基于黄芪汤益气效应解析代偿期乙肝肝硬化的“虚损”病机理论  

A Progress on the Interpretation of the Pathogenesis Theory of "Asthenia and Deficiency" of Compensated Posthepatitic Cirrhosis Based on the Tonifying-Qi Effect of Huangqi Decoction

作　　者：张华[1] 刘平[1,2] Zhang Hua Liu Ping(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine /Liver Disease Research Institute of Shanghai Institute of Traditional Chinese Medicine/Liver and Kidney Disease Key Laboratory of Ministry of Education （Shanghai University of Traditional Chinese Medicine） / Chronic and Asthenic Liver Disease Key Laboratory of State Administration of Traditional Chinese Medicine/Key Clinical Laboratory of Shanghai Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China Shanghai College E Research Institute of Internal Medicine of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China)

机构地区：[1]上海中医药大学附属曙光医院/上海市中医药研究院肝病研究所/肝肾疾病病证教育部重点实验室/国家中医药管理局慢性肝病虚损重点研究室/上海市中医临床重点实验室,上海201203 [2]上海中医药大学中医内科学E-研究院,上海201203

出　　处：《世界科学技术-中医药现代化》2016年第11期1833-1838,共6页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家重点基础研究发展计划("973"计划)(2006CB504801):肝硬化"虚损生积"中医病机研究;负责人:刘平;上海市科学技术委员会自然科学基金(2ZR1432300):基于代谢组学技术的湿热证"异病同证"生物学基础研究;负责人:张华;上海市教育委员会科研创新重点项目(14ZZ119):基于代谢组学及化学计量学方法的肝炎后肝硬化中医虚实证候分类特征研究;负责人:张华

摘　　要：中医病因病机理论的继承与创新是中医准确认识疾病、提高中医药临床疗效、引领中医学术发展的关键基础理论问题。基于课题组前期对肝硬化"虚损生积"病机认识以及从方剂效应探析中医病机理论病理特点的研究思路,以黄芪汤为载体开展的系统基础与临床研究发现,"益气补虚"黄芪汤可显著改善代偿期乙肝肝硬化的肝组织学病理变化,减轻肝细胞坏死,改善肝细胞功能,促进早期肝硬化组织学的逆转。黄芪与甘草协同增效的作用机制在于抑制促纤维化因子——转化生长因子(Transforming Growth Factor,TGF)β1生成及信号转导,抑制肝星状细胞的活化及细胞外基质的生成。本文为乙肝肝硬化等慢性肝病的虚损病机理论提供了临床及实验依据,深化和丰富了中医对肝硬化虚损病机中气虚为先的认识;提示气虚与细胞形质转化及其功能的病变有关,为进一步深入研究、提高中医药治疗慢性肝病的临床疗效提供了治法理论基础与临床实践依据。The heritages and innovation of etiology and pathogenesis theory of traditional Chinese medicine（TCM） are the key basic theoretical issues on accurately understanding of diseases, improving the clinical curative efficacy and guiding the academic development of TCM. Based on the known pathogenesis of ＂Asthenia and Deficiency Cause Accumulation＂ of liver cirrhosis and the study of the pathological features of the efficacy of prescriptions, basic and clinical researches of Huangqi decoction were carried out. In our previous studies, Huangqi decoction significantly improved the liver histopathological changes of hepatitis B cirrhosis at the compensatory stage, reduced liver cell necrosis, improved liver cell function, and promoted the histological reversal of early liver cirrhosis. Synergistic mechanism of astragalus and licorice action was revealed as the inhibition of the formation and signal transduction of fibroblast TGFβ1, the activation of hepatic stellate cells and the production of extracellular matrix, which provided a clinical and experimental basis for the asthenic pathogenesis theoretical understanding of chronic liver diseases, such as hepatic fibrosis and liver cirrhosis. This paper also deepened and enriched the theory of qi-deficiency over the asthenic pathogenesis of chronic liver disease, which suggested that the qi-deficiency was associated with cells transformation and functional malfunction. This study provided a new therapeutic theory and clinical basis for the profound study and the improvement of the clinical efficacy of TCM in the treatment of chronic liver disease.

关 键 词：肝硬化 病因病机 虚损 黄芪汤 转化生长因子Β1 

分 类 号：R241[医药卫生—中医诊断学]