Withered Yang: A Review of Traditional
Chinese Medical Treatment Of Male Infertility and
Pacific College of Oriental
*Division of Urology
University of California, San
Manoj Monga, M.D.
Division of Urology
200 West Arbor Drive (8897)
San Diego, CA 92103-8897
is a private, social and economic problem. Infertility is defined
as the inability to conceive a pregnancy within one year. Twenty-five
percent of couples will seek help for infertility at some point
during their relationship. Over two billion dollars are spent
in the United States annually on infertility therapies.
factor infertility is contributory in at least 50% of infertile
Currently the therapy for male factor infertility focuses on intricate
microsurgery to correct varicoceles or obstruction of the male
reproductive ductal system. Additionally, there has been a strong
shift away from evaluating and treating the male, and proceeding
directly to expensive artificial reproductive technologies.
attempts at medical therapy for male factor infertility have included
hormonal therapy (GnRH agonists and antagonists, gonadotropins,
anti-estrogens, testosterone, aromatase inhibitors), antioxidant
therapy, antibiotics, corticosteroids, methylxanthines, vitamins,
minerals and amino acids (zinc, arginine), and angiotensin-converting
enzyme inhibitors. The observation that no medication is approved
by the United States Food and Drug Administration for treatment
of male infertility confirms the conclusion that adequate controlled
studies of potential therapeutic agents are either lacking or
failed to elicit a significant improvement in fertility.
erectile dysfunction can be defined as the inability of a man
to obtain penile rigidity sufficient to permit coitus of adequate
duration to satisfy himself and his partner.
The personal and private nature of this problem has hindered
accurate estimates of the true prevalence in the general population.
Current estimates suggest that 20 to 30 million Americans
suffer from erectile dysfunction.
Recent advances in medical therapies for erectile dysfunction
has raised public awareness of the condition, however many men
shy away from conventional therapies due to concerns of side effects
and lack of efficacy. Long-term
satisfaction with current therapies ranges from 40-70%.
may represent an important therapeutic modality for male factor
infertility. The purpose
of this paper is to provide an introduction to the history of
Traditional Chinese Medicine (TCM) and the basic philosophy and
principles used to understand male erectile dysfunction and infertility
from an Eastern medical perspective. Finally, a summary is presented of the available
research evaluating the efficacy of acupuncture in the treatment
of these disorders.
Acceptance of an Ancient Modality
Alternative or complementary
medicine has become an increasingly popular option for many patients. This trend is reflected in the 47.3% increase
in total visits to alternative medicine practitioners, from 427
million in 1990 to 629 million in 1997, thereby exceeding total
visits to all US primary care physicians.
In this same period of time, the estimated expenditures
for alternative medical professional services increased 45.2%
with an estimated $21.2 billion dollars spent including at least
$12.2 billion paid out-of-pocket (1). TCM is one of the treatment modalities at the
forefront of this trend. Of
the techniques employed in TCM, the use of acupuncture for the
treatment of pain is the best known.
Other techniques including moxibustion, herbal medicine,
and massage play integral roles in traditional treatment of a
broad spectrum of diseases.
After many years of
growing public acceptance, Western scientists and researchers
have begun to take an interest in evaluating and employing acupuncture
in clinical practice. In 1997, after reviewing the scientific evidence,
the National Institute of Health (NIH) released a consensus statement
concluding that acupuncture is a promising modality for treating
a wide range of conditions including osteoarthritis, fibromyalgia,
addiction, stroke recovery, post-operative and chemotherapy nausea
and vomiting, and asthma. The NIH noted that one of the advantages of
acupuncture was its substantially lower incidence of side effects
than many drug therapies and medical procedures which sometimes
had no more supporting evidence than that of acupuncture therapy.
The NIH committee concluded
that there was sufficient evidence to support the incorporation
of acupuncture therapy into conventional medicine.
These conclusions were consistent with the stance adopted
by the World Health Organization (WHO) in 1980 when it issued
a list of forty diseases well suited to treatment by acupuncture.
Although male infertility and erectile dysfunction are
not addressed in the NIH and WHO statements, these conditions
appear in the earliest Chinese medical texts. Over thousands of years, TCM theory has evolved
a comprehensive framework for diagnosing and effectively treating
History of Traditional Chinese Medicine
One of the world's earliest
medical texts and the most revered of the Chinese medical tradition
is The Yellow Emperor's Classic of Internal Medicine.
