The present article will discuss the physiology of men’s sexual organs, some aspects of pathology and the treatment of the following conditions:
• Erectile dysfunction
• Premature ejaculation
• Low sperm count
Before discussing the treatment of specific conditions, we should look at the channels that affect men’s genital system and how the penis, testis, seminal vesicles and prostate fit in Chinese Medicine.
Chapter 65 of the “Spiritual Axis” says: “The Ren and Chong Mai originate from the Lower Dan Tian [literally “Bao”].”1 The actual term used by the “Spiritual Axis” is “Bao” which is often translated as “uterus”. However, while the term “Zi Bao” refers to the Uterus, the word “Bao” indicates a structure that is common to both men and women: in women, it is the Uterus, in men, it is the “Room of Sperm”. Both these structures reside in the lower Dan Tian and store Jing and, as the Extraordinary Vessels originate from here, they are closely connected to Jing.
The “Golden Mirror of Medicine” (Yi Zong Jin Jian, 1742) says: “The Du Mai arises within the lower abdomen, externally in the abdomen, internally in the ‘Bao’ . . . also called Dan Tian in both men and women: in women it is the uterus, in men it is the Room of Sperm.”2
This classic text therefore states clearly that Bao is a structure common to men and women, in the former corresponding to the “Room of Sperm” (or “Room of Jing”) and the latter to the Uterus. The “Room of Sperm” is in the lower abdomen but we know that the sperm is made in the testicles, seminal vesicles and prostate. I think it is therefore legitimate to assume that the prostate is a structure that is equivalent to the uterus in women and that therefore the Du Mai, Ren Mai and Chong Mai flow through the prostate.
CHANNELS INFLUENCING MEN’S GENITALIA
The genitals are related primarily to the Liver and Kidney channels and to the Ren, Chong and Du Mai. The Liver Luo channel, loops around the genitalia. While the influence of the Ren Mai on the genitalia is obvious, that of the Du Mai Vessel is often overlooked.
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.
The branch of the Du Mai going to the penis in men and vagina in women has clinical significance because it means we can use the Du Mai (rather than the Ren Mai) for genital problems in both men and women. We would want to do that when there is a pronounced Kidney-Yang deficiency.
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.
MALE PATHOLOGY
I would like to discuss two pathological conditions of the male genital aasystem i.e. Phlegm and stasis of Jing.
Male genital manifestations of Phlegm
• Prostatic hypertrophy
• Peyronie’s disease
• Priapism
• Erectile dysfunction
• Sweaty genitals
Male genital manifestations of stasis of Jing
Although it may seem strange to talk of “stasis” of Jing, it does occur in men and it is basically men’s equivalent of Stasis of Blood in the Uterus in women.
The clinical manifestations of stasis of Jing are:
stabbing pain lumbar region
pain in perineum
hypogastric pain
pain in testis and/or penis
erectile dysfunction
premature ejaculation
priapism
prostatic hypertrophy
premature greying of hair
itching or pain pubic region
abnormal sperm
Peyronie’s disease
Purple tongue
Choppy or Firm pulse
THE ROLE OF THE HEART IN THE MALE GENITAL SYSTEM
The menstrual and sexual function in women and the sexual function in men rely on the coordination and harmony between Kidneys and Heart. The Water of the Kidneys and the Fire of the Heart need to nourish each other. While the Kidney-Jing is the origin of sperm in men and menstrual blood/ova in women, the Heart plays an important role in erection and sexual arousal.
In particular, in men, the Heart plays a crucial role in erection, orgasm and ejaculation. Just as the discharge of blood at menstruation and the release of the eggs at ovulation depend on the descending of Heart-Qi, erection and ejaculation also depend on the descending of Heart-Qi. To perform these functions, Heart-Qi descends to communicate with Kidney-Qi.
Kidney-Water needs to ascend towards the Heart and Heart-Fire (the physiological Emperor Fire) needs to descend towards the Kidneys: the coordination between the descending of Heart-Fire and ascending of Kidney-Water ensures a normal menstruation and ovulation in women and normal sexual function in both men and women.
