional activities of various internal organs. Therefore, the heart is the "biggest organ of the five internal organs". "Lord" title. The spleen governs transportation and transformation, and governs blood. It transports the essence of water and grains as well as water, so that the tissues and organs of the human body are nourished and fully moistened by water. Its function of controlling blood also has the function of allowing blood to flow in the veins for nutrition. The whole body, so there is a saying that "the spleen is acquired".

Zhang Jiebin said in "The Complete Book of Jingyue·Impotence": "Those who are worried, anxious, and too melancholy often cause impotence. The meeting of Yin and Yang's main tendons will meet in Qi Street, and Yangming will do it. If the heart and spleen are damaged by excessive worry, the Yangming Chong meridians will become ill, and the sea of ??water, grain, qi and blood will be depleted. , Qi and blood are deficient and the Yang Daosi is weak. Diseases caused by the two Yangs during the day are caused by the heart and spleen, and there is no hidden disease, and the woman is not in the moon. "Therefore, if the body is weak, or thinks too much, or is sick. Later, if the Qi of the heart and spleen is damaged due to lack of nourishment, there may be weak sexual desire and a weak penis, accompanied by impotence as the main symptoms, such as palpitations, fatigue, and anorexia.

(5) Bile deficiency and panic can damage the kidneys: The liver is related to mental emotions and gallbladder. Therefore, the rise and fall of gallbladder qi often involves mental and emotional activities. "Lei Jing" says: "Although liver qi is Strongness does not come from the gallbladder. The liver and gallbladder help each other, and courage is achieved. ""Clinical Guide to Medical Records" says: "If there is stasis and damage to the yang, it must be treated from the gallbladder. The Gai Jing says: All eleven internal organs depend on the gallbladder. "It is also said: "Shaoyang is the pivot. If the courage can be relaxed, why is there depression?" "Jingyue Complete Book·Impotence" also says: "Anyone who is frightened and refuses to let go will also suffer from impotence. This is what the kidneys may be damaged during menstruation." Ye. Therefore, if a person is frightened and loses urine, it is a sign of kidney damage; or if there is a sudden fright when the yang is strong, the yang will become impotent, which is also a sign of gallbladder deficiency. It can lead to emotional depression, and it is easy to be frightened and damage the kidneys. If the person is weak, timid and suspicious, or has a history of impotence due to fright during sexual intercourse, and then recalls the scene when the fright occurred, he will be full of doubts every time he has sex and will not do anything impotent; he may also hear voices at ordinary times. And fear, hearing the sound and palpitating.

(6) Cold stagnates the liver pulse: "Lingshu Meridians" says: "The pulse of Jueyin from the liver foot... follows the femoral yin and enters the hair, passes through the yin organ, and reaches the lower abdomen..." and cold Evil easily damages Yang Qi, and its nature is stagnant. If the Yin and Cold are excessive, Yang Qi cannot be invigorated and Qi and blood cannot flow smoothly. Moreover, the cold nature can easily cause Qi to converge and tendons and muscles to contract. Therefore, "Lingshu·Jingjin" says: "The tendons of Jueyin of the foot...the disease is caused by the big finger branch of the foot, pain in front of the medial malleolus, internal auxiliary pain, genufemoral pain that twists the tendons, the vaginal organs are not used, and if it is injured inside, it will not rise. If it is injured by cold, the yin will shrink, and if it is injured by heat, it will be erect and unable to contract. "If the cold evil invades the liver meridian and remains there, it may cause qi stagnation in the liver meridian and blood coagulation, resulting in impotence due to insufficient blood volume required for penile erection." The main clinical features are abdominal distension and pain or testicular throbbing pain.

(7) Liver Qi stagnation: The liver governs dispersion and has the characteristics of relaxing and promoting hair growth.

