姚乃礼分期辨治原发性硬化性胆管炎经验

YAO Naili's Experience in Differentiating and Treating Primary Sclerosing Cholangitis by Stages

总结姚乃礼教授治疗原发性硬化性胆管炎的临床经验。认为本病病机特点为正虚邪盛,脾虚不运是贯穿于本病发生发展的根本原因,肝胆失于疏利是重要因素。临床应根据不同病程阶段进行辨证分析,早期证型多为肝脾不和、湿热蕴结、血虚风燥,迁延期证型多为肝郁脾虚、血瘀成积、脾虚湿滞,后期证型多为肝肾阴虚、阳虚水泛。临证时善用黄芪健脾土,滋肾水以调肝,同时整体调治顾兼病,临床疗效显著。

This paper summarized the clinical experience of professor YAO Naili in the treatment of primary sclerosing cholangitis(PSC).The pathogenesis of this disease is characterized by healthy qi deficiency and pathogen excess,with spleen deficiency failing to transport as the root cause,and the liver and gallbladder loss of soothing and draining as an important factor.Clinical treatment should be performed based on syndrome differentiation at different stages of the disease.At early stage,liver-spleen disharmony syndrome,damp-heat accumulation syndrome,and blood deficiency and wind-dryness syndrome are common.At the protracted stage,liver constraint and spleen deficiency syndrome,blood stasis accumulation syndrome,and spleen deficiency and dampness stagnation syndrome are the most frequent types.At the late stage,liver-kidney yin deficiency syndrome and edema due to yang deficiency syndrome are commonly seen.In clinical practice,Huangqi(Radix Astragali)is usually used to fortify spleen earth and enrich kidney water thereby regulating the liver.At the same time,the combined diseases are also treated with the concept of holism,obtaining remarkable clinical effect.