张玮四期辨治原发性胆汁性胆管炎思路与经验  

ZHANG Wei′s Thoughts and Experience on Treatment of Primary Biliary Cholangitis in The Fourth Stage

作　　者：陈海洋 张玮[1] CHEN Haiyang;ZHANG Wei(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院,上海200032

出　　处：《辽宁中医杂志》2024年第12期23-26,共4页Liaoning Journal of Traditional Chinese Medicine

摘　　要：旨在分析总结张玮教授原发性胆汁性胆管炎(primary biliary cholangitis,PBC)的辨证思路和用药特色。张师认为PBC乏力以肝气虚为主,血瘀病机贯穿疾病始终。依据中医宏观辨证和微观辨证将PBC分为四期治疗,发病初期核心病机为气虚血瘀湿蕴;进展期核心病机为气郁湿阻;肝纤维化期核心病机为肝脾肾虚;肝硬化阶段核心病机为肝肾阴虚、痰瘀凝结、脉络痹阻。治疗以“补虚化瘀”为基本治法贯穿始终,结合各期病机特点补虚重视肝脾肾,祛邪重视气郁、湿蕴、痰瘀、络阻。The purpose of this article is to analyze and summarize Professor ZHANG Wei′s syndrome differentiation and drug characteristics of primary biliary cholangitis(PBC).Dr.Zhang believed that the fatigue of PBC was mainly caused by liver Qi deficiency,and the pathogenesis of blood stasis ran through the disease.The treatment of PBC was divided into four stages according to TCM macro syndrome differentiation and micro syndrome differentiation.The core pathogenesis was Qi deficiency and blood stasis-damp accumulation.The core pathogenesis of advanced stage was Qi stagnation and dampness obstruction.The core pathogenesis of hepatic fibrosis was deficiency of liver,spleen and kidney.The core pathogenesis of liver cirrhosis stage is deficiency of liver and kidney Yin,coagulation of phlegm and blood stasis and obstruction of vein.The treatment is based on the principle of“tonifying deficiency and removing blood stasis”,which runs through the entire process.Combined with the characteristics of each stage′s pathogenesis,tonifying deficiency emphasizes liver,spleen and kidney,while dispelling evil emphasizes Qi stagnation,dampness accumulation,phlegm and blood stasis and obstruction of collaterals.

关 键 词：原发性胆汁性胆管炎 肝气虚 气虚血瘀 补虚化瘀 虚劳 

分 类 号：R256.4[医药卫生—中医内科学]