基于“调其虚实,和其逆顺”论治肝性脊髓病

Discussion on The Treatment of Hepatic Myelopathy Based on The Theory of“Adjusting Deficiency and Excess,Harmonizing the Normal Development and Reverse”

肝性脊髓病是在慢性肝病进程中出现的一种罕见的神经系统并发症,多以双下肢缓慢进行性加重的对称性痉挛性瘫痪为主要症状,致残率极高。目前该病发病机制尚不明确,西医尚无简便可行的治疗方法。肝性脊髓病属于中医学“痉病”范畴,继发于“肝积”“臌胀”等病,在先天禀赋不足、后天疫毒、酒食、药石、情志所伤等多种致病因素的共同作用下,或因肝失疏泄,痰瘀阻络,或因肝肾不足,阴血亏虚,或因外邪内浸,湿热留滞,或因脾胃失运,气血不足,导致邪壅经络、筋脉失养而发病,其病位在筋脉,病本在肝,涉及肾脾胃,病性为本虚标实。临证辨治应紧扣病机,以“调其虚实,和其逆顺”为法,以滋补肝肾为主,兼以调理脾胃,通腑泻浊,调畅气血,随症化裁。

Hepatic myelopathy(HM)is a rarely neurological complication in patients with chronic liver disease.The main symptom is progressive spastic paraparesis in both lower limbs.and it’s disability rate is extremely high.At present,the pathogenesis of HM is unclear,and there is no simple and effective treatment method in western medicine.This disease belongs to the"Convulsive disease"in traditional Chinese medicine which mostly based on diseases such as"Gan Ji"and"Gu Zhang".Its etiology and pathogenesis is composed of insufficiency of natural endowment,or injuries caused by acquired factors such as epidemic disease,alcohol,food,medicine,and emotion.These pathogenic factors cause liver-spleen-kidney-deficiency,obstruction in the meridians due to static blood,dampness-heat and phlegm turbidity,finally tendon loss nutrition.The disease position of HM in the tendons and veins,mainly affects the liver,followed by kidney and spleen,which manifestation is deficiency in origin and excess in superficiality.The clinical diagnosis and treatment should be closely related to the pathogenesis,and follow the method of"adjusting deficiency and excess,harmonizing the normal development and reverse",which also should be based on nourishing the liver and kidneys,as well as coordinating the spleen and stomach,unblocking bowels and purging turbidity,regulating the Qi and blood,and adjust the medication according to the condition.