Varicocele is a common disease of the male reproductive system, and the pampiniform plexus in the spermatic cord manifests abnormal dilatation, extension, and circuity, which is a vasculopathy. In this article, we believe that the relevance of the essence chamber collaterals to the spermatic vein in terms of anatomical morphology and physiological function is high and that when pathogenic qi invades the essence chamber, the qi and collaterals of the essence chamber are out of harmony, the fluid collaterals are impassable, and the blood collaterals are obstrcuted, and the essence chamber collaterals are blockaded with several pathological products, and even intermingled phlegm and blood stasis in the blood collaterals and form vascular clusters, resulting in the formation and development of varicocele. Based on this, this article proposes the core treatment principle of healing, harmonizing, activating, and dredging the collaterals, with the basic treatment method of nourishing qi and harmonizing collaterals, activating blood collaterals, and dredging blood stasis to, respectively treat degree Ⅰ, Ⅱ, and Ⅲ varicocele, aiming to prevent the change of the varicocele, dredge the curvature of the varicocele, and dissipate the knots of the varicocele. The proposal of essence chamber collaterals is of great significance to understanding the common law and pathological aspects of the occurrence and development of essence collateral and vascular lesions from the perspective of integrated traditional Chinese and Western medicine.

Based on the pathogenesis of erectile dysfunction (ED) from the meridian-zangfu relationship and the "brain-heart-kidney-essence chamber" axis, it proposes that dysfunction of the "brain-heart-kidney-essence chamber" axis is closely related to the occurrence of ED. Among these, brain-heart disharmony is the key pathogenic factor, kidney deficiency and essence depletion constitute an important basis, and essence chamber stasis is a critical mechanism. The treatment approach emphasizes harmonizing the brain and heart, regulating the mind, tonifying the kidney and replenishing qi, unblocking qi and blood to harmonize the essence chamber. The primary acupoints include Baihui (GV20)-Neiguan (PC6)-Shenmen (HT7), Taixi (KI3)-Guanyuan (CV4)-Sanyinjiao (SP6), and Zhongji (CV3)-Dahe (KI12)-Gongsun (SP4), with additional acupoints selected based on syndrome differentiation. This approach aims to restore the clarity of the brain and heart, replenish kidney qi, and unblock the essence chamber, thereby facilitating the restoration of normal functions of the brain, heart, kidney, and essence chamber, and alleviating ED symptoms and improving overall clinical efficacy.
Humans ; Male ; Meridians ; Erectile Dysfunction/physiopathology* ; Kidney/physiopathology* ; Brain/physiopathology* ; Acupuncture Therapy ; Acupuncture Points ; Heart/physiopathology*

Male infertility,a common condition in andrology,falls under the category of"no son"in traditional Chinese medicine(TCM).Unhealthy eating habits and excessive sexual activity,prevalent due to improved living standards,have contributed to the increasing incidence of male infertility.YE Tianshi proposed the theory of"maintaining with the sweet and restoring the body fluids",which emphasizes the importance of ample body fluid for the nourishment of the male essence chamber.Sufficient body fluid is crucial for normal sperm generation.In TCM,the primary pathogenesis of male infertility involves the loss of body fluids and insufficiency of yin essence.Sweet Chinese herbal medicinal is recommended as it nourishes yin,enriches essence,and replenishes male reproductive essence without producing phlegm and dampness.Therefore,when treating male infertility,attention should be given to the use of sweet Chinese herbal medicinal,adhering to the principle of"abundant body fluids nourish kidney yin,and abundant kidney yin supports semen production".Therapies such as purging fire to preserve body fluids with Zengye Decoction,nourishing yin to enrich essence with Guilu Erxian Decoction,benefiting qi to promote fluid production with Buzhong Yiqi Decoction,and warming yang and transporting fluids with Xianfu Shezi Decoction should be considered.Medication and dosage adjustments should be made based on the specific etiology,pathology,and related symptoms to improve the quality of male sperm and enhance the chances of conception.

