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However, in clinical practice, if the differentiation of pulse and symptoms is neglected and one adheres rigidly to fixed prescriptions and methods, diseases often remain uncured for a long time. For example: Patient Liu XX, female, adult. In 1962, more than 20 purplish-red nodules were found near both knees and ankles, accompanied by pain and fever, with symptoms worsening on cloudy days, and mild edema in the lower legs. A hospital in Tianjin diagnosed this as Erythema Nodosum (Jie Jie Xing Hong Ban). Initially, hormone therapy was used, and symptoms receded once, but relapsed exactly as before after one month; continuing the same method for over a month yielded insignificant results, so traditional Chinese medicine (TCM) treatment was adopted. A certain physician believed this disease belonged to Damp-Toxin Flowing Accumulation (Shi Du Liu Zhu), treating it with methods to clear heat, promote diuresis to remove dampness, resolve stasis, and dissipate nodules. After one month, most nodules receded, but two months later, they relapsed as before; re-treatment by the same physician using the same method proved ineffective. I was invited to examine the patient. Observation revealed that besides the more than 20 purplish-red nodules near the knees and ankles, which felt tough and painful upon pressure, and mild pitting edema in the lower limbs, there were also chest fullness, irritability, dizziness, headache, a thin white tongue coating, and a deep, fine, and choppy pulse. Upon reflection, since it belongs to Damp-Heat Flowing Accumulation and blood vessel stasis, why was the treatment ineffective? Repeatedly examining the pulse and recalling ancient insights, I finally gained understanding. Chen Guangsong said: "When heat exists in the Ying (Nutrient) level, leading to faintly visible macules, the urgent priority is to vent the macules. The method for venting macules involves cooling the blood and clearing heat; in severe cases, purgation may be necessary. This is akin to 'reducing the firewood in the furnace' (Yang Zao Jian Xin), removing blockages so that light naturally shines through. If substances like Jin Zhi (Gold Juice) or Ren Zhong Huang (Human Excrement Yellow) cannot purge, Da Huang (Rhei Radix et Rhizoma) and Yuan Ming Fen (Mirabilitum) can be added. Scholars should treat based on observed signs, applying divine clarity, and by carefully pondering the words 'irritability and constipation,' one will naturally understand." Thus, I determined: This was due to Qi stagnation and Blood stasis, Phlegm-Heat binding, and the persistence of Yangming Excess Heat. Therefore, I prescribed a formula to regulate Qi, invigorate Blood, clear heat, and promote purgation, modifying Fuyuan Huoxue Tang (Restore Vitality to Invigorate Blood Decoction): Chai Hu (Bupleuri Radix) 10g, Chi Shao (Paeoniae Rubra Radix) 9g, Zhi Shi (Aurantii Fructus Immaturus) 9g, Hua Fen (Trichosanthis Radix) 12g, Bai Jie Zi (Sinapis Semen) 6g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 15g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g. After taking 6 doses, most nodules receded, and symptoms such as dizziness, headache, chest fullness, and irritability decreased. Subsequently, the patient continued taking the above prescription for 45 doses, after which all symptoms disappeared. To consolidate the curative effect, the dosage was changed to 2 doses per week, resulting in complete recovery after one year.

Impotence (Yang Wei)
Impotence is a common and frequent disease among young and middle-aged men, significantly affecting normal sexual life between men and women. Therefore, from ancient times to the present, physicians of all dynasties have regarded this disease as an important subject in medical research.

