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Shuhuai He, Zun He, Bing He, Italy, Qihuang College of Traditional Chinese Medicine
Impotence, also referred to as erectile dysfunction, is when a man who is under the age when sexual function typically declines, being unable to attain or sustain an erection sufficient for normal, satisfying sexual intercourse. Acupuncture has significant benefits in the treatment of this disease. In Chinese medical theory this disorder is usually attributed to some combination of issues. The kidney governs reproduction and the liver governs sinews, thus the treatment can focus on vacuity of the liver and kidney. It can also be a problem like the life-gate fire being weak, or there is a lack of nourishment for the Zong Jin (ancestral sin- ew/gathering of sinews), although these approaches to treatment are often effective, they are still often dissatisfying. We have achieved remarkable effect in the treatment of impotence according to the theory of Su Wen: Wei Lun (chapter 44) “Treat impotence by specially select- ing Yang Ming channel.”
Treatment Method
Prescription: Qi Chong (ST 30), Zu San li (ST 36), Li Dui (ST 45), Bai Hui (Du 20), Zhong Wan (Ren 12), Guan Yuan (Ren 4).
Supplementary points: for Xuan Mai (string-like pulse), add Da Ling (P 7), Tai Chong (Liv 3), Da Dun (Liv 1); for a thick and greasy tongue coating, add Zhong Ji (Ren 3).
Methods: Use an even reinforcing-reducing technique on needle manipulation. If the patient’s pulse is weak, supplementing methods should be used, along with moxibustion.
Explanation：The treatment is based on the foot Yang Ming stomach
channel, supplemented by the foot Jue Yin Liver channel. Zhong Wan (Ren 12), Qi Chong (ST 30), Zu San Li (ST 36), Li Dui (ST 45), and Guan Yuan (Ren 4) are used to regulate the spleen and stomach, and clear and transform dampness and turbidity. The foot Yang Ming Chan- nel and Taiyin Channel meet in the genitals, and the Yang Ming Jing Jin (“sinew channel”) also “gathers in the genitals”, with a branch passing through the heart and connects with “eye system” (linking with brain), so Yang Ming channel points are the principle points. The liver governs sinews, and sinew lesions are always related to the liver, just as Su Wen: Wei Lun (Chapter 44) says: “Sinew flaccidity is an issue of the liver.” Therefore, the Jue Yin channel points Da Ling (P7), and Da Dun (Liv1) are used when there is a string-like pulse
Case Examples
Case 1: An Italian, 51 years old, has suffered from impotence for 7 years. He also suffered from headaches, dizziness, insomnia, excessive dreaming, anxiety, with a reddish tongue and string-like pulse. Initially the treatment method was to calm the liver and suppress the hyperactive yang, soothing the liver and regulating the Qi. Acupoints such as Si Shen Cong (EX-HN 1), Nei Guan (P6), Shen Men (HT7), Guan Yuan (Ren 4), San Yin Jiao (SP6), and Tai Chong (LR3) were used. After 5 treatments the headaches, dizziness, insomnia, and irritability were significantly improved, however, the impotence did not improve. Later, taking into consideration that Yang Ming nourishes the ancestral sinew, the Yang Ming channel was specially selected to treat the symptom of impotence, so we decided to focus on the Yang Ming channel points, with Jue Yin channel points to supplement, using acupoints such as Zhong Wan (Ren 12), Guan Yuan (Ren 4), Qi Chong (ST 30), Zu San Li (ST 36), Li Dui (ST 45), Da Ling (PC 7), Tai Chong (LR 3), Da Dun (LR 1), all with even reinforcing-reducing technique. After 3 treatments, all symptoms were clearly improved, and after 6 treatments, his sexual activity was normal. A year later the patient came to the clinic because of shoulder pain, and said that his sex life has been normal after the acupuncture treatment.
