I taught this course for our local associate here in Florida, FSOMA, the other week. I decided to post my lecture notes for all other Acu’s to check out and for the curious patient/potential patient to have a look into how I approach my care. The overall goal, is to make everyone more comfortable approaching, treating and seeking care for this extremely common condition that Acu & TCM can effectively treat!
As always, I’m available for questions, guidance and appointments!
The justification is a little odd as I just did a copy/paste.
Understanding ED in the Treatment Room.
By Dr. Lisa Lapwing
708-707-0383
Lisa.whacupuncture@gmail.com
Www.whole-healthacupuncture.com
Erectile Dysfunction, most commonly referred to in TCM texts as Impotence, is
the inability to get and keep an erection firm enough for sexual intercourse.
Reduced sexual desire (low libido) can be an additional symptom though, I
look at it as its own condition.
There can be various causes of ED involving dysfunction with hormones,
emotions, nerves, musculature and blood vessels. There can be physical
causes too such as physical trauma, malformations, obesity. I have found
there is also often a large mental/emotional component such as depression or
low self-esteem, harboring guilt or shame. Substance abuse and certain
medications can cause it as well, usually SSRI’s. In the last decade or so
we’ve also seen issues arising from porn-addiction which leads to mental and
physical complications.
As you hopefully know, the penis becomes erect when Qi and blood flow in.
Any hindrance to this can lead to ED.
These are not official statistics but from what I have seen in my 11 years of
practice is the largest occurrence is in men 60+ but I do see it a lot in men 40+
and have also treated it in men 20+. In the younger men, it’s often associated
with physical or mental trauma, in men whom are middle aged it tends to be
related to the decline of sex hormones and stress and in older gentlemen, it’s
sex hormone decline and general aging related.
Know that your treatment most often is usually only as good as your
differential. The positive of this is that it should reduce the fear in treating ED,
if your confident in your diagnosis and point prescription skills. If you put your
clinical hat on, you’ll be able to stay focused on treating this condition
effectively.
I’ve talked to many practitioners who are afraid to approach men’s health for
different reasons. Some are uncomfortable dealing with this area of the male
physique, some feel they haven’t learned enough about it and others have
said they don’t think it is treatable with OM. It is a treatable condition! Again,
especially, if you are confident in your differential diagnosis and acupuncture
skills.
If you are uncomfortable treating it for any reason, that is valid and guess
what, you don’t have to! Refer out. I don’t enjoy treating female fertility
therefore, I send patients to capable practitioners I’ve created relationships
with. This could be it’s whole own class but I’ll just note here that this is one
reason it’s good to get to know and create relationships with other
acupuncturists and other physicians in your area so you can refer patients. At
the end of the day, it’s all about they’re care, right!?
A proper differential is going to come from your initial consultation questions,
observation, tongue and pulse diagnosis.
Differentials and related Treatments
Ki Yang Xu:
incomplete erection, cold or chilly genitals/semen
Bl 23, Du 4, Rn 4, Sp 6, St 36, Ki 3
Moxa on Du & Rn 4 a good addition
Yin Xu with Empty Heat:
Easy erection but doesn’t last, premature-ejaculation, seminal emission
Ki 12, 6, 3, Sp 6, Bl 23, 18, Li 11
Ki Jing Xu:
constitutional weakness of Ki Yin & Yang with retraction of scrotum, scanty
pubic hair, sparse beard
Rn 4, 6, Ki 3, St 36, Sp 6, Du 4, YT or Du 16 for pituitary stimulation
Moxa on Du 4 & Rn 8 a good addition
Ht/Sp Xu’s:
palpitations, insomnia, abdominal distention, loose stools
Rn 4, Du 4, Bl 20, ST 36, Sp 9, Ht 7
Lv Qi Yu
emotional tension/stress, anger/irritation
Rn 4, 2, Bl 18, Lv 3, 2, Li 11, Buddha’s Triangle, Du 13
Fright Damaging the Ki’s:
this is our trauma/ptsd dx
Impotence following fright or normal erections at times other than during
intercourse, palpitations, dream disturbed sleep/night terrors, paranoia
Bl 15, 23, 52, Rn 3, Sp 6, Buddha’s triangle, NADA protocol, Du 24, Yintang
Damp Heat Retention in Lower Jiao:
genital itching, redness or aching, foul smelling or yellowed semen, infection
Rn 3, Bl 23, Sp 9, 6, St 40, Li 11, Du 14
Damp Phlegm Yu:
obesity, chest oppression, dizziness
Rn 4, St 36, 40, 25, Sp 15, 9, Ki 3
Stasis:
physical trauma/malformation, surgical damage, can have Ki xu signs too
Li 4, Sp 6, 10, Rn 4, Lv 8
Base Points important in most cases:
Ear - External Genitalia & sympathetic
Rn 4, 3, 2, 1 YES! REN 1!, Sp 10, Lv 8, Combo Sp 6, Ki 8 & Rn 6, Left then
Right, Shenmen, Buddha’s Tri, Du 24, 20, YinTang
Tituo
Tung lower Jiao combo of Ling Gu Da Bai Left side to Lv 3 Right side
Bl 32 - pudendal nerve
JiaJi’s @L1-2 for the penis
T11-L2 for the Sympathetic pathways of the genital organs
S2-5 for the Parasympathetic pathways of the genital organs
Let’s talk about needling Rn 1.