I. Issues Concerning the Etiology and Pathogenesis of Impotence
The *Neijing* (Classic of Internal Canon) refers to impotence as "Yin Wei" (Yin Flaccidity), "Yin Qi Bu Yong" (Genitals Not Functioning), and "Zong Jin Chi Zong" (Slackening of the Sinews). It believes the main causes are "severe Qi deficiency" and "heat". During the Sui and Tang dynasties, through research, it was explicitly stated that the etiology was labor injury and Kidney deficiency. For example, Chao Yuanfang in *Zhubing Yuanhou Lun* (Treatise on the Pathogenesis and Symptoms of All Diseases) said: "Labor injury to the Kidney, where Kidney deficiency fails to nourish the genitals, leads to flaccidity." He explicitly clarified that "labor" referred to sexual exhaustion caused by excessive sexual activity. Wang Tao in *Waitai Miyao* (Essential Prescriptions Worth a Thousand Gold for Emergencies) pointed out: "The source of the disease lies in the Kidney opening into the Yin. If labor injures the Kidney, and Kidney deficiency fails to nourish Yin Qi, flaccidity occurs." "Yin Wei caused by Five Labors and Seven Injuries, where the penis does not rise for ten years, is all due to damaging Yang in youth through excessive sexual intercourse." Physicians of the Song and Ming dynasties deepened their understanding of the etiology and pathogenesis of this disease. For instance, Yan Yonghe in Song Dynasty's *Jisheng Fang* (Prescriptions for Saving Lives) more clearly explained that this disease was caused by the exhaustion of True Yang, stating: "Five Labors and Seven Injuries, True Yang is exhausted... sexual function fails to arise." Wang Lun in Ming Dynasty's *Mingyi Zazu* (Miscellaneous Writings of Famous Doctors) pointed out that besides Mingmen Fire Decline, impotence could also be caused by Depressed Fire, saying: "Men suffering from impotence, ancient formulas often attribute it to Mingmen Fire Decline and deficiency-cold of Essence and Qi, which is indeed true; however, there are also cases caused by severe Depressed Fire." Zhang Jiebin in Ming Dynasty's *Jingyue Quanshu* (Complete Works of Jingyue) believed that impotence was not only caused by Mingmen Fire Decline but also by Damp-Heat, fright, and overthinking, stating: "(Impotence) mostly arises from Mingmen Fire Decline, deficiency-cold of Essence and Qi, or damage to the generating Qi of Yang due to Seven Emotions and labor fatigue... There are also cases where Damp-Heat is flourishing, causing the sinews to slacken." "Those who worry excessively, toil mentally, or suffer from deep depression often develop impotence." This explicitly indicated that the meaning of "labor" also included mental worry and depression. Qing Dynasty physicians, through research, believed that besides the previously mentioned causes such as sexual exhaustion, Seven Emotions, Depressed Fire, and Damp-Heat, there were also causes such as restraining sexual intercourse, loss of will, Liver Qi Stagnation, and Gallbladder Depression. Shen Jin'ao in Qing Dynasty's *Zabing Yuanliu Xizhu* (Sharp Candle of the Source and Flow of Miscellaneous Diseases) wrote: "There are those whose semen is emitted illegally, or who restrain sexual intercourse, injuring the sinews... There are also those who have lost their will, whose depression injures the Liver, preventing Liver Wood from dispersing freely, also leading to Yin flaccidity and non-arising." Hua Xiuyun, in the commentary of *Linzheng Zhinan Yian* (Guiding Manual of Clinical Experience Records), pointed out: "There are cases caused by sexual desire injuring the Liver and Kidney... There are also cases caused by fear... There are cases formed by mental worry and fatigue... There are cases where depression damages the generation of Yang, which must be treated from the Gallbladder, for the classics state that all eleven Zang-Fu organs depend on the Gallbladder, and also that Shaoyang acts as the pivot; if Gallbladder Qi expands freely, what depression would there be? Furthermore, when Damp-Heat is the pathogen, the sinews must slacken and fail to become firm and erect... When Yangming is deficient, the sinews slacken, for the Stomach is the sea of water and grain; if food intake is poor, Essence and Qi must be deficient. Moreover, the male external genitalia are called 'Shi' (Power); if Grain Qi is insufficient, seeking a powerful and firm erection is indeed difficult." Modern physicians mostly follow these previous theories, especially emphasizing Kidney Yang deficiency. In my decades of clinical practice, I found that merely following these theories could not solve all clinical problems. Through repeated exploration, I discovered that impotence could also be caused by Lung Yin deficiency and Qi deficiency. Among Depressive Disorders, there is not only Fire Depression but also Damp, Cold, Blood, and Phlegm depressions. I elaborated on these in my works *Zhongyi Neike Zhengzhi Beiyao* (Essentials of TCM Internal Medicine Diagnosis and Treatment, 1983) and *Nanbing Qizhi* (Strange Cures for Difficult Diseases, 1989), receiving a good response and being called "truly opening a new gate for physicians."

