“病-方(效)-证”的研究实践与创新发展(二)——一贯煎治疗肝硬化的方证病理学基础探析  

Research practice and innovative development of"disease-formula(effect)-syndrome"(Ⅱ)--A nalysis on pathological basis of formula and syndrome of Y iguanjian in treatment of liver cirrhosis

作　　者：陈佳美[1] 慕永平[1] 刘平[1,2] CHEN Jiamei;MU Yongping;LIU Ping(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Institute of Liver Diseases,Shanghai Academy of Traditional Chinese Medicine,Key Laboratory of Liver and Kidney Diseases and Syndromes of the Minstry of Education,Shanghai Key Laboratory of Clinical Traditional Chinese Medicine,Shanghai 201203,China;Institute of Interdisciplinary Integrative Medicine Research,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院,上海市中医药研究院肝病研究所,肝肾疾病病证教育部重点实验室,上海市中医临床重点实验室,上海201203 [2]上海中医药大学交叉科学研究院,上海201203

出　　处：《上海中医药大学学报》2023年第2期1-6,21,共7页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(82130120,81973613)。

摘　　要：基于肝炎后肝硬化气虚血瘀的核心病机及肝肾阴虚、湿热内蕴的主要证候病机,采用不同功效中医古典方剂进行肝硬化多模型的疗效比较研究,明确滋肾养肝的一贯煎对肝细胞损伤为主的肝硬化模型有突出的作用。临床研究证实,一贯煎可显著改善失代偿期乙肝肝硬化肝肾阴虚为主证患者的Child-Pugh评分;深入研究表明,一贯煎治疗肝硬化主要机制在于改善肝实质细胞衰减,调控干细胞分化促进肝再生,改善肝组织缺氧状态,抑制肝窦内皮细胞损伤,血管新生以及改善炎症微环境等。基于“病-方(效)-证”相关理论,认为肝硬化肝肾阴虚证的关键病理学基础与肝实质细胞衰减、肝再生障碍、肝组织缺氧、肝窦内皮损伤和血管新生,以及与巨噬细胞为主的炎症微环境病变有关。提示着力加强方证病理生物学基础研究可能成为中医药治疗慢性难治性疾病的突破口。Based on the core pathogenesis of blood stasis due to qi deficiency in post-hepatitis cirrhosis and the main syndrome pathogenesis of yin deficiency of the liver and kidney,and damp-heat brewing internally,a comparative study on the efficacy of multiple models of crrhosis with different efficacy of traditional Chinese medicine(TCM)formulas,to demonstrate that the kidney and liver nourishing formula Yiguanjian had a prominent effect on hepatocyte damage dominated liver cirrhosis model.Yiguanjian can significantly improve the Child-Pugh score of patients with yin deficiency of the liver and kidney in decompensated hepatitis B cirrhosis.In-depth studies have showed that the main mechanisms of Yiguanjian in the treatment of cirrhosis are to improve the attenuation of hepatic parenchymal cells,regulate stem cell differentiation to promote liver regeneration,improve the hypoxia state of liver tissue,inhibit the damage of hepatic sinusoidal endothelial cells and angiogenesis,and improve the inflammatory microenvironment.Based on the theory of"disease-formula(effect)-syndrome",it is believed that the key pathological basis of liver and kidney yin deficiency syndrome in cirrhosis is related to hepatic parenchymal cell attenuation,liver regeneration disorder,liver tissue hypoxia,hepatic sinus endothelial injury and angiogenesis,as well as macrophage-dominated inflammatory microenvironment lesions.It is suggested that strengthening the basic research of pathobiology of formula and syndrome may be the breakthrough of TCM treatment of chronic refractory diseases.

关 键 词：证候病机 方证病理学 肝硬化 一贯煎 肝细胞衰减 肝再生 肝窦内皮细胞 

分 类 号：R259[医药卫生—中西医结合]