目的 观察中药膏摩治疗气滞血瘀型慢性非细菌性前列腺炎的临床疗效.方法 选取2020 年1 月—2022 年10 月北京中医药大学房山医院男科治疗的气滞血瘀型慢性非细菌性前列腺炎患者120 例,采用随机对照方法将患者分为治疗组、对照组1、对照组2,每组40 例.治疗组采用前列腺膏膏摩治疗,对照组1 采用凡士林膏膏摩治疗,对照组2 采用前列安通片口服,3 组均治疗4周.观察3 组患者治疗前后慢性前列腺炎症状指数(NIH-CPSI)评分、中医证候积分、前列腺液中白细胞数量的变化,评估3 组临床疗效.结果 治疗后,3 组患者NIH-CPSI评分、中医证候积分、前列腺液中白细胞数量均较治疗前明显降低(P均<0.05),且治疗组NIH-CPSI评分、中医证候积分、前列腺液中白细胞数量均明显低于对照组 1 与对照组 2(P均<0.05).治疗组总有效率为94.7%(36/38),明显高于对照组1 的56.8%(21/37)和对照组2 的71.8%(28/39),差异均有统计学意义(P均<0.05).结论 采用前列腺膏膏摩治疗气滞血瘀型慢性非细菌性前列腺炎,可明显缓解患者疼痛症状,改善排尿异常,提高生活质量.

良性前列腺增生(BPH)实验模型是研究BPH发病机制和评价药物疗效的重要载体.该文对BPH症的体内外模型、造模原理、造模方法、评价指标等内容进行了综述,并对当前不同类型模型的优缺点进行了分析.目前,BPH模型更加趋近人类BPH临床特点,为评价药物疗效提供了重要载体.同时,模型已向细胞学方向发展,可以更加深入研究BPH的发病机制.相关检测指标从不同层面反映BPH的核心病理变化,为进一步探寻BPH的发病机制及开发防治药物提供保障.但并没有能完全模拟人类BPH的自然发展进程的模型,每一种模型及评价标准均有其独特的优势与局限性.在模型方面,BPH模型大多以前列腺体积增大(BPE)作为判定模型成功与否的标准,尚缺少可靠的模拟BPH进展及合并膀胱功能障碍的模型.在评价指标方面,BPH动物模型的复制缺少反映症状的行为学指标.中药对BPH模型的研究仅是对"病"的模型的复制与研究,而不是针对于"证""候",不能较好的模拟中医理论指导下的辨证论治.针对上述不足,应该进一步完善基于临床特点的造模方法,探索多因素复合模型,尤其是适合中医药基础研究的病证结合模型,复制更贴近疾病发展规律的模型,优化评价指标,对开发有效防治BPH的药物具有重大的理论意义和现实意义.

中华中医药学会组织中西医男科专家进行探讨,探索对良性前列腺增生以中医药为主导疗法的应用人群和治疗阶段.针对良性前列腺增生中医药具有很大的治疗优势,但必须要明确中医药在该病的什么阶段可以做为主导治疗方式,什么阶段最好采用现代医学治疗方式进行治疗,又在什么状况下可采用中西医结合治疗而获取临床的最佳治疗效果.经与会专家讨论认为,年老体弱,基础疾病多不能耐受麻醉和手术的具有临床症状的良性前列腺增生患者;不能耐受西药治疗药物的不良反应,或不能接受西药可能出现的不良反应的具有临床症状的患者;症状处于轻度下尿路症状[国际前列腺症状评分(IPSS)≤7分]和中度以上症状(IPSS≥8分)但生活质量尚未受到明显影响阶段的患者;膀胱逼尿肌功能减退,膀胱功能低下不能手术治疗,或经手术治疗后功能仍然不能使膀胱排空,仍存在较多残余尿的前列腺增生患者;前列腺增生合并前列腺炎,并且以前列腺炎为主要临床表现的前列腺增生患者;术后出现的非急性并发症等,是中医药治疗前列腺增生的优势阶段,可以采用中医药为主导的治疗.前列腺增生做为中医泌尿男科治疗的优势病种之一,在临床治疗中需充分考虑前列腺增生患者的症状程度及并发症状况、疾病的可能转归来确定具体的治疗方案.在以中医药为主导治疗时需定期复查患者的血清前列腺癌特异性抗原水平,排除前列腺恶性肿瘤的可能,足疗程、足周期的应用中医疗法进行治疗,同时亦可中西并用,使患者得到最有效的、最方便的、最经济的、最满意的治疗,将中医治疗该病的优势发扬光大.

