近年来男科疾病的发病率呈现明显增长趋势,而传统的中医学在男科领域未形成完善的理论体系,虽然男科病种相对较少,但机制复杂,因此需要提高和改进男科疾病的临床疗效,以满足患者就诊的需求.为此,中华中医药学会组织中西医男科专家一起进行探讨,邀请中西医临床一线的青年优秀专家,共同针对男科疾病领域探讨中医及中西医结合治疗的临床优势病种,如慢性前列腺炎、男性不育症、良性前列腺增生、勃起功能障碍、早泄等,明确西医诊断,规范中医临床辨证诊疗,制定出中医西医公认的、融合的诊疗方案,提供优势病种的中西医治疗建议,中医哪些疾病有优势,哪些病程有优势,何时适合中医治疗,何时该采用西医治疗、手术治疗等问题,形成专家共识,同时也为中医临床提供参考依据,充分发挥中医药优势,提高男科疾病的诊疗效果,给患者提供精准的、个性化的和最优化的治疗方案,同时把中医的优势发挥淋漓尽致,这样中医也才能立得住,才能创新,才能发展.

男性迟发性性腺功能减退在临床上属于男科的常见疾病,其发病机制与多种因素损害雄激素的正常分泌和生物活性有关.中医学虽无对应病名,但对本病的认识却比较早,治疗方法丰富.李曰庆教授认为其核心病机是“肾精日损,天癸渐衰”并兼夹心、肝、脾等脏腑功能的异常病理变化.在临床上,对本病的辨治经验丰富,见解有独到之处,强调辨证与辨病相结合,中医与西医相结合,身心同治,男女同调,疗效确切,现对其具体思路做一浅析,以供同道相互借鉴.

现代医学中勃起功能障碍(erectile dysfunction,ED)是指阴茎无法达到或维持足够的勃起以获得满意的性生活,并持续三个月以上[1],勃起功能障碍在中医学上称“阳痿”,是成年男性的常见病.1995年全世界约有1.52亿男性患有ED,预计2025年将有3.22亿[2].国外研究显示,40～70岁男性的ED发生率达到52％[3].国内有研究显示,ED总患病率为28.3％,40岁以上人群患病率为40.2％[4].阳痿给患者造成严重的心理和经济负担,对患者的生活质量和家庭幸福造成很大影响,已成为当今各国泌尿男科医生重点关注的问题.

天癸的概念起源于《素问》,一般认为它是基于肾气所产生的,又可反作用于肾气的一种精微物质,具有时限性、节律性、独立性、功能多样性等生理特点,不但对女性生理发挥作用,对维持男性的生育功能及男性性征也有重要作用.天癸功能的失调会导致男科疾病的发生.探讨天癸在男性生理及病理方面的作用有助于进一步揭示天癸的本质,同时可以对男科疾病的治疗提供新的思路和方法.

随着社会的发展、生活节奏的加快以及生活方式的转变,慢性前列腺炎(CP)、勃起功能障碍(ED)等男科疾病的发病率正呈逐年上升的趋势,伴随而来的男性患者心理障碍愈发受到人们的关注.叙事医学的诞生使得以往单纯将医生作为主体的医疗模式过渡到现代医学“时空-生理-心理-社会”的模式.以患者为主体,加强医患沟通,是推进医学人文的有效手段.将叙事医学应用到男科疾病中,有助于医生更好地了解患者的病情,走进患者的内心,构建良好的医患关系,促进医患融合,从而提高临床的诊疗效率,有助患者早日康复.

《妙一斋医学正印种子编》是明?岳甫嘉撰写于1635年,距今已有近300余年的历史,现今人文、地理、环境有了巨大改变,人的身体状况、精神健康、饮食结构较明朝也有了极大的不同,但书中涉及的理论如先天灵气、交合至理、交合有时、养精有道、炼精有诀、胎始从乾、父精母血、脉息和平、服药节宣、服药要领[1]以及方药的中和种子丸等仍对当今男科的诊疗起着积极的指导作用,本文试从书中关于时间的问题来论述对于现今治疗男性不育症的指导意义.

Professor Shi Hanzhang,chief physician,was the first batch of "inheriting the old TCM experts academic experience instructor" issued by the State Administration of Traditional Chinese Medicine.He was engaged in medical treatment for nearly 70 years,and saved thousands of lives during his whole lifetime.His surgical skills were profound.In the treatment of male diseases,he was skilled with unique experience.He advocated the clinical medication of external treatment for internal diseases by using traditional technique in new approach.He was accomplished in micro syndrome differentiation.He also combined traditional Chinese medicine with western medicine,with good curative effect.This paper summarized the clinical experience of Professor Shi Hanzhang to cherish the memory of him and spare no efforts to inherit and carry forward the application of his academic thinking.

