目的 探讨填精通络汤联合他达拉非治疗2型糖尿病勃起功能障碍(DIED)患者的临床效果.方法 选取2019年10月至2020年12月北京中医药大学东直门医院男科连续诊治的82例2型DIED患者作为研究对象.采用随机数字表法分为治疗组和对照组,各41例.治疗组采用填精通络汤联合他达拉非治疗,对照组单独采用他达拉非治疗.比较两组治疗前后国际勃起功能指数-5(IIEF-5)评分、中医证候评分、临床疗效及睾酮、雌二醇、内皮素-1、一氧化氮水平.结果 治疗后,两组IIEF-5评分均较治疗前明显改善,且治疗组改善情况优于对照组,差异具有统计学意义(P<0.05);治疗组中医证候评分较治疗前明显改善,且优于对照组,差异具有统计学意义(P<0.05);治疗后,两组睾酮、雌二醇、内皮素-1及一氧化氮水平均较治疗前明显改善,且治疗组改善情况优于对照组,差异具有统计学意义(P<0.05);治疗组治疗总有效率优于对照组,差异具有统计学意义(P<0.05).结论 填精通络汤联合他达拉非能有效改善2型DIED患者的勃起功能,可能与提高一氧化氮及睾酮水平,降低内皮素-1水平有关.

目的 探讨应用来曲唑联合高糖高脂饮食的方法构建多囊卵巢综合征伴胰岛素抵抗(polycystic ovarian syndrome-insulin resistance,PCOS-IR)大鼠模型.方法 6周龄雌性SD大鼠20只,普通饲料适应性喂养1周后,随机数字表法选取10只作为对照组,其余10只作为模型组.对照组给予普通饲料,模型组给予高糖高脂饲料喂养28 d.于喂养第8天,模型组大鼠开始每日用0.4 mL溶于1％(质量分数)羧甲基纤维素溶液(carboxymethyl cellulose solution,CMC)的来曲唑液(1 mg·kg-1·d-1)灌胃,对照组灌服等体积CMC溶液,连续灌胃21 d.自灌胃第7天起,每日晨行阴道涂片,观察阴道脱落细胞的周期变化,判断动情周期,直至实验结束.灌胃结束后,测量体质量,尾静脉采血测定大鼠空腹血糖(fasting blood glucose,FBG),ELISA法测定血清促黄体生成素(luteinizing hormone,LH)、促卵泡生成素(follicle stimulating hormone,FSH)、血清睾酮(testosterone,T)、空腹胰岛素(fasting insulin,FINS)浓度,并计算LH/FSH比值、胰岛素敏感指数(insulin sensitivity index,ISI)和胰岛素抵抗指数(insulin resistance index,HOMA-IR).留取卵巢组织,应用HE染色观察卵巢组织形态.结果 与对照组比较,模型组大鼠体质量、FBG、FINS、T、LH浓度、HOMA-IR指数、LH/FSH比值均明显升高,FSH及ISI浓度显著降低,差异均有统计学意义(P<0.01);阴道涂片显示,模型组大鼠动情周期均消失;对照组卵巢局部组织形态正常,模型组呈典型多囊样改变.结论 应用高糖高脂联合来曲唑灌胃的方法,可以成功构建PCOS-IR大鼠模型,模型大鼠出现明显的胰岛素抵抗、特征性的多囊卵巢组织及性激素改变.

目的 研究西洋参茎叶总皂苷(PQS)对多囊卵巢综合征伴胰岛素抵抗(PCOS-IR)大鼠的作用效应及机制.方法 建立PCOS-IR大鼠模型,分为正常组、模型组、PQS低剂量组(30mg/kg)和PQS高剂量组(60mg/kg),每组10只.给药4周后,ELISA法检测血清睾酮(T)、促卵泡刺激素(FSH)、促黄体生成素(LH)、空腹血糖(FBG)、胰岛素(FINS)水平,并计算胰岛素抵抗指数(HOMA-IR);HE染色观察卵巢组织形态学变化;免疫组化检测卵巢组织Bcl-2和Bax表达;Western blot法检测PI3 K、p-PI3 K、Akt、p-Akt蛋白表达.结果 与正常组比较,模型组大鼠出现典型多囊样改变,血清T、LH水平及LH/FSH比值、FINS及HOMA-IR指数均显著升高,卵巢组织中Bcl-2、p-PI3 K、p-Akt表达显著减少,Bax表达显著升高;与模型组比较,PQS组大鼠卵巢组织多囊样改变显著改善,血清T、LH水平及LH/FSH比值、FINS及HOMA-IR指数显著降低,卵巢组织中Bcl-2、p-PI3 K、p-Akt表达显著升高,Bax表达显著降低.结论 PQS对PCOS-IR大鼠具有显著治疗效应,机制可能与激活卵巢组织PI3 k/Akt信号通路,调控Bcl-2与Bax分子的表达相关.

