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When Yang Qi moves, erection occurs; when Yin Qi is still, flaccidity ensues. This happens even without sexual desire (as can be observed in young boys at night), let alone those with conscious intent.

However, the cause of non-erection lies in Qi failing to descend from the Heart. There are six reasons: First, it is due to congenital endowment, which cannot be forcibly strengthened. Second, it results from fear, causing Qi to become deficient. Third, mental agitation causes ministerial fire to fly upward, preventing Qi from descending. These three cases occur in individuals without disease. Fourth, excessive damp-heat pours downward into the Zongjin (tendons of the genitals), causing relaxation and failure to retract. Fifth, excessive depletion leads to deficiency of Mingmen Fire (Fire of the Gate of Life). Sixth, deficiency of Kidney Water with excessive heat consumes Qi through "vigorous fire" (Xue Lizhai stated that just as trees stand lush when moistened by dew but wither in severe heat, so too does erection require harmony between Water and Fire; if there is only Water without Fire, or only Fire without Water, or if Water and Fire excess transforms into damp-heat, erection will not occur; see the Flaccidity chapter for clarification). These cases occur in individuals with disease. For Mingmen Fire deficiency, use Fugui Bawei Wan (Aconite and Cinnamon Eight-Ingredient Pill); for Kidney Water deficiency, use Zhibai Bawei Wan (Anemarrhena and Phellodendron Eight-Ingredient Pill) (both discussed under Deficiency and Damage). For damp-heat, use Guzhen Tang (Solidify the True Decoction) or Chaihu Shengshi Tang (Bupleurum to Overcome Dampness Decoction) (these syndromes often present with sweaty, foul-smelling genitals and heat in the inner thighs, or conversely, coldness where the glans and testicles feel like ice; do not mistakenly diagnose this as cold, because damp-heat resides in the Zang-Fu organs, heat tends to rise while dampness flows downward, hence such symptoms).

For fire flaming upward without descending to interact, apply descending methods. For fear, apply calming methods.

When the Yin organ receives cold, it retracts; when it receives heat, it relaxes. In Shanghan (Cold Damage) diseases, scrotal retraction is characteristic of Yin syndromes, but also occurs in Yang syndromes because heat scorches the tendons causing dryness and retraction. However, discussing normal physiology, retraction is caused by cold, as seen in summer when the scrotum is soft and relaxed, and in winter when it is hard and retracted. Danxi treated a patient surnamed Bao who had an elongated, swollen, and flaccid penis with stretched, moist skin, making walking difficult due to thigh friction, with Qi rushing up in the hypochondrium, and weak, fatigued limbs. He used Xiaochaihu Tang (Minor Bupleurum Decoction) with a large dose of Huanglian (Coptis Rhizome) to circulate damp-heat, adding a small amount of Huangbai (Phellodendron Bark) to direct rebellious Qi downward, reducing the swelling and elongation. However, a firm mass remained, so he used Qingpi (Green Tangerine Peel) as the chief herb, assisted by powdered wind-dispelling herbs taken internally, and externally applied a paste of Wubeizi (Chinese Gallnut) mixed with Luffa juice. The condition was cured. For damp-heat causing swelling and protrusion, soak in a decoction of Puxiao (Mirabilite) and Jingjie (Schizonepeta). For severe cases, use Sanyi Chengqi Tang (Three-One Purging Decoction) to purge via the bowels.