董振华教授治疗原发性胆汁性肝硬化经验总结

【作者】 刘颖；

【导师】 董振华；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2012， 硕士

【摘要】 [背景]原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)是一种与自身免疫有关的慢性进行性胆汁淤积性肝病,早期以肝内小胆管非化脓性破坏性炎症为主要病理特征,晚期进展为肝硬化。目前西医对于早期病人应用以针对胆汁淤积的熊去氧胆酸(UDCA)治疗有一定疗效,但对于终末期患者只能进行肝移植。近年来,中医药治疗PBC的报道逐渐增加,中西医结合治疗能够更好地改善PBC患者的临床症状,提高患者的生活质量。董振华教授多年来从事风湿免疫病的中医、中西医结合治疗,在临床实践中潜心研究,对治疗原发性胆汁性肝硬化积累了丰富的治疗经验。[目的]本文通过对董振华教授治疗96例PBC病例整理,总结其病因病机、辨证规律、治疗用药的思路及特点。为今后提高临床疗效,发挥中医药治疗PBC优势,以及进一步研究和阐明中医药治疗PBC作用机制的创新性研究奠定基础。[方法]通过在北京协和医院病案室查阅及门诊跟诊收集导师治疗的PBC病例96例,并系统整理,依据导师辨证分型,观察分析证型分布规律及证型转化特点,并结合导师平时带教点拨及其近年来发表的相关学术论文,总结董振华教授对PBC病因病机、辨证治疗,以及遣方用药等方面的特色。[结果]1主证分布规律：①肝郁脾虚型32例,占总数33%②脾胃气虚型22例,23%③气阴两虚9例,9%④肝肾阴虚14例,15%⑤湿热蕴结14例,15%⑥瘀血阻络5例,5%。2各主证兼夹证候分布规律：①肝郁脾虚型兼证最多的是湿热和湿热血瘀,分别为13例(41%)和6例(19%)②脾胃气虚型中湿困伤津和湿热血瘀相对较多,均为3例(14%)；③气阴两虚型各兼夹证型有4个,均只有1例,各占11%④肝肾阴虚型中兼夹湿热和肝郁脾虚相对较多,各3例(21%)⑤湿热蕴结型兼有阴虚和血瘀比较多,分别为4例(29%)和2例(14%)⑥瘀血阻络型总数只有5例,兼夹湿热,脾虚湿热,气滞湿热伤阴各1例(20%)。[结论]1病因病机特点：以脾胃病变为中心,脾胃气虚贯穿疾病始终。2辨证特点：①主证辨证以正虚为主,而正虚之中又以脾胃为主,这与其脾胃气虚为病机关键,并贯穿疾病始终的思想是一致的。②各主证兼夹证候不尽一致,常为同时兼有数个病证,并且兼夹证型比较分散。由此可见,PBC证情表现比较繁杂。③PBC的中医证型与病情程度有一定相关性,随着疾病的进展部分病人的证候可以发生由轻到重的转化,经过治疗的干预,证型变化亦可以发生逆转。3遣方用药特点：遣方不拘一格,博采众方,组方上精于配伍,善用对药。中西互参,辨病用药,擅用中药拮抗激素,减毒增效,疗效卓著。更多还原

【Abstract】 [Background]Primary biliary cirrhosis(PBC) is a kind of chronic and progressive liver disease relate to autoimmunity.The early pathologic features of PBC is nonsuppurative and destructive inflammation in intrahepatic bile duct. Cirrhosis is the result.Now UDCA is the only Western medicine treatment for early PBC patient,and the patients in the advanced stage have to do liver transplant to saved their lives.In recent years,more and more Traditional Chinese medicine for the PBC has been reported. Clinical symptom and quality of life of the patients is improved by combined of Western and Chinese medicine.My mentor Professor Dong Zhenhua has work on rheumatoid immune disease TCM by treatment with TCM and treatment combined traditional Chinese medicine and Western medicine. He has accumulated rich experience in long-term clinical practice and research.[Objective]This study sums up the experience of Professor Dong Zhenhua by his96PBC cases, then looks into his way of thinking the pathological mechanism,the law of syndrome differentiation and finds out his unique feature.That will lay the foundations for raising the curative effect,giving full play to traditional Chinese medicine(TCM) advantages and further creative study on the action mechanism of TCM in treating PBC.[Methods]Collected96cases of PBC from medical records dept and outpatient clinic of Peking Union Medical College Hospital,These cases from June1999to January2012.Then review all cases, analyze distribution of syndrome types and its characteristic,combine with my mentor’s inspiration in the teaching and learning process and his articles published on this study recent period. Finally,sum up the experience of Professor Dong Zhenhua treating PBC,including the essence of etiology and pathogenesis of PBC,he law of syndrome differentiation,his unique Treatment characteristics.[Results]1.Distribution of the main symptom:①Liver stagnation and spleen deficiency syndrome,32cases,33%②Qi deficiency of the spleen and stomach syndrome22cases,23%③Qi-Yin deficiency syndrome,9cases,9%④Yin deficiency of the liver and kidney syndrome,14cases,15%⑤Stagnation of dampness and heat syndromel4cases,15%⑥Blood stasis obstructing the collaterals syndrome5cases,5%.2.Distribution of accompanied symptoms of each main symptom:①The most common accompanied symptoms of Liver stagnation and spleen deficiency syndrome,are damp-heat syndrome13cases(41%), damp-heat and blood stasis syndrome6cases (19%)②The most common accompanied symptoms of Qi deficiency of the spleen and stomach syndrome are damp-heat syndrome and dampness retention damage the body fluid syndrome both are3cases(14)③There are4accompanied symptoms of Qi-Yin deficiency syndrome each have1case,takes up11%④The most common accompanied symptoms of Yin deficiency of the liver and kidney syndrome are damp-heat syndrome and Liver stagnation-spleen deficiency syndrome,both are3cases(21%)⑤The most common accompanied symptoms of Stagnation of dampness and heat syndrome are Yin deficiency4cases(29%) and damp-heat syndrome2cases(14%)⑥Total number of blood stasis obstructing the collaterals syndrome is5.Damp-heat,deficiency of the spleen with abundance of hot-dampness, Qi stagnancy and hot-dampness damage the body fluid all lcases(20%).[Conclusions]1.The essence of etiology and pathogenesis:Centered on the spleen and stomach,spleen deficiency throughout the disease process.2.The feature of syndrome differentiation:①"the weakness of vital-qi" is the main type of of the main symptom,especially spleen and stomach qi,which in accordance with the essence of etiology and pathogenesis.②Accompanied symptoms of each main symptom are indeed many kinds and always accompanied one or two or three different symptoms at the same time. Thus it can be seen TCM syndrome type of PBC is really complicated③The patterns of TCM syndrome of PBC were related to the seriousness of the condition to the patients.With the progress of the disease,part of the TCM syndrome transform from mild to severe condition.But that can be reverse by treatment.3.The feature of prescription and drug usages:Based on syndrome differentiation,there are four feature as fellows:No limitations,absorption by learning from others;Professor Dong Zhenhua paying high attention to the compatibility and making the best use of pairs of herbs.He integrate Chinese and western medicine;Reduce the side effects of glucocorticoid and enhance efficacy by using Chinese medicine.His treatment is effective.更多还原