Priapism: TCM Causes, Dietary Therapy, and External Remedies

Priapism refers to a medical emergency characterized by persistent and painful erection of the penis without sexual excitement or desire. This condition requires prompt supports to restore venous drainage from the corpora cavernosa and minimize damage to the erectile tissue. Otherwise, it can lead to severe consequences.

Priapism and anejaculation both involve a persistent erection and a failure to ejaculate, but they are distinct conditions and should not be confused. The difference lies in the fact that for priapism,

Erection unrelated to sexual activity occurs acutely with penile pain and is prone to leaving sequelae; anejaculation occurs during sexual activity, generally without pain and without sequelae. In traditional Chinese medicine, both conditions were previously referred to as “qiangzhong” (persistent erection), “yangqiang bu dao” (persistent and unrelieving erection), “yin zong bu shou” (unrestrained and unretractable penis), etc., without clear distinction, but in fact, they are not the same.

I.Causes of priapism

The pathological mechanism of priapism involves obstruction of venous return from the penis, leading to blood stasis. This results in increased carbon dioxide levels, decreased oxygen content, and increased blood viscosity in the blood, causing congestion in the cavernous spaces of the penis. Obstruction occurs at the junction where veins converge, leading to penile edema. Penile edema further exacerbates venous return obstruction, ultimately resulting in thrombus formation and small artery embolism. Apart from spinal cord injury, compression of the penile root by advanced pelvic tumors, syphilis, and leukemia, the majority of causative factors remain unclear.

In traditional Chinese medicine, the causes of the wellness are considered as follows:

1. Yin Deficiency and yang hyperactivity: Excessive sexual activity and overindulgence in lust lead to Kidney Yin Deficiency. When yin is deficient, yang will inevitably become hyperactive. Liver qi fails to flow freely, stagnates, and transforms into fire. Or, indiscriminate use of yang-tonifying drugs consumes and injures Kidney yin, resulting in hyperactivity of ministerial fire, causing the penis to become engorged and remain erect without subsiding.

2. Damp-heat pouring downward: Excessive consumption of alcohol and rich, greasy foods generates dampness and heat. Alternatively, engaging in sexual activity after drinking alcohol, using alcohol to enhance arousal; or indulging in sexual pleasure, delaying ejaculation and retaining semen, leading to the accumulation of damp-heat and degenerate semen, causing blood stasis and obstruction in the lower energizer. This results in obstruction of the meridians and channels, leading to abnormal penile erection.

3. Injury from falls or impacts: Due to external force impact or injury to the perineal region from falls or dropping, the blood vessels are damaged, and blood circulation becomes abnormal. Stagnant blood blocks the meridians and fails to disperse, leading to abnormal penile erection.

II. Syndrome Differentiation and Diet Therapy

As this condition is an emergency, it is advisable to first place a small amount of glauber’s salt on the palm of the hand. Once the salt dissolves, the penis will become flaccid. Then, supports can be administered based on differentiation of patterns.

1.Exuberant ministerial fire with deficiency of Kidney yin

Often caused by excessive sexual activity or overuse of aphrodisiac drugs, leading to Kidney Yin Deficiency, where Yin Deficiency fails to It restrains yang but causes false yang to move in a disorderly manner, resulting in hyperactive yang. It is accompanied by signs of imbalance such as distending pain in the penis and testicles, soreness in the lower back, dizziness, sexual hyperactivity, restlessness and insomnia, red tongue with a thin yellow coating, and a wiry and rapid pulse. The supports principle is to nourish Kidney yin and purge ministerial fire. Daoyang Decoction can be taken.

Formula and Preparation Method: 90 grams each of Scrophularia ningpoensis (Chinese figwort root) and Ophiopogon japonicus (dwarf lilyturf tuber), and 0.9 grams of Cinnamomum cassia (cassia bark). Decoct in water and take orally.

In the formula, Scrophulariae Radix (Xuan Shen) and Ophiopogonis Radix (Mai Dong) nourish yin, reduce fire, detoxify, and disperse nodules. A small amount (one percent) of Cinnamomi Cortex (Rou Gui) is used as a counter-adjuvant to guide the fire back to its origin. This formula is from Shishi Milu (The Secret Records of the Stone Chamber) and has remarkable efficacy when taken.

One can also take Jieni Decoction. Formula and preparation method: 30 grams each of Radix Adenophorae Strictae, Magnetitum, Radix Trichosanthis, and Radix Scrophulariae, and 100 grams of Gypsum Fibrosum. First, boil Gypsum Fibrosum for 1 hour, then add Radix Adenophorae Strictae, Radix Trichosanthis, Magnetitum, and Radix Scrophulariae, and decoct for half an hour before taking the decoction.

In the formula, Shechuang (Capsella bursa-pastoris) can clear heat, detoxify, resolve phlegm, and reduce swelling, serving as the principal herb for supports priapism. It is combined with Tianhuafen (Trichosanthes kirilowii) and Xuanshen (Scrophularia ningpoensis) to nourish yin and disperse nodules, Gypsum Fibrosum to clear intangible heat, and Magnetitum to restrain the dissipated Heart qi. Therefore, taking this formula yields good effects.

