We analyzed the differences in the understanding of erectile dysfunction between Chinese and Western medicine, emphasized the holistic discriminatory treatment concept of Chinese medicine, and proposed that the key to the research and treatment of erectile dysfunction is to treat erectile dysfunction as a disease involving the regulation of multiple systems throughout the body, rather than a mere symptom. The preliminary summary and elaboration of the overall comprehensive prevention and treatment measures for erectile dysfunction treatment were also presented. Erectile dysfunction (ED) is one of the most common sexual dysfunctions in adult men, manifested by the inability of the penis to achieve and maintain a full erection for at least 6 months in order to obtain a satisfactory sexual life. According to a study 52% of men aged 40-70 suffer from varying degrees of erectile dysfunction. The etiology of this disease is complex, with psychological, vascular, neurological, endocrine, drug and other causes, and subjective and objective factors, and its pathological mechanism is not yet fully understood. 1, the difference between the understanding of Chinese and Western medicine 1.1 Western medicine focus on local analysis 1585 Ambroisepare in the “Ten Books of Surgery” and “Book of Reproduction”, accurately described the anatomical structure of the penis, giving a clear concept of penile erection. 20 century erectile dysfunction treatment methods have roughly experienced the following stages of development: since 1900, following the results of the research of Covey and Miao Le In the 1980s, the main treatment method was intracavernous injection of various vasoactive drugs (e.g. poppy bases, phentolamine, prostaglandin E1, etc.) into the penile corpus cavernosum. Since the 1990s, Sildenafil has gained widespread recognition for its excellent clinical efficacy in the treatment of erectile dysfunction, as well as for its role in the regulation of the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway. The new chemically synthesized drugs that act locally to cause erections have made research redundant. However, penile erection is caused by the combined action of the nervous system and transmitters, the endocrine system and hormones, resulting in the filling of the penile corpus cavernosum, and is also strongly related to psychological factors and social and environmental influences. Penile erection is a complex functional process closely related to the function of many systems throughout the body, so much so that it is difficult to give a very precise definition of erectile dysfunction. Japanese scholars define erectile dysfunction as the absence or insufficiency of more than one of the elements of the sexual process, i.e., sexual desire, erection, intercourse, ejaculation, and orgasm [2]. Obviously the occurrence of erectile dysfunction covers the whole process of sexual activity, and it is not enough to recognize it only from the perspective of penile erection. 1.2 Traditional Chinese medicine focuses on the overall understanding of erectile dysfunction seems to be a “local lesion”, but it is closely related to the strength and weakness of human organs, meridians and blood. The erection of the penis is closely related to the function of the five viscera, the kidney is the main function of the yin organ, the liver is the activity of the yin organ, the heart is the master of the soul to dominate the erection of the stems, the lung is the transmission of essence to the outer kidneys, the spleen is the master of transportation and intake to feed the innate. The five organs function normally, erectile function can only be performed. Ancient doctors have long been aware of this disease. Mawangdui medical book “the world’s most Tao talk” has “(penis) anger but not big, the muscle is not to also; big but not firm, the tendons are not to also; firm but not hot, the gas is not to also. The muscle does not arrive and use is atrophy, gas does not arrive and use is avoidance, all three to, this is called three attainment” is recorded. The “Xuan Nui Jing” points out: “The jade stem is not angry, and the qi does not arrive; angry but not big, the muscle qi does not arrive; big but not firm, the bone qi does not arrive; firm but not hot, the spirit qi does not arrive. Therefore, the angry, the essence of the Ming; large, the essence of the Guan; firm, the essence of the household; hot, the essence of the door …… “Ming dynasty doctor Wan Quan, “wide the discipline of the internal organs of the erection described the pathology, pointed out:” impotence and not lifting, liver gas is not to also, liver gas is not to and strong together is hurt its tendons, its semen flow drops and does not ejaculate carry on. The strong but not hot, the heart qi has not arrived, the heart qi has not arrived but the strong together will hurt the blood, the semen is clear and cold and not warm. Firm and soon, the kidney qi has not yet arrived, the kidney qi has not yet arrived and strong together will hurt the bone, its essence does not come out, although out also less.” Zhang Jingyue, a clinical expert of the Ming Dynasty, in his book “Jingyue Quanshu? Impotence” chapter incisively discussed the etiology of erectile dysfunction, and summarized into four categories: one said the life of the fire failure; two said damp-heat incandescence; three said too much depression; four said the big stroke and fear, force advocates multi-factor cause. 