孙敦坡 姜明孝 马小闵 王益松 刘兆飞 高绪柱

摘要 目的：探討大艾段温针灸法治疗肾虚肝郁型弱精症的临床疗效。方法：选取2018年1月至2019年12月课题病例招募组的肾虚肝郁型弱精症患者140例作为研究对象，按照随机数字表法随机分为观察组，药物对照组，常规温针对照组和普通针刺对照组，每组35例。观察组使用4 cm大艾段进行温针灸，药物组服用硫酸锌片、维生素E软胶囊、五子衍宗丸，常规温针组选用2.5 cm艾段，普通针刺组常规针刺，不加灸。各组均4周为1个疗程，2个疗程后分析4组中医证候、精液常规、精浆生化、性激素水平变化情况。结果：观察组疗效优于普通针刺组（P<0.05）;药物组精液量优于观察组（P<0.05）;观察组畸形率、a级精子、a+b级精子优于其他3组（P<0.05）;观察组精子活率优于常规温针组、普通针刺组（P<0.05）。观察组精浆果糖、中性α-葡萄糖苷酶优于其他3组（P<0.05）。观察组睾酮优于药物组（P<0.05）;观察组促黄体生成素、促卵泡生成激素优于其他3组（P<0.05）。结论：大艾段温针灸法治疗肾虚肝郁型弱精症疗效肯定，在改善精液常规、精浆生化指标、性激素水平相关参数方面，优于常规温针灸、普通针刺、药物，作用机制可能与调节性激素水平有关。

关键词 温针灸;弱精症;肾虚肝郁;精液常规;精浆生化;作用机制;饱和灸量;临床观察

Abstract Objective：To explore the clinical effect of Da′aiduan warming needle moxibustion on asthenospermia of kidney deficiency and liver depression type.Methods：A total of 140 patients recruited by the research group from January 2018 to December 2019 were randomly divided into an observation group，a drug control group，a conventional warming needling control group and a common needling control group，with 35 cases in each group.The observation group used 4 cm long mugwort segment for warming needling; the drug group used zinc sulfate tablet，vitamin E soft capsule，Wuziyanzong Pill; regular warming needling group used 2.5 cm mugwort segment; common needling group used only conventional needling，without moxibustion.Each group took 4 weeks as a course of treatment.After 2 courses，the changes of symptoms in traditional Chinese medicine，semen conventional indexes，seminal plasma biochemistry and sex hormone level in 4 groups were analyzed.Results：In the aspect of curative effect，the observation group was superior to the ordinary acupuncture group（P<0.05）; in the aspect of semen quantity，the drug group was superior to the observation group（P<0.05）; in the aspect of deformity rate，class a sperm and class a+a sperm，the observation group was superior to the other three groups（P<0.05）; in the aspect of sperm activity rate，the observation group was superior to the conventional warming needling group and the common needling group（P<0.05）.Fructose in seminal plasma and neutral α-glucosidase in the observation group were better than those in the other three groups（P<0.05）.In terms of testosterone，the observation group was better than the drug group（P<0.05）; in terms of luteinizing hormone and follicle stimulating hormone，the observation group was better than the other three groups（P<0.05）.Conclusion：The therapeutic effect of Da′aiduan warming needle moxibustion on asthenospermia of kidney deficiency and liver depression type is positive.It is superior to conventional warming needle moxibustion，common acupuncture and medicine in improving semen conventional indexes，seminal plasma biochemistry and related parameters of sexual hormone level.The mechanism of action may be related to regulating sexual hormone level.

Keywords Warm needling moxibuston; Asthenospermia; Kidney deficiency and liver depression; Semen conventional indexes; Seminal plasma biochemistry; Mechanism of action; Saturated moxibustion volume; Clinical observation

中图分类号：R245文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.10.020

近年来，由于环境污染加重、性传播疾病增多、长期不健康的生活习惯等，导致男性精子质量持续下滑，不育症的发病率持续升高，全世界不育症患者已超2亿，已成为全球关注的疾病。不育症中超过30%存在弱精表现，也是导致不育的最常见因素[1-2]。弱精症主要是指精液中a级精子量小于25%或（a+b级）精子数量小于50%的疾病[3]，具体发病机理尚未阐明，多与各类炎症、内分泌功能紊乱失调、免疫异常、精索静脉不同程度曲张、基因遗传等相关[4-5]。本研究应用大艾段温针灸疗法治疗肾虚肝郁型弱精症，临床疗效等较常规温针灸法、普通针刺疗法有所改善提高。现报道如下。

1 资料与方法

1.1 一般资料 选取2018年1月至2020年1月课题病例招募组的肾虚肝郁型弱精症患者140例作为研究对象，按照随机数字表法随机分为观察组，药物对照组，常规温针对照组和普通针刺对照组，每组35例。……