Friday, January 10, 2014

THE FIVE ELEMENTS - CLINICAL APPLICATION OF THE COSMOLOGICAL SEQUENCE

In this blog post, I would like to discuss the clinical use of the Five Elements and, in particular, their Cosmological sequence.  By "cosmological sequence" (my own term, not a Chinese one), I mean the arrangement of the Five Elements in a cross-like fashion rather than the circular arrangement of the Sheng and Ke cycles that are very familiar to every practitoner and student of Chinese medicine.

 The "Cosmological Sequence" has Water at the bottom, Fire at the top, Wood on the left, Metal on the right and Earth in the centre. These are associated with the compass directions of South for Fire (at the top), North for Water (at the bottom), East for Wood (on the left), West for Metal (on the right) and no direction for Earth in the Centre.  Earth has not compass direction as it is the centre, the point of reference.






Translation

Although the translation of Wu Xing as “5 Phases” has gained acceptance, it is not without its problems and many sinologists reject it. Wu Xing could be translated as “goings”, “conducts”, “movements”, “forces”, “agents”, “entities’, “activities”, “stages”. John Major argues for “5 Phases”; M Friedrich and and M Lackner suggest restoring “5 Elements”; Bodde favours “elements” over “phases”; A C Graham uses “5 processes”.


五 行


Indeed, the 5 Elements had different names in Chinese times at various times and various texts. These are some the other names used:

Wu Cai  Ability, talent, aptitude
Wu De     Power, potency
Wu Wei   Place, location, status, condition


The very first origin of the theory of the 5 Elements dates back  to the Warring States Period (476-221 BC) or even much earlier, some think even the Shang dynasty (1766-1050) if we take the 4 Directions Si Fang (plus a Centre) as a precursor theory of the 5 Elements.  I personally think that the ancient Four Directions of the Shang dynasty are the precursors of the Five Elements. Please note that in the diagram below the South is at the top.





Plan of the ritual complex built by emperor Wang Mang (AD 9) as a reconstruction of the Ming Tang of antiquity

During the Shang dynasty, the theory of the 4 Directions (plus a Centre) prevailed: this is obviously very similar to the scheme of the 5 Elements (with correspondence of seasons and directions).


An important feature of the 5 Elements is that it introduced a necessary Centre with the Earth Element.  The connection between the 4 Directions and the early 5 Elements confirms that the earliest arrangement of the 5 Elements was in the cross form and not the circular one of the Sheng cycle (in which there is no Centre). 
The theory of the 5 Elements was greatly developed by Zou Yan (305-240 BC) and his School of philosophy was called the “Yin-Yang School” (Yin-Yang Jia ) but it included the 5 Elements. Needham calls this School the “Naturalist School” and considers it “proto-science” as opposed to the pseudo-science of the Confucianists.
 In ancient times the 5 Elements (Wu Xing) were called Wu Cai i.e. the 5 Materials (but could also be “5 abilities” or “5 talents”).  It was Zou Yan who introduced the term Wu Xing and the cycles among them (Generating Sheng, Controlling Ke).


One of the earliest references to the 5 Elements describes them in terms of movements (note order and therefore numbers):
1. Water: that which soaks and descends
2. Fire: that which blazes and ascends
3. Wood: that which can be bent and straightened
4. Metal: that which can be moulded and changed
5. Earth: that which allows for sowing and to harvesting




If we take notice of the order in which the Elements are listed, we get these numbers:
             2

3        5        4

          1


If we add the number 5 (the number of change), we get the 5-Element numbers that are part of the system of correspondences.



