The
Treatment of Female Sexual Dysfunction
With the Fire-Needle Technique
j
A
case history by Shmuel Halevi Ph.D
Strange
as it may be, one can seldom encounter discussions and articles dealing directly
with sexuality in the realms of prevalent contemporary acupuncture and Chinese
medicine literature. In the ancient Chinese world, sexuality was definitely
considered a major topic within the framework of general health-care, so much so
that it won a respected canon of its own. This canon, the Su Nu Jing, was
compiled probably several centuries B.C.E, of five volumes, in a very similar
literary style as the famous “Huang Di nei Jing” – the Yellow Emperor’s
canon of internal medicine. 1
In
these five volumes all aspects of sexuality were discussed practically (and
depicted), with a significant bias to the influence of our sex-life on health,
and vice-versa. Consistent with Chinese medical tradition on other issues as
well, later generations throughout Chinese history, have contributed a huge mass
of commentary and interpretation to the text of the Su Nu Jing. This commentary
has served mainly to integrate the ideas and techniques described in the Su Nu
Jing, with the philosophy and concepts that form Chinese medicine.
In
this article, I have chosen a case of a young woman, whom I treated a year ago
for a complicated sexual dysfunction. Such cases are not very frequently
encountered in the acupuncture clinics in the west, or east for that matter,
despite their probable high occurrences in the population. This is due both to
cultural limitations, as well as personal psychological inhibitions.
Sexuality,
as is well known to any health-care practitioner, resides in the deepest nook of
most people’s souls, much as the organs involved with the sexual act itself.
The
case of this young woman, Dana for this article, involves two interesting
aspects:
Dana’s
story
I
first met Dana in my clinic on March 15, 2000.
She
was a slim good-looking fragile figure, with a somewhat pallid complexion
aged 26 years, a student. She came out right away with her problem, as if
spitting it out after a resolute decision to have it done with, once and for
all.
Her
main problem, as she have put it, was an intense pain in her vaginal labia area,
whenever it was touched. Having sex was a nightmare for her. She could hardly
touch herself on that region, and she had changed partners several times
already, due to her inability to enjoy, or satisfy her mates. The nature of her
pain was intense, pricking and burning. In the initial stage however, the pain
did not have a burning quality. She felt the pain only at the outer aspect of
the labia, and not deep inside. Various professional physicians who have
examined her during these years of anguish, did not come up with a definite
diagnosis, except that of dyspareunia of obscure aetiology, and frigidity. She
had been constantly referred to psychiatric treatment and sexology experts.
This
condition has been going on already for six years.
In
reply to my queries, Dana replied that six years ago she started taking
contraceptive pills, as she had initiated having sex with her boyfriend. Not
long after that she separated from her boyfriend, falling into a depression
period, which actually lasted until toay. She has been taking anti depressant
pills ever since, despite the fact that she didn’t care anymore for her first
boyfriend, so she said.
Along
with the main symptoms of pain and depression, Dana had a weak digestive system.
She was unable to digest heavy meals, and dairy food caused borborygmus and
loose stools. Ever since she had depression she was cold sensitive, and she
related this to her depression. Her depression caused her body to shrink (her
words…), and she felt as though she was contracted and cold. She had low
energy, no libido, pain in both her legs and she had had pneumonia twice in the
course of last year. Her pulse felt weak, slow to moderate, deep and feeble –
especially on the left wrist. Liver position was slightly hard on the surface.
The tongue was thin, feeble, normal color and slightly wet. It was scalloped
moderately on both sides, and Lung area had three short and shallow vertical
cracks. Tongue layer was white and thin.
Checking
her Mu points revealed mild tenderness on almost all Zang Mu points. Ren-17
Shanzhong and Left G-25 Jingmen were particularly tender. Also B-28 Panguangshu
and B-32 Ciliao were highly sensitive to touch.
Dana’s
eyelids were pale, and so were her nails, which also had a purplish hue.
