Traditional Chinese Medicine: Erectile Dysfunction (ED) and alternatives to Viagra

I recently saw my first client with ED and spent time researching how Traditional Chinese Medicine (TCM) approaches working with this condition.  Erectile dysfunction (ED) or impotence occurs when a man has consistent and repeated problems sustaining an erection. Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It is also sometimes also referred to as impotence.   Several studies have looked at the prevalence of ED including one, the Massachusetts Male Aging Study, that reported that ED is increasingly prevalent with age. At age 40, approximately 40% of men are affected. The rate increases to nearly 70% in men aged 70 years.  Age was the variable most strongly associated with ED, although there are emotional and physiological reasons attributed including: diabetes, obesity, heart disease, high blood pressure and atherosclerosis, endocrine diseases, lifestyle, diet, neurological and nerve disorders, medications, drug abuse, anxiety and depression. Additionally men may have difficulty obtaining or maintaining erections after various forms of cancer treatment. Surgery and radiation therapy to the pelvic area, hormonal therapy, chemotherapy, and various medications may all significantly impact a man’s ability to obtain or maintain an erection. Viagra is the leading medication prescribed for ED, although as with all medications,  it is not without its associated side effects:

  • HeadacheUntitled1
  • Flushing in the face, neck, or chest
  • Upset stomach, indigestion
  • Abnormal vision
  • Nasal congestion
  • Back pain
  • Muscular pain or tenderness
  • Nausea

If considering options than Viagra, such as those explored below, it would be advised see a TCM trained specialist.

Traditional Chinese Medicine (TCM) considers that the strength or weakness of men’s sexual function is associated with the energy of certain internal organs, including the kidneys, liver and heart. The Kidneys are one of the major organs to support the body’s sexual function by storing essence (Jing), controlling human reproduction, growth and development. Essence or Jing rules the production of sperm. The heart plays an important role in erection and arousal. Kidney essence is classified as yin, while qi is yang, yet they depend on each other to maintain a dynamic balance, if out of balance it can result in ED/impotence. Excessive sexual activities and frequent masturbation can deplete the kidney essence.

The Ming Men (located on the middle of the lower back) is an essential part of traditional Chinese physiology. Called the “Gate of Life,” it holds the Genuine Yin and Yang of the body from which all substances and functions develop. The term Ming Men refers to one of the body’s two kidneys, where the male’s “essence” is stored. In Kidney Deficiency cases, warming the Ming Men and Kidney Yang are necessary to balance the body.

index4Men’s sexual function disorders have been strongly associated fast paced life styles. This state of chronic stress restricts the flow of the qi through the Liver channel which travels through the pubic area and reproductive organs. When the Liver is affected by stress and the Liver channel is blocked then qi cannot flow smoothly leading to sexual dysfunction and disorders.

The process by which the penis becomes erect is complex, involving not only the nerves, muscles, blood vessels, and other tissues in the penis itself, but also includes factors such as emotion, lifestyle and general health. During arousal nerve impulses are sent to nerves in and around the penis, which cause an increase of blood flow into that organ, causing it to become firm and erect. If there is insufficient blood the penis is unable to achieve erection.

The Heart plays a crucial role in erection, orgasm and ejaculation. In TCM the ability to have an erection and ejaculation depend on the communication between the heart and kidneys. The Heart-Qi needs to descend to communicate with Kidney-Qi. Vice versa, Kidney-Water needs to ascend towards the Heart and contain Heart-Fire, the coordination between the descending of Heart-Fire and ascending of Kidney-Water ensures a normal sexual cycle in men. During the excitement phase of sexual response the Minister Fire within the Kidneys is aroused and flows up towards the Pericardium and Heart: for this reason the person becomes flushed in the face (the complexion is a manifestation of the Heart) and the heart rate increases during sexual excitation. With orgasm and ejaculation, there is a downward movement of Qi, which releases the accumulated Minister Fire downwards: in order for this to occur normally the downward movement of Heart-Qi is crucial. If there is deficiency of Minister Fire within the Kidneys it will result in decreased libido and ED or impotence in men. If Heart-Qi and Heart-Blood are deficient or not descending to communicate with the Kidneys, there may be ED, impotence or premature ejaculation.

tongue blood stasisThere are several other common patterns in ED including blood stasis and damp heat. In cases of Blood Stasis, the flow of energy (called Qi) and Blood is blocked or obstructed in the lower abdomen preventing needed blood flow to create and maintain an erection. This condition often presents with signs of a tight and tender to palpitation lower abdominal area. Treatment will focus on breaking the stagnation in the lower abdomen, returning the proper flow of Blood though the affected area.

