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Erectile Dysfunction and TCM

Skye Sturgeon, DAOM |

Article originally published June 6, 2025
by Dr. Skye Sturgeon

Erectile dysfunction (ED) is a prevalent condition characterized by the consistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Sometimes referred to as impotence, this condition becomes increasingly common in men between the ages of 40 and 70. Risk factors include obesity, a sedentary lifestyle, certain emotional states, including anxiety, depression, low self-esteem, and overstress, along with several diseases such as diabetes, hypertension, hyperlipidemia, atherosclerosis, and other vascular diseases, chronic kidney disease, stroke, and low testosterone. Common biomedicines that list erectile dysfunction as a potential adverse effect include antidepressants, anti-anxiety medications, anti-hypertensives, antihistamines, sedatives, muscle relaxers, antiseizure medications, antiarrhythmics, and several others. (Be sure to check the drug information accompanying the drugs being taken.) Other substances that have the potential to cause ED include smoking or vaping tobacco (nicotine), alcohol use, amphetamines, barbiturates, cocaine, marijuana, and opioids (including methadone).

Traditional Chinese Medicine Treatment Approaches for Erectile Dysfunction 

erectile dysfunction photo

Traditional Chinese Medicine (TCM) offers a unique perspective on the diagnosis and treatment of ED, emphasizing a holistic approach that addresses both physical and emotional well-being, both of which play an important role is supporting a patient’s normal erectile function. TCM treatments aim to restore balance to the body's energies, thereby improving sexual function. Common modalities include: 

  • Herbal Medicine: Treat the underlying conditions based on a thorough TCM diagnosis by prescribing formulas to tonify Kidney Yang, nourish Yin, clear Heat, etc. as appropriate.  
  • Acupuncture: Studies have indicated that acupuncture can be effective in treating ED, potentially by improving blood flow and reducing stress. 
  • Dietary Therapy: Avoid strong caffeinated tea or coffee, quit smoking, drink less alcohol; eat more protein; more warming foods and less cooling foods, more poultry and less red meat, avoid overeating fatty, spicy and greasy food, and eat more foods rich in zinc and vitamins. However, as mentioned, older men often have other diseases, such as hypertension, hyperlipidemia, arteriosclerosis, chronic cholecystitis, liver cirrhosis, urinary stones, gout, etc., so foods that are beneficial to improving the sexual function of older men may not be suitable for the rehabilitation and treatment of these diseases. Encourage the consumption of foods that support Kidney health and overall vitality, such as black sesame seeds, walnuts, and goji berries, all of which are considered beneficial for sexual health according to TCM. Also, since studies have shown that being overweight or obese can hinder sexual function, losing excess weight can be important. 
  • Lifestyle Modifications: Physical and mental work should be moderate, and rest and exercise appropriate for the age and constitution of the man. Practices like Tai Chi and Qigong are recommended to enhance Qi circulation, reduce stress, and improve overall energy levels, all of which can positively impact sexual function. The Qigong that is particularly beneficial to sexual dysfunction in the elderly (men and women) is the Returning Qigong, a Taoist method of guiding Qi. Practice this standing, head straight and looking forward, eyelids relaxed and drooping slightly open, tongue against the upper palate, feet apart and shoulder-level, hands hanging naturally. Slowly inhale, and when the inhalation is almost full, men are instructed to contract the anus and lift the testicles. Then relax. Slowly open your eyes, do some gentle joint movements, rub your hands together, and then use your hands to rub your head, face, and ears 18 times each. Practice this sequence 20 times per session. 

Chinese Herbal Possibilities 

TCM diagnosis is primarily based on the principles of pattern differentiation, which involves assessing the balance of Yin, Yang, Qi, and Blood within the body. Practitioners evaluate various factors such as tongue appearance, pulse quality, and a patient's medical history to identify underlying imbalances contributing to ED. For instance, a deficiency in Kidney Yang may present with symptoms such as cold extremities, fatigue, and a low libido. Conversely, an excess of Heat in the Liver or Heart may manifest as irritability, insomnia, and rapid pulse. 

The etiology and pathogenesis of sexual dysfunction in men as they age, according to TCM, can be summarized as follows: 

Kidney Yang deficiency 

Kidney Yang damage caused by deficiency of the five internal organs, excessive sexual intercourse, long-term illness, and many diseases can lead to sexual dysfunction. It is also the ultimate pathogenesis of sexual dysfunction in the elderly. 

In TCM, ED is often associated with imbalances in the body's vital energies, primarily the Kidney (腎 Shèn) and Yang. The Kidneys are considered the source of vital essence (Jing), which is believed to govern sexual function. Between Yin and Yang, Yang plays a direct role in the activation and maintenance of sexual function, while Yin provides support for Yang. Therefore, harmony and Spirit are the driving force of sexual function, and Essence and Blood are the basis of sexual function. 