目的 探讨实验性左侧精索静脉曲张(ELV)大鼠睾丸中是否存在铁死亡的细胞死亡方式.方法 24只SPF级SD大鼠,参照Turner法构建大鼠ELV模型,按随机数字表法分成分为假手术A组、假手术B组、手术A组和手术B组,每组6只.假手术A组和手术A组于造模2周后进行取材,假手术B组和手术B组于造模4周后进行取材,分别评估各组左侧精索静脉的曲张情况,同时取出各组左侧睾丸,HE染色观察形态学变化,ELISA法测定活性氧(ROS)、谷胱甘肽过氧化酶4(GPX4)浓度,分光光度法测定还原型谷胱甘肽(GSH)活性,比色法测定谷胱甘肽过氧化物酶(GSH-PX)活性,Western Blot检测左侧睾丸组织中核转录相关因子2(Nrf2)蛋白的表达.结果 手术A组和手术B组大鼠左侧精索静脉均较术前曲张2倍以上,ELV大鼠模型成功建立.手术A组和手术B组大鼠左侧睾丸组织内发生明显病理损伤,生精小管基膜损伤,各级生精细胞排列紊乱,细胞结构部分破坏,管腔生精细胞脱落,精子数量减少,管腔间隙增大,支持细胞形态欠佳.与相对应的假手术A组、假手术B组相比,手术A组和手术B组大鼠左侧睾丸组织中ROS浓度均明显升高,差异具有统计学意义(P<0.05).但GSH、GSH-PX活性与GPX4浓度均变化不明显,差异无统计学意义(P>0.05),Nrf2蛋白相对表达量也无明显变化,差异无统计学意义(P>0.05).结论 目前暂不能得出精索静脉曲张睾丸中存在铁死亡的细胞死亡方式,但是也不能否认其存在的可能.

精液微观辨证在临床上广泛应用,多与宏观症状一同作为辨证依据,但因缺少相关中医理论支持,故无法单独指导临床治疗.笔者从"阳化气,阴成形"理论入手,探讨"阳化气,阴成形"的理论内涵与外延、"阳化气,阴成形"对精液生成的作用及"阳化气,阴成形"功能失调导致精液异常的病机,提出了治疗精液异常时要以微调肾阴肾阳为主,配合调畅气血,同时兼顾五脏六腑寒热虚实,以调整阴阳偏颇,恢复"阳化气,阴成形"功能,为精液微观辨治提供理论支持.

慢性前列腺炎为本虚标实之证,本虚包括肾虚、脾虚等,标实则为湿热、气滞、血瘀等,病机以湿热为标、肾虚为本、气滞为变、血瘀为要.湿、虚、滞、瘀四者既可单独出现,又可相兼为病,初中期以邪实为主,本虚不明显,证型以湿热下注为主.随着病情进展,气血运行不畅,气滞于内,形成气滞,或因病情反复,迁延不愈,或素体禀赋不足、饮食调护不当等,加重正气耗损,致脾肾亏虚.久病入血、入络,瘀浊与湿热等病理产物互相影响,致血脉瘀阻,故血瘀贯穿慢性前列腺炎始终.在治疗上,以辨病为主,辨证为辅,同时由于精室具有易虚、易瘀、以通为顺的特点,活血化瘀应贯穿治疗始终.

男科疾病往往病情复杂,病因不明,临床疗效不佳.李海松教授临床用药不拘一格,常借鉴内科、妇科等其他学科的用药经验,灵活运用于男科疾病的治疗中.少腹逐瘀汤本用于治疗寒凝血瘀证痛经等妇科疾患,教授取中医异病同治之理,认为男性所属器官解剖位置特殊,且男科疾病发病部位局限,多以少腹部疾患为主,契合少腹逐瘀汤用药病位;从中医认为,男科疾病多滞、多瘀,血瘀病机贯穿男科疾病始终,运用少腹逐瘀汤治疗男科疾病契合本方主治;临床中,常将少腹逐瘀汤用于男科慢性前列腺炎、不射精症、血精症等方面的治疗,并根据患者寒热气血脏腑特点辨证施治,临床上取得了显著疗效.

