运用王琦教授“三辨”诊疗模式诊治精索静脉曲张性不育症的实践

Practice in the diagnosis and treatment of varicocele-induced infertility using Professor Wang Qi’s“three differentiation”model

以王琦教授“三辨”诊疗模式为基础,对精索静脉曲张性不育症的诊疗辨病为先,再以辨体为主导,结合辨证,总结出精索静脉曲张的根本病因为瘀血内阻,而精索静脉曲张导致不育症的主要病机为瘀热伤阴、肾精亏损;从而揭示不同体质患者精索静脉曲张性不育症的病机及证候的差异,精索静脉曲张患者以血瘀质为多,其他体质类型常见为阴虚质、阳虚质、湿热质、气虚质、气郁质。对于精索静脉曲张性不育症,瘀血内阻为主要的证候,常见合并的证候有肝肾阴虚证、肾阳亏虚证、精室湿热证、气血两虚证、肝郁气滞证。基于王琦教授主病主方思想的精髓制定精索静脉曲张性不育症的治疗方案,以活血泄热、化瘀通络、养阴生精为治法,自拟丹红通精方为主方,遵循“四维”运用模式在本病的临床诊疗中灵活应用,对各种合并的证候施予相应的治法与方药。从体质、疾病、证候不同层面更加客观、全面地把握疾病的本质以及发病规律和病变特点,灵活进行遣药组方,为本病的诊疗提供新的理解思路及更切合疾病的治疗方案。

Based on Professor Wang Qi's“three differentiation”model,the diagnosis and treatment of varicocele(VC)-induced infertility is a three-step process:disease differentiation as the first,followed by constitution differentiation in combination with pattern differentiation,thus concluding that the fundamental etiology of VC is“internal obstruction of static blood”and the main pathogenesis of VCinduced infertility is“static heat in blood aspect damaging yin and kidney essence depletion”.The differences in pathomechanism and pattern of VC-induced infertility with different constitutions were also revealed.The primary constitution of VC patients is blood stasis,while others include yin deficiency,yang deficiency,dampness-heat,qi deficiency,and qi constraint.For VC-induced infertility,internal obstruction of static blood is the main pattern,most commonly complicated by patterns of yin deficiency of of both liver and kidney,kidney-yang deficiency,dampness-heat in semen chamber,both qi and blood deficiency,liver constraint and qi stagnation.The treatment plan for VC-induced infertility is formulated as guided by Professor Wang's theory of“one major formula for one disease”.The therapeutic principles and method are activating blood and discharging heat,removing blood stasis and dredging collaterals,nourishing yin and promoting essence.Danhong Tongjing Prescription(DTP),an original formula,is Modern Chinese Clinical Medicine created as the main remedy.According to the“four-factor”model,the treatment plan is flexibly applied in the clinical diagnosis and treatment of VC-induced infertility,and corresponding treatment methods and prescriptions are applied to various complicating patterns.Comprehensive understandings of the nature,onset regularity,and pathological characteristics of the disease from different levels of constitution,disease,and pattern,as well as flexible design of clinical prescriptions can provide new ideas and more suitable treatment plans for the diagnosis and treatment of the disease.