Nocturnal emissions, premature ejaculation, and erectile dysfunction are among the most common causes of infertility. They are quite common in clinical practice and can have a significant impact on patients’ mental well-being, family harmony, and marital relationships. Patients with these conditions should seek treatment as early as possible.
Nocturnal emission refers to the involuntary loss (or spontaneous discharge) of semen and is categorized into wet dreams and spontaneous emission; premature ejaculation refers to ejaculation occurring too early during intercourse, followed by immediate flaccidity of the penis, failing to meet the requirements of normal sexual activity; erectile dysfunction refers to the inability to achieve an erection, or the inability to maintain a firm erection, thereby preventing normal sexual activity. Most patients suffer from one or two of these conditions, while those with all three are relatively rare. According to Traditional Chinese Medicine, the primary causes of nocturnal emission, premature ejaculation, and erectile dysfunction are a lack of harmony between the heart and kidneys, deficiency of kidney qi (either kidney yang or kidney yin), deficiency of the heart and spleen, and the descent of damp-heat.
I. Nocturnal Emission
This condition is divided into nocturnal emission and spontaneous emission. Ejaculation that occurs during a dream is called “nocturnal emission”; ejaculation that occurs without a dream, or even while awake, is called “spontaneous emission.” Occasional nocturnal emissions in young and middle-aged men that are not accompanied by other symptoms are generally a physiological phenomenon resulting from an overflow of accumulated semen; there is no cause for concern, nor is treatment necessary. However, if nocturnal emissions occur frequently, involve a large volume of semen, and are accompanied by headaches, insomnia, fatigue and weakness, soreness in the lower back and knees, or listlessness, this constitutes a pathological condition requiring early and active treatment. Long-term treatment is essential to achieve effective results.
Etiology and Pathogenesis of Nocturnal Emission: The pathogenesis of this condition lies in kidney dysfunction, the kidney’s failure to store essence, and the instability of the “semen gate.”
(1) Yin Deficiency with Excessive Fire Type: Due to excessive mental and physical exertion leading to depletion of yin and blood, or due to excessive worrying, delusional thoughts, and unrestrained sexual indulgence, kidney yin is damaged. Kidney deficiency gives rise to internal heat, which disturbs the semen chamber, thereby causing nocturnal emission.
(2) Kidney Deficiency and Instability Type: Patients of this type often experience nocturnal emissions due to early marriage, excessive sexual activity, congenital deficiency, or frequent masturbation, leading to depletion of kidney qi. In cases of yin deficiency, pathogenic fire becomes uncontrolled and disturbs the semen chamber; in cases of yang deficiency, the kidney fails to perform its function of storage, resulting in an unstable semen gate—both of which can lead to nocturnal emissions.
(3) Damp-Heat Descending Pattern: Patients with this pattern often suffer from irregular dietary habits—such as excessive consumption of strong alcohol and rich, heavy foods, or a preference for sweet, fatty, and spicy foods—which damage the spleen and stomach, leading to the internal generation of damp-heat. If this damp-heat descends, it can trigger erotic dreams and disturb the semen chamber, resulting in nocturnal emission.
Traditional Chinese Medicine Differential Diagnosis and Treatment
(1) Yin Deficiency with Excessive Fire Pattern: Due to deficiency of kidney essence, heart fire becomes excessively vigorous and the heart and kidneys fail to communicate. Patients present with insomnia and frequent, chaotic dreams, frequent nocturnal emissions—occurring several times a night or once every few nights—or the ability to achieve erection easily but with premature ejaculation. These symptoms are accompanied by dizziness, palpitations, restlessness and insomnia, soreness and weakness in the lower back and knees, and tinnitus. Urine output is scant and yellow; the tongue is red, and the pulse is fine and rapid. The treatment principle is to nourish yin, subdue fire, calm the spirit, and secure essence; Zhi Bai Di Huang Decoction, modified according to the specific syndrome, may be used for treatment. For acupuncture, select points such as Xin Shu (BL15), Shen Shu (BL23), Guan Yuan (CV4), and Zhong Feng (BL22), and add points as indicated by the specific symptoms; for example, add Shen Men (HT7) and Li Dui (HT14) for insomnia.
(2) Kidney Deficiency with Inability to Retain Essence Type: Due to depletion of kidney qi and an inability to secure the essence gate, patients present with frequent nocturnal emissions or even spontaneous ejaculation, accompanied by dizziness, tinnitus, soreness and weakness in the lower back and knees, mental fatigue and weakness, aversion to cold and cold extremities, and a pale complexion; or may be accompanied by erectile dysfunction, spontaneous sweating, shortness of breath, a pale tongue with a thin coating, and a deep and weak pulse. The treatment principle is to tonify the Kidneys and secure the essence. The formula and medication should be selected based on whether the condition is predominantly Yang deficiency or Yin deficiency. For cases with a predominance of Yang deficiency, Yougui Pill may be used; for cases with a predominance of Yin deficiency, Liuwei Dihuang Decoction combined with Jinsuo Gujing Pill may be used. For acupuncture, select points such as Shenshu, Qihai, Sanyinjiao, and Zhishi, combined with auxiliary points such as Xinshu, Shenmen, Neiguan, Shenshu, Taixi, and Zusanli.
