基于“湿热生虫”理论探讨慢性前列腺炎病机及当归贝母苦参丸加滑石组方思路

The pathogenesis of chronic prostatitis and the prescription of Danggui Beimu Kushen pills plus talc were discussed based on the theory of“damp heat producing insects”

慢性前列腺炎(CP)为成年男性常见疾病,其中医病因多与虚、湿、热、瘀相关,表现为虚实夹杂的病性特点。基于国医大师王琦从虫毒论治男性不育经验和中医“湿热生虫”理论,认为湿热常致虫毒患生,湿热证与虫毒证常同时出现,因此提出CP中医主导病机为肾虚湿热、血瘀虫毒。中医治疗应根据辨证给予“扶正”和“祛邪”,其中“祛邪”应注重辨治湿热、血瘀、虫毒。国医大师王琦、段亚亭根据《金匮要略》注“男子加滑石半两”,将当归贝母苦参丸加滑石用于CP的治疗。分析四味药物功用特点,当归化瘀润燥以行气血,贝母清热开肺以通水道,苦参清热燥湿以祛虫毒,滑石清热利水以通前窍,共奏清热利水、活血杀虫之效,符合CP“祛邪”的中医治法。结合现代药理研究认为,当归贝母苦参丸加滑石可能在下尿路症状感染、盆腔疼痛、细菌感染等方面具有治疗作用。

Chronic prostatitis(CP)is a common disease in adult men.The etiology of traditional Chinese medicine(TCM)is mostly related to deficiency,dampness,heat and blood stasis,which is characterized by deficiency and solid.Based on the Chinese medicine master WANG Qi’s experience in treating male infertility from insect venom and the theory of“damp heat producing insects”in Chinese medicine,it is believed that damp-heat often leads to insect poison,and damp-heat syndrome and insect poison syndrome often appear simultaneously.Therefore,it is proposed that the leading pathogenesis of CP in Chinese medicine is kidney deficienc and damp-heat syndrome blood stasis and insect poison.In TCM treatment,“Fuzheng”and“Quxie”should be given according to syndrome differentiation,among which“Quxie”should pay attention to the differentiation and treatment of damp heat,blood stasis and insect poison.Chinese medical masters WANG Qi and DUAN Yating,according to the notes of“man plus talc half”in Synopsis of Golden Chamber,used Danggui Beimu Kushen pill plus talc to treat CP.The functional characteristics of the four herbs were analyzed,angelica dispels stasis and moistens dryness to promote qi and blood,fritillaria can clear heat and open lung to clear water channel,sophora can clear heat and dryness to remove insect poison,talc can clear heat and benefit water to clear the front body,all playing the effect of clearing heat and benefiting water,activating blood and killing insects,which conforms to the TCM treatment requirements of CP“Quxie”.Combined with modern pharmacological studies,it is suggested that Danggui Beimu Kushen pill plus talc may have therapeutic effects on lower urinary tract symptoms,pelvic pain symptoms and bacterial infection.