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Method Article

A Traditional Chinese Medicine Characteristic Therapy for Erectile Dysfunction: Acupuncture

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DOI:

10.3791/69524

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November 21st, 2025

 ,  ,  ,  ,  ,  ,  , 
1Department of Urology, Hospital of Chengdu University of Traditional Chinese Medicine, 2Chengdu University of Traditional Chinese Medicine

* These authors contributed equally

In This Article

Summary

This protocol introduced an effective method to improve erectile function and negative emotions in patients with erectile dysfunction by using an acupuncture technique to transdermally stimulate the characteristic acupoints of the patient's body.

Abstract

Erectile dysfunction (ED) is a common disease of the male reproductive system, which seriously affects the quality of life of patients and their partners. The pathogenesis of ED is still unclear, and it is mainly related to the nervous system, vascular system, drugs, spirit, and psychology. Despite the availability of several ED treatments, including PDE5-Is, ICI therapy with vasoactive substances, vacuum erection devices, and prosthetic implants, the proportion of patients who do not respond or are dissatisfied with clinically available treatments remains high. Studies have found that acupuncture has a significant effect on ED, which can significantly improve erectile ability and erectile quality, and improve the satisfaction of ED patients and their spouses with sexual life. At the same time, because of its good compliance, small economic burden, and high safety advantages, it is gradually recognized by the majority of patients in clinical practice. This article is a clinical original study. This study elaborates on the methods and procedures of acupuncture for ED, including patient selection, material preparation, surgical procedures, postoperative care, and precautions. The therapeutic efficacy of this approach was also evaluated.This study proposes and evaluates a standardized operation protocol for acupuncture treatment of ED and assesses its clinical efficacy in order to visualize this theory of ethnic medicine and promote its effective inheritance.

Introduction

Erectile dysfunction (ED) refers to the inability to achieve or maintain an erection sufficient to achieve satisfactory sexual behavior1. Epidemiological surveys show that the incidence of ED is increasing year by year, and it is estimated that the global prevalence of ED will reach 322 million cases by 20252,3. As a common and frequent disease in adult men, ED not only affects men's physical and mental health, but also has a great impact on the quality of life of patients and their partners and family harmony, and is usually used as an early warning signal of cardiovascular diseases4.

ED is the onset of endothelial dysfunction caused by multiple factors. The categories of risk factors related to ED include the general health status of the individual, the presence of diabetes and cardiovascular disease (CVD), the presence of other genitourinary diseases, mental/psychological disorders, and socio-demographic diseases5. Interventions to alleviate the symptoms of erectile dysfunction include lifestyle changes, oral drugs, injection of vasodilators, and vacuum erectile devices, etc. However, these conventional treatments often have problems such as unsatisfactory or uncertain long-term efficacy, serious side effects, and various complications6. In view of this, more and more clinical doctors are exploring and developing traditional Chinese medicine (TCM) as a form of complementary and alternative therapy. They hope that through these new treatment methods, they can better meet the needs of patients and optimize the treatment outcomes.

Acupuncture is a part of traditional Chinese medicine (TCM). In recent years, acupuncture, under the guidance of TCM theory and combined with modern medical research, has unique advantages in the treatment of erectile dysfunction. Acupuncture not only alleviates the local symptoms of patients, such as impotence and difficulty in maintaining an erection, but also addresses the overall symptoms, such as fatigue, insomnia, loss of appetite, and constipation. Based on tongue diagnosis and pulse diagnosis, the syndrome type of the patient is determined, and appropriate acupoints are selected for treatment7,8. Acupuncture technique involves inserting needles into the skin and subcutaneous tissue of specific areas of the body and specific acupoints to stimulate some physiological reactions of the body9. Many scholars have used acupuncture to treat ED, which can significantly improve patients' anxiety and restore erectile function. Its mechanism may be related to stimulating nerve endings and inducing nerve impulses, and then affecting the levels of norepinephrine, acetylcholine, and its biological enzymes in the central nervous system10. At the same time, acupuncture technology has the advantages of simplemanipulation, few side effects, and can provide long-term and lasting curative effects, so it is used as a new choice for the treatment of ED11.

This protocol outlines the specific clinical process of acupuncture intervention in patients with ED, including patient eligibility assessment, medical device use, acupoint treatment, post-treatment care, and emergency response plan, in order to provide a standardized reference for the clinical application of acupuncture intervention in patients with ED.

