Exploring the Medication Patterns of Professor Zulong Wang in Treating Sleep-Related Painful Erection Based on Data Mining

Abstract

Objective

To explore the medication patterns of Professor Zulong Wang in treating sleep-related painful erection (SRPE) through data mining, aiming to discover new therapeutic strategies for traditional Chinese medicine in managing this condition.

Methods

Medical records of SRPE patients treated by Professor Zulong Wang at the First Affiliated Hospital of Henan University of Chinese Medicine from February 2021 to December 2024 were collected to establish a database. Frequency analysis, association rule analysis, and cluster analysis were employed to examine the frequency of herb use, four properties and five flavors, channel tropisms, and herb combinations.

Results

A total of 59 prescriptions meeting the criteria were included, involving 81 Chinese herbs, among which 27 herbs were used 10 or more times. The primary herb properties were cold, warm, and neutral, with bitter, sweet, and pungent flavors being most common. The herbs predominantly entered the liver, heart, spleen, and kidney channels. Forty-three commonly used herb combinations were identified, and cluster analysis revealed six core herb groups.

Conclusion

Professor Zulong Wang primarily treats SRPE with modified Huoluo Xiaoling Dan, focusing on unblocking collaterals and relieving pain, supplemented by soothing the liver and regulating qi, resolving stasis and phlegm, nourishing yin and reducing fire, and tonifying the kidney and activating blood circulation.

 

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Keywords

sleep-related painful erection - medication patterns - Huoluo Xiaoling Dan - unblocking collaterals and relieving pain - Zulong Wang - traditional Chinese medicine

Sleep-related painful erection (SRPE) refers to abnormal penile erection accompanied by distending pain during sleep, which is relieved or disappears after waking up or urinating. It may occur once or multiple times per night, severely affecting sleep quality, and can persist for months or even years. SRPE is one of the rare andrological diseases.[1] According to guidelines issued by the American Academy of Sleep Medicine, this type of abnormal erection typically occurs during the rapid eye movement sleep phase. The resulting repeated awakenings and discomfort significantly impair sleep quality, leading to daytime fatigue, anxiety, tension, and irritability.[2] The pathogenesis of SRPE remains unclear but may involve multiple factors such as sleep-disordered breathing, androgen fluctuations, neuroendocrine dysregulation, psychological factors, and local hemodynamic abnormalities.[3] [4]

Currently, Western medicine primarily employs antidepressants, antiepileptics, and muscle relaxants for SRPE treatment, with varying clinical outcomes.[5] In TCM, SRPE can be categorized under conditions such as “persistent erection” “uncontrolled erection,” or “strong yang” due to its characteristic symptoms. Although SRPE shares some similarities with certain subtypes of “abnormal erection,” particularly intermittent priapism in terms of recurrent episodes,[3] their pathophysiological mechanisms differ.[6] [7] Modern TCM practitioners have achieved notable clinical efficacy in treating SRPE using herbal medicine or specialized therapies like Guasha (scraping), based on holistic concepts and syndrome differentiation.[8] [9]

Professor Zulong Wang, a renowned TCM expert in Henan Province and doctoral supervisor, serves as Vice Chairperson of the Andrology Branch and Reproductive Medicine Branch of the China Association of Chinese Medicine. With over 30 years of clinical, teaching, and research experience in andrology, he has demonstrated significant efficacy in treating SRPE. This study employs data mining to analyze Professor Wang's medication patterns and prescription strategies for SRPE, aiming to provide new insights and approaches for TCM treatment of this condition.

Methods

General Data: Medical records of SRPE patients treated by Professor Zulong Wang from February 2021 to December 2024. The study was approved by the Ethics Committee of the First Affiliated Hospital of Henan University of Chinese Medicine, Ethics Approval Number: H2025HL-281-01.

