NAN KE

ANDROLOGY

Yang Wei: Erectile Dysfunction

From Chinese Medicine

and Biomedical Perspectives

Gloria R. Osorio, L.Ac., Dipl. O.M., MQP

Medical Qigong Practitioner

Submitted in fulfillment of the requirements for the degree of

Doctor of Acupuncture and Oriental Medicine
Oregon College of Oriental Medicine
November 30, 2011

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011

All Rights Reserved
The body is the wisdom tree, the mind like a bright mirror stand;
always strive to wipe it clean, making sure that no dust lands.
─Shenxiu disciple of the Fifth Patriarch Hongren, c638

Wisdom has never been a tree, and the bright mirror has no
stand; there has never been anything, so where can dust land?
─Sixth Patriarch Huineng, c638

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011

All Rights Reserved
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved
 CONTENTS

Foreword xi
Acknowledgements xvii
I. Erectile Dysfunction 1
II. Anatomy of the Penis 3
III. Mechanism of an Erection 4
IV. Causes of Erectile Dysfunction Classified by Clinical Manifestation 6
i. Disorders of Desire Leading to Erectile Dysfunction 10
ii. Disorder of Ejaculation 10
iii. Orgasmic Dysfunction 11
iv. Failure of Detumescence 11
V. Diagnosis of Erectile Dysfunction 12
VI. Biomedical Treatment Options 13
VII. Andropause 19
VIII. Peyronie’s Disease 22
IX. Premature Ejaculation 24
X. Chinese Medical Perspective: 27
i. Sexology in China 27
ii. Chinese Medicine on ED 28
iii. Disease Mechanism 28
iv. Etiology and Pathogenesis 29
a. Chong Mai 30
b. Acupuncture Points to Treat the Chong Mai 30
c. Topical Formulas 31
v. Identification of Patterns 32
1. KD Yang Deficiency 33
2. HT Blood Deficiency 34
3. LV Blood Deficiency 36
4. HT and GB /Qi Deficiency 37

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011

All Rights Reserved
 5. KD Yin Deficiency 38
6. HT and KD Qi Deficiency (HT and KD Not Communicating) 40
7. HT and KD Yin Deficiency (HT and KD not Communicating) 42
8. LV Qi Stagnation 44
9. Damp-Heat in the LowerJiao 45
10. Damp Heat in the LV Channel 46
11. Stasis of Jing with Phlegm 47
XI. Novel Theory for Erectile Dysfunction 49
i. Yin Deficiency of Marrow 50
ii. Yang Deficiency of Marrow and Brain 51
iii. Qi stagnation, Deficiency of Marrow and Blood Stasis 51
iv. Prescription for obstruction of the SanJiao and Yang Deficiency of Marrow 53
XII. 10 Methods of Treating Jing for Impotence 53
XIII. Premature Ejaculation in Chinese Medicine 55
Identification of Patterns 55
(1) HT/KD not Communicating and Yang Deficiency 55
(2) KD Yang Deficiency 56
(3) Topical Treatment for Any Pattern 58
(4) HT/KD not Communicating and Yin Deficiency 58
(5) HT/SP Blood Deficiency 58
XIV. Andropause in Chinese Medicine 59
XV. Nocturnal Emissions 59
XVI. Analysis of Studies in Chinese Medical Journals 64
XVII. Natural Ways to Boost Hormonal Levels 66
XVIII. Case Studies 70
Case 1 70
Case 2 77
Case 3 80
Afterword 82
Glossary 84
References 85-88
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved
 Foreword

This is a paper on men’s health, specifically erectile dysfunction (ED) from the Western and

Chinese medical perspectives, submitted in fulfillment of the requirements for the degree of

Doctor of Acupuncture and Oriental Medicine at the Oregon College of Oriental Medicine. It

explores pathomechanisms, possible causes and treatment methods and cures for this syndrome.

Andrology is a broad topic and the scope of this paper is narrowed down to ED given its purpose.

There is hardly any writing translated into English on the subject of andrology in Chinese

medicine, compared to the amount of literature there is in the Chinese language, and to the boom

in China of men’s healthcare and hospitals with whole wards dedicated to it, and clinics exclusively

for men’s health. And now that the baby boomer generation is coming to age, male care in the

West in all of its aspects is a hot topic; and Chinese medicine with its vast age old wisdom focused

on holistic care is most welcome.

The sources I employ for this paper are English translations of the Chinese Classics; available

literature in English on Chinese andrology; books on miscellaneous issues that are germane to the

subject; Chinese medical journals by specialists in andrology or nanke, my own clinical and

academic experience, and clinical case studies of actual patients under my care.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011

All Rights Reserved

xi
Through the writings of physicians of antiquity like Herophylus of Chalcedon, Galen, Rambam

(Moses ben-Maimon), and Hippocrates (and perhaps Shennong, Sun Simiao, and others, but

there are no translations) we can appreciate that historically physicians used a variety of therapies

for the betterment of their patients. Such therapies comprised herbal medicinals and therapies,

bloodletting, use of leeches, prolonged fasting, biomedical interventions, even Shamanism.

The patient that comes to consult on the issue of ED is the brand of patient that has decided and is

committed to the resolution of his particular concern. Most men identify with their penises, and

by the time they get to a consult they have came to terms with the fact that there is a problem and

are resolved to address it and are thus committed to do what is necessary. This is of course ideal in

clinical practice, because the outcomes are better for it.

I have found in many instances that a patient who, by all accounts is suffering from impotence will

suddenly have an affair soon after the beginning of treatment, and the impotence will subside or

disappear just as it came about. I explain this by the element that coming to terms with the fact of

such dysfunction is very unnerving to him, and beginning therapy appears to be a comforting

experience, that the brain releases a significant amount of oxytocin perhaps, suppressing the

amygdala so that fear and anxiety are gone by the knowing and trust that he will get better. So his

body responds by releasing even more oxytocin creating a feeling of happiness and well being*,

attracting thus a willing new partner who does not know him, but is vibrating at his same octave.

Other times, after only three weeks of treatment, at only the first phase of the therapy, the

mechanical part of the dysfunction improves, but their sexual lives do not, or even gets worse, at

which times the men have affairs or separate from their spouses, and the impotence is gone “for

good,” until the next time – because since these are lifestyle choices and psychogenic factors that

have to do with the patient, not the partner, the dysfunction will eventually return.
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved

xii
At times they come to a consult after a prolonged period of impotence following a loss of a loved

one, or after a major shift in their circumstances at home, at work, or socially. And finally, there is

the patient that has endured long term impotence in a loveless, unattractive relationship, but is set

on keeping that relationship for whatever reason, usually low self-esteem, or because it is meeting

an unconscious purpose; maybe just being the victim, but a purpose it is; eventually though it

comes to an end, and the ED improves on its own. These are examples of psychological type

erectile impotence. In this type of dysfunction, hormonal disorders play a significant role and it is

thus possible to treat it with Chinese herbology. It is crucial to discuss with the patient at the first

meeting all the possibilities with the psychological type of impotence, so that if he is tempted to

end therapy short, during the boosts of energy and euphoria at the onset of recovery, he is well

informed of the commonality of these episodes, and that he will eventually return when the

euphoria, or limerence phase with the new partner is over. Limerence usually lasts between one

and three months.

Psychological impotence is different from the erectile dysfunction related to physiological factors

like vascular disorders, neurological or metabolic factors, physical injury, or induration of penis

(Peyronie’s disease.) It is important to recognize our limitations when treating this type of patient.

Chinese herbology and acupuncture treat hormonal imbalances by approaching a functional

normalization as opposed to the end-stage pathology, but even thus, sometimes the imbalance is so

chronic and already deeply ingrained, that it has changed the view of the world of the patient, at

which time a more aggressive form of therapy might be necessary in the form of talk therapy or

endocrinology, and we must refer out.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011

All Rights Reserved

xiii
FUKE or women’s health in TCM is widely researched and written about, while NANKE or men’s

health, however researched, is not so much, and as mentioned earlier, the work is not translated

from the Chinese language, nor is the topic written much about. I had trouble finding enough

TCM literature translated into English to source my writing that I had to thus rely heavily on my

academic view and clinical experience and observations.

It is therefore that this paper contains some case studies on actual patients that are or were under

my care, and a healthy amount of personal views based on clinical observation. For the Western

portion of the writing, I freely used readily available and updated literature in English. The paper is

organized as follows: the Western male reproductive system and the anatomy of the penis; causes

and pathomechanisms of ED; and andropause; Chinese medical perspective on ED;

pathomechanisms and causes; Chinese herbal and acupuncture treatment; physical exercises to

release growth hormone (GH); supplementation to promote the release of testosterone; and

miscellaneous therapies for underlying causes.

I was trained in Chinese medicine and medical Qigong and these are essentially my methods of

treatment. However, in the doctoral portion of my training, at the Oregon College of Oriental

Medicine, which had an integrative approach to it, I discovered the importance of integrative

medicine in clinical practice. When a patient comes to see me for ED he is already seeing an M.D.

urologist or general practitioner, but if not, I encourage him to do so. I assure him of the inclusion

of whatever modality necessary to address his issue organically. It is thus that the treatment of ED

in my practice includes biomedical diagnosis (that he comes with), Lab tests, diet, exercise, herbal

therapy, acupuncture, Western supplementation, visual therapy, and miscellaneous therapies as

needed, in that order.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved

xiv
The treatment begins with a phone interview when a patient calls for an appointment. The health

complaints during that interview are high cholesterol and triglycerides; high blood pressure;

insomnia; fatigue; diabetes; knee pain; lower back pain; indigestion; depression; or he books for a

general treatment. Never is it ever impotence or ED. All of these complaints however are

precursors of impotence. Since I live and practice in the State of Illinois, I cannot order

biomedical lab work, so the patient is asked to procure a blood work order from his attending

Western physician with a request for the following values: C-reactive protein and fibrinogen: both

of which can indicate the presence of systemic inflammation, which other than high cholesterol as

a symptom, can go undetected, but untreated it can increase the risk of heart attack, stroke,

Alzheimer’s disease, cancer, and ED. Homocysteine level: according to the American Heart

Association, high homocysteine levels can damage the lining of the arteries and elevate the risk for

a heart attack as soon as the levels climb above 6.3 mcmol/L, and consequent ED. Thyroid: TSH

levels of over 4.0 –well within the normal range- increase the risk of heart disease; and even

increased levels of 2.0 to 4.0 elevates the risk of thyroid disease, and consequent ED. DHEA

(dehydroepiandrosterone): is made into several active substances including testosterone. Optimal

levels protect against bone loss, aging of the skin, increased body fat; it enhances sexual function,

fights anxiety and depression, relieves joint pain and boost immune capacity. Ideal level for a male

is 250-450 mcg/dl. Serum Testosterone: necessary for erections, ejaculations, and fertility; it

prevents impotence; protects the heart and arteries and reduces the risk of heart disease; it protects

the pancreas, kidneys, and digestive system; it stops and prevents andropause, joint and muscle

pain, osteoporosis, and obesity. Estrogen: as men age, their estradiol levels gradually raise, whereas

their progesterone and testosterone levels gradually fall.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011

All Rights Reserved

xv
These gradual changes lead to reduction in testosterone benefits and eventually to estrogen
dominance, and consequent ED, andropause, metabolic syndrome, etc. Estrogen dominance in
men also stimulates breast cell growth and prostate hypertrophy. Since the male prostate is the
embryonic equivalent of the uterus, is should not be surprising that estrogen dominance is also a
major cause of prostate cancer. All these tests are crucial for the appropriate and personalized
approach to treatment since they will immediately rule out some of the underlying conditions for
the disorder of erectile dysfunction.
_______________________________

Ideal Male Hormone Profile

_______________________________

DHEA 250-450 mcg/dl

Cortisol 9-14 mcg/dl
Estrogens Less than 100 pg/ml
Estradiol Less than 40 pg/ml
Progesterone 1,500-2,500 pg/ml
Testosterone 6,000-9,000 pg/ml
TSH 1.0-2.0 mU/L
Free T3 2.90-3.20 pg/ml
Free T4 1.2-1.4 ng/dl
While in Chinese medicine we treat the pattern of the presenting ailment and the root, the

integrative approach to medicine gives us more tools to act in the best interest of the patient to help

him recover with more expediency. For most patients it is unnatural to talk about their penises;

therefore, during the intake I ask about ED as part of the 10 questions, which are tailor-made to

what is germane. When I talk about sexual function, or dysfunction thereof, I do it as a matter of

fact, with pictures and names of all the parts, and explain in a scientific way, the possible reasons

why it is not doing what it is supposed to do, and the conversation becomes very scholarly, imper-

sonal, and productive; and he feels comfortable.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011

All Rights Reserved

xvi
 ACKNOWLEDGEMENTS

This is to make mention of my deep gratitude to my teachers, mentors, and Chinese medicine
literature writers and translators for the invaluable help they have lent me. To Dr. Beth Burch,
Dr. Zaoxue Lu, Dr. Tsueyhua Lai, and Anna Louis of the Oregon College of Oriental Medicine,
thank you for allowing me to take part in the doctoral program unequal to none in the United
States as of the writing of this paper. Special thanks are due to my first teacher of acupuncture,
the brilliant Dr. Alan Uretz, without whom none of this would have happened. He taught me the
ABCs of Chinese medicine and never recoiled, nor did he ever postpone it for “later” the
answers to my inquiries about everything during class sessions. Thank you to Dr. Martin who
showed me that humor is a wonderful way to master material for the long term and for the
boards, and to remember that it is always “mind over matter” - if you don’t mind, it doesn’t
matter. Thank you to my mentor for this paper the wonderful Dr. Guohui Liu for his guidance,
patience, and camaraderie. To Dr. Richard Tan, thank you for divulging the secret of how to
banish pain in a nanosecond; and to Dr. Ming Qing Zhu for the invaluable ZHU scalp
acupuncture that I use unequivocally for the most complicated disorders.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011

All Rights Reserved

xvii
 I. ERECTILE DYSFUNCTION

There is no evolutionary reason for the female orgasm, because women can get pregnant without

one; not men however, for whom it is imperative to achieve orgasm to perpetuate the species

(Symons D, 1979). [1] Erectile dysfunction (ED) is the medical term for impotence, and according

to the National Institute of Health (NIH), it is defined as the inability to achieve and sustain an

erection for successful sexual performance (NIH Consensus Statement of Impotence 1993). This

ailment is serious and it is linked to complex feelings of inadequacy and shaken confidence, which

over time tend to interfere with other aspects of life due to its psychological consequences.

Although ED does not affect life expectancy, in the majority of the male population it has a

negative effect on well being and quality of life. Some men conceal their difficulties from their

spouses which in turn makes the problem worse by its misinterpretation as unfaithfulness and

conflict that exacerbate the dysfunction. Once the problem is in the open however, medical

support can help resolve it. Several advances in diagnosing and treating specific causes of ED have

restored sexual function, but curiously enough, many patients and their general practitioners are

still unaware of this.

