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Professor LV Wenliang's experience in the treatment of liver cirrhosis

2020-03-03ShuangLiuWenLiangLv

Journal of Hainan Medical College 2020年22期

Shuang Liu, Wen-Liang Lv

Infections Disease Section,Guang' anmen Hospital of China Academy of Chinese Medcine Sciences, Beijing 100053,China

Keywords:Hepaticcirrhosis Lv Wenliang Experience

ABSTRACT Professor Lv Wenliang believes that cirrhosis is a disease of the essence of vacuity and evil, and the patient suffers from vacuity and poison stasis for a long time. Is Yin and Yang but turbulent, qi and blood disorder, liver and spleen is not consistent. Therefore, when the temporary syndrome from the Yin system Yang, to its outline; Adjust the air and blood to tamp the base; The liver and spleen should be dredged and the spleen should be regulated in accordance with its nature. Based on this objective, this paper discusses the clinical method of treating cirrhosis of liver by professor LV, so as to know its inverse, its shield and its life.

Cirrhosis is a kind of chronic, progressive and diffuse liver damage caused by one or more causes acting on the liver repeatedly for a long time[1]. The disease is insidious, the early patients have no specific symptoms and signs, and the appearance of ascites is the manifestation of decompensation of patients with liver cirrhosis. In this stage, patients often have symptoms such as asthenia, tasteless food, abdominal distention, abdominal pain, diarrhea, bleeding and so on [2]. Western medicine commonly used antiviral drugs to improve liver function, so as to actively prevent and treat complications. However, there are many adverse reactions of antiviral drugs, and there are problems such as drug withdrawal rebound, virus variation and drug resistance, so it can not change the final outcome of end-stage cirrhosis, nor effectively reverse liver fibrosis[3] . In ancient books of traditional Chinese medicine, the disease is usually classified as "distention", "fullness" and "jaundice". In clinical treatment, individual treatment is often adopted according to human conditions through syndrome differentiation and treatment, so it has great advantages in improving body immunity, reducing the adverse reactions of Western medicine treatment, improving clinical symptoms and improving the quality of life of patients.

Professor Lv Wenliang is vice president of Guang'anmen Hospital, Chinese Academy of traditional Chinese medicine, doctoral supervisor, director and academic leader of liver disease key specialty of the 12th Five Year Plan of the State Administration of traditional Chinese medicine, and famous Chinese medicine in Beijing. Learn from Professor Yao Naili and Professor Sun Guizhi, and have profound experience. Engaged in the clinical work of traditional Chinese medicine for nearly 30 years, with rich experience in diagnosis and treatment of liver cirrhosis, it can effectively delay and reduce liver failure. Professor Lv Wenliang believes that liver cirrhosis patients are disturbed by body deficiency, toxin and blood stasis, resulting in the disorder of yin and Yang, Qi and blood disorder, liver and spleen disharmony. Therefore, the treatment often starts from three aspects, and the clinical effect is also comprehensive. Now the diagnosis and treatment experience is summarized as follows.

