Editor's Note: The following excerpt is from an upcoming book entitled Gynecology: An Integrative Approach. Part one of this series appeared in the August issue.
Oriental Medicine Perspective: Introduction
Hyposexual desire according to TCM has the following main causes: Kidney life gate (ming men) fire depletion; liver qi deficiency; qi and blood deficiencies; and kidney and heart disharmony due to fright.
TCM Etiology and Pathology -- Differentiation and Treatment
1. Kidney Life Gate (Ming Men) Fire Depletion
Primary symptoms: Decrease or absence of libido; infertility
Secondary symptoms: Pale complexion; coldness of limbs; soreness and weakness of the knees and back; fatigue; listlessness; polyuria; loose stools; delayed menstruation that is scanty and pale in color
Tongue: Flabby, pale, white coating
Pulse: Deep, slow or deep and threadyPatients in this category usually lack prenatal essence (jing) from their parents; are yang deficient; or suffer from chronic disorders. Lack of kidney yang can lead to a decreased libido. Infertility; coldness; pale complexion; and soreness of the knees and back are all symptoms of yang deficiency. Loose stools are due to kidney yang with an inability to warm the spleen yang. Delayed and/or sparse menstruation may be due to coldness constricting the channels with deficiency.
Treatment principle: Warm the life gate (ming men) fire of the kidney.
Primary herbal description and explanation: The primary formula is zhan yu dan, which consists of lu jiao shuang (cornu cervi degelatinatium), 9g; du zhong (cortex eucommiae ulmoidis), 9g; tu si zi (semen cuscutae chinensis), 9g; dang gui (radicis angelicae sinensis), 9g; fu ling (sclerotium poriae cocos), 9g; she chuang zi (fructus cnidii monnieri), 7g; bai zhu (rhizoma atractylodis macrocephalae), 7g; rou cong rong (herba cistanches deserticolae), 9g; shu di huang (radix rehmanniae glutinosae conquitae), 9g; jiu cai zi (semen allii tuberosi), 9g; ba ji tian (radix morindae officinalis), 9g; xian mao (rhizoma curculiginis orchiodis), 7g; yin yang huo (herba epimedii), 15g; rou gui (cortex cinnamomi cassiae), 9g; and fu zi (radix lateralis aconiti carmichaeli praeparata), 7g.
The kidney yang tonics in this formula (lu jiao shuang; du zhong; tu si zi; rou cong rong; jiu cai zi; ba ji tian; xian mao; yin yang huo; rou gui; and fu zi) warm the ming men's fire to help restore libido lost through deficiency and coldness. Yin and blood tonics such as dang gui, shu di huang, fu ling and bai shao (radix paeoniae lactiflorae) are used to counterbalance the drying effects of yang tonics.
Single herb modifications: For qi deficiency, add ren shen (radix ginseng) and bai zhu. For loose stools, diarrhea or abdominal pain, add ren shen and/or rou dou kou (semen myristicae fragrantis). For lower abdominal pain, add wu zhu yu (fructus evodiae rutaecarpae). For trickling vaginal discharge, add bu gu zhi (fructus psoraleae corylifoliae). For lower back and knee pain, add dang gui and du zhong.
Herbal formula modifications: For qi deficiency, add ren shen yang ying tang. For loose stools, diarrhea or abdominal pain, add si shen wan. For lower abdominal pain, add fu zi li zhong wan. For trickling vaginal discharge, add wan dai tang. For lower back and knee pain, add du huo ji sheng tang.
Acupuncture points: The acupuncture points used are zusanli (ST36); yinlingquan (SP9); shenshu (BL23); hegu (LI4); mingmen (GV4); guanyuan (CV4); and rangu (KI2).
2. Liver Qi Stagnation
Primary symptoms: Decreased libido; irritability; short temper
Secondary symptoms: Stifling sensation in the chest; frequent sighing; breast distention and pain; irregular menstruation; dysmenorrhea; menstrual blood, dark in color with clots; occasional pain in the lower abdomen and genital area during intercourse
Tongue: Red, thin white coating
Pulse: WiryEmotional instability not only influences the patient's psychological state but can also bring about stagnation of qi and blood. Stagnation causes further lack of nourishment to the thoroughfare vessel (chong mai) and conception channel (ren mai), resulting in diminished libido. Irritability and rage from a short temper are several manifestations of emotional circumstances directly related to liver qi stagnation. Frequent sighing and breast distention are associated with qi stagnation in the middle burner (jiao). Irregular menstruation and menstrual blood containing clots are indicative of blood stagnation secondary to qi stagnation. Occasionally, pain may be experienced in the lower abdomen or genital area during intercourse as a consequence of stagnation within the liver channel pathway that traverses along the genitourinary region.