The ascending of the Kidneys and descending of the Heart in the menstrual and sexual sphere is also ensured by the communication between the Du Mai and the Ren Mai: in fact, both these extraordinary vessels originate from the space between the Kidneys, both flow through the Uterus (in men through the prostate) and both flow through the heart.
The Du Mai and Ren Mai form like a closed circuit and may be looked upon as one channel, one Yang, the other Yin. The Du Mai represents the Kidney-Yang and the Ren Mai the Kidney-Yin in the fluctuation of Yin and Yang during the menstrual cycle: the proper communication between Heart and Kidneys and between the Du and Ren Mai ensures a normal menstruation/ovulation and normal sexual function in both men and women.
With regard to sexual function, during sexual excitation the Minister Fire within the Kidneys is aroused and flows up towards the Pericardium and Heart: for this reason the person becomes flushed in the face (the complexion is a manifestation of the Heart) and the heart rate increases during sexual excitation. With orgasm and ejaculation, there is a downward movement of Qi which releases the accumulated Minister Fire downwards: in order for this to occur normally the downward movement of Heart-Qi is crucial.
A normal sexual desire, arousal, erection and orgasm therefore relies on three main factors:
• The ascending of Kidney-Water and descending of Heart-Fire
• The communication between Kidneys and Heart
• The connection between Du and Ren Mai.
If the Minister Fire within the Kidneys is deficient there will be a decreased libido in both men and women and an inability to reach an orgasm in women and impotence in men. If Heart-Qi and Heart-Blood are deficient or not descending to communicate with the Kidneys, there may be impotence or premature ejaculation in men and inability to reach an orgasm in women even in the presence of sexual arousal.
The “Discussion on Blood” written in 1884 by Tang Zong Hai says: “Fire is Yang and generates Blood which is Yin. On the other hand, Blood nourishes Fire and makes sure that Fire does not flare up, whilst Blood moistens the lower Burner. It is stored in the Liver, it fills the Sea of Blood and the Chong, Ren and Dai Mai, and it warms and nourishes the whole body . . . When Blood moistens the Lower Burner and the Sea of Blood, and Heart-Fire follows it down to the umbilicus, then Blood is flourishing and Fire does not flare excessively, so that men are free of disease and women are fertile.”
From this passage it is apparent that the Heart-Qi and Heart-Blood need to flow downwards to the Lower Burner to interact with Blood and Jing.
ERECTILE DYSFUNCTION
FACTORS AFFECTING ERECTION
• Du Mai – Kidney-Yang – Minister Fire – Fire of Ming Men
• Blood – Heart-Blood
• Chong Mai in four ways:
- Sea of Blood
- Post-Natal Qi (at ST-30 Qichong)
- Pre-Natal Qi (at Ren-1 Huiyin, KI-13 Qixue and Ren-4 Guanyuan)
- Influences penis through Zong muscles
• Liver channel (Main, Luo, Muscle and Divergent) wraps around penis
• Pathogenic factors such as Dampness, Blood stasis, stasis of Jing.
KIDNEY-YANG DEFICIENCY
Impotence, lower backache, dizziness, tinnitus, frequent-pale urination, nocturia, feeling cold, cold lower back and knees, Pale tongue, Deep-Weak pulse.
Gui Lu Bu Shen Tang
Lu Jiao Jiao, Gui Ban Jiao, Gou Qi Zi, Rou Cong Rong, Huang Qi, Shu Di Huang, Yin Yang Huo, Yi Zhi Ren, Ba Ji Tian.
Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), BL-23, Du-20, Ren-6, Ren-4, Ren-3, KI-3.
KIDNEY-YIN DEFICIENCY
Impotence, lower backache, dizziness, tinnitus, scanty-dark urine, night-sweating, insomnia, tongue without coating, Floating-Empty pulse.
Di Long Tang
Di Long, Shan Yao, Shan Zhu Yu, Tu Si Zi, Tian Men Dong, Gou Qi Zi, Gui Ban Jiao, Shu Di Huang, Mu Li, Mu Dan Pi.
Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), BL-23, Du-20, Ren-6, Ren-4, Ren-3, KI-3, LU-7 with KI-6 (Ren Mai).
