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。

Discussion on the evolution of the differentiation of symptoms and signs for classification of syndrome of sexual impotence from the ancient and modern perspectives

There were a great amount of records on the etiology,pathogenesis and classification of sexual impotence in ancient times.From the earlier knowledge of "insufficient qi",until the Dynasties of Jin,Sui,Tang and Song when doctors believed that sexual impotence was caused by excessive works and kidney deficiency.Doctors from the Ming Dynasty,for the first time,named it as "sexual impotence".From that time on,the knowledge to sexual impotence had become thorough,and doctors believed that life-gate fire deficiency,exhaustion of seven emotions,excessive dampheat,and even worries,anxiety,melancholy,panic and other emotions could induce sexual impotence.In the Qing Dynasty,the medical doctors found more evidences,and deemed that in addition to the above,there were also reasons such as restrained sexual intercourse,loss of ambition,blood stasis,insufficient heart qi,and spleen insufficiency.Modern Chinese medicine has considerable development and innovation in the understanding of sexual impotence,and its ideas are more abundant.Many doctors also put forward their own academic theories.The research team,in order to facilitate clinical syndrome differentiation and application,has summarized relevant literature reports,and summarized the sexual impotence into six fundamental syndrome types:liver qi stagnation syndrome,dampness and heat downwardflow syndrome,blood stasis syndrome,heart and spleen deficiency syndrome,kidney yang deficiency syndrome,and kidney yin deficiency syndrome.However,clinical diagnosis and treatment are not limited to this,and in general the symptoms are not beyond deficiency or excess.Syndrome differentiation is a characteristic advantage of traditional Chinese medicine.With the changes of environment and other factors,constant thinking and exploration is also required.