Acupuncture And Moxibustion
For Erectile Dysfunction
W. Watere, MD
A 40-year-old man presented with functional erectile dysfunction (sexual drive, but unable to perform normal sexual activity). In the last 15 years, he had no sexual partner and masturbated often. Currently, he was involved in an 8-month relationship, but reported erectile disturbance and an inability to perform intercourse without sildenafil citrate. The patient received 2 acupuncture treatments in combination with moxibustion in the first 5 weeks of treatment and then, once weekly for 25 sessions. In the 6th week, moxibustion was eliminated. At the end of treatment, the patient could perform sexually without use of sildenafil.
Functional Erectile Dysfunction, Sildenafil Citrate, Acupuncture, Moxibustion, Wind-Cold-Syndrome, Kidney Yang Deficiency
Erectile dysfunction is a common male sexual disturbance marked by the inability of the penis to maintain an erection.1 The erected penis is not hard enough for penetration or the erection lasts only a short time.2 Erectile dysfunction is caused by disturbance of the central nervous system, organic disease, a psychosomatic disorder, or use of some drugs.1,2 The most organic cause is neurovascular rather than a psychogenic etiology. Functional erectile dysfunction, more commonly seen than the organic type in clinical practice, is most often related to emotional states.2 According to Traditional Chinese Medicine (TCM), functional erectile dysfunction is caused by excessive masturbation or excessive sexual activity leading to decline or deficiency of fire from the Gate of Life, or by mental injury, which damages the heart and spleen as well as the kidney.1 Male sexual dysfunction and decline or loss of libido largely pertain to Kidney Yang Deficiency.3
A 40-year-old man presented to the TCM-Centre at Elisabeth Hospital in Recklinghausen, Germany. He reported functional erectile dysfunction. In the last 15 years, he had no sexual partner and often masturbated. He reported a current 8-month relationship with libido, but was unable to perform sexual intercourse without use of sildenafil citrate. He preferred to investigate nonpharmacological options, including TCM therapy.
The patient appeared depressed and fatigued. The skin of his limbs, lower back, lower abdomen, and pelvis were cold to the touch; he reported an aversion to cold. Five years earlier, the patient had undergone a left inguinal herniotomy. He also reported pain in the lumbar region for the past several years. He denied nicotine or alcohol use.
A urologist was consulted who prescribed sildenafil. Urological investigation results and laboratory findings, including hormonal test results, were normal.
The patient's tongue was pale with a thick, white coat. His lungs, heart, abdomen, backbone, and extremities were normal. No dysreflexia, impaired sensibility, bilateral inguinal adenopathy, or edema were present. No trigger points were discovered in the pelvic or genital region; his sensation was normal. The patient's blood pressure was 120/80 mm Hg; pulse regular at 88/min (according to TCM, his pulse was deep and weak).4
Traditional Chinese Medicine: Diagnosis, Treatment, Treatment Principles
The TCM diagnosis included Wind-Cold Syndrome and Kidney Yang Deficiency.1,5 Treatment included acupuncture with moxibustion.5,6 Treatment principles included eliminating wind and cold, strengthening Yang, and replenishing the Kidney essence.
Selected Acupuncture Points
The patient gave informed consent for treatment. Points stimulated were BL 23 (Shenshu), GV 4 (Mingmen), GV 20 (Baihui), ST 36 (Zusanli), CV 6 (Qihai), CV 4 (Guanyuan), CV 3 (Zhongji), SP 6 (Sanyinjiao), GB 20 (Fengchi), GB 41 (Zulinqi), LI 4 (Hegu), and LU 9 (Taiyuan).1,2,6-8
The patient was treated with a combination of acupuncture and moxibustion twice weekly, then reduced to once weekly. Needle type used was Hwato 0.25 x 40 mm; single-use, sterile needle (Suzhou Medical Appliance Factory, Suzhou, China). Needles remained in place for 30 minutes; 19 needles were inserted each time to an insertion depth of 0.5-1.5 cun (depending on location of the needle).
He was treated in a room with red-light for warmth, especially necessary for Wind-Cold-Syndrome. He was treated in a supine position. He relaxed and listened to Chinese instrumental (Yin and Yang) music for inner harmony. Thus, the patient's comfortable treatment room may have strengthened the effects of acupuncture.
