▲Xu Jingfan, a master of traditional Chinese medicine
Professor Xu Jingfan, a master of traditional Chinese medicine, has been practicing medicine for more than 60 years, adhering to the family tradition, knowing the ancient and modern, learning both Chinese and Western, and has accumulated rich experience in the treatment of chronic hepatitis. I am honored to participate in the third batch of national old Chinese medicine experts of the State Administration of Traditional Chinese Medicine to inherit the academic experience, under the tutelage of Mr. Xu, and to summarize the eight methods of treating chronic hepatitis by Mr. Xu.
Dampness and spleen transfer method
Patients with chronic hepatitis often suffer from dereliction of duty due to dampness and spleen and soil, such as abdominal distension and discomfort, distension after eating, loss of appetite, sticky mouth and vomiting, drowsiness of limbs, fatigue, loose stool, white or greasy tongue, and wet pulse, etc., and the body becomes weaker and weaker over time. Mr. Xu believes that at this time, it is imperative to find ways to open the spleen and eat, so that the digestion and absorption function can be restored as soon as possible. However, the treatment of the disease must seek its roots, and if the spleen is not damp, there is no way to achieve this purpose, so it is advisable to use the method of dissolving dampness and transporting the spleen. When clinical application, it is still necessary to pay attention to the distinction between clear and warm, and those who are wet and hot should be cleared, and those who are wet and cold should be warmed.
The main party selects Yin Chen Ping's stomach powder, Siling powder, etc. Commonly used medicines: Yin Chen, Huoxiang, Atractylodes, Magnolia officinalis, Tangerine peel, Banxia, Poria cocos, Ze Yuan, Coix seed, psyllium, etc. If the dampness is heavy, the moss is yellow and greasy, add Coptis chinensis and Ko Seed; if the moss is gray and greasy, then Coptis chinensis and grass kernels are used together; if there is dampness and turbidity, and the oil is averse, add Peilan, winter melon seeds, fried hawthorn koji, and raw malt; dampness obstructs qi stagnation, abdominal distension is even worse, and the abdominal skin, betel nut, wood fragrance, etc.; the spleen deficiency is obvious, the hunger and food are less, and the intake is not lucky, the moss is thin and white, add Codonopsis, dry ginger, burning grass, and Atractylodes atractylodes for atractylodes; the spleen and yang are deficient and sick for a long time, and the tongue is light, you can add aconite, dry ginger and other warm and dampness agents.
Liver soothing and spleen transporting method
Wang Xugao's "Xixi Book House Night Talk" has a cloud: "Liver qi is depressed in this scripture, and those who are bloated or in pain should be soothed in the liver." Xu Lao believes that patients with chronic hepatitis often have depressed mood, depression, vague pain in the liver area or under the two flanks, bitter mouth and other liver loss due to disease, long-term treatment, and liver stagnation. At this time, Xu Lao emphasized that the focus should be on soothing the liver, and if the liver qi is soothed, the spleen can be restored. Moreover, the method of soothing the liver is the most advantageous and characteristic therapy of traditional Chinese medicine, which is incomparable with Western medicine at present. However, the spleen is controlled for a long time, and every dampness can be combined, therefore, the spleen and dampness products are often used, and those who have been sick for a long time and enter the network should also be used as a blood vein.
The main side has Xiaoyaosan, four reverse san, four gentlemen's soup, six gentlemen's soup and so on. Commonly used medicines: Bupleurum chinensis, white peony, citrus aurantium, tulip, incense, Yanhusuo, Codonopsis, Atractylodes, Poria cocos, Herb burning, etc. If the stool is loose and greasy, add Atractylodes, Magnolia, fried hawthorn koji, abdominal distension, add wood incense, sand kernels, and if the pain in the liver area is obvious, add Lulutong, Tangerine, Angelica, safflower, loofah, Wang Buliuxing and other pain-relieving products.
Liver and spleen strengthening method
At this time, if the method of soothing the liver and regulating qi is used to enter the treatment, because the liver is mostly a dry product, it is beneficial to hurt the liver yin, but it will cause more and more sparseness, therefore, when the method of soft nourishing the liver and yin can be restored. However, the medicine of soft nourishing liver and yin, more smooth and moist, for people with spleen deficiency, it is not suitable, and liver depression is easy to take advantage of the spleen, and spleen deficiency is easy to be controlled by the liver, the so-called "soil deficiency and carpenter" is also, therefore, the health and spleen are more and more important. There are also a lot of spicy, dry and hot products in the spleen medicine, because the yin and blood of the liver have been injured, and they should also be used with caution.