The authorship of this text is attributed to the Emperor
Huang Di who reigned from 2696 to 2598 B.C.E.
It is likely that the text was formally compiled much later,
most likely between 480 and 222 B.C.E. during the era of the Warring
the text depicts a sophisticated medical philosophy suggesting
a culmination of ideas and technical expertise developed over
hundreds or thousands of years.
The medical philosophy
and techniques of early TCM evolved out of careful observation
and critical thinking, reinforced through empirical clinical experience
in a process consistent with modern principles of the scientific
method. These practices spread throughout the Far East,
most notably to Japan, Korea, and Tibet, where theoretical and
technical refinements over the centuries have produced a variety
of styles shaped by different cultures, yet retaining the original
holistic essence of the Chinese philosophy.
In Eastern cultures, acupuncture and herbal medicine were
and still are primary treatment modalities, employed to treat
all types of disease from the common cold to life-threatening
Acupuncture was virtually
unknown in the United States until 1972 when China opened its
doors to the West. It quickly captured the imagination of the
American public although primarily for its ability to manage pain. Over the years, the other equally important
modalities of herbal medicine, moxibustion, and Tui Na massage
have gained in popularity and the realization that TCM is not
limited to the treatment of pain has become widespread.
In 1985, the National Committee for
the Certification of Acupuncture and Oriental medicine (NCCAOM)
administered the first acupuncture certification exam, establishing
national safety, efficacy, and competence guidelines for the practice
of acupuncture in the United States.
Currently, applicants for national certification must complete
a full-time acupuncture program and demonstrate 1,725 hours of
education including 1000 didactic and 500 clinical hours.
There are also provisions for certification via apprenticeship
and professional practice and in many States acupuncture is considered
within an MD's scope of practice with no additional training or
certification. The highest
level of instruction recognized in the United States is the Masters
degree. The standards
established by the Accreditation Commission for Acupuncture and
Oriental Medicine (ACAOM) include 2,175 hours of instruction composed
of 705 hours in oriental theory, 360 hours in western sciences,
450 hours in herbal studies, and 660 hours of clinical practice.
Most schools have additional requirements, requiring 2,800
to 3,200 hours of education. The ACAOM is currently developing the standards
for a 4,000-hour doctorate program in Oriental Medicine.
The role of acupuncturists in the U.S.
medical community varies from state to state.
A few states do not license acupuncturists.
Several states require acupuncturists to practice under
the supervision of an MD. In
California, however, acupuncturists are considered primary care
physicians and health insurance companies are recognizing that
TCM is a safe and cost-effective alternative to certain drug therapies
and medical procedures. The
positive results emerging from clinical research, the favorable
stance the NIH has adopted, and the remarkable increase in demand
for alternative medicine in the past decade suggest that acupuncture
and TCM will remain a major component of the emerging complementary
Philosophy and Theory of Traditional Chinese Medicine
Man as a Microcosm of the Universe
TCM evolved out of the
philosophy that human physiology and health were a reflection
of the processes observed in the natural environment.
Consequently, the language of TCM relies heavily on the
use of natural metaphors to explain biological processes.
For example, red eyes and a flushed face can be explained
in terms of Heat rising from Fire in the body, just as the heat
from an actual fire was observed to rise and scorch whatever was
above it. The treatment
strategy in such a condition might involve cooling the Fire by
employing techniques to nourish the Water of the body, essentially
the same strategy used to put out a fire in the natural environment.
Yin and Yang
One of the most fundamental
concepts in Chinese medicine is the idea that two opposite yet
complementary forces underlie all natural phenomena.
These forces are called Yin and Yang and they represent
polar opposite qualities such as cold (Yin) and hot (Yang).
By extending this idea, winter is considered a Yin season
whereas summer is Yang. The
phenomenon of contraction or consolidation is Yin much as water
solidifies into ice in the winter. The heat of summer causes water to evaporate
therefore expansion is Yang.
This is one example of how a simple pair of opposite qualities
(hot and cold temperature) can be used to characterize events
(summer and winter) as well as physical processes (expansion and
contraction). Yin is also said to represent substance or things at rest. Yang is expressed as function or activity.
From a Western perspective, one understanding of Yin and
Yang in the body might be the balance between anabolic and catabolic
processes. A state of
homeostasis may be thought of as a perfect balance of Yin and
Yang. In order for a system to be in a catabolic
state, there must be relatively more catabolism (Yang) then anabolic
activity (Yin). Therefore,
repletion of one of the Yin/Yang paired forces results in a deficiency
or vacuity of the other. Yin is associated with substance and the fluids
of the body. In a patient
with Yin vacuity, there are often pathologies with the body fluids. There is relatively more Yang in these circumstances
and the heat associated with the Yang is said to dry up fluids.
