基于"脾气散精"理论探讨补中益气汤加减治疗肝硬化腹水OA

Hepatic ascites is a common severe complication of decompensated liver cirrhosis,characterized by complex pathogenesis that frequently involves functional disorders of multiple zang-fu organs including the liver,spleen and kidney.Dysfunction of"spleen-qi dis-tributing essence"constitutes a key link in the onset and progression of hepatic ascites.The spleen governs transportation and transfor-mation and serves as the pivot for ascent and descent of qi movement.If spleen-qi deficiency impairs essence distribution,internal exu-berance of dampness-fire,intermingling of clear and turbid substances,liver-intestinal disharmony,and inhibited lung-qi diffusion may occur,which further result in damp-water retention and the development of ascites.This pathogenetic understanding is highly consistent with the impairment of substance transport within the hepatic portal venous system in modern medicine.Therefore,therapeutically,trea-ting the spleen should be established as the fundamental principle.As a classic formula for regulating the spleen and stomach,Center-Supplementing and Qi-Boosting Decoction shares a high degree of compatibility with the pathogenesis of"spleen deficiency as the root cause"in hepatic ascites.In clinical practice,flexible modifications should be implemented on the basis of invigorating the spleen and replenishing qi.Heavy dosage of Huangqi(Astragali Radix)is applied to warm yang and promote dispersion;Baizhu(Atractylodis Mac-rocephalae Rhizoma)is appropriately used to invigorate the spleen and relax the bowels.For concurrent fire-heat syndrome,bitter-cold medicinals are supplemented to purge fire;for blood stasis,medicinals that activate blood and unblock collaterals are adopted;for exces-sive damp-water,diuretic medicinals to drain dampness are prescribed;for obstructed fu-organ qi,purgatives are used to unblock fu-or-gans and discharge turbidity;for yang deficiency,medicinals to warm yang and regulate qi are administered;and for essence-blood deple-tion,medicinals to nourish and replenish kidney-essence are adopted.