Because it can neither be too cold nor too warm, it is also quite particular about the specific application, and the selection of prescriptions and medicines is often flexible. Taking into account both warmth and coolness, Xu Lao thinks that Gui Shao Liujun soup is the most suitable. Cover Angelica sinensis is sweet, pungent and warm, nourishing blood and moistening dryness, for the blood qi medicine, long in moving and invigorating blood, spicy and fragrant, walking but not keeping, very suitable for the characteristics of the liver; white peony bitter and sour slightly cold, nourishing blood and soft liver, slowing down and relieving pain, collecting liver qi, collecting blood and yin medicine, good at static and yin, sour and collecting, keeping but not leaving, two medicines combined, spicy but not scattered, sour but not receiving, one open and one close, dynamic and static are appropriate, with the six gentlemen soup, nourishing blood and soft liver, converging liver qi, strengthening the spleen and invigorating qi, especially suitable for chronic hepatitis liver yin deficiency and spleen qi deficiency.
If the qi deficiency is obvious, add astragalus, if the liver yin and blood deficiency is obvious, add fried cooked ground, wolfberry, etc.; if the appetite is lost and the stool is too loose, go to angelica, add burnt hawthorn koji, ginger, fried grain malt; for those with tooth and epistaxis, add danpi, white grass root, buffalo horn, madder, lotus grass, etc.
Nourishing yin and soft liver
The liver dwells under the diaphragm, hiding blood and draining the Lord. It can be seen that the liver not only hides blood, but also stores fluid. Blood and fluid are tangible substances, which belong to yin and fill the liver body, so it is called liver yin. Xu Lao emphasized: "The liver yin should be filled, but I am afraid that it will be insufficient." "Only when there is enough yin blood can the qi be turned into use, and the right to vent the duties. The yin deficiency is prosperous, and the fire is prosperous, and the liquid is lost, and the righteousness is not resisting evil, and the disease is difficult to heal.
In general, chronic hepatitis is often caused by dampness, heat, evil poison and long-term detention. Chronic hepatitis is mostly acutely transformed, in the early stage of the disease, or overused bitter cold, or used more dryness, it can often lead to injury to yin, and there are also people with yin deficiency in the body, and the first feeling of dampness is also easy to heat up. Therefore, chronic hepatitis is often manifested as yin deficiency syndrome. At this time, Xu Lao emphasized that the liver yin should be nourished, the law should be soft, and the medicine should be sweet. Cover the yin in the Lord, born quietly, and joyful. The soft is slow, the soft can make the rigid, the moist can produce Jin, the fluid is enough, the blood is sourced, the sweet can replenish the energy to keep, its sex and slow, can slow the urgency of the liver, help the liver, and benefit the liver body.
When choosing the drug, Xu Lao especially admires the dendrobium taste, cover the dendrobium cold and sweet, this is the product of moisturizing the lungs and stomach, but the five organs are related, such as nourishing water can be carried out wood, and the lungs can also nourish the liver, Xu Lao believes that this product is used for patients with chronic hepatitis yin deficiency, not only has the effect of nourishing the liver, but also can stasis and blood circulation, prevent liver cirrhosis, and is now widely used in the treatment of vascular diseases of the Tongsai Vascular Tablets, Pulse Ning is Dendrobium officinalis as the king's medicine, and its effect of blood circulation can be seen in general. Using this method, if you see that the fire is blazing, you can always prepare a clear product, but always take soft cultivation as its main purpose. Because the bitter cold is too much, it is inevitable that there will be disadvantages of hurting yin.
In addition, Xu Lao believes that chronic hepatitis is mostly characterized by yin deficiency and evil love, yin deficiency will lead to long illness, and yin foot will retreat. If the liver yin is lost, one indicates that the patient may be sick for a long time, and the other indicates that the disease is deep, and the treatment is quite difficult, the so-called "yin deficiency is difficult to recover".
