基于“以通为用,寓补于通”探析早泄因机证治

Analysis of Etiology,Pathogenesis,Syndrome Differentiation and Treatment of Premature Ejaculation Based on Theory of“Unobstructed in Function,Treatment with both Tonification and Purgation”

基于《黄帝内经》“以通为用”理论,结合临床早泄的病机特点,总结出“精室失用,虚实夹杂”的核心病机。提出早泄基础病机为心肾不交,精室统摄失司;肾虚邪滞,精室开阖无度;肝郁脾虚,精室藏泄失调。“以通为用,寓补于通”是核心治法,该病的基本治疗方法为:交通心肾,率精室统摄之权,方选桂枝加龙骨牡蛎汤合交泰丸加减;益肾祛邪,固精室开阖之枢,方选金匮肾气丸合水陆二仙丹加减;疏肝健脾,畅精室藏泄之机,方选自拟柴芍畅精方。

Based on the theory of“unobstructed in function”in Inner Canon of Huangdi combined with the pathogenesis characteristics of premature ejaculation,the core pathogenesis of“dysfunction of semen chamber,deficiency-excess in complexity”was summarized in this paper.It was proposed that the basic pathogenesis of premature ejaculation include:disharmony between heart and kidney,and unconsolidation of semen chamber;kidney deficiency with pathogenic stagnation,and failure in opening and closing of semen chamber;liver depression and spleen deficiency,leading to disharmony in storing and releasing of semen chamber.The core therapeutic principle is“unobstructed in function,treatment with both tonification and purgation”.The basic therapeutic methods are outlined:harmonizing heart and kidney,consolidating the function of semen chamber,selecting formulas such as addition or deletion of Guizhi Jia Longgu Muli Decoction(桂枝加龙骨牡蛎汤)combined with Jiaotai Pill(交泰丸);replenishing kidney and expelling pathogen,consolidating the opening and closing of semen chamber,selecting formulas such as addition or deletion of Jingui Shenqi Pill(金匮肾气丸)combined with Shuilu Erxian Pill(水陆二仙丹);soothing liver and invigorating spleen,promoting the storing and releasing of semen chamber,selecting Zini Chaishao Changjing Formula(自拟柴芍畅精方).