1.3 Advantages of Chinese medicine treatment The development of Chinese medicine is greatly influenced by Taoist thought. Taoist internal elixir doctrine in the room contains a very rich content of sex therapy, although there are some non-scientific speculation and conjecture, but the content of its observation is more than reasoning, the overall kernel is reasonable and rich in scientific spirit, can provide a lot of useful inspiration to modern sex therapy. For example, special attention is paid to the coordination and unity of the body, mind and environment, emphasizing the choice of the object of sexual intercourse, the time of intercourse and environmental scenes, and the mutual feeling and coordination of both parties. Chinese medicine emphasizes holistic identification, which has certain advantages in the treatment of erectile dysfunction. The three characteristics of TCM treatment are worth advocating: First, sexual dysfunction is regarded as a part of the whole body function, not only the problem of sexual organs, which is consistent with the “physiological-psychological-social model” advocated by Hartmann and Fithian. This is in line with the “physiological-psychosocial model” of sex therapy advocated by Hartmann and Fithian. Masters and Johnson, and all modern sex therapists emphasize the same viewpoint of treatment [3]. Erectile function is closely related to the strength and weakness of human organs, meridians and blood, which determines that the general principle of erectile dysfunction treatment is: to identify the cause and effect relationship, to examine the evidence to seek the cause, and to examine the cause of treatment. The treatment must start from the whole, according to the person, know the normal and change, avoid the bias of medicine [4]. 2.1 Multi-visceral evidence-based treatment An overview of the current literature on the treatment of erectile dysfunction in Chinese medicine reports that there are “diagnosis and treatment from the liver”, “diagnosis and treatment from the heart”, “diagnosis and treatment from the spleen and stomach”, and “diagnosis and treatment from blood stasis” and many other views. Because the occurrence of erectile dysfunction psychological factors are very important, and Chinese medicine believes that “the liver is the master of emotions and sparing”, so the “treatment from the liver” view of treatment is quite popular. The Chinese medicine theory believes that the emotional activity is related to the function of all five organs, not only with the liver. Modern research has also confirmed that Chinese herbal medicine can act on the neuroendocrine immune network system to influence psychological activities by tonifying the kidney and strengthening the spleen [5]. In the author’s opinion, the identification and treatment of erectile dysfunction must distinguish the deficiency of the internal organs and examine in detail the cold, heat, yin and yang. The main method of treatment is: those who are deficient should be tonified, those who are real should be diarrhea; those who have fire need to be cleared, those who do not have fire should be warmed. The law of identification is: from the physical constitution, obese people are more phlegm-damp, more deficiency cold; thin people are more damp-heat, more deficiency fire; depressed people are more qi stagnation; anxious people are more liver fire. In young and strong patients, the five viscera are solid and the kidney energy is abundant, so the disease is more real and hot, and the real heat hurts yin, which can be accompanied by yin deficiency, and the disease is mostly in the heart, liver and kidney; in middle-aged and old patients, the five viscera are declining and the kidney energy is gradually losing, so the disease is more deficient and cold, and the disease is mostly in the kidney and spleen; if the kidney declines in old age, the stagnant evil blocks the veins and channels, and becomes a mixed evidence of deficiency and reality. Brain workers injured the heart and spleen, dark depletion of heart and blood, so the disease is more heart Ying deficiency, and sadness and good thinking, so more liver depression, so brain workers suffering from erectile dysfunction, the pathogenesis is more mixed, mainly deficiency; manual workers suffering from erectile dysfunction, because of their overwork, exertion injury kidney, so more kidney deficiency. 