Diagnostic Criteria: SRPE definition:[10] Erections occurring during sleep with associated pain that alleviates or disappears upon waking or physical activity, occurring once or repeatedly. TCM diagnosis referenced “persistent erection” criteria from Andrology in Traditional Chinese Medicine (Zhong Yi Nan Ke Xue).[11]

Inclusion Criteria: Patients meeting the above symptoms and TCM diagnostic standards with complete medical records; limited to initial visits; herbal decoction prescriptions only.

Exclusion Criteria: Duplicate outpatient prescriptions; nonherbal decoction treatments; patients with severe systemic or psychiatric comorbidities.

Data Standardization: Herb names standardized according to Chinese Pharmacopoeia.[12]

Database Establishment: SRPE cases were preliminarily screened via Excel by two independent researchers who cross-verified entries to ensure accuracy.

Data Analysis

Frequency analysis of herb properties (property, flavor, channel tropism). SPSS Modeler performed association rule mining for high-frequency herb pairs with network visualization. SPSS 20.0 conducted R-type clustering with dendrogram generation to identify prescription patterns.

 

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Results

The study included 59 eligible cases with corresponding 59 herbal decoctions.

Herb Frequency Analysis

Eighty-one herbs appeared in 59 prescriptions, with 27 herbs used ≥10 times. Top 10 herbs: Danggui (Angelicae Sinensis Radix), Huangbo (Phellodendri Chinensis Cortex), Moyao (Myrrha), Ruxiang (Olibanum), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Fuling (Poria), Sharen (Amomi Fructus), Zhufushen (Poria cocos cum Cinnabaris), Dihuang (Rehmanniae Radix), Baishao (Paeoniae Radix Alba; [Table 1]).

Table 1 Frequency statistics of herbs used by Professor Zulong Wang in treating sleep-related painful erection (frequency ≥ 10)

Number	Herbs	Frequency	Number	Herbs	Frequency
1	Danggui (Angelicae Sinensis Radix)	42	15	Zhimu (Anemarrhenae Rhizoma)	16
2	Huangbo (Phellodendri Chinensis Cortex)	38	16	Shanyao (Dioscoreae Rhizoma)	15
3	Moyao (Myrrha)	34	17	Chao Baizhu (Atractylodis Macrocephalae Rhizoma Praeparatum)	15
4	Ruxiang (Olibanum)	34	18	Yanhusuo (Corydalis Rhizoma)	14
5	Danshen (Salviae Miltiorrhizae Radix et Rhizoma)	32	19	Chishao (Paeoniaeradix Rubra)	13
6	Fuling (Poria)	32	20	Chao Yiyiren (Coicis Semen Preap)	13
7	Sharen (Amomi Fructus)	25	21	Zhenzhumu (Margaritifera Concha)	12
8	Zhufushen (Poria cocos cum Cinnabaris)	24	22	Chenpi (Citri Reticulatae Pericarpium)	12
9	Dihuang (Rehmanniae Radix)	23	23	Chaihu (Bupleuri Radix)	12

 

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Herb Properties and Channel Tropisms

According to the Chinese Materia Medica,[13] the 81 Chinese herbs were classified by their four properties, five flavors, and channel tropisms. The statistical results of this study showed that the frequency of use of the four properties of Chinese herbs was in the following order: cold-natured herbs (259 times) > warm-natured herbs (257 times) > neutral-natured herbs (191 times) > cool-natured herbs (11 times) > hot-natured herbs (7 times; [Table 2]). In terms of flavor, the frequency of use from high to low was bitter (384 times) > sweet (341 times) > pungent (234 times) > sour (64 times) > salty (17 times; [Table 3]).

