The Influence of Liver, Lung, and Spleen on Male Physiology and External Kidney Anatomy

Therefore, it is evident that the liver's function of regulating the flow of Qi is closely related to male sexual function. When the liver's function of regulating the flow of Qi is normal, libido is normal, intercourse is moderate, and ejaculation is timely; conversely, when this function is impaired, libido is abnormal, intercourse is excessive, and ejaculation is untimely. The liver meridian runs through the chest and ribs, passing under the breasts, so normal male breast development is related to the liver. If liver Qi is stagnant and its flow is obstructed, it can lead to breast swelling, lumps, and pain. The liver governs the free flow of Qi, regulating the Qi of the three Jiaos (upper, middle, and lower Jiao), and assisting the upper, middle, and lower Jiaos in regulating fluid metabolism. If the liver fails to regulate the flow of Qi, the Qi of the three Jiaos becomes obstructed, which can lead to various diseases such as urinary retention, constipation, and strangury.

The lungs govern the flow of qi, regulate the body's functions, connect all the blood vessels, and distribute qi, blood, essence, and body fluids to nourish the whole body. Clinical observations and research indicate that the lungs are also closely related to male physiology.

The lungs govern and regulate the entire body through "governing Qi" and "connecting with all the meridians." The lungs govern Qi; the circulation of Qi, blood, and body fluids relies on the distribution and dissemination of lung Qi. The lungs connect with all the meridians; the exchange of substances in the circulation of Qi and blood occurs through the lungs. Under physiological conditions, when the lungs' regulatory function is normal, Qi, blood, and body fluids circulate throughout the body, thus nourishing the genitals. If lung disease obstructs the distribution of Qi, blood, and body fluids, the genitals will lack nourishment, leading to functional pathological changes. For example, if lung Qi is deficient, it cannot disperse Qi, blood, and body fluids, and the reproductive organs will lack nourishment. Furthermore, lung disease often affects the reproductive organs, causing kidney Qi deficiency. Alternatively, if the lungs fail to regulate Qi, water accumulates and dampness forms, or damp heat descends to the reproductive organs; or if lung heat scorches the lungs and causes dryness in the reproductive organs; or if phlegm and turbidity are generated internally, the lungs fail to disperse and descend Qi, all of these can lead to decreased libido, impotence, urinary retention, and amenorrhea. Clinically, lung dysfunction commonly causes sexual dysfunction and decreased reproductive capacity. For example, some patients with recurrent asthma or chronic bronchitis, or even those with chronic emphysema or pulmonary heart disease, often experience low libido or impotence during an attack. Treating the lungs or adding appropriate lung-warming and lung-dispersing herbs to kidney-tonifying medications can help restore normal sexual function.

"The lungs are the master of qi, and the kidneys are the root of qi." The lungs and kidneys jointly govern the ascending and descending of qi in the body. The lungs belong to metal, and the kidneys belong to water; the yin of the lungs and kidneys nourish each other. This mutual transformation of metal and water, and the mutual generation of the lungs and kidneys, is mainly manifested in male physiology as the lungs' influence on reproductive essence. If the lungs and kidneys are in harmony, and the lung qi descends and purifies, the kidney's qi transformation function is normal, and reproductive essence can be generated normally. Under pathological conditions, if the lungs fail to disperse and purify, it will affect the kidney's qi transformation; or if there is yin deficiency in the lungs and kidneys, the source of kidney essence is insufficient, and reproductive essence is also lacking. In severe cases, the reproductive organs may be malnourished, leading to decreased libido, impotence, infertility, and other diseases.

**The anatomy of the external kidney is a continuous tradition in traditional Chinese medicine.**

A patient suffering from bladder prolapse went to see a doctor.

The doctor told him, "The left side of the external genitalia belongs to Yang, and the right side belongs to Yin. Now it is biased to one side, which is due to the imbalance of Yin and Yang."

The patient said, "Since the left side belongs to Yang and the right side belongs to Yin, what is the one sitting precariously in the middle?"

The doctor replied, "This is a geomancer."

This is a corny joke about testicles. In ancient my country, sexual organs were collectively referred to as "yin" or "yinqi." The character "睃" (su) was used to refer to the sexual organs of male children, as stated in the *Shuowen Jiezi* (a Chinese dictionary): "The abdomen is the yin of an infant." Sometimes it also referred to the sexual organs of adult men, as seen in the *Shiwen* (Ten Questions) medical book unearthed from Mawangdui, which records "human qi is nothing more than collagen." Later, the male sexual organs were collectively called "external kidneys." The male external kidneys include the penis, scrotum, testicles, seminal vesicles, and fertile tract.

1. Penis

Regarding the physiological functions of the penis, the Ling Shu (Spiritual Pivot) chapter "True and False Qi of the Acupuncture Points" states that "the penis is the mechanism of the body, the sign of yin essence, and the pathway of body fluids," recognizing that the penis is the male sexual organ and also governs the excretion of urine.

