刘凤斌运用育阴开淤法分期辨治自身免疫性肝病经验  

LIU Fengbin's Experience in Treating Autoimmune Liver Disease with the Method of Nourishing Yin and Removing Stasis Based on Stage

作　　者：杨希玲 雍秋红 黄超原 赵利娜[1] 郑逸远 彭冲 庄昆海[4] 刘凤斌(指导)[1] YANG Xiling;YONG Qiuhong;HUANG Chaoyuan;ZHAO Lina;ZHENG Yiyuan;PENG Chong;ZHUANG Kunhai(The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,510405;The Second Affiliated Hospital of Guangzhou University of Chinese Medicine;Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine;Baiyun Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine)

机构地区：[1]广州中医药大学第一附属医院,广东省广州市510405 [2]广州中医药大学第二附属医院 [3]上海中医药大学附属市中医医院 [4]广州中医药大学第一附属医院白云医院

出　　处：《中医杂志》2025年第7期674-679,共6页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82104549);中国博士后科学基金(2020M672603,2021M700960);广东省中医药重点学科建设项目(20220087)。

摘　　要：总结刘凤斌教授运用育阴开淤法分期治疗自身免疫性肝病(AILD)的临证经验。认为AILD病机总属本虚标实,本虚多见肝肾阴虚,日久兼有脾虚、阳虚,标实多见气滞、血瘀、湿热、痰毒。临证主张以育阴开淤为治疗原则,在养肝肾之阴的基础上,采用因势利导的方法祛除导致机体淤滞的不同病理因素,同时根据AILD各期特点进行分期论治。AILD前期及无症状期,肝郁气滞脾虚明显,治宜疏肝解郁健脾,方以自拟方柴芍气滞汤加减;临床症状期邪气尤盛,正气亏虚明显,可见湿热、水湿、痰毒为患,治宜补气健脾、清热祛湿,方以四君子汤合茵陈五苓散加减;肝功能失代偿期湿热痰毒瘀阻肝络,治宜养血软肝、健脾化瘀,方以自拟方软肝养血汤加减。同时治疗全程注重补益肝肾,顾护阴液。This paper summarizes Professor LIU Fengbin's clinical experience in treating autoimmune liver disease(AILD)using the method of nourishing yin and removing stasis based on stage differentiation.He believes that the pathogenesis of AILD generally involves both deficiency in essence and excess in manifestation,with essence deficiency often presenting as liver and kidney yin deficiency,which may progress to spleen deficiency and yang deficiency over time.The excess manifestation commonly includes qi stagnation,blood stasis,damp-heat,and phlegm toxicity.Clinically,he advocates for the treatment principle of nourishing yin and removing stasis.On the foundation of nourishing liver and kidney yin,different pathological factors causing stasis are eliminated according to their nature.Treatment is also tailored to different stages of AILD.In the early and asymptomatic stages,liver qi stagnation and spleen deficiency are prominent,warranting a therapeutic approach of soothing the liver,regulating qi and strengthening the spleen.The modified Chaishao Qizhi Decoction(柴芍气滞汤)is used.During the symptomatic stage,pathogenic factors become more pronounced,often accompanied by a significant deficiency of vital qi,with damp-heat,water retention,and phlegm toxicity as key pathological features.The treatment should focus on strengthening the spleen and dispelling dampness,using modified Sijunzi Decoction(四君子汤)combined with Yinchen Wuling Powder(茵陈五苓散).In the liver function decompensation stage,vital qi is severely deficient while pathogenic factors persist,with damp-heat,phlegm toxicity,and blood stasis obstructing the liver collaterals.Treatment should focus on nourishing blood,softening the liver,strengthening the spleen,and resolving stasis,using the modified Ruangan Yangxue Decoction(软肝养血汤).Throughout the treatment process,emphasis is placed on tonifying the liver and kidneys while protecting yin fluids.

关 键 词：自身免疫性肝病 名医经验 刘凤斌 

分 类 号：R259[医药卫生—中西医结合]