Etiology and Treatment of Semen Non-liquefaction in Traditional Chinese and Western Medicine

**Semen liquefaction disorder**

Normal semen, when first ejaculated, is thick and gelatinous due to the coagulation factors secreted by the seminal vesicles.

This prevents the semen that has just entered the vagina from flowing out too quickly. After ejaculation, the semen will settle in the prostate gland 10-20 minutes later.

Under the influence of liquefying factors secreted by the sperm, semen gradually liquefies. Changes in semen viscosity can affect sperm motility and survival.

Viability is affected because proteolytic enzymes can also liquefy thick cervical mucus; therefore, incomplete semen liquefaction also impacts viability.

This impairs the sperm's ability to penetrate cervical mucus, leading to infertility.

**Western Medical Etiology and Pathology**

Semen contains coagulation factors secreted by the seminal vesicles and liquefaction factors secreted by the prostate gland. Currently, it has been found that these factors contribute to...

Among the factors affecting semen liquefaction, the protease system is the most important. Zinc, magnesium, and calcium ions can completely inhibit it.

The first stage of semen liquefaction. Because semen coagulation proteins contain glycosyl groups, salivary glands involved in semen coagulation...

The levels of liquefaction acid or fructose in semen may affect the liquefaction process. This is especially true when there is a difference between semen liquefaction and coagulation factors.

When the balance is disrupted, semen exhibits abnormal liquefaction.

In chronic prostatitis, the secretory activity of the prostate gland decreases, leading to a reduction in the secretion or activity of proteolytic enzymes.

Decreased libido is one of the most common causes of abnormal liquefaction. However, when prostatitis is combined with seminal vesiculitis,

Because both liquefaction and coagulation factors decrease simultaneously, semen may not exhibit liquefaction abnormalities. Additionally, some systemic...

Factors outside of sex and accessory glands, such as changes in body temperature, testicular function, and endocrine changes, are all related to semen fluid.

It is related to chemical processes.

Furthermore, the liquefaction process of semen outside the body is also affected by various external factors, such as room temperature.

Factors such as temperature, sample agitation, and storage time of the semen can all affect the seminal plasma.

This affects the activity of enzyme systems, thereby influencing the degradation process of seminal plasma fibrin and leading to a decrease in semen liquefaction time.

abnormal.

**Traditional Chinese Medicine Etiology and Pathogenesis**

Semen belongs to the category of Yin fluids. The *Neijing* states, "Yang transforms into Qi, Yin forms into shape." Normal liquefaction of semen depends on...

The transformation of Yang energy depends on the balance of Yin and Yang. Insufficient or excessive Yang energy cannot maintain its proper function.

It maintains normal qi transformation function. If kidney yang is congenitally deficient, or if a serious or prolonged illness depletes kidney yang, cold pathogens can stagnate and damage it.

Kidney yang deficiency, or acquired malnutrition, impaired spleen function, and failure to transform dampness and turbidity, leading to stagnation of qi and failure of semen liquefaction. If the constitution is inherently yin...

The deficiency may be due to excessive sexual activity leading to depletion of kidney essence, excessive mental strain, emotional distress causing internal heat that depletes semen, or excessive consumption of warming and drying remedies.

Excessive heat from yang foods can damage yin, leading to yin deficiency and excessive fire. This causes the semen to become concentrated and viscous, making it difficult to ejaculate. A fondness for spicy foods can also exacerbate this.

Strong, rich flavors of alcohol can generate internal dampness and heat, which flows downwards. Alternatively, living in damp, low-lying areas allows dampness to seep in from the outside, accumulating over time and transforming into heat, affecting both the clear and turbid.

Semen liquefaction failure can also occur due to dampness, which is a yin evil, heavy and turbid in nature, sticky and difficult to expel; heat, a yang evil, easily damages yin.

The semen, due to its scorching heat and dampness, becomes viscous and difficult to expel, obstructing the meridians. Furthermore, the individual has a history of phlegm and dampness, and forces themselves to suppress ejaculation.

If ejaculation is not achieved, the semen will be displaced, causing turbidity and blood stasis to obstruct the orifices, leading to qi stagnation and blood stasis, resulting in difficulty in ejaculation and failure of semen to liquefy.

**Key Points of Western Medicine Diagnosis**

**(I) Symptoms**

This disease has no obvious symptoms or signs. However, some cases caused by prostatitis may present with corresponding symptoms and signs.

**(II) Laboratory Tests**

(1) Digital rectal examination: In patients with prostatitis, digital rectal examination may reveal an enlarged and tender prostate.

(2) Semen viscosity determination.

**Western Medicine Diagnostic Criteria and Differential Diagnosis**

According to WHO's in vitro diagnostic criteria, normal semen should liquefy within 60 minutes; liquefaction occurring after 60 minutes...

If semen is not completely liquefied after 1 hour, it is called incomplete semen liquefaction.

Chronic prostatitis is the most important and common cause of abnormal prostate liquefaction. Its symptoms, signs, and...

The key diagnostic points were outlined in the previous section. Similarly, even if inflammation is controlled, the damage to the glandular structure can lead to fibrosis.

