张敏建教授从郁证的定义剖析"气、血、痰、火、湿、食、瘀"诸郁在男科疾病中的特定表现,分析男科郁证的病因病机,讨论男科郁病的证治,认为对男科郁证的论治当首辨阴阳、次分脏腑、从寒热虚实而施治.张师认为男科疾病一般病程较长,故从郁证论治应在注重心理疗愈的同时,注意安全用药,不宜峻猛.实证用药要注意理气不耗气,活血不破血,清热不败胃,祛痰不伤正;虚证的治疗需注意补益心脾而不过燥,调补脏腑而不滋腻.

扶阳思想源远流长,指导临床效果显著,其思想根源于《黄帝内经》,发展于《伤寒论》.张敏建教授系全国第六批名老中医学术思想继承人指导老师,善用扶阳思想治疗男性疾病,其认为扶阳要分清虚实,关键在于分清阳虚与阳郁.辨清病位,男科病阳虚关乎心、肝、肾三脏,之后选用经方治疗,方得良效.

良性前列腺增生症是中老年男性常见病之一,是危害我国中老年男性健康的首要慢性病.张敏建教授强调东汉张仲景所著《伤寒杂病论》中诸多关于小便问题辨病和辨证的论述,其中对于诊治良性前列腺增生症而言,能否融会贯通正确理解小便不利与小便自利尤为重要.今从张敏建教授解析《伤寒论》第71和125条来介绍张师对良性前列腺增生症辨病辨证的临床经验.

目的 探讨男性不育初诊患者治疗前精液参数波动规律及可能的影响因素.方法 收集142例按要求每周检查1次精液并完成≥4次的男性不育初诊患者精液参数(精子密度、a级精子及(a+b)级精子),观察性激素、血生化、精浆生化和VC等可能的影响因素.以精液参数波动的绝对值(最大值-最小值)大小进行分组分析.精子密度波动分组(A、B、C三组),A组密度波动幅度≥10(1表示1×106/mL),B组密度波动3≤幅度＜10,C组密度波动幅度＜3;a级精子波动分组(D、E、F三组),D组波动幅度≥10％,E组波动5％≤幅度＜10％,F组波动幅度＜5％;(a+b)级精子波动分组(G、H、I三组),G组波动幅度≥10％,H组波动5％≤幅度＜10％,I组波动幅度＜5％;密度与活力同时波动分组(J、K二组),J组密度波动幅度≥3及a级精子波动幅度≥5％,K组密度波动幅度≥3同时(a+b)级精子波动幅度≥5％.结果 1、精液参数波动情况:142例精液参数均存在依次递减、依次递增、交叉增减的波动和单次出现极值0的现象.①精子密度波动:依次递减6例占4.23％,依次递增9例占6.34％,交叉增减127例占89.43％,B组交叉增减率占比高,与A、C组比较有统计学意义(P＜0.05),表明精子密度交叉增减在中度波动组明显.②精子活力波动:精子活力表现a级精子依次递减5例占3.52％,依次递增5例占3.52％,交叉增减132例占92.96％,单次出现0值31例占21.83％;(a+b)级精子依次递减8例占5.63％,依次递增5例占3.52％,交叉增减129例占90.85％,单次出现0值18例占12.68％.其中E组a级精子交叉增减率较高与D、F组比较有统计学意义(P＜0.05),表明a级精子交叉增减波动在中度波动组多见;(a+b)级精子交叉增减发生率G、H、I三组逐渐减少,有统计学意义(P＜0.05),提示(a+b)级精子波动幅度越大越表现为交叉增减.2、影响因素:A组LH、PRL降低伴随UA升高与B组比较有统计学意义(P＜0.05),同时发现B组LH、UA降低伴随T、TC升高与C组比较有统计学意义(P＜0.05),提示精子密度波动程度的影响因素复杂多变;I组精浆α-葡糖苷酶水平下降与H组比较有统计学意义(P＜0.05),提示精浆α-葡糖苷酶水平下降可能降低(a+b)精子活力波动的程度;VC与精液参数的波动无统计学意义.结论 男性不育患者精液参数存在明显波动现象,无论密度还是活力均存在逐渐递减、逐渐递增和交叉增减的波动现象且波动≥3次(3周),部分数据出现0值或检测7次(7周)才转折,这一现象可能与性激素、代谢水平和部分附属性腺功能相关.因此,WHO提出不育诊断检查精液应完成2～3次的方法有待进一步完善.

