TCM Approaches for Elderly Men's Health

This is an introduction to Traditional Chinese Medicine (TCM) in relationship to elderly men’s health. Of course, as we ourselves age, the definition of what “elderly” means becomes relative to our own viewpoint! For the purpose of our discussion, we will consider elderly to be older than 65, but we must acknowledge that at age 50, serious health problems begin to manifest in many. Over 34% of the population is over age 50 and the number is rising rapidly with the aging of the larger generations and longer lifespans.

For healthcare in general, there are four major categories that one should pay attention to:

1. What you put in your body and how well you eliminate waste
2. Movement and exercise
3. Adequate sleep and rest time (non-activity)
4. Healthy attitude and mental state (being happy)

For the first category, a general dietary suggestion is to invert the typical so called “food pyramid.” Plant-based diets are highly recommended. The second category is protein intake, and the third category is starches.  Of course, adequate fluid intake is also within the foundation of a good diet and assists with the proper functioning of the bowels in eliminating waste.

In the realm of traditional Chinese medicine, treatment for a variety of dysfunctions includes Acupuncture /moxibustion, Tui Na /Acupressure, raw herbs, and patent medicines. In treating illnesses, TCM focuses on three major components: Qi, Blood, and Phlegm congestion. By securing essential energy and getting rid of pathogenic energies or stagnant, congested energies balance is restored to the body.  7 Qíng 情 or emotional states and 6 Yín 淫 or exogenous influences are major contributors to the spiritual, emotional, mental, and physical imbalances in the human body.  Of course, Traditional Chinese Medicine assessment and diagnosis are always the rationale for designing the treatment plan.

There are approximately 10 major illnesses that affect elderly men. They include heart disease, diabetes, stroke, erectile dysfunction, liver disease, chronic obstructive pulmonary disease (COPD), cancer, HIV, depression, and traumatic injury.  This article will emphasize how TCM assesses, analyzes, and prescribes treatment for the variety of illnesses seen in this cohort. Due to the wide-ranging subject matter, this article will only cover two major categories of illnesses: cardiovascular disease (stroke) and erectile dysfunction. Other disease analyses will be provided in subsequent presentations, as a series of articles. This paper is a personal approach to the subject matter; feedback on your own experience, research, analysis, and approaches are always welcomed.

Cardiovascular Issues

Traditional Chinese Medicine in relationship to health always focuses on energy, or Qi flow and Blood circulation. In the US, about 197,000 people die each year of cardiovascular-related disease and over half are men. We need to be aware that:

• More than one out of four adult males are at risk of dying from cardiovascular disease.
• African American men are at higher risk for high blood pressure and related illness.
• High blood pressure occurs most often in men over 45 years of age.

The risk factors for developing heart disease vary, depending on cholesterol level, diet, physical activity, and other lifestyle habits such as smoking. A 2013 to 2016 report from The American Heart Association states that 51.2% of males aged 20 and above have some form of cardiovascular disease. Good health as an elderly man begins much younger than age 50!! Routine checkups, healthy eating, exercising, and avoiding stress can help prevent heart disease.

A stroke happens when arteries in the brain become blocked or ruptured. Either of these events prevents the cells from getting oxygen and this causes part of the brain to die. This occurrence is a leading cause of death and disability for adults. Medical conditions like high blood pressure, diabetes, and obesity can increase stroke risk, as well as certain behaviors such as tobacco and alcohol use.

To prevent death from cardiovascular disease for elderly men, there should be a medical checkup at least once every six months with a monitoring of blood pressure. Consuming an abundance of vegetables and fruits, and adequate hydration are important components of maintaining good health. Also recommended is exercise: such as Tai Chi, Dao Yin /Qi Gong, yoga, dancing, meditation and other low-impact forms of health exercises for good circulation of nutritious blood.

Often the etiology of circulatory issues comes from general weakness of the person, excessive consumption of sweet and fatty foods, and/or emotional injury that causes internal imbalance.  Frequently, the issue is in the chest region because it is a place where Yang energy disseminates. If Heart Yang is not very strong, then Spleen Yang cannot transport, causing Cold congealment and Blood Stasis or internal Phlegm congestion. Endogenous Phlegm is often a combination of Blood and Phlegm congestion. Spleen Yang deficiency, Ming Men Fire deficiency , and Liver and Kidney deficiency can all be factors in Heart Blood deficiency.

