Differentiation of the disease primarily concerns whether or not impotence pertains to deficiency syndrome or excess one, whether or not there exists the hyperactive fire. Impotence attributive to sex excess, anxiety, depression and fright is mainly indicative of deficiency of the spleen and kidneys, decline of fire of the life gate, thus pertaining to deficiency syndrome. Impotence due to the transformation of stagnant liver qi into fire, downward movement of damp heat and flaccidity of penis pertains to excess syndrome.

Impotence with pale complexion, aversion to cold, cold limbs, pale tongue with white coating, deep and thready pulse is indicative of the nonexistence of fire; while the one with irritability, dark yellow urine, greasy and yellowish tongue coating, soft-superficial, rapid or wiry, rapid pulse is indicative of the hyperactive fire. Other factors that might lead to impotence:

-- Any number of medical problems, such as diabetes, obesity, heart disease, high blood pressure, and atherosclerosis
-- Excessive use of alcohol, tobacco, and/or recreational drugs
-- Certain medications
-- Injuries to or surgical procedures performed on the spinal cord or the pelvic region
-- Mental or emotional problems, such as fatigue, stress, anxiety, and depression