目的 探讨中药参斛汤联合膀胱灌注表柔比星对非肌层浸润性膀胱癌患者经尿道膀胱肿瘤切除术(TURBT)后生存质量和复发率的影响.方法 选择2014年2月至2018年1月行TURBT治疗的非肌层浸润性膀胱癌168例,根据随机数字表法分为治疗组和对照组,每组各84例.治疗组中途退出14例,对照组中途退出12例.治疗组(70例)术后给予口服参斛汤联合表柔比星膀胱灌注治疗;对照组(72例)给予表柔比星膀胱灌注治疗.比较两组术后1年膀胱癌特异性量表(BCI)中泌尿维度评分和膀胱过度活动症评分量表(OABSS)评分;比较两组复发时间和术后1年复发率.结果 术后1年,治疗组BCI量表泌尿维度评分均高于对照组(P＜0.05),对照组OABSS评分高于治疗组(P＜0.05).两组平均复发时间比较,差异有统计学意义(P＜0.05),术后1年复发率差异无统计学意义(P＞0.05).结论 口服参斛汤联合表柔比星膀胱灌注治疗可以有效改善膀胱灌注后膀胱刺激症状和急迫性尿失禁并发症的发生,提高患者生存质量,降低患者术后1年的肿瘤复发率,优于单用表柔比星膀胱灌注治疗.

近些年来,随着国家计划生育政策的调整,门诊中就诊的男性不育症比例大幅增加,据统计有15％的夫妇在1年内不能受孕而寻求药物治疗,不育的夫妇中至少50％存在男性精子异常的因素[1].另外,有较多男性不育症病因不明确,精液常规检查无异常,给临床医生的诊断和治疗带来了困惑.随着人们对男性不育相关因素深入研究,精子DNA损伤作为一项新的评价精子功能的指标,逐渐受到临床的重视.传统的精液常规检查,易受时间和外界环境的干扰,易于波动,已不能对精子的受精能力及男性的生育能力进行准确的评价[2].中医药在改善精子功能方面有较好的优势,本研究旨在观察石革汤对肾虚夹湿型男性不育患者精子DNA完整性的影响.

目的 通过对90例男性不育弱精子症患者及30例正常男性进行分组处理观察石萆汤治疗弱精子症的可能靶点,探究石萆汤治疗肾虚夹湿型弱精子症的分子生物学机制.方法 选择2016年8月～2018年6月在福建中医药大学附属人民医院男科门诊就诊的男性不育弱精子症患者和生殖体检者共120例,其中30例正常组与30例弱精子症组患者暂时未接受治疗,60例治疗组患者给予石萆汤治疗16周.治疗前后采用Western blot检测患者精子线粒体膜蛋白PHB及JC-1流式细胞仪检测线粒体膜电位.结果 由Western blot结果,我们可以看到弱精子症组的患者精子线粒体膜蛋白PHB表达量明显低于正常组(P＜0.05);在给予石萆汤治疗16周后,治疗组患者精子线粒体膜蛋白PHB蛋白表达量显著高于弱精子症组(P＜0.05).通过对3组患者精子JC-1染色后进行流式细胞仪检测发现弱精子症组患者精子线粒体膜电位(红色荧光散点)与正常组和治疗组相比偏向下移,提示弱精子组患者精子症线粒体膜电位降低.而经过石萆汤治疗16周后流式红色荧光散点上移差异具有统计学意义(P＜0.05).结论 石萆汤治疗肾虚夹湿型弱精子症可能是通过调控精子线粒体膜蛋白PHB表达进而改变精子线粒体膜电位,最终提高精子活力,增强精子功能,值得在今后临床中应用,同时线粒体膜蛋白PHB可对精子功能进行衡量,可在今后的临床检验中进行检测反映精子功能与状态.

