Impotence: a form of male sexual dysfunction characterized by an inability to achieve or maintain an erection, and may or may not include the loss of libido (the desire for sexual activity). Impotence affects approximately 10 million American men, with an increased incidence correlated with age (25% of men over 65 years of age suffer from impotence). Causes include trauma/surgery, reduced blood circulation, alcohol/tobacco/drug use, chronic disease, stress, and general fatigue. Related subjects for which Oriental Medical treatment may be useful include premature ejaculation, the inability to ejaculate, spermatorrhea (the involuntary leakage of semen), male infertility, and prostate cancer.

Impotence and a reduced interest in sexual activity are most commonly associated with declining health and with aging; however, the various forms of sexual dysfunction are experienced by men at all stages of life, including the young and physically robust. Full sexual function, as a part of living a long and vigorous life, particularly with the ability to father children into one’s final years, has been a priority in Chinese culture and a focus for Chinese Medicine for millennia. This interest produced extensive research, study and experimentation, resulting in many excellent therapies. For this reason, Oriental Medicine has a great deal to offer to any man dealing with sexual function issues.

Oriental Medicine sees sexual function as being related to the function and health of the whole body. Just as there are many kinds of people, there are many diagnoses and forms of sexual dysfunction described in Oriental Medical texts. Only the basic issues considered in making a diagnosis will be discussed here.

There are five areas initially considered in looking for a cause for impotence.

  • Constitutional deficiency: Oriental Medicine sees each person as being born with certain congenital predispositions, resulting in varying levels of energy, stamina and vulnerability to differing types of illness or dysfunction. The basic constitution does not change, but it is affected both for good and ill by lifestyle and habits (such as diet, exercise, stress levels), and may be positively affected by acupuncture and herbs.

  • Lifestyle: In regard to impotence, particular attention must be paid to proper diet, reducing stress levels, avoiding the use of certain drugs (both pharmaceutical and recreational, such as tobacco and alcohol), and appropriate exercise. In the past, western medicine considered psychological causes to be predominate as a cause for impotence. The emphasis is currently placed on vascular obstruction. Oriental Medicine does not separate the physical from the psychological, seeing them as being part of a whole, expressing and affecting each other. Therefore, treatments affecting emotional/mental state and habits are seen to play an important role.

  • Trauma: Various forms of trauma may result in some level of impotence, including low-level trauma from certain types of exercise (such as bicycle riding). Severe impact to the genital region or spine may also cause reduced function. With the increased incidence and surgical treatment of prostate cancer, post-surgical impotence is showing up more frequently.

  • Cold, Heat, and Dampness: There are six evils traditionally considered in Oriental Medicine. These “evils” are a way of classifying disease states according to their expression (that is, whether a patient feels more hot/feverish or cold/chilly; whether the patient shows more signs of dampness [phlegm, sweat, feelings of heaviness] or more signs of dryness [dry skin, thirst, non-productive cough]). The three evils most typically found in impotence cases are Cold, Heat, and Damp.

  • Seven Passions: These are also called the seven emotions [joy, anger, worry, melancholy, grief, fear and fright]. When experienced long-term and to an excessive level, any of these predominate emotions can cause health problems which may express as impotency. Oriental Medicine considers these emotions as directly affecting body function, and as being treatable by physical [as opposed to psychological] means.

Sexual dysfunction is usually seen as an organic disorder, that is, as a dysfunction resulting from some imbalance in one or more of the 5 basic organ systems. These should be distinguished from the anatomical organs of Western medicine. Instead, we use the organ names to describe a functional system. The three most commonly involved in impotence are the Kidney system (representing urological and hormonal function, as well as the basic fire or vital force of the body and the basic individual constitution), the Liver system (which is responsible for the external genitalia and for smoothing the flow of energy and blood through all parts of the body), and the Spleen system (which represents the digestive function and provides the basic building blocks for blood and body fluids such as semen, as well as providing our energy and stamina on a daily level). Frequently, impotence can be related to a reduction in Kidney Yang, or Vital Fire; besides expressing as erectile dysfunction, symptoms of reduced Vital Fire may include such symptoms as a tendency to become cold easily, cold extremities, and a sore or weak low back and knees.

Oriental Medical treatment for impotence varies widely with the diagnosis and cause of the dysfunction. The herbal armamentarium is quite large, with many unusual animal, vegetable and mineral products being used. In years past, exotic and rare animal and plant substances were sought out at great expense and some detriment to the natural environment. I do not recommend the use of these substances in most cases as less expensive and more environmentally friendly alternatives (primarily plant products) have been shown to be equally effective. American Ginseng is one of the most famous herbs used in Oriental medicine. It is very important in the treatment of impotence, particularly that found in the aging population. Balanced herbal formulas can strengthen the overall health, while specifically boosting libido and stamina, increasing blood circulation, and calming the mind as necessary. The goal is to address the specific dysfunction, while increasing the harmonious function of the body. The evaluation and diagnosis of a case of sexual dysfunction is often complicated, and accurate diagnosis is critical for effective treatment. Because of this, though many patent formulas are available which treat certain types of impotence, long-term self-treatment is difficult to recommend. Some of the formulas (such as those that boost the Internal Fire) provide a short-term benefit with adverse consequences for the health and function of the patient over the long-term. In most cases, herbal treatments provide some immediate increase in function and overall energy, with an accumulative increase in effectiveness over 2-3 months of treatment.

Acupuncture needle treatments are particularly necessary in cases which involve constitutional problems and those with traumatic complications. An example is post-prostatectomy [surgical removal of part of the prostate gland] impotence. Three of the fundamental energetic channels of the body run through the prostate: the Governing Channel, the Conception Channel, and the Penetrating Channel. Each of these is intimately involved in sexual function. Acupuncture can be effective in reconnecting these channels after their surgical severance, allowing the free flow of energy necessary for healthy function. It is also very effective in increasing local blood flow and reducing injury. Acupuncture often provides immediate improvement in erectile function, thought as in all Oriental Medical treatments, results are cumulative and vary by individual. The speed of improvement is usually directly related to the length of time a patient has experienced symptoms prior to seeking treatment and the severity of the symptoms. Addressing declining function early results in a better prognostic outlook. The combination of acupuncture and herbs is the more effective treatment.

A Urological Examination by an MD is always useful, particularly in those experiencing a sudden loss of function. The advent of Viagra has provided greatly increased awareness and willingness to talk about impotence. Viagra, though not effective for all patients, can provide important immediate symptomatic benefit to the patient. Oriental Medicine is an excellent complement to this therapy in that it addresses the many underlying conditions which may cause sexual dysfunction, thereby promoting overall health, hormonal system balance, and libido, as well as addressing the immediate symptom picture.