黄宁宇 李悦 皮珊珊 糟小宾 李萌 叶永安 杜宏波

〔摘要〕 肝纤维化是各种慢性肝病向肝硬化发展过程中的关键步骤和影响肝病预后的重要环节。叶永安教授在肝纤维化治疗实践中形成了具有一定个人特色的诊疗思路。肝纤维化治疗首重病因，以毒立论;次重病机，强调守方;善调气血，由重向轻;兼调他脏，注重脾肾等观点，构成了其肝纤维化诊疗的主要思路。

〔关键词〕 肝纤维化;肝硬化;病毒;酒精性肝病;叶永安

〔中图分类号〕R256.4; R575          〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.07.019

〔Abstract〕 Liver fibrosis is a key step in the development of various chronic liver diseases to cirrhosis and an important link that affects the prognosis of liver diseases. Professor Ye Yongan has formed his own unique diagnosis and treatment thinking in the treatment of liver fibrosis. In the treatment of liver fibrosis， the first point is that the cause of the disease is toxicity; the second point is that catching the major pathogenesis by keeping suitable prescription; the third point is that regulating the Qi and blood follows the order from heavier to lighter; the fourth point is that regulating the spleen and kidney is important for the treatment of live fibrosis. The above viewpoints constitute the main ideas of professor Ye Yongan's diagnosis and treatment of liver fibrosis.

〔Keywords〕 liver fibrosis; liver cirrhosis; virus; alcoholic liver disease; Ye Yongan

叶永安教授是北京中医药大学东直门医院主任医师，教授，博士研究生导师，长江学者，4次牵头国家传染病中医科技攻关及重大专项的慢性乙型肝炎研究项目。叶永安教授从业三十余年来，在慢性肝病领域勤于探索，不断实践，逐步形成了具有个人风格的治疗思路，取得了较好的临床疗效。现对叶教授在肝纤维化治疗方面的思路总结如下。

1 重视病因论治，抗纤必溯病源

肝纤维化是肝脏细胞外基质的弥漫性过度沉积与分布异常，是肝脏对慢性损伤的病理性修复机制，是各种慢性肝病向肝硬化发展过程中的关键步骤和影响肝病预后的重要环节[1]。叶教授认为肝纤维化作为一种异常修复机制，肝纖维化活动多继发于肝脏慢性炎症，而慢性炎症的存在必有其特定病因。追溯病源，对因治疗，是肝纤维化治疗的首要经验。

1.1  从毒论纤，辨治有法

慢性肝病出现纤维化活动原因，叶教授常总结为一个毒字。……