Impotence refers to a condition in which adult men who have matured sexually are unable to complete sexual intercourse because of reduced or lost erectile function, resulting in unsatisfactory sexual life. Modern male science is called penile erectile dysfunction (ED). Chinese medicine has a long history of understanding impotence, and in long-term medical practice, two mainstream views on the pathogenesis of impotence have gradually emerged, namely the kidney deficiency view and the liver depression theory. The history of the formation of the kidney deficiency view of impotence is discussed below. 1. History of the names of impotence 1. 1 During the pre-Qin and Qin-Han periods, many names were given in descriptive texts from different aspects of impotence symptoms. The medical book of Mawangdui Han tomb? The earliest name for impotence is found in the “Tianxiazhidao Talks” [3], which calls impotence “unable”; the “Yang Sheng Fang” [3] calls it “unable to get up” and “old unable to get up”; the “Huangdi Nei Jing” [4, 5 [4, 5] recorded the name of the disease “Yin impotence” as well as “the inability to use the apparatus”, “the inability to use Yin”, “the inability to use the hidden curve”, etc., which influenced later generations of physicians. “The Shen Nong Ben Cao Jing [6] also used “Yin impotence” as its main name. 1. 2 In the Jin, Sui, and Tang dynasties, the name of impotence was “yin impotence” and “yin atrophy”, and the name of impotence was gradually generalized. The name of impotence was gradually generalized. In the Pulse Classic of Wang Shuhe of the Western Jin Dynasty [7], it was called “yin atrophy”; in the Acupuncture and Moxibustion Classic of Huangfu Qu [8], it was called “yin impotence” and “yin impotence without use”; in the Eastern Jin Dynasty, in Ge Hong’s Elbow Post Emergency Formula [ 9], it was called “yin atrophy”. 9] as “yin atrophy”; in the Sui Dynasty, Chao Yuanfang’s “Treatise on the Origin of Various Diseases” [10] as “yin impotence”, “yin atrophy” and “yin failure”; in the Tang Dynasty, Sun Si Fang’s “Treatise on the Origin of Various Diseases In the Tang dynasty, Sun Simiao’s “Prepared Emergency Thousand Gold Essentials” [11] called it “yin impotence” and “yin impotence without use”. 1. 3 During the Song, Jin and Yuan dynasties, most of them were called “yin impotence”, “yin atrophy”, “lack of prosperity in the common affairs” and “weakness of the yang path”. However, the name “Yang atrophy” has already appeared. In the Song Dynasty, Dou Cai’s “Bian Ji Xin Shu? Shen Fang” [12] in the Song Dynasty: “Wu Fu Dan …… can also augment Yang and cure impotence, and it is more effective for people with kidney deficiency”. This is the first time that the name “yang wilt” appears. 1. 4 During the Ming and Qing dynasties, the naming of impotence was gradually improved and stabilized, and although the previous name was not discarded, the name “impotence” appeared, and most doctors began to follow this name. In the Ming dynasty, Zhou Zhigang’s “Shenzhai Legacy? The name “impotence” was recorded in Zhou Zhigang’s “Shenzhai’s Legacy” [1] in the Ming Dynasty; Zhang Jiebin’s “Jing Yue Quanshu? Impotence” [12] listed a special section and described the ancient theory of treatment and classification; the Qing Dynasty “Secret Record of Miscellaneous Evidence Treatment” [13] clearly pointed out that “Yin impotence is impotence”. From the above, the four main names of impotence are “impotence”, “impotence”, “yin impotence”, “yin impotence” and “yin impotence”. “After the Song Dynasty, the term “yang atrophy” gradually appeared, and in the Ming Dynasty, the term “impotence” appeared. “Yin” is a generic term for male and female genital areas; “yang” is a term used to distinguish male and female genitalia from gender, referring to male genitalia. The meaning of “atrophy” and “impotence” is similar, both can refer to the same type of disease, but “atrophy” is more extended than the concept of “impotence”. The word “atrophy” can refer to both disease and withered grass, while “impotence” can only refer to disease. Therefore, “yin impotence” means “yin atrophy” and “yang impotence” means “yang atrophy”, both of which refer specifically to the weakness of the male genitalia. The word “impotence” has the meaning of atrophy, atrophy, atrophy, and weakness, so it is used to refer to the impotence of men’s penis by analogy. “The evolution of the term “yin impotence” to “yang impotence”, although only a word difference, reflects the change in the understanding of this