1.Support Yin and control Yang, and rectify the key points

As the saying goes in "the way of heaven and earth, the discipline of all things, the parents of change, the origin of life and death, and the house of gods" in "the general theory of yin and Yang should be like the elephant" [4], that is to say, yin and Yang are the objective laws of nature and the basic viewpoints of the movement and change of all things in the world. The birth, development, maturity, decline and extinction of the human body are all related to the interaction, chemical education, opposition and root of yin and Yang Department and development are closely related. The process of life is actually the process of constant transformation of the relationship between yin and Yang. Therefore, in the process of the occurrence and development of the disease, it is a guiding principle to ensure that yin and yang are flushed and regulated. "Suwen · jinguizhen speech"[4]said: "the abdomen is Yin Yang in Yin, liver. He also said: "the liver, the root of the pole The little Yang in the Yang is connected with spring Qi. Those who take the liver as their basis are both "the little Yang in Yin" and "the little Yang in Yang", which can show the double sides of yin and Yang[5]. And the five elements live together. The liver lives in the kidney, water, heart and fire. It is the viscera for Yin to do Yang, and it holds the nature of yin and Yang. That is, liver body is Yin, and Qi is used. Moreover, the liver Yang is often surplus, and the liver Yin is often insufficient. Therefore, the pathological changes of the liver are mostly deficiency of body Yin and hyperactivity of liver use. The disease of liver cirrhosis is located in the liver. The damage of liver body caused by toxin and blood stasis makes the liver Yin deficient and out of nourishment. If the liver body is not moistened, the patient will often feel the pain and discomfort of the right upper abdomen; if the Yin does not control the Yang, the patient will often feel dizzy, astringent and upset. Therefore, the first task of treatment is to help Yin and make Yang, and to correct its principle. According to the analysis of the core etiology and pathogenesis of liver cirrhosis, Professor Lv believes that although the deficiency of liver Yin is the beginning of the disease, it can not be treated alone in the liver. One is that the deficiency of liver is not supplemented. If the product of nourishing and greasy is added strongly, it is afraid that it will be difficult to move, and the positive deficiency and pathogenic factors will be more and more abundant. The other is that the five elements are related to each other, and the kidney is the mother. If the Qi is not consumed, it will be classified as essence. If it is not discharged, it will be classified as liver and blood, and the kidney, In the treatment of congenital origin, both for the mother and for the mother, we should pay attention to the kidney. Professor Lv often uses raw Rehmannia to adjust Yin and Yang and set things right. In this sutra, it is said in [6]: "the heart of Rehmannia is purple, the heart is clear, the Middle Yellow goes into the spleen, and the skin is black and the kidney is black.". The taste is thick and the Qi is thin. It can cool the blood and nourish the Yin internally and nourish the skin externally. If the patient is empty and has heat, it should be added. Raw rehmannia, sweet and bitter taste, cold nature, heart, liver, kidney, long for nourishing liver and kidney, cooling blood and clearing heat. According to Li Shizhen, "a hundred days of service is like a peach blossom, and three years of light life is not old.". For patients with liver cirrhosis, the long-term deficiency of the body, plus longterm use of antiviral drugs and other pure Yang products, seriously damaged Yin fluid, so there are often pathological manifestations of yin deficiency and internal heat. However, although there is fever, it is also mostly manifested as upset and internal heat, but not as deep as blood fever and vomiting. Therefore, Professor Lv often uses 20-30g of raw Rehmannia to adjust the bias of yin and Yang. One is to take its bitter and firm Yin, then it can nourish the solid Yin liquid, so as to protect its truth; the other is to take its cold and cutting heat, then it can clear away heat and cool blood, so as to fold the rest. The clinical medicine is accurate, the medicine is simple and appropriate, the strength is special, it can not only adjust the yin deficiency of the body, but also avoid the patients' body deficiency medication delay in the greasy.