In TCM, disease is viewed
as the result of disharmony or imbalance.
Although TCM treatments generally operate at a more complex
theoretical level, the balance of Yin and Yang in the body is
the ultimate therapeutic goal.
the concepts of Yin and Yang, there is no direct translation for
the idea of Qi. The direct
translation of Qi means "air" or "breath" and represents the vital
energy that permeates the universe.
In the human body, Qi is the active principal underlying
physiology and metabolism. Qi is also responsible for warming the body,
protecting the body from external pathogens, and producing and
distributing fluids and blood.
There are many different types of Qi and each organ is
said to have its own particular Qi enabling it to perform the
functions for which it is responsible. For example, the Qi of the Lungs facilitates
respiration. Lung Qi has
a natural tendency to move downward.
When the Lung is weak, its Qi can become "rebellious" causing
it to move upward rather than down resulting in coughing or difficulty
breathing. To supplement Lung Qi is to re-establish the
normal direction of the Lung Qi and restore the proper function
of the Lung
Chinese physicians recognized
the existence of the organs of the body and attributed functions
to them, many in terms of natural metaphor.
In some cases these functions coincide with our modern
Western understanding of organ function.
For example, the Stomach is said to be the cauldron in
which food and drink are cooked over the digestive Fire until
they are reduced to elements that can be assimilated by the body.
Heartburn and acid reflux were understood as an excess
of this digestive Fire rising from the Stomach. However, most functions attributed to the organs
were based on the observation of patterns, many of which have
no relation to the modern understanding of the organ's function. It was observed that many people who had Stomach
Fire also developed sores on their gums therefore it was inferred
that there was a relationship or pathway between the Stomach and
the gums. If a certain area of the body reduced epigastric
pain when stimulated, that area of the body was thought to be
part of the Stomach system. These
reactive areas of the body became the basis of the acupuncture
point system. If a particular emotion was frequently observed
in people who tended to develop epigastric problems, then the
emotion itself was considered to belong to the Stomach. An Organ, from a TCM perspective, represents a theoretical construct
of physiological patterns that may, from the Western perspective,
involve multiple organ systems.
The two organs most
commonly involved in the TCM understanding of male infertility
and erectile dysfunction are the Kidneys and the Liver.
According to TCM physiology, these two organs are very
closely related. The Liver stores Blood and the Kidney stores
the Essence Qi. The Essential
Qi of the male and female is what meets during conception to form
a new life. The concept of Essence, then, roughly corresponds
to our modern understanding of male and female gametes. The Liver Blood and the Kidney Essence are
Yin in nature; hence the Liver and Kidney are said to be of the
same source. They mutually
engender, nourish and support each other.
A weakness in one organ is often associated with imbalance
in the other.
The Kidneys are said
to govern water. Much
like the modern understanding of kidney function, one of the TCM
Kidney's principal functions is the transformation of fluids into
urine, which is then stored in the Urinary Bladder.
The processes of growth, development, and reproduction
derive from the Kidney Essence.
physiology attributes the storage of Blood to the Liver. Blood is closely related to the reproductive
Essence stored by the Kidneys.
The Liver also governs free coursing.
This is to say the Liver's function is to make Qi move
smoothly through the body. The
smooth flow of Qi ensures the proper functioning of all bodily
processes. If the Liver
is vacuous in smoothing the Qi, the physiological consequences
may be extensive, involving many other organ systems. The channel or meridian of the Liver wraps
around the genitals. Therefore
conditions involving the genitals are often associated with Liver
Western diagnostic thinking
tends to follow a linear process of isolating structural or biochemical
causes at the root of a chief complaint.
A symptom is often reduced to an organ; an organ reduced
to tissue, and a tissue to a pathological biochemical process.
The tissue may be excised or a drug prescribed to correct,
compensate for, or mask a chemical imbalance.
A thorough Western intake involves asking the patient many
questions but the intent is usually to allow the physician to
narrow his or her focus of the problem. In contrast, the questions asked by TCM physicians
tend to expand on the chief complaint and derive a broader understanding
of the context in which the disease process originated.
TCM diagnosis revolves
around identifying patterns of disharmony.
