从邪正理论探讨急性肝功能衰竭的中医治疗思路

Discussion on the Therapeutic Thoughts of Chinese Medicine on Acute Liver Failure from the Theory of Pathogenic Qi and Healthy Qi

急性肝衰竭是临床上危急重症之一。笔者在梳理历代中医辨治思路的基础上,结合现代医学认识,深入探讨急性肝衰竭的中医病因病机和治则治法,指出"邪实"盛极、正气在极短时间内急遽受损而至"本虚",进而出现"邪实本虚"并存的病机演变特点;据此提出"祛邪为主,兼以扶正"的基本治则,临床治疗需从祛邪(清热解毒凉血化瘀)与扶正(补益正气)两个方面切入,并应密切注意病情快速转归,为中医药治疗急性肝衰竭提供参考和借鉴。

Acute liver failure is one of the critical diseases in clinic.The authors combed through the thoughts of the past dynasties on Chinese medicine syndrome differentiation,combined with the understanding of modern medicine and then discussed the etiology,pathogenesis,therapeutic principle and treatment of acute liver failure in depth.The authors pointed out that the pathogenic qi becomes so excessive and the healthy qi becomes so deficient due to a rapid damage during a short period of time that the pathogenesis is characterized by the coexistence of＂excess of pathogenic qi and deficiency of healthy qi＂.According to this,the authors put forward the basic therapeutic principle of＂dispelling pathogenic qi mainly and reinforcing healthy qi simultaneously＂.The clinical treatment needs to start from the two aspects of dispelling pathogenic qi（clearing heat,resolving toxins,cooling the blood and dissolving stasis）and reinforcing healthy qi（supplementing healthy qi）,and should pay close attention to the rapid prognosis of the disease.The discussion provides reference for Chinese medicine in treating the acute liver failure.