Jing, the Extraordinary Vessels & the Physiology of the Male Reproductive System
Although Chinese medicine contains an extensive tradition relating to gynaecology and women’s physiology, comparatively less attention has historically been given to male disorders within classical and modern literature.
Yet in contemporary clinical practice, presentations involving the prostate, sexual function, fertility and Jing are increasingly common.
Understanding these conditions within Chinese medicine requires interpretation through the channels, Extraordinary Vessels, Jing and the internal organs.
In particular, the relationship between the Kidneys, Heart, Liver and the Ren, Chong and Du Mai plays an essential role in male reproductive physiology and pathology.
The Male Reproductive System in Chinese Medicine
While Chinese medicine has a rich tradition in the diagnosis and treatment of gynaecological problems, fewer ancient or modern texts are dedicated to the diagnosis and treatment of men’s problems. For example, Chinese medicine refers to the “Uterus” in all its classic texts, but no mention is ever made of the prostate. The Du Mai, Ren Mai and Chong Mai are said to arise in the Lower Burner and flow through the uterus: but where do they flow through in men? The classics do not say.
Topics explored include:
• The role of Jing and the Extraordinary Vessels in male reproductive physiology
• The relationship between Heart and Kidneys in sexual function
• Dampness, Phlegm, Blood Stasis and stasis of Jing
• The channels influencing the genital system
• Clinical differentiation in male reproductive disorders
Before discussing the treatment of specific conditions, we should look at the channels that affect men’s genital system and how the penis, testis, seminal vesicles and prostate fit in Chinese Medicine.
In particular, understanding the role of the Bao and the Extraordinary Vessels is essential in interpreting male reproductive physiology within Chinese medicine.
While the classics discuss the Uterus extensively, the concept of the Bao may also apply to men through the “Room of Sperm” — the structure associated with Jing and reproductive function.
The Bao, Jing & the “Room of Sperm”
Chapter 65 of the “Spiritual Axis” says: “The Ren and Chong Mai originate from the Lower Dan Tian [literally “Bao”].”1 The actual term used by the “Spiritual Axis” is “Bao” which is often translated as “uterus”. However, while the term “Zi Bao” refers to the Uterus, the word “Bao” indicates a structure that is common to both men and women: in women, it is the Uterus, in men, it is the “Room of Sperm”. Both these structures reside in the lower Dan Tian and store Jing and, as the Extraordinary Vessels originate from here, they are closely connected to Jing.
The “Golden Mirror of Medicine” (Yi Zong Jin Jian, 1742) says: “The Du Mai arises within the lower abdomen, externally in the abdomen, internally in the ‘Bao’… also called Dan Tian in both men and women: in women it is the uterus, in men it is the Room of Sperm.”2
This classic text therefore states clearly that Bao is a structure common to men and women, in the former corresponding to the “Room of Sperm” (or “Room of Jing”) and the latter to the Uterus. The “Room of Sperm” is in the lower abdomen but we know that the sperm is made in the testicles, seminal vesicles and prostate. I think it is therefore legitimate to assume that the prostate is a structure that is equivalent to the uterus in women and that therefore the Du Mai, Ren Mai and Chong Mai flow through the prostate.
Treatment principles associated with these presentations may therefore involve not only the Kidneys, but also the Extraordinary Vessels, the movement of Qi and Blood, and the circulation of Jing within the Lower Burner.
Within the Three Treasures line, formulas reflecting these treatment principles may include:
• Strengthen the Root®
• Nourish the Root®
• Red Stirring®
Channels & Extraordinary Vessels Influencing the Male Genital System
The male genital system is influenced not only by the internal organs, but also by a complex network of channels and Extraordinary Vessels.
In particular, the Liver and Kidney channels, together with the Ren, Chong and Du Mai, play an essential role in reproductive physiology and pathology.
The genitals are related primarily to the Liver and Kidney channels and to the Ren, Chong and Du Mai. The Liver Luo channel, loops around the genitalia. While the influence of the Ren Mai on the genitalia is obvious, that of the Du Mai Vessel is often overlooked.
