A. Impotence 

Impotence refers to softness of the penis during erection, inability to maintain erection, or powerless erection during sex. In TCM, this symptom is described as slackness of the ancestral sinew due to weakness, fright, or damp-heat, etc.

An article, "Symptoms of the Zang-Fu Organs Caused by Evils" in the classic text entitled Divine Pivot (Ling Shu), attributes impotence to ¡°yin atrophy.¡± An article, "Channel Sinew" describes it as uselessness of the private organ. "Discussion of Atrophy" in the classic text Plain Questions (Su Wen) describes these conditions as slackness of the ancestral sinew or sinew atrophy. The medical book, Formulas of Peace People-Favoring Dose-Making Bureau, describes it as ¡°inability to maintain erection during sex.¡±

Syndrome Identification and Treatment Determination

1. Weak fire of the life gate

symptoms: inability to achieve and/or maintain erection; thin, white and cold semen; general symptoms may include dizziness, tinnitus, bright white facial complexion, listlessness of the spirit, aching pains and softness of the lumbar area and knees, aversion to cold, cold limbs, pale tongue, white tongue coating, deep and thready pulse.

therapeutic principle: warm and tonify the lower origin

formula and ingredients: Right-Restoring Pill combining with Procreation Elixir

Deerhorn glue (lu jiao jiao), cuscuta seed (tu si zi), epimedium (yin yang huo), cistanche stem (rou cong rong), Chinese leek seed (jiu cai zi), cnidium seed (she chuang zi), eucommia bark (du zhong), lateral root of aconite (fu zi), cinnamon bark (rou gui), curculigo root (xian mao), morinda root (ba ji tian), velvet deer horn (lu rong). The above ingredients can warm the kidneys and strengthen the yang.

Cooked rehmannia root (shou di), tangkuei (dang gui), lycium berry (gou qi zi), cornus fruit (shan zhu yu). These herbs can nourish the blood and moisten the yin.

All these ingredients cooperate to play positive roles by mutually supplementing the yin and yang, so that the yang can be endlessly produced, assisted by the yin.

2. Damage of the heart and spleen

symptoms: inability to achieve and/or maintain erection, devitalized spirit, restless sleep, poor appetite/eating habits, colorless facial complexion, thin and slimy tongue coating, pale tongue, thready pulse.

therapeutic principle: enrich and tonify the heart and spleen

formula and ingredients: Spleen-Restoring Decoction

Codonopsis root (dang shen), astragalus root (huang qi), ovate atractylodes root (bai zhu), poria (fu ling), and licorice root (gan cao) can strengthen the spleen and enrich the qi.

Spiny jujube kernel (suan zao ren), polygala root (yuan zhi), longan fruit (gui ruan rou) can nourish the heart and calm the spirit. Tangkuei (dang gui) can supplement the blood.

All these ingredients cooperate to enrich the qi, supplement the blood, nourish the heart, and fortify the spleen.

3. Damage of the kidneys by fear

symptoms: impotence, powerless erection, timidity, tendency to doubt and suspicion, palpitations, susceptibility to fright, restless sleep, thin and slimy tongue coating, string-like and thready pulse.

therapeutic principle: enrich the kidneys and calm the spirit

formula and ingredients: Major Origin-Supplementing Variant Brew

Cooked rehmannia root (shou di), cornus fruit (shan zhu yu), eucommia bark (du zhong), and lycium berry (gou qi zi) can enrich the kidneys. Ginseng (ren shen) and tangkuei (dang gui) can tonify and enrich the qi and blood. Spiny jujube kernel (suan zao ren) and polygala root (yuan zhi) could be supplemented to nourish the heart and calm the spirit. Since fear can make the qi descend, cimicifuga root (sheng ma) and bupleurum root (chai hu) can be added to lift the yang qi.

4. Depressed liver and qi stagnation

symptoms: impotence, inability to achieve and/or maintain erection; general symptoms include depression, anxiety and irritability, discomfort of the chest and stomach, distension and oppression of the hypochondriac region, poor appetite/eating habits, sloppy stool, thin tongue coating, string-like pulse.

therapeutic principle: soothe the liver and resolve stagnation

Buplureum root (chai hu), white peony root (bai shao), and tangkuei (dang gui) can soothe the liver, resolve stagnation, nourish the blood, and harmonize the blood. Ovate atractylodes root (bai zhu), poria (fu ling), and licorice root (gan cao) can strengthen the spleen to assist transportation, fortifying the spleen (soil) to resist against the attack of the liver (wood). On the other hand, cyperus root (xiang fu zi), toosendan fruit (chuan lian zi), bitter orange (zhi ke) can be added to rectify the qi and adjust the liver. Psoralea (bu gu zhi), cuscuta seed (tu si zi), and lycium berry (gou qi zi) can be used to tonify and enrich the liver and kidneys.

These herbs act harmoniously to soothe the liver, resolve stagnation, rectify the qi, harmonize the middle-warmer (spleen and stomach), enrich the kidneys, and assist the yang.

