Peyronie disease

Keywords: Chinese medicine, Chinese herbal medicine, Peyronie's disease, varicocele, male sterility, sperm motility

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Peyronie's disease

Peyronie's disease refers to fibrosis of the cavernous sheath of the penis leading to contracture of the investing fascia of the corpora of the penis resulting in deviated and painful erection. In Western medicine, the cause of this condition is unknown. It occurs in adult men and may prevent intromission. It is rarely seen in those under 20 years of age. It is a slow and gradually developing disease. If the fibrosis extends into the corpus cavernosum, it may compromise tumescence distally. Fortunately for some, resolution of this condition may occur spontaneously over a period of many months, and minor Peyronie's disease which does not cause sexual dysfunction does not typically warrant treatment by Western medicine. Such treatment primarily consists of surgical removal of the fibrosis and replacement with a path graft. Unfortunately, treatment results are unpredictable and surgery may result in further scarring and exaggeration of the condition. Local injections of verapamil or high-potency corticosteroids may also be effective. Orally administered corticosteroids are not. In some cases, a prosthesis may have to be inserted to assist potency. Since Western medicine's treatment of this condition is not entirely satisfactory, alternative treatments, and especially nonsurgical treatments, are desired by many sufferers of this frustrating and embarassing disease. Recently, Zhang Bao-xing and Zhang Hai published an article on the Chinese medical treatment of Peyronie's disease. Titled, "The Treatment of 30 Cases of Penile Sclerosis & Nodulation with Chu Jie Tang (Eliminate Nodulation Decoction)," this article appeared in Shan Xi Zhong Yi (Shanxi Chinese Medicine), #4, 2001, on page 43.

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Cohort description:

All 30 cases included in this study were seen as out-patients at a hospital attached to the Henan College of Chinese Medicine. Three of the men were between 20-30, six were 31-40, 12 were 41-50, and nine were 50-60 years old. Ten cases had had this condition for one year or less, 12 cases had had it 1-2 years, and eight cases had had it for three years or more. All the patients met the diagnostic criteria appearing on page 227 in Nan Xing Sheng Zhi Su Wai Ke (External Medicine for the Male Reproductive System) published by the People's Health & Hygiene Publishing Co. in Beijing in 1989. These criteria were the same as the Western medical description given above.

Treatment method:

In order to dispel dampness and eliminated phlegm, transform stasis and soften the hard, and rectify the qi and free the flow of the network vessels, the following medicinals were administered: Pericarpium Citri Reticulatae (Chen Pi), 12g, Rhizoma Pineliae Ternatae (Ban Xia), 10g, Sclerotium Poriae Cocos (Fu Ling), 12g, Rhizoma Curcumae Zedoariae (E Zhu), 15g, Rhizoma Sparganii (San Leng), 15g, Spica Prunellae Vulgaris (Xia Ku Cao), 20g, Semen Sinapis Albae (Bai Jie Zi), 15g, Bulbus Fritillariae Thunbergii (Zhe Bei Mu), 12g, processed Resina Olibani (Ru Xiang), 10g, processed Resina Myrrhae (Mo Yao), 10g, Fructus Meliae Toosendanis (Chuan Lian Zi), 12g, Radix Bupleuri (Chai Hu), 10g, Radix Achyranthis Bidentatae (Niu Xi), 12g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g, Fasciculus Vascularis Luffae Cylindricae (Si Gua Luo), 15g, and Herba Ranunculi Ternati (Mao Zhao Cao), 20g. (1) One ji of these medicinals was decocted in water and administered orally per day, with one month equaling one course of treatment and three continuous courses being given. During this time, patients were forbidden to eat acrid, peppery, sweet, and fatty foods. They were counseled to keep a smooth and easy affect and to keep their sexual activity suitable. No further explanation of "suitable" is given by the Chinese authors of this study. However, sexual activity was not prohibited during therapy.

Treatment outcomes:

Cure was defined as disappearance of sclerosis and nodulation, no curvature of the penis during erection, and no aching or pain. Marked effect was defined as partial softening and lessening of penile sclerosis and nodulation, improvement in any aching and pain, and curvature of the penis during erection. Based on these criteria, 23 cases were cured and seven got a marked effect. Thus the total amelioration rate was 100%.

