运用黄芪治疗岭南地区代谢相关脂肪性肝病经验  

Clinical Experience of Treating Metabolic Associated Fatty Liver Disease with Huangqi(Radix Astragali)in Lingnan(岭南)Area

作　　者：陈智恒 高博文 张朝臻[2,3] 施梅姐 萧焕明[2,3] 谢玉宝 池晓玲[2,3] CHEN Zhiheng;GAO Bowen;ZHANG Chaozhen;SHI Meijie;XIAO Huanming;XIE Yubao;CHI Xiaoling(Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510006;Guangdong Province Traditional Chinese Medical Hospital;The Second Affiliated Hospital of Guangzhou University of Chinese Medicine)

机构地区：[1]广州中医药大学第二临床医学院,广东省广州市510405 [2]广东省中医院 [3]广州中医药大学第二附属医院

出　　处：《中医杂志》2023年第17期1819-1823,共5页Journal of Traditional Chinese Medicine

基　　金：全国名老中医药专家传承工作室建设项目(国中医药人教函[2022]75号);广东省名中医传承工作室建设项目(粤中医办函[2018]5号);全国中医临床优秀人才研修项目(国中医药人教函[2022]1号);广东省中医院临床研究专项(1010专项)(YN10101903);广东省中医药局科研项目(20225022)。

摘　　要：基于岭南地区代谢相关脂肪性肝病的病证特点,探讨运用黄芪治疗岭南地区代谢相关脂肪性肝病经验。认为脾虚阳弱、湿浊内蕴为发病之源,病初之期当用黄芪健脾暖土以伏虚火,升清温表以制湿浊,常用15~30 g,用药需递进施补,可伍太子参、白术、茯苓、防风等共奏培土制湿之效;气血郁滞,痰湿蕴热为病进之机,当取黄芪实脾荣肝、通阳行滞之性,常用30~60 g,斡旋气机流行,通和中焦阳气,同时配伍柴胡、白芍、郁金等温凉共济;顽浊痼脂瘀结于肝,为病著之期,可夹湿、痰、热诸邪,黄芪需用至60~90 g,以活血消脂,扶正祛邪,并配合山楂、决明子、路路通、泽泻等消脂降浊药。遣方时当根据不同季节特点配伍他药,调黄芪之升降,以顺应四时之性。Based on the unique syndrome characteristics of metabolic associated fatty liver disease(MAFLD)in Lingnan(岭南)area,this paper discussed the clinical experience of Huangqi(Radix Astragali)in the treatment of MAFLD in Lingnan area.It is summarized that spleen deficiency and yang weakness,and internal accumulation of damp-turbidity are the source of the disease,and at the early stage,Huangqi,commonly 15~30 g,could be used to fortify the spleen and warm the earth,thereby making the deficiency fire latent,as well as raise the clear and warm the exterior so as to inhibit damp-turbidity;medication needs to be progressively supplemented,and can be used to⁃gether with Taizishen(Radix Pseudostellariae),Baizhu(Rhizoma Atractylodis Macrocephalae),Fuling(Poria),and Fangfeng(Radix Saposhnikoviae)to back up the earth and inhibit dampness.Qi stagnation and blood constraint,yin dampness and heat accumulation are the pathogenesis of disease progression.Huangqi should be taken to invigorate the spleen and flourish the liver,unblock yang,and move stagnation.The dosage is often maintained at 30~60 g,to circulate the qi and unblock yang qi in the middle jiao(焦),usually combined with Chaihu(Radix Bupleuri),Baishao(Radix Paeoniae Alba)and Yujin(Radix Curcumae)integrating warm and cool medicinals.Stubborn turbid and fat condensing in the liver is a severe stage of the disease and may be concurrent with various pathogens such as dampness,phlegm,and heat,for which 60~90 g Huangqi should be used to invigorate blood and disperse fat,rein⁃force healthy qi and expel pathogens,often with medicinals that can disperse fat and direct the turbid downward such as Shanzha(Fructus Crataegi),Juemingzi(Semen Cassiae),Lulutong(Fructus Liquidambaris)and Zexie(Rhizoma Alismatis).When prescribing,it is suggested to combine with other medicinals according to the season,thereby ad⁃justing the ascending and descending of the property of Huangqi,thereby conforming to the nature of the four seasons.

关 键 词：代谢相关脂肪性肝病 黄芪 岭南地区 

分 类 号：R259[医药卫生—中西医结合]