Ever since the advent of Viagra® sildenafil citrate in 1998, it became obvious that ED is more

prevalent than previously thought. A study conducted in the Boston area from 1987 to 1989 found

that 52 percent of men between the ages of 40 and 70 suffered some degree of ED (Feldman HA

et al, 1994). [2] By deduction then, approximately 30 million men in the United States are affected

by ED (McKay D, 2004). [3] Given the expanding lifespan of men, it is further estimated that the

incidence of ED worldwide will more than double in the next quarter century (Goldstein I, 2000).
[4]
The disorder is predominantly related to age, with a prevalence of 2% at age 40 and rising to 25-
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 1
30% by the age of 65 (Furlow WL, 1985). [5] Although little data are available on the prevalence of

ED in men over 75, in an educated guess, it is probably over 50%.

The National Institute of Health estimates that ED affects as many as 30 million men in the United

States. [6] Incidence increases with age: About 4 percent of men in their 50s and nearly 17 percent

of men in their 60s experience a total inability to achieve an erection. The incidence jumps to 47

percent for men older than 75. [7] But ED is not an inevitable part of aging, for it presents a variety

of reasons and is treatable at any age.

Drugs like Viagra®, Cialis®, and Levitra®, have undoubtedly improved the quality of life of

millions of men suffering from ED who would have otherwise resorted to questionable and

unpleasant alternatives like penile implants, pumps, or painful injections and urethral

suppositories. But these drugs can have a significant and life threatening side effects which include,

but are not limited to difficulty breathing, tightness in the chest, chest pain, fast or irregular

heartbeat, fainting, memory loss, numbness of an arm or leg, one-sided weakness, painful and/or

prolonged erection, seizures, severe or persistent vision changes, blindness, sudden decrease or

loss of hearing, rash, hives, itching, swelling of the mouth, face, lips, or tongue, diarrhea, flushing,

headache, heartburn, stuffy nose, upset stomach, indigestion, and death (Akash R et al, 2005). [8]

It is practical for the patient to get a baseline blood levels of testosterone and estradiol before

beginning therapy for ED, because as men age, they often suffer from a deficiency of testosterone

and elevation of estrogen. Mood, musculature, sexual desire, strong erections and performance are

affected by these hormones. There are safe ways of naturally increasing testosterone levels and

reducing excess estrogen.

In spite of the studies mentioned above, there are other studies on the commonality of ED among

men of all ages, not just older men, or of same ethnicities, or same cultural backgrounds. It has

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 2

been quantified that more than 152 million men worldwide experienced ED in 1995, and that this

number is likely to rise to 322 million by the year 2025 (Ayta IA et al, 1999). [9]

There appears to be of late in biomedicine, a better understanding of male sexual function, in

terms of its physiology and pathophysiology. For example, there is now a clear definition of a

normal sexual function, and the functional activities of each element of the penile anatomy. In

terms of pathophysiology, the possible psychogenic element in ED has been recognized, as well as

the organic risk factors for development of the dysfunction. In terms of lab evaluation, new

hormonal, vascular, and neurological investigative procedures have been implemented, and as a

result, it is now easier to rule out certain causes for ED and to focus on a more precise antecedent.

From an etiological perspective, there is a distinction between organic and psychogenic form of

ED. The organic form is sub-classified in terms of physical injury, neurological, vascular, surgery or

radiation, anatomical and endocrinological causes. With the psychogenic form, the sub division

includes situation-dependent ED, and intrinsic psychological disorder (Lizza and Rosen 1999). [10]

There is also a frequent combination of both organic and psychogenic forms of ED; as well as a

purely occasional form triggered by beta blockers, SSRI’s, diuretics, and the use of certain illegal

drugs (Gresser U et al, 2002). [11]

II. ANATOMY OF THE PENIS

The penis is composed of the paired corpora cavernosa, a spongy tissue running the length of the

penis that is surrounded by a membrane called the tunica albuginea. The tissue of the corpora

cavernosa contains bundles of smooth muscle fibers intertwined in a collagenous extracellular

matrix, and distributed within this parenchyma is a complex network of endothelial cell-lined

sinuses, fibrous tissues, spaces or lacunae, veins, helicine arteries, and nerve endings. The urethra,

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 3

which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa

and is surrounded by the corpus spongiosum; and a static structure in the form of a conical

expansion of the corpus spongiosum that forms the head of the penis (Lue TF, 2000). [12]

III. MECHANISM OF AN ERECTION

The penis is under the control of the central and peripheral nervous system, and it is thus that an

erection begins with sensory or mental stimulation, or both. Impulses from the brain and local

nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in through the

arteries and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis

expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining the

erection. The penis is innervated by somatic and autonomic nerve fibers.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 4

The somatic innervation supplies the penis with sensory fibers and provides the perineal skeletal

muscles with motor fibers. Contraction of the perineal skeletal muscles during erection leads to a

temporary increase in corporeal body pressure to a level above the mean systolic pressure, and

thus helps to increase penile firmness (Goldstein I, 1988). [13]

Sexual stimulation triggers the brain to release the neurotransmitter nitric oxide (NO) by

parasympathetic neurons that innervate the corpora cavernosa of the penis. As NO diffuses into

the smooth-muscle cells lining the arteries of the corpora cavernosa and corpus spongiosum, it

activates the soluble enzyme guanylate cyclase which produces cyclic guanosine monophosphate

(cGMP), which in turn induces the activation of a biochemical cascade of protein kinases to

reduce the intracellular calcium concentration in the serum prompting the relaxation of the

smooth muscles of the penis; and simultaneously restricting the blood return via penile veins,

trapping blood in the organ, resulting in engorgement and erection (Moreland et al, 2001). [14]

The autonomic innervation of the penis is both parasympathetic and sympathetic. The sacral

parasympathetic neurons are chiefly responsible for the erectile function and are influenced by a

cortical-sacral efferent pathway. Maintenance of erection for an extended period of time without

significant changes in corporeal body blood can be achieved with repetitive stimulation for 40–50

sec, with a minimum latency period of 50 sec between each stimulus. The sympathetic innervation

of the penis mediates the detumescence after the orgasmic relief by activating phosphodiesterase

type 5 enzymes to catalyze the break down cGMP and cAMP, and maintain thus the penis in the

flaccid state (Goldstein I, 1988). [13]

The chain of events leading to erection and detumescence of the penis presents opportunities for

the treatment of ED, in the form of increasing the availability of NO and decreasing the activity of

PDE5. Viagra®, Cialis®, and Levitra®, are selective inhibitors of PDE5 by inhibiting the

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 5

degradation of cGMP and cAMP, but have tremendous side effects and significant risks. cGMP

appears to be the direct intracellular mediator of the NO pathway, and therefore men taking

organic nitrates for cardiovascular conditions must not take the drugs in this class, because the

mixing may result in life-threatening low blood pressure. Moreover, any of these drugs, as a side

effect, may induce sustained erection that does not subside for more than four hours, which is a

damaging condition known as priapism. (Akash R et al, 2005). [8]

IV. CAUSES OF ERECTILE DYSFUNCTION

CLASSIFIED BY CLINICAL MANIFESTATION

ED usually has a physical cause, such as disease, injury, or side effects of drugs; thus, it is necessary to first

rule out side effects of pharmaceutical drugs as contributing factors to ED; and following is a list of

drugs that have impotence as a side effect:

Diuretics and anti-hypertensives

Hydrochlorothiazide: Esidrix ®, Hydrodiuril ®, Hydropres®, Inderide®, Moduretic®, Oretic®,

Lotensin®
Propranolol (Inderal®)
Labetalol (Normodyne®)
Atenolol (Tenormin®)
Phenoxybenzamine (Dibenzyline®)
Spironolactone (Aldactone®)
Chlorthalidone (Hygroton®)
Triamterene (Maxide®, Dyazide®)
Furosemide (Lasix®)
Bumetanide (Bumex®)
Guanfacine (Tenex®)
Methyldopa (Aldomet®)
Clonidine (Catapres®)
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 6
Verapamil (Calan®, Isoptin®, Verelan®)
Nifedipine (Adalat®, Procardia®)
Hydralazine (Apresoline®)
Captopril (Capoten®)
Enalapril (Vasotec®)
Metoprolol (Lopressor®)

Antidepressants, anti-anxiety, and epilepsy drugs

Fluoxetine (Prozac®)
Lorazepam (Ativan®)
Oxazepam (Serax®)
Phenytoin (Dilantin®)
Tranylcypromine (Parnate®)
Sertraline (Zoloft®)
Isocarboxazid (Marplan®)
Amitriptilyne (Elavil®)
Amoxipine (Asendin®)
Clomipramine (Anafranil®)
Desipramine (Norpramin®)
Nortriptilyne (Pamelor®)
Phenelzine (Nardil®)
Buspirone (Buspar®)
Chlordiazepoxide (Librium®)
Clorazepate (Tranxene®)
Diazepam (Valium®)
Doxepin (Sinequan®)
Imipramine (Tofranil®)
Antihistamines

Dimehydrinate (Dramamine®)
Diphenhydramine (Benadryl®)

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 7

Hydroxyzine (Vistaril®
Meclizine (Antivert®)
Promethazine (Phenergan®)

Non-Steroidal Anti-inflammatory Drugs

Naproxen (Anaprox®, Naprelan ®, Naprosyn®)

Indomethacin (Indocin®)
Parkinson’s Disease Medications
Biperiden (Akineton®)
Benztropine (Cogentin®)
Trihexyphenidyl (Artane®)
Peocyclidine (Kemadrin®)
Bromocriptine (Parlodel®)
Levadopa (Sinemet®)
Anti-Arrhythmic

Disopyramide (Norpace®)
H2-Receptor Antagonists

Cimetidine (Tagamet®)
Nizatidine (Axid®)
Ranitidine (Zantac®)
Muscle Relaxants

Cyclobenzaprine (Flexeril®)
Orphenadrine (Norflex®)
Prostate Cancer Medication
Flutamide (Eulexin®)
Leuprolide (Lupron®)
Chemotherapy Drugs

Busulfan (Myleran®)
Cyclophosphamide (Cytoxan®)

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 8

Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to

cause ED. Since an erection requires a precise sequence of events, ED can occur when any of the

events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area

around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the

corpora cavernosa. Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a

result of disease, is the most common cause of ED. Diseases—such as diabetes, high blood

pressure, nerve disease or nerve damage, multiple sclerosis, atherosclerosis, and heart disease—

account for the majority of ED cases. Patients should be thoroughly evaluated for these conditions

before they begin any form of treatment for ED. Lifestyle choices that contribute to heart disease

and vascular problems also raise the risk of ED. Smoking, drinking alcohol excessively, being

overweight, and not exercising are possible causes of ED. Surgery—especially radical prostate and

bladder surgery for cancer—can also injure nerves and arteries near the penis, causing ED. Injury

to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth

muscles, arteries, and the fibrous tissues of the corpora cavernosa. In addition, ED can be a side

effect of many common medicines such as blood pressure drugs, antihistamines, antidepressants,

tranquilizers, H2-Receptor Antagonists, muscle relaxants, cimetidine: an ulcer drug, etc.

Psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual

failure can also cause ED. Even when ED has a physical cause, psychological factors may make the

condition worse. Hormonal abnormalities, such as low levels of testosterone, are a less frequent

cause of ED. The following classification summarizes the causes for ED: a) Disorders of desire

leading to ED b) Disorder of ejaculation, c) Orgasmic dysfunction, and d) Failure of

detumescence.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 9

 i. Disorders of Desire Leading to Erectile Dysfunction

Hypoactive sexual desire and causes

Psychogenic: depression, marital discord conducive to desire deficiency, performance anxiety

leading to excitement inhibition.

CNS disease: partial epilepsy, Parkinson’s, post-stroke, adrenoleukodystrophy.

Androgen deficiency: primary or secondary, androgen resistance.

Drugs: antihypertensives, psychotropics, alcohol, narcotics, dopamine blockers, antiandrogens.

Compulsive sexual behavior and cause

Psychogenic: obsessive-compulsive sexuality, excessive sex-seeking in association with affective

disorders, addictive sexuality, sex impulsivity.

Erectile dysfunction proper

Drugs: antihypertensives, anticholinergics, psychotropics, cigarette smoking, substance abuse.

Systemic diseases: cardiac, hepatic, renal, pulmonary, cancer, metabolic, post-organ transplant,

pelvic irradiation.

Androgen deficiency: primary or secondary, androgen resistance, other endocrinopathies.

Vascular insufficiency: atherosclerosis, pelvic steal, penile Raynaud’s, venous leakage.

Neurological disorder: Parkinson’s, Alzheimer’s, Shy-Drager, encephalopathy, spinal cord or

nerve injury.

Penile disease: Peyronie’s, priapism, phimosis, smooth muscle dysfunction, trauma.

ii. Disorder of Ejaculation

Premature ejaculation: primary or secondary

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 10

Psychogenic: neurotic personality, anxiety/depression, partner discord or other situational factors.

Organic: increased central dopaminergic activity, increased penile sensitivity.

Absent or retarded emission

Sympathetic denervation: diabetes, surgical injury, irradiation.

Drugs: sympatholytics, CNS depressants.

Androgen deficiency: primary or secondary, androgen resistance.

iii. Orgasmic Dysfunction

Drugs: selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase

inhibitors, substance abuse.

CNS disease: multiple sclerosis, Parkinson’s, Huntington’s chorea, lumbar sympathectomy.

Psychogenic: performance anxiety, conditioning factors, fear of impregnation, hypoactive sexual

desire.

iv. Failure of Detumescence

Structural penile disease: Peyronie’s, phimosis.

Priapism ─ primary or secondary

Primary priapism: idiopathic.

Priapism secondary to disease: hematologic: sickle cell anemia, leukemia, multiple myeloma;

infiltrative: Faber’s disease, amyloidosis; inflammatory: tularemia, mumps; and neurologic diseases,

solid tumors, trauma.

Priapism secondary to drugs: phenothiazines, trazodone, cocaine, intrapenile vasoactive injections

(Kandeel E et al 2001). [15]

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 11

 V. DIAGNOSIS OF ERECTILE DYSFUNCTION

This disorder often has multiple causes and diagnostic evaluation should include endocrinological,

neurological, psychological, and vascular factors.

Patient History

A patient’s medical and sexual histories help define the degree and nature of impotence. The

medical history can disclose diseases that lead to the disorder, and a simple recounting of sexual

activity might identify problems with sexual desire, erection, ejaculation, or orgasm. The use of

certain prescription or illegal drugs can suggest a chemical cause because drug effects are a

frequent cause of ED.

Physical Examination

A physical examination can give clues to systemic problems. For example, if the penis is not

sensitive to physical touch, a problem in the nervous system may be the cause. Abnormal

secondary sex characteristics, such as unusual hair pattern or breast enlargement, can point to

hormonal problems, which would mean the endocrine system is involved. The doctor might

discover a circulatory problem by observing decreased pulses in the wrist or ankles.

And unusual characteristics of the penis itself could suggest the source of the problem—for

example, a penis that bends or curves when erect could be the result of Peyronie’s disease.

