NAN KE ANDROLOGY Yang Wei: Erectile Dysfunction From Chinese Medicine and Biomedical ...

100 Pages·2012·0.94 MB·English

NAN KE
ANDROLOGY
Yang Wei: Erectile Dysfunction

From Chinese Medicine
and Biomedical Perspectives

Gloria R. Osorio, L.Ac., Dipl. O.M., MQP
Medical Qigong Practitioner

Submitted in fulfillment of the requirements for the degree of
Doctor of Acupuncture and Oriental Medicine
Oregon College of Oriental Medicine
November 30, 2011

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved
The body is the wisdom tree, the mind like a bright mirror stand;
always strive to wipe it clean, making sure that no dust lands.
─Shenxiu disciple of the Fifth Patriarch Hongren, c638

Wisdom has never been a tree, and the bright mirror has no
stand; there has never been anything, so where can dust land?
─Sixth Patriarch Huineng, c638

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved
© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved
CONTENTS

Foreword xi
Acknowledgements xvii
I. Erectile Dysfunction 1
II. Anatomy of the Penis 3
III. Mechanism of an Erection 4
IV. Causes of Erectile Dysfunction Classified by Clinical Manifestation 6
i. Disorders of Desire Leading to Erectile Dysfunction 10
ii. Disorder of Ejaculation 10
iii. Orgasmic Dysfunction 11
iv. Failure of Detumescence 11
V. Diagnosis of Erectile Dysfunction 12
VI. Biomedical Treatment Options 13
VII. Andropause 19
VIII. Peyronie’s Disease 22
IX. Premature Ejaculation 24
X. Chinese Medical Perspective: 27
i. Sexology in China 27
ii. Chinese Medicine on ED 28
iii. Disease Mechanism 28
iv. Etiology and Pathogenesis 29
a. Chong Mai 30
b. Acupuncture Points to Treat the Chong Mai 30
c. Topical Formulas 31
v. Identification of Patterns 32
1. KD Yang Deficiency 33
2. HT Blood Deficiency 34
3. LV Blood Deficiency 36
4. HT and GB /Qi Deficiency 37

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved
5. KD Yin Deficiency 38
6. HT and KD Qi Deficiency (HT and KD Not Communicating) 40
7. HT and KD Yin Deficiency (HT and KD not Communicating) 42
8. LV Qi Stagnation 44
9. Damp-Heat in the LowerJiao 45
10. Damp Heat in the LV Channel 46
11. Stasis of Jing with Phlegm 47
XI. Novel Theory for Erectile Dysfunction 49
i. Yin Deficiency of Marrow 50
ii. Yang Deficiency of Marrow and Brain 51
iii. Qi stagnation, Deficiency of Marrow and Blood Stasis 51
iv. Prescription for obstruction of the SanJiao and Yang Deficiency of Marrow 53
XII. 10 Methods of Treating Jing for Impotence 53
XIII. Premature Ejaculation in Chinese Medicine 55
Identification of Patterns 55
(1) HT/KD not Communicating and Yang Deficiency 55
(2) KD Yang Deficiency 56
(3) Topical Treatment for Any Pattern 58
(4) HT/KD not Communicating and Yin Deficiency 58
(5) HT/SP Blood Deficiency 58
XIV. Andropause in Chinese Medicine 59
XV. Nocturnal Emissions 59
XVI. Analysis of Studies in Chinese Medical Journals 64
XVII. Natural Ways to Boost Hormonal Levels 66
XVIII. Case Studies 70
Case 1 70
Case 2 77
Case 3 80
Afterword 82
Glossary 84
References 85-88

