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莫征远, 林昌稳, 陈鑫鑫, 叶凤琴, 罗娟, 王秀峰.从《黄帝内经》石水理念论治肝硬化腹水[J].湖南中医药大学学报英文版,2025,45(10):1937-1942.[Click to copy
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| 从《黄帝内经》石水理念论治肝硬化腹水 |
| 莫征远,林昌稳,陈鑫鑫,叶凤琴,罗娟,王秀峰 |
| (广西中医药大学研究生院, 广西 南宁 530001;广西中医药大学第一附属医院, 广西 南宁 530001) |
| 摘要: |
| 中医石水首见于《黄帝内经》，以腹部膨隆、不喘及胁下坚硬为主要症候，其临床表现与肝硬化腹水高度吻合，归属于中医学“石水”范畴。阴阳不和、邪气积结是本病发病的关键，多为阴邪作祟，病情虚实夹杂，涉及多个脏腑，最终造成精气血津液转化过程的全面失调。水液代谢障碍是疾病进展的重要环节，主要病位为“肝脾-三焦-肾”水液代谢轴，肝肾阳气受损状态是腹水进展的关键所在。文章提出化积解毒、通调枢机，疏浚水道、宣上通降，助火填阴、调气养精的整体治疗原则及清热利湿、解毒开窍的变证治法。探讨轻度腹水、重度腹水、顽固性腹水及水热互结变证型腹水的辨证论治思路，注重调理人体先天与后天的关系，改善滋养失调、邪气积结的恶性循环，恢复脏腑功能，改善复杂的病理内环境，体现中医辨证施治、整体调理的优势。 |
| 关键词: 肝硬化 腹水 《黄帝内经》 石水 阴阳不和 邪气积结 |
| DOI：10.3969/j.issn.1674-070X.2025.10.018 |
| Received:July 02, 2025 |
| 基金项目:广西中医药适宜技术开发与推广项目（GZSY22-21）；广西中医肝病临床医学研究中心（桂科AD17129001）。 |
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| Treatment of cirrhotic ascites based on the "stony edema" concept from the Huang Di Nei Jing (Huangdi's Classic of Medicine) |
| MO Zhengyuan, LIN Changwen, CHEN Xinxin, YE Fengqin, LUO Juan, WANG Xiufeng |
| (Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi 530001, China;The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi 530001, China) |
| Abstract: |
| Stony edema was first described in Huang Di Nei Jing (Huangdi's Classic of Medicine), characterized by abdominal distension, absence of dyspnea, and hardness beneath the ribs. These clinical manifestations closely resemble those of cirrhotic ascites, and thus, cirrhotic ascites is categorized under the scope of "stony edema" in Chinese medicine. The pathogenesis is primarily attributed to disharmony between yin and yang and the accumulation of pathogenic qi, with yin pathogens often playing a predominant role. The disease presents a complex mix of deficiency and excess, involving multiple viscera and ultimately leading to a global disturbance in the transformation of essence, qi, blood, and body fluids. Water metabolism disorder is a critical mechanism in the disease progression, mainly involving the "liver-spleen-sanjiao-kidney" axis of water metabolism. Impaired liver and kidney yang is the key factor driving the development of ascites. This article proposes holistic therapeutic principles for cirrhotic ascites based on the "stony edema" concept, including resolving accumulation and removing toxins, harmonizing the pivotal axis, dredging the water pathways, promoting ascending and descending functions, supporting fire and nourishing yin, and regulating qi and essence. Pattern-specific treatments are also discussed, such as clearing heat and draining dampness, removing toxins, and opening the orifices. The article discusses the pattern differentiation and treatment strategies for mild ascites, severe ascites, refractory ascites, and ascites with intertwined water-heat pattern, focusing on regulating the relationship between prenatal and acquired factors in the human body, breaking the vicious cycle of impaired nourishment and accumulation of pathogenic qi, restoring function of zang-fu organs, and improving the complex pathological internal environment, thereby highlighting the advantages of treatment based on pattern differentiation and holistic regulation in Chinese medicine. |
| Key words: liver cirrhosis ascites Huang Di Nei Jing (Huangdi's Classic of Medicine) stony edema disharmony between yin and yang accumulation of pathogenic qi |
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