The “Su Wen” (Chapter 60) describes an anterior branch of the Du Mai Vessel that flows to the external genitalia both in men and women, and to the pubic bone and from here ascends up the abdomen on the same trajectory as the Ren Mai.
The branch of the Du Mai going to the penis in men and vagina in women has clinical significance because it means we can use the Du Mai (rather than the Ren Mai) for genital problems in both men and women. We would want to do that when there is a pronounced Kidney-Yang deficiency.
The pathways of the channels flowing through the genitalia are as follows:
- A branch of the Du Mai flows down to the genitalia.
- The Kidney Main, Luo and Muscle channels flow through the genitalia.
- The Liver Main, Luo, Divergent and Muscle channels wrap around the genitalia.
Pathology of Male Disorders: Dampness, Phlegm & Stasis of Jing
Chronic male reproductive presentations may involve not only deficiency, but also obstruction.
Dampness, Phlegm, Blood Stasis and impaired circulation of Jing may all contribute to longstanding or more complex presentations.
Two important pathological factors within the male genital system are Phlegm and stasis of Jing.
Manifestations of Phlegm in the Male Genital System
- Prostatic hypertrophy
- Peyronie’s disease
- Priapism
- Erectile dysfunction
- Sweaty genitals
Stasis of Jing
Although it may seem strange to talk of “stasis” of Jing, it does occur in men and it is basically men’s equivalent of Stasis of Blood in the Uterus in women.
This concept is particularly important clinically, as longstanding obstruction may impair the circulation not only of Qi and Blood, but also of Jing itself.
The clinical manifestations of stasis of Jing are:
- stabbing pain lumbar region
- pain in perineum
- hypogastric pain
- pain in testis and/or penis
- erectile dysfunction
- premature ejaculation
- priapism
- prostatic hypertrophy
- premature greying of hair
- itching or pain pubic region
- abnormal sperm
- Peyronie’s disease
- Purple tongue
- Choppy or Firm pulse
The Relationship Between Heart & Kidneys in Male Reproductive Physiology
Beyond the role of the Kidneys and Extraordinary Vessels, the relationship between Heart and Kidneys is also central to sexual physiology.
The coordination between Heart-Fire and Kidney-Water plays an essential role in arousal, erection, ejaculation and reproductive function.
The menstrual and sexual function in women and the sexual function in men rely on the coordination and harmony between Kidneys and Heart. The Water of the Kidneys and the Fire of the Heart need to nourish each other. While the Kidney-Jing is the origin of sperm in men and menstrual blood/ova in women, the Heart plays an important role in erection and sexual arousal.
In particular, in men, the Heart plays a crucial role in erection, orgasm and ejaculation. Just as the discharge of blood at menstruation and the release of the eggs at ovulation depend on the descending of Heart-Qi, erection and ejaculation also depend on the descending of Heart-Qi. To perform these functions, Heart-Qi descends to communicate with Kidney-Qi.
Kidney-Water needs to ascend towards the Heart and Heart-Fire (the physiological Emperor Fire) needs to descend towards the Kidneys: the coordination between the descending of Heart-Fire and ascending of Kidney-Water ensures a normal menstruation and ovulation in women and normal sexual function in both men and women.
The ascending of the Kidneys and descending of the Heart in the menstrual and sexual sphere is also ensured by the communication between the Du Mai and the Ren Mai: in fact, both these extraordinary vessels originate from the space between the Kidneys, both flow through the Uterus (in men through the prostate) and both flow through the heart.
The Du Mai and Ren Mai form like a closed circuit and may be looked upon as one channel, one Yang, the other Yin. The Du Mai represents the Kidney-Yang and the Ren Mai the Kidney-Yin in the fluctuation of Yin and Yang during the menstrual cycle: the proper communication between Heart and Kidneys and between the Du and Ren Mai ensures a normal menstruation/ovulation and normal sexual function in both men and women.
With regard to sexual function, during sexual excitation the Minister Fire within the Kidneys is aroused and flows up towards the Pericardium and Heart: for this reason the person becomes flushed in the face (the complexion is a manifestation of the Heart) and the heart rate increases during sexual excitation. With orgasm and ejaculation, there is a downward movement of Qi which releases the accumulated Minister Fire downwards: in order for this to occur normally the downward movement of Heart-Qi is crucial.
