Article 53: Examination, Diagnosis, and Western Medical Treatment of Azoospermia

◇A Guide to Caring for Your Husband's Health as a Good Wife◇

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Treatment and recuperation of common diseases

What tests should be done?

1. Semen smear examination: No sperm were found in three consecutive examinations.

2. Testicular biopsy: This can be used to observe the spermatogenic function of the testes and is helpful in diagnosing true azoospermia and obstructive azoospermia.

3. Seminal duct imaging: to examine the vas deferens, seminal vesicles, and ejaculatory ducts for obstruction, inflammation, tuberculosis, or congenital malformations.

4. Immunological assays: Immunoglobulin assays can reveal whether inflammation is affecting testicular spermatogenesis.

5. Chromosomal karyotype analysis: to determine if there are any congenital genetic diseases.

6. Endocrine hormone assay: to understand the functional status of the hypothalamus-pituitary-testicular axis and provide a basis for treatment.

How does Western medicine treat this?

1. Impaired sperm production:

(1) Clomiphene: There are two ways to take the drug. One is to take 50 mg orally every day for 3 months. If it is effective, continue to take it until the sperm count recovers to 20 million to 60 million. The other is to take 25 mg orally every day for 25 days as one cycle. After resting for 5 days, continue to take the drug as above. Generally, 6 courses of treatment are used. If it is effective, the drug can be used for 6 to 24 months.

(2) Tamoxifen: 20 mg once a day orally for 6 to 12 months.

(3) Human chorionic gonadotropin (hCG) and urinary gonadotropin (urinary gonadotropin): Initially, hCG is used alone, 5000 units per week, divided into two intramuscular injections, for 3 weeks; from the 4th week, urinary gonadotropin is added, 75-150 units per injection, intramuscularly, for approximately 3-18 months. After achieving complete spermatogenesis, hCG can be used alone for maintenance.

(4) Treatment of hyperprolactinemia: A small number of patients with azoospermia have hyperprolactinemia. Drug treatment is used to reduce prolactin levels and improve spermatogenesis. The commonly used drug is bromocriptine. Initially, take 1.25-2.5 mg every night, and increase to 2.5 mg after 3 days, twice a day, for 3 consecutive months.

2. Obstructive azoospermia: If caused by inflammation and edema of the vas deferens, antibiotics and glucocorticoids can be used for treatment. If caused by cyst compression, the cyst can be removed. For epididymal duct obstruction, vas deferens-epididymis anastomosis can be performed. For vas deferens obstruction, vas deferens anastomosis can be performed. For ejaculatory duct obstruction, ejaculatory duct dilation can be performed.

How does Traditional Chinese Medicine differentiate syndromes and treat diseases?

1. Kidney Essence Deficiency Type: Symptoms include thin and scanty semen, no sperm, decreased or normal libido, pale complexion, fatigue, dizziness and tinnitus, soreness and weakness of the lower back and knees, forgetfulness, pale tongue with thin coating, and deep, thready and weak pulse.

Treatment principle: Tonify the kidneys and replenish essence.

Prescription: Ginseng (decocted separately) 10g, Ophiopogon japonicus 10g, Cistanche deserticola 10g, Dioscorea opposita 10g, Cornus officinalis 15g, Rehmannia glutinosa 20g, deer antler 5g, tortoise shell glue (melted) 10g, wolfberry 10g, fish maw 10g, Cuscuta chinensis 10g, Angelica sinensis 10g, Schisandra chinensis 10g, placenta hominis 5g, Platycladus orientalis seed 10g.

2. Kidney Yang Deficiency Type: Symptoms include thin and cold semen, low volume, no sperm, or with thick, sticky clumps, low libido, accompanied by aversion to cold, cold limbs, pale complexion, lethargy, poor appetite, frequent urination or nocturia, pale tongue with white coating, and deep, thready, weak pulse.

Treatment principle: Warm the kidneys and replenish essence.

Prescription: 15g of Curculigo orchioides, 15g of Epimedium brevicornu, 30g of Cistanche deserticola, 15-20g of deer antler glue (melted), 15-20g of tortoise shell glue (melted), and 10g of wolfberry.

3. Qi and Blood Deficiency Type: Symptoms include azoospermia, infertility after prolonged marriage, pale and dull lips and nails, pale or sallow complexion, palpitations, dizziness, shortness of breath, lethargy, fatigue, poor appetite, tinnitus, pale and tender tongue, and weak pulse.

Treatment principle: Tonify Qi and nourish blood.

Prescription: Ginseng (decocted separately) 6-10g, Poria 10g, Dioscorea opposita 10g, Angelica sinensis 10g, Astragalus membranaceus 15g, Paeonia lactiflora 10g, Rehmannia glutinosa 15g, Cinnamomum cassia (added later) 3g, Epimedium brevicornu 15g, Curculigo orchioides 10g, Gecko (remove head, feet and skin, grind into powder and take with water) 1 pair, Cordyceps sinensis 5-10g.

4. Blood stasis obstruction type: Symptoms include low semen volume, no sperm, history of trauma or surgery, genital pain or lower abdominal pain, testicular heaviness, irritability, difficulty urinating, dark purple tongue or ecchymosis, and wiry or hesitant pulse.

Treatment principle: Promote blood circulation, remove blood stasis, regulate qi and relieve stagnation.

Prescription: Codonopsis pilosula 10g, Salvia miltiorrhiza 10g, Artemisia capillaris 10g, Achyranthes bidentata 10g, Vaccaria segetalis 10g, Hirudo medicinalis 3g, Prunus persica 10g, Carthamus tinctorius 10g, Psoralea corylifolia 10g, Astragalus complanatus 10g, Pangolin scales (processed) 10g, Bupleurum chinense 5g, Citrus aurantium 5g.

5. Damp-heat retention type: Symptoms include low and viscous semen volume, absence of sperm, and possibly a large number of pus cells. There is a history of urinary tract infection. Masses and nodules can be palpated in the epididymis. Accompanied by dark and scanty urine, and even terminal dysuria or post-urination discomfort. The tongue is red with a yellow and greasy coating, and the pulse is slippery and rapid.

Treatment principle: Clear heat and promote diuresis.

Prescription: Alisma plantago-aquatica 10g, Coix lacryma-jobi 20g, Sargentodoxa cuneata 15g, Dioscorea hypoglauca 10g, Acorus tatarinowii 10g, Plantago asiatica (wrapped) 10g, Gentiana scabra 8g, Bupleurum chinense 10g, Scutellaria baicalensis 10g, Lindera strychnifolia 10g, Prunus persica 10g.