益气升清法在治疗肝硬变腹水中的应用
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摘要
肝硬变腹水病机乃本虚标实,治疗当强调扶正补虚,脾胃位居中焦,乃气机升降之枢,故需强调健脾益气以扶正气,升提清阳以降湿浊从而增强中医辨治肝硬变腹水的疗效。肝硬变腹水其标总以水湿为患,但气能行水,故有形之水湿,必依赖于无形之气的推动方不停聚为邪,故治水必治气,气足则水行。不论在肝硬变腹水的早期或晚期,不论是邪实为甚还是正虚为主,益气升清法需贯穿治疗的全过程,在早期可"见肝之病,知肝传脾,当先实脾"而达厚土制水以防腹水生成,在晚期可益气培土升清以助腹水消散及防止复发。
The pathogenesis of ascites of liver cirrhosis is asthenia in origin and sthenia in superficiality,so the treatment emphasizes strengthening genuine qi and nourishing deficiency. The spleen and stomach lie in the middle energizer,a key position for ascending and descending of qi activity,so invigorating spleen and replenishing qi should be emphasized to strengthen genuine qi,ascending clear qi and descending turbidity to enhance the curative effect of TCM in treating cirrhosis ascites. The superficiality of ascites of cirrhosis is excessive water dampness,but qi can drive water,so visible water dampness must depend on the invisible gas to avoid dampness accumulation,so removing water retention must first regulating qi,because sufficient qi can guide water movement. Tonifying qi and ascending clear qi method should run through the whole course of treatment of liver cirrhosis,whether in the early or late stage of liver cirrhosis ascites,whether the etiology is excessive pathogenic factor or deficient genuine qi. In the early stage,invigorating spleen can avoid formation of ascites; while in later stage,tonifying qi and invigorating spleen and ascending clear qi method can be adopted to disperse ascites and avoid recurrence.
The pathogenesis of ascites of liver cirrhosis is asthenia in origin and sthenia in superficiality,so the treatment emphasizes strengthening genuine qi and nourishing deficiency. The spleen and stomach lie in the middle energizer,a key position for ascending and descending of qi activity,so invigorating spleen and replenishing qi should be emphasized to strengthen genuine qi,ascending clear qi and descending turbidity to enhance the curative effect of TCM in treating cirrhosis ascites. The superficiality of ascites of cirrhosis is excessive water dampness,but qi can drive water,so visible water dampness must depend on the invisible gas to avoid dampness accumulation,so removing water retention must first regulating qi,because sufficient qi can guide water movement. Tonifying qi and ascending clear qi method should run through the whole course of treatment of liver cirrhosis,whether in the early or late stage of liver cirrhosis ascites,whether the etiology is excessive pathogenic factor or deficient genuine qi. In the early stage,invigorating spleen can avoid formation of ascites; while in later stage,tonifying qi and invigorating spleen and ascending clear qi method can be adopted to disperse ascites and avoid recurrence.
引文
[1]林培淳,林勇凯,李艺滨,等.肝硬变腹水治疗进展[J].现代中西医结合杂志,2014,23(29):3299-3301.
[2]利霞.益气法在肝硬化腹水治疗中的应用[J].四川中医,2001,19(9):7-8.
[3]张琴,王磊,刘平.肝炎后肝硬变患者生活质量与中医基本证候的相关性[J].中西医结合学报,2010,8(1):30-34.
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[6]林树煌,邹小玲,张美玲.益气健脾活血利水汤联合西药治疗乙肝后肝硬变腹水随机平行对照研究[J].实用中医内科杂志,2015,29(5):125-126.
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[8]乔永灵.健脾益气化瘀利水方治疗肝硬变腹水临床疗效观察[J].中国实用医药,2013,8(36):175-176.
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[18]朱建明.益气滋阴淡渗法治疗肝硬变腹水40例[J].陕西中医,2009,30(1):11-12.
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[20]金银鹏,傅青春.肝硬变腹水诊治进展[J].肝脏,2013,18(9):638-640.
[21]Zhao CQ,Zhou Y,Ping J,et al.Traditional Chinese medicine for treatment of liver diseases:progress,challenges and opportunities[J].J Integr Med,2014,12(5):401-408.
[2]利霞.益气法在肝硬化腹水治疗中的应用[J].四川中医,2001,19(9):7-8.
[3]张琴,王磊,刘平.肝炎后肝硬变患者生活质量与中医基本证候的相关性[J].中西医结合学报,2010,8(1):30-34.
[4]刘敏,李献平.关幼波治疗肝硬变腹水的经验[J].中医药通报,2006,5(4):11-12.
[5]邓静,刘树朋,彭玉龙,等.益气活血利水法治疗乙肝肝硬变初次腹水疗效观察[J].中医药通报,2015,14(2):51-53.
[6]林树煌,邹小玲,张美玲.益气健脾活血利水汤联合西药治疗乙肝后肝硬变腹水随机平行对照研究[J].实用中医内科杂志,2015,29(5):125-126.
[7]曾兰.盛国光诊治肝硬变腹水的经验[J].江苏中医药,2015,45(2):15-16.
[8]乔永灵.健脾益气化瘀利水方治疗肝硬变腹水临床疗效观察[J].中国实用医药,2013,8(36):175-176.
[9]李鸿晟.黄芪辅助治疗肝硬变腹水疗效观察[J].中国中医药咨讯,2011,3(17):212.
[10]孙秀玲,姜明霞.黄芪药理作用机制的研究进展[J].中医临床研究,2015,7(17):140-141.
[11]奚骏,齐艳艳,陈建杰.消臌方治疗乙肝肝硬变腹水临床观察[J].世界感染杂志,2011,11(2):117-119.
[12]葛珊珊,宋贵发,王震,等.白术药用浅谈[J].现代中医药,2015,35(2):57-59.
[13]王素君.益肝汤剂治疗肝硬变腹水30例临床观察[J].中医临床研究,2010,2(10):3.
[14]吴四平.补中益气汤加味治疗肝硬变腹水体会[J].中医临床杂志,2011,3(4):40.
[15]单勇.补中益气汤治疗肝硬变腹水58例[J].中国医学创新,2009,6(3):95.
[16]冯高飞,陈若,陈伟钊.升清降浊汤治疗原发性肝癌腹水疗效观察[J].辽宁中医杂志,2015,42(7):1285-1286.
[17]刘敏.益气实脾、温阳利水法治疗肝硬变腹水68例临床观察[J].中医药通报,2011,10(5):49-51.
[18]朱建明.益气滋阴淡渗法治疗肝硬变腹水40例[J].陕西中医,2009,30(1):11-12.
[19]王菲,侯留法,娄静.解毒益气汤治疗肝硬变腹水合并肠源性内毒素症30例[J].中医研究,2010,23(9):60-62.
[20]金银鹏,傅青春.肝硬变腹水诊治进展[J].肝脏,2013,18(9):638-640.
[21]Zhao CQ,Zhou Y,Ping J,et al.Traditional Chinese medicine for treatment of liver diseases:progress,challenges and opportunities[J].J Integr Med,2014,12(5):401-408.