探讨网络药理学在中药治疗男科疾病中的应用现状,网络药理学在中药治疗男科疾病内在机制研究方面应用广泛,如五子衍宗丸、右归丸、八正散等均被研究通过"多成分-多靶点"机制治疗男科疾病,但目前也存在预测多且缺少验证等问题,需要开展更深入的实验与临床研究加以验证.

目的 观察广嗣育麟汤对肾精亏虚型男性少弱精子症患者的影响.方法 120例少弱精子症患者冲服广嗣育麟汤免煎颗粒,疗程12周.观察和比较治疗前后患者精液常规检查、配偶受孕情况、中医证候评分及胞内磷脂酰肌醇激酶(PI3K)、磷酸化蛋白激酶B(p-AKT)、B淋巴细胞瘤-2基因(Bel-2)蛋白及mRNA的表达.结果 临床总有效率为92.7％(101/109);治疗后患者的精液液化状态、精液量、精子浓度、精子活动力均较治疗前明显提高,差异有统计学意义(P＜0.05);治疗后中医证候评分较治疗前降低(P＜0.05);治疗后的PI3K、p-AKT、Bcl-2蛋白及mRNA的表达明显上升(P＜0.05).结论 广嗣育麟汤治疗肾精亏虚型少弱精子症患者具有较好的疗效,值得临床推广,深入研究.

男性更年期综合征是男科领域常见的疾病之一,传统医学无本病相关病名的记载.李曰庆教授根据多年临床经验认为男性更年期综合征应从"虚""郁""瘀"论治,"虚"为基本病机和病理趋势,可以分为肾气虚、肾阳虚、肾阴虚和气血亏虚;"郁"为关键病机,表现为肝郁;"瘀"为病理产物,可以分为气虚致瘀、肾虚致瘀和肝郁致瘀."虚""郁"与"瘀"互相影响,常相兼为病.临床从"虚""郁""瘀"论治男性更年期综合征收效显著.

男性不育症指夫妇有规律性生活 1 年以上,且未采用任何避孕措施的情况下,由于男方因素导致女方无法自然受孕. 当前世界上约有15％的夫妇受到不育症的影响,其中约50％由男性生殖功能障碍引起[1] ,大多数患者的病因仍然无法找到.

Objective:To investigate the mechanism of Cuscuta chinensis Lam.and Lycium barbarum L.（SC-FL）improving Tripterygium wilfordii polyglycosides （GTW）-induced oligoasthenospermia model.Methods:Forty male SD rats were randomly divided into blank group （NC group）,model group （GTW group）,model+L-carnitine treatment group （GTW+LEV group） and model+SC-FL treatment group （GTW+SC-FL group）,10 rats in each group.The model of spermatogenesis disorder was established by giving GTW 40 mg·kg -1 ·d -1 for 4 weeks.After modeling,the GTW+LEV group was given L-carnitine （LEV）suspension 0.2 g·kg -1 ·d -1 ,and the GTW+SC-FL group was given SC-FL suspension 0.45 g·kg -1 ·d -1 for 4 consecutive weeks.The sperm quality,testis histological changes and related protein and m RNA expressions were detected in each group.Results:The sperm concentration and the ratio of forward motility grade+non-forward motility grade sperm in GTW+SC-FL group and GTW+LEV group were significantly higher than those in GTW group （P＜0.01）.And the sperm concentration in GTW+SC-FL group increased more significantly than GPW+LEV group （P＜0.01）.The results of hematoxylin-eosin staining showed that compared with the GTW group,the structures such as seminiferous tubules in the testis tissue of the rats were restored to a certain extent after treatment.The protein and m RNA expressions of Phosphatidylinositol-3 kinase （PI3K）,AKT Serine/Threonine-protein kinase （AKT） and B-cell lymphoma/leukemia-2 （Bcl-2） were up-regulated compared with GTW group and GTW+SC-FL group（P＜0.01,P＜0.05）.Conclusion:SC-FL can effectively alleviate the spermatogenic dysfunction caused by GTW,and its mechanism may be related to the PI3K/AKT signaling pathway.

阳痿是男科常见性功能障碍疾病之一.近年来,男科阳痿患者合并抑郁焦虑发生率逐年升高,影响了家庭与社会的和谐稳定.本文通过探讨"因郁致病"和"因病致郁"两方面的原因,初步分析了阳痿合并抑郁、焦虑的中医病因病机,并从现代医学角度分析了两者共同的生理病理学机制,提出了防郁致病与防病致郁的原则,探索了阳痿合并抑郁焦虑的临床治疗,如疏肝理气、和血解郁、清肝泄火等治法,为临床对阳痿合并抑郁焦虑的诊治提供了初步理论依据.