2.Regulate air and blood to tamp its foundation

In the theory of eight positive deities of Suwen, it is said that "the spirit of human beings should not be neglected to keep the blood and Qi". In the theory of Suwen Tiaojing, it is said that "the owner of human beings, blood and Qi ears", that is to say, the basic viewpoint that human body relies on Qi and blood to warm and moisten both inside and outside is clarified. As the saying goes in traditional Chinese medicine, "Qi is the beauty of blood, and blood is the mother of Qi". The normal operation of human body functions, blood as the material basis, and Qi as the power motor, complement each other and are the foundation of each other. "Zhang's Yitong" says: "blood and Qi have the same name, although they are divided into Yin-Yang and turbidity, they are always transformed by the essence of water valley, and their origins are also mixed in one area, and there is no clear turbidity.". In Zhu Danxi's opinion, "if Qi and blood flow are in harmony, all diseases will not be born. If there is depression, all diseases will not be born.". "All diseases are caused by Qi" is said in "the theory of Su Wen and Ju Tong"[4]. If the Qi mechanism of human body goes up and down abnormally, a series of pathological changes such as Qi deficiency, qi depression, Qi detachment, Qi inversion and qi stagnation will appear[7]. "Introduction to medicine" says: "blood is the beginning of all diseases". If blood goes wrong, there will be a series of pathological changes such as blood deficiency, blood stasis and blood non circulation. No matter which side of Qi and blood is profit and loss, it will affect the other side, resulting in the loss of Qi and blood, and the viscera organs will also show corresponding pathological reactions. Liver is the pivot of Qi and blood of human body. The guide of clinical medical cases - liver wind chapter says: "the East generates wind Body Yin uses Yang, which is rigid, active and dominates the rise ", that is to say, it highly summarizes the physiological function of liver. Wang Bingzhu "Suwen" [4]said: "the liver stores blood,... When people move, the blood runs through the meridians. When people are still, the blood belongs to the liver. Which one? The liver dominates the sea of blood. The liver is the main reservoir of blood, which has the function of storing and regulating blood volume. The liver blood is sufficient and suitable for storage and adjustment, so the body nourishes the spirit. Zhang jiebin's note of "classic of categories" said: "wood Qi moves, Qi reaches,... Cang Qi, wood Qi also". It is based on the liver to master the discharge, which can regulate and smooth the whole body's Qi mechanism, and the liver Qi reaches, which can dredge the volume and regulate the people. For patients with liver cirrhosis, the liver is the place where evil invades. If the liver is disturbed for a long time, the Qi and blood will be lost and the essence will be exhausted. Professor Lv believes that when the liver Qi is regulated, there is a way for the Qi to rise, and when there is a way for the Qi to rise, there is a way for the blood gas to rush into harmony. The liver is the fatigue mechanism, and the deficiency is not supplemented, so the clinical treatment should be to regulate instead of supplement, and to substitute for cutting. Therefore, Astragalus and white peony are often used as the basis of regulating qi and blood. Among them, Astragalus membranaceus, sweet taste, mild temperature, is good at invigorating qi and rising Yang, invigorating spleen and promoting water. In the treatment of liver cirrhosis, Professor Lv often controlled the dosage at 30-150g. One was to regulate and invigorate Qi, so as to consolidate its foundation; the other was to invigorate the middle and benefit the camp, so as to rectify its source. Among them, white peony, bitter and sour taste, slightly cold, is good at nourishing blood and softening liver, regulating yin and stopping perspiration Benefiting Yin and nourishing blood Tonify the liver yin, and pacify the rebellion of a and B ". In the treatment of liver cirrhosis, Professor Lv often controlled the dosage at 20-30g. One is to nourish blood and soften the liver, so as to strengthen its foundation; the other is to regulate Yin and accumulate sweat, so as to rectify its deficiency. In clinic, the two drugs are used together, the energy of the medicine is stable, the rate of qi circulation and blood inflation are maintained, especially the disharmony between the two drugs.

