基于“杂合以治”思想探讨肝纤维化的治疗思路与策略

萧焕明, 施梅姐, 谢玉宝, 池晓玲

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西南医科大学学报 ›› 2025, Vol. 48 ›› Issue (1) : 17-20. DOI: 10.3969/j.issn.2096-3351.2025.01.004
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基于“杂合以治”思想探讨肝纤维化的治疗思路与策略

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Exploring Treatment Ideas and Strategies for Liver Fibrosis Based on the Therapeutic Concept of "Combination Therapy with Diverse Methods and Prescriptions"

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摘要

肝纤维化是多种慢性肝病发展到肝硬化、肝癌的必经中间过程。但目前在肝纤维化的防治中仍然存在较多难点,且尚无肝纤维化防控的有效西药,因此阻断肝纤维化进展至肝硬化、肝癌的任务依然艰巨。长期实践证实,中医药对肝纤维化的预防及治疗均具有较好的效果,但是如何有效地提高中医治疗肝纤维化的疗效,使中医药在阻断肝纤维化甚至肝硬化、肝癌的发生发展方面更好地发挥优势,也是当前研究的重要课题。早在《黄帝内经》就提出“杂合以治”的治疗思想,从杂合以治的思想出发,整合中医不同疗法的优势,建立中医多方法、多靶点的肝纤维化治疗方案,对于提高肝纤维化的疗效具有重要意义。多维立体系列疗法在杂合以治的思想指导下,长期应用于阻断逆转肝纤维化,效果显著。

Abstract

Liver fibrosis constitutes a critical intermediary phase in the advancement of numerous chronic liver diseases towards cirrhosis and hepatocellular carcinoma (HCC). However, significant challenges remain in the prevention and treatment of liver fibrosis, especially in preventing its progression to cirrhosis and HCC. Unfortunately, there is currently no efficacious pharmacological intervention available for the prevention and management of liver fibrosis. Extensive longitudinal studies have substantiated the efficacy of Traditional Chinese Medicine (TCM) in the prevention and treatment of liver fibrosis. Enhancing the therapeutic efficacy of TCM in the treatment of liver fibrosis, as well as optimizing its potential to inhibit the onset and progression of liver fibrosis, cirrhosis, and HCC, continues to be a critical area of research. The therapeutic concept of "Combination Therapy with Diverse Methods and Prescriptions" was proposed as early as in "Huangdi Neijing". Building on this concept, integrating various TCM therapies to create a multi-method, multi-target treatment plan is crucial for enhancing liver fibrosis treatment efficacy. Guided by the therapeutic concept of "Combination Therapy with Diverse Methods and Prescriptions", the multi-dimensional and systematic therapeutic approach has been consistently employed to inhibit and reverse liver fibrosis, yielding significant outcomes.

关键词

肝纤维化 / 杂合以治 / 治疗思路 / 治疗策略

Key words

Liver fibrosis / Combination Therapy with Diverse Methods and Prescriptions / Treatment ideas / Treatment strategies

中图分类号

R221

引用本文

导出引用
萧焕明 , 施梅姐 , 谢玉宝 , . 基于“杂合以治”思想探讨肝纤维化的治疗思路与策略. 西南医科大学学报. 2025, 48(1): 17-20 https://doi.org/10.3969/j.issn.2096-3351.2025.01.004
Huanming XIAO, Meijie SHI, Yubao XIE, et al. Exploring Treatment Ideas and Strategies for Liver Fibrosis Based on the Therapeutic Concept of "Combination Therapy with Diverse Methods and Prescriptions"[J]. Journal of Southwest Medical University. 2025, 48(1): 17-20 https://doi.org/10.3969/j.issn.2096-3351.2025.01.004