糖尿病性勃起功能障碍是糖尿病最常见的并发症之一,本病属于中医"消渴"合并"阳痿"的范畴,从消渴合并阳痿的中医病机阐述与络病关系,提出治疗当以活血通络为基本治法,联合温肾、益气、疏肝、健脾等治法,兼顾治本与治标,同时处理好清热与补虚、清热与活血的关系,治疗糖尿病性勃起功能障碍可取得一定疗效.

目的 评价补肾消癃汤联合坦洛新治疗良性前列腺增生症的疗效及对血清睾酮(T)、雌二醇(E2)的影响.方法 选取2018年1月至2019年12月北京中医药大学房山医院诊治的70例良性前列腺增生症患者作为研究对象,采用随机数字表法分为治疗组(n=35)和对照组(n=35).治疗组采用补肾消癃汤+坦洛新治疗,对照组采用单纯坦洛新治疗,疗程8周,停药后随访2周.观察两组治疗前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、膀胱残余尿量(PVR)、前列腺体积(PV)、中医证候积分、T和E2水平,以及停药2周后IPSS,记录不良反应.结果 对照组完成治疗30例,总有效率66.7％,显效率30.0％;治疗组完成32例,总有效率87.5％,显效率62.5％;两组疗效差异具有统计学意义(P<0.05).两组治疗后除PV无明显变化(P>0.05),IPSS、QOL、Qmax、PVR、中医证候积分均有明显改善(P<0.05);治疗组在IPSS、QOL、Qmax、PVR、中医证候积分方面改善明显优于对照组(P<0.05).治疗组血清T、E2及T/E2变化显著(P<0.05),对照组无显著变化(P>0.05).治疗组停药2周后IPSS较停药前无明显变化(P>0.05),对照组停药2周后IPSS较停药前明显升高(P<0.05).结论 补肾消癃汤联合坦洛新可明显改善BPH临床症状,显著提高临床疗效,并且具有一定的停药稳定性,对血清T、E2水平有显著影响.

精索静脉曲张( VC )是精索静脉回流受阻或瓣膜失效,血液反流引起血液淤滞,蔓状静脉产生不同程度的异常迂曲、扩张.精索静脉曲张诱发睾丸温度升高、代谢物质反流、睾丸缺氧,雄激素、促性腺激素分泌降低等多种病理变化,影响男性精子发生发育,从而导致男性不育,是导致男性不育症常见原因之一.成年男性人群中精索静脉曲张发病率是11. 7％,在精液质量异常男性患者中发病率是25. 4％ [1].对于精索静脉曲张性不育,临床上目前以手术治疗精索静脉曲张来改善生育状况,存在部分患者术后复发率高,配偶妊娠率不理想等情况[2].中医药在治疗精索静脉曲张性不育方面积累了丰富的经验,现就近年来中医药治疗本病的研究进展综述如下.

李曰庆教授在治疗男科疾病方面经验丰富.临证时善于抓住男科疾病主要病机,以肝肾为本,将调补肝肾作为常法;重视郁在男科疾病的发病中的作用,灵活应用解郁之法;强调血瘀病机,将活血化瘀贯穿男科疾病始终.丰富中医药治疗男性不育的理论,提出宏微观相结合,微调阴阳治不育.倡导以疗效为根本,综合治疗,提出治标与治本相结合、治病与治人相结合、内治与外治相结合、男女同治等行之有效的治疗方法,为男科疾病的诊疗提供新思路.

