by Lun Xin,Rong Li,and Dai Wenjun
　　(Guangzhou University of Traditional Chinese Medicine, Guangzhou 510405, China)

Impotence refers to the inability of the penis in erection which leads to incapable sexual intercourse. The authors treated 69 cases of functional impotence in the clinic of male diseases from Jan. 1997 to June 1999. The result is reported as following:
　　Clinical Data
　　69 patients were enrolled in the treatment. The youngest patient was 22 years old, and the oldest one was 64 years old. They were 46 years old in average. The ages of 20 patients were from 22-40 years. The ages of 41 patients were from 41-60 years and 8 patients were older than 60 years. The shortest course of disease was 2 months, and the longest course was 15 years. All the patients were randomly assigned into stuck needle group with 40 cases and routine acupuncture group with 29 cases. All the patients had been inquired for the history and physically examined. Their cavernous body of penis had been injected with papaverine to exclude organic changes.
　　Therapeutic Method
　　1. Group with Stuck Needle Method:
　　In prone posture, the patients' eight-liao points were disinfected with routine sterile technique. The filiform needles of Huatuo Brand with the size of No.26-28 and the length of 2.5 cun were quickly inserted perpendicularly into the points. The needles were thrust slowly into 2 to 2.3 cun deep. They were then twisted in one direction for 3-6 rounds until sensation of heaviness and tightness were felt and the needles were difficult to be further twisted. The needles were retained for 30 minutes. When withdrawing the needles, they were twisted in the contrary direction for 2-3 rounds and then twisted right and left in small amplitude to release the adhesion of the needles. 2.Group with routine acupuncture treatment Patients received traditional acupuncture therapy according to syndrome differentiation. The point selection and time for needle retention were the same as those of stuck needle therapy group. All the patients received treatment once a day with ten days as one treatment course. The following treatment course was started after seven days of break. The clinical effect was evaluated after 2 treatment courses. The testosterone (Tes) and estradiol(E2) in the blood serum of the patients were tested before and after 2 treatment courses. RESULT
　　1. Criteria of Therapeutic Effect
　　Recovery: Voluntary and forceful erection of the penis with normal sexual activity; disappearance of the accompanied symptoms; normality of the blood serum hormone.
　　Effectiveness: Ability of the penis to erect but not strong enough for the in-and-out sexual activity; remarkable improvement in the blood serum hormone test.
　　Ineffectiveness: The condition and the blood serum hormone have no change before and after treatment.
　　2. Clinical Effect (Table 1)
　　Table 1. Comparison of the Therapeutic Effect(%)
　　Group
　　N RecoveryImprovement
　　No effect
　　Total effective rate  Stuck needle40
　　 13(33 ) 24(60) 3(7) 93%  Routine acupuncture 29 7(24) 14(48) 8(28)72%  Through statisical management, X2=5.0615 P<0.05. There is a significant difference, which indicates the effect of stuck needle therapy is better than that of the routine acupuncture. 3. The Change of the Blood Serum Hormone(Table 2)
　　Table 2. Change of the Blood Serum Hormone before and after Treatment(X ±S) Blood serum hormone
　　Before treatment
　　After treatment  Tes(ng/ml)149.09±89.35693.70±207.50 *  E2(pg/ml) 185.42±117.5149.21±20.26*  PRL(ng/ml) 74.38±38.45 17.02±10.11*  Note: *indicates comparison before and after treatment  (P<0.01) The blood serum hormone had a significant difference before and after treatment which indicates that both two acupuncture methods can improve the blood serum hormone condition(by RIA).
　　A Typical Case
　　Mr. Zhang, 48 years old, an associated professor. The first visit: Dec.10, 1997. Chief complaint: inability to have penis erection for 5 years. His son died 5 years ago in a car accident. When he copulated with his wife after one month, he was unable to erect his penis erection. He received treatment from many doctors and took a lot of tonics. However, he had no improvement and had insomnia, low sexual desire, lassitude, poor memory. Physical examination: normal body development, pale complexion, pale tongue, thin white coating, deep and thready pulse. Diagnosis: functional impotence. After one treatment course, the patient was able to erect but with weak force. His sexual desire was enhanced. After another course of treatment to consolidate the effect, the patient was able to erect voluntary with absence of the accompanied symptoms and normal blood serum hormone. He was clinically cured.
　　Discussion
　　Impotence is the common disorders with inability to erect the penis during sexual intercourse. It was classified into primary impotence and secondary impotence. The latter one belongs to dysfunctional impotence which occupies 80-90% of impotence patients. It affects patients in any age. Its cause is related to psychic factors and psychological conditions. The therapeutic effect is satisfied with proper treatment. According to the TCM theory, kidney stores essence and dominates reproduction. The kidney essence controls the reproductive ability. If kidney qi is flourishing, people has normal sexual ability. If kidney qi is weak, people have impotence and seminal emission with low sexual function. The eight-liao points are on the urinary bladder channel. Urinary bladder relates to the kidney, brain and all the internal organs. It has exterior-interior relations to the kidney. The eight-liao points have the effect to nourish yin, strengthen kidney essence and strengthen the loin and tendons. The modern neurological anatomy has proved that the external and internal reproductive systems are innervated by the parasympathetic and sympathetic and somatic nerves, which originate from the S1-S4 sacral spinal column. They comprise the nerve fibers which control the vessels in the cavernous body of penis. The location of eight-liao points is where the pudendal nerve emerges from. The possible effect of acupuncture is to stimulate the nerve directly and affect the release of the nerve transmitter and change of the endocrine to adjust the sexual nervous center to achieve normal sexual reaction. Stuck needle is considered as a kind of acupuncture accident which should be avoid. But the authors used it to treat chronic diseases and achieved remarkable effect. Its mechanism of enhancing the effect, as the authors consider, is as following: stuck needle is caused by that the needle body is wrapped by the muscular fibers and connective tissues. Therefore, it causes slight injury of the tissue in the acupoints and cause slight aseptic inflammation and edema which create a persistent stimulation to the acupoints until the inflammation and edema disappear. Secondly, the needling sensation is the key point to achieve therapeutic effect in acupuncture treatment. The patients have sensation of soreness, numbness, and heaviness when they get needling sensation. The stuck needle method causes stronger and longer needling sensation than the routine acupuncture stimulation. Thus, the proper application of stuck needle is able to strengthen the needling sensation and adjust yin and yang to enhance the therapeutic effect. According to modern medicine, the cause of functional impotence is related to the dysfunction of the hypothalamus-hypophysis-testicle axis. According to the test of the hypophysis sexual gland function of the 69 patients, the testosterone was lower and the estradiol was higher than those before treatment. In addition, the severity of impotence was in accordance with the abnormality of the blood serum hormone. After acupuncture, the adnormality of the hormone excretion was improved following the improvement of the impotence. It indicates that acupuncture can adjust the abnormal function of the hypothalamus-hypopysis-testicle axis to enhance the testosterone in the blood and reduce the estradiol and prolactin to normal level. It improves the function of the sexual glands, maintains normal sexual activity, then impotence is cured.