Table 2 Herbal property distribution

Number	Herbal property	Frequency
1	Cold	259
2	Warm	257
3	Neutral	191
4	Cool	11
5	Hot	7

Table 3 Herbal flavor distribution

Number	Herbal flavor	Frequency
1	Bitter	384
2	Sweet	341
3	Pungent	234
4	Sour	64
5	Salty	17

The distribution of herbal channel tropisms showed the following descending frequency order: liver channel (367 times) > heart channel (349 times) > spleen channel (344 times) > kidney channel (233 times) > lung channel (203 times) > stomach channel (132 times) > bladder channel (61 times) > gallbladder channel (27 times) > triple energizer channel (19 times) > large intestine channel (18 times) > pericardium channel (7 times) > small intestine channel (3 times; [Table 4]).

Table 4 Medicinal channel tropism distribution

Number	Channel tropism	Frequency	Number	Channel tropism	Frequency
1	Liver	367	7	Bladder	61
2	Heart	349	8	Gallbladder	27
3	Spleen	344	9	Triple energizer	19
4	Kidney	233	10	Large intestine	18
5	Lung	203	11	Pericardium	7
6	Stomach	132	12	Small intestine	3

Since a single Chinese herbal medicine may possess multiple flavors and channel tropisms, in the statistical process of this study, herbs with multiple channel tropisms were counted separately, resulting in a slightly higher number of herb types in the statistical results than the actual quantity.

 

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Herb Efficacy Analysis

With reference to the classification in Chinese Materia Medica,[13] the 81 Chinese herbs were categorized by therapeutic efficacy, with frequency of use ranked in descending order as follows: tonifying (166 times) > blood-activating and stasis-resolving (140 times) > heat-clearing (125 times) > dampness-percolating and diuresis-promoting (59 times) > sedative (53 times) = qi-regulating (53 times) > astringent (37 times) > exterior-releasing (22 times) > phlegm-resolving, antitussive and antiasthmatic (18 times) = liver-calming and wind-extinguishing (18 times; [Table 5]).

Table 5 Herb efficacy frequency distribution

Number	Efficacy	Frequency	Number	Efficacy	Frequency
1	Tonifying	166	9	Liver-calming and wind-extinguishing	18
2	Blood-activating and stasis-resolving	140	10	Phlegm-resolving, antitussive and antiasthmatic	18
3	Heat-clearing	125	11	Dampness-resolving	9
4	Dampness-percolating and diuresis-promoting	59	12	Interior-warming	8
5	Sedative	53	13	Wind-dampness expelling	8
6	Qi-regulating	53	14	Digestion-promoting	6
7	Astringent	37	15	Resuscitation-inducing	3
8	Exterior-releasing	22

 

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Herb Combination Analysis

The established database was analyzed using association rules in SPSS Modeler 18.0 software, with medicinal herbs appearing ≥10 times in prescriptions selected to generate an association rule network diagram ([Fig. 1]).

Fig. 1 Network diagram of association analysis for high-frequency Chinese herbs in SRPE treatment.Abbreviation: SRPE, sleep-related painful erection.

Drug support refers to the total frequency of herbal combinations appearing across all prescriptions, while drug confidence represents the ratio of prescriptions containing both the former and latter herbs. With confidence set at 1 and support at 35 in this study, 43 herbal combination association rules were obtained ([Table 6]).

Table 6 Herbal combination association rules (support count = 35, confidence = 1)

Number	Herbal combination	Support percentage	Number	Herbal combination	Support percentage
1	Ruxiang (Olibanum)→Moyao (Myrrha)	57.62	6	Moyao (Myrrha), Danggui (Angelicae Sinensis Radix)→Ruxiang (Olibanum)	57.62
2	Moyao (Myrrha)→Ruxiang (Olibanum)	57.62	7	Ruxiang (Olibanum), Danggui (Angelicae Sinensis Radix)→Moyao (Myrrha)	57.62
3	Moyao (Myrrha)→Danggui (Angelicae Sinensis Radix)	57.62	8	Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Moyao (Myrrha)→Ruxiang (Olibanum)	52.54
4	Ruxiang (Olibanum)→Danggui (Angelicae Sinensis Radix)	57.62	9	Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Ruxiang (Olibanum)→Moyao (Myrrha)	52.54
5	Moyao (Myrrha), Ruxiang (Olibanum)→Danggui (Angelicae Sinensis Radix)	57.62	10	Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Moyao (Myrrha)→Danggui (Angelicae Sinensis Radix)	52.54

