钱英教授学术思想与临床经验总结及和血法治疗乙肝肝硬化代偿期的理论和临床研究
发布时间：2018-07-26 16:49
【摘要】：钱英教授,男,1937年出生,天津市人,首都医科大学教授,主任医师,国家级名老中医。第三、四、五批全国老中医药专家学术经验继承工作指导老师。钱英教授具有50余年临床经验,以中医肝病诊疗最为擅长,兼治肾病及杂病。50余年的临床、教学和科研经历,使钱英教授拥有丰富的临床经验和较高的中西医理论功底,尤其在中医药治疗肝病方面造诣颇深,倡导“体用同调”、“肝病固肾”和“和血法”治疗各种肝病,疗效卓著。本论文主要由钱英教授学术思想渊源、整理挖掘钱英教授学术思想、临床经验及和血法治疗乙肝肝硬化代偿期的理论和临床研究三部分组成。第一部分主要从钱英教授特殊的学习、成长和工作经历入手,探寻其学贯中西、博采众长、兼收并蓄、师古而不泥古、勇于创新丰富的学术思想形成渊源。第二部分主要整理钱英教授学术思想和临床经验,包括“体用同调”和“肝病固肾”学术思想总结和临床经验总结。本部分首先总结了钱英教授两个重要的学术思想,即体用同调和肝病固肾。体与用,本来是中国古代哲学中的一对范畴。体,指本体,用,指功能活动。中医学用体和用来阐述生理物质基础与功能活动之间的关系。五脏均有体和用。肝体包括肝血与肝阴,肝用包括肝阳和肝气。钱英教授认为慢性肝病由轻到重的发生发展过程就是肝体受损而肝用失调的过程,即肝脏的生理结构物质基础受到损害,而功能活动作用障碍,二者不协调的过程。因此,钱英教授提出治疗肝病应体用同调。“体用同调”的“调”首先是指调节肝本脏的肝体和肝用,即调养肝体,养肝血补肝阴柔肝体,为肝用提供物质条件；同时调节肝用,疏肝气补肝阳调肝用,发挥肝脏的正常生理功能。其次“体用同调”的“调”还指调节由肝累及他脏的他脏体用失常。钱英教授根据“肝肾同源”的理论,提出“见肝之病,其源在肾,亟当固肾”的学术思想。他认为慢性肝炎、肝纤维化、肝硬化、甚至肝癌的发生过程就是正虚邪恋、正不达邪的过程。正气亏虚从根本上说首先是素体先天肾精不足；肝病日久,体用失调,势必子盗母气,累及肾脏,导致肾阴肾阳亏虚。钱英教授提出治疗肝病应及早固肾,滋补肾阴、温补肾阳以求阳中求阴、阴中求阳。或先调肝后补肾,或先补肾后调肝,或重在肝,或重在肾,或重在阴或重在阳,灵活使用肝肾同治法,方能应对复杂多变之证候。钱英教授强调亟当固肾,并不排斥当先实脾,他主张肝病的治疗先后天并重,重视调理肝脾肾。其次本部分还总结了钱英教授的临床经验,包括治疗肝病的临床经验总结和其他疾病总结。在肝病治疗方面,总结了“快速截断、逆流挽舟”治疗慢性重型肝炎,扶正、解毒、化瘀治疗肝癌,三焦气化理论治疗肝硬化腹水,祛湿、化痰、解毒、化瘀治疗黄疸,体用同调、和肝解毒治疗慢性乙型肝炎,肝肾同治、阴阳双补治疗肝性脊髓病,健脾祛湿、化痰通络治疗脂肪肝,祛湿化痰、解毒化瘀治疗酒精性肝病,益气养阴、调节免疫治疗自身免疫性肝炎,理气养阴、和血补肾治疗原发性胆汁性肝硬化等十个方面。在其他疾病治疗方面总结了泌尿系感染,乙肝相关性肾炎,IgA肾病,消化性溃疡,梅核气的治疗。第三部分对钱英教授和血法治疗乙肝肝硬化代偿期的理论进行总结并进行了临床研究。1、和血法治疗肝病的理论研究钱英教授受中医历代医家有关血证理论的影响,尤其受到其恩师秦伯未、关幼波、的影响,以及名老中医刘奉五的影响。秦伯未先生认为“在和血的基础上行血,在行血的基础上逐瘀,这是一个原则；再从瘀阻的原因,或加温药散其寒凝,或加气药疏其郁结,这是处方的方法”。关幼波先生治疗肝病提出“治病必治本,气血要遵循”、“治黄必治血,血行黄易却”。中医妇科名家刘奉五先生“若欲通之、必先充之”。钱英教授深受这些学术观点的影响,结合肝脏的生理病理特点,以及自己深刻的临床感悟,认为肝血不和是肝病发生的基础,提出和血法治疗慢性肝病的学术思想。他认为和血法是属于扶正为主、祛邪为辅的治疗大法；治疗慢性肝病不用血分药,是药不达所,犹如隔靴搔痒；“瘀血阻络”虽然是慢性肝病的核心证候之一,但治疗要以调和气血为大纲,以体用同调为要旨,立足于“和”字,和血法包括补血养血和活血化瘀,而非单纯活血化瘀。钱英教授认为“和血法”兼具“理血法”和“和法”的含义,含有理血法的各种特点,兼和法之精要。2、和血法治疗乙肝肝硬化代偿期的的临床研究肝硬化在人类主要死亡原因中居第4位或第6位,在我国,由慢性乙型肝炎导致的乙型肝炎肝硬化是肝硬化的最主要原因。如何防治乙型肝炎肝硬化,延缓肝硬化的发展进程,减少肝硬化失代偿期的发生,减少不良结局发生,延长患者生命,提高患者的生活质量,对患者进行经济有效的医学干预,一直是国内中医药临床研究的热门。钱英教授提出和血法治疗慢性肝病,对乙肝肝硬化代偿期患者,进行了长期深入的研究,根据多年的临床经验,创制了和血调肝汤。本论文临床研究的目的：观察和血调肝汤治疗乙型肝炎肝硬化的临床疗效及安全性。方法：遵循随机、对照的临床研究原则,将60例符合乙型肝炎肝硬化血瘀证诊断的患者,随机分为治疗组30例和对照组30例。治疗组给予口服恩替卡韦分散片0.5毫克,每日一次,并每日口服和血调肝汤；对照组给予口服恩替卡韦分散片0.5毫克,每日一次,疗程均为12周。观察治疗前后患者症状体征积分变化情况,治疗前后肝功能、乙肝病毒DNA、肝纤维化四项、甲胎蛋白指标；治疗前后门静脉内径(DPV)、门静脉血流速度(VPV)、脾静脉内径(DSV)、脾静脉血流速度(VSV)；治疗前后肝脏硬度值LSM变化。检测治疗前后血常规、尿常规、大便常规、心电图、肾功能的变化来判定用药安全性。结果：1、治疗前后症状评分比较：两组均能改善临床症状和体征的作用,治疗组优于对照组,两组比较有统计学差异(P0.05)。2、疗效评价：治疗组总有效率为71.6%,对照组总有效率为30%,治疗组优于对照组,两组比较有统计学差异(P0.05)。3、治疗前后肝功能比较：肝功能指标中ALT、AST在治疗组及对照组在治疗期均呈现下降趋势,其中治疗组下降程度更明显,但与治疗对照组比较无统计学意义p0.05;总胆红素(TBIL)在两组均呈现下降趋势,治疗组下降程度更明显,治疗12w时,两组比较有明显差异(P0.01)。治疗12周,前白蛋白在治疗组呈现上升,而对照组呈现下降,两组比较有明显差异(P0.05)。4、治疗前后肝纤维化四项比较：治疗12w,两组血清HA、 IV-C、 P-ⅢP、 LN均较基线下降,治疗组基线与12w比较,差异显著P0.01；对照组基线与12w比较,无显著性差异。治疗12w,两组组间比较,P0.05,无显著性差异。5、治疗前后甲胎蛋白比较：治疗期间两组甲胎蛋白变化不明显,差异无统计学意义(p0.05)。6、治疗前后乙肝病毒DNA载量比较：治疗12周,两组HBV-DNA载量比较,差异无统计学意义(p0.05)。7、治疗前后B超指标比较：治疗12w,治疗组门静脉内径(Dpv)、脾静脉内径(Dsv)较对照组门静脉内径(Dpv)、脾静脉内径(Dsv)均缩小,有非常显著性差异(P0.01);治疗组Dpv和Dsv治疗前后,有显著性差异(P0.05)；而对照组Dpv和Dsv治疗前后,无显著性差异(P0.05)。治疗12w,治疗组门脉血流速度(Vpv)、脾静脉血流速度(Vsv)较对照组门脉血流速度(Vpv)、脾静脉血流速度(Vsv)减慢,两组比较,均有显著性差异(P0.05)。8、两组治疗前后肝脏硬度值LSM变化：观察组和对照组分别有26例、30例完成Fibroscan,治疗12w,两组LSM均较基线降低；但治疗组基线与12w比较,有非常显著性差异,P0.01；而对照组基线与12w比较,无显著性差异(P0.05)。治疗12w,两组组间比较LSM, P0.05,有显著性差异。9、安全性指标：治疗前后血常规、尿常规、大便常规、心电图、肾功能均未见异常,两组间变化差异无统计学意义(P0.05),无不良事件发生。结论：(1)和血调肝汤可改善乙型肝炎肝硬化患者的临床症状,提高患者的生活质量。(2)和血调肝汤可以改善乙型肝炎肝硬化代偿期患者肝功能,尤其在降低总胆红素和提高血清白蛋白方面效果较好；降低门静脉系统压力,减慢门静脉及脾静脉血流速度以及缩小门静脉及脾静脉内径方面效果明显；改善肝纤维化指标方面有显著临床意义,但在降低乙肝病毒DNA载量和甲胎蛋白方面疗效不显著。(3)和血调肝汤可改善乙型肝炎肝硬化代偿期患者的肝脏硬度值。和血调肝汤具有用药安全性。
