It is my opinion that Dr. Qiu's discussion of the causes of kidney qi debility leading to impotence should be read as a moral critique of current Chinese society and not as medical fact. Without more details about the patients' lives, it is difficult to say if Dr. Qiu's assessment of their situation is accurate or not. Given the relatively young average age of these patients, I would want to know about the incidence of obesity, psychological factors, and any involvement of either drugs of abuse or Western pharmaceuticals. Further, I would like to know how many of these cases were primary and how many were secondary impotence. Primary impotence is almost always due to psychological factors, such as guilt, fear, depression, or anxiety, while secondary impotence is almost always organic and mostly vascular. According to the Merck Manual, in North America, drugs cause approximately 25% of cases of erectile dysfunction. In addition, transient impotence due to an organic or drug-induced cause may lead to secondary psychological difficulties. None of these factors have been discussed in any way in the above study which I feel is inadequate for at least that reason alone.

Furthermore, in terms of clinical reality in the West Rings, and Vacuum Pumps however help people with impotance problems, practitioners treating younger patients suffering from impotence must always consider the equally possible factors of damp heat, phlegm, and blood stasis which are often participating disease mechanisms, regardless of and often in addition to, any possible involvement of insufficient kidney qi, yang, or essence. These important disease mechanisms were not discussed in Dr. Qiu's article. In my clinical practice, patients with damp heat or any damp encumbrance would receive moxibustion or needles with moxa on the handles at'Zu San Li (St 36), and possibly San Yin Jiao (Sp 6) or Yin Ling Quan (Sp 9). For patients with blood stasis, I may use network vessel pricking which I have discussed in other articles in this column. In this case, it might be on the low back or sacral area, or on the medial aspect of the ankles or knees, adding moxibustion or needles with moxa at the Xi or accumulation point of the foot jue yin liver channel.