目的:探讨石萆汤对肾虚夹湿型弱精子症患者精子线粒体膜蛋白PHB及超微结构的影响.方法:选取福建中医药大学附属人民医院男科门诊就诊的肾虚夹湿型弱精子症患者(60例)和生殖体检者(60例)为研究对象.将生殖体检正常者纳入正常精液组(N组,n=30),检测为弱精子者纳入弱精子组(A组,n=30);确诊为肾虚夹湿型弱精子症的60例患者纳为石萆汤治疗组(T组,n=60).A组暂未接受相关治疗措施,T组连续口服石萆汤16周.三组受试者均禁欲7 d后经手淫方式采集精液,用计算机辅助精液质量分析仪(CASA)分析精液质量;采用荧光探针MitoTracker,激光扫描共聚焦显微镜(LSCM)观察精子细胞的荧光强度,分析精子细胞线粒体膜蛋白PHB阳性细胞的比例;用透射电镜观察精子细胞线粒体超微结构的变化.结果:三组受试者除精液量比较无统计学意义(P>0.05)外,N组受试者部分精子质量指标[精子(a+b)级活动力及精子成活率]、精子线粒体膜蛋白PHB水平均明显高于A、T两组,且T组上述指标检测结果明显高于A组,差异均具有统计学意义(P<0.05).MitoTracker荧光探针检测,LSCM观察显示N组可见精子中段结构,类似棒状;T组可见精子中段结构,但较短或弯曲状;A组的精子结构变形;荧光强度A、T组精子弱于N组,但T组优于A组(P<0.05).透射电镜观察显示N组精子线粒体鞘完整;A组精子出现水肿、呈现空腔,线粒体肿胀;A组精子线粒体鞘较完整、线粒体肿胀明显减轻、结构较完整、整齐.结论:石萆汤能够改善肾虚夹湿型弱精子症患者精子质量,可通过上调精子线粒体膜蛋白PHB表达阻滞精细胞凋亡,保护精子线粒体超微结构的完整性,来达到治疗弱精子症的目的.

Objectives:To study the effect of Guizhi combined keel oyster decoction on the levels of leptin and 5-HT in patients of premature ejaculation with heart-kidney disharmony type.Methods:72 patients with heart-kidney disharmony type premature ejaculation in Andrology Department of the People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine were selected and randomly divided into Guizhi combined keel oyster decoction group (group A,24 cases),JinsuoGujing pill group (group B,24 cases) and trazodone group (group C,24 cases).3 groups respectively received different medicine,all for a course of treatment of 4 weeks.The patients were followed up for 4 weeks after drug withdrawal.Compare treatment effect of three groups,the average vagina ejaculation latency (IELT) and premature ejaculation diagnosis scale (PEDT) of three groups before treatment and 8 weeks after treatment were compared.The blood Lpetin and serotonin (5-HT) levels of three groups before and after treatment were compared as well as the situation of adverse reactions during treatment.Results:The average IELT increased by 4.28 min after treatment in group A.Group B and group C increased by 1.15 min and 1.22 min respectively,and the differences among three groups were statistically significant (P ＜ 0.05).The ejaculation control ability and sexual satisfaction in group A had a significant increase after treatment,and group A was obviously better than these in group B and group C (P ＜ 0.05).After treatment,Leptin and 5-HT improved significantly in 3 groups,and group A was better than group B and group C,with statistically significant difference (P ＜ 0.05).Conclusion:Guizhi combined keel oyster decoction in treatment for the premature ejaculation patients with heart-kidney disharmony typecan significantly reduce blood Lpetin and improve the level of 5-HT,with good treatment effect and high safety.

