基于“治肝实脾”理论治疗慢性肝病  

Discussion on treating chronic liver diseases based on the theory of treating liver diseases by strengthening spleen

作　　者：陈丽 李润 韦羽恬 林娜 梁尧[1] CHEN Li

机构地区：[1]广西中医药大学第一附属医院,广西南宁530000

出　　处：《中医临床研究》2024年第32期103-107,共5页Clinical Journal Of Chinese Medicine

基　　金：广西自然科学基金项目(2018GXNSFAA050134);黄贵华广西名中医传承工作室建设项目(桂卫中医发[2017]2号)。

摘　　要：慢性肝病可见脂肪肝、肝囊肿、肝炎等疾病,归于中医学“肝积、胁痛、黄疸、鼓胀”等范畴。历代医家对慢性肝病多治以疏肝健脾理气。治肝实脾理论最早源于《难经》,后在《金匮要略》中被进一步阐述,“见肝之病,知肝传脾,当先实脾”,其中蕴含治未病思想,在治疗肝病时还加用调补脾胃之药,使脾胃中土健旺,预防肝木过旺而乘脾土。脾胃为仓癝之官、气血生化之源,脾气健运可防肝木相乘,又可滋养肝木。文章基于治肝实脾理论,从理论基础及病因病机出发,探讨该理论对慢性肝病的治疗作用,并了解到治肝实脾理论与现代肠-肝轴学说相契合,得知西医的肠与中医“脾”的功能密切相关,大肠也是“脾”功能的一部分,其食物的消化、吸收、传导作用是中医脾主运化思想的具体表现,以大肠为中心,联系肝脾两脏。因此应将实脾贯穿于慢性肝病治疗的全过程,未病先防,既病防变,先安未受邪之地,在治疗慢性肝病时常加用健脾益气祛湿之药,以防止慢性肝病恶化。患者应保持心情舒畅、饮食有节,进行形体锻炼,日常采用中药调理身体,使气血平和,这对预防慢性肝病的进一步传变有积极意义。Chronic liver diseases include fatty liver,liver cysts,hepatitis,etc.,and are classified as the categories of liver Caccumulation,flank pain,jaundice,swelling and so on in traditional Chinese medicine(TCM).Ancient TCM practitioners often treated chronic liver diseases by the methods of soothing the liver,strengthening the spleen,and regulating Qi(气).The theory of treating liver diseases by strengthening spleen originated from Nanjing(《难经》),and was further elaborated in Jingui Yaolue(《金匮要略》),that is,when liver diseases occurs,it will spread to the spleen,so spleen Qi should be reinforced before it is affected.It contains the idea of preventive treatment of disease.In the treatment of liver diseases,medicines for regulating and tonifying the spleen and stomach are added to enhance the vitality of spleen and stomach,so as to prevent immoderate liver wood from bullying spleen soil.The spleen and stomach are the organs for grain storage,and the source of Qi and blood generation and metaplasia.The healthy movement of the spleen and stomach can prevent spleen from being bullied by liver wood,and can nourish liver wood.Based on the theory of treating liver diseases by strengthening spleen and starting from the theoretical basis,etiology,and pathogenesis,this paper explores the role of this theory in the treatment of chronic liver diseases.It is understood that the theory of treating liver diseases by strengthening spleen is in line with the modern theory of intestinal-liver axis.It is found that the function of the intestine in Western medicine is closely related to spleen in TCM,and the large intestine is also a part of spleen in TCM.The digestion,absorption,and conduction of food in large intestine are the specific manifestations of spleen governing transportation and transformation in TCM,with the large intestine as the center,connecting the liver and spleen.Therefore,strengthening spleen should be carried through the whole process of the treatment of chronic liver diseases,preventing the disease

关 键 词：治肝实脾 肠-肝轴 慢性肝病 

分 类 号：R256.4[医药卫生—中医内科学]