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Opioid Addiction and Chinese Medicine

by Bob Flaws

In the book ‘Chinese Medical Psychiatry’, readers will see that, under many (if not most) disease categories, substance abuse is one of the three main subcategories of differential diagnosis. According to the National Institute of Mental Health, 28-30% of the adult U.S. population has a diagnosable mental or addictive disorder during any one year period. Because substance abuse can cause psychiatric disease and many patients with psychiatric disease seek relief from their symptoms through substance abuse, the DSM-IV lists substance-related disorders as one of its main categories of psychiatric disorders. However, there is no chapter on substance-related disorders in Chinese Medical Psychiatry. This is because, at the time this book was compiled, the authors did not have access to primary Chinese language materials on such disorders. Since then, I have found Chinese language materials at least on opioid addiction, and, therefore would like to share this information.

Western medicine and opioid intoxication & withdrawal

According to the DSM-IV, the symptoms of opioid intoxication include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgement, and/or impaired social or occupational functioning which develop during or shortly after opioid use. Typically, there will be pupillary constriction, drowsiness or coma, slurred speech, and/or impaired attention or memory. The symptoms of opiod withdrawal include three or more of the following arising within minutes to several days after cessation or reduction in opioid use after heavy, prolonged use: dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, or sweating, diarrhea, yawning, fever, or insomnia. These symptoms cause clinically significant distress or impairment in social, occupational and other important areas of life.

Chinese medicine and opioid intoxication & withdrawal

Li Xi-ru, in Shen Jing Jing Shen Yi Bing Gu Qin Xiao Fang (Ancient & Modern Effective Formulas for Neurologic & Psychiatric Disease) published by Science & Technology Press, Beijing, 1998, includes a chapter on "Addiction to Opioid Substances." According to Li, opioids' flavor is sour and astringent, their qi is aromatic, and their nature is warm and drying. It has also been long understood in Chinese medicine that opioids have toxins. Although opioids enter all 12 channels and thus can stop pain anywhere in the body, they especially enter the kidneys, large intestine, and lungs where they exert their damaging effects. After entering the body, they necessarily consume and scatter the righteous qi. If consumption endures, the yang qi must become vacuous and the five viscera must necessarily be affected by the heat of opioids' warming and shining. Thus it is said, "This medicinal's nature is categorized as pure yang; it likes to move and it likes to arouse."

Opioids' ability to relieve pain and act as an analgesic is based on their strongly moving nature. In Chinese medicine, it is said, "If there is pain, there is no free flow; if there is free flow, there is no pain." Hence according to the logic of Chinese medicine, anything which is strongly pain-stopping must also be strongly moving. It is opioids' moving, qi-rectifying, and depression-resolving abilities which also produce their initial euphoria. However, moving the qi is a species of attacking therapy. When used excessively or long-term, such attacking therapies consume and damage the righteous qi.

In addition, opioids are sour and astringent, especially to the yang ming. As mentioned above, they are also warm and drying. Therefore, their use tends to cause heat binding in the yang ming. The stomach and intestines lose their free flow and heat accumulates, consuming and damaging stomach and intestinal fluids. Because the intestinal bowels are no longer freely flowing, toxins and turbidity (including the toxins inherent in opioids) are not discharged from the body. Instead, these tend to accumulate internally. The stomach and intestines lose their harmony as do the stomach and the spleen.

Although opioids' nature is warm, because they scatter and disperse yang qi, ultimately they result in vacuity cold. Thus, if taken continuously, the vessels and network vessels become cold and wet and do not move. Thus there is body pain, the skin loses its warmth, and there is cold shivering. Likewise, the interstices lose their astringing and sweating occurs. If the eyes lose their warming and astringing, then there is profuse tearing. If the stomach loses its harmony and downbearing, there is nausea and vomiting. If the kidneys lose their warming and astringing, there is slippery essence. If the heart loses its warming and nourishment, there is vexation and chaos. If the lungs lose their warming and nourishment, there is sorrow and anxiety. All these symptoms are due to yang vacuity or yang desertion. If addiction of opioids results in consumption and damage to qi and blood, then the spirit mind loses its nourishment and symptoms of heart-spleen dual vacuity will appear, such as a yellow complexion, emaciation, sweating, lack of strength, and insomnia.

