从《灵枢·天年》“肝衰胆灭”理论探讨原发性胆汁性肝硬变的论治

Discussion on the Treatment of Primary Biliary Cirrhosis from the Theory of "Ganshuai Danmie" in Lingshu·Tiannian

原发性胆汁性肝硬变是一种慢性自身免疫性肝病,属于中医"黄疸""臌胀""积聚""胁痛"等范畴。依据"肝衰胆灭"理论,认为该病病初,患者可因感受内外之邪,或因情志失调而致肝气不畅,疏泄失常,胆汁分泌失调;病中,肝失疏泄、胆失藏泌之病理变化加重,而致脾胃功能失常;病进,肝病及肾,肝病及脾,肝脾同病,日久入肾;病终,肝衰胆灭,脏腑同病,神明受害。治疗从疏肝利胆着眼,结合脏腑,分论虚实,明辨气血。病初治以疏肝利胆、理气行血;病中治以疏肝健脾、顺气和血;病进治以补益肝肾、调气和血;病终治以通调脏腑、开窍醒神。

Primary biliary cirrhosis is a chronic autoimmune liver disease that belongs to the category of ' jaundice' ' swelling' ' accumulation' and ' hypochase pain' in Chinese medicine. According to the theory of ' ganshuai danmie ',it is believed that at the beginning stage of the disease,the patient may suffer from stagnation of liver qi,dysfunction of conveyance and dispersion,and bile secretion disorder due to the pathogenic qi inside or outside the body,or due to emotional disorders. It is believed that in the middle stage of the disease,the pathological changes of the liver dysfunction of conveyance and dispersion,biliary dysfunction and secretion are aggravated,resulting in the dysfunction of the spleen and the stomach. The disease develops further. The liver diseases spread to the kidney. The liver diseases spread to the spleen. The liver and the spleen also suffer from diseases,which spread to the kidney over time. At the end stage of the disease,the liver and the gallbladder are dead,and the zang-fu viscera are sick,and then the spirit is victimized. In treatment,we should disperse stagnated liver qi for promoting bile flow,combine with the zang-fu viscera,dissect the deficiency and excess,and identify qi and blood. The treatment at the beginning stage of the disease is to disperse stagnated liver qi for promoting bile flow,regulate qi and promote blood circulation. The treatment in the middle stage of the disease is to soothe the liver and invigorate the spleen,smooth qi and blood. The treatment at the further development of the disease is to nourish the liver and kidney,regulate qi and blood. The treatment the last is to regulate the zang-fu viscera and induce resuscitation.