Another reason for ED or impotency is the presence of damp heat. Whenindex5 damp heat accumulates it acts creases stagnation or impedes the free flow of Qi. There are many causes of damp heat including unresolved health issues, unresolved low-level pathogens, and or excessive alcohol intake. Signs that point to the presence of damp heat include itching, pain, and swollen prostate, sweating in the genitals, heaviness and aching in the lower limbs, greasy yellow coating on tongue. Treatment includes clearing heat and nourishing any underlying deficiencies.

In determining treatment for ED it is important to utilize the four basic techniques of assessment: questioning, smelling/listening, palpitation and inspection. Furthermore the constitution of the client is taken into account at the same time as TCM pattern differentiation. The following is a summary of pattern differentiation taken from Giovanni Maciocia and Shen-Nong.com, as well as, several other authors.

Primary Patterns:

Kidney Deficiency:

  • Weakness of Life-Gate Fire/Ming Men
  • Deficiency of Kidney Yang Deficiency
  • Deficiency of Kidney Yin Deficiency
  • Damage of the kidneys by fear

Damp Heat:

  • Downpour of Damp Heat into the Lower Burner
  • Damp Heat in Lower Burner
  • Damp Heat in Liver-Gallbladder Channel

Blood Deficiency/Stagnation:

  • Liver-Blood Deficiency
  • Heart and Gallbladder Qi Deficiency
  • Heart-Blood Deficiency
  • Damage of the heart and spleen
  • Blood Stasis

Qi:

  • Liver Qi Stagnation

Untitled2Weakness of Life-Gate Fire-The Gate of Life or Ming men is (located on the middle of the lower back) is an essential part of traditional Chinese physiology. Called the “Gate of Life,” it holds the Yin and Yang of the body from which all substances and functions develop. Along with the Yin-Yang theory, one of the most fundamental principles in Chinese medicine is that of the “Three Treasures.” The Three Treasures consist of jing (essence/potential energy), qi (energy/function), and shen (spirit or spirits). In terms of understanding the Ming Men the concepts of jing and qi are primary. Original Qi is stored in an energetic center called Ming Men. The relationship between the Kidney organ-system and Ming Men is defined by the relationship between the elements of Water and Fire, or Kidney and Heart as explained above. Strengthening Jing and the Life-Gate are often the first approach when working with ED/Impotency.

  • ED/Impotence
  • Seminal discharge, white/cold
  • Dizziness/vertigo
  • Tinnitus
  • Pale complexion,
  • Cold extremities
  • Listlessness of spirit
  • Weak aching lower back and legs
  • Frequent urination
  • Pale Tongue with white coating
  • Deep thready pulse

Formulas:

  • Wu Zi Yan Zong Wan (Five Ancestors Teapills)
  • Zan Yu Dan (Procreation Elixir)
  • Right-Restoring Pill combining with Procreation Elixir
  • Jin Suo Gu Jing Wan (Golden Lock Teapills) Kidney Yin and Yang deficiency with leakage of fluids creating instability at the Gate of Life.
  • Cong Rong Bu Shen Wan (Cistanches Tonify Kidney Pills)
  • Er Xian San (Two Immortals Teapills) regulates the chong and ren channels
  • Ge Jie Da Bu Wan (Gecko Tonic Teapills)

Deficiency of Kidney Yang symptoms: Yang is responsible for our physiological functions and energy. A deficiency of Kidney Yang is an internal condition results in cold and weakness, along with ED or impotence. A deficiency of Kidney Yang indicates a deficiency in the “Life Gate” or Ming Men. This coldness results in the lower libido, ED or Impotence. It is

  • ED/Impotence
  • frequent clear urination,
  • cold limbs,
  • dizziness,
  • tinnitus,
  • fatigue,
  • lower back weakness
  • Deep-Weak pulse
  • Pale tongue

Formulas:

  • You Gui San (Right side Replenishing teapills)
  • Wu Zi Yan Zong Wan (Five Ancestors Teapills)
  • Jin Gui Shen Qi San (Golden Book Teapills)
  • Ba Ji Yin Yang Teapills (Morinda Pills to Balance Yin and Yang)
  • Huan Shao Dan Wan (Return to Spring Teapills)
  • Ge Jie Dan Bu Wan (Gecko Tonic Teapills)

Deficiency of Yin Deficiency

  • ED/Impotence
  • Dizziness
  • Scanty urination
  • Night-sweating
  • Insomnia
  • Tinnitus
  • Floating-empty pulse
  • Red tongue w/o coating

Formulas:

  • Zuo Gui Wan (Return Left Pill)
  • Zhi Bai Di Huang Wan (Eight Flavor Rehmannia Teapills) with deficient heat
  • Liu Wei Di Huang San (Six Flavored Teapills)

Damage of the kidneys by fear-Fear can shock or injure the Kidney-Adrenals, along with leading to the disordered movement of qi.

