Erectile Dysfunction

Question 1

*ED, sometimes referred to as “impotence”

• ED, variations:
• -Total inability to achieve an erection
• -Inconsistent ability to do so
• -Tendency to sustain only brief erections
• 1985: 7.7 office visits for ED; 1999: 22.3 visits
• In older men, a physical cause: disease, injury or drug sideFX
• Increase with age: 5% of men in 40’s; 15-25% of men 65 or older, but not always inevitable.

Answer 1

Erectile Dysfunction

Question 2

• Erection begins with sensory or mental stimulation, or both
• Brain impulses and local nerves cause muscles to relax, allowing blood to flow, filling in space
• Blood creates pressure in corpora cavernosa, expanding the penis; the surrounding tunica albuginea traps the blood sustaining erection
• Contraction of muscles stops inflow of blood, opens outflow, erection reversed

Answer 2

Erectile Dysfunction

Question 3

*Most common causes:
Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as the result of a disease

• Diseases like diabetes, kidney disease, chronic alcoholism, MS, atherosclerosis, vascular disease, neurological disease account for 70%
• Smoking, overweight, no exercise
• Surgery (radical prostate and bladder) can causes damage to local nerves and arteries
• Injury to penis, spinal cord, prostate, bladder and pelvis
• BP drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants

*Stress, anxiety, guilt, depression, low self-esteem and fear of sexual failure cause 10-20% of cases

Answer 3

Erectile Dysfunction ætiology

Question 4

“listlessness of Yang”

Answer 4

Yang Wei

Question 5

Yang Wei indicates “listlessness of Yang”
“When the energy of Greater Yin predominates…there is impotence from great decline of Qi with inability to rise.”
“The genitals are an orifice of the Kidneys, when they are injured by overwork, the deficient Kidneys cannot nourish the genitals…”
“Worry and pensiveness deplete Qi, excessive worry leads to impotence.”

Answer 5

Erectile Dysfunction in TCM

Question 6

Zi Bao

Answer 6

the Uterus in women

Question 7

in men, Bao refers to

Answer 7

“Room of Sperm.”

Question 8

“The Directing and Penetrating vessels originate form the Lower Dan Tian (literally ‘Bao’).

Answer 8

Bao refers to a structure common to men and women:

Question 9

Giovanni: It is legitimate to assume that the prostate is a structure that is equivalent to the Uterus in women and that the Du, Ren and Chong Mai flow through the prostate.

Answer 9

Erectile Dysfunction in TCM

Question 10

Zong Jin

Answer 10

literally “Ancestral Muscle” refers to the rectus abdominus muscles or to the penis

Question 11

Chong Mai is related to

Answer 11

to the state of the “Ancestral Muscle”

Question 12

In women a slack Ancestral Muscle may cause

Answer 12

prolapse of uterus or leg atrophy

Question 13

Chong Mai influences the penis

Answer 13

specifically the corpus spongiosum and corpus cavernosum and therefore erection

Question 14

Chong Mai be used to treat ED when there is

Answer 14

Kidney and Heart disharmony
SP 4 L, PC 6 R, KD 12, CV 4, KD 16, BL 17, CV 6, BL 15, BL 23
Channels:
Du Mai, Ren Mai, Kidney and Liver
Points:
Distal: KD 4, LIV 1, LIV 5, GV 20
Local: KD 11, ST 30 are located directly over the insertion of the rectus abdominis

Question 15

Factors Affecting Erection:

Answer 15

• -Du Mai, Kidney Yang, Ming Men
• -Heart Blood
• -Liver Channel
• -Chong Mai
• Sea of Blood, Postnatal & Prenatal Qi, controls membranes, controls Ancestral Muscle, connecting channels in penis, communication of Heart & Kidneys

Question 16

Ætilogy: Erectile Dysfunction

Answer 16

Old age
Excessive sexual activity
Irregular diet
Emotional stress
Excessive physical activity
Overwork

Question 17

Erectile Dysfunction in TCM

Pathogenic Factors

Answer 17

• -Dampness from SP, KD and LIV channels
• -Blood stasis through Liver and Chong Mai
• -Phlegm
• -Essence Stasis
• Jing a vital substance in Lower Jiao
• Source of vitality
• Equivalent to blood stasis in women
• Stabbing pain in lumbar region, pain in perineum, hypogastric pain, pain in testes or penis, impotence, premature ejaculation, priapism, prostatic hypertrophy, premature graying hair, itching or pain in pubic area, abnormal sperm, T: purple, P: Choppy or Firm

