Treating Erectile Dysfunction with Traditional Chinese Medicine (TCM)

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There are many methods for treating erectile dysfunction and improving vitality in men with natural medicine. Traditional Chinese Medicine, Ayurveda, Exercise is all part of it.

I had the privilege of co-editing what is likely the number one resource in treating sexual dysfunction with integrative modalities. The Integrative Sexual Health book is part of the Weil library of Integrative medicine books published by Oxford University Press.

Today, I will focus on how Traditional Chinese Medicine works in treating erectile dysfunction. Some of the information below is excerpted from the Integrative Sexual Health book written by my colleague, Jillian Capodice.

Traditional Chinese Medicine (TCM) which can be traced back 3000 years, employs a philosophical and holistic approach to treating humans, based on the yin-yang, the five elements (wood, fire, earth, metal, and water), and employing massage, acupuncture, clinical diagnosis, and herbology.

Acupuncture has been the most studied since about 1971 when a New York Times reporter, James Reston, traveled to China to cover President Nixon’s trip to the country. Reston developed appendicitis and needed immediate surgery. Pain from the procedure was successfully treated with acupuncture and Reston was so impressed he wrote this 1971 article on the NYT.

A Brief on How TCM Works

According to TCM theory, kidney and liver are the two primary organs related to ED in the TCM understanding. The kidney stores the essence (jing), while liver stores blood (xue).

In addition to storing blood, liver can modulate blood volume and maintain the flow of blood. Sexual and reproductive functions are also under the control of liver. Thereby, kidney and liver are two important organs with a wide range of functions, particularly male sexual dysfunction in TCM.

The diagnosis of disease in TCM, unlike medical diagnosis, lies in identifying patterns of disharmony. Some practitioners like myself look use the best of both worlds to figure out the diagnosis of problems, especially as it relates to erectile dysfunction (ED).

Starting with the pillars of TCM, the key introductory concepts that must be understood are the basics of yin and yang theory and the nature of qi (energy), xue (blood) and jing (fluid essence).

This helps us to understand the importance of the nature of jing as in TCM jing corresponds to the essence of a person. It has also been characterized to be related to the reproductive system has been thought to characterize sperm in traditional texts. Jing is also closely related to shen or spirit, and it is a traditional concept that the spirit of a person and its seminal essence are closely related (regardless of their sex or gender). Jing and shen also represent spirit, vitality, growth, and renewal and are fundamental concepts of sexuality in TCM.

TCM in Male Sexuality

In TCM, the penis is the root of the liver and most TCM patterns for complaints of male sexual function disorders do have liver and kidney disharmony.

When the TCM liver is out of balance about male sexual function it not surprisingly leads to liver qi stagnation and interrupted the free flow of qi that can lead to ED. Liver qi stagnation is often combined with pathologies of the evils such as dampness, heat or cold. Lifestyle factors are common culprits that contribute to these pathologies. For example, in TCM the overconsumption of greasy and spicy foods and excessive alcohol consumption is a common cause of excess heat and dampness. On the other hand, excessive exposure to cold will exacerbate cold and or cold/damp pathologies. The kidney organ and meridian is almost always a factor in a TCM pattern differentiation of ED.

The kidney is deeply related to the jing and this coupled with kidney yin or yang deficiency is a common cause of erectile dysfunction. Lifestyle factors that contribute to kidney yang deficiencies include overwork (both physical and mental taxation), excessive consumption of cold and raw foods, excessive exposure to cold and overindulgence in sexual activity. Lifestyle factors related to kidney yin deficiency also include overwork, night shift work, and insomnia. These factors also deplete the jing.

The three most common main TCM patterns seen in male sexual dysfunction are:

  1. liver qi stagnation
  2. damp heat in the lower jiao
  3. kidney yang deficiency.

In patients with liver qi stagnation common symptoms may include low libido with difficulty maintaining an erection with or without painful urination, lower abdominal or groin pain, and mental/emotional stress. In those with damp heat predominant pathologies, symptoms include difficulty obtaining an erection, premature ejaculation due to blocked qi, low sperm count and poor lifestyle factors. In men with kidney yang deficiency, patients often present with an inability to obtain an erection, low or no libido, fatigue and poor lifestyle factors.

Studies on Acupuncture and Male Sexual Dysfunction

In one randomized controlled trial performed in 22 subjects with psychogenic erectile dysfunction (ED) and were randomized to acupuncture versus a sham control ( “fake acupuncture”, the control group, not exactly placebo). At the end of the study, there was a 68.4% improvement in the acupuncture group vs. the 9% improvement in the sham group.

For premature ejaculation  ninety heterosexual, and sexually active men between the ages of 28 and 50 were randomized to one of three arms. The treatment groups were paroxetine (Selected Serotonin Reuptake Inhibitor), 20mg/day, acupuncture or sham acupuncture twice weekly for four weeks. Acupuncture points were ST36, LI4, KI3, LIV3, EX-HN3 (yin tang) and CV3 (These points will make sense for acupuncture practitioners only). Acupuncture had a significantly stronger ejaculation-delaying effect than placebo, but it is unclear of the lasting effects in longer follow-up when acupuncture treatment ended.

