郁证引起阳痿的论治

随着现代生活节奏加快和激烈的社会竞争给人们带来极大的精神压力,郁证相应增加,常常会出现因郁致痿,因痿致郁。郁证与阳痿往往相互影响。文章从肝、心、脾对郁证后引起阳痿进行分析,从而为郁证后阳痿的治疗找到更好的解决方法。     

阳痿疾病与心理、社会因素

阳痿病是由于各种原因造成宗筋失养而弛纵,引起阴茎痿软不举,或者举而不坚的病症。临床所见,阳痿的发生除极少数为器质性病变以外,绝大多数为功能性病变。现代生活中,阳痿这种现象有增加的趋势,无不与焦虑、不满、抑郁等情志因素有关。正如《景岳全书》所述:“凡思虑焦劳,忧郁太过者,多致阳痿。”     

阳痿非皆阳虚浅谈

阳痿非皆阳虚浅谈史元生，史建军中国人民解放军５９２５２部队卫生队（焦作４５４１００）主题词阳痿／中医药疗法《景岳全书》说：“阴痿者，阳不举也”，指出阴痿即阳痿。述其病因病机，说阳痿“多由命门大衰，精气虚冷，或以七情劳倦，损伤生阳之气……亦有湿热炽盛，...     

阳痿中医治验

有关阳痿病因病机的问题 《内经》称阳痿为“阴痿”、“阴器不用”、“宗筋弛纵”,并认为其病的主要原因是“气大衰”和“热”。隋、唐时代,通过研究,明确提出它的病因是劳伤和肾虚。明·王纶《明医杂著》指出阳痿之病除命门火衰之外,还有郁火所致者。明·张介宾著《景岳全书》认为阳痿之病不但有命门火衰所致者,而且有湿热、惊恐、思虑等所致者。清代医家通过研究,认为阳痿的病因除了前代医家所述的房劳、     

阳痿同病异治举隅

阳痿指因命门火衰、肝肾亏损或因惊恐抑郁等所致，以阴茎痿软或举而不坚，不能插入阴道进行性交为主要表现的痿病类疾病。阳痿属国家标准疾病名称。是男性病中非常常见的疾病。性神经衰弱症、前列腺炎和某些慢性疾病出现阳痿，均可按阳痿进行辨证论治。笔者在临证中，运用整体动态观察，辨证与辨病相结合，紧扣病因脉证，祥审病证标本虚实．用中西结合之法每获效验。现列举数例，冀同道斧正。     

针刺治疗阳痿

阳痿是阴茎不能勃起或勃起无力或早泄等症。在《内经》中称为“阴痿”。张景岳说:“阴痿者,阳不举也”。说明阴痿即是阳痿。历代医家认为本证每多涉及肝、肾、阳明三经。     

治阳痿当安神

治阳痿当安神（１０００３７）北京市海军总医院中医科钱彦方阳痿病雏形于《养生方》称＂老不起＂，丰富于《黄帝内经》，诸多章节记戴了“阴痿＂、＂阴器不用＂、＂宗筋驰纵＂、＂筋痿＂等病证，列述了阳痿的多发因素：情志、湿热、房劳，特别对情志致痿，今日更应重新认...     

“因郁致病”与“因病致郁”理论溯源及临证思考

通过梳理“郁”的发展源流,从理论探讨广义之郁与狭义之郁的区别与联系,辨析“郁证”“郁病”的含义,阐明“因病致郁”“因郁致病”在疾病发生、发展中的相互关系,提出“郁-病-郁”与“病-郁-病”乃是临床常见的恶性循环现象,只有认识证与病在“因病致郁”“因郁致病”中的不同内涵,才能发挥中医“形与神俱”“病郁同治”的优势,对临床诊疗具有一定的指导意义。     

阳痿同病异治举隅

阳痿指因命门火衰、肝肾亏损或因惊恐抑郁等所致,以阴茎痿软或举而不坚,不能插入阴道进行性交为主要表现的瘘病类疾病。阳痿属国家标准疾病名称。是男性病中非常常见的疾病。性神经衰弱症、前列腺炎和某些慢性疾病出现阳痿,均可按阳痿进行辨证论治。笔者在临证中,运用整体动态观察,辨证与辨病相结合,紧扣病因脉证,祥审病证标本虚实,用中西结合之法每获效验。现列举数例,冀同道斧正。     

阳痿病名与归属及辨病演变考

阳痿在先秦名“不起”,秦汉至金元多以“阴痿”名,明代始称“阳痿”后,明清则多以“阳痿”名,少数虽以“阴痿”名,但同一书不相互作用。唐及其以前将其归属七伤,肾脏,劳、五不男、房中等门疾病,自金以降,多将其归属杂证门疾病。     

Erectile impotence precipitated by organic factors and perpetuated by performance anxiety.