目的:探讨石萆汤对肾虚夹湿型弱精子症患者精子活力、精子线粒体酶活性及精浆锌含量的影响.方法:选取符合纳入标准的病例76例,随机分为石萆汤治疗组38例;天然维生素E软胶囊+葡萄糖酸锌片对照组38例,检测两组治疗前后精液常规参数;精子线粒体呼吸链相关酶活性:琥珀酸脱氢酶(SDH)和细胞色素C氧化酶(COX)的水平;全自动精浆生化仪测定精浆锌含量的变化;评估治疗前后中医证候评分.结果:两组治疗后各项精液参数比较,治疗组优于对照组(P<0.05);两组治疗后精子线粒体呼吸链相关酶活性值均有升高,治疗组优于对照组(P<0.05);两组治疗后精浆锌含量升高,治疗组升高幅度高于对照组(P<0.05);两组治疗后中医证候评分,治疗组改善程度明显优于对照组(P<0.01).治疗16周后再随访12周,治疗组9例夫妇受孕成功,总有效率为86.11%;对照组仅4例夫妇受孕成功,总有效率为72.22%,两组比较有统计学差异(P<0.05).结论:石萆汤对改善肾虚夹湿证弱精子症患者的精液常规中的活力参数有明显作用,应与其激发精子线粒体酶活性和提高精浆锌含量以及治疗肾虚夹湿证临床症状有关,进而提升不育患者夫妇受孕能力,值得进一步深入研究.

Objectives:To compare the clinical efficacy of Wuzi Yanzong Decoction and Wuzi Yanzong Pill in the treatment of asthenospermia.Methods:60 patients with asthenospermia were randomly divided into group A and group B.Group A were given Wuzi Yanzong Pill and group B were given Wuzi Yanzong Decoction.The quality of sperm was observed before and after treatment.Results:In group A,there were 2 cured cases,8 markedly effective cases,14 effective cases and 6 invalid cases,and the total effective rate was 70.21％.In group B,there were 1 cured case,7 markedly effective cases,15 effective cases and 7 invalid cases,and the total effective rate was 68.89％.After 4 weeks of treatment,sperm motility of group A was better than that of group B (P ＜ 0.05),but after 8 weeks of treatment the two groups had no significant difference (P ＞ 0.05).Conclusion:The study confirmed that the decoction took effect quickly,but there was little difference in the long-term effect.

张敏建教授是福建省名老中医学术继承工作指导老师、中国中西医结合学会男科专业委员会主任委员、福建省中西医结合学会男科分会名誉主任委员.张敏建教授从医30余年来对男科疾病的诊疗积累了丰富的临床经验,形成系统的辨治策略.笔者有幸跟师临诊,收获颇丰,今将张敏建教授辨湿论治男科病的经验介绍如下.

目的:评价会阴三联针刺法治疗前列腺痛的临床疗效.方法:按随机数字表法将研究对象分为治疗组(A组)和对照组(B组)2组各40例,A组给予会阴三联钟刺法治疗,B组采用中药辨证治疗,用NIH-CPSI评分表与中医证候积分表进行疗效评价.结果:2组治疗效果比较差异无统计学意义,但三联针刺法起效较快、安全性高.结论:会阴三联针治疗前列腺痛安全、有效,应进一步对其深入、全面的研究.

目的:观察逐渐停药法预防慢性前列腺炎复发的效果.方法:研究对象按照随机数字表法分为逐渐停药组与直接停药组,在治疗4周后两组分别采取逐渐停药法和直接停药法,并跟踪观察复发状况.结果:A组复发15例,B组复发21例,两组比较有显著差异(P＜0.05).结论:逐渐停药法可以降低慢性前列腺炎复发率,值得进一步研究.