II. Several Issues Concerning the Treatment of Impotence
Since the Sui and Tang dynasties attributed impotence mainly to Kidney deficiency, physicians of all generations have attached great importance to this view. Some even called Kidney-Yang tonifying drugs as specific medicines for treating impotence. Some clinicians, upon hearing a patient complain of impotence, immediately used Deer Antler (Lurong), Morinda Officinalis Root (Bajitian), Cistanche Stem (Roucongrong), Curculigo Rhizome (Xianmao), Epimedium Herb (Yinyanghuo), Eucommia Bark (Duzhong), Dipsacus Root (Xuduan), Dog Spine (Gouji), Psoralea Fruit (Buguzhi), Cordyceps Sinensis (Dongchongxiacao), Gecko (Gejie), Goji Berry (Gouqizi), Placenta Humanis (Ziheche), Dodder Seed (Tusizi), Cynomorium Herb (Suoyang), Leek Seed (Jiuizi), Lepidolite (Yangqishi), Prepared Rehmannia Root (Shudi), Cornus Fruit (Shanzhuyu), Aconite Lateral Root (Fuzi), and Cinnamon Bark (Rougui), and even Silkworm Moth (Xiongcan'e), Deer Kidney, Donkey Kidney, Yellow Dog Kidney, and Sea Dog Kidney. Some pharmacological experts even compiled a comprehensive Kidney-tonifying formula, calling it a fine medicine for tonifying the Kidney. Zhang Jingyue, a great clinician of the Ming Dynasty, seeing the弊端 (drawbacks) of this understanding, proposed: "For impotence caused by Mingmen Fire Decline and deficiency-cold of Essence and Qi, Right Restoration Pill (Yougui Wan), Zanyu Pill (Zanyu Dan), or Stone-Carved Kidney-Tonifying Pill (Shike Anshen Wan) should be used. If the fire is not severely declined, but only due to weak Blood and Qi, Left Restoration Pill (Zuogui Wan), Banlong Pill (Banlong Wan), or Whole Deer Pill (Quanlu Wan) should be used." "For impotence caused by spleen and Kidney deficiency due to overthinking and fright, one must nourish the Heart and Spleen... Seven Blessings Decoction (Qifu Yin) or Guipi Decoction (Guipi Tang) should be used... For those who suffer too much from worry, thought, and fear, Yang Qi is often suppressed; without benefiting Fire, there will be no vitality, so Seven Blessings Decoction plus Cinnamon and Aconite and Goji Berry should be used." "For impotence caused by Liver and Kidney Damp-Heat leading to sinew slackening, it is also treated by clearing fire to firm the Kidney, but one must ensure that Fire signs and pulses match internally and externally to confirm the diagnosis, using Eight Flavor Rehmannia Pill for Nourishing Yin (Ziyin Bawei Wan), Danxi Great Tonifying Yin Pill (Danxi Dabu Yin Wan), or Tiger Hiding Pill (Hujian Wan)." Hua Xiuyun in Qing Dynasty's *Linzheng Zhinan Yian* commentary pointed out: "For cases caused by sexual desire injuring Liver and Kidney, the master's method requires vigorous tonification of True Yuan, because since Yang Qi is injured, True Yin must also be damaged; if purely using hot, dry, and astringent tonics, there will be harm from excess; thus, warm and moist animal-derived products are often combined for slow regulation. For cases caused by fear, since fear injures the Kidney and causes Qi to sink, treatment should firm the Kidney and slightly assist rising Yang. For cases formed by mental worry and fatigue, Heart, Spleen, and Kidney should be treated simultaneously. For cases where depression damages the generation of Yang, treatment must start from the Gallbladder... For cases where Damp-Heat is the pathogen, causing sinew slackening, treatment uses bitter flavors to firm Yin and light permeating agents to remove dampness; once dampness is removed and heat cleared, the disease retreats. For Yangming deficiency causing sinew slackening... treatment