Clinical Research Review On Kidney-tonifying TCM Method For Male Infertility

Abstract: Kidney-tonifying method is a common method for treating male infertility in clinical practice. During treatment, we should differentiate the syndrome and seek the cause, examine the cause and treat it, or warm and tonify the kidney yang or nourish the kidney yin or replenish the kidney and replenish the essence, all of which are mainly to regulate and tonify the kidney; on this basis, according to the patient's other symptoms, we should also use the method of invigorating qi, soothing the liver, activating blood circulation, clearing heat and removing dampness, and resolving phlegm and dispersing knots. Traditional Chinese medicine has a satisfactory clinical effect in treating male infertility with kidney-tonifying method, but there are still many problems to be solved: ① In terms of syndrome differentiation and treatment, although many doctors have conducted countless discussions and demonstrations on the syndrome differentiation of infertility, they have not yet reached a consensus, presenting a situation of a hundred schools of thought. If a unified standard for syndrome differentiation and classification can be formulated, it will be beneficial to improve the diagnosis and treatment level of male infertility in traditional Chinese medicine; ② The efficacy standard is quite arbitrary, and the efficacy reported by different doctors lacks comparability and cannot fully reflect the actual clinical situation. If a unified efficacy standard can be formulated in the future, it will be more conducive to the clinical summary of various reasonable treatments and the screening of excellent prescription combinations to improve clinical efficacy; ③ In terms of treatment, most of them are general clinical observations, and most of them are retrospective reports, while clinical trial studies are relatively rare. The existing experimental studies lack rigorous scientific research design and reasonable control observations, and their credibility and repeatability are low. Future research should start with the formulation of unified diagnosis, classification, and efficacy standards. On this basis, research should be conducted in accordance with strict scientific research design, reference, and evaluation methods. For those who cannot be identified with evidence, we should be good at using modern scientific and technological means, combining modern with traditional, macro syndrome differentiation with micro syndrome differentiation, so as to further scientificize and standardize the clinical research of traditional Chinese medicine in the treatment of infertility, and promote greater development of traditional Chinese medicine in the field of male infertility treatment.

Keywords: male infertility; kidney-tonifying method; warming and tonifying kidney yang method; nourishing yin and tonifying kidney method; replenishing essence and filling marrow method; oligospermia-type infertility; asthenozoospermia-type infertility; semen non-liquefaction-type infertility

CHINESE MEDICINE IN THE TREATMENT OF INFERTILITY

Supportive Service Of Wecistanche

Email:wallence.suen@wecistanche.com 

Whatsapp/Tel:+86 15292862950

According to the definition of male infertility by the World Health Organization (WHO), male infertility refers to a situation where a couple lives together for more than one year after marriage and does not take contraceptive measures, and the woman is infertile due to the man's reasons. With the development of modern medicine, various laboratory test methods have been widely used in clinical practice, resulting in an increasing number of cases of male infertility. According to recent research and surveys, infertile couples account for 15% to 18% of married families worldwide, and 30% to 50% of them are infertile due to male reasons. Modern medicine's current research on the treatment of male infertility has not yet completely solved all problems. Most of the treatments are empirical and experimental, lacking evidence-based medical evidence and having low efficacy. Emerging assisted reproductive technologies (artificial insemination, in vitro fertilization-embryo transfer, intracytoplasmic sperm injection, etc.) are not acceptable to ordinary families because of their high cost and low efficiency. According to literature, the understanding of male infertility in traditional Chinese medicine has been discussed as early as the third century AD. Historical documents have not only discussed the etiology and pathogenesis, but also accumulated rich experience in treatment. In recent years, due to the combination of advanced modern medical diagnostic technology, the syndrome differentiation of this disease has made breakthroughs and the efficacy has also been improved. According to traditional Chinese medicine, the main causes of male infertility are kidney deficiency, damp heat, blood stasis, etc., among which kidney deficiency is the basic pathogenesis. Relevant epidemiological surveys and studies have shown that the most common syndromes are kidney essence deficiency, kidney yin deficiency, and kidney yang deficiency. Therefore, in clinical practice, traditional Chinese medicine treatment of male infertility is mainly based on kidney tonification, and on this basis, it may also be combined with heat clearing and blood circulation, and its effect is remarkable. It is now reviewed as follows. The causes of male infertility include kidney deficiency, blood stasis, damp heat, etc., but the most common cause is kidney deficiency. Wang Liguang [1] studied and classified the medical records of male infertility by many famous old Chinese medicine practitioners such as Chen Wenbo, Xu Fusong, Wang Qi, Li Guangwen, Qin Yuehao, and Huang Haibo, and found that the most common syndromes were kidney essence deficiency, kidney yin deficiency, and kidney yang deficiency. Since "kidney deficiency" is the main pathological basis of male infertility, kidney tonification is a common method for treating male infertility in clinical practice. However, the kidney has the difference between yin and yang, and the difference between essence and qi, so kidney deficiency infertility can be divided into three types: insufficient kidney yang, deficiency of kidney yin, and deficiency of kidney essence. During treatment, we should differentiate the causes and treat them according to the causes, or warm and tonify the kidney yang or nourish the kidney yin or replenish the kidney essence, all of which are mainly to regulate and tonify the kidney; on this basis, according to the patient's other symptoms, we can also use the methods of invigorating qi, soothing the liver, activating blood circulation, clearing heat and dampness, and resolving phlegm and dispersing knots.