disease. The word “Yang” in “impotence” not only refers to the male genital organs, but also implies the understanding of the pathogenesis and treatment of impotence. As a result, the complex etiology of impotence was summarized into one point, namely “Yang deficiency”, and the treatment of impotence from the kidney by warming the kidney and strengthening the yang has gradually become the mainstream view of medical doctors in treating this disease. Therefore, the origin of the idea of impotence and kidney deficiency can be seen in the name of impotence. The study of ancient impotence literature by Qin Guozheng [14] showed that those who advocated the treatment of impotence from the kidney alone or those who stressed the need to harmonize the kidney function in the treatment of the causes together accounted for 91.89% of the total number of cases, indicating that the understanding of impotence mechanism in Chinese medicine was mostly discussed from the kidney or from multiple organs and the kidney. The concept of impotence and kidney deficiency is an important entry point for Chinese medicine practitioners to understand the pathogenesis of impotence, and it is also the theoretical cornerstone of the treatment of impotence from the kidneys. 3. History of impotence from the kidneys 3. 1 The physiopathological relationship between sexual function and the kidneys and Yin organs was discussed in ancient medical books and classical works of the Qin and Han dynasties. The Medical Book of the Han Tomb of Mawangdui? The “talk about the best way under the sky” [3]: “If you are angry but not big, your muscles do not arrive; if you are big but not firm, your tendons do not arrive; if you are firm but not hot, your qi does not arrive”. Erection “not big”, “not firm”, “not hot” of the pathogenesis of muscle, tendons, gas three does not arrive, “three to be into “This is the earliest discussion of the pathogenesis of impotence, and it laid the foundation for the theory of the pathogenesis of impotence from the kidney. The Huangdi Nei Jing [4, 5] linked “tendons, qi” and kidney from the relationship of meridians and internal organs, and discussed the relationship between penis and kidney and meridians. The tendons of Shaoyin, starting under the little finger, and the tendons of Taiyin …… and up through the femur of Yin, knotted in the Yin device …… and the tendons of the Sun.” The “Su Wen? The Golden T true speech cloud: “North black, into the kidney, open the orifice in the two yin.” The tendons of the kidneys are knotted in the yin device, and the kidneys are open to the front and back of the yin, from the anatomical relationship, the kidneys must have an impact on the physiological function of the penis. Su Wen? The kidneys are the strongest official, and the tricks come out of it.” Su Wen? Shanggu tianzhen theory” cloud: “two eight kidney qi Sheng, day sebum to, essence overflow diarrhea, yin and yang, so can have a son …… this their heavenly life is excessive, qi veins often general, and kidney qi surplus”. This means that the kidneys are strong in order to have the material basis for the fullness of the essence, so that men and women can be in harmony. The kidney stores essence, which is responsible for growth and reproductive function; essence can transform qi, and sufficient kidney essence can transform kidney qi, so that men can have normal reproductive function and no impotence. When discussing the etiology and pathogenesis from the kidney, Su Wen? impotence”: “the endless thoughts, the desire can not be achieved, the intention of the desire outside; into the room is too much, the clan tendons, the development of the tendons impotence, and for the white prostitution”; “Su Wen? Yin and Yang should be the elephant in the room: “60 years, the impotence of the yin, gas is greatly weakened, the nine orifices are not conducive, the lower deficiency on the real, weeping all carry on”, pointing out that too much room labor, over the age of the flowering armor can cause kidney deficiency impotence. 3. 