李曰庆教授对心肾不交理论有较为深刻的认识,治疗男科疾病时常从心肾不交立论,强调交通心肾,同时注重调理肝胆脾胃.本文介绍了李曰庆教授治疗遗精、男性不育、男性更年期综合症、尿频、早泄5个临床验案,以展示李曰庆教授治疗男科疾病的临症思路.

Objectives:To discuss the mechanism of Jiawei Buzhong Yiqi Recipe in treating Oligoasthenospermia mice by bbserving the impact of Jiawei Buzhong Yiqi Recipe on such mice's semen quality,mitochondria membrane potential and ultrastructures of mitochondria.Methods:Oligoasthenospermia mice induced using tripterygium glycosides were randomly divided into normal group,model group,control group,low Jiawei Buzhong Yiqi Recipe dose group and high Jiawei Buzhong Yiqi Recipe dose group,each of 12 mice.WLJU-9000 Sperm tester was adopted to analyze sperm quality,JC-1 fluorescent staining and flow cytometry was used to detect the percentage of normal mitochondria membrane potential's sperm (JC-1 + ％),and Hitachi HT770 Transmission Electron Microscopy was used to observe the ultrastructure of epididymal sperm.Results:The percentage of class A,A + B sperm in the control group and Chinese medicine group had statistically significant difference compared with the model group (P ＜ 0.05);and the control group had statistically significant difference compared with the low dose group (P ＜ 0.05),but not with the high dose group (P ＞ 0.05).The total number of sperm and sperm concentration in the control group and the Chinese medicine group had statistically significant difference compared with model group (P ＜ 0.05);but there was no statistically significant difference between the control group,low dose group and high dose group.The JC-1 + ％ in model group decreased more significantly compared that in the normal group (P ＜ 0.05);high dose group and low dose group had significant difference compared with control group (P ＜ 0.05);low dose group had significant difference compared with control group (P ＜ 0.05).Complete mitochondrial sheath structure was found in the cross section of sperm tail in normal group.In the model group,the sperm's mitochondria were significant swollen,with significant loose fiber and ruptured axial filament.After drug intervention,each group sperm's mitochondrial sheath structure was complete,the swollen was significantly reduced,and axial filament became complete and neat.Conclusion:Jiawei Buzhong Yiqi Recipe can significantly improve the sperm's generation and mature,possibly through adjusting the sperm mitochondrial function in mice (improving the mitochondria membrane potential and ultrastructures of mitochondria) to improve the quality of sperm.

Objective To observe the impacts of yishen jianpi formula on the semen quality,the mitochondrial ultrastructure and mitochondrial membrane potential(MMP)in the model mice of oligoasthenotspermia induced by tripterygium glycosides(GTW)and explore the potential effect mechanism of the formula on the disease.Methods The model mice of oligoasthenotspermia induced by GTW were randomized into a normal group,a model group,a positive control group(dongweili oral liquid),Chinese herbal medicine groups(low-dose and high-dose groups of yishen jianpi formula).The model mice received the intervention with dongweili oral liquid and Chinese herbal medicine.Weili color sperm tester was adopted to detect the semen quality in the mice,the transmission electron microscope was to observe the mitochondrial ultrastructure,the fluorescence staining and flow cytometry to detect the normal sperm percentage of MMP(JC-1+%).Results The A-grade sperm motility and the total sperm motility in the positive control group and Chinese herbal medicine groups were higher than those in the model group(P<0.05).The results in thepositive control group and the high-dose group of Chinese herbal medicine were lower than the low-dose group of Chinese herbal medicine(P<0.05).The difference was not significant statistically in comparison of the high-dose group of Chinese herbal medicine and the positive control group(P>0.05).The total sperm count in the positive control group and the Chinese herbal medicine groups was lower than that in the model group(P<0.05).The difference was not significant statistically in comparison among the positive control group,the low-dose group and the high-dose group of Chinese herbal medicine(P>0.05).In the model group,the mitochondria were swollen apparently,the fibers were loose and the axial filament broken.After intervention,the mitochondrial sheath structure was intact and the swelling was alleviated significantly,the fibers and axial filament were getting neat and complete.The sperm MMP was lower than that in the normal group(P<0.05).After intervention,MMP in the high-dose group of Chinese herbal medicine was higher than that in the low-dose group and the positive control group(P<0.05);and that in the low-dose group was higher than that in the positive control group(P<0.05).Conclusion Yishen jianpi formula improves mitochondrial structure and MMP of sperms so as to increase the semen quality and treat oligoasthenotspermia.