           7

8       10       9

          6

The Confucian philosopher Dong Zhong Shu (179-104 BC) elaborated on the 5 Elements and mentions both the Sheng cycle (notice that the numbers would be different than those of the cross-like arrangement); 
Heaven has 5 Elements: first, Wood; second, Fire; third, Earth; fourth, Metal; fifth, Water. Wood comes first and Water comes last, Earth being in the middle. This is the order that Heaven has made. Wood produces Fire, Fire produces Earth, Earth produces Metal, Metal produces Water, Water produces Wood. This is their “father and son” relationship. Wood dwells on the left, Metal on the right, Fire in front and Water behind, with Earth in the centre.  As transmitters, they are fathers; as receivers, sons. There is an unvarying dependence of the son on the fathers, and a direction from the fathers to the sons. Such is the Dao of Heaven.”
This is of course a Confucian, ethical interpretation of the 5 Elements (which I would say is alien to medicine). Notice the reference to the “Dao”: "Dao" was a Confucian as much as Daoist ideal.

Both the theory of the 4 Directions and of the 5 Elements were not only cultural phenomena but also had political overtones.  The introduction of a Centre with both the 4 Directions and even more so with the 5 Elements not by chance coincides with the political development of a strong central ruler called Huang Di  .
The theory of 4 Directions prevailed during the Shang and Zhou Dynasty (771-476 BC)  characterized by a Centre: this reflected the political structure of the Shang and Zhou States characterized by a strong ruler with the Mandate of Heaven Tian Ming .  This central authority collapsed during the fifth century with the rise of several states fighting each other without a strong, central ruler.  So it is not by chance that the shifting, flowing cycles of the 5 Elements appeared during the Warring States Period (476-221).

The theory of dynastic transmission based on the 5 Elements was elaborated by Zou Yan: he envisaged the dynasty transmission as linked to the reverse Ke (i.e. “Insulting”) cycle of the 5 Elements. In other words, a dynasty was followed by one pertaining to the Element controlling the Element of the previous dynasty.  For example, the dynasty pertaining to Fire would be succeeded by the one pertaining to Water (which overcomes Fire). To put it differently, a dynasty pertaining to Fire had to be succeeded by one pertaining to an Element that Fire could not conquer ("Insulting cycle"), i.e. Water. 

The onset of a dynasty would be preceded by omens heralding the ascension of a particular dynasty.  The following Table lists the opens that appeared in various dynasties.

Ruler                       Power               Omen                                               Colour
Huang Di               Earth                Earthworms, cricket                         Yellow
Yu (Xia)                 Wood               Luxuriant vegetation in winter         Green
Tang (Shang)         Metal               Metal blades in water                        White
King Wen (Zhou)   Fire                  Red birds                                          Red
Qin                         Water                                                                         Black


This is how a Qin text explains the succession of dynasties according to the 5 Elements:
Calculating the transmission cycle of Wu De (5 Powers), the First Emperor (Qin) held that Zhou had the Power of Fire and Qin was replacing the Power of Zhou and should follow the Power that Fire could not conquer. From then on, the Power of Water had begun its dominance. Let the beginning of the year be changed and all tributes to the court start at the 11th month, let robes, garments, feathers, fur, stakes and flags all be in black, let the number 6 be used for regulations…Let the Yellow River be renamed the “De Water” [ ], symbolizing the beginning of the Power of Water.  Let the policy be harsh, firm, perverse, and occult, with all affairs determined by law.  Be severe and strict rather than benevolent (ren ), kind (en ), harmonic (he ) and righteous (yi ) [a “dig” at Confucianists]. Only then will it be in accordance with the number of the 5 Powers.

As we have seen, there is a close interaction between the theoretical cosmology and political power in ancient China and it is not by chance that the theory of the 5 Elements developed from the Warring States periods onwards and it consolidated during the Qin and Han dynasty. 
The emerging political forces of this transitional period mobilized correlative cosmologies, Wu Xing in particular, to destroy the centrality of the old hegemonic state and to construct the new power relations of the imperial era.    
Using Wu Xing cosmology, they transformed the static cosmology of Si Fang (Four Directions) by replacing the notion of an eternal centre and its surrounding four quarters with five dynamically interacting cosmic phases, conquering and generating one another in sequential order.  