Laboratory Tests

Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of

creatinine and liver enzymes. Measuring the amount of available testosterone in the blood can

yield information about problems with the endocrine system and may explain why a patient has

decreased sexual desire; this does not mean however that decreased sexual desire is directly

proportional to the levels of free testosterone in the blood.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 12

Other Tests

Monitoring erections that occur during sleep—nocturnal erections—can help rule out certain

psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal

erections do not occur, then ED is likely to have a physical rather than a psychological cause. Tests

for nocturnal erections are not completely reliable, however. Scientists have not standardized such

tests and have not determined when they should be conducted for best results.

Psychological Examination

Before the beginning of any invasive treatment whatsoever, the patient must attend psychological

counseling to determine if any other treatment is necessary at all. If the patient skips this step, and

the problem is primarily psychological unbeknownst to him or the attending physician, either self

injection pharmacotherapy, implantation of prostheses or vacuum devices will likely fail. A

psychological examination, through interview and questionnaire, can reveal psychological factors.

A man’s sexual partner may also be interviewed to determine expectations and perceptions during

sexual activity.

VI. BIOMEDICAL TREATMENT OPTIONS

As mentioned above, many doctors and patients are not knowledgeable about available treatment

options for ED, but most doctors who do, suggest that treatments proceed from least to most

invasive. Sometimes, just making a few healthy lifestyle changes may solve the problem.

Quitting smoking, reducing alcohol consumption, losing excess weight, and increasing physical

activity may help some men regain sexual function. Cutting back on or replacing medicines that

could be causing ED is considered next. For example, if a patient thinks a particular blood

pressure medicine is causing problems with erection, he should tell his doctor and ask whether he

can try a different class of blood pressure medicine.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 13

Psychotherapy and behavior modifications in selected patients are considered next if indicated,

followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare

cases, surgery involving veins or arteries may be considered. Experts often treat psychologically

based ED using techniques that decrease the anxiety associated with intercourse. The patient’s

partner can help with the techniques, which include gradual development of intimacy and

stimulation. Such techniques also can help relieve anxiety during treatment for ED from physical

causes.

Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the

urethra at the tip of the penis. The appeal for a pill to improve sexual function has been cornered

by the pharmaceuticals Viagra®, Cialis®, and Levitra®, but with numerous side effects. Moreover,

worldwide sales of homeopathic remedies claiming to have this effect have been enormous, but

unfortunately few of them have had very rigorous scientific testing and it is doubtful whether many

would under scrutiny perform any better than placebo (Kirby RS et al, 1991). [16]

One of the few drugs studied in this category is yohimbine, an indole alkaloid which has (alpha)2

receptor blocking activity in vitro and is derived from the bark of the Pausinystalia yohimbe tree.

In a prospective double-blind study in patients with organic impotence yohimbine was not very

effective, but a similar study in patients with psychological ED showed some useful result (Susset

JG et al, 1989). [17]

Other options include:

- Intracavernosal pharmacotherapy.

- Surgical treatment: Venous leakage, Revascularization, Penile prostheses.

- Vacuum devices.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 14

A very common therapeutic strategy to treat ED is androgen supplementation, however true

hormone-related ED is at best rare (Wilson JD et al, 1980). [18] In hypogonadal patients androgens

can restore both sexual energy and potency, but there are no data to confirm a positive therapeutic

effect in patients whose free testosterone concentrations are already within the normal range.

Patients should be warned that androgen replacement therapy may enhance sexual energy without

improving potency and that the treatment may exacerbate or induce benign prostatic hyperplasia

BPH and prostate cancer. Close monitoring of prostate specific antigen PSA levels and urinary

flow rates is recommended before and during treatment (Bancroft J et al, 1983). [19]

- Intracavernosal pharmacotherapy: The drugs commonly used for this procedure are papaverine

(20-80mg), phentolamine (2-4mg), and prostaglandin E1 (20-40mg injected intracorporeally).

[20,21,22,23]
Most patients are able to learn how to inject the drugs very quickly if they get detailed

instruction and information sheet.

The principal side effect associated with self injection is prolonged erection. The patient must be

warned that an erection lasting longer than four hours requires pharmacological detumescence;

this is achieved by inserting a butterfly needle into one side of the corpora cavernosa, and

aspirating 20-40ml of blood, and replacing this with 5-10ml of the diluted (alpha)1 agonist

phenylephrine or noradrenaline (Anderson KE et al, 1991). [24]

- Surgical treatment: Men who are sensitive to the discomfort associated with self injection may

benefit from surgery. Surgery usually has one of three goals:

 Ligation: to block off veins that allow blood to leak from the penile tissues.

 Revascularization: to reconstruct arteries to increase blood flow to the penis.

 Penile Prosthesis: To implant a device that can cause the penis to become erect.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 15

Ligation: surgery to veins that allow blood to leave the penis usually involves an opposite

procedure—intentional blockage. Blocking off veins, called ligation, can reduce the leakage of

blood that diminishes the rigidity of the penis during an erection. However, experts have raised

questions about the long-term effectiveness of this procedure, and it is rarely done.

Revascularization: surgery to repair arteries can reduce ED caused by obstructions that block the

flow of blood. The best candidates for such surgery are young men with discrete blockage of an

artery because of an injury to the groin or fracture of the pelvis. The procedure is usually

unsuccessful in older men with widespread blockage. This revascularization of the corpora

cavernosa is a micro surgery in its last stages of research, but technically feasible. Success rates have

been reported on 50-60% of cases in younger patients in the short term.

Penile Prosthesis: implanted devices known as penile prosthesis had good results in the long term

for many men suffering from ED.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora

cavernosa. The user manually adjusts the position of the penis and, therefore, the rods.

Adjustment does not affect the width or length of the penis. The devise is semirigid, bulky, and

difficult to conceal, but inflatable versions are now available.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and

can be expanded using pressurized fluid. Tubes connect the cylinders to a fluid reservoir and a

pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the

small pump, located under the skin in the scrotum.

The pump causes fluid to flow from a reservoir residing in the lower pelvis to two cylinders

residing in the penis. Inflatable implants can expand the length and width of the penis to some

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 16

degree. They also leave the penis in a more natural state than malleable implants do when not

inflated.

Once a man has either a malleable or inflatable implant, he must use the device to have an

erection. Possible problems with implants include mechanical breakdown and infection, although

mechanical problems have decreased in recent years because of technological advances. With an

inflatable implant, an erection is produced by squeezing a small pump implanted in the scrotum.

The cylinders expand to create the erection. This surgery is not suited for everyone nor is it a cure-

all for all sexual dysfunction (Wilson SK et al, 1988). [25]

- Vacuum devices: these are inexpensive, non-invasive devices and a simple treatment option for

certain men. They cause an erection by creating a partial vacuum, which draws blood into the

corpora cavernosa, engorging and expanding the penis.

The devices have three components: a plastic cylinder, into which the penis is placed; a pump,

which draws air out of the cylinder; and an elastic ring, which is moved from the end of the

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 17

cylinder to the base of the penis as the cylinder is removed. The elastic ring maintains the erection

during intercourse by preventing blood from flowing back into the body. The elastic ring can

remain in place up to 30 minutes. The ring should be removed after that time to restore normal

circulation and to avoid skin irritation.

Couples may find that using a vacuum device requires some practice or adjustment. An erection

achieved with a vacuum device may not feel like an erection achieved naturally. The penis may feel

cold or numb and have a purple color. Bruising on the shaft of the penis may occur, but the

bruises are usually painless and disappear in a few days. Ejaculation may be weakened because the

elastic ring blocks some of the semen from traveling through the urethra, but the pleasure of

orgasm is usually not affected. The most pervasive complaint is that the erection produced in this

fashion is cold and lifeless, and that the ring used to retain the erection is uncomfortable, especially

at ejaculation (Witherington R, 1989). [26]

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 18

 VII. ANDROPAUSE

Mosby’s Medical Dictionary defines ―Andropause‖ as ―A change of life in males that may be

expressed in terms of a career change, divorce, or reordering of life. It is associated with a decline

in androgen levels that occurs in men during their late 40s or early 50s,‖ while Webster’s defines it

as ―A gradual and highly variable decline in the production of androgenic hormones, especially

testosterone in the human male together with its associated effects that is held to occur during and

after middle age, also called climacteric, and male menopause.‖

The word ―andropause‖ is not recognized, as of yet, by the WHO and its ICD-9 medical coding;

the word ―hypogonadism‖ which is a deficiency state in which testosterone falls below the normal

range, is used instead.

Andropause describes an emotional and physical change that many men experience as they age.

The symptoms are generally related to aging, and associated with significant hormonal alterations.

Andropause is widely understood in the medical community, and can be defined as a natural

subtle decline in hormones that occurs in aging men. The fact that the production of androgens by

the testes decrease as men age has been known for years, but only recently interest developed in

terms of the clinical implications of andropause. This state in the normal passage of time for some

men has been referred to as ―male menopause,‖ ―male climacteric,‖ ―late onset hypogonadism,‖

―androgen decline in the aging male (ADAM)‖ or ―viropause.‖ The term ―andropause‖ can be

considered inappropriate because the process is not universal and occurs subtly over time. In

women, menopause occurs universally and usually happens dramatically. The incidence of

andropause from ages 40-49 is estimated between 2-5%.

From ages 50-59, between 6-40%, from 60-69, between 20-45%, and from ages 70-79, between 34-

70%. The incidence of hypogonadism in men older than 80 is estimated at approximately 91%.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 19

Andropause or viropause is a syndrome associated with lack or absence of testosterone. Until

recently physicians were not aware, and some are still not, that these symptoms could be identified

and addressed medically.

Symptoms

Andropause is characterized by a subtle and gradual onset and slow progression of symptoms.

Mistakenly, often these changes are attributed to the unavoidable consequences of aging, but not

all men show symptoms of andropause as they age, and not all who show symptoms have

andropause; moreover, not all men show a significant decrease in androgens either. The syndrome

is characterized by diminished sexual desire and erectile quality, and a good sign of decreased

androgens is the absence of nocturnal erections, decreased intellectual activity, mood changes,

fatigue, depression, anger, and poor spatial orientation; decreased lean body mass, along with

muscle mass and strength; decreased body hair and bone density resulting in osteoporosis, which

can lead to increased incidence of bone fractures and breaks; increased fat surrounding the

internal organs and the mid-section. Other symptoms include low sex drive, low energy,

depression, sleep difficulties and insomnia.

Diagnosis

To diagnose andropause not all these symptoms need to be present, and not all appear to the

same degree in all men. Some may suffer from some of these symptoms, and others just mildly or

not at all. The ADAM questionnaire may be helpful in the diagnosis, but not all men who screen

positively for these symptoms suffer from andropause, it can be a mere side effect of certain drugs,

activities, or circumstances. A blood test is necessary to diagnose andropause.

After age 50 testosterone levels decrease at a rate of approximately 1% a year, but not in all men;

therefore, testosterone levels alone are not a reliable measure to diagnose andropause, because

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 20

there may be an increased level of sex hormone-binding globulin that binds the testosterone with

the result of less of it available to the tissues. And as men get older, there is less of a daily rhythm

to the secretion of the hormone. Younger men, have higher testosterone levels in the morning,

which dwindles throughout the day. In older men, this curve does not exist; it is flattened with a

steady low level in a 24 hour period, and it is not yet known what level defines deficiency.

Moreover, a man may have large variations in testosterone levels over time; he may have normal

levels one day and a decreased level the next. The standard measuring values at this time to

diagnose andropause is at a total testosterone level less than 200 ng/dl. Conversely, if the total is

greater than 600 ng/dl, low testosterone level may be ruled out. Currently, the best measurement of

androgen status is either free testosterone or bioavailable testosterone levels. It is common practice

to draw blood before 10 in the morning to capture the potential peak values.

ADAM QUESTIONAIRE

Yes No

Do you have a decrease in libido (sex drive)?

Do you lack energy?
Is your strength or endurance decreased?
Have you lost height?
Have you noticed decreased "enjoyment of
life"?
Are you sad or grumpy?
Are your erections less strong?
Have you noticed a recent deterioration in your
ability to play sports?
Do you fall asleep after dinner?
Has there been a deterioration in your work
performance?

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 21

Treatment

The goal of treatment is to restore sexual functioning, increase sexual energy and a sense of general

well-being, prevent osteoporosis by optimizing bone density, restore muscle strength and improve

mental functioning. Hormone replacement is often effective, but it is not a stand-alone miracle

treatment; it should be accompanied by proper lean, muscle building diet, and exercise.

Hormone replacement should aim not only to reach normal levels of serum testosterone, but to

normalize levels of secondary hormones dependent on testosterone; these include

dihydrotestosterone and estradiol.

VIII. PEYRONIE’s DISEASE

Condition coined in 1743 by Francois Gigot de la Peyronie, surgeon to Louis XV of France. The disease

is characterized by irregular dense plaques of fibrous tissue, usually on the dorsum of the penile

shaft, but also in front, or on the sides of the corpora cavernosa, accompanied by distortion or

angulation of the erect penis and in the early stages, pain on erection. The erectile deformity may

interfere with vaginal penetration making intercourse difficult or impossible. If the plaque is

extensive and associated with fibrosis of the underlying cavernosal erectile tissue it may result in a

band-like constriction or waisting of the penile shaft, which leads to flaccidity of the corpora

cavernosa, distally. Failure of erection in men with Peyronie's disease is usually psychogenic and

secondary to pain or performance anxiety. Impotence, however, may be caused by coexistent

penile arterial insufficiency, autonomic neuropathy, particularly in diabetic men, or cavernosal

veno-occlusive failure (Metz P et al, 1983). [27]

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 22

Etiology and Pathogenesis

The etiology of Peyronie's disease remains obscure, and it is not possible to predict its natural

course in an individual patient at presentation. Although the pain almost always subsides within a

few months, the plaque, and hence the degree of erectile deformity, may either resolve, stay the

same, or progress further. The uncertainty about the outcome as well as the need for a period of

observation must be explained to the patient. Peyronie's disease can now be evaluated much more

objectively using modern technology. The dimensions of the plaque, the presence of calcification

within it, and fibrotic encroachment upon the cavernosal spongy tissue can be accurately defined

by means of high resolution ultrasonography (Hamm B et al, 1986). [28]

Treatment

The variability in the course of the disease makes it difficult to evaluate the treatments used in the

initial acute phase. Thus common treatment with vitamin E, potassium aminobenzoate, and

orgotein are of doubtful benefit, and there is no convincing evidence that radiotherapy, ultrasonic

treatment, or steroids injected directly into the plaque influence the disease either; apart from

perhaps alleviating pain (Winter CC et al, 1975). [29]

The therapeutic potential of purified clostridial collagenase injected into the plaque is presently

undergoing experimental and clinical trials in the United States (Gelbard MK et al, 1985). [30] The

usefulness of surgery in Peyronie's disease is well documented. If during intercourse, the patient is

unable to penetrate the vagina because of curvature of the penis then it may be straightened with

Nesbit's operation. This surgery involves the excision of a single or multiple ellipses or diamond

shaped segments of normal tunica albuginea from the corpora cavernosa opposite the point of

maximum curvature; then suturing the edges together, straightening the penis, albeit at the expense

of the shortening of it (Nesbit RM, 1965). [31]

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 23
This operation is simpler, less time consuming, and more predictable than attempts at excising the

plaques and replacing the defects with a dermal graft or other substitutes (Pryor JP et al, 1979).[32]

If the patient has organic impotence then a semirigid penile prosthesis may be inserted with or

without excision or incision of the plaques (Devine CJ et al, 1974).[33]

Alternatively, intracavernosal self injections of papaverine may be employed, if necessary, as an

adjunct to corrective surgery. In patients with psychogenic impotence self injection may be

required only short term (Raz S et al, 1974). [34]

IX. PREMATURE EJACULATION

The definition of Premature Ejaculation (PE) is subjective, for there is no recognized standard

definition for it. Masters and Johnson define PE as the condition in which a man ejaculates before

his sex partner achieves orgasm in more than 50% of their sexual encounters. According to this

definition, the majority of men would suffer from PE. Others define PE as: ejaculation occurring

within 2 minutes of penetration, which is also questionable. Nowadays, sex therapists understand

PE as occurring when a lack of ejaculatory control interferes with sexual or emotional well-being in

one or both partners. Most men experience PE at least once in their lives. It affects 25% - 40% of

men in the U.S. The primary sign of PE is that it occurs before both partners wish, and it causes

distress. However, the problem may occur in all sexual situations, including during masturbation.

