Traditional Chinese Medicine's understanding of the etiology and pathogenesis of premature ejaculation and methods for doctors to diagnose premature ejaculation

67.

Traditional Chinese medicine believes that premature ejaculation has the following causes and mechanisms.

Traditional Chinese medicine believes that premature ejaculation is mostly due to kidney deficiency and is closely related to the heart, liver, and spleen.

The etiology and pathogenesis of this disease are as follows:

(1) Kidney Qi deficiency: The kidney stores essence and opens into the two lower orifices. When the kidney essence is solid, the opening and closing are regulated and the ejaculation is moderate. If there is excessive lust, immoderate sexual activity, excessive ejaculation, or masturbation in adolescence, the kidney qi will be damaged, the seminal gate will be weakened, and premature ejaculation will occur.

When the essence and qi of the kidneys are weakened over time, yin is depleted. When kidney yin is deficient, the ministerial fire moves recklessly, disturbing the seminal chamber and causing premature ejaculation.

(2) Damp-heat in the liver meridian: When the diet is rich, sweet and greasy, fried and roasted, damp-heat will be generated internally; when damp-heat flows down to the liver meridian, evil fire will move recklessly, excessive discharge will disturb the seminal chamber, and the essence will move recklessly, resulting in premature ejaculation.

(3) Deficiency of both heart and spleen: The heart stores the spirit and is the master of the five viscera and six bowels. The spleen is the foundation of postnatal life. The kidney's function of storing essence is completed under the leadership of the heart and by the nourishment of the spleen.

If one overworks, it will damage the heart and spleen, causing the kidneys to lose their function and the essence to be deprived of nourishment. As the essence of the kidneys becomes insufficient, the ability to retain essence is weakened. In addition, insufficient kidney essence will cause the ministerial fire to move recklessly, thus the seminal gate will be weakened, resulting in premature ejaculation.

(4) Yin deficiency and fire excess: Spleen deficiency leads to impaired function and kidney essence is not nourished. Over time, kidney yin becomes insufficient. Yin deficiency leads to excessive fire. In addition, the seven emotions disturb the heart, injure the liver, and stagnate the spleen, resulting in disharmony between the heart and kidneys, excessive fire, and fire disturbing the seminal gate, leading to premature ejaculation.

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Doctor diagnosed premature ejaculation

Because the definition and standards for premature ejaculation are inconsistent, diagnosing premature ejaculation is not an easy task.

Of course, severe premature ejaculation is quite obvious, and doctors can fully understand the condition by asking about the patient's medical history, conducting interviews, and investigating sexual activity.

Using personality tests such as SCL-90-R for psychological analysis can help understand the patient's mental and psychological state.

The penile vibration sensitivity measurement method can be used to measure changes in penile sensitivity threshold, which can provide insights into penile sensitivity and the function of penile sensory nerves.

In addition, doctors will conduct routine urological examinations and necessary laboratory tests to determine whether there are other contributing factors such as balanitis or other urinary tract infections.

Through the above process, doctors can generally make a clear diagnosis of premature ejaculation and its type, and then carry out corresponding treatment.

As a doctor, you should not easily diagnose someone with premature ejaculation, otherwise it will increase their psychological burden.

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Traditional Chinese Medicine's understanding of the pathogenesis of nocturnal emission

Traditional Chinese medicine believes that the kidneys are responsible for storing essence and open into the two lower orifices (urethra and anus). The main cause of seminal emission is the kidneys' failure to retain essence.

However, the mechanism that causes kidney failure to retain nutrients is quite complex.

The specific etiology and pathogenesis are as follows:

(1) Young people are ignorant and masturbate frequently, and their desires are aroused; or they marry young; or they are fond of the opposite sex but their desires are not fulfilled; or married people live apart for a long time and yearn for sex, so as to deplete their yin essence, cause their false fire to rise, disturb the seminal chamber, lose its function of closing and storing, and thus cause seminal fluid to be discharged.