目的 评价补肾消癃汤治疗肾虚血瘀型前列腺增生症(BPH)的临床疗效及安全性.方法 将符合纳入标准的106例BPH患者随机等分为治疗组和对照组,治疗组给予补肾消癃汤治疗,对照组给予前列舒乐颗粒治疗,疗程均为8周,停药后观察2周.观察2组治疗前后国际前列腺症状评分(IPSS)、生活质量(QoL)评分、最大尿流率(Qmax)、膀胱残余尿量、中医证候积分变化情况,统计2组疗效、不良反应发生情况,比较2组治疗结束及随访2周时IPSS各项评分.结果 治疗组完成治疗50例,总有效率为70.0％(35/50),对照组完成治疗49例,总有效率为51.0％(24/49).2组疗效比较具有显著性差异(P<0.05);2组治疗后IPSS评分、QOL评分、Qmax、膀胱残余尿量、中医证候评分均有明显改善(P均<0.05),而前列腺体积无明显变化(P>0.05);治疗组IP-SS评分、QOL、Qmax、中医证候积分改善情况明显优于对照组(P均<0.05);停药2周后,治疗组患者IPSS总分和各单项评分与2周前比较无显著性差异(P均>0.05),对照组停药2周后尿不尽、尿线细、夜尿次数及IPSS评分较停药前明显升高,且明显高于治疗组(P<0.05).结论 补肾消癃方可明显改善BPH引起的临床症状,治疗BPH安全、有效.

Objective To study the clinical efficacy of Bushen Huoxue decoction in the treatment of varicocele infertility and its influence on epididymis function and sperm vitality. Methods A total of 98 patients with varicocele infertility who were treated in our hospital from August 2016 to July 2018 were selected. The patients were randomly divided into control group of 49 cases and study group of 49 cases. The patients in the control group were treated with Maizhiling plus Wuzi Yanzong pill; the patients in the study group were treated with Bushen Huoxue decoction. After 12 weeks of treatment, the clinical efficacy of the patients was evaluated. The semen quality (including semen volume, sperm density, sperm motility, forward-moving sperm), sex hormones, and seminal plasma neutral α-glucosidase in the two groups were compared before and after treatment. After the end of treatment, the patients were followed up for 3 months to observe the pregnancy of the patients' spouse. Results After treatment, the total effective rate of the study group was87.76％, and the total effective rate of the control group was 69.39％. The semen quality, sex hormone and neutral α-glucosidase levels in the study group were better than those in the control group (P<0.05). Conclusion Bushen Huoxue decoction has a significant clinical effect in treating varicocele infertility. It can improve the semen quality, improve testosterone level and seminal plasma neutral α-glucosidase level, and improve the fertility of patients with varicocele.It is worthy of clinical promotion.

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.

目的:初步评价蜂花前清方(蜂花前清茶)治疗慢性非细菌性前列腺炎的安全性和有效性.方法:采用随机对照方法将90名患者分为试验组和对照组,每组45例,进行为期10周的临床观察.试验组患者服用蜂花前清茶,2次/d,每次2袋;对照组患者口服特拉唑嗪,1次/d,每次1片.本研究以NIH-CPSI量表为主要评价指标来观察临床疗效.所有数据采用SPSS 19.0软件处理.结果:参照NIH-CPSI量表评分,两组患者总有效率依次为79.5％、41.5％,其差异具有统计学意义(P＜0.05).结论:蜂花前清方(蜂花前清荼)治疗慢性非细菌性前列腺炎在疼痛、排尿等方面有独特优势.

Objective To observe the application effect of KAP health belief mode on the rehabilitation exercise of recovery phase in stroke.Methods A total of 70 patients who met the diagnostic criteria were randomly divided into control group and observation group where there were 35 cases each.Nursing was conducted to the stroke (recovery phase) nursing program of 13-set programs of traditional Chinese medicine issued by Beijing Traditional Chinese Medicine Authority in 2013 for the control group.KAP health belief mode was given to observation group on the nursing basis of control group.3 weeks before and after treatment and 8 weeks after discharging were the knot to compare to clinical nursing effect of patients in two groups.Results The scores of Barthel of functional training of diseased arms or legs for the patients of observation group, NIHSS and Fugl-Meyer assessment were superior to the patients of control group(P<0.05).Conclusions KAP health belief mode on the application effect of rehabilitation exercise of recovery phase in stroke is clear,which can get the diseased arms or legs recovered extremely.

