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Article(id=1322926865597477111, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.10.011, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339943550, onlineDateStr=2026-10-30, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339943550, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339943550, creator=13701087609, updateTime=1793339943550, updator=13701087609, issue=Issue{id=1322926740955341011, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='10', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1760025600000', pubDateStr='2025-10-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339913834, creator='13701087609', updateTime=1793340753123, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930261259846420, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930261259846421, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=54, endPage=57, ext={EN=ArticleExt(id=1322926865844941048, articleId=1322926865597477111, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Application and Innovation of Toxin Evil Theory in Urology and Andrology, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=

It is to discuss the application and innovation of the toxin evil theory in urology and andrology.It is believed that toxin in the body is the key etiological mechanism for men＇s morbidity.Turbidity toxin，heat toxin，blood stasis toxin and cancer toxin disturb men＇s essence chamber，leading to the failure of opening and closing，thus causing diseases such as male reproductive function decline，semen quality reduction，urinary tract infection or tumour.According to the different etiology and pathogenic characteristics，the treatment principle of eliminating turbidity and detoxifying，activating blood and detoxifying，clearing heat and detoxifying，and anti cancer and detoxifying is established in order to get rid of toxin evils in the essence chamber and restore the opening and closing of the essence chamber.At the same time，it is emphasized that the toxins do not exist in isolation，so it is necessary to identify the symptoms and the urgency of the disease，and to treat the disease with a variety of methods，in order to provide new ideas for the clinical diagnosis and treatment of urogenital diseases in traditional Chinese medicine.

, authors=Fu WANG, Anmin WANG, Dongyue MA, Hao WANG, Ziwei ZHAO, Jiutian YANG, Jun GUO, authorsList=Fu WANG, Anmin WANG, Dongyue MA, Hao WANG, Ziwei ZHAO, Jiutian YANG, Jun GUO, authorCompany=null, correspAuthors=Jun GUO, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322926866415366393, articleId=1322926865597477111, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=毒邪理论在泌尿男科中的应用与创新, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=

探讨毒邪理论在泌尿男科中的应用与创新。认为毒邪伏于体内是男子发病的关键病因病机。浊毒、热毒、瘀毒、癌毒等侵扰精室，导致开阖失司，从而引起男子生殖功能减退、精液质量降低、泌尿系感染或肿瘤等疾病。根据不同病因病机及致病特点，确立不同治则以化浊解毒、活血解毒、清热解毒、抗癌解毒，祛除精室毒邪，恢复精室开阖。同时强调毒邪非一而存，需认清标本缓急，多法兼合而治，以期为中医临床诊治泌尿男科疾病提供新的思路。

, authors=王福, 王安民, 马东岳, 王浩, 赵子维, 杨九天, 郭军, authorsList=王福, 王安民, 马东岳, 王浩, 赵子维, 杨九天, 郭军, authorCompany=null, correspAuthors=郭军, authorNote=

王福（1982-），男，山东日照人，副主任医师，硕士研究生导师，博士，研究方向：中西医结合泌尿男科临床。

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郭军（1965-），男，重庆人，主任医师，博士研究生导师，硕士，研究方向：中西医结合泌尿男科临床。E-mail：。
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王福（1982-），男，山东日照人，副主任医师，硕士研究生导师，博士，研究方向：中西医结合泌尿男科临床。

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王福（1982-），男，山东日照人，副主任医师，硕士研究生导师，博士，研究方向：中西医结合泌尿男科临床。

