益气化瘀法治疗早期肝硬化(1)
【摘要】目的：就益气化瘀法治疗早期肝硬化进行探讨。方法：选取三个案例进行分析，将益气健脾，活血化瘀辨证治疗肝硬化。结果：案例1:服上方治疗3个月后病愈。随访至今未见再发。案例2诸症悉除，复查肝功能，肝胆脾彩超均属正常范围。后用上方加减研末冲服月余，以巩固疗效，随访1年未见再发。案例3诸症悉除，复查肝功能及肝胆脾彩超，其中彩超示：脾脏肿大，余项均属正常范围。后用上方加减蜜丸服药月余，病告痊愈，随访2年未见再发。结论：臌胀为临床四大疑难重症之一，其病机为肝脾肾三脏功能失调，气、血、水停于腹中，本虚标实，虚实夹杂的病理过程。
【关键词】肝硬化；益气化瘀；弥漫性纤维化
【中图分类号】R259 【文献标识码】A 【文章编号】1004-7484(2012)10-0102-01
Qi and removing blood stasis in treating early stage cirrhosis
, http://www.100md.com
【Abstract】Objective：Yiqi Huayu method treatment early time liver cirrhosis of. Methods：a total of three cases were analyzed, the Qi of the spleen, promoting blood circulation to remove blood stasis syndrome differentiation and treatment of liver cirrhosis. Results：the case of 1: served 3 months after the treatment was over. Up to now no longer hair. 2 cases are in addition to all disease, the liver function, liver spleen ultrasound within the normal range. After using the above addition and subtraction grind end each month, in order to consolidate the curative effect, follow-up of 1 years again. 3 cases are in addition to all disease, the liver function and liver spleen ultrasound, including ultrasonography indicated: enlargement of spleen, the remainder were within normal range. After taking over addition and subtraction pill month, disease to cure, follow-up of 2 years showed no recurrence. Conclusion：swelling for clinical four severe problems, its pathogenesis is spleen kidney three dirty function disorders, gas, blood, water stop in the abdomen, the superficial, inclusion of actual pathological process.
, http://www.100md.com
【Key words】liver cirrhosis; supplementing qi and removing blood stasis; diffuse fibrosis
肝硬化是一种以肝组织弥漫性纤维化，假小叶和再生节结形成位特征的慢性肝病。数中医“鼓胀”范畴。从中医辨证来看，认为肝硬化往往以气虚血瘀或其他证型为常见，利用益气健脾，改善消化吸收功能，有利于白蛋白升高[1]；用活血化瘀药扩张肝血管，增强肝脏血液循环和肝脏血流量的作用，从而可减少病变部位缺血，改善营养及供氧，以防治肝细胞坏死，加速病灶的吸收和修复，使白蛋白升高，球蛋白降低，提高细胞免疫功能[2]，兹将益气健脾，活血化瘀辨证治疗肝硬化，举例如下。
案例1
沈××，男，32岁，巴东元渡河村农民。1998年10月中旬初诊。患“乙肝”5年。近因劳累过度而感全身困倦，右胁隐痛，腹胀纳差厌油，曾在当地某医院诊断为“肝硬化失代尝期”、“肝癌？”，住院2个多月，上症无明显好转，反而腹胀如鼓而求治于中医。症见腹部胀大，脉络暴露，面目俱黄，右胁隐痛，时有胀、刺痛，纳差厌油，双下肢浮肿，大便干稀交替，小便短黄少，面色酶暗，舌质暗红，苔黄腻，脉细弦。血检：血常规正常，肝功能：总胆红素328umol/L，直接胆红素170umol/L，总蛋白62.3g/L，白蛋白28.3g/L，谷丙转氨酶850u/L。肝脾彩超提示：肝硬化大量腹水，脾脏大于正常。证属肝脾血瘀，湿热温结中焦。治宜活血化瘀，健脾利湿，清热解毒退黄，方用调营饮合茵陈蒿汤加减[3]。
, 百拇医药
药用：丹参30g 赤芍20g 当归10g 条参15g 白术10 g 茯苓15g 伏毛15g 半边莲30g 虎杖15g 泽泻15g 猪苓15g 茵陈30g 水煎服，一日一剂。
二诊：服上方3剂后腹胀减轻，双下肢浮肿消退，恶心欲呕、厌油感消失。继上方再服10剂后，诸症减轻。复查肝功能：总胆红素38umol/L，直接胆红素12umol/L，总蛋白65.3g/L，白蛋白38.5g/L，谷丙转氨酶260u/L。肝脾彩超提示：肝硬化，伴少量腹水[4]。继上方加减如下：
