Chapter Thirteen: Andrological Diseases: Male Gynecomastia and Nocturnal Emission
Chapter Thirteen: Miscellaneous Andrological Diseases
What are male diseases?
Andrological diseases refer to diseases other than male spermatorrhea, impotence, and fertility disorders, such as gynecomastia, male menopausal syndrome, pubic sweating, cold genitals, penile retraction, and periodic nosebleeds.
What is male gynecomastia?
Gynecomastia, also known as male breast feminization, is a condition caused by male endocrine disorders. It is characterized by enlarged male breasts, unilateral or bilateral lumps, and pain, and can be physiological or pathological. Normally, the breasts of adult males are undeveloped, consisting only of small nipples and areolas. Breast development is observed in most newborns and about 70% of adolescent males, but it usually stops developing in adulthood. When a man's breasts enlarge and resemble those of a woman, it is called gynecomastia, or "male breast feminization," equivalent to "male mastitis" in traditional Chinese medicine.
The occurrence of this disease is mostly due to congenital deficiency, disharmony of qi and blood, imbalance of the Chong and Ren meridians, and stagnation of qi and phlegm; it can also be induced by surgical trauma, testicular injury, tumor lesions, or improper use of drugs. Since the nipple belongs to the liver and the breast belongs to the kidney, the onset of male mastitis is often related to liver and kidney dysfunction. Yu Tinghong said in "Collection of Medical Cases of External Symptoms": "Although nodules in the breast are said to be a liver disease, their root lies in the kidney."
This condition also needs to be differentiated from early-stage male mastitis and male breast cancer. Early detection and treatment with traditional Chinese medicine are more effective; however, as the breast grows, it affects appearance and requires surgical intervention. Men with this condition have a higher incidence of breast cancer (breast cancer) than those without breast enlargement, but this can be avoided with prompt and proper treatment.
Causes of male gynecomastia
Traditional Chinese medicine believes that the condition is caused by emotional imbalance, stagnation of liver qi, phlegm accumulation and qi stagnation, excessive sexual activity that damages the liver and kidneys, improper medication, surgical injury, testicular trauma, tumor lesions, etc. In particular, the main pathogenesis is liver and kidney yin deficiency, poor circulation of qi and blood in the meridians, phlegm accumulation, qi stagnation, and blood stasis.
Those suffering from qi stagnation and phlegm accumulation often have emotional distress or liver damage from anger, leading to stagnation of liver qi. Qi stagnation causes blood stasis, which in turn generates fire, which in turn condenses fluids into phlegm. The mutual binding of phlegm and qi obstructs blood flow, resulting in disharmony of the meridians and causing mastitis.
Those with liver and kidney yin deficiency often suffer from excessive sexual activity, which damages kidney essence, or have a pre-existing kidney deficiency. As a result, kidney essence cannot nourish the liver, leading to insufficient liver yin, impaired qi and blood circulation, and blocked meridians, which in turn causes mastitis.
Imbalances in Yin and Yang are often caused by external injuries, surgery, testicular tumors, or the effects of medications. These imbalances result in an excess of Yin essence, a deficiency of Yang energy, and an imbalance of Tian Gui (menstrual blood), leading to mastitis.
What is nocturnal emission?
Nocturnal emission refers to the frequent involuntary ejaculation of semen without conscious intervention. Nocturnal emission during sleep due to dreams is called wet dream; ejaculation without dreams, even while fully awake, is called spermatorrhea. Nocturnal emission is a term used in Traditional Chinese Medicine (TCM), and while Western medicine also refers to it as such, it considers it merely a clinical manifestation of certain diseases. In addition, TCM also uses other names such as spermatorrhea, spontaneous ejaculation, leakage of semen, spermatorrhea, sperm leakage, dream ejaculation, dream loss of semen, dream ejaculation, and spermatorrhea.
Nocturnal emission can be categorized into physiological and pathological causes. Generally, for normal unmarried adult men or those separated from their spouses for extended periods, an average of 1-2 nocturnal emissions per month without other discomfort is considered a normal physiological phenomenon. Statistics show that over 80% of unmarried men after puberty or those separated from their spouses for extended periods experience nocturnal emissions, a phenomenon known as "sperm overflowing when full." This is due to the rapid physiological and psychological maturation of males after puberty, especially significant changes in the reproductive system, such as increased testicular volume and significantly elevated androgen levels. Under the influence of the testes, seminal vesicles, prostate, bulbourethral glands, and other organs, semen is continuously produced. When it accumulates to a certain amount and reaches saturation, it is expelled through nocturnal emission, a normal physiological phenomenon harmless to health. However, if an adult male experiences nocturnal emissions more than twice a week, or ejaculation occurs while awake and with sexual awareness, accompanied by symptoms such as dizziness, tinnitus, fatigue, lower back pain, and insomnia, then it is considered pathological nocturnal emission. Substantive pathological nocturnal emission can be seen in Western medicine as sexual neurosis, prostatitis, balanitis, seminal vesiculitis, seminal colliculitis, and certain systemic chronic diseases. Therefore, nocturnal emission can also be considered a clinical manifestation of certain diseases. If substantive pathological nocturnal emission occurs, the cause should be identified and treated promptly and properly.
