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שלום אני מצרף מאמר שלי בנושא טיפול בפריון הגבר. המאמר התפרסם בגרסה האנגלית שלו במספר מגזינים בארצות הברית: טל Treatment of Oligozoospermia (Few Sperm Cells in the Semen) AND Asthenozoospermia (Impaired Sperm Motility) in Traditional Chinese Medicine / Tal belo l.ac m.a.o.m *Tal Belo Practices AND Teach Chinese medicine in tel Aviv Israel. Introduction: Each AND every night, millions of couples around the world have sexual intercourse with the intention of conceiving AND having a baby. Doctors evaluate that 10%-15% of the couples trying to conceive a baby encounter difficulties in achieving pregnancy. According to statistics, the chance of becoming pregnant is approximately 25% during each ovulation. This means that it takes an average couple between one month to four months to conceive. With healthy, fertile couples, 15% become pregnant within one month of trying, 55% within three months, 70% within 6 months, AND 88% within a year. This article reviews treatment of male infertility in traditional Chinese medicine, especially since Western medicine has no answer today for most cases of low sperm quantity AND quality, other than artificial inseminations, micro-manipulations AND invasive fertility techniques. Western Medicine: What is infertility? Infertility is defined by most medical protocols as inability to conceive after one year of unprotected intercourse. In order for a woman to become pregnant, the following processes must take place: · The man must produce a sufficient amount of normal AND active sperm. · The woman must produce normal eggs (ova). · Sperm must be able to move up the cervix AND meet the egg, which was collected by the fallopian tube. · When the sperm has fertilized the egg, they must move into the uterus AND plant themselves on its wall. Approximately 80% of the cases where infertility is diagnosed have a definite, known reason. Reasons for male infertility: · Reduction in sperm count: studies conducted in the last few years show that sperm quantity AND quality have been declining in the last 50 years. It is suspected that lifestyle, nutrition AND environmental factors are the causes of this decline. · Various infections: usually caused by chlamydia in the vas deference. In most of the cases this is an asymptomatic infection, AND the assumption is that 3%-7% of male infertility cases are linked to this infection. · Varicocele: dilation AND congestion of the testicle veins. Varicocele affects the blood drainage from the testicle, in various levels of severity, AND its incidence is 20%-40% in infertile men. · Environmental risk factors: exposure to chemicals, poisonous metals, heat, cellular phones, pesticides, smoking, drug AND alcohol consumption affect sperm quality AND quantity. Laboratory values: Oligozoospermia: few sperm cells in the semen. Less than 40 million sperm cells in the semen, OR less than 20 million per milliliter. Asthenozoospermia: impaired sperm motility. Clinical analysis of impairments in sperm production: Normal sperm production is controlled AND regulated by the gonadotrophin hormones. Disorders in sperm production can be analyzed according to the levels of these hormones. Impaired production with normal hormone levels: · The OTA (oligoteratoasthenozoospermia) syndrome – reduction in sperm concentration, reduced motility AND abnormal appearance of the sperm. Treatment includes sperm selection AND artificial insemination, OR in vitro fertilization. · Blockage in the sperm duct – lack of sperm in the semen, while testicle biopsy shows full sperm production. Treatment is surgical. · Infections – sometimes asymptomatic. High ejaculate volume, white blood cells in the semen, AND presence of microbes. The infectors are atypical: chlamydia, mycoplasma. Treatment is with antibiotics. · Varicocele: dilation of the veins draining the testicle. Treatment is surgical. Impaired production with low hormone levels: The reason for low hormone levels is impaired production of hormones in the brain (hypothalamus-hypophysis). When the problem is congenital, symptoms appear during childhood – non-development of secondary sex characteristics, small penis AND testicles, sparse body hair (for instance: the Kalman Syndrome). When the disorder is acquired, symptoms showing in adults are different: reduced libido, impotence, retrogression of secondary sex characteristics (for example: prolactinomas AND other growths). Treatment is mainly by hormones. Impaired production with high hormone levels: · Undescended testicles – testicles located outside the