基于“肝络微癥积”学说探讨中医药抗肝豆状核变性肝纤维化治疗策略

Exploration of the treatment of liver fibrosis in Wilson disease based on the Traditional Chinese Medicine theory of“micro-lumps in liver”

肝络微癥积是各种慢性肝病发展致终末期必经的一个病理阶段,相当于西医学中肝纤维化等疾病。中医认为肝络微癥积的基本病机为本虚标实,正气亏虚为本,痰浊、瘀血为标,其中痰瘀互结是其关键的病理因素,并贯穿本病始终。消补兼施、痰瘀同治乃本病治疗的基本原则。研究表明,肝豆状核变性导致的肝纤维化属于肝络微癥积的范畴,本文基于肝络微癥积学说,探讨了肝豆状核变性肝纤维化的中医病因病机、临床转归及其中医药干预策略。认为肝豆状核变性肝纤维化是发生在肝络的微癥积,痰瘀互结是本病基本病理特征,正气亏虚是其发病的关键,治疗总则不外乎消补兼施、痰瘀同治。旨为今后肝豆状核变性肝纤维化的临床防治提供借鉴。

Micro-lumps in liver is a pathological stage that occurs in the late stage of the development of a variety of chronic liver diseases;itis equivalent to liver fibrosis and other diseases in western medicine.According to traditional Chinese medicine(TCM),the basic pathogenesis of micro-lumps in liver is deficiency of the original qi,deficiency of the vital qi,and turbidities of phlegm and blood stasis,the foundation is Qi deficiency,and the presentation is phlegm turbidity and blood stasis,which forming the basic pathogenesis of micro-lumps in liver.Besides,the phlegm turbidity and blood stasisamong which the intermingled phlegm and blood stasis isare the key pathological factorsaffecting the whole disease throughout the whole process of the disease.The basic principle of the treatment of this disease is to simultaneously treat phlegm and blood stasis.Studies have shown that liver fibrosis in Wilson disease belongs to the category of micro-lumps in liver.Based on the theory of micro-lumps in liver,this paper discusses the TCM etiology,pathogenesis,clinical outcomes,and intervention strategies of liver fibrosis in Wilson disease.It is concluded that the disease is the accumulation of micro-lumps in liver,the intermingled phlegm and blood stasis is the basic pathological feature of the disease,the deficiency of vital qi is the key to its pathogenesis,and the general treatment is aimed at strengthening body resistance to eliminate pathogenic factors and dispel phlegm and remove blood stasis at the same time.We providea reference for the clinical prevention and treatment of liver fibrosis in Wilson disease.