Traditional Chinese and Western medicine diagnosis and treatment of azoospermia and hematospermia

**Azoospermia**

According to the World Health Organization's "Standard Examination and Diagnosis Manual for Infertile Couples," there are sixteen categories of infertility.

The classification does not list azoospermia as a separate condition, but rather categorizes it under idiopathic asthenospermia for analysis. It is generally believed that...

Azoospermia is defined as a decrease in sperm viability, with more than 40% of sperm being dead. This condition is a cause of male infertility.

One of the common causes.

**Western Medical Etiology and Pathology**

Normal semen consists of two parts: sperm and seminal plasma. Sperm death and seminal plasma quality are highly correlated.

Relationship. Defects in spermatogenesis, or sperm passing through inflamed seminal vesicles, prostate, or epididymis, can cause azoospermia.

Common causes include poor nutrition, deficiencies in vitamin A, vitamin E, and other trace elements, which can affect the production of essential nutrients.

The viability of sperm is greatly affected. Other factors such as high temperature and radiation can also cause azoospermia. Additionally, this condition...

It is closely related to antisperm antibodies and reduced sperm count, but not necessarily directly proportional to them.

**Traditional Chinese Medicine Etiology and Pathogenesis**

This condition is often caused by a weak constitution and congenital imbalances, compounded by early marriage, excessive sexual activity, and a habit of masturbation, which damages kidney qi and kidney yang.

Weakness leads to impaired sperm production and nourishment, resulting in an increase in dead sperm. This can be caused by inherent yin and blood deficiency, damage from excessive sexual activity, or...

Prolonged illness affecting the kidneys, excessive use of warming and drying substances that damage yin, or emotional distress leading to depletion of yin essence can all cause kidney yin deficiency.

Excessive heat can scorch kidney essence, leading to an increase in dead sperm. Spleen yang is rooted in kidney yang; deficiency of kidney yang often results in deficiency of both spleen and kidney yang.

If one's spleen and stomach are inherently weak, or if one's diet is irregular, or if overwork or excessive worry damages the spleen, the spleen and stomach's function of receiving and transforming food will be impaired, leading to a deficiency of qi and blood.

Insufficient biochemical source of semen, leading to malnourishment of kidney essence and excessive azoospermia. Also, a diet high in spicy and rich foods, alcohol, and damp-heat.

The production of kidney essence can lead to damage to the kidneys, or it can cause mental depression, liver dysfunction, and stagnation of liver qi, which in turn damages kidney water and kidney essence.

Etc., etc., can also cause azoospermia.

**Key Points of Western Medicine Diagnosis**

This condition is often discovered during semen analysis for post-marital infertility, where more than 40% of sperm are dead. Repeated testing three times is usually sufficient to confirm the diagnosis.

Diagnosis. Patients often have a history of excessive masturbation, nocturnal emission, etc., and sometimes also have orchitis, epididymitis, prostatitis, seminal vesiculitis, etc.

Inflammation or other lesions, or symptoms such as mental weakness and sexual dysfunction. Semen analysis or prostate endoscopy often occur simultaneously.

Pus cells were present.

**Western Medicine Differential Diagnosis**

Not all immobile sperm in semen are dead sperm; this is related to the degree of damage to the sperm membrane.

In dead sperm, the head membrane is damaged, allowing the staining solution to penetrate into the cell and stain it; while in live sperm...

The cells have intact cell membranes, and because the staining solution cannot penetrate into the cells, they do not stain. This method can...

Distinguishing between dead and live sperm is crucial. A higher proportion of immobile sperm than dead sperm in semen has clinical significance.

This indicates the presence of sperm immobilization factors in the semen sample, or a lack of nutrients in the semen that promote sperm motility.

substance.

The commonly used staining method in clinical practice is eosin staining. 0.1 mL of semen is mixed with 0.1 mL of 0.5% eosin Y...

Mix (Eosin Y prepared with 0.15 mol/L phosphate buffer), let stand for 1-2 minutes, and then prepare a semen smear.

Semen smears were air-dried and then observed under a high-powered microscope. Live sperm were not stained, while dead sperm were.