Case 2, was a 48 year old Italian, male. He suffered from left lumbardisc herniation for 2 years, and impotence for 6 years. He presented with pain in the left side of the low back which radiated to the outer calf. It was worse with walking and when he was fatigued, and better after resting lying down. There was obvious tenderness on the left side of lumbar vertebrae 4-5, and, when deeply pressed the pain radiated. Two years ago, before the back injury, he still had some limited erectile function,but after suffering from low back pain, could not get an erection at all. The patient was depressed, with a string-like pulse. In this case there were primary and secondary diseases, and successive symptoms. So, we focused on the treatment of low back and leg pain first. The following acupuncture points were selected, Shen Shu (BL 23), Hua Tuo Jia Ji of L4-5 (EX-B2), Da Chang Shu (BL 25), Huan Tiao (GB 30), Yang Ling Quan (GB 34), Wei Zhong (BL 40), and San Yin Jiao (SP 6). These were treated with acupuncture and moxibustion at the same time. After 6 treatments, the pain in the low back and legs was no longer obvious, and his physical activity went back to normal, but, there is no significant change in the impotence. We observed the patient’s depression, and strong, string-like pulse, and greasy tongue coating. We then considered the Su Wen’s statement “The external genitalia is the gathering place of the ancestral sinews” (Su Wen 45), The Yang Ming nourishes ancestral sinews, so we decided to focus on Yang Ming chan- nel points, supplemented by Jue Yin. Acupoints such as Zhong Wan (Ren 12), Guan Yuan (Ren 4), Qi Chong (ST 30), Zu San Li (ST 36), Li Dui (ST 45), Nei Guan (P 6), Yang Ling Quan (GB 34), Tai Chong (LR 3), were used with an even reinforcing-reducing technique. The impotence improved significantly after 4 treatments, and after a further 3 treatments, sexual function returned to normal.
Case 3 A 35 year old Italian. First visited on February 26, 2020.
Main complaint: impotence for over six months.
Medical history: Around October of the previous year, the patient was busy with work, and under great pressure, which marked the beginning of his sexual dysfunction. This gradually deteriorated to the point of total inability to get an erection at all after six months. Drugs such as Viagra were used. Additionally, irritability, insomnia and excessive dreaming were present. His appetite was normal, and he had smooth bowel movements. His pulse was string-like and slippery, and the tongue coating was thick and greasy. The intention of the treatment was to soothe the liver and relieve depression, regulate the stomach and remove dampness. So, Yang Ming and Jue Yin channel points were selected, such as Zhong Wan (Ren 2), Guan Yuan (Ren 4), Zhong Ji (Ren 3), Zu San Li (ST 36), Li Dui (ST 45), Nei Guan (P 6), and Tai Chong(LR 3). After 3 treatments, the symptoms were improved significantly, and his sexual life was basically normal. After 3 months, the symptoms recurred, and the previous method was used for 4 treatments, but was ineffective. After examining his pulse, the right Guan/middle position was weak under deep pressure, and the left Guan/middle position was string-like and thin. His other symptoms included mental fatigue, and he was upset and overwhelmed. The treatment was mainly based on Yang Ming, supplemented by Jue Yin. Acupoints such as Bai Hui (GV 20), Ben Shen (GB 13), Da Ling (PC 7), Zhong Wan (Ren 2), Guan Yuan (Ren 4), Qi Chong (ST 30), Zu San Li (ST 36), Li Dui (ST 45), and Tai Chong (LR 3), were used with supplementing manipulation, as well as moxibustion at Guan Yuan (CV 4) for 2 minutes, and five cones of moxa burned on Li Dui (ST 45). After 3 treatments, symptoms significantly improved, and after 5 treatments, he was back to normal. There was one additional treatment to consolidate the effects, and it was suggested that he exercise and manage his sexual desire.
Theoretical Discussion
The male external genitalia pertain to the “ancestral sinews”. In the Su Wen: Jue Lun (Chapter 45) it says: “The anterior yin (external genitals) is the place where the ancestral sinews gather.
