Transcript Impotence

Impotence
Defenition:
Want of ability or power
Entirely wanting vigour of body or mind ( dictionary )
1) Function and disfunction of male sexuality from western perspective
2) Function , disfunction and treatment according to chinese medicine
Erection is caused by a hydraulic effect in spongelike bodies within the penis.
Sexual arousal is transmitted through signals from the brain to the nerves in the penis.
2 mechanismes
Reflex erection. Peripheral
nerves and lower spinal chord
are stimulated by touch
Psychogenetic erection. The limbic
system of the brain is triggered by
erotic and emotional stimuli
Central nervous system & Endocrine system
An adequate level of testosterone ( testes ) and an intact pituitary gland (hypophysis) in
concert with the nervous system are at the base of an erection.
Secretion of nitric oxide ( NO ) causes relaxation of smooth muscles of corpus cavernosa.
The suprarenal gland of the kidneys produces sex steroids.
Together with the testes they produce the male hormone androgens. ( testosterone )
3 Steps involved ( produce and sustain erection )
1) Arousal ( senses & thoughts )
2) Nervous system response ( brain communicates sexual excitation & glands )
3) Blood vessel response ( body nervous system activates increased blood flow )
Medical dictionary
Impotence coeundi : the unability to perform the coitus
Neurogenic ( CS )
Endocrien
Urological ( operation )
Internal ( organic )
Medical ( drug ) induced
Old age ( fysical )
Impotence concupiscentiae : no sexual desire
Impotence erengendi : unability to have or keep an erection
Impotence generandi : ability to perform without procreation.
Impotence is in general reverred to as erectile dysfunction – ED
Inability to develop or mantain erection of penis during sexual performance.
-Various circulatory causes like alteration of voltage-gated potassium channel. ( arsenic poisoning )
-- most important organic causes: cardiovascular disease and diabetes.
-- neurological problems ( trauma, prostatectomy surgery )
-- hormonal insufficience ( hypogonadism )
-- drug side effects
-- psychological impotence: failure due to thoughts and feelings.
Neurogenic : disease or dysfunction central nervous system ( brain & spinal chord ) or local
nervous system of the penis e.g. Parkinson‘s disease, CVA ( cerebral vascular
accidents ) chronic periodontitis
spinal chord : Alzheimer‘s disease, disc herniation, tumours, multiple
sclerosis, trauma lower spinal chord area, surgery pelvic organs,
Endocrinologic: hyperprolactinemia : excess of prolactin through pituitary adenoma, drugs
hyper or hypo-thyroidism : loss of libido and ED
subnormal level of testosterone, excessive prolactine level
diabetes mellitus, renal failure, Wilson‘s disease, hypogonadism
Arteriogenic : artheriosclerosis ( tabacco, hypertension, hyperlipidemia, diabetes )
coronary heart ( atery ) diseases,
local trauma penile arteries, perineal & pelvis trauma, irradiation of pelvis
Venogenic : inproper closure, enlarged penile veins ( drainage venous blood )
hypercholesterolaemia, diabetes, Peyronie‘s disease, old age
Carvernosal disorders : CITA chronic inflammation of the Tunica Albeiginea
connective tissue disorder, growth of fibrious plaques
Pharmaceutically induced : ( 25 % ) antipsychotics, antidepressants ( including tricyclic )
anti hypertensive drugs, monoamine oxidas ( MAO ) inhibitors
Drugs : tabacco ( vasoconstriction-venous leakage- contractile effect penile smooth muscle )
alcohol long term lever depletion, viagra ect. long term kidney depletion
Psychological disorders : anxiety and stress : fear and worry about ability to perform.
body image issues, phobia of sexual nature.
depression : emotional unstability, effects of medication & disease.
relational : issues of anger, unhealthy relational patterns
mental disorders : psychosis, sexual deviation, obsessive-compulsive .
Sigmund Freud ( 1856-1939): Austrian neurologist and founder of Psychoanalysis
developed 5 psychosexual stages in progress of early childhood development
4) Latency stage : 6- puberty
Drives are hidden, ID is blend off , libinal drive
directed towards external : friends, hobbies.
3) Phallic stage : 3-6 years
Genetalia erogenous zone
Difference of male/female
Oedipus complex
Parents become focus of libido
energy ( ID/ ego conflict )
By identification with father
overcomes anxiety, conflict.
Super-ego moral values from
society introduced.
2) Anal stage : 18 month-3 years
Toilet trainig , conflict ID/ ego immidiate/delayed
gratification, eliminating bodily wastes coping
with parental demands
5) Genital stage : puberty - adult life
Centered upon genitalia, ego established
Independant from parents
Psychological detachment
Sexuality develops in a mature and
integrating manner.
Depending of the previous stages issues
will recure until they are fully worked
through.
1) Oral stage : birth to 1 year
Libidinal gratification through mouth ( breast,objects )
ID dominates ego, action based on pleasure principle
Immidiate gratification- avoiding pain.
Old age: aging has a significant impact on male functioning, it can up to threefold age 40-70
main reason kindney function exhaustion.
treatment : pottasum deficiency ( arsenic condamnation) PDE 5 inhibitor drug
libido stimulation viagra ( slidenafil ), levitra ( vardinafil ), cialis ( tadalafil )
prostaglandi tablets in urethra
injections into penis, penile prosthesis, penis vacuum pump, surgery implant
if there is sometimes full erection ( asleep) it is an indication to suggest that the
physical structure are functionally working.
Chinese medicine
Sexuality is seen as integral part of existence- 3 essentials = food, air, reproduction
Unique to chinese sexology `literature` is concept sexual act as a therapy for optimal health
Proper technique fostering sexually mature attitude. Daoist tantra exercises are used for health
issues. Delaying preventing ejaculation and cycling the orgasmic energy up through the spine
and into the brain. Breathing exercises are used to cycle the Qi in the DM/RN channel.
4 basic conditions
( Question- answere style commantary between `mysterious girl` and yellow emperor Huang Di )
The male reproductive organ must attain 4 stages during foreplay before it is `qualified` to enter
the jade-gate.
m.g. : a male who desires intercourse must first pass through four stages of attainment:
elongation, swelling, hardness and heat.
y.e. : What do these attainment mean ?
m.g. : If the stalk does not attain sufficient elongation the man`s viatal energy is too depleted for
the act. If he attains elongation but little swelling this means that his muscular energy is
insufficient for the task. If he achieves swelling but no hardness it means that his joints
and tendons are too weak for the act. If the organ gets hard but not hot then his spirit is
insufficient for the act. In order to prepare properly for sexual intercourse you must first
harmonise your muscles and bones with energy and your spirit. You must exercise self
discipline, follow the basic principles of Dao and never waste your semen carelessly.
Liv ( Ki & HT ) : directing Qi and blood= hardening SP: muscular energy= swelling
HT : focus, desire= heat Ki yang : storehouse vital energy= elongation
Healthy organs and organ interaction
Erection 4 physiological factors
1. blood : swelling, hardening
2. Shen : focus, sexual desire
3. Qi : sensation of heat
4. Jing : ejaculation
Ancient character of heart symbolises sexual connection, tantric
embrace, ancient scholars recognized HT coupled with GB rulers
of sexual function. I ching 44 Kou Gou intercourse becoming one
Ruler blood, directs blood to penis with help of chong mai.
disturbance shen: scattering Qi & focus, desire
liv. – zong jin: meeting of the ancestral
or 100 sinews.
Ruler of tendons & sinews
Yang ming nourishes penis
Controls storage blood & free flow Qi
Post natal source of Qi & blood
Encircles genital region
Unablity transformation body fluids
`wei` : flaccidity of zong jin
Dampness, overindulgence thinking
Qi dificiency
Kidney rules semen ( part of jing)
Brain, spinal chord – sea of marrow
Cerebrospinal fluid - c.f.
c.f. & semen similar consistancy
Lu :Indirectly involved post natal source of Qi
Po: body-soul instincts & somatic sensation
Connection with physical body
Body images issues
Daoist practitioners
Exercise & meditation
Importance perineum in mantaining pelvic organ health and indirectly sustaining jing.
Delaying preventing ejaculation and cycling the orgasmic energy up through the spine into brain.
Ancient text: secrets of the jade bedroom
Advisors of Huang Di, Peng-Tze and rainbow girl
r.g. : It is generally assumed that a man gains great pleasure from ejuculation. But when he
learns the Dao of yin & yang he will ejaculate less and less. Will this not deminish his
pleasure aswell?
P.T. : Not at all. After ejaculation a man feels tired his ears buzz, his eyes get heavy and he longs
for sleep. He is thursty and his limbs feel weak and stiff. By ejaculation he enjoys a brief
moment of sensation but suffers long hours of weakness as a result. This is not a true
pleasure. However, if a man regulates his ejaculations to an absolute minimum and retains
his semen, his body will grow strong, his mind will be clear and his vision and hearing will
improve. While the man occasionally deny himself the fleeting sensation of ejaculation, his
love for his women will greatly increase. He will feel as if he could never get enough of her.
Is that not the true and lasting pleasure of sex?
Evaluation
A thorough initial intervieuw concerning marital relation, recent loss of loved ones, lack of
oppurtunity, lack of partner, lack of confidence, duration, presence or absence of morning
erection, level of libido, are necessary yet high chance patient will not volunteer this
information.
