Approximately half of American men between the ages of 40-70 suffer from erectile dysfunction (ED). Similarly, the prevalence of cardiovascular disease (CVD), including hypertension, congestive heart disease / heart failure and stroke, increases from about 40 percent in men 40-60 years of age, to 70 percent in those ages 61 and older.
ED Through a TCM Lens
Let's begin by looking at erectile dysfunction through the lens of TCM theory, where the common diagnoses involve the liver and kidneys. The liver is involved with storing blood, maintaining the smooth flow of qi and blood, and modulating blood volume, which is directly associated with sexual function. The kidney stores essence, which is responsible for growth, development and reproduction. Patterns of disharmony for differential diagnosis of ED include kidney yin deficiency, blood stasis and liver qi stagnation. See Table 1 for signs and symptoms associated with the three TCM patterns.
Table 1: TCM signs and symptoms of kidney yin deficiency, blood stasis and liver qi stagnation.
Kidney Yin Deficiency |
Blood Stasis |
Liver Qi Stagnation |
| - Dry skin - Dry eyes - Dark, scanty urine - Pale face with flushed red cheeks - Red, peeled tongue - Rapid pulse - Fatigue - Irritability - Afternoon heat - Night sweats - Hot flashes |
- Dark circles under eyes - Dark complexion - Abdominal pain - Chest pain or pressure - Heart palpitations - Upper abdominal pain - Swelling, pain and/or stiffness in the arms, hands, legs, or feet |
- Depression - Mood swings - Sighing - Hiccups - Frustrated easily - Inappropriate anger - Sensation of lump in throat - Difficulty swallowing - Bitter taste in mouth - Excessive sleep - Constipation - Abdominal pain and discomfort - Stomach ache that improves after massage, but worsens with anger - Poor appetite - Churning sensation in stomach |
Cardiovascular Disease &ED: Connecting the Dots
Three common cardiovascular diseases afflicting Americans are heart failure, hypertension and coronary artery disease. See Table 2 for the signs and symptoms of each condition. As you can see, there are several signs and symptoms in common between the TCM diagnoses of erectile dysfunction and cardiovascular disease. In further exploration, you'll notice that the symptom profile of kidney yin deficiency can fit a patient with hypertension, vitamin D or omega-3 fatty acid deficiencies, menopause, coronary artery disease, or chronic dehydration.
Table 2: Signs and symptoms of heart failure, hypertension and coronary artery disease.
Heart Failure |
Hypertension |
Coronary Artery Disease |
| - Shortness of breath (dyspnea) with exertion or when lying down - Fatigue and weakness - Swelling (edema) in ankles, legs and eventually in abdomen (ascites) - Rapid or irregular heartbeat - Reduced ability to exercise - Persistent cough or wheezing with white or pink blood-tinged phlegm - Increased need to urinate at night - Very rapid weight gain from fluid retention - Lack of appetite - Nausea - Difficulty concentrating or decreased alertness - Sudden, severe shortness of breath and coughing up pink, foamy mucus |
- Shortness of breath (dyspnea) with exertion or when lying down - Fatigue - Dizziness or fainting spells - Chest pressure or pain - Swelling (edema) in ankles, legs and eventually in abdomen (ascites) - Bluish color to lips and skin (cyanosis) - Racing pulse or heart palpitations |
- Shortness of breath - Sweating - Weakness - Dizziness - Nausea - Rapid heartbeat - Palpitations |
Blood stasis paints a picture of most thrombotic conditions and can express itself as a bruise (non-moving blood), a blood clot or poor circulation. Obviously, reduced cardiac output would lead to poor blood perfusion in the pudendal arteries.
Liver qi stagnation covers a broad spectrum of conditions, from depression and anxiety to GI issues and heart conditions. Not surprisingly, herbal formulas such as Fo Ti for ED also improve cardiovascular health.
Even poor early-morning erections can indicate developing cardiovascular disease and should prompt you to inquire if the patient has shortness of breath on exertion or lower-extremity bilateral edema. The pudendal arteries are smaller than the cardiac arteries, and plaque build-up will have a greater effect on penile blood perfusion; thus the reference to the canary in a coal mine. Large clinical studies have demonstrated that men with erectile dysfunction have more than a 50 percent greater mortality rate compared to control groups with equivalent testosterone levels.
Practical Pearls
From a Western medical standpoint, it's not just low testosterone or an enlarged prostate that contributes to erectile dysfunction. Certainly obesity, smoking, sleep disorders, alcohol, specific medications, stress/anxiety/depression, inactivity, prostate surgery, and illness can have a negative effect on sexual function. Regardless, any patient presenting with ED to your clinic should be a red flag prompting a referral to their cardiologist.
Reference
- Pozzi E, et al. Longitudinal risk of developing cardiovascular diseases in patients with erectile dysfunction - which patients deserve more attention? J Sexual Med, 2020 Aug;17(8):1489-1494.
Resources
- Heart Failure. MayoClinic.com: www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142.
- Pang B, Zhou Q, Zhao TY, et al. Innovative thoughts on treating diabetes from the perspective of traditional Chinese medicine. Evid Based Complement Alternat Med, 2015;2015:905432.
- Yazdanyar A, Newman AB. The burden of cardiovascular disease in the elderly: morbidity, mortality, and costs. Clin Geriatr Med, 2009;25(4):563-77.
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