Besides being used to destroy the old cosmology and political order, Wu Xing cosmology further functioned as a political discourse of the imperial era, used by diverse factions of power in contesting imperial sovereignty, in defining norms for political behavior, and in constructing emperorship and the power relations that evolved around it.

The theory of the 5 Elements has many facets which also depend on the different ways in which they can be arranged, e.g. cosmological cycle, generating cycle, controlling cycle or insulting cycle.  For example, in one context the theory of the 5 Elements was used to represent a physical order of conquering forces of nature (controlling cycle).  In another context, it was used to depict a moral order of birth and nurturing (generating cycle).  


For the first Qin emperor, the theory of the 5 Elements was a cosmology of conquest and violence that replaced the moral intentionality of Heaven.  While for Han Confucian scholars, the theory of the 5 Elements was a moral cosmology manifesting the intention of Heaven.

Wang A H, Cosmology and Political Culture in Early China, Cambridge University Press, Cambridge, 2000
The Warring States Period marked the disintegration of the authority of the central ruler, authority which was not only political but also religious; the ruler was the connection between Heaven and Earth and he had god-like status. The ruler’s power was taken by four social groups, not established philosophical Schools but simply social groups:
1       1) The religious and Nature experts (like our modern scientists)
2       2) The state bureaucracy
3       3) The military class
4       4) The established philosophical Schools (Confucian, Mo Zi, Daoists, Legalists)

The class of religious and natural experts was an assortment of diviners, ritualists, astrologers, musicians, physicians, calendar experts, etc. The theories of Yin-Yang, 5 Elements and Qi were all developed by this group of people.  In their professions, these experts started to  build various correlative classifications between the natural order and the human world based on numerological sets of 2, 3, 4, 5, etc.
By applying these correlative categories to their own specialities, while serving their patrons, they replaced the king’s monopoly of communication with the divine with their own innovation – direct correlation of Heaven, Earth and Person.
The theory of the 5 Elements was used by these experts to curry favour with various rulers and use the theory to give legitimacy to a ruler’s reign or dynasty.  For example, the first Chinese Emperor defined himself as pertaining to Water and saying that it was the time of Water in the cycle of the Five Elements.

This is how the Book of Poetry describes the onset (and reason) of the Qin dynasty:
After the First Emperor of Qin had unified all under Heaven and proclaimed himself Emperor, someone advised him saying: ‘When Huang Di received the Power [De ] of Earth, Yellow Dragon and Earth worm appeared.  When the Xia received the power of Wood, Green Dragon stopped at the city gates and the grass and trees were luxuriant. When the Shang received the power of Metal, silver flowed out of the mountains. When the Zhou received the power of Fire, red birds appeared as an omen.  Now the Qin has replaced the Zhou, and the time of the power of Water has come’.”
Zou Yan said: “Whenever a sovereign is going to rise, Heaven will certainly show favourable omens to the people in advance.”

THE FIVE ELEMENTS IN THE NEI JING
The 5 Elements are mentioned in very many chapters of the Su Wen and Ling Shu.  The most common correspondences of the 5 Elements are with the following:
Colours, odors, directions, organs, seasons, flavours, numbers, orifices.  The numerology of 5 is used in many other instances to classify things such as the 5 stagnations, 5 fullnesses or 5 deficiencies.

CHAPTER 4 SU WEN
The East direction: greenish colour
Having entered it communicates with the Liver
Its orifice opens into the eye 
It stores the essence of the Liver
Its flavour: sour
Its class: herbs and trees
Its animal: chicken
Its grain: wheat
its tone: jue
Its number: 8
Its odor: rancid

CHAPTER 5 SU WEN
The East generates wind
Wind generates Wood
Wood generates sour flavour
Sour flavour generates the Liver
The Liver generates the sinews
The sinews generates the Heart
The Liver rules the eyes
Among the Zang it is the Liver
Among the colour, greenish
Among the tone jue
Among the voices: shouting; among the orifices: eyes; among the flavours: sour; among the emotions: anger

