李海松教授从痰论治男性不育症经验

男性不育症是男科常见的疑难杂症之一,目前在国际上没有特别明确的特效药物和治疗方法,其也困扰着无数家庭的和谐生活.李海松教授在男性不育症的诊治中见解独到,运用化痰法论治在临床中收获颇丰,特将其经验总结如下,以飨读者.     

“从瘀论治”在男性不育症临床诊疗中的应用

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。     

生精2号治疗弱精子不育症疗效观察

目的:探讨生精2号治疗弱精子不育症的疗效及作用机制。方法:采用随机分组,阳性药物对照的临床试验方法,将59例弱精子不育症患者分为两组。治疗组30例,采用口服生精2号配方颗粒治疗,1包/次,2次/d;对照组29例,采用口服中成药五子衍宗丸治疗,8粒/次,2次/d。两组均以3个月为1疗程,治疗前后对患者进行综合疗效评价,观察有无妊娠、精液质量检查和血清性激素(T、HSH、LH、PRL)检查。结果:经过3个月的治疗后,两组患者精子状态比较,治疗组患者精子成活率提升显著高于对照组(P0.05),具有统计学意义;总有效率治疗组为83.3%,对照组为69.0%,两组患者疗效比较治疗组总有效率明显高于对照组。结论:生精2号能够改善弱精子不育患者的精子成活率,未见明显不良反应。     

男性不育症传统中医诊断的困境与现代中医诊断的思考

在没有现代医学精液检查的年代,传统中医对男性不育症或从多个配偶的生育状况,或从配偶的月经状况,或从男性本身的临床症状来诊断,缺乏准确性.传统中医对男性不育症的诊治经验十分丰富,但因诊断不准确而使这些经验受到质疑.男性不育症的诊断及辨证论治与现代医学结合势在必行.笔者主张男性不育症的现代中医诊断应在现代医学精液检查基础上,结合临床证候进行辨证,即男性不育"从精论治".     

新益肾清利方治疗肾虚湿热型特发性弱精子不育症的随机双盲对照试验

目的:观察中药验方新益肾清利方治疗肾虚湿热型特发性弱精子不育症的临床疗效。方法:选择2015年1月至2017年2月上海中医药大学附属第七人民医院诊治的符合纳入标准的60例患者作为研究对象,采用随机、双盲、对照试验方法,以1∶1比例按照随机数字分入治疗组或对照组,每组30例患者,对受试者、干预措施实施者和结果测量者实施盲法;治疗组患者予以新益肾清利配方颗粒,对照组患者予以五子衍宗丸配方颗粒。两组疗程均为3个月,观察临床疗效,比较患者精子浓度、精子活动率、A级精子、A+B级精子及血清睾酮、泌乳素水平的变化情况。结果:(1)治疗组和对照组患者临床总有效率分别为86. 7%和70. 0%,其差异具有统计学意义(P <0. 05)。(2)治疗前后组内比较,两组患者精子浓度、精子活动率、A级精子、A+B级精子差异均有统计学意义(均P <0. 01);治疗后组间比较,两组患者精子活动率(P<0. 01)、A级精子改善存在明显差异,具有统计学意义(P <0. 05),治疗组优于对照组,精子浓度、A+B级精子改善差异均无统计学意义(均P> 0. 05)。(3)治疗前后组内比较,血清泌乳素与血清总睾酮差异无统计学意义(P> 0. 05);治疗后两组间比较,血清总睾酮与泌乳素差异无统计学意义(P> 0. 05)。两组患者治疗过程中均未发生不良事件。结论:中药验方新益肾清利方治疗肾虚湿热型特发性弱精子不育症的效果满意,能够明显改善精子活动率,尤其是提高A级精子比例。     

