This article is also available as a PDF in its published form EJOM, Vol 3, No. 3, Summer 2000 (pdf)
Male Ureo-genital Disorders
Abstract: In this article I introduce the reader to other forms of diagnosis and treatment of male ureo-genital problems. The standard TCM concepts of Kidney Deficiency, Yin Fire, and Damp Heat, while often useful, do not always provide the best treatment strategies for all patients. With the ability to utilise other points of view, it is my hope that readers will benefit patients with problems that have not responded to the standard TCM approaches.
For a variety of socio-anthropological reasons most acupuncturists treat more women than men. One of the primary differences between male and female patients is in the field of gynecology and endocrinology. Women tend to be far more sensitive to hormonal issues. This is true not only in terms of menstrual hormones, but also in terms of incidence of thyroid diseases as well as prevalence of autoimmune disorders which are often related to endocrinological status.
However, we cannot say that men do not have gynecological problems. It is only that men have different kinds of problems than women do as related to their reproductive organs. The term male gynecology may upset some women, but I see it as promoting equality, rather than separateness, between the genders.
In this article I will outline the Kiiko Matsumopto style treatment protocols for three male disorders: prostatitis, testicular problems, and erectile dysfunction.
The Matsumoto style relies heavily upon palpation as a form of diagnosis. Whenever we find pressure pain in the abdomen, we take note of it and we attempt to reduce the pressure pain during the treatment. We choose remote points that will reduce the pressure pain in the abdomen. The abdomen is not the only area used for diagnosis: we also palpate the chest, the neck and throat, and the back. The two principles of the Matsumoto style is to treat everything one finds and not just the presenting symptoms, and to attempt to treat the oldest injury/trauma/illness in the patient’s history if it still reflects in the body. This is based on the idea that as long as some past incident has a hold on the body-energetics, the body might not be able to deal with more recent issues. In other words, by letting go of the past we are able to deal well with the present.
Technically, we adhere to another principle, which is that we treat the abdomen mostly from the bottom up, as if fixing the basement before fixing the roof. There are often exceptions to this “rule,” that relate to how important or how deep an issue is. Although ureo-genital issues reflect in the lower abdomen, they do not always take precedents in treatment, and other issues might need to be addressed first.
In traditional female-gynecology, the three leg Yin channels are of primary importance. The Kidney rules our reproductive energies, while the Liver circles the genitals. Because women’s gynecology is strongly correlated to blood, the Spleen and Heart (or Pericardium) play a more significant role than they would in male gynecology. According to Master Nagano, in women, ST28 reflects the ovaries and Kid13 reflects the uterus. The ovaries are considered to be in the Kidney domain, hence we treat pressure pain on ST28 via Kidney points (most commonly Kid7). The uterus, which relates more to blood is considered to be influenced by the Liver and Spleen, and we tend to use Liver and Spleen points to release pressure pain on Kid13 (most commonly Liv4, Liv8, SP3, or SP7).
In male gynecology, the reflexes used are also Kid13 and ST28 but also Kid11 and ST30, as well as the midline (Ren) points. Master Nagano says that male gynecology involves the Liver and Kidney meridians.
According to Master Nagano this is a Liver and Kidney disorder. The treatment points are Kid6, Liv8, and G.B.31. These should be tested and ensure that they release the pressure pain found in the lower abdomen. One often needs to change the location of the point slightly in order to find the exact point that truly releases the abdominal findings.
Liv8 (Qu Quan – Bending Spring) requires that the knee be slightly bent when locating and needling it. Look for the slight nodule/gummy feeling at the edge of the crease. Many TCM practitioners take Liv8 quite a bit higher than we do (perhaps in an attempt to place it in the notch created by the femoral epicondyle). Liv8 is a “cyst shrinking” point: it is imperative that you find the exact Liv8 that eliminates the abdominal pressure pain. We also add direct moxa on this point. (We use very fine, yellow/gold coloured moxa with tiny sesame size grains and we make sure that the moxa is not pressed hard, so the heat is not intense. This kind of moxa can be used in Yin Deficiency and Heat conditions).
(In women the whole area above Liv8 can indicate hormonal imbalances if one finds puffy, thick tissue here. This area stretches for about 2-3 cun above Liv8 on the Liver channel. I have not found this correlation in men.)
Often, prostatitis patients have pressure pain on Liv2. We press on Liv2 (towards the thumb) with 3kg pressure. If this amount of pressure is painful, we needle both Liv4 and Liv8. This is a principle we call “treating Metal/Water in order to reduce Fire” (Water counters Fire, and Metal, as the mother of Water, enhances this ability). We locate Liv4 about one thumb’s width below the internal malleolus, just medial to the tibialis anterior, and we needle it superficially upwards with the flow of the channel.
