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1. Impotence

   Defenition: Want ofabilityor power Entirelywantingvigourofbodyormind ( dictionary ) Functionanddisfunctionof male sexualityfrom western perspective 2) Function , disfunctionandtreatmentaccordingtochinesemedicine
2. Erectioniscausedby a hydrauliceffect in spongelikebodieswithinthepenis. Sexual arousalistransmittedthroughsignalsfromthebraintothenerves in thepenis. 2 mechanismes Reflex erection. Peripheralnervesandlower spinal chordarestimulatedbytouch Psychogeneticerection. The limbicsystemofthebrainistriggeredbyeroticand emotional stimuli Central nervoussystem & Endocrinesystem An adequateleveloftestosterone ( testes ) and an intactpituitarygland (hypophysis) in concertwiththenervoussystemareatthebaseof an erection. Secretionofnitricoxide ( NO ) causesrelaxationof smooth musclesofcorpuscavernosa. The suprarenalglandofthekidneysproducessexsteroids. Togetherwiththetestestheyproducethe male hormoneandrogens. ( testosterone ) 3 Stepsinvolved ( produceandsustainerection) Arousal ( senses & thoughts ) Nervoussystemresponse ( braincommunicates sexual excitation & glands ) Blood vesselresponse ( bodynervoussystemactivatesincreasedbloodflow )
3. Medical dictionary Impotencecoeundi: theunabilitytoperformthecoitus Neurogenic ( CS ) Endocrien Urological ( operation ) Internal ( organic ) Medical ( drug ) induced Old age ( fysical ) Impotenceconcupiscentiae: no sexual desire Impotenceerengendi: unabilitytohaveorkeep an erection Impotencegenerandi: abilitytoperformwithoutprocreation. Impotenceis in generalreverredtoaserectiledysfunction – ED Inabilitytodevelopormantainerectionofpenisduring sexual performance. Variouscirculatorycauseslikealterationofvoltage-gatedpotassiumchannel. ( arsenicpoisoning ) - mostimportantorganiccauses: cardiovasculardiseaseanddiabetes. - neurologicalproblems ( trauma, prostatectomysurgery ) - hormonal insufficience ( hypogonadism ) - drugsideeffects - psychologicalimpotence: failure due tothoughtsandfeelings.
4. Neurogenic : diseaseordysfunctioncentralnervoussystem ( brain & spinal chord ) orlocal nervoussystemofthepenis e.g. Parkinson‘sdisease, CVA ( cerebralvascular accidents ) chronicperiodontitis spinal chord : Alzheimer‘sdisease, discherniation, tumours, multiple sclerosis, traumalower spinal chordarea, surgerypelvicorgans, Endocrinologic: hyperprolactinemia : excessofprolactinthroughpituitaryadenoma, drugs hyperorhypo-thyroidism : lossoflibidoand ED subnormal leveloftestosterone, excessiveprolactinelevel diabetes mellitus, renalfailure, Wilson‘sdisease, hypogonadism Arteriogenic : artheriosclerosis ( tabacco, hypertension, hyperlipidemia, diabetes ) coronaryheart ( atery ) diseases, localtraumapenilearteries, perineal & pelvistrauma, irradiationofpelvis Venogenic : inproperclosure, enlargedpenileveins ( drainagevenousblood ) hypercholesterolaemia, diabetes, Peyronie‘sdisease, oldage Carvernosaldisorders: CITA chronicinflammationoftheTunicaAlbeiginea connectivetissuedisorder, growthoffibriousplaques Pharmaceuticallyinduced: ( 25 % ) antipsychotics, antidepressants ( includingtricyclic ) anti hypertensivedrugs, monoamineoxidas ( MAO ) inhibitors Drugs : tabacco ( vasoconstriction-venousleakage- contractileeffectpenile smooth muscle ) alcohollongtermleverdepletion, viagraect. longtermkidneydepletion
