基于"精血同源"研究补肾养血法改善睾丸微循环促进睾丸生精功能的作用机制

Essence can change into blood, while blood can change into essence too (i.e. essence and blood sharing the same origin), it's the fundamental theory of traditional Chinese medicine. Opposing to regular dependency on Kidney storing essence to treat male infertility, a better performance was got in our previous work through tonify kidney and nourish blood (Yangjing capsule) contrast to through tonify the kidney (Wuzi Yanzong pills) exclusively. While the mechanism is still unclear. In this study, an oligo-asthenozoospermia mouse model, resulted by cyclophosphamide injection, was used to investigate the treatment function of Yangjing capsule comparing with Wuzi Yanzong pills. The capillary vessels on the surface of seminiferous tubule, the testis microcirculations, and the status of blood-testis barrier were observed, as well as the action of the two kinds of Chinese drugs on the VEGF, NO and other vasoactive factors in Sertoli and Leydig cells were analysised to bring light to the mechanism. In conclusion, the study contributes to understand "essence and blood sharing the same origin" in Traditional Chinese Medicine, to elucidate its nature and to guide the treatment of male infertility in clinic.

精能化血，血亦能化精，即"精血同源"是中医的基本理论。传统中医往往仅注重补肾精治疗男性不育症。然而，前期的临床研究发现，补肾养血比单纯补肾精能更加显著改善少、弱精子症患者精子质量，但其机制依然不清。本研究依据"精血同源"理论，以养精胶囊作为补肾养血的代表方，以五子衍宗丸为补肾精的代表方，利用动物模型及体外细胞实验，对比研究两类药物对环磷酰胺所致少弱精子症模型小鼠睾丸间质血管密度、生精小管表面微血管、睾丸微循环、血睾屏障的影响；同时研究两类药物对睾丸支持细胞和间质细胞血管内皮生长因子、一氧化氮等血管活性因子表达及分泌的影响，对支持细胞紧密连接蛋白Occludin的影响，以及对血管内皮细胞血管形成能力的影响，探讨其机制。阐明补肾养血法可能是通过改善睾丸微循环，从而更好的促进睾丸生精。这对于深入理解中医精血同源理论，丰富男性不育的中医治疗思路以及指导临床，具有重要的理论和现实意义。

“精血同源”是中医的基本理论，在该理论指导下临床使用补肾养血法改善睾丸的生精功能，效果显著，但其具体的作用机制不清楚。课题组前期的研究表明，补肾养血中药—养精胶囊，可以显著提高男性少、弱精子症患者精子质量。本项目基于前期研究和中医精血同源理论的支持，利用环磷酰胺制造小鼠生精损伤和睾丸微循环障碍模型，检测养精胶囊对模型小鼠微血管密度，微循环调节因子（VEGF、VEGFR、NO、NOS、Occludin）等微循环指标以及生精功能的影响。并利用睾丸MLTC-1和TM4细胞系，检测养精胶囊对Leydig和Sertoli细胞VEGF、VEGFR、NO、NOS、Occludin表达的影响。结果表明，养精胶囊能改善环磷酰胺所致小鼠的生精功能损伤，这与其调控Leydig、Sertoli细胞活性及微循环活性因子VEGF、VEGFR、NO、NOS、Occludin的分泌功能，促进微血管的再生，改善生精微环境密切相关。这阐释了“精血同源”中医理论的现代生物学基础，揭示了其科学内涵，对男性生精功能障碍的治疗具有理论指导意义和临床价值。