The diagnostician must gather as much information through
observing, interviewing and palpating the patient.
The TCM physician considers the organ correspondences for
the various pieces of information gathered.
Eventually, an Organ or a number of Organs begin to emerge
as components of the disease or disharmony.
The physician must then unravel the relationship between
the Organs that is leading to the imbalance.
Each Organ tends to damage or over-control another Organ
if its function is allowed to become excessive or replete.
Each Organ is also associated with another Organ, which
it nourishes. This is
the case of the Kidney and Liver. If the Kidney is vacuous, the Liver will tend to suffer from lack
There are many common
patterns of disharmony. Sometimes
a patient will present with a clinical picture closely matching
a classically recognized pattern but the majority of cases usually
require a sophisticated process of gathering seemingly unrelated
data and synthesizing it into a consistent picture of the patient's
health. Diagnosis generally
involves asking a series of questions concerning the overall state
of the patient's health. Based
on the knowledge of organ correspondences, the physician organizes
the presenting symptoms into an individualized TCM pattern. The observed signs and the reported symptoms
are pieces of a puzzle. A
single piece alone rarely means anything.
Lumping all the pieces of the puzzle together into one
disorganized pile only makes the clinical picture more confusing.
The art of TCM involves the skillful synthesis of all the
clinical data into a comprehensive picture of the patient's disease
pattern. Once this is accomplished, the proper course
of treatment to bring the body back into harmony emerges.
In general, there are
no simple correspondences between Chinese diagnoses and Western
diagnoses. A single Western diagnosis may be explained
by a number of TCM patterns.
The following tables give a rough indication of what patterns
may be involved in specific Western diagnoses of erectile dysfunction
and infertility. These tables are presented not as a tools for
diagnosis but to illustrate the depth and breadth of TCM diagnosis
and its applicability to the full range of diagnoses recognized
by the Western understanding of erectile dysfunction and infertility.
and Fright Damaging the Kidneys
and Gall Bladder Qi Vacuity
Depression of Liver Qi
of the Life Gate Fire
Channel Damp-Heat Pouring Downward
and Damp Obstructing Network Vessels
Obstructing Essence Vessel
Obstructing Essence Vessel
of the Life Gate Fire
obstructing essence vessel
Stasis obstructing network vessel
Phlegm and damp obstructing network vessels
Patterns of Sexual Dysfunction
complete discussion of the patterns listed above is beyond the
scope of this paper. Even if a patient's condition closely matches
a classical pattern, there will be nuances, which can only be
properly addressed by a complete diagnosis.
Specific patterns are usually part of a larger disharmony. In particular, since the Kidney and Liver are
closely related, sexual dysfunction commonly involves combinations
of Kidney and Liver patterns.
From a TCM perspective, all contributing elements of a
pattern must be addressed in order to effect a lasting change
in the patient's health. The following discussion focuses on a few common patterns and is
presented to illustrate the rationale behind TCM diagnosis and
Patterns of Infertility
Male infertility can
be the result of many factors including pathologies in the motility
and formation of sperm as well as obstructions in the genitourinary
Vacuity of Kidney Yang Infertility:
the Kidneys are viewed as the source of the sexual Essence in
the body, problems with sperm motility and formation are often
association with Kidney vacuity. Since Yang is associated with functional activity,
vacuity of the Kidney Yang is one mechanism to explain insufficient
sperm motility. The general
pattern of the patient's health will reflect other signs and symptoms
of Kidney Yang vacuity. Since
Yang is associated with heat, a Yang vacuity condition will include
cold phenomena. This may manifest as facial pallor, fatigue,
cold extremities, aversion to cold temperatures, dizziness, tinnitus,
aching low back and knees.
Vacuity of Kidney Yin Infertility
with the formation of sperm reflect a vacuity of the Essence. Since the Essence is Yin in nature and associated with the Kidney,
this pattern is vacuity of Kidney Yin.
Since Yin is associated with coldness, a vacuous Yin pattern
will have relatively more Yang or heat signs associated with it. Common signs and symptoms in a Kidney Yin vacuity
pattern include the subjective sensation of internal heat possibly
with malar flushing, dizziness, tinnitus, weakness of low back
and knees, and sleep disturbances.
Dampness in the Liver Channel
Liver is responsible for the smooth flow of Qi in the body. When the Liver is vacuous and Qi does not circulate properly, the
fluids of the body are not moved and transformed normally and
pathology may result. Congested
fluids tend to become thick and viscous resulting in the obstruction
of the proper flow of fluids including the Essence or sexual fluids.