Treatment principle: Spread liver qi.
Primary herbal prescription and explanation: The primary formula is jia wei xiao yao san, which consists of chai hu (radix bupleuri), 30g; dang gui, 30g; bai shao, 30g; bai zhu, 30g; fu ling, 30g; gan cao (radix glycyrrhizae), 15g; sheng jiang (rhizoma zingiberis recens), 30g; bo he (herba menthae), 3g; mu dan pi (cortex moutan radicis), 3g; and zhi zi (fructus gardeniae), 3g.
Chai hu functions as a guiding herb to the liver channel to help spread out liver qi stagnation. Dang gui and bai shao nourish the blood and soften the liver. Bai zhu and fu ling strengthen the spleen to prevent the liver from overacting on the spleen and stomach. Gan cao relaxes the muscles and helps sheng jiang harmonize the formula. Mu dan pi and zhi zi clear heat and reduce irritability.
Single herb modifications: For breast distention or pain, add qing pi. For dysmenorrhea, add yan hu suo (rhizoma corydalis), pu huang (pollen typhae) and wu ling zhi (excrementum trogopteri seu pteromi). For menstrual blood clots, add chuan xiong (radix ligustici), hong hua (flos carthami tinctorii), tao ren (semen persicae) and gui zhi (ramulus cinnamomi cassiae).
Herbal formula modifications: For breast distention or pain, add shi liu wei liu qi yin. For dysmenorrhea, add shi xiao san. For menstrual blood clots, add gui zhi fu ling wan.
Acupuncture points: The acupuncture points used are zusanli (ST36); yinlingquan (SP9); shenshu (BL23); hegu (LI4); taichong (LR3); and yintang. The ear point used is shenmen.
3. Qi and Blood Deficiencies
Primary symptoms: Decreased libido; dizziness; blurry vision; shortness of breath; fatigue; pale and dull complexion
Secondary symptoms: Poor appetite; dry mouth; light menstrual color (scanty amount)
Tongue: Pale, thin white coating
Pulse: Thready, rapid pulseConstitutional weakness, together with overwork or overexertion, creates deficiencies in qi and blood. Furthermore, qi and blood deficiency may cause lack of nourishment to the uterus; reproductive dysfunction; and hypoactive sexual desire. Blood deficiency leads to a lack of nourishment that manifests in symptoms such as dizziness; blurry vision; dry mouth; and a scanty amount of menstruation with light menstrual color. Qi deficiency includes shortness of breath; fatigue; pale complexion; and poor appetite.
Treatment principle: Tonify qi and blood.
Primary herbal prescription and explanation: The primary herbal formula is ba zhen tang, which consists of ren shen, 3g; bai zhu, 3g; fu ling, 3g; zhi gan cao (radix glycyrrhizae uralensis praeparata), 1.5g; shu di huang, 3g; dang gui, 3g; bai shao, 3g; chuan xiong, 3g; sheng jiang, 3g; and da zao (fructus zizyphi jujubae), 3g.
Ba zhen tang is the combination of si jun zi tang and si wu tang to tonify qi and blood. Dang gui tonifies and invigorates blood and does not have the common stagnating side-effects of other blood tonics. Shu di huang greatly tonifies the blood. Chuan xiong enters the blood level (xue fen) to tonify blood and regulate qi in that level. Bai shao nourishes yin and blood. Ren shen strengthens the source qi (yuan qi). Bai zhu strengthens the spleen and dries dampness. Fu ling and gan cao assist bai zhu and ren shen to tonify qi and strengthen the spleen, the postnatal source for qi production.