scrotum. Surgical treatment is required in order to prevent impairments in sperm production AND reduce the risk of testicular cancer. · Non-development OR atrophy of the testicles - disorder in the development of the male embryo. · Disorder in testicle cell differentiation – few OR no sperm cells. · Various chromosomal disorders – excess of the X chromosome, excess of the Y chromosome, deficiency of the Y chromosome. Usually men with these disorders display suspicious clinical symptoms. · Enzymatic disorder in testosterone production – the outer sex organs are female, while the inner sex organs are male. · Acquired disorders – environmental factors (heat AND radiation), background illnesses (diabetes, renal failure, cystic fibrosis), infectious diseases (like mumps), medicines, drugs, etc., affect sperm cell production. Chinese Medicine: Low sperm count AND quality are defined by Chinese Medicine as weakness of the water element AND kidneys. Sperm is compared to a seed in nature – hidden in the ground, under a cover of snow, which creates insulation AND a combination of moisture AND warmth, AND erupts outside when the snow melts AND conditions are ripe. In Emperor China, the emperor AND his wife enjoyed tonifying treatments to enhance their sexual potency (the emperor’s sperm quality AND his wife’s ripeness), in order to create optimal conditions for their embryo. The reasons for male infertility according the traditional Chinese medicine are: · Weakness of the Jing/essence. High frequency of semen ejaculation weakens the energetic “battery” called Jing in Chinese medicine. Daoist methods in the east are designed to teach techniques of avoiding ejaculation, in order not to waste this essence. Jewish Halacha adopts a sexual lifestyle (menstruation religious laws AND prohibition of excessive sexual activity), whose purpose is to prevent a waste of Jing, out of recognition of its importance as a life treasure which cannot be restored OR repaired. · Deficiency of Yin in the kidneys. Kidneys are the source of Yin AND Yang, AND according to Chinese medicine, they control fertility. Kidneys hold the prenatal quality – the same pure quality which children inherit from their parents, the potential they have for productivity AND continuity. Yin embodies pure substance quality. Deficiency of Yin in the kidneys can impair the quality AND integrity of the sperm. · Deficiency of Yang in the kidneys. Yang is the force driving the substance, that leads to the fulfillment of its potential. Sperm must be able to move up the cervix, AND this ability stems from the Yang Qi, the force driving AND fulfilling the potential, the force responsible for extracting the pure from the non-pure. Deficiency of Yang may result in asthenozoospermia. · The emotional world of the patient AND its influence on the direction of qi flow in the body, in a continuous state of fear and/or frustration; fear is the emotion characterizing the water AND kidney element. In a continuous state of fear, qi moves downwards AND does not allow sperm to move upwards. One of the most common fears is fear of sex. Prolonged frustration leads to qi stagnation, AND also impairs sperm motility. In an exegesis to the Genesis story (Bereshit Raba), the following question is asked: “How did Abraham learn Tora?” Rabbi Shimon said: ”His two kidneys became like two jars of water, AND flowed with Tora”. Kidneys represent in both Chinese philosophy AND in Jewish thinking the source of truth, like a mirror reflecting to a person all of his duties, with the first one of them being – to breed AND multiply. · Nutrition: warm energetic nutrition – fast, fried food, full of preservatives, food coloring AND white sugar, harms sperm quantity, as a result of inner heat AND phlegm accumulated in the lower heater. Cold AND moist nutrition – uncooked food, ice cream, milk products etc., can also cause qi stagnation in the lower heater, AND impair sperm motility. A Differentiating Diagnosis Excess conditions: the main reason for male infertility is qi stagnation, as a result of cold/ phlegm /emotional state. Cold – wet tongue, white coating, slow AND tied pulse, reduced libido, lack of self confidence. Phlegm – tongue with thick sticky coating, rolling pulse, swollen stomach after eating, soft feces. Fear/frustration – tongue with teeth marks, tied deep pulse, dimmed eyes, anxiety, depression OR nervousness. Excess conditions will usually lead to a state of asthenozoospermia: impaired sperm motility. Deficiency conditions: the main reason for male infertility is lack of YIN/ YANG/ JING. Deficiency