bubble_chart Concept

Impotence, also known as impotence, is referred to as yin impotence. In men who have not yet reached the age of "eighty-eight" when the reproduction-stimulating essence is not yet exhausted, if the penis cannot erect, or the erection is not firm, or it is firm but not lasting, resulting in the inability to perform sexual intercourse, it is called impotence.

In the Neijing, chapters such as Yinyang Yingxiang Da Lun, Wuchangzheng Da Lun, and "Pathogenic Qi Zangfu Bingxing," as well as books like Zhubing Yuanhou Lun, it is referred to as "yin impotence." Neijing．Jingjin chapter calls it "the non-use of the yin organ" or "non-erection." Hejiju Fang refers to it as "male sexuality not rising." Jingyue Quanshu calls it "impotence." If it is due to the decline of sexual function with age, as mentioned in Yinyang Yingxiang Da Lun

: "At the age of sixty, impotence," it is a normal physiological phenomenon and not a pathological condition. Wei Lun states: "Endless thoughts, unfulfilled desires, external lust, excessive sexual activity, all tendons slacken, leading to sinew flaccidity." Huangdi Neijing Suwen

annotations say: "The external genitalia are where all tendons gather... excessive sexual activity causes all tendons to slacken, leading to impotence," also referring to impotence as sinew flaccidity. However, sinew flaccidity is caused by "liver qi heat... dry sinew membranes leading to sinew tension and spasm," covering a broader range. Sinew flaccidity can include yin impotence, but the two are not equivalent. {|127|}Impotence is different from premature ejaculation. Premature ejaculation is when the penis can erect during the desire to have intercourse, but ejaculates too early, and after ejaculation, the penis becomes flaccid and cannot perform normal sexual intercourse. Impotence is when the penis cannot erect during the desire to have intercourse. Comparing the two conditions, premature ejaculation is milder while impotence is more severe. Impotence is one of the more severe conditions among all diseases of decreased sexual function. Conditions like seminal emission and premature ejaculation, if not cured over time, can further develop into impotence.

