邵铭治疗肝硬化腹水经验

Experience of SHAO Ming on Treating Cirrhosis Ascites

肝硬化腹水的基本病理变化可简括为肝、脾、肾受损,气滞、血瘀、水停腹中,其本为虚,且多虚实夹杂。邵铭主任医师认为,肝硬化腹水以辨正邪的消长盛衰为重点,当根据正邪盛衰衡量驱邪与扶正的侧重,腹水的形成及其变化反应邪正的较量,可依据腹水的多少明确邪正的盛衰;驱邪多以行气化瘀、利水通络,以行气为先,且肝脏体阴而用阳,肝阳为用以肝体为本,因此肝体当养,用药时刻注意顾养肝阴;扶正多以柔肝健脾、肺肾同调,柔肝首选白芍,健脾当分理气健脾、健脾祛湿、益气健脾区别选药,肺肾在水液代谢中的作用不可忽视,应分别予以调养;且应辨证与审因兼顾。

The basic pathological changes of cirrhosis ascites can be seen as the damage of liver, spleen and kidney, with Qi stagnation, blood stasis and water stoping in the belly. Its original is virtual and intermingled deficiency and excess. SHAO Ming considers that distinguishing the rise and fall between vital Qi and pathogens is the key to the disease. In treatment, we should measure the emphasis on strengthening the body resistance or eliminating evil according to vicissitude of vital Qi and patho- gens. Formation and change of ascites reacts the contest of evil and righteousness. So according to the number of ascites, we can clear the vicissitude of vital Qi and pathogens. Eliminating evil contains promoting Qi, dissipation blood stasis, and promoting di- uresis and dredging collaterals, with promoting Qi for the first. What＇s more, liver belongs to Yin in physique and Yang in func- tion, which means that liver Yang is the basis of liver body, so liver Yin should be raised and we must pay attention to nourishing liver Yin. Strengthening the body resistance includes softening the liver, strengthening the spleen and regulating the lung and kid- ney. Radix Paeoniae Alba is the first choice for softening liver. Strengthening spleen include regulating Qi-flowing for strengthe-ning spleen, invigorating the spleen and dispelling dampness and replenishing Qi to invigorate the spleen. The role of lung and kidney in the metabolism of water can not be ignored, and should be nursed. And we should consider both syndrome differentiation and reason.