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JOURNAL OF CHINESE MEDICINE NUMBER 69 JUNE 2002
TREATMENT BY CHINESE MEDICINE
LIVER & GALLBLADDER
BASED ERECTILE DYSFUNCTION
(Part Two)
by Shawn Soszka and Rihui Long
Introduction
Part one of this article focused upon the TCM pattern differentiation and diagnosis of Liver/Gall Bladder based erectile dysfunction. In part two of this article we turn to the treatment of these pathological patterns. The Chinese medical therapies discussed comprise Chinese herbal formulas, acupuncture, historically important herbs used in the treatment of impotence, and dietetic treatment of erectile dysfunction.
Herbal formulae and acupuncture treatment of the Liver/Gallbladder according to pattern differentiation.
This section focuses upon the herbal and acupuncture treatment of Liver and Gall Bladder patterns. The patterns in this section include Liver qi stagnation, blood stasis, Liver cold, liver blood and yin deficiency, Heart and Gall Bladder qi deficiency and damp heat in the Liver/Gall Bladder. Each of the herbal formulas are analyzed and compared to demonstrate their application in treatment. As a rule, herbal formulas for treating Liver patterns should include Kidney tonics, as Kidney deficiency is the primary basis of impotence.1 Should the Kidney yang require tonification, it is important to tonify the Kidney essence (jing) concurrently, because without tonification of the essence, a yang formula acts much like the pharmaceutical drug “Viagra” and can burn up the Kidney material substance causing side effects such as palpitations, etc.2
Liver qi stagnation
This pattern is extremely common in overworked professionals and frustrated youth. Within the biomedical field, the symptoms of this pattern fall within the classification of the psychogenic form of impotence. The treatment principle is to regulate and soothe Liver qi and support the yang.
Acupuncture
Zhongji REN-3,
Qihai REN-6,
Ganshu BL-18,
Taichong LIV-3,
Hegu L.I.-4,
Sanyinjiao SP-6.
These points are selected primarily for their qi regulating properties and their beneficial actions upon the lower jiao.
Zhongji REN-3 and Sanyinjiao SP-6 are both meeting points for the Spleen, Kidney and Liver channels. With the addition of Taichong LIV-3, these points also have beneficial effects upon the lower jiao. Qihai REN-6 (the Sea of Qi) and
Ganshu BL-18 (the Liver back-shu point) have the effect of regulating qi, and harmonizing and nourishing blood. Qihai REN-6 is specific for impotence, and Ganshu BL-18 has the additional effect of benefiting the sinews (the penis is known as the “ancestral sinew”). Taichong LIV-3 is the shustream, yuan-source and earth point of the Liver channel and has the property of nourishing Liver blood and yin.
Together with Hegu L.I.-4 it makes up the combination referred to as the “four gates” which has the effect of regulating the qi, and within this point prescription these two points enhance the overall qi movement, with both
Qihai REN-6 and Sanyinjiao SP-6 directing the regulating effect to the penis. Sanyinjiao SP-6 has the properties of harmonizing the Liver and tonifying the Kidney and therefore has a direct benefit upon the genitals and is considered a specific point for impotence.
Herbal formulae
Xiao Yao San (Rambling Powder) modification
This modification of Xiao Yao San gently relieves Liver qi stagnation while benefiting the Spleen, moves and nourishes the blood, and creates harmony between the five zang.
The three additional herbs, He Huan Pi (Cortex Albizziae
Julibrissin), Mei Gui Hua (Flos Rosae Rugosae) and Xuan
Cao (Hemerocallis Fulva) are helpful in treating emotionally based erectile dysfunction, especially in the case of depression with lack of appetite:
Chai Hu (Radix Bupleuri) 9g,
Dang Gui (Radix Angelicae Sinesis) 9g,
Bai Shao (Radix Paeoniae Lactiflorae) 9g,
Bai Zhu (Rhizoma Atractylodis Macrocephalae) 9g,
Fu Ling (Sclerotium Poriae Cocos) 9g,
Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 3g,
Bo He (Herba Menthae) 3g,
Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) 3g,
He Huan Pi (Cortex Albizziae Julibrissin) 9g,
Mei Gui Hua (Flos Rosae Rugosae) 5g,
Xuan Cao (Hemerocallis Fulva) 6g.
He Huan Pi can settle the five zang, harmonies the Heart spirit (shen) and disperse anger while making one feel “happy and high” according the classic text Shen Long Ben Jing (Divine Farmers Materia Medica).3 It may be used in conjunction with Ye Jiao Teng (Caulis Polygoni Multiflori) as they both have the implication of “harmonious intercourse” in Chinese. Mei Gui Hua (Chinese rose) is recognises in Chinese culture, as it is in Western culture, as a symbol of love and romance, and is prized for creating an ambience for love making. Furthermore, it has the medicinal properties of soothing the Liver and dispersing stagnant qi. The Ben Cao Gang Mu (Compendium of Materia Medica) recognises Xuan Cao as an excellent herb for freeing the chest and relaxing the diaphragm, calming the five zang and “making one happy, while releasing thoughts of unpleasant things.”4
Chai Hu Shu Gan Tang (Bupleurum Decoction to Spread the Liver) modification
This formula is very potent at dispersing Liver qi stagnation and is indicated for Liver qi stagnation and blood stasis based erectile dysfunction with painful genitals. Additionally, Chai Hu Shu Gan Tang may be used to treat endocrine related disorders such as hyperprolactinemia.5. It is important to note that this formula is not intended for long-term usage.