(2) If one’s diet is irregular, dampness will be generated internally and stagnate in the liver and gallbladder. If the liver qi is stagnant for a long time, the ministerial fire will be generated, forcing the essence to be discharged. Or, if one eats too much fatty and sweet food and drinks too much alcohol, damp heat will be generated internally, phlegm will be generated and fire will be generated, disturbing the mind and spirit, and the kidney will not be able to close and store, resulting in seminal emission. Or, if one is overworked and injures the spleen, the spleen yang will be damaged, the spleen will lose its function, dampness will be generated and heat will be generated, damp heat will flow downward, turbid qi will return to the kidney, the kidney essence will be restless, resulting in seminal emission.

(3) Excessive mental strain leads to delusional thoughts.

Excessive exertion of the mind depletes the Yin of the heart. When the Yin of the heart is insufficient, the Yang of the heart becomes excessive and fails to communicate with the kidneys. When the heart and kidneys do not communicate, the essence loses its master and is thus lost. When the mind is filled with delusions and desires are not fulfilled, the mind is restless. The sovereign fire moves and ignites the ministerial fire, disturbing the seminal chamber, and thus the essence is lost.

(4) Prolonged illness affects the kidneys, excessive sexual desire, overwork damages kidney qi, kidney qi deficiency, and weak seminal gate leads to seminal leakage; or entering the bedroom while drunk, or excessive sexual activity, damp heat arouses ministerial fire, forcing seminal leakage, or long-term untreated seminal leakage, kidney essence deficiency, kidney essence not being contained, seminal gate not being strong, leading to seminal loss.

(5) Emotions damage the liver, causing liver dysfunction, qi stagnation transforms into fire, and heat disturbs the seminal chamber, leading to seminal emission.

70.

Western medicine's understanding of nocturnal emission

In traditional Chinese thought, the preciousness of semen is overemphasized, so nocturnal emission is always regarded as a disease, a result of weak seminal control, kidney deficiency or weakness, which can lead to a great loss of vital energy.

In fact, nocturnal emission is a reflex ejaculation phenomenon. It can be caused by various factors such as tight underwear, heavy blankets when sleeping on your back, smegma buildup due to phimosis or redundant foreskin, a hot bed, or cold feet.

Generally speaking, healthy men who do not have regular sexual activity will experience nocturnal emission 1 to 4 times a month. Sometimes it may be slightly more, which is not abnormal and should not be a cause for concern.

Statistics show that about 80% of unmarried young people have experienced this phenomenon. Therefore, there is no need to be overly fearful or worried about it. After marriage and having normal and regular sexual life, nocturnal emission will decrease or disappear.

Of course, frequent nocturnal emissions may reflect some problems that should be taken seriously. In many cases, it is a pathological condition, and one should go to the hospital for examination in a timely manner, ask a doctor to analyze the cause, and receive treatment.

71.

Nocturnal emission can occur in normal people.

Ejaculation that occurs in men without sexual intercourse is medically termed nocturnal emission. If it occurs during sleep and in dreams, it is called "wet dream" or "wet ejaculation." If it occurs spontaneously while awake, without masturbation or sexual intercourse, it is called spermatorrhea.

There is no essential difference between the two.

As we all know, many men have had the experience of having strange ejaculations in their dreams, but are too embarrassed to ask others for advice.

Males reach sexual maturity 1-2 years after puberty, and this can continue until old age.

At this stage, in addition to the penis exhibiting adult characteristics, the testes and other organs also mature, and the reproductive organs produce semen, which consists of both sperm and seminal plasma, every moment, and it continuously accumulates in the vas deferens.

When semen reaches a certain quantity and becomes saturated, it will reflexively ejaculate when stimulated. This is called nocturnal emission, which is the reason behind the saying "when it is full, it overflows".

The role of nocturnal emission in male sexual behavior remains unclear.

Currently, people regard it as a normal physiological phenomenon and a normal part of human sexual behavior.