性高潮后综合征(post-orgasmic illness syndrome,POIS)属于男科罕见病,最早由瓦丁格教授在2002年发现并报道,是指男性在射精后几分钟到几小时内出现的严重乏力、疲劳、注意力下降、急躁易怒或情绪低落等全身症状,可持续2～7天,并且可在下次射精发生后再次发生,严重影响男性身心健康,目前国际上暂无公认的定义和指南相关论述[1-2].中医学中根据其症状表现可将本病归属于"房中病""房劳""房事伤"的范畴.李海松教授临床中较早关注本病的诊治,强调肝肾在本病发生的独特地位,提出肝郁肾虚是本病的核心病机,现将其临床经验总结如下.

在多年的临床工作中,李曰庆教授坚持"勤求古训,博采众方,汇通中西,传承创新",同时不断在临证中继承和发扬古籍经典,融会贯通中西医疗法. 针对男科疾病的病机,李曰庆教授提出男科疾病"虚瘀论",认为"虚"与"瘀"是男科疾病的核心病机.如男性不育症以阴阳失调为本、瘀阻为标;良性前列腺增生以肾虚为本、瘀滞为标;勃起功能障碍以瘀阻脉络为本,内蕴正亏;因此男科疾病多可从"虚""瘀"论治.从而创制出多种经验方,如活血通络起痿汤治疗阳痿,广嗣育麟汤治疗男性不育症,通前络汤治疗慢性前列腺炎等男科常见疾病.

李曰庆教授是首都国医名师,临证50余载,具有丰富的临床经验.李教授对很多药物的使用都有独到见解,以巴戟天为例,善用其补中有疏的特点来治疗男科疾病.常以巴戟天与川牛膝配伍补肾活血,治疗男性勃起功能障碍;巴戟天与菟丝子配伍补肾生精,治疗男性不育症;巴戟天与杜仲配伍补筋壮骨,治疗虚劳腰痛;巴戟天与郁金配伍补中有疏,治疗慢性前列腺炎;巴戟天与猪苓配伍补中兼利,治疗良性前列腺增生.李教授传承有序,又擅推陈出新,在巴戟天的使用方面独具特色.

良性前列腺增生(BPH)是泌尿男科的常见疾病,主要表现包括前列腺腺体增大,膀胱出口梗阻和下尿路症状,严重影响中老年男性的生活质量.本病属于中医"癃闭""精癃"的范畴,近年来多位医家根据学术典籍和自身的临床经验提出了对本病的认识,中医药治疗BPH的临床研究也呈现日益丰富的趋势.BPH基本的表现为年老肾气衰弱,膀胱气化不利,血行瘀阻不畅,病位在肾和膀胱,与肺、肾功能失调有关,本虚标实是基本病机特点.大量临床研究证明中医药能够改善BPH患者临床症状,提高生活质量,缩小前列腺体积,减少术后并发症,在临床应用中有确切疗效.此外中医药外治法如针刺疗法、艾灸、热水坐浴、穴位贴敷、肛门栓剂、灌肠疗法等也被广泛应用于临床,证明中医药治疗BPH方法多样.中西医融合治疗BPH优势互补,能够提高临床疗效,减少远期并发症的发生.该文将对近年来BPH中医病因病机和治疗进展进行评述,总结目前中医药临床治疗BPH研究现状,并从产出高质量临床研究、规范中医药临床诊治方案、结合前沿研究探索中医药机制三方面对中医药治疗BPH临床研究提出建议,以期推动中医药在本病治疗中的发展和应用.