Warming and tonifying kidney yang method

Warming and tonifying kidney yang method is mainly used for infertility caused by poor semen liquefaction, low sperm motility, oligospermia, azoospermia and other semen abnormalities due to insufficient kidney yang. Clinically, infertility, fatigue, sexual indifference, aversion to cold, especially below the waist and knees, loose stools, clear and long urination, frequent urination at night, pale tongue with white fur, and weak pulse are the indications. Kidney yang, which comes from the yang fire in the innate original qi, is also known as "yuanyang" and "innate fire". It is the original power of the human body, warming the limbs and bones, protecting the outside and solidifying, and controlling reproduction and growth and development. When kidney yang is weak, the heavenly essence is scarce, and the driving force is weak, the sperm motility is low; when yang qi is insufficient and the warming function is not functioning properly, the semen is cold and the semen does not liquefy, thus leading to infertility. Zhao Zhengping [8] treated 200 patients with male infertility of yang deficiency and blood stasis type with a self-prescribed modified Zanyu Decoction for warming the kidney and activating blood circulation. A double-blind method was used to set up a treatment group of 150 cases, which was treated with the self-prescribed modified Zanyu Decoction, and a control group of 50 cases, which was treated with Wuzi Yanzong Decoction. 20 days was one course of treatment, and the treatment effect was statistically analyzed after three courses of treatment. Results: After three courses of treatment, the sperm concentration of the treatment group was significantly higher than that of the control group (P < 0.01); the improvement rate of sperm motility index in the treatment group was 60%, and that in the control group was 24% (P < 0.01); the pregnancy rate in the treatment group was 28%, and that in the control group was 10% (P < 0.01). The total effective rate was 65% in the treatment group and 30% in the control group (P < 0.01), indicating that Jiawei Zanyu Decoction has a good effect on male infertility caused by oligospermia. He Qinghu et al. [4] used the classic Chinese medicine Jinkui Shenqi Pill to treat 38 cases of male infertility with kidney yang deficiency type oligospermia and asthenospermia, of which 29 cases were markedly effective, 6 cases were effective, and 3 cases were ineffective, with a total effective rate of 92.1%. The patients' sperm motility, viability, and total sperm count were significantly improved. LH, FSH, and T all increased significantly. Wang Zuxian [6] used the basic treatment method of nourishing the kidney and replenishing essence, and supplementing the kidney and invigorating yang, and combined with intramuscular injection of human chorionic gonadotropin to treat 56 patients with oligospermia type male infertility. The control group was treated with 14 cases of simple intramuscular injection of human chorionic gonadotropin. Results: The cure rate and total effective rate of the treatment group were 51. The difference between the two groups was statistically significant (P < 0.05). Li Haisong et al. [5] used the method of warming yang and replenishing essence to treat 220 cases of male infertility caused by abnormal semen (those with kidney deficiency and partial kidney yang deficiency according to TCM syndrome differentiation) with a self-prescribed Bushen Shengjing Pill. The pill was made of Shiba Inu Kidney, Deer Horn Glue, Cuscuta Seed, Lycium Barbarum and other drugs. The pill was taken orally at a dose of 6 g twice a day for 3 months as a course of treatment. After 1 to 2 courses of treatment, 64 cases were cured, accounting for 29.1%; 58 cases were markedly effective, accounting for 26.3%; 79 cases were effective, accounting for 35.8%; 19 cases were ineffective, accounting for 8.6%; and the total effective rate was 91. 4%.

