Updated: Mar 5, 2019
Biao Lu, Shiaoting Jing, Kehua Zhou, and Guanhu Yang
When treating male infertility with traditional Chinese medicine, the typical treatment involves tonifying Kidney Yin or Yang energy. In traditional Chinese medicine texts, there is a saying that goes, “Kidney has no excessive condition; it always needs to be tonified. Liver has no deficient condition.” But we have found over the years and through our own research that tonifying the kidney, while suitable for elderly patients, may not be appropriate for young patients diagnosed with male-factor infertility. In fact, giving young male patients with infertility kidney yang tonics will often worsen excess or damp heat symptoms.
We were involved in a research program which focused on tonifying kidney Yin or Yang to improve sperm quality. After 3 to 4 months of treatment, the patients rechecked their sperm quality. In a majority of cases, there was either no change, or the sperm quality was slightly worse than before. We found, therefore, that tonifying the kidney was not as effective as we thought in young male patients with infertility.
As described below, we usually use differentiation of symptoms and signs for male-factor infertility due to poor sperm quality with a satisfactory therapeutic effect in the treatment of each condition.
1. EXTERNAL PATHOGENIC FACTOR BLOCKING ESSENCE
Over the years, we noticed that many of our male fertility patients were young and did not exhibit many deficiency symptoms. More than 50% of male infertility patients have some kind of allergy, such as sinusitis or skin conditions. When the person has an external pathogen in the body, this triggers their immune system to become hyperactive, causing inflammation and attacking and damaging the sperm. Pulse: right Cun position is floating and indicative of external pathogen. We treat the patient with herbs and acupuncture as if we are treating a normal cold or allergy. Without clearing external pathogen, the functions of the reproductive system will not return normal and all the kidney tonic herbs will not work. For all infertility patients this is the first step. In the majority of patients, once “Biao” symptoms improve, their sperm quality and quantity also will improve usually without any kidney tonics.
One of the male patients who was 45 years old had a bad allergy and a low sperm quantity. After 3 months treatment of sinus allergy, his allergic symptoms are all under control and in the meantime, his quantity of normal sperm increased 10 fold. The points we used were GB 20 using warming techniques without needle retention together with acupuncture at LI 4, ST 36, DU 23, RN 12, auricular Shenmen, and SP 10.
2. DAMP HEAT IN THE LOWER JIAO
Damp heat in the lower Jiao often causes a temperature increase in the local tissue. Sperm prefers a cooler environment, so an increase in local body temperature may damage them. For men whose poor sperm test results are caused by varicocele, most western doctors recommend surgery in order to lower the local temperature. But in TCM, we can also lower the local body temperature without surgery.
This type of patient often feels hot. When you touch the wrist area to feel the pulse, it often feels clammy. The face is red, flushed. Those patients often have simultaneous prostate enlargement issue with symptoms like frequent urination, clammy external genital area, skin rash, feeling hot, and a thick yellow greasy coating at the back of tongue. Pulse: Chi position is strong and slippery, particularly on the right side. Treatments involve clearing damp heat in the lower Jiao. For example, the following herbal formulae can be used: Liu Yi San, Ba Zheng San, Long Dan XieGan Tang.
The acupoints used should include RN 4, SJ 5, SP 10, SI 4, and DU 20. One of the patients was 52 years old,
and had only 5% normal sperm before treatment. We used this group of acupoints combined with herbs including Hua Shi, Gan Cao, Wu Yao, Che Qian Zi, Ju He, Chao Bai Zhu, Bian Xu, and Fu Shen. After 4 months, his percentage of normal sperm increased to 11%.
3. HEAT IN THE BLOOD
Patients with heat in blood often have skin conditions such as psoriasis or eczema. The tongue is often red or dark red. Pulse: often rapid or sometimes floating in all positions. Treatment involves cooling the blood. Herbal examples include Ren Dong Teng, Tu Fu Ling, Ban Lan Gen, Bai Xian Pi, Chong Lou, Bai Mao Gen. One patient had severe skin eczema with only 2% normal sperm in his semen analysis. He was treated with herbal formulae that clear blood-heat and contain such herbs as Tu Fu Ling, Ren Dong Teng, Da Qing Ye, Shan dou Gen, Sao Xiu, Wu Yao, and Ju He. After three weeks, the quality of his sperm increased which was represented by up to 15% normal sperm as compared to 2% normal sperm under lab test before treatment.