The main recipe can be added or subtracted from consistent decoction, adjusting the camp to collect liver drink, nourishing water and clearing the liver. Commonly used medicines such as fried raw land, angelica, white peony, dendrobium, northern sand ginseng, barley winter, Polygonum multiflori, wolfberry, lotus grass, ligustrum, etc. If you sweat a lot at night, you can add Galu bean coat (or wild beans), floating wheat, oysters, keel, etc.; for insomnia, add acacia bark flowers, lilies, sour jujube kernels, schisandra, etc.; for those who are dizzy, add tribulus terrestris, tomorrow hemp, mulberry leaves, etc.; for those with high liver fire and hot cheeks, add black mountain gardenia, danpi, buffalo horn, etc.
Double tonifying the spleen and kidney
This method is the same treatment of the spleen and kidney, mostly used for chronic hepatitis for a long time or weak physique, spleen and kidney deficiency, symptoms of yellowing or paleness, slight edema of the limbs, fatigue and loose stools, loss of appetite, soreness of waist and knees, occasional slippery impotence, thin white moss, pale tongue or purple gas, tooth marks on the edges, and small chords with thin and soft pulses. The spleen is the acquired foundation, the kidney is the innate foundation, and the long-term illness affects the root, and most of its diseases have been serious. Xu Lao believes that the long-term illness is no longer damaged, the long-term damage is no longer tired, the spleen and kidney have been lost, the disease has reached the point of fatigue, the treatment is very difficult, and it is difficult to recover. At this time, the method of treatment should follow the tenet of "seeking the root of the disease", grasp the key points, and start with the spleen and kidney. Of course, when this method is used in clinical treatment, it should be subdivided into yin and yang, partial spleen and kidney, and qi and blood.
The main side should be added or subtracted from the right side of the pill. Commonly used medicines: yam, shengdi, dogwood, fried codonopsis, fried atractylodes, poria cocos, wolfberry, deer antler tablets, dodder seeds, hyssop, eucommia, boiled licorice. If you have diarrhea or loose stools in the morning, add simmered flesh fruit and psoralen, remove oxknee and cooked ground, add astragalus and purple river car if you have qi deficiency, add papaya and nine spice worms if you have pain in the liver area, and add fenugreek, fairy spleen, corn whisker, etc.
Wood method of clearing gold
Wang Xugao's "Xixi Book House Night Talk" mentions this method Shiyun: "The liver is on fire, and it is unstoppable. "Looking at its medicine, it is sand ginseng, wheat winter, dendrobium, loquat leaves, asparagus, jade bamboo, stone cassia and the like. It can be seen that in fact, this is a treatment method to achieve the purpose of flattening the liver fire by clearing and nourishing the lung yin, because the focus is on the lungs, the medicine should be gentle, and most of the products are mainly to moisten the lungs and generate Jin, so it is different from the method of filling the liver and kidneys.
The main side of the sand cucumber wheat winter soup is added and subtracted. Commonly used medicines: North and South Shashen, Ophiopogon vulgaris, Fat Yuzhu, Skullcap, Sichuan lily, reed root, white peony, danpi, raw licorice, etc. For those with frequent low-grade fever, add Artemisia annua, white myrtle, silver bupleurum, and Digupi; for those with night sweats, add floating wheat, red dates, and oysters; if the mouth is dry, add Dendrobium, winter melon seeds, and smallpox pollen; and for those with red skin, add raw land, Mutong, and bamboo leaves.
Perform qi and blood activation
Chronic hepatitis often has poor mood, liver stagnation and qi stagnation, recurrence, prolongation, long course of disease, long-term patient network, long-term illness and stasis, and eventually becomes a sign of qi stagnation and blood stasis, symptoms such as acupuncture in the liver area, pain in a fixed place, hypochondrium accumulation, blood mole or blood fistula, dull complexion, sometimes tooth epistaxis, purple tongue or purple petechiae, small or thin pulse, etc. Xu Lao believes that if the disease does not heal for a long time, there are many signs of blood stasis and internal resistance, and at this time, the method of blood circulation and blood stasis should be considered, or on the basis of syndrome differentiation, blood circulation and blood stasis should be considered.
