Seattle Institute of Oriental Medicine

Translations: Cases

Treatment of Impotence by Combining Xiao Chai Hu Tang and Si Ni San

David McGraw
Medical Chinese
8 . 2 . 04

Treatment of Impotence by Combining Xiao Chai Hu Tang and Si Ni San

Translated from Shang Han Ming Yi Yan An Jing Xuan (Refined Anthology of Cases from Famous Doctors [that are based upon] the Treatise on Cold Damage) pp. 470-471

Case: Male, 32 years old. Although the patient is in his age of vitality, he is suffering from impotence. Both of the patient's eyes are bright, shining and have shen, his physique is healthy, and he does not appear deficient, nor does he act with timidity. His pulse is wiry with strength, and his tongue has a white, slippery, slightly greasy coat. Along with impotence his chest and ribside feel uncomfortable and full, he has a bitter taste in his mouth, is experiencing heart vexation, and has ice-cold hands and feet. After carefully considering the possible causes, the practitioner determined the etiology to be long-term mental anxiety with an unrelieved negative mental state. The patient's Liver and Gall Bladder are depressed, restrained and not extending, thus causing his yang qi to suffer obstruction; this is as stated in the Shang Han Lun: "yang obstructed and bound". Qi depression should be coursed and moved. It is contrary to tonify yang because it will only strengthen the congealing effect of constrained fire.

Treatment is Xiao Chai Hu Tang + Si Ni San: Chai Hu 16g, Huang Qin 10g, Ban Xia 14g, Sheng Jiang 8g, Dang Shen 10g, Zhi Gan Cao 10g, Bai Shao 15g, Zhi Shi 12g, Da Zao 7 pieces.
Result: After taking three packets of the above formula, the patient was cured of impotence.

Practitioner's Discussion
Impotence at an age of vitality is not caused by excessively giving in to one's carnal desires, but rather by blocked emotions. When chest and ribside bitterness and fullness, bitter taste in the mouth, vexation, ice-cold hands and feet and a pulse that is wiry with strength are observed, this is a manifestation of yang that is depressed and unable to extend thus inhibiting the qi mechanism. When people have experiences that make them anxious or angry, or when they are unable to fulfill their desires, often this results in Liver and Gall Bladder depression inhibiting the shaoyang pivot mechanism, thus the yang qi is unable to smoothly extend. The Liver governs the sinews and the Liver channel flows around the genitals; The Kidney stores the will and is the official of one's resolve. The Liver and Kidney act as one entity, as the second and tenth heavenly stems have the same source. Thus, if there is Liver and Gall Bladder qi depression, inhibited coursing and discharging, and yang qi endures obstruction, then this results in impotence / inability to have an erection. Wang Jie-Zhai states, "Short-term impotence is caused by a loss of will...If the will (zhi) and thoughts (yi) are unfulfilled, then yang qi will not be soothed. Yang qi is true fire. Imagine this fire at its zenith placed within a dense organ, obstructing and oppressing its qi, unable to effuse or escape. Thus, erections wither because of cold. This is not waning of true fire, rather the result of depression and oppression." For the above case I chose to combine Xiao Chai Hu Tang and Si Ni San in order to simultaneously course and free the qi mechanism, and discharge yang qi. Certainly, mediating the pivot mechanism is essential here. The yang channels' pivot mechanism is located in the shaoyang; the yin channels' pivot mechanism is located in the shaoyin. Xiao Chai Hu Tang harmonizes and resolves the shaoyang pivot and disinhibits its qi; Si Ni San frees and smoothes the shaoyin pivot and outthrusts its yang. These two formulas used together enable the pivot mechanisms to open as one, thus the qi mechanism is disinhibited, yang qi flows smoothly, the [true] fire is outthrust, and impotence is cured.