肝硬化“虚积互生”的病机探讨  

Discussion on Pathogenesis of Mutual Transformation between Deficiency and Cumulative Pathological Changes in Liver Cirrhosis

作　　者：李瀚旻[1] 

机构地区：[1]湖北中医药大学附属医院肝病研究所,国家中医药科研细胞分子生物学三级实验室,湖北武汉430061

出　　处：《中华中医药学刊》2015年第12期2825-2827,共3页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81373513;90709041;30672590;30271562;30371787;81102531;81274147);国家重大基础研究发展计划(973计划)项目(2002CCC00300);国家中医临床研究基地(湖北)重点病种研究项目(JDZX2012054);国家"十二五"重大专项项目(2012ZX10005005-001-015);湖北省自然科学基金重点项目(2011CDB463);高等学校博士学科点专项科研基金项目(20124230110001);武汉市科技局科技攻关武汉市重大科技产业化专项项目(201260523199)

摘　　要：从生机学说探讨肝硬化"虚积互生"的病机认识,认为"虚"、"损"、"积"三者之间通过肝再生修复机制存在如下关系:肝损伤后通过正常肝再生修复而不会形成虚证,肝再生修复机制受到干扰后会出现虚证与实证两种结果,并会形成"因虚致实"、"因实致虚"恶性病理循环。肝再生紊乱是导致肝纤维化向肝硬化进展中出现"因实致虚"("积生虚损")、"因虚致实"("虚损生积")两种病机转换("虚积互生")的关键环节。治疗主张协调运用"扶正除积"与"除积复正"。在"虚积互生"的病机转换之中,"肝肾精虚"是肝纤维化向肝硬化进展的基础证候,常见的"肝肾阴虚"、"脾肾阳虚"、"肾虚邪实"诸证均在"肝肾精虚"的基础上发展而来。采用"补肾生髓成肝"可以通过调控肝损伤与肝再生失衡,打破"虚积互生"恶性病理循环,显著提高防治肝硬化的临床疗效。To explore the understanding of the pathogenesis of the mutual transformation between deficiency and cumulative pathological changes in liver cirrhosis from the viewpoint of vitality theory. The following relationship exists among deficiency,injuries and cumulative pathological changes via the mechanism of liver regeneration and repair. Firstly,liver injury will not lead to the formation of deficiency after normal liver regeneration. However,if the mechanism of liver regeneration repair is disturbed by some factors,it will lead to deficiency syndrome and excess syndrome,and will form a vicious pathological cycle of excess syndrome caused by deficiency syndrome and deficiency syndrome resulted from excess syndrome. Secondly,the disorder of liver regeneration is the critical link leading to the conversion of two pathogenesis： excess syndrome caused by deficiency syndrome（ cumulative pathological changes resulting in deficiency and injuries） and deficiency syndrome resulted from excess syndrome（ deficiency and injuries resulting in cumulative pathological changes）,in the progress of liver fibrosis transforming into liver cirrhosis. So,the ways of strengthening the body resistance and removing cumulative pathological changes and removing cumulative pathological changes to restore the body resistance are advocated to be used in liver diseases with coordinated application. In the pathogenesis of the mutual transformation between deficiency and cumulative pathological changes,essence deficiency of liver and kidney is the basic syndrome in the progress of liver fibrosis transforming into cirrhosis. Moreover,some common syndromes（ e. g. yin deficiency of liver and kidney,yang deficiency of spleen and kidney,and deficiency of kidney and sthenia of pathogenic factors） were developed on the basis of essence deficiency of liver and kidney. The treatment of tonifying the kidney to regulate liver regeneration and repair by affecting stem cells and their microenvironment can significantly improve the clinical effic

关 键 词：肝硬化 虚积互生 生机学说 肝肾精虚 调控肝再生 

分 类 号：R657.31[医药卫生—外科学]