张均倡运用经方辨治临床前代偿期肝硬化经验

ZHANG Jun-Chang’s Experience in Treating Pre-clinical Compensated Cirrhosis with Classical Prescriptions

对张均倡教授提出的临床前代偿期肝硬化概念、肝硬化逆转问题及基于“和法”运用经方辨治临床前代偿期肝硬化进行探讨。认为腹腔镜下肝脏形态学和病理学分析可作为临床前代偿期肝硬化诊断的重要手段,准确评估肝硬化分期对监测疗效和判断预后具有重要价值;早期肝硬化的逆转可减少与肝病相关的终点事件的发生;临床前代偿期肝硬化可归属中医“积聚”范畴,其辨治可借鉴仲景学说,基于“和法”分初期、中期、末期3个阶段运用经方进行辨治,即初期以小柴胡汤加减为主进行消散,中期以柴胡桂枝汤合四君子汤加减为主进行消补兼施,末期以柴胡桂枝干姜汤加减扶正兼消散。结合经方证治配伍规律,进一步发掘经方辨治肝硬化的潜力及优势,对提高中医药治疗肝硬化的临床疗效具有重要的现实意义。

This article discussed the definition of pre-clinical compensated cirrhosis,the reversal of cirrhosis and the use of the harmonizing therapy for pre-clinical compensated cirrhosis with the classical prescription based on syndrome differentiation advocated by Professor ZHANG Jun-Chang.It is concluded that the findings of hepatic laparoscopic morphology and hepatic pathology can be used for the diagnosis of pre-clinical compensated cirrhosis,and the accurate assessment of the stage of cirrhosis is of great value in monitoring the clinical efficacy and prognosis.Reversal of early cirrhosis can reduce the occurrence of endpoint events associated with liver disease.The pre-clinical compensated cirrhosis can be classified as“aggregation-accumulation”in the field of TCM,and its treatment can be based on the harmonizing therapy established by ZHANG Zhong-Jing.The treatment can be divided into three stages,i.e.,early stage treatment with modified Xiao Chaihu Decoction for dissipation,middle stage treatment with Chaihu Guizhi Decoction combined with Si Junzi Decoction for tonification and resolution,and the final stage treatment with modified Chaihu Guizhi Ganjiang Decoction for supporting healthy qi and dissipation.Based on the prescription rules of the classical prescription,the further exploration of the potential and advantages of classical prescription for the treatment of liver cirrhosis is of great practical significance in improving the clinical efficacy of Chinese medicine for the treatment of liver cirrhosis.