Shen Jianhua Yang Hongwei
(Guangzhou Liwan District Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, 510140)
Abstract: According to the physiology and pathology of male infertility, combined with the modern medical understanding of its relevant research, reference to the ancient and modern medical treatises on male infertility, and combined with their own clinical experience, we believe that the causes of male infertility are complex, and the treatment methods are multiple (tonifying the kidney, draining the liver, strengthening the spleen, nourishing yin, clearing heat, etc.), and the method of clearing heat is not only used to treat the seminal ventricular fever type of infertility, but also on the basis of dialectical evidence, the addition of the method (medicine) of clearing heat (deficiency heat and The method of clearing heat is not only used for treating seminal ventricular fever infertility, but also for treating various types of infertility by adding the method (medicine) of clearing heat (deficiency heat, solid heat) on the basis of dialectic, which can improve the efficacy. Yang Hongwei, Department of Infertility, Liwan District Hospital of Traditional Chinese Medicine, Guangzhou, China
Topic(s): Clearing heat, Chinese medicine, infertility, male, Chinese herbal therapy
The causes of male infertility are very complex, including the influence of six external evil spirits, diet and fatigue, as well as indiscipline in sexual intercourse, and deficiency of internal organs, as well as Qi and blood imbalance. The “Secret Records of the Stone Room” that “men can not have children, there are six diseases. …… an essence of cold, a gas failure, a phlegm, a phase of fire, a lesser essence, a gas depression, too.” It can be seen that male infertility is not all due to kidney and spleen deficiency, but phlegm and dampness, fire and qi depression are also common causes. The treatment of male infertility is based on the essence, which is the source of reproduction, so the treatment of male infertility is basically to benefit the essence, and as seen clinically, male infertility is commonly seen in seven types of evidence, such as kidney deficiency, lack of qi and blood, liver qi stagnation, blood stasis, dampness and heat in the seminal chamber, yin deficiency and fire, phlegm and dampness, and the corresponding treatment is to tonify the kidneys, strengthen the spleen, benefit the qi and blood, dredge the liver and relieve depression, invigorate the blood and open the essence, clear dampness and heat, nourish yin and clear heat, and dry dampness and resolve phlegm. In the application of these methods, according to the degree of deficiency, cold and heat to the comprehensive application, the author in clinical practice, found that in different types of infertility patients in different stages most have different degrees of “heat” (damp heat, solid heat, deficiency heat, stasis heat, depression heat) performance, therefore, in the treatment of male infertility, in addition to clearing heat as the main Therefore, in the treatment of male infertility, in addition to the evidence of clearing heat, the method (or medicine) of clearing heat (deficiency heat, actual heat) can be added on the basis of the evidence, and kidney essence deficiency, kidney yin deficiency, blood deficiency, etc. are often accompanied by symptoms of yin deficiency and blood heat (such as dry mouth, hot hands and feet, red tongue, fine pulse, etc.), so it is necessary to nourish yin and clear heat at the same time; while liver qi stagnation, blood stasis, phlegm and dampness are often depressed (stasis) and turn into heat, resulting in symptoms of depression heat, stasis heat (such as burning pain in the yin, i pain, bitterness in the mouth, yellow urine, yellow fur, etc.). Even in the case of deficiency, such as kidney yang deficiency, in order to prevent the dryness of yang tonics, appropriate amounts of sweet and cold heat-clearing herbs (such as Zhi Mu, Dendrobium, etc.) can be added to “seek yang in yin”. Therefore, making good use of heat-clearing methods can often improve the therapeutic effect. The following is a preliminary discussion on the use of heat-clearing methods in the treatment of male infertility.
1 Chronic prostatitis infertility
Sperm dysfunction and gonadal inflammation are considered to be two of the most difficult problems of male infertility. From the papers received at the “First Chinese Medicine Infertility Conference” held in Shanghai in October 1997, inflammation of the reproductive tract, prostatitis and seminal fluid non-liquidity closely related to infection have become one of the most common causes. The most common cause is the chronic inflammation of the prostate due to non-specific infection, causing local tissue congestion. Most of the blame is placed on the heart, kidney, liver, spleen and other internal organs. It belongs to the Chinese medical term “Baixian”, “urine and sperm”, “jingdu”, “lao lun” and “gonorrhea”. gonorrhea” “white turbidity” and other diseases. “The actuality of chronic prostatitis is mixed with deficiency, and when it is aggravated, the symptoms are mainly damp-heat: frequent urination, burning pain or astringent pain when urinating, white discharge from the urethra, yellow urine, yellow tongue and yellow pulse. Some patients show symptoms of qi stagnation and blood stasis: painful perineum and abdominal cramps, enlarged prostate, hardness, painful to touch, dark tongue or stasis, stringiness and astringency of the pulse. Patients with liver and kidney yin deficiency often have symptoms of yin deficiency and fire: insomnia and dreaminess, seminal emission, irritable heat in the five hearts, tender red tongue or light red with little moss and fine pulse, therefore, while tonifying the yin of the liver and kidney, we add medications to clear deficiency heat such as maitong, asparagus, dendrobium, danpi, duck’s foot skin and Zhi Mu; while patients with kidney yang deficiency, while tonifying the yang of the kidney, we supplement with tortoise gum and white peony, etc., one to control its dry heat and the other to make “Yang will be assisted by Yin and will be transformed into infinite”.