Commonly Used Chinese Herbs for Erectile Dysfunction

Common Cnidium Fruit

Common Cnidium Fruit is the fruit of Cnidium monnieri. It has been used basically for treating ringworm, swelling of women’s genitals and male impotence. Osthole is one major component of Common Cnidium Fruit, which has been shown to have vasodilating effect and relaxant effect on strips of rabbit corpus cavernosum, which might involve the release of nitric oxide (NO) from endothelium and inhibition of phosphodiesterase. (Liao et al. 2012)

Some other extracts of Common Cnidium Fruit such as imperatorin and xanthotoxin also exhibited relaxing effect on rabbit corpus cavernosum with intact endothelium. (Chiou et al. 2001)

Semen Cuscuta

Semen cuscutae is the dried ripe seeds of Cuscuta chinensis Lam. It has been used to treat impotence and seminal emission for thousands of years in China. The flavones from Semen cuscutae could reverse kidney-yang deficiency symptoms by restoring the testosterone level and androgen receptor expression in the kidney and testicle. (Yang et al.2008)

Ginseng

Ginseng is the root of some Araliaceae plants, which grow mainly in the northeast of China. Ginseng is an expensive and famous Chinese herb which is widely used in many Asian countries. It has been used to maintain homeostasis and enhance vital energy in human bodies for thousands of years. It was confirmed by a multicenter, placebo-controlled and double-blinded clinical study that the long-term administration of Korean red ginseng extracts could enhance erectile function in patients. (Choi et al. 2013)

Ginsenosides are the main active components in ginseng and have effects of anti-inflammation, anti-tumor, antioxidant, as well as apoptosis inhibition. Among various kinds of ginsenosides, ginsenoside Rg3 has received the most attention. Oral gavage with Rg3 could protect the erectile capacity in diabetic rats by preventing the degeneration of neurons in dorsal penile nerves and reducing the oxidative stress in the corpus cavernosum. (Liu et al. 2015)

Lycium barbarum L

Lycium barbarum L is the fruits of Lycium barbarum and has a large variety of biological activities. It plays an important role in treating some chronic diseases, such as hyperlipidemia, hepatitis, diabetes and male infertility. Polysaccharides extracted from Lycium barbarum exhibit antioxidant properties, which could shorten the penis erection latency and mount latency of hemicastrated rats (Zhao et al. 2016). Moreover, the administration of Lycium barbarum polysaccharides could promote nerve regeneration and erectile function recovery in rats suffering from cavernous nerve injury.

Tetrandrine

Tetrandrine is isolated from the root of Stephania tetrandra S Moore, a traditional Chinese herb with anti-inflammatory, antipyretic and analgesic effects. It was reported that tetrandrine could inhibit the Ca2+ influx from extracellular matrix and Ca2+ release from intracellular calcium pool in corpus cavernous smooth muscle cells (Liu et al. 2006)

Panax notoginseng

Panax notoginseng is planted mainly in Guangxi province and Yunnan province of China. Panax notoginseng saponins are the effective ingredients of Panax Notoginseng and are often used to treat cardiovascular or cerebrovascular diseases. It was reported that intraperitoneal Panax notoginseng saponins injection for four weeks improved erectile function in rats with diabetic ED by increasing Akt expression and suppressing oxidative stress in the penis. (Li et al. 2014)

Also, Panax notoginseng saponins could restore the endothelial function in corpus cavernosum through the endothelial nitric oxide synthase (eNOS)/cGMP pathway (Lin et al. 2013)

Epimedium (Icariin)

Icariin is one of the major active components in Epimedium, which is a traditional Chinese herb used to treat impotence. Icariin can improve erectile function through various mechanisms. Icariin could inhibit PDE5 activity and preserve the expression of NOS, thereby increasing the cGMP levels in spontaneously hypertensive rats (Liu et al. 2011).

NOTE: Epimedium is my main go to Chinese botanical for treating ED  along with adaptogenic herbs like Rhodiola and the amino acid L-Citrulline. Rhodiola is my favorite adaptogen because it has shown to help with physical and mental fatigue which is a major source of lack of performance in men. This combination works well to accomplish the end goal – provide blood flow to the pelvic area. L-Citrulline improves the availability of L-arginine in the body which helps with NO production, thus more blood to the pelvic organ. One study showed that L-Citrulline helps with erections.

Chinese Herbal Combinations for Erectile Dysfunction

Chinese herbs are used in the form of compound formulas, not in stand-alone. A variety of compound formulas have been created to treat ED, such as Shuganyiyang capsule and Yidiyin.

