从“燥化瘀”论治肝纤维化  

Treatment of Liver Fibrosis from Perspective of"Dryness Inducing Blood Stasis"

作　　者：杜燕 茆春阳 周波[1] DU Yan;MAO Chunyang;ZHOU Bo(Ningxia Medical University,Ningxia Yinchuan China 750004)

机构地区：[1]宁夏医科大学,宁夏银川750004

出　　处：《中医学报》2024年第11期2345-2349,共5页Acta Chinese Medicine

基　　金：宁夏自然科学基金项目(2023AAC03212);宁夏重点研发计划项目(2021BEG03112);宁夏医科大学2021年校级重点科研项目(XZ2021006)。

摘　　要：在肝纤维化的发病过程中“燥”是主要病因,一则温燥易耗伤津血,日久成瘀;二则寒燥仅次于寒邪,寒性收引,日久成瘀,瘀久脉络阻塞均可加重肝纤维化病情。因此,从“燥化瘀”论治肝纤维化应当遵循“润燥、化瘀、清泻肝火”的原则,其中润燥、化瘀是重点。治疗上应以温通经脉类活血化瘀药物为主,如三七、红花、川芎等药物,性温能散寒燥所凝滞之瘀血。若木火亢盛引起的肝纤维化,须加入重镇熄风之品,如煅龙骨、煅牡蛎,再加麦冬、竹茹等养阴生津药物以除所生燥邪,平复肝木;若因肾阳虚衰,无力温化水液,导致肝阳过盛,应从阴分入手,滋养肾阴清泻肝火,宜给予大补地黄丸、六味丸之类;若因秋天清肃之气过剩,金太过,克制肝木,肝的正常生理功能受损,须表里同治,以苦温药物祛除过剩之燥邪,佐以甘辛药物补充正气虚衰;若因湿邪在体内停留化热,湿热化燥,燥邪伤津,久则络热血瘀,加重肝纤维化病情,应运用生地黄、桑白皮、川贝母等凉润之物保存津液。In the pathogenesis of liver fibrosis,"Dryness"is the main cause.One reason is that Dryness can consume blood and Fluid and induce blood stasis over time.Another reason is that Cold Dryness,which is less serious than that of Cold evil factor,is harmful and Cold leads to retraction and then blood stasis over time.Eventually Cold Dryness causes meridian and collateral obstruction,which can aggravate the degree of liver fibrosis.Therefore,the treatment of liver fibrosis from perspective of"Dryness inducing blood stasis"should follow the principle of"relieving Dryness,removing blood stasis and clearing Liver Fire",of which the first two principles are the key points.In terms of clinical treatment,drugs functioning in warming and dredging the meridians and collaterals to invigorate blood circulation and remove blood stasis,such as Sanqi(Panax notoginseng),Honghua(Safflower),Chuanxiong(Ligusticum wallichii)can be used because they are warm in character and can dissipate blood stasis caused by Cold Dryness.As for the liver fibrosis with excessive Wood Fire syndrome,it is necessary to use drugs functioning in extinguishing Wind,such as Duanlonggu(Calcined keel),Duanmuli(Calcined oyster),and drugs functioning in nourishing Yin and producing Fluid,such as Maidong(Ophiopogon japonicus)and Zhuru(Caulis bambusae in taeniam),to remove Dryness and calm the Liver Wood.If the Kidney Yang is weak and the Water is unable to be warmed up,resulting in excessive Liver Yang,treatment should start from the Yin aspect,namely,nourishing the Kidney Yin to clear the Liver Fire,with Dabu Dihuang Pills or Liuwei Pills and the like.If the disease is due to the excessive descending Lung Qi in autumn and the normal physiological function of the Liver is impaired,and the normal physiological function of the liver is impaired,it is necessary to treat from the outside and the inside at the same time in treatment,by using bitter and warming drugs to remove the excess Dryness,accompanied by sweet and pungent drugs to supplement the deficiency of Zhen

关 键 词：肝纤维化 “燥化瘀” 温燥 寒燥 润燥 化瘀 清泻肝火 

分 类 号：R256.4[医药卫生—中医内科学]