董明国从湿热稽留、阴虚血瘀论治早期肝硬化经验

Experience of DONG Ming-Guo in Treating Early Cirrhosis from the Pathogenesis of Retention of Damp-Heat,and Blood Stasis Due to Yin Deficiency

肝硬化是指由各种病因长期损害肝脏,致肝脏进展成为肝炎、肝纤维化、假小叶形成的病理阶段。中医认为,无论隐源性抑或是继发性肝硬化,均存在明确的病理因素。董明国教授继承以往各名老中医辨治肝硬化的思路,并结合多年临床实践经验,认为早期肝硬化患者的主要病机为湿热稽留、阴虚血瘀,病位主要涉及脾胃与肝胆;对于湿热的治疗,主张采用“轻可去实”之法,运用轻清芳香之品,轻开宣达,醒脾祛湿,分消其势;对于阴虚血瘀,宜施“四面合围”之策,合用养阴益气、活血消癥、清热诸法,常选用新订之何炎燊的二甲调肝汤。通过“轻可去实”“四面合围”方法将病因尽除,分消其病势,以达祛除病因、稳定肝硬化进程的目的,为肝硬化的巩固治疗奠定基础。

Cirrhosis is a pathological stage in which the liver is damaged by various etiologic factors over a long period of time,and then progresses to hepatitis,hepatic fibrosis,and pseudo-lobule formation.In the view of traditional Chinese medicine(TCM),there are definite pathological factors for both cryptogenic and secondary cirrhosis.Based on the thoughts of previous famous TCM physicians in treating cirrhosis and his own clinical practice for years,Professor DONG Ming-Guo proposed that the pathology of early cirrhosis is mainly due to the retention of damp-heat,and blood stasis due to yin deficiency,and the location of disease mainly involves the spleen and stomach,liver and gallbladder.For the treatment of damp-heat,he advocated to follow the principle of“relieving exterior-excess syndrome with light and mild drugs”,and adopted light and mild drugs and aromatic drugs for dispersing and dispelling the damp-heat,and enlivening spleen to remove dampness,thus to relieve the impact of dam-heat pathogen.For the management of blood stasis due to yin deficiency,“comprehensive encircling therapy”consisting of the methods of nourishing yin and replenishing qi,activating blood and eliminating abdominal mass,and clearing heat was recommended,and the refined Erjia Tiaogan Decoction of HE Yan-Shen was usually adopted.Through“relieving exterior-excess syndrome with light and mild drugs”and“comprehensive encircling therapy”,the etiologic factors of the disease will be eliminated and their impact on the disease is relieved,and then the purpose of eliminating the etiologic factors of the disease and stabilizing the process of cirrhosis can be achieved,which will lay the foundation for the consolidation therapy of cirrhosis.