从“阳化气、阴成形”探讨男性不育的中医辨治

Discussion on TCM differentiation and treatment of male infertility from the theory of “yang transforms into qi while yin constitutes form”

“阳化气、阴成形”理论是中医阴阳理论的总纲,体现了中医古朴哲学思想中蕴含的生命观。在“阳化气”的温煦、推动作用下精子具有运动和授精能力;在“阴成形”的凝聚作用下生成精子并维持精子形态结构完整。“阳化气、阴成形”的功能失司是男性不育症的重要病机,“阳化气”功能失司则精子活动力弱、活率低;“阴成形”功能失司则精子数量少、畸形率高,甚至精子DNA碎片率高,该理论对认知男性不育症有着重要作用。中医辨证论治应围绕其病机,以温补肾阳、助化阳气;滋补肾阴、凝化阴气;阴阳互生、补肾填精为辨证论治法则。临床辨证用药应遵循多用子类药和酌加血肉有情之品的特点,围绕其病机在“主病主方论”学术思想指导下制方聚精汤,在滋补肾阴的同时温补肾阳以阳中求阴,兼以活血化瘀,子类药酌加血肉有情之品为方。前期研究表明聚精汤能有效提高精子活力、降低精子畸形率和改善精子DNA碎片化指数,安全性较好。

The theory of “yang transforms into qi while yin constitutes form” is the general outline of the yin-yang theory in traditional Chinese medicine, which embodies the concept of life contained in the ancient philosophical thought of China’s ancient medical practice. The spermatozoa can move and fertilize under the warming and propulsive effect of “yang transforms into qi”, while they are produced and their morphological and structural integrity is maintained under the cohesive effect of “yin constitutes form”. The malfunctioning of “yang transforms into qi while yin constitutes form” is an important pathogenesis of male infertility. Abnormality in the process of “yang transforms into qi” leads to insufficient activity and motility rate of the sperm, and dysfunction of “yin constitutes form” may induce low sperm count and high sperm deformity rate, and even high sperm DNA fragmentation rate. This theory can thus provide some insights into male infertility. TCM syndrome differentiation and treatment of the disease should be based on its pathogenesis, focusing on warming and activating kidney yang and aiding the transforming of yang into qi, enriching and nourishing kidney yin and condensing yin, and harmonizing yin and yang, tonifying the kidney and supplementing the essence. The clinical medication should follow the characteristics of using more herbal medicine of the seed category and adding animal-based ingredients when needed, and the creation of the prescription should be guided by the theory of “a stem formula for the dominant pathomechanism”. Jujing Decoction(Essence-Gathering Decoction) nourishes kidney yin while warming kidney yang to seek yin within yang, and also invigorates blood and dissolves stasis, with the recipe containing primarily seed medicine, and also blood and flesh products when appropriate. It has been shown in a previous study that Jujing Decoction can effectively improve sperm vitality, reduce sperm malformation rate and improve sperm DNA fragmentation index, and has a desirable safety profile.