A normal sexual desire, arousal, erection and orgasm therefore relies on three main factors:
- The ascending of Kidney-Water and descending of Heart-Fire
- The communication between Kidneys and Heart
- The connection between Du and Ren Mai.
If the Minister Fire within the Kidneys is deficient there will be a decreased libido in both men and women and an inability to reach an orgasm in women and impotence in men. If Heart-Qi and Heart-Blood are deficient or not descending to communicate with the Kidneys, there may be impotence or premature ejaculation in men and inability to reach an orgasm in women even in the presence of sexual arousal.
The “Discussion on Blood” written in 1884 by Tang Zong Hai says: “Fire is Yang and generates Blood which is Yin. On the other hand, Blood nourishes Fire and makes sure that Fire does not flare up, whilst Blood moistens the lower Burner. It is stored in the Liver, it fills the Sea of Blood and the Chong, Ren and Dai Mai, and it warms and nourishes the whole body . . . When Blood moistens the Lower Burner and the Sea of Blood, and Heart-Fire follows it down to the umbilicus, then Blood is flourishing and Fire does not flare excessively, so that men are free of disease and women are fertile.”
From this passage it is apparent that the Heart-Qi and Heart-Blood need to flow downwards to the Lower Burner to interact with Blood and Jing.
Treatment principles associated with these dynamics may include nourishing Kidney-Yin, warming Kidney-Yang, calming the Shen and restoring communication between Heart and Kidneys.
Within the Three Treasures line, formulas reflecting these treatment principles may include:
• Strengthen the Root®
• Nourish the Root®
• Calm the Shen®
Clinical Differentiation in Male Disorders
Although presentations may appear similar clinically, the underlying mechanisms may differ significantly.
Differentiation may involve deficiency, Dampness, Blood Stasis, Phlegm, obstruction within the channels or impaired communication between Heart and Kidneys.
Erectile Dysfunction
Factors Affecting Erection
- Du Mai – Kidney-Yang – Minister Fire – Fire of Ming Men
- Blood – Heart-Blood
- Chong Mai in four ways:
- – Sea of Blood
- – Post-Natal Qi (at ST-30 Qichong)
- – Pre-Natal Qi (at Ren-1 Huiyin, KI-13 Qixue and Ren-4 Guanyuan)
- – Influences penis through Zong muscles
- Liver channel (Main, Luo, Muscle and Divergent) wraps around penis
- Pathogenic factors such as Dampness, Blood stasis, stasis of Jing.
Kidney-Yang Deficiency
Impotence, lower backache, dizziness, tinnitus, frequent-pale urination, nocturia, feeling cold, cold lower back and knees, Pale tongue, Deep-Weak pulse.
Gui Lu Bu Shen Tang, Lu Jiao Jiao, Gui Ban Jiao, Gou Qi Zi, Rou Cong Rong, Huang Qi, Shu Di Huang, Yin Yang Huo, Yi Zhi Ren, Ba Ji Tian.
Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), BL-23, Du-20, Ren-6, Ren-4, Ren-3, KI-3.
Kidney-Yin Deficiency
Impotence, lower backache, dizziness, tinnitus, scanty-dark urine, night-sweating, insomnia, tongue without coating, Floating-Empty pulse.
Di Long Tang, Di Long, Shan Yao, Shan Zhu Yu, Tu Si Zi, Tian Men Dong, Gou Qi Zi, Gui Ban Jiao, Shu Di Huang, Mu Li, Mu Dan Pi.
Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), BL-23, Du-20, Ren-6, Ren-4, Ren-3, KI-3, LU-7 with KI-6 (Ren Mai).
Damp-Heat in Lower Burner
Impotence, difficult-painful urination, turbid urine, itching of genitals, urethral discharge, tongue with sticky-yellow coating with red spots on root, Slippery pulse.
Bi Xie Fen Qing Yin, Zhi Bo Di Huang Wan
Acupuncture: SP-4 on the left with P-6 on the right (Chong Mai), LIV-5, SP-9, SP-6, Ren-2, Ren-3, LIV-1, LIV-3.