 

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Cluster Analysis of High-Frequency Herbs

The 59 outpatient prescriptions meeting inclusion criteria were analyzed using SPSS Statistics 25.0 software for cluster analysis of Chinese herbs with usage frequency ≥10, resulting in a cluster analysis dendrogram that identified five distinct clusters: Core combination 1:Ruxiang (Olibanum), Moyao (Myrrha), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Huangbo (Phellodendri Chinensis Cortex). Core combination 2:Taizishen(Pseudostellariae Radix), Dihuang (Rehmanniae Radix), Tiandong (Asparagi Radix), Sharen (Amomi Fructus), Chishao (Paeoniaeradix Rubra), Chao Yiyiren (Coicis Semen Praeparatum). Core combination 3:Chaihu (Bupleuri Radix), Zhizi (Gardeniae Fructus), Bohe (Menthae Haplocalycis Herba), Chao Baizhu (Atractylodis Macrocephalae Rhizoma Praeparatum), Baishao (Paeoniae Radix Alba), Yanhusuo (Corydalis Rhizoma), Fuling (Poria), Mudanpi (Moutan Cortex). Core combination 4:Zexie (Alismatis Rhizoma), Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Zhimu (Anemarrhenae Rhizoma). Core combination 5:Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Zhufushen (Poria cocos cum Cinnabaris), Zhenzhumu (Margaritifera Concha; [Table 7]).

Table 7 Core combinations of herbs

Number	Core combinations of herbs
Core combination 1	Ruxiang (Olibanum), Moyao (Myrrha), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Huangbo (Phellodendri Chinensis Cortex)
Core combination 2	Taizishen(Pseudostellariae Radix), Dihuang (Rehmanniae Radix), Tiandong (Asparagi Radix), Sharen (Amomi Fructus), Chishao (Paeoniaeradix Rubra), Chao Yiyiren (Coicis Semen Praeparatum)
Core combination 3	Chaihu (Bupleuri Radix), Zhizi (Gardeniae Fructus), Bohe (Menthae Haplocalycis Herba), Chao Baizhu (Atractylodis Macrocephalae Rhizoma Praeparatum), Baishao (Paeoniae Radix Alba), Yanhusuo (Corydalis Rhizoma), Fuling (Poria), Mudanpi (Moutan Cortex)
Core combination 4	Zexie (Alismatis Rhizoma), Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Zhimu (Anemarrhenae Rhizoma)
Core combination 5	Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Zhufushen (Poria cocos cum Cinnabaris), Zhenzhumu (Margaritifera Concha)

 

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Discussion

This study systematically analyzed Professor Zulong Wang's medication patterns for SRPE treatment through data mining, exploring his core therapeutic philosophy through TCM theory. The discussion unfolds across three dimensions: understanding of etiology/pathogenesis, treatment principles and methods, and core herb combinations.

Etiology and Pathogenesis of Sleep-Related Painful Erection

SRPE resembles “persistent erection” (Qiang Zhong) in classical TCM literature. Its pathological core lies in yin-yang imbalance. TCM holds that dynamic yin-yang equilibrium underpins physiological normality. As noted in Basic Questions·Chapter on Vital Qi Communicating with Heaven [14]: “When yin is tranquil and yang firm, vitality flourishes.” Imbalance leads to yin-yang dissociation and essence exhaustion. Pain syndromes derive either from “obstruction-induced pain” or “malnourishment-induced pain.” Pathogenic factors (dampness, heat, phlegm, stasis) conglomerate in the lower energizer, obstructing meridians and vessels to cause pain. Concurrently, yin-yang disharmony, deficiency of qi, blood and essence leads to malnourishment of the genital vessels, thus resulting in pain.

