One condition always brings men to the clinic: when their penis isn’t working. Erectile dysfunction (ED) is the inability to attain or sustain a penile erection satisfactory for sexual intercourse. ED affects up to 20 to 25 million men in the US. The prevalence of partial or complete ED is > 50% in men aged 40 to 70 and prevalence increases with aging. In this article we examine ED in the context of Oriental Medicine (OM) and explore treatment principles.
Biomedicine Pathology, Etiology and TreatmentAccording to the Merck Manual most erectile dysfunction is related to vascular, neurologic, psychologic and hormonal disorders; drug use can also be a cause. Evaluation typically includes screening for underlying disorders and measuring testosterone levels. Treatment options include oral phosphodiesterase inhibitors, intraurethral or intracaversonal prostaglandins, vaccum erection devices and surgical implants. The major causes of ED are:
- Vascular disorders – most common is atherosclerosis of cavernous arteries of the penis, often caused by smoking and/or diabetes.
- Neurologic disorders – stroke, partial seizures, multiple sclerosis, peripheral and autonomic neuropathies and spinal cord injuries.
- Drugs: Anti-hypertensives, anti-psychotics, anti-depressants, sedatives, diuretics, steroids, alcohol, methadone, heroin, cannabis and tobacco.
- Other: Aging, hyperprolactinaemia, hypogonadism, hypothyroidism, hypopituitarism, orchitis, prostatitis, psychogenic (anxiety, loss of interest, boredom, depression, fear of sexual incompetence, marital discord or guilt over unconventional sexual impulses), excessive fatigue or stress.
Oriental Medicine Pathology, Etiology and TreatmentIn oriental medicine (OM) terms penile erectile function is connected to the Kidney and the Liver. Kidney Yang controls the functional aspect of an erection and Kidney Jing the ability to reproduce while the Liver channel passes through the external genitals. Weakness of the Kidney reduces the physiological “Fire of Desire” while the stagnation of Liver Qi reduces the physical ability. Sexual function depends not only on sound physiological health but also on the psychological state. Thus the emotional aspects of the Heart, Liver and Kidney systems can all influence sexual ability. Mental stress can obstruct the flow of Liver Qi which can have a dismal effect on the functioning of the ‘Ancestral Tendon of the Liver’ (as the penis is sometimes known). Anxiety and extremes of emotion, which destabilize Heart and Shen can interfere with erectile function. Another OM aspect of ED is related to Kidney dysfunction from fear or shock. In this case, severe fright damages the Zhi (willpower) and the Shen (spirit) profoundly, such that timidity and nervousness become constant personality traits. Such traits do not lend themselves to confident and effective sexual encounters.
Oriental Medicine Patterns and Treatments Principles
Liver Qi Stagnation
Frustration, anger, resentment, prolonged emotional turmoil and stress disrupt the circulation of Liver Qi and because the Liver channel passes through the penis, insufficient Qi arrives to enable an erection. This type of ED is often found in men stressed by overwork or facing the emotional conflicts of a midlife crisis and also seen in younger men overwrought with sexual anxiety or frustration.
- Inability to get / sustain an erection, loss of libido
- Tightness / fullness in the chest, hypochondriac discomfort or tightness, vague aches and pains, frequent sighing, dizziness, irritability, depression
- Abdominal distention, flatulence, alternating constipation and diarrhea
- Tongue is normal or dark, maybe with red edges and pulse is generally wiry
- Regulate and soothe Liver Qi
- Support Yang
Damp HeatThe Damp Heat that causes ED is most commonly a disorder of overconsumption of alcohol and rich foods. It can also be generated in the lower jiao by any long term Heat in the system, such as Heat generated by yin deficiency, qi stagnation or by prolonged stagnation of Dampness. In some cases it may be due to an unresolved or poorly treated external Damp Heat pathogen. In this case the Damp Heat often lingers in the lower jiao as low grade infection (chronic prostatitis). In every case Damp Heat weakens and softens the tendons (which include the penis).
- Inability to get / sustain an erection
- Loose stools or alternating constipation / diarrhea, concentrated urine
- Heaviness and aching in lower limbs, lethargy, afternoon fatigue
- Possible excessive sweating in groin area and scrotum, itching or pain in genitals
- Tongue is greasy yellow coat, especially over the root. Pulse is likely deep and slippery or soft and slippery – possibly rapid.
