血中蛋白－中醫的觀點

中醫以脾、肝、腎三臟來論治疾病所引起的血中蛋白、肝指數、膽紅素等問題，可以分成急性期及慢性期二個階段，在慢性期都以恢復過低的血中蛋白濃度為主，包括血中總蛋白、白蛋白、球蛋白及白球蛋白之比等等。血中蛋白濃度太低，容易造成肝細胞硬化、腹水、全身水腫、腎衰竭、肝昏迷、尿毒等，因而造成死亡。此類患者在慢性期之初，中醫辨證是屬脾虛，須以補脾胃之法，用六君子湯加方。中、後期屬陽虛，須以補脾陽用理中湯或六君子湯加乾薑、附子、肉桂等；後期大補脾肝腎之陽用腎氣湯或右歸飲加上乾薑、附子、肉桂加減來治療。疾病在急性期時急性發作或如猛爆性肝炎發作時在中醫辨證絕對是大熱證，一定用清熱解毒、通利肝膽及大腸之法，此時白蛋白還未變化，但球蛋白可能急遽增高，但治療的重點在轉胺酶（酵素）、膽紅素、膽固醇、三酸甘油脂、血糖等此類的血液檢查，主要評估肝臟對酵素、膽紅素、脂肪、膽固醇、血糖等等代謝及轉換的功能，及肝細胞發炎損傷的情形，此時雖然球蛋白過高卻不是醫療的重點。若治療後指數仍居高不下或一直往上攀升，就應當於此類方劑中加入乾薑、附子、肉桂、大黃，即用「溫瀉」法，即可將此類指數快速抑制下來。若使用過干擾素或類固醇，或已接受過一般中醫藥攻竣與清熱、解毒、平肝療法之後此類指數仍偏高時，要改變治療用藥，從四個方向來思考辨證用藥：偏脾氣虛，用香砂六君子湯加方。偏肝血虛，用四物湯加方。肝腎陰虛，用六味地黃湯加方。若用前述三個方向治療指數仍不下降，要考慮血枯問題的方向，於方中再加入何首烏、當歸、菟絲子、山茱萸、黃精、五味子等等，加重養肝血的藥物則此類指數即可下降。若已經使用過類固醇與干擾素治療者，患者體質會進入陽虛，必須在前述用藥中，加入乾薑、附子、肉桂，以大補陽法來治療。此類指數恢復正常，而血中蛋白也就恢復正常了。

關鍵字

血中蛋白；白蛋白；球蛋白；肝病

並列摘要

Traditional Chinese medicine uses the spleen, liver, and kidneys to treat blood protein, liver index, bilirubin and other problems caused by diseases. It can be divided into two stages: acute phase and chronic phase. In the chronic phase, low blood levels are restored. The main protein concentration is the ratio of total protein, albumin, globulin and albumin in the blood. Too low protein concentration in the blood can easily cause liver cell cirrhosis, ascites, systemic edema, kidney failure, liver coma, uremia, etc., which can lead to death. At the beginning of the chronic phase of this kind of patients, the syndrome differentiation of TCM is spleen deficiency, and the method of replenishing the spleen and stomach must be supplemented by the Liujunzi Tang. In the middle and late stages, it belongs to yang deficiency, so it is necessary to supplement the spleen yang with Lizhong Tang or Liujunzi Tang with dried ginger, aconite, cinnamon and so on. In the later stage, the yang of the spleen, liver and kidney can be treated with Kidney Qi Tang or Yougui Tang plus dried ginger, aconite, cinnamon, etc.