目的 观察艾可合剂与艾可胶囊药粉镇痛疗效差异. 方法 分别观察艾可合剂和粉剂两种剂型对醋酸所致小鼠扭体的影响和对热板法小鼠痛阈的影响,并比较两种剂型疗效差异. 结果 对醋酸所致小鼠扭体影响,两种剂型均可升高镇痛抑制率,减少扭体次数(P＜005),延长潜伏时间以粉剂作用明显(P＜0.05);而各给药组镇痛抑制率比较差异不显著(P＞0.05);对热板法小鼠痛阈影响,各给药组痛阈提高率提高不明显(P＞0.05).结论 两种剂型具有一定解除平滑肌痉挛而镇痛作用,两种剂型比较无显著性差异.

Chronic prostatitis is a common and frequently disease in andrology, Professor Zhang Minjian according to the circulation of liver meridian of TCM and physiology and pathology foundation of liver, combined with years of clinical experience, summed up the Eight therapeutic methods:dispersing stagnated liver qi, dispersing the depressed liver-energy and damp elimination, dispersing the depressed liver-energy and cooling heat, nourishing liver and relieving pain, warming liver to eliminating cold to remove dampness, dispersing stagnated liver qi and dispersing blood stasis and dredge collateral, dispersing stagnated liver qi and invigorating the spleen, invigoration of impairment of the liver and kidney.Professor Zhang Minjian used treatment from TCM theory of Liver on Chronic prostatitis, and had rich experience. All of them, the dispersing stagnated liver qi run through the treatment course.At the same time, Professor Zhang Minjian applied the Eight methods flexibly according to the clinical transmission characteristics of disease, and the therapeutic effect was conspicuous.

OBJECTIVETo observe the clinical efficacy of Shugan Yiyang Capsules in the treatment of asthenospermia and its action mechanisms.METHODSWe randomly assigned 135 asthenospermia patients to groups A (n = 47), B (n = 45), and C (n = 43) to be treated with Shugan Yiyang Capsules, oral levocarnitine, or combination of the two. We observed sperm quality and the level of α-glucosidase in the seminal plasma before and after medication.RESULTSThe total effectiveness rate was 70.21% in group A (markedly effective in 16 cases and effective in 17), 68.89% in group B (markedly effective in 15 cases and effective in 16), and 83.72% in group C (markedly effective in 16 cases and effective in 20), significantly higher in C than in A and B (P < 0.05). Both sperm quality and the level of α-glucosidase in the seminal plasma were improved in the three groups of patients, most obviously in group C.CONCLUSIONShugan Yiyang Capsules can be used for the treatment of asthenospermia, and its effect can be enhanced in combination with oral levocarnitine.

<正>由中国中西医结合学会男科专业委员会主办,河南省中医院、河南省中西医结合男科专业委员会承办的第八次全国中西医结合男科学术大会于2013年8月23日至25日在河南开封召开。来自全国31个省市、自治区的近400名代表参加了会议,会议共收到男性不育症、前列腺疾病、性功能障碍、男科杂病等方面论文377篇。30余名全国著名中医、中西医结合男科专家在会上做了精彩的专题讲座,充分诠释了本届大会"传承创新特色疗法,建设中国特色男科"的主题。大会开幕前,在中国中

目的 观察前列定痛汤加味治疗前列腺痛的临床疗效.方法 将76例前列腺痛患者随机分为治疗组和对照组,各38例.对照组给予α受体阻滞剂甲磺酸多沙唑嗪治疗,治疗组用前列定痛汤加味.于治疗前、治疗4周后测定慢性前列腺炎症状积分指数(NIH-CPSI)评分进行疗效比较.结果 治疗4周后治疗组在改善NIH-CPSI总积分及疼痛积分、生活质量积分、尿路症状积分方面优于对照组(P<0.05或P<0.01).结论 前列定痛汤加味治疗前列腺痛疗效显著.