Liver pathologies are often associated with emotional upset
such as anger and frustration.
Other signs and symptoms associated with a Liver dysfunction
include hypochondriac fullness or pain, and digestive difficulties.
Patterns of Erectile Dysfunction
Listed below are a few
patterns associated with the failure to achieve or maintain an
erection as well as the phenomenon of premature ejaculation.
Several of these patterns have already been discussed as
causes of infertility. A
vacuity of Kidney Yang, for instance, may be the root pattern
for a wide variety of diseases. In general, the treatment of Kidney Yang vacuity
diseases will involve the use of some of the same acupuncture
point combinations and utilize similar techniques but the treatment
of a specific pattern will be tailored to the unique qualities
of the specific complaint as well as the patient's constitution.
In cases where the root pattern was discussed in the infertility
section, the more general accompanying signs and symptoms will
not be duplicated below.
Vacuity of Kidney Yang
is a Yang component inherent in the process of achieving and maintaining
an erection. This is reflected
in the functional and circulatory activity required as well as
the heat and warmth produced in an erection.
A vacuity of Kidney Yang is a possible pattern that may
result in various degrees of erectile dysfunction.
Vacuity of Kidney Yin
cases of vacuous Kidney Yin, the Kidney Yang will tend to be in
relative repletion. This repletion Yang manifests as heat, which
may cause reckless movement in the orderly flow of the Essence. The result of this heat agitation may manifest
as premature ejaculation.
Fear and Fright Damaging the Kidney
dominant emotion associated with the Kidney is fear.
This correspondence is perhaps most graphically illustrated
by the incontinence experienced during a frightening experience. The functions of the Kidneys are also impaired
when a certain degree of fear is associated with sexual activity. This is a relevant concern in situations where
a man is overly concerned about his sexual performance or fearful
about causing pregnancy or contracting a sexually transmitted
disease. There is generally no problem achieving and
maintaining an erection outside of a situation involving sexual
Liver Channel Damp-Heat Pouring Downward
to the same processes mentioned under Dampness in the Liver Channel,
fluids may stagnate into Dampness and obstruct the vessels of
the penis resulting in the inability to achieve erection due to
a physical obstruction. Accumulated Dampness tends to engender heat. This condition is commonly related to emotional
frustration or constraint as mentioned above. Additionally, there may be signs of heat in
this pattern including itchiness and possibly rash of the scrotum,
reddish urine, and dysuria. From
a Western perspective, if there are prominent signs of heat in
the genital region, infertility due to increased temperature of
the testes may be a concern.
TCM Treatment Modalities
Over thousands of years,
the relationships or correspondences recognized by TCM have given
rise to a system of approximately 1,500 points many of which are
organized along channels or meridians throughout various regions
of the body. Every Organ has an associated meridian, linking a series of points
on the body. Each point
regulates some aspect of the functional activity of its corresponding
Organ system. Many of
these points occur far from their areas of influence.
The point to sedate Stomach Fire (heartburn), for example,
is located in the web of the second and third toes.
health of the body was thought to be the result of a balance between
the physiological forces of yin and yang as well as the proper
flow of Qi through the meridians and their corresponding Organ
systems. Acupuncture points
may be thought of as control points to regulate this flow of Qi
by bringing more of it to areas that are vacuous and dispersing
excess when too much Qi accumulates and becomes stagnant disrupting
normal function. Many
points also have empirical functions as well, which were recognized
over countless years of clinical observation.
flow of Qi is influenced by the insertion and manipulation of
fine needles at appropriate acupuncture point locations.
Moxibustion refers to the burning of the herb Mugwort or
Folium Artemisiae Argyi over specific points during a treatment. Moxibustion may be applied in a number of ways
including burning the herb over a point without making contact
with the skin or burnt on the handle of a needle inserted into
an acupuncture point. Fine
grades of moxa may formed into cones and applied directly to the
surface of the skin over a point. In general, moxibustion has a warming effect,
which is thought to tonify or strengthen the Qi dynamics of the
system and promote movement or circulation of Qi and Blood.
formulas constitute an important aspect of TCM treatment. Individual herbs are organized into broad therapeutic
TCM categories such as "Tonify the Yang" or "Nourish the Blood"
according to the principle action observed by the administration
of herb. Additionally, each herb is understood to have
a primary effect on one or more Organ systems. Herbs also exhibit specific properties of temperature as well as
qualities such as being bitter or aromatic.
