《伤寒杂病论》小便异常辨治规律及其在慢性前列腺炎下尿路症状中的应用

Rule of differentiation and treatment of urinary abnormality in the Treatise on Febrile and Miscellaneous Diseases and its application in lower urinary tract symptoms of chronic prostatitis

目的揭示《伤寒杂病论》小便异常症状的辨治规律,探索其在慢性前列腺炎下尿路症状中的应用。方法整理《伤寒杂病论》中所有小便异常症状的条文,归纳出小便异常症状共28种,借鉴西医对慢性前列腺炎下尿路症状的分类方法,将28种小便异常症状分为排尿期症状、储尿期症状、尿路刺激症状、尿色异常、排尿后症状5类。研究总结每一类小便异常症状的辨治规律,阐述其对慢性前列腺炎的治疗意义。结果《伤寒杂病论》中,排尿期症状主要责之于太阴脾虚及阳明胃弱、少阴肾阳亏虚、少阳枢机不利、下焦湿热(邪热),这四种证型也是慢性前列腺炎排尿期症状的主要病机,其中通过小便利与不利可以鉴别下焦瘀热或下焦水气;储尿期症状主要责之于胃肠积热、肺阳虚弱、肾虚不固,少部分是亡阳重症及阳明热盛,心神失常的表现,其中肾虚不固证和肺阳虚弱证是慢性前列腺炎储尿期的相关证型;尿路刺激症状主要责之于下焦邪热(湿热);以尿色可以判断有热无热,热进热退,判断表病与里病,实证与虚证,尿血主要责之于膀胱邪热;排尿后症状责之于肾虚失固。结论《伤寒杂病论》中小便异常辨治规律系统详实,对于慢性前列腺炎的中医治疗具有较强的临床指导价值。

Objective To reveal the rule of differentiation and treatment of uriary obnormality symptoms in the Treatise on Febrile and Miscellaneous Diseases,and explore its application in urinary tract symptoms of chronic prostatitis.Methods All the items of uriary obnormality symptoms in the Treatise on Typhoid and Miscellaneous Diseases were sorted out,and 28 kinds of uriary obnormality symptoms were summarized.Referring to the classification method of western medicine for lower urinary tract symptoms of chronic prostatitis,28 kinds of uriary obnormality symptoms were divided into 5 categories:micturition symptoms,urine-storing symptoms,urinary tract irritation symptoms,abnormal urine color and post-urination symptoms.The rule of differentiation and treatment of each category of uriary obnormality symptoms were studied and summarized,and its significance in guiding the treatment of chronic prostatitis was explained.Results In the Treatise on Febrile and Miscellaneous Diseases,micturition symptoms are mainly attributed to the weakness of Taiyin and Yangming,deficiency of Shaoyin kidney-Yang,stagnation of Shaoyang cardinal,hot and humid(evil heat)of lower energizer,these syndrome types are also the main pathogenesis of micturition symptoms in chronic prostatitis,and the lower energizer coke heat stasis and the lower energizer coke water vapor can be distinguished by the patency of urine;urine-storing symptoms are mainly caused by gastrointestinal heat accumulation,lung Yang asthmia and kidney asthemia,a few of them are the manifestations of Yang depletion of severe illness,Yangming's heat disorder and mental disorder,and the related syndrome types of chronic prostatitis in urine-storing period is kidney asthenia and lung Yang asthenia;urinary tract irritation symptoms are mainly due to the heat of lower energizer coke(dampness and heat);urine color can be used to judge the presence of heat and absence of heat,heat entering and heat retreating,surface disease and internal disease,excess and deficiency syndrome,and urinary blood is mainly responsible for the pathogenic heat of the bladder;post-urination symptoms are mainly responsible for the deficiency of the kidney.Conclusion The rule of differentiation and treatment of urinary abnormality symptoms in the Treatise on Febrile and Miscellaneous Diseases are systematic,detailed and true,it is of great value to guide the Chinese medicine treatment of chronic prostatitis.