从《灵枢·天年》“肝衰胆灭”理论探讨原发性胆汁性肝硬变的论治
|
摘要
原发性胆汁性肝硬变是一种慢性自身免疫性肝病,属于中医"黄疸""臌胀""积聚""胁痛"等范畴。依据"肝衰胆灭"理论,认为该病病初,患者可因感受内外之邪,或因情志失调而致肝气不畅,疏泄失常,胆汁分泌失调;病中,肝失疏泄、胆失藏泌之病理变化加重,而致脾胃功能失常;病进,肝病及肾,肝病及脾,肝脾同病,日久入肾;病终,肝衰胆灭,脏腑同病,神明受害。治疗从疏肝利胆着眼,结合脏腑,分论虚实,明辨气血。病初治以疏肝利胆、理气行血;病中治以疏肝健脾、顺气和血;病进治以补益肝肾、调气和血;病终治以通调脏腑、开窍醒神。
Primary biliary cirrhosis is a chronic autoimmune liver disease that belongs to the category of " jaundice" " swelling" " accumulation" and " hypochase pain" in Chinese medicine. According to the theory of " ganshuai danmie ",it is believed that at the beginning stage of the disease,the patient may suffer from stagnation of liver qi,dysfunction of conveyance and dispersion,and bile secretion disorder due to the pathogenic qi inside or outside the body,or due to emotional disorders. It is believed that in the middle stage of the disease,the pathological changes of the liver dysfunction of conveyance and dispersion,biliary dysfunction and secretion are aggravated,resulting in the dysfunction of the spleen and the stomach. The disease develops further. The liver diseases spread to the kidney. The liver diseases spread to the spleen. The liver and the spleen also suffer from diseases,which spread to the kidney over time. At the end stage of the disease,the liver and the gallbladder are dead,and the zang-fu viscera are sick,and then the spirit is victimized. In treatment,we should disperse stagnated liver qi for promoting bile flow,combine with the zang-fu viscera,dissect the deficiency and excess,and identify qi and blood. The treatment at the beginning stage of the disease is to disperse stagnated liver qi for promoting bile flow,regulate qi and promote blood circulation. The treatment in the middle stage of the disease is to soothe the liver and invigorate the spleen,smooth qi and blood. The treatment at the further development of the disease is to nourish the liver and kidney,regulate qi and blood. The treatment the last is to regulate the zang-fu viscera and induce resuscitation.
Primary biliary cirrhosis is a chronic autoimmune liver disease that belongs to the category of " jaundice" " swelling" " accumulation" and " hypochase pain" in Chinese medicine. According to the theory of " ganshuai danmie ",it is believed that at the beginning stage of the disease,the patient may suffer from stagnation of liver qi,dysfunction of conveyance and dispersion,and bile secretion disorder due to the pathogenic qi inside or outside the body,or due to emotional disorders. It is believed that in the middle stage of the disease,the pathological changes of the liver dysfunction of conveyance and dispersion,biliary dysfunction and secretion are aggravated,resulting in the dysfunction of the spleen and the stomach. The disease develops further. The liver diseases spread to the kidney. The liver diseases spread to the spleen. The liver and the spleen also suffer from diseases,which spread to the kidney over time. At the end stage of the disease,the liver and the gallbladder are dead,and the zang-fu viscera are sick,and then the spirit is victimized. In treatment,we should disperse stagnated liver qi for promoting bile flow,combine with the zang-fu viscera,dissect the deficiency and excess,and identify qi and blood. The treatment at the beginning stage of the disease is to disperse stagnated liver qi for promoting bile flow,regulate qi and promote blood circulation. The treatment in the middle stage of the disease is to soothe the liver and invigorate the spleen,smooth qi and blood. The treatment at the further development of the disease is to nourish the liver and kidney,regulate qi and blood. The treatment the last is to regulate the zang-fu viscera and induce resuscitation.
引文
[1]KIM K A,JEONG S H. The diagnosis and treatment of primary biliary cirrhosis[J]. Korean J Hepatol,2011,17(3):173-179
[2]郑盛,杨晋辉,尤丽英,等.自身免疫性肝炎-原发性胆汁性肝硬化重叠综合征的临床特征及诊疗分析[J].中国全科医学,2012,15(32):3710-3713.
[3]陈学平,金枝,罗志刚,等.自身免疫性肝炎-原发性胆汁性肝硬化重叠综合征36例临床与病理分析[J].昆明医科大学学报,2014,35(5):108-110.
[4]唐学良.原发性胆汁性肝硬化免疫发病机制的研究进展[J].中外医疗,2015,35(2):88-89.
[5]GERSHWIN M E,SELMI C,WORMAN H J,et al. Risk factors and comorbidities in primary biliary cirrhosis:a controlled interviewbased study of 1032 patients[J]. Hepatology,2005,42(5):1194-1202.
[6]林珮琴.类证治裁[M].北京:人民卫生出版社,2005.
[7]张扬,扈晓宇,杨芳.“肝主枢”理论探析及临证发挥[J].中国中医基础医学杂志,2013,19(1):13-14.
[8]毛德文.肝衰竭毒邪病因学说辨析[J].中医药导报,2007,13(1):8-11.
[9]KUMAGI TONJI M. Prsentation and diagnosis of primary biliary cirrhosis in the 21st century[J]. Clin Liver Dis,2008,12(2):243-259.
[10]刘卫军. S-腺苷蛋氨酸联合苦参碱治疗胆汁淤积性肝硬46例疗效观察[J].医学信息,2011,24(2):634-635.
[11]陆再英,钟南山.内科学[M].北京:人民卫生出版,2011:443.
