张晔铭 郑红刚 贺用和

〔摘要〕 原发性肝癌腹水是常见的中晚期肝癌并发症之一。贺用和主任医师主张肝癌与腹水同治，强调肝癌“内风暗旋、肝风内动”的病机，将肝癌腹水分为气滞湿阻、脾虚湿盛、水热蕴结、血瘀水停、阳虚水泛、阴虚水停6种证型：气滞湿阻证，治以温中健脾，利水化湿，采用柴胡疏肝散加减;水热蕴结证，治以清热利湿，攻下逐水，采用茵陈蒿汤或中满分消丸加减;血瘀水停证，治以活血化瘀、行气利水，采用调营饮加减;阳虚水泛证，治以补益肾阳、利水渗湿，采用济生肾气丸加减;阴虚水停证，治以滋阴补肾、柔肝利水，采用六味地黄丸加减。

〔关键词〕 原发性肝癌;腹水; 内风暗旋;肝风内动;贺用和

〔中图分类号〕R563.1;R248       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.05.017

The Experience of He Yonghe in Treating Ascites of Primary Liver Cancer

ZHANG Yeming1， ZHENG Honggang2， HE Yonghe2*

（1. Graduate School of Beijing University of Traditional Chinese Medicine， Beijing 100029， China;

2. Guang'anmen Hospital China Academy of Chinese Medical Sciences， Beijing 100053， China）

〔Abstract〕 Ascites of primary liver cancer is one of the common complications of middle and late stage liver cancer. Chief physician He Yonghe advocates the treatment of liver cancer and ascites together， emphasized the pathogenesis of "internal wind dark whirl， internal movement of liver wind" in liver cancer. He divides ascites of liver cancer into six syndromes： Qi stagnation and dampness obstruction， spleen deficiency and dampness accumulation， water heat accumulation， blood stasis and dampness obstruction， water flooding in Yang deficiency and water stopping in Yin deficiency. The syndrome of Qi stagnation and dampness obstruction should be treated by warming the spleen and invigorating the spleen and improving the hydration and dampness， and Chaihu Shugan Powder should be used. To treat the syndrome of water heat accumulation， it is necessary to clear heat and gain moisture， and to attack the water， modified Yinchenhao Decoction or Zhongman Fenxiao Pill should be used. Blood stasis and water stop syndrome should be treated with promoting blood stasis， Qi and water， modified Tiaoying Decoction should be used. Yang deficiency and water flooding syndrome should be treated by tonifying kidney Yang and benefiting water infiltration and dampness， modified Jisheng Shenqi Pill should be used. Yin deficiency and water stagnation syndrome should be treated by nourishing Yin and tonifying kidney， softening liver and promoting water， modified Liuwei Dihuang Pill should be used.

〔Keywords〕 primary liver cancer; ascites; internal wind dark whirl; internal movement of liver wind; He Yonghe

原發性肝癌包括肝细胞癌及肝内胆管癌，为我国常见的恶性肿瘤之一。腹水是中晚期原发性肝癌的常见并发症之一。相较于常见的肝炎性肝硬化导致的腹水，原发性肝癌腹水（简称肝癌腹水）更易伴随多种并发症，如肝肾综合征、肝性脑病、低蛋白血症、黄疸、贫血、电解质紊乱、出血、感染等，且由于肿瘤本身的病理特点，导致患者病情更加复杂[1-2]。由于西医治疗肝癌腹水存在较多的不良反应，近年来中医或中西医结合治疗肝癌腹水逐渐成为研究的新方向。中医治疗肝癌腹水，一方面可以有效缓解腹水的负荷，另一方面可以降低不良反应。中西医结合治疗肝癌腹水，可以有效提升患者生活质量，提高患者生存期。……