Xiao Xiang, 28, is a graduate student, unmarried, no girlfriend, intense study makes him exhausted, but the most distressing thing is that every night he has 2-3 times the erection of the penis, swelling and pain discomfort, difficult to sleep, must get up and walk for a while to get better, just fall asleep again erection pain, seriously affect the sleep. I have been to many hospitals and had many tests such as sex hormones, blood, prostate fluid routine, scrotal ultrasound, penile ultrasound, etc., and no problems were found. The symptoms improved while taking estrogen, and returned to the original state a few days after stopping the medication. This seriously affected his daily work and life, so much so that he could not write his graduation thesis. In fact, every normal male has nocturnal erections. During the day, the brain inhibits the occurrence of sexual response, and this inhibition of the brain disappears after going to sleep at night. Most nocturnal penile erections occur during REM sleep, and in general, normal men have 4-6 REM sleep cycles each night, meaning that 4-6 nocturnal penile erections occur during the night, and everyone has different sensitivity and tolerance to the occurrence of nocturnal penile erections. When an erection becomes painful or swollen during sleep at night and the symptoms do not resolve or disappear until after waking up from the pain or after needing to get out of bed and urinate, it is called a sleep-related painful erection. Patients with sleep-related painful erections may have single or several episodes per night, severely affecting sleep quality, often accompanied by anxiety, irritability, depression and other negative emotions, and some patients may develop ED. Possible causes and mechanisms of sleep-related painful erections include: structural disorders of REM sleep, decreased penile erectile tolerance, altered testosterone and dopamine levels, hematologic disorders (slow granulation, sickle cell anemia, thalassemia, etc.), cremasteropathy, and thalassemia, thalassemia, etc.), cremasteric injury or lesions, hyperviscosity. Sclerosis (or calcification of the penile corpus cavernosum) may also play a role in its development. Treatment options include: REM sleep depressants (e.g., clomipramine, clozapine), muscle relaxants (e.g., baclofen), estrogens, Paulette, goserelin, etc. Some of these drugs are clinically limited because of their ineffectiveness, some because of side effects, and some because of the need for long-term medication; surgical treatment is even less acceptable to patients. If the patient has a deficiency of the heart and spleen, he can use Gui Shen Tang with addition or reduction (Gui Shen Wan); if the patient has a stagnation of Qi and blood, he can use Blood Mansion and Blood Stasis Tang with addition or reduction (Blood Mansion and Blood Stasis Oral Liquid); if the patient has a deficiency of Yin and fire, he can use Zhi Bai Di Huang Tang with addition or reduction (Zhi Bai Di Huang Wan). In addition, patients should be instructed to relax, watch less pornographic videos, pictures and texts, and adopt a healthy lifestyle.