目的:观察温肾养血颗粒对卵巢储备功能低下(DOR)模型大鼠卵巢储备功能及子宫内膜形态的影响.方法:雌性SD大鼠110只,随机选取20只作为对照组,其余90只采用雷公藤多苷片50mg·kg-1·d-1连续灌胃2周的方法建立DOR大鼠模型.将造模成功的80只大鼠随机分为模型组、温肾养血颗粒低剂量组(6g·kg-1·d-1)、温肾养血颗粒高剂量组(12g·kg-1·d-1)和补佳乐组(0.12mg·kg-1·d-1),每组20只.连续灌胃2周后取材,HE染色观察卵巢及子宫内膜组织学变化,进行卵泡计数并测定子宫内膜厚度;ELISA法检测大鼠血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)、泌乳素(PRL)、抗苗勒管激素(AMH)、抑制素B(INHB)水平.结果:与对照组比较,模型组大鼠卵巢组织中生长卵泡总数显著减少,闭锁卵泡显著增多,子宫内膜厚度显著降低,血清FSH、LH水平显著升高,E2、AMH及INHB水平显著降低(P＜0.01).与模型组比较,温肾养血颗粒高、低剂量组和补佳乐组大鼠的卵巢组织形态学显著改善,生长卵泡总数显著增加,闭锁卵泡数显著减少,子宫内膜厚度显著增加,同时血清FSH、LH水平显著降低,E2、AMH及INHB水平显著升高(P＜0.01,P＜0.05).结论:温肾养血颗粒能够显著改善DOR模型大鼠的卵巢储备功能及子宫内膜形态.

目前糖尿病发病率逐渐升高,且趋于年轻化,而勃起功能障碍(ED)为糖尿病(DM)的常见并发症,因糖尿病的发病机制较为复杂,涉及到内皮、肌肉、神经及血管等多方面的病变,所以治疗糖尿病性勃起功能障碍(DMED)也较为棘手,但近几年来现代医学和传统医学在DMED的机理研究和治疗方面都积累了丰富的临床经验,使DMED的临床疗效有了明显的提高.故本文将对近几年中西医对DMED的机理研究和治疗进展做一综合回顾与探讨.

李曰庆教授认为特发性少弱精子症病机为脾肾亏虚,兼夹湿热、血瘀、痰浊等病理变化.治疗以补肾填精,益气健脾为主,配合活血化瘀,疏肝理气治法.用药以"微调阴阳"为主,药效平和,无大辛大热之品,疗效确切.文章主要介绍李教授治疗特发性少弱精子症的用药经验,常用药对有:生地黄—熟地黄—山萸肉、肉苁蓉—黄精、鹿角胶—巴戟天—仙灵脾、生黄芪—茯苓—太子参、丹参—三七—牛膝、水蛭—蜈蚣、白芍—乌药等.

目的 明确妊娠期糖尿病(GDM)患者的中医体质类型及其与孕产期并发症的相关性.方法 纳入144例在首都医科大学附属北京妇产医院建立孕产妇围产保健手册、定期进行相关检查的孕产妇,其中GDM组72例、对照组(无妊娠合并症)72例.测定孕妇入组时空腹血糖(FBG)、糖化血红蛋白(HBA1c)和糖化血清蛋白(GSP)水平,在入组时和分娩前分别进行中医体质辨识、记录孕产期并发症的发生情况.结果 GDM组FBG、HBA1c和GSP水平均高于对照组;入组时及分娩前GDM组的偏颇体质比例高于对照组(P<0.01).入组时,GDM组孕妇最常见的体质类型为阴虚质(27.8％)和痰湿质(20.8％);分娩前,GDM组以阴虚质(26.4％)、痰湿质(18.1％)为常见;GDM组妊娠高血压、剖宫产、胎膜早破、巨大儿、早产儿等孕产期并发症发生次数均高于对照组(P<0.05);阴虚质、气虚质、湿热质及痰湿质是GDM组孕产期并发症发生次数最高的4种体质类型;GDM组内阴虚质并发症发生次数高于平和质(P<0.05).结论 GDM患者易出现偏颇体质,以阴虚质和痰湿质最为常见,且阴虚质GDM患者孕产期并发症的比例高于平和质,为临床及早干预提供了思路.

