基于通补理论分期辨治肝硬化腹水经验  

Experience in Staged Differentiation and Treatment of Cirrhotic Ascites Based on the Theory of Tonification and Purging

作　　者：董海航 蔡雨洁 张会芹 陈艳[1] 涂钰莹 王冬凌 张引强[1] DONG Haihang;CAI Yujie;ZHANG Huiqin;CHEN Yan;TU Yuying;WANG Dongling;ZHANG Yinqiang(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing,10009l;Shanxi University of Chinese Medicine)

机构地区：[1]中国中医科学院西苑医院,北京市100091 [2]山西中医药大学

出　　处：《中医杂志》2025年第5期532-536,共5页Journal of Traditional Chinese Medicine

基　　金：中国中医科学院科技创新工程课题(CI2021A00805);中国中医科学院西苑医院提升中医药临床循证证据级别研究专项(XYZX0201-23);中国中医科学院西苑医院“青师计划”项目;全国中医特色临床技术传承骨干人才支持项目(010070011)。

摘　　要：认为肝硬化腹水患者具有正气衰少、邪实积聚的病机特点,临床当以通补理论为基础,分发作期与缓解期立法辨治,并根据邪正演进趋势持衡通补权重。发作期应通重于补,以通为补,畅达三焦助水气流行,明辨水湿瘀热轻重,攻邪务尽,避免伏病伤正,待“衰其大半”之机以调整用药趋势;缓解期当通补结合为主,寓通于补,兼清余邪防止闭门留寇,同时积极治疗原发病,以期愈病截根,勿令腹水复作。It is believed that patients with cirrhotic ascites exhibit a pathological mechanism characterized by the decline of healthy qi and the accumulation of pathogenic factors.Clinically,treatment should be based on the theory of tonification and purging,with a staged approach distinguishing between the active phase and the remission phase.The balance between tonification and purging should be adjusted according to the progression of pathogenic and healthy actors.In the acute phase,purging should take precedence over tonification,using purging as a means of tonification to facilitate the flow of water and qi through the triple energizer.The severity of water retention,dampness,blood stasis,and heat should be carefully assessed to ensure thorough elimination of pathogenic factors while avoiding harm to healthy qi.Medication adjustments should be made once the pathogenic factors are significantly weakened.In the remission phase,an integrated approach combining both tonification and purging should be adopted,incorporating purging within tonification to clear residual pathogens and prevent recurrence.Concurrently,proactive treatment of the underlying disease is essential to achieve complete recovery and prevent the recurrence of ascites.

关 键 词：肝硬化 腹水 通补理论 分期辨治 

分 类 号：R57[医药卫生—消化系统]