基于伏邪理论探讨乙型肝炎肝硬化

Discussion About Hepatitis B Cirrhosis Based on the Theory of Latent Pathogen

慢性乙型肝炎具有"发则有证可辨,伏则无机可循"的特点,与伏邪致病特点一致,其病因为伏邪内郁,病机特点为邪恋正虚,故治疗多以扶正祛邪为主。根据伏邪本身发病特点,分三期进行辨治:病邪潜伏期,多见里热,主要以清透伏邪为主,使病邪从外而解。肝炎发作期,正邪相争,湿热疫毒郁阻于体内,出现黄疸,或为"阴黄",或为"阳黄",治以清热解毒,利湿退黄为主。迁延不愈期,病机为肝肾亏虚,湿热未尽,应补益肝肾。慢性乙型肝炎病机错综复杂,常扶正透邪与清热解毒并行,清热利湿与补肾健脾同用等。

Chronic hepatitis B has the following characteristic:When it occurs,some syndromes can be seen;when it is latent,no pathogenesis can be found.This is consistent with the pathogenic characteristics of latent pathogen.Its pathogenesis is characterized by stagnated pathogen and deficient healthy qi,so the treatment mainly focuses on reinforcing healthy qi and removing pathogen.According to the characteristics of latent pathogen,it can be divided into three stages:In latent period of pathogen,internal heat is common,so clearing away latent pathogen is the most important,so that pathogen can be removed from the outside.In the period of hepatitis attack,the struggle between healthy qi and pathogenic qi,and dampness-heat and epidemic toxin stagnation in the body lead to jaundice,with"yin jaundice"or"yang jaundice",so the treatment should focus on clearing heat and removing toxin,excreting dampness and removing jaundice.In the prolonged period,the pathogenesis is deficiency of liver and kidney,and dampness-heat is not removed completely,so it is necessary to tonify liver and kidney.The pathogenesis of chronic hepatitis B is complex,so reinforcing healthy qi is often combined with clearing away latent pathogen,while clearing heat and draining dampness is often combined with tonifying kidney and invigorating spleen.