Erectile dysfunction, also known as “impotence,” is often caused by emotional distress, fear, anger, and damp-heat accumulation, primarily manifesting as kidney qi deficiency, blood deficiency, excessive damp-heat, and decline of the Mingmen fire. Among these, kidney deficiency is a major factor, as qi deficiency fails to promote blood circulation, and prolonged illness leads to obstruction of the meridians, preventing nourishment of the genital muscles, resulting in impotence. Traditional Chinese Medicine (TCM) treats this condition using a holistic approach, employing formulas such as Wuzi Yanzong Wan (Five-Seed Restoration Pill), Yubiao Bushen Wan (Fish Bladder Kidney-Tonifying Pill), Ziyin Bushen Wan (Yin-Nourishing Kidney-Tonifying Pill), and Tamsulosin + Jinkui Shenqi Wan (Kidney Qi Pill).

1. Wuzi Yanzong Wan

Wuzi Yanzong Wan consists of Gouqi Zi (Goji Berries), Tusi Zi (Cuscuta Seed), Fu Pen Zi (Raspberry), Wuweizi (Schisandra), and Cheqianzi (Plantago Seed). It tonifies the kidneys and benefits essence, used for impotence and infertility due to kidney deficiency, nocturnal emissions, premature ejaculation, lumbar pain, and post-urination dribbling.

The main ingredients, Gouqi Zi and Tusi Zi, serve as the monarch herbs, with Gouqi Zi filling essence and nourishing blood, being a mild tonic for kidney essence and liver blood. Tusi Zi strongly warms the kidneys and strengthens yang, balancing yin and yang. Fu Pen Zi and Wuweizi act as minister herbs, with Fu Pen Zi able to astringe and secure essence while benefiting the liver and kidneys; Wuweizi has all five flavors, with a strong sour taste that can tonify the kidneys and astringe essence to stop emissions. The formula includes Cheqianzi as an assistant herb, which has a slightly cold property that moderates the warming nature of the other herbs while also clearing heat and promoting urination for post-urination dribbling.

The entire formula focuses on kidney tonification, nourishing both kidney yin and yang, filling essence and marrow, making it a key formula for securing essence. Moreover, this formula is mild in nature, not drying or harsh, and has no adverse effects with prolonged use. It was originally used to treat male infertility, nocturnal emissions, impotence, premature ejaculation, post-urination dribbling, kidney deficiency-related lumbar pain, etc. Recent studies have found that this formula also has good efficacy for female infertility, urinary incontinence, and menopausal syndrome. Clinically, it is widely used in the treatment of nephrotic syndrome and diabetic nephropathy.

2. Yubiao Bushen Wan

Yubiao Bushen Wan consists of Fish Bladder Gel, Gouqi Zi, Lianxu (Lotus Stamen), Rou Cong Rong (Cistanche), Bajitian (Morinda Root), Du Zhong (Eucommia Bark), Dang Gui (Angelica), Tusi Zi, Bugu Zhi (Psoralea), Fu Ling (Poria), Yin Yang Huo (Epimedium), Rou Gui (Cinnamon), Shayuanzi (Astragalus), Niuxi (Achyranthes), and Fu Pian (Aconite). It tonifies the kidneys and benefits essence, primarily used for symptoms such as dizziness, tinnitus, lumbar pain, impotence, premature ejaculation, nocturnal emissions, infertility, and dark complexion due to kidney yang deficiency and kidney essence depletion.

The main component, Fish Bladder Gel, is rich in various amino acids, with L-arginine being a precursor substance for nitric oxide (NO) synthesis in the nitric oxide synthase (NOS)-NO-cyclic guanosine monophosphate (cGMP) pathway. It promotes relaxation of the smooth muscle in the corpora cavernosa by increasing cGMP, facilitating blood filling in the corpora cavernosa, thus inducing and enhancing penile erection.

The formula’s Rou Cong Rong has been recorded in the Tang Dynasty’s Ben Cao Shi Yi: “Three qian of Rou Cong Rong, decocted three times, taken hot, will ensure lifelong vitality of the male organ.” Modern medicine has also confirmed this, as Rou Cong Rong contains abundant amino acids, cysteine, vitamins, and rare minerals that nourish male sexual organs such as the kidneys, testicles, penis, and corpora cavernosa.

The Yin Yang Huo in the formula can enhance the secretion of the hypothalamic-pituitary-adrenal axis, promoting nucleic acid and protein synthesis in yang-deficient animals. Bajitian can tonify kidney yang, strengthen muscles and bones, and dispel wind-dampness. The combination of these herbs has a potent effect of tonifying yang and benefiting essence.