DAMP-HEAT IN LOWER BURNER
Impotence, difficult-painful urination, turbid urine, itching of genitals, urethral discharge, tongue with sticky-yellow coating with red spots on root, Slippery pulse.
Bi Xie Fen Qing Yin
Zhi Bo Di Huang Wan
Acupuncture: SP-4 on the left with P-6 on the right (Chong Mai), LIV-5, SP-9, SP-6, Ren-2, Ren-3, LIV-1, LIV-3.
DAMP-HEAT IN LIVER CHANNEL
Impotence, difficult-painful urination, rash external genitalia, irritability, tongue with red sides and sticky-yellow coating and red spots on the root, Wiry pulse.
Qing Gan Li Shi Tang
Huang Bo, Huang Qin, Qu Mai, Bian Xu, Hua Shi, Zhi Zi, Che Qian Zi, Mu Tong, Chai Hu, Yin Chen Hao, She Chuang Zi, Wang Bu Liu Xing, Jin Qian Cao.
Acupuncture: SP-4 on the left with P-6 on the right (Chong Mai), LIV-5, SP-9, SP-6, Ren-2, Ren-3, LIV-1, LIV-3.
LIVER-BLOOD DEFICIENCY
Impotence, dizziness, blurred vision, depressed mood, insomnia, Pale tongue, Choppy pulse.
Shao Yao Gan Cao Tang Jia Wei
Bai Shao, Zhi Gan Cao, Dang Gui, Shu Di Huang, Huang Jing, Shan Zhu Yu, Wu Wei Zi, Gou Qi Zi.
Acupuncture: LU-7 on the left with KI-6 on the right (Ren Mai), BL-23, Ren-4, LIV-8, Ren-3, ST-36, SP-6.
HEART AND GALL-BLADDER QI DEFICIENCY
Impotence, premature ejaculation, depressed mood, timidity, sighing, insomnia, palpitations, easily startled, Pale tongue, Weak pulse.
Da Bu Yuan Jian
Shu Di Huang, Shan Zhu Yu, Shan Yao, Gou Qi Zi, Du Zhong, Dang Shen, Gan Cao, Dang Gui.
Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), HE-7, GB-40, Ren-4, Du-20, ST-36, SP-6,.
HEART-BLOOD DEFICIENCY
Impotence, palpitations, dizziness, depressed mood, insomnia, Pale tongue, Choppy pulse.
Gui Pi Tang
Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), HE-7, HE-5, Du-24, Ren-15, Ren-4, Ren-3, BL-15, SP-6.
STASIS OF JING AND PHLEGMImpotence, pain in the testis and perineum, hypogastric pain, premature greying of hair, abnormal sperm (motility, shape, etc.), oppression of the chest, urethral discharge, Purple tongue, Firm-Slippery pulse.
Huo Xue Tong Jing TangDang Gui, He Shou Wu, Yi Mu Cao, Ji Xue Teng, Chuan Niu Xi, Gou Qi Zi, Xue Jie, Ban Xia, Dan Nan Xing, Gua Lou.
Acupuncture: SP-4 on the left with P-6 on the right (Chong Mai), Ren-3, LIV-5, SP-10, BL-34, ST-40, SP-9.
PREMATURE EJACULATION
HEART AND KIDNEYS NOT COMMUNICATING (Heart- and Kidney-Yin Xu)
Premature ejaculation, 5-palm heat, dizziness, tinnitus, night-sweating, palpitations, lower backache, depressed mood.
Zhi Bai Di Huang Wan plus Jin Suo Gu Jing Wan
Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), HE-7, KI-7, Ren-15, Du-20, BL-23, BL-32, Ren-4.
HEART AND KIDNEYS NOT COMMUNICATING (Heart- and Kidney-Qi Xu)
Premature ejaculation, dizziness, tinnitus, palpitations, lower backache, depressed mood, pale face.
Gui Pi Tang plus Jin Suo Gu Jing Wan
Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), HE-7, KI-7, Ren-15, Du-20, BL-23, BL-32, Ren-4.
LOW SPERM COUNT
KIDNEY-YANG DEFICIENCY
Low sperm count, dizziness, tinnitus, lower backache, cold back and knees, frequent-pale urination, etc. Pale tongue, Weak-Deep pulse.
