| ObjectivesThe subject of treatment by observing the influence of "Wenyang Huoxue Decoction" on penis in diabetic rats and penile blood flow in patients with erectile dysfunction(ED),to comfirm the "Wenyang Huoxue Decoction" is of advantages and trait of the disease.To discuss the mechanism of "Wenyang Huoxue Decoction" in the treatment of Ed and explore Chinese medicine treatment of ED.MethodClinical experiment:The 80 cases troubled by erectile dysfuntion,kidney deficiency and blood stasis of the sduty was from June 2017 to January 2018 in First Affiliated Hospital of Guangzhou University of Chinese Medicine,andrology/Urology Surgery clinic patients,aged 20-60 years of age.Using the randomized controlled trials.Divided the patiens into treatment group and control group,40 cases each.The treatment group were given“Wenyang Huoxue Decoction”.The control group were given Sildenafil.The course of treatment is 2 months.IIEF-5,Peak Systolic Velocity(PSV),Resistant Index(RI)were recorded before and after the treatment began every month.Using Excel 2007 and SPSS 17.0.All data are mean±standard deviation(x±s),before and after treatment data using paired sample T-test,ANOVA was used in inter-group comparison.Counted data using χ test;ranked data groups were analyzed by Kruskal-Wallis test and Wilcoxon test analysising the differences between before and after the treatment is significance or not.Animal experiment:60 SPFSD rats,all male,weight 220±15gram,were divided into vacuity contrast group,model group,Sildenafil group,"Wenyang Huoxue Decoction" low dose group(LD group),"Wenyang Huoxue Decoction" group(MD group)and“Wenyang Huoxue Decoction”high dose group(HD group),10 rats each,were kept in the lab of 8:00～21:00 light and 21:00～8:00 dark for one week.The diabetes mellitus model was established by intraperitoneal injection of Streptozotocin(STZ)in all the groups except vacuity contrast group.The erectile function was evaluated by APO test in all groups.After the model building,the model group was given 5ml pure water every rat every day by stomach perfusion.LD group was given "Wenyang Huoxue Decoction" for half of normal does eyery rat every day by stomach perfusion.MD group was given "Wenyang Huoxue Decoction" for normal does eyery rat every day by stomach perfusion.HD group was given "Wenyang Huoxue Decoction" for 1.5 times of normal does eyery rat every day by stomach perfusion.Sildenafil group was given Sildenafil solution by stomach perfusion.Vacuity contrast group was fed routine feeding without intervention.After the one month intervention,the rats were killed and the penises were obtained.Dectect the endothelial nitric oxide synthase(eNOS),neuron nitrc oxide synthetase(nNOS),phosphodiesterase 5(PDE5),Rho associated coiled-coil containing protein kinase 1(Rockl),Rho associated coiled-coil containing protein kinase 2(Rock2)in penises by western blot.The results were analyzed with Excel 2007 and SPSS 17.0.All data are mean±standard deviation(x±s).P<0.05 means the difference is statistically significant.Paired sample t test was used in intra-group comparison.ANOVA was used in inter-group comparison.ResultClinical experiment:1.Befor treatment,comparing treatment group with control group in age and state of IIEF-5,P=0.981 and 0.965,the difference is not statistically significant(both P>0.05),two groups of patients have comparability.2.After treatment,the results of the treatment group were compared with the results of the control group,P=0.1499 and the difference between the two groups is not statistically significant(P>0.05).Both "Wenyang Huoxue Decoction”and Sildenafil can improve the quality of sexual life in patients.3.PSV comparison:Intra-group comparison:Comparing the first,second examination of the treatment group,t=0.486,P=0.629,the difference is not statistically significant(P>0.05);Comparing the first,third examination of the treatment group,t=3.889,P=0.0.002,the difference is statistically significant(P<0.05);Comparing the first,second examination of the control group,t=5.031,P=0.000,the difference is statistically significant(P<0.05);Comparing the first,third examination of the control group,t=9.807,P=0.0.000,the difference is statistically significant(P<0.05);Both "Wenyang Huoxue Decoction" and Sildenafil can increase PSV.The effect of Sildenafil is faster.Inter-group comparison:First examination,comparing treatment group with control group,t=0.195,P=0.846,the difference is not statistically significant(P>0.05);Second examination,comparing treatment group with control group,t=5.017,P=0.000,the difference is statistically significant(P<0.05);Third examination,comparing treatment group with control group,t=4.480,P=0.000,the difference is statistically significant(P<0.05);The difference between treatment group and control group in PSV before treatment is not statistically significant,so they are comparable.The senond and third examination,the value of control group was better than that of treatment group.4.RI comparison:Intra-group comparison:Comparing the first,second examination of the treatment group,t=1.605,P=0.113,the difference is not statistically significant(P>0.05);Comparing the first,third examination of the treatment group,t=4.445,P=0.0.000,the difference is statistically significant(P<0.05);Comparing the first,second examination of the control group,t=4.312,P=0.000,the difference is statistically significant(P<0.05);Comparing the first,third examination of the control group,t=9.219,P=0.0.000,the difference is statistically significant(P<0.05);Both“Wenyang Huoxue Decoction”and Sildenafil can increase RI.The effect of Sildenafil is faster.Inter-group comparison:First examination,comparing treatment group with control group,t=1.309,P=0.395,the difference is not statistically significant(P>0.05);Second examination,comparing treatment group with control group,t=4.329,P=0.000,the difference is statistically significant(P<0.05);Third examination,comparing treatment group with control group,t=7.363,P=0.000,the difference is statistically