These qualities and properties allow for a great degree
of precision and sophistication in choosing an herb for a given
patient and their specific condition.
In TCM, a single herb is rarely prescribed alone.
Even if a certain herb is particularly indicated for a
patient, other herbs would be given to enhance the efficacy of
the major herb or help moderate possible undesirable effects.
In the majority of cases, herbal formulas are prescribed
which may consist of a dozen or more individual ingredients.
There has been an effort in recent years to evaluate the
pharmacological properties of many herbs but the understanding
of how herbs interact with each other in the context of complex
herbal formulations is unclear from a Western scientific perspective.
models of acupuncture function
role of acupuncture in the reduction of pain is one of the modality's
most widely recognized applications.
Reports of the use of acupuncture in surgical anesthesia
in Chinese hospitals served as many Westerners' first introduction
to the practice of TCM. While there are no definitive explanations
for acupuncture's analgesic effects, it has been hypothesized
that acupuncture needles stimulate nerves in the muscles which
transmit impulses to the spinal cord, midbrain, and pituitary
resulting in the release of endorphins and monoamines, blocking
pain messages. MRI studies
reveal increased blood flow in the thalamus and brain stem following
acupuncture treatment in patient's presenting with pain. Numerous clinical studies have demonstrated
that acupuncture analgesia works significantly better than placebo
and the efficacy of acupuncture analgesia in pediatric as well
as animal studies reinforces this conclusion.
there is some general consensus regarding the mechanisms underlying
the analgesic effects of acupuncture, there is little conclusive
research to suggest how acupuncture might have a regulatory effect
on systemic biological processes.
However, if acupuncture can cause the release of substances
in the brain to block pain signals, it is reasonable to speculate
that acupuncture may be able to stimulate the release or production
of other substances in the body.
In recent years, the focus of research has expanded beyond
acupuncture analgesia to include the evaluation of other effects
induced by needle stimulation. There is significant clinical evidence to suggest
that acupuncture has a regulatory effect on the circulatory, endocrine,
and nervous systems.
animal studies, needling of the point ST-36 resulted in increased
leukocyte count, reaching its highest level three hours after
needling. Stimulation of non-acupuncture points showed
no visible change in leukocyte count.
Five days of acupuncture treatment of patient's with pernicious
anemia raised red blood cell counts from 1 ml/mm3 to 3.37 ml/ mm3
and increased hemoglobin levels from 30 to 70.9%.
the treatment of appendicitis, acupuncture therapy was shown to
increase 17-hydroxycorticosterone steroid levels in the blood
by as much as a factor of two or three.
Twenty-four hour urine counts of 17-hydroxycorticosterone
and 17-ketosteroid were also generally elevated.
These results are consistent with increased secretion of
ACTH suggesting that acupuncture has an affect on the pituitary-adrenal
cortex system. Acupuncture
treatment of endemic goiter resulted in decreased levels of iodine
in the urine and increased thyroid absorption of iodine.
Similar findings for both of these studies were reported
in animal trials.
to have a homeostatic effect on the autonomic nervous system. In animal studies, acupuncture was found to return blood pressure
to normal level whether it was artificially raised by the injection
of adrenalin or lowered by cholinergic drugs.
Similarly, when cholinergic drugs were used to strengthen
intestinal peristalsis, acupuncture had a normalizing effect on
peristaltic contraction. In
the treatment of gastrointestinal spasm, acupuncture raised parasympathetic
tone, increasing the strength of peristalsis.
simple and popular hypothesis for these clinical findings is that
acupuncture stimulates nerve receptors at point locations, transmitting
signals to specific areas of the central nervous system, which
initiate physiological changes in the body.
The reason certain points have these effects still escapes
the modern scientific attempt to understand acupuncture outside
of its historic theoretical context. Nevertheless, researchers are confirming seemingly
bizarre phenomena, which TCM considers commonplace. A controlled, randomized study presented in
JAMA found that burning moxa over an acupuncture point on the
little toe was effective in correcting breech births.
A study of functional MRI scans revealed that the stimulation
of acupuncture points located along the side of the foot traditionally
used to treat visual problems, showed an increase of activity
in the visual cortex of similar magnitude to scans on the same
patients exposed to a flash of light.
Stimulation of a non-acupuncture point on the toe showed
no response in the visual cortex. These findings suggest that acupuncture is
a promising modality for more than pain management. Current research seems to raise more questions than it answers.