In addition to being governed by the heart, people's emotional activities are also closely related to the liver. Only when the liver's drainage function is normal and the qi mechanism is smooth, can the qi and blood be peaceful and the mood comfortable; and the movement of human blood, It is also necessary to rely on the assistance of the liver's dredging and releasing function to regulate the Qi movement so that the blood flow does not cause stasis. The Liver Meridian of Foot Jueyin wraps around the yin organ, so Shen Jin'ao said in "The Origin of Miscellaneous Diseases Xizhu: The Origin of Front Yin and Back Yin": "There are also people who have lost their aspirations. Depression damages the liver, and the liver wood cannot be loosened, which can also cause impotence. "I can't afford it." Therefore, if emotions are not working well, depression and anger damage the liver, qi is stagnant, and the liver fails to release, the liver qi will be stagnant, and the blood circulation will also be stagnant. The clinical syndrome is characterized by the inability to lift the yang thing or the lifting without firmness, accompanied by emotional depression, irritability and irritability, discomfort in the chest and hypochondrium, and excessive breathlessness.

(8) Liver meridian dampness and heat: The liver meridian wraps around the vagina and reaches the lower abdomen; while dampness evil is heavy and turbid in nature and is a tangible evil that can easily invade the lower part of the human body. "Jingyue Quanshu·Impotence" says: "There are also cases where dampness and heat are so intense that the tendons relax and cause impotence and weakness. For example, when the heat is extreme, everything will wither. This is also called the strong fire-eating gas." Wang Lun "Ming Yi Miscellaneous Works: Male Impotence" says: "The penis belongs to the meridians of the liver.

The liver is covered by wood. If the wood is exposed, it will stand tall, and when exposed to extreme heat, it will wilt. If the liver meridian If the patient suffers from dampness and heat, use Longdan Xiegan Decoction to clear liver fire and guide dampness and heat; if the patient suffers from dryness and heat in the liver meridian, use Liuwei Wan to nourish the kidney water and nourish liver blood to calm himself. "If the emotions are not good, the liver qi is stagnation, and the body fluid in this meridian will be relieved." It may turn into dampness and turbidity that accumulates and turns into heat over a long period of time; or it may be caused by eating too much fat and sweet food, which makes dampness and heat; or it may be caused by internal obstruction of dampness and heat in the middle burner, stagnation of the liver and gallbladder, injury to the tendons, resulting in relaxation of the tendons. Impotence. Clinically, it is characterized by the penis being lifted but not firm and accompanied by symptoms of liver and gallbladder damp-heat or damp-heat depression.

(9) Spleen and stomach dampness and heat: The spleen and stomach are the foundation of acquired diseases, and the spleen is the "organ of Taiyin wet soil". Dampness evil is most likely to damage the spleen, and spleen deficiency is most likely to produce dampness, which accumulates dampness evil. It will take a long time to heat up. "Suwen·Qi Tongtian Lun" says: "Due to dampness, the head is like a wrap; dampness and heat are not irritating, the big tendons are soft and short, and the small tendons are long and loose. Soft and short tendons are tight, and long tendons are flaccid." "Clinical Syndrome Guide Medical Records· "Impotence" also says: "More patients suffer from damp-heat, and the tendons will be relaxed and unable to lift. The treatment is bitter and hard to strengthen the yin, and the light infiltration will remove the dampness. The dampness will be removed, the heat will be cleared, and the disease will be resolved." If the diet is not moderate, and you are addicted to alcohol and rich wine. , body fat is not diligent and dampness and turbidity arises internally, or due to spleen deficiency and abnormal transportation and transformation, the dampness evil stops internally and accumulates heat for a long time; or the external dampness and heat evil is not exhausted, causing the spleen and stomach to lose control, resulting in weak sexual desire and inability to lift the penis. . Clinical symptoms include weak sexual desire, inability to lift or lift without firmness, accompanied by abdominal fullness and tightness, nausea and vomiting, and heavy limbs.

(10) Phlegm and blood stasis blocking collaterals: Penile erection depends on the increase of penile blood flow and the maintenance of storage for a certain period of time to maintain a certain erection time. Impotence is more common when the inguinal arteries are blocked by atherosclerosis, resulting in insufficient blood flow to the penis. The evil of phlegm and turbidity is everywhere, and it is especially easy to block the meridians. Therefore, if phlegm and blood stasis block the meridians, the Qi and blood will not prosper the tendons, resulting in the penis not being strong or not lasting, and normal sexual intercourse unable to be completed. Clinically, it is characterized by the penis being unable to hold up firmly or being unable to have intercourse even though it is not sustained for a long time, accompanied by testicular swelling and pain, yellow and sparse pubic hair, or a feeling of ants walking on the skin of the perineum.