[Abstract]:Professor Qian Ying, male, born in 1937, Tianjin City, Professor of Capital Medical University, chief physician, national famous old Chinese medicine. Third, fourth, the five batch of national traditional Chinese medicine experts' academic experience inheriting work instructor. Professor Qian Ying has more than 50 years of clinical experience, the most good at diagnosis and treatment of liver disease in Chinese medicine, and the treatment of kidney and miscellaneous diseases for the rest of the year of.50 clinical, teaching The experience of study and scientific research makes professor Qian Ying have rich clinical experience and high theory of Chinese and Western medicine, especially in the treatment of liver disease in Chinese medicine. It advocates "body use homology", "liver disease fixing kidney" and "Blood Law" to treat various liver diseases. This article is mainly based on the origin of Professor Qian Ying's academic thought. Professor Qian Ying is composed of three parts: academic thought, clinical experience and the theory and clinical study of liver cirrhosis compensatory period with blood method. The first part is mainly from Professor Qian Ying's special learning, growth and work experience to explore the academic thought of learning from the Chinese and the West. The second part mainly collects the academic thought and clinical experience of Professor Qian Ying, including the summary of the academic thought of "body and use homology" and "liver disease fixing kidney". This part first summarizes the two important academic ideas of Professor Qian Ying, namely, the body and the liver disease, the body and the use, originally in Chinese ancient philosophy. "A pair of categories. The body, refers to the body, used, and refers to functional activities. The relationship between the body of Chinese medicine and the relationship between the physical material base and the functional activities. The five organs have the body and use. The liver body includes liver and liver yin, and the liver uses liver Yang and liver qi. The process of regulating the physical structure of the liver is damaged, and the functional activity is impaired and the two is not coordinated. Therefore, Professor Qian Ying put forward the same adjustment for the treatment of liver diseases. "The tune" of "body use homology" first refers to the regulation of liver body and liver of the liver, that is, the liver body, the liver blood supplementing the liver and the liver and the liver, for the liver. Providing material conditions, regulating liver use, dispersing liver and liver Yang regulating liver, exerting the normal physiological function of the liver. Secondly, the "tune" of "body with the same tune" also refers to the adjustment of his dirty body involving the liver and his dirty. According to the theory of "liver and kidney origin", Professor Qian Ying's academic thoughts on the disease of the liver, its origin in the kidneys and the kidneys in urgent need. He thinks that the process of chronic hepatitis, liver fibrosis, liver cirrhosis and even liver cancer is the process of false and evil love, which is not the process of evil. The deficiency of positive Qi is fundamentally the deficiency of the congenital kidney essence of the vegetarian body; the liver disease is long, the body is misadjusted, it is bound to steal the mother Qi, and involve the kidney, causing the deficiency of kidney yin and kidney yang. Early fixation of kidney, nourishing kidney yin, invigorating kidney yang to seek Yang in the Yang, Yin in the Yang, or the first tonifying the liver, or the first tonifying the kidney, or