肝硬化腹水的中医药诊疗进展
|
摘要
肝硬化腹水是肝硬化失代偿期的常见并发症,属中医学"臌胀"范畴,为"风、痨、鼓、膈"四大顽症之一。其形成常由多种原因共同作用,如门脉压力增高、低蛋白血症、水钠潴留、周围血管扩张等。大量腹水可造成患者腹胀及饮食、呼吸与行动困难,并可增加腹腔感染、肾功能衰竭等并发症的风险,反复发作腹水严重影响患者的生活质量及预后,目前西医对该病仍未取得理想的治疗效果且复发率高,而中医从整体观念辨证论治和特色治疗出发,取得了一定的疗效。中医药治疗对于改善失代偿期肝硬化患者的生活质量极其重要。本文就肝硬化腹水的中医病因病机、诊疗现状及进展进行综述。
Ascites of liver cirrhosis is a common complication of decompensation of cirrhosis. It belongs to the category of Guzhang( 臌胀) in traditional Chinese medicine. It is one of the four major obstinate diseases of Feng( 风), Lao( 痨), Gu( 鼓) and Ge( 膈). Its formation is often caused by a variety of factors, such as increased portal pressure, hypoproteinemia, water and sodium retention, peripheral vasodilation, and so on. A large amount of ascites may cause abdominal distension, difficulty in eating, breathing and moving, and increase the risk of complications such as abdominal infection, renal failure, etc. Repeated episodes of ascites can seriously affect the quality of life and prognosis of patients. At present, Western medicine has not achieved ideal therapeutic effect and it has high recurrence rate, but TCM has achieved certain curative effect from the whole concept of syndrome differentiation and characteristic treatment. Traditional Chinese medicine is very important to improve the quality of life of patients with decompensated cirrhosis. This article reviews the etiology, pathogenesis, diagnosis and treatment of ascites in cirrhotic patients.
Ascites of liver cirrhosis is a common complication of decompensation of cirrhosis. It belongs to the category of Guzhang( 臌胀) in traditional Chinese medicine. It is one of the four major obstinate diseases of Feng( 风), Lao( 痨), Gu( 鼓) and Ge( 膈). Its formation is often caused by a variety of factors, such as increased portal pressure, hypoproteinemia, water and sodium retention, peripheral vasodilation, and so on. A large amount of ascites may cause abdominal distension, difficulty in eating, breathing and moving, and increase the risk of complications such as abdominal infection, renal failure, etc. Repeated episodes of ascites can seriously affect the quality of life and prognosis of patients. At present, Western medicine has not achieved ideal therapeutic effect and it has high recurrence rate, but TCM has achieved certain curative effect from the whole concept of syndrome differentiation and characteristic treatment. Traditional Chinese medicine is very important to improve the quality of life of patients with decompensated cirrhosis. This article reviews the etiology, pathogenesis, diagnosis and treatment of ascites in cirrhotic patients.
引文
[1]Biecker E.Diagnosis and therapy of ascites in liver cirrhosis[J].World J Gastroenterol,2011,17(10):1237-1248.
[2]王益新.疏肝化瘀培本利水治疗肝硬化腹水40例[J].光明中医,2009,24(12):2296-2297.
[3]关幼波.关幼波临床经验选[M].北京:人民卫生出版社,2006:141-156.
[4]潘洋,王炎杰,张琪.张琪治疗肝硬化腹水经验[J].中医杂志,2011,52(5):380-381.
[5]欧志穗,刘友章,杨汉彬.肝脾相关理论在肝硬化腹水治疗中的应用[J].时珍国医国药,2011,22(9):2272-2273.
[6]李佃贵,李刚,刘金里.李佃贵以“浊毒”立论治疗肝硬化经验[J].陕西中医,2006(11):1394-1395.
[7]程良斌.张赤志教授从痰论治肝硬化的经验[J].中西医结合肝病杂志,2011,21(2):108-109.
[8]陈如松.陈洪干辨治肝硬化腹水的经验[J].江苏中医药,2010,42(11):13-14.
[9]史丽萍.基于《黄帝内经》臌胀理论分析肝硬化腹水的中医诊治[J].中医临床研究,2017,9(21):33-35.
[10]崔文旺,周尔忠.周尔忠治疗肝硬化腹水经验[J].湖北中医杂志,2011,33(9):25-26.
[11]马素平.赵文霞肝硬化学术思想与益气活血利水法治疗肝硬化腹水临床研究[D].济南:山东中医药大学,2015.
[12]罗雪梅,周凯,舒发明,等.中医通法在肝硬化腹水治疗中的运用[J].四川中医,2015,33(10):28-30.
[13]聂伟.实脾祛邪法治疗肝硬化腹水32例小结[J].湖南中医杂志,1999,15(3):14-15.
[14]张学斌,张北平.以健脾逐瘀利水法为主治疗肝硬化腹水的临床观察[J].广州中医药大学学报,2002,19(4):272-274.
[15]袁晓清,潘博.健脾益肝汤治疗肝硬化腹水38例临床观察[J].湖南中医药导报,2008,8(5):252-253.
