PADAM & Chinese medicine
Posted in Bob Flaws’ Blog
by Bob Flaws
On pages 10-11 in issue #6, 2008 of Xin Zhong Yi (New Chinese Medicine), there’s an article titled “An Introduction to Prof. Zhou Fu-sheng’s Experiences Treating Male Menopausal Syndrome.” Prof. Zhou has more than 40 year’s clinical experience treating andrological disorders. In this article, the authors (students of Prof. Zhou at Guangzhou Chinese Medicine & Pharmacology University) equate male menopause with partial androgen deficiency in the aging male (PADAM). Further, they summarize Prof. Zhou’s approach to this condition in four basic points which I’d (Bob) like to share with my fellow practitioners who do not read Chinese.
The following is only a rough functional translation to present the gist of Prof. Zhou’s approach.
1. The basic disease mechanisms of this condition are kidney vacuity with loss of regulation of yin and yang
The main clinical manifestations of so-called male menopause or PADAM include a lowered mood, worry and anxiety, being sick at heart (melancholy?), insomnia, forgetfulness, vexation and agitation, irritability, restlessness, vexatious heat, hot flashes, sweating, chest oppression, shortness of breath, decreased sexual function, polyuria, and excessive nocturia. Within Chinese medicine, there is no disease category called male menopausal syndrome per se. However, the signs and symptoms of this condition can be reframed into the traditional Chinese disease categories of depression condition, visceral agitation, yang wilting (impotence), vacuity taxation, insomnia, and heart palpitations.
According to the famous passage at the beginning of the Su Wen (Simple Questions) describing the growth, maturation, and decline of men and women, “At eight [times] eight [in men], the tian gui [kidney water] is exhausted, the essence is scanty, the kidneys’ treasuring is in decline, the body is at its extreme [or climacteric], and this leads to the teeth and hair falling out.” Based on this, Prof. Zhou believes that between ages 48 to 64, the kidney essence gradually declines and becomes exhausted, true water is desiccated and exhausted, and yin fails to control yang. Thus yin and yang lose their regulation. Further, kidney debility can lead to psychiatric and neurological disorders, such as a lowered mood, nervous tension and agitation, insomnia, loss of strength, difficulty thinking, slowing of response to stimuli. It can also lead to sexual disturbances, such impotence, premature ejaculation, and decreased libido. According to Sun Si-miao in his Qian Jin Yi Fang (Supplement to Formulas [Worth] A Thousand [Pieces of Gold): “After 50 years in humans, yang qi declines day by day, a person’s strength gradually decreases, what was remembered before is lost later, ... one’s mood is abnormal, desire for food is without flavor, and sleep is not quiet.” All of this is due to the gradual decline of the kidney qi and gradual diminishment of the tian gui. This then leads to other abnormal changes in the viscera and bowels, yin and yang, and qi and blood.
In particular, Prof. Zhou believes that kidney vacuity may negatively affect the heart, liver, and/or spleen causing disturbances in the function of these viscera as well.
2. Liver depression, phlegm congelation, and blood stasis are the tips or branches of this condition
During middle age, people’s life activities typically increase and worries and anxiety are relatively many. Worry then causes the qi to bind and gather. According to Prof. Zhou, the psychiatric and autonomic nervous system symptoms of male menopause are mostly due to this lack of smooth or easy flow of the liver qi. In that case, the liver loses its spreading and extending and the qi mechanism loses its yang function. If the emotions lose their regulation, the liver becomes depressed and there is lack of smooth or easy flow. This then can lead to tension or stress, impaired memory, dizziness, and insomnia. If the liver is depressed and the qi is bound, the movement of the blood becomes static and stagnant. Because blood and fluids flow together, qi stagnation and blood stasis may both lead to phlegm, dampness, and turbidity. Thus Prof. Zhou believes that, although kidney vacuity is the root of PADAM, liver depression, phlegm turbidity, and blood stasis are its main tips or branches. Readers should note that all these disease mechanisms are mutually engendering. In other words, the causal relationships between them are all bi-directional.
3. Supplementing the kidneys, coursing the liver, and quieting the spirit are the crux of treating this condition
Based on the above, Prof. Zhou believes that supplementing the kidneys is fundamental to treating the root of this condition. For this purpose, he common uses
Shan Zhu Yu (Fructus Corni)
Gou Qi Zi (Fructus Lycii)
Shu Di Huang (cooked Radix Rehmanniae)
to supplement the kidneys and foster essence. These medicinals are warm but not drying. They fill and make replete the former heaven root. They secure and guard the kidney qi. They fill and make sufficient the essence and blood. Hence they are able to get a relatively good therapeutic effect. However, kidney vacuity must be subdivided into yin vacuity, yang vacuity, and yin and yang vacuity types.