2.2 Distinguish the symptoms and the urgency In the clinical treatment of erectile dysfunction, we should follow the treatment principle of “Nei Jing”, “treat the symptoms if it is urgent, and treat the essence if it is slow”, distinguish the priorities and master the symptoms. Only on the basis of identification can the essence of erectile dysfunction be grasped and treated in a focused manner, and once the major contradictions are resolved, the minor ones can be solved. For the sudden onset of the disease, we need to carefully find the cause of the disease, through psychological guidance, behavioral therapy and penile cavernous body injection, the use of traditional Chinese medicine to nourish Yin and Yang, dredge the liver and Qi, spleen and stomach, blood circulation, dampness and heat, traffic in the heart and kidneys and other treatment method identification; clinical evidence, there are a considerable part of erectile dysfunction patients, concurrent symptoms are not obvious, difficult to identify, should be used to identify the disease method, from the physical, age and other factors Consider, slow to treat the root of the problem, using the method of kidney supplementation. The kidneys are the “foundation of the heaven” and “receive the essence of the five viscera and six bowels and hide it”. Therefore, kidney deficiency can affect other internal organs and occur erectile dysfunction, while other internal organs lesions can also lead to deficiency of kidney essence and occur erectile dysfunction. Zhang Jingyue’s idea of paying attention to the essence of Yin is enlightening to male clinics. He believes that “the five viscera are the essence of the human body, the kidney is the essence of the five viscera, and the yin essence is the essence of life”. We advocate that for the long-term treatment of erectile dysfunction, we need to apply the strategy of treating the root of the problem, mainly by nourishing Yin and tonifying the kidneys [6], and using other methods to improve the patient’s physique through comprehensive conditioning to treat erectile dysfunction. 3, the overall understanding of erectile dysfunction 3.1 The overall theory of the body and mind of erection Erection is a complex process, is a perfect unity of psychology and physiology, the body and mind are inseparable. Sexual function includes both sexual physiology and sexual psychology, and the content of sexual function activity is much richer than the simple penile erection, only the normal penile erection does not represent the complete sexual function and sexual activity. Therefore, successful sexual activity cannot be achieved without penile erection, but only penile erection will never necessarily constitute a satisfactory sexual activity. In clinical work, we can often see many patients with erectile dysfunction, who have normal results in the nocturnal penile tumescence test (NPT), but in the waking state, they just can’t have an effective erection; and patients with sexual deviation and sexual perversion, although they have an erection, they only have sexual psychological satisfaction, and their sexual behavior is The sexual behavior is deformed. Even sildenafil is not a panacea for everything. Sildenafil is suitable for those who have sexual desire, but the erection is not firm and cannot complete satisfactory sexual intercourse. If there is no sexual desire, the use of sildenafil, the effect will not be good. 3.2 Is erectile dysfunction a symptom or a disease? Clinically, erectile dysfunction can be manifested either as an individual symptom or as a concomitant symptom of other diseases, only that it is prominent due to the great impact of erectile dysfunction on the body and mind, and sometimes even overshadows the manifestation of other diseases (such as diabetic ED, etc.). But it must be clear: is erectile dysfunction just a symptom? Or is it a disease? We believe that erectile dysfunction is not just a symptom, but should be studied and treated holistically as a disease that involves many tissue systems and complex factors. In addition to the local cavernous blood filling of the penis, erection requires the joint participation of the neuroendocrine and blood systems of the whole body. The study of erectile dysfunction as a symptom is necessary for the in-depth study of its pathological mechanism, but erectile dysfunction as a comprehensive disease, involving many systems of the whole body and social and psychological factors, if only focus on the local study of penile erection, is obviously incomplete and imperfect. Therefore, in addition to the study of chemically synthesized drugs that act locally, we should not ignore the comprehensive prevention and treatment measures such as Chinese medicine treatment and psychotherapy. 4, the overall comprehensive prevention and treatment measures of erectile dysfunction The sign of successful erectile dysfunction treatment is not only the recovery of penile erectile ability, but also the maintenance and restoration of the natural process of sexual relations is the goal, which is also the result expected by patients and their spouses. Therefore, it is important to consider the treatment plan in a holistic manner and to give appropriate measures. For example, eliminating patients’ misconceptions about erectile dysfunction; attaching great importance to the opinions and wishes of patients and their spouses; collaborating with doctors and patients, encouraging active participation of patients and building up confidence in treatment; adopting treatment plans that focus