Clinical efficacy and preliminary mechanistic exploration of Wendan decoction for erectile dysfunction with liver-qi stagnation syndrome

SUN Yang; WANG Xu; JING Yi; DENG Yidong; WANG Ao; CHEN Zhaowei; ZHANG Xinghao; ZHANG Ziheng; QIAN Huaying; TIAN Jinbo; TIAN Xintong; CAO Cheng-xu; SUN Zhixing; SUN Xinyi; HAN Ziyang; CHEN Yun

doi:10.13263/j.cnki.nja.2026.02.008

Abstract：Objective The aim of this study is to evaluate the clinical efficacy of Wendan Decoction in the treatment of erectile dysfunction(ED)with liver-qi stagnation pattern,and to explore its potential mechanisms and targets.Methods In this retrospective study,68 patients with ED of liver-qi stagnation pattern who attended the Andrology Department of Jiangsu Pro-vincial Hospital of Traditional Chinese Medicine from January 2024 to December 2024 were enrolled.The patients were assigned to the Wendan Decoction group(n=28)or the Chaihu Shugan San group(n=40),with a treatment duration of 8 weeks.The International Index of Erectile Function-5(IIEF-5),Erection Hardness Score(EHS)and Traditional Chinese Medicine syndrome score(TCMSS)were used to assess efficacy,and safety was monitored.Active components of Wendan Decoction and their puta-tive targets were obtained from public databases,and psychogenic-ED-related targets were collected.Common targets were identi-fied and subjected to enrichment analysis.After obtaining the targets of Chaihushugan Powder for psychogenic ED,Wendan-spe-cific targets were screened and analyzed.Molecular docking was performed to verify the binding of key components to key/com-mon and Wendan-specific targets.Brain-region enrichment of Wendan-specific targets was further conducted to predict the possi-bly modulated neural circuits.Results After treatment,IIEF-5,EHS and TCMSS were significantly improved in both groups compared with baseline(P＜0.01).The improvements in TCMSS(12.71±2.12 vs 14.15±3.88)and EHS(3.43±0.50 vs 3.02±0.76)were more significant in the observation group than those in the control group(both P＜0.01).No obvious adverse reactions were reported in either group.Network pharmacology suggested that core components of Wendan Decoction may act on key targets such as AKT1,TNF,TP53,IL6,IL1B,CASP3,ESR1,PTGS2,BCL2 and STAT3,thereby modulating PI3K-Akt,cGMP-PKG and other signaling pathways to exert anti-inflammatory,anti-apoptotic and antioxidative effects.Molecular docking showed stable binding between core components and these targets,with binding energies all＜-5 kcal/mol.Brain-region en-richment analysis indicated that the specific targets of Wendan Decoction were mainly distributed in key regions including the thalamus,basal ganglia,prefrontal and orbitofrontal cortices,hypothalamus,and cerebellum.Accordingly,Wendan Decoction may facilitate recovery from liver-qi stagnation-type ED by modulating the prefrontal-amygdala emotional circuit,the orbitofrontal-striatal reward circuit,and the frontoparietal attention network.Conclusion Wendan Decoction can effectively improve erectile function and accompanying symptoms in patients with ED of liver-qi stagnation pattern,with good safety.Its therapeutic effects may involve synergistic regulation of multiple components,multiple targets,multiple signaling pathways and multiple brain re-gions.