Objective To investigate the distribution frequency of different Chinese medicine syndromes in male infertilityand clarify the distribution chracteristics of male infertility for improving the syndrome differentiation in clinical Chinese medicine. Methods Total of 800 male patients with infertility were enrolled for clinical epidemiology study. All results were included in a database for statistic analysis. Results The frequency of single syndrome was as follows: the syndrome of kidney yang deficiency (74.9%), the syndrome of kidney yin insufficiency (81.8%), the syndrome of liver depression and qi stagnation (24.1%), the syndrome of dampness-heat pouring downward (55.6%), the syndrome of dual deficiency of qi and blood (6.0%). And most of time these diseases merge to appear. Among the type of multiple syndromes, the highest frequency distribution was the combination of the kidney yang deficiency syndrome, the kidney yin insufficiency syndrome and the dampness-heat pouring downward syndrome. Conclusion The male infertility pattern reflects the root of kidney deficiency and the branch of dampness-heat, and accompanying with the liver depression and qi stagnation and dual deficiency of qi and blood. The Chinese medicine syndrome of male infertility is complicated with the combination of two or more than two types of syndrome mostly.

补肾法是临床中治疗男性不育症的常用治法。治疗时应辨证求因、审因论治,或温补肾阳或滋补肾阴或益肾填精,皆以调补肾脏为主;在此基础之上同时根据患者的其他症状配以益气、疏肝、活血、清热利湿、化痰散结之法。中医药运用补肾法治疗男性不育症有令人满意的临床疗效,但是,仍有不少问题尚待解决:①辨证论治方面,尽管众多医家对不育症的辨证分型进行了无数探讨与论证,但至今仍未达成共识,呈现一派百家争鸣的局面。若能制定统一的辨证分型标准,将有利于提高中医药对男性不育症的诊治水平;②疗效标准随意性较大,不同医家报道的疗效缺乏可比性,不能完全反应出临床的实际情况,将来如能制定统一的疗效标准,将更有利于各种合理治法的临床总结和筛选出优秀的处方组合,以提高临床疗效;③治疗方面,多为一般的临床观察,且大部分为回顾性报道,而临床试验研究相对较少,现有的试验研究缺乏严谨的科研设计和合理的对照观察,可信性和可重复性低下。今后的研究应从制定统一的诊断、分型、疗效标准着手,在此基础上,按照严格的科研设计、参照、评价方法进行研究。对于无证可辨的,我们要善于利用现代科学技术手段,现代与传统相结合、宏观辨证与微观辨证相结合,使中医药治疗不育症的临床研究进一步科学化和规范化,促进中医药在男性不育症的治疗领域取得更大的发展。

ED occurrence is closely related to the incidence of collateral diseases, and the stasis and blockage of collaterals is the key pathogenesis of ED, while not enough attention has been given to it.This paper discussed the pathogenesis of ED, the relevance between ED and collateral disease, the connection between blood stasis and collaterals, and also introduced the modern medicine studies on treating ED from the respective of stasis. Meanwhile, different therapies for different syndrome differentiations were introduced in accordance with ED-collateral disease theories. It provided new treating thoughts for clinical treatment of ED.

Objective To observe the impacts of wuzi yanzong wan on sperm quality and sexual hormone level for the patients with sterility due to kidney essence deficiency.Methods One hundred and twenty patients were equally divided into two groups.In a treatment group,wuzi yanzong wan was prescribed,9 g each time,three times a day.In a control group,clomifene citrate capsules were prescribed,50 mg each time,once a day.The duration of treatment was 12 weeks.The semen parameter indexes and sexual hormone level were observed before and after treatment in two groups.Results The total effective rate was 81.7% in the treatment group and was 55.4% in the control group,presenting the statistically significant difference in comparison(P0.01).In the treatment group,semen volume,sperm density,sperm motility percentage and liquefied condition were all improved significantly after treatment(P0.01).The difference in the improvement of sperm motility was significant statistically as compared with the control group(P0.01).In the treatment group,the levels of plasma testosterone(T)and luteinzing hormone(LH)were different significantly before and after treatment in statistics(P0.05).Conclusion Wuzi yanzong wan achieves a satisfactory clinical efficacy on sterility due to kidney essence deficiency.It improves semen volume,sperm density and motility and results in a certain action on the increase of T and LH levels.