Differential diagnosis and treatment of oligospermia, semen non-liquefaction and cold semen
Clinical treatment of oligospermia often relies on traditional Chinese medicine. (1) Prepared Chinese medicines ① Liuwei Dihuang Wan, 9 grams each time, twice a day, orally. Suitable for oligospermia due to yin deficiency. ② Jinkui Shenqi Wan, 1 pill each time, twice a day, orally. Suitable for oligospermia due to kidney yang deficiency. ③ Wuzi Yanzong Wan, 9 grams each time, twice a day, orally. Suitable for oligospermia due to kidney deficiency. ④ Longdan Xiegan Wan, 6 grams each time, twice a day, orally. Suitable for oligospermia due to damp-heat stagnation. (2) Single prescriptions ① Leek seeds, roasted and ground into powder, 3 grams each time, twice a day, orally. Suitable for oligospermia due to insufficient kidney essence. ② Deer antler glue 50 grams, fresh placenta 50 grams, leek seeds 100 grams, Cistanche deserticola 100 grams. Grind into fine powder, 9 grams each time, twice a day, orally. Suitable for oligospermia due to yang deficiency. ③ 20g of wolfberry, 30g of dodder seed, 20g of mulberry, and 15g of epimedium. Decocted in water and taken orally twice daily, one dose per day. Suitable for oligospermia due to kidney deficiency and sperm depletion. ④ 30g of epimedium, 15g of plantain seed, 10g of alisma rhizome, 6g of akebia stem, 10g of loofah sponge, and 15g of poria cocos. Decocted in water and taken orally twice daily, one dose per day. Suitable for oligospermia due to dampness obstructing the seminal ducts. ⑤ Equal parts of notoginseng powder, leech powder, and centipede powder. 2g each time, twice daily, orally. Suitable for oligospermia due to blood stasis obstructing the seminal ducts. ⑥ 10g of psoralea corylifolia, 30g of dodder seed, 10g of morinda root, 10g of atractylodes macrocephala, 10g of epimedium, and 10g of cistanche deserticola. Decocted in water and taken orally twice daily, one dose per day. Suitable for oligospermia due to deficiency of both spleen and kidney. (3) Traditional Chinese Medicine Formulas: ① Anemarrhena asphodeloides 6g, Phellodendron chinense 6g, Rehmannia glutinosa 30g, Testudinis plastrum 15g, pig spinal cord 20g, Lycium barbarum 15g, Polygonum multiflorum 15g, Placenta hominis 10g. Decocted in water and taken orally twice daily, one dose per day. This formula is a modified version of Da Bu Yin Wan. It is suitable for oligospermia due to yin deficiency. ② Deer antler glue 10g, Ginseng 10g, Rehmannia glutinosa 15g, Dioscorea opposita 15g, Lycium barbarum 10g, Eucommia ulmoides 10g, Morinda officinalis 10g, Cornus officinalis 10g, Cuscuta chinensis 15g, Aconitum carmichaelii 6g, Cinnamomum cassia 3g, Broussonetia papyrifera 10g, Cistanche deserticola 10g. Decocted in water and taken orally twice daily, one dose per day. This formula is a modified version of Da Lao Er Wan combined with You Gui Wan. It is suitable for oligospermia due to deficiency of both spleen and kidney. ③ 10g of Chuanxiong (Ligusticum striatum), 10g of Danggui (Angelica sinensis), 10g of Lulutong (Liquidambar formosana), 10g of Chuanshanjia (Manis pentadactyla), 10g of Yanhusuo (Corydalis yanhusuo), 10g of Danshen (Salvia miltiorrhiza), 10g of Taoren (Prunus persica), 6g of Honghua (Carthamus tinctorius), 10g of Niuxi (Achyranthes bidentata), and 10g of Tusizi (Cuscuta chinensis). Decoct in water and take twice daily, one dose per day. This formula is a modified version of Shaofu Zhuyu Tang combined with Taohong Siwu Tang. It is suitable for oligospermia due to obstruction of the seminal ducts. To prevent oligospermia, one should practice moderation in sexual activity, avoid frequent intercourse to prevent depletion of sperm; abstain from smoking and alcohol, and avoid foods such as garlic, celery, and chili peppers; detect and treat cryptorchidism as early as possible, and thoroughly treat seminal vesiculitis, epididymitis, and vas deferens obstruction; couples should temporarily separate for a period of time to "conserve essence and preserve spirit."