Single herb modifications: For dizziness and blurry vision, add gou qi zi (fructus lycii) and nu zhen zi (fructus ligustri lucidi). For fatigue and shortness of breath, add ren shen, huang qi (radix astragali membranacei) and ling zhi (ganoderma lucidum). For poor appetite, add bian dou (semen dolichoris lablab), bai zhu and fu ling.
Herbal formula modifications: For dizziness and blurry vision, add qi ju di huang wan. For fatigue and shortness of breath, add ren shen yang ying tang. For poor appetite, add shen ling bai zhu san.
Acupuncture points: The points to be used include zusanli (ST36); yinlingquan (SP9); shenshu (BL23); hegu (LI4); guanyuan (CV4); qihai (CV6); mingmen (GV4); and neiguan (PC6).
4. Kidney and Heart Disharmony Due to Fright
Primary symptoms: Decreased libido; emotional suppression; being easily frightened; dramatic emotional fluctuations in which the patient overacts easily
Secondary symptoms: Insomnia; irritability; soreness and pain of the back and knees
Tongue: Red, scanty coating
Pulse: Deep, threadyThe kidney may become depleted from excessive fright or fear. Depletion results in disharmony between the kidney and heart. When the spirit (shen) is disturbed, sexual desire decreases as well. Insomnia and irritability are symptoms of shen disturbance. Soreness and pain of the back and knees are hallmark signs indicative of kidney deficiency ,since the kidneys reside in the back and affect the bone, according to the five elements classification.
Treatment principle: Nourish the kidney and liver, tranquilize the spirit.
Primary herbal prescription and explanation: The primary herbal formula is modified zhi bai di huang wan, which consists of shu di huang, 24g; shan yao (rhizoma dioscoreae oppositae), 12g; shan zhu yu (fructus corni officinalis), 12g; zhi mu (radix anemarrhenae asphodeloidis), 9g; huang bai (cortex phellodendri), 9g; fu shen (sclerotium poriae cocos pararadicis), 9g; bai zi ren (semen biotae orientalis), 9g; zhi gan cao, 6g; ci shi (magnetitum), 6g; hu po (succinum), 6g; suan zao ren (semen zizyphi spinosae), 9g; and yuan zhi (radix polygalae tenuifoliae), 9g.
Shi du huang, shan yao and shan zhu yu tonify the kidney and liver yin. Zhi mu and huang bai clear deficient heat that may cause irritability and flaring of deficient fire of the kidney affecting the shen. Fu shen, bai zi ren, hu po, suan zao ren, yuan zhi and ci shi tranquilize the spirit. Gan cao harmonizes the formula.
Single herb modifications: For loose stools, add bai zhu or sha ren (fructus amomi). For yin deficiency heat with five heart heat and thready, rapid pulse, add zhi mu.
Herbal formula modifications: For loose stool, add xiang sha liu jun ti tang. For yin deficiency with five heart heat and thready, rapid pulse, add qing hao bie jia tang.
Acupuncture points: The points used are zusanli (ST36); yinlingquan (SP9); shenshu (BL23); hegu (LI4); neiguan (PC6); sanyinjiao (SP6), xinshu (BL15) and taixi (KI3). The ear point used is shenmen.
Lifestyle Instruction
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Because low libido is mostly due to deficiency, diet is essential to rebuild the patient's essence (jing). In maintaining a nutritious diet, increase the intake of foods with warm properties such as lamb, onions and chives. A balanced diet should go along with a balanced lifestyle that includes proper work hours, exercise and play, all of which are essential for a healthy body.
Clinical Pearl: Modern Formula/Author's Recommended Formula
Primary herbal prescription and explanation: The following formula, zi shi ying zhu yang fang, consists of zi shi ying (fluoritum), 30g; yin yang huo (herba epimedii), 15g; xu duan (radix dipsaci asperi), 15g; hua jiao (pericarpium zanthoxyli bungeani), 1.5g; ba ji tian (radix morindae officinalis), 10g; hu lu ba (semen trigonellae foenigraeci), 10g; tu si zi (semen cuscutae chinensis), 10g; rou gui (cortex cinnamomi cassiae), 6g; sang piao xiao (ootheca mantidis), 12g; and jiu xiang chong (aspongopus chinensis dallas), 10g.
This formula is best for people with low sex drive with no physical or mental abnormalities or symptoms.
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