Clinical application of 5-Element Cosmological Cycle

The arrangement of the 5-Element as a cross has important clinical applications.
1)      The vertical connection between Water and Fire has three clinical applications. Kidneys and Heart do not only oppose each other in the Ke Cycle but they also mutually nourish each other and communicate with each other in three areas:
               a) In menstruation
               b) In mental-emotional sphere (Zhi and Shen)
               c) In sexual life
2) Earth in the centre is a manifestation of the importance of Stomach and Spleen as they make Post-Natal Qi and Blood.
3) Wood on the left and Metal on the right are a manifestation of the balance between Liver and Lungs: the Liver is on the left and its Qi ascends, the Lungs are on the right and their Qi descends.

The Cosmological sequence in menstruation
In the Cosmological sequence there is a "vertical" connection between Water and Fire in which they communicate with each other and nourish each other: this is very different than the relationship in the Generating cycle in which Water controls (and therefore diminishes) Fire. 

The communication between Kidneys and Heart is essential in menstruation.  The Kidneys are the origin of Tian Gui that, in women, corresponds to ovaries, ova and follicles. It is the tides of Kidney-Yin and Kidney-Yang that produce the menstrual cycle.  However, the Heart plays a role in this as it induces the downward movement that brings on bleeding at the onset of menstruation and the release of eggs at ovulation.  Heart-Yang also descends to Kidney-Yin to help to produce Tian Gui.

From a channel perspective, menstruation relies primarily on the activity of Du, Ren and Chong Mai all of which flow to the heart.

Points to stimulate descending of Heart-Qi for menstruation: SP-4 and P-6 (Chong Mai), plus HE-5 Tongli and Ren-15 Jiuwei.


The Cosmological sequence in the mental-emotional sphere

The connection between Kidneys and Heart is important also in the mental-emotional life.  The Kidneys house Zhi which is will-power, determination, spirit of initiative, drive, motivation while the Heart houses ShenShen and Zhi need to communicate and balance each other.  

The Zhi gives the Shen drive and determination in the pursuit of its goals, and the Shen directs and harnesses the Zhi. If the Shen is clear in its aims and plans, and the Zhi is strong, then the person will have the drive to pursue goals. Thus it is necessary for both Zhi and Shen to be strong.
 
If the Zhi is weak (which it could be also if the Shen over-regulates it), the person is depressed.  If the Zhi is excessive (which it could be if the Shen is too weak to regulate it), the person is reckless and takes risks. 

Points to stimulate descending of Heart-Qi for balance between Zhi and Shen:  Ren-4 Guanyuan, KI-13 Qixue, HE-5 Tongli, Ren-15 Jiuwei and Du-24 Shenting.


The Cosmological sequence in sexual life
In sexual life too, the communication between Kidneys and Heart is essential.  Heart-Qi and Heart-Blood descend to the genitals to promote erection in men and sexual arousal in women.  Many cases of erectile dysfunction are due not to a Kidney deficiency but to Heart-Qi and Heart-Blood not descending to the genitals.  

From a channel perspective, the Chong Mai is mostly involved in the descending of Heart-Blood and Heart-Qi to the genitals.

Points to stimulate descending of Heart-Qi for sexual life: Ren-4 Guanyuan, KI-13 Qixue, HE-5 Tongli, Ren-15 Jiuwei
Generating (Sheng) and Controlling (Ke) cycles of the 5 Elements
The Nei Jing contains many references to the cycles of the 5 Elements which confirms their arrangement away from the cross-like arrangement of earlier times according to directions.  For example, the Controlling cycle is mentioned frequently in relation to flavours and their excessive consumption.  Example: “If one consumes large amounts of pungent foods, the sinews will become tight and the nail wither.  This is because Metal (pungent) overcomes Wood (sinews and nails).  