[16]李佑桥,郑其进.益气温阳法治疗肝硬化腹水的临床研究[J].中医学报,2011,26(8):976-977.
[17]朱建明.益气滋阴淡渗法治疗肝硬化腹水40例[J].陕西中医,2009,30(1):11-12.
[18]赵晓威,尚尔寿.三棱莪术汤为主治疗肝硬化腹水40例[J].湖南中医药导报,2007,7(12):590-591.
[19]杨小军,张国梁,刘永华.中药敷脐辅助治疗肝硬化腹水临床疗效观察[J].辽宁中医药大学学报,2016,18(5):128-131.
[20]孙新锋,韩志毅,邢宇锋,等.敷脐透肠疗法联合人脐带间充质干细胞治疗肝硬化难治性腹水的效果[J].中国医药导报,2016,13(22):4-7.
[21]费景兰,梁浩卫,赵文霞.荷叶中药封包治疗顽固性肝硬化腹水患者疗效观察[J].光明中医,2015,30(6):1208-1210.
[22]蔡春江,梁燕,徐任.浊霾散敷脐联合艾灸法治疗鼓胀(乙型肝炎肝硬化腹水)疗效评价[J].中华中医药学刊,2016,34(4):1017-1020.
[23]杨咏华.艾灸神厥等穴合消胀散脐周外敷治疗护理肝硬化腹水[J].湖北中医杂志2012,34(2):37-38.
[24]龙舟.中医药治疗肝硬化腹水概况[J].中医临床研究,2012,4(5):20-21.
[2]王益新.疏肝化瘀培本利水治疗肝硬化腹水40例[J].光明中医,2009,24(12):2296-2297.
[3]关幼波.关幼波临床经验选[M].北京:人民卫生出版社,2006:141-156.
[4]潘洋,王炎杰,张琪.张琪治疗肝硬化腹水经验[J].中医杂志,2011,52(5):380-381.
[5]欧志穗,刘友章,杨汉彬.肝脾相关理论在肝硬化腹水治疗中的应用[J].时珍国医国药,2011,22(9):2272-2273.
[6]李佃贵,李刚,刘金里.李佃贵以“浊毒”立论治疗肝硬化经验[J].陕西中医,2006(11):1394-1395.
[7]程良斌.张赤志教授从痰论治肝硬化的经验[J].中西医结合肝病杂志,2011,21(2):108-109.
[8]陈如松.陈洪干辨治肝硬化腹水的经验[J].江苏中医药,2010,42(11):13-14.
[9]史丽萍.基于《黄帝内经》臌胀理论分析肝硬化腹水的中医诊治[J].中医临床研究,2017,9(21):33-35.
[10]崔文旺,周尔忠.周尔忠治疗肝硬化腹水经验[J].湖北中医杂志,2011,33(9):25-26.
[11]马素平.赵文霞肝硬化学术思想与益气活血利水法治疗肝硬化腹水临床研究[D].济南:山东中医药大学,2015.
[12]罗雪梅,周凯,舒发明,等.中医通法在肝硬化腹水治疗中的运用[J].四川中医,2015,33(10):28-30.
[13]聂伟.实脾祛邪法治疗肝硬化腹水32例小结[J].湖南中医杂志,1999,15(3):14-15.
[14]张学斌,张北平.以健脾逐瘀利水法为主治疗肝硬化腹水的临床观察[J].广州中医药大学学报,2002,19(4):272-274.
[15]袁晓清,潘博.健脾益肝汤治疗肝硬化腹水38例临床观察[J].湖南中医药导报,2008,8(5):252-253.
[16]李佑桥,郑其进.益气温阳法治疗肝硬化腹水的临床研究[J].中医学报,2011,26(8):976-977.
[17]朱建明.益气滋阴淡渗法治疗肝硬化腹水40例[J].陕西中医,2009,30(1):11-12.
[18]赵晓威,尚尔寿.三棱莪术汤为主治疗肝硬化腹水40例[J].湖南中医药导报,2007,7(12):590-591.
[19]杨小军,张国梁,刘永华.中药敷脐辅助治疗肝硬化腹水临床疗效观察[J].辽宁中医药大学学报,2016,18(5):128-131.
[20]孙新锋,韩志毅,邢宇锋,等.敷脐透肠疗法联合人脐带间充质干细胞治疗肝硬化难治性腹水的效果[J].中国医药导报,2016,13(22):4-7.
[21]费景兰,梁浩卫,赵文霞.荷叶中药封包治疗顽固性肝硬化腹水患者疗效观察[J].光明中医,2015,30(6):1208-1210.
[22]蔡春江,梁燕,徐任.浊霾散敷脐联合艾灸法治疗鼓胀(乙型肝炎肝硬化腹水)疗效评价[J].中华中医药学刊,2016,34(4):1017-1020.
[23]杨咏华.艾灸神厥等穴合消胀散脐周外敷治疗护理肝硬化腹水[J].湖北中医杂志2012,34(2):37-38.
[24]龙舟.中医药治疗肝硬化腹水概况[J].中医临床研究,2012,4(5):20-21.