Erectile Dysfunction (ED), also known as impotence, is the inability to maintain a sufficient erection for normal sexual activity. More than 50% of men between 40-70 years of age should have ED in a certain degree. In the last few years, attention has been devoted to this issue. This is evident in the light of the fact that between 1985 and 1999, the number of consultations on this issue tripled in the United States. Surely it has also to do with the introduction of Sildenafil (Viagra, Kamagra, Eriacta) in March 98 in the United States of America. TCM therapists have long been offering TCM solutions for this problem, but since the introduction of new drugs for an old problem, they are now increasingly challenged to observe the marriage of Eastern and Western traditions more closely. While TCM considers all the patient's health, Western school medicine can open our eyes even further when we look at it properly.
This article aims to summarize the physiological processes of the ED and its dysfunction in the Western sense and to put it in relation to the overall health of an individual. Finally, the TCM literature is consulted and some formulas for ED are analyzed on the basis of all the findings.
ED from the perspective of Western school medicine
The key to breakthrough for ED drugs such as Viagra, Levitra and Cialis is the chemical process called the Nitric Oxide Cycle. This is how a normal erection works: First, in the penis, the structures of the corpus cavernosus and the spongiosus are in relative tension, which prevents the blood stream from filling these absorbent tissues. Then, from the brain, which reacts to a sexual stimulus, commands are given over the spinal cord, which let the smooth muscle fibers relax in the corpora mentioned. These chambers fill with blood and the erection comes. And this is how the process works:
Nerves stimulate the release of nitrite oxide, which activates cGMP (cyclic guanosine monophosphate) in the corpus cavernosus and the corpus spongiosus.
CGMP slackens the smooth muscle fibers.
Blood flows in.
By increasing the blood pressure, the receding veins are clamped and the blood is trapped in the penis. The erection is now available.
The erection lapses when the enzyme PDE5 (phosphodiesterase type 5) degrades the cGMP.
Without cGMP, the smooth muscle cells in the corpora cav. Et. Spong Not slacken. They contract and the blood is squeezed out and the erection falls.
Drugs against ED interfere with this nitric oxide cycle. Medications such as Viagra inhibit PDE5, which means that this cGMP can no longer break down, so that this survives longer. The smooth muscle fibers remain so limp for a longer time and the blood is thus prevented from running out. The erection stays stronger and longer.
We can derive a lot from this process:
First, ED has something to do with normal or abnormal blood flow and is rarely based on a low level of male hormones. Secondly, this blood flow is based on the nitric oxide cycle, which relaxes the smooth muscles and dilates the blood vessels. Below are some TCM herbs that work on this nitric oxide cycle.
Western physiology knows two types of erections: reflexive and psychogenic. The reflexive happens after stimulation of the genital area. This is called reflective, because there is a reflexion between the genital area and the spinal cord. Psychogenic erection happens when messages from the brain pass over the spinal cord to the genital area. Therefore, two mechanisms are involved in the erection: physical and psychological.
TCM regards the ED in a similar sense as Western medical science. Erection involves the increase of both: yang-qi (energy, function) and yin-xue (substance) in the penis. In the TCM sense, the kidneys, liver, spleen and heart functions are involved in the process.
In TCM the kidneys are responsible for the reproductive capacity and for the corresponding organs. The testes are also called "external kidneys". The urethra (urethra) is one of the two lower portals, which is controlled by the kidney. The kidneys are the root of true yin and yang, and a void of one or the other causes the penis to not fill with substance (blood) or motility that leads the yin substance into the penis.
The liver is also responsible for the 'tendons' and the penis is the meeting point of a hundred tendons. In addition, the liver meridian leads around the genital region and provides it with blood. The liver heals the blood and when the reservoir is empty, not enough blood comes to the tendons of the penis. Narrowed liver qi can hinder the blood and qi flow. The liver is quickly disturbed by stress, anger and unfulfilled wishes, which is a psychological factor for ED.
The gastric spleen axis is the postnatal source for Qi and Xue, which is obtained from the diet. Insufficiency in this area can also lead to ED. If not enough Qi and Xue are present, the penis is not erected. The spleen is also the source of pathological moisture (pathological bodies). This moisture can sink and obstruct the liver and kidneys function.
The heart rules the blood and sends it to the penis. ED can also occur as a result of excessive heart fire. A dysfunction of the heart has to do with the psychological factors. Premature ejaculation or ED due to anxiety and anxiety may result.
Both Western school medicine and TCM agree that ED does not exist on its own, but that it is found in the context of other disorders. The following analogy can explain this concept. ED is like the image of a cypress: painting on a canvas alone means a little, but in the image of the night of Vincent van Gogh, it has a deep meaning due to its relationship to the environment. The pattern or syndrome detection in TCM takes account of the whole context in which a disturbance occurs. Western ED also sees ED in a wider context, namely:
Hypertension: The vascular walls become rigid and narrowed. This results in reduced blood flow to the penis. More than 65% of men with high blood pressure have an ED.
