肝硬化门脉高压中医病机演变规律探讨

Exploration of the evolutionary pattern of pathogenesis in liver cirrhosis with portal hypertension in traditional Chinese medicine

门脉高压是慢性肝病最常见且致命的并发症,属中医“络脉病”范畴,由于络脉联属,肝与脾胃大小肠关系密切。湿热残毒是代偿期门脉高压形成关键因素,痰湿瘀血是其病理基础,肝病传脾是肝硬化代偿期转至失代偿期必然病机演变过程。血枯精竭,清浊相混是失代偿期肝硬化门脉高压加重的内在原因,临床常见吐血、鼓胀等并发症。“本虚标实”是门脉高压总的病机特点,和胃气是保护门静脉第一要务。

Portal hypertension is the most common and fatal complication of chronic liver disease,which falls under the category of"collateral disease"in Traditional Chinese Medicine(TCM).Due to the interconnectedness of the collaterals,the liver has a close relationship with the spleen,stomach,and the large and small intestines.Damp-heat and residual toxins are key factors in the formation of compensatory portal hypertension,while phlegm-dampness and blood stasis form its pathological foundation.The transmission of liver disease to the spleen is an inevitable process in the evolution from the compensatory phase to the decompensatory phase of liver cirrhosis.The depletion of blood and essence,and the mixing of clear and turbid substances are the intrinsic reasons for the exacerbation of portal hypertension in the decompensatory phase of liver cirrhosis,with common clinical complications such as hematemesis and ascites."Deficiency of the root and excess of the branch"is the overall characteristic of the pathogenesis of portal hypertension,and protecting the stomach qi is the foremost task in preserving the portal vein.