For a male, especially in Asia, sexual performance carries an identity and a sense of self-esteem in his society and the world. Thus, sexual performance in the male has an unprecedented importance. In daily life, it is very easy for men to admit having common symptoms like fever but not erectile dysfunction. Admitting erectile dysfunction (ED) is contra to the male ego, particularly if it occurs during the midlife periods. It is reported that nearly 100 million people around the world are living with erectile dysfunction. In diabetic patients the incidence of ED is even more common. Of late, the number of diabetic patients is on the rise and as a result nearly 30% of ED in Singapore is attributed to diabetes.
Yet, only 10% of these 100 million, i.e., 10 million are seeking treatment, despite enormous advancements and treatment facilities in all parts of the world. In Asia lower treatment-seeking behavior (in China and Korea it is only 9 and 30%) could be attributed to its sensitivity and social stigma. Hence, many patients self medicate by resorting to local herbs and sex tonics, which are scientifically unproven.
Sexual herbs are eagerly consumed no matter how unappetizing or bizarre. In the continuous quest for better sex, humans have ingested such diverse items such as elephant tusks, lion blood, bull testicles and rhino horn; ram penis, pig genitals and the dried remains of the Mediterranean Cantharis beetle, otherwise known as "Spanish Fly". Sex drive in both men and women can be enhanced with herbs, so longer lasting erections, female lubrication and more intense orgasms could be achieved, resulting in satisfactory sex. Herbs, however, are unprocessed drugs and may interact with other medications. In view of this, some knowledge about these herbs and tonics will be of immense value to physicians who are engaged in treating sexual dysfunction. Thus, the present paper highlights some of the more popular and effective Asian herbs.
Asian herbs and health tonics for erectile dysfunction
Do herbs work to rectify ED in the aging male? These herbals can be found throughout Asia and range from Tongkat Ali, Ginseng to Tribulus etc. Those that act as testosterone releasers have some value, especially if the male has andropause and those containing some "pick-me-ups" and energizers like ginseng help the tired and fatigued male and possibly those with asthenia. Deer horn contains growth factors and taking these does help improve nocturnal erections in the male with somatopause. Popular in historic Singapore was "penis soup" and snake meat, whilst Surabaya was known for cobra meat and blood which was claimed to improve erectogenic prowess.
Chinese yam (Dioscorea opposita): Used often as a tonic for the reproductive system.
Eucomnia (Eucommia ulmoides): Potent herb used to treat impotency and fatigue.
Ginseng (Panax ginseng): This is an adaptogenic herb touted to have boosted the potency of Ottoman sultans. It increases the body's ability to handle environmental stresses and combat biochemical imbalances. It energizes you when you are fatigued and controls anxiety. It also increases sex-related hormones like testosterone and enhances sexual responses in both sexes. It thus acts as a tonic, stimulant and aphrodisiac. The most commonly used type is Chinese Ginseng renowned for increasing sexual vitality.
Fo-Ti-Tieng: Known as the elixir of long life, this herb has been used for over 2000 years in China to promote relaxation and improve memory, but has become popular as a powerful sexual stimulant. Modern research indicates that this herb contains an alkaloid that has a rejuvenating effect on the nerves, brain cells and endocrine glands.
Dong-quai: Also known as Chinese Angelica, is primarily used in treating women's conditions such as loss of sexual desire and menopause. Women have discovered this 5,000-year-old tradition that naturally provides balancing and normalizing support for women's unique rhythms, cycles and body systems. However, it increases the effects of hormones in both men and women and is also widely used as an aphrodisiac.
Deer Antlers (Cervi pantotrichum): The most popular sexual tonic. In the Chinese medical literature, kidneys are believed to manifest sexual function; hence foods and herbs such as this can invigorate impotency and infertility increasing semen production as well.
Seahorse (Hippocampus kelloggii): Promotes the kidney "yang" and normalizes sexual activity. Usually, it is used in powder form.
Gingko (Gingko biloba): This is an example of a tonic herb that equilibrates our body systems; for instance, when tired it energizes and under stress it relaxes. Its profound effect is noted in increased blood circulation, which is important for sexual excitement. Early reference to its medicinal use was cited in 2900 BC in the Chinese Materia Medica,where it was noted for increasing sexual energy. Gingko's circulation enhancer called terpene lactone increases cerebral as well as genital blood flow and it also significantly enhances production of dopamine, adrenaline and other neurotransmitters in the brain, which are responsible for improved pleasure arousal and alertness.