reinventing the liver, or again in the liver, or heavy in the kidney, or heavy in the yin or the Yang, and flexibly using the hepatorenal therapy, can deal with the complex and changeable syndrome. In this part, the clinical experience of Professor Qian Ying, including the summary of clinical experience in the treatment of liver disease and the summary of other diseases, was summed up in this part. In the treatment of liver disease, the treatment of chronic severe hepatitis, Fuzheng, detoxification, removing stasis for the treatment of liver cancer and the theory of gasification of triple coke in the treatment of liver diseases The treatment of hepatocirrhosis ascites, dampness, phlegm, detoxification, removing blood stasis to treat jaundice, treatment of chronic hepatitis B, liver and kidney therapy, yin and Yang double complement treatment of hepatic myelopathy, invigorating spleen and dampness, removing phlegm and dredging collaterals to treat fatty liver, removing dampness and eliminating phlegm, removing toxin and removing blood stasis to treat alcoholic liver disease, nourishing qi and nourishing Yin, regulating immunotherapy of autoimmune hepatitis Ten aspects of the treatment of primary biliary cirrhosis, such as Qi Nourishing Yin and nourishing Yin, and blood tonifying kidney. The treatment of other diseases, such as urinary infection, hepatitis B related nephritis, IgA nephropathy, peptic ulcer, and the treatment of plum nuclear gas, was summarized and the third part of the theory of Qian Ying and blood therapy for hepatitis B cirrhosis compensatory period was summarized and carried out in clinical practice. The study of.1, and the theory of blood method for the treatment of liver disease, Professor Qian Ying's influence on the theory of blood syndrome by Chinese medical practitioners, especially his teacher Qin Bowei, the influence of Guan Yu, and the influence of the old Chinese medicine Liu Fengwu. From the cause of the stasis, or the warming medicine to disperse its cold coagulation, or the hyperthermia, it is a prescription method. The influence of the point of view, combined with the physiological and pathological features of the liver, and his profound clinical perception, that the liver blood is not the basis of the liver disease, put forward and the blood method for the treatment of chronic liver disease. "Blood stasis obstructing collaterals" is one of the core syndromes of chronic liver disease, but the treatment should be based on harmonizing Qi and blood as the outline, using the same tone as the keynote, based on the word "and", and blood methods including enriching blood, nourishing blood and activating blood and removing stasis, rather than activating blood and removing blood stasis. The clinical study of liver cirrhosis in the fourth or sixth of the main causes of human death. In China, hepatitis B cirrhosis caused by chronic hepatitis B is the most important cause of liver cirrhosis in China. How to prevent and control hepatitis B in China? Liver cirrhosis, postponing the development of liver cirrhosis, reducing the occurrence of decompensated cirrhosis, reducing the adverse outcome, prolonging the life of the patients, improving the quality of life of the patients, and taking effective medical intervention to the patients, has always been a hot topic in the clinical study of Chinese traditional Chinese medicine. Professor Qian Ying put forward the treatment of chronic liver disease and hepatitis B liver disease with blood method. The patients with sclerotic compensatory period were studied