摘要
免疫缺陷病毒(human immunodeficiency virus,HIV)合并丙型肝炎病毒(hepatitis C virus,HCV)肝损伤主要由病毒、药物、毒物、酒精、免疫及环境等因素导致。外感疫疠毒邪是发病的始动因素,药物致毒时有发生,情志郁毒是重要的致病因素。外感疫毒、药物毒、情志郁毒长期作用于机体,致湿热郁毒横生,毒邪侵袭致机体气血阴阳失调,毒虚交结,既可由虚致实,也可由实致虚。故HIV合并HCV肝损伤为本虚标实之证,正虚为本,湿热郁毒为标。治疗时应以解毒补虚为基本治则。肝损伤急性发病期,应急则治其标,以抗炎护肝为主,重用清热利湿解毒退黄药,应用龙胆泻肝汤、茵陈蒿汤等加减;情志郁毒所致者应用柴胡疏肝散、逍遥散等以疏肝解郁、行气导滞;风阳上扰者应用镇肝熄风汤加减以清肝泻火、镇肝潜阳;应用重剂解毒药物同时需佐少量健脾益气药物以顾护正气,使邪祛而不伤正。肝损伤的慢性发展期或恢复期,应缓则治其本,以扶正固本,调畅气血为治则,应用四君子汤或黄芪汤加减以健脾益气,同时加用疏肝理气药物,使土得木而达。
The liver injury of human immunodeficiency virus(HIV)combined with hepatitis C virus(HCV)is mainly caused by virus,drug,poison,alcohol,immune and environmental factors.Exogenous virus is the initial factor of the disease,drug-induced poisoning occurs frequently,and emotional depression is an important pathogenic factor.Exogenous virus,drug-induced poisoning and emotional depression have long-term effects on the body,causing damp heat and stagnation of toxin.The invasion of toxin causes the imbalance of qi,blood,yin and yang,and the intermingled toxin and deficiency,which can lead deficiency to excess,and verse versa,which can be caused by both deficiency and deficiency.Therefore,the liver injury of HIV combined with HCV is the syndrome of root deficiency and branch excess,and the treatment should focus on detoxification and nourishing deficiency.In the acute stage of liver injury,the main treatment is anti-inflammatory and liver protection.The drugs of clearing away heat,removing dampness,detoxification and eliminating jaundice are heavily used,so Modified Gentian Liver-Draining Decoction,Virgate Wormwood Decoction,etc.can be adopted.For those with emotional depression,Bupleurum Liver-Soothing Powder,Free Wanderer Powder,etc.can be used to soothe the liver and resolve constraint,tranquilize the live and suppress the hyperactive yang.It is necessary to add a small amount of medicinals for fortifying the spleen and supplementing qi to protect healthy qi so as to eliminate pathogenic factors without hurting healthy qi.In the stage of chronic development or recovery of liver injury,we should treat the root of liver injury if it is not urgent.We should take strengthening healthy qi and regulating qi and blood as the treatment principle.Modified Four Gentlemen Decoction,or Modified Scutellaria Decoction can be used for fortifying the spleen and supplementing qi.At the same time,the medicinals for soothing the liver and regulate qi can be properly added.
作者
王延丽
孙燕
赵清霞
刘旭辉
侯明杰
WANG Yan-li;SUN Yan;ZHAO Qing-xia;LIU Xu-hui;HOU Ming-jie(Zhengzhou Sixth Peopled Hospital,Zhengzhou,Henan,China,450000)
出处
《河南中医》
2020年第2期178-182,共5页
Henan Traditional Chinese Medicine
基金
“十三五”艾滋病和病毒性肝炎等重大传染病防治科技重大专项项目(2017zx10202101-001-010)
河南省中医药科学研究专项课题项目(2014ZY02077)。
关键词
肝损伤
免疫缺陷病毒
丙型肝炎病毒
外感疫毒
药物致毒
情志郁毒
湿热郁毒
liver injury
human immunodeficiency virus(HIV)
hepatitis C virus(HCV)
exogenous virus
drug poisoning
emotional depression
damp-heat depression