A survey of 72 men with erectile impotence showed that for 14 the onset had been concurrent with the start of a temporary physical disability (in 8), temporary exposure to a chemical agent in doses thought to be significant (in 4) or the return of sexual opportunity after a long period of celibacy or near-celibacy (in 2 older men). After elimination of that possible cause the impotence had persisted owing to anxiety about sexual performance. In another 6 of the 72 there were persistent nonpsychic causes for the impotence. Thus, in 28% of the men surveyed the precipitating cause of erectile impotence was organic. A large proportion of the cases of erectile impotence participated by a temporary nonpsychic factor could probably have been prevented with appropriate professional advice--for example, at the time an antihypertensive drug capable of causing the dysfunction was first prescribed.     

Increasing rates of depression

Several recent, large epidemiologic and family studies suggest important temporal changes in the rates of major depression: an increase in the rates in the cohorts born after World War II; a decrease in the age of onset with an increase in the late teenaged and early adult years; an increase between 1960 and 1975 in the rates of depression for all ages; a persistent gender effect, with the risk of depression consistently two to three times higher among women than men across all adult ages; a persistent family effect, with the risk about two to three times higher in first-degree relatives as compared with controls; and the suggestion of a narrowing of the differential risk to men and women due to a greater increase in risk of depression among young men. These trends, drawn from studies using comparable methods and modern diagnostic criteria, are evident in the United States, Sweden, Germany, Canada, and New Zealand, but not in comparable studies conducted in Korea and Puerto Rico and of Mexican-Americans living in the United States. These cohort changes cannot be fully attributed to artifacts of reporting, recall, mortality, or labeling and have implications for understanding the etiology of depression and for clinical practice.     

Multidisciplinary survey of erectile impotence

A study was done of 220 men referred principally by family physicians to a multidisciplinary erectile dysfunction study group to determine the factors causing or contributing to impotence that had persisted for more than 2 months and for which no cause was apparent. The men were aged 21 to 79 (mean 50.3) years, and the duration of impotence was a few months to 15 years (mean 2.65 years). The men were to be assessed from general medical, endocrinologic/metabolic, psychiatric and urogenital viewpoints. The significance of the causal or contributory factors detected was scored by application of defined criteria and a four-point scale. The degree of loss of potency and of libido as well as level of concern were also scored by each specialist. Impotence was complete in 60%, and an associated decline in libido was reported by 38%. The level of concern was high--that is, normal--in 81% and slightly reduced in 9%. Full investigation by all the specialists was precluded by the severity of other conditions in 16 patients, by the return of potency following relief of anxiety/depression or genitourinary tract infection in 16 and for logistic or other reasons in 34. Although the cause of the impotence could be attributed in 186 of the patients, only 154 were fully assessed. Among these patients general medical factors were contributory in 46%, endocrinologic/metabolic factors in 44%, psychogenic factors (primary or secondary) in 60% and urogenital factors in 49%. Multiple contributing factors were identified in 65%, which underscores the importance of a multidisciplinary approach to assessing many cases of impotence.     