on individualization, etc. 4.1 Psychological treatment Sex is a physical instinct and sexual activity is a natural process. However, physical state, emotional fluctuations, environmental factors, etc. may affect the erectile function of the penis. People’s sexual activity and erectile state is not perfect and impeccable every time they have sex, once in a while due to other factors, erectile dysfunction, for people with poor psychological quality and poor psychological state or personality disorders, may produce erectile dysfunction role behavior reinforcement and role fear, patients are overly concerned about erection, unwilling to admit their normal sexual ability and exaggerate the erectile Negative impact, the ideological fixation on the disease state, resulting in the patient’s depression, guilt and low self-esteem, under the influence of constant psycho-social tension factors (including medical origin), forming a vicious circle, become a persistent disease that can not be cured. Therefore, the treatment of erectile dysfunction cannot be separated from psychotherapy. It has been reported that psychotherapy can regulate the function of the hypothalamus and cause changes in the hypothalamic-pituitary-gonadal axis through the regulation of the hypothalamus [7-8]. It indicates that psychotherapy has a good prospect for treating erectile dysfunction. However, we should also see that there are great differences between the East and the West in terms of cultural traditions and values, and the influence of social factors such as the cultural background, ethics and morality, and customs of the Chinese on the effectiveness of psychotherapy must be taken into account while using Western psychotherapy methods for treatment. Therefore, it is more practical and urgent to study and apply psychotherapy methods with Chinese characteristics. 4.2 Couples with overall treatment The occurrence of erectile dysfunction has a great relationship with the spouse, and the spouse plays an important role in the success of the treatment of erectile dysfunction. The occasional failure of sexual life in the life of the couple, will give the male partner to a huge psychological pressure, depression and anxiety and other emotional changes. If the spouse does not understand and to blame, these bad emotional factors, over time will inevitably lead to dysfunction of the internal organs of the patient’s body, the so-called “five will be too extreme, the fire hurt Yin”, and finally lead to the occurrence of erectile dysfunction. The spouse’s tolerance, understanding and concern can obviously alleviate the patient’s condition, enhance the patient’s confidence in treating the disease, and even improve the effect of treatment. Therefore, from the treatment point of view, the active role of the patient’s spouse in the treatment is highly emphasized. 4.3 Doctor-patient collaboration for overall treatment In the concept of many men, sexual function is an important expression of self-strength and self-esteem, and once erectile dysfunction occurs, it often brings great psychological impact to patients. On the other hand, many patients treat sexual function as personal privacy and refuse to seek medical consultation because they do not want to expose their condition. Excessive worry, fear, fear and other negative emotional reactions often make patients lack confidence in treatment, bringing great difficulties to the treatment of erectile dysfunction. Doctor-patient collaboration, that is, the doctor should care and considerate patients, pay attention to protect the patient’s personal privacy, in order to obtain the patient’s respect and trust, encourage patients and spouses to explain in detail the problems encountered and inner feelings, to find out the key to the problem; encourage the active participation of patients, so that patients can experience the pleasure of sexual activity in the treatment, to overcome the fear of sexual activity, mobilize the patient’s subjective initiative, stimulate patients to seek treatment With the help of feedback and communication, we encourage patients’ progress and gradually establish the normal process of sexual activity so as to restore erectile function. In addition, according to the patient’s occupation, couple relationship, living environment, personality characteristics and other different, the use of individualized treatment plan is also very important. In summary, the treatment of erectile dysfunction is a complex systemic project, of which the key is to treat erectile dysfunction as a disease involving the whole body multi-system, rather than just a simple symptom of the penis erection as an eye point. This urgently requires male medical practitioners to change the concept from a purely biomedical model to a biopsychosocial medical model, and to extensively apply the perspective and methods of physical and psychological treatment and overall comprehensive regulation to the study and treatment of erectile dysfunction. Reference: omitted Article published in: Journal of Shanghai University of Traditional Chinese Medicine, 2006; 20(4): 103-105 Article original, please cite!