PE is classified as primary (lifelong) or secondary (acquired). According to the International

Society for Sexual Medicine, lifelong PE is characterized by:

- Ejaculation that always or nearly always occurs within one minute or less of vaginal penetration.

-Inability to delay ejaculation on all or nearly all vaginal penetrations.

-Negative personal consequences, such as distress, frustration or other avoidance of sexual

intimacy.
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 24
And yet, another definition of PE is from the Diagnostic and Statistical Manual of Mental

Disorders (DSM) published by the American Psychiatric Association, secondary PE: -Persistent or

recurrent ejaculation with minimal stimulation before, on, or shortly after penetration, and before

one wishes it. It develops after one had previous satisfying relationships without ejaculatory

problems; and causes personal distress or relationship problems (Raz S et al, 1974). [34]

Treatment

Treatment options for premature ejaculation include sexual therapy, medications and

psychotherapy; or a combination of these.

Sexual Therapy

1. Masturbating an hour or two before intercourse so that ejaculation may be delayed during sex.

2. Avoiding intercourse and focusing on sexual play so that pressure is removed from sexual

encounter.

3) Penile Squeeze Technique which involves:

a) Beginning sexual activity and stimulating the penis, until almost ready to ejaculate.

b) Squeezing the glans of the penis and maintaining the squeeze until the urge to ejaculate

passes.

c) Wait for 30 seconds then go back to foreplay.

d) If the urge to ejaculate returns, repeat the process.

e) Repetition of the process constitutes mental conditioning and the feeling of knowing how

to delay ejaculation, to the point of being able to penetrate the partner without ejaculating.

I also learnt that men, who not necessarily suffer from PE, delay ejaculation when most

urged, by switching their thinking to a neutral or non-sexual imagery, as in a landscape

with trees, or rivers, or the like.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 25

Medications

Several antidepressants and topical anesthetic creams are used to treat PE, and although the drugs

are not approved by the FDA for this purpose, they are prescribed in pursuit of the benefit of their

side effects, which include delayed orgasm. On the other hand, a possible coeval side effect along

with delayed orgasm is decreased libido. The topical anesthetic creams dull the sensation of the

penis because they contain lidocaine or prilocaine, and are applied a short time before intercourse,

and wiped off before intercourse when the penis has lost enough sensation. The men who use

these creams and their partners report a lessened pleasure for obvious reasons.

Cognitive Behavioral Therapy

Also known as talk therapy involves what the name implies, talking to a therapist about it.

Counseling will likely help in combination with drug therapy.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 26

 X. CHINESE MEDICAL PERSPECTIVE

i. Sexology in China

The best known compendium on sexology in the West is perhaps the Kama Sutra from ancient

Hindu practices dating back many centuries BC. It treats sexual practices as an esoteric art of

sexual love between a man and a woman. Less known in the West are the ancient Chinese

sexology treatises dating back to 168 BC. The texts were only discovered in 1973 at the Ma Wang

Tui Han tomb in Changsa, Hunan Province, China. They are composed of more than 20 ancient

Chinese sex handbooks from the beginning of the Han Dynasty -206 BC- to the end of the Tang

Dynasty -907 AD. In these ancient texts are found that Chinese medical sexology regards as the

female giving Yin and receiving Yang; and the male giving Yang and receiving Yin. In principle, it

is an equal and harmonious exchange of sexual energy, since both Yin and Yang Qi are present in

all living things.

The equal exchange of Yin and Yang between a man and a woman in a physical, mental, and

spiritual intercourse constitutes balance; and in Daoist terms it mirrors the harmony of nature and

contributes to longevity. However, more is not better, because excessive sexual activity depletes Yin

and Jing in males and Yang in females. The Chinese take a natural approach to human sexuality.

In Chinese medical and erotic literature, sexology is called the ―art of the bedchamber.‖ It outlines

various techniques for men and women to satisfy one another in intensive, all consuming love

making and intimacy, and it emphasizes that strong sexual energy depends on one’s complete

health. This perspective is logic in Chinese medical thought because the SP (spleen) makes the

blood, the LV (liver) stores and moves it, the HT (heart) gives rise to desire, and the KD (kidney)

provides the Will. If any of these aspects are malfunctioning, ED may occur.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 27

 ii. Chinese Medicine on Erectile Dysfunction

In Chinese medicine Erectile Dysfunction or Impotence is called Yang Wei. Yang refers to penis,

and Wei means listless, flaccidity or withering. It is therefore listless of Yang. Yang Wei is the

inability to achieve an erection, or to maintain one for unencumbered intercourse. Conversely, the

ancient term for impotence was Yin Wei in which Yin refers to matter or flesh, hence penis. This

difference in terminology is probably due to the fact that Yin and Yin Wei refers to the penis shaft

that is called Yin Jing in Chinese, which literally means Yin Stem. Moreover, in ancient times

impotence was sometimes called Jin Wei which means listlessness of the sinews. This name could

be related to the term Zong Jin or ancestral muscle or sinew, which was another term for the penis.

iii. Disease Mechanism

The pathomechanism includes KD Disorders, LV Imbalance, SP Deficiency, HT Deficiency, and

of course the consequences of their respective Fu dysfunctions. Also, injury of Chong, Ren, Du,

and Dai mai; as well as Qi and Blood imbalances. The LV primary channel encircles the genitalia;

the luo connecting channel ascends to the genitals; the LV divergent channel ascends to the pubic

region, and the LV sinew channel binds with all other sinew channels at the genitals. The penis is

called Zong Jin which means meeting of the ancestral or 100 sinews. The HT and KD work in

accouplement to keep a healthy penile function; thus the HT above and the KD below have to be

tonified to this end if there is dysfunction. In the presence of ED whereas the HT is deficient, no

amount of KD tonifying will rectify the depressed penis. The HT is linked to the LowerJiao by the

Chong Mai and the Bao Mai, known in gyno as ―the uterus vessel‖ and it is via these vessels that

HT Fire and HT Blood descend to the genitals and promote erection.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 28

 iv. Etiology and Pathogenesis

The etiology of ED in Chinese medicine is comprised of old age, excessive sexual and physical

activity, irregular diet, drug use, and emotional stress. It is important to differentiate between Full

conditions and Empty conditions and their pathogenic factors. In Full Condition there is

Dampness, Phlegm, Blood Stasis, and Stasis of Jing. In Empty Condition there is KD Yang

Deficiency, HT Blood Deficiency, LV Blood Deficiency, HT/GB Qi Deficiency, and KD Yin

Deficiency.
(Please excuse the imperfectness of the translations, for they are due to the lack of knowledge of idiom of the Chinese translators, and given the
antiquity of the Chinese literature.)

Chapter 70 of the Su Wen Simple Questions mentions impotence calling it ―Yin Wei:‖ ―When

the energy of TaiYin predominates, there is impotence. In man, the diseases of unquietness of the

chest [LU], impotence and extreme debility of Yang energy, [it] fails to erect [the penis] and

inability of conducting sexual action will occur.‖ In chapter 44 of the Su Wen Simple Questions it

says: ―When one is affected by [sexual] desire without satisfaction and pursues outside excessive

goals [frequents prostitutes] or when one engages in excessive sexual activity [masturbates] the

penis, Zong Jin or Ancestral Muscle, will become slack causing impotence [Jin Wei] and seminal

emissions.‖ The Complete Book of Jing Yue, 1624 AD [Jing Yue Quan Shu] relates the etiology

of impotence to emotional stress: ―Worry and pensiveness deplete Qi, excessive worry leads to

impotence.‖ The Secret Formula of the Border Official Wai Tai Mi Yao, 752 AD, clearly relates

impotence to the KD: ―The KD controls the lower orifices; overexertion injures the KD, and the

deficient KD cannot control the lower orifices and impotence results.‖ The Discussion of the

Origin of Symptoms in Diseases Zhu Bing Yuan Hou Lun, 610 AD, also relates impotence to the

KD: ―The genitals are an orifice of the KD, when these are injured by overwork, the deficient KD

cannot nourish the genitals and impotence results.‖

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 29
Anatomically, the corpora cavernosa is controlled by the Chong Mai, and runs the length of the

shaft of the penis. In Chinese medicine an erection is related to the Shen and the Heart. HT Qi

and HT Blood need to descend to the penis to promote an erection, and it requires a precise

sequence of events: nerve impulses in the brain, spinal column, and the area around the penis,

response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa; which

from the Chinese medical perspective are essentially the LV, Chong, and Du Mai.

a. Chong Mai: The Chong Mai influences erection in seven ways:

1. It is the Sea of Blood: Chong Mai as the Sea of Blood provides blood to the Zong Jin: in this

sense this function occurs in synergy with that of the HT.

2. It is connected to the Post-Natal Qi: It is the Sea of Channels and is closely connected to Post-

Natal Qi of the ST through QICHONG ST30. Therefore the Chong Mai also provides the Qi

necessary for erection to occur.

3. It is connected to the Pre-Natal Qi of the KD: For erection to occur, both Post-Natal Qi and

Pre-Natal Qi are needed.

4. It controls the membranes: And most of the penis tissue is part of the membranes.

5. It controls the Ancestral Muscle Zong Jin: It influences the Zong Jin which is the penis.

6. It controls the Luo Mai in the penis: Which allows it to be filled with blood and erect.

7. It allows communication between HT and KD: And therefore the descending of HT Blood to

the penis.

It is therefore that Chong Mai is an important vessel to treat for ED.

b. Acupuncture Points to Treat the Chong Mai

(1)
Chong Mai master/couple (L) GONGSUN SP4 and (R) NEIGUAN PC6.
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 30
(2)
DAHE KD12: Stimulate the descending of HT Qi to the penis.

GUANYUAN REN4: Stimulate the descending of HT Qi to the penis.

QIHAI CV6: Stimulate the descending of HT Qi to the penis.

HUANGSHU KD16: Promote communication between HT and KD.

GUANYUAN REN4  JIUWEI REN15: Promote communication between HT and KD.

The above points all promote the communication between HT and KD.

c. Topical Formulas

The following are topical treatments for impotence. The medicinals are mixed according to their

properties for ED. The treatment is based on ointments to be rubbed onto the penis once a day.

All are designed to fill the corpora cavernosa with blood, and are to be used in conjunction with all

other forms of therapy, i.e. acupuncture, drinking herbal formulas, visual and physical stimulation.

To be made as ointment

(1)
WU WEI ZI 6g

HUANG QI 6g

LIU HUANG 3g

CHUAN SHAN JIA 2g

FU ZI 3g

SHE XIANG 0.3g

(2)
FU ZI 45g

CHUAN SHAN JIA 3g

LIU HUANG 6g

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 31

E JIAO 1.5g

SHE XIANG 0.3g

(3)
GU JING ZI 9g

TIAN MEN DONG 9g

YUAN ZHI 9g

SHENG DI HUANG 9g

SHU DI HUANG 9g

(4)
CHUAN NIU XI 9g

SHE CHUANG ZI 9g

TU SI ZI 9g

LU RONG 9g

ROU CONG RONG 9g

XU DUAN 9g

XING REN 9g

v. Identification of Patterns

KD Yang Deficiency may influence ED because of deficiency of Minister Fire or Fire of Mingmen.

And in terms of channels it implies pathology of the Du Mai which represents the Yang within the

genital system. Besides, during erection the Zong Jin becomes hard which is Yang, and lifts up

which is a Yang action, so erection is very much a Yang activity. Deficiency of KD Yang and of the

Minister Fire is a common cause of ED in both young and old men. This does not mean that all

ED is due to KD Yang Deficiency. It does mean however that regardless of the cause of the

dysfunction, even LV Qi Stagnation that affects Qi reaching the penis; in clinical treatment, a small
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 32
amount of KD Yang herbal tonification is always pertinent, i.e. Du Zhong, Suo Yang, He Shou

Wu, Huang Jing; as well as moxa of the LowerJiao, particularly Ren 2, 3, 4, 5 and 6; ST27, 28, 29,

and 30; KD 11, 12, 13, 14, and 15; LV, 10, 11, and 12.

With HT Blood Deficiency the Zong Jin needs the action of the HT for erection in two ways: HT

Qi must descend to the Zong Jin to promote erection; and the HT governs Blood that the Zong

Jin needs to fill the corpora cavernosa to achieve an erection. When LV Blood Deficiency is

present, the Main Channel, Connecting Vessel, Muscle and Divergent channels wrap around the

penis. Therefore, the LV channel plays a role in the pathology of erection, and it is most notable

when it suffers from Qi stagnation or Dampness.

Following is the description of 11 different patterns: 1) KD Yang Deficiency, 2) HT Blood

Deficiency, 3) LV Blood Deficiency, 4) HT and GB Qi Deficiency, 5) KD Yin Deficiency, 6) HT

and KD Qi Deficiency (HT and KD not Communicating), 7) HT and KD Yin Deficiency (HT

and KD not Communicating, 8) LV Qi Stagnation, 9) Damp Heat in the Lower Jiao, 10) Damp

Heat in the LV Channel, and 11) Stasis of Jing with Phlegm.

1. KD Yang Deficiency

- Clinical manifestation: impotence, low libido, premature ejaculation, LBP, dizziness, tinnitus,

frequent-pale urination, nocturia, feeling cold, cold lower back and knees.

- Tongue: pale

- Pulse: deep-weak

- Treatment Principle: Tonify and warm KD Yang, strengthen the Du Mai.