Chapter 25 of the Su Wen describes the Controlling cycle directly:
When Wood meets Metal it is felled
When Fire meets Water, it is extinguished
When Earth meets Wood, it is penetrated
When Metal meets Fire, it is destroyed
When Water meets Earth, it is interrupted



The Generating and Controlling cycles of the 5 Elements are also mentioned frequently to describe the progression of a disease.
Chapter 19 of the Su Wen says:
The Liver receives its Qi from the Heart
It transmits it to the Spleen
The Qi rests in the Kidneys
Death occurs when it reaches the Lungs



 

Sunday, August 11, 2013

STOMACH-YIN DEFICIENCY

STOMACH-YIN DEFICIENCY

Aetiology
The Stomach is a Yang organ but it frequently suffers from Yin deficiency.  Indeed, I would say that Stomach-Yin deficiency is very common in the patients we see.  The cause of Stomach-Yin deficiency is irregular eating habits.  That includes eating late at night, eating in a hurry, eating while working, eating standing up, etc. all very common habits in the patients we see. 

Another less common cause of Stomach-Yin deficiency is eating too drying foods.  The Stomach likes warm but moist foods such as soups, porridge or rice congee.  “Drying” foods includes broiled or baked foods which would include bread. Broiling and baking makes foods dry and causes dryness when eaten in excess.  That dryness can eventually lead to Stomach-Yin deficiency.  Interestingly, there is very little broiling and baking in Chinese cooking and even bread is steamed (man tou) rather than baked.

Diagnosis
How do we know there is Stomach-Yin deficiency?  Primarily from lack of coating on the tongue. The normal tongue coating derives from the Stomach rotting and ripening and it indicates a normal functioning of the Stomach.  When Stomach-Yin is deficient, there is no coating on the tongue.

However, there are some intermediate stages before reaching a full-blown Stomach-Yin deficiency and no coating on the tongue.  The very beginning of Stomach-Yin deficiency will manifest with a coating without root. A coating without root looks likes it is resting on the tongue rather than growing out of the tongue body the same way grass grows out of the soil.

The next stage of Stomach-Yin deficiency is manifested with a tongue that lacks a coating in patches, wherever the patches may be: they may not necessarily be in the Stomach area in the centre of the tongue. 

The tongues below all lack a coating in patches.














Please note that when the tongue lacks a coating but has a normal colour, it indicates Stomach-Yin deficiency without Empty Heat: it is only when the tongue lacks a coating and it is red, that it indicates Empty Heat deriving from Stomach-Yin deficiency.

The tongue below is a good example of a tongue that lacks a coating but is not red.












 The two tongues below are without coating and red, therefore indicating Stomach-Yin deficiency and Empty Heat. The tongue on the right indicates an extreme degree of Empty Heat.



 Another sign of Stomach-Yin deficiency is a Stomach crack (or cracks) on the tongue.  However, Stomach cracks may indicate a constitutional tendency to Stomach-Yin deficiency rather than the actual pathology.  In any case, when I see such cracks I nourish Stomach-Yin.



The tongues below show Stomach cracks.

















Treatment
The treatment depends a lot on the tongue: if there is coating but it is either rootless or
in patches, I use Shen Ling Bai Zhu San Ginseng-Poria-Atractylodes Powder.

If the coating is missing entirely, I use Sha Shen Mai Dong Tang
Glehnia-Ophiopogon Decoction.

With acupuncture, the points to nourish Stomach-Yin are very simple: Ren-12 Zhongwan, ST-36 Zusanli and SP-6 Sanyinjiao.

Obviously treatment must include also a change in eating habits.

Tuesday, June 18, 2013

THE TREATMENT OF MALE PROBLEMS IN CHINESE MEDICINE

While Chinese medicine has a rich tradition in the diagnosis and treatment of gynaecological problems, fewer ancient or modern texts are dedicated to the diagnosis and treatment of men’s problems.  For example, Chinese medicine refers to the “Uterus” in all its classic texts, but no mention is ever made of the prostate. The Du Mai, Ren Mai and Chong Mai are said to arise in the Lower Burner and flow through the uterus: but where do they flow through in men?  The classics do not say.

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.