While it may fail to explain how acupuncture works, in
many cases it appears to support the validity of the TCM understanding
of human physiology.
There has been no reported
studies done on animals all were performed on humans.
There has been several studies done both in the east and
west ranging from case study designs to the more traditional controlled
There has been several
case study designs done to test the effects of acupuncture on
male infertility. A small designs was done by Shealy comparing
6 college aged males with male infertility or hypospermia. They found that 5 out of the 6 patients had
improvement in sperm count and sperm quality.
Zhiyuan Q. (1996) developed
larger a case study design using 54 males treating them with acupuncture.
They fit in the criteria of low sperm count, poor sperm motility,
or lack of liquefied seminal fluid. They were an average age of
35 and had an average of 20.5 treatments. The same five acupuncture
points were used for each treatment. After the insertion of needles, moxibustion
(moxibustion treats and prevents diseases by applying heat to
points or certain locations of the human body) was applied for
30 minutes. Of the 54 cases, 30 cases (55.6%) were cured, 13 (24.07%)
were improved, and 11 cases (20.27%) were ineffective. The overall
effective rate was 79.63%. The results were confirmed by laboratory
. Jiasheng Z. (1987) researched 248 cases of male infertility using
acupuncture. He divided the cases into 5 different Traditional
Chinese Medical diagnoses. There were 4 basic points used for
each treatment with the addition of symptomatic points. In weaker
patients moxibustion was used. The patients were treated once
a day for a course of 20 treatments. He found, after his extensive
study, that 166 cases (73.6%) responded to the treatment showing
reduced signs of infertility.
Xinyun H. from Chengdu School of Traditional Chinese Medicine performed
a unique experimental design comparing a group of 54 males treated
by acupuncture and the addition of medication to a group of 54
males treated only by medication. They were suffering from male
idiopathic oligosprematic sterility.
The patients were randomly divided accordingly to odd or
even date they came in to the hospital. They all were administered 25mg of Clomiphene
everyday for 25 days. This study differed form the rest by treating
the patient for 3 months as one course because the sperm need
90 days to develop from spermatogonium to mature sperm. They found
that with the use of acupuncture in addition to medication there
was a 92.5% effective rate and the medication group a 74.1% effective
Fishl F, (1984) a study on 28 infertile males testing their
semen count, concentration, and motility using acupuncture. Each
patient received 10 treatments over a 3 week period. They checked
the spermiograms and hormone levels before and after each treatment.
All cases showed statistically significant improvement of sperm
quality. To investigate further, written psychological tests were
given before and after treatment. The tests showed no psychological
change caused by acupuncture, therefore proving the increase in
sperm quality is not a placebo-mechanism.
A study done on 30 males
(Gerhard) showed a increase in semen parameters of motility and
sperm count. The subject all had abstaines from andrologically
effective medication for a minimum of 12 months. They collected
sperm samples before, 1, 5 and 12 weeks following treatment. They
performed 10 acupuncture treatments in an 2 week period. They assessed by spermograms and hormone assays.
The strongest results were observed in the samples from
week 1. The spermograms showed a improvement in sperm motility
?? and sperm count ?? . The
hormone profile rose significantly in testosterone levels (p<0.05)
allowing an improvement in sperm motility. The hormone LH showed
with the group that had low levels an significant increase during
week 5. The study lacked an control group to show any
comparison or placebo effect.
Bartoov B, (1997) developed
a controlled study to assess the effectiveness of acupuncture
on the sperm quality of males suffering from subfertility related
to sperm impairment. Both groups were 35.8 + 5.5 years
of age and share the same statistical characteristics. They collected
semen samples of 16 acupuncture treated subfertile males, treating
them twice a week for 5 weeks, and semen samples of 16 untreated
subfertile males as a control group. They analyzed the semen with
routine and quantitative ultramorphological observations at 2-8
month intervals. Specific
combinations of acupuncture points were selected for each patient
according to the principles of Chinese Medicine.
No more then 12 points were used per session. In the experimentally
treated group, the fertility index expanded significantly (p
< .05) in total sperm fraction, percentage of viability,
total motile spermatozoa per ejaculation, and integrity of the
A similar study was
performed by Minhua assessing the effectiveness of acupuncture
on sperm count, motility rate, movement below Grade III, and abnormal
form in 39 males. The males were an average of 31.3 years and
diagnosed free from sexual dysfunction, cryptorchidism, varicocele,
and maldevelopment of external genitalia. They treated them every
other day for 90 days and used the same combination of acupuncture
points for each treatment. Two points on the abdomen were needled
to propagate a sensation to the genital region. The effects consisted
of the sperm count increasing per ml to more than 20 million,
spermatozoa motility rate increasing more than 20%, and the forward
movement of spermatozoa was raised more than one grade. After
acupuncture treatment for 120 to 240 days, the patients showed
marked improvement in sperm count and motility from pre and post-treatment
statistically (p < 0.001).
