Scholarly article on topic 'Effect of Traditional Chinese Medicine on oligoasthenospermatism: a narrative review'

Effect of Traditional Chinese Medicine on oligoasthenospermatism: a narrative review Academic research paper on "Clinical medicine"

CC BY-NC-ND
0
0
Share paper
OECD Field of science
Keywords
{Asthenozoospermia / Infertility / "Medicine / Chinese Traditional" / Review}

Abstract of research paper on Clinical medicine, author of scientific article — Du Gao, Yun Cui, Jun Wu, Fan Zhang, Yang Zhou

Abstract Objective To summarize the treatment of oligoasthenospermatism (OAS) with Traditional Chinese Medicine (TCM). Methods The literature describing OAS treatment with TCM in the past 4 years was searched. Three studies were reviewed, evaluated, and summarized. The etiology and pathogenesis, pattern differentiation, medicine administration, and combination of TCM with Western Medicine were all examined. Results TCM had an advantage in treating OAS and had fewer adverse events than conventional treatments. Conclusion Although TCM has an advantage in treating OAS and fewer adverse events, the efficacy of TCM and modern medicine on OAS is unsatisfactory.

Academic research paper on topic "Effect of Traditional Chinese Medicine on oligoasthenospermatism: a narrative review"

JTCM

Journal of Traditional Chinese Medicine

Online Submissions: http://www.journaltcm.com JTradit Chin Med 2014 October 15; 34(5): 616-620

info@journaltcm.com ISSN 0255-2922

© 2014 JTCM. All rights reserved.

REVIEW

Effect of Traditional Chinese Medicine on oligoasthenospermatism: a narrative review

Du Gao, Yun Cui, Jun Wu, Fan Zhang, Yang Zhou

Du Gao, Class 2011 Postgraduate Student of Zhejiang Chinese Medicine University, Hangzhou 310053, China; Department of Ophthalmology, the Ningbo Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Ningbo 315010, China

Yun Cui, Jun Wu, Department of Ophthalmology, the Ningbo Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Ningbo 315010, China Fan Zhang, Department of Gynaecology, the Ningbo Hua Chi Hospital, Ningbo 315000, China

Yang Zhou, Department of Traditional Chinese Medicine, The Second Hospital of Ningbo City, Ningbo 315000, China Supported by the project of famous old Traditional Chinese Medicine expert heritage studio in Zhejiang (No. GZS2012030); The project of science and technology of Traditional Chinese Medicine in Zhejiang (No. 2009CB071); Science and technology project of Ningbo (No. 2010C91040); Natural Science Fund Project of Ningbo (No. 2013A610273) Correspondence to: Prof. Yun Cui, Department of Androlo-gy, the Ningbo Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Ningbo 315010, China. gaoqiang19850103@163.com Telephone: +86-13732171623 Accepted: November 11,2013

Abstract

OBJECTIVE: To summarize the treatment of oligoasthenospermatism (OAS) with Traditional Chinese Medicine (TCM).

METHODS: The literature describing OAS treatment with TCM in the past 4 years was searched. Three studies were reviewed, evaluated, and summarized. The etiology and pathogenesis, pattern differentiation, medicine administration, and combination of TCM with Western Medicine were all examined.

RESULTS: TCM had an advantage in treating OAS and had fewer adverse events than conventional treatments.

CONCLUSION: Although TCM has an advantage in treating OAS and fewer adverse events, the efficacy of TCM and modern medicine on OAS is unsatisfactory.

©2014 JTCM. All rights reserved.

Key words: Asthenozoospermia; Infertility; Medicine, Chinese Traditional; Review

INTRODUCTION

Oligoasthenospermatism (OAS) accounts for 46% of male infertility worldwide,1 and its incidence is rising.2 The common causes of OAS are reproductive tract infections, varicocele, endocrine diseases, and systemic diseases. However, the cause of OAS is not clear in 40%-75% patients.2 The conventional medical treatment for OAS is administration of nutritional supplements such as vitamins, a variety of hormones, and other supportive treatments. However, the outcomes are not satisfactory.1 Traditional Chinese Medicine (TCM) has been studied and used for OAS in the past. We searched the literature for TCM studies treating OAS in the past 4 years to analyze and summarize its use.

