THE TREATMENT OF MALE DISORDERS Part 1 馬 萬 Copyright Giovanni Maciocia 里 I will conduct the discussion of male pathology in two parts. The first part will discuss the anatomy and physiology of the male genital system and the channels influencing it. The second part will discuss the various conditions affecting men’s genital system, i.e. • Erectile dysfunction • Premature ejaculation • Low sperm count • Benign prostatic hyperplasia • Chronic prostatitis Interestingly, in Chinese medicine, there are many more texts of gynaecology than there are of male pathology. MALE GENITALIA IN CHINESE MEDICINE CHANNELS INFLUENCING MALE GENITALIA PATHOGENIC FACTORS OF MALE GENITAL SYSTEM • Dampness • Phlegm • Stasis of Jing MALE PATHOLOGIES • Erectile Dysfunction - Impotence • Premature Ejaculation • Low Sperm Count • Benign Prostatic Hyperplasia • Prostatitis And Prostatodynia The male genital apparatus is sometimes called the "EXTERNAL KIDNEY" (Wai Shen 外 肾) in Chinese medicine. This comprises four elements: Penis Scrotum Testicles Room of the Sperm (Jing Shi 精 室) The External Kidney depends upon: Kidneys Liver Heart Spleen and Stomach HEART • Heart-Yang descends to help Kidney-Yin with production of Tian Gui • The Liver channel circles round • Heart-Yang descends to enable the external genitalia erection of the penis • The (physiological) Fire of the • The Liver stores Blood, Heart must descend to meet contributing to the production of Kidney-Water and produce Tian Gui Tian Gui • Heart Blood descends to the penis • Liver Blood contributes to normal to assist erection erection External Kidney (Penis, scrotum, SPLEEN AND LIVER testicles, STOMACH Room of Sperm) The Qi and Blood produced by the Spleen and Stomach • The Kidneys are the origin of Tian also contribute indirectly to Gui (sperm) the production of Tian Gui • The Kidneys influence the internal and external genitals • The Kidneys control the Zong Jin or Ancestral Muscle (penis) KIDNEYS HEART • Heart-Yang descends to meet Kidney- Yin to produce Tian Gui • The (physiological) Fire of the Heart warms the sperm The Liver stores the Blood contributing to the production of Tian Gui SPLEEN AND LIVER SPERM STOMACH The Post-Natal Qi and Blood of the Spleen and Stomach indirectly supplement the Tian Gui The Kidneys produce the Tian Gui which is the direct origin of sperm KIDNEYS ANATOMY OF MALE GENITAL SYSTEM Kidney-Jing – Tian Gui Seminal vesicle Ejaculatory duct Du, Ren and Chong Mai Vas deferens Prostate Epididymis Chong Mai (Zong muscle) – corpus cavernosum and spongiosum Testis Kidney-Jing – Tian Gui Du and Ren Mai The room of Sperm is a translation of Jing Shi 精 室 . This may be translated as “room of sperm” or “room of Jing [Essence]”. In the context of male genital pathology, I will translate it as “Room of Sperm”. The Room of Sperm in men is equivalent to the Uterus in women. However, there is an important difference: while in women the Uterus is an actual structure (both in Western and Chinese medicine), in men, the Room of Sperm is not an actual structure. There is no such anatomical entity in men’s pelvic cavity: it is purely a functional entity much like the Triple Burner, for example. However, it could be said also that the prostate and seminal vesicles together are equivalent to the Room of Sperm. Both the Room of Sperm and the Uterus are called the “Bao” 胞 in Chinese medicine. The word “bao”胞 is formed by a character that denotes a “container” and the radical for “organ”: it is therefore an organ that is hollow and that contains fluids, i.e. Blood in the case of the Uterus and sperm in the case of Room of Sperm. The Bao is situated in the Lower Dan Tian, i.e. the Lower Field of Elixir (the lower abdomen). Both menstrual blood and sperm are a form of Tian Gui. This term is difficult to translate because gui only denotes the 10th stem (of the 10 Heavenly Stems) which pertains to Water. Tian Gui (better left untranslated) is mentioned in the very first chapter of the Su Wen. It says that in girls, Tian Gui (menstrual blood) arrives at 14, while in boys (sperm) it arrives at 16. Tian Gui (both menstrual blood and sperm) is a transformation of the Kidney- Jing. THE ROOM OF SPERM AND THE “BAO” 胞 BAO 胞 LOWER DAN TIAN 丹 田 ROOM OF UTERUS – ZI In men In women SPERM BAO 子 胞 SPERM – TIAN MENSTRUAL BLOOD – GUI TIAN GUI 天 癸 天 癸 Looking at the previous diagram of the Room of Sperm in men and the Uterus in women, we can draw some interesting conclusions. 