5. Psychological disorders: anxietyand stress : fearandworryaboutabilitytoperform. bodyimageissues, phobiaof sexual nature. depression : emotional unstability, effectsofmedication & disease. relational : issuesofanger, unhealthy relational patterns mental disorders: psychosis, sexual deviation, obsessive-compulsive . Sigmund Freud ( 1856-1939): Austrian neurologistandfounderof Psychoanalysis developed 5 psychosexual stages in progressofearlychildhooddevelopment 4) Latencystage : 6- puberty Drives arehidden, ID isblend off , libinaldrivedirectedtowardsexternal : friends, hobbies. 3) Phallicstage: 3-6 years Genetaliaerogenouszone Differenceof male/female Oedipuscomplex Parentsbecomefocusoflibidoenergy ( ID/ egoconflict ) Byidentificationwithfatherovercomesanxiety, conflict. Super-egomoralvaluesfromsocietyintroduced. 5) Genital stage: puberty - adult life Centered upon genitalia, egoestablished Independantfromparents Psychological detachment Sexualitydevelops in a matureandintegratingmanner. Dependingofthepreviousstagesissues will recureuntiltheyarefullyworkedthrough. 1) Oral stage : birthto 1 year Libidinalgratificationthroughmouth ( breast,objects ) ID dominatesego, actionbased on pleasureprinciple Immidiategratification- avoidingpain. 2) Anal stage: 18 month-3 years Toilettrainig , conflict ID/ egoimmidiate/delayed gratification, eliminatingbodilywastescoping with parental demands
6. Old age: aginghas a significantimpact on male functioning, itcanuptothreefoldage 40-70 mainreasonkindneyfunctionexhaustion. treatment: pottasumdeficiency ( arseniccondamnation) PDE 5 inhibitordrug libidostimulationviagra ( slidenafil ), levitra ( vardinafil ), cialis ( tadalafil ) prostaglanditablets in urethra injectionsintopenis, penileprosthesis, penisvacuum pump, surgeryimplant ifthereissometimesfullerection ( asleep) itis an indicationtosuggestthatthe physicalstructurearefunctionallyworking.
7. Chinese medicine Sexualityisseenas integral partofexistence- 3 essentials = food, air, reproduction Unique tochinesesexology `literature` isconcept sexual actas a therapyfor optimal health Proper techniquefosteringsexuallymatureattitude. Daoisttantraexercisesareusedforhealthissues. Delayingpreventingejaculationandcyclingtheorgasmicenergyupthroughthespine andintothebrain. Breathingexercisesareusedtocyclethe Qi in the DM/RN channel. 4 basicconditions ( Question- answere style commantarybetween `mysteriousgirl` andyellowemperor Huang Di ) The male reproductiveorgan must attain 4 stagesduringforeplaybeforeitis `qualified` to enter thejade-gate. m.g. : a male whodesiresintercourse must first pass throughfourstagesofattainment: elongation, swelling, hardnessandheat. y.e. : What do theseattainmentmean ? m.g. : Ifthestalkdoes not attainsufficientelongationthe man`s viatalenergyistoodepletedfor theact. If he attainselongation but littleswellingthismeansthathismuscularenergyis insufficientforthetask. If he achievesswelling but nohardnessitmeansthathisjoints andtendonsaretooweakfortheact. Iftheorgangetshard but not hotthenhisspiritis insufficientfortheact. In order toprepareproperlyfor sexual intercourseyou must first harmoniseyourmusclesandboneswithenergyandyourspirit. You must exerciseself discipline, followthebasicprinciplesof Dao andneverwasteyoursemencarelessly. Liv ( Ki & HT ) : directing Qi andblood= hardening SP: muscularenergy= swelling HT : focus, desire= heatKiyang : storehouse vital energy= elongation