Chai Hu (Radix Bupleuri) 6-9g,
Chuan Xiong (Radix Ligustici Wallichii) 3-6g,
Xiang Fu (Rhizoma Cyperi Rotundi) 3-6g,
Bai Shao (Radix Paeoniae Lactiflorae) 6-9g,
Zhi Ke (Fructus Citri seu Ponciri) 3-6g,
Gan Cao (Radix Glycyrrhizae Uralensis) 3-6g,
Chen Pi (Pericarpium Citri Reticulatae) 6-9g,
Gong Ding Xiang (Flos Caryophylli) 1.5-4.5g.
The addition of Gong Ding Xiang (Clove Flower bud) enhances the ability of this formula to resolve qi stagnation based impotence. It has the medicinal properties of strengthening Kidney yang, moving qi and increasing libido, and is indicated for impotence with pain in the penis. Additionally, this herb is recognized as enhancing sexual desire and provoking arousal. The ancient Chinese herbalists divided the bud and fruit of this herb into male and female parts, the bud being designated as male.
Blood stasis
The primary causes of this pattern are a history of trauma (especially local post-surgical complications or athletic injury), prostate disorders, or the habit of holding back ejaculation during orgasm. Symptoms and signs include impotence, coldness of the penis, a sharp and stinging pain at the base of the penis and a heavy, dragging sensation. The tongue is dark red and may have purple spots. The pulse is intermittent (dai) and choppy (se).
Acupuncture
Hegu L.I.-4,
Sanyinjiao SP-6,
Xuehai SP-10,
Qimen LIV-14,
Geshu BL-17
All of these points share the property of regulating blood and dispelling stasis. Hegu L.I.-4 relieves pain in the sinews. Sanyinjiao SP-6 is the meeting point of the three leg yin channels (Liver/Kidney/Spleen) and has the action of invigorating the blood and relieving pain in the penis. Xuehai SP-10 (literally Sea of Blood”) has a strong stasis dispelling action while invigorating the blood. Qimen LIV-14 is the front-mu point of the Liver channel and has blood and qi moving properties. Geshu BL-17 is the hui-meeting point of the blood and can invigorate blood and dispel stasis.
Herbal formulae
Shao Fu Zhu Yu Tang (Drive out Blood Stasis in the Lower Abdomen) modification
This is a modification of one of the formulas developed by Wang Qingren the author of correcting the Mistakes of Former Medical Books (Yilin Gaicuo), and is one of the formulas of choice for impotence induced blood stasis, as it works primarily upon the lower burner. It invigorates the blood, dispels blood stasis and alleviates pain.6
Chao Xiao Hui Xiang (Dry-fried Fructus Foeniculi Vulgaris) 1.5g,
Chao Gan Jiang (Dry-fried Rhizoma Zingiberis Officinalis) 0.6g,
Yan Hu Suo (Rhizoma Corydalis Yanhusuo) 3g,
Dang Gui (Radix Angelicae Sinensis) 9g,
Chuan Xiong (Radix Ligustici Wallichii) 3g,
Mo Yao (Myrrha) 3g,
Guan Gui (Cortex Tubiformis Cinnamomi Cassiae) 3g,
Chi Shao (Radix Paeoniae Rubrae) 6g,
Pu Huang (Pollen Typhae) 9g,
Chao Wu Ling Zhi (Dry-fried Excrementum Trogopterori seu Pteromi) 6g,
Wu Gong (Scolopendra Subspinipes) 1 pc.,
Jiu Zi (Semen Allii Tuberosi) 9g.
Wu Gong has a very powerful action of traveling through the channels and removing blood stasis from even the most hidden places. Jiu Zi is commonly used for external genital problems including hernia, testicular swelling, and both rigidity and flaccidity of the penis.
Kang Wei Ling (Miraculous Formula for Both Penile Rigidity and Flaccidity)7
According to the book, Practical Chinese Sexology this formula was used in a recent clinical trial in China in which
737 cases of impotence were treated. Within six months, 665 of the 737 patients were cured of impotence.8
The formula consists of
Wu Gong (Scolopendra Subspinipes) 1 pc,
Dang Gui (Radix Angelicae Sinensis) 10g,
Bai Shao (Radix Paeoniae Lactiflorae) 15g and
Gan Cao (Radix Glycyrrhizae Uralensis) 6g.
Liver cold
The symptoms and signs include impotence (which may be accompanied by inguinal hernia), decreased libido, cold sensation in the testicles and scrotum, generalized coldness in the lower portion of the body, stuffiness and distention of the chest and abdomen and a pale face. The pulse is deep and tight and the tongue has a white coating.