These two topics fall under the headline of Female Sexual Dysfunction in general 2. Dyspareunia means literally painful coitus, and is divided into primary and secondary dyspareunia. The primary case is related mainly to initial attempts at sexual intercourse, and its main causes are either direct trauma or injury to the genitalia, or inflammatory conditions, ulcerations, allergy and the like.
Secondary dyspareunia develops in later years, and is unrelated to first coitus. Causes may include sequela of surgical procedures, or complication of diseases such as endometriosis, vaginitis, suburethral diverticulum and pelvic inflammatory diseases. It may also be attributed to various psychogenic disorders of which gender identity, fear and anger towards the partner, guilt, depression and the like, may be mentioned.
Frigidity is defined as recurrent and persistent inhibition of sexual excitement during sexual activity, manifested by failure to attain the lubrication-swelling response of sexual excitement, until completion of the sexual act. This goes in continuum with dyspareunia for obvious reasons, and attributed mainly to psychic factors, and often related also to inadequate stimulation by the partner, marital discord, depression and stress. Physical causes include pain of the genital region due to localized diseases, systemic conditions such as diabetes or hypothyroidism, and drugs such as oral contraceptives, tranquilizers and others.
The external genitalia, both in females and males, are circulated by the liver main channel, and the liver luo channel. Moreover, the liver system is the first energetic system to be considered in all cases involving depression.3
In my clinical experience over 20 years of practice, I have ascertained numerous times that oral contraceptives have their main adverse effect on Kidney Qi. Despite other conclusions of some practitioners of Chinese medicine, that relate the pill adverse effect mainly on liver and blood stagnation 4, I have no doubt that Kidney Qi is primarily affected by the contraceptive pill. This impression has its reinforcement within the basic concepts of Chinese medical physiology. The pill, as well as all other hormone based medications, interferes with the core of Kidney Qi functioning as regulating hormonal balance in general, and that of the uterus and ovaries in particular.
Administering oral contraceptives thus weakens Kidney Qi, and inhibits its regulatory task over the natural systems of the body. As a result, and according to the energy transmission cycle within the Zang-Fu, the Liver is undernourished, and becomes stagnant. This results of course in various stagnations, of which Blood, Qi, Heat etc. are only few.
Our Dana experienced depression during the same period when she had had her first sexual intercourse, and the same period when she started taking the pill. As soon as she separated from her first lover and boyfriend, there were extra grounds for the formation of emotional depression and agitation, based on real trauma.
Her first symptoms alongside the vaginal pain and emotional depression, were according to her testimony, sensation of cold and introversion. These symptoms are no doubt related to a deep reaction of sinking of Kidney Qi. The absence of the “burning sensation” in the labia region at the initial stage of her disorder, along with the intense pain and the cold intolerance, suggest a cold type Liver channel stagnation, more often encountered in male patients (exhibiting mainly as hernia syndrome)5. This is evidenced also by the hard quality of the superficial pulse on the left Guan position. Later on, no later than a year after the initial symptoms, and quite gradually as ascertained by my interrogation, the pain in her labia became the “burning sensation” of today. This is also frequently seen in clinical practice, when a Cold type stagnation turns into a Heat or Fire stagnation, after a prolonged time, mainly due to the local pressure and congestion of the affected site. Meanwhile, the primary symptoms of fear of cold and introversion remained intact, signifying the presence of the main and initial syndrome. This pattern of decreased Kidney Yang Qi is reflected in the sunken, xu, and slow-to-moderate pulse, the feeble and moist tongue with thin white moss, and the marked tenderness of G-25 Jingmen.
The symptoms and signs of the patient were definitely complicated, given the pneumonia incidents and other aspects, and I felt, as I usually feel in such cases, that a system more significant and primary had been affected. The conclusion was that the extra vessel Chong mai was involved.