Testing : medical examination are quiet costly so the stamp test is an alternative.
a roll of stamps, with dry adhesive backing is rold around the penis before sleep.
if stamps are broken: non-organic psychological reason
if stamps intact: physical cause.
Classical chinese diagnostic
70 % deficient nature ( kidney zang )
30 % excess Liv/GB
Stagnation liv. Qi
Gan han- liv. Channel cold
Liver-blood & yin dificiency
Blood stasis
HT & GB dificiency
Ki yang xu ( decline of mingmen fire )
Ki yin xu ( flare up fire )
Chuan yao : drug/herb induced damage to ki.
HT & SP deficiency
Damp-heat & phlegm ( downward
flow )
Ki yang xu: generative factor in sexual desire attaining sustaining erection
old age, chronic disease, long term cold exposure, overwork, drug use, malnutrition, excessive
sexual activity.
Symptoms: weakness and soreness of knees and lower back, coldness abdominal and lower jiao, frequent
urination, nocturia, oedema lower limbs, low libido, low sperm count, poor motility,
general fatigue & listlessness, constipation or loose stools
tongue: pale, moist, enlarged toothmarks, white coat pulse: deep & fine
Ki yin xu: spontaneous or premature ejaculation
stress, overwork, night shift work, staying up late at night, insufficient sleep, pharmaceutical &
recreational drugs ( chuan yao ).
Symptoms: night sweating, emotional tension stress, vertigo, tinnitus, weakness and pain low back & knees,
painfull heels, palpitation, dark urine, dry stools.
tongue: thin red
pulse: thin rappid deep may be choppy
HT & SP xu: overworked, physically & mentally exhausted, prone to worrying, irregular diet, too much raw
or sweet food.
Symptoms: pale lustreless facial complexion, thin weak body constitution, poor sleep, profuse dreams,
insomnia, nervous panic attacks, sexual performance anxiety, lack of appetite, post meal
distention, loose stools, forgetfullness.
tongue: pale, thin white coating
pulse: thready weak
HT & GB Qi xu: fright & shock injuring kidney Qi, severe damage of shen, Ki zhi chronic timidity, personality
disorders, frightened by sexual intercourse, shen unable to lead Qi into penis, scatterd shen
flaccid Qi
Symptoms: patient suffers during intercourse, normal erection other times, anxiety, shyness, being easily
storrtled, nervous disposition, palpitations, nightmares, insomnia, paranoia ( some cases )
tongue: pale, thin white greasy coating
pulse: fine deep or normal
Damp-heat & phlegm: obstruction of channels, rich flavoured food, alcohol
Symptoms: yellow hot urine, incomplete urination, dry mouth and lips, genital pain itchy, rash excessive
sweating around genital region, heavy sensation legs
tongue: red thick white/yellow coating pulse: rapid slippery/wiry
Phlegm: obese men disorder tan shi, obstruction liv./ yang ming channel preventing Qi & bood to reach penis
Symptoms: chestdiaphragm oppresion, nausea vomiting, aching heavy limbs, dizziness, palpitation, fatigue
damp sweaty scrotum.
tongue: shiney coating pulse: slippery
Blood stasis: trauma after surgery around genital region, older men, sportsmen bicyclists
Symptoms: cold sensation, sharp stinging pain at the base, heavy dragging sensation
tongue: dark red with purple spots
pulse: choppy or wiry
Liv. Qi stagnation: overworked middleaged men, frustated young men
Symptoms: loss of libido, genital pain, tightness fullness chest & hypochondriac region, frequent sighing & pain
dizziness, fatigue, irritability, depression, abdominal distention, constipation or diarrhoea
tongue: normal or dark, may have red ages
pulse: usually wiry
Liv. Channel cold ( gan han ): exposure to extremly cold environment
Symptoms: decreased libido, cold sensation testicles & scrotum, coldness lower portion of body, chest &
abdomen stiffness and distention, pale face
tongue: white coating
pulse: deep tight
Liv. blood & yin deficiency: troublefull erection, insufficient blood partial or soft
Symptoms: emotional upset, anger and irritability, depression, frequent sighing, dizziness, blured vision,
fatigue and weariness.
