谢晶日教授从“虚毒瘀”论治慢性乙型肝炎特色心悟

Professor XIE Jingri′s Unique Insight on Treating Chronic Hepatitis B Based on the“Deficiency,Toxin and Stasis”Theory

慢性乙型肝炎是一种由持续感染乙型肝炎病毒引起的以乏力、食欲减退、腹胀、腹痛等临床表现的肝脏慢性炎症性疾病。谢晶日教授认为慢性乙型肝炎总的病机为正气亏虚,湿热疫毒之邪滞于肝脾,病久湿热瘀毒互结,终致肝脾肾虚损。病位及病性方面,谢师指出慢性乙型肝炎初起责之于肝,继则累及脾、肾、胆、胃等,属本虚标实、虚实夹杂之证。治疗方面,谢师针对该病“虚毒瘀”的病机分别提出了“健运脾胃,顾护根本”“清热解毒,兼重除湿”“活血祛瘀,缓通肝络”的特色治法;用药方面,寒温并举,苦甘齐施,辛散气血,肝脾同调;常用药物有柴胡、黄芪、白术、太子参、陈皮、鸡内金、连翘、板蓝根、田基黄、水飞蓟、泽泻、猪苓、三棱、莪术、延胡索、川芎等,其辨证思路清晰,选方加减灵活,临床疗效显著。附验案1则以佐证。

Chronic Hepatitis B is a chronic inflammatory liver disease caused by persistent infection of hepatitis B virus,characterized clinically by fatigue,loss of appetite,abdominal distension and abdominal pain.Professor XIE Jingri believes that the overall pathogenesis of chronic hepatitis B involves the deficiency of healthy qi,and dampness-heat and pestilential toxin stagnate in the liver and spleen,eventually leading to a complex interplay of damp-heat and stasis toxins,resulting in damage to the liver,spleen and kidney.Professor XIE points out that the liver as the initial site affected,subsequently involving spleen,kidney,gallbladder,and stomach,indicative of a mixed pattern of deficiency in root and excess in manifestation.In terms of treatment,Professor XIE puts forward the unique treatment methods of“invigorating spleen and stomach to protect the foundation”“clearing heat and removing toxin,and dispelling dampness”“activating blood and dispelling stasis,and dredging the collaterals of liver gently”.His pharmacological approach combines cooling and warming properties,bitter and sweet flavors,and pungent herbs that disperse Qi and blood,achieving harmony between liver and spleen.Commonly used herbs include Radix Bupleuri,Radix Astragali,Rhizoma Atractylodis,Radix Pseudostellariae,Pericarpium Citri Reticulatae,Chicken′s Gizzard-membrane,Forsythia suspensa,Radix Isatidis,Herba Hyperici Japonici,Silybum Marianum,Rhizoma Alismatis,Polyporus umbellatus,Rhizoma Sparganii,Rhizoma curcumae,Rhizoma Corydalis,and Szechuan Lovage Rhizome.Professor Xie′s thinking of pattern differentiation is clear,with flexible modification of prescriptions and significant clinical outcomes.Supporting case 1 is attached to demonstrate the efficacy of these approaches.