Impotence refers to the inability to have an erection or maintain an erection until ejaculation, which is often seen in sexual neurastenia and some chronic diseases.

Etiology and pathogenesis
Impotence is usually caused by the decline of fire from the gate of life and exhaustion of essence and blood as a result of early marriage, indulgence in sexual activity or frequent masturbation, damage to the kidney by fright, damage to the heart and spleen and further the Stomach Meridian of Foot-Yangming and Chong Meridian by worries. There are also some cases caused by the downward flow of dampness-heat.

Syndrome differentiation
Failure to have an erection or inability to maintain a satisfactory erection, premature ejaculation. The accompanying symptoms are dizziness, blurred vision, tinnitus, insomnia, pale complexion, lassitude, soreness and weakness in the loin and knees, thready and weak pulse.

Treatment
Principles: To invigorate kidney qi and benefit the heart and spleen. Methods: Select acupoints on the Kidney Meridian of Foot-Shaoyin and the Stomach Meridian of Foot-Yangming and a back-shu point to apply acupuncture treatment, using the reinforcing manipulation. Moxibustion can also be used if necessary.
Acupoints: Shenshu (BL 23), Zusanli (ST 36) and Neiguan (PC 6).
Notes: Since the disease is chiefly due to the deficiency of kidney qi, Shenshu is used to invigorate kidney qi and improve the function of the Kidney Meridian. Zusanli, the he point of the Stomach Meridian of Foot-Yangming, helps relieve stagnation, calm the mind and invigorate the heart and spleen when used together with Neiguan.

Other Remedies
1. Pricking therapy
Acupoints: Shenshu (BL 23), Mingmen (DU 4), Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33), Xialiao (BL 34), Sanjiaoshu (BL 22), Guanyuanshu (BL 26), Baihui (DU 20), Dazhui (DU 14), Dazhu (BL 11) and Changqiang (DU l). Methods: Select one to two points each time. Prompt prick and sway the needle for 5- 10 minutes. Use a fine needle to prick the tendons if the patient is of weak constitution, and moxibustion treatment can be used at the same time. The treatment is given every two days, and a complete course includes five times treatment.

2. Electric acupuncture Apply an electro-acupuncture device to Qugu (RN 2., Rangu (KI 2), and four pairs of points Shangliao (BL 3l), Zhongliao (BL 33), Ciliao (BL 32) and Xialiao (BL 34) on both sides of the body, using low-frequency pulse circuit. The treatment lasts three to five minutes each time. When puncturing at Qugu, it's better to conduct the needling sensation towards the external genitalia.

3. Ear acupuncture Points: Auricular points for uterus (seminal vesicle, external genitalia, testis (ovary) and internal tragic apex. Methods: Select two to four points each time, and keep the needle in the skin for 10-20 minutes. If needle embedment therapy is used, it should last three to five days.

Notes
Tonics which benefit qi and strengthen the kidney yang can be taken during the acupuncture treatment to achieve a better result.