The Chong mai originates at the uterus, and descends to the perineum circa Ren-1 Huiyin, to ascend to the kidneys, the spine and the chest. This vessel is probably the most significant of all extra meridians, as it is the sea of Blood and Yuan Qi for all the ZangFu system. Among the various symptoms associated with this extraordinary vessel, we find various gyneocological disorders, pain and atrophy of the leg, and lung deficiency diorders including dyspnea and a probable consequent decrease of Wei Qi.6, 10
All of these existed in Dana’s case.
The Ling Shu describes Chong mai as the vessel carrying Yuan Qi (the source Qi) along with Zhen Qi to the various organs. If blood or Yang Qi are deficient, the Chong is unable to nourish the ZangFu and symptoms of cold and shivering result. Moreover, the Ling Shu also states that when the Chong mai is insufficient with Qi and Blood, one feels as if one’s body is shrinked and becomes small.7 This is exactly how Dana described her condition.
Last but not least, we find also in the same Ling Shu classic that the Chong mai runs from the interior to the exterior. It conveys Jing and Yuan Qi from the kidneys to the main organs and the periphery. Its welling is, as described before, at Ren-1 Huiyin. In this area, i.e: very close to the vaginal labia, stagnation commenced in Dana’s case. Further on, the Chong mai disperses in the chest region, the domain of the lungs. Insufficient energy carried to the lungs, along with general temperature decrease as shown before, result in deficient Wei Qi and subsequent insidents of pneumonia. These are also evidenced by the shape of Dana’s tongue, its vertical small cracks on the Lung area close to the tongue’s tip, the tenderness at Ren-17 Shanzhong, and the submerged deficient pulse.
To summarize this tortuous pathology, here is a “pathology-aetiology” diagram depicting the sequence of clinical development in the case of Dana:
As mentioned previously, treating sex-disorders by acupuncture, or any other method for that matter, calls for extra caution and sensitivity on behalf of the practitioner. We enter here a domain full of demons, prejudice, emotions, complexes… to name but a few.
The sex organs, as well as their visceral counterparts, lie in the most hidden domain of the physique and the psyche. The sex act by itself is probably one of the most Qi consuming activities, physically and emotionally, as it is concerned with the continuation of life itself. History and literature record events and circumstances where love, sex, passion and bedroom affairs, have caused major changes in human destiny, both in east and west.
Thus, we can not treat such disorders lightly, as we might, say, treat a backache or shoulder pain. Moreover, these disorders usually involve complicated patterns of disharmony, both of the mental and physical levels, and need therefor a very sophisticated approach and solutions.
The sex organs are considered in Chinese medicine as the physical links, or hinges, between Yin and Yang. The male has his genitalia protruding out of his body, becoming filled with Qi and blood in erection, thus becoming extremely Yang at the moment of insertion into the Yin of the female. The female on the other hand, opens up her deepest Yin, letting loose her Yin Qi as vaginal secretions and saliva, and accepting the male’s penis. When thus Yin and Yang unite, the male’s Yang Qi puts into movement his female partner’s Yang Qi, having her reaching her climax (orgasm), and releasing her Yang Qi. Yin becomes Yang, and the male absorbs whatever Yang Qi the woman releases. This is why the classics, such as the Su Nu Jing and others, advocate intercourse with as many young women as possible, without ejaculating the Jing, as a mean for prolonging life and attaining immortality.8
The male, on the other hand, exerting his Yang potential to the climax, becomes entrapped within the female inner domain, exhausts his Yang Qi to the climax, and becomes Yin – thus ejaculates the Jing spermatic fluid, and contracts. The Yin of the male contains the Yang essence of his nature, concealed within the Jing-fluid of his ejaculation. This Yang essence is responsible for the energetic urge of the sperm to unite with Yin essence of the female – the ovum.
This Yin Yang phenomenon is evidenced not only in the mere sexual relationship between male and female, but no less in sociology, morality and simple folklore.