(1)黄芪20g 条参15g 茯苓15g 赤芍50g 大黄6g 虎杖15g 丹参15g 三棱15g 莪术15g 伏毛15g 半边莲30g 茵陈20g 焦三仙各15g 水煎服，一日一剂。, 百拇医药(叶思文)
【关键词】肝硬化；益气化瘀；弥漫性纤维化
【中图分类号】R259 【文献标识码】A 【文章编号】1004-7484(2012)10-0102-01
Qi and removing blood stasis in treating early stage cirrhosis
, http://www.100md.com
【Abstract】Objective：Yiqi Huayu method treatment early time liver cirrhosis of. Methods：a total of three cases were analyzed, the Qi of the spleen, promoting blood circulation to remove blood stasis syndrome differentiation and treatment of liver cirrhosis. Results：the case of 1: served 3 months after the treatment was over. Up to now no longer hair. 2 cases are in addition to all disease, the liver function, liver spleen ultrasound within the normal range. After using the above addition and subtraction grind end each month, in order to consolidate the curative effect, follow-up of 1 years again. 3 cases are in addition to all disease, the liver function and liver spleen ultrasound, including ultrasonography indicated: enlargement of spleen, the remainder were within normal range. After taking over addition and subtraction pill month, disease to cure, follow-up of 2 years showed no recurrence. Conclusion：swelling for clinical four severe problems, its pathogenesis is spleen kidney three dirty function disorders, gas, blood, water stop in the abdomen, the superficial, inclusion of actual pathological process.
, http://www.100md.com
【Key words】liver cirrhosis; supplementing qi and removing blood stasis; diffuse fibrosis
肝硬化是一种以肝组织弥漫性纤维化，假小叶和再生节结形成位特征的慢性肝病。数中医“鼓胀”范畴。从中医辨证来看，认为肝硬化往往以气虚血瘀或其他证型为常见，利用益气健脾，改善消化吸收功能，有利于白蛋白升高[1]；用活血化瘀药扩张肝血管，增强肝脏血液循环和肝脏血流量的作用，从而可减少病变部位缺血，改善营养及供氧，以防治肝细胞坏死，加速病灶的吸收和修复，使白蛋白升高，球蛋白降低，提高细胞免疫功能[2]，兹将益气健脾，活血化瘀辨证治疗肝硬化，举例如下。
案例1
沈××，男，32岁，巴东元渡河村农民。1998年10月中旬初诊。患“乙肝”5年。近因劳累过度而感全身困倦，右胁隐痛，腹胀纳差厌油，曾在当地某医院诊断为“肝硬化失代尝期”、“肝癌？”，住院2个多月，上症无明显好转，反而腹胀如鼓而求治于中医。症见腹部胀大，脉络暴露，面目俱黄，右胁隐痛，时有胀、刺痛，纳差厌油，双下肢浮肿，大便干稀交替，小便短黄少，面色酶暗，舌质暗红，苔黄腻，脉细弦。血检：血常规正常，肝功能：总胆红素328umol/L，直接胆红素170umol/L，总蛋白62.3g/L，白蛋白28.3g/L，谷丙转氨酶850u/L。肝脾彩超提示：肝硬化大量腹水，脾脏大于正常。证属肝脾血瘀，湿热温结中焦。治宜活血化瘀，健脾利湿，清热解毒退黄，方用调营饮合茵陈蒿汤加减[3]。
, 百拇医药
药用：丹参30g 赤芍20g 当归10g 条参15g 白术10 g 茯苓15g 伏毛15g 半边莲30g 虎杖15g 泽泻15g 猪苓15g 茵陈30g 水煎服，一日一剂。
二诊：服上方3剂后腹胀减轻，双下肢浮肿消退，恶心欲呕、厌油感消失。继上方再服10剂后，诸症减轻。复查肝功能：总胆红素38umol/L，直接胆红素12umol/L，总蛋白65.3g/L，白蛋白38.5g/L，谷丙转氨酶260u/L。肝脾彩超提示：肝硬化，伴少量腹水[4]。继上方加减如下：
(1)黄芪20g 条参15g 茯苓15g 赤芍50g 大黄6g 虎杖15g 丹参15g 三棱15g 莪术15g 伏毛15g 半边莲30g 茵陈20g 焦三仙各15g 水煎服，一日一剂。, 百拇医药(叶思文)