Common TCM Pattern Analysis

For Heart Blood congestion and Heart Yang deficiency, the suggested herbal formula is Modified Gua Lou Xie Bai Gui Zhi Tang 瓜簍薤白桂枝湯 加減. The treatment principle is to support Heart Yang and clear Channels with this approach:

Guo lou and Xie bai clears Phlegm, regulates Qi flow and opens the chest area. Gui zhi, Dan shen jiu (wine-fried) warms the channels and invigorates the Blood flow, while Ju hong, Gan jiang, Dang shen and Gan cao warm the central Yang. If there is tightness in the chest, you may also add Hou po.

For Qi stagnation and Blood congestion the treatment principle is to move Qi, activate Blood, clear congestion and open Channels. The suggested formula is Xue Fu Zhu Yu Tang 血府逐瘀湯. The sweet, warm and spicy nature of Dang gui and Chuan xiong  can tonify Blood, open channels and remove Blood stagnation, Chi shao, Hong hua, Tao ren, and Nui xi clears blood flow and removes Blood stagnation. Chai hu, Jie geng and Zhi ke  invigorates the Liver, clears emotional congestion, and clears Lung energy. Gan cao  harmonizes all the herbs in the formula.

If the pattern is Spleen deficiency causing Phlegm congestion that is blocking the Heart channel, the treatment principle is to strengthen Spleen, remove Phlegm, eliminate Dampness and nurture the Heart. The suggested formula is Dao Tan Tang Jia Wei 導痰湯加味, Ban xia  is spicy and dry natured to dry Dampness and resolve Phlegm and Ju Hong regulates Qi, resolves Dampness and transform Phlegm. Fu ling strengthens the function of Spleen and resolves Dampness. Gan cao and Sheng jiang harmonize the center and tonify the Spleen. Zhi shi , Gua lou, and Xie bai opens the chest and resolves Phlegm.

For Liver and Kidney Yin deficiency with Blood stasis, the treatment principle is to tonify Liver and Kidney, activate Blood and resolve Blood congestion. The suggested formula is Modified Yang Yin Tong Bi Tang 養陰通痺湯加減. In this prescription, Sheng di huang, Mai men dong, Nu zhen zi, and Wu wei zi tonifies Liver and Kidney Yin. Dang shen and Gua luo benefits Qi and opens the chest, Hong hua , Hu tao ren, and Yan hu suo moves Qi and activates Blood flow. If there is a lot of chest pain, one can also add San qi.

If Yin and Yang are both deficient, and Qi and Blood are not flowing well, the treatment principles would be to regulate Yin and Yang, benefit Qi and nourish Blood. The recommended formula is Modified Zhi Gan Cao Tang 炙甘草湯加減. The formula includes E jiao, Sheng di huang, Zhi Gan cao, and Dang shen, which function to tonify the Qi and nourish the Yin and Blood. Gui zhi and Mai men dong are spicy and moisturizing to tonify both Qi and Blood. Adding Xie bai and prepared Fu zi can tonify Yang, remove Coldness and regulate Qi.  Dang gui and Dan shen are used together to nurture and invigorate Blood, creating a tonifying but not stagnating effect.

There are many other herbs that could be appropriate in the categories of Yin, Yang, Qi and Blood tonification and movement, as well as those in the category of removing Blood stasis, or Phlegm congestion.  Herbs that can benefit specific organ function can also be included when necessary. The above formula recommendations are only a suggestion for the possible analysis of symptoms and pattern differentiation.

Acupuncture or acupressure treatment is also recommended. For prevention:

• Stomach 36: to strengthen the center and remove Dampness
• Large Intestine 11: to build the immune system and decrease inflammation by clearing Heat
• Gallbladder 39: to expel Damp from the channels and connecting vessels Governing Vessel 20: to promote Yang energy
• Spleen 6, 9:to reduce Dampness in the body and promote good blood circulation
• Heart 7 or Pericardium 6: to promote calmness and well-being of the Heart

Erectile Dysfunction

Erectile dysfunction (ED), or impotence, occurs when a man cannot get or maintain an erection. It occurs occasionally in men during stressful events, but if it happens often, it can be a sign of severe health problems.  Erectile dysfunction may be caused by arteriosclerosis, which is the hardening of arteries. Note: atherosclerosis is a type of arteriosclerosis in which calcium/cholesterol plaque is deposited in the arterial lumen. ED is a sign that blood vessels are not in good shape. The following diseases and conditions can also lead to ED: Non-insulin dependent diabetes mellitus (NIDDM), heart and blood vessel disease, atherosclerosis, high blood pressure, chronic kidney disease, multiple sclerosis, and low testosterone. Smoking and alcohol use can also contribute to the decline of sexual energy. Erectile dysfunction occurs very often with men after the age of 75. The National Institutes of Health states that ED affects about 30 million men in the United States and that the vascular system, nervous system, and endocrine system can cause or contribute to ED. Many doctors see erectile dysfunction as a warning sign of an impending cardiovascular event or heart disease. Of course, men who experience ED should visit a qualified medical doctor immediately.