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articleTitle=null, refAbstract=null), Reference(id=1322926875097575754, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926865597477111, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=5, pageStart=148, pageEnd=150，153, url=null, language=null, rfNumber=［27］, rfOrder=26, authorNames=杨森, 刘建平, 刘龙辉, journalName=中医药导报, refType=null, unstructuredReference=杨森，刘建平，刘龙辉，等. 李佃贵基于浊毒理论从脾胃防治结直肠腺瘤进展经验［J］. 中医药导报，2023，29（5）：148-150，153., articleTitle=李佃贵基于浊毒理论从脾胃防治结直肠腺瘤进展经验, refAbstract=null), Reference(id=1322926875164684619, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926865597477111, doi=null, pmid=null, pmcid=null, year=2021, volume=14, issue=11, pageStart=2006, pageEnd=2009, url=null, language=null, rfNumber=［28］, rfOrder=27, authorNames=王浩, 张继伟, 郭俊, journalName=环球中医药, refType=null, unstructuredReference=王浩，张继伟，郭俊，等. 基于“脑—心—肾—精室”轴探讨男科疾病的诊治思路［J］. 环球中医药，2021，14（11）：2006-2009., articleTitle=基于“脑—心—肾—精室”轴探讨男科疾病的诊治思路, refAbstract=null), Reference(id=1322926875231793484, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926865597477111, doi=null, pmid=null, pmcid=null, year=2023, volume=21, issue=18, pageStart=3463, pageEnd=3466, url=null, language=null, rfNumber=［29］, rfOrder=28, authorNames=董峰, 杨金龙, 王永成, journalName=中西医结合心脑血管病杂志, refType=null, unstructuredReference=董峰，杨金龙，王永成，等. 丁书文教授基于热毒病机治疗心系疾病的运用［J］. 中西医结合心脑血管病杂志，2023，21（18）：3463-3466., articleTitle=丁书文教授基于热毒病机治疗心系疾病的运用, refAbstract=null), Reference(id=1322926875298902349, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926865597477111, doi=null, pmid=null, pmcid=null, year=2014, volume=37, issue=3, pageStart=152, pageEnd=155，164, url=null, language=null, rfNumber=［30］, rfOrder=29, authorNames=蒋燕, journalName=北京中医药大学学报, refType=null, unstructuredReference=蒋燕. 《医林改错》瘀血病证的初步探讨［J］. 北京中医药大学学报，2014，37（3）：152-155，164., articleTitle=《医林改错》瘀血病证的初步探讨, refAbstract=null), Reference(id=1322926875370205518, 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journalId=1255847919539208197, articleId=1322926865597477111, doi=null, pmid=null, pmcid=null, year=1995, volume=null, issue=null, pageStart=534, pageEnd=null, url=null, language=null, rfNumber=［33］, rfOrder=32, authorNames=吴谦, 刘国正, 刘振远, 王淑芬, journalName=医宗金鉴, refType=null, unstructuredReference=吴谦. 医宗金鉴［M］. 刘国正，刘振远，王淑芬，等，点校. 北京：中医古籍出版社，1995：534., articleTitle=null, refAbstract=null), Reference(id=1322926875626058065, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926865597477111, doi=null, pmid=null, pmcid=null, year=2018, volume=37, issue=12, pageStart=1207, pageEnd=1211, url=null, language=null, rfNumber=［34］, rfOrder=33, authorNames=梁燕凯, 路夷平, 吕培文, journalName=北京中医药, refType=null, unstructuredReference=梁燕凯，路夷平，吕培文，等. 