Discussion:

According to Zhang and Zhang, this disease is associated with the three channels of the liver, spleen, and kidney. If the patient's emotions are unfulfilled, the liver may become depressed and the qi stagnant. Thus the movement of the blood loses its smooth and easy flow and there is qi stagnation and blood stasis in the yin organ. If sexual desire is without limit, this may damage and consume kidney essence, resulting in yin vacuity and the movement of the blood becoming slow and relaxed. This may also cause blood stasis in the yin organ. A predilection for eating fatty, sweet foods and drinking too much alcohol may cause detriment and damage to the spleen and stomach, brewing and engendering phlegm and dampness. If this phlegm and dampness pour downward, they may congeal and bind in the yin organ.

Based on these disease causes and mechanisms, Zhang and Zhang believe that the appropriate treatment principles for dealing with this condition are to dispel dampness and eliminate phlegm, rectify the qi and free the flow of the network vessels, and transform stasis and soften the hard. Within this formula, Chen Pi, Ban Xia, Fu Ling, Bai Jie Zi, Zhe Bei Mu, and Bai Zhu fortify the spleen, dispel dampness, and transform phlegm. San Leng, E Zhu, Xia Ku Cao, Mao Zhao Cao, Ru Xiang, and Mo Yao quicken the blood and transform stasis, soften the hard and scatter nodulation. rm Chuan Lian Zi, Chai Hu, and Si Gua Luo course the liver, rectify the qi, and free the flow of the network vessels, while Niu Xi guides the other medicinals in this formula to move downward to the reproductive organs. Because these medicinals and these disease mechanisms are in accord, the treatment effects were completely satisfactory.

Varicocele & male sterility

Varicocele refers to abnormal dilation of the pampiniform plexus vein draining the testes and is the most common anatomic abnormality causing male infertility. Twenty-five percent of infertile men suffer from varicocele and the incidence of this condition is estimated to be 10-15% of the general population. Varicocele results in infertility because it causes pooling of blood and higher intrascrotal temperatures. In Western medicine, varicoceles are treated surgically via ligation of the internal spermatic vein. This procedure has reportedly resulted in 30-50% pregnancy rates in uncontrolled studies. In issue #11, 2002 of the Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), Sun Zi-xue published an article titled, "The Treatment of 65 Cases of Sterility Due to Varicocele with Yi Shen Tong Luo Fang (Boost the Kidneys & Free the Flow of the Network Vessels Formula)." Since this protocol purports to offer a nonsurgical treatment of this condition, a summary of its most important parts is given below. This article appeared on page 475 of the original Chinese journal.

Cohort description:

Of the 65 men included in this study, the youngest was 24 and the oldest was 40 years old, with a median age of 30.1 [+ or -] 4.18 years. The shortest duration of disease was two years and the longest was 10, with a mean disease course of 3.3 [+ or -] 1.53 years. Fifteen cases experienced grade 1 varicocele, 30 cases grade 2, and 15 cases grade 3. In five cases, there were no obvious clinical symptoms but ultrasound showed varicocele. Forty-nine of the men in this study suffered from primary onset infertility and 16 from secondary onset infertility. In eight cases, there was oligospermia, in 48 cases there was poor sperm motility, and in nine cases there was both oligospermia and poor motility. Twenty-one cases had already been treated surgically with ligation of the internal spermatic vein.

Treatment method:

Yi Shen Tong Luo Fang consisted of: cooked Radix Rehmanniae (Shu Di) and Radix Astragali Membranacei (Huang Qi), 20g each, Radix Salviae Miltiorrhizae (Dan Shen), 30g, Semen Cuscutae Chinensis (Tu Si Zi), Herba Epimedii (Xian Ling Pi), Radix Morindae Officinalis (Ba Ji Tian), and Radix Cyathulae (Chuan Niu Xi), 15g each, and Hirudo Seu Whitmania (Shui Zhi), 3g ground into powder and swallowed with the decoction. If there was dampness of the scrotum, 20 grams of Semen Plantaginis (Che Qian Zi) and 15 grams of uncooked Semen Coicis Lachryma-jobi (Yi Yi Ren) were added. If testicular sagging, distention, and pain was asevere, 12 grams of Semen Litchi Chinensis (Li Zhi He) and 15 grams of vinegar-processed Rhizoma Corydalis Yanhusuo (Yan Hu Suo) were added. One packet of these medicinals was decocted in water and administered orally per day in divided doses. Three months equaled one course of treatment, and the ejaculate was examined each month during treatment. If there was conception, the medicinals were stopped.

Treatment outcomes:

Eleven of the 65 cases were considered cured. This meant that their partner conceived. This also meant that the cure rate was 16.92%. Another 25 patients experienced what was termed a marked effect. Although these men's partners did not conceive, their sperm count increased and their sperm motility returned to normal. A further 18 patients got some effect. This was defined as an increase in sperm count and improvement in sperm motility. Eleven patients got no effect. Therefore, the total amelioration rate was 83.07%.

Discussion:

According to Dr. Sun of the Henan Provincial Chinese Medical Hospital, although all patients with varicocele have stasis obstructing the vessels and network vessels, the main disease mechanism of their infertility is kidney qi debility and vacuity. Based on the author's long clinical experience in treating this condition, he believes that it should be treated by boosting the kidneys and quickening the blood, transforming stasis and freeing the flow of the network vessels. Therefore, within the formula he has used Shu Di and Tu Si Zi to supplement the kidneys, nourish yin, and foster the essence. Xian Ling Pi and Ba Ji Tian to warm the kidneys and invigorate yang. Dan Shen and Chuan Niu Xi quicken the blood, transform stasis, and free the flow of the network vessels. Chuan Niu Xi can also lead the other medicinals to move downward to reach the site of the disease. A small amount of Shui Zhi is used to enter the blood aspect and break and crack static blood, scatter nodulation and free the flow of the network vessels. Huang Qi is used because the qi commands the movement of the blood. By boosting the qi, one can also quicken the blood. When Huang Qi is combined with Shui Zhi, Huang Qi supplements without causing congestion and stagnation and Shui Zhi breaks the blood without damaging the righteous. As this clinical trial shows, when oligospermia and decreased sperm motility are due to varicocele, this formula is able to get notable improvement in those conditions. As Dr. Sun notes, the total marked effectiveness rate was 55.38%.

Increasing sperm motility

Male infertility is often due to problems with sperm count, motility, and/or morphology. Spermatogenesis is continuous and requires from 72-74 days for maturation from germ cell. Semen analysis is the major test for evaluating male infertility. Semen is evaluated for volume, viscosity, gross and microscopic appearances, sperm count, motility, and morphology. In men with moderate oligospermia but no endocrine defects, clomiphene citrate may improve sperm counts. However, sperm motility and morphology do not seem to improve significantly. For azoospermia, insemination with donor sperm is an option. Since Western medicine does not have a lot of treatments to offer men with sperm motility and morphology problems, alternatives would be welcome. Internally administered Chinese herbal medicine based on individual pattern discrimination has been shown to improve both motility and morphology. For instance, in issue #8, 2002 of Hu Bei Zhong Yi Za Zhi (Hubei Journal of Chinese Medicine), Zhang Ke published an article titled, "The Treatment of Dead Sperm Condition with Yi Shen Sheng Jing Tang (Boost the Kidneys & Engender the Essence Decoction)," on page 46. A precis of that article appears below.

Cohort description:

The 18 patients in this study were 24-45 years of age and all had been diagnosed with dead sperm. Among these, eight were infertile.

Treatment method:

All 18 patients were treated with Yi Shen Sheng Jing Tang which consisted of: Herba Epimedii (Xian Ling Pi), cooked Radix Rehmanniae (Shu Di), and Herba Cistanchis Deserticolae (Rou Cong Rong), 15g each, Semen Cuscutae Chinensis (Tu Si Zi) and Fructus Lycii Chinensis (Gou Qi Zi), 20g each, Radix Astragali Membranacei (Huang Qi), 30g, and Radix Angelicae Sinensis (Dang Gui), 10g. If there was yin vacuity fire effulgence, uncooked Radix Rehmanniae (Sheng Di) was substituted for Shu Di and 15 grams each of Rhizoma Anemarrhenae Aspheloidis (Zhi Mu) and Radix Rubrus Paeoniae Lactiflorae (Chi Shao) and 30 grams of Herba Taraxaci Mongolici Cum Radice (Pu Gong Ying) were added. If there was damp heat pouring downward, 15 grams each of Rhizoma Dioscoreae Hypoglaucae (Bi Xie) and Semen Plantaginis (Che Qian Zi) and 30 grams of Rhizoma Smilacis Glabrae (Tu Fu Ling) were added. If there was liver depression and blood stasis, 10 grams each of Radix Bupleuri (Chai Hu), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), and Radix Albus Paeoniae Lactiflorae (Bai Shao) and 15 grams of Tuber Curcumae (Yu Jin) were added. If there was kidney qi depletion and vacuity, 15 grams of Radix Morindae Officinalis (Ba Ji Tian) and 30 grams of Radix Dioscoreae Oppositae (Shan Yao) were added. One packet of these medicinals was decocted in water and administered per day, and one month equaled one course of treatment.

Treatment outcomes:

Cure was defined as a 70% or more increase in live sperm and good sperm motility. Some effect was defined as a 60-70% increase in live sperm although sperm motility may have been still a bit slow. No effect meant that there were 40% or more dead sperm and sperm motility was weak. Based on these criteria, seven cases were judged cured, eight cases got some effect, and three cases got no effect.

Representative case history:

The patient was a 30 year-old male who had been married for two years without his wife becoming pregnant. The patient's wife had been tested and it was confirmed that she was not infertile. Accompanying symptoms included low back and knee soreness and limpness, lassitude of the spirit, lack of strength, a relatively soft erection, weak ejaculation, weak libido, a pale tongue with white fur, and a deep, fine, weak pulse. Sperm analysis showed live sperm at 25%. However, sperm motility was good for those sperm which were alive. In order to warm yang and boost the qi, supplement the kidneys and engender essence, the following medicinals were prescribed: Herba Epimedii (Xian Ling Pi), Herba Cistanchis Deserticolae (Rou Cong Rong), and Radix Morindae Officinalis (Ba Ji Tian), 15g each, Semen Cuscutae Chinensis (Tu Si Zi), cooked Radix Rehmanniae (Shu Di), and Fructus Lycii Chinensis (Gou Qi Zi), 20g each, Radix Astragali Membranacei (Huang Qi) and Radix Dioscoreae Oppositiae (Shan Yao), 30g each, and Radix Angelicae Sinensis (Dang Gui) and Radix Bupleuri (Chai Hu), 10g each. One packet of these herbs was decocted in water and administered per day. After 60 packets of these medicinals with additions and subtractions, the patient's clinical symptoms had disappeared and his live sperm rate had increased to 70%, his sperm motility was good, and his sexual desire had returned to normal. One half year later, the patient succeeded in impregnating his wife.

Discussion:

Within this formula, Xian Ling Pi, Tu Si Zi, and Huang Qi warm the kidneys and boost the essence, boost the qi and supplement vacuity. These are the ruling ingredients in this prescription. Gou Qi Zi evenly supplements the liver and kidneys and boosts the essence and blood. Rou Cong Rong warms and supplements kidney yang while also boosting the essence and blood. Dang Gui supplements the blood and is also able to quicken the blood. Shu Di nourishes the blood and enriches yin so that essence and blood engender each other.

Reference

1. This medicinal is sweet, acrid, and warm and enters the liver and lung channels. It treats scrofula, subcutaneous nodulations, pulmonary tuberculosis, and malaria-like disease. When taken internally as in decoction, its dose is 0.5-1 liang. It is classified as a heat-clearing medicinal. This medicinal's common English name is Cat's Claw, and it is a species of buttercup. In the US, it is available from both Mayway Corp. and Nuherbs Co.

abstracted & translated by Bob Flaws, LicAc, Dipl Ac & CH, FNAAOM

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