The most classic description of the relationship between sexual function and Kidney Yang can be found in the Huangdi Neijing’s Shanggu Tianzhen Lun 黃帝內經上古天真論 or “Comments on the Innocence of Ancient Times“. A deficiency in Kidney Yang can lead to symptoms such as chills, dizziness, backache, fatigue, and sexual dysfunctions like premature ejaculation or impotence. This syndrome, known in Chinese as shen kui 腎虧, reflects a cultural belief where loss of semen is thought to cause withdrawal-like symptoms, including anxiety and physical discomfort, lasting weeks to months after a single orgasm.  

Symptoms: Main symptoms include low libido, weak erection, or impotence. Other symptoms include thin semen, loose scrotum, frequent urination at night, cold pain in the waist and knees, fear of cold and cold limbs, and pale complexion. 

Tongue: The tongue might be pale, with white tongue coating, accompanied by a deep, thin, and weak pulse. 

Treatment method: Warm and tonify Kidney Fire, strengthen Yang  

Prescription: You Gui Pills (Jingyue Complete Book 景岳全書 )  

Modifications: For those with Qi deficiency, add Huang qi/Astragalus and Dang shen/Codonopsis; for those with diarrhea, add Rou dou kou/Myristica and Wu wei zi/Schisandra; for those with stomach deficiency and cold and vomiting, add Gan jiang/Zingiber. 

Liver Qi stagnation 

Liver Qi stagnation, whereby the flow of Qi is blocked, inhibiting the Spleen and Kidney, and resulting in sexual dysfunction. This can be due to the inconsistency between traditional sexual concepts and physiological sexual requirements, creating psychological imbalance. There may be psychological barriers caused by work or life pressure and troubles; emotional disharmony between sexual partners; various factors leading to a lack of sexual pleasure in the past or long-term lack of sexual partners; impacted mood during sexual intercourse due external factors such as a crowded household with children present, etc.  

Symptoms: Main symptoms include sexual indifference or lack of interest, lack of orgasm, impotence, and premature ejaculation. In most cases, the cause can be identified. There might also be mental depression, anxiety, tension, sighing, thirst, irritability, chest and flank pain, belching, or loss of appetite.  

Tongue: The tongue may be pale red with thin white or thin yellow fur, accompanied by a wiry or tight pulse. 

Treatment method: Soothe the Liver and relieve Liver Qi depression, dredge the meridians and invigorate Yang. 

Prescription: Xiao Yao San (Taiping Huimin Pharmaceutical Bureau Formulas 平惠民和劑局方) 

Modifications: For those whose depression has turned into Fire, add Zhi zi/Gardenia and Huang bai/Phellodendron; for those with headache, add Suan zao ren/Ziziphus, Ju hua/Chrysanthemum, and Gou teng/Uncaria Rhynchophylla; for those with thirst, add Tian hua fen/Trichosanthes root and Shi hu/Dendrobium; for those with constipation, add Xuan shen/Scrophularia and Zhi shi/Citrus aurantium; The elderly can often also have insufficient Yin, so, the way to invigorate Yang is to unblock and relieve depression, rather than to use too many drying and spicy warm herbs.  

Deficiency of both Heart and Spleen 

Too much work or life burden, excessive thinking, overwork, and eating without mindfulness can lead to deficiency of both Heart and Spleen, timidity of mind, insufficient Spleen, poor communication between Heart and Kidney, and deficiency of Ren, Du, and Dai meridians, all leading to decreased sexual function. 

Symptoms: The main symptoms include an aversion to sexual intercourse, impotence, premature ejaculation, pale complexion, palpitations, insomnia, forgetfulness, dizziness, fatigue, and loss of appetite. 

Tongue: The tongue may be pale with white coating, and the pulse may be weak. 

Treatment method: Nourish the Heart and Spleen. 

Prescription: Gui Pi Tang (Internal Medicine Abstracts 内科摘要) 

Modifications: For loose stools, double the amount of Bai zhu/Atractylodes macrocephala and add Rou dou kou/ Myristica; for dry mouth and bitter taste in the mouth, remove Mu xiang/ Costus root; for stomach Qi stagnation, add Mai ya (chao)/roasted malt and Bei sha shen/Glehnia root; for those with more obvious Yin deficiency, add Sheng di huang/Rehmannia glutinosa and Rou cong rong/Cistanche deserticola. 

Phlegm and Blood stagnation 

Due to trauma or disease, Phlegm and Blood stasis can block the blood vessels, and the Jing/Essence, Shen/Spirit, Blood and Qi cannot reach the genitals, leading to sexual dysfunction. 