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Protocol

This study involved patients from the Urology/Andrology Department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. The study protocol was approved by the Ethics Committee of the Affiliated Hospital of Chengdu University of Chinese Medicine (Ethics No. 2020KL-039). Patients were informed about the purpose and procedures of the study, and consent was obtained for the use of images and videos during the experiment.

NOTE: Before surgery, a patient assessment was performed. Coagulation function was examined in patients with possible coagulopathy. In this study, the diagnostic criteria for ED were formulated according to the Guidelines for the Diagnosis and Treatment of Erectile Dysfunction with Integrated Traditional Chinese and Western Medicine12: the persistent inability of the male penis to achieve or maintain sufficient erection to complete a satisfactory sexual life for a duration of ≥ 3 months.

1. Pretreatment evaluation

  1. Inclusion criteria: (1) met the above diagnostic criteria of ED; (2) International Index of Erectile Function (IIEF-5) score13 was 8-21, indicating mild to moderate disease; (3) age 20-55 years old; (4) having regular sexual partners and stable sexual relations during treatment; (5) had not received any treatment related to the disease in the past 4 weeks; (6) Serum testosterone (T) level was normal or decreased; (7) Patients voluntarily participated in the trial and signed informed consent.
  2. Exclusion criteria: (1) ED caused by drugs, surgery, trauma, congenital, or acquired organic penile lesions; (2) complicated with serious cardiovascular and cerebrovascular, endocrine, hematological, and psychiatric diseases; (3) the spouse with serious organic disease could not fully cooperate; (4) Poor compliance and difficulty in determining the efficacy.
    NOTE: Before treatment, patients were evaluated for suitability for acupuncture. Coagulation, hematological, and infection-related tests should be completed to rule out coagulopathy and infectious diseases.

2. Preparation before operation

  1. Material preparation: Prepare hand disinfectant, iodophor, cotton ball, medical tweezers, and acupuncture needle (refer to the Table of Materials and Figure 1).
    NOTE: Material preparation should include checking the packaging and expiry date to determine if the material is usable. In addition, all instruments should be sterilized.
  2. Environmental preparation: Ensure that the treatment room or ward is equipped with a suitable environment.
    NOTE: The environment must be kept clean and free of pollution. In addition, temperature and lighting conditions should be suitable for operation. In addition, patient privacy must be adequately protected.
  3. Staff preparation: Wear a uniform and use a seven-step hand washing technique to disinfect hands.
    NOTE: The operators are licensed acupuncturists or TCM practitioners who are able to perform the acupuncture manipulations independently and respond appropriately to any emergency situations that may arise during the treatment. The treatment procedures were according to the "Acupuncture and Moxibustion Therapeutics" (10th edition)14. The operator was not changed during treatment except in exceptional circumstances.
  4. Clean the surface the day before the patient prepares for surgery to ensure the removal of any surface contaminants. Before surgery, disinfect the acupoints from inside to outside with an iodophor cotton ball. Repeat the disinfection 2-3 times to ensure that the diameter of the disinfected area is not less than 5 cm.