Acupuncture Points

SHENSHU UB23 (needle and/or moxa)

PISHU UB20

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 33

 HOUXI SI3  SHENMAI UB62 (master/couple Du Mai)

BAIHUI DU20

QIHAI REN6

GUANYUAN REN4: tonifies KD Yin or Yang. For KD Yang use moxa.

ZHONGJI REN3

TAIXI KD3

Herbal Formula

Animal products tonify the extraordinary vessels.

> GU LU BU SHEN TANG

LU JIAO JIAO 9g or LU RONG 6g

GUI BAN JIAO 9g

GOU QI ZI 6g

ROU CONG RONG 6g

HUANG QI 6g

SHU DI HUANG 6g

YIN YANG HUO 6g

YI ZHI REN 6g

This formula tonifies and warms KD Yang. Animal ingredients direct this formula to the genital

system and the extraordinary vessels. GUI BAN JIAO nourishes the Ren and Chong Mai, and LU

RONG nourishes Du Mai.

2. HT Blood Deficiency

- Clinical manifestation: impotence, PE, palpitations, dizziness, depression, insomnia

- Tongue: pale

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 34

- Pulse: choppy

- Treatment Principle: nourish HT-Blood, calm the mind.

Acupuncture Points

SHENMEN HT7

TONGLI HT5

XINSHU UB15

HOUXI SI3  SHENMAI UB62 (master/couple Du Mai)

SHENTING DU24

JIUWEI REN15

GUANYUAN REN4

QIHAI CV6

XIALIAO UB34

Herbal Formula

>GUI PI TANG

REN SHEN 6g

HUANG QI 15g

BAI ZHU 12g

DANG GUI 6g

FU SHEN 9g

SUAN ZAO REN 9g

LONG YAN ROU 12g

YUAN ZHI 9g

BAI ZHI REN 9g

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 35

 ZHI GAN CAO 4g

SHENG JIANG 3 slices

HONG ZAO 5 dates

This formula nourishes HT Blood and calms the mind.

3. LV Blood Deficiency

- Clinical manifestation: impotence, PE, dizziness, blurred vision, depression, insomnia, numbness

of limbs.

- Tongue: Pale and thin.

- Pulse: Choppy or Fine

- Treatment Principle: Nourish LV Blood

Acupuncture Points

LIEQUE LU7 ZHAOHAI KD6 (master/couple Ren Mai)

GANSHU LV18

GUANYUAN REN4

QUQUAN LV8

ZUSANLI ST36

SANYINJIAO SP6

ZHONGJI REN3

XIALIAO UB34

Herbal Formula

> SHAO YAO GAN CAO TANG JIA WEI

BAI SHAO 9g

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 36

 ZHI GAN CAO 6g

DANG GUI 9g

SHU DI HUANG 9g

HUANG JING 6g

SHAN ZHU YU 6g

WU WEI ZI 4.5g

GOU QI ZI 6g

This formula nourishes LV Blood.

4. HT and GB Qi Deficiency

- Clinical manifestation: impotence, premature ejaculation, depression, timidity, sighing, insomnia,

palpitations, easily startled.

- Tongue: Pale

- Pulse: Weak

- Treatment Principle: tonify the HT and GB, lift mood, and calm the mind.

Acupuncture Points

SHENMEN HT7

TONGLI HT5

XINSHU UB15

QIUXU GB40

QIHAI CV6

BAIHUI DU20

ZUSANLI ST36

SANYINJIAO SP6

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 37

 HOUXI SI3  SHENMAI UB62 (master/couple Du Mai)

ZHONGJI REN3

XIALIAO UB34

Herbal Formula

> DA BU YUAN JIAN

SHU DI HUANG 15g

SHAN YAO 12g

SHAN ZHU YU 9g

GOU QI ZI 12g

DANG GUI 9g

REN SHEN 12g

DU ZHONG 9g

ZHI GAN CAO 6g

This formula strengthens the Original Qi and tonifies the HT, LV and KD.

5. KD Yin Deficiency

- Clinical manifestation: impotence, LBP, dizziness, tinnitus, scanty-dark urine, night-sweating,

insomnia.

- Tongue: no coating; also red if there is Empty-Heat.

- Pulse: floating, empty.

- Treatment Principle: Nourish KD Yin, strengthen the Ren and Chong Mai.

Acupuncture Points

SHENSHU UB23

GANSHU LV18

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 38

 HOUXI SI3  SHENMAI UB62 (master/couple Du Mai)

BAIHUI DU20

QIHAI CV6

GUANYUAN REN4

ZHONGJI REN3

TAIXI KD3

LIEQUE LU7  ZHAOHAI KD6 (master/couple Ren Mai)

Herbal Formula

> DI LONG TANG

DI LONG 6g

SHAN YAO 6g

SHAN ZHU YU 6g

TU SI ZI 6g

TIAN MEN DONG 6g

GOU QI ZI 6g

GUI BAN JIAO 6g

SHU DI HUANG 9g

MU LI 12g

MU DAN PI 6g

This formula is specific for KD-Yin and specific for ED in the elderly. It is well known among

herbalists that insects and small invertebrates are particularly effective for the elderly. This formula

nourishes KD Yin and the Ren and Chong Mai. Di Long treats impotence.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 39

 6. HT and KD Qi Deficiency (HT and KD Not Communicating)

- Clinical manifestation: impotence, PE, dizziness, tinnitus, palpitations, LBP, depression,

insomnia, poor memory, pale face.

- Tongue: Pale.

- Pulse: Deep-Weak.

- Treatment Principle: Tonify KD and HT Qi, calm the Mind.

Acupuncture Points

SHENMEN HT7

TONGLI HT5

XINSHU UB15SHENSHU UB23 (stimulate communication between HT and KD)

FULIU KD7

TAIXI KD3

GUANYUAN REN4JIUWEI REN15 (stimulate communication between HT and KD)

SHENTING DU24

BAIHUI DU20

HUANGSHU KD16 Promotes on its own communication between HT and KD

HOUXI SI3  SHENMAI UB62 (master/couple Du Mai)

Herbal Formula

(1)> GUI PI TANG + JIN SUO GU JING WAN

REN SHEN 6g SHA YUAN ZI 60g

HUANG QI 12g QIAN SHI 60g

DANG GUI 6g LIAN XU 60g

FU SHEN 9g LONG GU 30g

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 40

 SUAN ZAO REN 9g MU LI 30g

LONG YAN ROU 12g LIAN ZI 120g

YUAN ZHI 9g

BAI ZHI REN 9g

ZHI GAN CAO 4g

SHENG JIANG 3 slices

HONG ZAO 5 dates

The first formula tonifies the HT, and the latter tonifies the KD and stabilizes the Essence.

(2)> XUAN ZHI TANG

FU LING 6g

SHI GAN PU 6g

GAN CAO 6g

BAI ZHU 6g

SUAN ZAO REN 6g

YUAN ZHI 6g

CHAI HU 4.5g

DANG GUI 6g

REN SHEN 6g

SHAN YAO 6g

BA JI TIAN 6g

This formula tonifies the KD, makes HT Qi descend, establishes the communication between HT

and KD and calms the mind.

(3)> QI YANG YU XIN DAN

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 41

 REN SHEN 6g

YUAN ZHI 6g

FU SHEN 6g

SHI GAN PU 6g

GAN CAO 3g

CHEN PI 4.5g

SHA REN 4.5g

CHAI HU 4.5g

TU SI ZI 6g

BAI ZHU 6g

SUAN ZAO REN 6g

DANG GUI 6g

BAI SHAO 6g

SHAN YAO 6g

SHEN QU 6g

This formula tonifies the KD, makes HT Qi descends and calms the mind.

7. Ht and KD Yin Deficiency (Ht and KD not Communicating)

- Clinical manifestation: impotence in the elderly, 5-palm heat, dizziness, tinnitus, night sweating,

palpitations, LBP, depression, palpitations, insomnia, poor memory.

- Tongue: without coating, also Red if there is Empty-Heat.

- Pulse: Floating-Empty.

- Treatment Principle: Nourish HT and KD Yin, calm the mind.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 42

 Acupuncture Points

SHENMEN HT7

XINSHU UB15SHENSHU UB23 (stimulate communication between HT and KD)

HOUXI SI3  SHENMAI UB62

GUANYUAN REN4

TAIXI KD3

SANYINJIAO SP6

Herbal Formula

>ZHI BAI DI HUANG WAN + JIN SUO GU JING WAN

SHU DI HUANG 12g SHA YUAN ZI 60g

SHAN ZHU YU 6g QIAN SHI 60g

SHAN YAO 6g LIAN XU 60g

ZE XIE 9g LONG GU 30g

FU LING 9g MU LI 30g

MU DAN PI 9g LIAN ZI 120g

ZHI MU 9g

HUANG BO 9g

SHI WEI 6g

BIAN XU 6g

The first formula nourishes KD Yin and clears Empty-Heat; the second one firms and stabilizes

the Essence.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 43

 8. LV Qi Stagnation

- Clinical manifestation: impotence in the young that fluctuates according to emotional state,

premature ejaculation, abdominal distention, irritability, moodiness, depression.

- Tongue: normal-colored or slightly Red on the sides

- Pulse: wiry

- Treatment principle: Pacify the LV, move Qi, eliminate stagnation.

Acupuncture Points

TAICHONG LV3

YANGLINGQUAN GB34

NEIGUAN PC6

QIHAI CV6

ZHONGJI REN3

LIGOU LV5

BENSHEN GB13

SHENTING DU24

Herbal Formula

> XIAO YAO SAN

BO HE 3g

CHAI HU 9g

DANG GUI 9g

BAI SHAO 12g

BAI ZHU 9g

FU LING 15g

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 44

 GAN CAO 6g

SHENG JIANG 3 slices

This formula pacifies the LV, moves Qi and eliminates stagnation. It has been modified to deal

with LV Qi stagnation in the LowerJiao.

9. Damp-Heat in the LowerJiao

- Clinical manifestation: impotence, difficult-painful urination, turbid urine, itching of genitals,

urethral discharge.

- Tongue: sticky, yellow coating with red spots on root.

- Pulse: slippery.

- Treatment principle: Resolve Dampness and clear Heat from the LowerJiao.

Acupuncture Points

GONGSUN SP4 NEIGUAN PC6 (master/couple Chong Mai)

LIEQUE LU7 ZHAOHAI KD6 (master/couple Ren Mai)

LIGOU LV5

TAICHONG LV3

DADUN LV1

YINLINGQUAN SP9

SANYINJIAO SP6

SHUIFEN REN9

SANJIAOSHU UB22

QUGU REN2

ZHONGJI REN3

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 45

 XIALIAO UB34

Herbal Formula

> BI XIE FEN QING YIN

BI XIE 12g

YI ZHI REN 9g

WU YAO 9g

SHI CHANG PU 9g

This formula resolves Dampness in the LowerJiao and in the genital system.

10. Damp Heat in the LV Channel

- Clinical manifestation: impotence, difficult-painful urination, rash external genitalia, irritability.

- Tongue: Red sides and sticky-yellow coating with red spots on the root.

- Pulse: wiry

- Treatment principle: Resolve dampness and clear Heat from the LowerJiao, clear the LV.

Acupuncture Points

GONGSUN SP4 NEIGUAN PC6 (master/couple Chong Mai)

LIEQUE LU7 ZHAOHAI KD6 (master/couple Ren Mai)

YINLINGQUAN SP9

SANYINJIAO SP6

SHUIFEN REN9

SANJIAOSHU UB22

ZHONGJI REN3

XIALIAO UB34

LIGOU LV5
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 46
 DADUN LV1

TAICHONG LV3

Herbal Formula

> QING GAN LI SHI TANG

HUANG BO 9g

HUANG QIN 6g

QU MAI 6g

BIAN XU 6g

HUA SHI 6g

SHAN ZHI ZI 6g

CHE QIAN ZI 6g

MU TONG 3g

CHAI HU 6g

YIN CHEN HAO 6g

SHE CHUANG ZI 6g

WANG BU LIU XING 6g

JIN QIAN CAO 6g

This formula eliminates Damp-Heat from the LowerJiao and specifically from the LV channel.

11. Stasis of Jing with Phlegm

- Clinical manifestation: impotence, pain in the testis and perineum, hypogastric pain, premature

graying of the hair, abnormal sperm (motility, shape, etc.) feeling of oppression in the chest,

urethral discharge.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 47

- Tongue: purple and swollen with sticky coating

- Pulse: Firm-Slippery,

- Treatment Principle: invigorate Blood and the Essence, eliminate stasis, resolve Phlegm.

Acupuncture Points

GONGSUN SP4 NEIGUAN PC6 (master/couple Chong Mai)

SIMAN KD4

SHUIDAO ST28

ZHONGJI REN3

XIALIAO UB3

LIGOU LV5

TAICONG LV3

XUEHAI SP10

FENGLONG ST40

YINLINGQUAN SP9

SHUIFEN REN9

SANJIAOSHU UB22

Herbal Formula

> HOU XUE TONG JING TAN

DANG GUI 6g

HE SHOU WU 6g

YI MU CAO 6g

JI XUE TENG 6g

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 48

 CHUAN NIU XI 6g

GOU QI ZI 6g

XUE JIE 6g

PU HUANG 6g

TAO REN 6g

WANG BU LIU XING 6g

This formula invigorates Blood and the Essence.

XI. NOVEL THEORIES FOR ERECTILE DYSFUNCTION

The following is a new theory or concept championed by one Dr. Zhang Xiao Chu, from the

Shanghai University of Traditional Chinese Medicine, Shanghai, China that is not contained in the

Classics and that most of us have not heard of before.

The 6 extra Fu are related to the Mingmen and therefore impotence. The GB is one of the

6 extra Fu: it controls the ascending of Qi and effects (controls) erection. The Blood Vessels guide

the genitals because they wrap and bind around the male genitalia. The Brain, Marrow and Bones

are all derived from KD Jing and they all influence sexual function. The Brain is called the Sea of

Marrow in Chinese medicine, and the Ling Shu lists the following descriptions of excess and

deficiency in respect of the Sea of Marrow:

Excess: Full of vigor, great physical strength.

Deficiency: dizziness, tinnitus, weak legs, blurred vision, desire to lie down.

Points for balancing either excess or deficiency: DU20, DU16.

The vigor or fullness of the Sea of Marrow includes sexual vigor; therefore impotence is directly

proportional to deficiency. The Qi of the 5 Zang and 6 Fu ascends to, and nourishes the brain.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 49

That is why a deficiency of the ZangFu, from emotional stress or overwork, weakens the Marrow

and Brain and this affects sexual function.

KD Jing nourishes the marrow and the brain through the Du Mai. The Du Mai starts between the

KD where the Dong Qi throbs, one branch goes up the spine and enters the brain, and another

branch in the front goes to the penis, hence the connection between the marrow and erectile

dysfunction. In men, it flows around the Zong Jin and goes to the perineum.