Professor Wang classifies SRPE under “yin-yang dysregulation,” proposing an academic perspective of “liver–kidney yin deficiency as deficiency syndrome, with qi stagnation, blood stasis, and phlegm coagulation as excess syndrome—a mixed deficiency-excess pattern.”[10] On the one hand, Professor Zulong Wang believes that SRPE in young adults predominantly manifests as excess patterns. In contemporary fast-paced, high-stress societies, young adults often neglect healthy lifestyles, which over time damages liver qi and spleen–stomach function. Excessive stress coupled with the disease's refractory nature leads to emotional depression, causing liver dispersion dysfunction and liver qi stagnation, which subsequently results in blood stasis. Habitual consumption of spicy, greasy foods further impairs the spleen–stomach, generating phlegm-turbidity that obstructs the genital vessels and disrupts qi-blood circulation, ultimately forming blood stasis. Trauma may also cause localized “tangible accumulations” in the genital vessels, precipitating disease onset. Since SRPE primarily presents with distending pain, Professor Wang considers blood stasis the core pathological state.

On the other hand, Professor Wang observes that SRPE in middle-aged/elderly patients typically presents as deficiency patterns. Sexual overindulgence depletes kidney essence, leaving genital vessels malnourished, while excessive use of aphrodisiacs consumes liver–kidney yin fluid, generating deficient fire that pathologically stimulates the genital vessels.

 

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General Therapeutic Principles for Sleep-Related Painful Erection Treatment

Professor Zulong Wang's herbal prescriptions predominantly utilize warm, neutral, and cold-natured medicinals. As SRPE's core pathogenesis involves yang failing to enter yin with ministerial fire displacement, cold-natured herbs like Huangbo (Phellodendri Chinensis Cortex), Mudanpi (Moutan Cortex), etc. are employed to restrain ministerial fire. Additionally, since SRPE pain primarily stems from blood stasis, warm-natured blood-activating herbs such as Danggui (Angelicae Sinensis Radix), Ruxiang (Olibanum), and Chuanxiong (Chuanxiong Rhizoma) are selected to dissolve stasis and unblock collaterals. Warm-tonifying agents including Shanzhuyu (Corni Fructus)and Shudihuang (Rehmanniae Radix Praeparata) simultaneously nourish liver–kidney yin and subdue fire. Flavor distribution shows bitter > sweet > pungent dominance. Sweet medicinals tonify and harmonize yin and yang, whereas bitter–pungent combinations concurrently dry dampness and promote dispersion, thereby regulating qi movement, activating blood flow and resolving stasis, transforming phlegm-turbidity, and dispersing nodules. This triple-flavor synergy primarily targets liver, spleen, and kidney.

Channel tropism focuses on liver, heart, spleen, and kidney meridians. The Golden Mirror of Medical Tradition (Yi Zong Jin Jian) states: “The liver governs tendons—tendon disorders principally implicate the liver.” Genital vessel pathologies thus emphasize liver regulation. When recurrent illness causes liver qi stagnation with heart–mind agitation—where physical exhaustion and emotional burdens deplete heart qi. Transverse rebellion of liver qi overacts on spleen-earth, impairing the spleen–stomach's transportation–transformation function. This leads to abnormal water-dampness metabolism, resulting in phlegm accumulation that obstructs the genital vessels and disrupts normal qi-blood circulation. Kidney yin deficiency generates hyperactive fire, causing pathological excitation of the genital vessels (ministerial fire displacement). This heat disturbance manifests as abnormal penile erection.