Wu Zi Heng Zhong Wan Variation
Gou Qi Zi, Tu Si Zi, Wu Wei Zi, Fu Pen Zi, Che Qian Zi, Sang Shen Zi (Fructus Mori albi), Fu Zi, Jiu Cai Zi (Semen Allii tuberosi), Lu Ba Zi (Semen Trigonellae Foeni-graeci), She Chuang Zi, Dang Gui, Xu Duan, Dang Shen, Ba Ji Tian, Lu Jiao Jiao
Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), BL-23, Ren-4, KI-13, KI-12, BL-32.
KIDNEY-YIN DEFICIENCY
Low sperm count, dizziness, tinnitus, feeling of heat in the evening, night sweating, backache, tongue without coating, Floating-Empty pulse.
Ye He Sheng Jing Tang
Mu Dan Pi, Di Gu Pi, Chi Shao, Bai Shao, Shan Zhu Yu, Lian Qiao, Xia Ku Cao, Chai Hu, Zhu Ye, Fu Ling, Sheng Di Huang, Xuan Shen, Mai Men Dong, Zhe Bei Mu, Dan Shen, Gou Qi Zi, Yin Yang Huo, Mu Li.
Acupuncture: LU-7 on the left and KI-6 on the right (Ren Mai), Ren-4, Ren-7, KI-13, KI-12, BL-23.
LIVER-QI STAGNATION WITH KIDNEY DEFICIENCY
Low sperm count, lower backache, dizziness, tinnitus, night-sweating, irritability, abdominal distension. Tongue without coating, Pulse Weak and slightly Wiry on the left.
Zhi Bai Di Huang Wan Variation
Shu Di, Gou Qi Zi, Tu Si Zi, Shan Zhu Yu, Lu Jiao Jiao, Shan Yao, Fu Ling, Huang Bo, Zhi Mu, Suan Zao Ren, Chai Hu, Huai Niu Xi.
Acupuncture: LU-7 on the left and KI-6 on the right (Ren Mai), Ren-4, KI-13, KI-12, BL-23, LIV-3.
DAMP-HEAT IN THE GENITAL SYSTEM
Low sperm count, low motility, difficult urination, turbid urine, dark urine, painful urination, tongue with sticky-yellow coating and red spots on the root, Slippery pulse.
Long Dan Xie Gan Tang
Acupuncture: LU-7 on the left and KI-6 on the right (Ren Mai), Ren-9, ST-28, KI-12, Ren-3, Ren-5, BL-22, SP-9.
QI STAGNATION AND BLOOD STASIS
Low sperm count, poor motility, distension and discomfort of testis, pain in perineum, hypogastric pain, prostatic hypertrophy, Purple tongue.
Ge Xia Zhu Yu Tang
Acupuncture: SP-4 on the left and P-6 on the right (Chong Mai), LIV-3, SP-10, BL-17, KI-14, ST-30.
LOW SPERM MOTILITYKIDNEY-YANG DEFICIENCY
Low sperm motility, pale face, dizziness, backache, pale-frequent urination, etc.
Zuo Gui Wan Variation
Shu Di, Shan Yao, Gou Qi Zi, Tu Si Zi, Nu Zhen Zi, Han Lian Cao, Wu Wei Zi, Sang Ji Sheng, Lu Jiao Jiao, Yin Yang Huo, Suo Yang, Ba Ji Tian, Sha Ren, Gan Cao.
Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), BL-23, Ren-4, KI-13, KI-12, BL-32.
KIDNEY-YIN DEFICIENCY WITH EMPTY HEAT
Low sperm motility, backache, dizziness, tinnitus, night-sweating, 5-palm heat, malar flush, nocturnal emissions with dreams, Red tongue without coating, Floating-Empty and Rapid pulse.
Er Xian TangXian Mao, Yin Yang Huo, Ba Ji Tian, Dang Gui, Zhi Mu, Huang Bo.
Acupuncture: LU-7 on the left and KI-6 on the right (Ren Mai), Ren-4, KI-12, HE-6, KI-3, Ren-7.
