【作者】 周智毅；

【导师】 顾一煌；

【作者基本信息】 南京中医药大学 ， 中医学， 2009， 硕士

【摘要】 早泄是一种常见的男科疾病,主要表现为男性在性生活时,由于随意控制射精的功能降低,持续和反复发生阴茎插入阴道之前或插入阴道就很快射精,或不能有效地维持射精时间以达到夫妻双方满意性生活。目前该病的发病机制还不十分明确,一般认为,早泄原因不仅存在着部分精神心理性异常趋势如抑郁、不安、焦虑、强迫症和敌对心理等因素,而且存在着神经病理性器质性病变,即阴茎感觉过敏性或阴茎感觉神经兴奋性增高,以至于射精功能调节障碍而引起早泄。目前中医认为早泄的发生与心、肝、脾、肾功能失调有关,并以。肾之阴阳偏盛偏衰为主。在发病机理上归纳为阴虚阳亢、心火旺盛、心脾亏虚、心胆虚怯、肝经湿热、肾气不足等原因,进而导致精关疏泄失常,约束无能而罹患。但是在治疗方面,无论是现代医学还是传统中医疗法,都存在副作用大或者疗效不肯定的缺点。本研究希望通过对早泄机理进行中西医结合的思维论证,寻找到更有效的理论和治疗方法,并在临床中检验该方法的有效性。理论研究方面,笔者认为射精是由交感、副交感和体神经共同完成的,调控泄精的交感神经起自胸腰髓(T10～L2)旁的交感神经节,其传出纤维围绕腹主动脉形成腰交感神经网,向下跨过髂总动脉进入盆腔,组成腹下丛,这些肾上腺素能神经发出的交感神经节后纤维进入膀胱颈、前列腺、输精管和精囊。在阴部神经(体神经)的配合下调控射精的副交感神经来自骶髓(S2～S4)旁,在盆腔组成盆神经丛,其发出的纤维也进入膀胱颈等上述部位。早泄的发生与上述相关的神经功能障碍密切相关,而这些神经的走行又与脊柱的位置和形态密切相关。对脊柱的调整治疗应该能够对与射精相关的神经功能产生调整作用,从而达到治疗早泄的目的。而传统中医认为早泄发生与多种因素有关,与虚损(肾、心、脾虚)和肝经湿热关系最为密切。笔者认为早泄的病理与遗精相类似,是一种“虚性兴奋”的表现,依据朱丹溪的“主闭藏者肾也,司疏泄者肝也,二脏皆有相火,而其系上属于心”的理论观点,提出早泄主要是与“心肾失交”有关,建立“心—肾—精”的射精轴理论,从督任二脉着手,突出以心肾为脏腑的治疗核心,通过脊柱推拿手法调节机体的阴阳平衡。射精反射受脊髓射精中枢的调节,也受大脑射精中枢的调节,后者对前者起到控制作用。PE患者往往由于缺乏性知识,过分紧张、激动以及夫妻之间配合不好等原因而引起大脑射精中枢失调,导致射精功能障碍,并表现为焦虑、抑郁、紧张和失望。从Masters—Johnson提出性感集中训练以来,行为疗法一直作为治疗早泄主要手段之一。通过行为治疗调节大脑皮层的功能活动,降低高级中枢和脊髓射精中枢兴奋性,缓解射精的紧迫感,提高射精的刺激阈值。指导患者体验性高潮发生前的感觉,经过多次反复,建立新的条件反射。尤为值得重视的是,行为疗法对改善我国相对较封闭的性观念,提高患者夫妇健康的性知识和性技巧是最有效的手段。通过治疗不仅早泄得到纠正,更提高了性生活质量,这是其他疗法无法替代和比拟的。临床研究方面,把入选的57例早泄患者随机分为治疗组(27例)和单纯行为疗法对照组(30例),对治疗组进行脊柱推拿手法治疗配合行为疗法的处理,对照组接受单纯行为疗法治疗,同时对两组病例进行阴道内射精潜伏期、CIPE-5评分、配偶满意度等项目观测和统计学处理,以比较两组间疗效的差异。研究中发现所有患者在T10～L2脊旁可找到明显压痛点,左右分布不等;有1例患者出现明显脊柱侧弯;伴有腰酸症状者占52.6%,全部患者出现骶髂关节错缝。这些阳性体征分布与主管射精的射精中枢(胸髓下段、腰髓下段和脊髓骶段)所对应的脊柱区域相吻合。治疗一月后两组阴道内射精潜伏期、CIPE-5评分均较治疗前有显著性增加,p均＜0.01。经脊柱推拿手法配合行为疗法治疗后,治疗组射精时间、CIPE-5评分明显高于对照组。治疗组前后比较由重度向中度,或向轻度早泄转变的患者明显增多。并且与对照组治疗后阴道内射精潜伏期相比,差异有显著性(p＜0.01)。从CIPE-5评分来看,脊柱推拿手法+行为疗法组同样高于单纯行为疗法组,差异有显著性(p＜0.01),以上研究结果表明:运用脊柱推拿手法配合行为疗法治疗早泄疗效确切,且优于单纯行为疗法的疗效,同时印证了早泄的病理机制与脊柱平衡失调有关这一推断。更多还原

