TCM Approaches to Diagnosing and Treating Premature Ejaculation

Premature ejaculation refers to ejaculation that occurs too early during sexual intercourse and is a manifestation of a common sexual dysfunction in males. In mild cases, ejaculation occurs shortly after the penis enters the vagina (less than 2 minutes), before both partners achieve sexual satisfaction. In severe cases, ejaculation occurs as soon as there is contact with the female’s body, even before the penis enters the vagina.

Severe premature ejaculation is relatively easy to diagnose as ejaculation occurs before the penis enters the vagina, or right at the moment of entry, or only after a few thrusts (some believe that ejaculation within 10 – 15 thrusts should be included) inside the vagina. However, when ejaculation does not occur extremely quickly, diagnosing premature ejaculation becomes more difficult. Some believe that premature ejaculation occurs when a man is unable to control ejaculation for a sufficient duration during sexual intercourse, resulting in a woman with normal sexual function not achieving satisfaction in at least 50% of sexual encounters, or when he cannot control the ejaculatory reflex. On the other hand, others argue that if both partners can reach orgasm despite a short duration of sexual intercourse, it should not be considered premature ejaculation.

In clinical practice, the scope of premature ejaculation should not be defined too broadly, and specific situations must be analyzed on a case-by-case basis. For example, during the initial stage of marriage, due to environmental factors, psychological factors, physical health, or other reasons, occasional premature ejaculation occurring once or twice during sexual activity is, in the vast majority of cases, a temporary issue and not necessarily pathological. Only when premature ejaculation occurs frequently or with every sexual intercourse should it be referred to as premature ejaculation.

Premature ejaculation is characterized by rapid erection and early, fast ejaculation within a certain period of time. Over time, it can affect the sexual satisfaction of both men and women, and in some cases, may impact fertility. Especially if premature ejaculation is not supports correctly for a long time, it can lead to central functional exhaustion and result in impotence. Therefore, timely supports is necessary.

I.Causes of premature ejaculation

1. Psychological factors

The causes of true premature ejaculation are mostly due to excessive sexual excitement, so premature ejaculation is inseparable from psychological factors, such as excessive nervousness, over-excitement (especially for newlyweds who are afraid that sexual intercourse will not be successful or fear rapid ejaculation); or exposure to pornographic novels and movies, or local irritation caused by overly tight underwear.

Some cases of premature ejaculation stem from discordant marital relationships. For instance, harboring latent hostility, resentment, or irritation toward one’s wife, or conversely, excessive admiration or fear of her leading to feelings of inferiority, can often result in involuntary premature ejaculation. Additionally, excessive physical fatigue, insufficient energy, prolonged masturbation, or overindulgence in sexual activity can also cause sexual neurasthenia, ultimately leading to premature ejaculation.

2. Inflammation of external genitalia and urethra

Inflammation of the external genitalia and urinary tract can also cause premature ejaculation. Conditions such as posterior urethritis, prostatitis, seminal vesiculitis, or verumontanitis can lead to congestion of the verumontanum, making it more susceptible to stimulation and resulting in premature ejaculation.

3. TCM Understanding of the Etiology of Premature Ejaculation

In traditional Chinese medicine, the storage and release of semen are jointly regulated by the Heart, Liver, and Kidney. If the Heart fire is excessive and the ministerial fire is intense, the interaction of these two fires disturbs the semen gate, causing it to become insecure and leading to premature ejaculation or involuntary seminal emission. Alternatively, if emotional distress is not resolved, Liver qi stagnates, resulting in abnormal dispersion and regulation and a lack of restraint, which leads to premature ejaculation. Or, excessive sexual activity depletes essence, causing Yin Deficiency and fire excess, which scorches the essence chamber and results in a loss of control over semen retention. Another scenario is excessive masturbation or early marriage and childbirth during youth, which overtaxes the body, leading to Kidney qi deficiency and a failure to secure and store essence. It is evident that premature ejaculation has complex etiologies, with both deficiency and excess patterns, and cannot be generalized.