Symptoms: Main symptoms include impotence, aversion to sexual intercourse, and pain during sexual intercourse. For those who are obese, the main symptom is Phlegm obstruction with Blood stasis; while for those who are emaciated, the main symptom is Blood stasis with Phlegm obstruction. For those symptoms caused by trauma, it is important to check the medical history and verify the site of injury. For symptoms caused by internal injuries, there are systemic manifestations to support.  

Tongue: For those with more Blood stasis, the tongue may present with purple or black spots, and the pulse is sluggish. For those with Phlegm obstruction, the tongue may have a thick, white coat and the pulse is sluggish. 

Treatment method: Resolve Phlegm, move Blood, unblock meridians and invigorate Yang. 

Prescription: Fuyuan Huoxue Decoction (Medical Invention 醫學發明) combined with Beimu Gualou Powder (Medical Insights 醫學心悟). 

Modifications: For those with excessive Phlegm, add Dan nan xing/Arisaema with bile; for those with heavy Blood stasis, add Dan shen/Salvia and Tian qi/Panax notoginseng; for those with Qi deficiency, add Huang qi/Astragalus and Tai zi shen/Pseudostellaria. 

Dampness and Heat descending 

Due to unsafe sexual intercourse or poor genital hygiene, Dampness and toxicity invade. Dampness and Heat caused by other diseases can descend to the genitals, disorder the Qi and Blood and block Blood circulation, causing sexual dysfunction. 

Symptoms: Besides the main symptoms of sexual dysfunction, there may be symptoms such as scrotal wetness and itching, turbid urine, yellow urine, painful urination, fatigue, etc.  

Tongue: The tongue coating may be yellow or white, the tongue color is light red, and the pulse is usually slippery and rapid. 

Treatment method: Clear Heat and remove Dampness. 

Prescription: Long Dan Xie Gan Decoction (Medical Prescriptions 醫方集解) 

Modifications: For those with spleen deficiency and obesity, add Fu ling/Poria cocos and Zhe bei mu/Fritillaria thunbergii; for severe itching, add Ku shen/Sophora flavescens and Yin chen hao/Artemisia capillaris; for redness and heat in the genitals, add Pu gong ying/Taraxacum mongolicum, Che qian zi/Plantago asiatica, and Jin yin hua/Lonicera japonica. Additionally, the herb dregs of this prescription can be used as a genital wash. 

Yin Deficiency and Yang Excess 

Excessive masturbation or nocturnal emissions, excessive loss of semen, blood loss, and excessive spicy food can damage the Yin fluid. Kidney Yin damage caused by various diseases can also cause Kidney Yang excess, resulting in strong sexual desire but insufficient energy to sustain an erection or achieve desired sexual performance.  

Symptoms: Main symptoms include hypersexuality, flaccid erections, and difficulty in achieving orgasm. Systemic symptoms may include dizziness, nocturnal emissions, premature ejaculation, tinnitus, palpitations, irritability, and dry mouth. 

Tongue: The tongue may be red tongue with little or no coating, and the pulse may be rapid.

Treatment method: Nourish Yin, reduce Fire, and correct the Heart and Kidney communication.  

Prescription: Zhi Bai Di Huang Decoction (The Imperially Compiled Golden Mirror of Medicine 御纂醫宗金鑑)  

Modifications: For those with excessive Yin fire, replace Sheng di huang/raw Rehmannia with Shu di huang/cooked Rehmannia and add Qin jiao/Gentiana scabra. For those with body fluid damage and insufficient Yin, add Xuan shen/Scrophularia ningpoensis and Mai men dong/Ophiopogon japonicus. 

Traditional Chinese Medicine offers a comprehensive and individualized approach to diagnosing and treating erectile dysfunction. Syndrome differentiation is especially important for the treatment of sexual dysfunction in the elderly. The impact of psychological factors on sexual function is also an important consideration for the treatment plan. By focusing on restoring balance to the body's energies through herbal remedies, acupuncture, dietary adjustments, and lifestyle modifications, TCM addresses the multifaceted nature of ED and can provide relief, improving life satisfaction. 

References 

About the Author

Skye Sturgeon, DAOM is the Quality Assurance Manager and Special Consultant for Mayway, USA. Skye was the former Chair of Acupuncture & East Asian Medicine and core faculty member at Bastyr University, core faculty member and Faculty Council Chair at the American College of Traditional Chinese Medicine, and President and Senior Professor of the Acupuncture & Integrative Medicine College, Berkeley. Before making Chinese medicine his career choice, Skye held various positions in the Natural Foods Industry for 12 years and prior to that was a clinical biochemist and toxicologist.