(3) Damp-Heat Descending Pattern: This pattern is relatively rare. Patients primarily present with nocturnal emissions, a bitter taste in the mouth or thirst, hot and reddish urine, a yellow and greasy tongue coating, and a soft and rapid pulse. The treatment principle is to clear heat and drain dampness; Cheng’s Cao Teng Fen Qing Decoction may be used.
II. Erectile Dysfunction
This condition refers to the inability of the penis to achieve an erection, or the inability to maintain a firm erection sufficient for normal sexual intercourse.
Etiology and Pathogenesis of Erectile Dysfunction: This condition is most commonly caused by excessive sexual indulgence, prolonged masturbation, or excessive worry; in a small number of cases, it is caused by damp-heat descending.
Modern medicine holds that over 90% of cases are attributed to psychological and mental factors, while only 3% to 10% of patients are caused by organic lesions, such as congenital penile deformities, bilateral testicular atrophy resulting from mumps infection, chronic prostatitis, and spinal cord injuries.
Traditional Chinese Medicine (TCM) Differential Diagnosis and Treatment: TCM classifies erectile dysfunction into three types:
(1) Kidney Yang Deficiency Type: Patients present with an inability to achieve an erection or a weak erection, frequent seminal emission, thin and cold semen, accompanied by dizziness, tinnitus, soreness and weakness in the lower back and knees, cold extremities, listlessness, a pale tongue with a white coating, and a deep, slow, and weak pulse. The treatment principle is to warm and tonify kidney yang; remedies such as “Hagagui Quejiu” (a wine made from the whorl of the Chinese clam and sparrow) may be used. Acupuncture points include Guanyuan, Sanyinjiao, Ligou, and Mingmen.
(2) Heart-Spleen Deficiency Type: Patients present with difficulty achieving an erection or an erection that softens shortly after onset, accompanied by palpitations, shortness of breath, mental fatigue and physical weakness, a sallow or pale complexion, poor appetite, a pale tongue, and a fine, weak pulse. The treatment principle is to tonify the Heart and Spleen; Gui Pi Decoction with appropriate modifications may be used. Acupuncture points include Guanyuan, Sanyinjiao, Ligou, and Shenmen.
(3) Damp-Heat Descending Pattern: Patients present with an inability to achieve an erection, or erections that are short-lived, often accompanied by premature ejaculation, dampness or itching/pain in the genital area, and scanty, reddish urine. The tongue coating is yellow or thick, and the pulse is string-like or rapid. The treatment principle is to clear heat and transform dampness; Ba Zheng San with appropriate modifications may be used.
III. Premature Ejaculation
Premature ejaculation refers to ejaculation occurring too early during sexual intercourse, followed by immediate flaccidity of the penis, rendering normal sexual activity impossible.
Etiology and Pathogenesis of Premature Ejaculation: The etiology and pathogenesis of nocturnal emissions, erectile dysfunction, and premature ejaculation share commonalities, all being related to kidney deficiency. Modern medicine posits that premature ejaculation is caused by pathological excitation of the brain or increased excitability of the spinal cord centers; it may also result from certain endocrine disorders.
Traditional Chinese Medicine Differential Diagnosis and Treatment:
(1) Kidney Qi Deficiency Type: Patients present with premature ejaculation, soreness and pain in the lower back, weak and limp knees, cold extremities, shortness of breath, a pale tongue, and a deep, weak pulse. The treatment principle is to tonify the kidneys and replenish qi; the formula “Kidney Qi Pills” (with appropriate modifications) may be used.
Acupuncture Points: Guandi, Qihai, Shenshu, etc.
(2) Damp-Heat in the Liver Meridian Pattern: Patients present with premature ejaculation, irritability, a bitter taste in the mouth, yellow urine, painful urination, dampness, itching, or swelling in the genital area, a yellow or thick tongue coating, and a strong, taut pulse. The treatment principle is to soothe the liver, regulate qi, clear heat, and transform dampness; Longdan Xiegan Decoction with appropriate modifications may be used.
IV. Other Treatment Methods
For the three conditions—nocturnal emissions, erectile dysfunction, and premature ejaculation—in addition to the syndrome-differentiated use of Chinese herbal medicine and acupuncture, auricular acupuncture or auricular acupressure may be employed. Qigong may also be used as an adjunctive therapy, and single-herb treatments may be considered; for example, lotus leaf has been reported to treat nocturnal emissions, and bitter melon seeds to treat erectile dysfunction.
Regardless of the method chosen for treating the above three conditions, treatment must be conducted under a doctor’s guidance and requires a relatively long-term course to be effective.