Talking about the liver and gallbladder and treating the liver

Gallbladder at the same time According to the understanding of the physiology and pathology of the liver and gallbladder in Chinese medicine and modern medicine and the results of clinical practice, it is shown that the simultaneous treatment of liver and gallbladder is one of the treatment principles of liver disease.

1. Physiology and pathology of liver and gallbladder : Liver and gallbladder are connected, the liver resides under the flanks, the gallbladder is attached to the liver, and the liver and gallbladder are connected to the outside and inside by the meridian. Both meridians are distributed on the flank.

The five internal organs store the essence and qi without diarrhea, and the six fu-organs transfer the material without hiding. The liver and gallbladder all have diarrhea. The liver not only regulates the storage and regulation of blood, but also secretes bile to excrete bile, but the bile secreted by the liver can only be diarrhea and cannot be stored, otherwise it will lead to cholestasis. Gallbladder not only stores and concentrates bile, but also excretes bile, so it is also called the home of Qiheng. If only hiding but not diarrhea, it will cause cholecystitis and cholelithiasis.

The liver and gallbladder are physically connected and interdependent. The liver is in charge of planning, courage to decide, and jointly fulfills the function of thinking and decision. “When the courage rises, the qi of the internal organs rises.” “If a person has no stomach qi, the source will be cut off, and if there is no courage, the wood machine will stop and waste. One is the root, the other is the beginning.” To clear the turbidity and dredge the soil.”. The guilty person is the official of the righteousness, has the function of coordinating yin and yang qi and blood, mental sentiment and visceral activities to make it normal. Therefore, “the eleven viscera depend on the gallbladder.” Therefore, its importance in the diagnosis and treatment of liver disease cannot be ignored.

2. Syndrome element research prompts: Syndrome element is the basic element of syndrome differentiation, the basic diagnostic unit that must be clear, and the key to syndrome differentiation. Accurate judgment of syndrome elements can improve the accuracy of syndrome differentiation. Professor Liu Shaoneng, Wang Rongbing, etc., the research results of 1586 cases of chronic hepatitis B patients suggest that,

The main organs damaged by chronic hepatitis B are liver, gallbladder, spleen, stomach, kidney, triple burnt and so on. Explains the importance of viscera differentiation and the necessity of simultaneous treatment of liver and gallbladder.

3. Analysis of clinical medication: Looking at the prescriptions for liver disease in recent years, it can be summarized as the following categories.

(1) Clearing the liver, promoting the gallbladder and repelling the organs: medicines such as Yinchen, Gardenia, Rhubarb, Scutellaria, Polygonum cuspidatum, Dandelion, Honeysuckle, Lysimachia, Lobelia, etc. Various medicines have the functions of clearing heat and dampness, detoxification and purging fire, and clearing liver and promoting gallbladder and organs. Pharmacological studies have confirmed that the medicine can promote the secretion and excretion of bile, promote the binding and excretion of bilirubin, and relax the sphincter of Odti. Representative prescriptions such as Yinchenhao Decoction.

The six fu-organs are used for general purpose. Broadly speaking, the general purpose of the six-fu-organs should include the passage of the large intestine, the bladder, the discharge of the triple energizer, the lowering of the stomach qi, and the biliary function. Therefore, the effects of choleretic and purgative are the same.

One of the rescue principles for severe hepatitis is to promote the three benefits: choleretic, diuretic, and diarrhea, which coincides with the treatment of traditional Chinese medicine.

(3) Cooling blood, promoting blood circulation and promoting choleretics: medicines such as red peony root, paeonol, salvia miltiorrhiza, small thistle and so on. Pharmacological studies have confirmed that red peony root, salvia and other blood-cooling and blood-activating drugs are beneficial to the gallbladder, antioxidant, reduce thromboxane B2 and vascular tension, relieve micro bile duct spasm, improve blood viscosity, increase liver blood flow, dilute bile, and improve liver micro Circulation, promote liver cell regeneration and repair, and reduce intrahepatic bile duct inflammation and epithelial cell swelling and necrosis, promote bile duct epithelial cell regeneration, keep bile ducts unobstructed, improve cholestasis, and promote bilirubin binding. .

(4) Liver and choleretic: medicines such as white peony root, black plum, schisandra and so on. Pharmacological studies have confirmed that Wumei and Schisandra can promote gallbladder contraction and bile secretion. White peony can relax the smooth muscles of the biliary tract, and licorice has a beneficial effect on the gallbladder. The combination of the two drugs has the effect of acid and sweetening of Yin. After careful analysis, Sini San has the functions of soothing the liver and promoting gallbladder, as well as softening the liver and promoting gallbladder.

