从“以通为用”探讨阳痿的辨治

Discussion on the treatment of impotence based on the theory of"organs functioning normally when unobstructed"

《黄帝内经》首提“以通为用”,在治疗六腑和奇恒之腑疾病时应注重顺应其以通利为要的生理特性,后世医家在此基础上不断完善和拓展。男子精室亦属奇恒之腑,具有“以通为用”的特点。男子性功能与精室关系密切,故“以通为用”的学术理念可广泛应用于阳痿在内的泌尿男科疾病。阳痿的病机多为湿浊、瘀血等有形之邪累及精室,伤及宗筋,而虚、郁可贯穿本病发展的始终。基于此,以祛湿、化瘀、解郁为大法,通利精室局部,或以补助通,灵活辨证,遣方用药,临床每获显效。

Huangdi Neijing first proposes the concept of"organs functioning normally when unobstructed",i.e.,when treating diseases of the six fu viscera and the extraordinary fu viscera,attention should be paid to their physiological characteristics of maintaining a normal state of being unobstructed.On this basis,medical practitioners of later generations have continued to improve and expand the notion.The male essence chamber is also one of the extraordinary fu viscera and has the same physiological characteristic of"organs functioning normally when unobstructed".Since the male sexual function is closely related to the essence chamber,this academic concept can be widely applied to the treatment of male urological diseases,including impotence.The pathogenesis of impotence is mostly due to dampness-turbidity,static blood and other tangible pathogens that affect the essence chamber and injure the penis and testes,while deficiency and depression can run through the development course of the disease.Based on this theory,the main treatment methods for impotence are dispelling dampness,resolving blood stasis and relieving depression to unblock and activate the local areas of the essence chamber,or using tonifying methods to clear the essence chamber.In the course of treatment,flexibly differentiating syndromes and formulating suitable prescriptions and medications can help obtain a significant clinical effect.