Tribulus terrestris: This plant has long been used as a folk medicine in several parts of Asia and most widely in Eastern Europe and Bulgaria for sexual deficiency. The properties of this powerful ingredient have been associated with increased sperm production, sexual endurance and testosterone levels. Since testosterone plays a huge role for men, systemically, the addition of this herb can prove to be very beneficial. However, it is not a hormone as some believe. In Bulgaria, the hormone-balancing effects of Tribulus terrestris are used for premenstrual syndrome and menopausal syndrome.
There are three groups of active phytochemicals in Tribulus terrestris i.e., 1) dioscin- responsible for sexual energy by increasing the free testosterone level for men and modulates pregnenolone, progesterone, estrogen, etc. 2) sterols- this group protects the prostate from swelling and in combination with the X steroidal saponins and 3) steroidal saponins- influence the immune system and also possess antimicrobial properties (against herpes).
Tongkat Ali (Eurycoma longifolia): This native plant found throughout Southeast Asia is used as an aphrodisiac since 1996. It has to be used regularly and works by enhancing the testosterone and cGMP production. Benefits are felt gradually over a period of time, mainly because it enhances the natural biological synthesis of testosterone. When this hormone level is increased, health and vitality are restored. In studies on mice, Tongkat Ali increased the frequency and duration of sexual performance by enhancing testosterone levels increasing up to 440%. In a recent study on humans, 62% of the subjects showed an increase of the free testosterone index indicating its role in the biosynthesis of steroids. It has also been shown to increase sperm concentration and motility.
Gambih: A powder form medication, well known in Singapore and Malaysia, when applied on the surface of the penis results in prolonged erection and declining premature ejaculation.
Yohimbe (Pausinystalia yohimbe): An evergreen tree native to West Africa, also present in Asia, is the only herb listed in the Physician's index reference for sexual function. The US FDA approved yohimbe as the first plant-derived drug for treating impotency long ago and was dubbed the "herbal viagra" in the February 1999 edition of Environmental Nutrition. Alkaloids present in yohimbe such as isoyohimbine, allo-yohimbine, yohimbinine, yohimbane, yohimbenine and corynanthein block alpha-2 adrenergic activity leading to vasodilation.
Yohimbine has a dual aphrodisiac function: it improves sexual function by displacing epinephrine from alpha-2 adrenergic receptors in the pelvic area and it increases proneness to arousal through supplying the epinephrine from the alpha-2 receptors to the central nervous system (brain) where it is active as a neurotransmitter. Side-effects include nervousness, anxiety, insomnia and mild hypertension.
Epimedium extract (Horny Goat Weed): The Chinese refer to this herb as 'yin yang huo', a 'lichentious goat plant'; hence, its common name is well known as 'horny goat weed' in many western cultures. Scientifically, studies have shown that epimedium may restore low levels of both testosterone and thyroid hormone, which is reversal of hormones to their normal levels, which may account for some of its benefits in improving sexual libido.
Oat straw: The chemical and nutrient content of oat straw contains many essential vitamins and properties, which can improve the body's physical and emotional condition.
Oyster meat: Totally natural, oyster extract is excellent for men's reproductive health and endurance. It is a rich source for the amino acid taurine, which has a cardio-protective effect and also in nerve transmission. Historically known as an aphrodisiac, flavanoids in oyster meat have been shown to stimulate the reproductive system.
Nettle leaf: Amongst its many properties, nettle leaf has lately been shown to influence prostate health and prevention of prostate conditions, especially prostatitis, which is an inflammation of the prostate gland. Besides, there is also speculation that nettle leaf may help with male pattern baldness. Irrespective of the age, prostate health is essential for men. Prostate problems can interfere with a healthy sex life. Nettle is also considered to be an overall energizer of the body, as well as a natural diuretic and anti-inflammatory remedy. It is rich in iron, zinc and chlorophyll.
Animal testicles: Derived from bulls and wild boars, the orchic substance has been used as a way to possibly increase testosterone levels and sperm counts. In Singapore testis soap was very popular historically. It is still so in parts of China and Japan.
Cayenne: Cayenne is also known as capsicum and plays a very large role in blood circulation. When cayenne is ingested, it acts to dilate blood vessels, allowing blood flow to increase throughout the body, especially in the major organs. The male penis benefits greatly from the ingestion of cayenne. It is a widely held belief that cayenne aids in longer lasting erections, with stronger ejaculations and more intense orgasms.
