Jian Jiang
Impotence has been nicknamed "weak yin", "weak tendons", "no yin", "sorry" and "no yang" in past dynasties. When it comes to the etiology and treatment of impotence, it is generally believed that kidney deficiency leads to the abuse of aphrodisiac drugs such as cistanche deserticola, epimedium, Cynomorium songaricum, actinolite, bullwhip, deer whip and velvet antler. Is impotence really caused by kidney deficiency? In fact, the most common clinical symptom is depressive impotence.
1 Discussion on impotence with depression in ancient Chinese medicine books
1. 1 The cause of impotence was recorded as early as "Mawangdui Bamboo Slips and Silk Books: A Talk on the Best Way in the World": "Anger is not big, then the muscles are not up; Big but not strong, will be weak; Those who are firm but not hot are not angry. " Huangdi Neijing pointed out that impotence is related to psychological and emotional problems. Su Wen Lun Heng said: "I have endless thoughts, but I can't do what I want to do. I was addicted to the outside and went into too many houses. The tendons are slack and the hair is weak. " Lingshu specifically pointed out that fear can lead to impotence: "fear can damage essence, and essence damage can lead to bone weakness." "Zhang Yitong Wei Bi Men" commented on this: "If you don't understand fear, you will hurt your kidney, while the essence will be weak and weak, and the essence will fall from the bottom, that is, the kidney will hurt your essence and lose your qi. Check yang deficiency and use Bawei Pill. " It can be seen that "impotence" includes impotence caused by fear However, from the Han Dynasty to the Sui, Tang and Song Dynasties, mainstream physicians believed that impotence was mainly caused by strain and kidney deficiency, and it was not until the Ming and Qing Dynasties that they began to pay attention to the treatment of impotence caused by internal injuries.
Zhang Jiebin, a physician in the Ming Dynasty, pointed out in "Jing Luquan Shu, Impotence" that all anxiety, anxiety, depression and panic all lead to impotence, and that "those who worry too much about overwork and depression lead to impotence"; "If you worry too much, you will hurt your heart and spleen, and then you will get sick, and Yangming will rush your pulse ... Qi and blood will be deficient, and Yang Dao will be weak"; "Anyone who is frightened will also lead to impotence"; "Suddenly I panicked, and then Yang Daoli became soft, which was also a test."
Wang Lun's Miscellaneous Books of Ming Medicine 3 reminds that stagnation of liver qi (fire) can also cause jade terrier to faint: "Men can't afford impotence, the ancient prescription is yin, the fire is declining, and the essence is qi deficiency and cold, which is congenital. However, there are also people who are depressed or even paralyzed. "
In the Qing Dynasty, doctor Ao believed that depression of the liver leads to depression of the yang: "Those with depression of the liver-qi, who can't make a fire in the cell, are sad, while yang leads to depression." The heart hides the spirit, and the liver governs the catharsis. Therefore, Chen Shiduo pointed out that "those who are depressed and don't adopt children think that their lives are failing, but who knows that it is the lag of their painstaking efforts" ("Dialectical Records, Volume Ten Heirs"); "When people were young, they were depressed because of physical failure, so they were impotent, but they didn't just mention it. People think that the door of life is failing, but it is blocked by heart fire (Dialectical Record, Volume Nine Yin Flaccid Door). Words are sincere and intentions are good. Lin's Treatment of Impotence Based on Syndrome Differentiation said: "If you hurt the spleen and kidney, you can't afford to hurt it. Therefore, impotence is mostly caused by essence failure, or thoughtlessness, or fear of hurting the kidney ... Some people gamble on damp heat and relax muscles, leading to impotence. " Xu Chunfu's "Complete Works of Ancient and Modern Medical Systems" (Volume 92) records a case of impotence caused by fear of kidney injury: "Young men who want to have sex will be impotent for five or seven days."
