| 引用本文: |
黎柳,尧忠柳,龙玲,尹周安.基于“伏邪-免疫”动态解构乙肝“伏”与“发”及临床证治[J].湖南中医药大学学报,2023,43(7):1290-1295[点击复制] |
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| 基于“伏邪-免疫”动态解构乙肝“伏”与“发”及临床证治 |
| 黎柳,尧忠柳,龙玲,尹周安 |
| (湖南中医药大学, 湖南 长沙 410208) |
| 摘要: |
| 乙型病毒性肝炎（简称乙肝）“伏”与“发”的动态过程符合中医伏邪的发病特点，亦反映免疫状态的变化。“冬伤于寒”（外感）和“冬不藏精”（内因）共同导致病“伏”，此时免疫不应答，疾病暂未发作。正邪相争，即免疫应答活跃，乙肝急性发作，此为疾病转折点和治疗关键。正气极虚时，正虚劳复，伏邪亦可暴发，危及生命。乙肝后期，正邪相争不及，疾病慢性化，免疫炎症反复损伤，久则进展至肝硬化、肝癌等，此过程符合伏邪成巢、久病入络的机制。因此，在治疗上，急性期从少阳（或兼阳明）论治；慢性期从肝脾或肝肾同治，结合补法和托法以透邪外出；后期形质改变，则从痰瘀论治，形气同调，以通络消癥。并列举临床典型案例，以期为乙肝临床证治提供参考与借鉴。 |
| 关键词: 伏邪 免疫 乙型病毒性肝炎 潜伏 发作 发病机制 证治思路 医案 |
| DOI：10.3969/j.issn.1674-070X.2023.07.022 |
| 投稿时间：2023-02-20 |
| 基金项目:湖南省教育厅湖南省教育科学“十三五”规划课题（XJK20CGD021）；教育部“方剂学”线上线下混合式国家级一流本科课程建设项目（2020140653）；湖南省教育厅一般科研项目（20C1402）；湖南中医药大学校级科研项目（2020XGXM002）。 |
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| Dynamic deconstruction of “incubation” and “attack” and pattern identification and treatment of hepatitis B based on “latent pathogenic factor-immunity” |
| LI Liu,YAO Zhongliu,LONG Ling,YIN Zhouan |
| (Hunan University of Chinese Medicine, Changsha, Hunan 410208, China) |
| Abstract: |
| The dynamic process of "incubation" and "attack" in viral hepatitis B (briefly referred to as hepatitis B) is in line with the pathogenic characteristics of latent pathogenic factor in Chinese medicine and also reflects the change of immune status. "Invasion of pathogenic cold in winter" (external contraction) and "failure of kidney to store essence in winter" (internal cause) lead to the "incubation" of disease jointly. Meanwhile, there is no immune response and the disease has not yet attacked. A struggle between healthy qi and latent pathogenic factors means active immune response and acute attack of hepatitis B, which is the turning point of the disease and the key to treatment. When the healthy qi is extremely weak, overwork-induced relapse may happen, and the latent pathogenic factors can also break out, even endangering life. In the later stage of hepatitis B, with the abating of struggle between healthy qi and pathogenic factors, the disease changes into chronic one, and progresses to cirrhosis, liver cancer etc. over time due to the immune inflammation damaging the liver tissue repeatedly. The above process is in accord with the mechanism of latent pathogenic factors resulting in tangible foci and entering the collaterals in prolonged disease. Therefore, the treatment should focus on clearing pathogenic heat or dampness-heat in Shaoyang meridian (or along with Yangming meridian) in the acute phase, and on regulating the liver and spleen or the liver and kidney simultaneously by tonifying them combined with expelling pathogenic factors in the chronic phase. In the later stage, due to organic changes of the disease, the treatment should focus on eliminating phlegm and stasis, and treating the tangible foci and regulating qi simultaneously, so as to unblock collaterals and resolve masses. And typical clinical cases were illustrated in order to provide references for the clinical treatment of hepatitis B. |
| Key words: latent pathogenic factor immunity viral hepatitis B incubation attack pathogenesis thinking of pattern identification and treatment medical cases |
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