lies only in unblocking and tonifying Yangming." The 1985 edition of *Zhongyi Neike Xue* (TCM Internal Medicine) stated: "(Impotence) involves the Liver, Kidney, and Yangming meridians." It listed: ① Those with Mingmen Fire Decline presenting with "impotence, pale complexion, dizziness, vertigo, listlessness, soft waist and knees, pale tongue with white coating, mostly deep fine pulse, treated by tonifying Kidney and strengthening Yang, using Wuzi Yanzong Pill (Wuzi Yanzong Wan) or modified Zanyu Dan." ② Those with Heart and Spleen damage presenting with "impotence, lack of spirit, restless sleep, dull complexion, thin greasy coating, pale tongue body, fine pulse, treated by tonifying and benefiting Heart and Spleen, using modified Guipi Tang." ③ Those with Kidney injury from fright presenting with "impotence, mental distress, timidity and suspicion, palpitations and insomnia, string-tight fine pulse, thin greasy coating, treated by benefiting Qi and calming Spirit, using Dabu Yuanjian (Great Tonify Origin Decoction)." ④ Those with Damp-Heat pouring downward presenting with "impotence, short yellow urine, heavy lower limbs, yellow coating, deep slippery pulse, or soggy slippery rapid pulse, treated by clearing and transforming Damp-Heat, using modified Zhibai Dihuang Wan." The 1985 edition of *Shiyong Zhongyi Neike Xue* (Practical TCM Internal Medicine) stated: ① Mingmen Fire Decline: Method is warming and tonifying Lower Origin, using Yougui Wan etc.; ② Heart and Spleen Damage: Method is tonifying and benefiting Heart and Spleen, using modified Guipi Tang; ③ Kidney Injury from Fright: Method is tonifying Kidney and calming Spirit, using Dayu Tang; ④ Damp-Heat Pouring Downward: Method is clearing and transforming Damp-Heat, using Longdan Xiegan Tang. Although I paid attention to the use of previous methods and formulas in clinical practice, many were ineffective. After long and deep reflection, synthesizing the causes, it was largely related to: ① Unclear nature and location of the disease, ② Failure to distinguish root and branch, ③ Unclear proportion.

III. Several Issues Concerning Syndrome Differentiation and Treatment of Impotence
The book *Shiyong Zhongyi Neike Xue* points out: "(Impotence) Key points of syndrome differentiation: ① Distinguish presence or absence of Fire; Impotence accompanied by pale complexion, aversion to cold and cold limbs, pale tongue with white coating, deep fine pulse is 'No Fire'; Impotence accompanied by irritability and anger, yellow-red urine, yellow greasy coating, soggy rapid or string-tight rapid pulse is 'Has Fire'. The basis for differentiation relies mainly on pulse and tongue coating. ② Distinguish deficiency and excess of Zang-Fu organs: Damage caused by unrestrained desires, thinking, depression, and fright mostly leads to Spleen and Kidney deficiency, Mingmen Fire Decline, belonging to deficiency syndromes; Cases caused by Liver Depression transforming into Fire, Damp-Heat pouring downward, and sinew slackening belong to excess syndromes. 'Treatment Principles: Deficiency-type impotence should be tonified, excess-type should be purged, those with Fire should be cleared, those without Fire should be warmed. For Mingmen Fire Decline, since Yang Qi is deficient and True Yin is mostly damaged, and the Kidney dislikes dryness, the method of warming and tonifying should avoid purely using hot, dry, and astringent agents; warm and moist animal-derived products are suitable. For Damp-Heat pouring downward, treatment uses bitter flavors to firm Yin and light permeating agents to remove dampness.'"
