1.广州中医药大学第二临床医学院,广东省广州市白云区机场路12号,510405
2.广东省中医院
3.广州中医药大学第二附属医院
chixiaolingqh@163.com
收稿:2022-11-25,
修回:2023-05-11,
纸质出版:2023-09-02
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陈智恒,高博文,张朝臻等.运用黄芪治疗岭南地区代谢相关脂肪性肝病经验[J].中医杂志,2023,64(17):1819-1823.
CHEN Zhiheng,GAO Bowen,ZHANG Chaozhen,et al.Clinical Experience of Treating Metabolic Associated Fatty Liver Disease with Huangqi (Radix Astragali) in Lingnan (岭南) Area[J].Journal of Traditional Chinese Medicine,2023,64(17):1819-1823.
陈智恒,高博文,张朝臻等.运用黄芪治疗岭南地区代谢相关脂肪性肝病经验[J].中医杂志,2023,64(17):1819-1823. DOI: 10.13288/j.11-2166/r.2023.17.016.
CHEN Zhiheng,GAO Bowen,ZHANG Chaozhen,et al.Clinical Experience of Treating Metabolic Associated Fatty Liver Disease with Huangqi (Radix Astragali) in Lingnan (岭南) Area[J].Journal of Traditional Chinese Medicine,2023,64(17):1819-1823. DOI: 10.13288/j.11-2166/r.2023.17.016.
基于岭南地区代谢相关脂肪性肝病的病证特点,探讨运用黄芪治疗岭南地区代谢相关脂肪性肝病经验。认为脾虚阳弱、湿浊内蕴为发病之源,病初之期当用黄芪健脾暖土以伏虚火,升清温表以制湿浊,常用15~30 g,用药需递进施补,可伍太子参、白术、茯苓、防风等共奏培土制湿之效;气血郁滞,痰湿蕴热为病进之机,当取黄芪实脾荣肝、通阳行滞之性,常用30~60 g,斡旋气机流行,通和中焦阳气,同时配伍柴胡、白芍、郁金等温凉共济;顽浊痼脂瘀结于肝,为病著之期,可夹湿、痰、热诸邪,黄芪需用至60~90 g,以活血消脂,扶正祛邪,并配合山楂、决明子、路路通、泽泻等消脂降浊药。遣方时当根据不同季节特点配伍他药,调黄芪之升降,以顺应四时之性。
Based on the unique syndrome characteristics of metabolic associated fatty liver disease (MAFLD) in
Lingnan
(岭南) area, this paper discussed the clinical experience of Huangqi (
Radix Astragali
) in the treatment of MAFLD in
Lingnan
area. It is summarized that spleen deficiency and
yang
weakness, and internal accumulation of damp-turbidity are the source of the disease, and at the early stage, Huangqi, commonly 15~30 g, could be used to fortify the spleen and warm the earth, thereby making the deficiency fire latent, as well as raise the clear and warm the exterior so as to inhibit damp-turbidity; medication needs to be progressively supplemented, and can be used together with Taizishen (
Radix Pseudostellariae
), Baizhu (
Rhizoma Atractylodis Macrocephalae
), Fuling (
Poria
), and Fangfeng (
Radix Saposhnikoviae
) to back up the earth and inhibit dampness.
Qi
stagnation and blood constraint,
yin
dampness and heat accumulation are the pathogenesis of disease progression. Huangqi should be taken to invigorate the spleen and flourish the liver, unblock
yang
, and move stagnation. The dosage is often maintained at 30~60 g, to circulate the
qi
and unblock
yang qi
in the middle
jiao
(焦), usually combined with Chaihu (
Radix Bupleuri
), Baishao (
Radix Paeoniae Alba
) and Yujin (
Radix Curcumae
) integrating warm and cool medicinals. Stubborn turbid and fat condensing in the liver is a severe stage of the disease and may be concurrent with various pathogens such as dampness, phlegm, and heat, for which 60~90 g Huangqi should be used to invigorate blood and disperse fat, reinforce healthy qi and expel pathogens, often with medicinals that can disperse fat and direct the turbid downward such as Shanzha (
Fructus Crataegi
), Juemingzi (
Semen Cassiae
), Lulutong (
Fructus Liquidambaris
) and Zexie (
Rhizoma Alismatis
). When prescribing, it is suggested to combine with other medicinals according to the season, thereby adjusting the ascending and descending of the property of Huangqi, thereby conforming to the nature of the four seasons.
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