2. Clinical manifestations and diagnosis

1. Clinical manifestation: When attempting to have sexual intercourse, the penis cannot erect or the erection is not strong, and the patient cannot penetrate into the vagina for sexual intercourse.

2. Diagnosis

(1) Any adult male who has not passed the required number of Tiangui and has a weak penis that cannot erect during sexual intercourse, or is not strong when lifted, or is strong but not durable, or the penis becomes weak and soft immediately. Impotence can be diagnosed. When clinically diagnosed, it should be distinguished from the normal physiological phenomenon of a man's "eight-eight" essence being weak and unable to have sexual intercourse; it should also be distinguished from the fact that the penis can erect when he wants to have sex, ejaculate without intercourse, or ejaculate within a few seconds after entering the female. , the penis becomes weak after ejaculation, making it impossible to have normal sexual intercourse, which is the difference between premature ejaculation. The diagnosis of impotence is not difficult, but in order to distinguish psychological or organic impotence, a detailed medical history should be obtained. Carry out necessary physical examinations and special examinations to confirm the diagnosis and improve curative effect.

(2) Laboratory examination: Using modern radioimmunology, hormone levels such as plasma testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FGH) and prolactin (PRL) can be measured.

Those whose lesions are located in the testicles show hypergonadotropic hypogonadism, with increased plasma LH values ??and decreased testosterone values. Those with lesions in the pituitary gland show hypogonadism, with plasma LH and testosterone values ??lower than normal. If the main lesion is located in the hypothalamus, luteinizing hormone-releasing hormone (I.HRH) is inhibited. In addition to a decrease in plasma LH and testosterone values, there may be an increase in PRL values, and PRL is considered to have an antagonizing effect on plasma testosterone, leading to impotence. Some patients with latent hyperthyroidism only show an increase in plasma testosterone. This does not indicate an increase in the amount of testosterone produced by the testicles, but is simply the result of an increase in protein-bound testosterone. Clinical diagnosis can be based on the combination of their plasma T3 and T4 values. Increased height confirms the diagnosis. However, it should be noted that some patients with abnormal hormone levels may sometimes have nocturnal erections or successful sexual intercourse.

If the sexual life is always normal, the occasional failure of sexual intercourse cannot be called impotence. This may be caused by factors such as temporary fatigue, anxiety after a serious illness, etc. After the cause is eliminated, impotence will no longer occur. This kind of The situation does not need to be treated as impotence, but some people suffer from mental burden and develop impotence. Therefore, more than 25% of erection failures during sexual intercourse are considered impotence.

3. Syndrome differentiation and treatment

1. Kidney qi deficiency type

Syndrome is characterized by inability to erect or lift the penis, fatigue, dizziness and tinnitus, forgetfulness and deafness, shortness of breath and spontaneous sweating, and even asthma when moving, and soreness and weakness in the waist and knees. Pale tongue, thin coating, deep and weak pulse.

Treatment invigorates kidney qi and replenishes kidney essence.

Additions and subtractions of the prescription Luantong Yijing Pills: 3g deer antler (stewed separately), 15g dodder, 12g dogwood, 12g mulberry, 15g psoralen, 18g poria, 30g dangshen, 20g wolfberry, Morinda citrifolia 20g. Decoction in water or combined with the residue and then decoction, 1 dose per day.

Additions and subtractions: For those with soreness and pain in the waist and knees, add 12g of Eucommia ulmoides and 12g of dog's spine; for those with spontaneous sweating, add 30g of glutinous rice root, 30g of floating wheat, and 30g of astragalus; for those with dizziness, forgetfulness, insomnia and dreaminess, add 30g of glutinous rice root, Stir-fried jujube kernels 12g, Nocturnal vine 15g, or take Guipi pills together, 2 pills a day.

2. Mingmen Fire Deficiency Type

The syndrome is that the penis cannot be raised or is flaccid and weak, aversion to cold and cold limbs, dizziness and tinnitus, frequent nocturia and long clear urine, soreness and coldness in the waist and knees, and lukewarm limbs. The tongue is pale, the fur is thin and white, and the pulse is slow and slow.

Treat and warm the fire of life.

