How to Improve Premature Ejaculation Caused by Chronic Prostatitis: TCM Internal Treatment Methods

Chronic prostatitis accompanied by premature ejaculation has become a common issue affecting men’s health today. Epidemiological studies show that the global incidence of chronic prostatitis is between 9%–16%. More notably, about 40% of chronic prostatitis (CP) patients also suffer from premature ejaculation, forming a comorbid condition of “chronic prostatitis with premature ejaculation.”

Western medicine mainly uses antibiotics and α-blockers for symptomatic treatment, but the effects are often limited, with frequent side effects that prolong the disease course and increase both physical and psychological burdens.

Traditional Chinese Medicine (TCM), based on a holistic view and the principle of syndrome differentiation and treatment, shows unique advantages in managing this comorbidity. TCM theory holds that chronic prostatitis and premature ejaculation are pathophysiologically interconnected, forming a vicious cycle: “persistent seminal turbidity → internal accumulation of damp-heat and blood stasis → deficiency of liver and kidney → malnourishment of the genital tendons → failure to store essence.” This understanding aligns closely with the modern medical mechanism of “inflammatory factors leading to sensitization of the spinal ejaculation center,” providing a scientific basis for TCM intervention.

I. TCM Understanding of the Pathogenesis of “Chronic Prostatitis with Premature Ejaculation”

Classical TCM texts have long recorded similar conditions. Plain Questions – On Flaccidity mentions that “excessive thoughts, unfulfilled desires, and excessive sexual fantasies” can lead to “failure to secure the essence gate.” Treatise on the Origins and Symptoms of Diseases also discusses “bai yin (white discharge)” and “jing lou (seminal leakage),” recognizing the relationship between urinary system inflammation and sexual dysfunction. These classical insights laid the theoretical foundation for modern TCM approaches to the comorbidity of chronic prostatitis and premature ejaculation.

Core Pathogenesis

Modern TCM summarizes the pathogenesis of this comorbid condition as follows:

• Kidney deficiency as the root: Decline in kidney yin or yang leads to impaired essence storage, manifesting as premature ejaculation.
• Damp-heat and toxic stagnation as the manifestation: Chronic prostatic inflammation generates damp-heat and toxins that disturb the seminal chamber.
• Liver stagnation and spleen deficiency as the pivot: Emotional depression causes liver qi stagnation, while spleen deficiency leads to internal dampness.

II. Core Internal Treatment Strategies in TCM: Syndrome Differentiation and Herbal Formulas

TCM treatment for chronic prostatitis with premature ejaculation follows the principle of “treating both the root and manifestation through individualized prescriptions.” Based on different pathologic mechanisms, the condition can be divided into the following syndromes for targeted regulation:

(1) Damp-Heat in the Seminal Chamber

Main symptoms: Frequent urination, urgency, yellow urine, dampness and discomfort in the perineum, frequent premature ejaculation, bitter taste in the mouth, yellow greasy tongue coating.

Pathogenesis: Damp-heat sinks downward and disturbs the seminal chamber, causing loss of control over ejaculation.

Treatment principle: Clear heat and eliminate dampness, secure the seminal chamber.

Diuretic and Anti-inflammatory Pill:

Composed of herbs such as Plantago seed, Polygonum aviculare, Talc, Dianthus, Prunella, Safflower, Peach kernel, Angelica, Red peony root, Houttuynia cordata, and Vaccaria seed. The formula clears damp-heat, resolves blood stasis, and restores normal qi and blood circulation in the lower jiao—especially the seminal chamber—thereby reestablishing its physiological balance and the essence-sealing function.

Beitu Decoction:

Consists of Rhizoma Dioscoreae Tokoro, Cuscuta, Poria, Acorus, Verbena, etc. It clears damp-heat from the lower jiao while tonifying the kidney and securing essence, addressing both “damp-heat excess” and “underlying kidney deficiency.” For pronounced damp-heat, add Gentiana and Phellodendron; for blood stasis (perineal stabbing pain), add Curcuma and Salvia miltiorrhiza.

Modified Longdan Xiegan Decoction plus Liuwei Dihuang Pills:

This combination clears heat and detoxifies while nourishing qi and yin. It suits cases where damp-toxin damages yin. If yin deficiency affects yang, add Polygonatum and Cuscuta to harmonize yin and yang.

(2) Liver Stagnation and Kidney Deficiency

Main symptoms: Premature ejaculation with depression, anxiety, flank distension, soreness of the waist and knees, and symptom aggravation under emotional stress.