  • ED/impotence
  • soft erection
  • timidity
  • tendency to doubt and suspicion
  • palpitations
  • susceptibility to fright
  • restless sleep
  • thin and slimy tongue coating, string-like
  • thready pulse.

Formula: Huan Shao Dan Wan (Return to Spring Teapills)

Downpour of Damp Heat into the Lower Burner

  • ED
  • Premature ejaculation
  • Sweatiness of the scrotum
  • Heavy aching lower limbs
  • Thirst
  • Bitter taste
  • Dark burning urine
  • Yellow slimy coating on Tongue
  • Pulse is Slippery and rapid

Formula: Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction

Damp Heat in Lower Burner

  • ED/Impotence
  • Difficult-painful urination
  • Deep yellow urine
  • Itching of genitals
  • Urethral discharge
  • Sticky-yellow coating on tongue, with red spots on root
  • Slippery pulse

Formula: Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction

Damp Heat in Liver-Gallbladder Channel

  • ED/Impotence,
  • Difficult-painful urination
  • Rash external genitalia
  • Irritability
  • Sticky-yellow coating on tongue, with red spots on root
  • Wiry pulse

Formula: Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction

Liver-Blood Deficiency

  • ED/Impotence
  • Dizziness
  • Blurred vision
  • Depressed mood
  • Insomnia
  • Pale tongue
  • Choppy pulse.

Formula:

  • Shao Yao Gan Cao Tang Jia Wei (Peony and Licorice Teapills)
  • Si Wu Tang (Dang Gui Four)

Heart and Gallbladder Qi Deficiency

  • ED/Impotence
  • Premature ejaculation
  • Depressed mood
  • Timidity, sighing
  • Insomnia
  • Palpitations
  • Easily startled
  • Pale tongue
  • Weak pulse

Formula: Da Bu Yuan Jian

Heart-Blood Deficiency

  • ED/Impotence
  • Palpitations
  • Dizziness
  • Depressed mood
  • Insomnia
  • Pale tongue
  • Choppy pulse

Formulas:

  • Gui Pi Tong (Ginseng and Longan Combination)
  • Si Wu Tang (Dang Gui Four)

 Damage of the heart and spleen

The Spleen is the source of Blood production along with ensuring its flow within the vessels. If the spleen is operating properly then it transports and transforms sufficient nutrients for plentiful heart blood. Vise versa, according to the five-element theory, the Heart is the mother of the Spleen. If there is deficiency of Heart Blood or Qi it impairs the function of the Spleen to transport and transform. This domino effect will impede the Spleens ability to transport sufficient nutrients to keep Blood flowing in the vessels (ability to achieve and maintain erection).

  • Inability to achieve and/or maintain erection
  • Lassitude
  • Palpitations
  • Poor memory
  • Restless sleep
  • Poor appetite/eating habits
  • Colorless facial complexion
  • Thin and slimy tongue coating, pale tongue,
  • Fine or choppy pulse.

Formula:

  • Gui Pi Tong (Ginseng and Longan Combination)
  • Spleen-Restoring Decoction

Blood Stasis-Surgery, cancer, radiation and chemotherapy can potentially result in creating stagnation of blood to the perineum, which can impede the flow of blood and qi.

  • Prickling pain in testes
  • Pain or distention in chest and hypochondria
  • Stabbing pain
  • Dark complexion
  • Dry skin
  • Purplish dark tongue
  • Thready, uneven pulse

Formulas:

  • Xue Fu Zhu Yu Tang (Stasis in the Mansion of Blood Decoction)
  • Wen Jiang Tang Wan (Warm Cycle teapills)

Liver Qi Stagnation-Normal flow of liver qi ensures that all emotional processes are in harmony and blood is flowing sufficiently. If there is a stagnation of liver qi then this can result in the lack of nourishment to tendons including genitalia.

  • ED/impotence
  • Depression
  • Anxiety and irritability
  • Discomfort of the chest and stomach
  • Distension and oppression of the hypochondriac region
  • Poor appetite/eating habits
  • Loose stool
  • Thin tongue coating
  • String-like pulse.

