Impotence Medical Case

Spleen and Kidney Deficiency + Cold Damp Stagnation + Blood Stasis Obstructing Meridians, Concurrent Heart and Spleen Deficiency
1. Basic Information of the Medical Case
Patient: Male, 38 years old
Chief Complaint: Recurrent impotence for 4 years, accompanied by chills, cold limbs, and fatigue for half a year
History of Present Illness: The patient developed weakness in erection gradually 4 years ago due to long-term desk work and irregular diet, with intermittent improvement. Half a year ago, after strenuous physical labor and catching a cold, he experienced chills, cold limbs, cold pain in the waist and knees, significant decline in erectile function, along with decreased libido and flaccid erections, making intercourse difficult. Also observed were poor appetite, loose stools, 3-4 times daily, undigested food, chest tightness, abdominal distension, heavy limbs, fatigue, mental dullness, forgetfulness, insomnia, palpitations, shortness of breath, symptoms worsened after exertion. He previously took warming kidney and strengthening yang Chinese medicine, initially effective, but gradually less so, with side effects like dry mouth and bloating. Past history includes chronic gastritis, no hypertension or diabetes.
Tongue and Pulse: Pale, swollen tongue with teeth marks, white slippery coating, deep slow weak and fine pulse.
2. TCM Syndrome Differentiation
Spleen and Kidney deficiency, Cold Damp stagnation, Blood stasis obstructing meridians, combined with Heart and Spleen deficiency (primary deficiency with secondary excess, Cold Damp mixed with Blood stasis, Qi and Blood deficiency)
Syndrome basis: The patient’s constitution is weak in the spleen and stomach, with poor diet and overwork damaging the yang qi of the spleen and kidneys. Spleen yang deficiency impairs transportation and transformation, leading to internal retention of water and dampness, which condenses into cold; Kidney yang deficiency results in failure to warm, leading to internal cold and dampness, which circulates through the meridians and settles in the tendons and vessels, causing them to lose warmth and nourishment; prolonged spleen deficiency affects the kidneys, and both spleen and kidney deficiencies worsen symptoms like chills, cold limbs, cold waist and knees, and loose stools. The spleen is the source of qi and blood production; its deficiency results in insufficient qi and blood, failing to nourish the heart, leading to Heart and Spleen deficiency, manifesting as mental dullness, forgetfulness, insomnia, palpitations, and shortness of breath. Qi deficiency causes weak blood movement; Yang deficiency with cold and dampness obstructs qi movement, leading to internal blood stasis over time, causing weak erections, pale swollen tongue with teeth marks, white slippery coating, deep slow fine pulse—signs of spleen and kidney deficiency, internal cold dampness, and blood stasis obstructing meridians.
3. Treatment Principles
Strengthen the spleen and tonify the kidneys, warm the middle and dispel cold, eliminate dampness and pain, activate blood and resolve stasis, boost qi and nourish blood, tranquilize the mind and calm the spirit.
4. Prescriptions and Formulas
Formula: Aconite-based Regulating Middle Decoction combined with You Gui Pill, Shen Ling Bai Zhu San, Tao Hong Si Wu Tang with modifications.
Ingredients: Aconite, dried ginger, cinnamon, Codonopsis, white atractylodes, Poria, prepared licorice, Chinese yam, coix seed, roasted white hyacinth bean, lotus seed, cardamom, tangerine peel, prepared Rehmannia, Cornus, Lycium, Cuscuta, Eucommia, Dipsacus, Epimedium, Morinda, Cistanche, Cynomorium, Angelica, Astragalus, Prince Ginseng, Salvia, Paeonia rubra, Sichuan lovage, peach kernel, safflower, Achilles, route, Ziziphus, sour jujube seed, Biota orientalis,志远志, longan meat.
5. Explanation of the Formula
• Chief herbs: Aconite, dried ginger, cinnamon warm and tonify kidney and spleen yang, dispel lower jiao cold damp, warm and unblock tendons and meridians, essential for treating yang deficiency and cold stagnation; Codonopsis, Astragalus, and white atractylodes strengthen the spleen and boost qi, tonify the middle jiao, generate qi and blood, addressing