I don’t usually introduce this point until the 3 or 4th treatment. You need to
build rapport and gain trust first. Then if you decide it is necessary, explain the
importance of it. And it can be, an extremely pivotal point to your treatment,
especially, in cases where there are compounding conditions like BPH. The
prostate sits right above it.
Have your patient disrobe while you step out and have them place a
pillowcase or towel over their genitals.
Ask them to gently lift their testicles, so you can insert Rn 1 easily with only the
guide tube touching this sensitive area. Repeat to remove.
You and the patient both want to maintain privacy and this makes it simple.
If they refuse to cover up, you refuse to treat. It’s also that simple.
Talking on that point. You must be confident in your skills and keep your
boundaries up. There will be patients that try to push them. Stand your ground.
If at any time you don’t feel comfortable, you cease treatment and ask them to
leave.
You should also build confidence in your patient, assure them this is common
and they shouldn’t feel ashamed or guilty about wanting to treat it. Your
patients may not come right out and say this is what they are seeing you for.
You may see it on their intake, or after a few treatments for what they initially
came in for, say back pain, once you have both established a relationship built
on mutual trust and respect, they may feel comfortable enough to mention it.
Now, if you see it on their intake, you can definitely ask about it during your
questioning but if they're still uncomfortable, approach it again another time.
One of the reasons you want to approach this subject gently is these guys
have generally been shamed or made to feel guilty about their sexuality or
caring about the health of it. Sexual health is an extremely vital part of our
overall wellbeing. Assure them of this. You can treat shen in these instances
as well. You can always refer this person to someone who specializes in
counseling for sexual health/abuse. It’s a wonderful compliment to the care
you give them! I do have someone I recommend locally.
We’re not touching on herbs in this course but again, prescribe according to
your differential. One of my favorite go-to formula’s for most deficiency types
of ED is Evergreens Vitality.
Food therapy suggestions I like to make include; chicken, bone broth, walnuts
pistachio’s, green tea and to avoid dairy, gluten and excessively spicy foods.
We also know, exercise is good for all things.
If your patients tend to wear tight clothing especially or if they're overweight,
suggesting looser clothing and under clothes will keep circulation from being
cut off.
Top signs of improvement are of course, improved erections - looking for
better quality and increased regularity, morning erections and more emotional
stability. We know that if they are sleeping better, having more regular bowel
movements, etc. they are in-fact getting healthier overall but that doesn’t
always translate as improvements to our patients so I do my best to explain it
to them and assure them, as their overall health improves so will our target
condition, in time.
If you’ve been in practice awhile you know that patients are rarely suffering
from one condition. There’s usually multiple issues. As with anything, treat the
root and the branches will grow and repair. Foundation always comes first! Be
sure your patients know this so they don’t think you are “avoiding treating the
issue”. With ED, there is usually a blood flow issue and emotional issue on top
of whatever else is going on.
Get to know your patient's urologist too. Sometimes, their doc wants them on
low-dose daily cialis which can help treatment overall. But medications as we
know often, aren’t a cure. Your patients generally know this too and will come
in already frustrated about it. Another treatment gaining popularity is the
injection of pharmacological substances or PRP. There are several issues with
these treatments but I’ll leave you with this; they involve injections directly into
the penis which again, are not a cure and can have painful and sometimes
damaging side-effects. Patients are going to ask you about them so take the
time to educate yourself.
Conclusion.
Connect with questions concerns or suggestions!