[12]李忠意,田耀洲.化肝通络方组方规律探讨[J].中医药学报,2014,42(5):4-7.
[13]焦宝娟,韩丽静,万树全.活血化瘀中药为主治疗胆汁淤积性肝硬化瘙痒症30例[J].陕西中医,2013,34(1):18-19.
[14]陈永辉.陷胸三金汤加味治疗胆汁淤积性肝硬化疗效观察[J].四川中医,2014,32(2):116-117.
[15]吴海柱,刘奕.徐慧媛教授运用补中益气汤验案举隅[J].环球中医药,2014,7(8):644-646.
[16]郭艳青,刘文科,武胜平,等.仝小林教授治疗原发性胆汁淤积性肝硬化验案分析[J].时珍国医国药,2013,24(8):2029-2031.
[17]朱晓红,羌韧.甘草酸苷与熊去氧胆酸在自身免疫性肝炎及原发性胆汁性肝硬化治疗中的应用[J].齐齐哈尔医学院学报,2012,33(22):3058-3059.
[18]刘波,白鹤.丹参注射液与硫酸镁注射液联合治疗原发性胆汁性肝硬化[J].中国民间疗法,2009,17(6):25-26.
[19]PRINCE M I,CHETWYND A,CRAIG W L,et al. Asymptomatic primary biliary cirrhosis:clinical features,prognosis,and symptom progression in a large population based cohort[J]. Gut,2004,53(6):865-870.
[20]龙爱华,刘平,李风华,等.不同配比黄芪汤干预大鼠胆汁淤积性肝硬化作用观察[J].中国实验方剂学杂志,2006,12(7):28-30.
[21]龙爱华,刘平,李风华,等.从不同功效方剂干预大鼠胆汁淤积性肝硬化的效用探讨取效方证病机[J].中医药学报,2008,36(2):9-12.
[22]吕振,刘红,王金博,等.肝复乐胶囊联合熊去痒胆酸治疗原发性胆汁淤积性肝硬化的临床研究[J].世界最新医学信息文摘,2015,15(2):87-88.
[2]郑盛,杨晋辉,尤丽英,等.自身免疫性肝炎-原发性胆汁性肝硬化重叠综合征的临床特征及诊疗分析[J].中国全科医学,2012,15(32):3710-3713.
[3]陈学平,金枝,罗志刚,等.自身免疫性肝炎-原发性胆汁性肝硬化重叠综合征36例临床与病理分析[J].昆明医科大学学报,2014,35(5):108-110.
[4]唐学良.原发性胆汁性肝硬化免疫发病机制的研究进展[J].中外医疗,2015,35(2):88-89.
[5]GERSHWIN M E,SELMI C,WORMAN H J,et al. Risk factors and comorbidities in primary biliary cirrhosis:a controlled interviewbased study of 1032 patients[J]. Hepatology,2005,42(5):1194-1202.
[6]林珮琴.类证治裁[M].北京:人民卫生出版社,2005.
[7]张扬,扈晓宇,杨芳.“肝主枢”理论探析及临证发挥[J].中国中医基础医学杂志,2013,19(1):13-14.
[8]毛德文.肝衰竭毒邪病因学说辨析[J].中医药导报,2007,13(1):8-11.
[9]KUMAGI TONJI M. Prsentation and diagnosis of primary biliary cirrhosis in the 21st century[J]. Clin Liver Dis,2008,12(2):243-259.
[10]刘卫军. S-腺苷蛋氨酸联合苦参碱治疗胆汁淤积性肝硬46例疗效观察[J].医学信息,2011,24(2):634-635.
[11]陆再英,钟南山.内科学[M].北京:人民卫生出版,2011:443.
[12]李忠意,田耀洲.化肝通络方组方规律探讨[J].中医药学报,2014,42(5):4-7.
[13]焦宝娟,韩丽静,万树全.活血化瘀中药为主治疗胆汁淤积性肝硬化瘙痒症30例[J].陕西中医,2013,34(1):18-19.
[14]陈永辉.陷胸三金汤加味治疗胆汁淤积性肝硬化疗效观察[J].四川中医,2014,32(2):116-117.
[15]吴海柱,刘奕.徐慧媛教授运用补中益气汤验案举隅[J].环球中医药,2014,7(8):644-646.
[16]郭艳青,刘文科,武胜平,等.仝小林教授治疗原发性胆汁淤积性肝硬化验案分析[J].时珍国医国药,2013,24(8):2029-2031.
[17]朱晓红,羌韧.甘草酸苷与熊去氧胆酸在自身免疫性肝炎及原发性胆汁性肝硬化治疗中的应用[J].齐齐哈尔医学院学报,2012,33(22):3058-3059.
[18]刘波,白鹤.丹参注射液与硫酸镁注射液联合治疗原发性胆汁性肝硬化[J].中国民间疗法,2009,17(6):25-26.
[19]PRINCE M I,CHETWYND A,CRAIG W L,et al. Asymptomatic primary biliary cirrhosis:clinical features,prognosis,and symptom progression in a large population based cohort[J]. Gut,2004,53(6):865-870.
[20]龙爱华,刘平,李风华,等.不同配比黄芪汤干预大鼠胆汁淤积性肝硬化作用观察[J].中国实验方剂学杂志,2006,12(7):28-30.
[21]龙爱华,刘平,李风华,等.从不同功效方剂干预大鼠胆汁淤积性肝硬化的效用探讨取效方证病机[J].中医药学报,2008,36(2):9-12.
[22]吕振,刘红,王金博,等.肝复乐胶囊联合熊去痒胆酸治疗原发性胆汁淤积性肝硬化的临床研究[J].世界最新医学信息文摘,2015,15(2):87-88.