BACKGROUND:Kidney tonifying - spleen strengthening method being one of the modalities for treatment of astheno-oligozoospermia is currently commonly used in the clinical setting. To investigate the mechanism of YiShenJianPi (YSJP) Recipe, used in Traditional Chinese Medicine to benefit "the kidney" and strengthen "the spleen".MATERIALS AND METHODS:Oligoasthenozoospermia, male BALB/c mice were randomly divided into normal control, disease model, positive control, low-dosage and high-dosage groups. Oligoasthenozoospermia was induced by tripterygium glucosides intragastric administration before treatment started. Through using computer-aided sperm analysis to test the changes in sperm quality, utilizing flow cytometry to test the percentage of sperm with normal mitochondrial transmembrane potential (JC-1 + %), utilizing X-ray microscopy to observe epididymal sperm ultra-microstructure placing special emphasis and photographing the differences in mitochondria of the flagellum region.RESULTS:Compared with DM, sperm quality of the treated mice was significantly better (P<0.05, respectively). Compared with PC, the LD group had significantly better quality sperms, while the parameters in the HD group were numerically better. Compared with NC, all other groups had significantly lower percentage of sperms with normal mitochondrial membrane potential. In PC, LD and HD groups, the percentage of sperms with normal mitochondrial membrane potential was significantly higher than that of D. The 9+9+2 mitochondrial sheath structure was complete in NC but damaged in DM. In the treatment groups, this structure was fairly clear.CONCLUSION:YSJP improved semen quality with oligoasthenozoospermia by improving sperm mitochondrial membrane potential and restoring sperm mitochondrial ultrastructure.

Objective To investigate the clinical efficacy of compound Xuanju capsule works in the treatment of typeⅢ chronic prostatitis with kidney stasis syndrome, and explore it related therapeutic mechanism and etiology of chronic prostatitis. Methods A single armed, multi-center and prospective longitudinal clinical test was carried out to compare the before-after difference of 144 type Ⅲ chronic prostatitis patients with kidney stasis syndrome from 5 centers. All the patients were administered with compound Xuanju capsule as following: three times one day, three tablets one time, totally for six weeks. Total efficiency of before-after treatment, NIH-CPSI score, TCM syndrome score, the white blood cell and lecithin body in EPS, IIEF-5 score, TT, FT, IL-8, IL-10 and other indexes were used to analyzed its therapeutic mechanism and clinical efficacy on type Ⅲ chronic prostatitis. Results Clinical efficiency of Xuanju capsule was 90.97% for six weeks treatment of type Ⅲ chronic prostatitis patients with kidney stasis syndrome. The NIH-CPSI score and the white blood cells account in EPS were significantly decreased (P<0.001) whereas lecithin body increased (P<0.001). The TCM syndrome score including primary and secondary symptoms scores were significantly lower (P<0.01) than that of the control group. The IIEF-5 scores and other items had significant changes after treatment (P<0.001). The levels of FT and IL-10 elevated significantly (P<0.05), but the increase of T index and decrease of IL-8 had no significance (P>0.05). Conclusion These results suggest compound Xuanju capsule shows some improvements in alleviating clinical symptoms of type Ⅲ chronic prostatitis (kidney stasis syndrome) in different extent, especially in painful symptoms, and an obvious therapeutic effect on patients with erectile dysfunction. Moreover, changes of endocrine and inflammatory factor levels regulate and enhance the immunity of patients, which provides some cues for better clinical therapy.

良性前列腺增生症是一种常见于中老年男性、可造成排尿障碍的良性疾病.BPH在组织学上主要表现为前列腺间质及腺体成分的增生,在解剖学上主要表现为前列腺增大(Benign Prostatic Enlargement, BPE),因BPH而致的膀胱出口梗阻(Bladder Outlet Obstruction,BOO)可对尿动力造成影响,临床症状则以下尿路症状(Lower Urinary Tract Symptoms, LUTS)为主[1].当今科学技术的发展,使得医疗水平迅速提高,人类寿命也相应地得以延长,年龄的增长是BPH发生所必须具备的条件之一,目前,罹患BPH的男性患者正日益增多.