Clinical studies have shown that Yubiao Bushen Wan can significantly reduce the sperm DNA fragmentation index, repair damaged sperm DNA, improve sperm motility, and enhance sperm quality, thereby improving fertility in male patients with gonadal dysfunction causing erectile dysfunction symptoms and enhancing the quality of sexual life.

3. Ziyin Bushen Wan

Ziyin Bushen Wan consists of Sheng Shai Shen (Fresh Ginseng), Lu Rong (Deer Antler), Wuweizi, Tusi Zi, Suo Yang (Cynomorium), Yuan Zhi (Polygala), Shan Yao (Chinese Yam), Shu Di Huang (Rehmannia), Di Huang (Rehmannia), Huang Qi (Astragalus), Bajitian, Shan Zhu Yu (Cornus), Long Gu (Dragon Bone), Hu Lu Ba (Fenugreek), and Ma Qian Zi (Strychnos). It has the effects of nourishing yin, strengthening yang, and benefiting essence and marrow, used for symptoms such as lumbar and knee soreness, nocturnal emissions, and impotence with premature ejaculation.

Clinical research results indicate that after taking Ziyin Bushen Wan, patients showed significant increases in serum total testosterone and follicle-stimulating hormone levels, while estradiol levels significantly decreased. The increase in serum total testosterone can regulate the endothelial function of penile blood vessels, thereby enhancing erectile function. Follicle-stimulating hormone, an important gonadotropin secreted by the pituitary gland, promotes the secretion of male hormones from the gonads and adrenal glands, thereby enhancing male sexual function.

Estradiol, present in low amounts in males, is converted from testosterone under the action of aromatase, and has the function of protecting vascular endothelium and smooth muscle. An increase in estradiol levels in the body can lead to contraction of smooth muscle in penile tissue, reduced collagen content, and decreased serum testosterone concentration, promoting erectile dysfunction. Therefore, the decrease in estradiol levels after taking Ziyin Bushen Wan is beneficial for improving erectile dysfunction.

The erectile function score is the most authoritative scale for assessing male sexual dysfunction, directly reflecting the comparison of patients before and after medication, significantly impacting the patient’s physical and mental health and sexual happiness index. Studies have shown that after taking Ziyin Bushen Wan, patients’ erectile function scores significantly improved, allowing patients to intuitively feel the effects of the medication, greatly aiding in enhancing their sexual function and confidence.

4. Tamsulosin + Jinkui Shenqi Wan

Tamsulosin is a highly selective α-receptor blocker that can significantly improve lower urinary tract symptoms associated with benign prostatic hyperplasia. Literature shows that Tamsulosin can significantly improve erectile function, libido, and sexual satisfaction in patients with lower urinary tract symptoms related to benign prostatic hyperplasia. A dosage of 0.4 mg/day is more effective for improving erectile function than 0.2 mg/day. This may be related to the improvement of lower urinary tract symptoms, reduction in nocturia, enhanced quality of life, and its direct relaxation effect on the smooth muscle of the penile corpora cavernosa.

The relaxation of the smooth muscle in the corpora cavernosa plays an important role in the process of penile erection, and abnormal activation of α-receptors can lead to penile flaccidity. α-receptor blockers disrupt the contraction and relaxation balance of the smooth muscle in the penile blood vessels after engorgement, delaying vascular contraction after α-receptor blockade, thereby improving erectile dysfunction.

To enhance the treatment effect for lower urinary tract symptoms related to benign prostatic hyperplasia and erectile dysfunction, we combined it with Jinkui Shenqi Wan.Traditional Chinese Medicine believes that the pathogenesis of benign prostatic hyperplasia is due to “kidney qi deficiency and blood stasis,” and the main pathogenesis of erectile dysfunction in elderly patients is “kidney deficiency and blood stasis,” thus a warming and tonifying kidney yang treatment method is appropriate for benign prostatic hyperplasia combined with erectile dysfunction.

Jinkui Shenqi Wan is a classic formula for treating kidney yang deficiency, primarily indicated for symptoms such as lumbar pain, abdominal tightness, difficulty urinating, and cold limbs. Clinical studies have shown that Jinkui Shenqi Wan can significantly improve urinary frequency, urgency, and nocturia, and has effects against detrusor aging and improving nocturia. Additionally, this formula can significantly enhance the International Index of Erectile Function scores in middle-aged and elderly men with partial androgen deficiency syndrome, improving erectile function. Research results indicate that for patients with mild to moderate benign prostatic hyperplasia combined with erectile dysfunction due to kidney yang deficiency, low-dose Tamsulosin combined with Jinkui Shenqi Wan can significantly improve lower urinary tract symptoms and erectile function, with no significant adverse reactions.