Prescription Yougui Pill: 240g of Rehmannia glutinosa, 120g each of Chinese yam, wolfberry, dodder, Eucommia ulmoides, and antler glue, 90g each of dogwood and angelica, 60g each of aconite and cinnamon. Honey-made pellets, take 10g once, 3 times a day. You can also take 1/10 of the medicine as a decoction in water, 1 dose per day.

For premature ejaculation, add 20g of keel bone (fried first) and 20g oyster (fried first); for those with severe waist and knee pain and frequent urination at night, add 20g of golden cherry seeds and 10g of Yizhiren; for spleen deficiency , eat less and have loose stools, add 30g of astragalus, 20g of Codonopsis pilosula, and 30g of yam.

3． Stomach Qi Deficiency Type

Syndrome differentiation shows that the yang cannot be lifted or cannot be lifted firmly, the body is emaciated, the epigastrium is uncomfortable, the abdomen is distended and stuffy or the front is lingering, the appetite is dull, and the complexion is sallow. Pale tongue with white or less coating, and weak or slow pulse.

Treatment is used to replenish stomach qi and stimulate yang.

Recipe Shenling Atractylodes Powder: 15g each of epimedium, dangshen, yam, white tuckahoe, and coix seed, 6g each of licorice, tangerine peel, and amomum villosum, Atractylodes atractylodes, platycodon, white lotus seeds, and white 10g each of lentils and actinolite, 4 red dates.

4． Heart and Spleen Deficiency Type

Syndrome is characterized by decreased sexual desire, unsteady penis, fatigue, shortness of breath, palpitations, easily frightened, less food, abdominal distension, weakness in limbs, and loss of appetite and loose stools. The tongue is light and moist, the coating is white and slightly thick, and the pulse is weak and thready or knotted.

Treatment is used to nourish the heart and spleen, and to invigorate yang.

The prescription Guipi Decoction is flavored: 15g each of Astragalus and Xianlingpi, 10g each of Atractylodes, Poria, Longan, Fried Ziziphus Seed, Patchouli, and Honeycomb, 5g of Zhigancao, ginseng, angelica, Polygala 6g each.

5. Bile deficiency, panic and kidney damage type

Diagnosis of symptoms: After panic, sexual intercourse is not carried out, and fear occurs before sexual intercourse. Cowardice is paranoid and suspicious. People are easily startled when hearing sounds in the day, and are easily startled and startled when dreaming at night. The tongue is pale, the fur is thin, and the pulse is weak or knotty.

Treatment can strengthen yang and kidneys, soothe the mind and calm the mind.

Prescription Banlong Pills and Anshen Pills: 15g each of dodder, psoralen, and wine rehmannia root, 10g each of deer antler cream, deer antler gum (for yangfu), Bai Ziren, and wine angelica, 6g coptis, and 2g cinnabar (flush) ), Zhigancao 6g.

6． Cold Stagnation Liver Pulse Type

Syndrome: The penis is erect with heavy force and cannot be held firm when lifted, and the lower abdomen is distended and painful, causing pain in both groins and testicles, or the pain is tight and the testicles and scrotum are contracted upward, and the testicles and scrotum are contracted upward when exposed to cold. Aggravation can be relieved by heat, and the scrotum is moist and cold. In some cases, the testicles may shrink, the pubic hair may fall off, or the testicles and epididymis may become swollen, hard, cold, and painful. The tongue is light red, the coating is white, and the pulse is stringy or slow.

The treatment warms the liver and dispels cold, warms the meridians and unblocks the collaterals.

Modifications and subtractions of the prescription Wenjing Decoction: 15g each of Melanium japonica and litchi core, 6-10g Evodia, angelica root, white peony root, Chuanxiong rhizome, ginseng, cinnamon twig, pinellia ternata, paeonol bark, and paojiang 6g each. , donkey hide gelatin 10g, licorice 5g.

7． Liver meridian damp-heat type

Syndrome of the liver meridian is that the penis is not firm, irritable and irritable, dry throat and bitter mouth, bloating and pain in the flanks and lower abdomen, moist and itchy scrotum, bloating and pain in the testicles or accompanied by burning sensation, and red urine Stem pain. The tongue has red edges, yellow and greasy coating, and a stringy and rapid pulse.

Treatment can clear away dampness-heat in the liver and gallbladder.

