MEDICAL ACUPUNCTURE

Volume 21, Number 3, 2009

Clinical Pearls
# Mary Ann Liebert, Inc.
DOI: 10.1089=acu.2009.717

How Do You Treat Erectile Dysfunction in Your Practice?

E rectile dysfunction (ED) is often due to multiple

etiologies. Once causes like diabetes mellitus and vas-
cular insufficiency have been ruled out as the precipitating
clinical pathology, emotional problems have to be looked
into. A good history and physical examination is, of course,
very important.
I have always used a combination of acupuncture and
hypnotherapy for treating ED. Hypnotherapy helps to resolve
emotional problems uncovered during the initial interview.
Subsequent sessions help the patient to visualize normal
anatomy and function, restoration of blood supply to the pe-
nis, and achieving an erection. Along with the hypnotic
suggestions,IuseacupuncturepointsintheConceptiomVessel
(Ren Mai) and Stomach channel. I believe acupuncture di-
lates the penile vessels, helping to increase the blood flow.
The following acupuncture points are helpful for ED:
CV 2, CV 3, CV 4, GV 3, GV 4, GV 20, ST 29, ST 30,
BL 23, BL 52, KI 3, and KI 11. I use 0.16 or 0.25 gauge,
15 mm- or 22 mm-long needles, and select points from the
above list, but I mainly use: CV 2, CV 3, CV 4, ST 29, ST 30,
and GV 20. I might add 1 or more points from the list,
depending on the response.
My personal experience suggests that unless any associ-
ated emotional problems are resolved, acupuncture alone
may not be effective. I always combine hypnotherapy with
acupuncture to address associated psychological problems.
P.G. Parameswaran, MD
4003 Key Court
Missouri City, TX 77459
E-mail: acupuncturehypnosis@yahoo.com
Physical exam was normal, including normal testicular
volume; PSA was normal; total testosterone was decreased
(199 ng=dL); FSH and LH were normal.
Symptoms of diminished sex drive, nervousness, irrita-
bility, worrying, short temper, and constipation suggested
Liver and Spleen imbalance, deficient moisture, slack blood,
deficient Qi, and Kidney-Heart disharmony. The patient was
treated with a French Energetics approach for 6 visits and
then, 10 visits using triangular equilibration with evolution.
French Energetics:
Yang Ming to Tchong Mo tonification (LI 4, ST 36,
ST 40 ? SP 4, K 3, MH 6, with CV 2 and CV6).
Yang Ming to Jue Yin sedation (ST 36, 40, 41, 43 ? LR 3,
14, with CV 2–12, HT 7, MH 6, SP 4, and KI 3).
The patient reported improved libido and ability to
maintain an erection. Serum testosterone increased slightly
to 233 ng=dL (normal 241–827).
Triangular Equilibration:
A disturbance was identified in Shao Yin, Shao Yang, and
Tai Yang—treating HT 3, TH 5, GB 43, BL 62, and CV 7.
A disturbance was identified in Yang Ming, Tai Yin, Jue
Yin—treating ST 36, SP 6 and LU 7, MH 6, CV 17.
The patient initially reported that this treatment was not
as effective for his decreased libido; however, he was cal-
mer and more relaxed. Subsequently, during this treatment
cycle, the patient reported the return of AM erections and
declined the use of sildenafil titrate, and was able to dis-
continue his testosterone replacement therapy prescribed by
his endocrinologist.
Susan G. Kaplan MD, MPH
Hastings on Hudson, NY

A 40-year-old man requested acupuncture treatment for

decreased testosterone levels and erectile dysfunction.
He denied obstructive and irritative urinary symptoms.
E-mail: drsgkaplan@msn.com

There was no family history of prostate cancer. Medical

history was significant for hypothyroidism (treated and
managed by his endocrinologist with levothyroxine).
I share my knowledge and experience in treating erec-
tile dysfunction. Erectile dysfunction, in Traditional
Chinese Medicine, is caused by: 1) decreased flow of Qi and