8. Healthyorgansandorganinteraction Erection 4 physiologicalfactors 1. blood : swelling, hardening 2. Shen : focus, sexual desire 3. Qi : sensationofheat 4. Jing : ejaculation Ancientcharacterofheartsymbolises sexual connection, tantricembrace, ancientscholarsrecognized HT coupledwith GB rulersof sexual function. I ching 44 KouGouintercoursebecomingone Rulerblood, directsbloodtopeniswithhelpofchongmai. disturbanceshen: scattering Qi & focus, desire liv. – zongjin: meetingoftheancestralor 100 sinews. Ruleroftendons & sinews Controls storageblood & freeflow Qi Encircles genital region `wei` : flaccidityofzongjin Yang mingnourishespenis Post natalsourceof Qi & blood Unablitytransformationbodyfluids Dampness, overindulgencethinking Qi dificiency Kidneyrulessemen ( partofjing) Brain, spinal chord – seaofmarrow Cerebrospinal fluid - c.f. c.f. & semensimilarconsistancy Lu :Indirectlyinvolved post natalsourceof Qi Po: body-soulinstincts & somaticsensation Connection withphysicalbody Body imagesissues
9. Daoistpractitioners Exercise & meditation Importanceperineum in mantainingpelvicorganhealthandindirectlysustainingjing. Delayingpreventingejaculationandcyclingtheorgasmicenergyupthroughthespineintobrain. Ancienttext: secretsofthejadebedroom Advisorsof Huang Di, Peng-Tzeandrainbowgirl r.g. : Itisgenerallyassumedthat a man gainsgreatpleasurefromejuculation. But when he learnsthe Dao ofyin & yang he will ejaculatelessandless. Will this not deminishhis pleasureaswell? P.T. : Not at all. After ejaculation a man feelstiredhisearsbuzz, hiseyesget heavy and he longs forsleep. He isthurstyandhislimbsfeelweakandstiff. Byejaculation he enjoys a brief momentofsensation but sufferslonghoursofweaknessas a result. Thisis not a true pleasure. However, if a man regulateshisejaculationsto an absolute minimumandretains hissemen, hisbody will grow strong, hismind will beclearandhisvisionandhearing will improve. Whilethe man occasionallydenyhimselfthefleetingsensationofejaculation, his loveforhiswomen will greatlyincrease. He will feelasif he couldnevergetenoughof her. Is that not thetrueandlastingpleasureofsex?
10. Evaluation A thoroughinitialintervieuwconcerningmaritalrelation, recentlossoflovedones, lack ofoppurtunity, lack ofpartner, lack ofconfidence, duration, presenceorabsenceofmorningerection, leveloflibido, arenecessaryyethighchancepatient will not volunteerthisinformation. Testing: medicalexaminationarequietcostly so thestamptestis an alternative. a roll ofstamps, with dry adhesivebackingisroldaroundthepenisbeforesleep. ifstampsarebroken: non-organicpsychologicalreason ifstampsintact: physicalcause. Classicalchinesediagnostic 70 % deficientnature ( kidneyzang ) 30 % excessLiv/GB Blood stasis HT & GB dificiency Stagnation liv. Qi Ganhan- liv. Channel cold Liver-blood & yindificiency HT & SP deficiency Damp-heat & phlegm ( downwardflow ) Kiyangxu ( declineofmingmenfire ) Kiyinxu ( flareupfire ) Chuan yao : drug/herb induceddamagetoki.
