Summary: In a three-arm trial in men with diabetic erectile dysfunction and a traditional Chinese medicine pattern of qi deficiency with blood stasis, moxibustion combined with low-dose daily tadalafil achieved a 90% effectiveness rate, well above either moxibustion or tadalafil alone, with improved erectile scores and penile blood flow.
PICO Summary
| Element | Detail |
|---|---|
| Population | 90 men with diabetes-induced erectile dysfunction and qi-deficiency/blood-stasis syndrome; single centre, China. |
| Intervention | Mild moxibustion at ST36, SP6, SP9 every other day plus tadalafil 5 mg daily for 4 weeks. |
| Comparison | Moxibustion alone or tadalafil 5 mg daily alone. |
| Outcome | Total effectiveness 90.0% (combination) vs 46.7% (moxibustion) and 60.0% (tadalafil) (p<0.05). Combination improved IIEF-5 and EHS scores and lowered TCM symptom scores more than either alone, with greater peak systolic velocity on penile Doppler. No significant adverse effects. |
Moxibustion + tadalafil for diabetic ED
RCT · diabetic erectile dysfunction · 4 weeks
Moxibustion added to low-dose daily tadalafil raised the total effectiveness rate to 90% versus 60% with tadalafil alone, but the trial was small, single-centre and unblinded.
Expert Commentary
Diabetic erectile dysfunction responds poorly to PDE5 inhibitors in up to half of men, so interest in adjuncts is reasonable, and the combination here did outperform both monotherapies on effectiveness and on objective penile Doppler flow, which is more persuasive than symptom scores alone. I hold a measured view, though, for reasons intrinsic to this kind of trial. Moxibustion cannot be blinded, so expectation effects are hard to exclude, the study is single-centre with 90 patients over only four weeks, and the framing rests on a traditional Chinese medicine syndrome that does not map cleanly onto how most clinicians outside that tradition select patients. A daily low-dose tadalafil arm is itself a legitimate comparator, and the increment attributed to moxibustion should be read in that unblinded context. Can I use this with my patients? Cautiously and only as an optional adjunct. For a diabetic man with a partial response to PDE5 inhibitors who is interested in acupuncture-based therapy and has access to a competent practitioner, it is a low-risk addition, but I would continue optimising glycaemic control and standard ED management as the foundation and not present moxibustion as proven. Larger, sham-controlled trials would help.
References
Liu T, Yang ZX, Xu Y, et al. Moxibustion combined with low-dose tadalafil for diabetes mellitus-induced erectile dysfunction: a prospective, single-center, three-arm randomized controlled trial. Zhonghua Nan Ke Xue. 2025;31(2):55–60. (Article in Chinese.) PMID:40783974