Azoospermia can be divided into true and false. True azoospermia refers to the atrophy and degeneration of testicular spermatogenic cells, which can not produce sperm, also known as "congenital azoospermia"; Pseudoazoospermia means that the testis can produce sperm, but the vas deferens is blocked and the sperm cannot be discharged, so it is also called "obstructive azoospermia".
This disease belongs to the category of absolute infertility.
I. Etiology and pathogenesis
1. Testicular spermatogenesis dysfunction
(1) Hereditary diseases: such as hermaphroditism.
(2) Congenital abnormalities: azoospermia, bilateral cryptorchidism, germ cell dysplasia, severe oligozoospermia, etc.
(3) Endocrine abnormalities: common hypogonadism, hypogonadism, hyperprolactinemia, hyperthyroidism, excessive androgen and estrogen caused by hypergonadism.
(4) Sertoli cell syndrome: Sperm can be caused by congenital or acquired factors, leaving only Sertoli cells, leading to azoospermia.
(5) Vitreous lesions of seminiferous tubules: nonspecific lesions, which can be caused by nonspecific inflammation or parotitis and orchitis.
(6) Severe varicocele.
(7) High titer anti-sperm antibody.
(8) Edible crude cottonseed oil.
(9) Drug and radiation damage.
(10) Others: tuberculosis of reproductive system, serious systemic diseases, malnutrition, etc.
2. Obstruction of vas deferens
(1) Congenital malformation: ① Congenital absence of vas deferens: partial or total absence. ② Dysplasia of vas deferens: The whole or part of vas deferens is stunted, slender or blocked. ③ Congenital epididymal dysplasia: including head, body or tail dysplasia of epididymis, or the epididymis is not connected with testis. ④ Congenital absence of seminal vesicle or ejaculatory duct.
(2) Infection: Common infections include tuberculosis and gonorrhea. ① When mycobacterium tuberculosis invades the vas deferens, the wall of the vas deferens thickens, and the vas deferens becomes hard and thick, showing a beaded shape. The lesion can spread to the tail of epididymis and the whole epididymis and testis. ② Neisseria gonorrhoeae infection mainly destroys the tail of epididymis, rarely invades the head of epididymis and often involves vas deferens.
(3) Injury: It is mainly caused by iatrogenic injury, including varicocele surgery, hernia repair, testicular hydrocele inversion, etc. These operations may damage nerves and blood vessels in vas deferens, epididymis or spermatic cord, and cause secondary injuries.
(4) Tumors: Tumors and tumors in spermatic cord, epididymis and seminal vesicle cysts can reduce the fertility of one side and cause bilateral infertility.
Second, the clinical manifestations and diagnosis
1. No clinical symptoms and signs except infertility. Some patients have a history of prostatitis, seminal vesiculitis, epididymitis and epididymal tuberculosis. Some patients have testicular dysplasia, testicular atrophy, epididymal nodules and other local signs and other systemic symptoms.
diagnose
(1) Semen with more than 3 times is routinely azoospermic.
(2) Spermatogenesis can be observed by testicular biopsy.
(3) Angiography can determine whether the vas deferens is blocked or not.
(4) Immunological examination can determine whether there is immune infertility.
Third, dialectical treatment.
1. congenital deficiency type
Dialectical semen is thin and cold, with little quantity and no semen. Or with sticky lumps, low sexual desire. Accompanied by chills, cold limbs, pale face, listlessness, improper diet, weak waist and knees, thin stool, long urination or nocturia. The tongue is pale with white fur and thin pulse.
Tonify kidney, strengthen yang, replenish qi and replenish essence.
Prescription Wuzi Yanzong Pill and Shenqi Pill: 3g of Cinnamomum cassia, 3g of Radix Aconiti Lateralis Preparata, 40g of Semen Cuscutae (fried), 5g of Fructus Schisandrae Chinensis (steamed), 20g of cornu Cervi 10g, 20g of Rubi, 40g of Lycium barbarum, 0/0g of Rehmannia glutinosa, 0/0g of yam and Cornus officinalis 12g, 6g of Placenta Hominis, Radix Codonopsis and Atractylodis Rhizoma. Decoct with water.
2. Kidney yin deficiency type
According to syndrome differentiation, the amount of semen is small and sticky, even a little semen, azoospermia, normal or hyperactive sexual desire, weak waist and knees, mental fatigue and forgetfulness. Accompanied by dizziness, thirst, dry throat, upset, insomnia and dreaminess, and even tooth loss. Red tongue with little fur and thin pulse.
Treat nourishing yin and replenishing essence, tonifying kidney and benefiting qi.
Add and subtract Wuzi Yanzong Pill and Baxian Changshou Pill: Semen Cuscutae (stir-fried), Fructus Lycii each 40g, Fructus Schisandrae Chinensis 6g, raw and cooked parts 24g, Rhizoma Dioscoreae and Fructus Corni each 65438±02g, Radix Codonopsis, Radix Ophiopogonis, Polygonum Multiflori Radix, Cortex Moutan, Rhizoma Anemarrhenae and Cortex Phellodendri each 9g, Carapax et Plastrum Testudinis (stir-fried first), Rubi and seal kidney each 20g. Decoct with water.
