Sexual dysfunction as a social and pathological affliction must be as old as humanity itself. It affects men more than women both physically and psychologically. Women’s problems in sexual activity overall tend to be less visible than men’s, however, for women the consequences are harsher, since the inability to conceive is a serious issue. Both the Mawangdui manuscripts and the Suwen discuss men’s sexual dysfunc‑
tion more often and in more detail, partly because of the physical nature of their sexual endowment, but also because men in early China were supposed to be movers and shakers, empowered to dominate and lead in public life, as well as sexually superior at home. Men ideally ran the state in time of peace, went to war to attack the enemy or protect their home, and in the family ruled over their womenfolk.
Not being able to get an erection might be a problem, but the inabil‑
ity to produce progeny was a catastrophe. A man’s social standing would be jeopardized and his power at home seriously compromised.
Therefore, sexual prowess, authority, and power were closely intercon‑
nected. Any kind of sexual dysfunction was considered not only a per‑
sonal loss but a failure in society (Farquhar 2002, 48). What good is a man serving as a high official in society with power over thousands of households if he has no control even over his own member?
Even today, sexual dysfunction in healthy persons is confined mostly to men. The four most common male sexual disorders in Western medical literature are: 1) erectile dysfunction, 2) premature ejaculation, 3) spermatorrhea, and 4) nocturnal emission. Erectile dysfunction, com‑
monly known as impotence, 3 is by far the most common sexual disorder that affects most men at some time in their lives. Premature ejaculation is said to have occurred if the man ejaculates before he wants to, before his partner wants him to, or if the ejaculation occurs before the penis pene‑
trates the vagina. 4 Spermatorrhea is the involuntary emission of seminal liquid in the absence of sexual excitement or intercourse; it can occur at any time of the day. Nocturnal emission takes place at night and is usu‑
ally accompanied by sexually stimulating dreams. There is no direct mention of premature ejaculation or nocturnal emission in the Suwen.
Spermatorrhea is mentioned once as a disease caused by excessive sexual intercourse (44.2), and there are two direct references to erectile dysfunc‑
tion (yinwei陰痿) (5.4.2; 70.3).
The Yangsheng fang and Zaliao fang suggest that sexual dysfunction was a common problem in the sexual life of the Qin and Han elite. Both include numerous recipes for treating sexual dysfunction as well as for enhancing sexual performance. The Yangsheng fang contains cures for erectile dysfunction, increasing the size of the penis (jia 加), boosting male sexual prowess by “regulating yang” (zhi[yang] 治[陽]) or “washing the male organ” (xinan 洗男) with a concoction to stimulate it, facilitating sexual intercourse (shi jinnei 使近内), and generally improving relations.
There are prescriptions for women on how to tighten the vagina and in‑
crease pleasure (Li and McMahon 1992, 151‑52; Harper 1998, 328‑62).
3 The word “impotence” comes from the Latin impotentia, meaning “lack of power.” It was first used to describe loss of sexual power in 1655 but apparently is unfashionable today, though it remains an apt description of the condition.
4 The bio‑medical definition of erectile dysfunction (ED) is the inability to achieve or maintain an erection for the satisfactory completion of sexual inter‑
course, i.e., an adequate erection of sufficient hardness, maintained for a suffi‑
cient length of time of intercourse that ends in ejaculation and provides sexual satisfaction for both partners. In most cases, ED is caused by psychological fac‑
tors, which may be temporary (e.g., caused by fatigue or stress) or longstanding (e.g., due to feelings of anxiety and guilt). Inability to perform sexually may also be accompanied by symptoms of severe depression. About 10 percent of erectile dysfunction is caused by physical disorders (e.g., diabetes mellitus or a disorders of endocrine system) or by a neurological disorder (e.g., the damage to the spinal cord or alcohol‑related disorders). The problem is more common as men get older, possibly because of altered circulation or, occasionally, lower levels of tes‑
tosterone. See Smith 1990, 574; Brewer 1999, 137‑152; McMahon 1993, 50‑85.
The Mawangdui manuscripts are concerned mostly with various failures of sexual “mechanics,” perceived as the basis for satisfactory sex, whereas the Suwen depicts sexual malfunction as part of the etiology of disease and therefore of medical issues. For example, it describes the dis‑
ease called “kidney‑wind,” which is marked by profuse sweating, aver‑
sion to wind, a puffy face, spinal aches that prevent one from standing upright, a soot‑coloured complexion, and the inability of the “hidden twists” (male or female genitalia) to function smoothly (42.2). In this pas‑
sage, inability to perform sexually or sexual dysfunction becomes part of the etiology of “kidney‑wind” disease.
However, terminologies for the description of sexual dysfunction can also be gender specific. The Yangsheng fang uses buqi 不起 (not rising) to denote the failure to have an erection. There are three recipes for the condition “not rising due to old age” and one recipe for simple “not ris‑
ing.” The Tianxia uses wu 勿 (incapacity): “When [the penis] has great desire for [sex] and is unable [to perform], it is called incapacity.”