男性不育是男科中较为复杂难治的疾病,中医辨证论治具有一定优势.目前,以补肾为基本治则,对男性不育症病因病机研究和临床观察发现,男性不育合并血瘀的患者逐渐增多,许多可能引起男性不育的疾病也多存在着血瘀.所以,中医临床在辨证施治男性不育症时,要准确把握病因病机,对男性不育伴有血瘀的情况,采取“从瘀论治”,即在补肾填精的基础上,配合活血化瘀,兼以通络,可以显著提高临床的治疗效果.

目的:通过观察填精通络方及其拆方对糖尿病性勃起功能障碍大鼠性激素及阴茎海绵体eNOS酶表达的影响,探讨填精通络方在治疗糖尿病性勃起功能障碍的作用机制.方法:将60只SPF级雄性SD大鼠随机分为正常组、模型组、对照组、填精组、通络组及填精通络组6组,每组10只.除正常组外,其余组以腹腔注射链脲佐菌素制备糖尿病大鼠模型,任意时间血糖＞ 16.67 mmol·L-1为糖尿病成模标准,然后用阿朴吗啡阴茎勃起实验筛选糖尿病性勃起功能障碍大鼠模型.成模后,对照组予以0.2 mg· kg-1他达拉非灌胃,每周两次;填精通络组予以填精通络方以9.3 g·kg-1·d-1灌胃,填精组予以拆方Ⅰ号以7.2 g·kg-1·d一灌胃,通络组予以拆方Ⅱ号以2.1g·kg-1·d-1灌胃,正常组与模型组分别灌服等体积蒸馏水,连续30天.取腹主动脉血清,用酶联免疫分析法测定各组大鼠的性激素水平的差异;便携式血糖仪检测各组大鼠的血糖水平;免疫荧光检测离体阴茎组织eNOS酶含量.结果:与模型组比较,填精组、通络组及填精通络组的血糖明显降低(P＜0.01),阴茎海绵体eNOS酶的表达改善,血清睾酮(T)含量明显上升(P＜0.05),而卵泡刺激素(FSH)、黄体生成素(LH)含量变化不明显(P＞0.05);与对照组比较,填精通络组的血糖明显降低(P＜0.01),阴茎海绵体eNOS酶的表达改善,血清T含量明显上升(P＜0.05),而血清FSH、LH含量变化不明显(P＞0.05);与通络组比较,填精组和填精通络组的血糖明显降低(P＜0.05),但填精组阴茎海绵体eNOS酶的表达改善不如通络组,而填精通络组阴茎海绵体eNOS酶的表达改善优于通络组.结论:填精通络方能明显降低大鼠血糖水平,改善大鼠性激素水平和阴茎海绵体eNOS酶表达,从而改善大鼠的勃起功能障碍.

It is believed that diabetes is in the category of xiaoke in TCM and the erectile dysfunction is in the category of yangwei in TCM.Diabetic erectile dysfunction is the common complication of diabetes.The basic etiology and pathogenesis is kidney essence deficiency and blood stagnation in meridians and collaterals.The treating principle is tonify-ing the kidney,filling up the essence,activating blood circulation in collaterals.There is no particular effective approach to the disease in western medicine.TCM accumulates the rich clinical experiences in the treatment of it based on the syn-drome differentiation.In clinical practice,the clinical effects of diabetic erectile dysfunction are improved through the syn-drome differentiation,the combination of the four diagnostic methods and the individual prescription.

良性前列腺增生症是老年男性的一种常见病,张耀圣教授在深入研究前列腺组织解剖和生理病理学的基础上,根据"经络气血多少的辨证规律"并结合临床的实践体会,提出前列腺经络所属的新观点,认为前列腺为男子胞,并得出前列腺增生与任脉相关,病理以阴质结聚、阳气虚弱为主,治疗以补托、破血为主,兼以补肾、化痰、散结等,效果颇佳,故将其经验分享,为治疗前列腺增生症提供一种新的思路和方法.