Kid6 is needled superficially towards the achilles tendon, and G.B.31 is needled perpendicularly. It is possible that the patient will also have pressure pain on Kid2, upon 3kg pressure. This finding is more common in women than in men. Our Kid2 is not quite as close to the navicular bone as the TCM point location, but lies in the more fleshy part of the arch of the foot (slightly forward and below the TCM location). If Kid2 is painful, we compare the effect of Kid6 on releasing the abdomen against the effect of Kid7 with Kid10 in releasing the abdomen. This is because, if a Fire point is painful, the preferred treatment is the Metal and Water points. We define Kid7 as the “puffy” spot, from 2 to 4 fingers above the malleolous, and needle it at a 30-degree angle upwards toward the knee. Kid10 is needled superficially upwards.
Although we do not emphasise the treatment of the Spleen in male gynecology, if we find a nodule, puffiness, or a dent, on SP7, we use SP7 as well (preferably with direct moxa). Master Nagano says that SP7 is a Spleen channel point which affects the Kidneys, and thus uses it for water retention and ear infections. Our SP7 is on the back edge of the tibia, and some TCM practitioners will associate this point with Liv6 (we take the Liver channel on the bone itself).
Patients who are taking female hormones for the treatment of prostatitis, should be checked for hormonal imbalance, and S.I.3 can be added. A hormonal/pituitary imbalance often shows as pressure pain on U.B.2, and pressing on U.B.2 will often release the gynecological abdominal findings, confirming a pituitary connection. S.I.3 is the master point of the Du, and hence is chosen to fix brain/pituitary problems. We use U.B.2 as both a reflex and treatment point of hormonal problems, rather that U.B.1 simply as a matter of convenience. U.B.1 has been called Ming Men in ancient texts and hence can be considered to have a relationship to Ming Men and hormones (that which maintains the gates of life). Because of the relationship of the Liver and the eyes, points around the eyes can treat liver channel disorders.
U.B.66 is another hormonal point, as it is Water on Water. It is especially useful in the elderly population. We also use U.B.66 for dryness associated with hormonal depletion in old age, as well as to fix tailbone shifts.
Treating the sacrum is extremely important in male gynecological problems. Generally men have far tighter sacro-iliac ligaments than women do. It is my understanding that this may be due to their higher center of gravity, caused by broader shoulders and narrower hips, resulting in greater tension in the sacral area.
U.B.33 is a point we consider to be the “male sexual dysfunction” point (for women we use U.B.32). It is common to find gummy spots on the sacrum, almost as if the bones have a rough edge, in prostatitis and other male ureo-genital problems. It is my contention that breaking these areas of stagnation and smoothing them out helps the ureo-genital system.
A point just outside U.B.35 (Hui Yang – the Meeting of Yang, an important point for men) is called “prostate shrinking” point. You know you got the right point when you feel as if there is a nut inside the muscle. Because of the typical male tightness in the sacro-iliac area, men often jump when you palpate this area. Do not assume that because the point is tight, it is the correct point. Look for the point that has a nodule/gummy feeling, like a nut, under your fingers, and needle it, breaking down the gumminess.
It is now common practice to remove a testicle if there is a growth is suspected. The biopsy is done after the testicle was removed. Men’s balance is partially dependant on their testicles, since this is the lowest organ. The removal of a testicle can create structural problems resulting in back and then shoulder pain.
Because the Liver channel controls the testicles, we understand that removal of a testicle creates an imbalance in the Liver channel between both sides: the channel both sides circle the genitals intermingling in the testicles. By dogma it is consider that the side of the removed testicle is more deficient compared to the healthy side. Therefore we restore the balance to the Liver channel by needling Liv1 on the unhealthy side, and Liv2 on the healthy side. Liv1 is needled superficially in the direction of the channel flow (I use only Seirin #1 needles here), and Liv2 (on the opposite side) is needled towards Liv1, creating a vector across the Liver channel on both legs.
However, this “dogma” can be proven wrong, and I have had cases where Liv1 on the healthy side combined with Liv2 on the unhealthy side has done the best job for the client. I believe that this is because the imbalance between the two sides of the channel is what is most important, and that which way the imbalance presents is not always uniform.
In all cancers we check Liv9. Originally Kiiko was using this point for breast cancer, but its use has expanded to all cancers. Liv9 is Yin Bao, the Yin Wrapping (or the Yin Bladder), which we can interpret as related to cancer, cancer being a Yin substance that envelops itself.
Despite the pitches of a former presidential candidate on American television, erectile dysfunction is probably best treated without the use of Viagra. The process of gaining an erection involves the dilation of blood vessels but at the same time requires a certain amount of tension/excitement within the nervous system. Although the erection itself is within the domain of the sympathetic nervous system, it requires the cooperation of the parasympathetic nervous system as well. Orgasm is a unique process where these two normally antagonistic systems are activated together.