良性前列腺增生症( benign prostatic hyperplasia, BPH)是指男性(50岁以上)组织学上前列腺间质、腺体成分的增生和解剖学上前列腺的增大[1],临床上以下尿路症状( lower urinary tract symptoms,LUTS)为主要特征的一种疾病.我国40岁及以上男性BPH合并患病率为36.6％,其患病率较高且随年龄增长而增加[2, 3].西医的治疗方法主要是联合使用α-受体阻滞剂(特拉唑嗪及坦索罗辛等)以及5α还原酶抑制剂(如非那雄安、度他雄安等).中、重度BPH患者可选择进行手术或者微创治疗[4],其中经尿道前列腺电切术是手术治疗首选方案[5].但西医治疗存在局限性.例如,当患者前列腺尿道角角度过大,口服α受体阻滞剂疗效较差;手术等侵入性操作可能造成尿失禁、逆行性射精等,严重影响患者性生活质量[6-8].中医药认识该病由来已久,中医古籍中"癃闭、精窿、尿频"等症状与BPH的临床表现相互吻合[9].中药配伍可达到标本兼治的作用,治标可以缓解BPH患者急性排尿困难症状;治本通过解决BPH的核心病机肾虚血瘀,减轻LUTS[10].传统中医药以补肾利水法,提壶揭盖法,温补脾肾法治疗BPH[11].李海松教授认为,现代社会BPH的病因病机已经发生变化,瘀和虚成为该病的根本病机,在临床中以补益肾气、活血化瘀为基本治疗大法贯穿BPH疾病治疗始终,往往能收到良好的疗效.

目的 观察耳穴压豆联合中药治疗气滞血瘀型慢性前列腺炎的临床疗效.方法 选取2016年10月—2017年10月期间于北京中医药大学东直门医院男科门诊治疗的气滞血瘀型慢性前列腺炎患者120例,随机分为治疗组和对照组各60例.对照组采用理气活血等基础治疗,治疗组采用基础治疗同时,配合耳穴压豆联合中药通前络汤治疗.结果 治疗过程中脱落9例,符合方案111例.治疗后两组患者慢性前列腺炎症状指数(NIH-CPSI)评分与治疗前比较显著降低(P<0.05),且治疗组治疗后NIH-CPSI评分显著低于对照组(P<0.01).治疗后两组患者气滞血瘀证相关症状积分均明显低于治疗前(P<0.05),且治疗组治疗后气滞血瘀证相关症状积分明显低于对照组(P<0.05).治疗后两组患者广泛性焦虑量表(GAD-7)评分与治疗前比较显著降低(P<0.05),且治疗组治疗后GAD-7评分显著低于对照组(P<0.05).治疗后治疗组总有效率89.29％(50/56)明显高于对照组85.45％(47/55)(P<0.05),治疗组的抑郁焦虑情况明显改善.结论 采用耳穴压豆联合中药治疗慢性前列腺炎较单纯使用中药在NIH-CPSI积分、GAD-7评分、中医症候相关评分等方面的改善更为明显.

养生,原指道家通过各种方法颐养生命、增强体质、预防疾病,从而延年益寿的一种医事活动.养,即调养、保养、补养之意;生,即生命、生存、生长之意.现代意义的"养生"指的是根据人的生命规律主动进行物质与精神方面身心养护的活动.冬季如何养生是人们非常关心的话题,尤其是对于男性朋友来说,此时做好养生工作能够防止疾病入侵身体,增强抵御寒冷的能力,但也一定要有正确的养生方式.

目的:观察通前络汤对慢性前列腺炎模型大鼠血清及前列腺组织中IL-2、IL-8及IgM水平的影响,探讨通前络汤治疗慢性前列腺炎的作用机理.方法:SPF级雄性SD大鼠40只,体质量200～ 250 g,购入后适应性喂养1周后按照随机数字表法分为空白组、模型组、假手术组、通前络汤组,每组10只.模型组和通前络汤组大鼠称取其体质量后用水合氯醛(0.003 3 mL·g-1)麻醉,暴露前列腺背侧叶,两侧各注入25％消痔灵注射液0.1 mL,膀胱复位,逐层关腹.假手术组如上开腹,向前列腺背侧叶注射等量生理盐水.术后每只大鼠腹腔注射青霉素16×105 U以预防感染.空白组常规饲养.造模成功后,适应性喂养2d,第3天开始每日10时给予灌胃.空白组、模型组、假手术组:常规喂养,每日给予8 mL·kg-1的去离子水灌胃.通前络汤组每日用去离子水配置的通前络汤悬浆(8 mL·kg-1)、每毫升悬浆含通前络汤600mg(6 g· kg-1)灌胃(人体用量的6倍).药物干预28 d后全部动物处死取材,检测各组大鼠血清及前列腺组织中白细胞介素(interleukin-2,IL-2)、IL-8及IgM的水平.结果:血清中的结果显示,与空白组比较,模型组IL-8、IgM水平显著升高(P＜0.05),IL-2显著降低(P＜0.05),假手术组各项指标与空白组比较,差异无统计学意义(P＞0.05);与模型组比较,通前络汤组的IL-8、IgM水平显著降低(P＜0.05),IL-2水平显著升高(P＜0.05).前列腺组织中的结果也呈现出相似的趋势.结论:通前络汤可显著降低大鼠血清及前列腺组织内IL-8、IgM水平,提高IL-2水平,抑制炎性反应.