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved
Foreword

This is a paper on men’s health, specifically erectile dysfunction (ED) from the Western and
Chinese medical perspectives, submitted in fulfillment of the requirements for the degree of
Doctor of Acupuncture and Oriental Medicine at the Oregon College of Oriental Medicine. It
explores pathomechanisms, possible causes and treatment methods and cures for this syndrome.
Andrology is a broad topic and the scope of this paper is narrowed down to ED given its purpose.
There is hardly any writing translated into English on the subject of andrology in Chinese
medicine, compared to the amount of literature there is in the Chinese language, and to the boom
in China of men’s healthcare and hospitals with whole wards dedicated to it, and clinics exclusively
for men’s health. And now that the baby boomer generation is coming to age, male care in the
West in all of its aspects is a hot topic; and Chinese medicine with its vast age old wisdom focused
on holistic care is most welcome.
The sources I employ for this paper are English translations of the Chinese Classics; available
literature in English on Chinese andrology; books on miscellaneous issues that are germane to the
subject; Chinese medical journals by specialists in andrology or nanke, my own clinical and
academic experience, and clinical case studies of actual patients under my care.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved
xi
Through the writings of physicians of antiquity like Herophylus of Chalcedon, Galen, Rambam
(Moses ben-Maimon), and Hippocrates (and perhaps Shennong, Sun Simiao, and others, but
there are no translations) we can appreciate that historically physicians used a variety of therapies
for the betterment of their patients. Such therapies comprised herbal medicinals and therapies,
bloodletting, use of leeches, prolonged fasting, biomedical interventions, even Shamanism.
The patient that comes to consult on the issue of ED is the brand of patient that has decided and is
committed to the resolution of his particular concern. Most men identify with their penises, and
by the time they get to a consult they have came to terms with the fact that there is a problem and
are resolved to address it and are thus committed to do what is necessary. This is of course ideal in
clinical practice, because the outcomes are better for it.
I have found in many instances that a patient who, by all accounts is suffering from impotence will
suddenly have an affair soon after the beginning of treatment, and the impotence will subside or
disappear just as it came about. I explain this by the element that coming to terms with the fact of
such dysfunction is very unnerving to him, and beginning therapy appears to be a comforting
experience, that the brain releases a significant amount of oxytocin perhaps, suppressing the
amygdala so that fear and anxiety are gone by the knowing and trust that he will get better. So his
body responds by releasing even more oxytocin creating a feeling of happiness and well being*,
attracting thus a willing new partner who does not know him, but is vibrating at his same octave.
Other times, after only three weeks of treatment, at only the first phase of the therapy, the
mechanical part of the dysfunction improves, but their sexual lives do not, or even gets worse, at
which times the men have affairs or separate from their spouses, and the impotence is gone “for
good,” until the next time – because since these are lifestyle choices and psychogenic factors that
have to do with the patient, not the partner, the dysfunction will eventually return.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved
xii
At times they come to a consult after a prolonged period of impotence following a loss of a loved
one, or after a major shift in their circumstances at home, at work, or socially. And finally, there is
the patient that has endured long term impotence in a loveless, unattractive relationship, but is set
on keeping that relationship for whatever reason, usually low self-esteem, or because it is meeting
an unconscious purpose; maybe just being the victim, but a purpose it is; eventually though it
comes to an end, and the ED improves on its own. These are examples of psychological type
erectile impotence. In this type of dysfunction, hormonal disorders play a significant role and it is
thus possible to treat it with Chinese herbology. It is crucial to discuss with the patient at the first
meeting all the possibilities with the psychological type of impotence, so that if he is tempted to
end therapy short, during the boosts of energy and euphoria at the onset of recovery, he is well
informed of the commonality of these episodes, and that he will eventually return when the
euphoria, or limerence phase with the new partner is over. Limerence usually lasts between one
and three months.
Psychological impotence is different from the erectile dysfunction related to physiological factors
like vascular disorders, neurological or metabolic factors, physical injury, or induration of penis
(Peyronie’s disease.) It is important to recognize our limitations when treating this type of patient.
Chinese herbology and acupuncture treat hormonal imbalances by approaching a functional
normalization as opposed to the end-stage pathology, but even thus, sometimes the imbalance is so
chronic and already deeply ingrained, that it has changed the view of the world of the patient, at
which time a more aggressive form of therapy might be necessary in the form of talk therapy or
endocrinology, and we must refer out.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved
xiii
FUKE or women’s health in TCM is widely researched and written about, while NANKE ormen’s

health, however researched, is not so much, and as mentioned earlier, the work is not translated
from the Chinese language, nor is the topic written much about. I had trouble finding enough
TCM literature translated into English to source my writing that I had to thus rely heavily on my
academic view and clinical experience and observations.

It is therefore that this paper contains some case studies on actual patients that are or were under
my care, and a healthy amount of personal views based on clinical observation. For the Western
portion of the writing, I freely used readily available and updated literature in English. The paper is
organized as follows: the Western male reproductive system and the anatomy of the penis; causes
and pathomechanisms of ED; and andropause; Chinese medical perspective on ED;
pathomechanisms and causes; Chinese herbal and acupuncture treatment; physical exercises to
release growth hormone (GH); supplementation to promote the release of testosterone; and
miscellaneous therapies for underlying causes.
I was trained in Chinese medicine and medical Qigong and these are essentially my methods of
treatment. However, in the doctoral portion of my training, at the Oregon College of Oriental
Medicine, which had an integrative approach to it, I discovered the importance of integrative
medicine in clinical practice. When a patient comes to see me for ED he is already seeing an M.D.
urologist or general practitioner, but if not, I encourage him to do so. I assure him of the inclusion
of whatever modality necessary to address his issue organically. It is thus that the treatment of ED
in my practice includes biomedical diagnosis (that he comes with), Lab tests, diet, exercise, herbal
therapy, acupuncture, Western supplementation, visual therapy, and miscellaneous therapies as
needed, in that order.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved
xiv
The treatment begins with a phone interview when a patient calls for an appointment. The health
complaints during that interview are high cholesterol and triglycerides; high blood pressure;
insomnia; fatigue; diabetes; knee pain; lower back pain; indigestion; depression; or he books for a
general treatment. Never is it ever impotence or ED. All of these complaints however are
precursors of impotence. Since I live and practice in the State of Illinois, I cannot order

biomedical lab work, so the patient is asked to procure a blood work order from his attending
Western physician with a request for the following values: C-reactive protein and fibrinogen: both
of which can indicate the presence of systemic inflammation, which other than high cholesterol as
a symptom, can go undetected, but untreated it can increase the risk of heart attack, stroke,
Alzheimer’s disease, cancer, and ED. Homocysteine level: according to the American Heart
Association, high homocysteine levels can damage the lining of the arteries and elevate the risk for
a heart attack as soon as the levels climb above 6.3 mcmol/L, and consequent ED. Thyroid: TSH
levels of over 4.0 –well within the normal range- increase the risk of heart disease; and even
increased levels of 2.0 to 4.0 elevates the risk of thyroid disease, and consequent ED. DHEA
(dehydroepiandrosterone): is made into several active substances including testosterone. Optimal
levels protect against bone loss, aging of the skin, increased body fat; it enhances sexual function,
fights anxiety and depression, relieves joint pain and boost immune capacity. Ideal level for a male
is 250-450 mcg/dl. Serum Testosterone: necessary for erections, ejaculations, and fertility; it
prevents impotence; protects the heart and arteries and reduces the risk of heart disease; it protects
the pancreas, kidneys, and digestive system; it stops and prevents andropause, joint and muscle
pain, osteoporosis, and obesity. Estrogen: as men age, their estradiol levels gradually raise, whereas
their progesterone and testosterone levels gradually fall.

© Gloria R. Osorio, L.Ac., Dipl. O.M., MQP, 2011
All Rights Reserved

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