Introduction
Impotence means that the penis in adult cannot erect or erect insufficiently for sexual intercourse. According to TCM, impotence is caused by intemperance of sexual Fife and decline of fire in mingmen (gate of life); or by overanxiety that impairs the heart and spleen and leads to asthenia of the thoroughfare vessel; or by downward migration of damp-heat in the liver and kidney that leads to flaccidity of the genitalia. Clinically impotence is usually of asthenia syndrome.

Syndrome Differentiation
1. Impairment of the Heart and Spleen
Frigidity in sexual life, or insufficiency of erection, palpitation and susceptibility to fright, insomnia and amnesia, lusterless complexion, spiritual lassitude and fatigue, shortness of breath and spontaneous sweating, light-colored tongue with white fur, thin and weak pulse.

2. Decline of Fire in Mingmen (Gate of Life)
Impotence, or premature ejaculation, thin and cold semen, blackish eyelids and complexion, dizziness, cold sensation in the body and spiritual lassitude, aching loins and tinnitus, light-colored tongue, deep and thin pulse.

3. Downward Migration of Damp-heat
Impotence, insufficiency of erection, eczema of scrotum with foul smell, aching and distension in the lower abdomen, yellow and brown urine, or stabbing pain, itching and burning sensation in urination, yellow tongue fur, soft and rapid pulse.

Treatment
1. Body Acupuncture
Prescription:
Guanyuan (CV 4), Shenshu (BL 23), Sanyinjiao (SP 6) and Taichong (LR 3).

Modification:
For impairment of the heart and spleen, Xinshu (BL 15), Pishu (BL 20), Neiguan (PC 6) and Zusanli (ST 36) are added; for decline of fire in mingmen (gate of life), Mingmen (GV 4) and Ciliao (BL 32) are added; for downward migration of damp-heat, Pangguangshu (BL 28), Yinlingquan (SP 9), Ligou (LR 5) and Xingjian (LR 2) are added.

Performance:
Guanyuan (CV 4) is needled till the needling sensation radiates to the perineum. Sthenia syndrome is treated with reducing needling technique while asthenia syndrome is treated with reinforcing needling technique. For the treatment of decline of fire in mingmen (gate of life), moxibustion is used.

2. Ear Acupuncture
Prescription:
Internal Genitalia ( TF2 ), External Genitalia ( HX4 ),  Middle border ( AT1,2,4i ),  Liver (CO12), Kidney (CO10), Endocrine (CO18) and Ear Shenmen (TF4).
Performance: Each time 3 - 5 acupoints are selected and needled with filiform needles and medium

stimulation.
Or embedment of needles or ear pressure with Wangbu liuxingzi (Semen Vaccariae) is used.