3. Blood stasis type
Syndrome differentiation: less semen, no sperm. Silence, chest tightness, irritability, pudendal pain, or abdominal pain, or fatigue without other obvious symptoms, frequent tongue pulse, only abnormal semen routine examination. The tongue is purple and dark, with petechiae on the edge of the tongue and heavy and astringent pulse.
Treating blood circulation, removing blood stasis, dredging essence and qi, tonifying kidney and replenishing essence.
Xuefu Zhuyu Decoction combined with Wuzi Yanzong Pill: Zhiren, Carthamus tinctorius each 65438±00g, Radix Paeoniae Rubra, Radix Angelicae Sinensis and Radix Rehmanniae each 65438±02g, Rhizoma Chuanxiong and Fructus Schisandrae each 6g, Semen Cuscutae, Rubus, Rhizoma Curculiginis and Fructus Lycii each 20g, Herba Epimedii, Radix Bupleuri, Radix Achyranthis Bidentatae, Fructus Gleditsiae Abnormalis and Radix Glycyrrhizae each 6g. Decoct with water, and blende with yellow wine.
4. Damp-heat resistant type
According to syndrome differentiation, the amount of semen is small and thick, there is no sperm, urine is short and red and turbid, and even white and turbid after urine. Red tongue, yellow greasy fur and slippery pulse.
Treat clearing heat and promoting diuresis, dredging essence, inducing resuscitation and tonifying kidney.
Chinese yam, medlar, plantain seed, Alisma orientalis, Anemarrhena asphodeloides, Cortex Phellodendri, Achyranthis Radix, Radix Isatidis, Fructus Lipuidambaris, Rhizoma Acori Graminei, Radix Rehmanniae, Poria, Cornus officinalis, a total of 65438±05g. Decoct with water.
5. Phlegm-dampness accumulation type
Syndrome differentiation: less semen, no sperm. Hard pain accompanied by abdominal pain and testicular swelling, red tongue, white and greasy fur, and heavy, slippery or slow pulse.
Yiqi Huatan, Ruan Jian San Jie.
Prescription He Ju Pill: He Ju Pill (stir-fried), Toosendan Fructus (stir-fried), Seaweed, Thallus Laminariae, Peach Kernel 65438±00g each, Rhizoma Corydalis (processed with vinegar), Cortex Cinnamomi, Cortex Magnolia Officinalis (processed with ginger), Akebia stem, Radix Aucklandiae and Fructus Aurantii Immaturus (stir-fried with bran).
Each 3g
Fourth, adjuvant therapy.
1. Prescription
(1) Qibaomei beard pill, Shengsui Yulin pill, Qijudihuang pill, Shengjing capsule, Shengjing tablet, Shengjing pill and Zhongjingling pill (suitable for kidney deficiency type).
(2) Huoxue Siwu Pills and Compound Danshen Tablets (suitable for blood stasis and heat type).
2. Prescription
(1) Fructus Schisandrae, Fructus Lycii, Semen Cuscutae, Ruby, Semen Plantaginis each 15g, Radix Bupleuri, Radix Paeoniae Alba and Fructus Aurantii each 12g, Semen Persicae and Flos Carthami 3g, and Radix Glycyrrhizae 6g. Placenta Hominis powder, dog kidney, Rhizoma Curculiginis, Herba Epimedii, Radix Morindae Officinalis and Herba Cynomorii for yang deficiency; Radix Rehmanniae Preparata, Rhizoma Dioscoreae, Corni Fructus, Radix Asparagi, Radix Ophiopogonis, Fructus Ligustri Lucidi, and Ecliptae Herba are added for patients with yin deficiency; Pangolin, Semen Vaccariae, Fructus Lipuidambaris, Radix Cyathulae, Lumbricus, Herba Artemisiae Anomalae, Radix Angelicae Sinensis and Ramulus Cinnamomi are added for blood stasis. Decocting in water, taking 1 dose every 3 ~ 4 days, and taking 7 ~ 1 dose every month is1course of treatment.
(2) Flos Chrysanthemi Indici 15g, Flos Lonicerae 20g, Cortex Phellodendri 10g, Rhizoma Anemarrhenae 10g, Herba Taraxaci 10g, Herba Violae 10g, Fructus Ligustri Lucidi 10g, and Rhizoma Atractylodis 8g. Decoct with water, daily 1 dose, and take it in the morning and evening.
(3) Placenta Hominis powder 20g (taken separately), Flos Lonicerae 20g, Poria 20g, Radix Polygoni Multiflori 15g, Radix Astragali 15g, Fructus Lipuidambaris 15g, and Herba Lycopi 10g. Decoct with water, daily 1 dose, and take it in the morning and evening.