Dr. Zhang has prescriptions to influence the marrow; some for the Yin Deficiency of Marrow and

Brain, and others for Yang Deficiency of Marrow and Brain. This is an interesting concept that the

deficiency of marrow could be Yin or Yang. The first prescription has food items, based on a

Western herbalism concept called ―the doctrine of signatures‖ that predicates upon the idea that

the shape or color of certain food items or herbs that resembles certain organs would be used to

balance that organ. Thus, the following prescription is for Yin Deficiency of Marrow and contains

walnuts because walnuts resemble the brain; and Egg Yolk because it resembles the color of the

brain matter.

i. Yin Deficiency of Marrow

Walnuts 10g

Egg Yolk 1

SHU DI HUANG 15g

BEI SHA REN 15g

GOU QI ZI 12g

SHA REN 2g

ZE XIE 10g

CHAN YONG 10g Warms and nourishes marrow and boosts sexual function.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 50

 Foods: venison, royal jelly, sea cucumber (Oloturia), eel.

The following prescription is for impotence from Yang Deficiency of Marrow and Brain. When

the marrow and brain suffer from Yang Deficiency, the Mingmen declines, the Du Mai is weak,

the genitals are not warmed, and fail to function properly.

ii. Yang Deficiency of Marrow and Brain

Acupuncture Points
DU20 and DU4 each 7-15 moxa cones.

Herbal Formula

ZI HE CHE 4g

LU RONG 1g

SHENG and SHU DI HUANG 15g each

SHAN ZHU YU 10g

GOU QI ZI 10g

TU SI ZI 30g

SHAN YAO 15g

FU LING 10g

FU ZI 10g

FENG FANG 3g

Foods: deer kidney, gecko

iii. Qi stagnation, Deficiency of Marrow and Blood Stasis

This is a pattern seen in chronic cases.

Treatment principle: eliminate stagnation, invigorate Blood, open obstructions, and tonify the

Yang of marrow.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 51

 Herbal Formula

SHI CHANG PU 6g (opens the orifices)

CHANG XIONG 10g

YU JIN 10g

YUAN ZHI 10g (opens the orifices in the brain)

CHI SHAO 10g

DANG GUI 10g

HUANG QI 20g

TU SI ZI 20g

YIN YANG HUO 15g

CI SHI 15g

And yet another theory by one Dr. Chen Jing Hua who is a follower of Li Don Yuen, which relates

ED to the SanJiao, not as a channel, but as it is described in Chapter 66 of the Nan Jing: ―Below

the umbilicus the Motive Force or Dong Qi, throbs; this is the source of life‖ it is the organ that

allows the Yuan Qi and the Minister Fire to emerge from the space between the KD and separate

into various parts of the body and affect the 5 Zang and 6 Fu. Dr. Chen relates this theory to the

food essences of the ST and SP that enter the internal organs to the Brain upwards and irrigate the

Ancestral Muscle Zong Jin downwards. If the UpperJiao is obstructed, LU Qi cannot descend and

the Ancestral Muscle cannot function properly. If the MiddleJiao is obstructed, Dampness

accumulates and the Ancestral Muscle will be flaccid. If the LowerJiao is obstructed, LV Qi

stagnates, KD Qi is deficient, the urinary and genital orifices are not open, the Ancestral Muscle

cannot extend and the sexual function if thus compromised.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 52

 iv. Prescription for obstruction of the SanJiao and Yang Deficiency of Marrow

ZI SU YE 3g (work on the UpperJiao and make Qi descend)

SU ZI 10g (work on the UpperJiao and make Qi descend)

XING REN 10g (work on the UpperJiao and make Qi descend)

BAN XIA 10g (work on the MiddleJiao)

CHEN PI 6g (work on the MiddleJiao)

YI YI REN 12g (work on the LowerJiao)

ZHI SHI 10g (work on the LowerJiao)

SHI CHANG PU 6g (opens the orifices of the three Jiaos)

YIN YANG HUO 15g (KD tonic)

JIU XIANG CHONG 6g

QI CAO 2g

LUO SHI TENG 10g: enters the luo channels to open the three Jiaos.

XII. 10 METHODS OF TREATING JING FOR IMPOTENCE

1. Tonify Qi and Nourish Jing: used for impotence or PE against a background of Qi Blood

Deficiency. Under such conditions, PE is called Liu Jing, i.e. slippery Jing, where there is some

sperm discharge, decreased sexual desire, frequent urination, cold genitals, cold sweating after

sexual intercourse, dilute sperm: REN SHEN, HUANG QI, DANG SHEN, TAI ZI SHEN,

SHAN YAO, BAI ZHU, FU ZI, LU JIAO SHUANG, SANG PIAO XIAO, BA JI TIAN.

2. Nourish Blood and the Jing: DANG GUI, SHU DI HUANG, HE SHOU WU, BAI SHAO,

E JIAO, LU JIAO JIAO, GOU QI ZI, ZI HE CHE, JI XUE TENG.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 53

3. Tonify KD and nourish Jing: This formula very heavily tonifies KD Yang and will not be good

for someone with KD Yin Deficiency: FU ZI, ROU GUI, LU RONG, BA JI TIAN, XIAN

MAO, YIN YANG HUO, SHA YUAN ZI, LAI FU ZI, ZI HE CHE, HAI MA, SUO YANG,

ROU CONG RONG.

4. Lift Qi and astringe Jing: used when Yuan Qi is weak and there is leakage of sperm such as

nocturnal emissions or PE: HUANG QI, REN SHEN, QIAN SHI, LIAN XU, JIN YING ZI, YI

YI REN, SHAN YAO, SHAN ZHU YU, BAI SHAO, WU WEI ZI, LONG GU, MU LI, BU

GU ZHI.

5. Tonify the HT and Supplement Jing: used when there is HT Blood Deficiency, nocturnal

emission, premature ejaculation, and impotence. Zhang Jing Xue: ―Jing is stored in the KD, but it

is governed by the HT; when Jing is discharged pathologically, it is due to the HT‖: WU WEI ZI,

LI ZHI ROU, LONG YAN ROU, SUAN ZAO REN, HUANG QI, HU PO, DANG GUI, ZI

HE CHE.

6. Move LV Qi and Supplement Jing: Used for LV Qi Stagnation affecting the penis: CHAI HU,

BAI SHAO 30-60g, CHUAN LIAN ZI, LI ZHE HE, JU HE, WU YAO, XIANG FU, QING

PI, YU JIN, JU HUA, GOU QI ZI, SHAN ZHU YU.

7. Resolve Phlegm, eliminate stagnation and nourish Jing: used for penis and prostate problems

such as Peyronie’s disease and BPH: BAI BU, BAI JI, BAI WEI, SHAN CI GU, JIANG CAN,

MU DAN PI, DI GU PI, MU LI, BIE JIA, GUI BAN, DI LONG, BAI JIE ZI, ZE LAN, PEI

LAN, BAI DOU KOU, SHAN ZHA.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 54

8. Eliminate Toxin and Nourish Jing: To eliminate Damp-Heat and Toxic Heat in the genital

system. For prostatitis, epididimytis, and swollen scrotum: BIAN XU, QU MAI, PU GONG

YING, BAI HUA SHE SHE CAO, DONG KUI ZI, BI XIE, YI YI REN, JIN YIN HUA.

9. Invigorate Blood and Penetrate Jing: for blood stasis in the genital system, prostatic hypertrophy,

carcinoma of prostate, Peyronie’s disease, ejaculation problems such as premature or inability to

ejaculate: DANG GUI, JI XUE TENG, YI MU CAO, CHUAN NIU XI, CHONG WEI ZI, HE

SHOU WU, GOU JI, BU GU ZHI, XU DUAN, TAO REN, HONG HUA, DAN SHEN, XUE

JIE.

10. Make Qi descend and return Jing: used in rebellious Qi of the Chong Mai, problems of

ejaculation, hypogastric distension: CHEN XIANG, LIZHI HE, CI SHI, HUANG QI, WU

YAO, DONG GUA ZI, SHE CHUANG ZI, SU ZI.

XIII. PEMATURE EJACULATION IN CHINESE MEDICINE

In Chinese medicine, Premature Ejaculation (PE) is deficiency of the KD not holding onto sperm:

it is therefore seen as a ―leaking‖ pathology, akin to uterine bleeding from Qi deficiency, sweating

from LU Qi Deficiency or nocturnal sweating from Yin deficiency. It follows therefore, that most

cases of premature ejaculation are due to some form of KD Deficiency.

However, the HT also plays a role in that HT Qi and HT Blood need to descend to the penis to

promote normal erection and ejaculation. Thus PE may be due to HT Heat causing HT Qi and

HT Blood to descend too early, thus causing PE.

Identification of Patterns

(1) HT/KD not Communicating And Yang Deficiency

- Clinical man infestation: tinnitus, depression, palpitations, PE, dizziness, pale face, LBP.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 55

 Herbal Formula

> GUI PI TANG + JIN SUO GU JING WAN: the first tonifies the HT, and the second tonifies

the KD and retains sperm. (p. 39)

Acupuncture Points

SHENMEN HT7

TAIXI KD3

BAIHUI DU20

HOUXI SI3 SHENMAI UB62 (master/couple Du Mai)

XINSHU UB15

SHENSHU UB23

CILIAO UB32

JIUWEI REN15  GUANYUAN REN4

HUANGSHU KD16

(2) KD Yang Deficiency

-Clinical manifestation: tinnitus, depression, palpitations, PE, dizziness, pale face, LBP, exhaustion,

cold limbs, pale-frequent urination.

-Tongue: pale

-Pulse: weak, deep

Herbal Formula

> GUI FU DU JIN ZAN YU DAN

ROU GUI
FU ZI
DU ZHONG

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 56

 JIN YING ZI

SHU DI HUANG

YIN YANG HUO

BAI ZHU

GOU QI ZI

DANG GUI

SHAN ZHU YU

QIAN SHI

XIAN MAO

SHE QUAN ZI

JIN CAI ZI

ROU CONG RONG

BA JI TIAN

Acupuncture Points

HOUXI SI3 SHENMAI UB62 (master/couple Du Mai)

BAIHUI DU20

SHENMEN HT7

TONGLI HT5

JIUWEI REN15

SHENSHU UB23

PISHU UB20

MINGMEN DU4

Moxa GUANYUAN REN4

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 57

 (3) Topical Treatment for Any Pattern

Equal amounts of SHE CHUANG ZI and DI GU PI. Used as a wash prior to intercourse.

(4) HT/KD not Communicating And Yin Deficiency

- Clinical manifestation: tinnitus, depression, palpitations, PE, dizziness, 5-palm heat, LBP, night

sweats.

Herbal Formula

> ZHI BAI DI HUANG WAN + JIN SUO GU JING WAN (p.42)

Acupuncture Points

HOUXI SI3 SHENMAI UB62 (master/couple Du Mai)

SHENMEN HT7

TAIXI KD3

GUANYUAN REN4

BAIHUI DU20

SHENSHU UB23

CILIAO UB32

(5) HT/SP Blood Deficiency

- Clinical manifestation: tiredness, depression, palpitations, PE, dizziness, pale face, loose stools.

- Herbal Formula: GUI PI TANG Mod. with astringent herbs such as LONG GU, WU WEI ZI

or MU LI.

Acupuncture Points

HOUXI SI3 SHENMAI UB62 (master/couple Du Mai)

SHENMEN HT7

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 58

 ZUSANLI ST36

JIUWEI REN15

MINGMEN DU4

BAIHUI DU20

XINSHU UB15

PISHU UB20

The prostate is not mentioned in classical texts.

XIV. ANDROPAUSE IN CHINESE MEDICINE

During male andropause, the ratio of testosterone to estrogen decreases; just as the ratio of

estrogen to testosterone in women, passing through menopause, declines as well. Testosterone is at

its peak during adolescence. It abates thereafter, and the rate reduction sharpens by about age 50.

In Chinese medicine, we treat the pattern in principle, thus andropause would fall mainly under a

deficiency, i.e. KD Deficiency, KD Jing Deficiency, SP Qi Deficiency, and LV Qi Stagnation and

deficiency; and treated accordingly.

XV. NOCTURNAL EMISSIONS

Nocturnal emissions must be distinguished between with or without dreams and Damp-Heat. In

relation to Damp-Heat in treatment, first calm the Shen and firm the Zhi; and second only,

consolidate the Jing. Jing is generated from the ST and SP, it is stored in the KD but it is governed

by the HT. In nocturnal emissions the classification is: emissions with dreams, emissions without

dreams, and emissions due to Damp-Heat. Nocturnal emissions with dreams are mild, akin to

emissions from Damp-Heat; and those without dreams are severe. And as in Damp-Heat in

treatment, the main method for emissions with dreams is to calm the Shen and settle the Zhi; and

consolidate Jing only secondarily.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 59
 EMISSIONS WITH DREAMS

These are due to the HT. HT Blood Deficiency or HT Fire, Shen agitated, three sub-categories:

a) With many dreams, b) Young person with HT Fire, c) Anxiety, HT Deficiency.

a) With many dreams

> FU SHEN TANG

FU SHEN

YUAN ZHI

SUAN ZAO REN

SHI CHANG PU

DANG SHEN

FU LING

HUANG LIAN

SHENG DI HUANG

DANG GUI

GAN CAO

LIAN ZI

b) Young person with HT Fire

> QING XIN WAN

HUANG BO

BING PIAN.

c) Anxiety, HT Deficiency

> YUAN ZHI WAN

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 60

 YUAN ZHI

FU LING

FU SHEN

DANG SHEN

LONG CHI

SHI CHANG PU

EMISSIONS WITHOUT DREAMS

Nocturnal emissions without dreams are due to the KD. The KD stores Jing, when KD Qi is not

firm (Bu Gu), Jing may leak out. There are 4 sub-categories: a) KD Yin Deficiency with

Empty Heat, b) KD Qi not Firm, Jing not Consolidating, c) HT Qi Deficiency, d) Excessive Sexual

Desire [Yuan Qi Deficiency] Yuan Qi Xu.

a) KD Yin Deficiency with Empty Heat

> SAN CAI FENG SUI DAN

TIAN MEN DONG

SHENG DI HUANG

REN SHEN

HUANG BO

SHA REN

GAN CAO

b) KD Qi not Firm, Jing not Consolidating

(1)> SANG PIAO XIAO SAN

SANG PIAO XIAO

DANG SHEN

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 61

 FU LING
LONG GU

GUI BAN

SHI CHANG PU
DANG GUI

YUAN ZHI

(2)> JING SUO GU JING WAN

QIAN SHI

LIAN XU

LONG GU

BAI JI LI

LONG GU

MU LI

LIAN ZI

c) HT Qi Deficiency

(1)> ZHEN ZHUFEN WAN

ZHEN ZHU MU

HUANG BO

GE KE

(2)> DING ZHI WAN

FU LING

FU SHEN

DANG SHEN

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 62

 SHE GAN PU

YUAN ZHI

d) Excessive Sexual Desire, Yuan Qi Xu

> JING GONG SHA XIANG SAN

DANG SHEN

HUANG QI

YUAN ZHI

FU LING

FU SHEN

JIE GENG

MU XIANG

GAN CAO

Damp-Heat: 2 sub-categories: a) Damp-Heat Infusing Downwards, b) Damp-Heat severe

swelling of genitals, profuse nocturnal emissions.

a) Damp-Heat Infusing Downwards

-Clinical Manifestation: dark urine, sweaty genitals, nocturnal emissions with or without dreams.