The sperm were stained red. At least 200 sperm were observed and the percentage of live and dead sperm was calculated.

**Western Medical Treatment**

Treatment of this disease remains a challenging issue. For those with a clear cause, such as genital tract infections, [treatment may be possible].

Symptomatic treatment is used; for immunological infertility, corticosteroids, sperm washing followed by artificial insemination, or in vitro fertilization can be used.

Insemination is ineffective for azoospermia caused by abnormal sperm structure; it is also effective for azoospermia caused by abnormal seminal plasma.

For this condition, some researchers have suggested methods such as improving the seminal plasma environment or exchanging seminal plasma with that of a normal person, but these methods are still under investigation.

Exploration phase.

**Traditional Chinese Medicine Treatments**

According to the differentiation of syndromes based on the internal organs and the eight principles of syndrome differentiation, this syndrome can be clinically classified into kidney qi deficiency, kidney yang deficiency, kidney yin deficiency, and dampness.

There are four syndrome types related to heat accumulation. Spleen and kidney yang deficiency can be treated as a concurrent syndrome. There are four key points to improving sperm motility: 1.

The purposes are: firstly, to nourish Yin and reduce internal heat, thereby improving the overall condition; secondly, to clear heat and promote diuresis, thereby controlling infection; and thirdly, to warm and tonify kidney Qi, thereby regulating internal balance.

The fourth function is to soothe the liver and regulate qi, thereby improving local blood circulation.

**(I) Kidney Qi Deficiency Syndrome**

[Main Symptoms] Excessive dead sperm, fatigue, shortness of breath, reluctance to speak, pale complexion, cold extremities, or accompanied by sexual dysfunction.

The patient suffers from low libido, impotence, and premature ejaculation. His tongue is pale with a thin white coating, and his pulse is deep and thready.

[Treatment] Tonify the kidneys and promote the flow of Qi.

[Prescription] Wuzi Yanzong Wan (from Shesheng Zhongmiaofang) with added ingredients.

**(II) Kidney Yang Deficiency Syndrome**

[Main Symptoms] Excessive azoospermia, cold limbs, pale complexion, impotence, premature ejaculation, soreness and weakness of the lower back and knees, dizziness.

Symptoms include lethargy, frequent and clear urination, a swollen tongue with a thin white coating, and a deep, thready, and weak pulse.

[Treatment] Warm the kidneys and strengthen yang.

[Prescription] Modified Zanyudan (from Jingyue Quanshu).

**(III) Kidney Yin Deficiency Syndrome**

[Main Symptoms] Excessive azoospermia, weakness in the lower back and knees, tinnitus and dizziness, insomnia and excessive dreaming, hot flashes in the palms, soles, and chest, and dry mouth and throat.

Dryness, excessive libido or seminal emission, red tongue with little saliva, and thready and rapid pulse.

[Treatment] Nourish kidney yin.

[Prescription] Yin-nourishing and Seed-Promoting Pills (from *Miaoyizhai Medical Printing and Seed-Promoting Compilation*), modified into a decoction. Ingredients: Anemarrhena asphodeloides, Phellodendron chinense, Astragalus membranaceus.

Winter, mulberry fruit, dodder seed, wolfberry fruit, schisandra fruit, prepared rehmannia root, raw rehmannia root, polygonatum rhizome, achyranthes root, fleeceflower root, white poria cocos.

Poria cocos, cypress seed kernel, and yam.

**(iv) Damp-Heat Accumulation Syndrome**

[Main Symptoms] Excessive azoospermia, obesity, chest tightness and palpitations, dry and sticky mouth, swollen and painful kidneys, and scanty urination.

Red tongue, loose stools, or dizziness, impotence, seminal emission, red tongue body, yellow and greasy tongue coating, and wiry and rapid pulse.

[Treatment] Clear heat and promote diuresis.

[Prescription] Modified Bazheng Powder (from the Imperial Pharmacy Formulary).

**VIII. Prevention and Care**

(1) Avoid excessive drinking, smoking and overwork, and do not wear tight pants, etc.

(2) Avoid taking hot baths above 38°C and avoid contact with chemicals.