Although some erectile dysfunction can be rooted in structural blockages and other issues, in many cases it is an autonomic nervous system disorder. Other symptoms typical to an ANS disorder can be easily sweating, easily nervous, palpitations, temperature imbalance, insomnia, and lack of time adjustment (that is, sleepy during the day yet overly awake at night and unable to sleep).
A typical pulse in ANS disorders is a pulse Master Nagano calls a tight pulse. This pulse is often thready and has a “wiry” or tight quality. Most significantly this pulse either disappears or changes quality upon deeper palpation.
There are many abdominal and other reflex areas that will display pressure pain in an ANS disorder. However, none of them are conclusive. Ren17 is called “anxiety reflex” and typically shows in ANS type patients. Pressure pain (with 3kg pressure) on P.8 may be an indication of ANS disorder: if on one side P.8 is painful but on the other side it is not, this is a clear indication of ANS disorder as we consider the Pericardium channel to be the ANS channel. The occipital region can also reflect ANS problems, especially blood pressure imbalances (both low and high blood pressure). Tightness in the SCM muscle is commonly seen as well, as the vagus nerve runs through the SCM, and tightness in the SCM congests the parasympathetic action of the vagus nerve.
It is not necessary to have an ANS pulse or any particular body reflex for the diagnosis of an ANS imbalance. Most often we diagnose an ANS disorder from the symptoms, and we confirm the diagnosis by ascertaining that ANS points indeed resolve, or help resolve, the abdominal findings and other reflexes.
If there is SCM tightness, this should be resolved first, to allow parasympathtic function to flow into the organs. We release the SCM using opposite side Shao Yang points. If the patient has a rapid pulse we use S.J.5 and G.B.41 opposite the tight SCM, making sure that the tightness is softened and the pressure pain is eased. If the pulse is normal or slow, we us ~S.J.8 and G.B.40 (still on the opposite side of the SCM to be released). The point we call “~S.J.8” is about one-third down form the elbow to the wrist, and is at the mound of the muscle (it is in fact above S.J.9). If the point releases the SCM on the opposite side, then it is the right point.
Ren17 pain is released by use of Pericardium channel points. However prior to using the Pericardium channel, we use S.J.5 with G.B.41, bilaterally, especially if the patient has a rapid pulse.
We determine which points to use on the Pericardium channel as follows: If there is pressure pain (with 3kg pressure) on P.8, we needle P.3 and P.5, according to the “Metal/Water overcoming Fire” principle. If the patient likes the pressure on P.8, P.8 is needled, however, many patients dislike the idea of a needle in the centre of the palm, and in such cases P.4 can be used instead. This P.4 is 3 fingers below P.3. If the patient does not like nor dislikes the pressure on P.8, then P.6 is needled. All Pericardium points are needled shallowly and with the flow of the channel. I use Seirin #1 on P.8. (A note on the location of P.3 and P.4: The Japanese P.3 is located between the two tendons of the bicep muscles, in the centre of the crease, and not medial to the medial tendon as per TCM. P.3 is located 3 fingers below that. In thin and muscular people you will be able to see a depression in the muscle, otherwise, brush your hand lightly down the Pericardium channel to feel this depression.)
We always differentiate between rapid pulse and slow pulse for ANS patients, as the pulse rate determines the treatment strategy. Rapid pulse patient requires emphasis on the abdomen, while slow pulse type patient is treated on the back. Rapid pulse is considered 85 beats per minutes or faster. Slow pulse is 65 BPM or less. We normally treat patients with a pulse rate of 65-85 BPM as if they had a rapid pulse. It is very important to not mix the two strategies.
For the rapid pulse type, we treat the point under the 3rd toe, in the centre of the phalangeal-metatarsal joint (plantar side). This is our main blood pressure imbalance point, used for both high and low blood pressure. This point often releases Ren17, as well as the occiput (on the opposite side of the toe used). The third toe does not have any points on it and is in the domain of the Stomach sinew meridian. Akabane determined that it relates to the chest and diaphragm. We also use Ren6 and Liv12 for rapid pulse type. We needle Liv12 superficially and towards the pubic bone. It is important to find the tight spot around Liv12. (In the case of erectile dysfunction, the tightness on Liv12 may be disrupting blood circulation into the genitals.)
If the patient has a slow pulse rate, then DU2, needled superficially upwards, is used in lieu of Ren6 and Liv12. (It is important to not stimulate the abdomen when a patient has a slow pulse as abdominal stimulation can further slow the pulse rate.)