II. Syndrome Differentiation and Dietary Therapy

1.Exuberant ministerial fire

This syndrome often results from unfulfilled sexual desires or frequent masturbation, leading to the depletion of Kidney yin essence, followed by a deficiency of Liver yin, which fails to nourish and contain the ministerial fire of the Liver and Kidney. Additionally, excessive sexual desire kindles Heart fire, and the convergence of these two fires scorches the spermatic gate, impairing its ability to retain semen and resulting in premature ejaculation. Clinical manifestations include hypersexuality, premature ejaculation, accompanied by palpitations and insomnia, restlessness and anxiety, dizziness and blurred vision, bitter taste in the mouth, dry throat, red tongue with a yellow coating, and other signs of imbalance. supports should focus on clearing and draining the ministerial fire, and Huanglian Ejiao Jizihuang Decoction may be used with modifications.

Formula and Preparation Method: Coptis chinensis Franch. (Huang Lian) 5g, Phellodendron chinense Schneid. (Huang Bai) 5g, Radix Paeoniae Alba (Sheng Bai Shao) 10g. Decoct to 100 ml, strain out the dregs, add 30 ml of dissolved Colla Corii Asini (E Jiao) juice, wait until lukewarm. Take 2 fresh eggs, separate the egg whites and take the yolks, add them to the medicinal juice, stir well, and take it all at once. Administer once every night before bedtime.

This formula originally comes from Treatise on Febrile wellness and is a well – known prescription for supports Yin Deficiency with exuberant fire and restlessness and insomnia due to deficiency. In the formula, Paeoniae Radix Alba nourishes the Liver; Coptidis Rhizoma reduces Heart fire. The reason for removing Scutellariae Radix and adding Phellodendri Chinensis Cortex is to purge ministerial fire in the Kidney. Additionally, Ovum Gallus Domesticus and Colla Corii Asini are added to nourish yin and blood. The whole formula takes into account both the root cause and the signs of imbalance, so it can achieve satisfactory results.

2.Yin Deficiency with yang hyperactivity

Early marriage in youth or unrestrained sexual activity after newly getting married leads to excessive consumption of yin essence, resulting in Yin Deficiency and yang hyperactivity. Fire disturbs the essence chamber, and the function of containment is impaired, leading to premature ejaculation. It is often accompanied by signs of imbalance such as spermatorrhea, restlessness and insomnia due to deficiency, soreness and weakness of the waist and knees, five-center heat, red tongue with scanty coating, and thin and rapid pulse. The supports principle is to nourish yin and subdue yang. One can consume pork Kidney with Chinese wolfberry leaves.

Formula and Preparation Method: 1 pair of pig Kidneys, 250 grams of Chinese wolfberry leaves, pepper powder, and an appropriate amount of sesame oil. Wash and slice the pig Kidneys, stir-fry them in sesame oil until hot, then add an appropriate amount of water and Chinese wolfberry leaves to make soup. Season with pepper powder and salt. Consume in two divided doses daily.

In the formula, pig Kidney is salty and neutral in nature and flavor, and is mainly indicated for lumbago due to Kidney deficiency, premature ejaculation, impotence, spermatorrhea and night sweats. According to “Rihuazi Bencao” (Japanese-Chinese Materia Medica), “It is suitable for those with Kidney deficiency and heat to consume it.” Goji berry leaves, namely the leaves of Lycium barbarum L. (Chinese wolfberry), are bitter, sweet and cold in nature and flavor, and have the functions of tonifying deficiency, benefiting essence, clearing heat and relieving thirst; they are used to supports fever and polydipsia due to consumptive wellness.

One can also take Placenta Cordyceps Decoction. Formula and preparation method: Take half a fresh placenta, 20 grams of Rehmanniae Radix (Chinese foxglove root), and 10 grams of Cordyceps. Wash the placenta and cut it into pieces. Place it in a steamer and steam it together with Cordyceps and Rehmanniae Radix until cooked, then consume. Take it every other day for 1 to 2 weeks.