2 Semen non-liquefaction disorder
Semen non-liquefaction disorder refers to the non-liquefaction or partial liquefaction of semen within one hour after ejaculation, which affects the operation of sperm and is one of the main causes of male infertility. There is no corresponding record on semen non-liquefaction in Chinese medicine, which is generally related to gonorrhea, white turbidity, semen turbidity, semen cold and semen heat. The current understanding of the cause of the disease in Chinese medicine is generally related to Yin deficiency or Yang deficiency of the body, indiscipline in intercourse, damp heat, cold condensation, and excessive thinking. There is a consensus on the classification of the disease, which is mainly divided into five types: yin deficiency and fire, kidney and yang deficiency, damp-heat injection, phlegm and blood stasis (1)(2), among which yin deficiency and fire is the most common. The clinical treatment with the addition of flavor of Liangdi Tang is made by adding flavor to Liangdi Tang (3). Two Di Tang is composed of 30 g each of Sheng Di Huang and Xuan Shen, 15 g each of Bai Shao and Mai Dong, and 10 g each of Di Bone Peel and Aconite. This formula, Di Bone Bark and Sheng Di Huang can clear the heat in the bones, which originates from the heat of the kidney meridian. By clearing its bone marrow, the kidney qi will be cleared without damaging the kidney qi; Xuan Shen, Mai Dong, Agaricus blazei and Bai Shao nourish Yin and clear heat. On this basis, add 15g of each of chasteberry, dry lotus grass and white vetch, 12g of dendrobium to enhance its effect of nourishing yin and clearing heat, and 2 times more of ground bones to enhance the power of clearing yin and heat, and halve the amount of xuan ginseng to nourish yin without nourishing greasiness and remove fire without harming yang. From the above analysis, on the basis of nourishing Yin, the strength of clearing heat (clearing deficiency heat) is obviously strengthened and the therapeutic effect is improved.
3 Male immune infertility
Positive serum anti-sperm antibodies (As-Ab) in men is one of the important factors causing immune infertility. According to statistics, about 10%-30% of patients with unexplained infertility are tested positive for serum anti-sperm antibodies (As-Ab) (4). This antibody causes self-agglutination of ejaculated sperm, decreases viability, prevents sperm from crossing the cervical mucus and restricts sperm adhesion to the egg zona pellucida, prevents sperm from binding to the egg and affects fertilization of the egg and embryo survival, thus affecting male fertility and causing immune infertility (5). In ancestral medicine, there is no corresponding record of male serum As-Ab positivity, and it is generally classified as infertility, which is related to gonorrhea, sperm clouding, and sperm heat, and is currently treated in Chinese medicine by tonifying the kidneys and activating blood circulation (6). The author found in clinical practice that the disease is mainly related to kidney deficiency (Yang deficiency, Yin deficiency), blood stasis, heat (damp heat, deficiency heat, stasis heat), and the pathogenesis is mainly manifested as positive deficiency and evil love, yin and yang dysregulation. It can be clinically divided into Yang deficiency and blood stasis type, Yin deficiency and fire type, and Damp-Heat type, among which the Yin deficiency and fire type is the most common. However, regardless of the type, heat (damp-heat, deficiency-heat, stasis-heat, stagnation-heat) is the common manifestation of all types. In men, qi is the mainstay, and deficiency of kidney yang leads to insufficient warmth and weakness, resulting in blood stasis and heat due to stagnation, which manifests as stasis-heat (or heat due to depression); due to the fast pace of modern life, high work pressure and rich nightlife, “yang is always in excess and yin is always in deficiency”, resulting in symptoms of yin deficiency and fire; some patients do not pay attention to hygiene or unclean sexual intercourse Some patients do not pay attention to hygiene or have unclean sexual intercourse, which leads to internal violation of dampness and toxicity, resulting in damp-heat infiltration. Therefore, all clinical types show the common symptoms of “heat”, among which deficiency heat is more common. The author used White Peel Drink (Silver Flower, Wild Chrysanthemum, Snow Lotus, Damp Peel, Ground Bone Peel, Duck’s Foot Peel, Artemisia, Inverted Grass, White Ivy) with flavor to treat men with positive serum As-Ab, and achieved satisfactory results. Among them, Yinhua and Wild Chrysanthemum clear heat and detoxify the toxin to dispel external evil, Snow Lotus, Ground Bone Bark, Duck’s Foot Bark, Artemisia, Inverted Herb and White Ivy clear deficiency heat, and Dampi not only clear deficiency heat but also invigorate blood circulation to remove blood stasis; then distinguish the main and priority of symptoms and add medicine according to evidence, so as to regulate the overall balance of yin and yang, support the righteousness and dispel evil, and achieve both primary and secondary treatment.