The Chinese medical treatment of opioid addiction & withdrawal

According to Li, treatment of opioid addiction should be based on pattern discrimination. Li identifies five main patterns associated with opioid addiction. If there are toxins binding in the viscera and bowels, one can use Xian Fang Jie Du Ling (Immortal Formula Guard Against Toxins Efficacious [Medicine]). If there is yang vacuity or yang desertion, one can use Gui Fu Wu Zhu Yu Tang (Cinnamon, Aconite & Evodia Decoction). If the righteous qi is greatly debilitated, one can use Bu Yuan Jie Du Tang (Supplement the Source & Resolve Toxins Decoction). If there is cold stagnation and stasis obstruction, one can use Shao Fu Zhu Yu Tang (Lower Abdomen Dispel Stasis Decoction), and, if there is essence qi debility and detriment impotence, then one can use Jin Shui Bao (Golden Water Treasure). Of course, individual patients each have their own habitual bodily constitutions and other disease mechanisms based on diet, lifestyle, and past medical history. Therefore, these five patterns and their formulas will need to be modified in real-life clinical practice. Nevertheless, they do provide a starting place for the main disease mechanisms and their associated patterns of this condition.

Xian Fang Jie Du Ling

Composition: Radix Bupleuri (Chai Hu), 10g, Radix Et Rhizoma Rhei (Da Huang), 20g, Fructus Immaturus Citri Aurantii (Zhi Shi), 20g, Rhizoma Coptidis Chinensis (Huang Lian), 6g, Radix Scutellariae Baicalensis (Huang Qin), 10g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 20g, Fructus Zizyphi Jujubae (Da Zao), 6 pieces, Rhizoma Pinelliae Ternatae (Ban Xia), 20g, Fructus Gardeniae Jasminoidis (Zhi Zi), 20g, Semen Praeparatus Sojae (Dan Dou Chi), 20g, Fructus Crataegi (Shan Zha), 20g, Rhizoma Corydalis Yanhusuo (Yan Hu Suo), 20g, uncooked Rhizoma Zingiberis (Sheng Jiang), 6g, Radix Glycyrrhizae (Gan Cao), 10g.

Functions: Washes and cleanses the viscera and bowels, tranquilizes the spirit and clears the orifices, regulates and rectifies the spleen and stomach.

Indications: Opioid withdrawal characterized as a repletion pattern.

Formula explanation: Within this formula, Rhubarb and Immature Aurantium wash and cleanse the viscera and bowels, free the flow of the bowels, and drain turbidity. Scutellaria, Coptis, Gardenia, Prepared Soybeans, and Licorice clear the heart and drain turbidity, tranquilize the spirit and eliminate vexation. Corydalis, Crataegus, White Peony, Ginger, and Red Dates regulate and rectify the spleen and stomach, protect yin and stop pain. When all these medicinals are used together, the wash and cleanse the viscera and bowels of toxins and turbidity, tranquilize the spirit and clear the orifices, and restore the spleen and stomach function.

Additions & subtractions: If abdominal distention is marked, there has been no eating for several days, and there is nausea, repeated vomiting, dry, bound, black-colored stools which only move once every 15-20 days, greyish black, thick, dry tongue fur with scant fluids, and a bowstring, replete pulse due to stomach and intestinal depression and blockage, add Mirabilitum (Mang Xiao) and Folium Sennae (Fan Xie Ye) to strengthen the function of freeing the flow and draining combined with Fructus Meliae Toosendan (Chuan Lian Zi) and Radix Auklandiae Lappae (Mu Xiang) to relax and resolve the abdominal pain. If there is chest and rib-side distention and fullness, vexation and agitation, easy anger, a dry mouth with a bitter taste, reddish yellow urine, thick, dry, yellow tongue fur with scant fluids, and a bowstring, forceful pulse due to liver-spleen depression and blockage, add Tuber Curcumae (Yu Jin), Cortex Magnoliae Officinalis (Hou Po), and Cortex Albizziae Julibrissin (He Huan Pi) to strengthen the resolution of depression and coursing of the liver. If there is heart vexation, restlessness, non-smoothly flowing urination, bone pain, bone itching, and decreased sexual desire due to liver-kidney depression and blockage, add cooked Radix Rehmanniae (Shu Di), Fructus Corni Officinalis (Shan Zhu Yu), and Radix Cyathulae (Chuan Niu Xi) to supplement in the midst of freeing the flow.

