A. Impotence
Impotence refers to softness of the penis
during erection, inability to maintain erection, or powerless
erection during sex. In TCM, this symptom is described as
slackness of the ancestral sinew due to weakness, fright, or
damp-heat, etc.
An
article, "Symptoms of the Zang-Fu Organs Caused by Evils" in the
classic text entitled Divine Pivot (Ling Shu), attributes
impotence to ¡<yin atrophy.¡\ An article, "Channel Sinew"
describes it as uselessness of the private organ. "Discussion of
Atrophy" in the classic text Plain Questions (Su Wen) describes
these conditions as slackness of the ancestral sinew or sinew
atrophy. The medical book, Formulas of Peace People-Favoring
Dose-Making Bureau, describes it as ¡<inability to maintain
erection during sex.¡\
Syndrome Identification and Treatment Determination
1. Weak
fire of the life gate
symptoms:
inability to achieve and/or maintain erection; thin, white and
cold semen; general symptoms may include dizziness, tinnitus,
bright white facial complexion, listlessness of the spirit,
aching pains and softness of the lumbar area and knees, aversion
to cold, cold limbs, pale tongue, white tongue coating, deep and
thready pulse.
therapeutic principle: warm and tonify the lower origin
formula
and ingredients: Right-Restoring Pill combining with Procreation
Elixir
Deerhorn
glue (lu jiao jiao), cuscuta seed (tu si zi), epimedium (yin
yang huo), cistanche stem (rou cong rong), Chinese leek seed
(jiu cai zi), cnidium seed (she chuang zi), eucommia bark (du
zhong), lateral root of aconite (fu zi), cinnamon bark (rou
gui), curculigo root (xian mao), morinda root (ba ji tian),
velvet deer horn (lu rong). The above ingredients can warm the
kidneys and strengthen the yang.
Cooked
rehmannia root (shou di), tangkuei (dang gui), lycium berry (gou
qi zi), cornus fruit (shan zhu yu). These herbs can nourish the
blood and moisten the yin.
All these
ingredients cooperate to play positive roles by mutually
supplementing the yin and yang, so that the yang can be
endlessly produced, assisted by the yin.
2. Damage
of the heart and spleen
symptoms:
inability to achieve and/or maintain erection, devitalized
spirit, restless sleep, poor appetite/eating habits, colorless
facial complexion, thin and slimy tongue coating, pale tongue,
thready pulse.
therapeutic principle: enrich and tonify the heart and spleen
formula
and ingredients: Spleen-Restoring Decoction
Codonopsis
root (dang shen), astragalus root (huang qi), ovate atractylodes
root (bai zhu), poria (fu ling), and licorice root (gan cao) can
strengthen the spleen and enrich the qi.
Spiny
jujube kernel (suan zao ren), polygala root (yuan zhi), longan
fruit (gui ruan rou) can nourish the heart and calm the spirit.
Tangkuei (dang gui) can supplement the blood.
All these
ingredients cooperate to enrich the qi, supplement the blood,
nourish the heart, and fortify the spleen.
3. Damage
of the kidneys by fear
symptoms:
impotence, powerless erection, timidity, tendency to doubt and
suspicion, palpitations, susceptibility to fright, restless
sleep, thin and slimy tongue coating, string-like and thready
pulse.
therapeutic principle: enrich the kidneys and calm the spirit
formula
and ingredients: Major Origin-Supplementing Variant Brew
Cooked
rehmannia root (shou di), cornus fruit (shan zhu yu), eucommia
bark (du zhong), and lycium berry (gou qi zi) can enrich the
kidneys. Ginseng (ren shen) and tangkuei (dang gui) can tonify
and enrich the qi and blood. Spiny jujube kernel (suan zao ren)
and polygala root (yuan zhi) could be supplemented to nourish
the heart and calm the spirit. Since fear can make the qi
descend, cimicifuga root (sheng ma) and bupleurum root (chai hu)
can be added to lift the yang qi.
4.
Depressed liver and qi stagnation
symptoms:
impotence, inability to achieve and/or maintain erection;
general symptoms include depression, anxiety and irritability,
discomfort of the chest and stomach, distension and oppression
of the hypochondriac region, poor appetite/eating habits, sloppy
stool, thin tongue coating, string-like pulse.
therapeutic principle: soothe the liver and resolve stagnation
Buplureum
root (chai hu), white peony root (bai shao), and tangkuei (dang
gui) can soothe the liver, resolve stagnation, nourish the
blood, and harmonize the blood. Ovate atractylodes root (bai
zhu), poria (fu ling), and licorice root (gan cao) can
strengthen the spleen to assist transportation, fortifying the
spleen (soil) to resist against the attack of the liver (wood).
On the other hand, cyperus root (xiang fu zi), toosendan fruit
(chuan lian zi), bitter orange (zhi ke) can be added to rectify
the qi and adjust the liver. Psoralea (bu gu zhi), cuscuta seed
(tu si zi), and lycium berry (gou qi zi) can be used to tonify
and enrich the liver and kidneys.
These
herbs act harmoniously to soothe the liver, resolve stagnation,
rectify the qi, harmonize the middle-warmer (spleen and
stomach), enrich the kidneys, and assist the yang.
5.
