Varicocele is a common cause of male infertility, but the mechanisms by which it disrupts testicular homeostasis and impairs spermatogenesis remain incompletely elucidated. This article reviews current evidence on the multifactorial disturbances in the testicular microenvironment induced by varicocele, with a focus on hemodynamic, biochemical, and structural abnormalities. Anatomical predisposition, venous valve incompetence, and impaired venous return collectively lead to chronic venous hypertension, causing progressive dilation of the pampiniform plexus and severe hemodynamic dysregulation. These primary vascular abnormalities subsequently establish a foundation for downstream cellular damage, including testicular hyperthermia, hypoxia, and metabolic stress. Among these pathological processes, oxidative stress is widely recognized as a central mediator of testicular injury. Excessive reactive oxygen species overwhelm intrinsic antioxidant defenses, disrupt mitochondrial function, damage germ cell DNA, and impair epididymal sperm maturation, ultimately leading to reduced sperm concentration, motility, and viability. Simultaneously, elevated inflammatory cytokines and immune dysregulation further compromise Sertoli and Leydig cell function, activate inflammasome signaling and amplify inflammatory injury. These inflammatory signals also synergize with oxidative damage to disrupt the blood–testis barrier, resulting in increased permeability, autoimmune activation, and accelerated loss of germ cells. Structural impairment of the seminiferous epithelium, mitochondrial dysfunction, and the activation of intrinsic and extrinsic apoptotic pathways further exacerbate spermatogenic failure. Ultimately, varicocele induces a multifaceted and sustained cycle of testicular microenvironment disruption, impairing spermatogenesis at multiple levels—from Sertoli cell function and blood–testis barrier integrity to germ cell survival and sperm DNA stability.

前列腺癌是严重威胁男性健康的恶性肿瘤，现代医学在控制及生存质量方面仍面临诸多挑战，如术后并发症、耐药性、生存质量下降等。本团队提出“脑-心-肾-精室”轴理论，构建了前列腺癌病机以肾精亏虚为主、精室为核心病位，脑心失调为枢、督脉为纽的辨治体系，在临床实践中展现出独特优势。本文系统解析该理论体系在前列腺癌防治中的核心优势环节：①多靶点调控前列腺癌变微环境，延缓病机传变；②干预雄激素受体信号，延缓耐药进程优势；③形神共调、身心同治，改善晚期生存质量优势；④以督脉为枢纽整合脑心肾精室，实现整体与局部协同调控优势。这些优势环节深刻体现了该理论立足整体、病证结合、形神共调、多靶点干预的特色，为中医药精准辨治前列腺癌及克服现代医学瓶颈提供了新思路和新策略。

Background: Primary premature ejaculation (PPE) affects men’s sexual confidence, impairs couple relationships, and may lead to anxiety and depression. Compound Jinji Granule (CJG) is a traditional Chinese medicine (TCM) formula for treating PPE. Preliminary rat experiments suggested its potential in delaying ejaculation, and this study aims to further validate its clinical efficacy. Methods: This multicenter, double-blind, double-dummy, randomized controlled non-inferiority trial enrolled patients with PPE diagnosed with liver depression and kidney deficiency pattern. Participants were randomly assigned to an experimental group or a control group for 4 weeks. The experimental group received CJG plus a placebo matching dapoxetine, while the control group received a placebo matching CJG plus dapoxetine. The primary outcome was the change in stopwatch-measured average intravaginal ejaculatory latency time (IELT) during treatment. Secondary outcomes included the premature ejaculation profile (PEP), TCM symptom score, degree of IELT improvement, and clinical global impression of change (CGI-C). Results: A total of 92 subjects were enrolled, with 7 dropouts (4 in the experimental group, 3 in the control group). After 4 weeks of treatment, the average IELT in the experimental group increased from 0.29 ± 0.12 min at baseline to 2.03 ± 0.83 min ( P < 0.01); in the control group, it increased from 0.34 ± 0.15 min to 2.48 ± 1.08 min ( P < 0.01). Both groups showed significant improvements across all PEP outcomes. TCM symptom scores improved significantly in both groups, with the experimental group showing superior improvement compared with the control group. The proportion of patients reporting at least mild improvement was significantly higher in the experimental group than in the control group (73.91% vs. 53.33%, P < 0.05). In addition, no significant between-group difference was observed in the proportion of patients achieving an increase in IELT of >1 min or >3 min ( P > 0.05). Adverse events in the experimental group included diarrhea (n = 1), abdominal bloating (n = 1), dry mouth (n = 1), and constipation (n = 1), while those in the control group included nausea (n = 4), headache (n = 3), and dizziness (n = 2). All adverse events in both groups were mild and well tolerated, and no serious adverse events were reported. Conclusion: CJG significantly prolongs IELT, improves ejaculatory control and sexual satisfaction, effectively alleviates ejaculation-related distress and couple communication, and demonstrates good safety.