(4) swim bladder 10g, placenta 10g, pilose antler 3g (melted separately), Radix Rehmanniae Preparata 20g, Semen Astragali Complanati 10g, Polygonum Multiflori Radix 15g, Fructus Corni 12g, and Radix Angelicae Sinensis/kloc-. Decoct in water and take it twice, daily 1 dose (suitable for kidney deficiency type).
(5) Semen Cuscutae 15g, Mulberry 15g, Radix Codonopsis 15g, Rhizoma Polygonati 15g, Radix Morindae Officinalis 10g, Fructus Schisandrae Chinensis 10g and Fructus Lycii 10g. Poria cocos 10g, Rhizoma Pinelliae Preparata 10g, Semen Plantaginis 15g, Fructus Cnidii 10g, Radix Glycyrrhizae Preparata 6g, Rubus 12g, Pericarpium Citri Tangerinae 3g, and Cortex Cinnamomi 3g (orally). Decoct in water and take it twice, daily 1 dose (suitable for kidney deficiency type).
(6) 6g of safflower, 9g of peach kernel, 20g of radix rehmanniae, 9g of cortex moutan, 20g of poria cocos15g, 20g of yam, 20g of honeysuckle, 0g of cortex phellodendri10g, and 0g of fructus liquidambaris15g. Decoct with water, and take it twice, daily 1 dose (suitable for stasis-heat type).
(7) Colla cornus Cervi, Colla Plastri Testudinis, Herba Cistanches and Fructus Schisandrae Chinensis 600g each, Herba Epimedii, Semen Allii Tuberosi, Semen Cuscutae and Rhizoma Dioscoreae 240g each, Ginseng, Poria, Fructus Psoraleae and Semen Platycladi 200g each, Black beans 2400g, Gecko 1 pair, 2 sets of Placenta Hominis and 2 pairs of bovine testis. All medicines are powder, honey is pill, and the weight of pill is 10g, three times a day, each time 1 pill, with meals.
(8) Appropriate amount of Herba Epimedii, Herba Cistanches, Rhizoma Curculiginis and Fructus Lycii. Daily 1 dose, decocted in water, and taken twice. Or made into honeyed pills, weighing 9g, 2 pills each time, 2-3 times a day, and taken with boiled water. Six months is 1 course of treatment.
(9) Male silkworm moth, colla cornus Cervi, Herba Epimedii, Radix Aconiti Lateralis Preparata, Semen Cuscutae, Achyranthis Radix, Ruby, Herba Dendrobii, Semen Allii Tuberosi, Herba Cistanches, Cortex Cinnamomi, Radix Morindae Officinalis, and seal kidney. First, boil the antler powder with cold water until it boils. After the powder is dissolved, add 100 ~ 200ml yellow wine to the silkworm moth powder, boil it with slow fire, turn off the fire, add the remaining powder (Cuscuta chinensis should be soaked in 65% Chinese liquor 12h), stir and make into pills, weighing 9 ~ 12g. Take 1 pill in the morning, afternoon and evening. 15 ~ 20 days is 1 course of treatment (suitable for kidney-yang deficiency).
3. Acupuncture therapy
(1) Acupoints: Shenshu, Zusanli, Qugu and Shenque (moxibustion), with Renmai Meridian and Beishu as the main points, acupuncture 1 time a day, and tonic method (suitable for those with deficiency of kidney-yang and essence).
(2) Acupoints: Sanyinjiao, UnionPay, Zusanli, Guanyuan and Taixi, which are the main acupoints of the spleen meridian of Foot Taiyin, Ren meridian and Foot Shaoyin meridian. Acupuncture/kloc-0 times a day, with tonic method (suitable for kidney yin deficiency and essence deficiency).
(3) Acupoint selection: The acupoints of bladder meridian are mainly curved bone, rank edge, secondary point and so on. Tonifying Xie Ping or purging method (suitable for those with blood stasis and spermatic cord obstruction).
(4) Acupoint selection: Renmai and Zutaiyin meridians are the main acupoints, that is, Zhongji, Yinlingquan and Sanyinjiao, and the lower method is used (suitable for those with damp-heat accumulation and poor semen).
(5) Acupoints: The spleen meridian and ren meridian of Foot Taiyin mainly include Zhongji, Fenglong, Yinlingquan and Taibai. Purging method (suitable for patients with phlegm blocking collaterals and obstruction of spermatic cords and meridians).
(6) Point selection: Ren Du, Foot Shaoyin and Foot Temples are the main points, and ginger-separated moxibustion and acupuncture are used for treatment. First, moxibustion at Guanyuan, Qihai and Sanyinjiao points separates ginger, and then moxibustion at Mingmen, Shenshu and Taixi points separates ginger. Moxibustion for five days in each group, 1 time every day, 1 time is1course of treatment (suitable for patients with kidney deficiency and sperm deficiency and azoospermia).
Verb (abbreviation of verb) nursing
(1) Eat more foods rich in vitamins (especially vitamin E).
(2) Avoid smoking, drinking and overeating spicy food.
(3) Avoid wearing tight pants. And control sexual intercourse.