Recent rethinking of spermatorrhea
- Post By: 汉青
- Date:
- Category: Clinical Reflections
At the end of last year, a young man came to visit, complaining of spermatorrhea. It was reported that he had been dreaming for several years. After multiple treatments, his condition was good and bad. Recently, the unexplained cause was aggravated. In severe cases, he had been treated twice a night. After the spermatorrhea, his body was sore and weak, his mental state was poor, and he was in extreme pain.
Prescriptions for preoperative medicine are mostly treated with kidney tonification, and there are also agents for refreshing and invigorating the spleen, and also products for diuresis and expectoration. Sometimes they are effective, sometimes they are aggravated, and when they are good, they can last up to once a month. At that time, I distinguished and proved that there was a feeling of kidney incapacity and discord between the camp and the guard. Guizhi plus keel oyster soup immediately entered my mind, so I used this side to add a few things to clear the face and hide the sun, told him to relax his mind and follow it indifferently to see the after-effects. After taking this formula, the effect is good, and it has been conditioned a few times afterwards, and it is best to reach once every 15 days.
However, he had many other problems, such as diarrhea, palpitations, stomach blockage, poor nutrition, and I was impressed by the lack of taste in his mouth. These problems are undoubtedly directly related to kidney deficiency, but kidney tonification is not a stopgap measure at this time.
For this reason, I re-examined the ancient people’s understanding of this disease.
The ancient people’s understanding is actually very simple. First of all, the ejaculation proves that the vaporization function of the kidney is still normal, and the kidney essence is still retained. The ancients believed that “the five organs are abundant, but they can diarrhea”. The function of the viscera is good, but it can not retain the goods, which is easy to cause deficiency damage.
其次，古人基本上都认为，遗精的病因主要在心，正所谓“ 心有所动，肾必应之 ”，所以现在网络上对该问题都要求戒色，我看是很难的，但是心静对此病绝对有好处。
剩下的情况，无非就是心脾两虚，湿热下注，下元虚损等等了，总的来说，实证多于虚证，特别是有湿郁于脾胃，很容易化热扰动肾气，所以我始终认为慎用补法，只有合并出现滑精的情况，才应该考虑滋补肾阴。
古人的方法很简单，心火旺的清心去火，心火虚旺的养心安神，相火旺的要疏肝清火养阴，相火虚旺的要补心脾，唯肾元极亏时才用左归或右归。
古人对寒凉药的运用也比较谨慎，最重的也就是用黄连黄柏之类，很少用到矿物药清热，且多用肉桂反佐，如此可见一斑。
我思考，对于这类缠绵多年的疾病应该抽丝剥茧，逐层解决，不能好大喜功，更不能贪图短效，老师一直教育我们要治病求本，还是应该从病机的最深处入手，抓住主要矛盾不放，次要矛盾逐个击破，方能圆满。
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去年年底，有位青年男士前来求诊，主诉遗精，据闻已梦遗数年，历经多方治疗，病情时好时坏，近期不明原因加重，严重时一夜两次，遗精后浑身酸软无力，精神不佳，痛苦至极。
观前医之方，多以补肾论治，亦有清新健脾之剂，也有利湿祛痰之品，有时收效，有时加重，好的时候能够坚持到一个月一次。我当时辨证明显感觉到有肾不纳气，营卫不和之象，桂枝加龙骨牡蛎汤马上进入脑海中，于是用了此方加了几位清相潜阳之物，嘱其放松心态，淡然从之，以观后效。此方服用后，效果不错，后续调理了几次，最好的时候达到15天一次。
但是，他还有许多别的问题，腹泻、心悸、胃堵、纳差，给我留下深刻印象的是口中淡而无味。这些问题毫无疑问跟肾虚有直接的关系，但是，补肾在此时并非权宜之计。
为此我又重新审视了古人对此病的认识。
古人的认识其实还是很简单的，首先，遗精证明肾的气化功能还正常，肾精还有所保留，古人认为“ 五脏盛，乃能泻 ”，脏腑的功能是好的，只不过留不住货，容易造成虚损。
其次，古人基本上都认为，遗精的病因主要在心，正所谓“ 心有所动，肾必应之 ”，所以现在网络上对该问题都要求戒色，我看是很难的，但是心静对此病绝对有好处。
剩下的情况，无非就是心脾两虚，湿热下注，下元虚损等等了，总的来说，实证多于虚证，特别是有湿郁于脾胃，很容易化热扰动肾气，所以我始终认为慎用补法，只有合并出现滑精的情况，才应该考虑滋补肾阴。
古人的方法很简单，心火旺的清心去火，心火虚旺的养心安神，相火旺的要疏肝清火养阴，相火虚旺的要补心脾，唯肾元极亏时才用左归或右归。
古人对寒凉药的运用也比较谨慎，最重的也就是用黄连黄柏之类，很少用到矿物药清热，且多用肉桂反佐，如此可见一斑。
我思考，对于这类缠绵多年的疾病应该抽丝剥茧，逐层解决，不能好大喜功，更不能贪图短效，老师一直教育我们要治病求本，还是应该从病机的最深处入手，抓住主要矛盾不放，次要矛盾逐个击破，方能圆满。
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