明清时期中医古籍肿瘤防治认知源流述要［J］. 北京中医药，2018，37（12）：1207-1211., articleTitle=明清时期中医古籍肿瘤防治认知源流述要, refAbstract=null), Reference(id=1322926875697361234, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926865597477111, doi=null, pmid=null, pmcid=null, year=2022, volume=37, issue=8, pageStart=4488, pageEnd=4492, url=null, language=null, rfNumber=［35］, rfOrder=34, authorNames=任明名, 顾立梅, 杨文娟, journalName=中华中医药杂志, refType=null, unstructuredReference=任明名，顾立梅，杨文娟，等. 国医大师周仲瑛从湿热瘀毒、脾气亏虚论治结直肠癌经验［J］. 中华中医药杂志，2022，37（8）：4488-4492., articleTitle=国医大师周仲瑛从湿热瘀毒、脾气亏虚论治结直肠癌经验, refAbstract=null), Reference(id=1322926875781247315, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926865597477111, doi=null, pmid=null, pmcid=null, year=2020, volume=15, issue=8, pageStart=1553, pageEnd=1556, url=null, language=null, rfNumber=［36］, rfOrder=35, authorNames=郭军, journalName=世界中西医结合杂志, refType=null, unstructuredReference=郭军. “脑-心-肾-精室”轴在中医男科学中的理论构建及应用［J］. 世界中西医结合杂志，2020，15（8）：1553-1556., articleTitle=“脑-心-肾-精室”轴在中医男科学中的理论构建及应用, refAbstract=null), Reference(id=1322926875852550484, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926865597477111, doi=null, pmid=null, pmcid=null, year=2013, 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朝代/作者著作论述
西汉《黄帝内经》明确指出了风寒暑湿燥火之邪过度偏亢亦能引起寒毒、热毒、湿毒、清毒、燥毒等诸毒证
东汉·张仲景《金匮要略》将毒邪所致疾病分为阳毒和阴毒，并提及食毒、虫兽伤毒、秽浊之毒
东汉·华佗《中藏经》提出了毒邪这一名词及邪毒概念，独立结毒科专论梅毒、秽疮风毒，列举风毒、热毒、湿毒、火毒、风湿热毒、湿热之毒、痰毒、阴毒、痈毒、疮毒、毒疮、蛊毒、结毒、蛇毒、药毒、酒毒、箭毒以及热毒痢、伤寒阳毒、无名肿毒、蓄蛊毒等诸毒症的证候及治疗方法
西晋·王叔和《脉经》首次提出毒邪从外来后还可内伏，明确提出阴阳毒可从伤寒、用药不当、汗下过度转化而来
东晋·葛洪《肘后备急方》记载了溪毒、沙虱毒、犬毒、熊虎爪牙伤毒、狐溺毒、食毒、瘴气疫疠温毒等7种毒证和解毒方药
东晋·刘涓子《刘涓子鬼遗方》收录天疽锐毒、大头温抱头火丹毒、眼胞菌毒、手发背手心毒、肠风脏毒、蝼蛄串肘痈肘后毒、痘毒、委中毒、鱼口便毒、杨梅疮结毒、胎火胎毒、气毒、火痰毒、肛门痈脏头毒等14种毒证的证候及治疗方法，使毒证的种类达40余种之多
隋·巢元方《诸病源候论》认为疾病多由毒气或热毒、湿毒、湿热毒、寒毒等毒邪所引起，并将蛊毒病、兽毒病、丹毒病、杂毒病、蛇毒病五门作了72论专篇进行论述，重点介绍了外科、毒虫野兽及药物、食物等特殊毒邪证候
唐·孙思邈《千金要方》首次列出脏腑温病阴阳毒，还专列诊溪毒证（亦治射工虫毒），记载了五石毒、药毒、食毒、蛊毒、鼠毒、蜂毒、蚍蜉毒、蛇毒等毒证的证候及治疗方药
唐·王焘《外台秘要》记载了热毒、温毒、风毒、丹毒、丁毒、丹疹毒、恶毒疮、蛊毒、溪毒、药毒、虫毒及伤寒百合病、伤寒狐惑病、毒肿瘰疬、天行热毒、山瘴疟、历节风、脚气等近50种与邪毒有关的病证
北宋·韩祗和《伤寒微旨论》提出寒毒伏于春日而发
南宋·陈言《三因极一病证方论》将虎狼毒虫归为不内外因，提出暑毒、酒毒、饮食百毒、丹毒、热毒、湿毒等
金·刘完素《素问玄机原病式》重视药毒对人体的危害
明·薛己《口齿类要》在《口齿类要》将喉痹分为阳毒、阴毒，在《外科枢要》中对疮疡59证的病因病机多以毒邪立论，在《疠疡机要》中共记载了治毒的方剂112首
《外科枢要》
《疠疡机要》
明·王肯堂《肯堂医论》提出痘疹为胎毒所致
明·陈实功《外科正宗》对外科127种证多以毒立论，认为痈、疽、发背、瘰、脏毒、结毒、臀痈、时毒、龙须毒、天蛇毒、合谷毒、眼泡菌毒、小儿遗毒烂斑、阴毒、中砒毒、汗毒等毒证皆与毒邪有关
明·张介宾《景岳全书》认为发斑证、风寒诸病、斑疹、疮毒、大头瘟者等都是毒邪所致，并记载暑毒
明·吴又可《瘟疫论》将瘟疫的疫气归于毒气范畴，并认为这种疫毒是有流行性和传染性的
清·喻昌《医门法律》把毒因作为医师的首要辨证程序之一，并用药毒治病
清·王洪绪《外科全生集》主“毒即是寒”之论，提出解寒而毒自化
清·杨栗山《伤寒瘟疫条辨》提出以升降散为代表的清热解毒治疫方15首
清·张锡纯《医学衷中参西录》从中西医学角度对毒邪学说进行论述，首次提出“毒菌”一词，明确提出了以毒攻毒、化毒、补正胜毒的治疗大法
), ArticleFig(id=1322926871159124269, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926865597477111, language=CN, label=表1, caption=