Modification and subtraction of Dongyuan Zhengyuan Decoction: 10g each of gentian, Phellodendron, Alisma, Qianghuo, Bupleurum, Anemarrhena, Plantain Seed, Scutellaria baicalensis, roasted licorice, wine-roasted twigs and cohosh. 6g each.

8． Spleen and stomach damp-heat type

Syndrome diagnosis shows weak sexual desire, inability to lift yang, abdominal distension, nausea and vomiting, sticky mouth and sweet taste, dry mouth without desire to drink, heavy and weak limbs, and uncomfortable bowel movements. Red tongue, yellow greasy or white greasy coating, slippery or slippery pulse.

Treatment can clear away heat and reduce dampness, and relieve the middle Jiao.

Modification and subtraction of the prescription Sanren Decoction: 20g of raw Yiren, 10g each of Pinellia ternata, Alisma, Almond, and Talc, 5g each of Dactylops sinensis and Pale Bamboo leaves, and 6g each of Magnolia officinalis, White Knot kernel and Agastache rugosa.

9. Liver qi stagnation type

Syndrome differentiation: inability to lift yang things or not lift them firmly, mental depression and unhappiness, chest tightness and discomfort with a tendency to sigh, fullness in the chest and flanks, dry throat or a feeling of foreign matter blocking the throat, bitter mouth, and willpower Feeling depressed or suspicious. The tongue is light red, the coating is thin white or yellow, and the pulse is deep and stringy.

Treatment can soothe the liver and relieve stagnation, regulate qi and dissipate stagnation.

Modification and subtraction of the prescription Bupleurum Shugan Powder: 15g each of Citrus aurantium, Cyperus rotundus, and Green Calyx plum, 10g each of Bupleurum, white peony root, Chuanxiong, and Yujin, and 6g each of Zhigancao and Mint.

10． Phlegm and blood stasis blocking collaterals type

Syndrome is characterized by the penis being unable to lift firmly or being firm but not lasting, dizziness and tinnitus, soreness and weakness of the lower limbs, swelling and pain in the lower abdomen and testicles, and yellow and sparse pubic hair. The tongue is dark red or has ecchymosis, the tongue coating is turbid and greasy, and the pulse is slippery, weak or stringy.

It is used to remove blood stasis and resolve phlegm, replenish qi and unblock meridians.

The prescription is also Shaodan: 15g of Chinese yam, 10g each of polygala root, Acorus calamus, Morinda officinalis, Cistanche deserticola, wolfberry, Rehmannia glutinosa, Achyranthes achyranthes, dogwood, Eucommia ulmoides, Poria cocos, Pueraria mulberry and Schisandra chinensis. 4 jujubes.

4. Adjuvant treatment

1. Prescriptions

(1) Nanbao, Jingui Shenqi Pills, Yougui Pills, Fugui Bawei Pills, Shenbao (applicable to Mingmen fire-deficient type).

(2) Guipi Pills, Shiquan Dabu Pills, Bazhen Pills, and Baizi Yangxin Pills (applicable to patients with heart and spleen deficiency).

(3) Xiaoyao Pills, Shuganliqi Pills, Shugan Pills (suitable for liver qi stagnation).

(4) Longdan Xiegan Pills, Bazhen Powder, and Ganlu Disinfectant Pill (suitable for damp-heat type of liver meridian).

(5) Wubishan Pills, Jingui Shenqi Pills, Qiangqiang Chunbao Pills, and Guilu Bushen Oral Liquid (suitable for kidney qi deficiency).

(6) Shenling Baizhu Powder (suitable for stomach qi deficiency).

(7) Manna Disinfectant Pill (suitable for damp-heat type of spleen and stomach).

(8) Xiaoyao Pill (suitable for liver qi stagnation).

(9) Wuji Baifeng Pill (suitable for cold stagnation of liver pulse).

(10) Liuwei Dihuang Pills and Longmu Gujing Pills (suitable for those with bile deficiency, panic, and kidney damage).

2. Recipe

(1) 60g of angelica root, 40g of white peony root, 20g each of licorice, cnidii, centipede and nine-spice insect.

Mix all medicines into fine powder and mix well, divide into 40 packets, take 1 packet in the morning and evening with boiled water twice a day. A course of treatment is 20 days. During the period of taking the medicine, avoid cold and irritation.

