What should I do if I haven't released semen during ejaculation recently?

Patient's question:

I recently experienced no semen discharge during ejaculation, feeling very lethargic, and a decrease in libido. How can this be treated? I am 39 years old.

Doctor's answer:

Azoospermia
Azoospermia refers to the condition where sperm is not found in multiple semen analyses (usually more than three times). It is one of the causes of male infertility.
Key diagnostic points for azoospermia
If sperm is not found in three or more semen analyses, the condition can be diagnosed as azoospermia. When necessary, testicular biopsy, seminal tract imaging, and endocrine hormone radioimmunoassay may be performed to help differentiate between obstructive azoospermia and congenital azoospermia.
Analysis of azoospermia based on syndrome differentiation
Azoospermia is often caused by congenital insufficiency, weak constitution, kidney essence deficiency, and declining life fire; or by postnatal dysfunction, excessive deficiency, spleen failure in transportation, and lack of essence and blood; or by chronic damp-heat, blood stasis, and obstruction of the seminal tract; or by prior mumps, Shaoyang pathogenic toxins flowing downward to the Jueyin, leaving residual toxins, making it difficult for sperm to be produced. Syndrome differentiation first identifies the pattern of deficiency or excess.
- Deficiency patterns are often due to kidney deficiency, accompanied by reduced libido, impotence, premature ejaculation, lower back and knee weakness, dizziness, tinnitus, spontaneous sweating, night sweats, insomnia, and palpitations. The tongue is slightly red with a thin white coating, and the pulse is fine and weak.
- Excess patterns are often due to blood stasis and heat, accompanied by normal or increased libido, testicular swelling and pain, and hematospermia. The tongue tip and edges are red, and the pulse is slippery and rapid.
The general treatment principle focuses on tonifying the kidneys, replenishing essence, clearing heat, and resolving blood stasis.
Syndrome differentiation and treatment for azoospermia
Kidney deficiency pattern
Symptoms
Azoospermia, infertility, small and soft testicles, reduced libido, impotence, and premature ejaculation; lower back and knee weakness, dizziness, tinnitus, spontaneous sweating, night sweats, insomnia, and palpitations. The tongue is slightly red with a thin white coating, and the pulse is fine and weak.
Treatment
Tonify the kidneys and replenish essence.
Medications
1. Main formula: Jujube Essence Decoction (from "Clinical Treatment of Male Diseases in Traditional Chinese Medicine" by Leng Fang Nan)
- Prescription: Fish bladder 10g, placenta 10g, deer horn 3g (melted separately), prepared rehmannia 20g, Tribulus terrestris 10g, polygonum multiflorum 15g, cornus officinalis 12g, angelica sinensis 12g, and white peony root 15g.
- Decoct twice and take in two doses daily. One decoction per day.
2. Chinese patent medicines
(1) Qibao Meiridan, oral, 9g per time, 3 times daily.
(2) Shengmi Yulingdan, oral, 9g per time, 3 times daily.
(3) Qiji Dihuangwan, oral, 9g per time, 3 times daily.
3. Single formulas and empirical prescriptions
(1) Qiyuan Yangjing Decoction (prescribed by Guo Yunlong)
- Prescription: Euonymus alatus 10g, Chinese yam 15g, goji berries 10g, poria 15g, Achyranthes bidentata 10g, polygonum multiflorum 15g, peach kernel 10g, 15g, walnuts 10g, prepared rehmannia 20g, cornus officinalis 10g, white 10g, and Rubus chinensis 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus alatus 10g, and Euonymus 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