基于扶阳思想探讨慢加急性肝衰竭病机及治法

慢加急性肝衰竭属于中医黄疸、肝瘟等范畴。基于扶阳思想,慢加急性肝衰竭的基本病机为阳虚为本、毒邪为因。治疗上提出"次第治疗"原则,初期宜清通上焦阳明郁热,予桂枝法,方选桂枝二陈汤和茵陈蒿汤加减,使邪有出路;中期宜疏通中焦脾胃,予培土法,方选黄芪建中汤加减,以恢复中焦枢转之机;后期宜温扶下焦元阳,予四逆法,方选茵陈四逆汤加减,以补充坎中元阳,最终实现三焦阴阳自和的状态。

Exploration on Pathogenesis and Therapeutic Methods of Acute-on-chronic Liver Failure Based on Strengthening Yang Thought

Acute-on-chronic liver failure(ACLF) belongs to the category of jaundice and liver plague in traditional Chinese medicine(TCM). Based on the strengthening yang thought,the author proposes that yang deficiency is the fundamental pathogenesis of ACLF and toxic pathogen is the cause of the disease. The principle of sequent treatment is recommended for the treatment. At the early stage,the heat of Yangming in the upper energizer should be cleared up by Guizhi method,and modified Guizhi Erchen Decoction and Yinchenhao Decoction can be used to make the pathogen out. At the middle stage,the spleen and stomach in the middle energizer should be dredged by the method of cultivating the soil,and modified Huangqi Jianzhong Decoction can be used to restore the transportation function. At the last stage,the primordial yang in the lower energizer should be warmly strengthened by Sini(four-inverse) method,and modified Yinchen Sini Decoction can be used to tonify the primordial yang in Kan. All the treatments aim at achieving spontaneous harmonization of yin and yang in the triple energizer.