韩氏中医治疗慢性肝病验案2则

HAN’s experience for treating 2 cases of chronic liver disease in TCM

验方攻补汤治疗慢性肝病以疏肝健脾、活血消癥为治疗大法。临证时刻注意攻伐勿过,以健脾疏肝、攻补兼施为大法,重视健脾益气药物的运用,结合疏肝、柔肝、补肝、潜肝阳敛肝阴以防理气药香燥戕害肝体。慢性肝病病程较长,久病穷肾患者多表现为肝肾亏虚的症状,针对这种情况临床重视补肾药物的应用,常用补肾药物有巴戟天、菟丝子、枸杞子、熟地黄等,同时为防止此类药物滋腻碍胃多配伍炒白术、醋青皮等动化药物,以防呆滞。治疗慢性肝病慎用破血逐瘀药,以活血养血滋养肝体为要,治黄勿忘治血,活血以退黄,和肝理脾重视气机,辨病与辨证相结合,分型施治,久病补肾兼以清化。韩氏中医认为肝脾不和、肝郁脾虚是慢性肝病主要病因,故治疗时应时时注意和肝理脾、调畅气机,并注意疏肝解郁,把握病机灵活化裁,标本兼治。气机不通,肝脉瘀阻为慢性肝病的主要病机,治疗应注重理气活血化瘀以阻止和逆转肝硬化,临床时针对肝病患者本虚标实、虚中夹实的病理实质,时刻注意破血药度和量,勿妄用逐瘀之品。依据慢性肝病不同阶段,结合辨证施治,在采用攻补汤治疗的基础上分型施治。文章分析韩氏中医治疗慢性肝病验案2则,以期为相关研究提供参考。

The treatment of chronic liver disease with the Gongbu decoction(攻补汤)is based on the principle of soothing the liver and invigorating the spleen,activating blood circulation and eliminating dysentery.Attention should always be paid not to overattack during treatment.The treatment is to strengthen the spleen and soothe the liver,attack and tonify at the same time,attach importance to the use of drugs for invigorating the spleen and replenishing Qi(气),and combine with soothing the liver,softening the liver,tonifying the liver and other methods to protect the liver Yin(阴)to prevent Qi-regulating drugs damage to the liver.The course of chronic liver disease is long,and most of the patients with chronic liver disease show the symptoms of deficiency of liver and kidney.In view of this situation,clinical attention is paid to the application of kidney-tonifying drugs.Commonly used kidney tonifying drugs were Bajitian(Radix Morindae Officinalis),Tusizi(Semen Cuscutae),Gouqizi(Fructus Lycii),Shu Dihuang(Radix Rehmanniae Preparata),etc.,at the same time to prevent the decline of gastric function,fry Baizhu(Rhizoma Atractylodis Macrocephalae),Qingpi(Pericarpium Citri Reticulatae Viride)processed with vinegar and other drugs were added.Drugs for breaking blood and removing blood stasis should be used carefully in the treatment of chronic liver disease.The main treatment should be promoting blood circulation,nourishing blood and nourishing liver body.Jaundice is treated by the method of promoting blood circulation,regulating the liver and spleen,and paying attention to Qi.The combination of disease differentiation and syndrome differentiation should be used according to different types,and the patients with long illness should be treated by tonifying the kidney and cleaning therapy.HAN believes that disharmony between the liver and spleen,liver depression and spleen deficiency are the main causes of chronic liver disease,so attention should be paid to regulating the spleen and regulating Qi.Attention should be paid to soothing the liver and relieving depression to grasp the pathogenesis and use drugs flexibly to cure both symptoms and root causes.Obstruction of Qi and stagnation of liver pulse are the main pathogenesis of chronic liver disease.Treatment should pay attention to regulating Qi,activating blood circulation,and removing blood stasis for preventing and reversing liver cirrhosis.In view of the pathological condition of asthenia in origin and excess in superficiality,and asthenia accompanied by sthenia in patients with liver disease,attention should be paid to the use of blood-breaking drugs.According to the different stages of chronic liver disease,the patients were treated according to syndrome differentiation and classified on the basis of the treatment of the Gongbu decoction.This paper analyzes 2 cases of chronic liver disease of HAN,in order to provide reference for related research.