Objective:To investigate the strategy of balanoplasty in penile reconstruction with free forearm flap.Methods:From October 2010 to October 2015, 20 patients (19-41 years old) underwent penile reconstruction with free forearm skin flap in Xijing Hospital of Air Force Military Medical University, including 14 cases of transexuals (female to male), 3 cases of hermaphroditism, 2 cases of congenital penile dysplasia and 1 case of penile defect after trauma. According to the tissue quantity of forearm flap and the development of glans, three methods were adopted to reconstruct the glans: free forearm skin flap + E-shaped cartilage framework, free dorsalis pedis flap + E-shaped cartilage framework or free glans transplantation. The patients were followed up for a long time postoperation to observe the morphological changes of the glans after different method of balanoplasty.Results:Among the 20 patients, 18 cases were treated with distal part of free forearm flap and E-shaped cartilage framework for glans reconstruction, 1 case of transexuals used free dorsalis pedis flap and E-shaped cartilage framework for glans reconstruction, and 1 case of hermaphroditism used free glans transplantation to reconstruct glans. After 10-36 months of follow-up, all reconstructed penises survived. The shape of glans reconstructed by dorsalis pedis flap was the most plump and natural with clear coronal sulcus; the amount of glans tissue reconstructed by forearm skin flap was slightly insufficient, and the coronal sulcus was slightly flat, while the overall shape was satisfactory. The reconstructive glans with free glans transplantation was not plump, but they retained the shape of glans, which was lifelike.Conclusions:If the tissue quantity of forearm skin flap is sufficient, the distal part of free forearm flap and E-shaped cartilage framework is used; if the tissue quantity of forearm is seriously insufficient, the free dorsalis pedis flap and E-shaped cartilage framework is used. For hermaphroditism patients with well-developed glans, autologous glans free transplantation is used.Individualized strategy of balanoplasty according to different conditions of patients is conducive to obtaining satisfactory appearance of the glans.

Since it was introduced in the 1970s, skin and soft tissue expansion has been widely used in the field of plastic and reconstructive surgery, and has achieved good results. In the field of ear reconstruction, there are many related studies and reports available. The author reviewed and summarized the history and current progress of skin and soft tissue expansion and its application in auricular reconstruction, and offered author’s personal opinion on the classification and naming of ear reconstruction based on expansion technique.

Objective:To investigate the strategy of balanoplasty in penile reconstruction with free forearm flap.Methods:From October 2010 to October 2015, 20 patients (19-41 years old) underwent penile reconstruction with free forearm skin flap in Xijing Hospital of Air Force Military Medical University, including 14 cases of transexuals (female to male), 3 cases of hermaphroditism, 2 cases of congenital penile dysplasia and 1 case of penile defect after trauma. According to the tissue quantity of forearm flap and the development of glans, three methods were adopted to reconstruct the glans: free forearm skin flap + E-shaped cartilage framework, free dorsalis pedis flap + E-shaped cartilage framework or free glans transplantation. The patients were followed up for a long time postoperation to observe the morphological changes of the glans after different method of balanoplasty.Results:Among the 20 patients, 18 cases were treated with distal part of free forearm flap and E-shaped cartilage framework for glans reconstruction, 1 case of transexuals used free dorsalis pedis flap and E-shaped cartilage framework for glans reconstruction, and 1 case of hermaphroditism used free glans transplantation to reconstruct glans. After 10-36 months of follow-up, all reconstructed penises survived. The shape of glans reconstructed by dorsalis pedis flap was the most plump and natural with clear coronal sulcus; the amount of glans tissue reconstructed by forearm skin flap was slightly insufficient, and the coronal sulcus was slightly flat, while the overall shape was satisfactory. The reconstructive glans with free glans transplantation was not plump, but they retained the shape of glans, which was lifelike.Conclusions:If the tissue quantity of forearm skin flap is sufficient, the distal part of free forearm flap and E-shaped cartilage framework is used; if the tissue quantity of forearm is seriously insufficient, the free dorsalis pedis flap and E-shaped cartilage framework is used. For hermaphroditism patients with well-developed glans, autologous glans free transplantation is used.Individualized strategy of balanoplasty according to different conditions of patients is conducive to obtaining satisfactory appearance of the glans.

