“中虚精变”理论与男性精液疾病辨治再谈

Further discussion on the theory that the“middle deficiency causes seminal changes”and the differentiation and treatment of male semen diseases

“中虚精变”理论的提出,分析了男性精液疾病与脾胃的关系,为从脾胃论治精液疾病确立了基本框架。脾胃作为运化精微、濡养脏腑的重要器官,脾胃异常势必影响其他脏腑功能,从而共同影响精室。据此,进行“中虚精变”理论与男性精液疾病辨治的再探讨,明确中虚致病的若干途径,确立具体治法,拓展理论内涵,对于临床实践有着莫大裨益。首先,脾居中央以溉四旁,心、肺、肝、肾四脏的生成皆与脾胃有关,这决定了中虚在引发精液疾病过程中的关键地位;其次,导致精液改变的原因众多,既包括脾胃对精室的直接影响,亦包含兼有的四脏病变,如脾虚及肾导致精气皆亏,脾虚及肝导致血乏气郁,脾虚及肺导致宣肃失职,脾虚及心导致血亏神乱,脾虚生邪导致痰湿瘀结,皆能引发精室的异常和精液的改变;再次,精液疾病的辨治除纯用健脾法外,更当肾脾同治以复先后天之资助,肝脾同治以复精血之化生,肺脾同治以复气机之宣肃,心脾同治以复心神之调控,兼祛实邪以复气血之畅通;最后,“中虚精变”指导精液疾病的治疗具有减少疾病辨治难点、拓宽疾病辨治思路的优势,但未来仍需积极纳入和拓展优势病种,进行健脾方药影响精子的分子水平论证,以及肠道菌群失调为介质的中虚与生殖关系研究,以使“中虚精变”理论的内涵更加丰富。

This paper analyzes the relationship between male semen diseases and the spleen and stomach,and establishes a basic framework for treating semen diseases from the spleen and stomach.However,the spleen and stomach are important organs for transporting the essence and nourishing the zang-fu organs.Hence,an abnormal spleen and stomach inevitably affects the functions of other zang-fu organs,thus jointly affecting the semen chamber.Accordingly,the theory that“middle deficiency causes seminal changes”and the differentiation and treatment of male semen diseases are further discussed to clarify the pathogenesis of medium deficiency,establish specific treatment method,and expand the theoretical connotation.First,the spleen occupies the center of the hospital with four other organs.The production of the heart,lung,liver,and kidney is related to the spleen and stomach,and this determines the important role of the middle deficiency during the process of causing semen diseases.Second,there are numerous causes of semen changes,and both the spleen and stomach directly affect the semen chamber,which also contains four organs that involve the following:spleen deficiency affects the kidney,resultsing in loss of essence and qi;spleen deficiency affects the liver,resultsing in loss of blood and stagnation of qi;spleen deficiency affects the lung,resultsing unable derisive and descending;spleen deficiency affects the heart,resultsing in loss of blood and god disorderly;spleen deficiency causes phlegm,dampness and blood stasis conjointly and can trigger semen chamber abnormal and semen changes.In addition to the pure spleen-strengthening method,the differentiation and treatment of semen diseases should be treated using the simultaneous treatment of kidney and spleen to restore nature and nurture mutual funding;the simultaneous treatment of liver and spleen to restore the transformation of essence and blood;the simultaneous treatment of lung and spleen to restore the derisive and descending of Qi;the simultaneous treatment of heart and spleen to restore mental regulation;and the simultaneous treatment of removing real evils to restore Qi circulation and blood.Finally,the theory of the“middle deficiency causes seminal changes”in guiding the treatment of diseases in semen has reduced the disease treatment difficulty and expanded the advantage of syndrome differentiation thinking;however,there is still a need to actively filtrate and expand advantageous diseases,demonstrate the effect of spleen-strengthening herbs on the sperm molecular level,and study the relationship between the middle deficiency and reproduction by allowing for the alteration of intestinal flora as a mediator to make the theory of the“middle deficiency causes seminal changes”content richer.