To sum up, the causes of impotence, in addition to fatigue, kidney deficiency, fire failure, hot and humid betting, have more than seven emotions. All thoughts are endless, frustrated desire, excessive lust and lust, worry, anxiety, depression, panic, tension, depression, loss of ambition and so on. , will inevitably lead to impotence.
1.2 Pathogenesis Through the discussion of the emotional causes of impotence by the above parties,
It is known that the pathogenesis of impotence is related to liver, heart, spleen and kidney. Because the liver governs the discharge and fixation, it has a close relationship with the liver. The penis is gathered by tendons and dominated by the liver. Su Wen Jue Lun says: "Yin is the former, and the tendons and veins gather together." "Lingshu Jing" contains: "The liver is the combination of tendons; Tenderness gathers in the shade. " Zongjin has two meanings: first, it refers to the meridians of Yin San Sanyang circulating on the body surface, starting from the ends of the limbs and converging in the front of the vulva, namely tendons and ligaments; The second refers to the male penis, or generally refers to the anterior position of the vulva.
Zhang Zi's Scholars in the Jin Dynasty explains this in Volume II: "Besides, the men in Neijing are the meeting of setting bones. The main muscle of the liver, the testis, is the pill in the bag. Although it governs the external kidney, it is not induced by Yin Huan, and it has no telescopic reason with the jade stem. " In the Ming Dynasty, Li Zhongzi's "Pathogenesis of Clash Transmission" clearly stated: "Yin organs are the foundation of tendons, while the tendons of spleen, stomach, liver and kidney are all tied to Yin organs, so tendons belong to liver." Xia Jing in the Western Zhou Dynasty said: "People with muscle weakness were born in the liver." If the main muscle of the liver is dysfunctional, it can directly lead to impotence. The physiological function of the liver controlling the flow of qi is related to the smoothness of qi, which is influenced by emotion, and then affects emotion, and finally affects the function of the main muscle of the liver, leading to impotence. Wanquan's "Guang Si Qi Harmony" in Ming Dynasty concluded: "Those who are excited by Yang Dao have liver qi." It can be seen that stagnation of liver qi is the physiological basis of normal erection. On the contrary, liver qi loss will affect erection.
When talking about the symptoms of "liver wind" in Treatise on Febrile Diseases and Su Wenfeng Theory, Zhang Jingyue pointed out: "The liver is the yang in the yin, and its pulse surrounds the yin. Strong is lewd, sick is jealous of yin, so I hate women. "
1.3 treatment Through the analysis of the emotional causes and pathogenesis of impotence, we can already understand the importance of treating impotence from depression (soothing the liver, regulating qi and relieving depression, nourishing the heart and calming the nerves). I want to write you another prescription to prove it.
In the Ming Dynasty, Zhou Zhigan recorded the treatment of impotence with Xiaoyao Powder to soothe the liver, regulate qi and relieve depression: "Impotence, committed by poor young people, belongs to depression, so Xiaoyao Powder is used to dispel it, then it is decocted with Tribulus terrestris, and then it is taken with water pills to dispel yang."
Ye believes that impotence can be treated by both heart, spleen and kidney in the third volume of Clinical Guide to Medical Records. "Anyone who suffers from depression and damages Yang must be treated from the gallbladder. The eleven zang-organs of Buddhist scriptures all depend on the gallbladder, and the cloud is shaoyang as the pivot. If you relax, there is nothing left. " Among them, there is a medical record of Yang's impotence: "Xu (30) has a thin and astringent pulse, rising fever, and likes to suffer hardships. Last year, due to impotence due to fine sliding, it was ineffective to use two to one hundred supplements. This is anxiety and depression, so it is necessary to dredge qi and blood from Shaoyang. "
Jin Shen 'ao put forward the treatment methods of soothing the liver, regulating qi and relieving depression, nourishing the heart and calming the nerves in The Origin of Miscellaneous Diseases: "If you lose your will, depression will hurt your liver, and the liver will not relax, which will also lead to yin impotence. Yu Tang (Cimicifuga Rhizoma, Bupleuri Radix, Rhizoma Chuanxiong, Rhizoma Cyperi, Fructus Tribuli, Cortex Mori, and Folium Citri Tangerinae) should be enlarged.