General rules to follow for healthy libido:

• Don’t overdo it.
• Refrain from sexual activity when one is tired, too hungry, exhausted, fearful, angry, inebriated, or experiencing illness.

Common TCM Pattern Analysis

Yin deficiency and Fire rising for premature ejaculation. Here, the treatment principle is to tonify Yin and reduce Heart Fire. The recommended herbal prescription is Zhi Bai Di Huang Tang (ZBDHT) / Wan 知柏地黄丸 or Feng Sui Dan with Zhi Bai Di Huang Tang /Wan 封髓丹知柏地黄丸 Here, Feng Sui Dan is added to ZBDHT and includes a larger amount of Huang bai plus Xi Sha Ren (salt-fried Burmese cardamon) and Zhi gan cao (honey-fried licorice root). In addition to the action of ZBDHT to clear Yin deficient Fire, the incorporation of Feng Sui Dan restores the Kidney’s function of drawing Qi into the lower Dan Tian and consolidates Essence. This augmented formula is indicated when the is both False Heat above and Yang deficient Cold in the Lower Jiao.

If the pattern is Central Qi deficiency with inability to maintain rigidity, the treatment principle is to tonify Qi, and support the center. The recommended herbal formula is Bu Zhong Yi Qi Tang 補中益氣湯.

If there is Kidney Yang deficiency with inability to be aroused, the treatment principle is to warm the Kidneys and support Yang.

Recommended herbal prescriptions are You Gui Yin Wan 右歸飲丸 or Jin Suo Gu Jing Wan 金鎖固精丸. You Gui Yin Wan is indicated when there are signs of chronic Yang deficiency and Jing/Essence exhaustion. Jin Suo Gu Jing is more appropriate when besides obvious Kidney and Jing deficiency, there is a need to astringe Jing and prevent the leakage of fluids.

Additional formula considerations:

Modified Qi Yin Tang 起陰湯, containing Huang qi, Ren shen, Bai zhu, Shu di huang, Wu wei zi, Rou gui, Bai zi ren, Yuan Zhi, Shan zhu yu.

Tian yi tang 天一湯 containing Di gu pi, Mu dan pi, Shu di huang, Xuan shen, Qian shi, Shan yao, Nui xi, Rou gui.

Recommended dosages would be according to your analysis of the patient’s symptoms, syndromes, and individual constitution.

Acupuncture recommendations: (Moxibustion is also recommended, when appropriate)

• Conception vessel 3: Dispels stagnation, benefits the lower jiao and fortifies the Kidneys
• Conception vessel 4: Fortifies the Yuan Qi, benefits Essence and nourishes the Kidneys
• Conception vessel 6: Tonifies Qi, especially Yuan Qi, nourishes the Kidneys and fortifies Yang
• Conception Vessel 1: Regulates the anterior and posterior Yin
• Stomach 36: Supports the Zheng Qi, fosters the Yuan Qi Tonifies Qi, and nourishes Blood and Yin
• Spleen 6: Harmonizes the Liver, the Lower Jiao, and tonifies the Kidneys
• Spleen 9: Opens and moves the water passages and benefits the Lower Jiao
• Urinary bladder 23 Tonifies the Kidneys, fortifies Yang, benefits Essence, nourishes Kidney Yin, and firms Kidney Qi
• Kidney 3: Nourishes Kidney Yin, clears deficiency Heat, and tonifies Kidney Yang
• Kidney 12: Tonifies the Kidneys and astringes Essence
• Governing vessel 20: Subdues Yang and nourishes the Sea of Marrow

Other complementary approaches include:

• Qi gong practice: Microcosmic orbit exercise to build and tonify the Conception and Governing vessels
• Moxibustion to tonify and warm: The Conception vessel at Ren 1,3,4,6, Governing vessel 2, and Ming men area, Kidney shu (Urinary bladder 23) area
• Massage: The testicles and epididymis by warming one’s hands and gently massaging these areas.

Hopefully, this introduction will give you some valuable clinical insight to help your male patients as they age. Future articles will discuss other major health issues affecting elderly men. In the meantime, be healthy …be safe … be kind.

References:

• American Heart Association: https://www.heart.org/.
• American Stroke Association: https://www.stroke.org/.
• Center for Disease and Control Prevention: https://www.cdc.gov/.
• Healthline: https://www.healthline.com/.
• Illinois Department of Public Health: https://dph.illinois.gov/.
• National Institutes of Health: https://www.nih.gov/.