中虚精变理论之“中虚致实”观内涵及对男性不育症诊治的启示

Connotation of ‘Middle Deficiency Generating Excess Evil’ within Theory of Middle Deficiency Causing Seminal Changes and Its Enlightenment to Diagnosis and Treatment of Male Infertility

中虚精变理论主要阐发精液疾病与脾胃关系,以及精液疾病从脾胃论治的策略。本文在中虚精变理论基础上提出“中虚致实”观,描述脾虚影响水液代谢和阴血运行致实邪蕴积、损伤精室的重要过程,实际上契合了男性不育虚实夹杂的病机特点。“中虚致实”观认为中虚所致之“实”的本体以湿、瘀为核心,可衍生热、痰、浊、毒邪,其内涵可据此转变为“脾虚湿瘀论”,即脾虚和湿、瘀诸邪蕴积共同引发精室损害,导致男性不育的产生。在“脾虚湿瘀论”指导下明确相应的治则规范、方药准备和组方实际,不仅能够启发男性不育临床诊治,所使用的核心方药更有相关报道论证其疗效。但拓展试验研究广度和深度、筛选方药、确立优势病种等仍然是理论转向实践过程中亟待解决的问题。

The theory of middle deficiency causing seminal changes mainly elucidates the relationship between semen diseases and Spleen and Stomach, and the strategy of treating semen diseases from Spleen and Stomach. Based on the theory of middle deficiency causing seminal changes, this study put forward the concept of ’middle deficiency generating excess evil’, and described the important process of Spleen deficiency affecting water metabolism and Yin-blood circulation leading to accumulation of excess evil and damage of semen chamber, which actually fitted the pathogenesis characteristics of male infertility with deficiency mingled with excess. According to the concept of ’middle deficiency generating excess evil’, the essence of ’excess evil’ caused by middle deficiency is centered on dampness and blood stasis, which can lead to heat, phlegm, turbidity and toxic pathogens. Its connotation can be transformed into ’the theory of dampness-blood stasis induced by Spleen deficiency’, that is, Spleen deficiency and dampness and blood stasis accumulation jointly lead to semen chamber damage and male infertility. Under the guidance of ’theory of dampness-blood stasis induced by Spleen deficiency’, clear corresponding treatment standards, prescription preparation and prescription practice can not only inspire the clinical diagnosis and treatment of male infertility, but also the core prescriptions used have been reported to demonstrate its efficacy. However, to expand the breadth and depth of experimental research, to select prescriptions and to establish dominant diseases are still urgent problems to be solved in the clinical process of theoretical specialization.