of YIN – dry red tongue, deep, weak AND fast pulse, night sweats, dry mouth, thirst. Deficiency of YANG – Pale dry tongue, slow deep pulse, premature ejaculation, spontaneous sweating, lower back aches/thigh aches. Deficiency of JING – lined dry tongue, weak pulse, ejaculate with little semen, fatigue. Deficiency conditions will usually lead to oligozoospermia (few sperm cells in the semen). Treatment: Acupuncture AND moxa: The main points for treatment of oligozoospermia AND asthenozoospermia are: SP-6: SAN YIN JIAO, “crossing of the three YIN paths”. The meeting point of the YIN meridians in the leg – kidneys, liver AND spleen. This point supports sperm quantity AND quality. Treatment is by acupuncture of both sides, AND a tonifying method. This point tonifies the YIN, gently disperses phlegm AND supports sperm quality. CV-3: ZHONG JI “center of the two poles”. The name of this point is identical to the name the given by the Chinese to the North star at the center of the sky. This point is located at the center of the body, on the vertical AND horizontal axes, AND serves as the main point for improving sperm quality AND quantity. Treatment is by acupuncture according to the disperse method of “burn the mountain”*, in order to radiate qi in the direction of the vas deference. * “Burn the mountain” technique: rubbing two fingers along the needle in order to radiate the qi towards the scrotum. CV-4: GUAN YUAN “reservoir of source energy”. This point is a reservoir of source energy, the same potential we received from our parents, AND which is like a non-pure treasure as long as it is not fulfilled. In order to make the most of this treasure AND make it pure, we must connect to this reservoir AND activate it. Treatment is by acupuncture, according to the “burn the mountain” technique, in order to radiate qi in the direction of the vas deference. Treatment is given once a week for 12 meetings, AND afterwards the patient is asked to repeat his sperm test. In excess conditions, it is possible to add the following: LIV-3: in a state of prolonged emotional frustration, acupuncture according to the disperse technique. ST-36: When there is qi stagnation as a result of cold – use moxa. SP-9: in Phlegm conditions. Main point for phlegm accumulation in the lower heater. UB-67+SI-3: Opening the DU, to move the yang qi in paths. In deficiency conditions: KID-3: for JING deficiency. KID-7: for YANG deficiency. UB-23: for YANG deficiency. Treatment by moxa. For deficiency of YIN – needling. KID-6+LU-7: Opening the REN, to support kidneys AND JING. Chinese herb Treatment: Medical treatment by Chinese herbs has its roots in ancient history. For thousands of years mankind has searched AND used plants, minerals AND animal parts in order to support AND tonify the essence (Jing) AND the sperm. The materia medica of Chinese herbs includes plants AND substances which enhance the sperm, such as: Ginseng (Chinese, Korean OR Siberian), Gou Qi Zi, Shu Di Huang, Chuan Xiong AND Hong Shen. In this article I propose two formulas, one for treatment of Oligozoospermia AND the other for Asthenozoospermia. Oligozoospermia Asthenozoospermia Shu Di Huang-12g Shu Di Huang-12g Shan Yao-9g Shan Yao-9g Shan Zhu Yu-9g Chuan Xiong-6 Ren shen-9g Hong Shen-6g Gou Qi Zi-12g Bei Xie-9g Dang Gui wei-6g Xu Duan-9g Du Zhong-6g Dang Gui wei-6g Gui Jiao-9g Han Lian Cao-6g Niu Xi-6g Huang Bai-12g Lu Jiao Jiao-9g Shan Zhu Yu-9g Rou Gui-9g Tu Si Zi-6g Tu Si Zi-6g Ren shen-9g Gou Qi Zi-12g An analysis of the formulas: Asthenozoospermia: Shu Di Huang, Gou Qi Zi, Shan Yao, Ren shen, Tu Si Zi, Shan Zhu Yu – tonify the Qi, Jing AND kidneys. Chuan Xiong, Hong Shen, Dang Gui wei, Han Lian Cao – support sperm motility by moving the blood AND the Qi. Bei Xie – for absence of sperm liquefaction. Xu Duan - for patients with dead sperm. Huang Bai – for patients with infection in the vas deference. Oligozoospermia: Shu Di Huang, Gou Qi Zi, , Tu Si Zi, Shan Zhu Yu, Gui Jiao – tonify Jing AND Yin. Tu Si Zi, Rou Gui, Du Zhong, , Lu Jiao Jiao – tonify the Jing AND Yang. Ren shen, Shan Yao – tonify the Yuan Qi. Dang Gui wei, Niu Xi – move the Qi towards the lower heater. Bibliography 1.The yellow emperor’s classic of internal medicine. Ilza weith ; pelanduk pub. 2.Chinese herbal medicine. Bensky/gamble ; eastland press 3.The merck manual of diagnosis AND therapy . merck & co rahway nj 1992 4.The English Chinese encyclopedia of practical t.c.m . xu xiang-cai ; Beijing 1991 5.acupuncture , case histories. Zhang dengbu ;Churchill livingstone

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