古代医家对毒邪的认识

, figureFileSmall=null, figureFileBig=null, tableContent=
朝代/作者著作论述
西汉《黄帝内经》明确指出了风寒暑湿燥火之邪过度偏亢亦能引起寒毒、热毒、湿毒、清毒、燥毒等诸毒证
东汉·张仲景《金匮要略》将毒邪所致疾病分为阳毒和阴毒，并提及食毒、虫兽伤毒、秽浊之毒
东汉·华佗《中藏经》提出了毒邪这一名词及邪毒概念，独立结毒科专论梅毒、秽疮风毒，列举风毒、热毒、湿毒、火毒、风湿热毒、湿热之毒、痰毒、阴毒、痈毒、疮毒、毒疮、蛊毒、结毒、蛇毒、药毒、酒毒、箭毒以及热毒痢、伤寒阳毒、无名肿毒、蓄蛊毒等诸毒症的证候及治疗方法
西晋·王叔和《脉经》首次提出毒邪从外来后还可内伏，明确提出阴阳毒可从伤寒、用药不当、汗下过度转化而来
东晋·葛洪《肘后备急方》记载了溪毒、沙虱毒、犬毒、熊虎爪牙伤毒、狐溺毒、食毒、瘴气疫疠温毒等7种毒证和解毒方药
东晋·刘涓子《刘涓子鬼遗方》收录天疽锐毒、大头温抱头火丹毒、眼胞菌毒、手发背手心毒、肠风脏毒、蝼蛄串肘痈肘后毒、痘毒、委中毒、鱼口便毒、杨梅疮结毒、胎火胎毒、气毒、火痰毒、肛门痈脏头毒等14种毒证的证候及治疗方法，使毒证的种类达40余种之多
隋·巢元方《诸病源候论》认为疾病多由毒气或热毒、湿毒、湿热毒、寒毒等毒邪所引起，并将蛊毒病、兽毒病、丹毒病、杂毒病、蛇毒病五门作了72论专篇进行论述，重点介绍了外科、毒虫野兽及药物、食物等特殊毒邪证候
唐·孙思邈《千金要方》首次列出脏腑温病阴阳毒，还专列诊溪毒证（亦治射工虫毒），记载了五石毒、药毒、食毒、蛊毒、鼠毒、蜂毒、蚍蜉毒、蛇毒等毒证的证候及治疗方药
唐·王焘《外台秘要》记载了热毒、温毒、风毒、丹毒、丁毒、丹疹毒、恶毒疮、蛊毒、溪毒、药毒、虫毒及伤寒百合病、伤寒狐惑病、毒肿瘰疬、天行热毒、山瘴疟、历节风、脚气等近50种与邪毒有关的病证
北宋·韩祗和《伤寒微旨论》提出寒毒伏于春日而发
南宋·陈言《三因极一病证方论》将虎狼毒虫归为不内外因，提出暑毒、酒毒、饮食百毒、丹毒、热毒、湿毒等
金·刘完素《素问玄机原病式》重视药毒对人体的危害
明·薛己《口齿类要》在《口齿类要》将喉痹分为阳毒、阴毒，在《外科枢要》中对疮疡59证的病因病机多以毒邪立论，在《疠疡机要》中共记载了治毒的方剂112首
《外科枢要》
《疠疡机要》
明·王肯堂《肯堂医论》提出痘疹为胎毒所致
明·陈实功《外科正宗》对外科127种证多以毒立论，认为痈、疽、发背、瘰、脏毒、结毒、臀痈、时毒、龙须毒、天蛇毒、合谷毒、眼泡菌毒、小儿遗毒烂斑、阴毒、中砒毒、汗毒等毒证皆与毒邪有关
明·张介宾《景岳全书》认为发斑证、风寒诸病、斑疹、疮毒、大头瘟者等都是毒邪所致，并记载暑毒
明·吴又可《瘟疫论》将瘟疫的疫气归于毒气范畴，并认为这种疫毒是有流行性和传染性的
清·喻昌《医门法律》把毒因作为医师的首要辨证程序之一，并用药毒治病
清·王洪绪《外科全生集》主“毒即是寒”之论，提出解寒而毒自化
清·杨栗山《伤寒瘟疫条辨》提出以升降散为代表的清热解毒治疫方15首
清·张锡纯《医学衷中参西录》从中西医学角度对毒邪学说进行论述，首次提出“毒菌”一词，明确提出了以毒攻毒、化毒、补正胜毒的治疗大法
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毒邪理论在泌尿男科中的应用与创新
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王福 , 王安民 , 马东岳 , 王浩 , 赵子维 , 杨九天 , 郭军
中华中医药学刊 | 国家项目点击 2025,43(10): 54-57
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中华中医药学刊 |国家项目点击 2025 , 43 (10) : 54 -57
毒邪理论在泌尿男科中的应用与创新
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王福（1982-），男，山东日照人，副主任医师，硕士研究生导师，博士，研究方向：中西医结合泌尿男科临床。

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王福（1982-），男，山东日照人，副主任医师，硕士研究生导师，博士，研究方向：中西医结合泌尿男科临床。

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王福, 王安民, 马东岳, 王浩, 赵子维, 杨九天, 郭军
作者信息
  • 中国中医科学院西苑医院，北京 100091
通讯作者:
郭军（1965-），男，重庆人，主任医师，博士研究生导师，硕士，研究方向：中西医结合泌尿男科临床。E-mail：。
作者简介:

王福（1982-），男，山东日照人，副主任医师，硕士研究生导师，博士，研究方向：中西医结合泌尿男科临床。

Application and Innovation of Toxin Evil Theory in Urology and Andrology
Fu WANG, Anmin WANG, Dongyue MA, Hao WANG, Ziwei ZHAO, Jiutian YANG, Jun GUO
Affiliations
  • Xiyuan Hospital，China Academy of Chinese Medical Sciences，Beijing 100091，China
出版时间: 2025-10-10 doi: 10.13193/j.issn.1673-7717.2025.10.011
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摘要
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探讨毒邪理论在泌尿男科中的应用与创新。认为毒邪伏于体内是男子发病的关键病因病机。浊毒、热毒、瘀毒、癌毒等侵扰精室，导致开阖失司，从而引起男子生殖功能减退、精液质量降低、泌尿系感染或肿瘤等疾病。根据不同病因病机及致病特点，确立不同治则以化浊解毒、活血解毒、清热解毒、抗癌解毒，祛除精室毒邪，恢复精室开阖。同时强调毒邪非一而存，需认清标本缓急，多法兼合而治，以期为中医临床诊治泌尿男科疾病提供新的思路。

毒邪理论  /  泌尿男科  /  浊毒  /  热毒  /  瘀毒  /  癌毒

It is to discuss the application and innovation of the toxin evil theory in urology and andrology.It is believed that toxin in the body is the key etiological mechanism for men＇s morbidity.Turbidity toxin，heat toxin，blood stasis toxin and cancer toxin disturb men＇s essence chamber，leading to the failure of opening and closing，thus causing diseases such as male reproductive function decline，semen quality reduction，urinary tract infection or tumour.According to the different etiology and pathogenic characteristics，the treatment principle of eliminating turbidity and detoxifying，activating blood and detoxifying，clearing heat and detoxifying，and anti cancer and detoxifying is established in order to get rid of toxin evils in the essence chamber and restore the opening and closing of the essence chamber.At the same time，it is emphasized that the toxins do not exist in isolation，so it is necessary to identify the symptoms and the urgency of the disease，and to treat the disease with a variety of methods，in order to provide new ideas for the clinical diagnosis and treatment of urogenital diseases in traditional Chinese medicine.

