活血健脾法在肝硬变腹水治疗中的应用

The Application of Activating Blood and Strengthening Spleen in the Diagnosis and Treatment of Ascites in Cirrhosis

肝硬变腹水属本虚标实证,肝脾虚弱为本,瘀、痰、湿、水为标,久病及肾,活血健脾化瘀法为治疗的关键。《肝硬化腹水中医诊疗专家共识意见》将肝硬变腹水分为气滞水停证、脾虚水停证、湿热水停证、血瘀水停证、脾肾阳虚水停证、肝肾阴虚水停证。治疗方法主要有:内服汤剂治疗和外治疗法(针灸推拿、穴位贴敷、灌肠、脐疗等)。目前,活血健脾法治疗肝硬变腹水药物机制及疗效指标的研究不规范,药物制剂的制作,特别是外敷药物的使用也不规范,另外,尚缺乏大样本、多中心的研究报道,今后仍需进一步深入研究。

Ascites of liver cirrhosis is characterized by primary deficiency and secondary excess,weakness of liver and spleen is the primary cause,while blood stasis,phlegm,dampness and water are the seconary causes.Chronic disease involves the kidney,and promoting blood circulation,strengthening spleen and removing blood stasis are the key points of treatment.According to Consensus Opinion on TCM Diagnosis and Treatment of Ascites due to Cirrhosis,ascites due to cirrhosis can be divided into the following types:qi stagnation and water stagnation,spleen deficiency and water stagnation,damp and heat and water stagnation,blood stasis and water stagnation,spleen kidney yang deficiency and water stagnation,liver-kidney yin deficiency and water stagnation.The main treatment methods include decoction for oral administration and external treatment(such as acupuncture and massage,acupoint application,enema,umbilicus therapy,etc.).At present,the study on the mechanism and therapeutic index of the method of promoting blood circulation and invigorating the spleen in the treatment of ascites due to cirrhosis is not standardized,and the preparation of pharmaceutical preparations,especially the use of external drugs,is also not standardized.In addition,there is still a lack of large sample and multi center research report,and further research is needed in the future.