Hypercholesterolemia: The blood flow to the penis is diminished by plaque formation in the arteries. 80% is the risk for men with high cholesterol.
Cardiac diseases: Coronary and other cardiac diseases lead to ED as in the above two reasons.
Diabetes: High blood glucose levels damage nerves and blood vessels. 85% of diabetic men have ED to some extent.
Prostate: Some prostate procedures lead to ED due to the proximity of the prostate to important nerves.
Depression: Some drugs for depression can cause ED. ED can in turn weaken the self-esteem, which in turn can lead to an intensification of a depression.
Spinal cord injury: The nerve pathways from the brain to the penis are interrupted and the erection is disturbed.
Medications: Various medications affect the erection: heart medications, antihypertensives, chemotherapy, antidepressants.
Smoking / alcohol: Smoking damages the blood vessels and can hinder the blood supply to the penis. Alcohol temporarily prevents the erection. Before the sex to drink larger amounts of alcohol is not advisable.
The above reasons or contexts in which ED is a part of it all have to do with the blood flow and their restricted function can lead to ED. Each point of the above list can be based on multiple syndrome. There are a total of 13 different syndromes associated with ED.
The first treatment for ED is the use of Viagra, Kamagra, Levitra, Cialis or Tadalis SX. There are other methods, for example the intraurethral application of muse, which improves blood flow to the penis. Self-therapy by means of injections into the penis at the desired time is another possibility. Also, the use of a vacuum around the penis to improve blood circulation is possible. A rubber ring is then applied to the base of the penis shaft. Radical still is the operative implantation of penis implants. A pump is placed in the scrotum that fills the implants as required. This is done when other methods fail. Sex therapy, which consists of advice, how couples should communicate with each other, can also be advisable. It is also experimented with substances that are absorbed through the nose and which act on the brain and not directly on the genital system. It is hoped that this is also suitable for women.
Western school medicine follows a general treatment strategy. Step 1 is to improve the general health situation of the male, for example by trying to normalize the blood pressure. In step 2, all other conditions such as diabetes, hypercholesterolemia, cardiac diseases etc. are used. In step 3, ED is specifically treated, namely:
Viagra or Levitra or Cialis
Alprostadil as an injection
Each stage: vacuum pump
Last chance: implants
Unfortunately, the inclusion of alternative methods of healing in ED is not foreseen in Western school medicine. There is, however, growing evidence that acupuncture and TCM drug therapy are effective at ED. TCM also has something to offer when it comes to the treatment of ED related problems such as heart disease, diabetes, etc. The diagnosis is based on the patient's symptoms, which provide sufficient decision-making criteria for syndrome differentiation, TCM diagnosis and thus immediate therapy. TCM drug therapy is based on the choice of a formula that requires the syndrome. This has to be considered, because the urological problems of the man in China in this kind have only been known as Nan Ke for about 30 years. And you should stick strictly to the TCM diagnosis and do not mix them with Western diagnoses. Modern clinical research provides a fascinating insight into possible biochemical processes that have TCM drugs, and there are studies that are of clinical relevance to our practice.
TCM drugs related to the nitric oxide cycle
The authors state that the nitric oxide cycle plays a role in many diseases: hypertension, diabetes, recovery after stroke, migraine, Parkinson's disease, Alzheimer's disease, pulmonary hypertension and acute respiratory diseases. Medicines that affect the nitric oxide cycle are indicated for many different diseases. There is no uniformly recognizable syndrome, which would combine all these agents, when looking at the various TCM herbs that affect the nitric oxide cycle. So even quite different characteristics in the TCM sense: some are of cold nature, others of hot, some supplement the Qi, others in turn clarify heat. This is reminiscent of a principle of TCM drug therapy: "Equal disease - different treatment options; Various diseases - same treatment (tong bing yi zhi, yi bing tong zhi). A disease can therefore be accessible to different treatment options because it can be based on different syndromes. Conversely, a single herbal mixture can be used in various syndromes, again because of the various syndromes present. The important point here is that the nitric oxide cycle plays a role in various diseases, and that there are many herbs that influence this cycle and thus the slackening of the smooth muscle, and consequently also herbs that can be found in quite different categories With very different principles of action in the TCM sense.
To treat ED, therefore, a TCM therapist will by no means pack all the herbs of Achike & Kwan's list into a single recipe. The mode of action of a herb is not clarified in detail in the Western sense. For example, the effect of ginseng on the slacking of smooth muscle is believed to be mild. Ginseng is also considered an aphrodisiac. TCM therapists agree that ginseng plays only a subordinate role in the treatment of impotence. On the other hand, there are many TCM drugs that do not play a role in the nitric oxide cycle, but they are still involved in ED, because of their affinity for a corresponding syndrome, and with good success. While both, TCM and Western medicine ED treat as an accompanying disease in the context of other basic morbidity, it is interesting to see that the nitric oxide cycle plays primarily a role in diseases of the vascular system, for example in hypertension, diabetes, etc.