The *Su Nu Jing* uses the terms "anger," "large," "firm," and "hot" to describe the changes in penile engorgement, growth, warmth, and duration, referring to these as the "Four Attainments." It states, "The way of intercourse is for the man to observe these four attainments." The reason for the absence of these four attainments is that "if the penis is not angry, the vital energy will not arrive; if it is angry but not large, the vital energy will not arrive; if it is large but not firm, the vital energy will not arrive; if it is firm but not hot, the vital energy will not arrive." The presence of all four attainments-anger, large, firm, and hot-represents a normal physiological response of the sexual organs. In other words, "Anger is the clarity of essence; large is the gate of essence; firm is the entrance to essence; hot is the gateway to essence." Later generations used the term "three arrivals" to describe penile activity, believing that the normal functioning of the heart, liver, and kidneys was key to whether the penis could become engorged, erect, large, hot, and long-lasting. For example, the *Guangsi Jiyao* records: "Before intercourse, the man experiences three arrivals... The three arrivals are: when the penis is erect and vigorous, it indicates the arrival of liver qi; when it is large and hot, it indicates the arrival of heart qi; when it is firm and long-lasting, it indicates the arrival of kidney qi. When all three arrivals are present, the woman is pleased. If the penis is flaccid and cannot erect, it indicates the arrival of liver qi. Forcing intercourse before the arrival of liver qi will injure the tendons, and the semen will drip and not ejaculate; if it is large but not hot, it indicates the arrival of heart qi. Forcing intercourse before the arrival of heart qi will injure the blood, and the semen will be cold and not warm; if it is firm but does not last long, it indicates the arrival of kidney qi. Forcing intercourse before the arrival of kidney qi will injure the bones, and the semen will not be released, or if it is released, it will be scant." This ancient understanding has certain guiding significance for the diagnosis and treatment of impotence.

The presence or absence of morning erections is one of the preliminary criteria for differentiating between functional and organic erectile dysfunction. The kidneys govern growth and development; sufficient kidney qi leads to strong vitality and longevity, while deficiency of yang qi weakens vitality and increases the risk of premature aging. Penile erection, its firmness, duration, and frequency are external signs reflecting the strength of kidney qi in mature adult men. Western medicine believes that the presence or absence of libido often reflects the normality of bodily functions, and in old age, it can reflect whether the body is aging. Those who experience early sexual aging tend to experience early physical aging, while those who experience late sexual aging tend to experience late physical aging. Research results show that those who still have normal libido and sexual activity in old age generally have good bodily functions, often aging gracefully without decline, and enjoy health and longevity.

The penis is composed of tendons, and the liver governs the tendons; the seminal duct also passes through the penis, therefore the medical text *Yilin Shengmo* states that "diseases of the penis should be treated by addressing the liver," and "diseases of the seminal duct should be treated by addressing the kidneys." This provides a certain theoretical basis for the treatment of external genital diseases based on the differentiation of organs.

2. Scrotum

The scrotum, resembling a pouch, hangs from the perineum and contains the testes, epididymis, and other tissues. Its outer skin is highly elastic, expanding and contracting in response to changes in external and internal temperature to regulate scrotal temperature, which is beneficial for sperm production and storage. Its loose, soft texture also provides cushioning, protecting the testes and preventing or reducing damage from external forces. Observing changes in the tightness, size, and color of the scrotum can provide insight into the overall condition and provide a basis for diagnosis and treatment. The liver and kidneys are closely related to the physiology and pathology of the scrotum. However, some believe that since the scrotum is composed of muscles, which are governed by the spleen, scrotal diseases should be treated by addressing the spleen, as stated in *Yilin Shengmo*: "Scrotal diseases should be treated by addressing the spleen." However, because the liver and kidneys are also closely related to the scrotum, treatment should also consider addressing the liver and kidneys.

The scrotum, shaped like a pouch, hangs down at the perineum and contains the testicles and other tissues. Its outer skin is highly elastic, expanding and contracting with changes in external and internal temperature to regulate the temperature inside the scrotum, which is beneficial for sperm production and storage. Furthermore, its loose and soft texture provides excellent cushioning, thus protecting the testicles and preventing or reducing damage from external forces.

3. Testes

The medical book "Fifty-Two Prescriptions" from Mawangdui refers to the testicles as "orange". The later "Huangdi Neijing" adopted this term, also using names such as "testicle", "ball", and "yin oval".

Ancient people recognized the close connection between the testicles and kidneys, hence referring to the testicles as "external kidneys." For example, the *Qixiao Liangfang* states, "The external kidneys are hard and swollen," referring to hardened and enlarged testicles. This naming clearly intentionally divides the kidneys into internal and external parts, recognizing that reproductive essence is produced by the "external kidneys," which aligns with modern anatomical and physiological understanding. What is even more valuable is that ancient physicians discovered that the testicles are one of the decisive factors in male fertility. For instance, the *Guangsi Jiyao* records five diseases causing men to "lack offspring," one of which is "jian," meaning "only one testicle in the external kidneys, or none at all." This disease is actually anorchia or solitary testis.

Fang Yu, a physician of the Ming Dynasty, believed that the testicles were formed from tendons, and the liver was the master of tendons; therefore, diseases of the testicles should be treated by addressing the liver. The medical text *Yilin Shengmo* states, "When encountering diseases of the testicles, one should treat them by addressing the liver." However, since the testicles are dependent on the kidneys, and the kidneys are the master of the testicles, diseases of the testicles should also be treated by addressing the kidneys.