活血化瘀法在肝硬化中医药治疗中的实践应用与发展

Practical application and development of activating blood and resolving stasis treatment method for liver cirrhosis

从中西医结合角度阐释肝硬化的血瘀病机及其活血化瘀治法的理论基础与实践应用。围绕肝硬化的中医病机证治,首先分析了中西医肝脏的概念异同,认为肝脏微循环系统即是中医“肝络”,其在维持肝脏生理稳态中发挥重要作用,而微循环障碍(或“肝络”瘀阻)则是肝硬化的核心病理(病机);继而,从中医经典文献、近代名医经验、现代循证医学评价方面论证了活血化瘀是肝硬化的重要中医药治法,在具体实践时需根据活血化瘀中药的不同功效、疾病不同阶段等灵活应用,并注重与其他治法合理配合;最后,提出改善肝脏微循环是活血化瘀中药祛瘀生新治疗肝硬化的重要药理基础与治疗策略。

This article states that blood stasis is the pathogenesis of liver cirrhosis,and explains the theoretical basis and practical application of the blood-activating and stasis-resolving method in the treatment of liver cirrhosis from the perspective of integrated traditional Chinese and Western medicine.Focusing on the traditional Chinese medicine(TCM)pathogenesis as well as syndromes and treatment of liver cirrhosis,we first compare the similarities and differences in the concepts of liver between the two medical systems,and hold that the liver microcirculatory system is termed as“Gan Luo”(liver collaterals)in TCM,which help to maintain the physiological homeostasis of the liver;and that the microcirculatory disorder(or stasis and obstruction in“liver collaterals”)is the core pathology(pathogenesis)of liver cirrhosis.As has been proved in TCM classical literature,experience of famous TCM doctors in modern times and contemporary evidence-based medical evaluation,blood-activating and stasis-removing method is an important TCM treatment method for liver cirrhosis.However,it should be applied flexibly according to the different effects of herbs for activating blood and resolving stasis and different stages of the disease,and attention should also be paid to appropriate coordination with other treatment methods in the real practice.Finally,we propose that improving liver microcirculation is a pivot pharmacological basis and therapeutic strategy for the treatment of liver cirrhosis with blood-activating and stasis-resolving herbs to eliminate stasis and generate new blood.