- Clear Dampness and Heat
Kidney deficiency is an important cause of ED. It can involve either Jing, Yang or Yin deficiency or a combination. It can be inherited or may develop as a result of overwork, age, chronic illness or excessive ejaculation.
Kidney Yang Deficiency
Kidney Yang is the basis of sexual desire and also plays a role in the mechanics of getting and sustaining an erection.
- Low libido, inability to get/maintain an erection
- Listlessness and fatigue, pale complexion, cold intolerant, cold extremities, urinary frequency, nocturia or edema of lower limbs with scanty urine
- Weak, cold and sore lower back and knees
- Tongue is pale wet and swollen, pulse is deep and thready or slow and weak
- Tonify the Kidneys
- Warm and support the Yang
Kidney Yin Deficiency
Kidney Yin is damaged through overwork (especially while under stress), late nights, shift work, insufficient sleep, febrile diseases, insufficient hydration and the use of some prescription, recreational and in this case, tonic drugs. Kidney Yin deficiency type ED is fairly common in young men (in their 30s and 40s) who consume large quantities of hot natured yang tonic herbs like red ginseng and deer horn to increase sexual potency.
- ED or premature ejaculation worse when patient is stressed or fatigued. Maybe frequent desire for sex but inability to initiate or maintain an erection or there maybe erotic dreams with spontaneous emission.
- Soreness or weakness of lower back and knees (possibly exacerbated by sex)
- Dry mouth and throat, insomnia, restlessness, facial flushing, molar flush, nigh sweats, five palm heat
- Tendency to dry stools and constipation
- Tongue is red and dry with little or no coat, pulse is thready and rapid
- Nourish and Strengthen Kidney Yin
- This pattern can be constitutional or a complication of chronic Liver Qi stagnation that generates Heat, or lingering Damp Heat, both of which may consume Yin. It may develop in men who work long hours under significant pressure or in men who have a history of excessive sexual activity and drug use (Marijuana and cocaine are particularly dangerous to Kidney Yin).
- Also drugs like Viagra or Cialis that enable men to have erections can prove counterproductive for patients in this category. The excessive sexual desire they experience combined with the drug assisted ability to have frequent sexual intercourse can lead to further exhaustion of Yin.
Heart Blood and Spleen Qi DeficiencyOverwork, physical and mental exhaustion, worry, irregular diet and too much raw or sweet food can damage the Spleen, when then fails to generate sufficient Qi and Blood. Similarly, any situation that overwhelms the Spleen’s ability to replace Qi and Blood, like a prolonged or severe illness, can lead to Qi and Blood deficiency. The primary weakness in this pattern is in the Spleen, which is unable to generate enough Blood to nourish the Heart and stabilize the Shen. Instability of the Shen can then be the basis of ED with psychological components. Weakened or scattered Shen cannot lead Qi to the penis or if an erection occurs it can easily be lost.
- Inability to get or maintain an erection, possibly associated with performance anxiety; ED worse with fatigue – erections obtained during sleep or masturbation.
- Pale complexion, fatigue, low spirits, insomnia, dream disturbed sleep, forgetfulness, palpitations with or without anxiety, panic attacks.
- Tongue is pale with thin white coat, pulse is thready and weak
- Tonify and nourish Heart and Spleen
- Support Yang
Heart and Gallbladder Qi DeficiencyThis pattern describes an anxious or timid personality type, traits that me be congenital or acquired. When congenital it can be the result of of a significant shock or prolonged fearful situation experienced by the mother during pregnancy, or weakness of the parental Kidney Jing. When acquired it is the result of some sudden and violent or extreme shock or fright. Other, more insidious events, like emotional or physical abuse during childhood, may contribute. It may also sometimes follow other debilitating illnesses that plunder Qi. This pattern also underlies impotence of psychogenic origin.
- Inability to get / sustain an erection
- Patient is anxious, timid, shy, easily startled and may appear very nervous and may be very uneasy about intimate relationships
- Palpitations and insomnia
- Tongue is thin with a greasy coat, pulse is wiry and Thread
- Benefit the Heart, Gallbladder and Kidney, calm the Shen
- Support Yang