11. Kiyangxu: generative factor in sexual desireattainingsustainingerection oldage, chronicdisease, longtermcoldexposure, overwork, druguse, malnutrition, excessive sexual activity. Symptoms: weaknessandsorenessofkneesandlower back, coldness abdominal andlowerjiao, frequent urination, nocturia, oedemalowerlimbs, lowlibido, lowspermcount, poormotility, generalfatigue & listlessness, constipationorloosestools tongue: pale, moist, enlargedtoothmarks, whitecoat pulse: deep & fine Kiyinxu: spontaneousorprematureejaculation stress, overwork, nightshiftwork, stayinguplateatnight, insufficientsleep, pharmaceutical & recreationaldrugs ( chuanyao ). Symptoms: nightsweating, emotional tension stress, vertigo, tinnitus, weaknessandpainlow back & knees, painfullheels, palpitation, darkurine, dry stools. tongue: thinred pulse: thinrappiddeepmaybechoppy HT & SP xu: overworked, physically & mentallyexhausted, pronetoworrying, irregulardiet, toomuchraw orsweetfood. Symptoms: pale lustrelessfacialcomplexion, thinweakbodyconstitution, poorsleep, profuse dreams, insomnia, nervouspanicattacks, sexual performanceanxiety, lack ofappetite, post meal distention, loosestools, forgetfullness. tongue: pale, thinwhitecoating pulse: threadyweak HT & GB Qi xu: fright & shockinjuringkidney Qi, severedamageofshen, Kizhichronictimidity, personality disorders, frightenedby sexual intercourse, shenunabletolead Qi intopenis, scatterdshen flaccid Qi Symptoms: patientsuffersduringintercourse, normal erectionothertimes, anxiety, shyness, beingeasily storrtled, nervousdisposition, palpitations, nightmares, insomnia, paranoia ( somecases ) tongue: pale, thinwhitegreasycoating pulse: finedeepor normal
12. Damp-heat & phlegm: obstructionofchannels, richflavouredfood, alcohol Symptoms: yellowhoturine, incompleteurination, dry mouthandlips, genital painitchy, rashexcessive sweatingaround genital region, heavy sensationlegs tongue: redthickwhite/yellowcoating pulse: rapid slippery/wiry Phlegm: obesemendisorder tan shi, obstructionliv./ yangmingchannelpreventing Qi & boodtoreachpenis Symptoms: chestdiaphragmoppresion, nauseavomiting, aching heavy limbs, dizziness, palpitation, fatigue dampsweatyscrotum. tongue: shineycoating pulse: slippery Blood stasis: trauma after surgeryaround genital region, oldermen, sportsmenbicyclists Symptoms: coldsensation, sharp stingingpainatthebase, heavy draggingsensation tongue: darkredwithpurplespots pulse: choppyorwiry Liv. Qi stagnation: overworkedmiddleagedmen, frustatedyoungmen Symptoms: lossoflibido, genital pain, tightnessfullnesschest & hypochondriacregion, frequentsighing & pain dizziness, fatigue, irritability, depression, abdominal distention, constipationordiarrhoea tongue: normal ordark, mayhaveredages pulse: usuallywiry Liv. Channel cold ( ganhan ): exposuretoextremlycoldenvironment Symptoms: decreasedlibido, coldsensationtesticles & scrotum, coldnesslowerportionofbody, chest & abdomenstiffnessanddistention, pale face tongue: whitecoating pulse: deeptight Liv. blood & yindeficiency: troublefullerection, insufficientblood partial or soft Symptoms: emotional upset, angerandirritability, depression, frequentsighing, dizziness, bluredvision, fatigueandweariness. tongue: red, slightornocoating pulse: threadyorwiry
13. Treatment Basic mainacc. 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 ( taixi ) & 10 & 12 , SP 6 ( sanyinjiao ), ST 29 & 30 Kiyangxu: warm & tonifykiyangaddKi 10, Kiyinxu: tonifykiyin, disperse fireaddKi 2 & 6, PC 8 Shuanyao : tonifyki Liv. Qi stag. : move Qi addLiv. 3, PC 6 GanhanLiv.: tonifyliv. Moxa liv. Blood & yinxu: tonifyyin & moveblood Blood stasis : movebloodaddKi 5 HT & GB xu ( shock ): calmshen & 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 Dampheat & phlegm: disperse heat & damporphlegmaddLiv. 10 & 11 & 12, SP 9, GB 34, ST 36, Ki 10
14. Additional information Clock pair relation GB-HT: sexualityisconnectedtothepsychologicalissuesofshame & guilt ( feelingdirty ) ( day-midnight ) GB isseenasthestorehouseof pure fluidsand clean thoughts, itgivescourage tothemind, erasesphysical & psychologicaltoxinsgives spiritual purity. A proper sexual functioninvolves a quiet HT & deceisive GB. Fright & trauma: ( sexual abbuse, relatedissues ) A verydeepblockageofthe Qi flowwhichcanonlybe healedifthetraumaisintegrated.
