According to the definition of World Health Organization, the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse is defined as infertility, which occurs in about 15% of couples all over the world. In 50% of voluntarily childless couples, a male-infertility-associated factor has been found along with abnormal semen parameters. Clinically, microscopic syndrome differentiation of semen or endocrine syndrome is used with macro-syndrome differentiation in Chinese medicine to improve the accuracy of diagnosis and the efficacy of treatment. In the theory of Chinese medicine, Semen and sperm belong to innate Kidney essence which is supported by food essence derived from the Spleen. Semen and sperm are defined as ying, on the other hand, sperm motility and sperm vitality are defined as yang. Besides, phlegm, dampness, blood stasis, and heat which lead to genital tract obstruction have to be taken into consideration. We organized published reports regarding to the microscopic syndrome differentiation of semen in male infertility for clinical management in the article.