Medical Case Record: Initial Consultation

Patient Lin, male, 58 years old, Qionghai, Hainan Province. First consultation on July 7, 2021, presenting with decreased libido and memory loss for over 1 year, aggravated in the past month.

 

Chief Complaint

The patient developed decreased sexual desire and impaired memory without obvious triggers 1 year prior. All symptoms worsened significantly in the last month, so he sought Traditional Chinese Medicine (TCM) treatment at our clinic.

Current Clinical Manifestations

Diminished libido, poor memory, persistent lassitude, tidal fever with night sweats, soreness and weakness of lumbus and knees, stuffiness in chest and hypochondrium, irritability and easy anger, palpitations, insomnia with frequent vivid dreams, poor appetite, disrupted sleep; normal urination and defecation. Tongue presentation: Red tongue with scant coating; Pulse: Thin and string-like.

Physical Examination

Vital signs stable; no abnormal sounds on cardiopulmonary auscultation.

Auxiliary Examinations

Routine electrocardiogram, cardiac ultrasound, and six sex hormone tests showed no abnormal findings.

Western Medicine Diagnosis

Male Menopause Syndrome

TCM Diagnosis

Depression Syndrome

TCM Pattern Differentiation

Kidney deficiency with liver stagnation, accompanied by heart blood insufficiency

Therapeutic Principles

Tonify kidney and soften liver, nourish heart and invigorate spleen, calm and tranquilize the spirit

Core Prescription: Modified Zuogui Yin Combined with Ganmai Dazao Decoction

Raw herbs dosage per dose:

Radix Rehmanniae Preparata (Shudi) 15g

Rhizoma Dioscoreae (Huai Shanyao) 30g

Fructus Lycii (Gouqizi) 30g

Radix Glycyrrhizae Preparata (Zhigancao) 5g

Poria Cocos (Fuling) 30g

Fructus Corni (Shanzhuyu) 15g

Fructus Tritici Levis (Fuxiaomai) 30g

Fructus Jujubae (Dazao) 10 pieces

Fructus Aurantii Immaturus (Zhiqiao) 15g

Radix Paeoniae Alba Stir-fried (Chaobaishao) 30g

Radix Bupleuri (Chaihu) 15g

Administration Instruction

14 doses in total, decocted with water. 1 dose daily, take 150mL warm decoction half an hour after breakfast and dinner respectively.

Lifestyle Advice

Maintain a positive mood, follow a light diet, keep regular daily schedules, and avoid overexertion.

Follow-up Consultations

Second Consultation (July 21, 2021)

The patient reported no adverse reactions after medication, slightly improved energy levels. Tidal fever, night sweats, lumbago & knee weakness, chest-hypochondriac distension, irritability and palpitations were all mildly relieved. Appetite remained poor, sleep slightly improved, urination and defecation normal. Tongue: Red with thin white coating; Pulse: Slightly thin and string-like.

Modification to original formula: Add Cortex Eucommiae (Duzhong) 30g, Radix Polygalae Preparata (Zhiyuanzhi) 15g, Cortex Albiziae (Hehuanpi) 10g. Prescribe another 14 doses with identical decoction and taking instructions. Advise patient to return for consultation if discomfort occurs.

Third Consultation (August 4, 2021)

No side effects after continuous herbal intake. The patient reported remarkable recovery in libido and memory, stable mental state. Only occasional mild lumbago, knee soreness and chest stuffiness remained. Appetite fully recovered, sleep sound, urination and bowel movements normal. Tongue: Red with thin white coating; Pulse: String-like.

Prescribe 14 more doses of the modified second-consultation formula to consolidate curative effects.

Long-term Follow-up

Subsequent follow-up confirmed all clinical symptoms vanished completely, and the patient recovered well.

Case Discussion

Male Menopause Syndrome has complex and diverse etiologies and pathogenesis. Suwen·Yinyang Yingxiang Dalun (Plain Questions·Treatise on the Manifestations of Yin and Yang) records: "At forty years of age, yin qi naturally declines by half, and daily activities become fatiguing; at fifty, the body gains weight, hearing and vision deteriorate; at sixty, erectile dysfunction appears, qi is greatly depleted, nine orifices function poorly, upper excess and lower deficiency coexist, and nasal discharge and lacrimation emerge."

Suwen·Shanggu Tianzhen Lun (Plain Questions·Treatise on the Natural Truths of Ancient Times) states: "At forty years old for men, kidney qi declines, hair sheds and teeth wither; at forty-eight, yang qi exhausts in the upper body, complexion dulls, sideburns turn gray; at fifty-six, liver qi declines, tendons lose mobility; at sixty-four, tiankui (reproductive essence) dries up, essence diminishes, kidney function fails, the whole body becomes exhausted, teeth and hair fall out."

 

When men reach the age of 56 to 64, tiankui gradually depletes, kidney qi fades, essence and blood become insufficient, and yin-yang loses balance, further triggering dysfunction of the liver, heart and spleen.

The kidney is the congenital root, storing primordial yin and yang, governing human reproduction, growth, aging and sexual function. During male menopause, depleted kidney essence, declining kidney qi and exhausted tiankui lead to withered qi and blood, physical weakness, and fading sexual and reproductive capacity, marking the transition from middle age to old age. Predisposing factors for this condition include: innate physical deficiency, excessive sexual activity damaging essence and blood, irregular daily routines, physical and mental overstrain, sleep deprivation, or emotional trauma from long-term anxiety, rage, excessive joy or grief.

