四君子汤合五苓散加减辨治肝硬化腹水临床研究

Clinical Research on Treating Patients of Liver Cirrhosis Ascites with Sijunzi Decoction and Wuling Decoction

目的:观察用以四君子汤合五苓散为基础方加减而成的中药汤剂辨治脾虚水停证肝硬化腹水患者的临床效果。方法:选择2010年4月—2013年11月于我院就诊的经彩超、肝功等检查,并经中医临床辨证为脾虚水停证肝硬化腹水患者73例为研究对象,随机分为对照组36例和治疗组37例。对照组患者给予加强营养、利尿、保肝,维持水电解质和酸碱平衡等常规西医基础治疗;治疗组患者在常规西药治疗的基础上给予以四君子汤合五苓散为基础方加减而成的中药汤剂内服治疗,2周为1个疗程。治疗1个疗程后,观察两组患者腹大胀满、颜面下肢浮肿、脘腹痞胀、食少便溏、倦怠懒言等临床症状改善情况,比较两组患者体重、腹围、尿量的变化情况,肝功能变化情况等,比较两组治疗的有效率。结果:经治疗后两组患者腹大胀满、颜面下肢浮肿、脘腹痞胀、食少便溏、倦怠懒言等症状均有所改善;对照组的有效率为66.7%,治疗组的有效率为86.5%,治疗组的有效率明显高于对照组,两组患者的有效率比较有显著的差异性(P<0.05)。与治疗前相比,两组患者体重、腹围均有所减少,排尿量有所增多,肝功能均有所改善,腹水均有所消退,但是以治疗组的变化程度更加明显,且差异性显著(P<0.05)。结论:四君子汤合五苓散加减功可益气健脾、利湿行水,该方对脾虚水停证肝硬化腹水患者进行治疗,能有效改善患者腹大胀满、颜面下肢浮肿、脘腹痞胀、食少便溏、倦怠懒言等症状,降低患者的体重和腹围,提高肝脏的功能,利于患者腹水的消退,凸显出中医药辨证论治的优势与特色,值得临床深入研究应用。

Objective： To investigate the clinical efficacy of treating patients of liver cirrhosis ascites with Sijunzi Decoction and Wuling Decoction. Methods ： 73 liver cirrhosis ascites cases were randomly divided into a control group of 36 cases and a treatment group of 37 cases from April 2010 to November 2013. Patients in the control group were treated with conventional western medicine foundation treatment, such as scaling up nutrition, diuresis, protecting liver, maintaining water and electrolyte or acid-base balance while patients in the treatment group were treated with self-made decoction--Sijunzi Decoction and Wuling Decoction for treatment, two weeks for a course. We observed the improvement of clinical symptoms, mainly including abdominal distension, edema, deficiency of food, loose stool, tiredness, and so on. We compared the change of weight, abdominal circumference, urine volume, liver function and effective rate of the two groups. Results： The clinical symptoms of the patients in two groups, such as abdominal distension, edema, deficiency of food, loose stool, tiredness were improved clearly. The efficiency for patients in the control group was 66.7% while for patients in the treatment group was 86.5%. The clinical efficacy of the treatment group was higher than that of the control group and the difference was significant （ P〈0.05 ）. The weight and abdominal circumference reduced clearly. The urine volume increased. The liver functions were improved, and ascites had faded after treatment.The degree of change in the treatment were more pronounced and the difference was significant （ P〈0.05 ）. Conclusion ： The Sijunzi Decoction and Waling Decoction have the function of invigorating spleen to supplement qi and inducing diuresis to alleviate edema. It can improve the clinical symptoms, reduce the patient＇s weight and abdominal circumference, improve the liver function and promote the edema subsided, which shows the advantages and characteristics of TCM, and is worthy of further research and development.