Damp-Heat in Liver Channel
Impotence, difficult-painful urination, rash external genitalia, irritability, tongue with red sides and sticky-yellow coating and red spots on the root, Wiry pulse.
Qing Gan Li Shi Tang
Huang Bo, Huang Qin, Qu Mai, Bian Xu, Hua Shi, Zhi Zi, Che Qian Zi, Mu Tong, Chai Hu, Yin Chen Hao, She Chuang Zi, Wang Bu Liu Xing, Jin Qian Cao.
Acupuncture: SP-4 on the left with P-6 on the right (Chong Mai), LIV-5, SP-9, SP-6, Ren-2, Ren-3, LIV-1, LIV-3.
Liver-Blood Deficiency
Impotence, dizziness, blurred vision, depressed mood, insomnia, Pale tongue, Choppy pulse.
Shao Yao Gan Cao Tang Jia Wei, Bai Shao, Zhi Gan Cao, Dang Gui, Shu Di Huang, Huang Jing, Shan Zhu Yu, Wu Wei Zi, Gou Qi Zi.
Acupuncture: LU-7 on the left with KI-6 on the right (Ren Mai), BL-23, Ren-4, LIV-8, Ren-3, ST-36, SP-6.
Heart and Gall-Bladder Qi Deficiency
Impotence, premature ejaculation, depressed mood, timidity, sighing, insomnia, palpitations, easily startled, Pale tongue, Weak pulse.
Da Bu Yuan Jian, Shu Di Huang, Shan Zhu Yu, Shan Yao, Gou Qi Zi, Du Zhong, Dang Shen, Gan Cao, Dang Gui.
Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), HE-7, GB-40, Ren-4, Du-20, ST-36, SP-6,.
Heart-Blood Deficiency
Impotence, palpitations, dizziness, depressed mood, insomnia, Pale tongue, Choppy pulse.
Gui Pi Tang
Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), HE-7, HE-5, Du-24, Ren-15, Ren-4, Ren-3, BL-15, SP-6.
Stasis of Jing and Phlegm
Impotence, pain in the testis and perineum, hypogastric pain, premature greying of hair, abnormal sperm (motility, shape, etc.), oppression of the chest, urethral discharge, Purple tongue, Firm-Slippery pulse.
Huo Xue Tong Jing Tang, Dang Gui, He Shou Wu, Yi Mu Cao, Ji Xue Teng, Chuan Niu Xi, Gou Qi Zi, Xue Jie, Ban Xia, Dan Nan Xing, Gua Lou.
Acupuncture: SP-4 on the left with P-6 on the right (Chong Mai), Ren-3, LIV-5, SP-10, BL-34, ST-40, SP-9.
Premature Ejaculation
Heart and Kidneys Not Communicating (Heart- and Kidney-Yin Xu)
Premature ejaculation, 5-palm heat, dizziness, tinnitus, night-sweating, palpitations, lower backache, depressed mood.
Zhi Bai Di Huang Wan plus Jin Suo Gu Jing Wan
Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), HE-7, KI-7, Ren-15, Du-20, BL-23, BL-32, Ren-4.
Heart and Kidneys Not Communicating (Heart- and Kidney-Qi Xu)
Premature ejaculation, dizziness, tinnitus, palpitations, lower backache, depressed mood, pale face.
Gui Pi Tang plus Jin Suo Gu Jing Wan
Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), HE-7, KI-7, Ren-15, Du-20, BL-23, BL-32, Ren-4.
Low Sperm Count
Kidney-Yang Deficiency
Low sperm count, dizziness, tinnitus, lower backache, cold back and knees, frequent-pale urination, etc. Pale tongue, Weak-Deep pulse.
Wu Zi Heng Zhong Wan Variation: Gou Qi Zi, Tu Si Zi, Wu Wei Zi, Fu Pen Zi, Che Qian Zi, Sang Shen Zi (Fructus Mori albi), Fu Zi, Jiu Cai Zi (Semen Allii tuberosi), Lu Ba Zi (Semen Trigonellae Foeni-graeci), She Chuang Zi, Dang Gui, Xu Duan, Dang Shen, Ba Ji Tian, Lu Jiao Jiao
Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), BL-23, Ren-4, KI-13, KI-12, BL-32.