bubble_chart Pattern Analysis

1. Kidney Yang Deficiency︰Impotence, pudendal coldness, lumbago, weak knees, tinnitus, alopecia areata, loose teeth, fear of cold and cold limbs, emaciation, shortness of breath and lack of strength, dizziness and blurred vision, pale complexion, pale and swollen tongue with tooth marks or moist coating, deep and thin pulse with weak chi pulse. Primordial yang is also called true yang. In modern times, it is often believed that the fire of the life gate is equivalent to true yang (Research on the Kidney). "From a clinical perspective, patients with decline of the life gate fire often exhibit symptoms consistent with kidney yang deficiency... It can be considered that the fire of the life gate is kidney yang" (Fundamentals of Chinese Medicine). Therefore, primordial yang, true yang, the fire of the life gate, and kidney yang can essentially be regarded as synonyms. Deficiency of primordial yang is also deficiency of true yang, deficiency of kidney yang, or decline of the life gate fire. Leijing Tuyi: "The life gate and the kidney share the same qi." The kidney governs the two yin organs. Zhubing Yuanhou Lun·Deficiency Fatigue and Impotence states: "Kidney deficiency fails to nourish the external genitalia, leading to weakness." Here, kidney deficiency often refers to kidney yang deficiency, which is the decline of the life gate fire. Yiguan states: "When male sexual function declines first, it is due to the decline of the life gate fire." Jingyue Quanshu·Miscellaneous Syndromes also notes: "Most cases of male impotence arise from the decline of the life gate fire... Decline of fire accounts for seven or eight out of ten cases, while excess fire is rare." Therefore, impotence due to primordial yang deficiency may manifest symptoms of kidney yang deficiency (lumbago, weak knees, tinnitus, alopecia areata, loose teeth, fear of cold, cold limbs, shortness of breath, pale tongue, and deep pulse). The causes may include excessive sexual desire and lack of restraint in sexual activity, congenital weakness compounded by unrestrained sexual indulgence, or frequent masturbation in youth damaging kidney qi. Treatment should focus on warming and tonifying kidney yang, using formulas such as Right-Restoring Pill or Zanyu Dan with modifications. Although this condition is attributed to the decline of the life gate fire, it is inevitably preceded by damage to essence, leading to kidney yin deficiency as well. Jingyue Quanshu: "Abundant essence leads to priapism, while depleted essence results in impotence." Strictly speaking, this condition involves deficiency of both yin and yang, though yang deficiency is the predominant manifestation. Treatment should emphasize warming and tonifying while avoiding dry-heat remedies. Although dry-heat agents may yield temporary effects, they deplete essence, blood, and yin fluids, leading to poor long-term outcomes. Warming and tonifying therapies must incorporate yin-nourishing, essence-replenishing, and blood-tonifying ingredients. As the saying goes, "Those skilled in tonifying yang must seek yang within yin, so that yang is aided by yin and generation and transformation become inexhaustible." Hence, the "Lin'an Zhinan Yi'an" states: "Since yang qi is damaged, true yin is inevitably impaired. If treatment relies solely on harsh, hot, and dry tonics, it will lead to imbalance. It is often necessary to incorporate warm and moistening substances from flesh and blood to regulate the condition gradually."
2. Deficiency of Both Heart and Spleen︰If there is spleen qi deficiency, then palpitation, shortness of breath, spontaneous sweating, complexion shallow yellow, emaciation, mental fatigue and lack of strength, reduced appetite, abdominal distension, loose stool, pale tongue, and thin pulse; if there is heart-spleen blood deficiency, then palpitation, severe palpitation, susceptibility to fright, dreamfulness, insomnia, complexion sallow-white, emaciation, mental fatigue, pale tongue, and thin pulse. However, in general clinical practice, it is mostly a syndrome of dual deficiency of heart-spleen qi and blood. This is due to insufficiency of heart-spleen qi and blood, caused by excessive mental exertion and prolonged contemplation, which depletes the heart and spleen. Neijing·Yinyang Bie Lun states: "The disease of the second yang arises from the heart and spleen, with inability to conceal emotions," referring precisely to this condition. Insufficiency of heart qi and blood manifests as symptoms such as palpitation, shortness of breath, spontaneous sweating, dreamfulness, and forgetfulness. Spleen qi deficiency manifests as a sallow-white and dull complexion, bodily fatigue and lack of strength, emaciation, anorexia, loose stool, pale lips, white tongue, and thin pulse. When both heart-spleen qi and blood are deficient, the postnatal source of transformation is insufficient, leading to inadequacy of congenital kidney qi. As the essential qi of the kidney declines, kidney yang fails to warm and nourish, resulting in symptoms of impotence. At this stage, treatment should focus on tonifying and replenishing the heart and spleen. If the middle energizer spleen-stomach qi becomes robust and the postnatal source of transformation is sufficient, then heart blood will be replenished, kidney qi will be abundant, and male sexual vitality will also flourish. Formulas such as Returning to Spleen Decoction and Major Original-Qi Tonifying Decoction may be used with modifications.
3. Fear Damaging the Kidney︰Restless and uneasy, prone to suspicion and fright, listlessness, insomnia with dreamfulness, the penis can usually achieve erection, but during intercourse, anxiety and unease arise, leading to impotence and inability to erect, with the tongue and pulse often appearing normal. This condition arises from sudden fright or terror, as stated in the Neijing: "Fear damages the kidney." The Neijing Zhiyao annotates: "Fear causes impotence." The Benshen chapter further states: "Prolonged fear and unresolved fright injure the essence, and when essence is injured, it leads to bone soreness, flaccidity, and cold extremities." The Leijing annotates: "Flaccidity refers to the impotence of flaccidity." In the early stages of the illness, symptoms of insufficient kidney qi are often absent, but over time, signs of deficiency such as bone soreness, cold limbs, and seminal emission may appear. Further progression can lead to impotence due to insufficient primordial yang. Since the illness stems from fright or terror, the patient experiences restlessness, palpitations, and excessive doubt during intercourse, resulting in impotence and inability to erect. Treatment should focus on tranquilizing the spirit and calming the mind, using a modified Mind-Stabilizing Pill.
4. Dampness-heat︰Impotence accompanied by dampness or itching and pain in the genital area, scanty and dark urine, yellow or thick tongue coating, and wiry or rapid pulse. The patient's constitution is often obesity with excessive dampness, compounded by a diet rich in heavy flavors or excessive alcohol consumption, leading to internal accumulation of dampness-heat in the Yangming. "Deficiency of Yangming results in slackness of all tendons" (Wei Lun), manifesting not only as impotence but also heaviness, soreness, and weakness in the lower limbs, or accompanied by sweating, itching, pain in the genital area, dark urine, yellow tongue coating, wiry pulse, and other symptoms of dampness-heat in the lower energizer. Treatment should focus on clearing heat and overcoming dampness, using modified Bupleurum Dampness-Overcoming Decoction or Gentian Liver-Draining Decoction.

