Clinical Observation On The Clinical Efficacy Of Acupuncture And Moxibustion Combined With Drug Therapy in The Treatment Of Functional ED Ⅲ
Mar 28, 2025
Introduction
Erectile dysfunction (ED) is a condition characterized by the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. As a multifactorial condition, it is influenced by psychological, physiological, and social factors. Functional ED, distinct from organic ED, often has no identifiable structural causes and is frequently associated with emotional or psychosocial stressors. Traditional Chinese Medicine (TCM) provides a unique perspective on ED, categorizing the condition into various syndromes such as damp-heat downward flow, decline of Mingmen fire, and liver qi stagnation, among others. This study aims to explore the clinical characteristics, syndrome distribution, and associated factors of functional ED, while evaluating the efficacy of TCM and integrated treatments.
efficacy of TCM Herbal Cistanche Supplements for Treating Erectile dysfunction (ED)
Results
1. General Data
1.1 Age Factors
The study collected data on 100 patients, 61 of whom met the diagnostic criteria for functional ED and were included in the clinical observation. The mean age of the included patients was 36.43 ± 1.03 years (range: 19-61 years). Among them:
12 patients (19.7%) were under 30 years old.
27 patients (44.3%) were between 30 and 40 years old.
22 patients (36.0%) were over 40 years old.
1.2 Distribution of TCM Clinical Symptoms and Syndromes
The TCM clinical symptom data of the 61 functional ED patients were further analyzed. Syndrome differentiation was performed by two TCM physicians with intermediate or higher qualifications. The results showed the following distribution:
Damp-heat downward flow: 27 cases (44.3%).
Decline of Mingmen fire: 13 cases (21.3%).
Liver qi stagnation: 5 cases (8.2%).
Kidney damage due to fright: 6 cases (9.8%).
Heart-spleen deficiency: 4 cases (6.6%).
Mixed syndromes: 6 cases (9.8%).
Analysis of the frequency of TCM symptoms revealed common accompanying symptoms, including decreased libido, swollen tongue body, inability to maintain erection, physical fatigue, yellow tongue coating, and damp scrotum. Among these, decreased libido was the most frequently observed symptom. A comprehensive analysis of TCM syndromes indicated that symptoms associated with damp-heat downward flow and decline of Mingmen fire occurred most frequently. See Table 1 for details.
Tab. 4 Clinical symptom frequency table of TCM
| Symptom | Frequency | Percentage (%) | Symptom | Frequency | Percentage (%) |
|---|---|---|---|---|---|
| Decreased libido | 52 | 85.2 | Insomnia and dreaminess | 40 | 65.6 |
| Swollen tongue body | 50 | 82.0 | Poor appetite | 38 | 62.3 |
| Inability to maintain erection | 49 | 80.3 | Irritability | 37 | 60.7 |
| Physical fatigue | 48 | 78.7 | Damp scrotum | 36 | 59.0 |
| Yellow tongue coating | 47 | 77.0 | Pale tongue | 32 | 52.5 |
| Damp scrotum | 46 | 75.4 | Weak pulse | 31 | 50.8 |
| Tired limbs | 45 | 73.8 | Purple tongue | 30 | 49.2 |
| Yellow urine | 44 | 72.1 | Frequent urination | 29 | 47.5 |
| Dizziness and tinnitus | 43 | 70.5 | Dry stools | 28 | 45.9 |
| Soreness in the lower back | 42 | 68.9 | Thin pulse | 27 | 44.3 |
| Five-center heat sensation | 41 | 67.2 | Clear and prolonged urination | 24 | 39.3 |
Note: The table reflects the frequency and percentage of clinical symptoms observed in patients with functional ED based on TCM syndrome differentiation.
1.3 Body Mass Index (BMI)
Body mass index (BMI = kg/m²) is a widely recognized and effective clinical method for assessing weight status [29]. In this study, data from 100 ED cases were analyzed, distinguishing between the functional ED group (61 cases) and the non-functional ED group (39 cases).
In the non-functional ED group (39 cases):
BMI ranged from 15.1 kg/m² to 27.4 kg/m², with an average of 23.84 ± 0.49.
In the functional ED group (61 cases):
Weight ranged from 57 kg to 85 kg.
Pre-obesity (also known as "healthy obesity") was identified in 35 cases (57.4%), and Grade I obesity was identified in 25 cases (41%). The proportion of mild to moderate obesity reached 98.4%.
BMI ranged from 16.4 kg/m² to 29.8 kg/m², with an average of 25.03 ± 0.20.
A t-test comparing BMI between the two groups indicated a significant difference in mean BMI (P < 0.05). This result suggests that being overweight is a common characteristic among patients with functional ED. See Tables 2 and 3 for details.