> ER HUANG SAN

HUANG BO

HUANG LIAN

FU LING

ZE XIE

BI XIE

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 63

b) Damp-Heat Severe Swelling of Genitals, Profuse Nocturnal Emissions

> CANG BAI ER CHEN TANG

CANG ZHU

BAI ZHU

BAN XIA

CHEN PI

FU LING

GAN CAO

HUANG BO

SHENG MA

XVI. ANALYSIS OF STUDIES IN CHINESE MEDICAL JOURNALS

Following are some clinical studies conducted in China and parallel to it, clinical experience of

doctors in China treating ED. Keep in mind, that these studies do not meet the requirements of

proper, randomized, double-blind clinical trials, considered the gold standard in the West.

a) ―New Chinese Medicine‖ Xin Zhong Yi Vol. 36, No. 2, 1989: 156 cases of impotence were

treated with the formula ZHUANG YANG QI WEI WAN Strengthening Yang and Arousing

Impotence Pill: DANG SHEN, BAI ZHU, GOU QI ZI, DONG CHONG XIA CAO, SHU DI

HUANG, YANG QI SHI, JIU CAI ZI, BIE JIA, GUI BAN, DU ZHONG, SUO YANG, YIN

YANG HUO, DANG GUI, XU DUAN, ROU CONG RONG, BU GU ZHI, ZI HE CHE.

The results were: 96 cured (61%), 36 improved (23%), and 18 no improvement (16%).

b) Journal of Chinese medicine Zhong Yi Za Zhi, Vol. 43, No. 6, 2002, p.446: Li Jin Kun et al

―Clinical Observations on the Treatment of 180 Cases of ED from psychological problems with

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 64

the formula SHENG JING ZHU YU TANG Generating Essence and Assisting Fertility

Decoction:

REN SHEN 10g

HUANG QI 12g

E JIAO 9g

XIAN MAO 12g

YIN YANG HUO 12g

SHAN YAO 15g

SHENG DI HUANG 20g

FU LING 12g

GUI BAN 6g

MU DAN PI 12g

NU ZHEN ZI 12g

FU PEN ZI 10g

DAN SHEN 12g

The cases fell into the following patterns

KD Qi Deficiency: 84 cases (46.66%)

Results: 35 cures, 38 improves, 11 no results.

Deficiency of the Fire of Mingmen: 78 cases (43.33%)

Results: 30 cured, 37 improved, 11 no results.

HT and SP Deficiency: 11 cases (6.11%)

Results: 2 cured, 5 improved, 4 no results.

KD Deficiency from Fear and Anxiety: 7 cases 3.88%)

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 65

Results: 0 cured, 2 improved, 5 no results.

c) Journal of Chinese Medicine Zhong Yi Za Zhi, Vol. 29, No. 3, 1988, p.54.

Not a very good treatment. It appears to be symptomatic type as opposed to treating the pattern as

we do in Chinese medicine.

Wu Fang Chun et al ―The Treatment of 100 cases of ED with Acupuncture‖

The age of the patients ranged between 24 and 53 y/o

Patients were treated every 2-3 days for a course of 10 treatments. After a rest of 5-7 days, a second

course was given, up to 5 courses.

Acupuncture Points

CILIAO UB32

QUGU REN2

YINLIAN LV11

DADUN LV1

Additional points according to symptoms:

Insomnia: BAIHUI DU20, NEIGUAN PC6

Tiredness: ZUSANLI ST36

Results: 63 cured, 10 improved, 14 mild improvement, 13 no results.

XVII. NATURAL WAYS TO BOOST HORMONAL LEVELS

Testosterone is a steroid hormone from the androgen group found in living things, i.e. mammals,

birds, insects, reptiles, and other vertebrates. It is primarily secreted in the testes and the ovaries,

but a small amount is also secreted by the adrenal glands. It is primarily a male hormone and an

anabolic steroid. An adult human male produces about ten times more testosterone than their

female counterparts, but females are more sensitive to it.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 66
Testosterone protects the heart and arteries and reduces the risk of heart disease. It can counter

cholesterol and angina. It protects the pancreas, kidneys, and digestive organs. It prevents joint and

muscle pain, and obesity. It is essential for health and well-being as well as prevention of

osteoporosis. Protein and healthful fats increase sex hormones, fortifying thus sexual energy and

erections. Spicy and salty foods increase the effects of adrenal hormones, including testosterone,

DHEA, and cortisol. A diet to boost energy and vitality is necessary for a healthy sex life; thus,

animal protein and fruits are essential, as well as certain bulbs. Meats promote adrenal hormones

and the level of efficiency of sex hormones. Fruits increase the levels of thyroid hormones, and

make us nimble. Certain bulbs, like yams dioscorea (Nigerian yams) dramatically increase levels of

Pregnenolone, which is a steroid hormone responsible for the steroid-genesis of androgens and

estrogens, progesterone, mineralocorticoids, and glucocorticoids. The following nutrients and

activities are designed to boost testosterone levels and other sex hormones for a more satisfying

sexual life.

Vitamins and minerals: A and E, and Zinc: increase sex hormone levels and functioning, and Zinc

is a precursor of the neurotransmitter Nitric Oxide.

- Get rid of the belly: in a study conducted at the University of Pittsburg, they showed that carrying

excess body fat elevates estrogen levels, which causes testosterone levels to sink. Getting rid of the

fat around the mid-section also promotes the secretion of growth hormone.

- Reduce only 1 to 2Lbs. per week: cutting calories greater than 15% would make the brain think
that the body is starving, so it would shot down testosterone production to wait out the famine,
preventing the body from burning fat efficiently.
- Skip the Atkins Diet: Protein intake should be about 16% of the daily calories. In a study

conducted at Penn. State University, it was demonstrated that higher levels of protein can cramp

testosterone levels.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 67

- Have morning sex: An erection causes the circulating testosterone levels to rise significantly.

- Do strenuous exercises: the bulk of workout should involve compound weight lifting exercises

that train several muscle groups. Studies have shown that doing squats, running 30 sec. sprints,

bench presses or back rows increases testosterone significantly.

- Eat nuts as midnight snacks: Certain nuts help in the production of NO, precursor of testosterone

and they are good late night snacks, i.e. pine nuts, almonds, pistachios, sunflower seeds.

- Have a restorative sleep at night: According to a study at the North Carolina University, it is

imperative to have a good night sleep, especially when working out because otherwise testosterone

levels can plunge by as much as 40% in a short amount of time.

- Skip alcohol, except maybe for 1 glass of red wine occasionally with food: Alcohol is not only a

poison to the liver, but it affects the endocrine system causing the testes to stop producing the male

hormone.

- Eat a sandwich at 3 p.m.: The body needs a steady supply of calories to make testosterone.

- The diet must contain approximately 30 percent fat, but not less: The body needs dietary fat to

produce testosterone, the Omega3 type. Ideal fats are contained in nuts and seeds, fatty fish like

salmon and tuna, avocados, olives, mackerel, and anchovies.

-Get more Zinc: Zinc is important for the production of testosterone because it inhibits the activity

of aromatase, an enzyme that turns testosterone into estrogen.

Foods high in zinc include oysters, beef, liver, crab, seafood, poultry, nuts and seeds, salmon,

brown rice, cheese, pine nuts, beans, turkey, or it can be supplemented with at least 50mg of Zinc.

For a male to rid the body of estrogen, it is necessary to eat raw cruciferous vegetables like

broccoli, cabbage, and cauliflower because these vegetables contain a chemical called

diindolylmethane , or DIM, that helps the body get rid of the excess estrogen, or it can also be

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 68

supplemented. Other cruciferous vegetables are Brussels sprouts, bok choi, radishes, turnips,

collard greens, and kale. Eating more fiber will help flush out xenoestrogens. Examples of

xenoestrogens are: man-made estrogens that are found in pesticides, artificial growth hormones

and steroids, air fresheners, and plastic containers. Use glass products as much as possible to avoid

plastic containers. Avoid perfumes that have ―parabens‖ as one of the ingredients. Parabens are

xenoestrogens. Most xenoestrogens accumulate in body fat, so the best defense would be to lose

fat.

Chinese herbal formula to help increase testosterone production and inhibit the
activity of aromatase together with exercise, diet, and sleep

>NO NAME FORMULA TANG

LONG YAN ROU 30g tonify the HT

REN SHEN 8g deputy of Long Yan Rou

HU ZHANG 40g aggressively disinhibits the activity of aromatase

HUANG QIN 15g deputy of Hu Zhang

LU RONG 20g tonifies and warms the Yang

YIN TANG HUO 20g tonifies and warms the Yang

GOU QI ZI 15g nourishes blood

HE SHOU WU 20g nourishes blood, tonifies KD Yin

HUANG JING 15g nourishes blood, tonifies KD Yin

ZHI GAN CAO 3g harmonizes all the herbs

ACUPUNCTURE POINTS FOR ED

-Point selection for the pattern +

-Primary ED points suited for any pattern:

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 69

DU20, UB32, 35, SP6, ST29, 30, REN2, 3, 4, 5, 6.

-Useful ED points: KD2,10,11, DU4, SP10, LV1,3,5,8,12, HT7, ST36,40, UB17,18, 23,52.

CASE STUDIES

My patients come from referrals of current or former patients, colleagues that have other

specialties, and physicians. The ones from colleagues are usually as last resort, when it was

determined that the patient needs Qigong therapy. The ones from physicians are patients that

either do not respond to biomedical treatment or refuse the biomedical options.

I perform a Western physical intake and Chinese 4 diagnostic evaluation: inquiry, observation,

palpation and auscultation; revise all the forms I forwarded to them prior to the consult; do a Shen

assessment; and revise all lab results I requested in the telephone interview.

Case 1

- A 39 y/o heterosexual male, attorney and college professor suffering from long term insomnia.

He complained of total sleeplessness for the past week with sudden onset of ED.

History

- Insomniac for approximately 5 years, waking up 3 to 4 times a night for no apparent reason. In

the past week to date he has not slept at all and is beginning to exhibit signs of mental instability

(per his own assessment,) and also sudden onset of ED.

- Prescriptions: AMBIEN CR (zolpidem tartrate) sleeping pills, Tylenol PM (acetaminophen),

Melatonin (pineal gland hormone), Equanil (meprobamate.)

- In the past week he has been completely awake, to the point that in a couple of occasions he took

all of the above throughout the night, with no desired effect whatsoever; instead he was more

awake, fidgety and paranoid.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 70

He attempted to have sexual relations during this period of time, but for the first time ever found it

impossible. The penis was completely soulless and non-responsive.

- Lifestyle includes alcohol consumption in the form of beer, whisky, or any hard liquor.

He also suffered from gastritis and duodenal ulcers since he passed the bar and started working at

a law firm, on top of being a college professor. For the gastritis he took Prilosec OTC (omeprazol)

and Pepto-Bismol (bismuth subsalicylate.) Sometimes he woke up in the middle of the night with

nausea and abdominal cramps; felt better after bowel movement in the morning, but it was

incomplete, and had additional BM throughout the day. Had poor appetite and after eating felt

nauseous, full, and uncomfortable. Urination was normal, had occasional night sweats, and

preferred warm drinks and warm environment. He had knee pain on the medial aspect of both

legs and occasional LBP (lower back pain) and even more sporadically UBP (upper.) At times felt

dizziness, as if the room spun and needed to hold on to something, and he also got depressed

frequently.

During the interview I recognized the patient as basically promiscuous; he said that the prior week,

to coincide with the sleeplessness, after happy hour with one beer too many, he experienced ED

with a new partner that he never experienced before (the ED.) He reported that that time the penis

had absolutely no spirit even though he had normal morning and during-sleep erections that woke

him up. He said he tried again the next day with the same partner, but it didn’t work; so he tried

with a different one that afternoon, but didn’t work either; he got instead, in both occasions severe

pain in the testes as if to explode, and was just miserable. He was in a panic and his attending M.D.

was going to prescribe Viagra, but he refused; he came instead to see me through a referral from

his acupuncturist, whom I’ve treated before for the same condition. On the mini-phone-interview I

conducted prior to the visit he only mentioned insomnia.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 71

TCM Examination

Palms were moist.

Pulse Rate: 78/bpm.
BP: 138/80.

Tongue: slightly red and semi-dry with thin white coating and shallow cracks.

Pulse: (L) CUN: thin, GUAN: wiry and rapid, CHI: weak, sunken. (R) CUN, GUAN and CHI:

empty, weak, slippery and rapid.

Pale face, looked fatigued, eyes were sunken and had dark rings around them. Reaction was slow

and he was irritable.

The patient’s severe sleeplessness, irritability, and dizziness pointed to LV-Yang rising leading to

the imbalance of Yin and Yang. The pulse being thin on CUN on the (L) was a sign of blood

deficiency to the heart; coupled with strenuous mental work and sudden ED caused unrest for the

Hun (spiritual soul) and Po (physical soul) leading to severe insomnia. When LV overacts and

damages the SP there’s no appetite as the SP fails to transport and transform, hence gastritis and

eventual ulcer. The weak pulse (L) and (R) on the CHI position indicates KD Yang Deficiency

and because of this deficiency, KD Yang is unable to warm the Middle and LowerJiaos and there’s

dampness, causing insufficient bowel movement and contributing to ED. On abdominal palpation

by the side of the 5th sternocostal angle the pt. had slight discomfort (L) and (R); and in the middle,

around REN15 and REN16, it felt to him very tender and guarded it. The rectus abdominis were

tense, LowerJiao felt empty and cold, specifically along REN mai where there was a very apparent

hole or emptiness in the area of GUANYUAN and SHIMEN (REN 4 and 5) that coupled with

the nagging LBP, sudden ED and inability to get an erection indicated that the fire in the cauldron

was languishing, leading to the conclusion that there was Yang Deficiency.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 72

While the pathological heat, empty heat in the MiddleJiao, indicated by the slightly red tongue with

shallow cracks pointed to KD Yin Deficiency, he also liked warmth because the root was cold in

the LowerJiao (akin to ice, that when held in the hand, for being so cold it turns to heat, empty

heat.)

In general, parallel to the fact that the patient was stressed and mentally overworked, the symptoms

he exhibited are associated with the normal decline experienced by most once entered in the 6th

cycle of life; which in this case was exacerbated by previous abuses in lifestyle.

His diet left quite a bit to be desired: he usually ate donuts and coffee, quick fast food lunches,

drank beer quite a bit and sometimes a shot of hard alcohol in his office and before lectures if he

had a rough day, but purportedly not every day. When he didn’t have to lecture he said he went to

nice restaurants and later went to bars before heading home between midnight and 2am. He lived

alone, didn’t have pets, and had only one plant. He watched the news on TV all day long in his

office; unless he was in court, and did not exercise at all.

