Xing-Yu Jiang ,Shu-Hui Chen ,Ji-Gang Cao＊

1Hubei University of Chinese Medicine,Wuhan,China.

Abstract The views of the unities between heaven and man and between form and spirit in The Yellow Emperor’s Classic of Internal Medicine essentially reflect the mutual influence of physical and psychological factors.In today’s social environment,psychological and social factors have become important factors that affect the incidence of male asthenospermia.Therefore,the treatment of asthenospermia focuses more on the principle of simultaneous treatment of mind and body.With the development of modern biological-psychological-social medicine,the characteristics and advantages of psychosomatic medicine of traditional Chinese medicine are more prominent,which may provide new ideas for the diagnosis and treatment of asthenospermia.

Keywords:Asthenospermia,TCM,Psychosomatic medicine,Emotional therapy

Introduction

Infertility is a disease with seriously negative impact on a man’s physical,psychological,emotional well-being,especially family harmony.According to the definition of the World Health Organization,infertility is the failure to achieve clinical pregnancy after normal unprotected intercourse for 12 months or more.In China,approximately 1 of 10 couples is infertile,of which approximately 40%are male factors.Sperm motility is essential for fertilization and is an important index of male fertility.Only motile sperm can reach the fertilization site through the female reproductive tract.In China,with the implementation of the three-child policy and the accelerated aging of society,the Ministry of Civil Affairs will upgrade the response to aging as a national strategy [1,2].Asthenospermia (AZS) is a sperm disease of reduced sperm motility,with a total motility of <40% or progressive movement rate of sperm within 1 hour after ejaculation of <32% [3].AZS was identified as the cause of infertility in approximately 19% of men.However,the etiological mechanism of AZS has not been fully clarified.At present,AZS is considered related to abnormal sperm structure and energy deficiency.The causes of structural abnormalities and energy deficiency can be related to flagella,mitochondria,ion channels,miRNA,oxidative stress,habits,and environmental and other factors.The conventional medical treatment for AZS is administration of nutritional supplements such as vitamins,a variety of hormones,and other supportive treatments.However,the outcomes are not satisfactory;Moreover,if this drugs are stopped,sperm motility will decrease.The side effects of hormonal drugs and the high cost of assisted reproductive technology have led to proposed higher requirements for the treatment of AZS[4-18].

Traditional Chinese Medicine (TCM) has been studied and used for AZS in the past.In TCM,AZS belongs to the “cold essence” and “thin essence”categories [19].Ancient and modern physicians of TCM have different views on the etiology and pathogenesis of AZS.Jingjun [20] proposed that the main disease of AZS is the lack of kidney essence and loss of both Qi and blood.Li Haisong [21] believes that the deficiency of Qi and blood in Zang Fu organs,mixed with damp heat,blood stasis,lack of liver Qi,and stagnation of Qi mechanism can lead to male AZS.Zhang Haifu [22] believes that in addition to kidney essence deficiency,damp heat and blood stasis are also important causes of AZS.In real life,psychosocial factors can also cause AZS,so this disease also belongs to the scope of psychosomatic diseases.As a way of releasing pressure,people engage in poor lifestyle habits such as alcoholism,smoking,and lust,coupled with the rapid pace of life in modern society,general overthinking,and high work pressure,which cause psychological tension,seriously impacting reproductive ability if continued for a long time.

In recent years,with the transformation from the traditional biomedical model to the biological-psychological-social-medical model,the focus of clinical treatment of AZS is gradually inclined to the direction of psychosomatic treatment.Therefore,psychosomatic medicine of TCM provide a new treatment ideas for the treatment of AZS.

Psychosomatic medicine of TCM

Psychosomatic medicine of TCM is a science guided by the basic theory of TCM,integrating the knowledge system of modern psychosomatic medicine and studying the combined psychological and physical diseases caused by social and psychological factors.This academic thought comes from the theories of“seven disease-causing emotions,” “unity of form and spirit,” and “unity of heaven and man” in TCM and develop and form the theoretical thoughts of “five zang-organ emotional theory,” “personality constitution theory,” and “rigid and flexible syndrome differentiation theory.” The seven emotions,namely joy,anxiety,anger,worry,sadness,fright and fear,will lead to happiness and peace if properly protected.This shows the influence of emotional factors on mental and physical health.Moreover,an ancient books of TCM,Neijingproposed that “physically,they tried not to exhaust their body,mentally,they freed themselves from any anxiety,regarding peace and happiness as the target of their life,and taking self-contentment as the symbolof achievement.As a result,their body was seldom susceptibleto decline and their spirit was never subject to exhaustion.” According toThe Yellow Emperor’s Classic of Internal Medicine,the ancients had advocated the prevention of diseases by regulating emotions and pleasing the mind and body,and recognized the impact of emotional and physical factors on physical health.Therefore,in the environment of the modern complex medical system,diseases should be treated with both mind and body[23-26].