早泄作为最常见的男性性功能障碍之一,困扰着相当一部分中青年男性.对于早泄的治疗,中医和西医均有相应的措施,如何在现有条件下将中西医治疗早泄的方法有机地结合起来,充分发挥二者优势,更好地为患者解除病痛,是每个男科医生关注的重点.中医与西医虽然在理论体系上不同,但在对于早泄的治疗上却有着各自不同的优势.现将早泄的中医与西医治疗策略进行对比,使中医与西医优势互补、扬长避短,拓展临床医生对于早泄的治疗思路.

近年来,中医男科发展迅速,中医男科人才培养逐渐走向正轨,男科就诊患者越来越多,科研成果越来越多,学术交流也日益密切.然而冷静思考,中医男科仍存在精华与糟粕并存,疗效突破少,理论创新不足,机制难说清等问题.中医男科想取得更好发展,应努力做到以下三个方面:疗效需突破,理论有创新,机制要说清.

目的：探讨菟丝子-枸杞子（SC-FL）改善雷公藤多苷（GTW）诱导的少弱精子症模型的机制研究。方法：将40只SD大鼠随机分为空白组（NC组）、模型组（GTW组）、模型+左卡尼汀处理组（GTW+LEV组）和模型+SC-FL处理组（GTW+SC-FL组）。予GTW 40mg·kg -1 ·d -1 4周构建生精障碍模型。成模后分别予LEV和SC-FL治疗，连续4周。通过精液质量、激素水平、蛋白表达、睾丸超微结构等观察SC-FL对大鼠产生的影响。结果：药物干预后，精子浓度及前向运动级+非前向运动级精子比率（PR+NP）上调（P＜0.01）；激素分泌和PI3K及p-AKT蛋白表达改善；超微组织结构得到一定恢复。结论：SC-FL对能够有效减轻GTW造成的生精功能障碍，其机制可能与相关激素及PI3K/AKT通路有关。

BACKGROUND AND AIM:Achyranthis Bidentatae Radix plus Semen Vaccariae are traditional Chinese medicines, which have been widely applied in the treatment of migraine and Erectile Dysfunction (ED) for many years. This study verified the effect of Achyranthis Bidentatae Radix plus Semen Vaccariae in improving migraine-induced ED and explored its potential mechanism.METHODS:Key targets and signaling pathways of Achyranthis Bidentatae Radix plus Semen Vaccariae in migraine-induced erectile dysfunction treatment were predicted by network pharmacology. A rat model of migraine was established by nitroglycerin injection. Apomorphine was injected into rats to screen the migraine-induced erectile dysfunction model, Achyranthis Bidentatae Radix-Semen Vaccariae granule suspension administered, and erectile function evaluated. Hematoxylin and eosin staining was used to compare the histological structure of the penile tissue, while RT-qPCR and Western blotting were used to determine mRNA and protein levels, respectively.RESULTS:Screening allowed us to identify common targets for migraine and ED; the signaling pathway exhibiting the greatest change was the Myosin light chain kinase- Calcium (MLCK-CaM) signal pathway. From Western blotting and RT-qPCR, we found that the levels of MLCK mRNA and protein in rats from Group B rats were significantly higher (P <0.05) than those in Groups A and C. Furthermore, the mRNA and protein levels of CaM were significantly higher in Group B (P <0.05) than in Groups A and C.CONCLUSION:Data indicate that the regulatory effects of Achyranthis Bidentatae Radix plus Semen Vaccariae on migraine-induced ED in a rat model are mediated by the MLCK-CaM signaling pathway.

近些年来,男性的生殖能力逐年下降,不育症已经成为困扰成年男性的高发疾病.男性不育症的发病机制复杂,多数患者难以找到确切的病因,临床治疗十分困难.李曰庆教授认为,男性不育症的治疗应区分好病因,使用中西医融合的方式来治疗.特发性少精子症多由于脾肾亏虚,当滋阴补肾,健脾益气;特发性弱精子症主要是由于肾阳不足,治疗方法是补肾助阳;特发性畸形精子症多由于湿热瘀滞,治疗上应清利湿热,活血通络.文章总结李曰庆教授治疗特发性男性不育症经验,举验案一则,以供探讨.

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.

目的 基于"中医传承辅助系统(V2.5)",解析中国专利数据库(CPD)医治少弱精子症的处方特点与规律.方法 检索CPD医治少弱精子症的处方,运用"中医传承辅助系统(V2.5)"中的关联规则及熵聚类等方法,探究药物组合、配伍规律及新方分析等.结果 本研究共纳入处方74首,其中应用频次最高的中药包括菟丝子、枸杞子、淫羊藿等;得出药物组合6个、配伍规律5种、新方组合9首.结论 CPD医治少弱精子症的处方多以"补益脾肾,疏肝活血"为主,并随症加减.

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.