The diagnosis was as follows: Insomnia due to LV Yang Rising causing HT Shen failing to enter

Yin. LV Qi Stagnation, KD Yin Deficiency, SP, HT and KD Qi and Yang Deficiency.

Treatment Principle: Subdue LV Yang, Nourish the HT and quiet the Shen. FCLVQi (Free

course LV Qi) Tonify SP, HT and KD.

- The patient has had acupuncture in the past with a different practitioner.

- After the interview and before the acupuncture protocol, I gave him a Qigong treatment and slept

deeply for 15 minutes solid until he slowly woke up and we proceeded to needling; he asked how

long he slept, told 15 minutes, he said he felt as if it was for several hours.

Acupuncture Points

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 73

The following points were the ones used throughout his active treatment during a 3-month period.

ANMIAN: calms the spirit and pacifies the LV.

SHANGXING DU23: calms the spirit.

SHENTING DU24: benefits the brain and calms the spirit.

BAIHUI DU20: raises Yang, benefits the brain and calms the spirit, effective in sudden onset and

chronic ED.

ZHONGWAN REN12: tonifies ST and fortifies the SP, regulates Qi and alleviates pain.

SHENMEN HT7 threaded to DALING PC7: clear heat from the heart and calm the spirit,

regulate and tonify the heart, harmonizes the stomach and intestines.

SANYINJIAO SP6: meeting point of LV, KD, SP.

NEIGUAN PC6: regulates the heart and calms the spirit, harmonizes the stomach and alleviates

nausea, opens the Yin Wei mai.

WAIGUAN SJ5: opens Yang Wei mai.

ZHAOHAI KD6: nourishes the kidneys and clears deficiency heat, regulates Yin Qiao mai, calms

the spirit, regulates the LowerJiao.

HUIYANG UB35: this point is suitable for all male sexual disorders. Needling should elicit deqi

in the perineum or genitals.

XINSHU UB15GUANYUAN REN4: descends HT Qi to the penis.

MINGMEN DU4: tonifies the kidneys, benefits the lumbar spine, regulates Du mai.

QICHONG ST30: meeting point of YangMing and Chong mai. Chong influences the LowerJiao

including the genitals. QICHONG alleviates swelling and pain of the penis and testes.

GESHU UB17: harmonizes the diaphragm and descends rebellious Qi, nourishes, harmonizes,

and invigorates the blood.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 74

QUGU REN2: regulates the LowerJiao, warms and invigorates the kidneys.

GANSHU UB18: spreads LV Qi, regulates and nourishes liver blood, clears damp heat, benefits

the sinews and male genitalia.

PISHU UB20: tonifies SP Qi and Yang, resolves dampness, raises SP Qi and holds the blood,

regulates and harmonizes Qi in the MiddleJiao.

JIMEN SP11: benefits the genitals. [3]

EAR SHENMEN: tranquilizes the mind and allows a harmonious connection to essential spirit.

Alleviates stress, pain, tension, anxiety, depression, insomnia, and restlessness.

TRANQUILIZER POINT: for overall relaxation and relieving generalized anxiety; reduces high

blood pressure and chronic stress.

Herbal Formula

> SHI JUE MING TANG + YI SHEN TANG mod.

This list contains the herbs used to modify at different times depending upon his state.

SHI JUE MING: nourishes LV Yin and subdues LV Yang.

LONG GU + MU LI: subdues LV Yang and quiets the spirit.

ZHE SHI: heavily calms the LV and quiets the spirit.

SHENG DI HUANG: supplements KD by enriching and nourishing Yin.

BAI SHAO YAO: nourishes blood, soothes LV, boosts SP.

SUAN ZAO REN: quiets the spirit, nourishes LV, and supplements blood.

ZHU YUAN ZHI: promotes KD-HT harmony and quiets the spirit.

ZHU FU SHEN: nourishes the HT, quiets the spirit, and boosts the SP.

ZHI MU: clears heat from HT and ST and nourishes KD.

ZHU SHA: clears HT heat and quiets the spirit.

BAN XIA + BEI SHU MI: harmonize the center, boost SP, quiet the spirit.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 75

CHEN PI: dries dampness, normalizes functions of SP and ST, regulates Qi.

FU LING: removes pathogenic dampness, warms and invigorates the SP and ST, calms the mind.

I prepared the formula and dispensed it in a bottle.

He took 6oz. 3x/day for 12 weeks, but continued to come for acupuncture and Qigong treatments
3 times a week.

Outcome
Prior to herbal supplementation and frequent acupuncture treatments, the patient stopped all

sleeping drugs, sexual activity, alcohol and mindless late nights for a month; he took the TV and

cleared all clutter and mirrors out of the bedroom. After the fifth day of taking the formula he slept

for 4 hours straight and got up once to urinate, then returned to snooze, but not deep sleep, until

the morning; and so on for the rest of the week and the next, he slept 3, 4, to 5 hours a night.

After the full second week and into the third, he slept solidly from midnight to 6 am. The fourth

week he slept successfully from 11pm to 6am, and would’ve continued, was it not for the alarm

clock every morning. He then suspended the formula (without my knowledge) and the third day

after that he didn’t sleep very well, at which point he started it again with the leftover and came

back for more, to continue with the same formula with minor adjustments for 2 more months.

After the first month he successfully resumed his sexual activity, but he said not as often. He

stopped all sleeping drugs and says he drinks one glass of red wine per day and nothing more.

I made a diet modification plan for him and gave him recipes, consisting of a list of foods that he

could mix and match daily: dark leafy greens, asparagus, red, black and brown rice, yellow sweet

potatoes and purple sweet potatoes, lamb cooked any way he likes, rabbit, seaweed, pig’s feet soup,

beef tendon soup, ox tail soup, chicken soup, zero simple sugars or artificial sweeteners, hot water

or teas instead of coffee; basil, cardamom, cloves, avocados, limes, onions, garlic, black beans,

kidney beans, string beans, steamed squash, steamed pumpkin, any fruits he likes, sardines,
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 76
salmon, octopus, chicken livers, anchovies, eel, eggs, chicken hearts, one glass of red wine per day,

no beers whatsoever, water without ice as much as he likes, but at least 6 6oz. per day. For snacks:

prunes, walnuts, raisins, almonds, dry apricots, seeds, and 1 piece of bitter Belgian, Lebanese or

Brazilian chocolate per day, pistachios, dates, figs; spearmint tea at night.

I taught him breathing exercises to strengthen dantien and keep the fire lit, and also abdominal

exercises to strengthen the Yang. I strongly suggested he learns and practices TaiChi or yoga, and

to work diligently on energy cultivation through Qigong.

Case 2

- A 45 y/o man, Interior designer, married for 7 years with 4 children.

- Complains of declined sexual energy, premature ejaculation, and nocturnal emissions.

- Per his attending Western urologist all the tests were normal and concluded that he was fine.

TCM Interview

- Reflexes were normal.

- Shen was agitated.

- He exhibited some movement limitation on his back and lower back muscle tightness.

- BM = once a day either daily or every other day.

- Nocturnal emissions were with many strange dreams.

Treatment Principle: Hold the Essence. Tonify KD Yang.

Acupuncture Points

SHENSHU UB23 (needle and moxa)

PISHU UB20 (needle and moxa)

HOUXI SI3  SHENMAI UB62

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 77

 BAIHUI DU20 (needle and moxa)

QIHAI REN6 (moxa)

GUANYUAN REN4 (moxa)

ZHONGJI REN3 (moxa)

TAIXI KD3 (needle and moxa)

Zhu Scalp Acupuncture

<LJ> Lower Jiao area: This area representing the LowerJiao starts from DU21 and

extends 1 cun posterior posteriorly. Part of it overlaps with the MiddleJiao area. It is

bounded on the sides by the Foot TaiYang of the UB.

Functions: Tonifies KD and LV, regulates menstruation, promotes urination,

ascends Yang Qi, astringes, unblocks channels, and alleviates pain.

Indications: For disorders of the LowerJiao including the urinary system,

reproductive, and endocrine system. Examples are lower abdominal pain, urinary

problems, irregular menstruation, infertility (M + F) dysmenorrhea, leukorrhea,

vertigo, low back pain, tinnitus, deafness, and impotence.

Herbal Formulas

> FU SHEN TANG, mod.

FU SHEN

YUAN ZHI

SUAN ZAO REN

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 78
 SHI CHANG PU

DANG SHEN

FU LING

HUANG LIAN

SHENG DI HUANG

DANG GUI

GAN CAO

LIAN ZI

HE SHOU WU
DU ZHONG
SUO YANG
LU RONG

YIN YANG HUO

After 3 weeks on this formula taken T.I.D., the patient has not seen any significant

result; at which time I prescribed the following formula:

> JING SUO GU JING TANG mod.

SHA YUAN ZI
QIAN SHI
LONG GU
LIAN ZI
MULI

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 79

 HE SHOU WU
DU ZHONG
SUO YANG
LU JIAO JIAO

In Chinese medicine, all ―leaking‖ problems (loss of control of fluids and stool), such as nocturnal

emission, premature ejaculation, enuresis and leucorrhea should be treated by using astringent

medicinals to strengthen the controls. JIM SUO GU TANG as an astringent medicine can

strengthen the controls and ―lock up‖ the channels of the fluids. In other words, it has effects to

keep (hold) the essence of life energy flow against loss. This formula is often used to treat the male

sexual dysfunctions of nocturnal emission and premature ejaculation.

Outcome

After 8 weeks of taking the second formula continuously, the patient showed significant

improvement and continued to take the formula. Moreover, he was recommended extraneous

abdominal exercises and some aerobics during the week. I adjusted his diet by incorporating more

dark green vegetables and red meat to help the body with testosterone production.

Case 3

57 y/o heterosexual male, attorney, complains of impotence, PE, LBP, depression, insomnia, poor

memory affecting his job performance, palpitations, depression.

Tongue: Pale with teeth marks and ―chicken feet‖ cracks in the area of the MiddleJiao.

Pulse: (B) Deep/Weak/Thready

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 80

Diagnosis: KD and HT Qi Deficiency (HT and KD not communicating), agitated Shen,

Treatment Principle: Tonify KD and HT Qi, calm the mind.

Acupuncture Points

SHENMEN HT7

TONGLI HT5

XINSHU UB15SHENSHU UB23 (stimulate communication between HT and KD)

FULIU KD7

TAIXI KD3

GUANYUAN REN4JIUWEI REN15 (stimulate communication between HT and KD)

SHENTING DU24

BAIHUI DU20

HUANGSHU KD16 Promotes on its own communication between HT and KD

HOUXI SI3  SHENMAI UB62 (master/couple Du Mai)

Herbal Formula

GUI PI TANG + JIN SUO GU JING WAN

REN SHEN SHA YUAN ZI

HUANG QI QIAN SHI

DANG GUI LIAN XU

FU SHEN LONG GU

SUAN ZAO REN MU LI

LONG YAN ROU LIAN ZI

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 81

 YUAN ZHI

BAI ZHI REN

Outcome: The formula worked very well for the impotence, but there were few adjustments

throughout for the KD to hold essence thus resolve PE, until this too was achieved. Moreover, the

LBP due to KD Yin Deficiency was completely resolved and he was able to be pain free. The

testosterone levels became normal as per blood work that the patient obtained from his attending

allopathic doctor. The treatment continued for 6 more months taking the formulas regularly with

minor adjustments depending on his condition at a given day. He also continued with the

acupuncture treatments for the same period of time. ♠

Afterword

Erectile Dysfunction in the United States and around the world turned out to be more prevalent

than previously thought. In China they are ahead of the curve, for at this point they have entire

integrative biomedical and TCM hospitals and clinics dedicated exclusively to the care of men,

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 82

never seen in the past. I am hopeful that here in the United States, as the population continues to

age; the demand for Chinese medical care in this regard will only increase, because people are

living longer. In the current climate of limited resources for health care in the States, people may

contest the relevance of recent advances in the treatment of impotence, and many will dispute the

investment in the treatment with Chinese medicine given the unconventionality of it and because it

is unlikely that insurance will cover it insofar. I can say with a high degree of certainty that Chinese

medicine is a valid treatment option for a dramatic palliation of this imbalance; and as we have

seen in the course of this paper, suffering from it has repercussions beyond ED, and not just

greatly affecting quality of life as a minor inconvenience.

Most men who seek Chinese medicine for this condition, need greater than the 15 minutes they

get with an allopathic doctor and they want a sympathetic interview with a clear explanation of the

problem and informed advice about self administered treatments and all other possibilities,

including Chinese medicine. More education is required to counter the considerable

misinformation concerning impotence not only among the general public but among allopathic

doctors, who are often reluctant to discuss sexual matters with the patients, and definitely know

little about the options there are with Chinese medicine. Additionally, more studies are needed to

evaluate the clinical value of the biomedical diagnostic tests available, the options patients have with

Chinese medicine and the real possibility there is to avoid biomedical invasive treatment and

surgical intervention.

In Chinese medicine, we treat the whole person and not just the symptoms. That is to say that we

go to the root causes of the problem and resolve it from that end, where the symptoms disappear

just as they came about through a functional normalization process. Why do men need to suffer

needlessly given the tremendous option they have with Chinese medicine?

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 83

 GLOSSARY
ADAM Androgen Decline in the Aging Male (ADAM Questionaire).
Andrology Gk. Andros man, logos science: The study of the health of males.
Andropause A variable complex of symptoms, including decreased Leydig cell numbers and
androgen production, occurring in men after middle age, purported to be
analogous to menopause in women.
Chong Mai Penetrating Vessel.
Dong Qi Motive Force below the umbilicus, Source of Life, Throbbing light of the cauldron,
Minister Fire.
ED Erectile Dysfunction.
FCLVQi Free-Course Liver Qi.
Fu Chinese concept referring to the hollow internal organs, i.e. gallbladder, small
intestine, stomach, large intestine, urinary bladder, SanJiao.
GB Gallbladder
HT Heart
Jing Life Essence contained in semen and housed in the core.
KD Kidney
LBP Lower Back Pain.
LI Large Intestine
LowerJiao Area from the umbilicus to perineum.
LU Lung
LV Liver
Middle Jiao Area from the diaphragm to the umbilicus.
Minister Fire Dong Qi.
Nan Ke Chinese Andrology.
NO Nitric Oxide
PC Pericardium
PE Premature Ejaculation.
Qi Life Energy.
SI Small Intestine
SJ SanJiao (Triple Burner)
SP Spleen
ST Stomach
UB Urinary Bladder
UBP Upper Back Pain.
UpperJiao Area comprising head, chest, down to the diaphragm.
WHO World Health Organization.
Yuan Qi Original Qi (the Qi we come with when born).
Zang Chinese concept referring to the solid internal organs, i.e. liver, heart, spleen,
lungs, kidneys, pericardium (an organ in Chinese medicine).
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 84
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testosterone and triiodetironine in young men. Medicine & Science in Sports & Exercise 38 (5):
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© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP All Rights Reserved 88