Formula:

  • Xiao Yao San (Bupleurum and Dang Gui Formula
  • Jai wei xiao yao san (Bupleurum and Peony Formula) clears deficient heat
  • Chai Hu Shu (Disperse Vital Energy in Liver), for liver qi stagnation and Liver Blood Stasis

Traditional Formulas used for ED/Impotence:

Ge Jie Da Bu Wan (Gecko Tonic Teapills), Qi, Yang, Blood and Jing deficiency

Symptoms:

  • Weakness or pain in low back knees
  • Joint pain and stiffness
  • Difficulty walking
  • Weakness, fatigue, exhaustion, listlessness
  • Weak voice, pale face
  • Spontaneous sweating
  • Occasional chills and feverishness
  • Dizziness, vertigo, tinnitus, hearing loss
  • Forgetfulness, poor memory,
  • Frequent urination, nighttime urination
  • Edema,
  • Chronic diarrhea w/undigested food, abdominal distention, poor appetite
  • Cold limbs, cold intolerance
  • Decreased sex drive, impotence
  • Shortness of breath, wheezing, shallow breathing aggravated by exertion, shallow breathing aggravated by exertion, chronic persistent cough
  • Palpitation
  • Insomnia

Jin Suo Gu Jing Wan (Golden Lock Teapills), Kidney Yin and Yang Deficiency creating instability at the Gate of Life

Symptoms:

  • Chronic leakage of fluids, spermatorrhea, nocturnal emissions, premature ejaculation, impotence,
  • Urinary frequency, night urination, urinary dribbling or incontinence
  • Fatigue, weakness, listlessness
  • Excessive sweating
  • Weakness and rapid fatigue in muscles, sore and weak low back and limbs
  • Chronic watery diarrhea
  • Tinnitus

Wen Jiang Tang Wan (Warm Cycle teapills) * deficiency and cold in Chong and Ren channels causing blood stasis

Symptoms:

  • Five palms heat
  • Dry lips and mouth
  • Dry skin or hair
  • Fatigue, weak or cold limbs
  • Impotence
  • Pain in the testicles
  • Urinary incontinence

*primarily used for women in the category of warm the menses and dispel blood stasis, but can be used for spermatorrhea, erectile dysfunction, orchialgia, seminal insufficiency.

Supplementary herbs and formulas:

  • Wu Chi Pai Feng Wan (Black Chicken White Phoenix Pills)
  • Tonic wine: soak red deer antler, ginseng roots, lycii berry and schizandra in rise wine. Take 1 tsp 3 times a day, especially for winter.
  • Planetary Herbs: Damiana Male Potential
  • Ashwagandha
  • Shilajit
  • Damiana
  • Yohimbe
  • Ginseng

Moxibustion and Qi Gong: In cases of Kidney deficiency that require warming, moxibustion can also be performed at index6these acupuncture points. The moxibustion treatment involves the burning of a herb, Ai Ye-mugwort, to warm and circulate the energy in the local area, strengthening the Life Gate fire.

Qi Gong has specific movements to strengthen the Gate of Life (http://www.funwithqigong.com/2009/07/open-and-move-from-the-gate-of-life/)

References:

http://www.shen-nong.com/eng/exam/specialties_menimpotence.html

https://www.jcm.co.uk/liver-gallbladder-based-erectile-dysfunction-treatment-by-chinese-medicine-part-1.html

http://www.altmd.com/Articles/TCM-for-Erectile-Dysfunction

http://maciociaonline.blogspot.com/2013/06/the-treatment-of-male-problems-in.html

http://www.itmonline.org/5organs/kidney.htm

http://www.tcmtreatment.com/images/diseases/impotence.htm

http://www.theacupunctureclinic.co.nz/male-sexual-dysfunction-by-will-maclean/

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5 Comments (+add yours?)

  1. Tony
    Jun 14, 2016 @ 10:49:57

    Very informatiove.

    Reply

  2. Tony
    Jun 14, 2016 @ 10:50:21

    Good article.

    Reply

  3. markspeaksup
    Jun 11, 2017 @ 16:05:45

    i was devastated after my operation for my prostate, I could not perform my duties as effectively as before, I lost total interest in sex because my manhood kept failing me, but I am totally better now and free from Erectile dysfunction, just by using herbal drugs I purchased from this great doctor, Dr Jose Alessio,the truth about ED is that it can only be tackled using herbs, my libido is higher and at my age I have great sex, you can contact him via email on joseherbals28@gmail.com

    Reply

  4. George
    Aug 07, 2017 @ 15:44:52

    how do I find a place in my area that will focus on these things?

    Reply

  5. foodscrap
    Aug 07, 2017 @ 18:19:09

    I would look for an acupuncturist who also specializes in Chinese Herbal Medicine, or you can find an herbalist in your state by using the following site: https://www.americanherbalistsguild.com/member-profiles

    Reply

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