不育症患者精子DNA损伤的临床分析与治疗研究

目的了解不育症患者的精子DNA损伤情况,并探讨不育症患者精子DNA损伤的治疗方法。方法选取2017年1月至2018年8月广东省妇幼保健院诊治的600例男性不育症患者作为研究对象。采集其精液标本进行精液分析,根据其精液分析结果,将患者分为精液正常组、弱精子症组、少精子症组,再采用精子染色质扩散方法对三组患者的精子DNA完整性进行检测,比较三组患者的精子DNA损伤率、精子DNA碎片化指数(DFI)。按照精子DNA完整性检测结果,将600例不育症患者分为精子DNA损伤组、精子DNA完整组,比较其精子密度、精子活动力、精子存活率、精子形态正常率。采用Pearson相关分析法,研究不育症患者精子DNA损伤与精液分析指标间的相关性。给予精子DNA损伤组患者左卡尼汀口服液治疗,比较治疗前后患者的DFI指数和精液分析指标。结果①弱精子症组、少精子症组、精液正常组的精子DNA损伤率、DFI指数比较,差异均具有统计学意义(P<0.05),从高至低依次为弱精子症组、少精子症组、精液正常组。②精子DNA损伤组的精子密度、精子活动力、精子存活率、精子形态正常率均低于精子DNA完整组,差异具有统计学意义(P<0.05)。③经相关性分析,不育症患者的精子DNA损伤与精子密度、精子活动力、精子存活率、精子形态正常率等精液分析指标密切相关,呈负相关。④经左卡尼汀治疗后,精子DNA损伤患者的精子密度、精子活动力、精子存活率、精子形态正常率均较治疗前增高,差异具有统计学意义(P<0.05),其DFI指数较治疗前降低,差异具有统计学意义(P<0.05)。结论不育症患者的精子DNA碎片化严重,其精子DNA损伤主要与其精液质量有关,临床上可采用左卡尼汀对精子DNA损伤予以治疗,可有效改善其精液质量,减轻其精子DNA碎片化。     

周少虎教授从瘀论治阳痿经验

阳痿,是男性性功能障碍疾病之一。周少虎教授长期从事男科临床,对男科疾病有独到见解,笔者介绍周少虎教授从瘀论治阳痿经验。周少虎教授认为阳痿的最终病理趋势是血瘀,治疗时应从瘀论治,同时以经络学说、脏腑气血辨证为指导,临床上辨证施治。     

补肾益脑片治疗男性不育症的临床研究

目的:积极探索治疗男性不育症的有效方法,使不育患者恢复生育能力.方法:用当今医学及生物物理检查手段,在中医辨证施治思想指导下,用中药补肾益脑片治疗,每月复查.结果:治疗男性不育165例,怀孕61例占36.97%,显效62例占37.58%,有效18例占10.90%,无效24例占14.55%,总有效率85.45%.结论:补肾益脑片治疗男性不育症有明显的疗效.     

中医治疗精液液化异常所致不育症的疗效观察

精液液化异常是男性不育症的常见致病因素之一, 约占精液异常所致不育症的25%左右。我院男科在中医理论指导下,通过对本症的病因病机的深入探索,运用滋阴活血、兼清湿热之法,从1998年以来,对72例精液液化不全和不液化患者采用自拟的液化汤系列方剂进行治疗,取得了满意的疗效。在此基础上,我们设立对照组,对液化汤的临床疗效进行了对照分析,现报告如下。     

排卵障碍性不孕症治疗进展

排卵障碍是导致女性不孕症的主要原因之一,而女性不孕会危害家庭稳定和社会和谐。中西医治疗本病都取得了一定的疗效。本文就中药疗法、针灸疗法、中西医结合疗法等几个方面进行阐述,并在此基础上进行讨论,阐明了中西医结合治疗本病具有促排卵效果好、远期疗效肯定等优势,对指导临床工作具有一定的意义。     

