Impotence

Also yáng wilt; yīn wilt; yáng rising failure; failure to rise; loss of yīn organ use. Inability to perform coitus from failure to achieve or maintain a full erection. Impotence is caused by debilitation of the life gate fire, liver-kidney vacuity fire, heart-spleen vacuity, depressed liver qì, liver channel damp-heat pouring downward, spleen-stomach damp-heat, or fright damaging the kidney.

Patterns

Debilitation of the life gate fire (命门火衰 mìng mén huǒ shuāi) causing impotence is identified by genital cold, lumbar pain, limp knees, tinnitus, hair loss, loosening of the teeth, fear of cold, cold limbs, emaciated body, shortness of breath and lack of strength, dizziness, bright-white facial complexion, pale enlarged tongue possibly with dental impressions, and a fine slow sunken weak pulse.

Medicinal therapy: Warm and supplement the kidney with Right-Restoring [Life Gate] Pill (右归丸 yòu guī wán) or Procreation Elixir (赞育丹 zàn yù dān).

Acumoxatherapy: Select CV-4 (Pass Head, 关元 guān yuán), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), BL-23 (Kidney Transport, 肾俞 shèn shù), GV-4 (Life Gate, 命门 mìng mén), and KI-3 (Great Ravine, 太溪 tài xī); needle with supplementation and add moxa.

Point selection according to signs: For seminal emission and seminal efflux, add CV-6 (Sea of Qì, 气海 qì hǎi) and BL-52 (Palace of Essence, 精宫 jīng gōng). For dizzy head and tinnitus, add GV-20 (Hundred Convergences, 百会 bǎi huì), GB-2 (Auditory Convergence, 听会 tīng huì), and TB-3 (Central Islet, 中渚 zhōng zhǔ).

Liver-kidney vacuity fire (肝肾虚火 gān shèn xū huǒ) impotence arises when damage to liver-kidney yīn causes frenetic movement of kidney fire. It is accompanied by premature ejaculation, seminal emission or efflux, vexation and thirst, red tongue, and rapid fine pulse.

Medicinal therapy: Enrich yīn and downbear fire. Use Anemarrhena and Phellodendron Eight-Ingredient Pill (知柏八味丸 zhī bǎi bā wèi wán) or Major Yīn Supplementation Pill (大补阴丸 dà bǔ yīn wán).

Acumoxatherapy: Needle with supplementation at CV-4 (Pass Head, 关元 guān yuán), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), BL-23 (Kidney Transport, 肾俞 shèn shù), BL-18 (Liver Transport, 肝俞 gān shù), and KI-3 (Great Ravine, 太溪 tài xī), and with drainage at KI-2 (Blazing Valley, 然谷 rán gǔ), KI-6 (Shining Sea, 照海 zhào hǎi), LR-3 (Supreme Surge, 太冲 tài chōng), GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán), HT-8 (Lesser Mansion, 少府 shào fǔ), and HT-7 (Spirit Gate, 神门 shén mén).

Heart-spleen vacuity (心脾虚 xīn pí xū) impotence is associated with signs of heart-spleen qì vacuity such as heart palpitation, shortness of breath, spontaneous sweating, emaciation, lassitude of spirit and lack of strength, reduced food intake, distension of the stomach duct, sloppy stool, pale tongue, and a fine pulse, or with signs of heart-spleen blood vacuity such as heart palpitation or fearful throbbing, susceptibility to fright, profuse dreaming, loss of sleep, bright-white facial complexion, emaciated body and lassitude of spirit, pale tongue, and a fine pulse. In clinical practice, heart-spleen qì vacuity and heart-spleen blood vacuity are not clearly differentiated.

Medicinal therapy: Nourish the heart and spleen with Spleen-Returning Decoction (归脾汤 guī pí tāng) or Major Origin-Supplementing Brew (大补元煎 dà bǔ yuán jiān) and variations.

Acumoxatherapy: Select BL-15 (Heart Transport, 心俞 xīn shù), BL-20 (Spleen Transport, 脾俞 pí shù), BL-23 (Kidney Transport, 肾俞 shèn shù), LR-6 (Central Metropolis, 中都 zhōng dū), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo); needle with supplementation and add moxa.