In the formula, the placenta, also known as Ziheche, tastes sweet and salty and is warm in nature. It has the function of vigorously replenishing qi and blood and serves as a tonic and strengthening medicine, applicable to various syndromes of deficiency and insufficiency of essence and blood. Rehmanniae Radix tastes sweet with a slight bitterness and is cold in nature. It has the function of cooling blood, clearing heat, nourishing yin, and tonifying the Kidney. Cordyceps benefits the Kidney and tonifies the Lung. The entire formula focuses on nourishing yin and tonifying the Kidney, clearing heat and reducing fire, and can also replenish qi and nourish blood.

In addition, one can also choose food therapy prescriptions that nourish yin and replenish essence for consumption.

3.Insecure Kidney Qi

Excessive sexual activity, congenital weakness, or old age and physical decline can lead to Kidney qi deficiency and insufficient vital fire, resulting in decreased libido and premature ejaculation during intercourse. It is often accompanied by spermatorrhea, soreness and weakness of the waist and knees, clear and copious urine, frequent urination at night, pale tongue with white coating, and a deep and weak pulse. The supports should focus on nourishing the Kidneys and consolidating essence, and one can consume Walnut and Silkworm Pupa Soup.

Formula and Preparation Method: 150 grams of walnut kernels, 60 grams of silkworm pupae. First, lightly stir-fry the silkworm pupae, then place them together with the walnuts in a bowl, add an appropriate amount of water, and steam until cooked. Consume as desired.

In the formula, silkworm chrysalis is the pupa of Bombyx mori. It is sweet and neutral in nature and flavor. According to Yilin Zuanyao (Essentials of Medicine Compiled in the Forest of Medicine), it can “enhance yang qi”. It contains high-quality proteins, especially essential amino acids for the human body, vitamin E, trace elements such as calcium and phosphorus, and various hormones. It is nutrient-rich and suitable for supports impotence and premature ejaculation caused by Kidney deficiency. In ancient times, there was a formula called “Can’e Fenbu Wan” (Silkworm Moth Tonifying and Supplementing Pills), which was prepared with male silkworm moths as the main medicinal ingredient. In this formula, when combined with walnut meat, its effect of tonifying the Kidney and strengthening yang becomes even more remarkable.

One can also take Fuyuan Decoction. Formula and preparation method: 50 grams of Dioscoreae Rhizoma, 20 grams of Cistanches Herba, 10 grams of Cuscutae Semen, 2 walnut kernels, 500 grams of lean lamb, 1 set of lamb spine, 100 grams of japonica rice, 3 stalks of scallions, an appropriate amount of ginger, Chinese prickly ash, star anise, cooking wine, ground pepper, and salt. First, wash the lamb spine and chop it into pieces; wash the lamb, remove the blood, and cut it into 1-inch long chunks. Then, grind Dioscoreae Rhizoma, Cistanches Herba, Cuscutae Semen, and walnut kernels into a coarse powder, put them in a gauze bag, and chop the ginger and scallions. Put the Chinese herbal medicines, meat, and japonica rice into a casserole, add an appropriate amount of water, bring to a boil over high heat, skim off the foam, add Chinese prickly ash, star anise, and cooking wine, and simmer until the ingredients are well-cooked. Consume the meat

In the formula, mutton and lamb spine warm the middle and warm the Kidney, replenish qi and benefit blood. They are combined with cistanche, dodder seed, and walnut meat to replenish the Kidney and enrich essence, while Chinese yam nourishes both the Spleen and Kidney. Together, they achieve the effects of replenishing qi and benefiting blood, warming the Kidney and strengthening the Spleen. It is used to supports impotence, premature ejaculation, tinnitus, dizziness, and weak waist and knees caused by insufficient Kidney yang and Kidney essence deficiency, and has proven efficacy.

In addition, dietary therapy prescriptions for warming the Kidney and strengthening yang are also selected for consumption.

4.Deficiency of the Heart and Spleen

Excessive brain work and persistent overthinking leading to fatigue in ordinary people can result in a syndrome of dual deficiency of the Heart and Spleen, manifesting as premature ejaculation. Patients in this category often present with palpitations, excessive dreaming, poor appetite, a sallow complexion, physical fatigue, a pale tongue, and a thin pulse. The supports principle is to nourish the Heart and Spleen, replenish qi, and stabilize essence. The modified Weibu Decoction can be used for oral administration.

