馬曉北教授治療慢性乙型病毒性肝炎經驗介紹

劉沙 馬曉北

[摘要] 馬曉北教授認為慢性乙型病毒性肝炎多為本虛標實之證。以正氣虧虛為發病的基礎，濕熱毒邪是致病的主要因素。濕熱毒邪互結，肝脾腎三臟俱損發為本病，治療上強調分清虛實，標本兼治，分期論治。活動期以祛邪為主，重在清熱利濕解毒，待毒去熱解后仍從本論治;穩定期以扶正為主，重在肝脾腎同調以恢復患者的正氣，提高人體免疫力。以經驗方加味黃精湯為基礎方，臨證加減化裁。同時注重調養結合，心肝同治，形神同調，整體調治，臨床效果較突出，并附經典驗案一則以證其效。

[關鍵詞] 馬曉北;加味黃精湯;慢性乙型病毒性肝炎;分期論治

[中圖分類號] R256.4? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2020）07（c）-0169-04

Introduction of Professor Ma Xiaobei′s experience in the treatment of chronic hepatitis B

LIU Sha? ?MA Xiaobei

Graduate School， China Academy of Chinese Medical Sciences， Beijing? ?100700， China

[Abstract] Professor Ma Xiaobei thinks that chronic hepatitis B is mostly the syndrome of deficiency in origin and excess in superficislity. Based on deficiency of healthy qi， dampness heat and toxin is the main factor. Damp heat and toxin are combined， liver， spleen and kidney are all damaged. The treatment emphasizes distinguishing false and true， treating both symptoms and root causes， treating by stages. During the activity period， the main treatment is to dispel pathogenic qi， the key is to clear away heat， remove dampness and toxin， and the treatment will be based on this theory after toxin; during the stable period， the main treatment is to strengthen the thealthy qi， and the key is to harmonize the liver， spleen and kidney so as to restore the patient′s healthy qi and improve the human body′s immunity. It is based on the empirical Modified Huangjing Decoction. At the same time， we should pay attention to the combination of nourishing， the treatment of heart and liver， the coordination of body and spirit， the overall treatment， and the clinical effect is more prominent. A classic case is attached to prove its effectiveness.

[Key words] Ma Xiaobei; Modified Huangjing Decoction; Chronic hepatitis B; Treatment based on stages

慢性乙型病毒性肝炎是由乙型肝炎病毒（HBV）感染引起，HBV感染可引起肝臟炎癥、肝纖維化等肝臟實質性的病理損害，繼而發展為肝硬化、肝癌等疾病[1]。截至2018年4月，我國慢性HBV感染者9300萬人，慢性肝炎患者高達2000萬人，其中30%的慢性肝病患者將發展至肝硬化甚至肝細胞癌[2]，不僅給患者的身心造成巨大的損害，而且增加了家庭以及社會的經濟壓力。目前西醫治療慢性乙型病毒性肝炎主要以免疫調節劑干擾素聯合抗病毒藥物恩替卡韋為代表，可有效提高HBeAg轉陰率和血清學轉換率[3]，但長期服用對腎功能有一定的毒副作用[4]。西醫治療容易忽略患者臨床癥狀的改善和患者的預后。中醫對該病的治療在改善患者癥狀、延緩病情發展、延長患者生命、提高生存質量等方面有明顯的優勢。……