The most common terms in the Suwen include “yin flaccidity” (yin‑
wei), “not rising” (buqi), and “unusable” (buyong). As regards the first, the Hanshu (ch. 53) mentions that Prince Tuan suffered from yin flaccid‑
ity every time he approached a woman. Wei by itself, as Yang Shangshan describes it in the Taisu, is a condition of “powerlessness,” “lack of capa‑
bility,” “given to weakness,” or “being rendered useless.” According to Paul Unschuld, wei may originally have only denoted the inability to walk. However, it was subsequently subsumed under the five phases and yin‑yang doctrines, so that it’s meaning of “incapacity” came to ex‑
tend to a wider range, including a general state of exhaustion leading to the loss of ability affecting all the organs and their correlatives. Hence, Unschuld translates wei as “limpness” and says that it “is not a label for a disease, nor is it a standard symptom. Limpness means a lack of strength or firmness; it means drooping or exhaustion. . . or may simply be a sign of being tired or of getting old” (2003, 212‑17). The syndrome is some‑
times also known as yangwei 陽痿, general weakness of yang or positive life energy (Luo 1995), or simply penis limpness.
The Suwen devotes a whole chapter to the wei syndrome. It shows that flaccidity is a syndrome that affects not only the penis but all other parts of the body. It says:
Heat in the lung . . . . leads to flaccidity of the legs.
Heat in the heart . . . . leads to flaccidity of the vessels.
Heat in the liver . . . . leads to flaccidity of the tendons.
Heat in the spleen . . . . leads to flaccidity of the flesh.
Heat in the kidney . . . . leads to flaccidity of the bones.
If vessels, tendons, flesh, and bones are flaccid, limp, tired, ex‑
hausted, or drooping, it follows that the most affected physical function of the body will be mobility, and walking is the most basic of all move‑
ments. On the other hand, since the greater part of the penis is made up of skin, tissues, blood vessels, and nerves, it is not surprising that when flaccidity occurs there, it sets the stage for erectile dysfunction.
The Suwen states that if a man understands the “seven ways of di‑
minishing and eight procedures of increasing [qi],” he can regulate his sexual behavior and therefore prevent injuries that lead to premature aging and early death. Those who know the bedchamber arts will live out their allotted lifespan but for those ignorant of the Dao of sex, there will be early weakening of joints and other parts of the body (5.4.2). It further links sexual flaccidity to the winter season, when the weather is damp and overcast and there is lots of dust. At this point qi cannot flow smoothly in the chest and there may be sexual dysfunction (70.3). The Lingshu makes the same connection: “[When the kidney pulse] is big, it indicates yin flaccidity” (4.2.4), but it also allows for the possibility that this occurs due to heat rather than cold or dampness (13.1.12) or because
“a man has an injury to his sexual organ” (65.2.1).
Another dimension of sexual dysfunction is the injury inflicted to the sexual organ of men to turn them into eunuchs. Eunuchs have a long history in China. Oracle bones from the reign of King Wuding (r. 1720‑
1691 BCE) show them as part of the Shang court. However, the earliest written reference appears in the Zuozhuan of the year 535. The Zhouli 周禮 (Rites of Zhou) calls them siren寺人: men who take care of the emperor’s women and are in charge of punishment. Their presence was so promi‑
nent during the Eastern Zhou that it offended Confucius, who left the state of Wei after only a month’s stay. The Shijing says:
Not heaven but women and eunuchs bring misfortune to mankind.
Wives and those without balls bleat with similar voices.
By the Eastern Han, under Emperor Huandi (r. 146‑67 CE), eunuchs were acknowledged as an “evil influence that could bring ruin to an em‑
pire” (Tsai 1996, 11‑12). Their influence continued throughout Chinese history and in fact ruined the empire on many occasions. However, the most famous of all eunuchs in the Han is the court historian Sima Qian, who was castrated for political reasons under Emperor Wu (r. 140‑187).
He lived for another ten years to finish the historical record Shiji (Goldin 2002, 75‑77).
Henry Tsai also provides a description of the physical and physio‑
logical changes that took place after Wei, the infamous eunuch in the Ming, was castrated at the age of twenty‑three:
There is an apparent loss of height and beard; his nose has become broader and his earlobes thicker. Decreasing hormone level caused loss of elasticity:
his skin wrinkled, his joints stiffened and his muscle strength gradually weakened. His nail had a dull yellow appearance, the half‑moon disap‑
peared and the nails developed ridges. (1996, 4‑5)
Though Wei lived in Ming China, this description certainly applies to eunuchs in ancient times—after all, the physical and physiological characteristics of human beings have not changed much in the last five thousand years. Therefore, any damage to the male sexual organ pro‑
duces changes in the physical appearance of the man.
Another explanation for erectile dysfunction is vessel theory.
Among the vessels, the Jueyin [liver] Vessel of the foot joins at the geni‑
tals and links up with the various tendons. Should there be a tendon dis‑
order, the inner thigh will hurt and spasm, and sexual dysfunction may result. Different specific causes—internal or external, cold or heat—lead to various forms of flaccidity, but the connection to the vessels is made clear. Yet another cause is natural aging, which means that the amount of essence is reduced over time and a diminishing of sexual prowess occurs starting around at age forty, culminating in the inability to have children around the age of sixty‑four.
Given the importance of eugenics, it is obvious why the subject of sexual dysfunction preoccupied the early Chinese. Sexual dysfunction was not just a medical problem, but had widespread social implications.
As Vivienne Lo emphasizes: “Promotion of reproductive health and pre‑
vention of sexual weakening were always a central focus of Chinese self‑
cultivation” (2005, 246). As such, considerable efforts were channeled
into making sure that sexual and reproductive physiology functions op‑
timally including the use of aphrodisiacs.