One of the difficulties: the classification and differential diagnosis of impotence] Clinical practice has proven that the clinical diagnosis of impotence is not difficult, the difficulty is that if the specific cause of impotence is not identified, it will bring great difficulty and blindness to the treatment, and may also labor without success, so that the patient wasted money. However, for many male TCM physicians, it is often difficult to diagnose the cause of the disease due to the lack of knowledge about Western medicine. And in general hospitals, due to the limited structure of equipment, most lack the conditions to carry out etiological identification. This requires that the male clinical physician must have some knowledge of Western medicine, but also to master the necessary operational skills. 1, the clinical examination must be detailed medical history, to understand the patient’s onset, the onset of special, as well as the patient before and after the onset of medication. Based on the clues provided by the patient, the initial determination of functional impotence or organic impotence, or drug impotence. If it is drug impotence, the patient should be asked to stop the medication first if possible, and then discuss the medication treatment. If the patient has functional impotence, as long as the treatment is proper and combined with psychological guidance, the patient can generally be cured. However, since Chinese medicine is still lacking in fast-acting medication, the doctor should not be in a hurry and abuse “warm tonic” products; instead, he should “keep to the disease mechanism” and regulate as he should. 3, if the patient is initially determined to be organic impotence, further investigation should be conducted. It is important to understand the pathogenesis and diagnosis of vascular, endocrine and neurogenic impotence (including physical diagnosis and laboratory tests). In hospitals (or clinics) with poor conditions, the medical practitioner should master simpler methods for differential diagnosis of the patient, such as the penile hardness test ring and the poppy bases injection test method. 4, such as through the examination, confirmed as organic impotence, but also can not easily “expel” the patient out of the door. The reason is that Chinese medicine has the opportunity to use medicine for organic diseases, and most of these patients have combined psychological factors. For such patients, we must be patient and induce them to relieve their psychological burden; then through appropriate Chinese medicine treatment, generally can also achieve certain clinical results. If impotence is caused by other chronic systemic diseases, the primary disease should be actively treated first, or the primary disease and impotence should be considered together and treated in steps according to the priority of the symptoms. If the primary disease is healed, impotence often works as well. Do not take away from the main body and do not take the Yang as the only thing. The patient with impotence sometimes does not have many clinical manifestations, except for the inability to get an erection, but no other physical discomfort, and even the tongue and pulse are normal. Even the tongue and pulse are normal. In Chinese medicine, the main method of diagnosis and treatment is to determine the type of symptoms based on the “four diagnoses”. This situation of no “evidence” to identify undoubtedly increases the difficulty of Chinese medicine treatment. In order to solve this problem, one is to strengthen clinical experience and master the general rules. For example, functional impotence in young adults is mostly caused by liver depression; in elderly impotence, there is more kidney failure; with reproductive inflammation, there is more damp heat in the lower jiao, etc. Secondly, we should take a detailed medical history and measure the evidence by cause. Third, with the help of modern science and technology, the “microscopic” examination can help the “macroscopic” dialectic. For example, through the PBI examination, to understand the patient’s penile blood supply; through the endocrine examination, to understand the patient’s sex hormone level, etc.. If the patient has a normal PBI, indifferent libido and low sex hormone level, it can be diagnosed as a deficiency in Chinese medicine, deficiency of kidney yang, and can be treated with blood and flesh products to nourish the kidney and strengthen yang. The third difficulty: the choice of the law and change] Chinese medicine on the treatment of impotence, some take effect very quickly, see the dose and start; some are very little effect, repeated treatment without success; some patients or even several years and little effect. In the meantime, they change doctors, change methods, change prescriptions, and fail repeatedly, which makes patients feel cold and doctors feel discouraged. In fact, the slow effect of patients, not all due to failure to treat, mistreatment, but the complexity of the disease mechanism or drug power is not enough to make. For this part of the patient, we must not be eager to achieve, change the order overnight, the more healing chaos, but to examine the disease mechanism, accurately grasp the timing of law-abiding and law-changing. The purpose of keeping the law is to gradually change the patient’s physique and correct the internal pathology that causes impotence through the long-term use of a certain method. Generally speaking, for patients with mainly deficiency and internal phlegm and stasis, it is necessary to keep the method and to build up the success with time; especially when some patients have achieved certain efficacy and the basic characteristics of the disease have not changed, it is necessary to adhere to the principle of “not changing the formula with efficacy” and to keep the method. 2, change of method There are two indications for change of method, one is that the previous treatment is not effective due to wrong dialectical evidence, and even aggravated by change of evidence; one is that the treatment is effective, but the previous treatment has reached a certain level and the evidence has changed. For the latter, even if impotence has received a certain effect, it is often necessary to change the method at the right time. In particular, when applying a drug that is aggressive or toxic, or a treatment that is mainly attacking, or using a large team of warm and dry drugs to strengthen the Yang, we should pay more attention to “stop when the disease is in the middle” and change when it is time to change; do not overuse or use for a long time, so as not to cause physical disorders.