Representative case history: The patient was a 30 year old male railroad engineer who had ingested 1g of heroin per day for the last five years. When he entered the hospital, he was emaciated and his facial complexion was dark and blackish. He was averse to cold and felt chilled in the back of the neck. His skin has the texture of chicken skin, he was fatigued, and he lacked strength. His intake was torpid and he was not eating. His bowels only moved once every 30 days. In addition, he had abdominal pain, distention, and fullness, body and bone pain which were difficult to bear, he was manic, agitated, and restless, his speech was senseless, and he had toxic sores and ulcerations on his four limbs and cheeks which exuded a mixture of pus and blood. His urination was reddish yellow and not smoothly or easily flowing, and his sexual desire had disappeared. The man's tongue was purple and dark with thick, greyish black, somewhat yellow, dry fur. His pulse was bowstring, slippery, and rapid. The right bar was also choppy.

Based on these signs and symptoms, the man's pattern was categorized as toxins binding in the viscera and bowels with heart and brain depression and blockage. The treatment principles were to wash and cleanse toxins and turbidity, calm the spirit and arouse the orifices, regulate and rectify the spleen and stomach. Therefore, he was given modified Xian Fang Jie Du Ling: Radix Bupleuri (Chai Hu), 10g, Radix Et Rhizoma Rhei (Da Huang), 20g, Fructus Immaturus Citri Aurantii (Zhi Shi), 20g, Mirabilitum (Mang Xiao), 30g, processed Rhizoma Pinelliae Ternatae (Ban Xia), 30g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 30g, uncooked Rhizoma Zingiberis (Sheng Jiang), 20g, Fructus Zizyphi Jujubae (Da Zao), 10 pieces, Fructus Gardeniae Jasminoidis (Zhi Zi), 20g, Semen Praeparatus Sojae (Dan Dou Chi), 6g, and Radix Glycyrrhizae (Gan Cao), 6g. One ji of these medicinals was decocted in water per day and administered orally.

After taking three ji, the patient's bowel movements were loose like oily sheep feces. His abdominal distention had disappeared and his abdominal pain was reduced. The patient's emotions were slightly more calm and his intelligence was clearer, plus his urination was smoothly and easily flowing. Thus all his symptoms were somewhat better. His pulse was bowstring and slippery, while his tongue was pale with thick, yellow fur. Therefore, Cortex Magnoliae Officinalis (Hou Po), 20g, and Cortex Albizziae Julibrissin (He Huan Pi), 30g, were added to the original formula which was then represcribed for two weeks. By then, the sores and ulcers on his limbs and cheeks had healed and the scabs itched. His emotions were stable and his thinking was clear. All the symptoms of withdrawal had basically disappeared and he as able to control his cravings for drugs. The man's appetite and volume of food consumed increased. He sometimes still experienced body pain and bone itching, but these episodes were shorter in duration and their symptoms were less. His pulse and tongue returned to normal and the man was discharged from the hospital.

Gui Fu Wu Zhu Yu Tang

Composition: Radix Rubrus Panacis Ginseng (Hong Shen), 10g, Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), 9g, Fructus Evodiae Rutecarpae (Wu Zhu Yu), 12g, Ramulus Cinnamomi Cassiae (Gui Zhi), 10g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 10g, Semen Zizyphi Spinosae (Suan Zao Ren), 60g, Os Draconis (Long Gu), 15g, Concha Ostreae (Mu Li), 15g, Radix Glycyrrhizae (Gan Cao), 10g, uncooked Rhizoma Zingiberis (Sheng Jiang), 25g

Functions: Warms yang and secures desertion, controls the symptoms of withdrawal

Indications: The symptoms of heroin withdrawal and addictive craving

Formula explanation:Within this formula, Aconite is the ruling medicinal. It is able to free the flow and move all 12 channels at the same time as it warms yang. Red Ginseng supplements the heart and lung qi. Dragon Bone and Oyster Shell secure desertion and quiet the spirit. Evodia warms the center, stops vomiting, and stops diarrhea. Sitr-fried Zizyphus Spinosa nourishes the heart and quiets the spirit. These are the ministerial medicinals. They are assisted by Cinnamon Twigs, White Peony, and uncooked Ginger which regulate and harmonize the constructive and defensive, resolve the muscles and stop pain. Licorice is the envoy. When all these medicinals are used together, they warm yang, secure desertion, and quiet the spirit.