Astragalus: This unique herb works primarily on the nervous system and immune system and is believed to stimulate energy levels, along with strengthening the body's immune system. It is also noted to increase the sperm count. Astragalus also targets the urinary tract and kidneys, to maintain a healthy state.
Sarsparilla: The Chinese refer to this herb as 'khao yen' and believe strongly in its abilities to act as an aphrodisiac and a sexual stimulant. Sarsaparilla has been used worldwide for its systemic benefits, especially sexually.
Licorice root: Many cultures have used licorice root and value its properties. Because it contains magnesium, silicon and thiamine, the body accepts this herb for overall health at a cellular level. Its effect on hormonal levels has been applauded by many and, as a tonic for the body's well-being, it is believed to have great benefits.
Pumpkin seed: Besides having a pleasant flavor, pumpkin seeds are known to possess antidepressant properties in Chinese history. More importantly, pumpkin seed ingestion can influence positively prostate health, which is very important for male sexual health. It is commonly used to strengthen the prostate gland and promote healthy hormone function in men. Myosin, an amino acid found in pumpkin seeds, is known to be essential for muscular contractions.
Cuscuta: Is commonly used in long-term tonic programs. It is a gentle tonic for the kidney yin and yang and also helps nourish Chi. It helps the kidney to consolidate the Chi and is widely used to improve vision, nourish the sperm and marrow and strengthen bones and sinews and to strengthen sexual functions. Cuscuta seed is commonly used in tonic formulations designed to benefit yin and yang. It is most commonly used to strengthen the uro-genital functions such as impotence, premature ejaculation, frequent urination and leukorrhea as well as ear ringing and aching lower back, symptoms which often accompany deficient kidney conditions that cause sexual weakness.
Dendrobium: This variety of Chinese orchid is an excellent and delicious Yin Jing tonic and longevity herb. It is said to quickly and effectively replace spent "adaptive energy" and is widely used by the orientals who engage in high sexual activity to replace the spent energy and to replace fluids; and thus it is commonly called "honeymooners tea." When combined with licorice root, it is also called "healer's tea," as it provides healing energy which can be transmitted to others and replace spent healing energy.
Curculiginis: Is used in yang tonic formulations to warm up the kidney function, to strengthen sexual function, for infertility in men and women, urinary incontinence, low back pain and weakness in the legs. Further, it is also used to strengthen the bones and ligaments.
Cornus cornus: Is very sour and like all sour herbs, it helps control ejaculation of sperm and problems of impotence, premature ejaculation and frequent urination due to weak bladder. Because of its warm nature and direct action on genital function, many Asian herbalists consider Cornus to have "aphrodisiac" qualities. When mixed with the appropriate herbs, Cornus is very useful for stabilizing excessive or prolonged menstrual bleeding due to deficiency and weakness.
Cordyceps sinensis: Is one of the most popular herbs in the world. It has been revered for thousands of years in the Orient, but has historically been very rare. As a result of modern growing techniques, it is now available to everyone at a fraction of its traditional cost. It is a truly extraordinary tonic herb. Cordyceps is used for the purposes of strengthening the primary kidney functions, which include sexual function, brain power, structural integrity and healing ability, according to traditional Chinese health theory.
Cnidium seeds: The small fruit is considered to be a superb tonic to the primal yang essence and is thus used in many tonics for both men and women. It is widely believed in the Orient to be a superb longevity herb and an excellent sexual tonic and stimulant. Mainly this is used to overcome sexual malaise and weak sexual potency. The classics repeatedly mention it as an aphrodisiac. It was used almost routinely in imperial formulas designed specifically for the emperor. Cnidium seed was often used in combination with Cuscuta seed in aphrodisiac formulations, since the two herbs work synergistically. It is also used to increase fertility in both men and women. Cnidium has some astringent quality, which means that it will help prevent premature ejaculation in men. Furthermore, Cnidium seed has anti-infective qualities whereby it is used for sores in the genital areas.
Cistanches: Is one of the more popular and more potent, yin-yang tonic herbs and is found in many formulas designed to strengthen sexual function, in particular impotence. It has been widely used to alter the fertility of both sexes. The ancient classics indicate that Cistanches increases both the flow of yang energy and blood flow to the genitals.
Alpinia fruit: Is a kidney yang tonic used to warm the kidney and to retain its essence. Also helps in alleviating impotence, spermatorrhea and dribbling of urine.