Point selection according to signs: For seminal emission and seminal efflux, add the points mentioned above. For heart palpitation and insomnia, add HT-7 (Spirit Gate, 神门 shén mén) and PC-6 (Inner Pass, 内关 nèi guān). For dizzy head and vision, add ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and BL-17 (Diaphragm Transport, 膈俞 gé shù), and apply moxa at GV-20 (Hundred Convergences, 百会 bǎi huì).

Depressed liver qì (肝气郁结 gān qì yù jié) patterns arise when affect-mind dissatisfaction cause binding and depression of qì and disturb the liver’s free coursing. Impotence occurring in such patterns is accompanied by the classic signs of binding depression of liver qì such as oppression in the chest, frequent sighing, rib-side distension, bitter taste in the mouth, and a dry throat that may feel as though it is blocked by a foreign body. The tongue is thin and white, while the pulse is sunken.

Medicinal therapy: Course the liver and resolve depression. Use Depression-Freeing Decoction (达郁汤 dá yù tāng) plus complanate astragalus seed (Astragali Complanati Semen, 沙苑子 shā yuàn zǐ) and psoralea (Psoraleae Fructus, 补骨脂 bǔ gǔ zhī). Alternatively, use Counterflow Cold Powder (四逆散 sì nì sǎn) plus psoralea (Psoraleae Fructus, 补骨脂 bǔ gǔ zhī) and mistletoe (Taxilli Herba, 桑寄生 sāng jì shēng).

Acumoxatherapy: Select CV-3 (Central Pole, 中极 zhōng jí), CV-2 (Curved Bone, 曲骨 qū gǔ), PC-6 (Inner Pass, 内关 nèi guān), LR-3 (Supreme Surge, 太冲 tài chōng), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), BL-18 (Liver Transport, 肝俞 gān shù), BL-17 (Diaphragm Transport, 膈俞 gé shù), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ); needle with even supplementation and drainage or with drainage.

Liver channel damp-heat pouring downward (肝经湿热下注 gān jīng shī rè xià zhù) patterns develop when mind-affect depression causes depressed liver qì that prevents fluids from being transformed and allows damp turbidity to arise, which in time transforms into heat and obstructs qì dynamic. In this case, impotence takes the form of an insufficient erection. Other signs include dampness or itching of the scrotum, reddish urine with pain on urination, and a dry mouth with a bitter taste. There are signs of depressed liver qì and liver channel signs such as impatience, agitation, and irascibility, rib-side pain, lesser abdominal pain, and distending pain in the testicles.

Medicinal therapy: Clear heat and disinhibit dampness with Gentian Liver-Draining Decoction (龙胆泻肝汤 lóng dǎn xiè gān tāng) or Chinese Angelica, Gentian, and Aloe Pill (当归龙荟丸 dāng guī lóng huì wán).

Acumoxatherapy: Select LR-8 (Spring at the Bend, 曲泉 qū quán), CV-1 (Meeting of Yīn, 会阴 huì yīn), BL-18 (Liver Transport, 肝俞 gān shù), GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán), LR-2 (Moving Between, 行间 xíng jiān), SP-9 (Yīn Mound Spring, 阴陵泉 yīn líng quán), KI-7 (Recover Flow, 复溜 fù liū), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo). Needle with drainage.

Spleen-stomach damp-heat (脾胃湿热 pí wèi shī rè) patterns are attributable to damp-turbidity brewing internally and transforming into heat. This pathomechanism develops from dietary irregularities or from a liking for strong liquor and rich food in obese patients who get little exercise. Externally contracted damp-heat may also be a factor. The main signs are impotence with weak libido, torpid intake, nausea and vomiting, sticky mouth with sweet flavor, and oppression and fullness in the chest and heavy limbs. The tongue fur is yellow and slimy or white and slimy, while the tongue is red. The pulse is slippery and rapid.

Medicinal therapy: Diffuse the center burner; transform dampness and clear heat. Use Three Kernels Decoction (三仁汤 sān rén tāng) or Sweet Dew Toxin-Dispersing Elixir (甘露消毒丹 gān lù xiāo dú dān).