Medical Acupuncture is pleased to continue this regular feature, Clinical Pearls, which we have found to be very useful and
practical to the readership. All of us are confronted with clinical challenges, especially when dealing with therapeutic strategies. We
hope this ongoing collection of Clinical Pearls will be easily accessible and ready to put into action for the benefit of our patients, and
even ourselves. How often do we ask our colleagues, ‘‘How do you treat . . . ?’’ This time, we posed the question: ‘‘How do you treat
erectile dysfunction in your practice?’’ Herein lie your contributions. We trust that our readership will continue to participate in this
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153
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blood in the GV and CV channels; 2) decreased peripheral
Qi=blood circulation; 3) association with Spleen Qi defi-
ciency; and 4) Kidney Yang=Essence deficiency.
The treatment plan includes: 1) improve Qi and blood
flow in the GV and CV channels; 2) strengthen the Lung Qi
(to improve the peripheral blood circulation); 3) tonify
the Spleen to make the muscular structure stronger; and
4) improve the Yang=Essence energy of the Kidney to
correct hormonal and Essence deficiencies.
Acupoints for erectile dysfunction are: 1) to improve the
Qi and blood flow in the GV and CV meridians, LU 7
2,
SI 3
2, LR 3
2, and SP 10
2; 2) for improving peripheral
blood circulation and strengthening the lungs, LU 9
2,
BL 13, CV 17, and LU 1
2; 3) for tonifying the spleen,
SP 8
2 (acute), SP 9
2 (chronic), BL 20
2, GB 25
2, and
LR 13
2; and 4) for treating kidney Yang=Essence defi-
ciency, KI 3
2, KI 6
2, KI 7
2, KI 10
2, and BL 23
2.
Apart from the above acupoints, it would be wise to add
the following acupoints if the problem is due to psy-
chosomatic and=or spiritual disorders. Acupoints for psy-
chosomatic indications: GV 20, EXHNN 1
4, auricular
acupuncture-Shenmen and psychosomatics. Acupoints for
a spiritual disorder: BL 17
2, BL 46
2, GV 9, GV 4,
GB 41
2; microsystem scalp acupuncture, MS 4
2; nose
acupuncture, external genitalia points; auricular acupunc-
ture, external genitalia points are very effective treatments.
I recommend treating the patient twice a week for 3 weeks
with electroacupuncture. Once the condition begins to im-
prove, the patient would be treated once a week for 8 weeks;
if the patient is then consistently better, twice a week for
8 weeks. After that, he would be treated once a month for
6 months.
Erectile dysfunction may also include curvature of the
penis or other issues, all of which would be included under
the term Peyronie’s Disease (PD). In Traditional Chinese
Medicine, PD is caused by: GV and CV meridian imbal-
ance, and Qi being blocked in the penis shaft (at the GV and
CV meridians). There are 4 different types of curvatures that
may occur during an erection (upwards, downwards, side-
ways, s-shaped). Upward curvatures are the most common
whereas s-shaped curvatures are the most unusual. Upward
and downward curvatures are associated with GV and CV
meridian hyper- or hypo-activity. If the GV meridian is
stronger than the CV meridian, the curvature will go up-
ward; if the CV meridian is stronger than the GV meridian,
the curvature will go downward. In patients where there is a
meridian imbalance, the penis will curve sideways.
A treatment plan for PD includes: 1) balance energy flow
between GV and CV meridians; 2) keep GV and CV in a
vital energetic mid-line; 3) balance left and right meridians;
and 4) improve Qi and blood circulation.
Acupoints for Peyronie’s Disease: 1) balance energy flow
between GV and CV, LU 7
2, SI 3
2, GV 4, GV 9, GV 14,
CV 4, CV 12, and CV 17; 2) to keep GV and CV vital
CLINICAL PEARLS
energy in mid-line, GV 20, EXHN 1
4, GV 24.5 (EXHN 3),
CV 22, and CV 23; 3) to balance left and right meridians,
SP 21
2, TE 8
2, GV 14, PC 6
2, CV 17, GB 34
2,
GV 4, SP 6
2, CV 4; and 4) to improve Qi and blood
circulation, SP 10
2, LR 3
2, LU 9
2, and CV 17.
Erectile dysfunction may also be treated with micro-
systems: 1) nose acupuncture; 2) auricular acupuncture;
3) scalp acupuncture; 4) hand acupuncture; and 5) foot
acupuncture. These offer tremendous therapeutic gains.
Acupuncture treatment: 1) points for microsystem nose
acupuncture are in the bottom of philtrum; 2) points for
microsystem auricular acupuncture are on the ascending
helix above the lower handle of anti-helix; 3) microsystem
scalp acupuncture, MS 4, bilateral lines from ST 8 parallel
to the GV line that is 1 cun in length, half a cun behind the
hairline (the right represents the left and the left represents
the right); 4) microsystem hand acupuncture, point is at the
base of knuckles of the middle fingers, the middle finger
represents the shaft of the penis, the web space represents the
testicles; and 5) foot acupuncture, the achilles tendon rep-
resents the shaft of the penis, the insertion point corresponds
to the base of the penis shaft. All of the microsystem points
react very quickly to acupuncture; however, to maintain a
full recovery, classical acupuncture is also indicated.
Steven K.H. Aung, MD, OMD, PhD, FAAFP, CM
Clinical Associate Professor, Faculty of Medicine
and Dentistry
University of Alberta
Adjunct Professor of Extension, Rehabilitation Medicine,
Public Health, and Pharmacy and Pharmaceutical
Sciences
University of Alberta
Edmonton, Alberta, Canada
Associate Clinical Professor, College of Dentistry
New York University
New York, NY
E-mail: draung@aung.com
W ith the popularity of drugs like sildenafil, there
may be little call for acupuncture in erectile dys-
function (ED). Nevertheless, the condition can reflect a wide
range of CM patterns involving the Heart, Spleen, Liver and
Kidneys. The Spleen makes the Blood, the Liver stores and
moves it, the Heart gives rise to desire, and the Kidneys
provide the motive force. If any of these aspects are
malfunctioning, then ED can occur. Acupuncture, therefore,
involves identifying a pattern and treating accordingly, with
the addition of local points to encourage the Qi to flow in
the pelvis.1 General points might include GV 20, BL 32–35,
CV 4, ST 30, SP 6, and various pattern points that can be
found in Table 1. A regimen of 6–12 treatments, once to twice
a week, would be reasonable.
CLINICAL PEARLS 155