Erectile dysfunction is predominantly a deficiency pattern rather than an excess pattern. Excess pattern is easier to treat, while deficiency pattern is more difficult to cure. Among deficiency syndromes, erectile dysfunction due to insufficient primordial yang of the lower energizer is the most common. The treatment should focus on warming and tonifying kidney yang, combined with nourishing yin, replenishing essence, and tonifying blood to achieve gradual and effective results. For cases where prolonged overthinking depletes essence and blood, leading to a deficiency of both the heart and spleen, the treatment should aim at tonifying and replenishing the heart and spleen. For excess syndromes caused by dampness-heat pouring down, heat-clearing and dampness-purging formulas should not be used for a long time; they should be discontinued once the condition improves, otherwise, it may lead to complications such as cold retention and pudendal coldness. In recent times, insect-based medications, such as Zhufeng Wan, have been commonly used to treat deficiency pattern erectile dysfunction with satisfactory results.

bubble_chart Documentation

1. "Shen Zhai's Posthumous Writings. Impotence": "A man in his late twenties, extremely greedy and widowed, was depressed and unhappy, eventually developing atrophy-flaccidity disease, unable to achieve an erection for a whole year. Despite continuous use of warming and tonifying medicines, his condition worsened daily, with fire rising to his head, making it impossible to lower. Clearing and descending treatments were ineffective, but he found slight relief after taking Jianzhong Decoction. One day, while reading the Materia Medica, he came across Puncturevine Caltrop Fruit, also known as 'Yi Han Cao,' which thrives in fire and can invigorate the body's true yang and resolve fire stagnation in the heart meridian. He used over a pound of it, stir-fried until fragrant, removed the thorns, and ground it into powder. Within five days, he saw improvement, and after a month, all symptoms were cured."
2. "Shen's Comprehensive Medical Book. External Genitalia and Anus Disease Origins": "People with mental illnesses, depressed and liver-damaged, with liver wood unable to disperse, also suffer from impotence. Yida Decoction is recommended: Cimicifuga Rhizome, Bupleurum, Sichuan Lovage Rhizome, Cyperus, Puncturevine Caltrop Fruit, Mulberry Bark, Tangerine Leaf, plus Acorus, Milkwort Root, Wolfberry, and Dodder Seed."
3. Gujin Yian An . Impotence": "A young man newly married, wishing to copulate, was prevented by his wife, and against his will, suffered from impotence for five to seven days."
4. Chen Yumei: "Observation on the Efficacy of 'Kang Wei Ling' in Treating 737 Cases of Impotence." ( Journal of Traditional Chinese Medicine ): The prescription uses 15 grams of Centipede, 60 grams each of Chinese Angelica, Peony Root, and Liquorice Root, ground into powder, divided into 40 packets. Take half to one packet each time, morning and evening on an empty stomach with white wine or yellow wine. A course of treatment lasts 15 days. Within six months, 655 cases were cured, accounting for 88.9%; 77 cases improved, accounting for 10.4%; and 5 cases were ineffective, accounting for 0.7%.