Understanding AZS based on TCM

TCM believes that the main cause of AZS is kidney essence deficiency.The kidney is the foundation of congenital essence,as it contains the essence of congenital and acquired traits.Reproduction is an inborn essence,which is key to human reproduction.The acquired essence is used to nourish the kidney.If the kidney is replenished,it can warm the kidney Yang and nourish the kidney Yin,thereby maintaining the harmony of Yin and Yang and vigor of Qi and blood.In the future,Tianzi will be born,which can transform the kidney essence into reproductive essence to breed offspring.Second,the liver stores blood,and the kidney stores essence.The liver blood is nourished by the kidney essence,and the kidney essence is supplemented by the liver blood.The two constitute the relationship of mutual breeding and transformation.In addition,the liver controls catharsis,and the kidney controls kidney govern storage.The two functions are used together to regulate male ejaculation function.Therefore,the viscera of AZS of psychosomatic diseases mainly lie in the liver and kidney.Adverse environmental,psychological,and other factors easily cause liver deterioration and block the normal physiological function of the liver.The liver and kidney are homologous,so the generation,filling,and storage functions of the kidney essence are damaged.Therefore,the kidney essence will gradually become deficient.Severe kidney essence deficiency syndrome leads to the deficiency of reproductive essence,so it will lead to the disease of weak essence.

If the AZS is recognized from the perspective of psychosomatic diseases,the psychosomatic medicine of TCM tends to regard it as depression syndrome.Excessive thinking and negative emotions lead to blood stasis,and the viscera of the disease mainly involve the heart,liver,and kidney.The viscera of AZS is the kidney,which contains the innate essence to nourish the reproduction essence.However,if the kidney Qi is insufficient and the kidney essence is deficient,the sperm will lose its source of nutrition and gradually lead to problems such as low sperm motility.However,in real life,people will have negative emotions and poor habits due to their surrounding social environment and psychological factors,which is more likely to lead to different degrees of psychological obstacles.The heart is the official monarch and Lord God.Excessive thinking and great pressure can easily lead to deficiencies of the heart Yin and heart blood,resulting in the hyperactivity of heart fire and upward fire,which is difficult to sink by kidney water.Heart fire is warm but becomes cold,resulting in “fine cold.” The liver governs catharsis,favors stripping,and reaches but inhibits depression.These poor habits and negative emotions will affect the liver to play its normal viscera function,which will lead to stagnation of the liver Qi and even to stagnation of Qi and blood.If the Qi and blood circulations are blocked,the functions of the Zang Fu organs will be weakened,the meridians become difficult to nourish,which leads to the weakening of the meridians and Qi,causing the congestion of meridians and collaterals.The Yin organ of the liver meridian of the foot Jueyin is the place where the essence of male reproduction is generated and stored.The liver meridian is blocked,the Qi and blood are stagnant,and Yin organs are difficult to maintain.There will be problems such as low number,low vitality,and high sperm deformity rate,which will eventually lead to male infertility.

Treatment of AZS

Emotional therapy of TCM

Psychological counseling is important in the treatment process.In the process of treating patients,first,medical personnel should share disease knowledge to patients and their families,explain the etiology and pathogenesis of the disease,and relieve the doubts and worries in the hearts of patients and their families so that patients can correctly release their negative emotions and relieve mental pressure.Anxiety and depression are common in all the patients with AZS and andrology diseases [27].At the same time,doctor should also tell patients the importance of treatment,encourage patients to actively participate in their treatment and ensure on-time return visits to improve their prognosis and quality of life.This method is widely used in the treatment of AZS [28,29].It can improve the compliance and achieve curative effect of patients’treatment by applying psychological care for patients with AZS and eliminating the doubts of patients and their families.In clinical practice,the reasonable treatment of AZS combined with psychotherapy has good effects.It can not only reduce the use of drugs and reduce the toxic and side effects of drugs but also shorten the disease course and improve patient prognosis[30].

Treatment of five zang organs

Psychosomatic diseases are mostly caused by the seven emotions,resulting in visceral dysfunction.“Su Wen Yin Yang Ying Xiang Da Lun” points out “anger hurts the liver,” “thinking hurts the spleen,” “sadness hurts the lung,” and “fear hurts the kidney.” Therefore,the main treatment principle is to adjust the Yin and Yang of the five zang organs.