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.

Background: Erectile dysfunction is a common male disease, the constant pace of life, increasing pressure on life, and changes in diet, living environment, lifestyle, etc., lead to an increase in the number of patients with erectile dysfunction (ED). Acupuncture has been widely used in clinical trials of ED in recent years. There are many clinical trials that confirm that acupuncture can improve male erectile function. This study used a network meta-analysis (NMA) to compare the effectiveness and safety of different forms of acupuncture on ED. Methods: We will search for PubMed, Cochrane Library, AMED, EMBASE, WorldSciNet; Nature, Science online and China Journal Full-text Database (China National Knowledge Infrastructure), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials (RCTs) included in the China Resources Database. The time is limited from the construction of the library to December 2018. The quality of the included RCTs will be evaluated with the risk of bias tool and evidence will be evaluated by Grading of Recommendations Assessment, Development and Evaluation. STATA 13.0 and WinBUGS 1.4.3 through the GeMTC package will be used to perform an NMA to synthesize direct and indirect evidence.

Objectives:To evaluate the protective effect of Qilin pills on the sperm DNA damage of infertile patients.Methods:66 infertile patients with recurrent spontaneous abortion whose DNA fragmentation index (DFI) was above 15％ were divided into 2 groups randomly.The treatment group (33 patients) took Qilin pills and Weishenxin capsules orally,while the control group (33 patients) received Weishenxin capsules,both for 3 months.The sperm DFI and semen routine parameters (SRP) were detected and compared before and after treatment.Results:There was no significant difference in the sperm density,rate of sperm activity,progressive motility and DFI between the two groups before treatment (P ＞ 0.05).Statistical differences were found in the rate of sperm activity,progressive motility in the treatment group,compared with control group and pre-treatment data(P ＜0.01).The sperm density was obviously increased compared that of the control group and pre-treatment data (P ＜ 0.05).The sperm DFI significantly decreased in the treatment group (P ＜ 0.05).Conclusion:Qilin pills are effective in improving the sperm motility and DNA integrity in the patients with recurrent spontaneous abortion.

男性不育症不是一种独立的疾病,而是由一种或多种疾病和(或)因素导致的结果.李曰庆教授认为男性不育多因阴阳失调所致,治疗应把握阴阳失调的本质,清补共用、攻补兼施,选择合适的剂型,夫妻同调,综合辨治.

目的 研究不同类型的睾丸微石症(TM)对成年男性精子质量的影响及其可能的原因,以期为临床提供一定的依据.方法 回顾性分析2014年1月至2017年3月间体检时发现的睾丸微石症患者59例,根据B超检查结果 分为限制型TM组(LTM组)22例和经典型TM组(CTM组)37例,采集两组的精液进行常规检查,观察分析两者精液质量的差异.结果 CTM组与LTM组精子质量指标的对比,两组精子浓度、精子总数、精子总活力、前向运动精子率、不活动精子率及精子平均运动速率等六个方面比较,差异均有统计学意义(P<0.05,P<0.01).而在精液量、精子畸形率等两个方面之间的比较,两组之间差异均无统计学意义(P>0.05).说明CTM组在精子活力、浓度、存活率等方面均较差.结论 经典型TM对精液质量的影响大于限制型,尤其是在活力、活率和浓度等方面.