ETIOLOGY AND PATHOGENESIS OF OAS

There are no relative records on OAS in the TCM ancient literatures. According to patients clinical display, it belongs to Traditional Chinese Medicine"no child", "cold sperm". Nevertheless, ancient and modern physi-

cians of TCM have different views on the etiology and pathogenesis of OAS. In terms of ancient ones of TCM, the causes of OAS are cold sperm Qi deficiency, phlegm, excess Kidney fire, semen scarcity, and Qi stagnation. However, many modern TCM researchers have different views on the causes of OAS. Sun et al3 hypothesized that Kidney deficiency and blood stasis are responsible for OAS. Additionally, Wang et al 4 maintained that weakness of the Spleen and Kidney are integral to the pathogenesis of OAS, but Tian et al 5 argued that Kidney-essence deficiency was the main cause of OAS. Min6 found that there is a close physical relationship between the Liver, Kidney, and male reproductive function. Finally, Wang8 believes that Kidney deficiency with toxic dampness is the main patho-genesis of OAS.

OAS TREATMENT BASED ON TCM PATTERN DIFFERENTIATION

Zhang9 classified OAS patients as having Kidney-essence deficiency, essence and blood deficiency, excessive labour, Liver- Qi stagnation, Yin deficiency and Yang hyperactivity, and damp heat in the lower energiz-er. The herbs prescribed for Kidney-essence deficiency are: Lurong (Cornu Cervi Pantotrichum), Danggui (Radix Angelicae Sinensis), Dangshen (Radix Codonopsis), Sangshen (Fructus Mori), Nuzhenzi (Fructus Ligustri Lucidi), Renshen (Radix Ginseng), Huangqi (Radix Astragali Mongolici), Tusizi (Semen Cuscutae), Ziheche (Placenta Hominis), Shanzhuyu (Fructus Corni), Xian-mao (Rhizoma Curculiginis), Gouqizi (Fructus Lycii), Yinyanghuo (Herba Epimedii Brevicornus). The herbs prescribed for essence deficiency and blood are: Yupiao-jiao (Inglucies Piscis), Lujiaojiao (Colla Cornus Cervi), Ziheche (Placenta Hominis), Danggui (Radix Angelicae Sinensis), Jixueteng (Caulis Spatholobi), Ejiao (Colla Co-rii Asini), Huangjing (Rhizoma Polygonati Sibirici), Gouqizi (Fructus Lycii), stir-frying with liquid adjuvant Heshouwu (Radix Polygoni Multiflori). The herbs prescribed for overstrain are: Ziheche (Placenta Hominis), Longyanrou (Arillus Longan), Danggui (Radix Angelicae Sinensis), Fuling (Poria), Wuweizi (Fructus Schisandrae Chinensis), Suanzaoren (Semen Ziziphi Spinosae), Houpu (Cortex Magnoliae Officinalis). The herbs prescribed for Liver- Qi stagn- ation are: Chaihu (Radix Bupleuri Chinensis), Baishao (Radix Paeoniae Alba), Ch-uanlianzi (Fructus Toosendan), stir-frying with liquid adjuvant Xiangfu (Rhizoma Cyperi), Nuzhenzi (Fructus Ligustri Lucidi), Huangjing (Rhizoma Polygonati Sibirici), Yujin (Radix Curcumae Wenyujin), Gouqizi (Fructus Lycii), Shanzhuyu (Fructus Corni), Lizhihe (Semen Litchi). The herbs prescribed for hyperactivity of Yang owing to Yin deficiency are: Mohanlian (Herba Eclip-tae prostratae), Sangshen (Fructus Mori), Guijia (Cara-pax et Plastrum Testudinis), Mudanpi (Cortex Moutan Radicis), Biejia (Carapax Trionycis), Nuzhenzi (Fructus