Treatment from the heart.The heart is the master of the five zang organs.People who are restless will have no control over their internal organs and damage their other internal organs.“The classic of analogies of the nine Qi” states that “although the five internal organs belong to each other,if you ask for the reason,you will find it from your heart.” Under the interference of long-term negative emotions,patients with AZS easily cause hyperactivity of the heart fire and stagnation of the heart Yang,so they form the situation of heart kidney disharmony.With a long disease course,the heart fire is too strong and upward,making it difficult to warm the kidney water;thus,the kidney water becomes too cold and the essence becomes difficult to nourish.Cao Jigang uses the method of“regulating fire and controlling water” to communicate with the heart and kidney to reduce the heart fire,warm the kidney water,and help the heart fire in the kidney water.Therefore,it can help both water and fire,and generate and strengthen essence,with remarkable curative effect[31].

Treatment from the liver.The male testicle stores the essence and is where the pulse of the liver meridian flows.When the function of the five Chi extends to the liver,and the Qi mechanism is disordered.The onset of visceral dysfunction is characterized by the rush of liver Qi,impatience,and irritability.If these emotions are successful,the Qi mechanism becomes rough,manifested as liver Qi stagnation and poor belching.Qi depression is easy to turn into fire.The heart is the viscera of fire and the son of the liver.Hyperactivity of the liver fire is easy to lead to hyperactivity of the heart fire.Liver depression and Qi stagnation also lead to poor Qi and blood functions.Meridians are difficult to nourish.The liver and kidney are homologous,that is,essence and blood are homologous,making it difficult to replenish the kidney essence.TCM believes that sperm is transformed by kidney essence,so liver depression and Qi knot will also affect the growth and maturity of sperm.On the basis of the etiological and pathogenic characteristics of AZS,the treatment of AZS is based on the liver,and the combination of clearing the liver,soothing the liver,and tonifying the kidney can restore health[32].

Treatment from the kidney

“Su Wen six sections on Tibetan images” says,“the kidney manages closure and is the root of storage and the house of Jing”.The kidney governs the generation,storage,and excretion of reproductive essence.When men reach a certain age,the essence in the kidney is gradually filled,and “Tiangui” is generated under the excitation of the kidney Qi,which promotes the development of male reproductive organs,the generation of reproductive essence,or the maintenance of sexual function.The kidney Qi promotes the generation of reproductive essence through “Tiangui”and maintains biological function.Therefore,AZS is mostly treated from the kidney.Kidney Qi can stimulate and promote the physiological activities of tissues and organs of the body.If the innate wealth is insufficient and kidney Qi and Tiangui are deficient,the generation of reproductive essence will be blocked.Mild cases can lead to reduced reproductive ability,and severe cases can lead to infertility.Kidney and essence deficiencies are the main causes of AZS [33].Treatment with Shengjing decoction can promote the secretion of hypothalamic hypochondriac pituitary;regulate the release of follicle-stimulating hormone,luteinizing hormone,and testosterone;improve the functional disorder of gonadal axis;regulate the concentrations of the sex hormones;reduce antisperm antibodies;reduce sperm aggregation;significantly improve sperm motility.[34,35].

Acupuncture and other therapies

Acupuncture and moxibustion are an important part of TCM.They require the unity of heaven and man and the integration of form and spirit,and emphasize the holistic view and treatment of mind and body.Clinical studies have confirmed that acupuncture and moxibustion play a special role in adjusting patients’spirit and emotion and have obvious curative effect in the treatment of male AZS[36,37].Many studies have shown that acupuncture or the combination of acupuncture and TCM has significant curative effects on various psychosomatic diseases[38-49].

In addition to the commonly used treatment methods,the characteristic treatment methods used in TCM include massage,qigong,and food therapy.With these treatment methods in TCM,the effect of adjuvant treatment can be achieved.

Expectations

With the progress of technology,research on AZS in modern medicine has become more in-depth.The etiology of AZS has been studied at the gene and RNA levels.Facing its complex etiology,TCM has certain advantages in the treatment of such diseases.As an emerging medical discipline,psychosomatic medicine of TCM not only uses conventional disease treatment methods but also studies the interaction between psychological,environmental,and behavioral factors and diseases to provide a more humanized treatment scheme for patients’ conditions.In addition,the development of TCM psychosomatic medicine also needs to keep pace with the times;explore and innovate;constantly optimize and reform diagnosis and treatment technology;develop new medical products and technical means by combining science and technology with humanities to improve the more accurate identification,positioning,and prevention of diseases;open up more treatment ideas for medical workers;and promote the development and progress of TCM psychosomatic medicine.