for a long time. According to many years of clinical experience, we created the decoction of blood regulating liver. The purpose of this clinical study was to observe the clinical efficacy and safety of blood regulating liver soup in the treatment of hepatitis B liver cirrhosis. Methods: following the randomized, controlled clinical study principles, 60 cases were conformed to hepatitis B liver hard. The patients diagnosed with blood stasis syndrome were randomly divided into 30 cases in the treatment group and 30 cases in the control group. The treatment group was given 0.5 mg of Entecavir Dispersible Tablets oral and daily oral and blood regulating liver soup, and the control group was given 0.5 mg of Entecavir Dispersible Tablets daily, once a day for 12 weeks. The symptoms and signs of the patients were observed before and after treatment. Liver function, hepatitis B virus DNA, liver fibrosis four, alpha fetoprotein index, portal vein diameter (DPV), portal vein flow velocity (VPV), splenic vein diameter (DSV), splenic vein blood velocity (VSV) before and after treatment, and changes of liver hardness LSM before and after treatment. Blood routine, urine routine, routine of stool, electrocardiogram, kidney before and after treatment. Results: 1. Results: 1, before and after treatment, symptom score comparison: the two groups can improve the effect of clinical symptoms and signs, the treatment group is better than the control group, the two groups have statistical difference (P0.05).2, the curative effect evaluation: the total effective rate of the treatment group is 71.6%, the total effective rate of the control group is 30%, the treatment group is better than the control group, two The group had a statistical difference (P0.05).3, the liver function before and after treatment: the liver function index of ALT, AST in the treatment group and the control group showed a downward trend in the treatment period, and the treatment group decreased more obviously, but compared with the treatment control group, there was no statistical significance P0.05; the total bilirubin (TBIL) in the two groups showed a downward trend, the treatment group under the treatment group. In the treatment of 12W, the two groups were significantly different (P0.01). In the 12 week treatment, prealbumin was increased in the treatment group, while the control group decreased, and the two groups were significantly different (P0.05).4. The four comparison of liver fibrosis before and after treatment: the treatment of 12W, the two groups of serum HA, IV-C, P- III P, LN were all lower than the baseline, and the baseline and 12W in the treatment group. Comparison, the difference was significant P0.01; there was no significant difference between the baseline and the 12W in the control group. The treatment 12W, the comparison between the two groups, P0.05, no significant difference.5, the comparison of alpha fetoprotein before and after treatment: there was no significant change in the alpha fetoprotein in the two groups during the treatment (P0.05).6, and the DNA load comparison of HBV before and after treatment was 12 weeks, There was no significant difference between the two groups of HBV-DNA load (P0.05), and the comparison of B-ultrasound indexes before and after treatment: the treatment of 12W, the internal diameter of the portal vein (Dpv), the internal diameter of the splenic vein (Dsv), the inner diameter of the portal vein (Dpv), the inner diameter of the splenic vein (Dsv), and the significant difference (P0.01); there were significant differences (P0.) before and after the treatment of Dpv and Dsv (P0.) in the treatment group (P0.) 