For this type of patient, we often use Ba Liao (BL 31-34), SP 10, LR 2, LI 11, and SP 4. We also used auricular shenmen and often see congested veinules after needling. In this case, we may also prick and bleed a few drops of blood.
4. KIDNEY YANG DEFICIENCY
Less than 10% of patients have kidney yang deficiency. The patient always feels cold; hands and feet are always cold. No skin rash or infection is present in the body. Pulse: not floating. Tongue: tooth marks, pale. Patient often feels tired or fatigued. Treatment involves using warm herbs such as Gui Zhi, Sheng Jiang, Yang Qi Shi, and Fu Zi. When we are treatin the patient, we need to be careful that the patient does not develop any heat signs such as skin rash, sore throat, canker sores, etc. If we see this, we need to stop using Yang tonic herbs and instead use herbs to clear heat. Once, we had a patient with cold hands but no other symptoms. This patient and his wife had tried IVF three times without success. We used herbs with warming properties such as Fu Zi, GuiZhi, Gan Jiang, and Xi Xin, for six months. Finally his wife got pregnant naturally.
Acupuncture points: RN 4, RN 6, SJ 4, DU 20, and GB39. Moxibustion is often very helpful.
5. KIDNEY YIN DEFICIENCY
Patient often feels dry, thirsty, has hair loss, lower back pain, is forgetful, and has difficulty concentrating. Tongue: very thin, reddish. Pulse: thready, thin. Herbal formula: Liu Wei Di Huang Wan modified (Six Ingredient Pill with Rehmannia modified). In these cases, it is often beneficial for the patient to reduce the frequency of his sexual activities in order to conserve Kidney Yin. When we use Kidney Yin tonic herbs, we also need watch carefully for dampness; that is why Liu Wei Di Huang Wan also has ZeXie, Dan Pi, and Fu Ling, which help to clear any heat and leach out dampness.
Acupuncture points: KI 3, KI 6, LU 7, UB 23, UB 52, RN 4, RN 6, DU 20, and auricular kidney point.
6. SINKING QI IN THE MIDDLE BURNER
Patient often feels fatigued, has a pale complexion, sometimes has indigestion or feels light-headed. Herbal formula: Bu Zhong Yi Qi modified (Tonify the Middle and Augment the Qi Decoction Modified). The spleen and stomach provide nutrition and thus energy like batteries. Nutrition from the spleen and stomach guarantees the normal functioning of the kidney. For many patients, once we start working on the Middle Jiao with the Bu Zhong Yi Qi approach, they immediately feel more energized with increased libido and less depression; their sperm quality and quantity tend to improve quickly. If this condition does not change, Kidney Qi therefore is not going to get better. Good spleen and stomach function are the key to for treatment.
Acupuncture points: DU 20 or DU 26, RN 12, SJ 5, SP 4.
On the contrary, most patients had damp heat in the Lower Jiao or were fighting some sort of external pathogen. These are the most common constitutional types we see in the clinic, but the patients can often experience liver Qi stagnation (1), or heart and kidney/ Spleen disharmony (2), Blood stagnation (3), or other types of symptoms simultaneously.
We also often use the following protocol for acupuncture treatment of male infertility combined with the above differentiation of symptoms.
Front: SP 10 using Electro-acupuncture, DU 20, RN 4, KI 6.
Back: UB23, UB52, UB26, UB32, GB20.
Liu Bao-guang, Clinical observation of San Yu Tang in treatment of male infertility, Shandong J. Trad. Chin. Med., 1999, vol. 18, no. 5, pp. 203–204.
Chen Xiao-Yuan, Treatment methods of warming the spleen and kidney nourishing the heart, and replenishing Essence in 25 male infertility patients, New J. Trad. Chin. Med., 1998, vol. 30, no. 5, p. 38.
Zhuo Guang-an and Zhang Zong-sheng, Treatment with Hua Yu Tian Jing Tang in 46 inflammatory and obstructive azoospermia patients, Beijing J. Trad. Chin. Med., 1998, no. 1, pp. 44–45.