参考文献

1
MARCELLIN P, GANE E, BUTI M, et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study[J]. Lancet, 2013, 381(9865): 468-475.
2
XIAO HM, SHI MJ, JIANG JM, et al. Efficacy and safety of AnluoHuaxian pills on chronic hepatitis B with normal or minimally elevated alanine transaminase and early liver fibrosis: a randomized controlled trial[J]. J Ethnopharmacol, 2022, 293: 115210.
3
LIU YQ, ZHANG C, LI JW, et al. An-Luo-Hua-Xian pill improves the regression of liver fibrosis in chronic hepatitis B patients treated with entecavir[J]. J Clin Transl Hepatol, 2023, 11(2): 304-313.
4
RONG G, CHEN Y, YU Z, et al. Synergistic effect of Biejia-Ruangan on fibrosis regression in patients with chronic hepatitis B treated with entecavir: a multicenter, randomized, double-blind, placebo-controlled trial[J]. J Infect Dis, 2022, 225(6): 1091-1099.
5
JI D, CHEN Y, BI JF, et al. Entecavir plus Biejia-Ruangan compound reduces the risk of hepatocellular carcinoma in Chinese patients with chronic hepatitis B[J]. J Hepatol, 2022, 77(6): 1515-1524.
6
Lu Z, Sun YM, Chen S, et al. Multiple Low-Level Viraemia Suggest Hindered Liver Fibrosis Regression in Chronic Hepatitis B Patients During Antiviral Therapy[J]. J Viral Hepat, 2024, 31(12): 898-902.
7
ZHANG M, CHEN S, WU X, et al. Persistent steatosis correlates with decreased fibrosis regression during anti-HBV treatment in patients with chronic HBV infection[J]. J Med Virol, 2023, 95(10): e29156.
8
施梅姐, 萧焕明, 谢玉宝, 等. 慢性乙型病毒性肝炎免疫耐受期患者应否治疗: 一项临床随机对照试验的分层分析结果[J]. 中药药理与临床, 2023, 39(1): 62-66.
9
ZHAO ZM, ZHU CW, HUANG JQ, et al. Efficacy and safety of fuzheng Huayu Tablet on persistent advanced liver fibrosis following 2 years entecavir treatment: a single arm clinical objective performance criteria trial[J]. J Ethnopharmacol, 2022, 298: 115599.
10
CHENG DY, ZHAO ZM, WAN G, et al. Impact of Fuzheng Huayu tablet on antiviral effect of entecavir in patients with hepatitis B cirrhosis[J]. Hepatobiliary Pancreat Dis Int, 2022, 21(5): 479-484.
11
崔璐瑶, 张潇潇, 崔坡, 等. 益气活血方治疗慢性病毒性肝炎肝纤维化的临床研究[J]. 中华肝脏病杂志, 2020, 28(5): 403-409.
12
YU W, GE CQ. Effects of Bushen Huayu Decoction combined with entecavir on liver function and hepatic fibrosis in patients with compensated cirrhosis[J]. Am J Transl Res, 2024, 16(8): 4163-4173.
13
卓永祥, 彭梦楠, 林明, 等. 运用疏肝健脾法治疗乙肝肝纤维化的临床疗效评价[J]. 广州中医药大学学报, 2020, 37(11): 2063-2068.
14
时克, 张群, 黄云义, 等. 抗肝纤维化治疗对乙型肝炎肝硬化患者发生肝癌的影响[J]. 中华肝脏病杂志, 2021, 29(7): 685-689.
15
CHEN H, WANG X, ZHANG J, et al. Exploration of TCM syndrome types of the material basis and risk prediction of Wilson disease liver fibrosis based on 1H NMR metabolomics[J]. J Pharm Biomed Anal, 2024, 245: 116167.
16
SHI MJ, XIAO HM, XIE YB, et al. Differences in microRNA expression in chronic hepatitis B patients with early liver fibrosis based on traditional Chinese medicine syndromes[J]. Evid Based Complement Alternat Med, 2020, 31: 5956940.
17
史娜, 宋娟丽, 尹玉红, 等. 红外肝病治疗仪联合抗病毒治疗及强肝丸对老年慢性乙型肝炎患者血清细胞因子、肝纤维化的影响[J]. 中西医结合肝病杂志, 2024, 34(1): 16-19.
18
何创, 杨永和, 王芬. 解毒化痞膏肝区外敷联合肝病治疗仪治疗肝硬化门脉高压及肝脏硬度的疗效观察[J]. 中医临床研究, 2020, 12(22): 11-14.
19
李姗, 殷冬林. 穴位针刺联合膈下逐瘀汤治疗肝硬化临床研究[J]. 湖北中医杂志, 2023, 45(5): 8-11.
20
姜昊, 熊振芳, 李芷涵, 等. 艾灸联合耳穴埋籽择时治疗肝硬化患者失眠的临床疗效观察[J]. 时珍国医国药, 2023, 34(4): 902-905.
21
李楠, 潘璇, 轧春妹, 等. 八段锦运动疗法对慢性乙型病毒性肝炎患者康复的影响[J]. 解放军护理杂志, 2012, 29(4): 13-16.
22
邵巧玉, 陈苏, 包晓春, 等. 思维导图式八段锦训练对代偿期肝炎肝硬化患者心理状态、疲乏的影响[J]. 中国医药导报, 2024, 21(15): 149-151.
23
王兴, 田力铭, 程双立, 等. 八段锦对乙型肝炎肝硬化失代偿期患者负性情绪及生活质量的影响[J]. 中国民间疗法, 2020, 28(17): 115-117.
24
庞力, 金伟. 八段锦对非酒精性脂肪肝患者临床观察[J]. 光明中医, 2023, 38(4): 673-676.
25
董雪莲, 米秀英, 罗红英, 等. 循经推按联合脂肝合剂对非酒精性脂肪性肝病患者肝脏硬度及脂肪衰减参数的影响[J]. 中国民间疗法, 2022, 30(16): 76-79.
26
谭凯文, 陆筱颖, 陈海峰, 等. 芪蛭通络胶囊联合药棒循经推按法治疗缺血性卒中有效性临床研究[J]. 辽宁中医杂志, 2021, 48(11): 84-87.
27
张宝芳, 程明亮, 王豫萍, 等. 蓝莓对大鼠肝纤维化的作用及其对核转录因子-κB表达的影响[J]. 中华肝脏病杂志, 2018, 26(8): 590-595.
28
祝娟娟, 程明亮, 穆茂. 用苹果辅助逆转大鼠肝纤维化的实验性研究[J]. 重庆医科大学学报, 2011, 36(3): 285-289.
29
王香存, 乔明月, 李凯. 健脾补肾利水方联合中药穴位贴敷及夜间药膳对肝硬化腹水的辅助治疗效果[J]. 河南医学研究, 2022, 31(13): 2444-2447.
30
张广清, 罗利娟, 邓燕妹, 等. 中医特色慢病管理对乙型肝炎肝硬化营养不良患者的影响[J]. 中西医结合肝病杂志, 2021, 31(2): 120-124.
31
谭风雷, 吴亮亮, 邓泽润, 等. 夜间加餐对肝硬化患者影响的Meta分析[J]. 实用肝脏病杂志, 2021, 24(5): 625-628.
32
徐建龙. 孙光荣“气血为先, 杂合以治” 学术经验管窥[J]. 山西中医, 2024, 40(7): 3-5.

基金

国家“十三五”重大传染病专项肝纤维化课题(2018ZX10725506-003)
池晓玲国家中医药管理局名老中医药专家传承工作室项目(国中医药人教函〔2022〕75号)
第五批全国中医临床优秀人才研修项目(国中医药人教函〔2022〕1号)
广东省自然基金项目(2023A1515011092)

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