Acupuncture
Yinshi ST-33,
Ganshu BL-18,
Taichong LIV-3,
Guilai ST-29,
Sanyinjiao SP-6,
Guanyuan REN-4,
Dadun LIV-1.
Yinshi ST-33 and Ganshu BL-18 are used as a point combination for the treatment of cold in the Liver channel.
Taichong LIV-3 regulates the lower jiao, relieves pain in the genitals and moves qi and blood. When cold coagulates in the channels it often causes stagnation of qi and blood, therefore it is important to address both aspects. Guilai
ST-29 and Sanyinjiao SP-6 work in concert to harmonize and warm the lower jiao, benefit the genitals and relieve coldness and pain in the penis and scrotum. Guanyuan REN-4 is the meeting point of the Liver, Kidney and Spleen channels on the Conception vessel and has the action of regulating the lower jiao and dispelling cold in the genital region. Finally, Dadun LIV-1 is a well-regarded point for cold in the Liver channel especially when the genital region is affected.
Herbal formulae
Nuan Gan Jian (Warm the Liver Decoction) modification
This formula is used to treat cold coagulation in the Liver channel. The principle of treatment of this excess pattern is to warm the Liver and disinhibit the qi.
Dang Gui (Radix Angelicae Sinensis) 6-9g,
Gou Qi Zi (Fructus Lycii Chinensis) 9g,
Xiao Hui Xiang (Fructus Foeniculi Vulgaris) 6g,
Rou Gui (Cortex Cinnamomi Cassiae) 3-6g,
Wu Yao (Radix Linderae Strychnifoliae) 6g,
Chen Xiang (Lignum Aquilariae) 6g,
Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) 3-5 pcs.
In the case of Liver cold due to yang deficiency, add Yin Yang Huo (Herba Epimedii) and Lu Rong (Cornu Cervi Parvum). Ying Yang Huo enters the Liver and Kidney channels and has the function of warming the mingmen fire, revitalizing Kidney yang and strengthening the sinews. Lu Rong enters the Liver and Kidney channels and has the action of reinforcing the Kidney yang and nourishing both the blood and jing (essence). Additionally, Nuan Gan Jian may be combined with You Gui Wan (Restore the Right Decoction) when faced with more pronounced cases of Liver cold of a deficient nature.
Liver blood and yin deficiency
Liver blood deficiency can occur either because a Spleen disorder results in failure of blood production, or due to damage to Liver yin and blood. The latter pattern is seen in individuals who either maintain an excessive nightlife, work at night (the “graveyard” shift), or through activity resulting in excessive sweating. In this pattern, there is a lack of available blood to swell the penis. The symptoms include anger, depression, frequent sighing, dizziness, muscle spasms, numbness, blurred vision, fatigue and impotence.9 The tongue is red with little coating and the pulse is thready or wiry. The treatment principle with this pattern is to nourish the Liver yin and blood while softening the Liver.
Acupuncture
Guanyuan REN-4,
Ganshu BL-18,
Geshu BL-17,
Sanyinjiao SP-6,
Taichong LIV-3,
Ququan Liv-8
Guanyuan REN-4 plays an important role as the meeting point of the Spleen, Liver, and Kidney, all of which have a role in the production of blood. It has an overall effect of regulating the lower jiao. Ganshu BL-18 (the Liver back-shu point) and Geshu BL-17 (the hui-meeting point of blood) harmonise, regulate and nourish the Liver blood. Sanyinjiao SP-6, like Guanyuan REN-4 is a meeting point of the Spleen, Liver and Kidney channels, and has the actions of benefiting the genitals, harmonising the Liver and tonifying the Spleen. Taichong LIV-3 and Ququan LIV-8 both nourish Liver blood and yin, with Taichong LIV-3 having a regulatory effect upon the lower jiao, while Ququan LIV-8 directly benefits the genitals and is recommended for blood deficiency based impotence.
Herbal formulae
Shao Yao Gan Cao Tang10 (Peony and Licorice Decoction) modification
The basic formula is used to treat Liver blood deficiency with internal wind-like symptoms such as spasms and cramps. The additional herbs help generate blood and nourish the yin. When the blood and yin are sufficient, normal erections can occur.
Bai Shao (Radix Paeoniae Lactiflorae) 15g,
Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 15g,
Dang Gui (Radix Angelicae Sinensis) 12g,
Sheng Di Huang (Radix Rehmanniae Glutinosae) 12g,
Huang Jing (Rhizoma Polygonati) 9g,
Shan Zhu Yu (Fructus Corni Officinalis) 9g,
Wu Wei Zi (Fructus Schisandrae Chinensis) 9g,
Gou Qi Zi (Fructus Lycii Chinensis) 6g.