糖尿病阳萎与性激素及慢性并发症的关系

研究性激素和糖尿病慢性并发症在糖尿病阳萎发病中的意义，探索糖尿病阳萎发生的机理。测定３９例糖尿病患者血清促黄体素，促卵泡素，催乳素和睾酮的浓度，同时调查其慢性并发症的发病情况。发现１８例糖尿病阳萎患者血清ＬＨ，ＦＳＨ，ＰＲＬ和Ｔ浓度与２１例非阳萎糖尿病患者相互鸨显著差异，但糖尿病植物神经病变在阳萎组中的发生率     

对糖尿病阳痿患者MMPI的分析研究

目的：探讨糖尿病阳痿患者明尼苏达多项人格调查表（MMPI）的模式特点,尝试对糖尿病阳痿患者的心理状态和心理特征进行评定和描述,为其心理治疗提供较为客观的依据。方法：对102例糖尿病阳痿患者的MMPI测查结果进行统计学分析。结果：102例患者中有75例（73．5％）剖析图异常,23例（22．5％）剖析图显著异常。Hs、D、Hy量表原始分显著高于常模,Pa量表原始分显著低于常模。大部分患者的两点编码模式为13／31、12／21和23／32型。结论：大部分糖尿病阳痿患者存在心理障碍,有些甚至存在比较严重的心理障碍。他们的个性特征带有癔病色彩,表现为被动依赖、敏感多疑、易紧张、好诉苦、否认症状背后的心理问题。心理治疗不仅可以改善患者的情绪,提高性生活质量,同时也会减少糖尿病的其它并发症。     

阳痿辨证分型古今演变探讨

古代对阳痿的病因病机、分型等论述有相当丰富的记载，从较早的“气不至”认识，到晋隋唐宋时代医家对阳痿的发生多责之劳伤、肾虚。明代医家首次以“阳痿”命名，阳痿的认识已臻完善，认为命门火衰、七情劳倦、湿热炽盛，甚至思虑、焦劳、忧郁、惊恐等，皆可致痿。清代医家开拓扩展，认为除上述外还有忍房事、失志、瘀血、心气不足、脾虚等。现代中医对阳痿的认识，仍有所发展创新，思路更加丰富，许多医家也提出各自的学术理论。课题组通过总结整理文献，为方便临床辨证及应用，将阳痿概括为肝气郁结证、湿热下注证、瘀血阻滞证、心脾两虚证、肾阳虚衰证、肾阴亏虚证六个基本证型。然临床诊治并不拘泥于此，概而言之不外虚实两端。辨证论治是中医学的特色优势，随着环境等因素改变，仍需不断思考与探索。     

浅谈抑郁症与“肝阳气虚”的关系

通过对抑郁症与中医郁症概念的分析,总结和探讨抑郁症的相关病机理论,指出现代抑郁症的概念并不能完全等同于中医郁证的范畴,并进一步指出中、重度抑郁症中核心病机肝阳气虚被忽视的原因。同时,对中、重度抑郁症的病机结合肝阳气虚的理论进行解读,指出从肝阳气虚对抑郁症诊治的思路。     

前列腺素E1在阳痿患者中的临床应用

前列腺素Ｅ１是一种平滑肌松弛剂，使阴茎动脉平滑肌松弛。彩色多普勒血流显像提示血管内腔扩大，动脉血流速度加快，使血液迅速充盈海绵体组织，引起阴茎膨大勃起。本组３５例阳痿患者注射ＰＧＥ１后，呈现完全勃起２４例，占６９％。结果显示海绵体内注射ＰＧＥ１增加血流动力，ＰＧＥ１既可用作筛选血管性阳痿，又可作为治疗阳痿的药物。     

COMTval158met 基因多态性对抑郁症易感性的影响及抗抑郁剂疗效相关性研究

目的探讨儿茶酚胺氧位甲基转移酶(COMTval158met)基因多态性和抑郁症的发病及抗抑郁剂临床疗效的相关性。方法对275例抑郁症患者采用随机数字表法给予文拉法辛缓释剂或帕罗西汀片治疗6周;于治疗前和治疗1、2、4及6周后采用汉密尔顿抑郁量表(HAMD17)评定抑郁严重程度和疗效;抽取所有患者及202例正常对照组的静脉血,采用聚合酶链反应-限制性片段长度的多态性(PCR-RFLP)方法检测COMTval158 met各突变点基因多态性并进行基因分型。结果研究组的Met/Met、Val/Met、Val/Val基因型及Met、Val等位基因频率和正常对照组的差异无显著性(P均>0.05)。两治疗组的痊愈组和非痊愈组之间及和正常对照组的COMTval158met等位基因频率和基因型频率差异均无显著性(P均>0.05)。结论COMTval158me基因多态性可能和抑郁症的发生、疗效无关联性。