toxin evil theory  /  urology and andrology  /  turbidity toxin  /  heat toxin  /  blood stasis toxin  /  cancer toxin
王福, 王安民, 马东岳, 王浩, 赵子维, 杨九天, 郭军. 毒邪理论在泌尿男科中的应用与创新. 中华中医药学刊, 2025 , 43 (10) : 54 -57 . DOI: 10.13193/j.issn.1673-7717.2025.10.011
Fu WANG, Anmin WANG, Dongyue MA, Hao WANG, Ziwei ZHAO, Jiutian YANG, Jun GUO. Application and Innovation of Toxin Evil Theory in Urology and Andrology[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (10) : 54 -57 . DOI: 10.13193/j.issn.1673-7717.2025.10.011
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毒邪理论是中医阐述病因病机的经典理论之一。毒邪与诸多病邪相似，可分原发与继发两种：前者指毒邪（毒气），是对人体有明显损害的致病性邪气，包括外来与内生两种；后者为邪毒（毒力），是指毒邪中所含的一种致病性毒性物质，或非毒邪（常邪）侵入人体后，在疾病的发展过程中逐渐转化或产生出的一种致病性毒性物质[1]。从秦汉至今，诸代医家对毒邪理论不断探索、补充及完善，至现代，多将毒邪与邪毒相提并论，并衍生出“伏毒”“浊毒”“瘀毒”等学说[2]，多应用于论治痹病、脾胃病及肿瘤等疾病中[3-5]。见表1。
泌尿男科疾病病因复杂，现代医家多施补肾、活血等法而治[6-7]，少有医家从毒论治。基于此，笔者结合临床泌尿男科疾病的特点，探讨毒邪理论在泌尿男科中的应用与创新，以期为中医诊治泌尿男科疾病提供新思路。
1　“毒邪”理论的阐述
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毒邪理论是阐述毒邪的病因及其侵犯人体后引起病理变化的一种学术观点[8]。一般而言，毒邪既可作为病因产生强烈致病作用，又可作为病机、病理产物内居人体使脏腑阴阳失衡而为病[9]。然诸家之见不一，按毒之来源可分为外来毒邪与内生毒邪两类；按毒之属性又可分为阳毒和阴毒；或以病邪区分为热毒、瘀毒、癌毒等[10]；亦有药毒之说，即中药之偏性和峻烈之性，治疗时常用其偏性纠正疾病[11]，如《内经》所言：“大毒治病，十去其六；常毒治病，十去其七；小毒治病，十去其八”。
虽涵义各有不同，但毒邪致病特性大趋一致[8]，在泌尿男科疾病中亦然：①毒邪起病骤然，传变迅速，易沿精室传至各脏腑脉络，而生变证，为变证之因；②毒邪多由他邪蓄积、转化而生，“因于渐变，成于质变”，蕴于精室为患；③毒邪易相兼为患，热毒、痰毒、瘀毒等极易兼夹，互虐胶结于精室，致其失用；④毒邪至后期，形成精室癌毒后，易走窜入里，侵及筋脉、气血、经络，传变脏腑；⑤诸种毒邪积精室日久，蕴蓄不解，损耗全身气血，加之正虚邪聚，病势缠绵难愈。
2　毒邪贯穿泌尿男科疾病始终
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浊毒、热毒、瘀毒、癌毒为泌尿男科病发之关键。泌尿男科疾病的病位主要在于精室，精室涵盖前列腺、睾丸、阴茎等在内的生殖器官，司溺窍、精窍之开阖[12]。笔者认为，人体所受之邪毒，或直接侵袭精室，或由血脉经络传至精室，而致精、溺二窍失于开阖为病。究其本源，多由于浊毒、热毒、瘀毒，及三者互杂久伏而生之癌毒，袭扰精室所致，故本文以此切入介绍泌尿男科疾病之毒邪病机。
2.1　浊毒伏于机体互结蓄积，害清为病
浊毒互结是贯穿泌尿男科疾病的核心病机之一。国医大师李佃贵首将浊与毒并称，创立“浊毒学说”，认为湿、痰、饮等秽浊黏腻之病理产物，内蕴生毒，久则浊毒互结致脏腑功能紊乱、气血运行失常，邪合病起[13]。
