Retrograde Ejaculation: TCM Dietary Therapy and Causes

Retrograde ejaculation refers to a pathological condition where, during sexual intercourse, an individual can achieve orgasm and has the ejaculatory action, but instead of semen being ejaculated out of the urethral orifice, it is ejaculated backward into the bladder. It differs from anejaculation in that anejaculation involves the absence of orgasm and ejaculatory action.

Retrograde ejaculation can lead to functional infertility. Although dietary therapy has certain therapeutic effects on it, the fundamental supports methods are still etiological supports and surgical supports.

1 .Causes of retrograde ejaculation

1.Dysfunction of sphincter contraction at the bladder neck

The primary cause of retrograde ejaculation is the dysfunction of bladder sphincter contraction, resulting in its inability to close tightly during ejaculation. It is commonly seen in cases such as bladder neck ataxia caused by juvenile diabetes mellitus, neurogenic bladder urethral stricture due to spinal cord injury, intravesical orifice contracture following transurethral electroresection for prostatic utricle hypertrophy, and incomplete closure of the bladder neck sphincter due to tearing after transurethral electroresection for prostatic hypertrophy, all of which can lead to retrograde ejaculation. The use of medications such as guanethidine and reserpine, which have a blocking effect on adrenergic nerves (sympathetic nerves), can also result in retrograde ejaculation.

2. TCM Understanding of the Etiology of Retrograde Ejaculation

In traditional Chinese medicine, this wellness is considered to be related to the decline of Spleen and Kidney function and injury to the meridians. Prolonged wellness can lead to a weak constitution and damage to the Spleen and stomach; or excessive strain can result in deficiency of both the Spleen and Kidney. Spleen deficiency leads to impaired transportation and transformation functions and dysregulation of containment, while Kidney deficiency results in the bladder’s inability to retain, thus causing semen to flow backward. Alternatively, surgical injury or emotional depression can damage the sinews and vessels, causing the genital sinews to become lax and unrestrained and the bladder to close improperly, leading to semen flowing backward.

II. Syndrome Differentiation and Dietary Therapy

1.Spleen-Kidney deficiency and damage

Spleen deficiency leads to impaired transportation and transformation, and Kidney deficiency results in the bladder losing its constraint, causing orgasm without ejaculation during sexual intercourse. Such patients are often caused by juvenile diabetes and commonly present with signs of imbalance such as soreness and weakness of the waist and knees, dizziness and blurred vision, shortness of breath and lack of strength, dry mouth and throat, thirst with a desire to drink, frequent urination or incontinence, red tongue with scanty coating, and a thin and rapid pulse. The supports should focus on nourishing the Spleen and Kidney, and Zhu Yi Wan (Pig Pancreas Pills) can be selected for administration.

Formula and Preparation Method: 250 grams of pig pancreas, 120 grams of Dioscorea opposita (Chinese yam), 120 grams of Trichosanthes kirilowii (Chinese cucumber root). First, grind Dioscorea opposita and Trichosanthes kirilowii into fine powder. Then, mash the pig pancreas and mix it with the powdered herbs to form pills. Take 9 grams each time, three times a day, after cooking. Continue for 15 to 20 days, or adjust the duration according to the patient’s condition.

In the formula, pig pancreas nourishes the Lung, tonifies the Spleen, and moistens dryness. Ben Cao Jing Shu (Compendium of Materia Medica Commentary) states, “Pig pancreas is a sweet, cold, and smooth substance; sweetness and coldness generate body fluids, and smoothness removes greasiness and dirt…” Moreover, using pig pancreas to supports diabetes follows the principle of supports like with like (using an organ to nourish its corresponding organ). Chinese yam is sweet, mild, and substantial in nature, neither dry nor greasy. It can both replenish qi and nourish yin, and is particularly effective in nourishing the Spleen and Kidney. Pharmacological studies have shown that it contains mucoprotein, which hydrolyzes in the body into proteins and carbohydrates with nourishing effects. Trichosanthes root can clear heat, generate body fluids, and quench thirst, making it an essential herb for supports diabetes. Therefore, this formula can supports retrograde ejaculation caused by bladder neck ataxia due to diabetes.

One can also consume stewed rabbit meat with wolfberries. Recipe and preparation method: Take 15 grams of Lycii Fructus (wolfberries) and 250 grams of rabbit meat, add an appropriate amount of water, stew over a gentle flame until cooked, then add salt and seasonings. Consume the soup and meat, one dose per day.

In the formula, Lycium barbarum L. (Gou Qi Zi) is sweet and neutral in nature and taste, enters the Liver and Kidney meridians, and can nourish the Liver and Kidney and replenish yin to assist.

Yang-nourishing, promoting fluid production to quench thirst. Clinical studies have shown it can lower blood glucose levels. Rabbit meat is pungent in flavor, neutral in nature, and non-toxic. It can tonify the middle-jiao and replenish qi, strengthen the Spleen and nourish yin. When used together with wolfberries, it can nourish the Liver and Kidneys, strengthen the Spleen and benefit the stomach, and replenish both yin and yang.

2. Meridian Injury

Due to meridian injury from surgery or emotional depression leading to abnormal qi movement, the spermatic duct is not smoothly opened, resulting in orgasm during intercourse but no ejaculation of semen. It is often accompanied by signs of imbalance such as flaccidity and weakness, numbness in the lower limbs, frequent urination, involuntary urinary incontinence, or difficulty in urination with only a few drops, white tongue coating, and a slow pulse. The supports should focus on promoting blood circulation and unblocking the meridians, and modified Taoren Porridge can be taken.

Formula and Preparation Method: 10 grams of Prunus persica (L.) Batsch seed (Tao Ren), 10 grams of Vaccaria segetalis (Neck.) Garcke (Wang Bu Liu Xing), 5 grams of Lindera aggregata (Sims) Kosterm. (Wu Yao). Decoct these herbs together in water to obtain the juice, remove the dregs, then add 100 grams of Nonglutinous rice (Jing Mi) to cook into porridge. After the porridge is cooked, add 2 grams of Cinnamomum cassia Presl powder (Gui Xin Fen) and 50 grams of brown sugar. Consume it in the morning and afternoon.

In the formula, peach seed (Semen Persicae) and brown sugar promote blood circulation and remove blood stasis, cowherb seed (Semen Vaccariae) promotes blood circulation and reduces swelling, lindera root (Radix Linderae) regulates qi and disperses cold, cassia twig (Cinnamomi Ramulus) warms and unblocks the blood vessels, and adding japonica rice (Oryza sativa L. var. japonica) nourishes the Spleen and strengthens the stomach, supporting the middle energizer. This ensures that the entire formula can not only promote blood circulation, remove blood stasis, and unblock the collaterals but also avoid depleting blood and injuring yin.

One can also consume sheep stomach porridge. Recipe and preparation method: Take one sheep stomach, clean and cut it, boil it until nearly cooked, then add 100 grams of japonica rice, an appropriate amount of scallion, ginger, fermented soybean, and Sichuan pepper. Cook into porridge, add salt and a small amount of seasonings before consumption.

In the formula, sheep stomach and japonica rice replenish qi and strengthen the middle-jiao, while green onion, ginger, Chinese prickly ash, etc., regulate and unblock the meridians. Therefore, this formula is suitable for patients with retrograde ejaculation caused by qi deficiency and blood stasis leading to meridian obstruction.