In my clinical practice, I found that pure deficiency, pure excess, pure cold, or pure heat, or conditions confined to one Zang-Fu organ or one meridian/collateral, are rare. Therefore, simply applying tonification, purgation, clearing, or warming rarely yields results. Even if attention was paid to nourishing Yin when tonifying Yang, or using "bitter flavors to firm Yin, light permeating agents to remove dampness" when removing dampness, it was often ineffective. Synthesizing the reasons, it is mostly related to the aforementioned: ① Unclear nature and location of the disease, ② Failure to distinguish root and branch, ③ Unclear proportion. So how to distinguish these three factors? Through repeated exploration, I found five main methods:
1. According to the basic viewpoints of TCM theory, analyze all issues with a monistic perspective. For example: Non-arising of sexual function, thin and cold semen, dizziness and tinnitus, pale complexion, listlessness, sore and weak waist and knees, aversion to cold and cold limbs, pale tongue with white coating, deep fine pulse should be explained primarily by the single diagnosis of Mingmen Fire Decline, rather than invoking Lung or Spleen syndromes.
2. According to the Zang-Fu organs, meridians, Qi and Blood, Yin and Yang described in basic theory, try to apply a monistic viewpoint for analysis. For example: Impotence, dizziness and headache, irritability, bitter taste and dry mouth, yellow-red urine, string-tight rapid pulse should be explained primarily by a single Liver pathology.
3. When symptoms are numerous and various manifestations are hard to explain by a single cause, or even contradictory, when explaining root/branch and proportion, one must prioritize the pulse. For example: Symptoms include dizziness and headache, bitter taste and dry throat, yellow urine and constipation, impotence. If the pulse is string-tight, consider concomitant Cold and prioritize Cold; if the pulse is slippery and rapid, consider Phlegm-Heat as primary; if the pulse is string-tight and rapid, consider Liver-Gallbladder Excess Fire as primary.
4. When symptoms are complex and deficiency and excess appear together, differentiate the degree of deficiency and excess primarily by pulse and complexion. For example: Usually having strong erections that do not subside, but becoming flaccid during intercourse, occasionally experiencing hot and painful urination, dry mouth. If the pulse is string-tight, large at the Chi position, and choppy, it should be Kidney Yang deficiency; conversely, if the Chi pulse is rapid, it is primarily Hyperactive Ministerial Fire. Again: Impotence, yellow urine, body heat, red tongue with yellow coating, but pale complexion, empty-large and rapid pulse should be diagnosed primarily as Qi and Yin deficiency, with Damp-Heat as secondary.
5. When syndrome differentiation is difficult, carefully analyze the effects after medication administration, combining pulse and symptoms for prudent analysis. One should establish the concept that anything ineffective is incorrect, and anything effective is correct. If medication is ineffective, one should consider that the prescription has at least some flaws; only then can the cause be identified.

IV. Brief Introduction to Treatment Cases
1. He XX, Male, 30 years old. Impotence for 3 years, previous doctors frequently used Kidney-tonifying and Yang-strengthening decoctions and pills along with Western medicine without effect. Examining him, aside from occasional cold symptoms, he had no other discomfort, pulse was string-tight and moderate. Recalling that Zhang Zhongjing used Guizhi Tang (Cinnamon Twig Decoction) for disharmony of Ying and Wei, and "those who lose essence with tight hypogastrium and cold glans penis" should use Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell), I tentatively prescribed Guizhi Jia Longgu Muli Tang. Unexpectedly, he recovered after 10 doses.