所谓浊，害清之邪也。《金匮要略》言：“清邪居上，浊邪居下”，浊分内生、外侵两种[14]：长居湿潮之地，或涉水淋雨之后，外部浊邪侵袭阴器累及精室，此为其一；内浊则由饮食不节、中焦脾胃失运所致，水谷不化精微，反生湿浊、痰浊等，其性黏腻、重浊善趋下，流注精室而为病。浊邪蕴结成毒，则为“浊毒”，二者互结胶着不解，深伏下焦精室之内，可致精液生化乏源、阴筋失于濡养，精、溺二窍为之壅塞，临床可见排尿、排精异常，或宗筋萎软不举，或会阴部坠胀疼痛，或精液不液化、少弱精症等[15]。此外，浊毒久积精室，易缠绵入里，通过脉络将毒输布至肾（水之下源）、脾（水之中源）、肺（水之上源）等脏腑，致全身水液代谢障碍，而生腹胀便溏、涕增痰多、小便清长等症；或劫耗脏腑经络之气血，呈现虚实夹杂之证，顽固难愈。
2.2　热毒伏于机体胶结凝聚，灼伤为患
火热之邪凝聚，可化生热毒，如《重订通俗伤寒论》言：“火盛者，必有毒”。现代学者根据热毒来源将其分为外生与内生两种[16]，对于精室热毒亦可据此而分：外生热毒蕴于精室，即外来火热之邪直接侵及精室，或由他邪（湿、痰等）入里化热、化火，蓄积精室化热蕴毒；内生热毒则多与饮食不节、情志内伤、房劳失度等因素有关，致脏腑气血阴阳失常，病理产物丛生，蕴蓄精室热毒为患[17]。
热毒为“阳毒”也，“热从毒化，变从毒起”，为病则兼具火热与毒邪双重特性。热毒起病骤然，其势迅猛鸱张，凝聚局部精室燔灼脉络、煎熬阴津气血，则不通不荣、失于流转，可见尿道灼痛，阴茎、睾丸肿痛疮疡，血精等热毒炽盛之象；热毒有走窜之性，常流窜经络血脉[18]，若窜扰心络、脑络，致心神不藏、脑神难安，可见早泄、阳痿等；若循经直入肾络，损伤肾体，可致肾失司封藏、精关不固，见排尿、排精异常等；甚则热邪炽盛，致下焦蓄血，可见尿血、血精、少腹急痛等症。
2.3　瘀毒伏于机体互虐阻滞，戕害血脉
中医学认为“瘀毒”是泌尿男科疾病的重要病候和核心病机之一。所谓广义之瘀，为积血也；而瘀毒之瘀，可分为三[19]：一为秽浊之瘀，即湿、痰等污浊之物渗留，混杂凝滞其中血脉，使之成瘀；二为离经之瘀，即血失于固摄或溢于脉外，停稽不去而为瘀，所谓“既是离经之血，虽清血鲜血，亦是瘀血”；三为癥积之瘀，即血结癥块困结，不化不流为瘀，所谓“血凝而不流”也[20]。三者任一瘀邪蕴结不解，即可渐盛而变生毒邪，如《金匮要略》所云：“毒者，邪气蕴蓄不解之谓。”反之，毒盛内壅，则煎熬血液，变生为瘀，二者胶着不解、相互促生，既成“瘀毒”。
瘀毒困阻精室，精血难以外达阴茎，濡养、充盈失职，则致萎软不举之阳痿；或瘀毒久留，堵塞溺窍，则致小便点滴不出，尿细如线之癃闭；或瘀毒滞涩精室精窍，而致不射精；亦可见瘀毒交阻精室，使气血津液等养分难以通行血脉荣盈精液，而致少弱精、男子不育等。
2.4　癌毒伏于机体流注滋生，留结成弊
癌毒，《仁斋直指附遗方论》首次阐明癌有“毒根深藏、穿孔透里”之性，并言癌者：“上高下深，岩穴之状，颗颗累垂”；现代诸多医家将其定义为诱发肿瘤或促进肿瘤进展的致病因素，或作为病理产物而客观反映的“有形之癌肿”[21-22]。
于男子而言，癌毒非外感六淫、七情内伤、饮食劳倦等所生之邪中伤精室，立生而成癌肿，乃邪毒长期侵袭、久居潜伏精室，致积块渐增、毒势愈盛，最终“恶肉乃起，息肉乃生”[23]。人体所受之邪，多先产生热毒、浊毒、瘀毒，而后三者互相依附从化，伏毒入里，缠绵稽留精室，才生危重之癌毒。同时，癌毒既起，因其有“酷烈走窜”之性，速耗气血津液，阻滞脏腑气血运行，复生湿、痰、瘀等，缠绵难愈。临床多表现为睾丸癌、阴茎癌、前列腺癌[24]等，热毒而生者伴肿瘤局部皮温过高，或红肿疼痛、发热、口干、大便秘结等；浊毒而生者伴癌肿皮肤晦而不泽，烂后不易愈合，或乏力纳差、形体羸瘦等；瘀毒而生者伴肌肤甲错，皮肤瘀斑或血块，青筋横起等；抑或多毒杂合，多症并见，需切准病机、灵活施治。
3　基于“毒邪理论”辨治泌尿男科疾病
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3.1　利湿祛痰以化体内浊毒
湿为阴邪，善趋于下，化生为百病，滞留精室，令人便下、精液浑浊，出现尿频、尿急、弱精等诸症；湿邪、水饮凝聚胶着而成痰，痰之所在精室，阻滞气机、闭阻脉道，引起阳痿、不射精、排尿困难等症[25]。由此可见，湿、痰为浊之源，久则生壅滞之变而化毒，共客于精室，扰其开阖，损其形状，而发为病。