Also, in the Ling Shu: Wu Yin Wu Wei (Chapter 65) it says: “[When] Eunuchs remove their ancestral sinew there is damage to the Chong and Ren [Mai]”
Foot Yang Ming and Taiyin channels connect with ancestral sinews.
The Foot Yang Ming Channel sinews “bind at the thigh bone and gather in the genitals.” The Foot Taiyin Channel sinews “ascend along the medial aspect of the leg, bind in the thigh bone, and then gather in the genitals.” Suwen: Jue Lun (Chapter 45) says: “Where ancestral sinews gather, is where Taiyin and Yang Ming meet.”
Yang Ming disease and Wei Zheng (flaccidity syndrome). The Ling Shu Gen Jie (Chapter 5) states：“The Yang Ming is the “cover”… [if] the cover is broken then the qi does not have a place to stop, and then flaccidity disease arises, thus in cases of flaccidity disease [one should] select the Yang Ming.”
The “Yang Ming” here refers to the stomach and spleen, the origin of the qi and blood which nourish and moisten the five viscera and six bowels, the ancestral sinews, skin, flesh sinews and bone, It is exactly as the Su Wen: Jue Lun (Chapter 45) says: “The Yang Ming is the sea of the five viscera and six bowels, and governs the moistening of the ancestral sinews.” and “[If] the Yang Ming is vacuous, then the ances- tral sinews are slack”
So, dysfunction of the Yang Ming can induce the loss of nourishment of the ancestral sinews, causing flaccidity or softness of the genitals, or stiffness but not firmness. It is through this understanding we can rationalize treating impotence by using points from the Yang Ming.
The Yang Ming Stomach Channel meets the Chong Mai. The Chong Mai originates from the reproductive organs. In Ling Shu: Wu Yin Wu Wei (Chapter 65) it says: “The Chong Mai and Ren Mai both arise within the Bao (“uterus”)”
The “uterus” here not only refers to the female reproductive organs, but also includes the male reproductive organs. Ling Shu:Dong Shu (Chapter 62) says: “The Chong Mai is the sea of the twelve channels, and the great network of the Shaoyin arises under the kidney, emerging in the Qi Jie (the ‘streets of qi’, ST 30).”
Shaoyin pertains to the kidney, and the Qi Jie pertains to the Yang Ming channel, which pertains to the spleen and stomach. Thus the Chongmai can store prenatal and postnatal essence, and it is called the sea of the twelve channels, also the Chong Mai connects to the internal reproductive organs, therefore the Yang Ming Channel and its acupoints and the Qi Jie can be used for the treatment of diseases of the reproductive organs such as impotence.
Note: The term Qi Jie (Street of Qi) is an alternate namefor to ST 30 Qi Chong, but it should be noted that the Qi Jie have a variety ofexpressions in the upper body as well as the abdomen. ST 30 is seen as a point ofinteraction between the stomach and the Chong Mai, allowing the essence in the Chong Mai to be replenished by the postnatal qifrom the stomach and spleen.
The stomach and large intestine represented by Yang Ming are the sea of water and grain. A “sea” is the area where there is a confluence of the Qi and blood in the channels and they merge and are transferred onwards. In the Ling Shu: Hai Lun (Chapter 33) it says: “The stomach is the sea of water and grain, its openings are above, in the Qi Jie (ST 30), and below in [Zu] San Li (ST 36).”
So we can say: Qi Jie and Zu San Li points are important for the transfer of Qi and blood in the human body. “Shui Gu” or “Water and Grains” represents the Qi and blood formed by food and drink through the spleen and stomach, which can reach and nourish the ancestral sin- ews through the Yang Ming channel and Chong Mai to ensure its functions.