5. Downrush of the damp-heat

symptoms: atrophy and softness of the penis, damp scrotum, foul odor of the genitals; general symptoms include aching pains and heaviness of the lower extremities, soggy and rapid pulse.

therapeutic principle: clear heat and transform damp

formula and ingredients: Gentian Liver-Draining Decoction

Gentian root (long dan cao), scutellaria root (huang qin), gardenia fruit (shan zhi), buplureum root (chai hu) can clear heat and discharge fire, consolidating the kidneys depending upon their bitter taste. Manshurian aristolochia stem (mu tong), plantago seed (che qian zi), and alisma tuber (ze xie) can clear and excrete damp and heat. Tangkuei (dang gui), fresh rehmannia root (sheng di) can nourish the blood, quicken the blood circulation, cool the blood; they act concomitantly with the herbs that can clear heat and discharge fire, so the whole recipe could play the role of supplementing when discharging so that the fire-discharging herbs, which are much too bitter and dry in nature, would not damage the yin fluids.

Disease prevention and mental adjustment

With regard to disease prevention, if the disease is due to sexual indulgence, the patient should calm the mind, refrain from sexual indulgence, and avoid masturbation. If the disease is characterized by general weakness, malnutrition, mental or physical overwork, the patient should increase nutritious foods, ensure good rest, control the sexual activities in a moderate way. With regard to mental adjustment, the patient should keep in mind that in order to be able to resolve the disease successfully, he should adopt a habit of regular physical exercise, refrain form sexual relations for a period, and if in a stable relationship, ask for support and consideration from his partner. All these approaches will benefit the treatment.  

B. Premature Ejaculation

Premature ejaculation means quick ejaculation at the beginning of intercourse, even prior to intercourse. The earliest record of this pattern is seen in the article, "Descendant Producing" in the book Collection of Syndrome Identification. Premature ejaculation usually occurs concomitantly with seminal emission, impotence, etc. Therefore, the treatments of these diseases are approximately similar.

Excessive sexual activities and frequent masturbation can deplete the kidney essence. The kidney yin becomes insufficient, the minister (kidneys) fire thus overwhelms, provoking the occurrence of premature ejaculation. Poor inborn endowment, bad postnatal nutrition, or prolonged seminal emission can result in double deficiencies of the kidney yin and kidney yang; premature ejaculation may arise in this condition.

Syndrome identification and treatment determination

1. Yin deficiency and effulgent fire

symptoms: frequent sexual desires, easy and quick erection, or powerless erection, premature ejaculation during sexual relations, seminal emission, dizziness, palpitations, dry mouth and throat, red tongue, thready and rapid pulse.

therapeutic principle: moisten the yin and lower the fire.  

formula and ingredients: Anemarrhena, Phellodendron, and Rehmannia Pills, or Major Yin Supplementation Pills

The first formula includes:

anemarrhena root (zhi mu) moistening the kidney yin

phellodendron bark (huang bai) discharging fire and consolidating the yin

cooked rehmannia root (shou di huang) moistening the kidney yin

cornus fruit (shan zhu yu) moistening the kidneys and enriching the liver

dioscorea root (shan yao) discharging the damp of the spleen

mountan bark (dan pi) draining the liver fire

alisma tuber (ze xie) lowering the kidney turbidity

The second formula encompasses:

anemarrhena root (zhi mu) moistening the kidney yin

phellodendron bark (huang bai) discharging the fire and consolidating the yin

cooked rehmannia root (shou di huang) nourishing the genuine yin, subduing the yang, and controlling the fire

turtle shell (gui ban) nourishing the genuine yin, subduing the yang, and controlling the fire

pig¡¯s spine marrow (zhu ji sui) filling the semen and supplementing the yin fluids

2. Deficiencies of the yin and yang

symptoms: aversion to cold, cold limbs, bright white facial complexion, short breath, aching pains and softness of the lumbar area and knees, impotence, thin seeds, pale tongue, weak pulse.

therapeutic principle: moisten the kidney yin and warm the kidney yang

formula and ingredients: Golden Chamber Kidney Qi Pills

Cinnamon twig (gui zhi) and prepared lateral root of aconite (fu zi) warm and tonify the kidney yang slightly to produce the kidney qi mildly.

Cooked rehmannia root (shou di huang) can moisten and supplement the kidney yin.

Cornus fruit (shan zhu yu) can moisten and enrich the liver and kidneys.

Dioscorea root (shan yao) can moisten and enrich the spleen and kidneys.

Poria (fu ling) can excrete water and damp; mountan bark (dan pi) can discharge the liver fire; alisma tuber (ze xie) can excrete water and damp.

These three ingredients (cornus fruit, dioscorea root and poria) can discharge when supplementing so that tonification will not cause stagnation.

This formula suggests that a doctor, who is skillful in tonifying yang, must seek the yang within the yin, because the yang can be produced endlessly when it is helped by the yin.

Serious premature ejaculation can result in impotence, while impotence is usually accompanied by premature ejaculation. When doctors try to cope with these diseases, they should consider all these conditions comprehensively.  

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