2. Niu XX, Male, 61 years old.
Impotence for over 20 years, previous doctor claimed Kidney Yang deficiency, treating with Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill), Nanbao (Male Treasure), San Shen Wan (Three Kidneys Pill), Royal Jelly etc., without effect. Detailed inquiry revealed that besides non-arising of sexual function, or occasional emission upon slight arousal, he constantly felt heaviness in his calves, sometimes mild edema, or hot/painful urination, dizziness and head distension, with no other discomfort. Tongue coating was yellow-white and greasy, pulse was empty-large, string-tight, tight, and slightly slippery. Synthesizing pulse and symptoms, reflecting repeatedly: Both Zhang Zhongjing and Wang Shuhe stated that an empty-large pulse indicates constitution of Qi and Blood deficiency, or Qi and Yin deficiency; tight indicates Cold; slightly slippery indicates Phlegm-Heat combination. Although signs showed Heat, it was still appropriate to prescribe Huang Qi (Astragali Radix) and Dang Gui (Angelicae Sinensis Radix) to benefit Qi and nourish Blood; Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Chinensis Fructus), and Sheng Di Huang (Rehmanniae Radix) to benefit Lung and nourish Kidney; Cang Zhu (Atractylodis Rhizoma), Fu Ling (Poria), and Ze Xie (Alismatis Rhizoma) to dry dampness and promote diuresis; Huang Lian (Coptidis Rhizoma) and Rou Gui (Cinnamomi Cortex) to communicate Heart and Kidney. After 2 months of medication, all symptoms returned to normal. He also reported that proteinuria had completely disappeared.
3. Huo XX, Male, 28 years old.
After half a year of marriage, he found that either sexual function did not arise, or arose but was not firm, or premature ejaculation occurred upon slight contact, causing great dissatisfaction in his wife. Doctors first gave Kidney-tonifying and Yang-strengthening treatments, combined with Western medicine, without effect; later combined with acupuncture, also without merit. Examination showed that apart from impotence, he had no other symptoms, only occasional dry throat, thin white tongue coating, and floating-moderate pulse. Synthesizing pulse and symptoms, reflecting: Floating pulse is the pulse of Heart and Lung. His dry throat was due to Lung Yin deficiency failing to generate Kidney Water. Therefore, I planned to nourish Kidney Water and assist Kidney Yang, prescribing Tian Dong (Asparagi Radix) and Mai Dong (Ophiopogonis Radix) to nourish Lung and Yin, Yinyanghuo (Epimedii Herba), Shechuangzi (Cnidii Fructus), and Roucongrong (Cistanches Herba) to assist Kidney Yang. Effective after 3 doses, cured after 20 doses.
4. He XX, Male, 29 years old.
Married for over 3 years, either sexual function did not arise, or arose but was not firm. Took Nanbao, San Shen Wan, Shenqi Wan (Kidney Qi Pill), Liushen Dihuang Wan (Six-Ingredient Rehmannia Pill), Deer Antler Essence for nearly 3 years without effect. For the past half year, frequently experienced toothache, headache, irritability, insomnia, especially in the last two months, almost daily epistaxis and gingival bleeding, forcing the use of fire-purging drugs. However, after taking them, sexual numbness and discomfort appeared, while other symptoms did not decrease. Examining tongue coating: yellow-white and greasy; pulse: string-tight and rapid. Reflecting: String-tight pulse is Liver pulse; tight and rapid indicates Cold-Fluid retention transformed into Heat after long stagnation. Toothache, headache, irritability, and insomnia are also Liver syndromes. Therefore, I prescribed Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) removing Lead Calx (Qian Dan), adding Gan Cao (Glycyrrhizae Radix et Rhizoma) and Xuanshen (Scrophulariae Radix) as the method. After 4 doses, headache, toothache, irritability, and epistaxis decreased; continuing for 30 doses resulted in complete cure.

Xu Lao (Deficiency Consumption)
What is Xu Lao? Some say it refers to hematopoietic system diseases, others say it refers to nutritional deficiency diseases. Which is correct? Which is wrong? It is difficult to decide. Until reading *Shiyong Zhongyi Neike Xue* (Practical TCM Internal Medicine) edited by Fang Yaodeng et al., I gained a somewhat comprehensive understanding. It states: "The scope of Xu Lao is very broad, almost involving various systems of Western medicine, including autoimmune deficiency or immune function stability disorders, endocrine gland dysfunction, hematopoietic dysfunction, metabolic disorders, nutritional deficiencies, neurological dysfunction or excessive inhibition (non-protective) induced diseases, and other organ system functional decline diseases, any condition whose main clinical manifestation is chronic functional decline or virtual hyperexcitability." However, since this statement is too general and lacks specific reference, it often makes it difficult for readers to apply it to studying classical TCM texts and clinical practice.