基于病机“拐点”探讨乙肝后肝硬化的证治

Treatment of Post-Hepatitis B Liver Cirrhosis Based on Inflection Point in Pathogenesis

中医认为,疾病病机进展一般包括由表入里、由浅入深、从阳入阴、从热转寒、由实转虚等不同的情况,然表里之隙、阴阳之间、寒热之隔、虚实之化的转折中必然存在病机之"拐点"。在乙肝后肝硬化的病程进展中,亦存在一个短暂时期的病机"拐点",在此"拐点"前,此病较为易治,肝硬化病程可逆;在此"拐点"后,此病较为难治,肝硬化不可逆。乙肝后肝硬化的病机拐点包括由热转寒和由气入血两类,前者可予柴胡桂枝干姜汤合理中汤治疗;后者可予柴胡桂枝干姜汤合旋覆花汤治疗。

In the development and change of diseases,there are generally changes from the surface to the inside,from shallow to deep,from Yang to Yin,from Heat to Cold,from excessivness to deficiency,etc.There must be a "inflection point" of pathogenesis in these aspects.In the course of post-hepatitis B liver cirrhosis,there is a short "inflection point" of the pathogenesis.Before this "inflection point",the disease is Yang,the disease lies in the Qi point,which is easier to treat,and the course of cirrhosis is reversible;after the "inflection point",the disease is Yin,the disease is in the blood and is more difficult to treat.The cirrhosis of the liver was irreversible.During clinical treatment,if the pathogenesis changes from Heat to Cold,the treatment should start with warming and dryness.The prescription should be Chaihu Guizhi Ganjiang Decoction.If the pathogenesis changes from Qi to blood,the treatment should be to promote blood circulation and remove blood stasis Chaihu Guizhi Ganjiang Decoction combined with Xuanfuhua Decoction should be used.