浊毒之治当以解毒化浊为要，亦需从本入手，利湿祛痰使浊化毒祛。《素问·至真要大论篇》有“以苦燥之”“以淡泄之”等论述，使湿浊从溺窍而出，然精室之毒、痰亦需顾及，故在用药上宜采用苦寒燥泄之品，解毒化浊，佐以祛痰涤浊。陈士铎[26]在《辨证录》中针对白浊、溺管疼痛、精阻、小便闭塞等清浊不分者，常用滑石、泽泻、猪苓等利湿解毒化浊，专祛浊毒污垢，使水通精化；当代医家李佃贵[27]创制调脾胃、化浊毒治疗大法，在化浊解毒同时，喜用苍术、白扁豆以助脾运，截断浊毒生成之源，或采藿香、佩兰芳香辟秽之性以化湿邪、醒脾胃、宽中州，重视中轴脾胃。笔者综合既往经验，采用经典方剂宣清导浊汤《温病条辨》为基础方。从组方思路分析，猪苓乃诸药中“性之最利者”，专以淡渗化浊，茯苓甘淡，能补能渗，使“水湿无所聚，则痰饮无由生”，共用为君；萆薢、泽泻祛湿降浊，以乏生痰之源；配以滑石、车前子、金银花、皂荚解精室之毒；并少佐白术、陈皮健脾，合“水唯畏土，其制在脾”之意，如此精室湿浊邪毒可化。
3.2　清热降火以泻体内热毒
火热之邪化毒入里，留驻精室，灼伤脉络、耗伤精血，影响其用而发病，多见尿道灼痛，血尿、血精，精液不液化，阳强、梦遗、早泄等[28]。《素问·至真要大论篇》有“热者寒之”等论述，然邪热炽盛，其性近燥，使水竭、血枯、液干，故在用药上主用苦寒之品，清热解毒，稍佐甘凉柔润之药，泻火保津。刘河间在《素问·玄机原病式篇》首次阐明“火郁发之”的治则，常用芩连柏、栀子、犀角等，通过宣发郁热外达，减热毒之损伤；当代医家丁叔文[29]遵叶天士“苦泄”之法，确立排泄大法，喜用苦寒之芩连、白头翁、青黛等给热毒以出路，以达邪下行。基于此，本文从热毒立论，选用五味消毒饮《医宗金鉴》加减，清透泄热。方中易金银花为忍冬藤，既可清解精室之热毒，又入络而止痹痛、入经而灭血燔；蒲公英、败酱草、野菊花更助泻火解毒之效，并佐凉润知母、玄参、生地黄养阴护津，又兼清热之功，使热降毒消。
3.3　活血解毒以祛体内瘀毒
瘀毒相互交织积聚，痹阻脉络，是引起泌尿男科疾病迁延不愈的核心病机。临床常表现为小便刺痛，尿线变细，甚或点滴难出，阴茎勃起障碍，小腹、会阴部、睾丸局部刺痛，精索静脉迂曲增粗等，治疗当化瘀通络、解毒活血。
瘀久生毒，其本质在瘀，《素问·阴阳应象大论篇》中载“血实宜决之”等论述，其揭露瘀毒者当活血化瘀的本质。血不离气，王清任[30]尤重气血之合，认为“治病之要诀，在明白气血”“元气既虚，必不能达于血管，血管无气，必停留而瘀”，并留下补气消瘀诸方（补阳还五汤、黄芪桃红汤等）广泛应用于临床。陈可冀院士[31]强调“因瘀化毒、因毒致瘀、瘀毒互结”，秉王清任血府逐瘀汤之意，拟“活血解毒”之法，认为川芎、赤芍等药可活其血脉、化其瘀滞，亦可改善血管微循环状态。基于此，本文认为瘀毒滞于精室者，亦需从活血通脉入手，故选用血府逐瘀汤《医林改错》为基础方，配伍解毒、益气之品，以化精室之瘀毒。方中桃仁、红花濡润行散，共入下焦精室活血通脉；赤芍、川芎助其活血化瘀之功，牛膝引诸药下行直达精室脉络；佐当归补血活血，合“通中有补”之意；并加解毒之品连翘、益气之品黄芪，以助祛邪解毒，又能促使旧血排出、新血产生而扶正。
3.4　扶正消癥以抗体内癌毒
癌毒伏藏隐匿于精室，其性戾顽劣、走窜不定，常依附于诸邪，损正伤气，辨治当以抗癌解毒为核心，兼扶正补益而治。《素问·至真要大论篇》针对结聚之病邪，有“结者散之”“留者攻之”等言论，癌毒正属结聚之证因，当遵此法，故在用药上宜采用散结消癥之品；另癌毒一旦形成，则掠夺气血津液以自养，机体因失荣而虚弱，加之放化疗伤阴最速，易致燥病，还需酌加益气养阴之品敛护阴津，扶正祛邪[32]。
吴谦在《医宗金鉴·积聚治法》中指出，“积聚宜攻，或兼补药，一攻三补”，并自创温白丸、桃仁煎、控涎丹等方[33]；李东垣则提出“养正积自消”，提倡扶正固本以去除癌毒[34]；国医大师周仲瑛创立“癌毒”学说，认为邪深毒盛为主，拟抗癌解毒为基本方法，具而分治[35]。综合各家经验，本文从“正邪盛衰”角度分期论治精室癌毒：初期癌毒亢盛、正虚不显时，以抗癌解毒配合软坚散结、逐瘀除癥为主，选取土茯苓、白花蛇舌草、半枝莲、漏芦、山慈菇等，直攻精室癌毒，抑其暴戾之性；中期兼有脏腑功能失调时，可循“脑-心-肾-精室”轴理论[36]，适当伍入调理脏腑功能之品；晚期癌毒盛、正虚甚者，则以补益为主，施黄芪、太子参、炒白术、红景天等，使“正气存内，邪不可干”，兼顾抗癌解毒。
4　切准病机，灵活施治
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4.1　多法杂合以清机体所生之毒
男性机体所生之浊、热、瘀、癌毒，常多毒邪相合、多病机交错，兼夹转化，杂合为患。故临证过程中，须根据症情变化分清主次，多法合用；同时毒邪易走窜传变，当截其传舍，断其再传之路径。