It would be beyond the scope of this article to list all treatment options for all syndromes involved in ED. Here, we present some of the formulas that SunTen, the supplier of Complemedis AG, manufactures and show for lab tests and clinical studies that they are effective.
In TCM, the case of renal weakness and its complications often occurs. For a Kidney Yang weakness we use the following combination:
Men's Formula MA-511 (Wen Yang)
With reduced sex drive, impotence, general weakness, fatigue, cross pain.
Men's Formula MA-511 (Wenyang)
Warms the Kidney Yang
Nourishes Blood and Jing
Strengthens the functions of endocrine system and vitality
Improves energy metabolism
Improves the function of the sexual organs
Ginseng and Eucommia activate the nitric oxide cycle which promotes blood delivery to the penis.
Gelatina Cornu Cervi is a traditional means of manhood. It contains several amino acids, which strengthen the energy metabolism.
Epimedium improves the function of the sexual organs and accelerates sperm secretion.
Wang (2004) made a clinical study with 58 men with ED. The spleen and the kidneys were strengthened. A classical formula was obtained which contained 7 of the abovementioned agents. 79% of men were cured, 17% improved function, and 3% did not. Another study in rats with a similar formula worked like this: The rats were fed with a cholesterol-rich diet for four months. The one group received the formula, the other did not. The group that did not get herbs showed microscopic changes to the penis that led to ED. The other had no damage. Blood pressure and cholesterol levels remained the same in both groups, indicating that the herbs did not improve the ED because they reduced blood pressure or cholesterol. On the other hand, they showed increased expression of two proteins, namely caveolin-1 and Basic Fibroblast Growth Factor in the tissues of the penis. The authors hypothesized that these proteins play an important compensatory role by possibly stimulating the formation of new vessels, helping to regenerate nerves, or influencing other microstructures that could be damaged in the event of high cholesterol loading.
These studies show two facts: Firstly, there are probably different mechanisms by which TCM drugs are biochemical, whether through the nitric oxide cycle or the growth factor path, or others that are not yet known to date. Secondly, it should be noted that TCM drugs also act when the therapists do not know the exact biochemical mechanism.
Ginseng Nutritive Combination (Ren Shenyang Rong Tang)
Another common syndrome for ED in TCM is spleen-stomach weakness, which leads to qi and blood deficiency and can no longer fill the tendon of the penis. The spleen-stomach weakness can also lead to secondary kidney weakness. Thus one syndrome can pass into another. The most famous formula for this condition is Ginseng Nutritive Combination.
Stomach spleen weakness leading to impotence and general weakness and digestive problems such as bad appetite, tension in the abdomen and loose stool.
Complements the Qi and the blood
Strengthens the internal organs
Ginseng and Paeonia activate the nitric oxide cycle, which leads to an increased blood supply to the penis.
Ginseng Nutritive Combination has the formula from the study to the rats mentioned above, eight herbs in common. The formula has multiple effects, including lowering blood glucose levels, improving pulmonary function and immunostimulatory properties. Although the formula pursues a slightly different therapeutic principle than the above-mentioned Men's Formula MA-511, but still works with ED, this reminds us of the earlier statement: 'Same disease - different treatment; Different diseases - equal treatment '. Interestingly, of the 12 herbs, only two of them are known to be active in the nitric oxide cycle. However, the formula in this type of ED is common. Again, attention should be drawn to the fact that treatment should be done on the floor of syndrome differentiation. Knowledge of the biochemical mechanisms are useful and they give confidence in what we do, but these knowledge only act as a support to traditional TCM treatment.
40% of the cases of ED have their cause in vascular problems, 30% have diabetes and another 25% are the result of surgical procedures, accidents and neurological conditions and only 3% are based on endocrine dysfunction. This is in contrast to the popular opinion. What may TCM do in these rare cases? Xu (2003) treated 58 cases of impotence caused by prolactinaemia with the formula Jia Wei Shao Yao Gan Cao Tang. Prolactinaemia occurs in a prolactinoma, a pituitary tumor, but can also be a (secondary) effect of medication Or hypothyroidism.
2 x daily for 4 weeks are a treatment cycle. 3 such cycles are necessary.