4 Spermopenia
Spermopenia is a condition in which the sperm count in semen examination is less than 20×109/L. According to traditional Chinese medicine, the kidney harbors sperm and is the master of reproduction, and the strength and weakness of kidney qi and the surplus and deficit of kidney essence determine the reproductive ability of a person. Therefore, the treatment of sperm reduction is mostly based on kidney tonification, but in clinical practice, it is found that the treatment is more effective when applied together with the heat-clearing method, because kidney stores sperm, liver stores blood, kidney sperm has to be constantly filled by the sperm transformed by liver blood, liver blood depends on the nourishment of kidney sperm, sperm and blood nourish each other, liver and kidney are of the same origin, and pathologically interact with each other, insufficient yin fluid can lead to hyperactivity of yang, and yang in excess also burns yin fluid, leading to deficiency of yin. The liver fire is too strong and can also rob the kidney yin, resulting in kidney yin deficiency. Therefore, in the treatment of spermopenia, it is not only necessary to tonify the kidneys, but also to emphasize the regulation of the liver and the clearing of heat. The author often uses the six son soup (chasteberry, wolfberry, cuscuta, cherry, raspberry, wu wei zi) to tonify the kidneys, and with the four rebellious powder, four wonderful powder to regulate the liver and clear the heat, can often achieve better results; on the other hand, sperm reduction is closely related to the inflammatory disease of the reproductive tract, often accompanied by yin deficiency fire or damp heat within the manifestation, and most of the original deficiency and the symptoms, so in the treatment should be treated according to the different conditions. As long as the treatment of inflammation correctly deal with the relationship between anti-inflammatory and kidney essence, in the process of anti-inflammatory to avoid damage to the kidney essence, supplemented by the essence of the medicine; in the process of kidney essence to avoid provoking, aggravating inflammation, supplemented by the medicine to clear heat, which is more important, according to the specific situation to coordinate the proportion, clear priorities, it is possible to achieve very satisfactory results. For example, patient He, male, 25 years old, married for many years cohabiting without contraception, no spermatozoa, testicular biopsy: microscopic testicular varicocele occasionally see sperm cells, no sperm. Pathological diagnosis: testicular germ cell dysplasia. Self-perceived fatigue, low back pain, perineal discomfort, dry mouth and bitterness, impatience and irritability, heat in the palms of the hands, stomach and stool can be regulated, red tongue with white fur and fine pulse. Symptom characteristics: (1) Kidney deficiency (2) Liver stagnation and heat, proposed method to tonify the kidney and dredge the liver, nourish Yin and clear heat. Single-day prescription: Radix chasteberry, Fructus Lycii, Semen Cuscutae, Radix chinensis, Raspberry, Radix Scutellariae, Radix Scutellariae Sinensis, Radix Paeoniae Alba 15g each, Radix Bupleurum, Radix Scutellariae Sinensis, Radix Eucommiae Sinensis, Radix Horticariae Sinensis, Radix Horticariae Sinensis, Radix Danshen, Radix Dandelion 30g each. After 2 months, the semen was rechecked and the sperm count was 17 million/ml, the blood test was 300 units of GPT Lai’s method, the clinical symptoms disappeared, the pulse was fine, so the medicine was used to clear the liver and heat, supplemented by nourishing the yin and tonifying the kidneys with (1) 10g each of Antelope Bone, Yu Jin, Chai Hu, Su Xin Hua, Citrus aurantium, 30g each of Salvia miltiorrhiza, Serpent’s Tongue, Yin Hua and Panax notoginseng, 30g each of Snow Lotus, Duck’s Foot Bark, Inverted Buckwheat (2) above to Chai Hu, Antelope Bone, plus Erzhi Wan, alternately, after the observance of the law with the symptoms of the increase and decrease, 2 months after the re-examination of semen, sperm count 79 million / ml, viability: 60%, 55% of the heterogeneous sperm, white blood cells: +, and then the observance of the law and increase and decrease, 10 days later informed his wife has been pregnant.
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