Ligustri Lucidi), Digupi (Cortex Lycii Radicis). The herbs prescribed for damp heat in the lower energizer are: Qumai (Herba Dianthi Superbi), Bianxu (Herba Polygoni Avicularis), Dongkuiguo (Fructus Malvae Verti-cillatae), Pugongying (Herba Taraxaci Mongolici), Yiy-iren (Semen Coicis), Lianqiao (Fructus Forsythiae Suspen-sae), Wuhuaguo (Receptaculum Fici Caricae), Jinyinhua (Flos Lonicerae). Zhang10 hypothesized that Kidney deficiency for OAS may be associated with blood stasis or damp heat. The therapeutic principles for treatment are: nourishing Kidney essence, tonifying Qi and warming Yang, promoting blood circulation of Qi, clearing heat, and removing dampness. Cao7 proposed that therapy for the pattern differentiation should be based on microcosmic syndrome differentiation of semen. For example, the deficiency of Kidney Yin was often correlated with low semen volume, which may have certain clinical significance.

TCM HERBAL MEDICINES PRESCRIBED FOR OAS

The prescription of traditional medicines for the treatment of oligospermia and asthenospermia in clinic is common in China. Geng11 randomly divided 80 OAS patients into treatment and control groups. The treatment group was administered modified Tianxiong powder for treating oligospermia and asthenospermia. Tianxiong powder is composed of: Fuzi (Radix Aconiti Lateralis Preparata) 6 g, Huangqi (Radix Astragali Mongolici) 10 g, Baizhu (Rhizoma Atractylodis Macrocepha-lae) 15 g, Fuling (Poria) 15 g, Guizhi (Ramulus Cinna-momi) 10 g, Longgu (Os Draconis) 10 g, Tusizi (Semen Cuscutae) 15 g, Gouqizi (Fructus Lycii) 20 g, stir-frying with liquid adjuvant Heshouwu (Radix Polygoni Multi-flori) 15 g, Roucongrong (Herba Cistanches Desertico-lae) 10 g, Ciwujia (Radix et Caulis Acanthopanacis Santi-cosi) 10 g, Danshen (Radix Salviae Miltiorrhizae) 10 g. The control group was administered Wuziyanzong pill. The pregnancy and total effective rates in the treatment group were 8.57% and 91.43%, respectively, and 5.71% and 85.71% in the control group (P>0.05). Each group saw a significant increase in sperm density, sperm motility, and percentage of normal sperm morphology. However, the improvements of them in the treatment group were superior to those in the control group (P<0.05). Geng12 randomized 210 patients with OAS into two groups, with 126 in the treatment group and 84 in the control group. The treatment group was administered Shengjingzhongzi decoction, which is composed of: Chaihu (Radix Bupleuri Chinensis) 12 g, Zhiqiao (Fructus Aurantii Submaturus) 18 g, Yujin (Radix Curcumae Wenyujin) 12 g, Gouqizi (Fructus Lycii) 18 g, Nuzhenzi (Fructus Ligustri Lucidi) 15 g, Baishao (Radix Paeoniae Alba) 18 g, Xianmao (Rhizoma Curculiginis) 9 g, Yinyanghuo (Herba Epimedii Brevicornus) 18 g, Tusizi (Semen Cuscutae) 12 g, Danggui (Radix