【Abstract】 The premature ejaculation is a very common ejaculation disease caused by the decreasing of patients’ ability of controlling ejaculation by self-determination, which causes ejaculating quickly before or after the insertion or the sexual intercourse being not able to persist to satisfy both sides.This condition often lasts or takes place repeatedly.The mechanism of this disease has not been discovered clearly.Most people think the reason lies in not only some unconventional psychical sex tendency such as blahs,discomfort,worry,force syndrome and hostile mental state,but also some neuropathic pathologic disease which causes disorder of ejaculation function inducing premature ejaculation because of the penis getting sensitive.By the TCM theory,the occurring of the premature ejaculation relates to the disfunction of the visceras of heart,liver,spleen and kidney,in which the excess or insufficiency of YIN and YANG in kidney are most common.The mechanism is conclude as deficiency of YIN and excess of YANG,excess of heart fire,deficiency of heart and spleen,deficiency of QI in heart and gallbladder,damp and hotness in liver and deficiency of QI in kidney,which leads to disorder of the production and eduction of JING。But there are the disadvantage of more side-effect or less effects in both morden medicine and TCM.We hope this research will find the mechanism of this disease by the ideas of combination of morden medicine and TCM,and more effective theory and means,as well as verify the validity of this therapy in clinical research.In terms of theory research,we consider that the course of ejaculation is completed by sympathetic nerve,sub- sympathetic nerve and the body nerve.The sympathetic nerve adjusting ejaculation comes from the sympathetic ganglion on the side of pectoral and lumbar acanthi(T10～L2),which makes up of lumbar sympathetic nerve net by the efferent nerve fibre.Then the nerve goes through the iliac artery trunk,makes up into under-stomach plexus,which gives off post- acanthi fibre going into bladder neck,prostate,spermaduct and spermatophore.The sub-sympathetic nerve which adjusts ejaculation by the help of the pubic nerve comes from the surrounding of the sacrum rachis(S2～S4),and make up the basin plexus in the basin,the fibre comes from which goes into the bladder neck also.The route of the mentioned nerve is born on the rachis.Treatments to the rachis can act on the adaption of neural function,which may be used to cure the premature ejaculation.In the TCM,the premature ejaculation concerns with the collapse of kidney,heart and spleen and damp and hotness of liver.The author thinks that the mechanism of premature ejaculation is a kind of "false exciting",similarly to spermatorrhea.Based on the stand view of ZuDanxi about "kidney in charge of storing,liver in charg of releasing,the two of them having fire in them,which belongs to heart",we regard that the therapy of this disease should be built on the theory of "axis of heart-kidney-semen",and take the Jing of REN and DU and kidney as the key mechanism to adjust the YIN and YANG of body by the technique of spine manipulation.The ejaculation reflex is mediated not only by the spinal ejaculation centre,but also by ejaculation centre of the brain,which controls the latter.Deficiency of the knowledge,overly tension,or agitation,bad cooperation,all of those Patients with PE usually have,can lead to dysfunction of the brain ejaculation centre and result in functional impairment of ejaculation,accompanied with anxiety,depression,tension,disappointment.Ever since the Master-Johnson method was set up,the behavior therapy has been used as one of the main treatments of PE.The behavior therapy can contribute to controlling ejaculation reflex which is one offunction of human cerebral cortex,and inhibit irritability of the ejaculation centres in brain and spine so that the great urgency to ejaculate can be released,and penile sensitivity threshold can be raised.Patients are learned to experience the feeling just before orgasm again and again,in order to set up new ejaculation reflex.It is also a effective method that can propagate sex knowledge and sex skills to couples,which is more impotant in our society of conservative sex attitudes.In the clinical research,57 PE patients were ramdomly devided into treating(27) and single behavior therapy(30)groups.In the treating group,patients were treated with spine manipulation and behavior threpy.In the single behavior group,patients were treated with behavior therapy.The IELT,CIPE-5 scores,wife sexual satisfaction of these patients were recorded and statistically analyzed,to assess and compare the differences between the two groups.In this clinic research,all of the patients who can be found obvious pressive pain spot near the spine which distributes on the right or the left.There are one patients whose spine bends from the side.There are also 52.6%of the patients who feel lumbar ache,and all of whose sacrum and ilium get slip from each other.The distributing of these positive syndrome keeps consistent with the parts of rachis which are in charge of the centrum of ejaculation(substrate of pectoral and lumbar acanthi and sacrum part of spine).After one month’s therapy,the IELT,CIPE-5 scores for both groups turned out to be better obviously(P＜0.01).After the therapy of spine manipulation,with behavior at the same time,the items of time of ejaculation,and the CIPE-5 score for the treating group are both better than the control group The patients get more obviously whose syndrome turn better for the treating group,but the effects is also obvious for the control group(P＜0.01).The above results indicate the effects of the spine manipulation with acupuncturing is affirmatory and better than single behavior therapy.And it is also confirmed that the mechanism of premature ejaculation has relation with sacrum and ilium getting slip from each other.更多还原