陈四清辨治慢性乙肝临证经验撷英  

Clinical experience of Professor CHEN Siqing in the differentiation and treatment of chronic hepatitis B

作　　者：铁生花 于侑新 陈亚兰 吕春风 陈四清[1] TIE Shenghua;YU Youxin;CHEN Yalan;LYU Chunfeng;CHEN Siqing

机构地区：[1]南京中医药大学附属医院,江苏南京210029

出　　处：《中医临床研究》2023年第33期59-61,共3页Clinical Journal Of Chinese Medicine

摘　　要：慢性乙型病毒性肝炎(简称慢性乙肝)为慢性肝病常见病种之一,仍为临床难治之疾。江苏省中医院感染科陈四清主任中医师,系首届国医大师周仲瑛教授嫡传弟子,又师从孟河医派名家张继泽教授临证学习多年,擅长辨治肝病、肿瘤、腹泻、皮肤瘙痒等疑难病症,陈师认为疫毒感染是慢性乙肝的主要病因,疫毒与湿热胶着,久居于体内,致脾胃湿困,气血生化乏源;或邪郁久化;或火热之邪深入营血,耗血动血,损伤肝阴,而乙癸同源,肝病日久累及肾,肾阴亦虚,表现为肝肾阴虚之证;阴阳互根,阴病及阳,晚期亦可出现肾阳不足,故核心病机为湿热疫毒瘀郁,肝脾肾功能失司,病性本虚标实,虚实夹杂,病位在肝、脾、肾,强调肝为主脏,主张分肝胆湿热证、肝郁脾虚证、肝肾阴虚证3个基本证型论治。治疗上宜清热利湿贯穿始终,疏肝健脾补肾同中有异,并且在长期诊疗肝病的临床实践中总结出针对转氨酶和乙肝病毒两大指标使用的药对或队药,以垂盆草、鸡骨草、地耳草、五味子降低转氨酶;金钱草、郁金配伍降低胆道酶;土茯苓、忍冬藤降低慢性乙肝病毒载量。笔者临证跟师学习时,常感中医药效之奇,故对其经验初步总结,另附验案一则,为临床诊疗慢性乙肝提供新思路。Chronic viral hepatitis B is one of the common diseases of chronic liver disease,and it is still difficult to treat clinically.CHEN Siqing,a director of Infection Department of Traditional Chinese Medicine in Jiangsu Province,is a direct disciple of Professor ZHOU Zhongying,one of the first batch masters of traditional Chinese medicine,and has studied for many years from Professor ZHANG Jize,the famous doctor of Menghe School of Medicine.Director CHEN Siqing is good at distinguishing and treating liver disease,tumor,diarrhea,pruritchy skin and other difficult diseases.Professor CHEN Siqing believes that epidemic virus infection is the main cause of chronic hepatitis B.Epidemic virus and dampness and heat are glued together in the body for a long time,causing the spleen and stomach to be wet and sleepy,and the source of Qi(气)and blood transformation is in deficiency;or the evil depression is prolonged;or the hot evil goes deep into the blood,which is consuming.Therefore,the core pathogenesis is dampness-heat epidemic toxicity and stasis,resulting in liver,spleen and kidney dysfunction.It is deficiency in origin and excess in superficiality,excess and deficiency are mixed,and the disease is located in the liver,spleen and kidney,emphasizing that the liver is the main diseased organ.It is advocated to divide the disease into 3 types:liver-gallbladder dampness and heat syndrome,liver depression and spleen deficiency syndrome,and liver and kidney Yin(阴)deficiency syndrome.In the treatment,eliminating,heat and dampness should be used throughout to soothe the liver,strengthen the spleen and tonify the kidney.In addition,in the long-term clinical practice of diagnosis and treatment of liver disease,the drug pairs or drugs used for the two major indicators of transaminase and hepatitis B virus have been summarised.Chuipencao(Pendant basin grass),Jigucao(Chicken bone grass),Diercao(Earthen grass),Wuweizi(Schisandra)can reduce transaminase;the combination of Jinqiancao(Money grass)and Yujin(Tulip)can reduce biliary enzy

关 键 词：乙肝 湿热 疫毒 中医药治疗 

分 类 号：R256.4[医药卫生—中医内科学]