Question 18

Impotence, low libido, premature ejaculation, lower backache, dizziness, tinnitus, frequent pale urination, nocturia, feeling cold, cold lower back and knees
T: Pale
P: Deep weak

Answer 18

Kidney Yang Deficiency

TX: Tonify and Warm the Kidney Yang, strengthen the Du Mai
BL 23, BL 20, SI 3, BL 62, GV 20, CV 6, 4, 3, KD 3
Gui Lu Bu Shen Tang Plastrium Testudinis-Cornu Cervi Tonifying the Kidneys Decoction
You Gui Wan Restoring the Right Pill

Question 19

Impotence in the elderly, lower backache, dizziness, tinnitus, scanty-dark urine, night sweating, insomnia
T: no coating, red if empty heat
P: Floating empty

Answer 19

Kidney Yin Deficiency

TX: Nourish Kidney Yin, strengthen the Ren and Chong Mai
BL 23, 18, SI 3, BL 62, GV 20, CV 6, 4, 3, KD 3, LU 7/KD 6
Di Long Tang Pheretima Decoction
Zou Gui Wan Restoring the Left Pill

Question 20

Impotence, premature ejaculation, dizziness, blurred vision, depression, insomnia, numbness of limbs
T: Pale and thin
P: Choppy or Fine

Answer 20

Liver Blood Deficiency

LU 7, KD 6, BL 18, 34; CV 4, 3, LIV 8, ST 36, SP 6,
Shao Yao Gan Cao Tang Jia Wei Augmented Dioscorea-Glycyrrhiza Decoction

Question 21

Impotence, premature ejaculation, depression, timidity, sighing, insomnia, palpitations, easily startled
T: Pale P: Weak

Answer 21

Heart & Gall Bladder Qi Deficiency

TX: Tonify the Heart and GB, Calm the Spirit
HT 7, 5, BL 15, GB 40, CV 6, GV 20, ST 36, SP 6,
SI 3/BL 62, CV 3, BL 34
Da Bu Yin Jian Great Tonifying the Original Decoction

Question 22

Impotence, premature ejaculation, dizziness, tinnitus, palpitations, lower backache, depression, pale face
T: Pale
P: Deep weak

Answer 22

Heart & Kidney Qi DeficiencyHT & KD not communicating

TX: Tonify Kidney and Heart Qi, Calm the Mind
HT 7, 5, BL 15; KD 7, 3, BL 23, CV 4; CV 15, GV 24;
GV 20; SI 3/BL62
Gui Pi Tang plus Jin Suo Gu Jing Wan

Question 23

Impotence in the elderly, five palm heat, dizziness, tinnitus, night sweating, palpitations, lower backache, depression, insomnia, poor memory
T: No coat, red if empty heat
P: Floating Empty

Answer 23

Heart & Kidney Yin DeficiencyHT & KD not communicating

TX: Nourish Heart and Kidney Yin, calm Mind
HT 7, CV 15, SI 3/BL 62, BL 23, CV 4, KD 3, SP 6
Zhi Bo Di Huang Wan plus Jin Suo Gu Jing Wan

Question 24

Impotence in the young that fluctuates according to the emotional state, premature ejaculation, abdominal distention, irritability, moodiness, depression
T: Normal or slightly red color on the sides
P: Wiry

Answer 24

LIVER QI STAGNATION

TX: Pacify the Liver, move Qi, eliminate stagnation
LIV 3, GB 34, PC 6; CV 6, 3; LIV 5; GB 13, GV 24
Xiao Yao San Free and Easy Wanderer variation

Question 25

Impotence, difficult painful urination, turbid urine, itching of genitals, urethral discharge
T: Sticky yellow coat, red spots on root
P: Slippery

Answer 25

DAMP HEAT IN LOWER JIAO

TX: Resolve Damp, clear Heat from Lower Jiao
SP 4/PC 6; LU 7/KD 6; LIV 5, 3, 1; SP 9, 6, CV 9,
BL 22; CV 2, 3, BL 34
Zhi Bo Di Huang Wan Dioscorea Separating the Clear Decoction

Question 26

Impotence, pain in testes and perineum, hypogastric pain, premature graying of hair, abnormal sperm (motility, shape, number…) feeling of oppression of chest, urethral discharge
T: Purple, swollen, sticky coating
P: Firm, slippery

Answer 26

STASIS OF ESSENCE & PHLEGM

TX: Invigorate Blood and Essence, eliminate stasis, resolve Phlegm
SP 4/PC 6, KD 14; ST 28; CV 3, BL 34; LIV 5, 3; SP 10;
ST 40, CV 9, SP 9, BL 22
Huo Xue Tong Jing Tang Invigorating Blood and Penetrating the Essence Decoction