中医外治法是目前所知起源最早的治疗疾病方法,其起源于原始社会,来源于社会实践,历经千载,逐渐成熟,为人类的健康事业作出卓越的贡献。中医外治发展经历4个阶段:起源于先秦、成长于汉唐、创新于宋元、成熟于明清。外治方药由单味药到复方药,外治方法从简单的外敷到多种剂型应用,外治应用从经验到理论升华,逐步形成系统的中医外治理论体系。

Objective To observe the changes of the testis tissue, semen quality and serum sex hormone level in mice model of oligoasthenotspermia induced by tripterygium glycosides, and discuss the possible intervention mechanism of Yishen Jianpi recipe to oligoasthenotspermia. Methods Mice model of oligoasthenotspermia was induced by tripterygium glycosides and the mice were randomly divided into normal group, model group, L-carnitine group, Chinese medicine group( Yishen Jianpi recipe low-dose and high-dose group ) each group inclucled 120 mice. Chinese medicine and L-carnitine were used for intervention, Pathological section HE staining and electron microscope were used to observe the pathological changes of tissue, Weili sperm tester were used to observe the semen quality, serum sex hormone levels were detected by enzyme linked immunosorbent assay. Results A level and total sperm motility in the&nbsp;L-carnitine group and Chinese medicine group were higher than those in the model group (P<0. 05); the L-carnitine group were lower than the low-dose group (P<0. 05);compared with the L-carnitine group, the high-dose group was not significant difference (P>0. 05). Sperm total in the L-carnitine group and Chinese medicine group were higher than that in the model group (P<0. 05);among the L-carnitin group, low-dose and high-dose group, there were no statistical significance(P>0. 05). Serum follicle stimulating hormone and lutein level in other group were higher than that in the normal group (P<0. 05); intervention groups were higher than model group(P<0. 05);there was no significance difference between model group and in-tervention groups (P>0. 05). There was no significance difference in serum T level between the model group and intervention groups (P>0. 05);the model group and intervention group were lower than that in the normal group (P<0. 05). Conclusion Yishen Jianpi recipe can regulate the level of serum sex hormone in mice model of oligoasthenotspermia and affect the occurrence of sperm to achieve the goal of im-proving the quality of semen in the treatment of oligoasthenotspermia.

鉴于临床论治阳痿疗效不太满意的现实,该共识根据中医基本理论,结合流行病学研究结果和临床实践结局,提出“肝郁血瘀肾虚”是阳痿中医发病学基本病理变化的理论观点.该共识认为,在阳痿发病过程中,肝郁的病理变化具有普遍性而为主要病理特点、血瘀是发病的最终病理趋势、肾虚是发病的主要病理趋势,且三者互为因果,共同作用,影响阴茎的勃起;中青年时期以肝郁血瘀为主、肾虚次之,老年时期以肾虚血瘀为主、肝郁次之.治疗当以疏肝、活血、益肾为基本原则,根据肝郁、血瘀、肾虚轻重程度选用疏肝剂、活血剂、补肾剂加减化裁治疗,也可选用疏肝药、活血药、补肾药组方治疗.具体可选四逆散合秃鸡散、益肾活血汤、柴丹振阳颗粒等方剂加减.

鉴于弱精子不育症发病机制复杂,症状、体征表现不明显或无症状、体征,难以做到精准分证论治,该共识根据中医脾肾相生和精血互化学说理论,以及临床实践结局,提出“脾肾两虚夹瘀”应为无症状性弱精子不育症基本病理变化的理论观点.该共识认为脾肾不足为本是发病基础、瘀滞不畅为标是发病趋势, “脾虚”“肾虚”“血瘀”构成了无症状性弱精子不育症发病的三大关键环节.治疗当以健脾益肾、活血养精为基本原则,临床可选用健脾剂、补肾剂、活血剂加减化裁治疗,也可选用健脾药、补肾药、活血药组方治疗,具体可选补中益气丸合五子衍宗丸加活血剂、或十全大补丸合五子衍宗丸加活血剂、或聚精助育汤等方剂加减.

阴茎勃起功能障碍（Erectile Dysfunction，简称ED）是影响男性性生活质量的常见疾病，国、内外流行病学资料显示[1,2]，在有性生活人群中，ED的发生率高达39.4%，且随伴发疾病以及年龄而增加。因此，随着我国逐步进入老龄化社会，ED患病人数呈现上升态势。

男性不育症是诸多男科常见病中较为难治的疾病，现从男性不育症辨证上要宏观辨证与微观辨证相结合，治疗上宏调阴阳与微调阴阳相结合两方面探讨男性不育症的临床辨治，希望能给读者在诊治男性不育症上以启迪。