(3) Sexual life should be regular; one should neither abstain from sex nor indulge in it.

(4) Eat more vegetables and soy products regularly.

(5) Actively treat the primary disease.

**Hematospermia**

The presence of blood in semen is called hematospermia. It is both a medical condition and a symptom. It is most commonly seen in...

Seminal vesiculitis often occurs concurrently with chronic prostatitis, hence the name prostatospermia. It is most common in young and middle-aged men and women, but can also occur in other groups.

Elderly people.

**Western Medical Etiology and Pathology**

The most common cause of hematospermia is seminal vesiculitis. The seminal vesicles are located above the prostate gland, and between the bladder and rectum.

Between the intestines, its end merges with the end of the vas deferens to form the ejaculatory duct, which leads to the urethra. Its secretions participate in the production of semen.

The composition of seminal fluid. Because the seminal vesicles are adjacent to organs such as the prostate, urethra, and rectum, when these organs are inflamed,

Bacteria can easily spread to the seminal vesicles, causing inflammation, swelling, and congestion of the seminal vesicle walls. This is because the seminal vesicle wall contains a...

The tiny vascular network, containing numerous capillaries, is easily injured and prone to bleeding. (Except for sexual activity.)

In addition to occasional hematospermia, patients often experience mild perineal, rectal, and lower abdominal pain, or urinary tract symptoms such as painful urination.

Symptoms of systemic infection.

In addition, the following diseases are also common causes of hematospermia:

(1) Congenital malformations: such as Müllerian duct cysts and adhesions to the seminal vesicle and ejaculatory duct, which are prone to...

Infection and bleeding, seminal vesicle dilation, ejaculatory duct dilation, and vascular malformations, such as submucosal veins in the prostatic urethra, may occur.

Varicose veins, etc.

(2) Damage: such as damage to glandular tissue caused by prostate stones, damage caused by excessive prostate massage, etc.

(3) Infection: This is the main cause of hematospermia, with Escherichia coli infection being the most common, followed by...

Streptococcus, gonococcus, and tuberculosis infections can also cause bleeding.

(4) Tumors: Among benign tumors, benign prostatic hyperplasia is the most common, while malignant tumors can also cause hematospermia.

(5) Other causes include seminal vesicle amyloidosis and cirrhosis. Additionally, excessive masturbation, frequent sexual intercourse, and vigorous sexual activity can also contribute.

Sexual intercourse can also cause hematospermia.

**Traditional Chinese Medicine Etiology and Pathogenesis**

Excessive sexual activity is the main cause of hematospermia, and kidney deficiency is the main pathogenesis of hematospermia. Excessive sexual activity damages the kidneys.

Kidney yin deficiency leads to internal heat, which intensifies during dreaming or intercourse. This may be due to external pathogens or internal damp-heat, causing seminal emission.

When the seminal vesicle is disturbed, blood overflows from within, resulting in hematospermia. Some patients with hematospermia have a weak constitution and blood, exacerbated by the depletion of semen and blood.

If this continues for a long time, symptoms of deficiency of both qi and blood may appear in the later stages.

**Key Points of Western Medicine Diagnosis**

**(I) Clinical Manifestations**

Semen containing blood is ejaculated during sexual intercourse, masturbation, or nocturnal emission. The semen appears pale red to the naked eye, or...

It contains bright red blood streaks, and microscopic examination reveals a large number of red blood cells. In cases caused by seminal vesiculitis, it is often accompanied by decreased libido and premature ejaculation.

Symptoms include loose stools, mild perineal pain or a feeling of heaviness, painful ejaculation, frequent urination, and painful urination; these may be caused by prostatitis.

Other symptoms may include burning sensation during urination, frequent urination, dribbling after urination, or a milky white discharge from the urethra after urination.

It can even lead to sexual dysfunction such as premature ejaculation, nocturnal emission, and erectile dysfunction; caused by tumors, tuberculosis, trauma, cirrhosis, and

Those caused by blood disorders will be accompanied by corresponding symptoms and signs.