When looking at the diagram of energy mutations via the six divisions of channel segments, (Please refer to the sketch below) and in accordance with the trigram system of the Yi Jing (I Ching), The transformations of energetic phases from the absolute Yang (Du mai), progresses anticlockwise, exactly in the same order of the penetration of Xie Qi (evil Qi) via the six divisions. Taking this Yi Jing diagram as a basis for energetic chanelling in the body, we can see that absolute Yang (Du mai) progresses into absolute Yin (Ren mai), and thus commences its mutation cycle back to the state of absolute Yang. 9
On its way back it progresses through the stage of Tai Yin (lung and spleen, giving nourishment and combining energy to form the Zhen Qi that flows in the meridian system), and advances to the Shao Yin stage.
The Shao Yin, a transient stage between big Yin (Tai Yin) and end of Yin (Chueh Yin), hides the most important and inner most Zang. The heart and the kidney. The kidney dominates the sex organs and the sexual activity, the heart dominates the shen-soul and emotions. This is why sex is so much linked with emotions.
The last stage belongs to the Chueh Yin (Liver and Pericardium). This is the barrier, or the hinge, combining the Yin with the Yang. Here the energy of the liver transforms into the Shao Yang, the beginning of the Yang cycle. This is why the liver energy engulfes the genitalia, which, as described before, form the hinge between female and male. This is also the valve through which the Yang Qi released by the female’s orgasm, is assimilated by the male’s system, and diverted to his Shao Yang stage for further mutations in the Yang hemisphere. (Please see the sketch below). The concept which lies in the foundation of this sketch, originates also from the Yi Jing, and as a matter of fact from the basics of Yin Yang theory. Whenever Yang reaches its maximum, it will polarize and become Yin. When Yin reaches the end of its course (Chueh Yin), it will transform into beginning of new Yang (Shao Yang).
Having delineated this sequence of energetic flow in the six divisions, may further clarify the connection between the stagnation of Qi and Blood at the genitalia region, causing problems such as dyspareunia and frigidity, in Dana’s case. The transmission of problematic knotted energy from the previous stage, i.e: Shao Yin, due to emotional related origins, involving both the heart and kidney systems (contraceptives and love affair), have caused energy to congeal at the very orifice where energy emerges from the inside to the outside, meaning: the Chong mai. 10
In most cases involving either pain or other acute symptoms, one would usually commence by treating the Biao (symptoms), and then , after alleviating the acute symptoms, proceeding to treat the Ben (underlying causes of disharmony).
In this case however, and since the pain existed only during coitus or a direct contact with the affected region, I felt that trying to achieve a symptomatic relief first, would not work. The pattern was too deep, involving major systems for already a substantial period of time.
I therefor decided to treat the main pattern of disharmony right at the beginning of my treatment, following the famous Chinese idiom: “Bu tong ze tong, tong ze bu tong” (stagnation causes pain, resolving the stagnation removes the pain) . My prescription for this purpose included the following points combinations: 10
St-30 Qichong along with K-11 Henggu, are two points on the route of the Chong mai, and in the vicinity of the disease focus. K-11 Henggu is indicated for pain in the genitalia related to Chong mai stagnation.
St-30 Qichong is the point where the Chong mai surges from the inside to the surface, and meets with the Stomach meridian. It is therefor the most appropriate point to balance, regulate and adjust the amount and quality of Qi and Blood carried by this vessel to the various organs. It is also said to be able to adjust the nutritive and defensive energies of the body, being the intersection of the Stomach and the Chong functionalities. This is by virtue of its being “the sea of nourishment” point. By putting this extra meridian into motion via Sp-4 Gongsun, supplementing and adjusting its energy by St-30 Qichong, and acting symptomatically on the disease focus, I planned to restore this important meridian’s functioning.
B. Liv-5 Ligou, Ren-3 Zhongji - The second combination acted directly on the liver meridian cold
stagnation. The liver luo channel runs through the genital region, and embarks on its route from Ligou. This point is indicated specifically for all genital region afflictions, and emotional depression as well. It was therefor an indispensable point for this case. Ren-3 Zhongji is indicated also for genital pain, is a meeting point of the three Yin channels of the leg with the Ren mai, and exerts therefor a powerful influence on all lower Jiao diseases.