Herbal efficacy frequencies rank: tonifying > blood-activating/stasis-resolving > dampness-percolating and diuresis-promoting > sedative = qi-regulating. Healthy qi maintains yin-yang equilibrium and qi-blood harmony.[15] Healthy qi deficiency inevitably disrupts circulation of qi, blood, yin, and yang. Kidney yin deficiency with ministerial fire hyperactivity disturbing genital vessels requires yin-nourishing fire-reducing methods to rebalance yin and yang, complemented by qi-boosting essence-stabilizing protocols to tonify liver and kidney—hence tonifying herbs dominate. As qi stagnation, blood stasis, and phlegm-turbidity constitute SRPE's main pathogenic factors, blood-activating collateral-dredging, liver-soothing spleen-fortifying, and phlegm-resolving nodule-dispersing methods explain the prominence of blood-activating and stasis-resolving, dampness-percolating and diuretic, and qi-regulating medicinals. Sedative herbs are routinely combined to tranquilize the mind and enhance therapeutic outcomes.

 

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Core Herb Analysis for Sleep-Related Painful Erection Treatment

Prioritizing Analgesia for Symptom Relief

Association rules revealed Professor Wang's top five herb combinations all derived from Huoluo Xiaoling Dan, primarily comprising Danggui (Angelicae Sinensis Radix), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Ruxiang (Olibanum), Moyao (Myrrha) to activate blood circulation, resolve stasis, and unblock collaterals for pain relief. This reflects his symptom-focused approach targeting “pain.” Danggui (Angelicae Sinensis Radix) is the key of blood medicines that both nourishes and activates blood. Danshen (Salviae Miltiorrhizae Radix et Rhizoma) is a potent stasis-resolving herb with additional blood-cooling and mind-tranquilizing effects. Ruxiang (Olibanum) is pungent-dispersing and warm-dredging with strong qi-moving and pain-relieving properties. Moyao (Myrrha) is specialized in stasis-dispersing pain relief. Their synergistic combination enhances blood-activating and pain-relieving effects. Huoluo Xiaoling Dan improves local blood circulation, reduces blood stasis, and alleviates stasis-induced pain/swelling.

The blood stasis state in TCM corresponds to pathological conditions such as vascular injury and obstruction in modern medicine. The formation of this process is often accompanied by inflammatory responses and vascular endothelial cell damage. Huoluo Xiaoling Dan can alleviate endothelial cell injury, promote blood circulation, and exert blood-activating, stasis-resolving, and analgesic effects.[16] Modern pharmacological studies have shown that Danggui (Angelicae Sinensis Radix) contains components such as angelica polysaccharides, ligustilide, and ferulic acid, which possess analgesic, anti-inflammatory, and immunomodulatory effects.[17] Danshen (Salviae Miltiorrhizae Radix et Rhizoma) contains active ingredients including salvianolic acid B, protocatechualdehyde, and tanshinone IIA, which can improve microcirculation and demonstrate anti-inflammatory, analgesic, and vascular endothelial protective effects.[18] [19] Ruxiang (Olibanum) contains acid compounds with significant anti-inflammatory activity.[20] Both Ruxiang (Olibanum) and Moyao (Myrrha) contain chemical constituents such as quercetin, monoterpenes, sesquiterpenes, and triterpenes, which exhibit pharmacological activities including analgesia, anti-inflammation, and neuroprotection, effectively reducing inflammatory responses, protecting blood vessels, and promoting nerve recovery.[21] [22] In clinical practice, Professor Zulong Wang focuses on patients' primary symptoms and consistently applies blood-activating and stasis-resolving principles throughout the treatment process, utilizing Huoluo Xiaoling Dan supplemented with other medicinals modified to different syndrome patterns.

