从玄府理论论治肝纤维化

Discussion About Treating hepatic fibrosis Based on the Theory of Sweat Pores

肝纤维化基本病机为玄府郁闭、肝脾失养、络脉瘀阻。外感湿毒及情志内伤阻滞气机,使肝失调达,气机郁闭,疏泄失常,久则酿生火、热、毒邪,阻滞玄府。饮食内伤、外感湿毒或他邪及脾,导致脾失健运,运化失司,湿聚而不散,痰湿内生,导致气血津液失调,一则气血津液生成不足,则玄府失于濡养而致闭塞;二则湿邪困阻,气血津液运行不畅,湿郁蕴热,则玄府闭阻,阳气怫郁,郁结不通。肝肾阴液互养、精血互生,故肝病日久成瘀,使正气不足,伤及肾脏,导致肝肾亏虚,气化失职,阴阳失衡,气血流通障碍;另因肝玄府失于濡养,则玄府郁闭,津液不布,气机郁滞,痰瘀阻滞。故玄府郁闭、肝脾失养、络脉瘀阻是肝纤维化发病之本,外感六淫之邪为发病之标,发病关键在于玄府郁闭,运用理气药、理血药、补益药、清热祛湿泻火药等开玄通络法,以提高疗效。

The basic pathogenesis of liver fibrosis is stagnation of sweat pores,liver-spleen lack of nutrition,and collateral stasis.External contraction,dampness-toxin and internal emotional injury block qi movement resulting in the liver failing to disperse,qi movement stagnation,abnormal discharge.For a long time,it will generate fire,heat,toxin and pathogen,and block sweat pores.Diet internal injury,external contraction,dampness-toxin or other pathogens affecting the spleen,resulting in dysfunction of the spleen in transportation,stagnated accumulation of dampness,and the endogenous phlegm and dampness,causing the imbalance of qi,blood and body fluid.On the one hand,if the generation of qi,blood and body fluid is insufficient,sweat pores lose nourishment and leads to occlusion.On the other hand,dampness and pathogens obstruction,poor operation of qi,blood and body fluid,dampness depression and heat accumulation will cause closed sweat pores,and yang qi depression.Liver-kidney yin fluid nourish each other,and essence and blood generate each other,so long-time liver disease leads to blood stasis,resulting in deficiency of healthy qi and kidney injury,leading to deficiency of liver and kidney,dysfunction of qi transformation,imbalance of yin and yang,and obstruction of qi-blood circulation.In addition,due to the loss of nourishment of the liver,its sweat pores are blocked,the body fluid is not distributed,the qi movement is stagnant,and the phlegm and blood stasis are blocked.Therefore,stagnation of sweat pores,liver-spleen lack of nutrition,and collateral stasis are the root causes of hepatic fibrosis,while six external pathogens are its manifestations.The key to the onset is stagnation of sweat pores.Qi-regulating medicinals,Blood-regulating medicinals,tonics,heat-clearing,dampness-removing and heat-purging medicinals can be used to open sweat pores′collaterals,so as to improve the clinical curative effect.