abstracted  & translated by

Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

On pages 118-120 of issue #2, 2006 of the Zhong Yi Za Zhi (Journal of Chinese Medicine), Yang Xin et al. published an article titled, "Clinical Observations on the Treatment of 50 Cases of Premature Ejaculation with Chinese Medicinals Combined with Antidepressants." A summary of that article is presented below.

Cohort description:

Altogether, there were 150 out-patients with premature ejaculation (PE) from the Andrology Department of the Zhejiang Hospital of Integrated Chinese-Western Medicine in Hangzhou enrolled in this study. The diagnostic criteria for premature ejaculation were those found in the DSM-IV. Fifty-eight of these patients suffered from primary onset PE and 92 from secondary onset PE. All the men were 23-52 years of age, with an average age of 31. All had a normal penis and testicles. These men had suffered from PE for from three months to eight years, with an average disease duration of 10 months. One hundred sixteen patients were married and 34 were unmarried. However, the unmarried men had all been in sexual relationships for one half year or more. These 150 men were randomly divided into three groups of 50 patients each, and there were no significant statistical differences between these three groups. All these men also met the diagnostic criteria for the Chinese medical pattern of yin vacuity-yang hyperactivity with non-securing of the essence gate or bar. The main signs and symptoms of this pattern included easy sexual arousal, premature ejaculation or seminal emission, low back and knee soreness and limpness, vacuity vexation, insomnia, vexatious heat in the five hearts, a red tongue with scanty fur, and a fine, rapid pulse. Exclusion criteria included abnormal serum parameters of sex hormones, such as testosterone, follicle-stimulating hormone, prolactin, or estradiole (E2). Also excluded were those with prostate, seminal vesicle, urinary tract, and/or psychiatric disorders.

Treatment method:

Group 1 were administered Zhi Bai Gu Jing Tang (Anemarrhena & Phellodendron Secure the Essence Decoction) which consisted of:

Zhi Mu (Rhizoma Anemarrhenae)
Huang Bai (Cortex Phellodendri)
Jin Ying Zi (Fructus Rosae Laevigatae)
Gou Qi Zi (Fructus Lycii)
Wu Wei Zi (Fructus Schisandrae)
Long Gu (Os Draconis)
Mu Li (Concha Ostreae)
Jin Nei Jin (Endothelium Corneum Gigeriae Galli)
Suan Zao Ren (Semen Zizyphi Spinosae)
He Huan Pi (Cortex Albiziae)

Fifty milliliters of the liquid made from these medicinals was administered each time, three times per day.

Group 2 were administered 50 milligrams per day of sertraline (Zoloft®).[1]

Group 3 received both the Zhi Bai Gu Jing Tang and the sertraline.

All three groups were treated for four weeks.

Study outcomes:

Marked effect was defined as the ability to control ejaculation in order for the woman to be sexually satisfied or to control ejaculation for five minutes with both partners satisfied with their sexual activity. Some effect was defined as lack of complete ability to control ejaculation. However, the patient was able to control their ejaculation for more than two minutes and both partners were basically satisfied with their sexual activity. No effect meant that the patient could not control his ejaculation for at least two minutes or that neither partner was satisfied with their sexual activity. Based on these criteria, in group 1, 18 cases got a marked effect, 15 got some effect, and 17 got no effect, for a marked effectiveness rate of 36% and a total effectiveness rate of 66%. In group 2, 20 cases got a marked effect, 15 got some effect, and 15 got no effect, for a marked effectiveness rate of 40% and a total effectiveness rate of 70%. In group 3, 33 cases got a marked effect, 13 got some effect, and four got no effect, for a marked effectiveness rate of 66% and a total effectiveness rate of 92%. Therefore, the combined administration of the Chinese medicinals with sertraline was more effective than either of these two therapies alone.

The following table shows the mean times of ejaculatory latency time expressed in minutes of the members of the three groups before and after treatment.

The next table shows the satisfaction rates before and after treatment.

Discussion:

Life-long PE is a syndrome characterized by a cluster of symptoms. Rapid ejaculations become manifest around the first sexual encounters in puberty or adolescence. Intravaginal ejaculation latency time 1) usually occurs within 30-60 seconds or, maximally, within two minutes after vaginal penetration, 2) is present with nearly every sexual partner, and 3) remains similar throughout life or may become aggravated during aging. In addition, this syndrome may lead to secondary psychological, sexual, and relationship problems. Although, the etiology of this dysfunction is unclear, it probably includes neurobiological and environmental factors. In part, PE is thought to be mediated, in part, by disturbances of serotonergic (5-hydroxytryptamine, 5-HT) neurotransmission and ejaculation-mediating 5-HT receptors in the central nervous system. Sertraline increases the conduction of 5-HT and thus slows ejaculation. However, in some patients, this medicine can cause decreased libido, soft erections, marked gastro-intestinal tract symptoms, and/or dizziness. As this study shows, small dose of sertraline with Chinese medicinals can get a better therapeutic effect with less or no side effects.

According to Chinese medical theory, the kidneys store the essence and rule reproduction. If kidney yin is insufficient and vacuity heat harasses internally or ministerial fire tends to become effulgent, this heat may disturb the essence chamber leading to the discharge of the essence qi. Likewise, if kidney qi is vacuous and depleted, the essence gate or bar may be insecure and, therefore, the essence may easily be discharged. However, although the storage and discharge of essence is mainly governed by the kidneys, it is also closely related to the heart and liver. Premature ejaculation is commonly seen with the liver's loss of control over coursing and discharge, emotional depression, heart vacuity-gallbladder timidity, and lack of tranquility of the heart spirit. Therefore, the authors of this article bleieve that the basic disease mechanisms of PE are heart spirit lack of tranquility and kidney essence insecurity. Hence within the above formula, Zhi Mu and Huang Bai enrich yin and downbear fire. Jin Ying Zi, Gou Qi Zi, and Wu Wei Zi enrich yin and boosts the kidneys. Long Gu, Mu Li, and Ji Nei Jin subdue yang, constrain the essence, and secure discharge. Suan Zao Ren calms the heart and quiets the spirit, while He Huan Pi courses the liver and resolves depression. When all these medicinals are used together, root and tip or branch are treated simultaneously.

Copyright © Blue Poppy Press, 2006. All rights reserved.

Endnote: