CLINICAL APPLICATIONS

* Male infertility

* Male sexual and reproductive disorders, such as infertility, low sperm count, poor sperm motility, mobility and morphology, premature ejaculation, and spermatorrhea

 

WESTERN THERAPEUTIC ACTIONS

* Regulates the sex organs and hormone production

* Balances hormone productions to treat sexual and reproductive disorders

* Antiaging and adaptogenic effects to improve general health

 

CHINESE THERAPEUTIC ACTIONS

* Tonifies Kidney yin and Liver blood

* Replenishes Kidney jing (essence)

* Revitalizes Kidney yang and ming men (life-gate) fire

 

DOSAGE

Take 3 to 4 capsules three times daily. Dosage can be increased up to 6 to 8 capsules three times daily. For optimal results, this formula should be taken continuously for two to three months, or until successful pregnancy of partner.

 

INGREDIENTS

Che Qian Zi (Semen Plantaginis)

Chuan Xiong (Rhizoma Chuanxiong)

Dang Gui (Radix Angelicae Sinensis)

Fu Ling (Poria)

Fu Pen Zi (Fructus Rubi)

Gou Qi Zi (Fructus Lycii)

Huang Qi (Radix Astragali)

Jiu Cai Zi (Semen Allii Tuberosi)

Shu Di Huang (Radix Rehmanniae Praeparata)

Tu Si Zi (Semen Cuscutae)

Wu Wei Zi (Fructus Schisandrae Chinensis)

Xian Mao (Rhizoma Curculiginis)

Yin Yang Huo (Herba Epimedii)

Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata)

 

BACKGROUND

Infertility is the inability to conceive after one year of unprotected intercourse. Infertility may be due to sperm disorder (35%), decreased ovarian reserve or ovulatory dysfunction (20%), tubal dysfunction and pelvic lesions (30%), abnormal cervical mucus (5%), and unidentified causes (10%). Specifically, sperm disorder refers to defects in quality or quantity of sperm, which may be caused by endocrine disorders, genetic disorders, and drugs and toxins (anabolic steroids, corticosteroids, androgens, estrogens, aspirin, opioids, alcohol, nicotine, marijuana, and many others).[1]

 

FORMULA EXPLANATION

Vital Essence is mainly composed of herbs that tonify Kidney yin, yang and jing (essence). Tonifying Kidney yin will boost sperm count. Warming the Kidney yang will increase sperm mobility and motility. Replenishing Kidney jing (essence) will improve sperm morphology.

        Gou Qi Zi (Fructus Lycii), Shu Di Huang (Radix Rehmanniae Praeparata) and Dang Gui (Radix Angelicae Sinensis) tonify Kidney yin and Liver blood. They replenish the foundation of the Kidney. Jiu Cai Zi (Semen Allii Tuberosi), Tu Si Zi (Semen Cuscutae), Xian Mao (Rhizoma Curculiginis) and Yin Yang Huo (Herba Epimedii) vitalize the Kidney yang, increase libido, and improve sperm mobility and motility. Fu Pen Zi (Fructus Rubi) and Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata) are essential Kidney jing (essence) tonics for the treatment of male infertility. Chuan Xiong (Rhizoma Chuanxiong) moves blood and prevents the tonic herbs from creating stagnation in the body. Huang Qi (Radix Astragali) tonifies the zhong (central) qi to enhance energy. Fu Ling (Poria) and Che Qian Zi (Semen Plantaginis) are dampness-eliminating herbs that offset the cloying properties of the yin and jing (essence) tonics. Fu Ling (Poria) also strengthens the Spleen to ensure maximum absorption of the Kidney tonics. Che Qian Zi (Semen Plantaginis) ensures the absence of blockage in the lower jiao. Finally, Wu Wei Zi (Fructus Schisandrae Chinensis), an astringent, is added to prevent further leakage of jing (essence).

        Together, the herbs in Vital Essence tonify Kidney yin, yang and jing (essence) to successfully treat male reproductive disorders.

 

CAUTIONS & CONTRAINDICATIONS

* It is important to remember that this formula is designed to treat infertility. They do not offer any protection against sexually transmitted diseases.

* Many drugs are known to damage and impair healthy sperm, including but not limited to anabolic steroids, corticosteroids, androgens, estrogens, aspirin, opioid analgesics, cimetidine, methotrexate, spirolactone, and sulfasalazine. Patients who take these medications should consult their physician to see if these drugs can be substituted or discontinued.

* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui (Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[2]^,[3],[4]

* According to most textbooks and contemporary references, the classic entry of "He Shou Wu" is now separated into two entries: the unprepared Sheng Shou Wu (Radix Polygoni Multiflori) and the prepared Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata), as they have significantly different therapeutic effects and side effects. Sheng Shou Wu (Radix Polygoni Multiflori) is a stimulant laxative that treats constipation, but may cause nausea, vomiting, abdominal pain, diarrhea, and in rare cases, liver disorder (dose- and time-dependent, and reversible upon discontinuation).[5] On the other hand, Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata) is a tonic herb that is safe and well-tolerated. The dramatic changes in the therapeutic effect and safety profile are attributed to the long and complicated processing of the root with Hei Dou (Semen Sojae) through repeated blending, cooking, and drying procedures. When properly processed, the chemical composition of the root changes significantly. Many new compounds are generated from the Maillard reaction (four furanones, two furans, two nitrogen compounds, one pyran, one alcohol and one sulfur compound). Furthermore, the preparation process causes changes in the composition of sugars and 16 kinds of amino acids; it also reduces the pH of the herb from 6.28 to 5.61.[6],[7] In summary, these changes give rise to the tonic effects of the prepared roots, and eliminate the adverse reactions associated with the unprepared roots. Note: Due to medical risks and legal liabilities, it is prudent to exercise caution and not use this herb in either prepared or unprepared forms in patients with pre-existing or risk factors of liver diseases.

 

CLINICAL NOTES

* Vitality and Vital Essence are two formulas that are frequently combined together. Vitality tonifies Kidney yang to treat sexual dysfunction. Vital Essence replenishes Kidney yin and jing (essence) to treat reproductive disorders. Together, they complement and enhance the clinical success of each others.

* Semen analysis is extremely important, as sperm factors account for approximately 35% of all cases of infertility. Parameters evaluated include ejaculate volume, viscosity, appearance, pH balance, sperm count, motility, and sperm morphology. Semen composition of fructose less than 120 mg/dL is indicative of ejaculatory duct obstruction or agenesis of seminal vesicles. Most patients may already have an analysis. They should be instructed to re-test and compare the results after taking herbs for two to three months.

* Hormonal analysis is also important. Testosterone level studies are indicated for patients displaying loss of libido and possible hypogonadotropic abnormality. Normal FSH at baseline analysis correlates with improvement in semen parameters.

* Testicular volume estimation for impaired spermatogenic function or oligospermia should be performed.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Deep and small pulse on the left chi.

 

SUPPLEMENTARY FORMULAS

* With impotence, erectile dysfunction or low libido, add Vitality.

* For decreased sperm motility or mobility, add Kidney Tonic (Yang).

* For low sperm count, add Kidney Tonic (Yin).

* With premature ejaculation or spermatorrhea, add Vitality and Jin Suo Gu Jing Wan (Metal Lock Pill to Stabilize the Essence).

* For stress and anxiety, add Calm or Calm (ES).

* To improve the quality of sperm for in vitro fertilization (IVF), add Polygonum 14.

* With difficulty in ejaculation, add Wei Ling Xian (Radix et Rhizoma Clematidis) and Shi Chang Pu (Rhizoma Acori Tatarinowii) with Resolve (Lower).

* With thick or condensed semen due to deficiency fire of the Kidney, add Nourish.

* With prostatitis, add P-Support.

* For varicocele, add Resolve (Lower) and P-Support.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Needle and moxa: Dahe (KI 12), Qugu (CV 2), Sanyinjiao (SP 6), Guanyuan (CV 4), Zhongji (CV 3)

* Needle and moxa: Qugu (CV 2), Yinlian (LR 11), Dadu (SP 2), Ciliao (BL 32)

* Needle and moxa: Shenshu (BL 23), Guanyuan (CV 4), Rangu (KI 2), Fuliu (KI 7), Zusanli (ST 36), Sanyinjiao (SP 6)

 

Classic Master Tung's Points:

* Infertility (male): Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14); Endocrine, Kidney and Testicle point on the ear. Moxa du (governing) channel on the back

* Spermatorrhea: Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Tongshen (T 88.09), Tongwei (T 88.10), Shuijin (T 1010.20), Shuitong (T 1010.19), Tianhuangfu [Shenguan] (T 77.18). Moxa Guanyuan (CV 4), Zhongji (CV 3), Zhongshu (GV 7)

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Low sperm count, poor motility, mobility, morphology: Tianhuangfu [shenguan] (T 77.18), Dihuang (T 77.19), Renhuang (T 77.21)

 

Balance Method by Dr. Richard Tan:

* Left side: Linggu (T 22.05), Lieque (LU 7), Shuiquan (KI 5), Sanyinjiao (SP 6)

* Right side: Yangxi (LI 5), Zusanli (ST 36)

* Alternate sides from treatment to treatment

 

Auricular Medicine by Dr. Li-Chun Huang:

* Emission: Shenmen, Liver, Neurasthenia Point (front and back), Neurasthenia Area (front and back), Nervous Subcortex, Dream Disturbed Sleep Area, Heart, Kidney. Bleed Ear Apex.

 

NUTRITION

* Patients should be advised to eat more clams, oysters, sea cucumbers, and lamb.

* Excessive use of certain herbs such as echinacea, ginkgo biloba, and St. John’s Wort have been associated with infertility and should be avoided.

* Consume an adequate amount of selenium (200 to 400 mcg daily), as deficiency has been associated with reduced sperm count and sterility in men.

* Consume an adequate amount of vitamin C and bioflavonoids (2,000 to 6,000 daily), as they are important in sperm production.

* Consume an adequate amount of vitamin E (200 to 400 IU daily), which helps to balance hormone production.

* Adequate intake of zinc (80 mg daily) is important for normal functioning of the reproductive organs.

* Avoid alcohol, coffee, and cigarette smoking.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Infertility or inadequate sperm: Eat three quail eggs before bedtime daily for one month.

 

LIFESTYLE INSTRUCTIONS

* Avoid excessive sexual intercourse or ejaculation. While taking herbs, sexual activity should be reduced to once a week until the sperm lab report is normal.

* Certain artificial lubricants may prevent the sperm from reaching the cervix. Saliva may also have a negative effect on spermatozoa.

* Avoid drinking alcohol, which reduces sperm count.

* Avoid smoking (and exposure to secondhand smoke of) cigarettes and marijuana, as they impair sperm production.

* Avoid stress as much as possible.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Male sperm disorders account for approximately 35% of failed pregnancies. Disorders of sperm production can evolve from an assortment of conditions that include, but are not limited to, spermatogenesis, azoospermia, varicocele, retrograde ejaculation, in addition to endocrine, genetic, social, pharmaceutical and psychological factors. As men age, the sperm density and testosterone levels appear to decrease while estradiol and estrone levels increase.[8] Therefore, herbs must be used to regulate the endocrine system, balance the hormones, and promote blood circulation. Vital Essence is designed with such general and specific effects to treat male infertility.