Angelicae Sinensis) 12 g, Wuweizi (Fructus Schisandrae Chinensis) 12 g, stir-frying with liquid adjuvant Hes-houwu (Radix Polygoni Multiflori) 12 g, Huangqi (Radix Astragali Mongolia) 20 g, Cheqianzi (Semen Plan-taginis) 20 g, Chuanniuxi (Radix Cyathulae) 15 g, Fu-penzi (Fructus Rubi Chingii) 15 g, Chuanxuduan (Radix Dipsaci Asperoidis) 20 g, Chenpi (Pericarpium Citri Reticulatae) 12 g, Gancao (Radix Glycyrrhizae) 6 g. The control group was administered WuziYanzong pill. The total effective rates were 89.68% and 71.43% in the treated and the control groups, respectively (P< 0.05). Wang et al13 randomized 80 patients with oligo-zoospermia into a treatment and control group. The treatment group was administered Yijing Decoction, and the control group was given vitamin E. They found that two patients were cured, six patients had marked effects, and 16 patients saw effects in the treatment group. The total effective rate was 63.16% in the treatment group. Zero patients were cured, two patients saw marked effects, and five patients saw effects in the control group. The total effective rate was 19.44% in the control group (P<0.05). Hu14 randomly divided 246 patients with oligozoospermia into a treatment and control group with 126 and 120 patients, respectively. The treatment group was administered Hushiyulin Pill, which is composed of: Yinyanghuo (Herba Epimedii Brevicornus), Shanzhuyu (Fructus Cor-ni), Huangqi (Radix Astragali Mongolici), Tusizi (Semen Cuscutae), Baishao (Radix Paeoniae Alba), Chenpi (Pericarpium Citri Reticulatae), Lurong (Cornu Cervi Pantotrichum), Danggui (Radix Angelicae Sinensis), Gouqizi (Fructus Lycii), Shudihuang (Radix Rehmanni-ae Praeparata), Chishao (Radix Paeoniae Rubra), Huangbai (Cortex Phellodendri Amurensis), Niuxi (Radix Achyranthis Bidentatae), Lujiaojiao (Colla Cornus Cervi), Sanqi (Radix Notoginseng). The control group was administered Shengjing capsule. Patient A + B grade sperm count, sperm density, and sperm motility were improved in both groups, but the treatment group was improved significantly more (P<0.05).

TREATMENT OF OAS WITH TCM PATENT MEDICINES

Song et al15 randomized 92 OAS patients into a treatment and control group. The treatment group was administered Bushenkangle capsule and the control group was given WuziYanzong pill. They found that 15 patients were cured, 17 patients saw marked effects, and eight patients saw effects in the treatment group, with a total effective rate of 86.96% . In the control group, 12 patients were cured, 13 patients saw marked effects, and six patients saw effects, with a total effective rate of 67.39% (P<0.05). In another study, the treatment group was given compound Xuanju capsule, and the control group was administered vitamin E capsule. Grade A sperm and sperm density improved in

both groups (P<0.05), but the improvement in the treatment group was superior (P<0.05). Eighty OAS patients were randomized into two groups;16 the treatment group took Huangjingzanyu capsule, and the control group was administered vitamin E, B6, Clomi-phene citrate, testosterone undecanoate, zinc preparations, and human chorionic gonadotropin. In the treatment group 12 patients were cured, nine saw marked effects, 15 cases saw effects, and the total effective rate was 90.00%. In the control group, eight patients were cured, five patients saw marked effects, 14 patients saw effects, and the total effective rate was 67.50% (P< 0.05). In another study, 120 OAS patients were randomized into two groups;17 the treatment group was given Shengjing pills, while the control group was administered vitamin E. The Shengjing prescription significantly improved sperm concentration and motility (P<0.05), decreased serum FSH levels and elevated serum T levels (P<0.05), reduced DFI and seminal plasma elastase, and increased the percentage of hypotonic swelling sperm and the levels of seminal plasma a-glu-cosidase, fructose, zinc, and acrosin. Therefore, Shengjing prescription has good clinical efficacy and improves semen parameters in patients with OAS by multiple mechanisms. Sixty male Kidney- Yang deficiency and OAS patients were randomized into two groups;18 a treatment and control group. The treatment group was given Wang capsule and the control Clomiphene capsules. The total effective rate of the treatment group was 86.67% , while the control group was 70% (P< 0.05).

