基于“中虚精变”的男性精液疾病与脾胃关系探讨

Relationship between male semen diseases and spleen and stomach based on the statement“middle deficiency causes seminal changes”

"中虚精变"是类比《内经》"中气不足,溲便为之变"所提出的理论,中虚指代中焦脾胃之虚衰,精变包含了精子、精浆的变化,整个理论的提出旨在分析男性精液疾病与脾胃间关系,以及从脾论治精液疾病的相关策略。首先,脾胃经筋联络阴器,构成脾胃与男性生殖器官生理联系的前提,包括脾胃生血,精血互化,血盛精充而能育;脾胃生气,固摄精关,调精关开阖则能控精液藏泄;脾胃斡旋气机,畅达精道,使精液运行有序而不受阻;脾胃运化水液,濡润精室,则精室阴阳和调而生精、藏精、泻精有道。其次,中焦脾胃虚衰原因复杂,饮食失节、情志失调、先天不足、药物及手术损伤、应激损伤、久病虚损和湿邪困遏等皆可诱发其虚而引发精液疾病。再次,中虚所致精变,包含精子数量、活力的异常,精液量、色、质的异常,精液排泄的异常,基本涵盖了所有精液疾病的内容。最后,形成虚证健脾兼益肾、实证祛邪兼护脾,虚实夹杂分轻重、疾病混杂抓病机,无证可辨用通补、方药有度不偏颇的论治原则,为从脾论治精液疾病确立了基本框架,并借助于动物实验研究和临床研究报道对上述内容进行了简要论证,表明"中虚精变"的理论是真实的,是能够作为临床参考的理论。

The statement“middle deficiency causes seminal changes”is an analogy of the statement“urine and stool change due to middle deficiency”from Neijing.The“middle deficiency”is mainly the deficiency of spleen and stomach,and the“seminal changes”included the changes of sperm and seminal plasma.The statement is made to describe the relation between male semen diseases and spleen and stomach,and strategies of treating semen diseases from spleen.Firstly,the connection between the spleen and stomach meridian sinew and the reprodutive organs is the basis for the male semen to be under the effects of the spleen and stomach,including the spleen and stomach transforming blood,essence and blood mutual transformation,and sufficient blood with essence for fertility;Spleen and stomach transform qi,control the passage,storage and discharge of semen.The spleen and stomach regulate qi movement and ensure the smooth discharge of the semen without blockage.The spleen and stomach transport water,moisten the semen chamber,adjust the Yin and Yang of the semen chamber to ensure the proper production,storage and discharge.Secondly,the causes of spleen and stomach deficiency in the middle energizer are complicated,including irregular diet,emotional disorder,congenital deficiency,medication and surgical injury,stress,prolonged illness and dampness,etc.,which can induce deficiency and cause semen diseases.Thirdly,deficiency,including abnormal sperm count and vitality,abnormal semen volume,color and quality,and abnormal semen excretion can cover all aspects of semen diseases.Finally,treatment principles are summarized including tonifying the deficient spleen and kidney,eliminating pathogens and protecting spleen,differentiation of severity and identification of key pathogenesis,and general tonification for indiscernible pattern with balanced prescription.Animal laboratory experiments and clinical studies are used to validate the statement and show that the theory of“middle deficiency causes seminal changes”can be applied as reference to clinical practice.