Pharmacological studies have confirmed that warm-yang drugs can promote blood circulation, improve liver blood flow, increase bile secretion, and strengthen the contractile function of the gallbladder, bile duct and intestinal tract. For example, cinnamon contains cinnamaldehyde to promote bile secretion, and the main component of cinnamon sticks is cinnamaldehyde. Dried ginger has the effect of promoting bile secretion. Although aconite has no direct choleretic effect, its aconitine-like effect is similar to adrenal cortex hormone. This is similar to the Chinese medicine’s belief that Aconite can warm the body’s yang. Asarum also has anti-inflammatory effects similar to cortisone acetate. So far, glucocorticoids are still used in the treatment of severe hepatitis. Ebony has the effect of contracting the gallbladder, relaxing the bile duct sphincter, and increasing the secretion of bile.

It has been reported that warm-yang drugs such as Paofuzi and Amomum villosum have significant effects in improving liver tissue pathology, especially in dilating bile ducts and dredging cholestasis, suggesting that adding warm-yang drugs in the treatment of chronic liver disease can improve microcirculation and promote bile. Metabolism and other effects. However, Chinese medicine believes that warm-yang medicine has the ability to invigorate qi and blood, invigorate the liver yang, and relieve the power. Professor Qian Ying believes that “Liver-yin is difficult to replenish in the body, but liver-yang is invisible but can quickly warm up.”

4. Clinical observation

The prescription analysis is as follows: Bupleurum, Scutellaria baicalensis Georgi, Polygonum cuspidatum, Rhubarb, clearing liver and promoting gallbladder and promoting organs, Danshen, Red peony root, turmeric, cooling blood, promoting blood circulation and promoting gallbladder, Bupleurum, Citrus aurantium, Pinellia for soothing liver and gallbladder, regulating qi and reducing phlegm, ebony plum , Peony root, licorice soften the liver and promote choleretics.

5. Experience:

(1) Liver disease not only refers to viral hepatitis, but also includes cholestatic hepatitis, steatohepatitis, alcoholic hepatitis, drug-induced hepatitis, etc.

(2) The liver and gallbladder in Chinese medicine are not only an anatomical concept, but more importantly, a functional activity system. Therefore, the above-mentioned prescriptions not only act on the liver and gallbladder, but also on the whole body, by regulating the yin and yang, qi and blood of the whole body, the viscera and meridians are used to dispel pathogens, stabilize or strengthen the body, and to a certain extent also embody the overall concept of Chinese medicine.

(3) The simultaneous treatment of liver disease and liver and gallbladder emphasizes that liver disease should pay attention to gallbladder from the perspective of viscera differentiation.

The condition of liver disease is complex and changeable, and the symptoms and signs are mixed. The clinical symptoms need to be combined with the above-mentioned methods.

Chronic disease and kidney are undoubtedly, but the late liver disease should also pay attention to the liver and kidney yang failure and the spleen and kidney yang failure and should be differentiated. The clinical manifestations of the former are characterized by mental and emotional abnormalities and hepatic wind internal movement, similar to hepatic encephalopathy. The latter is characterized by abnormalities in water and water transportation and metabolism, and is similar to ascites due to liver cirrhosis.

There is no word for choleretics in ancient Chinese medicine books. Comprehensive clinical practice, the method of choleretics has the following effects:

Promote the secretion and excretion of bile; promote the metabolism of bilirubin and reduce blood bilirubin; promote the contraction of the gallbladder and the relaxation of the biliary sphincter; promote the excretion of metabolites and toxic substances; promote the dissolution and excretion of gallstones; beneficial The secretion and excretion of bile acid; inspire the gasification of the twelve meridians of the viscera, promote clearness and reduce turbidity, and dredge the soil.

It should be pointed out that in the treatment of liver disease, the pure and mechanical use of traditional Chinese medicine to promote choleretics from the perspective of Western medicine should be avoided.

6. It has been a conclusive conclusion that liver disease can strengthen the spleen, but from the results of the above-mentioned Chinese and Western medicine theories and practices, the simultaneous treatment of liver and gallbladder should also be one of the treatments for liver disease. At the same time, in terms of chronic hepatitis, simultaneous treatment of liver and gallbladder is beneficial to the recovery of liver disease, and to a certain extent can block or delay the occurrence of liver cirrhosis, chronic severe hepatitis and biliary system diseases. Therefore, the simultaneous treatment of liver and gallbladder also embodies the preventive medicine idea of ​​preventing changes and curing pre-existing diseases.