基于“失精家”新解桂枝加龙骨牡蛎汤证治

Diagnosis and treatment of Guizhi-Longgu Oyster Decoction based on the new interpretation of‘patient with frequent seminal loss'

“失精家”本意原指失精-肾虚-虚劳,治疗采用培后天以补先天,并加以潜敛固涩精气。文章结合现代社会疾病谱的特点进行新解读、新运用及新发展。通过重新考察“精”的含义,基于《黄帝内经》《难经》对“失精家”内涵进行分析,并通过《神农本草经》理解桂枝加龙骨牡蛎汤方义,以期探讨桂枝加龙骨牡蛎汤方证。发现“失精家”并不仅局限于有形的精液遗失患者,对于因为挫折、重大心理创伤及情志障碍所造成的无形精气的损失更符合“失精家”的范畴。桂枝加龙骨牡蛎汤中未提供一味补肾益精的药物,因此“失精家”不应为单纯的亡失精液,其病机应从精、神失交定位,其方证是患者遭受重大家庭变故、心理罹受巨大创伤或精神刺激后出现少腹拘急,脱发,头晕目眩,梦遗失精,失眠多梦或噩梦连连,怕冷,易疲劳,脉虚。

‘Patient with frequent seminal loss’originally meant that patients with seminal emission,kidney deficiency and consumptive diseases need to be treated by nurturing to complement nature,converge and arresting jingqi,which is the basic principle.In this paper,new interpretation,new application and new development were carried out according to the characteristics of spectrum of diseases in modern society.By re-examining the meaning of‘jing’,the connotation of‘patient with frequent seminal loss’was analyzed based on Inner Canon of Yellow Emperor and Nan Jing,and the meaning of prescription of Guizhi-Longgu Oyster Decoction was understood through Shennong’s Classic of the Materia Medica,to explore the syndromes treated with Guizhi-Longgu Oyster Decoction.It was found that‘patient with frequent seminal loss’are not only the patients with tangible semen loss,but also more with the loss of intangible essence caused by frustration,major psychological trauma and emotional barriers.In Guizhi-Longgu Oyster Decoction,there is no medicine for nourishing the kidney and strengthening the essence.Therefore,the‘patient with frequent seminal loss’not only refer to those patients losing semen.The pathogenesis should be located from the loss of Jing and spirit,and the syndromes are:After suffering major family changes,psychological trauma or mental stimulation,patients suffer from less abdominal anxiety,hair loss,dizziness,dream sperm loss,insomnia,dreams or nightmares,fear of cold,easy fatigue,pulse deficiency.