**(II) Diagnostic Points**

Gross hemospermia and microscopic hemospermia are the main diagnostic points for seminal vesiculitis. Other characteristics also include:

(1) Age of onset: Primarily affects young and middle-aged adults, but can also occur in the elderly and adolescents. Clinically, the most common [symptoms/conditions] are...

The youngest was only 14 years old, and his first nocturnal emission was bloody; the oldest was 78 years old, and he experienced bloody semen during nocturnal emission. However, most of them...

Born in a sexually active youth.

(2) Intermittent onset: Many patients with hematospermia stop bleeding on their own without treatment, but this does not mean they are cured.

(3) Other symptoms are not obvious and may not be noticed at first. It is only after the woman's menstruation is ruled out that the man is hematospermia.

**Western Medicine Differential Diagnosis**

Hematospermia should be differentiated from hematuria, bloody urine, and seminal turbidity.

**(I) Hematuria, Blood in Urine**

Both are conditions involving blood in the urine, belonging to the urinary tract. However, hematuria is generally painless and is mostly caused by...

It can be caused by urinary tract tuberculosis or tumors. Hematuria is accompanied by symptoms such as frequent urination and painful urination, and is often caused by acute urinary tract infections.

Caused by conditions such as urinary tract stones.

**(II) Cloudy Urine**

The main symptom is a whitish, semen-like discharge often presenting at the urethral opening, which is mostly caused by prostatitis.

In addition, prostate and seminal vesicle tuberculosis, seminal vesicle cysts, seminal vesicle cancer, prostate and seminal vesicle stones, and gonococcal seminal vesicle disease.

Inflammation and other diseases can cause hematospermia, and clinical examinations should be conducted to differentiate between them.

**Western Medical Treatment**

**(I) Anti-inflammatory**

Treatment should be based on prostatitis and seminal vesiculitis, using sulfonamides or antibiotics for infection control, such as sulfamethoxazole.

SMZ, norfloxacin, and tranexamic acid are sometimes used for ejaculation via seminal vesicle and prostate massage (in acute cases).

Except during the period, allow the fluid containing bacteria in the seminal vesicles to be emptied as soon as possible to facilitate recovery.

**(II) Hemostasis**

Diethylstilbestrol, Vitamin K, and Anluoxue, etc.

**Traditional Chinese Medicine Treatments**

**(I) Damp-Heat Accumulation Syndrome**

[Main Symptoms] Large volume of semen, dark red in color, painful ejaculation, burning and distending pain in the testicles, lower abdomen and perineum, and flushed face.

Red eyes, bitter taste in mouth, dry throat, chills and fever, chest tightness and discomfort, frequent urination with hot, reddish, and painful urination, or cloudy urine, constipation.

The tongue is red with a yellow or yellow-greasy coating, and the pulse is wiry and rapid or wiry and slippery.

[Treatment] Clear the lower burner, cool the blood and stop bleeding.

[Prescription] Modified Longdan Xiegan Tang (from *Lan Shi Mi Cang*). For those with deep red semen, add Sophora japonica flower, Cirsium japonicum charcoal, and Epimedium.

Agrimonia pilosa; for those with constipation, add charred rhubarb.

**(II) Liver and Kidney Deficiency Syndrome**

[Main Symptoms] Bright red semen, possibly accompanied by painful ejaculation, lower abdominal and vulvar discomfort, and lower back and knee pain.

Symptoms include weakness, dizziness, tinnitus, irritability, dry mouth, scanty dark urine, red tongue with little saliva, and a thready, rapid pulse.

[Treatment] Nourish Yin and reduce fire, cool blood and stop bleeding.

[Prescription] Modified Erzhi Wan (from Zhengzhi Zhunsheng).

**(III) Qi and Blood Deficiency Syndrome**

[Main Symptoms] Due to prolonged illness, the semen is pale and thin, the complexion is sallow, dizziness, insomnia, forgetfulness, poor appetite, and poor bowel movements.

The patient presents with symptoms including fatigue, lower back and knee pain, pale tongue with white coating, and weak, thready pulse.

[Treatment] Replenish Qi and blood, and guide blood back to the spleen.

[Prescription] Modified Gui Pi Tang (from "Annotated Prescriptions for Women").