2.Damp-heat pouring downward, obstruction of meridians and collaterals by blood stasis

The Foot Jueyin Liver Meridian (LR) reaches the lower abdomen and encircles the external genitalia. If damp-heat pathogens descend along the Liver Meridian, they can obstruct the collateral vessels of the penis, leading to persistent penile swelling and erection. signs of imbalance include dark-colored penile swelling, prolonged erection without subsidence, accompanied by lumbar and knee soreness, restlessness with insomnia, burning pain during urination, red tongue with yellow coating, and wiry-slippery-rapid pulse. The supports principle is to clear damp-heat and promote blood circulation to dissipate stasis. Taoren Heidou Gancao Decoction may be administered.

Formula and Preparation Method: 10 g Semen Persicae (Taoren), 20 g Semen Sojae Preparatum (Heidou), 10 g Radix et Rhizoma Glycyrrhizae Uralensis (Gancaoshao). Decoct in water and take orally. One dose per day, divided into two administrations.

In the formula, peach seed (Tao Ren) promotes blood circulation and disperses blood stasis, following the principle that when blood circulates, dampness is eliminated, thereby removing obstruction in the collaterals of the penis; black soybean (Hei Dou) enters the Kidney meridian and has the effects of nourishing the Kidneys and detoxifying; licorice tip (Gan Cao Shao) can helps with occasional pain in the penis. Therefore, after taking the formula, damp-heat is eliminated, blood stasis is dispersed, and priapism can be supports.

One can also take Coicis Semen and Hyacinth Bean Decoction. Formula and preparation method: 30 grams of Coicis Semen, 15 grams of roasted Hyacinth Bean, 15 grams of Hawthorn Fruit, 10 grams of Licorice Tip, and an appropriate amount of brown sugar. Wrap the Licorice Tip in gauze, and put it together with the Coicis Semen, Hyacinth Bean, Hawthorn Fruit, and brown sugar into a pot, add water to make porridge. After it is cooked

Remove the tips of Glycyrrhizae Radix, one dose per day.

In the formula, Coicis Semen (Yi Yi Ren) and Hyacinth Bean (Bian Dou) strengthen the Spleen, eliminate dampness, and clear heat; Hawthorn Fruit (Shan Zha) promotes digestion, removes food retention, breaks Qi Stagnation, and disperses blood stasis; Licorice Root (Gan Cao) is added to helps with occasional pain in the penis. Therefore, after taking it, blood stasis can be resolved and damp-heat can be eliminated.

In addition, heat-clearing and dampness-eliminating dietary prescriptions can be selected for consumption .

3.Stagnation of static blood

This syndrome is caused by falling, stumbling, or being struck in the genital area by a hard object, leading to abnormal penile erection. It results from damage to the blood collaterals and blood stasis obstructing the meridians, thus accompanied by signs of imbalance such as swelling and pain in the genital area, soreness and distending pain in the waist, a dark tongue, and a wiry pulse. The supports should focus on promoting blood circulation to remove blood stasis and supplementing Kidney qi. It is advisable to consume Tao Ren Yi Mi Hei Dou Zhou (Peach Kernel, Coicis Seed, and Black Soybean Porridge).

Formula and Preparation Method: 10 grams of Prunus persica (L.) Batsch seed (peeled and tipped), first decoct to extract the juice and remove the dregs, then add 20 grams of Coix lacryma-jobi L. var. ma-yuen (Rom.Caill.) Stapf, 20 grams of black soybean, and 50 grams of Oryza sativa L. var. japonica Kato to cook into porridge. After the porridge is cooked, add 2 grams of Cinnamomum cassia Presl powder and 50 grams of brown sugar, and divide into 2 doses for consumption.

In the formula, peach seed (Taoren) and brown sugar can promote blood circulation to remove blood stasis, coicis semen (Yimi) can induce diuresis to remove dampness and clear heat, black soybean (Heidou) can tonify the Kidney and replenish qi, and cassia twig without epidermis (Guixin) can warm and unblock the blood vessels to helps with occasional pain. After taking it, blood stasis can be dispersed and Kidney qi can be strengthened, so the condition of penile erection dysfunction can be supports.

III. External Folk and Proven Prescriptions

In addition to internal consumption of dietary therapy prescriptions, external application of medicinal cloth soaking and wrapping method can be used. Prescription: 15 grams each of Angelicae Sinensis Radix (Dang Gui), Pheretima (Di Long), Radix Aconiti Kusnezoffii (Cao Wu), Faeces Trogopterori (Wu Ling Zhi), Olibanum (Ru Xiang), Myrrha (Mo Yao), and Semen Sinapis Albae (Bai Jie Zi), and 5 grams of Semen Momordicae (Mu Bie Zi, stir-fried until yellow and then ground into powder). Decoct the herbs in water to obtain about 300 milliliters of liquid. Soak a medicinal cloth in the liquid and wrap it around the penis for half an hour each morning and evening.