| 唐胜强,洪靖,邢赛伟,等.张杰辨治病毒性肝炎后肝硬化经验探析[J].浙江中医药大学学报,2022,46(4):408-411. |
| 张杰辨治病毒性肝炎后肝硬化经验探析 |
| ZHANG Jie's Experience in Treating Liver Cirrhosis after Viral Hepatitis |
| DOI：10.16466/j.issn1005-5509.2022.04.010 |
| 中文关键词: 肝硬化 虚、毒、瘀 肝脾建中 医案 临证经验 张杰 |
| 英文关键词: liver cirrhosis deficiency, toxin and blood stasis liver and spleen construction for the middle-Jiao medical records clinical experience ZHANG Jie |
| 基金项目:国家中医药管理局全国名老中医药专家张杰传承工作室建设项目(国中医药人教发[2012]149号) |
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| 中文摘要: |
| [目的] 总结张杰教授辨治病毒性肝炎后肝硬化的经验。[方法] 通过临床跟诊，阅读张师著作，整理分析相关医案，总结张师辨治病毒性肝炎后肝硬化的经验，并附验案一则。 [结果] 张师认为肝硬化的病位在肝，涉及脾肾，并创“虚、毒、瘀”理论，认为正虚是该病发生的前提和内在条件，肝炎病毒(湿热毒邪)侵及血分，戕害肝体是重要的发病因素，肝木失疏，脾土失运，肾失开阖，痰湿浊毒瘀阻肝络为发病病机，致腹腔内形成癥积痞块等顽疾。治疗上，张师主张肝脾建中，兼顾肾脏以补虚治本；利湿清热，解毒以祛邪；化瘀消癥，气血水并治。所附医案，张师辨为肝郁脾虚、浊毒瘀滞，治宜疏肝健脾、化瘀消癥、利湿解毒，以桂枝人参汤、小柴胡汤、茵陈蒿汤加减治疗，收效甚佳。 [结论] 张师临床辨治病毒性肝炎后肝硬化，以“虚、毒、瘀”理论为主线，善从肝脾入手，以肾为本，思路清晰，经验特色鲜明，拓宽了该病的诊治思路，值得学习和推广。 |
| 英文摘要: |
| [Objective] To summarize Professor ZHANG Jie's experience in the treatment of liver cirrhosis after viral hepatitis. [Methods]Through clinical follow-up， reading Professor ZHANG's works， sorting and analyzing relevant medical records， Professor ZHANG's experience in syndrome differentiation and treatment of liver cirrhosis after viral hepatitis was summarized， and one medical case was attached. [Results] Professor ZHANG believes that the disease of liver cirrhosis is located in the liver， involving the spleen and kidney， and creates the theory of “deficiency， toxin and blood stasis”. He believes that deficiency of healthy Qi is the premise and internal condition for the occurrence of the disease. Hepatitis virus(damp heat toxin) invades the blood and damages the liver body， which is an important pathogenic factor of the disease. The pathogenesis is stagnation of the liver Qi， dysfunction of the spleen in transportation，dysfunction of kidney Qi in consolidation， and phlegm dampness， turbidity， toxin and blood stasis blocking the liver collaterals， which cause persistent diseases such as mass formation in abdominal cavity. In terms of treatment， Professor ZHANG advocates liver and spleen construction for the middle-Jiao， and that the kidney should be taken into account to remedy the deficiency; draining dampness，clearing heat and relieving toxicity to dispel evil; activating blood promotion and resolving blood stasis， treating Qi， blood and water together. The attached medical case was identified by Professor ZHANG as liver depression and spleen deficiency， turbid toxin and blood stasis. It was appropriate to soothe the liver and spleen， remove blood stasis and eliminate symptoms， diuresis and detoxification， and added and subtracted Guizhi Renshen Decoction， Xiaochaihu Decoction and Yinchenhao Decoction were adopted， and the effect was good. [Conclusion] Professor ZHANG's clinical treatment of liver cirrhosis after viral hepatitis takes the theory of “deficiency， toxin and blood stasis” as the main line， starts from the liver and spleen， takes the kidney as the foundation， has clear ideas and distinctive experience characteristics， and widens the ideas of diagnosis and treatment of the disease， which is worthy of learning and promotion. |
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