Formula and Preparation Method: Equal parts of sea cucumber, bird’s nest, lean pork, and eel meat. Grind the above ingredients into coarse powder, add water and boil, or add one fresh placenta hominis or an appropriate amount of longan flesh, and boil until extremely tender. Then, take the juice for drinking and consume as desired.

In the formula, sea cucumber can nourish essence and blood and tonify Kidney qi. The well-known traditional Chinese medicine practitioner Shi Jinmiao was adept at using it to supports cold scrotum and sperm deficiency, often achieving good results. Bird’s nest is the nest built by swiftlets and other birds, formed by the coagulation of saliva or a mixture of saliva and down feathers. It is rich in colloids, proteins, calcium, phosphorus, potassium, etc., and is an excellent tonic that can invigorate yang, replenish qi, and enrich essence and marrow. Eel contains proteins and vitamin A. Longan flesh nourishes blood, calms the mind, and tonifies the Heart and Spleen. When combined with placenta hominis, a substance of flesh and blood nature, it can nourish the Heart and Spleen, strengthen Kidney qi, and naturally supports premature ejaculation.

One can also take Sparrow Meat and Codonopsis and Polygonatum Decoction. Formula and preparation method: 5 clean sparrows, 15 grams of Codonopsis pilosula, 15 grams of Polygonatum sibiricum, and appropriate amounts of cooking wine, soy sauce, monosodium glutamate, and stock. First, arrange the cleaned sparrows in a soup bowl, add Codonopsis pilosula and Polygonatum sibiricum, then pour in stock, cooking wine, soy sauce, and monosodium glutamate. Cover tightly, seal the opening with cotton paper, place it in a pot, and steam it over water until it is thoroughly cooked and tender.

In the formula, sparrows are animals with blood and flesh and strong sexual instinct. They can stimulate sexual nerves, enhance sexual desire, and invigorate yang and benefit essence. Codonopsis Root (Dangshen) and Siberian Solomonseal Rhizome (Huangjing) can both replenish qi, nourish the Heart and Spleen, and also have the effects of promoting fluid production and nourishing blood. When these three substances are used in combination, they produce a good effect.

In addition, one can choose to consume dietary therapy formulas that nourish qi and blood.

III. External Folk and Proven Prescriptions

1. 20 grams of Cnidium monnieri (L.) Cusson (Fructus Cnidii), 10 grams of Juglans regia L. pericarp (Qinglongyi). Decoct in water, wash the penis and genital area after cooling.

2. Decoct Galla Chinensis in water, use the hot decoction to fumigate the perineal region for several minutes, and then soak the glans penis in the lukewarm decoction. Do this once every night, with 10 times constituting one course of supports.

3. Cnidium monnieri (L.) Cuss. (Fructus Cnidii) 10 g, Asarum heterotropoides var. mandshuricum (Maxim.) Kitag. (Radix et Rhizoma Asari) 10 g, Chrysanthemum morifolium Ramat. (Flos Chrysanthemi) 5 g, Punica granatum L. (Pericarpium Granati) 10 g. Decoct in water, and when lukewarm, wash and soak the penis and genital area before sexual intercourse.

4. Schisandra chinensis (Fructus Schisandrae), Polygala tenuifolia (Radix Polygalae), Cnidium monnieri (Fructus Cnidii), Camphor, Fossilia Ossis Mastodi (Os Draconis) 5 grams each. Decoct in water, and when lukewarm, wash and soak the penis and genital area before sexual intercourse.

5. Polygalae Radix (Yuanzhi) 6 g, Cnidii Fructus (Shechuangzi) 3 g, Galla Chinensis (Wubeizi) 6 g. Decoct in water, let it cool to a warm temperature, and then wash and soak the penis and genital area before sexual intercourse.

6. Asarum (Xixin) and Caryophylli Flos (Dingxiang), 20 grams each, and 95% ethanol, 100 milliliters. Soak the above herbs in ethanol for half a month. When using, apply this leaching solution to the glans penis, and engage in sexual intercourse after 1.5 to 3 minutes.