2 Yin-nourishing and kidney-tonifying method

Yin-nourishing and kidney-tonifying method is mainly used for infertility caused by insufficient kidney yin and deficiency of essence and blood, such as oligospermia and azoospermia. Clinically, the main symptoms are soreness of waist and knees, weakness of legs, dizziness and tinnitus, insomnia and dreaminess, weight loss, hot flashes and night sweats, and fever in the five hearts. Kidney yin is the basis of essence, blood, body fluid, and fluid in the body, and is the material basis for the activity of yang energy in the kidney. If kidney yin is insufficient, yin deficiency and fire are strong, and essence is deficient, oligospermia and azoospermia will occur. Zhuang Tianqu [9] used the method of tonifying the kidney and soothing the liver, and formulated a prescription: Epimedium 30 g, Rehmannia glutinosa 30 g, Lycium barbarum 15 g, Polygonatum sibiricum 15 g, Polygonatum multiflorum 15 g, Bupleurum 10 g, and Citrus hand 10 g. 40 cases of asthenozoospermia were treated, 8 cases were markedly effective, accounting for 20%, 24 cases were effective, accounting for 60%, 8 cases were ineffective, accounting for 20%, and the total effective rate was 80%. Compared with before treatment, the a-grade sperm, b-grade sperm, and sperm motility rate were significantly improved, with significant differences (P < 0.05). Yang Hongwei et al. [10] used the method of tonifying the kidney and clearing away heat to treat 40 cases of oligospermia and asthenozoospermia, with a total effective rate of 87.5%. The sperm density and the percentage of fast forward-moving sperm of the patients were significantly improved compared with before treatment, and the difference was significant (P < 0.05).

3. Yijing Tansui Method

Yijing Tansui Method is used to treat infertility caused by poor semen quality and low sperm density due to insufficient kidney essence. Clinically, the main symptoms are dizziness, tinnitus, soreness of waist and knees, sexual dysfunction, fatigue and forgetfulness. It often uses herbs with a greasy and thick texture, such as Rehmannia glutinosa, Lycium barbarum, Cuscuta chinensis, Polygonatum sibiricum, and processed Polygonum multiflorum, to replenish essence and blood. As the Yellow Emperor's Classic of Internal Medicine says: "If the essence is insufficient, it should be replenished with flavor." For example, Polygonatum sibiricum. Wang Zhigang [11] used Huangjing Zanyu Capsule to treat male infertility and asthenozoospermia. 80 male infertility and asthenozoospermia patients (diagnosed as kidney essence deficiency in traditional Chinese medicine) were randomly divided into two groups, 40 cases in each group. The treatment group took Huangjing Zanyu Capsule orally, and the control group took Shengjing Capsule orally. The course of treatment was 3 months. Results: There was no significant difference in the total effective rate between the two groups after treatment. The sperm motility index of the treatment group was significantly improved compared with that of the control group (P < 0.01). Conclusion: Huangjing Zanyu Capsule can significantly improve sperm motility and has a definite effect on male infertility and asthenozoospermia. The total effective rate of the treatment group of Yusi Pills produced by Beijing Hospital of Traditional Chinese Medicine for the treatment of male infertility due to kidney deficiency, sperm deficiency and dampness and heat was 40%, and the total effective rate was 82.86%, which was significantly different from the control group (P < 0.05). Wang Jingge [2] used the Wenbu Piyang Bu Shen Tianjing recipe to treat 20 cases of male infertility and asthenozoospermia, 2 cases were cured, 6 cases were significantly effective, 10 cases were effective, 2 cases were ineffective, and the total effective rate was 90%.