1) The Uterus is a physical structure in the lower abdomen (in both Western and Chinese medicine) which stores Blood. The Room of Sperm is more an energetic centre than a physical structure. We can therefore say that, in women, the Lower Dan Tian is “full” while, in men, it is “empty”. As the Uterus stores Blood, women are far more prone to Blood stasis in the lower abdomen than men. 2) Following on from this observation, while women are prone to Blood stasis in the Lower Dan Tian, men are prone to Stasis of Jing, a pathology that exists only in the context of male genital diseases. 3) As Tian Gui is sperm in men and menstrual blood and ova in women, excessive sexual activity is a cause of disease in men but not so much in women as they do not lose menstrual blood or ova during sex. CHANNELS INFLUENCING MALE GENITALIA The main channels that influence the male genitalia are: Liver (Main, Luo, Divergent and Muscle channels) Kidney (Main, Luo and Muscle channel) Du Mai Chong Mai Ren Mai The pathways of the channels flowing through the genitalia are as follows: • A branch of the Du Mai flows down to the genitalia. • The Kidney Main, Luo and Muscle channels flow through the genitalia. • The Liver Main, Luo, Divergent and Muscle channels wrap around the genitalia. Du Mai Liver muscle Liver Luo • Du Mai-Ren Mai • LIV-Main-Luo- Divergent-Muscle • KI-Main-Luo-Muscle LIVER MAIN CHANNEL • Reaches pubic region via SP-12 and SP- 13 where it encircles the external genitalia • Ascends crossing the Ren Mai at Ren-2, Ren-3 and Ren-4. LIVER LOU CHANNEL • Starts from LIV-5 Ligou • Connects with the Gall-Bladder channel on leg • Ascends to and encircles the external genitalia LIVER DIVERGENT CHANNEL • Diverges from the Liver Main channel on foot • Ascends to the pubic region where it converges with the Gall-Bladder Main channel LIVER MUSCLE CHANNEL • The Liver Muscle channel originates on the dorsum of the big toe and ascends the medial side of the foot to converge at the anterior aspect of the medial malleolus; it then proceeds along the medial aspect of the tibia to converge at the medial condyle. It continues upwards along the medial aspect of the thigh to the genitals where it connects with the Spleen Muscle channel. KIDNEY MUSCLE CHANNEL • The Kidney Muscle channel begins beneath the little toe and joins the Spleen Muscle channel at the inferior aspect of the medial malleolus; it converges in the heel where it joins with the Bladder Muscle channel, then ascends the leg and converges at the medial condyle of the tibia. It then joins with the Spleen Muscle channel and follows the medial surface of the thigh to converge at the genitals. • A branch ascends along the inner aspect of the spinal column to the nape of the neck where the channel converges at the occipital bone, joining with the Bladder Muscle channel. DU MAI “It starts in between the kidneys where the Dong Qi throbs, it goes to the uterus and the pubic bone. In women, it flows around the vagina, passes to the perineum, then the buttocks to meet the Kidney and Bladder channels in the thighs… … In men, it flows around the penis and goes to the perineum.” “Su Wen”, chapter 60 ABDOMINAL BRANCH OF DU MAI The abdominal branch of the Du Mai starts in the perineum, flows up the abdomen (in the midline), up to the umbilicus, past the heart, throat, chin, around the lips and reaches the eyes. “Su Wen” Chapter 60 The “Su Wen” (Chapter 60) describes an anterior branch of the Du Mai Vessel that flows to the external genitalia both in men and women, and to the pubic bone and from here ascends up the abdomen on the same trajectory as the Ren Mai. It says: “It starts in the lower abdomen, goes down to the pubic bone, in women to the vagina. Its Luo channel goes around the vagina, passes to the perineum, then the buttocks, down to meet the Kidney and Bladder channels inside the upper thighs; it then rises up the spine and wraps around the kidneys . in men it goes around the penis and then the perineum . the main vessel starts in the lower abdomen, goes up to the umbilicus, past the heart, throat, chin, around lips and then reaches the eyes.” CHONG MAI PATHWAY I will illustrate here only the part of the Chong Mai’s pathway that concerns the genitalia. •Branch 1 (Internal branch) Originates inside the lower abdomen (uterus in women) and emerges at the Perineum (REN-1). REN-1 •Branch 2 (Abdominal branch) –This branch emerges at ST-30, connects with the Kidney channel at KI-11 and ascends through the Kidney channel to KI-21, then disperses in the chest and breast. THE CHONG MAI AND THE MALE GENITAL SYSTEM All ancient Chinese texts state that the Du, Ren and Chong Mai either start from the Uterus or flow through the Uterus: none of these books say where these vessels flow in men.