Yang Ming and mind. The Foot Yang Ming channel branch reaches to the heart, and connects to eyes and brain, so the Yang Ming channel has the effect of regulating the mind. The onset of impotence is often related to mental stress and depression. The Yang Ming channel mainly treats emotion and mental symptoms, and Ling Shu: Jing Mai (Chapter10) states that when the channel is disturbed then there are illnesses like: “When one hears the sound of wood they are fearful and alarmed, the heart will tend to be agitated, alone one bars the door and blocks up the windows and huddles in their home. ”
Zhen Jiu Da Cheng describes the Li Dui (ST 45) point as governing the treatment of: “One who is often startled and prefers lying down, the madness of wanting to climb high and singing, abandoning one’s clothes and walking away”
These are clearly mental disorders, so Yang Ming channel points can regulate the mind.
Li Dui is an important acupoint for the treatment of impotence. The Li Dui acupoint was used in the three cases above. The authors believe that Li Dui plays an important role in the treatment of impotence. Li Dui is the jing-well point of the Yang Ming channel, so it belongs to metal in the five phases. Metal generates water, and nourishes the kidney. The kidney governs reproduction, so this is beneficial in the treatment of im- potence. The lung belongs to metal, and governs the Qi. Su Wen: Liu Jie Zang Xiang Lun (Chapter 9) says: “The lung is the basis of the Qi.” The lung governs Qi, which is mainly reflected in the generation of Zong Qi (“pectoral qi”, or “the great qi of the chest” ). Zong Qi pertains to the acquired Qi of the body, and plays a very important role in functional activities of viscera and channels, and the ascending and descending of the Qi. Exuberant Zong Qi ensures the normal movement of Qi and is conducive to the recovery from impotence. Metal restrains wood in the five phases, and maintains the normal ascending and descending of the lung, which in turn can promote dispersing and discharging functions of the liver, and be beneficial for the recovery from impotence. The Li Dui point in Zhen Jiu Da Cheng is mainly used to treat mental disorders as described above. Although there is no record of using Li Dui to treat impotence, Li Dui belongs to the Foot Yang Ming Channel, and has the functions of regulating liver and kidney, enhancing the Qi and is tied to the reproductive system, so Li Dui has a marvelous effect on impotence.
Summary: According to the Nei Jing one should “treat flaccidity by specially selecting the Yang Ming channel”. The treatment method based primarily on the Yang Ming channel and supplemented by Jue Yin channel has achieved a good curative effect, and because the male reproductive organs pertain to the ancestral sinews, and the Yang Ming collaterals are in the ancestral sinews. Yang Ming is the sea of water and grains, it is the source of the generation of the Qi and blood. The Yang Ming channel converges with the Chong Mai which originates from the reproductive organs. A branch of the Yang Ming channel reaches the heart and connects to the brain, therefore the Yang Ming channel has the effect of regulating the mind. Yang Ming “cover” breaking often can cause impotence. If the Yang Ming is abnormal, or the source of genera- tion of the Qi and blood is lacking, or dampness and turbidity block the collaterals, there is an unclear mind, the ancestral sinews are not nourished, these will all cause impotence. Therefore, the use of the Yang Ming as the principle channel in treatment has achieved good results.