Even with scar tissue formation, the glandular secretory function is irreversibly reduced or lost, and semen may still exhibit liquefaction.

Incomplete.

Furthermore, changes in the quantity or composition of prostatic secretions can also affect the biochemical indicators of seminal plasma.

Abnormalities are observed, such as increased pH, decreased zinc ion concentration, high fructose content, and increased seminal plasma osmotic pressure. According to...

The assessment of these indicators can also be used to further evaluate the extent to which prostatitis affects semen liquefaction.

At the same time, based on medical history, symptoms, signs, and endocrine test results, other systemic diseases and testicular abnormalities were also considered.

The differential diagnosis is not difficult based on the influence of testicular function or endocrine regulation.

**Western Medical Treatment**

**(I) Etiological Treatment**

Especially for those who also have prostatitis, comprehensive treatment including antibiotics is necessary.

**(II) Drug Treatment**

For example, hyaluronidase 1500U, once daily via intramuscular injection, or chymotrypsin 5mg, once every other day via intramuscular injection.

Injection, one course of treatment lasts 2 to 3 weeks.

**(III) Topical Medications**

Currently commonly used agents include α-amylase preparations, Alevaire solvent (tetrabutylphenol solvent), and chymoprotein.

The enzyme, pancreatic deoxyribonuclease, and sputolysin were dissolved in phosphate buffer.

Usage: It can be inserted into the vagina before intercourse, or added directly to semen in the correct proportions externally to promote sexual intercourse.

The semen is liquefied before artificial insemination.

**(iv) Physical Therapy**

Semen samples can be agitated or drawn into a syringe and injected under pressure using an 18 or 19 gauge needle.

Place the semen into a glass container and aspirate repeatedly 5-6 times. The liquefied semen can then be used for artificial insemination.

**(V) Artificial Insemination**

Highly motile sperm are collected from non-liquefied semen after sperm washing to remove seminal plasma or after upstream treatment.

Artificial insemination.

**Traditional Chinese Medicine Treatments**

**(I) Yin Deficiency with Hyperactivity of Fire Syndrome**

[Main Symptoms] Thick, non-liquefied semen, difficulty ejaculating, dizziness, tinnitus, palpitations, insomnia, thirst, and frequent urination.

Yellowish-red tongue, dry stools, hypersexuality, nocturnal emission, premature ejaculation, red tongue with little coating, and thready, rapid pulse.

[Treatment] Nourish Yin and reduce fire.

[Prescription] Modified Zhi Bai Di Huang Tang (from Zheng Yin Mai Zhi).

**(II) Kidney Yang Deficiency Syndrome**

[Main Symptoms] Thick, non-liquefied semen, cold semen leading to infertility, impotence, premature ejaculation, lower back and knee weakness, aversion to cold, and cold limbs.

Frequent urination at night, clear and copious urine, dizziness and tinnitus, pale tongue, and deep, thready, and slow pulse.

[Treatment] Warm the kidneys and dispel cold, replenish qi and essence.

[Prescription] Modified Erxian Decoction (from *Clinical Handbook of Traditional Chinese Medicine Prescriptions*). Ingredients: Morinda officinalis, Curculigo orchioides, Epimedium brevicornu, and prepared...

Earth, stir-fried Angelica sinensis, Phellodendron chinense, Anemarrhena asphodeloides, Vaccaria segetalis, centipede, Lindera strychnifolia, fennel, Evodia rutaecarpa.

**(III) Damp-Heat Retention Syndrome**

[Main Symptoms] Thick, non-liquefied semen containing pus and white blood cells; difficulty ejaculating; painful ejaculation; or blood in the semen.

Spermatitis, cloudy semen, accompanied by frequent urination, urgency, painful urination, lower abdominal distension, back pain, fatigue, drowsiness, poor appetite, yellow and greasy tongue coating, and a soft pulse.

Count or slide count.

[Treatment] Clear away damp heat.

[Prescription] Modified Bixie Fenqing Decoction (from Danxi Xinfa).

**(iv) Phlegm and Blood Stasis Obstructing the Orifices Syndrome**

[Main Symptoms] Thick, non-liquefied semen, numerous dead sperm, sometimes visible white blood cells, difficult ejaculation, and a history of phlegm.

Symptoms include dampness, obesity, fatigue, shortness of breath, dizziness, palpitations, perineal and lower abdominal distending pain, pale tongue or tongue with ecchymosis.

Spots, greasy tongue coating.

[Treatment] Promote blood circulation and resolve phlegm.

[Prescription] Modified Huoxue Sanyu Decoction (from *Wai Ke Zheng Zong*). Ingredients: Chuanxiong, Danggui, Fangfeng, Chishao, Lianqiao, Tian

Pollen, soapberry thorns, peach kernel, safflower, scutellaria, bitter orange peel, rhubarb, pinellia, tangerine peel.

**VII. Prevention and Care**

(1) Avoid alcohol and spicy or irritating foods.

(2) Active treatment of the underlying cause is necessary.

(3) During treatment, appropriate restraint in sexual activity is beneficial to the recovery of this disease.