REMEDIES for erectile dysfunction (ED) are probably as old as writing.

If you are not wild about popping the little blue pill, there are other options available - and we don't mean Power 1 Walnut or the scores of potentially lethal fake sex drugs peddled in back lanes.

Some men swear by these alternative treatments even though they may not deliver instant results the way Viagra does.

TRADITIONAL CHINESE MEDICINE

Asked if he has ever popped Viagra before, puppeteer Victor Khoo quips: 'Touch wood, I don't need it yet.'

Instead, he regularly imbibes 'health tonics' brewed from Chinese herbs to strengthen his body.

'I've been going to a Chinese physician in People's Park for more than 20 years. Chinese herbs may take longer to react than Western medicine, but the effects are a lot better and more organic in the long run.'

Mr Wu Yue, a physician at Raffles Chinese Medicine, treats about six patients with ED problems each month.

According to him, in traditional Chinese medicine (TCM), ED is caused by a number of factors, including overindulgence in sex and stress or anxiety.

These upset the yin and yang balance of the body, as well as qi (energy) flow to organs such as the heart, liver, spleen and kidney.

Treatments include acupuncture with moxibustion (a TCM technique that involves the burning of mugwort, a small, spongy herb, to facilitate healing), as well as herbs and pills.

Mr Zhong Xi Ming, a senior physician at Eu Yan Sang TCM Centre for Reproductive Health at Paragon, says he will take the patient's pulse, check his tongue and ask him about personal and family history before making a diagnosis.

Mr Wu says: 'The TCM approach towards erectile dysfunction is always holistic. Using TCM, underlying causes of the dysfunction are also treated, such as diabetes, anxiety or hypertension. In this way, the patients' overall health and well-being will also improve.'

TONKGAT ALI

Tongkat Ali (chemically known as Eurycoma longifolia) is a traditional herb which has long been extolled for its medicinal qualities.

In Vietnam, it is known as the herb that can cure a hundred diseases. But Tongkat Ali (which means walking stick in Malay) is best known as a male aphrodisiac. It is now available in a variety of products, from coffee to soft drinks.

Its exact mechanism of action is still unknown, although it is believed to increase testosterone (male hormone) levels.

Papers researching its qualities date back to the 1950s but none refers to human studies. One paper involving rats reported improvement in the sexual performance of the animals.

Urologist Peter Lim says that while research on the plant's properties is still skimpy, there is evidence that regular supplements of the herb do increase testosterone levels in roughly six in 10 patients. But he also says one has to take it over a long period and in fairly substantial quantities for it to be beneficial.

So those hoping that it will deliver an immediate kick like Viagra will be sorely disappointed.

Doctors advise against taking the herb with other medications as the interactions and side effects are still unclear.

Sales executive Simon Tay, 39, who takes Tongkat Ali-laced coffee occasionally, says: 'It actually tastes quite good.'

But does it help?

'Seriously, I don't actually notice any difference. Then again, I don't have problems in that department yet. But there's no harm in taking it, right? You never know,' he says.

MANHOOD THERAPY

Urut batin (manhood massage) is a traditional form of massage which remains popular in Malaysia and Indonesia. It is widely available in many Malaysian cities, and is especially popular in villages in Kelantan and Terengganu. There are several practitioners here.

Mr B. Ghani, 47, learnt the art from an Indonesian massage master.

Says the home-based masseur who has been practising for 15 years: 'In urut batin, we concentrate a lot on acupoints and blood flow to the sexual organs.When blood flow to this area is good, a man will function well.'

Besides the genitals, other parts of the anatomy such as the throat, tail bone, inner thighs and the groin are worked on, he says.

MrGhani claims it benefits not just those suffering from ED but also men who want to maintain good sexual health.

He also encourages his clients to open up: 'Sometimes ED problems are not just physical. There may be other factors - his environment and stress, among others - affecting a man's performance as well.'

He encourages his clients to think of an urut batin session as a workout. 'I teach them exercises to do on their own too,' he added.

Referring to the sexual organ, MrGhani says: 'This is the part which gives men the most satisfaction, and yet the amount of time they spend on exercising it is zilch.'

This article was first published in The Straits Times on May 3, 2008.