3. Operation procedure

  1. Position selection
    1. Take the supine or prone position with the operating site fully exposed and the legs naturally straight.
      NOTE: To fully expose the acupoint, choose the body posture according to the target acupoint. Needling needles should not penetrate areas of broken, inflamed, or bleeding skin.
  2. Acupuncture point selection
    1. The acupoint location was referred to the national standard of the People's Republic of China "Name and Location of Meridian Points" (GB/T 12346-2021)13. The acupoint selection was as follows: acupoint group 1: Baihui (GV 20), Qhai (GB 6), Guanyuan (CV 4), Zusanli (ST 36) and Taichong (LR 3). Group 2: Baihui (GV 20), Shenshu (BL 23), Mingmen (GV 4), Sanyinjiao (SP 6) and Taixi (SP 6). Those with bilateral distribution of the above acupoints were taken on both sides. The acupoints of the two groups were used alternately.
      NOTE: In the measurement of acupuncture points, the proportional finger-length method (F-cun) is the core principle followed. It measures the distance between acupuncture points based on the size of the patient's own fingers. The specific definition is as follows: Bend the middle finger. The distance between the two ends of the joint is exactly 1 F-cun; bring your four fingers together and use the fold at the middle joint of the middle finger as a reference. At this point, the overall width of the four fingers corresponds to 3 F-cun. Place your index finger and middle finger together, and the total length of the two fingers together is considered as 1.5 F-cun (Figure 2).
    2. Baihui (GV 20): Located on the head, the anterior hairline is 5 inches straight.
    3. Qihai (GV 6): Located in the lower abdomen, anterior midline, 1.5 inches below the umbilicus.
    4. Guanyuan (CV 4): Located in the lower abdomen, anterior midline, when the umbilicus is 3 cun below.
    5. Zusanli (ST 36): Located on the lateral side of the calf, 3 cun below the Dubi, and on the line between Dubi and Jiexi.
    6. Taichong (LR 3): Located on the dorsum of the foot, between the first and second metatarsal bones, and in the depression in front of the metatarsal junction.
    7. Shenshu (BL 23): At the waist, under the spinous process of the second lumbar spine, one and a half inches apart.
    8. Mingmen (GV 4): Located between the spinous processes of the second and third lumbar vertebrae.
    9. Sanyinjiao (SP 6): On the medial side of the calf, when the foot is 3 cun above the tip of the medial malleolus, posterior to the medial margin of the tibia.
    10. Taixi (SP 6): Located on the medial side of the foot, the depression between the posterior side of the medial malleolus and the tendon and bone of the heel.
  3. Acupuncture therapy
    1. In group 1, place the patient in the supine position after bladder evacuation, and sterilize the local skin. Use disposable sterile acupuncture needles (0.30 mm × 25 mm and 0.30 mm × 40 mm). Insert the needles horizontally at Baihui (GV 20) for 15-20 mm, straight at Taichong (LR 3) for 15-20 mm, and straight at Guanyuan (CV 4), Qihai (CV 6) and Zusanli (ST 36) for 35-38 mm.
    2. Point group 2: Place the patient in the prone position and routinely sterilize the local skin. Select the disposable sterile acupuncture needles (0.30 mm × 40 mm) and insert straight at Shenshu (BL 23), Mingmen (GV 4), and Sanyinjiao (SP 6) for 35-38 mm. Select a 0.30 mm × 75 mm disposable sterile acupuncture needle and a 0.30 mm × 25 mm disposable sterile acupuncture needle. Insert the needles horizontally at Baihui (GV 20) for 15-20 mm and straight at Taixi (GV Taixi) for 15-20 mm.
    3. After acupuncture insertion, treat the two groups with the lifting and thrusting twirling method for level-reinforcing and level-reducing. After inserting the needle into the acupoint to a certain depth, move the needle up and down. The speed, force and amplitude of pulling (retracting the needle upward) and inserting (pushing the needle downward) should be consistent, with no significant difference in lightness or heaviness. When rotating the needle, the rotational angles, speeds, and forces in both clockwise and counterclockwise directions should be equal, and avoid unilateral excessive force. After acupuncture at the acupoints, the patient may experience sensations such as soreness, numbness, distension, or heaviness, or the person performing the acupuncture may feel that the needle sinks and becomes firm, which is called "Deqi". The degree of deqi is taken as the degree, and the transmission of acupuncture sensation at the abdominal and lumbosacral acupoints is appropriate. The needles were retained for 30 min after deqi, once every other day for 2 weeks.

4. Postoperative care

  1. Ensure that the patient avoids contact between the needle area and water for 24 h.
  2. Ensure that the patient keeps the diet light and avoids smoking, alcohol, seafood, and spicy or irritating foods.

5. Efficacy assessment

  1. IIEF-5 score16: It includes five indicators: the degree of confidence in the hardness of the penis during erection, the frequency of achieving an erection state upon sexual stimulation, the frequency of being able to insert into the vagina after erection, the frequency of maintaining an erection state during sexual intercourse, and the frequency of reaching sexual climax after intercourse. Each indicator ranges from 0 to 5 points, with a total score ranging from 0 to 25 points. ED is diagnosed with an IIEF-5 score of 21 or less, with lower scores indicating more severe erectile dysfunction. Scores were evaluated before and after treatment and 2 weeks after the end of treatment (follow-up).
  2. Self-rating Anxiety Scale (SAS) score15: Assess the degree of anxiety of patients. Give each item 1, 2, 3, and 4 points according to the frequency of symptoms. Add the scores of each item, multiply by 1.25, and take the integer part of the value as the final score. Total scores range from 25 to 100. SAS score < 50 is defined as normal, 50 to 100 as anxiety, with higher scores indicating more severe anxiety symptoms. The scores were evaluated before and after treatment and during follow-up.
  3. Self-rating Depression scale (SDS) score17: Assess the degree of depression in patients. Give each item 1, 2, 3, and 4 points according to the frequency of symptoms. Add the scores of each item, multiply by 1.25, and take the integer part of the value as the final score. Total scores range from 25 to 100. SDS scores < 53 is classified as normal, and 53 to 100 as depression, with higher scores indicating more severe depressive symptoms. The scores were evaluated before and after treatment and during follow-up.
  4. Serum T content: Collect the fasting venous blood (3 mL) before and after treatment from 8:00 a.m. to 9:00 a.m., and determine the serum T content by radioimmunoassay. The normal reference range of serum T level is 1.75-7.81 ng/ mL.
    NOTE: Efficacy assessment should be performed by the same investigator according to established criteria throughout the treatment course.