Even though all the
studies showed a positive effect of acupuncture on male infertility
many of the studies went by strict scientific rigor.
Most of the studies did not allow for the 90 day growth
of sperm from spermatogonium to mature sperm.
Chinese Herbal Studies
mentioned in TCM Treatment modality section, TCM is a multifaceted
approach which includes herbal medicine which can be compared
to the allopathic use of medications.
Several studies have been performed using TCM herbal formulas
consisting of a combination of herbs in a formula, which is complied
for a specific complaint.
R and Wen H conducted a study on male infertility of 202 patients
using a Chinese herbal formula.
The patients were diagnosed under the pattern of Kidney
Yang Vacuity (see related section). The formula consisted of 15 medicinals and
was administered twice a day for 60 days.
The patients were diagnosed with oligospermia and had not
taken hormones or the herbal formula 2 months prior to the study. They divided the patients in to 3 groups depending on sperm densities
ranging from group 1 at 211.90x104+137.85 x104
to group 3 at 1621.86 x104 +1098.50 x104. They tested for sperm volume, density, and
activity along with the levels of testosterone, LH, and FSH. They
organized the results under cured, effectively treated, somewhat
effectively treated, and ineffectively treated.
60.9% or 123 people were cured which was defined as 40x106
ml density of sperm, 2 ml sperm volume, activity 50%, grade III
or IV sperm, pregnant spouse or child birth. Effectively treated was 29.7% or 60 defined
as 20x106 ml sperm density, activity 50%, grade III
and/or IV sperm. Somewhat
effectively treated was 6.4% or 13 patients defined as density
of sperm doubled or still less then 20x106 ml or density
unchanged but activity doubled. 6% or 3 patients were ineffectively treated.
Kho G, Sweep CGJ, Chen X, Rabsztyn PRI, Meuleman
E (1999) conducted a pilot study of 16 patients suffering from
erectile dysfunction. They
used the same eight acupuncture points on all patients treating
twice a week for four weeks. Low frequency electrical stimulation was used
for thirty minutes on four of the acupuncture points during all
the treatments. Blood
samples were drawn to test for stress hormones such as adrenocorticotropic
hormone, gonadotrophines follicle stimulating and leutinizing
hormones, and testosterone. They evaluated the patients over a twelve week
period and found erectile improvement in 15% and 31% reported
increase in sexual activity.
In the final interview two months after the first treatment
39% still reported improvement in their sex life in terms of activity
and global quality of erection. The overall improvement rate was 54%.
Eur Urol 1994;26(1):52-5
The place of acupuncture in the management of
psychogenic erectile dysfunction.
LS, Kilic S, Sarica K, Bayar M, Saygin B
Department of Urology, University of Ankara,
Medical School Ibn-I Sina Hospital, Turkey.
Successful sexual functioning is a complex process
involving psychological and social responses as well as neurological,
biochemical and vascular processes. Today it is believed that
more than 50% of the sexual dysfunction cases have an organic
etiology. Reflecting the controversy over the management of psychogenic
erectile dysfunction, there are several different methods which
are currently in clinical use. In this prospective study we aimed
to evaluate the curative effects of acupuncture therapy in men
with purely psychogenic erectile dysfunction. Of the 29 patients
treated with this procedure 20 patients demonstrated successful
erections following a varYing number of acupuncture sessions.
In the light of our findings we may conclude that acupuncture
may be an effective alternative in the management of purely psychogenic
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of males suffering from subfertility related to low sperm quality.
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F, Riehler R, Bieglmayer C, Nasr F, Neumark J (1984): Correlation of psychological changes and spermiogram improvements
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treated with Acupuncture and moxibustion: A Report of 248 Cases.
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treatment of Male Infertility with abnormal seminal fluid findings:
a report of 39 cases. International Journal Clinical Acupuncture
Q (1997): Male infertility:
three cases treated by acupuncture. Journal of Chinese Medicine
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of 54 cases of Male Infertility treated by acupuncture and moxibustion.
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