Blood stasis is divided into light and heavy, the light one can be channeled, and the heavy one needs to be attacked, but the product of the attack is easy to hurt the righteousness, and during the period, the strength of the patient's physique should be weighed, and Meng Lang should not be hasty. Those who stay strong and have a strong physique can be expected to achieve short-term results and control the progression of the disease. If the physique is weak, it will not be able to tolerate the attack, if it is reluctant, the righteousness will be more hurt, and it will be easy to change. Therefore, when using, one is to grasp the principle of stopping the disease, and the other is to be compatible with the products of Fuzheng, or to strengthen the spleen and invigorate the qi, or to nourish the yin and camp, etc., and the clinical should be handled flexibly. And "qi is the blood handsome", qi is bloody, qi stagnation is blood stasis is very beneficial, so the use of blood circulation and blood stasis, when compatible with the liver and qi products, in order to help the circulation of qi and blood.
The main recipe Angelica Huoxue San, Rejuvenation Huoxue Soup, Blood Fever Pill, Taohong Siwu Tang and other prescriptions are added and subtracted. Commonly used medicines: Angelica sinensis, red peony, white peony, salvia, peach kernel, safflower, triangular, curcuma, licorice, turtle shell, Yanhusuo, Bupleurum, Xiangfu, ginseng notoginseng, etc. For those with qi deficiency, add Codonopsis, Astragalus, and Atractylodes, and for those with severe pain in the liver area, add nine spice worms, burnt frankincense, burnt myrrh, and ground turtle worms. or combined with external application of blood-invigorating analgesics, it can often obtain better curative effects. If the stasis is difficult to dissolve for a long time, you can add cannon beetles, leeches, ground turtle insects, saffron seeds, zealand, etc. If the bleeding is obvious, remove the three edges, curcuma, ground turtle insects, add madder, lotus root charcoal, military charcoal, etc.
Heat clearing and dampness removal method
Most of the chronic hepatitis has a history of acute hepatitis, and the pathological factors of acute hepatitis are always damp heat, which can be felt from the outside, or through the mouth through unclean diet. If acute hepatitis is untreated or prolonged repeatedly, it will gradually turn into chronic hepatitis, and a considerable number of patients have insidious symptoms during acute illness and cannot be diagnosed and treated in time, and the disease has become chronic when it is discovered. However, looking at the overall etiology, most of them are caused by the dampness and heat of the liver meridian that are not purified and do not heal.
Damp heat is the basic etiology and pathology of this disease, which can run through the whole of the disease, even in the stage of liver and kidney loss, it is also due to the deficiency of reality and residual dampness and heat. Especially in the re-active stage of chronic hepatitis, regardless of whether there is jaundice or not, there is generally more dampness and heat connotation, so it should be supplemented with the method of clearing the liver and promoting dampness, and with the syndrome, it should be combined with strengthening the spleen, soothing the liver, practicing stasis, and nourishing yin. If the heat poison is more severe during the active period, it is often used to clear heat and detoxify dandelion, anchovy, comfrey, prunella vulgaris, Iwami wearing, half-branch lotus, and soybean grass. According to the condition, three or four flavors are selected, and they also have the effect of lowering enzymes. At the time of the clinical syndrome, it is still necessary to distinguish the severity of dampness and heat, and those with more white and less yellow are more damp and heavy, and those with more yellow and less white are more hot and heavy, which has a guiding role in the selection of clinical drugs.
Main side: hot and heavy, Yinchen artemisia soup, gardenia cypress soup, wet heavy Yinchen stomach Ling soup. Commonly used drugs: Yinchen, Gardenia, Phellodendron chinensis, Rhubarb, Atractylodes, Magnolia officinalis, Tangerine peel, Ze Yuan, Psyllium, Pig Red Porium, etc. If the dampness is heavier than the heat, the stomach qi is not in harmony, the stomach qi is reversed, and the nausea and vomiting are seen, it is advisable to add Huoxiang, Koren, Banxia, ginger, etc. to aromatize and stop vomiting; if the heat is full of upset and frustration, add Coptis chinensis to clear the heart and remove the trouble; if you see red headache, blood gums, red tongue, red pulse, red and other symptoms, and those with liver and gallbladder fever, it is advisable to clear the liver and gallbladder, such as gentian laxative liver soup, prunella soup, etc. ■
[The content is compiled from: "China Traditional Chinese Medicine News" June 7, 2007 Sixth Edition, Author: Lu Weimin, Xu Danhua, Department of Gastroenterology, Jiangsu Provincial Hospital of Traditional Chinese Medicine]