Medical History: The patient, RR is a 35-year-old male, approximately 5’10” tall and 180 lbs. His chief concern is low libido. The patient has had a normal libido for most of his adult life; however, six months ago he began having a lack of sexual desire.
RR states that he has led an active life, exercises regularly and is currently training for the Portland Marathon. He has been partnered with a woman for four years now and had a mutually satisfying sex life until six months ago. His partner is a 45-year-old female with two children from a previous relationship. The couple would like to have another due to RR’s age and lack of children. The patient is a financial adviser for an insurance company, which until this last summer was very stressful. He now enjoys less stress due to a promotion and hours that are more regular. His only other health concern is that at an annual exam two years ago his doctor found, due to a heart murmur, that he has a bicuspid valve rather than a tricuspid valve in his heart at an annual exam two years ago.
Questioning exam: The problem began approximately six months ago. Prior to this, the patient and his partner had enjoyed a full sex life, having sex approximately 3—4 times per week as a norm. The low libido slowly came on over the course of a month and has persisted and gotten worse. The couple currently enjoys sex 1-2 times per month, more often when she is ovulating. There is no erectile dysfunction and, he functions fine during intercourse.
The patient states that he is “not sure if the problem is mental or physical”. He believes that the condition started when his life relaxed out of a much more stressful time; and does coincide with the timing of them buying a house and deciding to try for a baby. The fact that his life got better and he manifested this causes him much guilt and grief.
Nothing apparently makes the situation better or worse nor is there any time associated with the problem. It seems to continue most of the time. He states that they have a healthy relationship and openly discuss the problem together. She is supportive of him and was the person who suggested he come and try acupuncture.
Diet / Digestion:
RR eats a healthy, varied and balanced organic, low carbohydrate diet. He is currently trying to lose 5 pounds gained over the Christmas season. His digestion is good; he has a little gas occasionally, usually from eating beans or peppers. He takes multi-vitamins as well as psyllium seed to “cleanse his system.”
Urination/Thirst:
The patient drinks 1-2L of water per day and has no issues with urination. He has no history of urinary problems, infections, stones etc. His urine is clear and commensurate with his input. He urinates 1-2 times during the night.
Sleep:
RR sleeps 6-8 hours per night and has no trouble falling asleep or staying asleep. For the last few months however, he has not been waking up rested at all and feels tired most of the time. He states that he does dream but does not remember them at all.
Ears/Eyes/Nose/Throat/Lungs:
The patient’s eyes, ears and nose are normal. On his second appointment, he came in with phlegm in his lungs and a cough, which was resolved with acupuncture and herbal medicine. He otherwise has no lung problems, no history of smoking.
Emotions:
RR states that his emotions are “steady” and aside of one 2-year episode of depression, he is generally happy. He does not feel that he will be prone to the depression again. He wishes he could feel “elated” more often however, and states that being “steady” is somewhat boring and disheartening.
Regarding the libido, RR states that he feels very “passive” about the whole issue of having children. He was the one who began discussions to have the baby, yet he does not seem “active” in making it. He states that since the summer, he has generally felt passive about his entire life in general and this worries him.
Patient Concerns:
RR is obviously concerned about his complaint and has spent time discussing it with his partner. They both very much would like to have children and given her age, it may be difficult. He feels guilty for “adding to the problem by having no desire.”
It was pointed out by the patient that he had “some type of minor heart defect” that was pointed out to him as a child. He has never had issues around this, however, once discussed, the patient pointed out that he had always felt “closed” around the heart area.
Pulse exam: Thready in both the Cun and Guan positions, weak in the Chi on both sides.
Tongue exam: Red with small cracks in center and a thin white coating.
OM Diagnosis: Liver Qi Stagnation/Liver Yin Xu, Kidney Qi Xu, Heart Qi Xu
Treatment Principle: Treatment Principles: Move Liver Qi, soothe Liver; tonify Heart Qi, Tonify Kidney.
Point Prescription: LI 4/LV 3 – To move Qi and blood and assist with moving the Liver Qi.
LV 14 – Front Mu of Liver, moves LV Qi.
HT 3/Ht 7 – Calm the shen, tonify the heart
CV 17 – Front Mu of the Pericardium to help strengthen the Pericardium, but also to assist it in allowing the Heart’s Qi to bring Joy to the patient.
CV 14 – Front Mu of the Heart, tonfies the Heart Qi to strengthen the patient’s Heart Qi to ward off any future problems with the bicuspid heart valve problems, but also to bring more Joy to the patient.
GV 20 and GV 24 – This combination can calm the mind, as GV 24 can powerfully calm the mind, especially when there is the Liver involved. GV 20 helps to move the Qi upward and calm the mind.
Herbal Formula: Xiao Yao Wan patent formula was prescribed at a dosage of 12 pills three times per day.
Lifestyle Prescription: The patient is encouraged to continue his already good exercise program as well as diet. He was also encouraged to find some activities that bring joy to his life and participate in them more often during the coming months.
Results: The patient recieved some results from three treatments and it was determined that a focus on the Heart Qi Xu may be a good course of treatment.
After using Ht 3 and Ht 7 acupoints, the patient experienced a very “light hearted” sensation and began to laugh on the table, insisting that I somehow may be “tickling his chest”. After this treatment the patient reported back that he felt more “free to express joy and emotion” and his wife reported that he was more intimate and able to enjoy the time they had together.
Synopsis: The patient was treated four more times to help with eduction regarding stress as well as to continue to monitor emotional state. He and his wife continued to receive regular maintenance acupuncture as well, resulting in a pregnancy approximately six months later.
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