 The formula uses Cuscuta australis, Cistanche deserticola, Lycium barbarum, and Eucommia ulmoides as the main ingredients to nourish the kidney and replenish essence; 

Cistanche deserticola

Poria cocos, dried ginger, and Atractylodes macrocephala are the auxiliary ingredients to warm the yang and strengthen the spleen to increase the source of postnatal metabolism; Astragalus membranaceus and Angelica sinensis are the auxiliary ingredients to invigorate qi and nourish blood; Prunus persica and red peony root are used to activate blood circulation and unclog the meridians; and Achyranthes bidentata is used to guide the medicine directly to the site of the disease. Sun Gang et al. [3] used Bushen Yijing Decoction to treat 80 patients with oligospermia and asthenospermia. The prescription composition was: Astragalus 30 g, Angelica 15 g, White Peony 15 g, Chuanxiong 10 g, Salvia miltiorrhiza 20 g, Rehmannia glutinosa 20 g, Cuscuta 30 g, Lycium barbarum 20 g, Rubus idaeus 15 g, Schisandra 10 g, Deer Horn Glue (melted) 10 g, Plantago (separate package) 10 g, Curculigo 10 g, Epimedium 15 g, Cyathula officinalis 15 g, 1 dose per day, decocted in 500 mL of water, taken twice. 3 months as a course of treatment. 8 cases of oligospermia were treated, 2 were cured, 5 were effective, and 1 was ineffective. The cure rate was 25%, and the effective rate was 87. 5%; 25 cases of asthenospermia, 18 cases were cured, 5 cases were effective, 2 cases were ineffective, the cure rate was 72%, the effective rate was 92%; 47 cases of oligospermia and asthenospermia, 30 cases were cured, 12 cases were effective, 5 cases were ineffective, the cure rate was 63.82%, the effective rate was 89.36%.

The above is based on the diagnosis and treatment of symptoms from a macro perspective, but in clinical practice, many patients with male infertility have no obvious and typical changes in their tongue and pulse symptoms, that is, no symptoms can be identified. Bi Huanzhou et al. [31] conducted symptom observation and syndrome analysis on 389 male infertility patients without pre-defined syndrome classification and found that 52 of the 389 patients (accounting for 13.37%) had no other clinical symptoms except infertility, that is, no syndrome to be identified, and the emergence of no syndrome cases, indicating that the traditional diagnosis of male infertility has a blind spot. At this time, we need to use modern scientific and technological means to conduct microscopic syndrome differentiation, that is, semen syndrome differentiation. The basic theory of semen syndrome differentiation is: the reproductive organ is located in the yin position, semen belongs to water and is yin, which is yin in yin; essence belongs to fire and is yang, which is yang in yin. Sperm is yang in yin, and sperm itself can be divided into yin and yang. The sperm body is yin-yang in yin; sperm survival rate and sperm activity rate are yang-yang in yang. According to the theory of "Yang turns into Qi, Yin forms shape" in Huangdi Neijing, the strength of sperm motility and the survival rate of sperm are due to the rise and fall of kidney Yang. Because Yin and Yang are both interdependent and mutually restrictive, Yin often harms Yang and Yang harms Yin. Even Yin and Yang are both deficient. When Yang is deficient, cold is generated internally. Microscopic observation shows that semen is clear and cold, sperm motility is weakened, and sperm survival rate decreases. Yin deficiency causes internal heat, or hyperactivity of the phase fire, burning body fluids, and semen volume is small, viscous, liquefaction is abnormal, sperm motility is weakened, and survival rate decreases. For example, Qi deficiency infertility: Qi deficiency causes fatigue, and microscopic manifestations mainly show weakened sperm motility and reduced survival rate. Liver depression infertility: Long-term depression turns into heat, and boiling body fluids can reduce semen volume, make it viscous, liquefaction is abnormal, sperm number may decrease, vitality decreases, and even dead sperm increase. Based on this theory, we can identify and treat patients with abnormal semen but no obvious identifiable macroscopic syndrome. Clinically, we can either replenish semen and nourish the kidney, or benefit the kidney and strengthen yang, or nourish yin and reduce fire according to their semen routine, and have achieved good results, which are reviewed as follows.