C. K-3 Taichi, Ren-4 Guanyuan, Ren-6
Qihai – was the third points combination devised for this treatment. This
powerful combination reinforces the kidneys, strengthens and activates Yuan and
Jing Qi, and regulates the sex organs. The third combination was planned to
repair the main cause of Dana’s disharmony, meaning, Kidney Qi in general and
Yang Qi in particular.
The
treatment process and its outcome
I
asked Dana to come for treatment every other day, and told her she would
probably need around 20 sessions. I also tried to explain to her the pathology
of her case, according to my understanding. This made sense to her, and gained
her cooperation and hope. In conjunction with my findings, I advised her to
refrain from coffee (the main food in my experience that adversely affects liver
functioning), Chocolate (the second main food in that respect), Coca Cola and
the like. She was not to touch cold beverages, ice creams etc. (which she did
not desire anyhow), and too much sour food. Milk products she could not tolerate
in any case, so it did not pose a problem.
She
was to consume hot vegetable soup with chicken brew everyday, drink green tea
regularly, and refrain fron sex completely until further notice (not a big deal
for her, anyhow…).
As
mentioned above, she received acupuncture treatment every other day, for three
weeks. The points-combinations were utilized in the order stated above, most
points by tonification using a mild form of “burning the mountain fire”
technique.11
Liv-5 Ligou was manipulated evenly, letting the Qi propagate along the inner thigh until the pubis. This was done by massaging the liver meridian route upward while manipulating the needle with the other hand. Ren-3 Zhongji was manipulated in a downward direction causing the Qi sensation to reach the genitalia. Ren-4 Guanyuan as well as Liv-5 Ligou were often heated by a moxa roll on top of the needle handle, until the heat penetrated inside the body.
This fashion of treatment was carried out five weeks, for fourteen treatments. By the end of this period Dana’s general condition improved dramatically. She gained weight, pinkish color developed on both her cheeks, stopped taking her tranquilizers (complying with my advice), and started a Tai Ji Quan course. Her pulse felt much stronger, and her optimism regained.
Still, she complained of pain in her vaginal labia whenever she touched the place, although to a much lesser extent than before. She still felt the burning sensation now and then, but also in a much milder form.
At this point I decided to apply the “fire needle” technique at Ren-3 Zhongji. I have often utilized this vigorous technique in cases where a simple moxibustion or warm-needle would not suffice.
Despite the exsistence of burning sensation on the pain focus, I was certain, as mentioned above, that the main syndrome was in principle that of a cold stagnation,. This phenomenon is often comparable to administration of some mentholic ointment on the body, which has both cooling effect and burning sensation at the same time.
Fire needle is applied in China mostly for rheumatic diseases of the cold type.12 A needle, usually with a wooden handle, is heated over an alcoholic lamp until it reddens, and then inserted rapidly (and usually painfully) into the desired point. My personal technique is a bit more tolerable. I insert a 26-28 gauge acupuncture needle, and heat its handle with a cotton wool soaked in 96% alcohol. This is done until the needle is white hot, and the heat penetrate intensely into the body. The torch is then removed, and the needle is left in situ for some 15 minitues more.
I have started applying this technique to Dana on the 15th session, utilizing only Liv-5 Ligou and Ren-3 Zhongji as a prescription. The fire needle was applied only to Zhongji of course, and only after Deqi was felt to propagate clearly to the genital region. Despite the heat sensation Dana felt tremendously comfortable with this procedure, and obviously enjoyed the sensation of the intense heat.
The next day her pain disappeared completely.
A few days later a mild pain recurred upon her touch of that region, but this time without any burning sensation at all. She was given three more sessions during the next two weeks, after which we could definitely say that her problem was completely resolved.
This article can not be finished without adding a somewhat personal touch.
A month ago, on January 2001, Dana got married. Upon calling me on the phone to herald the exciting news, she also whispered: “… and don’t you worry doc, everything is fine with me now…”.
j
References
Link
to Dr. Halevi's homepage.