Traditional Chinese medicine believes that seminal emission is mainly caused by kidney deficiency and weak seminal control, or by heat disturbing the seminal chamber. The disease can involve all five internal organs, with the heart, liver, and kidneys being particularly closely related. Seminal emission due to pure deficiency is rare, especially in the early stages; it is often a mixture of deficiency and excess, or even predominantly excess. Therefore, treatment for seminal emission should avoid simply tonifying the kidneys and astringing; it is essential to differentiate between deficiency and excess and treat accordingly. In the early stages and in young adults, the condition is predominantly excess or a mixture of deficiency and excess, so treatment should focus on eliminating excess or simultaneously tonifying deficiency. If the patient is elderly and weak, or if seminal emission is frequent, prolonged, or has developed into premature ejaculation, then treatment should focus on tonifying deficiency and consolidating the seminal essence.
Traditional Chinese Medicine Causes of Nocturnal Emission
(1) When one has something one desires, one's emotions are stirred within, and one's desires are expressed without, but one's wishes are not fulfilled.
(2) When emotions are not in harmony, liver qi is not smooth and cannot flow freely, qi stagnation occurs, and prolonged stagnation can lead to fire.
(3) External damp-heat or excessive consumption of alcohol and rich food can lead to internal damp-heat, or phimosis, unclean vulva, accumulation of dirt and dampness can cause damp-heat to disturb the seminal chamber.
(4) Congenital deficiency or prolonged illness affecting the kidneys, excessive sexual activity or old age and physical weakness.
(5) Excessive thinking damages the heart and spleen, or improper diet.
The above-mentioned reasons can lead to qi stagnation, internal damp-heat disturbance, congenital deficiency, and failure of qi to retain essence, thus causing this disease.
Although the causes of this disease are numerous and the underlying principles are complex, its basic pathogenesis can be summarized in two points. First, pathogenic factors of heat or dampness descend along the meridians and disturb the seminal vesicle, causing an imbalance in its opening and closing, resulting in the leakage of semen due to the disturbance. The disease is most closely related to the heart, liver, and spleen. Second, due to the deficiency of the spleen and kidneys themselves, the function of sealing and consolidating is lost, causing the seminal gate to fail to hold, and the semen to slip away due to deficiency. The disease mainly involves the spleen and kidneys.
In the early stages of seminal emission, especially in young adults, the condition is often a manifestation of excess heat, such as heart fire, liver fire, and damp-heat. It is crucial not to immediately assume it's due to kidney deficiency and resort to tonifying and astringent methods, as this will only exacerbate the internal damp-heat and fire, leading to more frequent seminal emission. The primary approach should be to clear damp-heat. Once the damp-heat and fire are cleared, the lower abdomen and seminal chamber will be calmed, the seminal gate will be strengthened, and seminal emission will cease. In cases of prolonged seminal emission, especially in cases of uncontrollable spermatorrhea or in elderly individuals with weak constitutions, the condition is often a deficiency of the spleen and kidneys, requiring tonification of the kidneys and astringency of semen.
Western medical causes of nocturnal emission
Currently, Western medicine is not entirely clear about the exact pathogenesis of nocturnal emission caused by solid diseases, but there may be three reasons for this:
(1) Lack of proper sex education and excessive mental stress. After puberty, males experience a surge in testosterone secretion and rapid development of their sex organs, making them extremely sensitive to sexual stimulation. Sexual thoughts frequently arise in their minds. This excessive focus on sexual matters keeps a constant focus of excitation in the cerebral cortex, making them highly susceptible to nocturnal emission. However, due to a lack of sex education, excessive mental stress after a nocturnal emission occurs exacerbates the problem.
(2) It can be caused by diseases of the external genitalia or lower urinary tract, such as phimosis or redundant foreskin causing itching and frequent scratching of the external genitalia; inflammation caused by prostatitis, urethritis, and seminal vesiculitis, and bladder fullness can easily induce nocturnal emission. In addition, when suffering from prostate disease, the prostate is often congested, and the spinal ejaculation center is pathologically excited, which often causes nocturnal emission.
(3) After strenuous physical or mental labor, the body is exhausted and weak, sleep is deep, and the activity of the subcortical center is enhanced, which can easily induce nocturnal emission.
How to prevent nocturnal emission?
(1) Emotional regulation: First, eliminate fear, maintain a cheerful mood, and clear your mind of distractions. In particular, participate in appropriate cultural and sports activities. Learn about sexual physiology and hygiene, and promote sexual morality.
(2) Develop good living habits: Control sexual desire, quit the bad habit of frequent masturbation, avoid watching unhealthy videos and reading materials, and prevent excessive fatigue and mental stress. When sleeping, it is advisable to lie on your side, and the bedding should not be too thick or too warm. It is not advisable to wear tight pants. It is advisable to eat less fatty, sweet, and spicy foods, and avoid tobacco, alcohol, coffee, etc.
(3) Deal with nocturnal emission correctly: After experiencing nocturnal emission, you should first distinguish whether it is physiological or caused by a medical condition, and do not panic. Physiological nocturnal emission does not require treatment, while medical condition nocturnal emission should be treated promptly and properly, and the results are generally quite satisfactory.
(4) Pay attention to hygiene: In particular, those with phimosis need to clean their foreskin and glans frequently to prevent inflammation and irritation that could lead to nocturnal emission; those with paraphimosis should have a circumcision as soon as possible.