关于慢性前列腺炎中医病名的两点商榷

Discussion on the Name of Chronic Prostatitis in Chinese Medicine

有学者认为,慢性前列腺炎在症状上与古医籍中的“精浊”“白淫”“劳淋”相似,病机可追溯到《素问·痿论》;“精浊”之名首见于《证治汇补》。对此,笔者提出两点商榷:第一,《素问·痿论》中虽然出现了“白淫”一词,但痿论篇主论“五脏使人痿”,所引文句当属“筋萎”病因,而非白淫;又,“白淫”在《黄帝内经素问》《针灸甲乙经》《备急千金要方》等书中并不特指男性病证。“白淫”的早期认识尚不统一,以《素问·痿论》作为本病文献记载的源头有待商榷。第二,“精浊”病名并非首见于《证治汇补》。明代《医灯续焰》中已有“精浊脉证”一节,详细论述了“精浊”的概念、病因、脉象、“精浊”与“便浊”的鉴别诊断以及“精浊”治法;《景岳全书·杂证谟·淋浊》对“精浊”病因与治法亦有论述,二书均早于《证治汇补》。王肯堂《证治准绳》中所论“赤白浊”与张景岳、李用粹的“精浊”在内涵上没有本质区别,作为病名的“精浊”二字已是呼之欲出,亦值得注意。

Most scholars think that the symptoms of chronic prostatitis are similar to those in ancient medical books,such as"Jing Zhuo""Bai Yin"and"Lao lin",and the pathogenesis can be traced back to Weilun of Suwen;the name of"Jing Zhuo"is first seen in Zhengzhi Huibu.In this regard,the author puts forward two points of discussion:first,although the word"Bai Yin"appears in Weilun of Suwen,the main topic of the"five internal organs make people impotence"in Weilun Pian,the quoted sentence belongs to the cause of"muscle impotence",but not Bai Yin;in addition,"Bai Yin"does not specifically refer to male disease syndromes in such books as Huangdi Neijing Suwen,Zhenjiu Jiayi Jing,and Beiji Qianjin Yao Fang.The early understanding of"Bai Yin"is not unified.It is questionable to take Weilun of Suwen as the source of the disease's literature records.Second,the name of"Jing Zhuo"disease is not first seen in Zhengzhi Huibu.Third,there is a section of"Jing Zhuo Mai Zheng"in the Yideng Xuyan of Ming Dynasty,which discusses in detail the concept,etiology,pulse condition,differential diagnosis of"Jing Zhuo"and"Bian Zhuo",the treatment of"Jing Zhuo";in Lin Zhuo in Zhazheng Mo of Jingyue Quanshu,the causes and treatment of"Jing Zhuo"are also discussed,both of which are earlier than Zhengzhi Huibu.There is no essential difference in the connotation between"Ci Bai Zhuo"and"Jing Zhuo"of Zhang Jingyue,Li Yuxi in Wang Kengtang's Zhenzhi Zhunshen.As a disease name,the word"Jing Zhuo"is already in the air,and it is also worth noting.