Pathogenesis: Liver qi stagnation leads to disrupted flow, and kidney qi deficiency causes loss of seminal control.

Treatment principle: Soothe the liver, relieve depression, and tonify the kidney to secure essence.

Shugan Bushen Decoction:

Contains Bupleurum, Angelica, White Peony for nourishing blood and soothing the liver; Cornus and Schisandra for tonifying the liver and kidney; combined with Cuscuta and Epimedium to reinforce kidney essence—balancing “soothing the liver” and “tonifying the kidney.” If liver stagnation is severe, add Curcuma and Peppermint; if kidney deficiency is pronounced, add Rehmannia and Morinda officinalis.

Modified Xiaoyao Powder:

Uses Bupleurum and Tribulus to soothe the liver, Morinda and Acanthopanax to strengthen the liver and kidney. It is suitable for young patients with psychogenic premature ejaculation.

(3) Kidney Deficiency with Blood Stasis

Main symptoms: Persistent premature ejaculation, soreness in the lower back and knees, stabbing or distending pain in the perineum, hard prostate upon palpation, tongue with purple spots.

Pathogenesis: Kidney deficiency causes loss of storage, while blood stasis obstructs the seminal passage, leading to malnourishment of the seminal chamber.

Treatment principle: Tonify the kidney, replenish essence, and resolve stasis to open the collaterals.

Modified Taohong Siwu Decoction:

Peach kernel and Safflower invigorate blood and dispel stasis; Angelica and White Peony nourish blood; Rehmannia replenishes essence; add Salvia and Vaccaria to open collaterals; for stabbing pain, add Corydalis and Trogopterus dung. In severe cases, add insect medicines such as Leech and Centipede for stronger stasis removal, combined with Rehmannia and Lycium fruit to tonify the kidney, Epimedium and Cuscuta to reinforce yang—achieving “tonifying without stagnation, unblocking without harming the vital qi.”

(4) Deficiency of the Spleen and Kidney

Main symptoms: Premature ejaculation with frequent clear urination, lower abdominal heaviness, fatigue, poor appetite, loose stools, pale tongue with white coating.

Pathogenesis: Spleen deficiency leads to internal dampness, and kidney deficiency causes loss of seminal control.

Treatment principle: Strengthen the spleen, replenish qi, warm the kidney, and secure essence.

Modified Buzhong Yiqi Decoction:

Astragalus, Codonopsis, and Atractylodes strengthen the spleen and replenish qi; Cimicifuga and Bupleurum raise yang; add Angelica for nourishing blood; Cuscuta and Epimedium to tonify the kidney. For cases with damp-heat (yellow urine, bitter mouth), add Phellodendron and Rhizoma Dioscoreae Tokoro; for severe premature ejaculation, add Euryale seed and Cherokee rose fruit.

Professor Ju Baozhao’s modified Wumei Pill with Atractylodes and Poria is suitable for spleen-kidney deficiency with mixed cold and heat patterns.

III. Lifestyle Regulation and Relapse Prevention

TCM emphasizes that “30% lies in treatment, 70% in self-care.” The recovery from chronic prostatitis with premature ejaculation requires lifestyle adjustments to block recurrence triggers:

Regular routines: Avoid prolonged sitting and staying up late to reduce local prostate pressure. Take a warm sitz bath (38–40 °C) for 15 minutes before bedtime to promote local blood circulation.

Dietary care: Avoid spicy foods, alcohol, and cold raw foods. Eat more Chinese yam, lotus seeds, and walnuts to strengthen the spleen and kidney. For damp-heat, drink coix seed and adzuki bean soup; for kidney deficiency, eat goji berry porridge.

Emotional regulation: Since liver stagnation is an important trigger, practice relaxation methods such as meditation and walking to maintain emotional balance.

Moderate exercise: Choose low-intensity activities like brisk walking or Baduanjin to strengthen the body while avoiding vigorous exercise that increases pelvic congestion.

Conclusion

Chronic prostatitis with premature ejaculation is a complex disorder where “inflammation and functional impairment” intertwine. Western medicine often struggles to eradicate the root cause, while TCM, grounded in holistic principles and syndrome differentiation, accurately addresses the core pathogenesis of “kidney deficiency as the root, damp-heat and stasis as the manifestation, and liver-spleen imbalance as the pivot.” Through internal herbal regulation combined with lifestyle management, TCM aims to eliminate inflammation, strengthen seminal control, and harmonize the whole body—achieving coordinated results in treating both symptoms and root causes.