 

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Regulating Qi and Resolving Turbidity, Balancing Yin and Yang

Cluster analysis identified six core combinations: core herbal combination 1 include Ruxiang (Olibanum), Moyao (Myrrha), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Huangbo (Phellodendri Chinensis Cortex)–modified Huoluo Xiaoling Dan. Core herbal combination 2 include Taizishen (Pseudostellariae Radix), Dihuang (Rehmanniae Radix), Tiandong (Asparagi Radix), Sharen (Amomi Fructus), Chishao (Paeoniaeradix Rubra), Chao Yiyiren (Coicis Semen Praeparatum). The combination of Taizishen (Pseudostellariae Radix), Tiandong (Asparagi Radix), and Shudihuang (Rehmanniae Radix Praeparata) synergistically harmonizes yin and yang, consolidates healthy qi, supplemented by Sharen (Amomi Fructus) to transform dampness, harmonize the stomach, and anchor kidney qi, along with Chishao (Paeoniaeradix Rubra) to cool blood and resolve stasis. This formula collectively achieves the therapeutic effects of nourishing blood, stabilizing essence, enriching yin, and descending fire, constituting a modified application of Sancai Fengsui Dan (Three Treasures Marrow-Sealing Elixir) principles.

Core herbal combination 3 consists of Chaihu (Bupleuri Radix), Zhizi (Gardeniae Fructus), Bohe (Menthae Haplocalycis Herba), Chao Baizhu (Atractylodis Macrocephalae Rhizoma Praeparatum), Baishao (Paeoniae Radix Alba), Yanhusuo (Corydalis Rhizoma), Fuling (Poria), and Mudanpi (Moutan Cortex). Analysis of the herbal composition suggests this is a modified Danzhi Xiaoyao Powder, a classic formula for harmonizing the liver and spleen. This formula has the effects of soothing the liver to relieve depression, strengthening the spleen, and nourishing blood. Modern clinical studies have also found that this formula has antianxiety and antidepressant effects and can alleviate emotional distress.[23] Chaihu (Bupleuri Radix) soothes the liver and relieves depression and regulates qi movement; Baishao (Paeoniae Radix Alba) nourishes blood and softens the liver; Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria) strengthen the spleen and replenish qi; Bohe (Menthae Haplocalycis Herba) assists Chaihu (Bupleuri Radix) in soothing the liver; Mudanpi (Moutan Cortex) and Zhizi (Gardeniae Fructus) clear heat and cool blood; with the addition of Yanhusuo (Corydalis Rhizoma) to promote blood circulation and relieve pain. The combination of these herbs resolves liver depression, strengthens the spleen, regulates qi movement, resolves blood stasis, and allows yang qi to properly return to yin.

Core herbal combination 4 consists of Zexie (Alismatis Rhizoma), Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), and Zhimu (Anemarrhenae Rhizoma). Analysis of the herbal combination suggests this is a modified Zhibai Dihuang Pill, formed by adding Zhimu (Anemarrhenae Rhizoma) and Huangbo (Phellodendri Chinensis Cortex) to the “three tonifying and three draining” base. The combination of Zhimu (Anemarrhenae Rhizoma) and Huangbo (Phellodendri Chinensis Cortex) replenishes kidney yin, reduces deficient fire, and regulates the balance of yin and yang. The “three tonifying” components refer to: Shudihuang (Rehmanniae Radix Praeparata) tonifying the kidney and replenishing essence, nourishing yin and blood; Shanzhuyu (Corni Fructus) tonifying the liver and kidney; and Shanyao (Dioscoreae Rhizoma) tonifying the spleen and kidney. The “three draining” components refer to: Fuling (Poria) strengthening the spleen and percolating dampness; Zexie (Alismatis Rhizoma) draining kidney turbidity; and Mudanpi (Moutan Cortex) clearing latent liver fire. Additionally, Zhimu (Anemarrhenae Rhizoma) nourishes yin to reduce fire and clears lung and stomach heat, while Huangbo (Phellodendri Chinensis Cortex) clears heat and dries dampness, drains ministerial fire from the kidney.