Wild asparagus root: Promotes the production of kidney yin and prolonged use is beneficial for sexual weakness. Even though its greatest value is in its "love tonic" attributes, wild asparagus root is often used in tonics designed to overcome impotence or rigidity on the physical level. Prolonged consumption will make the skin soft, supple and smooth. In the modern era of vanity, this kind of skin is a sure sign of attainment. Beautiful skin is the result of pure blood and healthy lungs. Asparagus root is useful for those who are experiencing dry skin due to a dry environment or due to internal dryness.
Gynostemma: Is widely believed to have health benefits such as delaying aging and in particular senility and fatigue. It is also known to increase vigor, digestion and sexual functions and to reduce oxygen deficiency at high altitudes.
Longan: Delicious tonic fruit used by the Chinese as a blood tonic, to nurture the heart and to add luster and beauty to the skin. It is believed among the Chinese people that Longan is not only a great tonic for the skin, but is also a fantastic sex tonic.
Lotus seed: Primarily used as an astringent in kidney and spleen tonic formulations. Commonly used to prevent or treat premature ejaculation, spermatorrhea and is also used in women's formulas to treat leucorrhagia.
Lycium fruit (Fructus lycii): This delicious fruit is very widely used throughout Asia as a yin essence and blood tonic. Lycium fruit has been given to improve sexual function, in particular by increasing the levels of androgen.
Morinda root is often used to increase the general and sexual strength in men i.e., impotence, premature ejaculation, soreness of the lower back and knees and infertility. In women, it is used to treat infertility.
Psoralea: It is a yang tonic herb used to enhance sexual and overall energy. It is routinely used in formulas with Eucommia, Cistanche, Cuscuta, Epimedium, etc. to strengthen male sexual functions. Psoralea also acts as an astringent. Further, its benefits include preventing nocturnal emissions and premature ejaculation in men.
Rehmannia: Primarily referred to as "kidney's own food." Hence, it is believed to be a kidney tonic and longevity herb and is found in many common "anti-aging" formulations for longevity and rejuvenation.
Schizandra fruit: Famous tonic historically consumed by Chinese royalty and by Daoist masters. It is one of the few herbs that contains all three treasures. Schizandra is renowned as a beauty tonic and is considered to be a youth-preserving herb. In China, it is also used to improve memory functions. It is also said to produce abundant sexual fluids, increase sexual endurance and to strengthen the whole body.
Walnut kernel: Used to improve the kidney functions and therefore it is used to strengthen the lumbar region of the back, the legs and sexual organs. It is commonly combined with other kidney tonics to enhance this action. In addition, walnuts are said to be beneficial to the brain since the brain is believed to be controlled by the kidney function.
How do these herbs help with sex? In many instances, they act as an "aphrodisiac" probably. An aphrodisiac (the word derives from Aphrodite, the Greek goddess of love and beauty) is anything that provokes sexual interest or desire. And indeed many herbs can enhance sexual desire. Additionally, when it comes to sex, traditional medicines have been claimed to improve mood, increase sexual desire, drive and pleasure. The sexual drive is perhaps the most fascinating of all the "bodily drives." True, its original purpose may have been to ensure the continuation of humankind. But the concept of procreation probably ranks much lower on most of our scales than a desire for plain, "old-fashioned" sexual enjoyment. Herbs thus provide the urge - the libido or desire or drive to have sex as often as we like. Lack of sexual drive can turn sex into more of a chore than a pleasure. The herbs described in this discussion help put sexual desire and drive back into the patient's life or back into the life of the person he loves.
Setting the mood and desire to have sex are certainly the first two steps of sexual enjoyment. There are many ways to ensure maximum sexual pleasure. Herbs help by initiating a change in the body's internal milieu, such as increasing the body's production of testosterone, the "male" hormone that functions in both men and women to create a sexual response. Because of this role, most of these herbs are more effective when taken consistently over a period of time. Within a few weeks of taking a herb, one should gradually begin to notice a change in one's sexual response with increasing sexual pleasure.
Furthermore, herbs have multiple properties that may also aid health conditions that might otherwise inhibit sex i.e., 1) male problems of impotence, prostate problems and male menopause 2) female problems of menopause and premenstrual syndrome 3) chronic health problems such as arthritis or diabetes and 4) other conditions that affect overall well-being, such as lack of energy or addiction to cigarettes, alcohol or drugs.
