Treating Erectile Dysfunction in the Clinic: Clinical Pearls from Meridians

Treating Erectile Dysfunction in the Clinic: Clinical Pearls from Meridians

Two of PCOM’s faculty (Mitchell Harris and Stephen Bonzak) and one of our alumni (Barbara Ferrero) were featured in the Spring 2016 issue of Meridians: The Journal of Acupuncture and Oriental Medicine. Mitchell Harris, dual chair of clinical procedure and faculty governance at PCOM-Chicago, is also Meridians JAOM’s new Clinical Pearls editor. The topic discussed in the Spring issue’s Clinical Pearls section was:

How Do You Treat Erectile Dysfunction in Your Clinic?

By Mitchell Harris, DAOM, LAc, Dipl OM (NCCAOM)

Erectile dysfunction (ED) is a condition that is often brought about either directly as an initial chief complaint or after the practitioner has gained the patient’s trust while treating other conditions. ED can wrongfully be considered by some patients as a deficit of masculinity, thus the organic and psychological aspects should be dealt with in a mindful way so as not to alienate the patient’s view of their identity while encouraging a new perspective.

As practitioners, we want to engage the patient’s spirit and keep them involved in their treatment plan, which could take weeks, or even months, to possibly achieve a more full recovery. That said, increments of change can be quickly noted in quality and length of erection by needling and moxibustion, which enacts qi and blood movement and tonfication through the local area.

For a local area treatment for erectile dysfunction, needle UB-33 manually at a depth of roughly 60 mm for 5-15 min. After that, one may needle the pudendal nerve point region, located in the gluteal region (at the point 50-60% of the distance along a straight line from the posterior superior iliac spine to the lower inner edge of the ischeal tuberosity). Use a needle up to 90 mm in length until a stimulation of da qi arises in the pudendal area. If no sensation arises this may clue one in to possible vacuity in the area. Stimulate for 5-15 min or use e-stim for low frequency (2-10Hz) for 15 min with strength sufficient to be felt in the pudendal area. Do this at least once a week for 5 weeks. I learned this from a study done in Japan for ED among diabetic patients that showed positive results.

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By Stephen Bonzak, LAc, Dipl OM (NCCAOM), FICEAM

The western medical diagnosis of erectile dysfunction can be modeled in East Asian medical terms using yin-yang, Five Phase, and Six qi. According to the Huangdi Neijing, the Cold Water of the North, located in the lower abdomen, can only rise up through Wood and stimulate the penis to become erect when the Fire of the South located in the chest descends down through Earth and Metal to warm it up. Put in different terms, the “ancestral sinew” becomes erect when there is enough yang-infused blood moving through the Jueyin Liver channel below.

Therefore, erectile dysfunction can occur due to one of several pathologies: 1) Shaoyin Heart Fire is too weak to descend and warm the Kidney Water below preventing it from generating good quality blood that can circulate through Jueyin Liver Wood, 2) there is a block in Taiyin Spleen Earth and/or Yangming Stomach Metal preventing the Heart Fire from descending from the South to the North, or 3) too much Jueyin Wood Wind is surging upward causing Shaoyin Heart Fire to flare up and away out of storage, or 4) the blood of Jueyin Liver Wood is weak and cannot hold the yang inside it.

As an herbalist, I treat ED using formulas primarily from the Shanghan Lun and the Jingui Yaolue. For each of the patho-dynamics described above, here are some formula ideas that can help treat this condition:

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By Barbara Ferrero, LAc

I practice in a small mountain town where many athletes reside. I treat a lot of orthopedic disorders and have several patients with spinal cord injury (SCI). Most SCI patients are men, and many of them deal with a degree of erectile dysfunction (ED). In patients with spinal cord injury, the incidence of sexual dysfunction is elevated. ED affected 89.5% of the patients in a study published by the International Journal of Impotence Research.

In the absence of nerve injury, ED is usually related to Kidney yin and/or yang deficiency. In my limited clinical experience, I have a 100% success rate using Chinese medicine—an indication that this option, even when used as an addition to the pharmaceutical route, can be very valuable.

However, when the ED is caused by trauma, there is always a pattern of dysfunction from the site injury, mostly Du and UB channel qi and Blood stagnation. I did not find that only treating the pattern has yielded any results in the short term (within eight treatments).

As with other symptoms of paralysis, I observed that sometimes the physiology works, even if the patient is unable to voluntarily elicit a certain movement or function. Speculating that this may be the case in ED, I tested a point combination to fuel and course the Liver qi, using Li Gou, Liver 5, since it goes to the external genitals.

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