Clinical attention should be paid to cirrhosis

Cirrhosis is a chronic liver disease characterized by diffuse fibrosis of liver tissue, pseudolobules and regenerative nodule formation. In our country, whether it is relative incidence or absolute number of cases, cirrhosis patients are the first in the world, of which 75%~80% are developed from chronic hepatitis B. It is an intractable disease that seriously jeopardizes people’s health and consumes social resources. Modern medicine believes that the conventional treatment of cirrhosis should take comprehensive measures, including antiviral, anti-fibrosis and treatment of complications. For decompensated cirrhosis, liver transplantation remains a successful and proven treatment, but its major limitations undoubtedly lie in the lack of donors, high cost, and transplantation-related complications and morbidity and mortality. Therefore, it is particularly urgent to promote the reversal of cirrhosis or to find alternative therapies to liver transplantation in the presence of persistent pathogenic factors (mainly hepatitis B virus in China). Cirrhosis is not documented in traditional Chinese medicine, and is usually categorized as “coercive pain”, “Y accumulation”, “dropsy”, and so on. Regarding its basic pathogenesis, most scholars believe that it is related to “internalized dampness and heat, blood stasis and obstruction of collaterals, and deficiency of qi and yin”. However, in recent years, many scholars have suggested that “phlegm stasis and congealment” is closely related to the formation and development of liver cirrhosis. On the basis of summarizing the theoretical practice of the previous scholars and the results of modern clinical researches, I have suggested that “deficiency of liver qi and phlegm stasis and congealment” has great influence on the formation and development of liver cirrhosis, and it also affects the development of liver cirrhosis and dropsy. I propose that the disease mechanism of “deficiency of liver qi and loss of liver qi, phlegm stasis and condensation” largely influences the formation, development and regression of cirrhosis, which is of great clinical significance. As early as in Nei Jing (The Inner Classic), it was proposed that accumulation of evidence “congeals blood and does not dissipate”. Sui “the source of all diseases on the phlegm and drink disease symptoms” mentioned: “phlegm, this by the blood congestion, drinking water accumulation and not dissipate, so into phlegm also.” It can be seen that at that time, it was already recognized that phlegm would be formed when blood stasis and water stagnation occurred. The Yuan “Danxi Xinfa Diaoqin” pointed out: “Diaoqin, liver fire, wood qi real, there is dead blood, phlegm flow”; “Danxi Xinfa Ke Kei” also said: “Jaeger, tangible evil, or food, or phlegm, or blood, stagnation into a block. Proposed coercive pain, the formation of accumulation of evidence related to phlegm and stasis. Ming Jingyue quanjiu has a cumulative evidence of “its disease is mostly in the blood” recorded. Qing Tang Rongchuan “blood evidence on blood stasis” emphasized: “blood stasis in the meridians and internal organs, then the formation of the Y obstruction”. Therefore, looking at the views of medical doctors through the ages, we can believe that the formation of Y accumulation is closely related to “phlegm condensation” and “blood stasis”. Contemporary famous hepatologist Guan Youbo thinks, cirrhosis is damp and heat of the evil trapped spleen for a long time, transport failure, transfer power, positive loss of qi, the spleen qi deficiency, turbid qi is not transformed, wet and turbid phlegm cohesion and agglutination. The heat ravages the blood, injuring yin and depleting blood, and the deficiency of qi and blood stagnation, resulting in stagnation of stagnant blood, which stays and does not go away. Blood clotting and phlegm-dampness accumulate, blocking the blood channels to become plaques, which then congeal and harden. Contemporary famous Chinese medicine professor Li Shoushan also thinks that phlegm and blood stasis is the key to the pathogenesis of liver cirrhosis, one, dampness and heat stay in the spleen and stomach, spleen and stomach are out of harmony, phlegm and dampness are more prevalent, out of the right chemistry, it becomes fat and turbidity, which makes the condition recur or aggravate; two, the epidemic and poison lie within the body, in the liver body, stagnation of liver gas, robbing liver yin, depletion of kidney water, deficiency of essence and blood, for a long time blood stasis and become accumulations, the body is out of balance, the hepatic microcirculation is impaired, the proliferation of connective tissues, which makes the cirrhosis stubborn. Cirrhosis. Clinical studies have shown that phlegm and stasis is a common symptom of chronic viral hepatitis, and the points of phlegm and stasis are positively correlated with the levels of serum hyaluronic acid (HA), laminin (LN), and pre-collagen III (PCIII), suggesting that phlegm and stasis have a close relationship with liver fibrosis. In addition, modern medicine believes that the key pathological basis for the formation of cirrhosis lies in the excessive deposition and insufficient degradation of extracellular matrix (ECM, the main component of which is collagen), and it is now widely believed that this pathological change is related to the stasis-blood mechanism of traditional Chinese medicine. However, morphologically, the collagen fibers in the sclerotic liver are white in color, pliable in texture, and firm and cemented, which are different from the pain, lumps, bleeding and cyanosis of stasis, and belong to the category of stubborn phlegm in Chinese medicine. Therefore, synthesizing the views of ancient and modern medical doctors, it can be considered that “phlegm stasis and coagulation” is a pathological product formed in the process of chronic liver injury, and it is also one of the key mechanisms for the formation and development of liver cirrhosis, and it is a link that must be emphasized in the treatment of cirrhosis by traditional Chinese medicine. In addition, the basic mechanism of liver cirrhosis is closely related to “deficiency of liver qi”. Liver qi deficiency is first seen in Nei Jing, for example, Su Wen Shang Gu Tian Zhen Lun has the record of “Husband …… seven or eight, liver qi is weakened, tendon can’t be moved”. Ling Shu Ben Shen” said: “Liver gas deficiency is fear”. Sui “the source of all diseases,” mentioned: “liver gas is not enough, then the disease eye is not clear, the two wounds constriction, …… then it is appropriate to make up for the”. Qing Zhang Xichun, “medical Zhongzhong Senxi Lu”, said: “Since I have been clinical evidence, where the liver gas is weak can not be organized, with all the liver tonic medicine are ineffective, reuse of astragalus as the main ……. He said that the liver is weak and no complementary method, the original is not to see the word of the road also”. The above viewpoints make people’s understanding of physiological and pathological liver qi deficiency and its treatment gradually become more and more perfect. Modern Qin Bo Wei believes that “the liver qi deficiency seen in clinical practice is a deficiency of the essence of the liver organ, which is often accompanied by a deficiency of liver blood”. The late famous old Chinese medicine doctor Zhang Bo Yu that “clinical liver qi deficiency, liver yang deficiency is not uncommon, especially in hepatitis, cirrhosis cases. According to Liu Shunong, a famous doctor in Shanghai, “as far as cirrhosis is concerned, it is due to the deficiency of liver positive qi, and the evil of dampness and heat invades the liver by taking advantage of the deficiency, and stays but does not go, which causes the change of liver circulation, resulting in the unfavorable blood flow and stagnation of veins and channels”. Zhang Qin et al. comprehensively analyzed the clinical symptoms, signs and other information of 900 patients with post hepatitis cirrhosis, and the results showed that the basic syndromic pathogenesis reflecting the disease was qi deficiency and blood stasis. From perceptual understanding to rational understanding, the theory of the basic pathogenesis of liver cirrhosis “deficiency of liver qi” is becoming clearer day by day. Condensing the views of ancient and modern medical doctors, it can be concluded that the formation of liver cirrhosis is closely related to the pathogenesis of “deficiency of liver qi, phlegm and stasis”, and “tonifying qi, eliminating stasis and eliminating phlegm” is the treatment rule that should be emphasized in the clinical evidence.