3.Dredge the liver and regulate the spleen to conform to its nature

According to the theory of blood syndrome[8], "the nature of wood mainly lies in relieving, eating Qi into the stomach, relying on the Qi of liver and wood to relieve it, while the water valley is transformed; if the liver's clear Yang does not rise, the water valley can not be relieved, and the syndrome of full infiltration is inevitable.". That is to say, the influence of liver Qi on the spleen and stomach transport of Zhongjiao is clarified, and the importance of liver regulating spleen and human body is emphasized. The stomach is the sea of water and valley, which is mainly accepted and ripened. The spleen is the foundation of the barn. It is mainly transported and transported. The spleen rises the stomach and falls the stomach. The Qi and blood flow freely and continuously. The Qi and blood are biochemical active. The water essence is distributed in four directions, and the body is full of spirit. However, although the spleen and stomach are the place of delicacy and absorption, the pivot of qi movement, the up and down flow of Qi is still regulated by liver qi. If the Qi of the liver reaches the level of Qi, it will help the spleen and stomach to move; if the Qi of the liver is disadvantageous, it will not only lead to tiredness of the spleen and stomach to absorb, but also lead to the stagnation of wood on the earth and the transmission of disease and Qi, so that the earth will not be damaged and all kinds of diseases will occur. It is based on the words of "the five constant political treatise on the plain question" [4]: "the period of occurrence is called Qi Chen, soil dredging, Cang Qi Da", and "Nan Jing" says: "therefore, when you treat the disease of the liver, you know that the liver should be passed on to the spleen". That is to say, it emphasizes the close relationship between the physiology and pathology of the liver and the spleen. Therefore, liver regulating spleen and regulating spleen is to conform to the principle of the vital energy of human body. We should pay attention to the harmony of the two internal organs and the smooth access to their vital energy in clinical practice. Professor Lv believes that patients with liver cirrhosis often suffer from liver deficiency and qi depression for a long time, and violate the spleen, resulting in disorder of Qi mechanism of the spleen and stomach, not rising the turbidity, not falling down, and losing the division of health, so they often have weakness, abdominal distention and pain, stupor, loose stools and other symptoms. Therefore, in the treatment, Baizhu is often used to invigorate the spleen and Qi, dry and damp the phlegm, and stir fry it to increase the effect of invigorating the spleen and moistening the dampness; in addition, it is also used to prevent the wind from being sweet, moist and not dry, so as to relieve the depression of the liver; it is often used to combine Huoxiang and Peilan to invigorate the spleen and stomach; it is often used to stir fried apricot kernel and jianghoupu together, so as to open up the bitter and reduce the bitter, so as to publicize the ventilating machine, so as to regulate the Central Road[9]; and it is often used in combination with The big belly skin, take its broad, middle and quick Qi, to help the second medicine and the power of the middle Qi; often use Poria cocos and faban pinellia, invigorate the spleen and melt the drink, remove dampness and phlegm, so as to eliminate the phlegm of the middle Jiao; often use hawthorn, jiaoshenqu and jiaomalt, so as to eliminate the accumulation and stagnation, invigorate the spleen and strengthen the spleen, so as to clean up the food stagnation of the gastrointestinal tract; often use Scutellaria, Coptis and phellodendron, so as to clear away the heat, dry the dampness, relieve the fire and detoxification, so as to dissipate the heat of the three jiao In addition, artificial bezoar is often used to benefit the liver and gall, dispel the evil and eliminate the heat, so as to increase the effect of clearing away heat and detoxification; tangerine peel and vinegar are often used together to dredge the liver and Qi, regulate the Qi and strengthen the middle, so as to increase the power of promoting the aging. In the clinical treatment, we should combine the specific situation of the patients, add the dosage of the medicine, attack and supplement simultaneously, then we can benefit the positive without retaining the evil, without the risk of retaining the enemy behind the door, eliminate the evil without hurting the positive, without the fault of deficiency. It is based on the movement of middle Jiao, the regulation of Qi and mechanism, the elimination of toxin and blood stasis, the body peace.