2 In the Jin, Sui and Tang dynasties, the pathogenesis of impotence from the kidney was further refined, and the pathogenesis of impotence was explained from multiple angles, including kidney yin, kidney yang, kidney qi and kidney essence. In the Western Jin dynasty, Ge Hong’s “Prescriptions for the Post-Elbow Emergency? In the formula for the treatment of lumbago and pain in the lumbar region [9], it is clearly pointed out that the pathogenesis of impotence is kidney deficiency and coldness (kidney yang deficiency). In the Tang dynasty, Sun Simiao’s “Prepared Emergency Thousand Gold Essential Formula? Bladder House Formula? Miscellaneous tonic” [11] clouded: “treating yang deficiency, scrotal itchiness, urine with residual leaking, leakage and deficiency, cloud for failure, Cistanches for deficiency and benefit of yang formula”. From the kidney Yang deficiency to explain the pathogenesis of impotence, paying special attention to the Yang Qi of men, that Yang Qi plays a vital role in male sexual activity, pointing out that “men, the Yang of all, often resides in dryness, Yang Qi wandering, forceful discharge, then into the disease of deficiency and injury”. Therefore, the vital gate is less warmed by fire, which is a necessary condition for sexual function; when the vital gate fire fails, the zong tendons are not warmed, resulting in impotence and inactivity, which promotes the mechanism of treating impotence from the kidney yang theory in different degrees. In the Sui Dynasty, Chao Yuanfang’s “Treatise on the Origin of Diseases? In the Sui Dynasty, Chao Yuanfang’s “Treatise on the Origin of Various Diseases and Conditions?”[10] considered that the pathogenesis of impotence is the deficiency of both kidney yin and yang. The long time has not been, then Yin impotence is also weak”; “Yin and Yang weakness, and the wind evil into the kidney, so Yin does not rise, or lead to abdominal pain”; “kidney open orifice in Yin, if labor injury in the kidney, kidney deficiency can not be glorified in the Yin organ, so atrophy is also weak. Yang Shangshan, “Huangdi Neijing Tai Su? Volume 3? In the commentary “Yin and Yang” [4], it is believed that impotence in old age is due to deficiency of kidney energy, “When a person is 60 years old, the kidney energy declines, the essence decreases, and the tendons become impotent”; in the commentary “Five Viscera Pulse Diagnosis “The kidney pulse of impotence is very large and full of Qi and blood, the Sun is full of Qi, the Shao Yin is less blood, the essence is less blood, so the Yin is not impotent”. 3. 3 The Song, Jin and Yuan periods continued to deepen the explanation of the pathogenesis of impotence due to kidney deficiency in terms of kidney yang deficiency, kidney qi deficiency, kidney yin deficiency, kidney essence deficiency, and kidney yin and yang deficiency, and was influenced by the “bureau formula” at that time to use warm and dry ideas, and the pathogenesis of impotence due to kidney yang deficiency was emphasized by medical practitioners. In addition, the pathological mechanism between the kidney and other internal organs has begun to be involved, such as the explanation of the pathological mechanism of impotence from “heart-kidney yin deficiency and hyperactivity”, in which the kidney water cannot help the heart fire, and the heart fire is hyperactive and consumes the kidney yin. Due to the deficiency of kidney yin, the heart yang loses the restraint of kidney yin and becomes hyperactive, resulting in impotence due to disturbance of the heart and mind, and the mind does not keep its place. 3. 4 During the Ming and Qing dynasties, the idea of impotence with the kidney as the core of the pathogenesis was established, not only emphasizing that deficiency of the kidney causes impotence, but also suggesting that actual kidney causes impotence, and also the influence of emotions and internal organs on the kidney, deepening and bringing into play the idea of impotence from the kidney, making it more perfect. 3. 4. 1 “fear hurts the kidney” on impotence in the Ming dynasty Zhang Jiebin “class” [15] in the commentary of the “Nei Jing” provisions about “fear hurts the kidney” cloud: “fear is essence, so hurt the kidney. All those who are suddenly afraid are more likely to urinate, and even impotence is a symptom of this”. It is believed that fear can lead to impotence. Jing Yue Quan Shu? Miscellaneous evidence of impotence”[2] in the chapter on impotence discussed in detail the pathogenesis of impotence caused by fear. “Where the fear does not release, also to impotence. The scriptures say: fear hurts the kidneys, that is, this is also said. Therefore, where there is a big fright and fear, can make people lose urine, that is, the test of injury to the kidneys. Or in the Yang prosperous time, suddenly have a fright, then Yang Road immediately impotent, also its test. In the Qing dynasty, Ye Tianshi’s “Clinical Guide to Medical Cases? The case of impotence in the Qing Dynasty, Ye Tianshi’s “Clinical Guide to Medicine?”