Manipulation of the needles with thrusting and lifting technique (reinforcing) was applied until De Qi was achieved. The patient received 25 acupuncture sessions with 10 moxibustions.
In the patient's 6th week of acupuncture treatment, moxibustion was discontinued because the thick white coat of his tongue decreased, his pale tongue normalized, and De Qi increased. The patient reported that his sexual ability had improved; he discontinued use of sildenafil.
In the 10th session, the patient experienced De Qi so strongly that he reported not being able to stand and was fearful of paralysis of his extremities. This indicated that his Qi flow had increased to optimal and Yang deficiency decreased.
After 15 treatments, the patient was absent from treatment for 6 weeks. He stated that his sexual ability was better and he felt stronger in both body and mind. His tongue's color and white coating were normal, as was his pulse. After that, he received acupuncture treatment once weekly for a total of 25 treatments. At the end of treatment, the patient asserted that he was able to perform normal sexual activity without use of sildenafil.
Acupuncture points BL 23 and GV 4 warm and tonify primary Yang of the kidney. CV 3, 4 directly warm and strengthen the penis due to their location near the penis; thus, needling these points increases blood supply in the penis. LU 9 is an influential point dominating pulse and vessels, which promotes blood circulation also in the penis. SP 6 nourishes Yin to tonify Yang. GV 20 and ST 36 raise the depressed Yang; GB 20, 41, and LI 4 eliminate wind and cold; CV 6 reinforces Qi and strengthens Yang.1,7-9
Moxibustion was applied to BL 23, GV 4, CV 3, 4, and 6, ST 36, and SP 6. In this case, moxibustion was used for tonification and increasing blood flow to the penis.3 The application of burning moxa was limited to a few minutes until the local skin flushed. After the 6th week, moxa application was discontinued due to treatment response.
The combination of acupuncture and moxibustion for this patient with functional erectile dysfunction was successful. He was able to perform sexual intercourse without use of sildenafil. Acupuncture and moxibustion may be powerful tools and useful (alternative) therapies to treat sexual dysfunction. Further research should address whether acupuncture plus moxibustion is more effective than use of sildenafil.
- Ganglin Y, Zhenhua L. Advanced Modern Chinese Acupuncture Therapy. Beijing, China: New World Press; 2000.
- Dengbu Z, Guangzhong D. Acupuncture-Moxibustion Therapy. Jinan, China: Shandong Science & Technology Press; 1996.
- Aung SHK. Sexual dysfunction: a modern medical acupuncture approach. Medical Acupuncture. 2002;13(2):7-9.
- Yubin L. Pulse Diagnosis. Jinan, China: Shandong Science & Technology Press; 1996.
- Nian Fang S, Liang WQ. Diagnostics of Traditional Chinese Medicine. Jinan, China: Shandong Science & Technology Press; 1990.
- Liangyue D,Yijun G, Shuhui HJ, et al. Chinese Acupuncture and Moxibustion. Beijing, China: Foreign Languages Press; 1999.
- Qunhui M. Effective Points Therapy of Acupuncture. Beijing, China: Foreign Languages Press; 1998.
- Gongwang L, Liya C, Goto S. Clinical Acupuncture & Moxibustion. Tiajin, China: Tianjin Science & Technology Translation & Publishing Corp; 1996.
- Beijing College of Traditional Chinese Medicine. Shanghai College of Traditional Chinese Medicine, Nanjing College of Traditional Chinese Medicine, The Institute of Academy of Traditional Chinese Medicine. Essentials of Chinese Acupuncture. Beijing, China: Foreign Languages Press; 1993.
Dr W. Watere specializes in Internal Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. He is Chief of TCM-Centre, Elisabeth Hospital, Recklinghausen, Germany. Dr Watere is a Fellow of German Academy of Medical Postgraduate Training and German Acupuncture Society, Düsseldorf, Germany.
W. Watere, MD, PhD*
Zentrum für TCM, Elisabeth Hospital
Röntgen Strasse 10
45661 Recklinghausen, Germany
Phone: 49-2361-60 13 66
Fax: 49-2361-60 13 80
Web site: www.akupunktur-watere.de
*Correspondence and reprint requests