男性少弱精子症是男科临床上的疑难病,本文基于李海松教授多年的临床经验,将男性少弱精子症的核心病机总结为"肾虚血瘀",主张以"补肾活血"为男性少弱精子症的主要治疗方法,其中肾精不足、血虚不化者,以填肾精、益精血为主,方选中和种子丸加减;肾气亏虚、血运不行者,以补肾气、运气血为主,方选金匮肾气丸加减;肾阴耗伤、血枯不荣者,以滋肾阴、养阴血为主,方选左归丸加减;肾阳虚衰、血瘀不畅者,以温肾阳、行瘀血为主,方选右归丸加减,临床根据患者的实际情况加减变化,希望能够为临床男性少弱精子症的诊治提供更为广阔的思路.

目的 系统评价热淋清颗粒对于湿热下注型慢性前列腺炎的效果与安全性,为临床用药提供一定的参考.方法 计算机检索Pubmed、Cochrane library、知网、万方、维普等数据库(建库至2021年5月).按照纳排标准最终选择出11篇文献,并采取RevMan5.3.5对纳入的文献进行Meta分析.结果 根据Meta分析显示,用热淋清颗粒结合西医常规对于湿热下注型慢性前列腺炎有效率胜于单用西药治疗[合并RR及95％CI为0.21(0.17～0.25),P0.22,I2=23％];且两组的不良反应发生率无统计意义(P=0.70＞0.05).结论 用热淋清颗粒结合西医常规对于湿热下注型慢性前列腺炎的疗效优于单用西药,并且没有显著增长不良反应的发生率,安全性较高.

Review question / Objective: To evaluate the efficacy and safety of TraditionalChinese Medicine (TCM) on the treatment of male infertility due to sperm DNA fragmentation (SDF).

慢性前列腺炎是男科较为常见的疾病,其病因病机复杂,单纯从某一病机论治通常难以取得良好的效果.李海松教授临床经验丰富,指出精室具有易虚易瘀的重要特征,所以慢性前列腺炎也应当从瘀、虚论治.其中,瘀既是核心病机又是病理产物,可以分为络脉瘀阻、因郁致瘀、痰湿致瘀、因火致瘀;虚为基本病机和病理趋势,可分为肾气亏虚和脾气亏虚.瘀和虚二者关系紧密,相互作用,从瘀、虚论治慢性前列腺炎拓宽了诊疗思路.

To explore the mechanism through which liver cirrhosis (LC) causes erectile dysfunction (ED). Bioinformatic analysis was used to predict the potential signalling pathways in LC-induced ED, and N-nitrosodiethylamine was used to establish a rat model of LC. H&E staining, Western blotting and RT-qPCR were used to detect pathological tissue damage and changes in mRNA and protein expression levels. In addition, the expression levels of sex hormones such as estradiol (E2), prolactin (PRL) and testosterone (T) were measured. The hypoxia-inducible factor (HIF) pathway was an important pathway in our bioinformatics prediction. Pathological damages were detected in the liver and penile tissues of the model rats. Compared with the normal group's serum hormone levels, E2 and PRL were increased in LC rats, while T was decreased (p < 0.01). The mRNA and protein expression results from penis tissues showed that endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) were both downregulated, and HIF-1α was upregulated in the model group compared to the normal group (p < 0.01). These data suggest that LC hinders erectile function and causes histopathological changes in the penis by affecting the expression of HIF-1α, eNOS, iNOS, E2, PRL and T.

目的 为了探索牛膝-王不留行治疗糖尿病勃起功能障碍大鼠的靶点、机制.方法 通过TCMSP数据库收集牛膝-王不留行活性成分及潜在靶点;通过GeneCards数据库和DisGeNET数据库收集糖尿病勃起功能障碍相关的疾病靶点,并与药物活性成分靶点取交集得到共同靶点,进行PPI分析;使用Cytoscape构建可视化"药物-靶点-疾病"网络并进行分析,通过R语言对共同靶点进行GO富集与KEGG富集分析.通过腹腔注射链脲佐菌素(STZ)溶液(55 mg·kg-1)构建糖尿病大鼠模型,予以阿扑吗啡(APO)皮下注射(100 ug·kg-1)筛选糖尿病勃起功能障碍(DMED)模型.造模成功后予以牛膝-王不留灌胃干预.通过APO诱导来评估大鼠勃起功能,运用HE染色观察大鼠阴茎海绵体组织结构变化,采用PCR和Western blotting方法检测组织相关蛋白及mRNA的表达,以验证牛膝-王不留行对DMED治疗作用及机制.结果 网络药理学研究结果表明ICAM-1和NOS是牛膝-王不留行在治疗DMED中的关键靶点.实验结果表明牛膝-王不留行可以明显的改善DMED大鼠的勃起功能,同时可以明显改善阴茎海绵体组织结构结构.与模型组相比,药对可以抑制大鼠阴茎组织中ICAM-1蛋白及mRNA的表达,并促进NOS蛋白及mRNA的表达.结论 牛膝-王不留行通过抑制ICAM-1和促进NOS蛋白及mRNA的表达,进而改善阴茎海绵体组织结构,从而调节DMED的大鼠的勃起功能.