臌胀从肝论治
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摘要
肝主疏泄,能疏通畅达一身之气机。肝气为病,多易波及他脏。臌胀之初多肝气郁滞,郁则盛,脾胃主运化水湿,但脾胃气机的升降必借助肝气的疏达始能调和不病,今肝气不和不能正常疏达反来克伐,则脾失健运,水湿难以运化而停滞腹中形成胀满。臌胀的形成与肝的生理功能、生理特性以及病理变化密切相关。臌胀从肝论治是根据肝的升达疏泄作用对气、血、水、脏腑以及情志的影响作用和臌胀与脏腑、气、血、水的密切关系而确定的。临床上通过调肝的方法使脏腑功能调和,气、血、水调畅,进而使人体气血恢复调和的状态,从而达到治疗本病的目的。臌胀早期肝郁脾虚,气滞湿阻,宜疏肝理气,健脾祛湿;臌胀中晚期肝郁血瘀水停,宜疏肝活血,化瘀利水;臌胀中晚期肝肾阴虚水停,宜柔肝滋肾,养阴利水;臌胀中晚期肝气阳虚水停,宜补肝气,温肝阳。臌胀无论从病因、病机还是辨证施治中的理法方药选择上,均应注重调肝。
The liver dominates dispersion and can disperse the qi movement of the whole body. Liver disease often involves other organs. In the early stage of tympanites,it is usually liver qi depression leading to excess. The spleen and stomach transport and transform water dampness. The descent and ascent of qi movement of spleen and stomach depend on the dispersion of liver qi. Depressed liver qi couldn't disperse but restricts in turn,leading to failure of spleen to transport and water dampness failing to transport and transform but stays in the abdomen and becomes tympanites. The formation of tympanites is closely related to the physical function,physical feature and pathological changes of the liver. The treatment of tympanites from the aspect of liver is based on the influence of dispersion of liver on qi,blood,water,viscera and emotions as well as the close relationship between tympanites and viscera,qi,blood and water. Clinically,the method of regulating the liver is applied to harmonize the visceral function and smooth the flow of qi,blood and water,thus making qi,blood and water in human body return to harmonious state and realize the objective of the treatment of this disease. In the early stage of tympanites,liver depression and spleen depression,qi stagnation and dampness obstruction should be treated by dispersing liver qi,strengthening spleen and removing dampness. In the the middle and late stage of tympanites,liver depression,blood stasis and water retention should be treated by dispersing liver,activating blood flow,resolving blood stasis and promoting diuresis; yin deficiency of liver and kidney and water retention should be treated by softening liver,nourishing kidney and yin and promoting diuresis; qi and yang deficiency of the liver and water retention should be treated by tonifying liver qi,warming liver yang. For the selection of theory,strategies,formulas and medicinals in the syndrome differentiation and treatment of tympanites,regulation of the liver should be attached great importance.
The liver dominates dispersion and can disperse the qi movement of the whole body. Liver disease often involves other organs. In the early stage of tympanites,it is usually liver qi depression leading to excess. The spleen and stomach transport and transform water dampness. The descent and ascent of qi movement of spleen and stomach depend on the dispersion of liver qi. Depressed liver qi couldn't disperse but restricts in turn,leading to failure of spleen to transport and water dampness failing to transport and transform but stays in the abdomen and becomes tympanites. The formation of tympanites is closely related to the physical function,physical feature and pathological changes of the liver. The treatment of tympanites from the aspect of liver is based on the influence of dispersion of liver on qi,blood,water,viscera and emotions as well as the close relationship between tympanites and viscera,qi,blood and water. Clinically,the method of regulating the liver is applied to harmonize the visceral function and smooth the flow of qi,blood and water,thus making qi,blood and water in human body return to harmonious state and realize the objective of the treatment of this disease. In the early stage of tympanites,liver depression and spleen depression,qi stagnation and dampness obstruction should be treated by dispersing liver qi,strengthening spleen and removing dampness. In the the middle and late stage of tympanites,liver depression,blood stasis and water retention should be treated by dispersing liver,activating blood flow,resolving blood stasis and promoting diuresis; yin deficiency of liver and kidney and water retention should be treated by softening liver,nourishing kidney and yin and promoting diuresis; qi and yang deficiency of the liver and water retention should be treated by tonifying liver qi,warming liver yang. For the selection of theory,strategies,formulas and medicinals in the syndrome differentiation and treatment of tympanites,regulation of the liver should be attached great importance.
引文
[1]肖冰,赵长鹰.肝硬化腹水从三焦论治探要[J].四川中医,2005,23(1):8-9.
[2]蒋本尤.以肝郁为核心论治肝硬化腹水五法[J].北京中医,1994,24(2):24-25.
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[8]谢晓琳.疏肝活血利水汤治疗肝硬化腹水临床观察[J].内蒙古中医药,2012,22(2):22-23.
[9]许雪君.一贯煎为主治疗肝硬化腹水32例小结[J].湖南中医杂志,1992,8(5):7-9.
[10]陈广梅,赵红兵,何晶,等.养阴活血利水方治疗阴虚型肝硬化腹水的临床疗效观察[J].四川中医,2013,31(2):68-69.
[11]单德成.邹元甫治疗肝硬化腹水经验撷萃[J].四川中医,2001,19(5):5-6.
[12]陶杨,辛国秋,蒋波涛.补肝利水汤治疗肝硬化腹水临床观察[J].中国中医急症,2013,22(7):1236-1237.
[2]蒋本尤.以肝郁为核心论治肝硬化腹水五法[J].北京中医,1994,24(2):24-25.
[3]周道红,周晓雁,周晓雷.标本兼顾治疗肝硬化腹水[J].四川中医,2000,18(8):12-14.
[4]邵铭.徐景藩治疗肝硬化腹水经验探析[J].辽宁中医杂志,2008,35(3):343.
[5]杜学盘,黄瑞华.疏利三焦法治疗臌胀——附燮理达肝汤治疗臌胀34例临床观察[J].光明中医,1998,13(5):48-50.
[6]王爱坚.四逆散为主治疗肝硬化腹水32例[J].山西中医,1999,15(2):34.
[7]杨现省.疏肝活瘀汤治疗肝硬化腹水30例[J].中国中医基础医学杂志,2005,11(1):76.
[8]谢晓琳.疏肝活血利水汤治疗肝硬化腹水临床观察[J].内蒙古中医药,2012,22(2):22-23.
[9]许雪君.一贯煎为主治疗肝硬化腹水32例小结[J].湖南中医杂志,1992,8(5):7-9.
[10]陈广梅,赵红兵,何晶,等.养阴活血利水方治疗阴虚型肝硬化腹水的临床疗效观察[J].四川中医,2013,31(2):68-69.
[11]单德成.邹元甫治疗肝硬化腹水经验撷萃[J].四川中医,2001,19(5):5-6.
[12]陶杨,辛国秋,蒋波涛.补肝利水汤治疗肝硬化腹水临床观察[J].中国中医急症,2013,22(7):1236-1237.