姚乃礼以“肝络”理论辨治慢性乙型病毒性肝炎肝纤维化

慢性乙型病毒性肝炎、早期肝硬变的始动因子及持续因素是湿热疫毒,发病之本是正气不足;病机在于"毒损肝络",疾病渐进深入;瘀、毒、湿、热是主要致病因素。治以化瘀通络、扶正解毒之法。(1)肝络失和:湿热疫毒初袭肝络,络脉气机不畅,多以气滞表现为主,常见胸胁或脘腹胀满、嗳气,或腹中包块,聚散不定,按之不痛,大便不畅,舌暗红,脉弦或弦细。对于气分表现明显者,常予疏通气血、疏肝通络之法,临证多以旋覆花、桂枝、当归、木香、香附、姜黄、郁金等辛香通络之品。(2)肝络瘀滞:肝络气机不畅,气滞常与血瘀兼见,患者多见局部胀满疼痛,甚者刺痛,口干不欲饮,舌暗紫,脉弦涩或细涩,治疗常以化瘀通络之法,临证常用黄芪、白术、莪术、丹参、桃仁等。(3)络损成积:肝络气血不畅日久,瘀、毒、湿、热蕴结肝络,形成结节、积块、癥瘕,患者多见局部肿块或癥积,面色晦暗或黯黑,肌肤甲错,如鱼鳞状,痛如针刺,按之加重,舌质紫暗或有瘀斑,舌下络脉曲张或有结节状,脉细涩,病证较深重,常治以化瘀消癥散结之法,常用丹参、莪术、浙贝母、牡蛎、虫、山慈菇、鸡内金等,同时随证佐以虫类药以搜剔在络之邪,如全蝎、地龙、蜈蚣、蝉蜕等药。(4)络脉失养:机体感受疫毒邪气,其本在于素体不足,正气亏虚,络虚留邪,精微化生不足,肝络愈虚而毒邪深伏;或邪毒侵袭,伤及正气,正邪交争,则肝络益损,临证可见神疲乏力,少气懒言,爪甲不荣,皮肤起屑或干燥,唇舌色淡,脉虚或弱等络虚不荣的表现,治以养血和络之法,常以黄芪、白术、茯苓、当归、白芍、丹参等药。

Yao Naili Treating Liver fibrosis of Chronic Hepatitis B Based on Theory of "Liver Collateral"

The initiating and persistent factors of chronic hepatitis B and early liver cirrhosis are the hot and humid epidemic,and the origin of the disease is Zheng Qi deficiency. The pathogenesis lies in "toxic damage to the liver and collaterals",and the disease gradually deepens;stasis,poison,humidity,and heat Is the main pathogenic factor. Treatment of that should be Huayu Tongluo and Fuzheng Jiedu.(1) Hepatic dysfunction: Hot and humid epidemic first hits the liver collaterals,the qi and qi are not smooth,and most of them are mainly manifested by Qi stagnation. Common chest and thorax or abdominal fullness,belching,or abdominal masses are scattered. It is not painful,the stool is not smooth,the tongue is dark red,and the pulse strings or strings are thin. For those who have obvious Qi performance,the method of clearing Qi and blood and clearing the liver and collaterals is often given.The clinical evidences are mostly spiced Tongluo drugs such as convolute flowers,cinnamon sticks,angelica,woody incense,incense,turmeric,turmeric.(2) Liver collateral stagnation: Liver Qi stagnation is often accompanied by Blood stasis,and patients often experience local fullness and pain,even tingling,dry mouth,not wanting to drink,dark purple tongue,astringent or thin astringent pulse. In treatment the method of Huayu Tongluo is often applied. In clinical practice,Huangqi (Astragalus),Baizhu (Atractylodes),Ezhu (Curcuma),Danshen (Salvia),Taoren (peach kernel) and so on are often used.(3) Collateral formation: Liver Qi and Blood are not smooth for a long time,stasis,poison,wetness;heat builds up liver collaterals,forming nodules,lumps,and symptoms. Patients often see local masses or lumens,and their faces are dull or dark. The skin is like fish scales,pain like acupuncture,worsening,purple tongue or ecchymosis,veins under the tongue or nodules,thin veins,deeper symptoms,often treated The method of dissipating stasis and stasis is commonly used in Danshen (Salvia),Ezhu (Curcuma),Beimu (Fritillaria),Muli (Oyster),Zhechong (Ascaris),Shancigu (edible tulip),Jineijin (gizzard pepsin),etc. At the same time,it is accompanied by insects to search for evils in the network,such as Quanxie (whole scorpion),Dilong (lumbricus),Wugong (cricket),Chantui (cicada) and other medicines.(4) Loss of collaterals: The body feels the epidemic and poisonous gas,which is due to the lack of corpuscles,the deficiency of the righteousness,the deficiency of the collaterals,the lack of subtle metaplasia,the deficiency of the liver network and the deepening of the poisonous evil;Righteousness,righteousness and evil,the liver and the network will be damaged,and the clinical evidence shows that the fatigue is weak,less air,lazy words,disgruntled claws,dandruff or dry skin,pale lips,weak or weak pulses,etc.,The method of nourishing blood and collaterals is often treated with Huangqi (Astragalus),Baizhu (Atractylodes),Fuling (Poria),Danggui (Angelica),Baishao (radix paeoniae alba),Danshen (Salvia).