Chinese medicine first documented the “five male infertility” in the “Jin Dan Jie Yao”, namely “Tian, Gandhara, Leakage, Timidity, and Change”, which gave a deeper understanding of the etiology of male infertility. In recent years, due to unhealthy lifestyle, mental stress and environmental pollution, the quality of male sperm has decreased and the incidence of male infertility has increased. We are now discussing the ideas and methods of clinical diagnosis and treatment of male infertility with Chinese and Western medicine as summarized below. A. Male infertility should be identified first, then identify the evidence, the combination of disease and evidence Identification is the essence of Chinese medicine, to reveal the nature of the disease from a macroscopic point of view has important significance. The actual fact is that the same symptoms appear in different places. In fact, there are great differences in the appearance of the same symptoms in different diseases. The symptoms in TCM can be understood as the pathophysiological reaction state produced by the action of the cause on the human body, which can be seen at a certain stage of different diseases, and the identification of symptoms is only to recognize the specific pattern of a certain stage in the development of diseases. Disease identification is a comprehensive analysis of clinical symptoms, signs and laboratory test results and the identification of disease categories, so as to make a diagnosis of disease names. Further, identification of disease is not only to clarify the name of the disease and determine the diagnosis, but to recognize the general pattern of the whole process of disease development, to recognize as much as possible the pathological tissue changes, physiological functional disorders and the corresponding biochemical and molecular level changes underlying the disease. For male infertility must apply modern medical methods and means to identify the disease in depth and carefully, to discover the different causes and various physiopathological changes, and then to identify the evidence according to the theory of Chinese medicine and combine the disease with the evidence in order to achieve better clinical results. Male fertility requires the following basic conditions: 1) the testicles can produce normal sperm; 2) the gonads function normally and the epididymis can promote sperm maturation and acquisition; 3) the vas deferens is open and ejaculation is normal. Any disorder in any of the links may affect the male reproductive function. Male infertility patients should first take a detailed medical history after consultation, such as whether orchitis is combined with mumps during adolescence, and some patients may experience some degree of testicular atrophy, resulting in spermatogenic disorders; whether there are chronic respiratory diseases such as bronchial dilatation, chronic paranasal sinusitis, chronic bronchitis, etc., which are sometimes associated with abnormal sperm cilia or epididymal secretion disorders; whether to take drugs that can affect male fertility; environmental and occupational factors; and whether to take drugs that can affect male fertility. The physical examination is not only a general examination, but also a special examination. In addition to the physical examination of the whole body, especially the examination of tissues and organs that can reflect the endocrine function, the examination of reproductive organs mainly includes the size and elasticity of testicles, the presence of varicocele and syringomyelia, the skin of scrotum, and the examination of epididymis, etc. The most important thing for male infertility is the examination of semen. The semen examination mainly includes semen volume, sperm density, sperm vitality, A- and B-grade sperm percentage, semen pH, sperm morphology, biochemical examination of semen, immunological examination and so on. If there is no sperm in the semen or severe oligospermia (at least 3 tests), an azoospermia factor (AZF) test is required. Specific types of AZF deficiency are associated with specific spermatogenic defects, e.g. AZFa deficiency is usually associated with complete absence of spermatogonia (testicular only supporting cell syndrome); AZFb deficiency is usually associated with germ cell maturation arrest; mZFc deficiency is more common and is associated with multiple azoospermia and severe oligospermia, etc. “1 Serum is also checked for The testicular spermatogenic function should be evaluated by examining sex hormones (T, FSH, LH, E2, PRL), serum inhibin B, etc. Seminal plasma fructose and seminal plasma neutral d-glucosidase should be detected as indicators of vas deferens obstruction to determine whether it is a testicular lesion or vas