从虚论治慢性乙型肝炎思路探析  

An exploration of theoretical approaches to chronic hepatitis B from a deficiency perspective

作　　者：孔得名 李思泽 李小科[1,2] 杜宏波[1,2] 叶永安[1,2] KONG De-ming;LI Si-ze;LI Xiao-ke;YE Yong-an(Department of Spleen and Gastroenterology,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing,100007,China)

机构地区：[1]北京中医药大学东直门医院脾胃病科,北京100700 [2]北京中医药大学中医肝病研究院

出　　处：《中西医结合肝病杂志》2024年第10期870-874,878,共6页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：国家科技重大专项“十三五”课题(2018ZX10725505);中央高水平中医医院临床科研业务费项目(DZMG-XZYY-23003);北京中医药大学东直门医院2023科技创新专项(DZMKJCX-2023-014)。

摘　　要：慢性乙型肝炎(CHB)起病隐匿,病程缠绵,其发病与正虚关系密切,正气与邪气消长变化的矛盾贯穿CHB病程始终,从CHB进展至肝硬化、肝癌的过程是邪气不断耗伤正气、正虚抗邪能力逐渐消减的动态变化过程。CHB之虚常见于脾,兼及于肝,亦可及肾,常为多脏虚并见,可涉及气、血、阴、阳各方面,治疗当辨明虚损的病位与特点,重在肝脾同调,强调“中州为先,调肝为要”,兼及于肾,同时不泥于补,注重和顺脏气,用药不宜峻猛,补虚不可恋邪。Chronic Hepatitis B(CHB) has an insidious onset and a lingering course,closely related to the deficiency of vital energy.The entire course of CHB is characterized by the dynamic interplay between the strengthening of vital energy and the weakening of pathogenic factors.The progression from CHB to cirrhosis and liver cancer reflects the continuous depletion of vital energy and the gradual decline in the body's ability to resist the pathogenic forces.The deficiency in CHB is most commonly observed in the spleen,often affecting the liver and sometimes the kidneys,frequently involving multiple organs.This deficiency can encompass aspects of Qi,blood,Yin,and Yang.Treatment should focus on identifying the specific location and nature of the deficiency,with emphasis on harmonizing both the liver and spleen.The principle is to "prioritize the central region and focus on liver regulation," while also considering the kidneys.However,treatment should not be overly fixated on supplementation,but rather aim to harmonize the organ energies gently,avoiding overly potent medications and ensuring that tonification does not reinforce the pathogenic factors.

关 键 词：虚 慢性乙型肝炎 理论探讨 

分 类 号：R256.4[医药卫生—中医内科学]