(2) 20g each of Codonopsis pilosula, Chinese yam, Poria cocos, raspberry, dodder seed and rehmannia glutinosa, 15g golden cherry seed, 12g each epimedium and atractylodes, 25g each leek seed and cotton seed, and 10g dogwood.

Take 1 dose per day, decoction in water.

(3) Codonopsis 20g, Astragalus 15g, Atractylodes 15g, Poria 20g, Ziziphus kernel 15g, longan meat 20g, Angelica 20g, Polygala 15g, Chinese yam 20g, Cynomorium 15g, Cistanche deserticola 15g, Lycium barbarum 60g , costus 5g. If you are timid and suspicious, have palpitations and are easily frightened, and have restless sleep, add amber (1.5g of finely ground flour once, twice a day). Decoction in water, 1 dose per day.

(4) Dog whip, sparrow, shrimp, epimedium, Morinda officinalis, Cistanche deserticola, sweet wolfberry, Ligustrum lucidum, Huaiyam. The medicine is made into fine powder, and the honey is used as pills, each pill is 10g. Take 1 pill each in the morning and evening. One month is considered as a course of treatment, and the efficacy is evaluated after 2 courses of treatment. Avoid sexual intercourse while taking medication.

(5) 10g Hailong (grind and drink), 15g Cnidium monnieri, 20g Xian Lingpi, 10g curculigo, 15g Cuscuta, 10g Schisandra chinensis, 15g Cistanche deserticola, 15g Morinda officinalis, 10g ginseng (stewed separately) Take it with you), 15g of deer antler glue (take it with you in yanghua). For patients with severe yang deficiency, add 6g of cinnamon and 10g of Futian tablets; for patients with spermatorrhea and premature ejaculation, add 10g of dogwood, 10g of mulberry octopus, and 15g of raspberry. Decoction in water, 1 dose per day.

(6) 30g epimedium, 20g each of leek seeds and actinolite, 12g wolfberry, 15g rehmannia glutinosa, 6g ginseng, and 2g gecko. Decoction in water, 1 dose per day. Take it for 15 days as a course of treatment, usually 1 to 3 courses (applicable to kidney qi deficiency type).

(7) Cnidium monnieri 10g, Epimedium 10g, actinolite 10g, Polygala 5g, Schisandra chinensis 5g. For colds, add 3g cinnamon and 10g aconite; for nocturnal emissions and premature ejaculation, add 15g golden cherry seeds and 10g mulberry octopus. Decoction in water and take 2 times, 1 dose per day. (Applicable to Mingmen fire-depleted type).

(8) 30g Codonopsis pilosula, 10g Atractylodes macrocephala, 15g Poria cocos, 6g Zhigancao, 12g Chinese yam, 12g lentils, 15g lotus seed meat, 6 jujubes, 6g Amomum villosum (lower back), 6g tangerine peel, Platycodon grandiflorum. 9g, epimedium 12g, psoralen 12g. Decoction in water, 1 dose per day (applicable to patients with stomach qi deficiency).

(9) 30g astragalus, 20g white peony root, 6g licorice, 12g cassia twig, 30g kudzu root, 20g atractylodes, 15g poria, 6g tangerine peel, 30g malt, 20g divine song. Decoction in water, or re-decoction with residue, 1 dose per day (applicable to patients with stomach qi deficiency).

3． Body acupuncture treatment prescription

(1) Main points: perineum, Changqiang, and Qugu. Matching points: Sanyinjiao, Rangu, Ququan. The perineum needle is 1.5 cun. When the needle is released, there will be soreness, swelling and numbness; when the needle is long and strong, the needle tip should be inserted upward and parallel to the sacrum, and the needle can be inserted 0.5 to 1.5 cun. There is often local pain and swelling, or it may spread to the anus, and the curved bone can penetrate 1.5 inches. After gaining qi, cross-twist the three main points to the left and right, and use the tonic method to remove the needles for 30 seconds. After Sanyinjiao, Rangu and Ququan gain Qi, twist them left and right crosswise, and use the tonic method to keep the needles for 5 minutes.

Each time, 3 main acupoints and 1 to 2 accessory acupoints are acupunctured, once every other day, and 7 times is a course of treatment. Each time, moxa sparrows were used to peck the perineum point 49 times.