Bu Gan Tang (Tonify the Liver Decoction) modification
Bu Gan Tang is based upon the formula Si Wu Tang (Four-Substance Decoction) and its primary purpose is to tonify and regulate the blood, while nourishing the Liver yin.11
Dang Gui (Radix Angelicae Sinensis) 9-12g,
Chuan Xiong (Radix Ligustici Wallichii) 6-9g,
Bai Shao (Radix Paeoniae Lactiflorae) 9-15g,
Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 15-24g,
Suan Zao Ren (Semen Ziziphi Spinosae) 6-9g,
Mu Gua (Fructus Chaenomelis Lagenariae) 6-9g,
Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 3-6g,
He Shou Wu (Radix Polygoni Multiflori) 9-15g.
Heart and Gallbladder qi deficiency
As discussed in part one of this article, this pattern manifests with disturbance of the personality, which is typically expressed as fear, shyness, timidity, anxiety neurosis and tendencies toward paranoia. Additionally with this pattern, vivid sexual dreams have been noted in which there is a tendency for the erotic aspect of the dream to suddenly “cool down” as the dream progresses.12 This is referred to as Yi Ying (mind intercourse) and was first discussed in Chapter 44 of the Su Wen Nei Jing (Yellow Emperor’s Classic of Medicine). Shen (spirit) disturbance is a prominent component of this disorder. It may be advisable to co-manage patients demonstrating this pattern with a qualified sexual counselor. The treatment principle with this pattern is to benefit the Heart, Gall Bladder and Kidney, while calming the shen and supporting the yang.
Acupuncture
Shenmen HE-7,
Danshu BL-19,
Xinshu BL-15,
Zhishi BL-52,
Jianshi P-5,
Dazhong KID-4,
Riyue GB-24.
The primary goal of this point prescription is to calm the shen and benefit the Heart, Gall Bladder and Kidneys. Shenmen HE-7 is the earth point of the Heart channel and has the actions of calming the shen and regulating and tonifying the Heart. Riyue GB-24 and Danshu BL-19 are the Gall Bladder front-mu and back-shu points respectively, and have regulatory and tonifying effects upon the Gall Bladder qi. They are employed together when signs of Gall Bladder qi deficiency are present. Xinshu BL-15 is the backshu point of the Heart channel and has the properties of calming the shen, and tonifying and nourishing the Heart, while regulating the Heart qi. Zhishi BL-52 has a Kidney tonifying effect and is useful in impotence via its Kidney qi regulating action. Both Jianshi P-5 and Dazhong KID-4 are useful in treating symptoms such as disturbances of the shen, fright-palpitations and fear.13
Herbal formulae An Shen Ding Zhi Wan (Quiet the Spirit and Stabilize the Will Pill) modification
The purpose of this formula is to calm the shen, while benefiting the Heart, Kidney and Gall Bladder. The additional herbs Suan Zao Ren, Wu Wei Zi and Rou Cong Rong benefit the Heart and Kidney while calming the shen; while Yang Qi Shi, according to the Ming Dynasty physician Li Shizheng, gets its name from its function, raising the yang, and therefore making the penis harden.
Ren Shen (Radix Ginseng) 3g,
Fu Ling (Sclerotium Poriae Cocos) 9g,
Fu Shen (Poriae Cocos Pararadicis Sclerotium) 9g,
Yuan Zhi (Radix Polygalae Tenuifoliae) 9g,
Long Gu (Os Draconis) 9g,
Shi Chang Pu (Rhizoma Acori Graminei) 6g,
Suan Zao Ren (Semen Ziziphi Spinosae) 9g,
Wu Wei Zi (Fructus Schisandrae Chinensis) 9g,
Rou Cong Rong (Herba Cistanches) 12g,
Yang Qi Shi (Actinolite) 5g.
Qi Yang Yu Xin Dan14 (Arouse the Yang and Please the Heart Special Pill) modification
This formula calms the shen and benefits the Heart, while tonifying the yang. There are herbs to help tonify the Gall Bladder and generate the qi. This formula is traditionally taken as a honey-rolled pill, but may be decocted.
Suan Zao Ren (Semen Ziziphi Spinosae) 18g,
Shan Yao (Radix Dioscoreae Oppositae) 18g,
Fu Shen (Poriae Cocos Pararadicis Sclerotium) 12g,
Bai Shao (Radix Paeoniae Lactiflorae) 12g,
Tu Su Zi (Fructus Perillae Frutescentis) 12g,
Shen Qu (Massa Fermentata) 9g,
Chai Hu (Radix Bupleuri) 9g,
Dang Gui (Radix Angelicae Sinensis) 9g,
Bai Zhu (Rhizoma Atractylodis Macrocephalae) 9g,
Ren Shen (Radix Ginseng) 6g,
Yuan Zhi (Radix Polygalae Tenuifoliae) 6g,
Shi Chang Pu (Rhizoma Acori Graminei) 6g,
Chen Pi (Pericarpium Citri Reticulatae) 6g,
Sha Ren (Fructus seu Semen Amomi) 6g,
Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 6g.