Liv12 is called Ji Mai, the urgent or anxious pulse, which represents sympathetic dominance. We can easily see how this point reflects the autonomic nervous system by assuming a Tai Chi posture with the tailbone suspended and dropping straight down. This is a neutral position. When we tilt the pelvis forward, pressing into the thigh (Liv12 area) we can feel that this creates an anticipation, a sense of urgency, in us. Tilting the pelvis back (sticking the tailbone backwards) also changes our emotional disposition and we feel less calm. From this we can understand that the tailbone (DU2) and the inner thigh (Liv12) play a major role in the state of the autonomic nervous system.
Master Kawai uses special diode rings that he places on the middle finger (pericardium channel). These are extremely useful in all cases of ANS disorders, and because they can be worn at all times, can serve as homework for the patient. (Diode rings can be obtained from Kiiko Matsumoto at 8 Centre Street, Natick, MA 01760, USA. The cost is $73, including shipping, paid in US dollars.) For gynecological issues, Master Kawai uses a diode ring on the small finger. Master Kawai has also constructed a special “cock ring” consisting of a double diode ring, specifically for erectile dysfunction. This ring is worn as a “cock ring” and stimulates healthy circulation in the area. However, these rings are not available except to Master Kawai’s patients in Japan.
The importance of treating the autonomic nervous system in all patients who present as such cannot be over-emphasised. A 30 year old man who complained of a “leaky penis” (meaning he was leaking urine, not semen, in small dribs) and urinary frequency and urgency (an inability to hold urine even for a minute or so). He showed no standard ureo-genital abdominal findings, nor did he display Kidney deficiency signs. However, his clammy hands, tight pulse, and tight SCM, led me to believe that this indeed was an ANS disorder, and that perhaps it was nervousness that caused the leaky penis. After two treatments concentrating on releasing the SCM and adjusting the autonomic nervous system, this patient reported his penis stopped leaking and that he was able to finish conversations rather than to run to the bathroom when pressure arose. Three months later he called to confirm that he was still doing fine in the “leaking” department.
Because of the importance of releasing the sacrum in male ureo-genital problems, it often becomes necessary to release the occipital and neck region, in accordance with the cranio-sacral principle that the two areas are related. I always check the cervical vertebrae and the occiput (U.B.10, G.B.20 area) on all patients. Because pressure pain here can be a reflection of the vertebreal artery (Hua Tuo of cervicals C2- C5) or the basilar artery (below the occiput), this area can serve as a reflection of the rest of the spine all the way down to the sacrum, since the basilar arteries join and turn downwards to form the spinal artery which nourishes the spine (they also move forward into the circle of Willis to nourish the brain).
The points that release the occiput and cervicals are Liv8, Kid10, and ~S.J.8 (the same point which releases the SCM), all on the side of tightness. On the back we treat U.B.58, U.B.40 (taken closer to U.B.39), and U.B.60, all on the tight side, with U.B.60 needled against the flow of the channel with some stimulation and U.B.58 and U.B.40 needled perpendicularly and shallowly.
In spite of great advances in societal outlook on gender roles, we can still differentiate between the genders in the way they handle (or mishandle) their emotions. This can reflect in the body also. I find that men display broken vessels (visible Luo vessels) in the subcostal area, far more frequently than women. This is the area of Ren15 through Liv14, and even more laterally, as well as just under the ribs. Whenever I notice these blood vessels, whether red or blue, I use a gentle seven-star technique on them, and stop when the tiniest drop of blood is released. One can also just rub the area until it is red to activate the blood vessels.
Luo vessels are the vessels of blood, and the blood is the carrier of the Shen and emotions. Often suppressed emotions will result in the appearance of Luo vessels, and activating the Luo and bleeding them, allows those emotions to be circulated and vented. I have found a high correlation between the Qiao vessels (the statement of how I reflect on who I am, how I stand up to myself and to the world, pelvic constriction, back pain, as well as physical ankle pain) and the Luo vessels across the lower ribs (Liv14, Ren15 area). There is no classical text explanation for this. Nowadays, we would view Luo vessels in this area as possibly related to the Ren Luo (Ren15), and hence the importance of releasing these blood vessels for ureo-genital reasons becomes apparent.
However, I associate these Luo vessels with the Qiao vessels, specifically with the Yin Qiao, which also relates intimately with the genital region. Before the idea of a Luo vessel for the Ren and the Du (Ren15, DU1) was developed, there was the idea of the Qiao vessels being the Luo of the Ren and the Du. It is possible that this is what the classics had in mind. We can also see these blood vessels as obstruction in the diaphragm/chest/heart, and hence they are important to release as they will further release the belt (Dai) and genitals. We know that there are two watchtowers in the body, Ren8 (Shen Que) and Ren14 (Ju Que). These are watchtowers that guard over the two main obstacles of life, the belt/genitals and the diaphragm/heart which can be said to represent the separate self (the will to live of the kidney) and the larger, universal self (represented by the penetrating compassion of the Heart). When one watchtower is released, the area under guard by the other can be released also.