(2) Main points: Huiyin, Changqiang, Qugu, Guanyuan, Zhongwan, Zusanli, Zhongdu, Pishu, Ququan, Jimai, Shenmen, and Juque. Matching points: Sanyinjiao, Rangu, Ququan, Shenshu, Mingmen, Taixi, Weishu, Pishu, Tianshu, Xinshu, Zusanli, Ganshu, Yanglingquan, Jimai, Zhongwan, Shenjue , Zhongji, Xingjian, Qimen, Dahe, Danshu, Fenglong, Qihai, Geshu, and Baliao. The above main acupoints and accessory acupoints are selected based on syndrome differentiation, and either tonic, flat tonic, or purgative methods are used; moxibustion is also used according to the condition, or the acupoints are selected to be treated only with warm moxibustion. In addition, ear acupuncture, massage, qigong, diet and single prescriptions can be used according to the needs of the condition.

(3) Shenshu, Guanyuan, Yangguan, Rangu, Fuliu, Zusanli, Sanyinjiao. Injection once a day, 3 to 5 points each time, 10 times is a course of treatment. The patient is required to urinate before the injection, and sexual intercourse is prohibited during the treatment. When performing the technique, it is best if the needle sensation can reach directly to the penis.

(4) At the Juyang point, at the midpoint of the line connecting Zhibian point and Huantiao point, use a 5-inch stainless steel needle (slightly shorter for thin people) to penetrate the opposite pubic symphysis diagonally. After there is numbness, swelling and pain at the base of the penis (i.e., deqi), leave the needle in place for 30 minutes, perform acupuncture every 10 minutes, and perform lifting, inserting and twisting techniques (leveling tonifying and leveling diarrhea). On the basis of acupuncture at Juyang points, acupoints are allocated based on syndrome differentiation. ① For those with insufficient kidney yang, Guanyuan, Mingmen, Shenshu, and Sanyinjiao should be used. Use the tonic method of lifting, inserting and twisting, Mingmen and Shenshu acupuncture followed by moxa stick moxibustion at Qizhuang (moxa stick moxibustion is also acceptable). ②For those with heart and spleen deficiency, use Shu, Neiguan, Zhongwan, Zusanli, Pishu, Guanyuan, Sanyinjiao, and Shenshu. Use the supplementary method of inserting and twisting. ③For patients with heart and kidney yin deficiency, Zhongji, Subiliac, Sanyinjiao, Daling, Shenmen, and Fuliu are recommended.

The tonic method of lifting, inserting and twisting is used, and Daling is the method of purging. Among the above points, Guanyuan and Zhongji require the needle sensation to reach directly to the glans. The needle retention time is the same as lifting the Yang point. Acupuncture is performed every other day, 12 times is one course of treatment, and there is a week's rest between courses.

4． Auricular acupuncture is directed to the kidneys, subcortex, and external genitalia. Cut a piece of tape about 0.6cm x 0.6cm in size, stick a Wangbuliuxingzi on the center, clamp it with tweezers, and stick it on the above acupoints, then apply slight pressure with your fingers, alternating between ears. 10 times is a course of treatment, 2 times a week.

5. Moxibustion

(1) Main acupoints: Guanyuan, Shenshu (double); accessory acupoints: Zusanli, Sanyinjiao. Moxibustion lasts for 15 to 30 minutes each time, and moxibustion at Guanyuan for 5 to 15 minutes until the local area becomes red and hot. People with yin deficiency and excessive fire should not use moxibustion or use less moxibustion. In addition, combined with Qigong acupoint massage: After moxibustion, use both thumbs to press the double Shenshu, then apply the hypothenar rolling tonic massage for 5 minutes, press the Guanyuan with the index finger, and then use the palm of the hand to massage clockwise, evenly and gently rotating the massage 5 to 15 minutes, at a frequency of 90 times per minute (this method belongs to Bodhidharma's internal strengthening method), which can enhance the cohesion of the internal organs. For mild cases, the effect will be achieved after one treatment, for severe cases, it will take 1 to 2 courses of treatment. Each course of treatment lasts for 12 to 15 days, once a day or once every other day, and rest for 3 to 5 days after each course of treatment.