tongue: red, slight or no coating
pulse: thready or wiry
Treatment
Basic main acc. Points: RN 2 & 3 & 4 ( zhongji & guanyuan ) & 6,
DM 1 & 3 & 4 ( mingmen ), ex 1 ( yintang )
BL 23 ( shenshu ) & 31 & 52 ( zhishu ),
Ki 1 & 2 & 3 ( tai xi ) & 10 & 12 ,
SP 6 ( sanyinjiao ),
ST 29 & 30
Ki yang xu: warm & tonify ki yang add Ki 10,
Ki yin xu: tonify ki yin, disperse fire add Ki 2 & 6, PC 8
Shuan yao : tonify ki
Liv. Qi stag. : move Qi add Liv. 3, PC 6
Gan han Liv.: tonify liv. Moxa
liv. Blood & yin xu: tonify yin & move blood
Blood stasis : move blood add Ki 5
HT & GB xu ( shock ): calm shen & move Qi add DM 20, Ex 6 ( si shencong ),HT 7, PC 5, GB 20
HT & SP xu: tonify HT & SP add HT 7, PC 6 & 7, BL 15 & 20, ST 36, Liv. 13
Damp heat & phlegm: disperse heat & damp or phlegm add Liv. 10 & 11 & 12, SP 9, GB 34, ST 36, Ki 10
Additional information
Clock pair relation GB-HT: sexuality is connected to the psychological issues of shame & guilt ( feeling dirty )
( day-midnight )
GB is seen as the storehouse of pure fluids and clean thoughts, it gives courage
to the mind, erases physical & psychological toxins gives spiritual purity.
A proper sexual function involves a quiet HT & deceisive GB.
Fright & trauma: ( sexual abbuse, related issues ) A very deep blockage of the Qi flow which can only be
healed if the trauma is integrated.
Micro orbit breathing:
The micro orbit is also known as ` The Self winding wheel of the law` and the circulation of light a Taoist yoga
Qi energy cultivation technique. It uses the pathway of DM & RN to circulate the Qi.
Inbreath: Qi is gathered around navel using the PC muscle to stirr it up and send it through the spine up to
the head. Tongue touches palate to bridge the pathway.
Outbreath: Qi descends from head to navel completing the cycle.
PC muscle
The pubococcygeus muscle or PC muscle is a hammock like muscle found in both sexes, that stretches from
the pubic bone to the coccyx ( tail bone ) forming the floor of the pubic cavity and supporting the pelvic
organs. It is part of the levator ani group of muscles. According to tantra yoga a knowledge how to handle
this muscle is essential in developing a mature sexuality. In general it is believed that too much sex injures
the jing, some authors also state that too little sex may harm health. At least a healthy perineum is the base
of a mature sexuality.
Anima
Jung a student of Freud developed the term Anima for man´s encounter with his unconscious desire, his
instinctual cravings of merging with life, which is a confrontation with the `beast` inside lurking on the
crossroad to riddle mankind with the mystery of life. It is the Sphinx from thr Oedipus tale.
Oedipus
A greek myth used by Freud to understand the impact of sexual deveolpment in childhood.
Laius king of Thebes was warned by an oracle that his son would slay him. Accordingly when his wife Jocasta
bore a son he exposed the baby on Mt. Cithaeron first pinning his ankles together ( swell-foot ). A shepherd
took pity on the infant who was adopted by King Polybos of Corinth and his wife and was brought up as their
son. In early manhood Oedipus visited Delphi and upon learning that he was fated to kill his father and
marry his mother he resolved never to return to Corinth. Travelling towards Thebes he encountered Laius
who provoked a quarrel in which Oedipus killed him. Counting on his way Oedipus found Thebes plagued by
a Sphinx, who put a riddle to all the passersby and destroyed those who could not answere. Oedipus solved
the riddle and in reward he received the Throne of Thebes and the hand of the widowed queen. In his
search to determine who killed Laius ( and thus end a plague on Thebes ) Oedipus discovered it was he who
killed the late king, his father. Jocasta also soon realized that she had married her own son and Laius`s
murderer and she hanged herself. Oedipus seized a pin from her dress and blinded himself with it. Oedipus
was driven into exile only accomponied by his daughter. He found refuge and reconcilation with the Gods in
a grove of trees called Colonus near Athens.
Thus to Freud the development of sexuality is very much focused on the parents as first role models. The
childhood sexuality is projected onto the opposite gender ( phallic phase ). The boy is attracted
( unconsciously ) to his mother and sees his father as oponent. To overcome this dilemma the boy identifies
with his father to bridge the conflict. His ego is too weak to oppose his father.
The myth of Oedipus may be understood not only as a sexual issue but also as a new conscious awakening.
As long as we are not in touch with the Tao we are blind to reality and impotent on a shen level. Thus reality
is something we create and not something which is out their independat of ourselfs. On the other hand we
are connected to everything through the Qi which is forming a world wide web.
Quantum fysics has shown us that no matter how objective an experiment is, it is influenced by the mere
fact of the presence of the observer. Thus it is essential not only to gather knowledge but also to find means
of expirience to actualize the material.
Questions?