阳痿,即阴茎勃起功能障碍(erectile dysfunction,ED),是指阴茎持续无法达到和维持足够的勃起以获得满意的性生活.目前,现代医学常规治疗阳痿见效迅速,但难以从根本上解决问题.与之相对,中医药治疗阳痿远期治疗效果相对较好.李海松教授根据多年临证经验,提出阳痿的诊疗重在防治,应当时刻关注“治未病”理念,临床论治时注重综合考虑性命双修、身心同治、标本同治、中西合璧、夫妻同治等多个方面,取得了良好的疗效.本文将李海松教授关于阳痿治疗中应用“治未病”理念的经验进行整理,以供同道交流学习.

传统医学中的七情有两种含义,一指情志,即怒喜思悲恐忧惊;二指药物配伍,包括单行、相须、相使、相畏、相杀、相恶、相反,本文所指的即是后者[1].关于七情配伍的记载最早见于四大经典之一的《神农本草经》[2],详述药物阴阳配合之理,极大程度上影响并启发了后世医家.黄芪味甘,性温.归肺脾经,具有补气固表,利尿排毒,排脓敛疮生肌的功能.用于气虚乏力,食少便溏,中气下陷,久泻脱肛,便血崩漏,表虚自汗等[3].黄芪始载于《神农本草经》:"主痈疽,久败疮,补虚,小儿百病".

Objective To observe the effects of Zuogui pills on the expression levels of stem cell factor (SCF) protein and mRNA in the testis of oligoasthenozoospermia rats induced by tripterygium glycosides (TG), and based on this, to explore the mechanism of Zuogui pills on improving the reproductive function of these rats.Methods From March to April 2014, 36 SD, SPF grade rats were randomly divided into normal group, TG model group and Zuogui pill treatment group, with 12 rats in each. The normal group received intragastric administration of deionized water during the whole intervention period; for modelling, at 4 weeks before the experiment, both TG model group and Zuogui pill treatment group received oral administration of the suspension of TG 40 mg? kg-1? d-1, then, during the 5th-8th weeks of experiment, the TG model group received intragastric administration of deionized water, Zuogui pill treatment group received oral administration of the suspension of Zuogui pill 6 g? kg-1? d-1. At the end of the 8-week intervention, all the rats were sacrificed, and their testicular tissues were collected aseptically, fixed, embedded and sectioned. Immunohistochemistry was used to detect the expression level of SCF protein in the testicular tissue. Real-time PCR was employed to measure the expression level of SCF mRNA in the testicular tissue.Results Both the expression levels of SCF protein and mRNA in the testicular tissue were significantly higher compared with the TG model group (P<0.05).Conclusion Zuogugui pill can promote the division and proliferation of spermatogonial stem cells and inhibit the apoptosis of spermatogenic cells by up regulating the expression levels of SCF protein and mRNA.

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.

Though not fatal,erectile dysfunction (ED) affects the patient's quality of life and family harmony,with high cost of treatment,which has become one of the clinical medical problems need to be resolved.Though traditional Chinese medicine and western medicine belong to different medical system,they are similar in terms of diagnosis and treatment of ED,patients,therapeutic purpose and classification.It's very necessary to compare the diagnosis and treatment of ED by traditional Chinese medicine and western medicine,to provide a new treatment thought and push forward the research in ED eventually.

什么是慢性前列腺炎 慢性前列腺炎是由于前列腺受到微生物等病原体感染或某些非感染因素刺激而发生的炎症反应,以及由此造成前列腺区域不适或疼痛、排尿异常、尿道异常分泌物等症状的一类疾病,其中90％以上是非细菌性前列腺炎.其临床表现有以下几个方面: 1.疼痛症状:主要表现为以前列腺为中心辐射周围区域的疼痛,常见于阴囊、小腹、会阴、腰骶、大腿内侧等部位.一些患者可出现肛周坠胀、排便习惯改变等消化道症状.

家有娇妻的哀声怨气甚至谩骂,外有私立男科医院广告的“恐吓”打击,一句经典的广告词“不做一分钟男人”,就让许多男性心甘情愿地变成私立医院的宰割对象,躺上冰冷的手术室治疗台,做所谓的阴茎背神经阻断术和五花八门毫无作用的理疗.早泄这顶帽子让广大男性身心痛苦,备受煎熬.那么到底什么是早泄?早泄应该怎么治疗?早泄患者该怎么办?今天我们就来聊聊这个话题.