Table 1. Patterns in ED cavernosa to cause an erection and sustain it until after

orgasm.
CM Pattern Points

Liver Qi stagnation LV 1,3,5, 8, BL 18

Traditional Chinese Medicine (TCM) Diagnosis
Cold in the Liver Channel LV 1,5, CV 4,6, ST 29,30 (Moxa)
Blood stasis SP 4,8,10, BL 17, CV 3, BL 32 Deficiency of Kidney Qi, deficiency of Kidney Yin,
Deficient Kidneys BL 23, CV 6, KI 3, GV 4, ST 36 Kidney Yang, or both.
Spleen Qi deficiency SP 3,6,9, ST 36,40 There is a lack of libido, erectile dysfunction, premature
Damp Heat KI 10, LV 5,8, BL 23, SP 6,9 ejaculation, or inability to ejaculate. The inability to have
Heart and Spleen deficiency HT 7, BL 15,20, ST 36, SP 3
and maintain an erection and to ejaculate is a function of
Yin and Yang, respectively. Post coital headache and lower
back pain also suggests Kidney Qi deficiency.
Of course, acupuncture should only be part of an inte-
Dai Mo controls the flow of Qi in Ren Mo, Du Mo, and
grated approach which would also include lifestyle routines
Governor Vessel. It also moves Spleen Qi upwards and
such as regular exercise, Dorey’s pelvic floor exercises,2
controls the flow of Liver Qi. Liver controls the flow of blood.
adequate rest, and a stress-free environment for intimacy.
Conception Vessel (Ren Mo) governs Yin ( Jing, blood,
and fluids).
REFERENCES
Treatment
1. Deadman P. The treatment of erectile dysfunction by acu-
puncture. J Chin Med. 2007;(85):5–14. I do the following:
2. Dorey G, Speakman MJ, et al. Pelvic floor exercises for erectile Super Ming Men: GB 25(þ) BL52 (), BL 23, and
dysfunction. BJU Int. 2005;96(4):595–597. GV 4, 5.5 Hz for 15 minutes
Ren Mo: LU 7, KI 6; Dai Mo: GB 41, GB 26, TF (TH) 5
Michael T. Greenwood, MD, MB, BCHIR, CCFP, FCFP, for 20 minutes in neutral
CAFCI, DABMA, FAAMA, FRSA KI 3(), KI 9 (þ), 5.5 Hz for 20 minutes
103-284 Helmcken Road Plus: CV 4 ( Gate of Prime), CV 6 (Lower Sea of Qi),
Victoria, BC, V9B 1T2 CV 2, and CV 3.
Canada
These are done bilaterally.
E-mail: michaeltgreenwood@shaw.ca
Patients are advised to exercise regularly, get refreshing
sleep, quit smoking, and moderate intake of alcohol. They
are encouraged to discuss medications and side effects with
E rectile dysfunction is the inability to have a sus-
tained penile erection during sexual activity until or-
gasm is achieved. It my be due to the following causes:
their regular physician.