In the east, many herbal tonics and preparations are used to assist the aging male improve his ability to have sexual drive or perform penetrative sex by increasing sexual stimulation, erectile, ejaculatory orgasmic and other responses for sexual function and satisfaction. Apart from the benefits mentioned above pertaining to potential aphrodisiac properties, the "testosterone releasers" will have some impact on andropausal males and the "energy enhancing herbs and tonics like ginseng help the tired and fatigued male and possibly those with sexual asthenia. Deer horn and antlers uniquely contain growth factors and taking these may help improve nocturnal erections in the male with somatopause. Folklore remedies such as "Penis soup"and Snake meat, the famous cobra meat and cobra blood from Surabaya, Indonesia claim to improve erectogenic prowess - these myths including that of taking dog, wild boar, bull and ostrich testicles are mainly village doctor remedies still being practiced widely in the developing regions of Asia. On the other hand, in China the horny goat weed is still popular and may have some scientific merit for enhancing sexual drive as recently the active agent Icariin was isolated from the weed. The latter, better known as Epimedii herba, has the specific property of increasing erectile function with no influence on systematic blood pressure. The mechanism of Icariin is believed to be a cGMP specific PDE5 inhibitor to increase cGMP level in corpus cavernosum, which may have no effects on cAMP to influence systemic blood pressure. Hence Icariin, extracted from a herb used for centuries could well be a safe and effective agent for the treatment of erectile dysfunction. With better and more research on herbals and tonics and attention to toxicology and manufacturing standards, the future for herbals and tonics may be promising for these scientifically unproven folklore medicines.
1. Kaiser FE. The Medical clinics of North America: The aging male patient Erectile dysfunction in the aging man. 1999 PA WB Saunders
2. Lim PH, Li MK, Ng FC, Chia SJ, Consigliere D, Gooren L, et al Clinical efficacy and safety of sildenafil citrate (Viagra) in a multi-racial population in Singapore.A retrospective study of 1520 patients Int J Urol. 2002;9:308–15
3. Lim PH, Moorthy P, Tan RS. Aging men's health-A case based approach. An overview of erectile dysfunction in aging men 2005 Thieme NY:123–30
4. Komesaroff PA, Black CV, Cable V, Sudhir K. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women Climacteric. 2001;4:144–50
5. Wang KY, Dahlen M. Chinese Herbal Medicine 1994 Hong Kong Workman Press
6. Malo AF, Roldan EF, Garde J, Soler AJ, Gomendio M. Antlers honestly advertise sperm production and quality Proc Biol Sci. 2005;272:149–57
7. Rowland DL, Tai W. A review of plant-derived and herbal approaches to the treatment of sexual dysfunctions J Sex Marital Ther. 2003;29:185–205
8. CHEMEXCIL CHEMEXCIL. . Tribulus terrestris
L. (N.O. Zygophyllaceae). Selected medicinal plants of India. A monograph of identity, safety and clinical usage 1992 Tata Press:323–6
9. Ang HH, Cheang HS, Yusof AP. Effects of Eurycoma longifolia
J (Tongkat Ali) on the initiation of sexual performance of inexperienced castrated male rats Exp Anim. 2000;49:35–8
10. Lunenfeld B. Men's health and aging: The 5th
world congress on the aging male Taylor Francis. 2006;1:1–70
11. Carey MP, Johnson BT. Effectiveness of yohimbine in the treatment of erectile disorder: Four meta-analytic integrations Arch Sex Behav. 1996;25:341–60
12. Kuang AK, Chen JL, Chen MD. Effects of yang-restoring herb medicines on the levels of plasma corticosterone, testosterone and triiodothyronine Zhong Xi Yi Jie He Za Zhi. 1989;9:737–8,710
13. Hryb DJ, Kahn MS, Romas NA, Rosner W. The effect of extracts of the roots of the stinging nettle (Urtica dioica) on the interaction of SHBG with its receptor on human prostatic membranes Planta Med. 1995;61:31–2
14. Liang P, Li H, Peng X, Jiao J, Liu J, Ye Z. Effects of Astragalus membranaceus
injection on sperm abnormality in Cd-induced rats Zhonghua Nan Ke Xue. 2004;10:42–5,48
15. Bucci LR. Selected herbals and human exercise performance Am J Clin Nutr. 2000;72:624S–36S
16. Zhu J, Halpern G, Jones K. The scientific rediscovery of a precious ancient Chinese herbal regimen: Cordyceps sinensis
: Part II J Alternat Complement Med. 1998;4:429–57
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Conflict of Interest: None declared