除畸胶囊治疗精子畸形率过高不育182例

精液质量是决定男性生殖能力的主要因素。精液质量除在检查中估价精子的活力、精子的数量、液化时间等一系列重要指标外,发现精子形态结构异常及其发生率是极为重要的。正常精液中也有相当多的异常精子,临床实验室检查一般把精子顶体完整率达到80%为正常,如超过20%的畸形则视为异常。有的专业书上定为20%～40%的范围,但如果超过20%的畸形率则将影响受孕率,如果达到40%左右的畸形率就会严重影响到精液的质量而造成不育。笔者近几年在不孕不育门诊治疗182例精子畸形引起不育的患者,取得了良好的效果,有效率达到95.05%,怀孕率达60%,现报道如下…     

加味地黄汤治疗男性少精、弱精子不育症

在男性不育症中,因少精、弱精子所致是造成不育的主要原因之一,我院男性科自1998年至2002年共收集、筛选治疗200例少精、弱精子不育患者,通过临床治疗观察,取得良好疗效,结果总结如下.     

Pre-treatment considerations in childhood hypertension due to chronic kidney disease

Hypertension(HTN) develops very early in childhood chronic kidney disease(CKD). It is linked with rapid progression of kidney disease, increased morbidity and mortality hence the imperative to start antihypertensive medication when blood pressure(BP)is persistently 90 th percentile for age, gender, and height in non-dialyzing hypertensive children with CKD. HTN pathomechanism in CKD is multifactorial and complexly interwoven. The patient with CKD-associated HTN needs to be carefully evaluated for co-morbidities that frequently alter the course of the disease as successful treatment of HTN in CKD goes beyond life style modification and anti-hypertensive therapy alone. Chronic anaemia, volume overload, endothelial dysfunction, arterial media calcification, and metabolic derangements like secondary hyperparathyroidism, hyperphosphataemia, and calcitriol deficiency are a few co-morbidities that may cause or worsen HTN in CKD. It is important to know if the HTN is caused or made worse by the toxic effects of medications like erythropoietin, cyclosporine, tacrolimus, corticosteroids and non-steroidal anti-inflammatory drugs. Poor treatment response may be due to any of these co-morbidities and medications. A satisfactory hypertensive CKD outcome, therefore, depends very much on identifying and managing these co-morbid conditions and HTN promoting medications promptly and appropriately. This review attempts to point attention to factors that may affect successful treatment of the hypertensive CKD child and how to attain the desired therapeutic BP target.     

Acute kidney injury due to bilateral ureteral obstruction in children

Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures. It needs to be promptly suspected in order to attempt a quick renal function recovery. In this paper we concentrated on uncommon causes of obstruction, with the aim of giving a summary of such multiple, rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction, difficult to be suspected at times. Conversely, typical and well-known diseases have been just run over. We considered pediatric cases of ureteral obstruction presenting as bilateral, along with some cases which truly appeared as single-sided, because of their potential bilateral presentation. We performed a review of the literature by a search on PubMed, CrossRef Metadata Search, internet and reference lists of single articles updated to May 2014, with no time limits in the past. Given that we deal with rare conditions, we decided to include also papers in non-English languages, published with an English abstract. For the sake of clearness, we divided our research results into 8 categories: (1) urolithiasis; (2) congenital urinary tract malformations; (3) immuno-rheumatologic causes of ureteral obstruction; (4) ureteral localization of infections; (5) other systemic infective causes of ureteral obstructions; (6) neoplastic intrinsic ureteral obstructions; (7) extrinsic ureteral obstructions; and (8) iatrogenic trigonal obstruction or inflammation. Of course, different pathogenic mechanisms underlay those clinical pictures, partly well-known and partly not completely understood.     

Treatment of pharyngeal gonorrhea due to beta-lactamase-producing gonococci

Between March 1978 and October 1980 seven patients with beta-lactamase-producing gonococci in the pharynx were treated wit spectinomycin of cefuroxime or both. One-day treatment with spectinomycin was effective in only one of six patients and with cefuroxime in only one of four patients. Prolonged treatment with cefuroxime was successful in all five cases so treated.     

黄氏生精丸治疗精液异常不育症116例

自1979年以来,笔者用家传验方黄氏生精丸治疗精液异常不育症116例,疗效满意,现报道如下: 临床资料