Semen exists in a liquid state within the reproductive tract. Upon ejaculation from the penis, it immediately transforms into a gel-like or clotted grayish-white substance. At this stage, sperm are contained within the semen or attached to its surface, unable to swim freely. After 5–45 minutes, a spontaneous liquefaction process occurs, liquefying the gel and transforming it into a thin, flowing liquid. This coagulation-liquefaction process is enzymatically catalyzed. A protein-like substance secreted by the seminal vesicles forms the matrix for the gel-like substance, while a fibrinolytic enzyme secreted by the prostate gland participates in the liquefaction process. This enzyme can also dissolve the self-coagulated clot. This liquid coagulation-liquefaction process of semen has certain physiological significance. The initial liquid state facilitates ejaculation. The subsequent clot formation allows the semen to remain in the vagina for a longer period, enabling the sperm to rest and acquire energy. Once liquefied, the sperm have sufficient energy to penetrate cervical mucus and continue their journey deeper into the reproductive tract, eventually reaching the fallopian tubes. When the prostate or seminal vesicles are inflamed, the lack or destruction of proteolytic enzymes causes an imbalance in the enzyme system, resulting in semen that fails to liquefy or liquefies incompletely after one hour, becoming too viscous. This is called semen non-liquefaction, a pathological condition. In this situation, sperm cannot migrate, naturally leading to infertility. Therefore, diseases of the seminal vesicles and prostate are important causes of non-liquefaction.
Methods for treating semen non-liquefaction: ① Thoroughly treat primary diseases such as prostatitis and seminal vesiculitis to restore their normal function. ② Rinse the vagina with physiological saline containing 4% α-amylase before intercourse, or inject 1 ml into the vagina after intercourse; alternatively, mix 50 mg of the enzyme with cocoa butter to make a 3 cm long suppository, which can be inserted into the vagina before intercourse. α-amylase not only promotes semen liquefaction and affects glycogen-containing vaginal or cervical secretions, but also serves as an energy source for sperm motility. ③ Add normal human seminal plasma to the semen to promote liquefaction. However, it is essential to first ensure that the seminal plasma is free of antisperm antibodies and infection, and that it has undergone high-speed centrifugation to remove sediment and three freeze-thaw cycles. ④ Ejaculate the semen into a container containing culture medium, repeatedly aspirate with a syringe fitted with 18- or 19-gauge needles until the semen is thin, then centrifuge and wash twice, and finally re-inject the sperm into a certain amount of culture medium for artificial insemination. ⑤ If the semen is too viscous, the fractional ejaculation method can be used. The first three ejaculations should remain inside the vagina, and the penis should be immediately withdrawn, with the remaining semen ejaculated outside. This is because the latter part of the semen mainly contains seminal vesicle secretions, resulting in a higher viscosity.
Thin, watery semen, also known as clear, thin, and cold semen, is considered by Traditional Chinese Medicine (TCM) to be invariably related to kidney deficiency, particularly kidney qi deficiency and kidney yang deficiency. It can be caused by congenital insufficiency, inherent weakness, or frequent masturbation in adolescence, which damages kidney qi and leads to thin, watery semen. This is often accompanied by weakness, emaciation, pale complexion, fatigue, shortness of breath, and lower back and leg weakness, indicating kidney qi deficiency. Treatment should focus on tonifying kidney qi. A traditional Chinese medicine formula called Wuzi Yanzong Wan (五子衍宗丸) with the addition of 15g of yam, 12g of Xianmao (仙茅), and 9g of ginseng can be used, three doses per week for 4-8 weeks. If left untreated or mistreated, this condition can develop into kidney yang deficiency and decline of the fire of the gate of life (命门火), resulting in a series of symptoms of deficiency and cold, such as cold limbs, aversion to cold, fatigue, loose stools, lower back pain, and impotence. Treatment should focus on warming and tonifying kidney yang, using the following formula: 30g Rehmannia glutinosa (processed), 15g each of prepared Aconitum carmichaelii (processed), jujube peel, Eucommia ulmoides, Dioscorea opposita, and Lycium barbarum, 12g Cistanche deserticola, 9g each of tortoise shell glue and cinnamon, and 6g deer antler powder. First, decoct the prepared Aconitum carmichaelii, then add the remaining herbs, obtaining 600ml of liquid. Dissolve the tortoise shell glue in the liquid, decoct, and take orally, three times a day, one dose per day. Take 2g of deer antler powder with each dose for five consecutive days, then stop for three days before resuming. This can be repeated for over 30 doses. Clear and cold semen is generally caused by kidney qi deficiency, kidney yang weakness, and insufficient essence. Therefore, treatment should focus on tonifying kidney qi and kidney yang, supplemented by tonifying essence and moderating sexual activity.