Representative case history:The patient was a 24 year old male who was initially examined in May 4, 1993. For the past two years, the man had been an opium addict. He had previously tried to withdraw from this addiction. However, after three months he had relapsed. When he stopped smoking opium, he had become agitated and anxious and had required sedatives to sleep. The man was prescribed: Radix Rubrus Panacis Ginseng (Hong Shen), 10g, Radix Lateralis Praeaparatus Aconiti Carmichaeli (Fu Zi), 9g, Fructus Evodiae Rutecarpae (Wu Zhu Yu) and Radix Polygalae Tenuifoliae (Yuan Zhi), 12g each, uncooked Rhizoma Zingiberis (Sheng Jiang), 25g, stir-fried Semen Zizyphi Spinosae (Suan Zao Ren), 60g, and Os Draconis (Long Gu), Concha Ostreae (Mu Li), and Pericarpium Papaveris Somniferi (Ying Su Ke), 20g each. The man took one ji, two ji, three ji, two ji, and one ji respectively on days 1-5 after stopping smoking opium. On the sixth day, his psychological state had improved, his eating and sleep were both good, and his urination had increased. Therefore, he was prescribed: Radix Astragali Membranacei (Huang Qi) and stir-fried Semen Zizyphi Spinosae (Suan Zao Ren), 30g each, Radix Codonopsitis Pilosulae (Dang Shen), 20g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), Sclerotium Pararadicis Poriae Cocos (Fu Shen), and Radix Polygalae Tenuifoliae (Yuan Zhi), 10g each, Radix Angelicae Sinensis (Dang Gui), 12g, Pericarpium Citri Reticulatae (Chen Pi), 9g, and Radix Glycyrrhizae (Gan Cao), 6g. One ji was administered per day for 12 ji. On reexamination, the man's body weight had increased by 4kg. and his body felt good. Thus he was prescribed Gui Pi Wan (Restore the Spleen Pills) in order to secure the treatment effects.

On follow-up after two years, he had not smoked opium.

Bu Yuan Jie Du Tang

Composition:Rhizoma Atractylodis Macrocephalae (Bai Zhu), 30g, Sclerotium Poriae Cocos (Fu Ling), 30g, Radix Astragali Membranacei (Huang Qi), 30g, Arillus Euphoriae Longanae (Long Yan Rou), 30g, Semen Zizyphi Spinosae (Suan Zao Ren), 30g, Radix Panacis Ginseng (Ren Shen), 5g, cooked Radix Rehmanniae (Shu Di), 20g, Radix Angelicae Sinensis (Dang Gui), 10g, Fructus Corni Officinalis (Shan Zhu Yu), 20g, Fructus Lycii Chinensis (Gou Qi Zi), 20g, Radix Dioscoreae Oppositae (Shan Yao), 20g, Radix Auklandiae Lappae (Mu Xiang), 10g, Radix Polygalae Tenuifoliae (Yuan Zhi), 10g, uncooked Rhizoma Zingiberis (Sheng Jiang), 6g, Radix Glycyrrhizae (Gan Cao), 6g.

Functions: Fills the essence and secures the marrow, banks and supplements the spleen and stomach

Indications: Opioid withdrawal characterized as a vacuity pattern.

Formula explanation: Within this formula, the ingredients of Gui Pi Tang (Restore the Spleen Decoction) bank and supplement the spleen and stomach, while the ingredients of Da Bu Yuan Jian (Greatly Supplementing the Source Decoction) fill the essence and secure the marrow. When these two formulas are used together, they promote the supplementation of qi and blood, the recuperation of kidney vacuity, and the tranquilizing of the essence spirit.

Method of use:First administer Da Cheng Qi Tang (Major Order the Qi Decoction), i.e., Radix Et Rhizoma Rhei (Da Huang), Mirabilitum (Mang Xiao), Fructus Immaturus Citri Aurantii (Zhi Shi), and Cortex Magnoliae Officinalis (Hou Po), in order to free the flow of the bowels and expel toxins. Once the tongue fur turns white and the pulse relaxes, showing that toxins have been dispelled and the righteous has begun to recuperate, then use the above formula. If there is a bitter taste in the mouth, a dry throat, nausea, and dry vomiting, add Radix Bupleuri (Chai Hu), Rhizoma Pinelliae Ternatae (Ban Xia), uncooked Radix Rehmanniae (Sheng Di), and Herba Houttuyniae Cordatae Cum Radice (Yu Xing Cao) to Da Cheng Qi Tang. If there is insomnia, add Cortex Albizziae Julibrissin (He Huan Pi).