Damp heat in the Liver/Gallbladder
Impotence may be caused by damp heat obstructing the Gall Bladder and Liver channels. The primary pathogenesis is flaccidity of the zong jin (“meeting of the ancestral, or one hundred, sinews”) when the genital area is soaked in damp heat. Clinical manifestations include impotence accompanied by irritability, frustration, foul-smelling dampness or sweating in the groin region, and yellow, cloudy and painful urination. The treatment principle is to clear heat and disinhibit dampness. The tongue is typically red with a yellow, greasy coating while the pulse is rapid and wiry.
Acupuncture
Zhongji REN-3,
Ququan LIV-8,
Yanglingquan GB-34,
Ligou LIV-5
The points Zhongji REN-3, Ququan LIV-8 and Ligou LIV-5 all have the action of draining damp and clearing heat, with Zhongji REN-3 and Ququan LIV-8 having a more direct effect upon damp heat in the genital region. Yanglingquan GB-34 relieves damp heat in the genital region and is a noted point for damp heat based impotence.
Herbal formulae
Long Dan Xie Gan Tang (Gentiana Longdancao Decoction to Drain the Liver)
This formula is indicated for damp heat in the lower burner, Liver or Gall Bladder channels. It is excellent for treating damp heat in the Liver channel with concurrent flaring up of excessive fire in the Gall Bladder channel.15
Long Dan Xie Gan Tang is best for treating patients with a strong constitution, symptoms of Liver and Gall Bladder heat, and impotence of an excess type. It has been suggested that adding one of the Kidney tonics such as Yin Yang Huo is necessary to protect the Kidney.16
Long Dan Cao (Radix Gentianae Scabrae) 6g,
Zhi Zi (Fructus Gardeniae Jasminoidis) 6g,
Huang Qin (Radix Scutellariae Baicalensis) 6g,
Chai Hu (Radix Bupleuri) 6g,
Ze Xie (Rhizoma Alismatis Plantago-aquaticae) 9g,
Sheng Di Huang (Radix Rehmanniae Glutinosae) 9g,
Dang Gui (Radix Angelicae Sinensis) 6g,
Che Qian Zi (Semen Plantaginis) 12g,
Gan Cao (Radix Glycyrrhizae Uralensis) 6g.
Er Miao San (Two-Marvel Powder) Modification
Er Miao San is an excellent base formula for treating many different forms of damp heat. This particular modification is appropriate for treating damp heat that weakens the ancestral sinews (the penis) thus causing impotence. A history of sexually transmitted disease including syphilis, genital herpes, gonorrhoea, and even the early stage of AIDS has been noted in cases of damp-heat impotence. This formula may also be applied to the genitals as a wash.
Cang Zhu (Rhizoma Atractylodis) 12g,
Huang Bai (Cortex Phellodendri) 10g,
Che Qian Zi (Semen Plantaginis) 30g,
Shi Wei (Folium Pyrrosiae) 10g,
Fu Ling (Sclerotium Poriae Cocos) 30g,
Shan Yao (Radix Dioscoreae Oppositae) 30g,
Gou Qi Zi (Fructus Lycii Chinensis) 20g,
Ze Xie (Rhizoma Alismatis Plantago-aquaticae) 15g,
Bei Xie (Rhizoma Dioscoreae) 15g,
Zhu Ling (Sclerotium Polypori Umbellati) 12g,
She Chuang Zi (Fructus Cnidii Monnieri) 30g,
Tu Fu Ling (Rhizoma Smilacis Glabrae) 30g.
Both She Chuang Zi and Tu Fu Ling play an important role in the formula. She Chuang Zi is indicated in cases of impotence with genital itching and dampness according to the Ming dynasty text “Shen Long Ben Cao Jing (The Divine Farmer’s Materia Medica)”.17 Tu Fu Ling has been used in the treatment of sexually transmitted diseases for more than one thousand years. These two herbs are excellent for treating skin conditions as well as impotence.
Bei Xie Tang (Dioscorea Hypoglauca Decoction) Modification
This formula was suggested in an article as an alternative to Long Dan Xie Gan Tang, which the author believed to be too harsh.18 This modified formula is particularly useful in treating damp heat in the Gall Bladder/Liver channels coupled with Kidney qi deficiency.19 Bei Xie Tang is an excellent choice for treating jing zhuo, a disease that literally translates as “turbid sperm” manifesting as a constant, turbid, milk-like discharge, irritation of the urethra, and normal coloured urine. This usually occurs due to sexual over-indulgence or improper practice of withholding seminal emissions20.
Bei Xie (Rhizoma Dioscoreae),
Yuan Zhi (Radix Polygalae Tenuifoliae),
Rou Cong Rong (Herba Cistanches),
Chuan Niu Xi (Radix Cyathulae),
Hang Bai Shao (Radix Paeoniae Lactiflorae),
Huang Qi (Radix Astragali),
Tu Fu Ling (Rhizoma Smilacis Glabrae),
Zhi Zi (Fructus Gardeniae Jasminoidis),
Bai Hua She She Cao (Herba Oldenlandiae Diffusae).
[Note: herbal amounts unavailable from source].