(2) Qihai, Guanyuan, Zhongji, Qugu, Shenshu. Instruct the patient to lie supine or prone, loosen his clothes and urinate. First, ignite the moxa and put it into the moxibustion device. Then slightly warm the Xiaoqing Ling liquid that has been soaked in 95% alcohol. Then take out the red cloth soaked in the Xiaoqing Ling liquid and place it on the Qi. From Hai point to Qugu point, place the moxibustion device on the acupuncture point that should be moxibustion, hold the handle of the moxibustion device and apply moxibustion repeatedly. Moxibustion Qihai point first. When the patient feels strong heat penetration, moxibustion should be moved down to Guanyuan point immediately. When the patient feels the same sensation as above, moxibustion should be done on another point. But when moxibustion on Qugu point, the strong heat penetration sensation will be transmitted to the root of the penis. Moxibustion is performed 3 times on each acupoint, and the dressing must be changed after each moxibustion session. This is one treatment, and 10 times is one course of treatment. Start the second course of treatment 3 to 5 days apart (preparation method of Xiaoqing Lingye: 30g each of Aconite and Yizhiren, 20g each of Nux vomica and Epimedium, 20 centipedes, and 25g fried leeks. Combine all the medicines* ** It is a fine powder. After soaking it in 95% alcohol for 7 days, shake the medicine in the bottle up and down and soak it for another 3 days. Filter it with gauze and bottle it. At the same time, put red cloth pieces of different sizes into the bottle and soak it for 3 days to prepare. for moxibustion).

6． Massage prescription

(1) Yongquan, Dahe, Mingmen, Changqiang, Shenshu. ① Use Mofa Moyongquan, Dahe, and Mingmen points. ②Use kneading and massaging methods to knead and massage Yongquan, Dahe, Changqiang and Shenshu. ③Knock on the spring and the gate of life with the tapping method. ④ Rub Yongquan point with rubbing method (using peppermint oil).

(2) The second lumbar vertebra, Shenjue, and curved bones. The patient takes a sitting position and uses the lumbar fixed-point pulling method to pull the second lumbar vertebra. Then the patient lies on his back and uses his middle finger to point points along the Ren channel from Shenjue to Qugu point in order, going back and forth about 10 times. The technique is from light to heavy, operating to the penis, If there is numbness and heat in the perineum, the patient should sit down and hit the lumbosacral area from light to heavy with boxing until the patient's lower abdomen becomes hot. If accompanied by systemic symptoms, it can be treated with other techniques. The above method is performed once a day (pull method once every other day), and every 10 times is a course of treatment. After a 5-day rest, the second course of treatment can be continued.

7． Massage therapy: Place the threaded surface of the fingertip of one thumb on Guanyuan. Inhale when pressing and restore when exhaling. Repeat 5 to 7 times. The feet are slightly wider than the shoulders, and stand naturally relaxed, with both hands clenching fists on both sides; clenching your teeth, closing your mouth, exhaling through your nose, turn your waist to the left, and move the index and middle fingers of your right fist, and the second finger of your ring finger and little finger. Tap the back of the phalanx to Guanyuan, and tap the back of the left fist to the corresponding part behind you. Inhale when returning, and when exhaling again, turn your waist to the right, exchange the two fists, and also tap Guanyuan and its corresponding parts relatively relatively. So far, it is massage once.

When repeating the massage, first light, then heavy, then light. Use the small thenar of one hand to rub Guanyuan, 16 times in clockwise and counterclockwise directions. Rub the palms of both hands against each other until they are hot, then rub Guanyuan back and forth 16 times each while they are still hot. Do the above once every night, and 10 times constitute a course of treatment.

5. Nursing care

(1) The husband and wife should be explained the anatomy, physiology, sexual intercourse and psychological knowledge about the reproductive system to both partners to eliminate misunderstandings and ignorance about sexual behavior.

(2) Relieve men’s pressure on sexual behavior and avoid couples having sexual intercourse under pressure. Having sexual intercourse under pressure will only aggravate sexual anxiety and make treatment more difficult.

(3) It is necessary to guide patients to reveal their feelings, dare to reveal their anxiety and fear, analyze their causes and effects, and find ways to relieve anxiety. In this regard, the wife’s attitude is very important, and strive to win the favor of his wife. With understanding and close cooperation, *** participated in the treatment.