Erectile Dysfunction
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FOR DISPLAY ONLY chapter 58 Men’s Health: Erectile Dysfunction rectile dysfunction (yáng wêi 阳痿) is an inability to Eachieve and maintain an erection, achieve ejaculation, BOX 58.1 PATTERNS or both. Men presenting with erectile dysfunction often Liver qi constraint experience other complaints in addition to difficulty with · traditional approach erections, including loss of libido, ejaculatory failure, in- · modern strategy ability to achieve orgasm and premature ejaculation. These Blood stasis problems can also be dealt with using the strategies outlined · systemic, mild to moderate in this chapter. · severe, with marked stasis in lower burner Erectile dysfunction is a complicated issue, often as- · alternative strategies sociated with vascular disease and a tangle of social and Damp-heat emotional factors such as overwork and fatigue, anxiety and · chronic, dampness greater than heat depression, disinterest in the sexual partner, fear of sexual · with yin deficiency incompetence, marital discord or guilt about unconven- Qi and blood deficiency tional sexual impulses. · Heart blood and Spleen qi deficiency In Chinese medicine, the ability to achieve erection · fear damaging Kidney qi (with reasonable frequency, based on the age of the patient) · Heart and Kidney axis disruption ultimately reflects the state of the Kidneys and the distri- Kidney deficiency bution of qi and blood. A number of factors must be in – yang deficiency sync in order for erection and reproduction to take place. · diminished mìng mén fire First, intact Kidney yang is necessary to provide the ‘fire of · with enlarged prostate and poor fluid desire’ and the yang hydraulics to enable erection to occur. metabolism – yin deficiency Second, Liver qi must be free flowing so that qi and blood can reach the extremity of the Liver channel to inflate the ancestral sinew of the Liver (i.e., the penis). Third, sufficient developing cardiovascular disease and systemic blood quantities of qi and blood must be available to fill the penis stasis. In the absence of clear Kidney deficiency signs when opportunity presents. Finally, the shén, which relies and symptoms, patients with an inability to achieve on adequate qi and blood for stability, focus and anchorage, erection and no nocturnal or early morning erections, must be willing and able. blood stasis is the most likely diagnosis. 3. Associated with chronic infection or inflammation of PATHOLOGY the genitourinary system. This is usually associated Experience suggests there are five main groups of erectile with a chronic prostate infection, or prostatic inflam- dysfunction: mation and swelling. 1. Those due to stress and poor circulation of qi and 4. Insufficient qi and blood available to fill the penis; blood to the periphery. Mostly Liver constraint prob- disturbance of the shén and zhì (anxiety, lack of confi- lems, this type of erectile dysfunction is intermittent dence, fear of failure/intimacy). Seen in patients with and reflects increasing stress levels; when relaxed or on weak or scattered qi and blood. There are mechanical holiday, normal service is resumed. aspects of insufficient ‘hydraulic fluid’ to inflate the shén 2. Blockage of the penile vasculature by blood stasis. penis, and a that is too scattered to focus the qi Clinical experience suggests that blood stasis is a and blood where it is required. significant contributor to erectile dysfunction. Erectile 5. From exhaustion or age. This is the classic pattern of dysfunction may appear before other classic features of erectile dysfunction, involving weakness of Kidney blood stasis, and is considered an early warning sign of yang and yin, and diminishing mìng mén fire. Copyright © 2018 Eastland Press FOR DISPLAY ONLY 58 / Men’s Health: Erectile Dysfunction 975 ETIOLOGY BOX 58.2 KEY DIAGNOSTIC POINTS External pathogens · erectile dysfunction in otherwise reasonably well These can invade the lower burner via the local collaterals individuals is most likely early blood stasis or the tài yáng channels, becoming lodged and chronic if · during periods of emotional stress, usually qi the acute phase is mismanaged. Persistent damp-heat in the constraint lower burner ‘steams and softens’ the ancestral sinew of the · loss of libido with erectile dysfunction is most Liver, blocking movement of qi and blood to the penis. likely yang deficiency Emotional factors · intact sexual desire with loss of ability is most Male sexual function depends on both physiological and likely yang blockage by blood stasis or damp- psychological health, with the emotional aspects of the heat Heart, Liver and Kidney systems all influencing sexual abil- · frequent need to have sex (not like true lust, ity. Specifically, mental stress can