[16] commented: “There are also those who get it because of fear. 3. 4. 2 “life gate fire failure” on impotence “life gate fire failure” on impotence: Ming dynasty doctor Zhang Jiebin [2], as a representative of the warm tonic school, according to “Yang Qi is like the sky and the sun, losing its place will break life and not manifest “According to the principle of “the kidney is the main water, the essence of the five viscera and the six bowels is hidden”, he proposed that “all men who are impotent are mostly due to the failure of the fire of the vital gate and the coldness of the essence. The famous assertion that “most men are impotent because the fire of the vital gate has failed and the essence is cold. But seven or eight out of ten have failed, and only one has flourished”. 3. 4. 3 “True yin deficiency” on impotence Han Shan Zheng’s “Treatise on impotence” [17] at the end of the Qing Dynasty: “Those who suffer from yang deficiency are few, but those who suffer from yin deficiency are many” and “Those who suffer from true yang are inherent, but those who suffer from true yin are many. How can we say that impotence is the result of the failure of true fire?” It is believed that impotence is the result of the excess of fire, indulgence in sexual intercourse, or severe masturbation, depletion of yin essence, and loss of nourishment of the tendons. 3. 4. 4 The theory of impotence is based on “the fire in the kidney”. The “Kidney meridian fire depression and the disease, so take the medicine of Phellodendron and Zhi Mu to clear the fire and strengthen the kidneys, so we must examine, not to be partial to the fire failure. Jing Yue Quan Shu? Miscellaneous evidence? Impotence” [2], although emphasizing that fire failure of the vital gate can cause impotence, but also pointed out that the kidney can also cause impotence, the cloud: “but with fire or without fire, the pulse evidence can be distinguished. However, there are only seven or eight out of ten cases of fire failure, and only one case of fire. 3. 4. 5 “Lung and kidney deficiency” on impotence: Li Shizhen, Ming Dynasty, “Ben Cao Gang Mu? The main treatment? The main medicine for all diseases? Impotence” [19]: “Impotence, with dampness and heat, belongs to the liver and spleen; with deficiency, to the lungs and kidneys. 3. 4. 6 The theory of impotence by “non-intercourse between the heart and kidney” has a more complete understanding of impotence caused by non-intercourse between the heart and kidney in the Ming and Qing dynasties. In the Qing Dynasty, Chen Shiduo’s “Discernment Record? The heart’s failure, but also the kidney water deficiency. The essence is enough to hand over to the heart …… although long war and can not drain the essence; deficiency is the heart has nothing to feed, timid in the, this is not war”. Ye Tianshi “uncut version of Ye’s medical case? The formula follows? Ling Gui Zhu Jiang Tang [21]: “Heart and kidney do not intermingle, palpitations, impotence and inactivity”, “Emotional and mental fretfulness, heart and kidney do not intermingle, less sleep and impotence”. The Book of Evidence? Volume 9? This pathogenic mechanism is discussed in “The Treatment of Impotence”[20] from the principle of impotence treatment, “Therefore, to treat the disease of impotence, the heart must be tonified above and the kidneys must be tonified below, and the heart and kidneys must be both vigorous, and then the phase fire of the Gate of Life must be tonified before impotence can be aroused”. 3. 4. 7 “Liver and kidney pathology” on impotence from liver and kidney deficiency: Xiao Jing, Ming dynasty, “Xuan Qi Wei Zheng Lun? Medical theory? The five qi diagrams [22]: “impotence, thin essence, brittle tendons and bones, exhaustion of the liver and kidney qi”. It is pointed out that deficiency of liver and kidney qi can cause impotence. In the Qing dynasty, Feng Zhaozhi Zhang’s “Feng’s Secret Book of the Brocade? The size of miscellaneous diseases together” [23]: “The Yang Road is the meeting of the tendons, the bell of the liver and kidney, and the gathering of the Yang. There is a deficiency of the kidney deficiency of the essence of slippery, there is a cold essence of the essence of the clear, or the thing and not firm, firm that is flowing and not ejaculation …… are insufficient essence, and the treatment of the person, always no more than the two families of liver and kidney, nourishing the essence of blood yuan yang, the cover of the same source of the E and K.”