Bei Xie, the leading herb, can tonify Liver blood and yin and strengthen the tendons and is indicated for milk-like discharge and pain in the penis.21 Bei Xie together with Yuan Zhi, Rou Cong Rong, Chuan Niu Xi and Hang Bai Shao served as the basic formula with Huang Qi added to tonify Kidney qi and Tu Fu Ling, Zhi Zi and Bai Hua She She Cao added to clear heat and disinhibit dampness.
Important herbs in treating erectile dysfunction
There are a number of herbs that have been used throughout the centuries of Chinese herbal practice that have proved to be of great benefit in the treatment of sexual disorders including erectile dysfunction and are often found in modifications of traditional herbal formulas. The herbs used are of either animal, insect, mineral or plant (especially seeds) origin. The use of plant seeds/fruit is consistent with the reproductive theme of the penis, while animal-based herbs are full of vitality and generally strengthen the weakness associated with erectile dysfunction. The insect herbs are used to open the orifices and channels and have application in disorders associated with blockage such as stagnation, stasis, phlegm and dampness. In addition, the ancient Chinese scholars noted certain insects to have an extremely high libido. In general, animal-based medicines are of great benefit, as they tend to nourish the yin and yang and have greater life force potency, which can stimulate reproductive energies.
Lu Rong
Lu Rong (Cornu Cervi Parvum) is the antler of young male deer. It is salty, sweet and warm and enters the Kidney and Liver channels. Its primary use is to strengthen yang deficiency, tonify the Kidneys and regulate the Governing, conception, Directing and Girdle vessels.
Zi He Che
Zi He Che (Placenta Hominis) is dried human placenta and as such is not a commonly used herb in western clinical practice because of the standards of practice laws. Nevertheless, it is an excellent herb for treating sexual dysfunction including erectile dysfunction. It is sweet, salty and warm, and enters the Lung, Liver and Kidney channels.
Can E
Can E (Bombycis Mori) is the male silkworm butterfly, which is said to continuously copulate from the moment after it bursts forth from its cocoon until death. Ancient physicians saw the value of this insect in bolstering male sexual activity.22 Can E are collected immediately after leaving the cocoon and are prepared by grinding into a powder after being baked until crispy and are burnt yellow in colour. Can E is salty, warm and slightly toxic and enters the Liver and Kidney channels.
Wu Gong
Wu Gong (Scolopendra Subspinipes) is the Chinese centipede and is excellent in unblocking the collaterals especially of the Liver/Gallbladder channels. It has been used in ancient empirical formulas to treat hernia and retracted testicles, and can be found in the patented formula Kang Wei Lin. This herb can be added to a formula when treating “blockage” type erectile dysfunction. It is acrid, warming and toxic and enters the Liver.23
She Chuang Zi
While She Chuang Zi (Fructus Cnidii Monnieri) is commonly used for its ability to stop itching, it was used in ancient times as a yang tonic.24 Its specific usage was to treat impotence and infertility. It is a very powerful herb and should be considered a leading herb in the treatment of impotence.25 Research has found that this herb can prolong and revive the copulation period of mice.26 It also increases the weight of the prostate gland and testicles.27 It is pungent, bitter and warm and enters the Kidney channel. It should not be used with damp heat conditions.
Jiu Zi
Jiu Zi (Semen Allii Tuberosi) is the seed of the Chinese leek and is used to tonify the Kidney yang. It is useful in treating impotence in which a deficiency of Kidney yang is evident. The herb has the action of warming the Kidneys, while securing the essence and fortifying the yang. It is acrid, sweet and warming and enters the Kidney and Liver channels.28
Gou Qi Zi
Gou Qi Zi (Fructus Lycii) is indicated for yin and blood deficiency erectile dysfunction patterns of the Liver and Kidneys and should always be paired with Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae).29 It is sweet and neutral and enters the Liver, Lung and Kidney channels.
Yin Yang Huo
Yin Yang Huo (Herba Epimedii) is indicated in Kidney yang deficiency erectile dysfunction. This herb is known in the West as “Horny Goat Weed.” It came by the name as it has been found that male goats that consume this plant experience a marked increase in libido. The essential oil can be extracted by lightly steaming the herb and can be used to increase sperm production.30 Yin Yang Huo should not be used in cases with empty fire due to yin deficiency.31 It is acrid, sweet and warm, and enters the Liver and Kidney channels.
Rou Cong Rong
Rou Cong Rong (Herba Cistanches) has many uses including immune stimulation, uterine tumours and fibroids and improving sex drive and erections in elderly men. It is primarily a yang tonic and has the ability to balance hormone levels when progesterone is low. It is especially good for the treatment of uterine cancer. It is sweet, salty and warm and tonifies both the Kidney and Large Intestine channels. It is said that this herb grows best in fields in which horses have copulated and where the semen has been absorbed into the soil.32
He Shou Wu
He Shou Wu (Radix Polygoni Multiflori) is commonly associated with Kidney yin deficiency and is often used a general tonic. The use of this herb in the treatment of impotence stems from a legendary story: A man by the name of Tianer (Farmer), suffered from congenital weakness, and at the age of fifty-eight, was still unable to reproduce or maintain an erection. One day, desperate and depressed, Tianer got rather drunk, and as a result, he found himself lying in one of his fields. As he considered his ill fortune, he noticed two plants intertwine with each other, release, and then repeat this sensual performance. He immediately dug out these plants, ground them into a powder, and took them with wine. Within seven day he noticed a new feeling of hardness and warmth in his erect penis. He had several children over the next ten years and proudly changed his name to “Lenshi” (being able to pass on his family’s bloodline).
Yang Qi Shi
Yang Qi Shi (Actinolitum), literally “the stone for raising the yang”, warms the Kidney and strengthens yang. It is good for treating erectile dysfunction in men and infertility in women. In the Song dynasty, people used the single herb in powder form to treat impotence.
Dietetics: foods to treat sexual dysfunction
The treatment of disease using food substance is a long-standing tradition in Chinese medicine, whilst avoiding disease is even better and is achieved through eating a healthy diet that provides all the vital nutrients to support the body. There is a saying in Chinese medicine that reflects the importance of proper diet “Seven parts diet therapy, three parts herbal treatment.”33 Food is a subtle, yet powerful medicine and each food has its own energetic property making it appropriate for specific health disorders. Food selection should be based upon differentiation of patterns.
The foods that can be used to treat sexual dysfunction are often animal-based products although some seeds and fruit are also useful. The following section is a list of medicinal foods categorised by their actions. Some of the animal-based products do not meet food quality standards or are simply not compatible with Western culture; therefore, items should be selected at the reader’s discretion.
Kidney yang deficiency
Walnut, Deer meat, lamb, beef, shrimp, rooster liver.
Kidney yang and jing deficiency
Yu du (fish) and Dong Chong Xia Cao (Cordyceps Sinensis) stew, Ge Jie (gecko), pigeon.
Kidney yin and jing deficiency
Turtle, Mu Li (Concha Ostreae), Sha Shen (Radix Adenophorae seu Glehniae), beef marrow, pork marrow.
Qi and blood deficiency
Chicken, Long Yan Rou (Arillus Euphoriae Longanae), Li Zhi (Litchi Fruit), Shan Yao (Radix Dioscoreae Oppositae).
To consolidate the Kidneys and astringe the jing
Lian Zi Rou (Semen Nelumbinis Nuciferae), Lian Zi Xin (Plumula Nelumbinis Nuciferae), Lian (Whole Lotus), Qian Shi (Semen Euryales Ferox), Bai Guo (Semen Gingko Bilobae).
Damp-heat
Dong Gua (Winter Melon), Ku Gua (Bitter Melon), Lian Zi Xin (Plumula Nelumbinis Nuciferae), Si Gua (Towel Gourd).
Liver qi stagnation
Celery and shitake mushroom stir-fry combination.
Heart and Gall Bladder qi deficiency
Long Yan Rou (Arillus Euphoriae Longanae), Ren Shen (Radix Ginseng), Fu Shen (Poriae Cocos Pararadicis Sclerotium) cooked with quail.
Liver cold
Dang Gui (Radix Angelicae Sinensis), Sheng Jiang (Rhizoma Zingiberis Officinalis Recens), with lamb soup.
Liver blood and yin deficiency
Dang Gui (Radix Angelicae Sinensis), Gou Qi Zi (Fructus Lycii Chinensis) and Huang Jing (Rhizoma Polygonati) added to abalone or lobster soup.
Conclusion
Understanding the nature of erectile dysfunction from both a Chinese medicine and biomedical perspective is necessary for the modern Chinese medicine practitioner. It is important to recognise the impact impotence has upon men socially, mentally, emotionally and physically. Biomedical research has made great strides in understanding the mechanisms of erectile pathophysiology. Chinese medicine recognises the elaborate inter-relationship between the zangfu systems and the importance of maintaining the balance between them.
Erectile dysfunction affects several different age groups, from teenage boys to older men. The aetiology typically differs between the age groups with congenital and psychogenic factors (Liver/Gall Bladder) affecting younger men and primarily organic diseases (Kidney deficiency) affecting older men. We hope that this article has demonstrated the thorough understanding of this disorder within Chinese medicine and given an account of the therapies within Chinese medicine that are safe and non-invasive, and have proven themselves repeatedly in clinical testing.
This article demonstrates the prominence that the Liver and Gall Bladder have in the differential diagnosis of erectile dysfunction. It is unfortunate that western TCM practitioners, who for the most part consider only Kidney disease patterns when treating impotence, largely ignore the Liver and Gall Bladder. By focusing the treatment section of this paper upon the Liver and Gall Bladder and the patterns that affect them, it is our desire that the TCM community furthers its understanding of the myriad of differential patterns that may manifest as erectile dysfunction.
Notes
1 Long R, Classical Chinese Medicine Perspective On Erectile
Dysfunction, Personal Communication, NCNM Portland, OR
2000.