Core herbal combination 5 consists of Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Zhufushen (Poria cocos cum Cinnabaris), and Zhenzhumu (Margaritifera Concha), which can be considered a modified Erchen Decoction. The Danxi's Experiential Therapy (Dan Xi Xin Fa) states: “Generally for treating phlegm…Erchen Decoction with Baizhu (Atractylodis Macrocephalae Rhizoma) and the like should be used.”[24] In the formula: Banxia (Pinelliae Rhizoma) dries dampness and resolves phlegm; Chenpi (Citri Reticulatae Pericarpium) is pungent-moving and bitter-draining, regulating qi and moving stagnation, drying dampness and resolving phlegm; Tangerine peel and Pinellia transform damp-phlegm without damaging healthy qi, incorporating movement within the drying method, with the addition of Zhufushen (Poria cocos cum Cinnabaris) and Zhenzhumu (Margaritifera Concha) for their tranquilizing effects. The whole formula achieves the effects of drying dampness and resolving phlegm, regulating qi and harmonizing the middle, regulating spleen–stomach qi movement, and clearing internal phlegm-dampness obstruction. When dampness is eliminated and phlegm resolved, yang qi can properly return and spread, and the genital vessels' qi and blood flow smoothly. Pharmacological research has found that Erchen Decoction can reduce blood viscosity, improve blood circulation, and ameliorate inflammatory responses.[25]

Furthermore, Professor Zulong Wang employs syndrome differentiation and treatment for SRPE's different syndrome characteristics, emphasizing the synergistic relationships between herbs. Based on the “balance theory” and the disease mechanism understanding of “liver–kidney yin deficiency as the deficiency aspect, qi stagnation, blood stasis, and phlegm coagulation as the excess aspect, forming a mixed deficiency-excess pattern,” in clinical practice SRPE is divided into four patterns for treatment: ① Liver depression and qi stagnation syndrome, commonly seen in young adults, treated with modified Huoluo Xiaoling Dan combined with Danzhi Xiaoyao Powder to soothe the liver and regulate qi, unblock collaterals, and relieve pain. ② Phlegm-stasis binding syndrome, often accompanied by penile induration and cavernous fibrosis, treated with modified Huoluo Xiaoling Dan combined with Erchen Decoction to dispel stasis and resolve phlegm, unblock collaterals, and relieve pain. ③ Yin deficiency with fire hyperactivity syndrome, commonly seen with frequent erections and dull discomfort, treated with modified Huoluo Xiaoling Dan combined with Zhibai Dihuang Pill to nourish yin and reduce fire, unblock collaterals, and relieve pain. ④ Kidney deficiency with blood stasis syndrome, often accompanied by lumbar disc herniation and spinal cord lesions, treated with modified Huoluo Xiaoling Dan combined with Sancai Fengsui Dan to benefit the kidney and activate blood, unblock collaterals, and relieve pain.

 

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Conclusion

This study utilizes data mining technology to summarize and analyze Professor Zulong Wang's medication patterns in treating SRPE, comprehensively summarizing the core academic philosophy and characteristics of formula selection in his treatment of this disease. His “balance theory” academic philosophy provides important reference for TCM treatment of difficult andrological diseases. However, this study still has some limitations: as SRPE is a rare disease, the number of TCM prescriptions included in the analysis was relatively small, which to some extent affected the comprehensiveness and representativeness of the data mining results. Future research should expand the sample size to validate the clinical efficacy of core formulas, and further explore pharmacodynamic material bases and mechanisms of action, to promote the establishment of standardized TCM diagnosis and treatment systems.

 

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Conflict of Interest

The authors declare no conflict of interest.

CRediT Authorship Contribution Statement

Hanbin Zhao: Conceptualization, data curation, formal analysis, investigation, and writing-original draft. Miaomiao Ma: Project administration, supervision, and writing-review and editing. Yuanyuan Li: Data curation, formal analysis, and ethodology. Guangzhao Wang: Data curation, formal analysis, and investigation. Wenbo Zhu: Data curation, formal analysis, and investigation. Zulong Wang: Supervision and writing-review & editing.

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Publication History

Received: 10 April 2025

Accepted: 07 July 2025

Article published online:
30 September 2025