Impotence

Chief Complaint: Impotence

Western diagnosis: Impotence

Medical History: Patient is a 27 year old caucasian male who presented with complaint of sexual dysfunction for two years duration. It is not continuous but has been steadily worsening.

Patient maintains a healthy diet, is moderately physically active and under tremendous psychological stress. maintains a monogamous relationship with a girlfiend.

He has been experiencing lumbago concurrent with the impotence since it began. He was involved in a motorcycle accident seven years prior in which, among other injuries, he shattered his left fibula and ankle. He now has decreased ROM in his left ankle and his gait is altered. This limits his physical activities and has set up mechanical imbalances in his pelvis and SI-joint.

The impotence is aggrivated by emotional stress but is not a constant problem

Questioning exam: His energy level fluctuates between excellent and very low.
He tends towards irritibility and frustration.
He has frequent tinnitus
Body odor is a burnt quality.
Ankle stiffness & pain is better with motion, but not too much.
Has developed prefernece for rough, aggressive sex. He finds that it turns him on more.
Has developed firm nodules around his scrotum (follicular cysts) that seem inversely related to his impotence. Often feels "blocked" in his genitals.
Frequent headaches with a sense of tight pressure.

Pulse exam: Wiry throughout, Forceful in the rear positions, 70 bpm.

Tongue exam: Pale body, thick greasy coat (slightly yellow) in rear. Red tip.
SLV are dark, non-distended.

OM Diagnosis: Long term Liver & Gall Bladder stagnation with Qi and Blood channel stasis (due to injury). This leads to heat, which decocts the fluids into phlegm nodules.

Treatment Principle: Move Qi & Blood in lower jiao (pacify the Liver) and dissolve phlegm accumulation.

Point Prescription: Acupuncture treatments emphasized heavier stimulation, which seem to benefit him most. This makes sense, given his attraction to more aggressive sexual activity. It's as though he's trying to forcefully free up his obstructions (typical of phlegm stagnation)
GB-8, 30, 29, 34, 39, 41
ST-25, 28, 29, 36, 40
SP-3, 6
Ren-1, 3, 4, 5
LVR-13, 14, 3
LI-4
UB-15, 18, 20, 22, 23, 24, 25, sacral pts
DU-1, 2, 3, 20

Herbal Formula: I use granules mostly from Blue Light but occasionally from KPC.
I initially began with a modified combination of Yue Ju Wan & Tao He Cheng Qi Tang.
That seemed to help the psycho-emotional constraint, but the nodules weren't affected. I played around with a few different formulas until I came accross Si Hai Shu Yu Wan; Hai Zao, Hai DAi, Hai Ge Ke, Hai Piao Xiao, Kun Bu, Chen Pi, Mu Xiang. He seems to respond to Da Fu Pi (perhaps due to cold invasion in the Liver channel from accident). So I modified it with some of that.

Lifestyle prescription: Qi Gong and meditation work for his pelvic centers.

Results: Results have for the most part been positive. There are many levels to sexual dysfunction and i do not know if all of them can be adressed by needles alone. He's happy, impotence improved, the nodules have improved but persist.