基于“三焦气化”理论探讨良性前列腺增生燥湿相兼证的中医辨治

Exploration on Traditional Chinese Medicine Syndrome Differentiation and Treatment of Benign Prostatic Hyperplasia with Dryness-Dampness Syndrome Based on the Theory of "Triple Energizer Qi Transformation"

摘要:

基于“三焦气化”理论分析良性前列腺的病机与中医辨治，认为良性前列腺增生的核心病机在于三焦气化失司，津液输布障碍，上焦宣发不及则津液不布，中焦运化失权则水湿内停，下焦气化不利则开阖失度，终致湿浊停聚于下、津液失润于上，形成小便涩滞与口干并见的燥湿相兼证。其病机呈三期演变：初期为少阳枢机不利，三焦气化壅滞；中期为中气虚弱，枢转三焦失职；晚期为下焦瘀阻，三焦水道闭塞。以“通调三焦，复其气化”为治疗总则，借流湿润燥之法，旨在疏通津液运行之道，使停湿得化、燥结得润。临证分期论治，初期疏利少阳，宣上导下；中期补中益气，升清降浊；晚期化瘀散结，通络开窍。因病机常多期交织、虚实错杂，故辨治仍需灵活权变。

Abstract:

Abstract：Based on the theory of "triple energizer qi transformation，" this paper analyzes the pathogenesis and traditional Chinese medicine （TCM） syndrome differentiation and treatment of benign prostatic hyperplasia （BPH）. It is proposed that the core pathogenesis of BPH lies in the disordered qi transformation of the triple energizer and impaired distribution of body fluids. When the upper energizer fails to diffuse and disperse adequately， body fluids fail to disperse. When the middle energizer fails to control its transporting and transforming function， water-dampness accumulates internally. When the lower energizer qi transformation is dysfunctional，opening and closing functions are disordered， and these eventually result in dampness and turbidity accumulating in the lower part and fluids failing to moisten the upper part of the body. This gives rise to the dryness-dampness syndrome characterized by difficult urination accompanied by dry mouth. The pathogenesis of BPH evolves through three stages：the initial stage involves inactivation of Shaoyang pivot and stagnation of triple energizer qi transformation；the middle stage involves deficiency of the middle qi and disordered pivot of the triple energizer；the advanced stage involves stasis and obstruction in the lower energizer and blockage of the triple energizer water passage. The general treatment principle should be "regulating the triple energizer and restoring its qi transformation，" using the method of moistening dryness by resolving dampness to unblock the passage of body fluid circulation， so that retained dampness is resolved and dryness and accumulation are moistened. Clinical treatment is stage-specific：in the initial stage，dredging the Shaoyang，dispersing the upper part and directing pathogenic factors to the lower part；in the middle stage，strengthening middle energizer to nourish qi， and ascending lucid yang and descending turbid yin；in the advanced stage，resolving stasis and dissipating mass，and unblocking collaterals and opening the orifices. Because the pathogenesis often involves interwoven stages and intermingled deficiency and excess，treatment should be flexibly adapted according to syndrome differentiation.