Kidney-Yin Deficiency
Low sperm count, dizziness, tinnitus, feeling of heat in the evening, night sweating, backache, tongue without coating, Floating-Empty pulse.
Ye He Sheng Jing Tang: Mu Dan Pi, Di Gu Pi, Chi Shao, Bai Shao, Shan Zhu Yu, Lian Qiao, Xia Ku Cao, Chai Hu, Zhu Ye, Fu Ling, Sheng Di Huang, Xuan Shen, Mai Men Dong, Zhe Bei Mu, Dan Shen, Gou Qi Zi, Yin Yang Huo, Mu Li.
Acupuncture: LU-7 on the left and KI-6 on the right (Ren Mai), Ren-4, Ren-7, KI-13, KI-12, BL-23.
Liver-Qi Stagnation with Kidney Deficiency
Low sperm count, lower backache, dizziness, tinnitus, night-sweating, irritability, abdominal distension. Tongue without coating, Pulse Weak and slightly Wiry on the left.
Zhi Bai Di Huang Wan Variation: Shu Di, Gou Qi Zi, Tu Si Zi, Shan Zhu Yu, Lu Jiao Jiao, Shan Yao, Fu Ling, Huang Bo, Zhi Mu, Suan Zao Ren, Chai Hu, Huai Niu Xi.
Acupuncture: LU-7 on the left and KI-6 on the right (Ren Mai), Ren-4, KI-13, KI-12, BL-23, LIV-3.
Damp-Heat in the Genital System
Low sperm count, low motility, difficult urination, turbid urine, dark urine, painful urination, tongue with sticky-yellow coating and red spots on the root, Slippery pulse.
Long Dan Xie Gan Tang
Acupuncture: LU-7 on the left and KI-6 on the right (Ren Mai), Ren-9, ST-28, KI-12, Ren-3, Ren-5, BL-22, SP-9.
Qi Stagnation and Blood Stasis
Low sperm count, poor motility, distension and discomfort of testis, pain in perineum, hypogastric pain, prostatic hypertrophy, Purple tongue.
Ge Xia Zhu Yu Tang
Acupuncture: SP-4 on the left and P-6 on the right (Chong Mai), LIV-3, SP-10, BL-17, KI-14, ST-30.
Low Sperm Motility Kidney-Yang Deficiency
Low sperm motility, pale face, dizziness, backache, pale-frequent urination, etc.
Zuo Gui Wan Variation: Shu Di, Shan Yao, Gou Qi Zi, Tu Si Zi, Nu Zhen Zi, Han Lian Cao, Wu Wei Zi, Sang Ji Sheng, Lu Jiao Jiao, Yin Yang Huo, Suo Yang, Ba Ji Tian, Sha Ren, Gan Cao.
Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), BL-23, Ren-4, KI-13, KI-12, BL-32.
Kidney-Yin Deficiency with Empty Heat
Low sperm motility, backache, dizziness, tinnitus, night-sweating, 5-palm heat, malar flush, nocturnal emissions with dreams, Red tongue without coating, Floating-Empty and Rapid pulse.
Er Xian, Tang Xian Mao, Yin Yang Huo, Ba Ji Tian, Dang Gui, Zhi Mu, Huang Bo.
Acupuncture: LU-7 on the left and KI-6 on the right (Ren Mai), Ren-4, KI-12, HE-6, KI-3, Ren-7.
Conclusion
Although comparatively less discussed within classical literature, male reproductive disorders may be understood clearly through the framework of Chinese medicine physiology, pathology, channels and Extraordinary Vessels.
In many chronic presentations, pathology may involve not only deficiency of Kidney Yin or Yang, but also Dampness, Blood Stasis, Phlegm and stasis of Jing.
Understanding the relationship between Jing, the Extraordinary Vessels, Heart and Kidneys remains central to the differentiation and treatment of male disorders in Chinese medicine.
These themes are explored further in the accompanying educational presentation and Male Disorders in Chinese Medicine course.
Further Study
For a deeper understanding of these patterns in clinical practice:
– Explore the Benign Prostatic Hyperplasia and Erectile Dysfunction presentation
– Explore the Male Disorders course