刘沙 马晓北

[摘要] 马晓北教授认为慢性乙型病毒性肝炎多为本虚标实之证。以正气亏虚为发病的基础，湿热毒邪是致病的主要因素。湿热毒邪互结，肝脾肾三脏俱损发为本病，治疗上强调分清虚实，标本兼治，分期论治。活动期以祛邪为主，重在清热利湿解毒，待毒去热解后仍从本论治;稳定期以扶正为主，重在肝脾肾同调以恢复患者的正气，提高人体免疫力。以经验方加味黄精汤为基础方，临证加减化裁。同时注重调养结合，心肝同治，形神同调，整体调治，临床效果较突出，并附经典验案一则以证其效。

[关键词] 马晓北;加味黄精汤;慢性乙型病毒性肝炎;分期论治

[中图分类号] R256.4          [文献标识码] A          [文章编号] 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感染可引起肝脏炎症、肝纤维化等肝脏实质性的病理损害，继而发展为肝硬化、肝癌等疾病[1]。截至2018年4月，我国慢性HBV感染者9300万人，慢性肝炎患者高达2000万人，其中30%的慢性肝病患者将发展至肝硬化甚至肝细胞癌[2]，不仅给患者的身心造成巨大的损害，而且增加了家庭以及社会的经济压力。目前西医治疗慢性乙型病毒性肝炎主要以免疫调节剂干扰素联合抗病毒药物恩替卡韦为代表，可有效提高HBeAg转阴率和血清学转换率[3]，但长期服用对肾功能有一定的毒副作用[4]。西医治疗容易忽略患者临床症状的改善和患者的预后。中医对该病的治疗在改善患者症状、延缓病情发展、延长患者生命、提高生存质量等方面有明显的优势。……