Chen Shiduo pointed out in the "Classification of Syndrome Differentiation" that the treatment of impotence should "follow the liver qi, then the wood will achieve its nature"; At the same time, it attaches great importance to the treatment from the heart, and thinks that "it is appropriate to publicize the inner depression, relax the will and mind, open the Yang Can, and make Yin stand up"; Lianxin Qinghuo Decoction (Radix Scrophulariae, Radix Rehmanniae, Radix Salviae Miltiorrhizae, Rhizoma Dioscoreae, Semen Euryales, plumula Nelumbinis, Radix Ophiopogonis, Fructus Schisandrae Chinensis and Radix Asparagi) is used to treat impotence caused by pericardial fire, while Yin Decoction (Radix Ginseng, Radix Morindae Officinalis, Radix Astragali, Fructus Schisandrae Chinensis, Radix Rehmanniae Preparata, Cortex Cinnamomi, Radix Polygalae, Semen Platycladi and Fructus Corni) is used to treat impotence. Xuanzhi decoction (Poria cocos, Acorus calamus, Glycyrrhiza uralensis Fisch. , Atractylodis Rhizoma, Semen Ziziphi Spinosae, Cortex et Radix Polygalae, Bupleuri Radix, Radix Angelicae Sinensis, Ginseng Radix, Rhizoma Dioscoreae, Radix Morindae Officinalis), Qiyangyuxin Dan (Ginseng Radix, Cortex et Radix Polygalae, Poria, Rhizoma Acori Graminei, Glycyrrhrizae Radix). Orange, Amomum villosum, Bupleurum chinense, Cuscuta chinensis, Atractylodes macrocephala, Ziziphus jujuba Mill, Angelica dahurica In these prescriptions, the use of drugs for nourishing the heart and calming the nerves is far more impressive than that of drugs for tonifying the kidney.
The ancients thought that kidney deficiency in middle-aged and elderly people was excusable, and impotence in young and middle-aged people could not be treated by tonifying kidney. Therefore, Cheng pointed out in "Medical Description, Miscellaneous Syndrome and Impotence": "Adolescent impotence is due to loss of will, but it should be depressed and not supplemented." His theory is similar to impotence in the suicide note of Shenzhai, that is, juvenile poverty and impotence are mostly depression. In fact, today, the stagnation of impotence has nothing to do with age and wealth, but the degree of stagnation may be different.
In addition, the views of the two wise men are also quite interesting. One is Wang, whose cloud says, "If you are depressed and clear about your ambition, your yang will relax." (It was published in Feng's Secret Record of Preventing Pulse Impotence, Cheng Wenyou's Medical Description and Danbo's Miscellaneous Diseases in the Qing Dynasty). This can be understood as the use of soothing the liver to relieve depression, calming the nerves, and using psychological counseling non-drug methods for treatment. The other is Zhang Jiebin, who clearly pointed out in "Pure Moon Surgery for Impotence" that impotence can be treated by non-drug methods of psychological enlightenment: "(Treating impotence) will definitely let go of your arms and relax your spirit, but it will be effective, but only medication is useless." Impotence that can be treated by non-drug methods can only be impotence with depression syndrome.
2. Clinical diagnosis and treatment of depressive impotence
2. 1 From the inquiry, we found out the cause and the course of impotence, which is a hidden disease related to male dignity. Due to cultural reasons, most patients do not realize that it is related to emotional factors. If you want to diagnose impotence with depression syndrome clearly, you must look at your eyes, face and color, listen to the diagnosis consultation carefully, and focus on the time, cause and process of onset, including whether you have negative emotions such as depression, anxiety, fear and worry, whether you have psychological pressure or mental tension in your study and work, whether you have the habit of masturbating for a long time, and how your husband and wife feel, especially your wife's attitude towards sex life. In the process of listening to the patient's illness, it is necessary to observe the patient's personality and temperament endowment type. The survey found that most patients with impotence are introverted and emotionally unstable [16]. Doctors should comprehensively analyze whether there is a causal relationship between the above situation and impotence.