Acumoxatherapy: Select CV-4 (Pass Head, 关元 guān yuán), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), CV-3 (Central Pole, 中极 zhōng jí), SP-9 (Yīn Mound Spring, 阴陵泉 yīn líng quán), BL-31 through BL-34 (Eight Bone-Holes, 八髎 bā liáo), KI-7 (Recover Flow, 复溜 fù liū), LR-8 (Spring at the Bend, 曲泉 qū quán), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ); needle with drainage.

Fear and fright damaging the kidney (经恐伤肾 jīng kǒng shāng shèn) causes impotence that is characterized by failure to achieve an erection only in sexual contact and that is associated with general susceptibility to fright, suspicion, and apprehension. The tongue and pulse in such cases may be normal.

Medicinal therapy: Quiet the spirit and stabilize the mind using Mind-Stabilizing Pill (定志丸 dìng zhì wán).

Acumoxatherapy: Select GV-1 (Long Strong, 长强 cháng qiáng), HT-7 (Spirit Gate, 神门 shén mén), CV-14 (Great Tower Gate, 巨阙 jù què), BL-19 (Gallbladder Transport, 胆俞 dǎn shù), BL-23 (Kidney Transport, 肾俞 shèn shù), and GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán); needle with supplementation.

Phlegm-stasis (痰瘀 tán yū) can be responsible for a poor or unlasting erection with limp aching lower limbs. Other signs include dizziness, tinnitus, distension and pain in the smaller abdomen and testicles, and dry sparse yellowed pubic hair, dull tongue with stasis macules and slimy tongue fur, and a hard but forceless or interrupted (结代 jié dài) wrist pulse with a faint instep yáng pulse. Phlegm-stasis impotence is rarely discussed in traditional literature, and its appearance in modern literature seems to be based on the biomedical recognition that impotence can be the result of arteriosclerosis, hyperlipemia, hypertension, and obesity.

Medicinal therapy: Treat by quickening the blood, dispelling stasis, and transforming phlegm, assisted by boosting qì and supplementing the kidney. Use Rejuvenation Elixir (还少丹 huán shào dān) or House of Blood Stasis-Expelling Decoction (血府逐瘀汤 xuè fǔ zhú yū tāng).

Acumoxatherapy: Main points: CV-1 (Meeting of Yin, 会阴 huì yīn), CV-2 (Curved Bone, 曲骨 qū gǔ), and LR-12 (Urgent Pulse, 急脉 jí mài). Supporting points: ST-40 (Bountiful Bulge, 丰隆 fēng lóng), CV-6 (Sea of Qì, 气海 qì hǎi), BL-15 (Heart Transport, 心俞 xīn shù), BL-17 (Diaphragm Transport, 膈俞 gé shù), BL-23 (Kidney Transport, 肾俞 shèn shù), GV-4 (Life Gate, 命门 mìng mén), and BL-31 through BL-34 (Eight Bone-Holes, 八髎 bā liáo). First tap BL-15, BL-17, BL-23, GV-4, and Eight Bone-Holes. Then needle ST-40 making the needle sensation travel upward rather than downward. Then needle CV-1, and after obtaining qì, twirl and remove needle without retaining. Needle CV-2, CV-6, and LR-12, with drainage, retaining the needles for ten minutes. Finally, after needling, moxa CV-6. Treat once every two days in 12-session courses. At least two courses are necessary.

Note: Impotence is not easy to cure when, as is most commonly the case, it forms a vacuity pattern. In the treatment of vacuity impotence, success has been attained in recent years by the use of chóng products such as in Agelena and Hornet’s Nest Pill (蜘蜂丸 zhī fēng wán), which comprises agelena (Agelena, 草蜘蛛 cǎo zhī zhū), hornet’s nest (Vespae Nidus, 露蜂房 lù fēng fáng), cooked rehmannia (Rehmanniae Radix Praeparata, 熟地黄 shú dì huáng), placenta (Hominis Placenta, 紫河车 zǐ hé chē), epimedium (Epimedii Herba, 淫羊藿 yín yáng huò), and cistanche (Cistanches Herba, 肉苁蓉 ròu cōng róng).

Etymology

Chinese: 阳 yáng, yáng, the opposite of yīn; 痿 wěi, wilt, droop. Here, as is often the case, yáng refers to the male member. In The Inner Classic (内经 nèi jīng), it was called yīn wěi, yīn wilt, yīn denoting, as it commonly does, the private parts.