15. Microorbitbreathing: The microorbitis also knownas ` The Selfwindingwheelofthelaw` andthecirculationoflight a Taoist yoga Qi energycultivationtechnique. Itusesthepathwayof DM & RN tocirculatethe Qi. Inbreath: Qi isgatheredaroundnavelusingthe PC muscletostirritupand send itthroughthespineupto thehead. Tonguetouchespalatetobridgethepathway. Outbreath: Qi descendsfromheadtonavelcompletingthecycle. PC muscle The pubococcygeusmuscleor PC muscleis a hammocklikemusclefound in bothsexes, thatstretchesfromthepubicbonetothecoccyx ( tailbone ) formingthefloorofthepubiccavityandsupportingthepelvicorgans. Itispartofthelevatoranigroupofmuscles. Accordingtotantrayoga a knowledgehowto handle thismuscleis essential in developing a maturesexuality. In generalitisbelievedthattoomuchsexinjuresthejing, someauthors also statethattoolittlesexmayharmhealth. At least a healthyperineumisthebaseof a maturesexuality. Anima Jung a studentof Freud developedthetermAnimafor man´s encounterwithhisunconsciousdesire, hisinstinctualcravingsofmergingwithlife, whichis a confrontationwiththe `beast` insidelurking on thecrossroadtoriddlemankindwiththemysteryoflife. Itisthe Sphinx fromthrOedipustale.
16. Oedipus A greekmythusedby Freud to understand theimpactof sexual deveolpment in childhood. LaiuskingofThebes was warnedby an oraclethathissonwouldslayhim. AccordinglywhenhiswifeJocastabore a son he exposedthebaby on Mt. Cithaeronfirstpinninghisanklestogether ( swell-foot ). A shepherdtookpity on theinfantwho was adoptedby King Polybosof Corinth andhiswifeand was broughtupastheirson. In earlymanhoodOedipusvisited Delphi and upon learningthat he was fatedto kill hisfatherandmarryhismother he resolvednevertoreturnto Corinth. TravellingtowardsThebes he encounteredLaiuswhoprovoked a quarrel in whichOedipuskilledhim. Counting on hiswayOedipusfoundThebesplaguedby a Sphinx, whoput a riddleto all thepassersbyanddestroyedthosewhocould not answere. Oedipussolved theriddleand in reward he receivedthe Throne ofThebesandthehandofthewidowedqueen. In hissearchtodeterminewhokilledLaius ( andthus end a plague on Thebes ) Oedipusdiscoveredit was he whokilledthelateking, hisfather. Jocasta also soonrealizedthatshehadmarried her ownsonandLaius`smurdererandshehangedherself. Oedipusseized a pinfrom her dressandblindedhimselfwith it. Oedipus was drivenintoexileonlyaccomponiedbyhisdaughter. He foundrefugeandreconcilationwiththeGods in a groveoftreescalledColonusnear Athens. Thusto Freud thedevelopmentofsexualityisverymuchfocused on theparentsasfirstrolemodels. The childhoodsexualityisprojectedontotheoppositegender ( phallicphase ). The boyisattracted ( unconsciously ) tohismotherandseeshisfatherasoponent. Toovercomethisdilemmatheboyidentifieswithhisfathertobridgetheconflict. His egoistooweaktoopposehisfather. The mythofOedipusmaybeunderstood not onlyas a sexual issue but also as a newconsciousawakening. As longasweare not in touchwiththe Tao weare blind torealityand impotent on a shenlevel. Thusreality issomethingwecreateand not somethingwhichis out theirindependatofourselfs. On theotherhandweareconnectedtoeverythingthroughthe Qi whichisforming a worldwide web. Quantum fysicshasshownusthatno matter howobjective an experimentis, itisinfluencedbythemerefactofthepresenceoftheobserver. Thusitis essential not onlytogatherknowledge but also to find meansofexpiriencetoactualizethe material.
17. Questions?