obstruct the flow of Liver more like an irritation or itch that needs to qi, with a very direct and dismal effect on the functioning be scratched) without the ability to achieve or of the ‘ancestral sinew’. Anxiety and extremes of emotion, maintain erection – yin deficiency with heat which destabilize the Heart and the shén, can also play · with genital sweating or rashes – damp-heat havoc with the ability to achieve and maintain an erection. · associated with some type of sexual or Kidney dysfunction can result from fear or shock. Severe or dysmorphic anxiety, most likely qi and blood prolonged fear or a sudden shock damages zhì, the anima of deficiency or Heart Kidney axis disruption the Kidney and the shén, or disrupts the Heart-Kidney axis. · erectile dysfunction in patient with diabetes – In such cases, timidity and nervousness may become con- most likely blood stasis, and/or damp-heat stant personality traits. Such traits do not lend themselves to confident and effective sexual encounters. sence and yin to release a short burst of yang that temporar- ily increases desire, but ultimately leads to profound erectile Dietary factors problems and fertility issues. Repeatedly dipping into this A diet that introduces damp-heat into the system, or that finite reserve has a dire effect on both Kidney yin and yang. weakens the Spleen, can contribute to erectile dysfunc- Excessive or inappropriate use of yang tonic herbs in an tion. Damp-heat from excessive rich, sweet, oily food and attempt to achieve a sort of super potency or ultra health alcohol, or simply overeating, accumulates in the middle can cause problems in a similar way to the stimulant drugs burner then gradually seeps into the lower burner, soften- above. Men (young and relatively robust men in particular) ing the sinews, inducing swelling and blocking qi and blood who consume large quantities of hot-natured yang tonic distribution. Middle burner damp-heat also gradually de- herbs such as red ginseng and deer horn in order to increase pletes yin and drains the Kidneys while chronic damp-heat sexual potency deplete Kidney yin by tapping excessively gradually influences the blood by increasing its thickness and inappropriately into their yang and essence reserve. and viscosity, resulting in blood stasis. A raw or cold diet, or one with insufficient protein, Overwork, age, Kidney deficiency weakens the Spleen and leads to qi and blood deficiency, damages Spleen yang and ultimately drains Kidney yang. A An important cause of erectile dysfunction, loss of libido by-product of a weak Spleen and resulting inefficient diges- and male infertility, Kidney deficiency can involve either tion is dampness, which can sink into the lower burner, essence, yang, yin or a combination of these factors. It can stagnate, and over time generate damp-heat. be congenital or develop from overwork, age, chronic illness or excessive ejaculation and masturbation. Medications and drugs Kidney yang qi is particularly affected by prolonged Certain prescription and recreational drugs have a deleteri- exposure to cold conditions, as well as excessive lifting or ous effect on desire and the ability to develop and maintain standing. In some cases, particularly in younger men, Kid- an erection. Antihypertensive agents (in particular, beta ney qi may be weakened while Kidney yang remains intact, blockers), antidepressants and antipsychotic agents have a in which case the cold symptoms are not seen. significant impact. Recreational drugs with a deleterious Kidney yin is damaged through overwork, especially erectile effect include cannabis and nicotine, the opiate while under stress, late nights, shift work, insufficient sleep, group, and stimulants. Stimulants such as cocaine and febrile disease, insufficient hydration and the use of some amphetamine derivatives (speed, ice) plunder reserves of es- drugs and medications. Copyright © 2018 Eastland Press 976 58 / Men’s Health: Erectile Dysfunction Ejaculation – how much is too much? of age, ejaculation once a week seems about right; for men The issue of potential damage done by excessive sexual 50–60, once every two weeks, 60+ once every two weeks activity (ejaculation in males, pregnancies and terminations if possible or every three weeks if not. Signs of Kidney in females) is a question that has preoccupied the Chinese deficiency should be checked for, the most common being for centuries, and one that remains controversial among increasing premature ejaculation and erectile dysfunction, those involved in Chinese medicine today. Sperm is a tiredness, backache and urinary frequency. When evident, manifestation of essence, thus essence is lost with ejacula- recommended frequency of ejaculation should be reduced. tion. From a Chinese medicine perspective, essence should be jealously