1.4 Classification and Grouping
A total of 61 functional ED patients were included in this study. Among them:
Mild ED: 47 cases (77%).
Moderate ED: 14 cases (23%).
The 61 patients were randomly divided into three groups, and their baseline levels were compared in terms of age, IIEF-5 score, and BMI to ensure comparability:
Acupuncture-Medication Combined Group (Group A):
21 cases.
Average age: 40.86 ± 1.91.
Average BMI: 25.01 ± 0.32.
Average IIEF-5 score: 13.57 ± 0.31.
Acupuncture Treatment Group (Group B):
20 cases.
Average age: 40.15 ± 1.68.
Average BMI: 25.47 ± 0.46.
Average IIEF-5 score: 13.05 ± 0.37.
Tadalafil Medication Group (Group C):
20 cases.
Average age: 40.86 ± 1.91.
Average BMI: 25.01 ± 0.32.
Average IIEF-5 score: 13.35 ± 0.39.
The results showed no significant differences in baseline characteristics such as age, BMI, and IIEF-5 score among the three groups before treatment (P > 0.05). This indicates that the baseline levels of the groups were generally consistent, making the grouping meaningful and the groups comparable. See Tables 4 and 5 for details.
Table 2. Comparison of BMI in 100 ED Patients
| Group | n | BMI (kg/m²) |
|---|---|---|
| Functional ED | 61 | 25.03 ± 0.20* |
| Non-functional ED | 39 | 23.84 ± 0.49 |
| Note: Compared with the non-functional ED group, the difference is significant (P < 0.05). |
Table 3. Observation of the Frequency of BMI in Functional ED Patients
| Category | Frequency | Cumulative Frequency (%) |
|---|---|---|
| Normal | 1 | 1.6% |
| Pre-obesity | 35 | 57.4% |
| Grade I obesity | 25 | 41.0% |
Table 4. Classification of Functional ED Patients by Severity
| Severity | Frequency | Proportion (%) |
|---|---|---|
| Mild | 47 | 77.0 |
| Moderate | 14 | 23.0 |
Table 5. General Data Comparison of Three Groups (Mean ± SD)
| Group | Age (years) | BMI (kg/m²) | IIEF-5 |
|---|---|---|---|
| A Group | 40.86 ± 1.91 | 25.01 ± 0.32 | 13.57 ± 0.31 |
| B Group | 40.15 ± 1.68 | 25.47 ± 0.46 | 13.05 ± 0.37 |
| C Group | 40.86 ± 1.91 | 25.01 ± 0.32 | 13.35 ± 0.39 |
Note:
Age, BMI, and IIEF-5 scores were not significantly different between groups before treatment (P > 0.05). This indicates that the baseline levels were consistent, and the grouping is meaningful and comparable.
2. Efficacy Evaluation
The cure and significant improvement rates were compared among all groups. After treatment, the results for the 61 functional ED patients were as follows:
Cured: 2 cases (3.3%).
Significant improvement: 27 cases (44.3%).
Effective: 22 cases (36.1%).
Ineffective: 8 cases (13.1%).
The overall effective rate reached 86.9%.
2.1 Comparison of IIEF-5 Scores Before and After Treatment in the Three Groups
After treatment, the IIEF-5 scores in all three groups showed an upward trend. A significant difference was observed when comparing pre- and post-treatment scores within each group (P < 0.01). Among the groups, Group A showed the most significant improvement.
This suggests that all treatment approaches were effective for functional ED, but acupuncture combined with medication yielded the best results. See Table 6.
2.2 Comparison of MSF-4 Scale Scores Before and After Treatment in the Three Groups
After treatment, the MSF-4 (International Sexual Desire Scale) scores of all three groups showed significant increases, with Group A demonstrating the greatest improvement. Significant differences were observed in pre- and post-treatment scores within each group (P < 0.01), indicating that all treatment methods were effective for functional ED. However, Group A showed superior results. See Table 7.
Table 6. Comparison of IIEF-5 Scores in the Three Groups
| Group | Before Treatment | After Treatment | P |
|---|---|---|---|
| A | 13.57 ± 0.31 | 20.14 ± 0.26*▲ | 0.001 |
| B | 13.05 ± 0.37 | 18.00 ± 0.29* | 0.001 |
| C | 13.35 ± 0.42 | 19.13 ± 0.21* | 0.001 |
Note:
Significant differences were observed in pre- and post-treatment scores within each group (P < 0.01).
▲ Group A showed the most significant improvement.
