基于现代文献报道的精液不液化所致男性不育的中医证治规律分析

Analysis on the Characteristics of TCM Syndromes and Treatment in Male Patients with Infertility Attributing to Non-liquefaction Semen based on TCM Literatures Review

目的:基于现代文献报道分析、总结精液不液化所致男性不育的中医辨证、治疗规律。方法:通过检索CNKI中文期刊全文数据库,获取2002—2012年间发表的与精液不液化所致男性不育症中药有效治疗相关的文献报道,建立数据库,分析涉及的证候及用药分布情况,归纳、总结其辨证、治疗规律。结果:纳入分析的39篇文献中,属辨证论治者19篇,专方治疗者15篇,中西医结合治疗者5篇。1)辨证论治的文献中,共计出现辨证结果16个,排在前五位的是肾阴虚证,下焦湿热证,肾阳虚证,痰瘀阻滞证及肾阴虚、下焦湿热证,但从用药看不单纯是针对所辨证候,而是兼顾了疾病的复杂病机;从运用专方或专方结合西医手段治疗用药情况看,以滋阴清热、凉血化瘀及清热利湿、软坚散结的药味出现频率为高,且均有以淫羊藿为代表的补阳药物的较高出现频率,反映了20个专方的药物构成是针对虚实夹杂的复杂病机的。2)基于辨证的用药及专方用药特点,体现了辨病与辨证相结合及补中有泻,补而不滞,泻中有补,顾护正气的补清相兼与阴中求阳、阳中求阴的阴阳平衡的基本治疗原则和用药特点。结论:本病存在虚实夹杂、错综复杂的病机,虚主要表现为肾阴虚、肾阳虚,实主要表现为下焦的湿热(毒)及瘀血、痰浊;临床治疗时当根据患者的具体情况,明辨其虚与实的孰轻孰重以及阴虚、阳虚和湿热(毒)、瘀血、痰浊的不同与侧重。

Objective： To analyze and summarize the characteristics of TCM syndromes and treatment in male patients with infertility at- tributing to non-liquefaction semen based on TCM literatures review. Methods： Literatures on TCM syndrome of male patients with infer- tility attributing to non-liquefaction semen published from 2002 to 2012 were retrieved from CNKI database. The selected literatures were recruited in a new database. The characteristics of TCM syndromes and treatment in male patients with infertility were further analyzed and summarized. Results： Among the recruited 39 literatures, 19 articles were on syndrome differentiation and treatment, 15 articles were on special prescription treatment, 5 articles were on integrated treatment of CTM and western medicine. In 19 articles on syndrome differentiation and treatment, top 5 of syndrome type with frequency were as follows： deficiency of kidney yin, damp-heat diffusing down, deficiency of kidney yang, phlegm-accumulation stasis, deficiency of kidney yin and damp-heat diffusing down. The given treat- ment was considered as the syndrome differentiation and the complex pathogenesis. The high frequency of traditional Chinese medicine category in the 15 articles on TCM special prescription and 5 articles on integrated TCM and western medicine were as follows, nouris- hing yin and clearing heat, cooling blood to remove blood stasis, clearing heat and removing dampness, resolving hard lump. Among all the prescriptions, it indicated that the complex mechanism for infertility male attributing to non-liquefaction semen targeted on notifying yang. The characteristics for the treatment to combine differentiation of TCM sydrom and diseases revealed that it is necessary to reinforce insufficiency and reduce excessiveness, keep balance between Yin and Yang. Conclusion ： The mechanism of male infertility attributing to non-liquefaction semen is complex, mingled with excess and deficiency syndromes. The scheme of treatment on this disease is deter- mined on the situation of patients. It is necessary to weigh and consider balance between insufficiency and excessiveness.