Representative case history:The patient was a 23 year old male who had both smoked and eaten opium for the last five years. He consumed 1.5g of opium per day. When he entered the hospital, his body was emaciated and his essence spirit was abstracted. He was confused, emotionally unstable, fatigued, and lacked strength. His eyes had a dull, vacant look. Sometimes he spoke nonsense. At the time of examination, the man had not slept for several days. His stools were dry and bound, moving once every 12-16 days. His urination was reddish yellow, his mouth was dry, and his throat was parched. He was nauseous and had dry heaves, bringing up nothing. His tongue was dark with thick, dry, grey fur and scant fluids. His pulse was vacuous, fine, and forceless.

Based on these signs and symptoms, the man's pattern was categorized as toxins binding in the viscera and bowels with spleen-kidney dual vacuity. Therefore, the treatment principles were to first free the flow of the bowels and expel toxins and he was administered Da Cheng Qi Tang with additions and subtractions: Radix Et Rhizoma Rhei (Da Huang), 6g (added later), Mirabilitum (Mang Xiao), 10g, Fructus Immaturus Citri Aurantii (Zhi Shi), 10g, Cortex Magnoliae Officinalis (Hou Po), 20g, uncooked Radix Rehmanniae (Sheng Di), 20g, Herba Houttuyniae Cordatae Cum Radice (Yu Xing Cao), 30g, processed Rhizoma Pinelliae Ternatae (Ban Xia), 30g, Radix Bupleuri (Chai Hu), 10g, Cortex Albizziae Julibrissin (He Huan Pi), 30g, and Radix Glycyrrhizae (Gan Cao).

After taking three ji of these medicinals, he passed some black-colored, loose stools and he was able to sleep peacefully 2-3 hours per night. His dry throat had disappeared and all his other symptoms had improved. His mind was clearer. however, he had fearful throbbing and fright palpitations. His pulse was fine and weak and his tongue was pale with white fur. Therefore his pattern was recategorized as heart-spleen dual vacuity and heart-kidneys not communicating. The new treatment principles were to fill the essence and secure the marrow, bank and supplement the spleen and stomach. For these purposes, he was prescribed Bu Yuan Jie Du Tang. After three ji, all his symptoms were markedly less. His defecation and urination were normal, and his psychological state had improved. His speech was clear and he was able to sleep four hours per night. After taking another 13 ji, his eating and drinking were normal, his essence spirit was good, and he had no craving for opium. Thus he was judged cured and discharged from the hospital.

Shao Fu Zhu Yu Tang

Composition: Fructus Foeniculi Vulgaris (Xiao Hui Xiang), 15g, dry Rhizoma Zingiberis (Gan Jiang), 8g, Rhizoma Corydalis Yanhusuo (Yan Hu Suo), 15g, Radix Angelicae Sinensis (Dang Gui), 10g, Resina Myrrha (Mo Yao), 10g, Radix Ligustici Wallichii (Chuan Xiong), 12g, Cortex Cinnamomi Cassiae (Rou Gui), 8g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 10g, Pollen Typhae (Pu Huang), 15g, Feces Trogopterori Seu Pteromi (Wu Ling Zhi), 15g.

Functions: Quickens the blood and dispels stasis, warms and frees the flow and stops pain.

 

Indications: Opioid addiction abdominal pain

Formula explanation: Within this formula, Fennel dispels cold and rectifies the qi. Therefore, it is the ruling medicinal for treating cold pattern abdominal pain. Dry Ginger scatters cold. Corydalis rectifies the qi, quickens the blood, and stops pain. these are the ministerial medicinals. Myrrh, Dang Gui, Ligusticum, Red Peony, Pollen Typhae, and Flying Squirrel Feces quicken the blood, free the flow and disinhibit the blood vessels, and stop pain. Cinnamon warms the center and supplements yang, scatters cold and stops pain. These are the assistant and envoy medicinals. When used together, these medicinals quicken the blood and dispel stasis, warm and free the flow and stop pain.

Additions & subtractions:One can add Semen Pruni Persicae (Tao Ren), Radix Et Rhizoma Rhei (Da Huang), and Fructus Immaturus Citri Aurantii (Zhi Shi) to strengthen this formula's effect for opioid addiction abdominal pain.