4.Examples

Zhang Mou, male, 67 years old, first diagnosed on June 24, 2019, chief complaint: abdominal distention for more than 3 years, aggravation for more than 5 months. Current medical history: the patient reported that there was no obvious inducement to abdominal fullness 3 years ago. He was treated in local hospital with rabeprazole enteric coated tablets, aluminum magnesium carbonate chewable tablets, Xiangsha Yangwei tablets, and the symptoms were slightly relieved. In May 2019, he was hospitalized in Beijing 302 hospital due to the aggravation of abdominal distention. The auxiliary examinations were as follows: five items of hepatitis B: HBsAg +, anti HBE +, anti HBC +, HBV-DNA quantification: 4.53 × 102iu / ml, blood biochemistry: total bilirubin (TBIL): 22.7 μ mol / L, direct bilirubin (DBIL): 7.9ummol/l; Liver function: (aspartate aminotransferase, AST): 130u / L, (alanine aminotransferase, ALT): 129.3u/l, (alkaline phosphotase, ALP): 122u / L. The therapeutic effect of entecavir, jiuweigantai and Fuzheng Huayu capsule was not good. For further treatment. The symptoms of carvings include abdominal distention, shortness of breath, weakness, tingling of both sides, dry eyes, bitter mouth, dry throat, bleeding gums, numbness and acid sinking of back, restless sleep at night, salivation during sleep, no appetite for food, stupor, once a day of defecation, loose stools, yellow urine, red tongue, thin yellow fur, fine pulse strings. Western medicine was diagnosed as cirrhosis and traditional Chinese medicine as distention. Syndrome differentiation belongs to the method of regulating liver and spleen and regulating qi and blood. Prescription: raw Astragalus 30g, stir fried Atractylodes

12g, Fangfeng 6G, almond 9g, paeony 30g, Poria 20g, pinellia 9g, hawthorn 20g, Shenqu 20g, malt 20g, tangerine 15g, Niuhuang 0.15g, Shengdi 12g, Agrimonia 30g, bupleurum 9g, abdominal 15g. 14 doses, decocted in water, 1 dose per day, two times at different temperatures, supplemented by Chinese patent medicine Yinzhihuang granules. Second diagnosis (August 27, 2019): after taking it for 2 months, abdominal distention and hypochondriac pain are relieved, but there are still fatigue, bitter mouth, narcolepsy, sleeping well, loose stools, red tongue, slightly greasy fur, and smooth pulse. The treatment was unchanged. The astragalus root was changed to 60g in the middle of the upper part, and 9 g vinegar, 9 g Patrinia and 9 g sedge were added. 14 doses, 1 dose per day, morning and evening. Three diagnosis (September 23, 2019): take it for more than one month, the condition is obviously improved, abdominal distension and fatigue are reduced. Sleeping can be, occasionally loose stools, light red tongue, moss white slightly greasy, still to reconcile the liver and spleen as a method. Remove the bezoar from the top, change the Atractylodes to 20g, 14 doses, 1 dose per day, morning and evening. One month later (October 29, 2019), the patient was followed up by telephone. The patient's condition was stable without discomfort. The HBV-DNA quantity was less than 1.0 ×103iu / ml in recheck. Blood biochemistry: DBIL: 5.6 μ mol / L, TBIL: 17.5 μ mol / L, liver function: AST: 48U / L, ALT: 45u / L, ALP: 59u / L.

