| ObjectivesThe mechanisms causing the decline of sexual function with age are not fully understood. Previous studies have shown that 55% of men have erectile dysfunction (ED) by the age of 75 years. Although more frequent systemic disease and greater intake of medication are often associated with older men, the aging process undoubtedly play a significant role in the development of ED. Penile erection is elicited by the release of nitric oxide (NO) in the nerve terminals of the penis as a result of sexual stimulation of central or peripheral origin. Because NO is a short-lived molecule whose level can not easily be measured, NO activity is commonly estimated by measuring levels of nitric oxide synthase ( NOS ) and its enzyme activity. There are 3 known isoforms of NOS: type I, or neuronal NOS ( nNOS ), type II, or inducible NOS ( iNOS ), and rypeHI, or endothelial NOS (eNOS ). Among the 3 isoforms, the nNOS is the main NOS isoform responsible for the synthesis of the physiological mediator of penile erection, NO. NO diffuses to the adjacent target smooth muscle tissue and then stimulates guanylcyclase. The subsequent elevation in cGMP triggers a reduction of cytoplasmic Ca2+ and the subsequent relaxation of the corpora cavernosa.TCM holds that the Five-Zang viscera are the center of the whole body, which plays an enormous role in the vital activities of the body. It is closely related to many basic responses in life science. The spleen is in charge of transportation and transformation, and plays a vital role in the Five-Zang viscera. So the spleen is called the acquired foundation and the sources of Qi and blood.In addition, we gathered and analyzed the characteristics of erectile dysfunction in old patients compared to the young. According to the clinical experience of Pro. Zhou Xue-Wen and the ideas above, we adopted Chineses Herbs to deal with the patients with erectile dysfunction and assess the clinical efficacy.The main contents were as follow:1. Mechanisms of old patients of erectile dysfunction. We have focused on the effect of aging on the protein and gene expression of nNOS in adult ( 5 moo old ), old (20 mon old), and senescent (30 mon old ) rat. In addition, we have measured NOS activity in tissue homogenates from different age groups. (1) The expression of NOS I protein and mRNA in the penis were detected by Western blot and RT-PCR respectively. (2) NOS activity in the penis was detected with ultravioletspectrophotometry.2. Clinical analysis of erectile dysfunction in old patients. Ninety-five erectile dysfunction patients over 60 years as study group and sixty patients below 40 years as control were evaluated by international index of erectile function file 5 (IIEF-5) . We also evaluated the etiology classification, Chinese medicine syndrome, percentage of risk factors and BMI.3. Clinical efficacy of Pi Shen Huan Yang Tang for old patients with erectile dysfunction. Each group has been treated for 2 weeks with Pi Shen Huan Yang Tang (low, medium and high dose) as study group, Wu Zi Yan Zong Pill as positive control medicine and Transfer Factor as negative control medicine. We adopted sexual humoral level and IIEF-5 before and after treatment to assess the clinical efficacy among the different groups.Results1. Mechanisms of old patients with erectile dysfunction. Our results indicate that aging causes a significant decrease of gene and protein expression of nNOS in the senescent and old rats compared to the adult, furthermore, NOS activity decreases significantly in the senescent group.2. Clinical analysis of old patients with erectile dysfunction. In study group compared with the control, IIEF-5 score was (8.87 + 0.57) vs.( 12.61+0.69), risk factors percentage was (64.2%) vs.(23.3% ). According to the Chinese medicine syndrome, old patients with erectile dysfunction mainly showed as the syndrome of the deficiency of the Spleen affecting the Kidney.3. Clinical efficacy of Pi Shen Huan Yang Tang for old patients with erectile dysfunction. Compar...
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