Therefore, the root cause of this syndrome lies in kidney deficiency and liver stagnation, while heart-spleen deficiency acts as secondary manifestation. Our clinical approach targets the four zang-fu organs (kidney, liver, heart, spleen) based on its pathogenesis: tonify kidney essence to replenish deficiency, soothe and disperse liver qi to unblock stagnation, invigorate spleen and nourish heart to calm the spirit. This method treats both root and branch, replenishing kidney essence to nourish the sea of marrow, smoothing liver dispersion function, stabilizing heart-spleen spirit, and enriching qi, blood and tendons to restore normal physical physiology.

 

Pathogenesis Analysis of This Patient

This middle-aged male patient reached the age of "seven eight", with gradually depleted tiankui and damaged kidney essence causing yin-yang imbalance in the kidney. This leads to impaired liver dispersion, dysfunctional spleen transportation, deficient essence and blood, chaotic qi movement, upward disturbance of heart spirit, insufficient heart yin and malnutrition of the heart, resulting in all clinical symptoms. Treatment requires pattern differentiation and simultaneous regulation of root and branch symptoms.

 

Formula Compatibility Explanation

Monarch Herbs (Primary Tonification for Liver & Kidney) Radix Rehmanniae Preparata nourishes kidney essence and replenishes primordial yin; Fructus Lycii tonifies kidney and liver, nourishes yin and improves eyesight; Fructus Corni reinforces liver-kidney function, astringes essence and relieves night sweats. Combined, they nourish liver and kidney, replenish yin and marrow.

Minister Herbs (Soothe Liver, Tonify Spleen & Nourish Heart) Fructus Tritici Levis nourishes heart yin, boosts heart qi, calms spirit and eliminates tidal fever; Rhizoma Dioscoreae invigorates spleen, consolidates kidney and nourishes yin; Radix Bupleuri disperses stagnated liver qi and clears heat; Stir-fried Radix Paeoniae Alba astringes yin, nourishes blood and softens liver. Together, they enhance liver soothing, spleen invigoration and heart nourishment effects.

 

 

Assistant & Guide Herbs (Regulate Qi, Harmonize Middle Jiao) Poria Cocos invigorates spleen, calms heart and drains dampness; Fructus Aurantii Immaturus moves qi and relieves chest stuffiness; Fructus Jujubae tonifies qi, harmonizes middle jiao and moistens dryness; Radix Glycyrrhizae Preparata tonifies heart qi and harmonizes all ingredients. They work synergistically to invigorate spleen, regulate qi, relieve chest distension and harmonize digestion.

The whole formula features precise herbal matching fully aligned with the patient's TCM pattern, delivering comprehensive effects of tonifying liver and kidney, dispersing stagnated liver qi, invigorating spleen, calming heart and soothing nerves. It replenishes primordial yin, unblocks stagnated qi and stabilizes disturbed spirit, fully restoring physiological balance and delivering rapid therapeutic outcomes.

 

Modification Rules for Clinical Adjustment

For patients with severe lumbago & knee weakness, severe irritability, palpitations, insomnia and frequent dreams: add Cortex Eucommiae to tonify kidney, strengthen bones and tendons; Radix Polygalae Preparata to calm spirit and improve memory; Cortex Albiziae to relieve depression and tranquilize mind.

 

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How Cistanche Tubulosa Solves Male Menopause Discomfort (Based on the Clinical TCM Case Above)

The case above records a typical 58-year-old male patient suffering from kidney deficiency, liver stagnation and heart blood insufficiency-classic male menopause symptoms: low libido, memory loss, fatigue, night sweats, soreness in waist and knees, mood swings, insomnia and poor appetite.

In TCM theory, Cistanche Tubulosa is the top-grade kidney-tonifying herb, perfectly targeting the root cause of this syndrome: depleted kidney essence and tiankui decline in aging men.

1. Cistanche Tubulosa as a TCM herb for kidney deficiency & low libido

As shown in the clinical case, aging men's core issue lies in exhausted kidney essence, which directly triggers decreased sexual function. Modern research confirms Cistanche Tubulosa's high-content echinacoside promotes testosterone secretion, inhibits kidney cell apoptosis, accelerates kidney cell proliferation and repairs damaged renal tissue. It replenishes kidney yin and essence fundamentally, reversing diminished libido caused by male menopause.

2. Cistanche Tubulosa as a TCM herb for memory loss & brain fog

Depleted kidney essence fails to nourish the sea of marrow, leading to poor memory, brain fatigue and insomnia in middle-aged men. The flavonoids and phenethyl alcohol glycosides in Cistanche Tubulosa deliver powerful antioxidant effects, clear free radicals, protect nerve cells, improve sleep quality and boost cognitive function-directly easing the insomnia and memory impairment seen in the medical case.

3. Cistanche Tubulosa as a TCM herb for mood irritability & liver stagnation

Kidney deficiency generates liver qi stagnation, presenting as chest tightness, sudden anger and emotional instability. Cistanche Tubulosa nourishes kidney water to soften liver wood, harmonizing liver dispersion function without harsh stimulating effects, soothing chronic irritability and depressive mood in male menopause patients.

4. Cistanche Tubulosa as a TCM herb for fatigue, night sweats & waist-knee soreness

Soreness of lumbus and knees, persistent weariness and tidal night sweats are hallmark signs of kidney yin deficiency. Cistanche Tubulosa tonifies kidney, strengthens bones and tendons, relieves spontaneous night sweats, eliminates chronic fatigue and boosts overall physical stamina-matching the therapeutic targets of Zuogui Yin formula in the clinical case.

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