从“见肝之病,知肝传脾,当先实脾”小议肝病的治疗

Brief Discussion of the Treatment of Liver Disease From "Seeing Liver Disease,Knowing it Transforming to the Spleen and Reinforcing the Spleen First"

"见肝之病,知肝传脾,当先实脾",是在治疗肝病的同时,采用调补脾土的方法,即治其未显出病状的脾脏,目的是增强脾气,防止被肝气克伐,阻断传变环节,防止肝病的发展恶化。此处"实脾",应从两方面理解:一是补脾,即采用"甘味"药补中健脾,脾运健旺则气血化生充足,既防病邪入侵,又使肝得以滋养濡润,条达肝气;二是调脾,即采用调和之法,防止脾气机壅滞,从而使脾运化功能正常的目的[7]。肝病的常见证型有虚实之分。实证常见于情志不舒导致肝失疏泄引起的肝气郁结,气郁化火,气滞血瘀,气火上逆;阴不制阳导致的肝阳上亢,肝阳化风;火邪、寒邪、湿热之邪侵及肝经而引起的肝气郁结,肝火炽盛,寒凝肝脉,肝经湿热等病症。实证治疗分两个方面,一为肝脏邪气有余而正气尚足,脾气不衰时,当泻肝护脾。在治肝的同时采用化脾湿,清脾热,行脾气的治疗方法,用药如陈皮、木香、砂仁、黄连等,防止脾气壅滞,保持脾气健运;二为肝病实而脾气受损时,治疗当泻肝补脾。

＂ Seeing liver disease,knowing it transforming to the spleen and reinforcing the spleen first＂ means that when treating the liver disease,the method of regulating and tonifying the spleen is simultaneously adopted even though the symptoms of the spleen disease haven’t shown. The purpose is to strengthen the spleen qi,prevent from being restricted by the liver qi,block the transforming process and prevent the deterioration of the liver disease. ＂ Reinforcing the spleen＂ includes tonifying the spleen and regulating the spleen. For tonifying the spleen,sweet drugs can tonify the middle energizer and strengthen the spleen. Vigorous transportation function of the spleen ensures sufficient qi and blood transformation,which can not only prevent pathogens from invading into the body but also moisten and nourish the liver to disperse liver qi. For reregulate the spleen,it means that the harmonizing method can be applied to prevent the obstruction of the spleen qi movement,thus making normal transportation and transformation function of the spleen possible 7. The common liver diseases are of deficient type and excess type. Excess syndrome is commonly caused by liver dysfunction due to emotional upset,including liver qi depression,qi depression transforming into fire,qi stagnation and blood stasis,upward flow of qi and fire; yin failing to control yang,seeing as liver yang hyperactivity,liver yang transforming into wind; heat pathogen,cold pathogen and damp-heat pathogen attacking liver meridian,seeing as liver qi depression,liver fire exuberance,cold coagulating the liver meridian,damp heat of the liver meridian. The excess syndrome should be treated from two aspects. When the pathogenic qi is excessive and healthy qi of the liver is sufficient,and the spleen qi hasn’t declined,the liver-purging and spleen-protecting method should be applied. At the time of treating the liver,the methods of resolving spleen dampness,clearing spleen fire and moving spleen qi should be also applied with the herbs like chenpi,muxiang,sharen,huanglian,etc,in order to prevent the stagnation of spleen qi and maintain vigorous transportation of the spleen qi. In the cases of liver disease of excess pattern and the spleen qi has declined,the method of purging liver and tonifying spleen should be applied.