Chapter contents

INTRODUCTION

An enquiry about the sexual life of the patient should always form part of the interrogation. This is not one of the traditional 10 questions from Chinese books, partly for cultural reasons. In fact, starting from the Ming period and especially during the Qing dynasty, Chinese medicine was heavily influenced by the prevalent Confucian morality, which condemned any talk or display of sexuality.

WHY WE ASK

Questions about sexual symptoms are asked primarily to ascertain the state of the Kidneys. In fact a Kidney deficiency is at the basis of many sexual symptoms such as impotence, premature ejaculation or frigidity.

In men, apart from asking about any sexual problems such as impotence, it is important to establish whether any of their symptoms is aggravated by sexual activity or if they feel excessively tired after sexual activity. An aggravation of a symptom after sexual activity always indicates a Qi deficiency, often of the Kidneys. A Kidney deficiency is indicated also if a man feels especially tired after sexual activity and particularly if the tiredness is accompanied by dizziness, backache, weak knees, etc.

However, it should not be forgotten that other organs play a role in the origin of sexual symptoms and particularly the Liver and the Heart. The Heart, in particular, plays an important role in sexual desire and in the achievement of a normal erection in men.

WHEN WE ASK

I generally ask about sexual symptoms when the patient presents with a clear Kidney- or Heart-deficiency pattern. I also ask about sexual symptoms when the patient is clearly under emotional stress and I suspect that this may be due to sexual problems such as impotence in men or failure to achieve an orgasm in women.

HOW WE ASK

For obvious reasons, the practitioner needs to be particularly tactful when asking about sexual symptoms, especially when the practitioner and patient are of the opposite sex. In some cases, when I feel instinctively that the patient would not appreciate such questions, I do not ask them.

An enquiry about sexual activity in men is important not only for diagnostic reasons but also to be able to advise them about appropriate levels of sexual activities according to Chinese medicine.¹ There are significant differences between the sexual physiology of men and of women that are not often taken into account when advising patients about the desirable frequency of sexual activity: the Chinese caution about ‘excessive sexual activity’ is more relevant to men than to women. In fact, the Tian Gui, a direct manifestation of Essence (Jing), is sperm in men and menstrual blood in women: quite simply, because men lose sperm but women do not obviously lose menstrual blood during intercourse, sexual activity may potentially be weakening for men (when it is too frequent) but not so much for women.

MEN

The sexual symptoms discussed are: