Cơ chế “bổ thận – tráng dương” trong y học cổ truyền và sinh học sinh sản nam: cầu nối bằng chứng cổ truyền – hiện đại

Male infertility constitutes a significant global health challenge, affecting a substantial proportion of couples and exhibiting a rising trend. While advanced reproductive technologies offer solutions, many cases remain unexplained or respond poorly to conventional treatments, highlighting an urgent need for safe, accessible, and long-term adjunctive therapies. In Traditional Chinese Medicine (TCM), the "kidney-tonifying and yang-warming" principle has long been central to addressing male reproductive issues like diminished libido, erectile dysfunction, and male infertility, particularly those associated with seminal abnormalities. This review seeks to bridge the understanding between these traditional concepts and modern reproductive biology, by synthesizing evidence on the mechanisms and efficacy of such interventions in male reproduction, specifically examining their impact on the hypothalamic-pituitary-testicular (HPT) axis, spermatogenesis, and sperm quality.

Researchers, clinicians (urologists, reproductive endocrinologists), and academics interested in male infertility, Traditional Chinese Medicine, and reproductive biology.

This structured narrative review systematically explores the role of "kidney-tonifying and yang-warming" interventions, rooted in Traditional Chinese Medicine, for male infertility. Utilizing a comprehensive search of PubMed/MEDLINE and Web of Science, the study synthesizes clinical and experimental evidence, categorizing interventions into four main types: multi-herb formulas, specific compounds like icariin, combinations of vitamins or L-carnitine with traditional approaches, and acupuncture. The findings reveal that while evidence quality and consistency vary, interventions combining L-carnitine with traditional medicine show particularly promising quantitative signals, including higher pregnancy rates and improvements across multiple semen parameters and testosterone levels. Other traditional medicine approaches, such as those employing icariin, primarily demonstrate preclinical mechanistic insights, impacting the hypothalamic-pituitary-testicular (HPT) axis, Leydig/Sertoli cells, spermatogenesis, and mitigating oxidative stress and inflammation, thereby enhancing sperm quality. However, the review highlights significant gaps, notably the scarcity of "hard" reproductive outcomes like live birth, substantial heterogeneity across interventions and methodologies, and limited long-term safety data. Consequently, "kidney-tonifying and yang-warming" strategies may serve as valuable selective adjunctive options for male infertility, but their integration into clinical practice necessitates high-quality, standardized Randomized Controlled Trials (RCTs) with robust safety monitoring and the inclusion of definitive reproductive outcomes. The emphasis remains on bridging traditional wisdom with modern evidence for more effective and safer male infertility management.