李素领治疗肝硬变腹水伴泄泻经验

Li Suling′s Experience in Treating Cirrhosis and Ascites with Diarrhea

"土败木贼,湿热留恋,瘀血阻络"是肝硬变腹水伴泄泻基本病机。李素领教授在辨治肝硬变腹水泄泻时,着重于阴水与泄泻的关系,重在利水。故以健脾利水化瘀为法,以春泽汤、平胃散、参苓白术散合方为基础加减,自拟健脾利水化瘀基本方(红参10 g,茯苓30 g,炒白术30 g,猪苓30 g,泽泻15 g,炒苍术15 g,厚朴15 g,枳壳15 g,陈皮15 g,砂仁10 g,炒山药30 g,炒白扁豆30 g,炒莲子30 g,炒薏苡仁30 g,鸡内金12 g,炒神曲15g,炒麦芽30 g,川芎15 g,炮穿山甲15 g)。并对临床常见的脾气虚衰、脾肾阳虚证,水浊潴留、湿热蕴结证,水困津乏、脾肾阴虚证,气机壅塞、瘀血阻滞证4个证型进行辨证施治,兼顾合并自发性细菌性腹膜炎、胆汁淤积等情况,寒热并用,随证治之。

The basic pathogenesis of cirrhosis and ascites with diarrhea is " Liver invading Spleen,Dampness and Blood stasis".Professor Li Suling focuses on the relationship between Yin Water and diarrhea when treating cirrhosis with ascites and diarrhea,and focuses on clearing Dampness. Therefore,the method of treatment is Jianpi Lishui Huayu. Based on Chunze Decoction,Pingwei Powder,and Shenling Baizhu Powder,Li created his basic recipe named Jianpi Lishui Huayu Basic Prescription: Hongshen( red ginseng) 10 g,Fuling( poria) 30 g,Chaobaizhu( fried white atractylodes rhizome) 30 g,Zhuling( grifola) 30 g,Zexie( alisma)15 g,Chaocangzhu( Fried rhizoma atractylodis) 15 g,Houpo( magnolia officinalis) 15 g,Zhike( fructus aurantii) 15 g,Chenpi( pericarpium citri reticulatae) 15 g,Sharen( amomum villosum) 10 g,Chaoshanyao( fried yam) 30 g,Chaobaiabiandou( fried white lentils) 30 g,Chaolianzi( fried lotus seeds) 30 g,Chaoyiyiren( fried coix seeds) 30 g,Jineijing( endothelium corneum gigeriae galli) 12 g,Chaoshenqu( fried medicated leaven) 15 g,Chaomaiya( fried malt) 30 g,Chuanxiong( Ligusticum wallichii)15 g,Paochuanshanjia( cannon pangolin) 15 g. In addition,as for the four common syndrome types of clinical syndromes,namely,deficiency of Spleen Qi,deficiency of Spleen and Kidney Yang,retention of Water and Turbidity,accumulation of Dampness and Heat,deficiency of Water and Fluid,deficiency of Spleen and Kidney Yin,Qi congestion,and Blood stasis,corresponding treatment should be used,taking into account the combination of spontaneous bacterial peritonitis and cholestasis,etc. and Cold or Heat method can be used accordingly in treatment.