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In his youth, Richard1 would physically prevent ejaculation during masturbation by applying pressure to his penis. By the time he got married, he was producing little or no semen during sexual intercourse.
When he remained childless after several years of marriage, he sought help from a Traditional Chinese Medicine (TCM) practitioner and was diagnosed with retrograde ejaculation. In TCM terms, preventing ejaculation over such a prolonged period had caused qi stagnation and reversed qi flow, which obstructed the normal pathway of his semen, and caused it to empty into the bladder instead of emerging through the penis.
Among men, low sperm count, or oligospermia, is a common cause of infertility. Most seek help after they have failed to conceive after a year of unprotected sex, says Eu Yan Sang Senior Physician Huang Chun Xiang. “Many have consulted with a western doctor and completed the relevant fertility tests prior to TCM treatment and consultation,” he notes.
Given the cultural importance placed on continuing the family line, it should come as no surprise that TCM has time-honoured treatment protocols in place for treating infertility, both in males and females. Indeed, the very first references to this were found inscribed on oracle bones, mostly turtle shells, dating back to the prehistoric Shang dynasty, with later references in medicinal texts from the Han dynasty onwards.
Richard underwent twenty sessions of treatment, which included herbal medication as well as tui na (medical massage) and acupuncture to the 3rd lateral line of his forehead every two days. Clinical tests at the end of twenty sessions showed that his semen production and sperm counts were both near normal.
Identifying the right imbalance
As in Western medicine, a low sperm count diagnosis in TCM is based on both clinical symptoms and the results of semen analysis. A low sperm count is defined as fewer than 15 million sperm per millilitre of semen.
Both Western medicine and TCM also agree on the strong correlation between sperm count and age. TCM practitioners interpret this primarily in relation to the kidneys, which store kidney qi or ‘essence’ and control reproduction, and to a lesser extent, the health of the liver and spleen.
According to the Huangdi Neijing, the fundamental doctrinal source for Chinese medicine for the last 2000 years, the kidney qi of a 16-year-old male is abundant; tian kui (fertility essence) causes his reproductive capabilities to mature, and he is able to have children. At 40, kidney qi begins to decline and kidney essence begins to deplete. After the age of 48, the body’s yang, vital essence and kidney qi is much reduced, and it is difficult for him to have children.
Problems occur when men who should be at their prime find that the health of their sperm – their sperm count as well as the morphology and motility of the sperm – is too poor to successfully conceive a child. This could be due to several factors, from medical, physiological or psychological factors, to lifestyle choices.
The resulting imbalances cause four main syndromes, and treatment depends on which particular syndrome is at play.
In the case of Liver stagnation and Kidney deficiency syndrome, treatment involves relieving the stagnation and improving qi flow by nourishing and harmonising the liver and kidneys with herbs like Chaihu Shugan San (柴胡疏肝散) and Wuzi Yanzong Wan (五子衍宗丸).
When Spleen and Kidney deficiency syndrome is diagnosed, the treatment principle is to nourish qi and blood with the herbal remedy Sheng Jing Tang (生精汤).
Kidney deficiency and blood stagnation syndrome is treated by promoting blood circulation to dispel stasis. The kidneys are nourished and the semen pathway is cleared with herbal remedies like Shaofu Zhuyu Tang (少腹逐瘀汤) and Wuzi Yanzong Wan (五子衍宗丸).
Finally, Damp heat accumulation syndrome is treated by clearing heat and dispelling dampness. The herbal remedy Si Miao Wan (四妙丸) is often prescribed to clear heat and dampness in the kidneys and liver (lower jiao).
Beyond the specific herbal remedies prescribed, patients are advised to make soups and teas with Chinese yam (淮山), Chinese Foxglove Root (生地), prepared Radix Rehmanniae (熟地), wolfberry (枸杞子), mulberry (桑葚子), Fructus Rosae Laevigatae (金樱子), Fructus rubi (覆盆子), and Fructus ligustri lucidi (女贞子).
“These herbs can aid in nourishing the kidney and essence,” says Senior Physician Huang. It is, however, advisable to consult a qualified TCM professional before beginning with any treatment regimen.
Combining the best of treatments
Most often, herbal remedies are used in conjunction with acupuncture and tui na.
“In practice, we select different acupoints on the Ren Mai, Du Mai, the three yin meridians that belong to the spleen, kidney and liver meridian, which are often the affected organs related to infertility,” he says. Often, pressure is also applied to acupoints in the lower abdomen and sacral regions as treatment is more effective when the healing sensation reaches the perineum and pubic area.
“A good number of patients seek TCM treatment to complement tests and treatment they are currently receiving from their doctors,” Senior Physician Huang notes. TCM complements Western medical treatment by nourishing the essence, kidney and spleen, and relieving liver stagnation, he says.
“I have observed that this combined approach has a distinct advantage over treatment with Western medication alone. In addition, TCM is a relatively safe and effective form of treatment with minimal side effects.”
As part of the holistic approach TCM takes, TCM practitioners also address lifestyle factors that could help treat or prevent low sperm count.
“Patients should maintain a positive mood and good family relations, a healthy sex life, and exercise in moderation,” says Senior Physician Huang. “They should also avoid overexertion, cigarettes and alcohol, as well as other harmful substances.”
1Not his real name
It is a common problem for men over 40, but not one that is often talked about.
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