2.2 Distinguish the syndrome types of depression from clinical manifestations According to the emotional factors recorded in ancient literature, the accompanying symptoms of impotence include backache (soreness of waist and knees, soreness of waist and feet, pain of bones and muscles), dizziness (dim eyes, short sight, dizziness and headache), cold and heat (fine cold, hot flashes due to bone steaming, cold feet, night fever, and chills).
As Xu Ling said when commenting on Clinical Guide Medical Records: "There are many symptoms of impotence, and it is more difficult for servants." This functional, diverse, extensive, repetitive and bizarre clinical manifestation basically conforms to the characteristics of depression syndrome [17]. This can be further divided into two types: one is the intuitive manifestation of overt depression syndrome, such as insomnia and dreaminess, depression and anxiety, sadness and fear, bad mood and great mental stress. There is also a clinical manifestation of recessive depression syndrome, and it is necessary to analyze and identify whether there are recessive depression syndromes such as "general depression syndrome", "strange depression syndrome" and "strange depression syndrome" [18- 19].
2.3 From the treatment of depression, it is worth pondering that the ancient prescriptions that mainly tonify the kidney, such as Fu Huo Ming Dan (dialectical record), Zhuang Huo Dan (dialectical record), Wan (Jingyue's complete book) and Qi Yin Fu (Jingyue's complete book), all contain keel, jujube and other ingredients to some extent. In addition, Dayu decoction (miscellaneous diseases, rhinoceros candle), Xuanzhi decoction (syndrome differentiation classification record) and Qiyang Yuxin pill (syndrome differentiation classification record) for treating impotence caused by kidney injury are mostly composed of drugs for soothing the liver, regulating qi and/or nourishing the heart and calming the nerves. Not to mention Guipi decoction for treating impotence caused by heart and spleen damage.
For impotence with depression, not only ancient doctors thought that it should be treated from the perspective of soothing the liver and relieving depression, nourishing the heart and calming the nerves, but also modern times. For example, anshen decoction (Radix Bupleuri, Radix Paeoniae Alba, Radix Angelicae Sinensis, Rhizoma Acori Graminei, Poria, Semen Ziziphi Spinosae, Radix Polygalae, Amber, Scolopendra, Radix Glycyrrhizae and Herba Epimedii) combined with psychological counseling to treat depression [25], and Bupleurum plus Gulong Muli Decoction to treat depression. From its point of view, the objective existence of impotence with depression is obvious.
Of course, another undeniable phenomenon is that even if impotence with depression is treated from depression, some drugs for tonifying kidney are often involved in clinic. This may be because so far, doctors have not paid enough attention to depression and impotence, or because patients with depression and impotence have different degrees of kidney deficiency at the same time, or because not tonifying kidney does not conform to the inertial thinking of both doctors and patients. After kidney-tonifying drug treatment, the yang meridian vibrates, which may be due to kidney deficiency, but the possibility of placebo effect cannot be completely ruled out. With the deepening understanding of impotence with depression, it is not far to find out these problems.
3 Conclusion
A large number of clinical facts have proved that sildenafil citrate (trade name Viagra) is effective for patients with simple and psychogenic ed [28], but some patients still have unsatisfactory curative effect [29], and need to cooperate with psychotherapy [30-3 1]. Although the drug has reached the patent protection period (20 14 May 12), there is no cheaper generic drug in China market to benefit patients. On the other hand, most antipsychotics and antidepressants can not treat psychogenic impotence at the same time, but have side effects of inducing or aggravating impotence. Therefore, it is still a long-term task of Chinese medicine to study the clinical diagnosis and treatment characteristics of impotence with depression.