TREATMENT OF OAS WITH TCM AND WESTERN MEDICINE

Overall, 180 oligozoospermia patients were randomized into three groups, A, B, and C.19 Group A was administered compound Xuanju capsule combined with L-arginine, group B was given L-arginine only, and group C was given compound Xuanju capsule. After treatment, sperm density, A grade sperm, and (A + B) grade sperm improved in all groups from before treatment (P<0.05). However, the improvement in group A was superior to that in the other two groups (P<0.05). Sixty oligozoospermia patients were randomized into a treatment or control group.20 The treatment group was given compound Xuanju capsule combined with L-car-nitine, and the control group was given only L-carni-tine. The total effective rate of the treatment group and control groups were 86.7% and 70%, respectively (P< 0.05). Su et al21 randomly divided 86 and 78 oligozoo-spermia patients into study and control groups, respectively. The study group was administered zinc gluco-nate combined with Huangjingzanyu capsule, and the control group was treated only with Huangjingzanyu capsule. After treatment, the sperm density, grade A sperm, and (A + B) grade sperm improved in each

groups from before treatment (P<0.05). However, the improvement in study group was superior to that in the other group (P<0.05). The total effective rate of the treatment and control groups were 93.02% and 70.51%, respectively (P<0.05). In another trial, 154 ol-igozoospermia patients were divided into a treatment and control group.30 The treatment group was administered Honghuangxianzi Yin combined with L-carni-tine. The total effective rates were 85.71% and 66.07% in the of treatment and control groups, respectively (P< 0.05).

TREATMENT OF OAS WITH ACUPUNCTURE AND TCM MEDICINAL HERBS

Shi22 randomly divided 97 OAS patients into three groups: a Chinese herb medicine group, an acupuncture group, and an acupuncture combined with herbs group. The effective rate of the Chinese herb group was 72.72% , that of the acupuncture group was 70.97% , and that of the acupuncture combined with herbs group was 84.84%. Therefore, the clinical effect in the acupuncture combined with herbs group was superior to that of the other two groups (P<0.05). Sixty OAS patients were randomly divided into a treatment and control group.23 The control group was given conventional Western medicine plus injection of human chorionic gonadotropin and sodium chloride, while the treatment group was given electroacupuncture combined with the co-xuanju capsule. In the treatment group, 16 patients were cured, seven patients saw marked effects, and five patients saw effects with a total effective rate of 93.3%. In the control group, seven patients were cured, eight patients saw marked effects, and four cases saw effects with a total effective rate of 63.3% (P<0.05).

CONCLUSION

The efficacy of Western Medicine on OAS is unsatisfactory. Modern TCM treatment of male infertility from OAS has better effects. Nevertheless, its use still has some limitations. For example, most prescriptions used are not clearly defined. Moreover, few clinical studies are actually randomized and double-blinded. Finally, the standards of diagnosis and effect evolution are not consistent, and clinical pattern differentiation has not yet reached a consensus. More rigorous studies are warranted to support the findings.

REFERENCES

1 Guo J, Song CS, Geng Q, et al. Clinical observation on treatment of oligospermia and asthenospermia with Liu-wushengjing decoction. Zhong Guo Zhong Xi Yi Ji He Za Zhi 2007; 27(11): 986-988.

2 World Health Organization. WHO manual for the standardized investigation and Diagnosis of the infertile couple. Cambridge: Cambridge University Press, 2000: 23.

3 SunJM, Hao JG, Yang ZX, et al. Effect of sperm density and survival rate on treatment of Idiopathic oligospermia or asthenospermia sterility with Bushen Huoxue Decoction. Liaoning Zhong Yi Za Zhi 2012; 39(11): 2233-2234.

4 Wang QS, Bin B, Tang QL. Treatment determination of oligospermia and asthenospermia based on deficiency of spleen and kidney. Liaoning Zhong Yi Za Zhi 2012; 39 (5): 889-890.

5 Tian FY, Sun FH, Gan HM. Clinical observation on treatment of oligospermia and asthenospermia with Compound Xuanju capsule. Hubei Zhong Yi Za Zhi 2012; 34 (8): 15-16.

6 Min Z. Explore the pathogenesis of male infertility from the relationship between liver and kidney. Beijing Zhong Yi Yao 2009;28(10): 783-784.