significant(P<0.05);The difference between treatment group and control group in RI before treatment is not statistically significant,so they are comparable.The senond and third examination,the value of control group was better than that of treatment group.Animal experiment:1.ANOVA was used in inter-group comparison for weight.F=1.425,P=0.23,The difference is not statistically significant(P>0.05).The weight of each group is comparable.Paired sample t test was used in intra-group comparison for weight befor and after model establishing.In vacuity contrast group,t=4.18,P=0.01,The difference is statistically significant(P<0.05).In model group,t=-6.72,P=0.00,The difference is statistically significant(P<0.05).In LD group,t=-5.60,P=0.00,The difference is statistically significant(P<0.05).In MD group,t=-5.89,P=0.00,The difference is statistically significant(P<0.05).In LD group,t=-4.80,P=0.00,The difference is statistically significant(P<0.05).In Sildenafil group,t=-5.17,P=0.00,The difference is statistically significant(P<0.05).In addition to the vacuity contrast,the weight of rats were reduced.Model establishing was succeed.2.Erectile times comparison:F=2.872,P=0.02,The overall difference is statistically significant(P<0.05);Comparing vacuity contrast group with model group,q=81.64,the difference is statistically significant(P<0.05).Comparing vacuity contrast group with LD group,q=90.71,the difference is statistically significant(P<0.05).Comparing vacuity contrast group with MD group,q=90.71,the difference is statistically significant(P<0.05).Comparing vacuity contrast group with HD group,q=99.78,the difference is statistically significant(P<0.05).Comparing vacuity contrast group with Sildenafil group,q=90.71,the difference is statistically significant(P<0.05).It was suggested that the erectile function of rats decreased after the DM model was created by STZ.3.eNOS comparison:F=366.7,P=0.000,The overall difference is statistically significant(P<0.05);Comparing vacuity contrast group with model group,q=9.07,the difference is statistically significant(P<0.05).In the DM model,the eNOS content of the penis was reduced.Comparing vacuity contrast group with LD group and Sildenafil group,q=8.16 and 7.06,the difference is statistically significant(both P<0.05).Comparing vacuity contrast group with MD group and LD group,q=2.65 and 1.71,the difference is not statistically significant(both P>0.05).The content of eNOS in the penis of DM rats can be recovered by both large and medium dose of"Wenyang Huoxue Decoction"4.nNOS comparison:F=134.9,P=0.000,The overall difference is statistically significant(P<0.05);Comparing vacuity contrast group with model group,q=4.53,the difference is statistically significant(P<0.05).In the DM model,the nNOS content of the penis was reduced.Comparing vacuity contrast group with LD group and Sildenafil group,q=4.53 and 4.51,the difference is statistically significant(both P<0.05).Comparing vacuity contrast group with MD group and LD group,q=1.76 and 1.71,the difference is not statistically significant(both P>0.05).The content of nNOS in the penis of DM rats can be recovered by both large and medium dose of“Wenyang Huoxue Decoction”.5.PDE5 comparison:F=177.8,P=0.000,The overall difference is statistically significant(P<0.05);Comparing vacuity contrast group with model group,q=7.26,the difference is statistically significant(P<0.05).In the DM model,the PDE5 content of the penis was increased.Comparing model group with LD group,q=0.91,the difference is statistically significant(P<0.05).Comparing model group with Sildenafil group,MD group and LD group,q=5.29,6.18 and 6.84,the difference is not statistically significant(all P>0.05).The content of PDE5 in the penis of DM rats can be reduced by Sildenafil and large,medium dose of“Wenyang Huoxue Decoction”.6.Rockl comparison:F=238.9,P=0.000,The overall difference is statistically significant(P<0.05);Comparing vacuity contrast group with model group,q=4.54,the difference is statistically significant(P<0.05).In the DM model,the Rock2 content of the penis was increased.Comparing model group with LD group and Sildenafil group,q=0 and 1.77,the difference is not statistically significant(both P>0.05).Comparing vacuity contrast group with MD group and LD group,q=-0.88 and-0.86,the difference is not statistically significant(both P>0.05).The content of Rockl in the penis of DM rats can be reduced by both large and medium dose of“Wenyang Huoxue Decoction”.7.Rock2 comparison:F=213,P=0.000,The overall difference is statistically significant(P<0.05);Comparing vacuity contrast group with model group,q=214.07,the difference is statistically significant(P<0.05).In the DM model,the Rock2 content of the penis was increased.Comparing model group with Sildenafil group,MD group and LD group,q=171.28,188.15 and 183.64,the difference is not statistically significant(all P<0.05).The content of Rock2 in the penis of DM rats can be reduced by Sildenafil and large,medium dose of "Wenyang Huoxue Decoction"Conclusion"Wenyang Huoxue Decoction" can cure ED exactly.In animal experiment,"Wenyang Huoxue Decoction" can increased eNOS,nNOS and reduced PDE5,Rockl,Rock2 DM model rats in the penis of DM model rats.In clinical experiment,the curative effect of "Wenyang Huoxue Decoction" was no less than the curative effect of Sildenafil.Therefore,it is considered that "Wenyang Huoxue Decoction" can effectively improve the blood supply and nutritional environment of impotence penis,and it is an effective prescription for the treatment of ED.By analysing the results of this study and the discussion of the mechanism of "Wenyang Huoxue Decoction",The Chinese medicine mechanism of "Wenyang Huoxue Decoction" for curing ED is:Warming Kidney Yang,promoting blood circulation,nourishing penis.Its pharmacological mechanism may be "Wenyang Huoxue Decoction" can improve of the peripheral circulation and reduce penile injury and remodeling caused by ischemic and anoxic so to cure ED. |
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