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  • Title: [Clinical and mechanism research on functional erectile dysfunction treated with moxibustion and qiangshen shugan qiwei decoction].
    Author: Zhang H, Sun ZX, Men B, Fu XJ, Chen JS.
    Journal: Zhongguo Zhen Jiu; 2021 Dec 12; 41(12):1325-30. PubMed ID: 34936269.
    Abstract:
    OBJECTIVE: To observe the clinical therapeutic effect on functional erectile dysfunction (FED) of kidney deficiency and liver stagnation treated by Baixiao moxibustion and qiangshen shugan qiwei decoction. METHODS: A total of 120 patients with FED were randomized into an observation group (60 cases, 2 cases dropped off) and a control group (60 cases, 4 cases dropped off). In the control group, the patients were treated with oral qiangshen shugan qiwei decoction (Radix Rehmanniae Praeparata, Rhizoma Dioscoreae, Rhizoma Curculiginis, Herba Epimedii, etc.), one dose daily. In the observation group, on the base of the treatment as the control group, Baixiao moxibustion was exerted along the distribution of governor vessel on the back, 30 min each time, once a week. The treatment duration was 4 weeks in the two groups. Before and after treatment, the scores of international index of erectile function-5 (IIEF5), erectile hardness scale (EHS), erectile dysfunction inventory of treatment satisfaction (EDITS) and TCM symptoms were observed in the patients of the two groups. Before and after treatment, the levels of serum sex hormones (testosterone [T], luteinizing hormone [LH], estradiol [E2], prolactin [PRL]) and the expressions of relevant proteins (matrix metalloproteinase-3 [MMP-3], matrix metalloproteinase-9 [MMP-9] and vascular endothelial growth factor [VEGF]) were determined in the patients of the two groups separately. The penile vascular function (peak systolic velocity [PSV], end-diastolic velocity [EDV], resistance index [RI]) was compared before and after treatment. Besides, the clinical therapeutic effect was evaluated. RESULTS: After treatment, the scores of IIEF5, EHS and EDITS were all increased as compared with the values before treatment (P<0.05), and the scores of TCM symptoms were reduced as compared with the values before treatment in the patients of the two groups (P<0.05). After treatment, the scores of IIEF5, EHS and EDITS in the observation group were higher than those in the control group (P<0.05), and the score of TCM symptoms was lower than the control group (P<0.05). After treatment, the levels of T and LH in serum of the two groups and the expressions of serum MMP-3 and MMP-9 in the observation group were all increased as compared with those before treatment (P<0.05), the levels of E2 and PRL in the observation group and VEGF expressions in the two groups were all reduced as compared with those before treatment (P<0.05). The levels of serum T and LH and the expressions of MMP-3 and MMP-9 in the observation groups were all higher than those in the control group (P<0.05), and the levels of E2 and PRL and VEGF expression were lower than the control group (P<0.05). After treatment, PSV was increased and EDV was reduced as compared with those before treatment in the patients of the two groups (P<0.05), RI in the observation group was reduced as compared with that before treatment (P<0.05). After treatment, PSV in the observation group was higher and EDV and RI were lower than the control group (P<0.05). The total effective rate was 87.9% (51/58) in the observation group, higher than 76.8% (43/56) in the control group (P<0.05). CONCLUSION: The combined therapy of Baixiao moxibustion and qiangshen shugan qiwei decoction effectively increases erectile function, erectile hardness and treatment satisfaction in the patients with functional erectile dysfunction of kidney deficiency and liver stagnation, as well as improves penile vascular function. The effect mechanism of this therapy may be related to the regulation of serum sex hormones and relevant proteins. 目的：观察百笑灸联合强肾疏肝起痿方治疗功能性勃起功能障碍（FED）肾虚肝郁证的临床疗效。方法：将120例FED肾虚肝郁证患者随机分为观察组（60例，脱落2例）和对照组（60例，脱落4例）。对照组口服中药强肾疏肝起痿方（熟地黄、炒山药、仙茅、淫羊藿等）治疗，每日1剂；观察组在对照组的基础上于背部督脉循行线进行百笑灸治疗，每次30 min，每周治疗1次，两组均治疗4周。观察两组患者治疗前后国际勃起功能量表（IIEF5）、阴茎勃起硬度量表（EHS）、勃起功能障碍治疗满意度（EDITS）及中医症状评分；检测两组患者治疗前后血清性激素[睾酮（T）、黄体生成素（LH）、雌二醇（E2）、泌乳素（PRL）]水平及相关蛋白[基质金属蛋白酶-3（MMP-3）、基质金属蛋白酶-9（MMP-9）、血管内皮生长因子（VEGF）]表达水平；比较两组患者治疗前后阴茎血管功能[收缩期峰值流速（PSV）、舒张速度（EDV）、阻力指数（RI）]；并评定临床疗效。结果：治疗后，两组患者IIEF5、EHS、EDITS评分均较治疗前升高（P<0.05），中医症状评分较治疗前降低（P<0.05）；观察组患者IIEF5、EHS、EDITS评分高于对照组（P<0.05），中医症状评分低于对照组（P<0.05）。治疗后，两组患者血清T、LH含量及观察组患者血清MMP-3、MMP-9表达水平均较治疗前升高（P<0.05），观察组患者血清E2、PRL含量及两组患者VEGF表达水平均较治疗前降低（P<0.05）；观察组患者血清T、LH含量及MMP-3、MMP-9表达水平高于对照组（P<0.05），E2、PRL含量及VEGF表达水平低于对照组（P<0.05）。治疗后，两组患者PSV较治疗前升高、EDV较治疗前降低（P<0.05），观察组患者RI较治疗前降低（P<0.05）；治疗后，观察组患者PSV高于对照组、EDV及RI低于对照组（P<0.05）。观察组总有效率为87.9%（51/58），高于对照组的76.8%（43/56，P<0.05）。结论：百笑灸联合强肾疏肝起痿方可有效提高FED肾虚肝郁证患者的勃起功能、勃起硬度和治疗满意度，改善阴茎血管功能，其机制与调节血清性激素及相关蛋白表达水平有关。.
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