7 Cao JG. The experience of Anfang Zhou on treatment of male infertility from microcosmic semen pattern differentiation. Hubei Zhong Yi Za Zhi 2009; 31(3): 29-30.

8 Wang XC, Pan TM. Research progress on treatment of male infertility with method of Chinese Medicine. Hubei-Zhong YiZa Zhi 2012; 34(1): 148-149, 156.

9 Zhang ZS. Clinical observation on treatment of oligosper-mia and asthenospermia with the therapy of TCM pattern differentiation. Xian Dai Zhong Xi Yi Ji He Za Zhi 2012; 21(36): 4050-4051.

10 Zhang RL, Ouyang HG. Randomized controlled clinical study on treatment of asthenospermia with Zhu Yu Decoction Combined with zinc sulfate, vitamin E, and vitamin C. Shi Yong Zhong Yi Nei Ke Za Zhi 2012; 26(11): 87-88.

11 Geng Q, Lv BD, Huang XJ, et al. Effect of modified Tianxiong powder in treating oligospermia and astheno-spermia. Zhong Guo Zhong Xi Yi Ji He Za Zhi 2010; 30 (5): 496-498.

12 GengJF. Clinical observation on treatment of 126 infertility due tooligospermiaand asthenospermia patients with Shengjingzhongzi decoction. Hunan Zhong Yi Za Zhi 2012; 28(1): 18-19.

13 Wang Q, Ning KQ, Huang XF, et al. Curative effect observation in treating oligospermia and asthenospermia with Yijing decoction made by theirselves. Liaoning Zhong Yi Za Zhi 2012; 39(10): 1970-1971.

14 Hu CZ. Clinical observation on treatment of 126 infertility due tooligospermiaand asthenospermia patients with Hushiyulin Pill. Ya Tai Chuan Tong Yi Yao 2012; 8(1): 55.

15 Song HD, Zhou ML. Curative effect observation in treating oligospermia and asthenospermia with Bushenkangle capsule. Zhong Guo Xian Dai Yao Wu Ying Yong 2012; 6 (17): 24-25.

16 Wu T. Effect observation in treating oligospermia and as-thenospermia with Huangjingzanyu capsule.Ya Tai Chuan Tong Yi Yao 2012; 8(6): 73.

17 Sun ZG, Lian F, Jiang KP, et al. Study on Shengjing Pian in patients with idiopathic asthenozoospermia. Zhong

Hua Nan Ke Xue Za Zhi 2012; 18(8): 764-767.

18 Wang XC, Guo RL, Zhao JC. Clinical observation on treatment of oligospermia and asthenospermia with Sizi-

zhongwang capsule. Zhong Guo Min Zu Min Jian Yi Yao2012: 65-66.

19 Tang X, Liang JH, Wan L. Clinical observation on treatment of 50 oligospermia and asthenospermia patients with compound Xuanju capsule. Guangxi Yi Xue 2012; 34(10): 1344-1345, 1351.

20 Zhang ZD, Chen G, Yang J, et al. Clinical observation on treatment of 60 oligospermia and asthenospermia patients with compound Xuanju capsule combined with levocarni-tine. Zhong YiYao Dao Bao 2012; 18(7): 24-26.

21 Su N, Kang JL, Wang W, et al. Treatment of idiopathic oli-

goasthenozoosperm with zinc gluconate plus Huangjing Zanyu Capsule. Zhong Cheng Yao 2012; 34(3): 401-404.

22 Shi XF. Effect observation on treatment of oligospermia and asthenospermia with acupuncture and moxibustion combined with Chinese medicine. Zhong Guo Dang Dai YiYao 2009; 16(15): 115-116.

23 YingXQ, Zhu YZ, Zhao YZ, et al. Clinical study on treatment of Asthen-ospermia with electroacupunctur combined with the co-xuanju capsules. Zhong Guo Xian Dai Yi Sheng 2010; 48(30): 4-5, 20.