Table 7. Comparison of MSF-4 Scores in the Three Groups
| Group | Before Treatment | After Treatment | P |
|---|---|---|---|
| A | 7.57 ± 0.42 | 11.43 ± 0.36*▲ | 0.001 |
| B | 7.70 ± 0.16 | 10.50 ± 0.17* | 0.001 |
| C | 6.65 ± 0.46 | 9.40 ± 0.37* | 0.001 |
Note:
Significant differences were observed in pre- and post-treatment scores within each group (P < 0.01).
▲ Group A demonstrated the most pronounced improvement compared to Groups B and C (P < 0.01).
2.3 Changes in TCM Symptom Scores Before and After Treatment in the Three Groups
After treatment, the TCM symptom scores in all three groups showed a downward trend, indicating improvement in symptoms across all groups. A comparison of clinical symptom scores before and after treatment revealed significant differences within each group (P < 0.01). This suggests that all three treatment methods were effective for functional ED, but acupuncture combined with medication resulted in the most significant symptom improvement. See Table 8.
2.4 Comparison of Cure and Significant Improvement Rates Among the Three Groups (Efficacy Statistics)
The cure and significant improvement rates after treatment were compared among the three groups:
Group A:
21 cases: 2 cured, 12 significant improvement, 5 effective, 2 ineffective.
Total effective rate: 90%.
Group B:
20 cases: 7 significant improvement, 9 effective, 4 ineffective.
Significant improvement rate: 35%, total effective rate: 80%.
Group C:
20 cases: 8 significant improvement, 8 effective, 4 ineffective.
Significant improvement rate: 40%, total effective rate: 80%.
The significant improvement rate of Group A was notably higher than that of Groups B and C, with a statistically significant difference (P < 0.01). The total effective rate of Group A was also higher than that of Groups B and C, with statistical significance (P < 0.05). This suggests that acupuncture combined with medication significantly improves the efficacy of functional ED treatment. See Table 9.
When comparing cure and significant improvement rates among patients with different degrees of functional ED:
Mild ED (47 cases):
2 cured, 22 significant improvement, 25 effective, 6 ineffective.
Significant improvement rate: 51.1%, total effective rate: 87.2%.
Moderate ED (14 cases):
5 significant improvement, 7 effective, 2 ineffective.
Significant improvement rate: 35.7%, total effective rate: 85.7%.
The results indicate that treatment efficacy varies with the severity of the condition, with mild functional ED showing the highest significant improvement rate of 51.1%. See Table 10.
Table 9. The Comparison of the Three Groups' Cure and Significant Improvement Rates (n, %)
| Group | n | Cured | Significant Improvement | Effective | Ineffective | Significant Improvement Rate (%) | Total Effective Rate (%) |
|---|---|---|---|---|---|---|---|
| A | 21 | 2 | 12 | 5 | 2 | 67* | 90▲ |
| B | 20 | 0 | 7 | 9 | 4 | 35 | 80 |
| C | 20 | 0 | 8 | 8 | 4 | 40 | 80 |
Note:
*P < 0.01: Group A's significant improvement rate was higher than Groups B and C.
▲P < 0.05: Group A's total effective rate was higher than Groups B and C.
Table 10. Comparison of Treatment Effect by Degree of Functional ED Severity
| Degree | n | Cured | Significant Improvement | Effective | Ineffective | Significant Improvement Rate (%) | Total Effective Rate (%) |
|---|---|---|---|---|---|---|---|
| Mild | 47 | 2 | 22 | 15 | 6 | 51.1* | 87.2 |
| Moderate | 14 | 0 | 5 | 7 | 2 | 35.7 | 85.7 |
Note:
The significant improvement rate for mild functional ED was significantly higher than that for moderate functional ED (P < 0.01).
Table 11. Three Groups of Treatment Safety Comparisons (n)
| Group | Cases | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|---|
| A | 21 | 18 | 3 | 0 | 0 |
| B | 20 | 18 | 2 | 0 | 0 |
| C | 20 | 18 | 2 | 0 | 0 |
Note:
There were no significant differences among the groups in safety (P > 0.05), indicating high safety for all treatments.
2.5 Comparison of Safety Among the Three Groups During Treatment
Most patients followed medical advice, adhered to treatment requirements, and cooperated well during the treatment process, which was relatively safe overall:
Group A:
3 cases experienced mild adverse reactions, such as needle retention or skin itching at the acupuncture site. These were resolved, and treatment continued without further issues.
Group B:
2 cases experienced similar mild adverse reactions (needle retention, skin itching), which were managed, allowing treatment to proceed smoothly.
Group C:
2 cases experienced mild side effects, such as dry mouth and headache, possibly related to drug usage. These symptoms appeared early in the treatment and resolved spontaneously without intervention.