Shuganyiyang capsule

Shuganyiyang capsule is a formula composed of 15 Chinese herbs, which could increase blood circulation, activate Yang and replenish vital essence of human bodies. It was reported that Shuganyiyang capsule improved the intracavernous pressure in arteriogenic ED in rats by activating the NOS-cGMP pathway and reducing the expression of PDE5. (Wang et al. 2012)

Yidiyin

Yidiyin, a Chinese herbal decoction used to treat diabetic ED, was shown to improve the erectile function in diabetic patients and rats. The combined use of Yidiyin and hypoglycemic drugs could increase patients’ scores on an international index of erectile function-5 (IIEF-5) more than the hypoglycemic drug alone. Animal experiments indicated that administration of Yidiyin increased rats’ erectile function through activating NOS-cGMP pathway (Feng et al. 2012)

Final Thoughts on treating Erectile Dysfunction with Traditional Chinese Medicine.

As a patient, you want to know if TCM works for ED. And it does. Like any treatment, TCM doesn’t work for everyone. It is even more of challenge (not impossible) treating ED successfully with TCM after prostate cancer treatment since prostatectomy or radiation (two main methods of treating prostate cancer) often, not always, damage the tissues associated with erections.

The perfect combination of treatments, including exercise, stress management, acupuncture, targeted nutrients and botanicals and judicious use of pharmaceuticals. The cause of lack of penile luster needs to be addressed. While pharmaceuticals can work, they are more like “band-aids” than a cure. In other words, drugs like Viagra, Cialis, and Levitra treat the symptom (ED) not the root of the problem, but they serve a purpose – there’s nothing wrong with a “band-aid” when you have a cut, but there’s a problem if you’re constantly getting cuts.

Common causes of ED like metabolic syndrome, diabetes, heart disease need to be addressed. Additionally, more than fifty percent of sexuality is mental. If your mind is right, your organ will likely be too.

Lastly, while scientifically proving all aspects of natural medicine, particularly TCM can be a challenge, there needs to be a scientific foundation in most recommendations. Such scientific standards were behind the formulation of XYVGGR and Mr. Happy. These are not a panacea but it attempts to rebuild sexual health while improving pelvic circulation. (See When Mr. Happy Does NOT work for ED)

Make it a Great Day!

 

Reference:

Bartlik, Espinosa, Mindes; Integrative Sexual Health, Oxford University Press, 2018

Xiao HJ, Wang T, Chen J, et al. Chuanxiongzine relaxes isolated corpus cavernosum strips and raises intracavernous pressure in rabbits. Int J Impot Res 2010;22:120-6.

Liao H, Jacob R. Chinese herbal drugs for erectile dysfunction through NO-cGMP-PDE5 signaling pathway. Zhonghua Nan Ke Xue 2012;18:260-5.

Liu JH, Chen J, Wang T, et al. Effects of tetrandrine on cytosolic free calcium concentration in corpus cavernosum smooth muscle cells of rabbits. Asian J Androl 2006;8:405-9.

Chiou WF, Huang YL, Chen CF, et al. Vasorelaxing effect of coumarins from cnidium monnieri on rabbit corpus cavernosum. Planta Med 2001;67:282-4.

Choi YD, Park CW, Jang J, et al. Effects of Korean ginseng berry extract on sexual function in men with erectile dysfunction: a multicenter, placebo-controlled, double-blind clinical study. Int J Impot Res2013;25:45-50.

Liu T, Peng YF, Jia C, et al. Ginsenoside Rg3 improves erectile function in streptozotocin-induced diabetic rats. J Sex Med 2015;12:611-20.

Yang J, Wang Y, Bao Y, et al. The total flavones from Semen cuscutae reverse the reduction of testosterone level and the expression of androgen receptor gene in kidney-yang deficient mice. J Ethnopharmacol 2008;119:166-71.

Zhao ZK, Yu HL, Liu B, et al. Antioxidative mechanism of Lycium barbarum polysaccharides promotes repair and regeneration following cavernous nerve injury. Neural Regen Res 2016;11:1312-21.

Li H, He WY, Lin F, et al. Panax notoginseng saponins improve erectile function through attenuation of oxidative stress, restoration of Akt activity and protection of endothelial and smooth muscle cells in diabetic rats with erectile dysfunction. Urol Int 2014;93:92-9.

Liu T, Xin H, Li WR, et al. Effects of icariin on improving erectile function in streptozotocin-induced diabetic rats. J Sex Med 2011;8:2761-72.

Feng XT, Qin CB, Leng J, et al. Yidiyin, a Chinese herbal decoction, improves erectile dysfunction in diabetic patients and rats through the NO-cGMP pathway. Biosci Biotechnol Biochem 2012;76:257-63.

Wang J, Wang Q, Liu B, et al. A Chinese herbal formula, Shuganyiyang capsule, improves erectile function in male rats by modulating Nos-CGMP mediators. Urology 2012;79:241.e1-6.

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by Dr. Geo

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