Mechanism of traditional Chinese medicine in treating erectile dysfunction: A review

A narrative review of TCM mechanisms for ED — heavy on preclinical theory, thin on human evidence

Journal: Medicine | Published: 2026-Feb-13 | Type: Review | PMID: 41686568 Authors: Zhang Ruoran, Wang Jingkai, Xu Peng, Wang Hailuo, Pang Kun (Jiangsu University; Nanjing Medical University; Xuzhou Central Hospital / Nanjing University of Chinese Medicine) Funding/COI: Funding not disclosed; authors declare no conflicts of interest

Summary

This is a narrative review summarizing proposed molecular mechanisms by which traditional Chinese medicine (TCM) compounds may treat erectile dysfunction — pathways involving apoptosis, fibrosis, oxidative stress, smooth muscle, and vascular endothelial function. The authors argue TCM's multi-component, multi-target nature is an advantage. They also, to their credit, acknowledge that most of the evidence underpinning this review comes from animal studies, and that robust clinical trials are largely absent.

Claims

• TCM compounds act through anti-inflammatory, antioxidant, and vascular/neural protective mechanisms in preclinical models
• Multi-component TCM formulas offer potential synergistic effects across multiple biological targets
• No standard endpoints for drug dosage, treatment duration, or efficacy assessment currently exist for TCM in ED
• Some herbal medicines have documented hepatotoxic and nephrotoxic potential
• Phase II and Phase III clinical trial data are described as lacking

Study Quality

This is a narrative review with no described systematic search methodology, no PRISMA framework, no inclusion/exclusion criteria, and no quality assessment of cited studies. It cannot be treated as a systematic review. Without a structured search protocol, the selection of studies is potentially arbitrary and prone to confirmation bias — papers supporting TCM mechanisms are likely over-represented.

The discussion section openly states that most cited studies involve specific signaling pathways in animal models, and that the field lacks extensive phase II and III clinical trial data. That's an unusual and valuable degree of candor for this paper type, but it also amounts to the authors admitting their review summarizes a largely preclinical evidence base.

Red Flags

• No systematic search methodology described — this is a narrative review, not a systematic review
• The overwhelming majority of underlying studies are preclinical (animal/cell models), with limited human data
• No sample sizes, effect sizes, or clinical outcome data reported anywhere in the abstract or discussion
• Funding source not disclosed, which is a significant omission for a TCM review authored at Chinese medical institutions with institutional incentives to validate TCM
• "Has been shown to be effective and safe" appears in the abstract without a single citation to support that claim
• Acknowledged hepatotoxicity and nephrotoxicity of certain herbal compounds is mentioned but not quantified or specifically attributed

Strengths

• Authors honestly acknowledge the lack of clinical trial evidence and call for phase II/III studies
• The multi-mechanism framing is scientifically coherent — multi-target pharmacology is a legitimate research direction
• Identifying the absence of standardized dosing and efficacy endpoints is a useful contribution to the field's agenda
• No COI declared (though funding opacity limits how much weight this carries)

Verdict

A review that summarizes animal-model mechanisms for TCM in ED, dressed up with language suggesting clinical utility that the evidence doesn't yet support. The paper is most useful as a bibliography of preclinical signaling pathway research — it is not evidence that TCM treats ED in humans. The authors' own discussion undercuts the abstract's optimism: most studies are in animals, clinical trials are largely absent, and some compounds have toxicity concerns. File under "hypothesis-generating, not practice-informing."