Chapter Sixty-One: Symptoms, Examinations, and Western Medical Treatment of Azoospermia
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Treatment and recuperation of common diseases
What are the symptoms?
Patients often have a history of excessive sexual activity, frequent masturbation, nocturnal emission, or irregular diet, and semen analysis shows that more than 40% of sperm are dead.
Clinical manifestations vary considerably; some are asymptomatic, while others are accompanied by orchitis, prostatitis, seminal vesiculitis, varicocele, or neurasthenia, sexual dysfunction, and other diseases.
What tests should be done?
1. Routine semen analysis: Microscopic examination revealed a sperm mortality rate exceeding 40%, and white blood cells were visible.
2. Sperm live eosin staining: This method is relatively accurate for diagnosing the number of dead sperm.
3. Semen fructose measurement: The fructose content in the semen of patients with azoospermia is lower than normal.
4. Routine examination of prostatic fluid: uneven distribution of lecithin bodies, reduced or absent number, and increased white blood cells.
Which diseases should it be differentiated from?
1. Pseudo-necrospermia: This is caused by improper examination methods or failure to submit the semen sample for examination within 30 minutes at a room temperature of 35-37°C after collection, resulting in an excessive number of dead sperm. This is a human-caused factor.
2. Low sperm motility: Low sperm motility means that the sperm that are ejaculated are basically not moving (but not dead) or moving very slowly when examined under a microscope. Such sperm should not be mistaken for dead sperm.
How does Western medicine treat this?
The key to treating azoospermia is to treat prostatitis and seminal vesiculitis. At the same time, other causes of azoospermia should be addressed and actively treated, such as surgical treatment of varicocele, use of hormone medications to regulate endocrine function, and supplementation with various nutrients. In addition, medications to promote sperm formation and improve sperm motility are also necessary to comprehensively improve semen quality and increase the woman's fertility rate.
1. Antibiotic Treatment: Primarily used for abnormal semen caused by chronic bacterial prostatitis or seminal vesiculitis. Antibiotics that can diffuse into the prostate are selected, with trimethoprim being the first choice. Clinical practice has shown that the combined use of trimethoprim and rifampin can achieve better results. Specific dosage: Trimethoprim 80 mg per tablet, rifampin 300 mg per tablet, one tablet in the morning and two tablets in the evening, taken orally for 15 consecutive days; then two tablets each evening once daily for 15 consecutive days; then one tablet each evening once daily for 90 consecutive days as one course of treatment.
Clindamycin and erythromycin can both diffuse highly into the prostate. Clindamycin is taken 1 gram three times a day, while erythromycin is taken 0.2 to 0.5 grams four times a day. To avoid drug resistance, after taking each of the above antibiotics for 7 to 10 days, another antibiotic should be taken, and the treatment should continue for 8 to 16 weeks.
In addition, antibiotics such as compound sulfamethoxazole, norfloxacin, kanamycin, ciprofloxacin, josamycin, and cephalosporins can be tried.
Combination therapy is generally recommended, and it is best to use it under the guidance of drug sensitivity testing. For patients with chronic gonorrhea, medications such as linbizhi and junbizhi can also be considered.
2. Non-steroidal anti-inflammatory drug (NSAID) treatment: Primarily used for chronic non-bacterial accessory gland inflammation. Commonly used drugs include aspirin, indomethacin, phenylbutazone, and isobutylphenylpropionic acid. For example, indomethacin 25-50 mg three times daily; phenylbutazone 100 mg three to four times daily, taken continuously for one month, can reduce congestion and edema of the accessory glands and has a certain therapeutic effect on azoospermia.
In addition, since chlamydia and mycoplasma infections cannot be ruled out, tetracycline can be considered, 0.5 g each time, 4 times a day; doxycycline 100 mg once a day, for 1 to 2 weeks.
How does Traditional Chinese Medicine differentiate syndromes and treat diseases?
1. Kidney Yin Deficiency Type: Symptoms include low semen volume, examination reveals dead sperm, tinnitus and deafness, soreness and weakness of the lower back and knees, five-center heat (heat in the palms, soles, and chest), dry mouth and throat, red tongue with little or no coating, and thready and rapid pulse.
Treatment principle: Nourish Yin and tonify the kidneys.
Prescription: 15g Rehmannia glutinosa (raw), 15g Rehmannia glutinosa (prepared), 15g Dioscorea opposita, 15g Polygonatum sibiricum, 9g Alisma plantago-aquatica, 12g Paeonia suffruticosa, 12g Poria cocos, 12g Salvia miltiorrhiza, 12g Paeonia lactiflora (red), 12g Paeonia veitchii (white), 6g Plantago asiatica (wrapped), 15g Tortoise shell, 15g Lycium barbarum, 12g Morus alba.
2. Kidney Yang Deficiency Type: Symptoms include thin and cold semen, examination reveals dead sperm, impotence, soreness and pain in the lower back and knees, cold limbs, fatigue, frequent and clear urination or nocturia, pale tongue, white coating, and weak and deep pulse.
Treatment principle: Warm the kidneys and strengthen yang.
Prescription: 15g of wolfberry, 15g of mulberry mistletoe, 12g of cistanche, 15g of dodder seed, 10g of leek seed, 10g of curculigo, 12g of dipsacus root, 12g of epimedium, 6g of aconite (decocted first), 6g of cinnamon, 12g of yam, 12g of plantain seed (wrapped), 6g of schisandra fruit, 12g of cornus fruit, 12g of placenta, 12g of deer antler glue (melted).
3. Qi and Blood Deficiency Type: Symptoms include low sperm count, examination reveals dead sperm, lethargy, pale complexion, palpitations, shortness of breath, poor appetite, abdominal distension, loose stools, pale and swollen tongue with white coating, and weak and thready pulse.
Treatment principle: Nourish Qi and Blood.
Prescription: Ginseng (decocted separately) 15g, Angelica sinensis 12g, Astragalus membranaceus 15g, Atractylodes macrocephala 12g, Rehmannia glutinosa (processed) 15g, Poria cocos 15g, Citrus reticulata peel 10g, Polygala tenuifolia 10g, Paeonia lactiflora 10g, Cinnamomum cassia 6g, Epimedium brevicornu 12g, Curculigo orchioides 12g, Cervi cornu colla (melted) 12g, Schisandra chinensis 6g, Glycyrrhiza uralensis (processed) 6g.
4. Damp-heat accumulation type: Symptoms include copious and viscous semen, examination reveals dead sperm, irritability, thirst but no desire to drink, scanty, dark, painful urination, or urethral discharge, testicular swelling and pain, red tongue with yellow and greasy coating, and slippery and rapid pulse.
Treatment principle: Clear heat and dampness.
Prescription: Dioscorea hypoglauca 15g, Acorus tatarinowii 9g, Phellodendron chinense 12g, Atractylodes macrocephala 15g, Poria cocos 12g, Nelumbo nucifera seed heart 12g, Salvia miltiorrhiza 12g, Plantago asiatica (wrapped) 12g, Alisma plantago-aquatica 10g, Coix lacryma-jobi 15g, Talcum 15g, Dianthus superbus 12g, Polygonum aviculare 12g, Paeonia suffruticosa 10g.