Modifications were made, which took into account the individual situation in the individual patients with their syndrome patterns so as to meet the classical rules of TCM. 68.97% achieved a full erection and the values for prolactin and testosterone were in the normal range, 10.34% showed a clear success and only at 8.62% was this little and at 12.07% at all unsatisfactory. This formula could be modified as needed, but since this article is about the products of the manufacturer SunTen, you could make a very similar product based on a combination of Peony & Licorice Formula and Men's Formula MA-511 (Wen Yang). Treatment in this way would mean evidence-based therapy from the perspective of Western and Chinese medicine.
Other therapy options for ED
Since ED is a condition that occurs within various systemic diseases, and because TCM, like the Western school medicine ED, is part of a different context (hypertension, hypercholesterolaemia, diabetes, prostatitis, mental problems), we can consider some of these situations:
Prostate Formula PR-681 (Tong Dao)
ED, which has as a complication a prostatitis
Complements the kidney yang
Promotes blood circulation
Strong urogenital functions
Prostate diseases are one of the reasons for ED. This is because of the anatomical proximity to nerve tracts, which play a role in the ED. The formula has long been administered in Japan with enlarged prostate. There, it was found that symptoms such as frequent night urinary urge and weak urine flow are affected. The agent has an anti-inflammatory effect and promotes blood circulation.
In this formula there is no agent that affects the nitrite oxide cycle.
The use of this formula shows a parallel to Western medicine in which the general condition of the patient is improved and treated first.
Hypertension HB-345 (Jiang Ya)
Treats high blood pressure, hyperthyroidism, cerebral insults, epilepsy and dizziness.
Hypertension HB-345 (Jiang Ya)
Calms the liver and exhales wind
Supplements liver and kidney yin
Contains Eucommia, which affects the nitrite oxide cycle
From the perspective of TCM, this formula automatically has some influence on the ED.
Cholesterol reduction CR-201 (Jiang Zhi)
Treats high cholesterol and triglyceride levels
In this formula is also Shan Zha (Fructus crataegi), which also stimulates the nitric oxide cycle.
The remedy is a general formula for reducing high cholesterol levels, which can lead to vascular diseases and which in turn can lead to ED. Also in this formula, there are herbs that directly influence the nitric oxide cycle. Thus, the formula also demonstrates again that, according to the theory of TCM, specific problems can be dealt with which make sense from a general point of view. This cholesterol-lowering mixture is not designed directly against ED, but it supports other efforts on this subject efficiently. (The exact composition of this formula could not be found.)
There are many formulas in the market that are not directly related to the individual needs of a single individual patient, but which are still justified by adapting to a wide range of the population in any case. Four of these are presented in the following, because they can also be used in many cases by ED:
Three Ginseng Pill (San Shen Pian)
Energies donor, immunostimulatory, promoting blood circulation, improving the general condition.
Ginseng products are consumed by a broad population population.
This combination provides a balance between herbs of warm and cool nature. Two of the four herbs are involved in the nitric oxide cycle, which is active in ED.
Ginkgo Cnidium Pill YSP
Promotes cerebral blood circulation and improves memory functions.
This formula has been developed for people who have problems with the memory. Interestingly, there is evidence that ginkgo helps in Libidoproblems, which has arisen on the ground of a therapy with modern antidepressants. Cohen and Bartlik (1998) found that 120 mg of ginkgo extract improved the sexual desire and orgasm ability in 84%. The authors also report that the formula works better in women than in men.
In the USA are widely taken vitamins in addition to food. The formula Yin Essentials supplements such therapies with some useful herbs.
Among these are several, which also have a positive effect on ED:
Fructus Schizandrae (Wu Wei Zi)
Fructus Crataegi (Shan Zha)
Rhizoma Curcumae longae (Jiang Huang)
Supports the regeneration ability of the body in the resting phase.
Contains Shan Zha (Crataegi, Fructus), which affects the nitric oxide cycle and thus ED favorably.
Wu Wei Zi (Schizandrae, Fruits) is a base of the kidney, which in the TCM sense supports sexual functions and the reproductive capacity.
Turmeric improves blood circulation, which makes an important contribution to remedying ED.
Contains the following herbs of TCM:
Radix Eleutherococci senticosi (Ci Wu Jia)
Radix Ginseng (Ren Shen)
Radix Panacis quinquefolii (Xi Yang Shen)
Fructus Crataegi (Shan Zha)
Radix Astragali (Huang Qi)
Herba Epimedii (Yin Yang Huo)
Foliae Ginkgo (Yin Guo Ye)
Ginseng, Shan Zha (Fructus crataegi) and Ginkgo cause an improvement in the erection.
Both Western school medicine and TCM see ED in a larger context. Both the physiological basis and the clinical effect speak for the use of TCM medicines for the treatment of ED. It has been shown that several Chinese medicines influence the nitric oxide cycle, which plays an important role in ED. There are some clinical studies. When TCM is operated according to the syndrome differentiation, a selection of specific medicinal products is possible, which influence the physiological environment, which is important for a normal erection. The mechanisms are partially known.