治痿獨取陽明”治陽痿
意大利岐黃中醫學院 何樹槐 何駿 何斌
陽痿又稱為陰莖勃起功能障礙，是指男子未到性功能衰退年齡，陰莖勃起不堅和不能持 續足夠堅挺的時間，難以獲得滿意的性生活。針灸對本病症的治療有良好的效果。通常根據腎主生殖和肝主筋的理論多從肝腎虧損、命門火衰、宗筋失養論治，雖可取效， 但常常效差人意。我們根據《素問•痿論》：“治痿獨取陽明”理論治療陽痿取得了顯著的效果。
治療方法：
主穴 ：氣沖、足三里、歷兌、百會、中脘、 關元。
加減： 脈弦者加大陵、太衝、大敦；舌苔厚 膩者加中極。
刺灸法 ：針刺平補平瀉法，脈虛者針刺補 法，加用灸法。
穴解 ：治療以陽明為主，厥陰為輔。其中中脘、氣沖、足三里、歷兌、關元調理脾胃， 清化濕濁。足陽明經與太陰經會於陰器，陽 明經筋“聚於陰器”，經別通於心，係於目系(內係於腦)，故以陽明經穴為主。肝主筋，筋的病變總與肝有關，正如《素問•痿論》說：“筋痿者，生於肝，使內也。”故脈弦者加用厥陰經穴大陵、大敦。
病案舉例
病案1，意大利人，51岁，患有阳痿症7年，兼見頭痛頭暈，失眠多夢，精神緊張， 舌質偏紅，脈弦。先以平肝潛陽、疏肝解鬱治療，穴如四神聰、內關、神門、關元、三陰交、太衝等，經5次治療後，頭痛頭暈、失眠急躁均有明顯好轉，但陽痿症無改善，仍不能完成性生活。後考慮陽明主潤總筋，宗治痿獨取陽明之法，擬以陽明為主厥陰為輔治之，穴如中脘、關元、氣沖、足三里、 歷兌、大陵、太衝、大敦，諸穴均採用平補 平瀉法。經用此法3次治療後明顯好轉，6次治療後性生活恢復正常。一年後因肩痛來診，說經針灸治療後性生活一直正常。
病案2，意大利人，男， 48歲。患有左側腰椎間盤突出2年，陽痿6年。現病症左側腰腿痛，腰痛連及小腿外側，走路和勞累時明顯，臥床休息後好轉，檢查腰椎4~5左側有明顯壓痛，深按時有放射痛出現。原有陽痿症，陰莖尚可輕度勃起，患腰腿痛之後，完 全不能勃起，精神憂鬱，脈弦。病有主次， 症有先後，先以腰腿痛治療為主。主穴有腎 俞 、夾脊穴(L4、5)、大腸俞、環跳、陽 陵泉、委中、三陰交，針刺並灸。經過6次 治療後，腰腿痛已不明顯，活動形如常人，但陽痿無明顯改變。觀其精神憂鬱，脈弦而 有力，舌苔帶膩。考慮“前陰者，宗筋之所 聚”(《素問•厥論》)，陽明主潤總筋，改以陽明為主，厥陰為輔治之，穴如中脘、 關元、氣沖、足三里、厲兌、內關、陽陵泉、太衝，針刺平補平瀉法。經4次治療後 陽痿明顯好轉，又經3次治療，性功能恢復正常。
病案3 患者意大利人，男， 35歲，公司職员。2020年2月26日就诊。
主訴：陽痿六個多月。
病史：大約在去年10月份工作繁忙壓力大， 開始出現性功能減退，並且逐漸加重以致完 全不能勃起，已有6個多月，曾用過偉哥一類的藥物。此外兼見心煩急躁，失眠多夢， 納食尚可，二便調暢。診脈弦滑，舌苔厚膩。擬疏肝解鬱、調胃利濕之法，治取陽明、厥陰經穴為主，穴如中脘、關元、中極、足三里、厲兌、內關、太衝。經過3次治療顯著好轉，性生活基本正常。 3個月後原疾復發，再按原法治療4次未效。診其脈右關沉取乏力，左關弦而細，而症見精神倦怠，心煩意亂，不知所措。治療以陽明為主，輔以厥陰，穴如百會、本神、大陵、中脘、關元、氣沖、足三里、厲兌、太衝，針刺補法為主，艾條灸關元2分鐘，艾炷灸厲兌5壯。經3次治療明顯好轉， 5次治療恢復正常，又鞏固1次結束治療，並囑其控制淫欲，鍛煉身體。
