The Treatment of Female Sexual Dysfunction

With the Fire-Needle Technique

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A case history by Shmuel Halevi Ph.D

Sexuality in Chinese medicine – a general introduction

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:
 1. Involvement of extraordinary vessel in her pathology, plus
other energetic mechanisms that have clear linkage with the aetiology
of her dysfunction.
2. A unique treatment technique, also not frequently applied in
routine acupuncture practice.

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.

Dyspareunia and frigidity in western medicine

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.

Chinese medicine diagnosis

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:

Summary of clinical manifestations

• A severe pain in the vaginal labia region which started after a

separation from her boyfriend and after commencing the ingestion of
oral contraceptives.
• Sensation of burning pain which developed later.
• Emotional depression which developed since the mentioned
separation.
• Fear of cold and sensation of physical introversion.
• Leg pain.
• Weak digestion.
• Two occurrences of pneumonia in the last year.
 • Deep and weak pulse, especially on the left side, hard on left
superficial Guan position.
• Pale lids, pale fingernails with purplish hue.
• Thin and scalloped tongue, vertical small cracks on Lung area.
Moist and thin white fur.
• Mu points corresponding to the gynaecological region very
tender. Mu point Ren-17 also very tender.

Some reflections concerning sexology in Chinese medicine

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

The treatment plan

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

A. Sp-4 Gongsun, St-30 Qichong, K-11 Henggu – this served as

the main combination to act on the Chong mai. Sp-4 Gongsun is the
main confluent point of this extra meridian, and is supposed to “open”
the vessel and activate its energy. Among its other clinical indications,
this point treats gynaecological disorders and depression, all of which
presented in Dana’s case. Gongsun is also the connecting-luo point of
the spleen, and treats various digestive disorders, related to a weak
spleen. Being a Luo point, this point is also capable of energetic
balancing between the spleen meridian, its coupled meridian – the
stomach, and its confluent meridian – Chong mai.

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.

Addendum…

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…”.

References
1. Who Can Ride The Dragon, by Zhang Yu Huan and Ken Rose,
Paradigm publications p. 169.
2. The Merck manual 14th edition, p. 1635.
3. Mental Disorders by Heiner Fruehauf, JCM No. 48 May 1995.
4. For example: Bob Flaws in The Pill and Stagnant Blood, JCM No. 32
Jan.1990.
5. Liver Syndromes by Vivienne Brown, JCM No. 14 Jan. 1984.
6. The Extraordinary Channel Chong Mai and its Clinical Applications by
Prof. Mei Jiangham, JCM No. 43, Sept. 93.
7. Ling Shu, chapter 33 (Discourse on the seas).
8. For example in: Qian Jin Fang (Prescriptions Worth a Thousand Gold
Ducats) by Sun Si Miao.
9. Lessons transcripts by Lucien M. DeShepper, 1982.
10. The 8 extraordinary vessels, part II by: Giovani Macicocia JCM No. 30,
May 1989.
11. Points indications were mainly taken from the Acupuncture Manual
by: Peter Deadman and Mazin Al-Khafaji.
12. Acupuncture a Comprehensive Text, Shanghai college of TCM, 4th
edition 1985, p. 525.
13. Acupuncture a Comprehensive Text, Shanghai college of TCM, 4th
edition 1985, p. 431.

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