Downrush of the damp-heat
symptoms:
atrophy and softness of the penis, damp scrotum, foul odor of
the genitals; general symptoms include aching pains and
heaviness of the lower extremities, soggy and rapid pulse.
therapeutic principle: clear heat and transform damp
formula
and ingredients: Gentian Liver-Draining Decoction
Gentian
root (long dan cao), scutellaria root (huang qin), gardenia
fruit (shan zhi), buplureum root (chai hu) can clear heat and
discharge fire, consolidating the kidneys depending upon their
bitter taste. Manshurian aristolochia stem (mu tong), plantago
seed (che qian zi), and alisma tuber (ze xie) can clear and
excrete damp and heat. Tangkuei (dang gui), fresh rehmannia root
(sheng di) can nourish the blood, quicken the blood circulation,
cool the blood; they act concomitantly with the herbs that can
clear heat and discharge fire, so the whole recipe could play
the role of supplementing when discharging so that the
fire-discharging herbs, which are much too bitter and dry in
nature, would not damage the yin fluids.
Disease
prevention and mental adjustment
With
regard to disease prevention, if the disease is due to sexual
indulgence, the patient should calm the mind, refrain from
sexual indulgence, and avoid masturbation. If the disease is
characterized by general weakness, malnutrition, mental or
physical overwork, the patient should increase nutritious foods,
ensure good rest, control the sexual activities in a moderate
way. With regard to mental adjustment, the patient should keep
in mind that in order to be able to resolve the disease
successfully, he should adopt a habit of regular physical
exercise, refrain form sexual relations for a period, and if in
a stable relationship, ask for support and consideration from
his partner. All these approaches will benefit the treatment.
B.
Premature Ejaculation
Premature
ejaculation means quick ejaculation at the beginning of
intercourse, even prior to intercourse. The earliest record of
this pattern is seen in the article, "Descendant Producing" in
the book Collection of Syndrome Identification. Premature
ejaculation usually occurs concomitantly with seminal emission,
impotence, etc. Therefore, the treatments of these diseases are
approximately similar.
Excessive
sexual activities and frequent masturbation can deplete the
kidney essence. The kidney yin becomes insufficient, the
minister (kidneys) fire thus overwhelms, provoking the
occurrence of premature ejaculation. Poor inborn endowment, bad
postnatal nutrition, or prolonged seminal emission can result in
double deficiencies of the kidney yin and kidney yang; premature
ejaculation may arise in this condition.
Syndrome
identification and treatment determination
1. Yin
deficiency and effulgent fire
symptoms:
frequent sexual desires, easy and quick erection, or powerless
erection, premature ejaculation during sexual relations, seminal
emission, dizziness, palpitations, dry mouth and throat, red
tongue, thready and rapid pulse.
therapeutic principle: moisten the yin and lower the fire.
formula
and ingredients: Anemarrhena, Phellodendron, and Rehmannia
Pills, or Major Yin Supplementation Pills
The first
formula includes:
anemarrhena root (zhi mu) moistening the kidney yin
phellodendron bark (huang bai) discharging fire and
consolidating the yin
cooked
rehmannia root (shou di huang) moistening the kidney yin
cornus
fruit (shan zhu yu) moistening the kidneys and enriching the
liver
dioscorea
root (shan yao) discharging the damp of the spleen
mountan
bark (dan pi) draining the liver fire
alisma
tuber (ze xie) lowering the kidney turbidity
The second
formula encompasses:
anemarrhena root (zhi mu) moistening the kidney yin
phellodendron bark (huang bai) discharging the fire and
consolidating the yin
cooked
rehmannia root (shou di huang) nourishing the genuine yin,
subduing the yang, and controlling the fire
turtle
shell (gui ban) nourishing the genuine yin, subduing the yang,
and controlling the fire
pig¡¯s
spine marrow (zhu ji sui) filling the semen and supplementing
the yin fluids
2.
Deficiencies of the yin and yang
symptoms:
aversion to cold, cold limbs, bright white facial complexion,
short breath, aching pains and softness of the lumbar area and
knees, impotence, thin seeds, pale tongue, weak pulse.
therapeutic principle: moisten the kidney yin and warm the
kidney yang
formula
and ingredients: Golden Chamber Kidney Qi Pills
Cinnamon
twig (gui zhi) and prepared lateral root of aconite (fu zi) warm
and tonify the kidney yang slightly to produce the kidney qi
mildly.
Cooked
rehmannia root (shou di huang) can moisten and supplement the
kidney yin.
Cornus
fruit (shan zhu yu) can moisten and enrich the liver and
kidneys.
Dioscorea
root (shan yao) can moisten and enrich the spleen and kidneys.
Poria (fu
ling) can excrete water and damp; mountan bark (dan pi) can
discharge the liver fire; alisma tuber (ze xie) can excrete
water and damp.
These
three ingredients (cornus fruit, dioscorea root and poria) can
discharge when supplementing so that tonification will not cause
stagnation.
This
formula suggests that a doctor, who is skillful in tonifying
yang, must seek the yang within the yin, because the yang can be
produced endlessly when it is helped by the yin.
Serious
premature ejaculation can result in impotence, while impotence
is usually accompanied by premature ejaculation. When doctors
try to cope with these diseases, they should consider all these
conditions comprehensively.
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