deferens obstruction. If necessary, testicular biopsy should be performed. In Chinese medicine, liver stagnation and blood stasis, blood stagnation and dampness, phlegm and dampness congestion, blood stagnation and obstruction, cold clotting of meridians and veins, spleen and kidney deficiency, and stagnation of sperm organs are the most common types. Kidney deficiency and blood stasis are the main pathogenesis of male infertility. The kidney is the root of the innate nature, and its main function is to store sperm, growth and reproduction, and to open the ears and the two yin. The sperm it contains is the root of reproduction and development, and the production of sperm depends on the nourishment of kidney yin and the warmth of kidney yang. The fire of the Kidney is the driving force for reproduction and development; its function as a division of the anterior yin directly governs the function of erection and sperm discharge of the external genitalia. The “Ling Shu? In the chapter of “Meridians”, it is said that “when a man is born, he first becomes a sperm, and when the sperm becomes a sperm, the brain marrow is born”. Su Wen? In the book of “Shanggu Tianzhen”, “The husband? The kidneys are in full bloom in the second and eighth year, and the heavenly sebum arrives, so that the essence can be dipped, and the yin and yang can be harmonized, so that we can have children? The seventh and eighth liver qi failure, tendons can not move, the sky is exhausted, less essence, kidney failure, the form are extremely? And no son”. Tiankui is a substance that promotes the maturation of the reproductive function, and can promote the passage of the Ren pulse, the flourishing of the Tai Chong pulse, and regulate the production and excretion of semen, so that the body has the ability to reproduce. The surplus and deficit of the heavenly sebum depends on. |! Kidney Qi is strong, then the day sebum to, kidney Qi is weak, then the day sebum exhaustion. Modern medicine believes that the growth and development of the reproductive system is governed by the endocrine system, the study of the nature of the kidney confirms that the kidney in Chinese medicine is similar to the hypothalamus. Pituitary gland. The role of the gonadal axis. Therefore, the strength and weakness of the kidney actually reflects the functional state of the body’s main endocrine and physical condition, and of course also determines the strength of fertility, and kidney deficiency is the main pathological mechanism of male infertility. Male infertility has a long course, mostly for a long time, “long illness must have stasis”, “strange illness must have stasis,, . The main cause of male infertility is a long-standing disease, “long-standing disease must have stasis”, “strange disease must have stasis,”. This leads to low vitality. Therefore, stasis of blood is often based on chronic inflammation and tissue damage, resulting in poor blood flow and loss of local tissue nourishment. Therefore, blood stasis is another major pathological mechanism of male infertility. The treatment of oligospermia is based on activating blood stasis and nourishing kidney yin; activating blood stasis and nourishing kidney yang; activating blood stasis and nourishing kidney yang is an important theory and treatment principle in Chinese medicine. This has become the basis for the treatment of blood circulation and stasis in later generations. Chinese herbal medicine can improve blood circulation and nerve nutrition, promote the repair of damaged tissues, improve the physical and chemical properties of blood, and help improve the function of testicles and epididymis. Chinese herbs are often used to activate blood circulation and eliminate stasis, such as angelica, peach kernel, safflower, salvia, yanghusuo, nux vomica, red peony and wang bu liu xing. Kidney deficiency is the main pathological mechanism of male infertility, and kidney tonics have the effect of regulating the function of the reproductive system, which is one of the main methods of treating male infertility. “The kidney harbors sperm” and the production of sperm depends on the nourishment of kidney yin and the warmth of kidney yang. The strength and weakness of the true yin and yang in the kidneys determine the normal male reproductive function or not. If the kidney is deficient, or if the essence is cold, or if there is heat due to yin deficiency, the treatment should be to differentiate between yin and yang, and not to use warm tonic to avoid burning the yin essence, or to abuse nourishing and greasy to curb yang energy. In general, it is advisable to use both yin and yang tonic, or with emphasis. To nourish the yin to take into account the yang, the yang does not hurt the yin essence. That is, the former said: “good supplement Yang, must seek Yang in Yin, then Yang to Yin help and biochemical endless good supplement Yin, must seek Yin in Yang, then Yin to Yang up and inexhaustible source of water”. The dynamic qi is fire as Yang, and the semen is water as Yin. In the details, among the semen, the secretions of the epididymis, prostate gland and seminal vesicle gland can be called “yin in yin”, while the sperm is “yang in yin”. The sperm itself can be separated into yin and yang, with the sperm body being yin, or “yin in yang”, and the sperm activity rate being yang, or “yang in yang”. “Therefore, the number of spermatozoa is influenced by kidney yin, and the activity rate is determined by the strength and weakness of kidney yang. The treatment is to invigorate blood stasis and nourish kidney yin as the main treatment for oligospermia, and to invigorate blood stasis and warm kidney yang as the main treatment for weak spermatozoa. For oligospermia, we use Radix Rehmanniae Praeparata, Radix et Rhizoma Huangjing, Radix chasteberry, Cornu Cervi Pantotrichum, Radix et Rhizoma Polygonatum and Radix rhizoma Polygonatum to nourish kidney yin, slightly supplemented with Cuscuta sinensis, Radix et Rhizoma sangzhi, etc. to tonify yang and benefit yin. Meanwhile, according to modern pharmacological research, Epimedium has the effect of promoting semen secretion, and Atractylodes has the effect of promoting sperm epithelial cell division, which can be used clinically with the formula. For weak spermatozoa, the use of Cuscuta, mulberry cuttlebone, cistanches, Epimedium, deer antler gum, Xianmao, Kozi flesh, Ba Ji Tian and other warm tonics. Kidney yang products, together with the qi tonic Huang Qi, princeton ginseng, etc. In addition, the kidney is the essence of the first day, and the spleen is the essence of the second day, and the two support each other and promote each other. Jing Yue Quan Shu? On the Spleen and Stomach” says, “The beginning of human life is based on the source of essence and blood; the birth of human life is based on the nourishment of water and grain. If it is not the essence and blood, there is no way to establish the foundation of the body; if it is not the water and grain, there is no way to make the body strong. It is because the sea of water and grain depends on the first heaven as its master, and the sea of essence and blood must depend on the latter heaven as its capital.” The spleen transports water and grain essence to produce qi and blood, and the essence of the kidney depends on the spleen to transport water and grain essence to replenish it. Therefore, while nourishing the kidneys, supplemented with drugs that benefit the spleen such as Atractylodes, Poria, Radix Codonopsis, etc., to achieve the effect of nourishing the innate by nourishing the latter. Some antibiotics such as neomycin, gentamicin, erythromycin, H2 receptor blocker cimetidine, etc. often lead to a decrease in semen quality; immunosuppressants such as cyclosporine can cause a decrease in sperm density and viability”‘. Modern research has found that Chinese herbal medicines such as trigonelline, dirong, yiwu, and serpentine have spermicidal effects, and bone marrow has estrogen-like effects, which should be avoided in clinical practice. In the “Jin Yin Gangmu”, it is stated that “the way to gather sperm is to have a low desire for one day, to restrain labor for two days, to restrain anger for three days, and to be careful with taste for four days”. The “Gynecological Jade Ruler” also says that “for men to seek an heir, it is important to clear the mind and have little desire”. Therefore, in the process of treatment, attention should be paid to the spiritual and life regulation. The fact that infertility is often a great psychological burden for men, helping patients to relieve mental stress and build confidence to cure the disease is also important for the treatment of male infertility. The diet of male infertility patients should be enhanced with nutrition, not partial diet, more milk, egg yolk, lean meat, fish roe and other foods rich in high quality protein, more fresh vegetables, fruits and other foods to supplement vitamins and some trace elements. According to the climate of the four seasons, choose the appropriate food for health. Quit smoking and alcohol, according to the literature “1 drinking alcohol on the hypothalamus. Pituitary gland. In addition, some physical and chemical factors, such as radiation, radiotherapy and chemotherapy, heat, and other factors, can affect male fertility. radiotherapy and chemotherapy, heat, electromagnetic radiation, heavy metals (e.g., lead, mercury, cadmium, etc.), and organochlorine compounds (e.g., dioxins, bicyclic furans, PCBs, etc.) have an impact on male reproduction.