        Vital Essence has many herbs to increase the quantity and improve the quality of sperm. Pharmacologically, Fu Pen Zi (Fructus Rubi) and Yin Yang Huo (Herba Epimedii) have been shown to increase the production and release of testosterone.[9]^,[10] Xian Mao (Rhizoma Curculiginis) stimulates the reproductive system to increase the weight of the testicles.[11] Jiu Cai Zi (Semen Allii Tuberosi) and Xian Mao (Rhizoma Curculiginis) have positive aphrodisiac properties that affect sexual behavior in male subjects, such as an increase in penile erection, mating performance, mount frequency, mount latency, and ejaculation frequency.[12]^,[13] In addition, administration of Yin Yang Huo (Herba Epimedii) not only stimulates the sensory nerves and increases sexual desire and activity, it also increases sperm production.[14] Clinically, many herbs in Vital Essence have been used with great success to treat male infertility. According to one study, use of fresh Gou Qi Zi (Fructus Lycii) in a formula effectively increased sperm count and improved sperm motility. Of 42 patients, 33 successfully conceived children.[15] According to another study, one formula was reported to have a 95.3% rate of effectiveness in treating 129 males with poor sperm count using an herbal formula in decoction daily that contained 12 grams each of Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata), Huang Jing (Rhizoma Polygonati), Huang Qi (Radix Astragali), Yin Yang Huo (Herba Epimedii), Gou Qi Zi (Fructus Lycii), Tu Si Zi (Semen Cuscutae), and Zi He Che (Placenta Hominis).[16]

        Obstructed blood circulation may adversely affect sperm emission and spermatogenesis. Therefore, Vital Essence contains herbs to invigorate and improve blood circulation to peripheral parts of the body, such as Dang Gui (Radix Angelicae Sinensis) and Chuan Xiong (Rhizoma Chuanxiong). Use of Dang Gui (Radix Angelicae Sinensis) is associated with significant effects on angiogenesis, the physiological process that promotes blood vessel formation in various parts of the body.[17] It also improves overall blood circulation by decreasing the whole blood specific viscosity, or improving the hemorrheological changes associated with blood stagnation.[18] Administration of Chuan Xiong (Rhizoma Chuanxiong) is associated with increased blood perfusion.[19] The mechanism of this action is attributed mainly to its effect to inhibit thrombus formation and platelet aggregation.[20]

        In this formula, Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata) is well known for its antiaging effect as it demonstrated a marked effect to improve general health and increase life expectancy.[21] Tu Si Zi (Semen Cuscutae) has an adaptogenic effect to improve both mental and physical health.[22] Though these two herbs do not treat male infertility directly, they address the underlying deficiencies associated with many cases of infertility.

        In summary, Vital Essence is one of the best formulas to treat male infertility. Not only does it treat the underlying sexual and reproductive disorders, it also restores the overall health and well-being of patients.

 

COMPARATIVE ANALYSIS

One striking difference between Western and traditional Chinese medicine is that Western medicine focuses and excels in crisis management, while traditional Chinese medicine emphasizes and shines in holistic and preventative treatments. Therefore, in emergencies, such as gunshot wounds or surgery, Western medicine is generally the treatment of choice. However, for treatment of chronic idiopathic illness of unknown origins, where all lab tests are normal and a clear diagnosis cannot be made, traditional Chinese medicine is distinctly superior.

        There is no drug treatment for male infertility. Those with sperm disorders (low sperm count, poor sperm motility, mobility and morphology) are usually treated with physical medicine, such as artificial insemination. However, there are no drug options available to increase sperm quantity and quality.

        One main function of Kidney yang is regulation of sexual and reproductive functions. Vital Essence is a Kidney yang tonic formula that emphasizes more on maintaining reproductive functions and treating reproductive disorders, such as low sperm count, poor sperm motility, mobility, and morphology. Though this formula is definitely effective, it does not have an instantaneous effect, but rather requires continuous use for two to three months for maximum effect.

        Reproductive disorder is perhaps best treated with integration of Western and traditional Chinese medicine. Herbal therapy has been found to be exceptionally effective for male infertility to increase sperm quantity and quality. In most cases, the use of herbal therapy is sufficient for mild to moderate cases of male infertility. In severe cases where herbs improve the condition but the patient still cannot achieve fertilization, artificial insemination can also be employed to enhance the success rate.