目的 探讨四君五皮饮加减结合螺内酯在肝硬化腹水患者中的临床疗效。方法 选取2021年5月—2024年5月期间在湖南省中西医结合医院治疗的共计100例肝硬化腹水患者。通过随机数字表法将其分为两组,对照组（n=50）和观察组（n=50）。对照组给予螺内酯治疗,观察组在对照组的基础上加用四君五皮饮加减。观察并记录两组患者临床疗效、腹水消退情况及肝功能指标等。结果 治疗后观察组患者腹围及腹水深度显著低于对照组,腹水消退总有效率（98.00%）明显高于对照组（86.00%）;治疗后观察组患者双目或皮肤发黄、恶心呕吐、食欲不振、脘腹撑急及腹胀的症状积分、丙氨酸氨基转移酶（alanine aminotransferase,ALT）、天门冬氨酸氨基转移酶（aspartate aminotransferase,AST）、总胆红素（total bilirubin,TBil）水平显著低于对照组,白蛋白（albumin,ALB）水平显著高于对照组;肾功能评估显示,两组治疗前后血肌酐（serum creatinine,Scr）、尿素氮（blood urea nitrogen,BUN）均在正常范围,组内治疗前后及组间比较差异无统计学意义。在治疗期间,两组不良反应发生率比较,差异无统计学意义（z=0.088,P=0.711）。结论 四君五皮饮加减联合螺内酯可有效促进肝硬化腹水消退、改善肝功能及凝血功能,且对肾功能无明显不良影响,安全性良好,值得临床推广。

Objective To investigate the clinical efficacy of the addition and subtraction of Sijun Wu Pi Drink combined with spironolactone in patients with cirrhotic ascites. Methods A total of 100 patients with cirrhosis ascites treated in Hunan Combined Traditional Chinese and Western Medicine Hospital between May 2021 and May 2024 were selected. They were divided into two groups, the control group (n=50) and the observation group (n=50) by a random number table method. The control group was given spironolactone treatment, and the observation group was added with Sijun Wupi Drink plus reduction on the basis of the control group. Observe and record the clinical efficacy, ascites subsidence and liver function indexes of the two groups. Results Markedly reduced abdominal circumferences and ascites depths were observed in the observation group, alongside a superior total ascites resolution rate of 98.00%, significantly surpassing the control group's 86.00%. Symptom scores for jaundice (manifesting as yellowing of the eyes or skin), nausea, vomiting, anorexia, epigastric fullness, and abdominal distension, along with levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil), were considerably lower in the observation group after treatment. In contrast, the albumin (ALB) level was significantly elevated in the observation group. Renal function evaluations revealed that both serum creatinine (Scr) and blood urea nitrogen (BUN) levels remained within normal limits before and after treatment in both cohorts, showing no statistically significant variations within or across groups. Throughout the treatment course, the incidence rates of adverse reactions exhibited no statistically significant difference between the two groups (z=0.088, P=0.711). Conclusion The modified Sijun Wupi Decoction combined with spironolactone can effectively promote the resolution of ascites in liver cirrhosis patients, improve liver function and coagulation parameters, with no significant adverse effects on renal function, demonstrating good safety and clinical applicability.