Prof.Shi Hanzhang is the famous expert of TCM andrology in China and is one of the founders of TCM andrology.Prof.Shi has been engaged in medical work for over 70 years and has accumula-ted extremely rich experiences in the treatment of many intractable male disorders,especially for chronic pros-tatitis,erectile dysfunction and premature ejaculation.Prof.Shi Hanzhang believes that damp heat is the key factor in the entire process of chronic prostatitis.Hence,resolving damp is the essential step in the diagnosis and treatment.Impotence is closed related to the functions of heart,liver and kidney.The treatment of it focu-ses on activating blood circulation,removing stasis and warming kidney with herbal medicine.Premature ejac-ulation is also related to the heart,liver and kidney.If the case is caused by failure of kidney in storage,the treatment should be tonifying kidney,controlling essence and filling up the marrow.If the case is caused by disharmony between the heart and kidney,the method for tranquilizing the mind should be adopted.If the case is related to failure of liver in maintaining the free flow of qi and malnutrition of tendons,the method for smoothing liver qi,removing stagnation,nourishing blood and softening liver should be used.In the paper,the statements focus on the theories and thoughts of Prof.Shi Hanzhang on the treatment of male disease,aiming to effectively guide clinical practice.

少弱精子症是男性不育症发生的主要因素.目前西医治疗疗效局限,针灸作为中医药的重要组成部分,具有"简、验、廉、便"的特点.本文就近年来关于针灸治疗少弱精子症的研究文献进行回顾与整理.结果显示针灸治疗该病疗效显著且在腧穴选择、刺激方式、综合治疗以及作用机制研究等方面都取得了一些进展,本文将从中医辨证分型、腧穴处方、穴位刺激方式、针灸复合疗法等方面深入探讨针灸治疗该病的临床疗效及可能的作用机制.

傅山(又名傅青主)在治疗不育症方面,一是从脏腑出发:以肾为中心,兼顾他脏;二是从气血精出发:注重调气,兼以补血固精.另外注重辨证论治,不拘泥以一脏,并提出了男子不能生育的六种病因:精寒,气衰,痰多,相火盛,精少,气郁.注重从痰论治,使男科的许多疑难病症得到解决,这也与金元王隐君创立的“顽痰怪症”说和“痰生百病”论相应,更验证了傅山的学说:即久痰入肾,男科疾病既要治肾,又要治痰.男性不育症一般治疗周期长,病情复杂,加之现代生活方式易助湿生痰,所以傅山这一学说也提供了一个新的思路和方法.

少弱精子症是男性不育的重要原因之一,且发病机制尚未完全明确.传统中医药通过辨证论治,在治疗本病方面取得了良好的疗效,但大多数医家往往注重从脾肾论治,而忽视从其他脏腑论治.中医理论认为,肾藏精而主生殖为先天之本,脾主运化为后天之本,少弱精子症多责之于脾肾,但却与肺、心、肝关系密切,在治疗上应以补肾健脾为主,辅以养心、润肺、疏肝,综合辨证,方能取得良好的疗效.

Erectile dysfunction together with gingival atrophy is a commonly seen disease,and there are no systematic analyses with regards to this concurrently-occurring disease.Clinicians tend to overlook macroscopic syndrome-identification during treatment,treatment of the whole person lacks certainty.This essay aims to analyze erectile dysfunction-gingival atrophy occurrence from the kidneys,spleen,stomach and other organ-systems.Erectile dysfunction-gingival atrophy has commonly-seen syndromes like kidney yin deficiency,kidney jing deficiency,spleen-stomach imbalance,qi-blood deficiency,stomach fire uprising,resulting in injury to the meridians etc.Its treatment requires emphasis on tonifying kidney yin,strengthening the spleen and stomach,clearingstomach fire and other therapeutic methods.

Breast cancer is a common malignant tumor for woman,which is a serious threat to woman's health.Professor WANG Pei believes the pathogenesis of breast cancer is liver qi stagnation,and also the deficiency of both spleen and kidney,as well as the phlegm stasis and pathogenic toxicity.The main treatment method is soothing liver qi stagnation,accompanied with invigorating spleen and kidney,and activating collaterals and eliminating stagnation.Professor WANG Pei has good effect in treating breast cancer in terms of unique herb usage,treatment based on the whole,modified prescriptions along with disease changes and focus on mental and diet adjustment.

Erectile dysfunction is a common complication arising from diabetes mellitus.According to statistics,the incidence rate of diabetes mellitus erectile dysfunction (DMED) is approximately 35％-75.2％,amounting to 3-5 times of the incidence rate of non-diabetic erectile dysfunction.The treatment of diabetic erectile dysfunction is multi-disciplinary,hence more complicated.Traditional Chinese medicine has specific advantages in treating DMED through syndrome differentiation.This paper summarized the location,etiology,pathogenesis and treatment principles of DMED.

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.