. It is pointed out that impotence occurs due to deficiency of essence and blood in the liver and kidney. The theory of impotence from the actual evidence of liver and kidney: Zhang Jiebin, “Jing Yue Quan Shu? Miscellaneous evidence? Impotence”[2]: “Where dampness and heat in the liver and kidneys cause relaxation of the tendons, it is also impotence”. In the Qing Dynasty, Zheng Yutan’s “Miscellaneous Diseases: A Collection of Methods? Yin impotence and seminal slippage” [24]: “Due to liver and kidney deficiency, dampness and heat congestion in the lower jiao, resulting in impotence, yin sweat, seminal slippage and steam heat”. 3. 4. 8 “Spleen and kidney yang deficiency” on impotence Zhang Jiebin, Jing Yue Quan Shu [2]: “Yi Qi Dan, treats deficiency of the spleen and kidney and cold, easy diarrhea and abdominal pain from time to time, impotence and coldness”. Chen Xiuyuan of the Qing dynasty, “The Book of the Times” [25]: “Returning Shao Dan, treats deficiency of the spleen and kidneys, tasteless diet, less wonderful face, weakness of the waist and knees, dreaming of loss of energy or juvenile impotence, etc.” 3. 4. 9 “Deficiency of Yang Qi in the Five Organs” on impotence Chen Shiduo, Qing dynasty, “Discernment Record? The man is impotent when he has intercourse, and the woman is in the process of getting excited, but the man is impotent first, his yang is not firm, and the sperm is difficult to shoot far, people think that the fire of the Gate of Life is failing, who knows the great deficiency of yang qi? If Qi is strong, Yang is strong, and if Qi is weak, Yang is weak. This qi is also the true qi of the five viscera, not just the fire of the Gate of Life. If the five viscera are killed, the true qi of the five viscera will be depleted and cannot help the fire of the Gate of Life, so the fire of the Gate of Life will fail. 4. Potential changes in the view of impotence and kidney deficiency In summary, we can outline the theoretical outline of the view of impotence and kidney deficiency more clearly from the evolution of the ancient Chinese medical literature on the pathogenesis of impotence from kidney theory. From the earliest interpretation of the pathogenesis of impotence in relation to the anatomy of the meridians and organs, to the discussion of impotence in relation to the imbalance of the yin and yang essence of the kidney itself, and then to the analysis of impotence and the actual pathogenesis of the disease from the role and relationship between the kidney and other internal organs and pathogenic factors at a deeper level, this also reflects the evolution of ancient Chinese medicine theories while thinking about the essence of impotence and kidney deficiency. In modern Chinese medicine, the kidney is the master of reproduction, and on the basis of the kidney essence, it is the root of the phase fire, and the phase fire is the source of the libido and the erection of the tendons in human beings; the heart collects the spirit, which is the master of the fire, and the heart and the fire have a strong dominant and restraining effect on the phase fire, which can also directly or indirectly affect the libido and the erection of the tendons; the liver collects the blood, which is the master of the drainage and the master of the tendons, and the liver blood, under the guidance of the liver qi, has a rapid effect on the erection of the tendons. The spleen is the source of the posterior, the source of biochemistry of qi and blood, and it has a supporting role in moistening the tissues; the lung is the master of all qi, and the qi of the lung can reach the kidney water, which also has a supporting role in the erection of the tissues. The meridians, the Liver Vessel “follows the femoral Yin, enters the hair, and passes through the Yin Vessel”; the tendons of the Foot Yang Ming and Foot Tai Yin “gather in the Yin Vessel”; the tendons of the Foot Shao Yin and Foot Turk Yin “knot in the Yin Vessel”; the Chong, Ren and Du Vessels The three veins originate from the uterus (the sperm chamber for men) and have three branches, of which the Chong and Ren veins are the main pathways for the transmission of the sebum, while the Du vein reaches the zong tendon directly and affects the erection of the penis. The whole impotence mechanism is still based on the function of the kidney, the coordinated functioning of the five organs is the key to sexual erection, and the meridians and zong tendons are the channels to complete sexual erection. Therefore, the concept of impotence and kidney deficiency has changed with the times.