浊毒内结精室难以去除，久郁生热或气血运行受阻，“徒清热则浊不退，徒祛瘀则热愈炽”，则夹热毒、瘀毒致病；反之热毒、瘀毒久蕴亦可生浊，合而生疾，且《温热逢源》云：“病有蓄血，温热之邪与之纠结，热附血而愈觉缠绵，血得热而愈形胶固”。基于此，笔者借鉴李佃贵“湿热浊毒”及陈可冀“瘀毒致变”理论思路，以连朴饮《霍乱论》合桂枝茯苓丸《金匮要略》为复方组药，清精室所生、所留之合毒。从组方思路分析，“精室瘀热浊毒”为湿、痰留聚不化而成，予苦寒黄连、栀子以清热利导给邪出路，降泄精室湿浊；加半夏、石菖蒲，精室瘀毒遇辛散之性则郁结得开，厚朴更助降泻浊毒之功；桃仁、牡丹皮活精室瘀积、消癥散结，桂枝助桃仁之力；配伍等量之白芍养血和血，酌加茯苓利而行之，寓有湿祛血止之用。若兼癌毒者，则仅需加抗癌解毒之品即可，兼顾扶正养益。
此外，诸毒迁延至后期，可随络脉传变周身脏腑，衍生癌瘤。吴以岭院士[37]创立“脉络学说”，拟“营卫承制调平”之法为核心干预治疗脉络疾病。笔者认为毒邪传舍亦可以此为基而拟方组药，调和机体营卫，使脏腑功能气煦血濡、达阴平阳秘之态，毒邪无以通过营卫、血脉而动，从而截断传舍。
4.2　解毒还需权衡标本缓急，细查详辨而治
毒邪晦杂多变，然亦有“标本缓急”之分，若有发病，必需细查详辨，依“急则治其标，缓则治其本”原则而治。
热毒燔灼精室可发为急性前列腺炎、附睾炎、龟头炎等，起病较急，可见尿道灼热疼痛，或局部红肿、拒按，皮温稍高，此为急证、标实，当急投寒凉清热之品除患者病痛。浊毒堵塞精室，水液运化失司，停留局部，可见急性尿潴留，患者尿道窘迫，膀胱胀大，则需急通水道。瘀毒滞涩精室脉络，气血运行受阻，可表现为少腹、睾丸、腹股沟等处坠胀刺痛，此需及时止痛，而后缓化其瘀。除外，亦有痼疾复发而急者，如癌毒留结精室者，突现局部剧烈疼痛、高热、尿血、溃烂等，则需“先治其卒病，后乃治其痼疾也”。故在诊治过程中，知本末、明急缓、晓变化才是标本缓急应用之理。
5　小结
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综上所述，从毒邪理论的病因病机及致病特点分析，将毒邪具体划分为浊毒、热毒、瘀毒、癌毒，认为毒邪侵扰精室，使其失用，精、溺二窍开阖失司，引起男子生殖功能减退、精子质量降低、泌尿系统感染，甚或引起泌尿系肿瘤等疾病。基于此，本文从毒邪理论探讨男子疾病的辨治方药，治则强调利湿祛痰、活血解毒、清热降火、扶正消癥，以消机体所生、久蕴内伏之毒邪；同时，诊治还需切准病机，认清标本缓急，多法杂合而施祛除病邪，以期为中医临床诊治泌尿男科疾病提供新思路。
基金
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  • 国家中医药管理局高水平中医药重点学科建设项目(zyyzdxk-2023238)
  • 中华中医药学会青年求实项目(2023-QNQS-02)
文献
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2025年第43卷第10期
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doi: 10.13193/j.issn.1673-7717.2025.10.011
  • 首发时间：2026-10-30
  • 出版时间：2025-10-10
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国家中医药管理局高水平中医药重点学科建设项目(zyyzdxk-2023238)
中华中医药学会青年求实项目(2023-QNQS-02)
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    中国中医科学院西苑医院，北京 100091

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郭军（1965-），男，重庆人，主任医师，博士研究生导师，硕士，研究方向：中西医结合泌尿男科临床。E-mail：。
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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