Note: the patient in this case, an old man, is 88 years old. The main complaint is abdominal distention. The disease has been prolonged for many years, and the body is deficient. It is the imbalance of yin and Yang, Qi and blood loss, liver and spleen loss. According to the theory of "three causes and one disease syndrome - fullness", it says: "bulging The liver governs the spleen, the temper is not right, must distend in the stomach ". According to Professor Lv, the liver of the patient in this case was injured by poison and evil. As a result, the liver and collaterals lost harmony and Yin damaged qi stagnation. As a result, the liver and spleen were rebellious, resulting in disharmony between the liver and the spleen, and the Qi mechanism in the middle energizer went up and down abnormally, resulting in abdominal distention. As a result, the liver lost catharsis, the Qi mechanism went down and down, and the blood flow was not smooth. As a result, the two flanks were stinging and painful. As a result, the liver and spleen were maladjusted, the spleen was deficient, and the patient had no right to take a picture, so And the spleen is too Yin and wet soil, likes dryness and dampness, and is cemented with damp heat and Blood Stasis Toxin, which often affects the transportation and transformation of Zhongjiao spleen. If the healthy transportation is not good, there will be less appetite and food, shortness of breath and weakness. In Suwen · Tiaojing Lun [4], it is said that "blood and Qi are not in harmony, and all diseases are caused by changes". Epidemic toxin soaks the liver, which leads to the maladjustment of liver function. It is due to stagnation of Qi mechanism, poor blood circulation, loss of harmony of Qi and blood in the whole body, and loss of fullness and moistening. As a result, the eyes, throat, back become numb and sour, and gums bleed. Dampness and heat accumulate in the liver and gall, and bile lose its normal channel. If it overflows inside and outside, you will see bitterness of mouth, and heat will disturb the mind Then I see sleep is poor. In this case, the patients are not able to bear attack and attack, and they are not benefited. Therefore, the treatment should be based on "harmony". In the formula, Radix Astragali, stir fried Atractylodes macrocephala and Fangfeng are used together to make YUPINGFENGSAN, which can be made up to be solid, to make up the middle part to contain the powder, to fix the surface, to raise the Qi of the whole body, and to make the Qi and blood fill the whole body [10]; the combination of Atractylodes macrocephala and poria cocos has the function of Invigorating Qi and spleen, to match Pinellia ternata, to make the body dry and turbid, and to eliminate the phlegm of the middle Jiao; the combination of almond, tangerine peel and big belly peel can smooth the Qi mechanism of the middle and upper two jiao; and Jiao Sanxian can eliminate accumulation and stagnation, and increase the effect of spleen movement. Bupleurum can relieve liver depression, promote Yang Qi, and guide various herbs to liver channel. Paeony can soften the liver and nourish blood. The combination of the two can nourish the liver body and help the liver use, so that the liver Qi can be reached, and the liver blood can be nourished. It can clear the heat, cool the blood, nourish the Yin, and help the white peony to nourish the liver body. It can assist Niuhuang, clear the heat, cool the liver and detoxify. It can detoxify and astringe the bleeding. In addition, Yinzhihuang granule, a Chinese patent medicine, was added to eliminate the damp heat epidemic toxin in the body. The combination of the whole prescription is excellent, then the liver can regulate the spleen and the Qi can regulate the blood volume, and the Yin and yang can match each other. In the second diagnosis, the symptoms of hypochondriac pain and abdominal distention were all eviated, but the symptoms of spleen deficiency and damp heat such as fatigue and stomachache were still existing. Therefore, Huangqi was changed to 60g to increase the original prescription's strength of Invigorating Qi and strengthening the spleen. At the same time, vinegar was added to regulate qi, so as to make up without stagnation, and Patrinia villosa and sedge were added to help clear away heat, dryness, dampness and detoxification. The symptoms of the three diagnoses were all reduced, and the damp heat was light, but there was still loose stools. Therefore, to remove the bezoar of clearing away heat and detoxification, and to change the Atractylodes to 20g, making the whole recipe more powerful in strengthening the spleen and removing dampness.

5. Conclusion

Liver cirrhosis is in the final stage of liver disease. At this time, liver structure and blood supply are destroyed. If the disease is allowed to develop, liver failure, portal hypertension and many complications will occur, even liver cancer will occur, so the mortality rate is high. However, modern doctors have different views on the etiology and pathogenesis of liver cirrhosis, and there is no definite method or rule for treatment in each family. Professor Lv believes that patients with liver cirrhosis who have been disturbed by body deficiency, toxin and blood stasis for a long time will have complicated internal and external environment, mixed with deficiency and excess, maladjusted basic principles and difficult to reconcile themselves. Therefore, the treatment should start from the fundamental pathogenesis, take Yin and Yang, Qi and blood, spleen and stomach as the basic points, and take the principle of rectifying, consolidating and conforming to its nature, so as to make the whole body harmonious and make all kinds of waste flourish. This paper summarizes Professor Lv's clinical experience in the treatment of liver cirrhosis, and develops new ideas for the same purpose.

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