从《脾胃论》析肝硬化

Analysis of Cirrhosis from Piweilun

肝硬化为虚实夹杂、难于治理之症,经参读李东垣《脾胃论》,以为从脾胃论治肝硬化,既可究其发病根源,又可寻其治疗关键,不施为在临床上治疗肝硬化的一大法门。东垣视肝与脾胃之关系甚密,脾胃虚弱不能散精于肝,土薄木贼则成臌;脾胃虚弱不能制约肾水,肾水得到亢旺的肝木资助而泛滥。治其水不在利下、不在淡渗,而在于温补脾胃之阳气。东垣补脾以党参、白术、山药、扁豆等轻剂益之;疏肝常以郁金、佛手、木香、砂仁等;养血柔肝时需注意养肝不滞脾,滋补肝肾时应补而不留邪。肝硬化的治疗中顾护脾胃、培补气血生化之源的思想应贯穿始终,为其重中之重。

Cirrhosis is the insufficiency - excess syndrome that is difficult to treat. Trying to read Piweilun of LI Dongyuan, the treatment on cirrhosis from the spleen with stomach is an appropriate way to be applied in the clinical treatment of cirrhosis, which is not only to study the fundamental causes of its pathogenesis, but also to study its key treatment. LI Dongyuan thinks that the relationship between the liver and spleen - stomach is very close. Because of deficiency, spleen - stomach fails to spread the essence to the liver and leads to restricting by the liver, which develops tympanities. The deficiency of spleen -stomach has no a- bility to restrict kidney- water, and kidney- water floods because of the exuberant liver. The treatment is not promoting urination or resolving dampness, but to warm yang and replenish qi of the spleen - stomach. LI Dongyuan is good at giving Dangshen, Baizhu, Shanyao, Biandou and others that function gently to strengthen spleen and giving Yujin, Foshou, Muxiang, Sharen to sooth liver. However, we have to realize that nourishing blood and softening liver could not make spleen qi stagnation, while nourishing liver and reinforcing kidney could not make pathogenic factors delay. The most important treatment for cirrhosis is to protect and benefit spleen- stomach, which is an indispensable thought to treat this disease.