2 Ibid.
3 Yang SZ. The Divine Farmer’s Materia Medica: A Translation of
the Shen Nong Ben Cao Jing, Boulder, Blue Poppy Press, 1998
4 (Editor Unknown) Ben Gao Hang Mu (Compendium of Materia
Medica) by Li Shizhen Beijing, People’s Health Publishing
House, 1975. [Chinese]
5 Fruehauf H, Dharmananda S. Pearls from the Golden Cabinet.
Portland, NCNM 1998.
6 Bensky D, Barolet R. Chinese Herbal Medicine Formulas &
Strategies. Seattle, Eastland Press, 1990.
7 Yang DX. Practical Chinese Venereology. Chengdu, Sichuan
Science and Technology Publishing House, 1980.
8 Ibid.
9 Lin A: A Handbook of TCM Urology & Male Sexual Dysfunction.
Boulder, Blue Poppy Press, 1992.
10 Ibid.
11 Bensky D, Barolet R. Chinese Herbal Medicine Formulas &
Strategies. Seattle, Eastland Press, 1990.
12 Yu YP, Treatment of Endocrine-Metabolic Diseases with Chinese
Medicine, Hangzhou, China 1992.
13 MaClean W, Lyttleton J. Clinical Handbook of Internal Medicine
(Vol. 1). Australia, University of Western Sydney Macarthur,
1998.
14 Fruehauf H, Dharmananda S. Pearls from the Golden Cabinet.
Portland, NCNM 1998.
15 Kou, M: “Kidney Deficiency and Erectile Dysfunction”
Personal Communication. Portland, NCNM 2000.
16 Yang SZ. The Divine Farmer’s Materia Medica: A Translation of
the Shen Nong Ben Cao Jing, Boulder, Blue Poppy Press, 1998
17 Becker S. “The Treatment of Damp-Heat Impotence” Journal of
Chinese Medicine 1999(61): 25-7.
18 Ibid.
19 Ibid
20 (Editor Unknown) Ben Gao Hang Mu (Compendium of Materia
Medica) by Li Shizhen Beijing, People’s Health Publishing
House, 1975.
21 Long R: “Classical Chinese Medicine Perspective On Erectile
Dysfunction.” Personal Communication, NCNM Portland, OR
2000.
22 Ibid.
23 Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica.
Seattle, Eastland Press, 1993.
24 Kou, M: “Kidney Deficiency and Erectile Dysfunction”
Personal Communication. Portland, NCNM 2000.
25 Ibid.
26 Yeung HC. Handbook of Chinese Herbs. Rosemead, Institute of
Chinese Medicine, 1983.
27 Ibid.
28 Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica.
Seattle, Eastland Press, 1993.
29 Lin YK, Chinese Herbology, Shanghai, Shanghai Science and
Technology Publishing House, 1984.
30 Kou, M: “Kidney Deficiency and Erectile Dysfunction”
Personal Communication. Portland, NCNM 2000.
31 Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica.
Seattle, Eastland Press, 1993.
32 Kou, M: “Kidney Deficiency and Erectile Dysfunction”
Personal Communication. Portland, NCNM 2000.
33 Ibid.
34 Kou, M: “Kidney Deficiency and Erectile Dysfunction”
Personal Communication. Portland, NCNM 2000.
Additional References
Deadman P, Al-Khafaji M, Baker K. A Manual of Acupuncture,
England, Journal of Chinese Medicine Publications, 1998.
(Editor Unknown) Ben Gao Hang Mu (Compendium of Materia Medica) by Li Shizhen Beijing, People’s Health Publishing House, 1975.
Li DQ, Jiang JX, Gao Y, Shi LH. Prescriptions of Traditional
Chinese Medicine, Shanghai, Publishing House of Shanghai College
of TCM, 1990.
Ni MS. The Yellow Emperor’s Classic of Medicine: Neijing Suwen, Boston, Shambala Publications, 1995.
Yang DX. Practical Chinese Venereology. Chengdu, Sichuan Science and Technology Publishing House, 1980.
Yang SZ. The Divine Farmer’s Materia Medica: A Translation of the Shen Nong Ben Cao Jing, Boulder, Blue Poppy Press, 1998.
Yu YP, Treatment of Endocrine-Metabolic Diseases with Chinese Medicine, Hangzhou, China 1992.
Shawn Soszka is a Naturopathic physician and Chinese medicine practitioner in Portland, Oregon (USA). He is a recent graduate of the
National College of Naturopathic Medicine where he completed the
Classical Chinese Medicine program developed by Heiner Fruehauf.
He can be contacted at Dr_Soszka@hotmail.com.
Rihui Long MS, LAc, a 1981 graduate of the Chengdu University of
Traditional Chinese Medicine (Sichuan, China), has been teaching and
practising in the Classical Chinese Medicine program at the National
College of Naturopathic Medicine in Portland, Oregon (USA) since
1996. He is a recognised expert of the Neijing (Yellow Emperor’s
Classic) and has extensive experience treating sexual disorders and sexually transmitted diseases. |
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Post time: 2009-04-27 17:17:08
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