Representative case history:The patient was a 52 year old male worker who developed a morphine addiction due to a series of surgeries for abdominal pain, including a cholecystectomy and surgery for intestinal adhesions. The pain and the morphine use continued for five years. The pain felt like being cut by a knife and was difficult to bear. When the man's abdomen was palpated in the supine position, the pain was fixed in location and intestinal noises increased in strength. The patient had already been administered a large number of qi-moving, pain-stopping, yang-warming, and cold-scattering medicinals without effect.

Based on the above history, signs, and symptoms, the man's pattern was categorized as qi stagnation and blood stasis, for which he was prescribed Shao Fu Zhu Yu Tang with added flavors: Fructus Foeniculi Vulgaris (Xiao Hui Xiang), 15g, dry Rhizoma Zingiberis (Gan Jiang), 8g, Rhizoma Corydalis Yanhusuo (Yan Hu Suo), 15g, Resina Myrrha (Mo Yao), 10g, Radix Angelicae Sinensis (Dang Gui), 10g, Radix Ligustici Wallichii (Chuan Xiong), 10g, Cortex Cinnamomi Cassiae (Rou Gui), 8g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 10g, Pollen Typhae (Pu Huang), 15g, Feces Trogopterori Seu Pteromi (Wu Ling Zhi), 15g, Semen Pruni Persicae (Tao Ren), 10g, Radix Et Rhizoma Rhei (Da Huang), 10g (added later), and Fructus Immaturus Citri Aurantii (Zhi Shi), 12g.

After taking one ji of these medicinals, the abdominal pain stopped. Another three ji were prescribed to secure the treatment effect. Then the man was prescribed Dang Gui Shao Yao San (Dang Gui & Peony Powder) with added flavors: Radix Angelicae Sinensis (Dang Gui), 12g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 20g, Rhizoma Alismatis (Ze Xie), 10g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g, Radix Ligustici Wallichii (Chuan Xiong), 12g, mix-fried Radix Glycyrrhizae (Gan Cao), 4g, Fructus Immaturus Citri Aurantii (Zhi Shi), 12g, Rhizoma Corydalis Yanhusuo (Yan Hu Suo), 12g, Radix Dioscoreae Oppositae (Shan Yao), 12g, and Sclerotium Poriae Cocos (Fu Ling), 12g. Altogether, the man took 10 ji of this prescription.

Approximately every other month, the man had one episode of abdominal pain. However, the symptoms were less. If he took two ji of Shao Fu Zhu Yu Tang followed by five ji of Dang Gui Shao Yao San, the pain stopped. This occurred three times the following year, and two times the second year. Three years later, there were no further recurrences and the man's health returned to normal.

Jin Shui Bao

Composition: Cordyceps Chinensis (Dong Chong Xia Cao). This is a ready-made medicine manufactured by the East West National Medicinal Factory.

Functions: Protects the lungs and boosts the kidneys, supplements the essence and marrow, promotes yang prosperity.

Indications: Impotence due to heroin addiction in turn due to lung-kidney dual vacuity with essence qi debility and detriment.

Representative case history: The patient was a 28 year old male. Five years previously, the patient had become addicted to smoking and eating opium. Over time, this had resulted in him becoming impotent. The man eventually was treated for his addiction and the symptoms of addiction disappeared. However, the symptoms of his impotence did not improve. This was accompanied by lassitude of the spirit, shortness of breath, dizziness, lack of strength, dampness and a chilly feeling of the scrotum, a pale tongue with white fur, and a deep, fine pulse.

Based on these signs and symptoms, the man's pattern was categorized as lung-kidney dual vacuity with essence qi debility and detriment. Therefore, the treatment principles were to supplement the kidneys and protect the lungs, secrete the essence and boost the qi. The formula chosen was Jin Shui Bao gelatin capsules. Three capsules were administered each time, three times per day. After seven days, the man's essence spirit gradually improved. His sleep and eating were both good. He sometimes had an erection, but his penis did not get stiff and hard. In addition, he could only maintain an erection for a short period of time. Therefore he continued taking this medicine for 30 days, after which his penis was able to maintain a sufficiently stiff and hard erection for 10 minutes. He stopped taking this medicine and his sex life returned to complete normalcy. On follow-up after a half year, there had been no recurrence.

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