從中西醫整合角度推演肝硬化腹水之治療模式

肝硬化的形成機理目前已知是由各種不同可能造成肝損傷的原因，造成肝臟慢性持續發炎，使肝臟細胞不斷壞死，而再生速度趕不上壞死速度，壞死細胞遍布疤痕組織，導致肝臟纖維化，久而久之形成肝硬化，而肝硬化後續衍伸的併發症，除了威脅了生命，對於生活品質的影響更是讓患者苦不堪言，近幾年在慢性肝病進一步演化為肝纖微化或肝硬化的致病路徑上有越來越多突破的研究發現，尤其是在分子生物學的層次上，發現許多致肝纖微化的發炎介質，而中醫藥在治療肝病的研究上，除了臨床辨證施治外，也致力於藥物作用於抗肝纖微化的機轉研究，使得肝硬化的治療面向更加全面。本案例為大腸癌後合併肝硬化引起腹水併發症，透過整合中醫傳統辨證與納入「微觀證型」的辨證論治思維，在腹水與其他相關併發症上皆獲得穩定改善。藉此個案分享進行分析與討論，期許讓更多同道在治療肝硬化腹水上有更全面的思考方向。

關鍵字

肝硬化；腹水；肝纖維化；微觀辨證；中西醫整合

並列摘要

The mechanism of liver cirrhosis is currently known to be caused by a variety of different causes of liver injury. Due to chronic inflammation of liver, so the liver cells continue to necrosis, and regeneration rate can not keep up with necrosis rate, necrotic cells throughout the scar tissue, leading to liver fibrosis, over time the formation of cirrhosis. Many complications are caused by liver cirrhosis not only threaten to life, but also the quality of life. In recent years, research has further evolved into more and more breakthrough discoveries on liver fibrosis or cirrhosis of pathogenic micro-pathway in chronic liver disease, especially at the molecular biology level, finding out many inflammatory medium factors of liver fibrosis. Nowadays liver disease research of Chinese medicine not only using clinical syndrome differentiation, but also committed to the role of drugs in the anti-liver fibrosis of the machine research, making cirrhosis treatment more comprehensive. In this case, patient has colorectal history and liver cirrhosis complicated ascites, the thinking process of treatment is integration of Chinese medicine pattern identification for determining treatment and concept of micro-syndrome. Patient got improvement on many ways after treatment, so we discuss and analyze how we think and treat on this case, and wish offering more comprehensive thinking process on treatment of liver cirrhosis and ascites.