Since it was introduced in the 1970s, skin and soft tissue expansion has been widely used in the field of plastic and reconstructive surgery, and has achieved good results. In the field of ear reconstruction, there are many related studies and reports available. The author reviewed and summarized the history and current progress of skin and soft tissue expansion and its application in auricular reconstruction, and offered author’s personal opinion on the classification and naming of ear reconstruction based on expansion technique.

Objective To evaluate the clinical outcome of reduction plasty for labia minora hy-pertrophy with redundant praeputium clitoridis .Methods A total of 84 cases were included from June 2013 to December 2016 .Arc-shaped resection of labia minora and crescent resection of redundant pra-eputium clitoridis were the two essntial surgical procedure ,and 5-0 VICRYL Rapide was used for su-turing the incision .Results The 84 cases were operated with this mothod with satisfactory aesthetic result .Complications ,such as hematoma ,infection and poor wound healing ,were not observed .Ede-ma was resoluted after one to two weeks .After the reduction plasty of the labial labia ,the vagina and perineum were completely covered in the natural state ,without scar ,also the sensitivity of clitoris was improved due to the better expoure post-operationally .Conclusions The same-stage reduction plasty for labia minora hypertrophy with redundant praeputium clitoridis is a reliable and effective method . Both satisfactory aesthetic result and improved sexual sensitivity are achived ,without hematoma ,in-fection and poor wound healing .

Objective: This study aimed to present our clinical experience of the utilization of remnant ear for the inferior part and lobule reconstruction in microtia patient with the fully pre-expansion ear reconstruction technique. Methods: During 2017.01—2018.12, 156 cases of unilateral ear reconstruction were performed. The operation was divided into three stages. Six months after the ear reconstruction, the third stage of the remnant ear utilization was performed. The surgery was planned according to the microtia classification and the remnant morphology. Results: All the patients had no complications. Follow-up period ranged from 7—24 months, and ten months on average. All the patients with typeⅠmicrotia had satisfying results of the inferior part and lobule reconstruction. Sixteen cases of types Ⅱand Ⅲ microtia patients had unfortunate outcomes, because the residual ears were too small to reconstruct the earlobe, and the incisure appeared when remnant and reconstructed ear was connected in cases of severe remnant malposition. The rest of patients were satisfied with the reconstruction. Conclusions The utilization of the remnant ear based on the types of microtia and the remnant morphology could achieve the satisfying result of reconstruction for most of the microtia patients.

Objective: This study aimed to present our clinical experience using a novel method for autologus costal cartilage framework fabricationin fully expansion technique ear reconstruction without skin graft. Methods: During Steptember 2016 to Steptember 2017, autologus costal cartilage framework with expansion technique were performed for 63 patients with microtia. Autologous costal cartilage was stacked up to form the structure and height, the natural appearance of auriculocephalic angle was achieved at the same stage, so the second-stage elevation of ear and postauricular skin graft was unnecessary. The delicate structure of the reconstructed ear and ideal bilateral symmetry were achieved by the optimized cartilage stack-up. Results: Three patients out of total 63 patients had cartilage frame work exposure, and were treated with superficial temporal fascia transfer combined with skin graft. The rest 60 patients had satisfied results. Follow-up ranged from 8 months to 18 months and 12 months follow-up was on average. The novel frame work fabrication method was based on the sufficient full pre-expansion procedure. The ideal structure, bilateral symmetry, and excellent definition of the framework, as well as the natural dorsal appearance of the reconstructed auricular were achieved. Conclusions The cartilage " stack-up" method is essential for the full expansion without skin grafts ear reconstruction technique. The combination of the cartilage " stack-up" framework fabrication and full pre-expansion provide a well-defined, well-projected and bilateral symmetrical ear.