For yang vacuity, Prof. Zhou uses Jin Kui Shen Qi Wan (Golden Coffer Kidney Qi Pills), Gui Lu Er Xian Jiao (Turtle & Deer Two Immortals Gelatin), and You Gui Wan (Restore the Right [Kidney] Pill).
For yin vacuity, he uses Liu Wei Di Huang Wan (Six Flavors Rehmannia Pill), Qi Ju Di Huang Wan (Lycium & Chrysanthemum Rehmannia Pill), and Zuo Gui Wan (Restore the Left [Kidney] Pill).
For yin and yang dual vacuity, he uses Er Xian Tang (Two Immortals Decoction).
To course the liver and rectify the qi, Prof., Zhou uses Xiao Yao San (Rambling Powder), Chai Hu Shu Gan San (Bupleurum Course the Liver Powder), Xiao Chai Hu Tang (Minor Bupleurum Decoction), Si Ni San (Four Counterflows Powder), and Ban Xia Xie Xin Tang (Pinellia Drain the Heart Decoction). For instance, he commonly uses:
Chai Hu (Radix Bupleuri)
Yu Jin (Tuber Curcumae)
Bai Shao (Radix Alba Paeoniae)
Xiang Fu (Rhizoma Cyperi)
Ju Hua (Flos Chrysanthemi)
Zhi Shi (Fructus Immaturus Aurantii)
Suan Zao Ren (Semen Zizyphi Spinosae)
Dan Shen (Radix Salviae Miltiorrhizae)
Shi Jue Ming (Concha Haliotidis)
Fo Shou (Fructus Citri Sacrodactylis)
He Huan Pi (Cortex Albiziae)
In order to calm the heart and quiet the spirit, Prof. Zhou commonly uses:
Zhen Zhu Mu (Concha Margaritiferae)
Ci Shi (Magnetitum)
Shi Chang Pu (Rhizoma Acori Tatarinowii)
Yuan Zhi (Radix Polygalae)
To regulate and smooth the flow of the qi and blood, he common uses Xue Fu Zhu Yu Tang (Blood Mansion Dispel Stasis Decoction) with additions and subtractions.
For phlegm and stasis engendering wind, he commonly uses Huang Lian Wen Dan Tang (Coptis Warm the Gallbladder Decoction) plus Tao Hong Si Wu Tang (Perica & Carthamus Four Materials Decoction) as his base formula.
For impotence, premature ejaculation, and decreased libido, Prof. Zhou commonly uses:
Huang Jing (Rhizoma Polygonati)
Shan Zhu Yu (Fructus Corni)
He Shou Wu (Radix Polygoni Multiflori)
Gou Qi Zi (Fructus Lycii)
Lian Zi (Semen Nelumbinis)
Sha Shen (Radix Glehniae)
Yu Zhu (Rhizoma Polygoni Odorati)
Long Yan Rou (Arillus Longanae)
Ren Shen (Radix Ginseng)
Zhi Ma (Semen Sesami Indici)
Ju Huan (Flos Chrysanthemi)
Jue Ming Zi (Semen Cassiae)
Bu Gu Zhi (Fructus Psoraleae)
Sang Shen (Fructus Mori)
Fo Shou (Fructus Citri Sacrodactylis)
Prof. Zhou makes the point that, in such case, one cannot simply use yang-supplementing medicinals like Lu Rong (Cornu Parvuum Cervi) and Ba Ji Tian (Radix Morindae Officinalis).
If there is vexatious thirst, epistaxis, bleeding gums, dry, bound stools, dry, scratchy eyes, seminal emission, dizziness, heart palpitations, and insomnia due to vacuity fire harassing internally with ministerial fire frenetically stirring, then Prof. Zhou uses Zhi Bai Di Huang Wan (Anemarrhena & Phellodendron Rehmannia Pill) or Huang Lian E Jiao Tang (Coptis & Donkey Skin Glue Decoction) with Shi Gao (Gypsum), Zhi Zi (Fructus Gardeniae), and Huang Qin (Radix Scutellariae) in order to enrich yin and downbear fire, level and regulate yin and yang.
4. Regulating, conserving & nourishing life cannot be overlooked
In Chinese medicine, “regulating, conserving, and nourishing life” imply the promotion of health through regulating one’s diet and lifestyle. Based on his more than 40 years clinical experience in the treatment of andrological disorders, Prof. Zhou is a strong proponent that any medical treatment must be supplemented and supported by correct diet and lifestyle. For instance, in terms of diet, he says to lower one’s salt intake, eat less oils and fats, and generally eat a clear, bland diet. One should stay away from “violent” or “fierce” foods and drinks. In particular, one should eat more fresh vegetables and fruits. As for protein, Prof. Zhou believes that chicken, fish, and rabbit are all easily assimilated foods and that one should eat dairy foods and bean products. In terms of lifestyle, he says to get regular exercise and reduce one’s stress.