理論探討
前陰部的男性生殖器官屬於宗筋。《素問• 厥論》：“前陰者，宗筋之所聚”，又《靈 樞•五音五味》：“宦者，去其宗筋，傷其衝任……。”
足陽明、太陰經聯繫宗筋。足陽明經筋“結於髀，聚於陰器。”足太陰經筋“上循陰股，結於髀，聚於陰器。《素問•厥論》說： “前陰者，宗筋之所聚，太陰陽明之所會也。”
陽明病及痿證。《靈樞•根結》：“陽明為闔••••••闔折則氣無所止息，而痿疾起矣，故痿疾者，取之陽明。”陽明泛指脾胃，為氣 血生化之源，濡養五臟六腑、宗筋、皮肉筋骨，正如《素問•痿論》：“陽明者，五藏六府之海，主潤宗筋”，又“陽明虛則宗筋 縱”，所以陽明有病可導致宗筋失養，引起陰器痿軟或挺而不堅。故陽痿可治取陽明。
陽明經與衝脈相會合。衝脈源於生殖器官，《靈樞•五音五味》：“衝脈、任脈皆起於胞中。”胞中並非單獨指女性生殖器官，也應包括男性生殖器官。《靈樞•動輸》： “衝脈者，十二經之海也，與少陰之大絡起於腎下，出於氣街。”少陰屬腎，氣街屬於 陽明經，隸屬脾胃，所以沖脈可蓄納先後天之精氣，故稱之為十二經之海。又衝脈內系生殖器官，所以陽明經及其經穴氣街等可用於生殖器官及陽痿病症的治療。
陽明胃腑為水穀之海。“海”是經絡中的氣 血匯合轉輸的部位。《靈樞•海論》：“胃者水穀之海，其輸上在氣街，下至三里。” 即是說氣街和足三里穴是人體氣血轉輸的重要穴位， “水穀”即飲食物經脾胃運化而形成的氣血，可通過陽明經、衝脈輸送宗筋、濡養宗筋，保證其功能。
陽明與神誌。足陽明經經別上通心，系目系連於腦，所以陽明經穴有調節神誌的作用。 陽痿的發作與精神緊張、精神憂鬱有密切的關係。陽明經主治精神、神誌症候，《靈
樞•經脈》是動則病：“聞木聲則惕然而驚，心欲動，獨閉戶塞牖而處” ；《針灸大成》歷兌穴主治“多驚好臥，狂欲登高而歌，棄衣而走。”等神誌異常症，所以陽明經穴有調節神誌的功效。
厲兌是治療本病的重要穴位。以上3個病例中均用歷兌穴，作者的經驗認為歷兌對陽痿 的治療有重要作用。歷兌是陽明經五輸穴中的井穴，配五行屬於金，補金可生水補腎， 腎主生殖，有益於陽痿的恢復。金屬於肺而主氣，《素問•六節藏象論》說：“肺者，氣之本。”肺主氣主要體現在宗氣的生成， 宗氣屬於後天之氣，對臟腑經絡的功能活動和氣機升降有非常重要的作用，宗氣旺盛， 氣機升降正常有利於陽痿的恢復。金克木， 肺的升降健全，可推動肝的疏泄功能，有利於陽痿的恢復。厲兌可治療神誌性病症，《針灸大成》歷兌穴主治“多驚好臥，狂欲登高而歌，棄衣而走。”等神誌異常症。歷兌穴雖無治療陽痿病症的記載，但歷兌屬於足陽明經，有調節肝腎氣機的作用，所以歷兌對陽痿症有神奇的效果。
小結：《內經》“治痿獨取陽明”的宗旨， 採用以陽明經為主，厥陰經為輔的方法治療陽痿症取得了良好的效果。因為男生殖器官屬於宗筋，陽明絡於宗筋。陽明為水穀之 海，氣血生化之源；陽明經匯於衝脈，衝脈起於生殖器官；陽明經別通於心絡於腦，有 調節神誌的作用，主不明則易患痿證，故陽明闔折常可引起痿證。總之陽明失常，或氣 血生化乏源，或濕濁阻絡，神誌不明，宗筋 失養，發為陽痿，故治以陽明為主取得了良好的效果。