Indarjit Singh, MD
 Physical abnormality, e.g., Peyronie’s disease
La Mer Medical Group
 Metabolic cause: diabetes mellitus
P O Box 201
 Vascular: atherosclerosis, hypertension, stroke
Camarillo, CA 93011
 Neurological: cerebrovascular accident, Parkinson’s,
multiple sclerosis
 Surgery: for prostate cancer, bladder cancer–due to


damage to pudendal nerves
Medications: tricyclics, SSRIs for depression, beta
I n my clinic, I typically see people who are non-
responders to medication (i.e., sildenafil citrate, tadalafil,
vardenafil). From a classical Chinese medicine perspective,
blockers, alfa blockers
rather than a Traditional Chinese Medicine (TCM) per-
 Psychological factors: depression, sexual abuse, and
spective, I usually do not treat using the 12 Primary Chan-
performance anxiety
nels at all, but go directly to the Ying Qi level or Blood level,
 Illicit drug use and smoking
and treat using the Luo Channels. Remember, that the blood
 Alcohol may reduce testosterone levels and thus,
contains Qi and Shen, as well as housing the emotions of the
reduce libido
Wujingshen and all acquired emotions as well.
 Low levels of DHEA may affect libido.
The Luo Channels deal more specifically with emotions
The goal is to increase acetylcholine and nitric oxide in than the 12 Primary Channels; more specifically, emotions or
corpora cavernosa to stimulate production of cGMP. This thought patterns that have been placed in hiatus for awhile. All
will relax smooth muscles and let blood enter the corpora trauma—whether it be emotional or physical, embarrassment,
156
or a lack-of-performance issue—are deposited into the Luo.
For example, if a man experiences erectile dysfunction (ED)
and begins to say that he is not the man he used to be and
begins to feel inadequate in other aspects of his life, the Luo
Channels now expand and grow to accommodate the energetic
charge from this negative thinking. The 12 Primary Channels
deal with issues that are of the conscious mind, while the Luo
can deal with the conscious mind but also the unconscious
mind.
The Luo Channels are created every time these phrases
are uttered and the energy of that emotion is placed into a
channel system that will off-branch from the 12 primary
and create a new branch trajectory. The size of this new
channel and its trajectory all are indicative of the magni-
tude of the issue to be dealt with and its attached mental
dialogue.
CLINICAL PEARLS
The primary way to treat using this Channel system is to
bleed the area (1 or 2 drops of blood from the acupuncture
needle, for example) of the base of the Luo or the root cause,
using a 7-star hammer. Finding the root cause is accom-
plished through palpation and learning to read the Qi in the
Luo similar to the pulses.
This process allows the issues to become purged out of
the Luo, and through correct dialogue with the patient, begin
to find resolution to the emotional issues that may be the
catalyst for the ED.
Ted J. Cibik, PhD, ND, DMQ (China), CHFS
Executive Director
Inner Strength, Inc.
825 Lovers Leap Road
Leechburg, PA 15656