6. Management of adverse events

  1. Dizzy: Stop acupuncture immediately, remove all the acupuncture needles, make the patient lie flat with the head slightly lower, unbutton the clothes, and pay attention to keep warm. If the patient lies still for a while, give him hot tea or sugar water to drink, then he can return to normal. On the basis of the above treatment, the severe cases can be treated with acupuncture at Shuigou (GV 26), Shuliao (BL 32), Neiguan (PC 6), Zusanli (ST 36), Yongquan (ST 34), etc., or moxibustion at Baihui (GV 20), Guanyuan (CV 4), Qihai (CV 6), etc. If the patient is still unconscious, breathing is weak, and the pulse is weak, other treatments or first aid measures may be considered.
  2. Needle breaking: The surgeon must be calm and advise the patient not to change the original position in order to prevent the stump from falling into the deep muscle. If the residual needle body is still partially exposed outside the skin, forceps can be used to clamp out. If the stump is flat with the skin or slightly depressed in the body, the left thumb and the second finger of the food can be used to squeeze both sides of the pinhole vertically, so that the stump is exposed outside the body, and the right hand holds the forceps to remove the needle. If the stump is completely deep into the subcutaneous or deep muscle layer, it should be removed by X-ray positioning.
  3. Subcutaneous hematoma: If there is a small amount of subcutaneous bleeding and local bleeding, it generally does not need to be treated and can subside spontaneously. If local swelling pain is more intense, cyanosis area is large and affects the activity function, can make cold compress to stop bleeding first, then make hot compress or rub gently in the local area, in order to promote local blood stasis dissipate and absorb.

7. Statistical analysis

  1. Data collection: Measures to evaluate efficacy were collected by the same investigator before and after treatment.
  2. Data analysis: Use the paired t-test to compare the data collected before and after treatment. All statistical tests were two-sided; Differences were considered statistically significant at P < 0.05.

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Results

This study describes the surgical method of acupuncture intervention in patients with erectile dysfunction. In this study, 30 eligible patients participated and completed the trial. The same diagnostic criteria were applied to all patients. The same acupuncture treatment was performed on all patients by the same investigator. The IIEF-5 score, SAS score, SDS score, and serum T content were evaluated before and after treatment (2 weeks later). The results of the study showed that IIEF-5 score, SAS score, SDS score, and se...

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Discussion

Normal erection is a neurovascular phenomenon controlled by psychological factors and coordinated by the endocrine, vascular, and nervous systems18. Penile erection is a complex physiological process involving a series of neurovascular activities such as arterial dilatation, smooth muscle relaxation, and venous occlusion. In addition, the process also depends on the balance of the endocrine environment, and if any of these links are disturbed, it may lead to the occurrence of ED1...

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Disclosures

The authors have no conflicts of interest to disclose.

Acknowledgements

This study was supported by the National Natural Science Foundation of China (Grant number: 82405412) and the National Natural Science Foundation of China (Grant number: 82474319).

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Materials

List of materials used in this article
NameCompanyCatalog NumberComments
Hand sanitizerShanghai Likang Disinfection high-tech Co. Ltd.Huwei Xiao Zheng Zi (2003) No. 0001/
iodophorChengdu Yongan Pharmaceutical Co.Ltd.Chuan (Deyang) Wei Xiao Zheng Zi (2014) No. 008/
Sterile cotton ballsShandong Weigao Ruixin Medical Technology Co. Ltd.Lu Drug supervision Machinery production Xu 201000031/
Medical tweezersShandong Weigao Ruixin Medical Technology Co. Ltd.Lu Drug supervision Machinery production Xu 201000031/
Sterile acupuncture needlesChangchun AKang Medical Instrument Co. Ltd.Ji Drug supervision machinery production Xu 20150075/

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