摘要
失代偿期肝硬化的主要表现为腹水和黄疸,尹常健教授指出腹水为水湿泛滥,责之肝脾肺肾多脏失调,气机逆乱;黄疸难消在于湿热痰瘀蕴结血分,瘀热阻络。肝郁脾虚是本病的发病基础,肝肾阴虚是最终结局,提前防治肝肾阴虚至关重要。尹教授提出“八字辨证”的方法,准确概括不同阶段本虚和标实的主要矛盾。强调本病肝肾阴虚阶段肝郁脾虚仍持续存在,无论利水还是滋阴都要从健脾入手,健脾助运令气血顺畅,才能化生阴精。尹教授提出分阶段治疗的理念,即先消腹水再滋阴,创制蝉衣利水方重点利水,腹水消退后,转而在健脾和胃的基础上滋补肝肾。治疗过程还应注意避免温热伤阴、逐瘀伤正,积极联合应用抗生素控制腹腔感染等。
The main manifestations of decompensated cirrhosis are ascites and jaundice.Professor YIN Changjian points out that ascites is dampness and flooding,which is due to the disorder of the liver,spleen,lung and kidney and qi.Jaundice is difficult to disappear,which is due to the damp-heat-phlegm and blood stasis accumulating,and blood stasis and heat blocking collaterals.Liver stagnation and spleen deficiency is the basis of the disease onset,liver and kidney yin deficiency is the final outcome,and preventing and treating liver and kidney yin deficiency in advance is very important.Professor YIN puts forward the method of“eight-character syndrome differentiation”,which accurately summarizes the main contradiction between“asthenia in origin”and“asthenia in superficiality”in different stages.Professor YIN emphasizes that liver stagnation and spleen deficiency still exist in the stage of liver and kidney yin deficiency.It is necessary to start from invigorating the spleen wherher regulating water or nourishing yin.Only by invigorating the spleen to help transport qi and blood smoothly,can yin essence be produced.Professor YIN proposes the concept of stage treatment,that is,to eliminate ascites first and then nourish yin.He makes Chanyi Lishui Formula(蝉衣利水方),which lays emphasis on regulating water,and nourishes liver and kidney on the basis of strengthening spleen and stomach after ascites subsides.In the course of treatment,attention should also be paid to avoid warm and heat injuring yin and eliminating blood stasis injuring vital qi,and actively combine application of antibiotics to control abdominal infection.
作者
韩宁
张欢
张永
HAN Ning;ZHANG Huan;ZHANG Yong(Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China)
出处
《山东中医杂志》
2022年第4期355-359,共5页
Shandong Journal of Traditional Chinese Medicine
基金
国家重点研发计划“中医药现代化研究”基金项目(编号:2018YFC1704103)。
关键词
失代偿期肝硬化
尹常健
肝肾阴虚
蝉衣利水方
名医经验
decompensated cirrhosis
YIN Changjian
liver and kidney yin deficiency
Chanyi Lishui Formula
experience of famous doctors
