基于方证相关理论解析肝硬化湿热内蕴病机

The Pathogenesis of Dampness Heat Accumulation Syndrome of Liver Cirrhosis Based on the Theories of Chinese Formula and Syndrome

在肝硬化发病过程中,湿(瘀)热内蕴是重要的中医证候病机之一。对方剂效应原理的研究由以往侧重于方药配伍转向方-证互参,采用多个模型进行类方比较研究,来验证方证病理基础。茵陈蒿汤及其类方(栀子柏皮汤、茵陈五苓散、甘露消毒丹和茵陈四逆汤)对DMN、CCl4和胆管结扎等大、小鼠肝硬化模型干预作用,表明DMN诱导的肝纤维化大鼠模型与茵陈蒿汤方证病机高度相关,属于湿(瘀)热内蕴。进一步揭示炎症早期属于湿热内蕴,是以库普弗细胞(KC)经典激活途径为主的炎症反应及脂肪酸代谢异常,为茵陈蒿汤方证的主要病理基础。针对此病机,尤其是肝硬化失代偿期,炎症活动明显,肝功能明显异常时,湿(瘀)热内蕴可能是其主要证型。应用清热利湿的茵陈蒿汤以及茵陈蒿汤类方治疗时,需首辨阴阳,分清湿热偏重,时刻不忘活血化瘀。只有精准明辨中医证候病机,临床才可取得满意疗效。

As a part of pathogenesis of liver cirrhosis（blood stasis）, the dampness heat accumulation（DHA） syndrome is very important in traditional Chinese medicine. Different from the perspective of formula-efficacy-syndrome in the past, the researchers focused on corresponding permit on formula-syndrome. Yinchenhao Decoction（YCHD） and its analogus formula（including Zhizi Baipi decoction, Yinchen Wuling powder, Ganlu Xiaodu pill and Yinchen Sini decoction） were explored on the hepatic cirrhosis rats and mice model induced by DMN, CCl4 or bile duct ligation. The results revealed that the pathogenesis of DMN-induced cirrhosis rat model highly correlated with the DHA syndrome corresponding to YCHD. The inflammatory early stage of liver cirrhosis chimed with the symptoms of DHA syndrome, reflecting an inflammatory reaction caused by Kupffer cells（KCs） activation and fatty acid abnormal metabolism and the direct correlation to the treatment of YCHD. Therefore, DHA syndrome could be the main type to the TCM syndrome in liver cirrhosis, especially at the stage of decompensated cirrhosis occuring evident inflammation and liver function disorder, which corresponded to its mechanisms. The treatment based on syndrome differentiation in the application of YCHD and its analogus formulae should first distinguish yin from yang, identify damp and heat and aware of removing blood stasis in TCM treatment. Only by precise identification of TCM syndrome can achieve favorable efficacy in clinic.