05) and no significant difference (P0.05) before and after treatment of Dpv and Dsv in the control group. The treatment group was treated with 12W, the velocity of portal blood flow (Vpv), the velocity of splenic vein blood flow (Vsv) compared with the control group, the velocity of portal blood flow (Vpv), the velocity of splenic vein (Vsv) slowed, and the two groups were significantly different (P0.05).8, and the liver hardness value LSM changes before and after treatment in the two groups were observed. There were 26 cases in the group and the control group, 30 cases completed Fibroscan, the treatment of 12W, two groups of LSM were lower than the baseline, but the baseline and 12W in the treatment group were significantly different, P0.01, while the control group compared with 12W, there was no significant difference (P0.05). The two groups were compared with LSM, P0.05, significant difference.9, safety index: before treatment: safety index: before treatment: before treatment After blood routine, urine routine, stool routine, electrocardiogram and renal function, there was no significant difference between the two groups (P0.05) and no adverse events. Conclusion: (1) and blood regulating liver soup can improve the clinical symptoms and improve the quality of life of patients with hepatitis B liver cirrhosis. (2) and blood regulating liver soup can improve hepatitis B liver cirrhosis. The liver function of patients in compensatory period is better, especially in reducing total bilirubin and raising serum albumin, reducing portal pressure, slowing down the velocity of portal and splenic vein and reducing the internal diameter of portal vein and splenic vein, and it has significant clinical significance to improve the index of liver fibrosis, but in reducing hepatitis B disease. The effect of toxic DNA load and alpha fetoprotein was not significant. (3) and blood regulating liver soup could improve the liver hardness of the patients with liver cirrhosis and liver cirrhosis. And the decoction of blood regulating liver has the safety of medication.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R259
本文编号：2146651
[Abstract]:Professor Qian Ying, male, born in 1937, Tianjin City, Professor of Capital Medical University, chief physician, national famous old Chinese medicine. Third, fourth, the five batch of national traditional Chinese medicine experts' academic experience inheriting work instructor. Professor Qian Ying has more than 50 years of clinical experience, the most good at diagnosis and treatment of liver disease in Chinese medicine, and the treatment of kidney and miscellaneous diseases for the rest of the year of.50 clinical, teaching The experience of study and scientific research makes professor Qian Ying have rich clinical experience and high theory of Chinese and Western medicine, especially in the treatment of liver disease in Chinese medicine. It advocates "body use homology", "liver disease fixing kidney" and "Blood Law" to treat various liver diseases. This article is mainly based on the origin of Professor Qian Ying's academic thought. Professor Qian Ying is composed of three parts: academic thought, clinical experience and the theory and clinical study of liver cirrhosis compensatory period with blood method. The first part is mainly from Professor Qian Ying's special learning, growth and work experience to explore the academic thought of learning from the Chinese and the West. The second part mainly collects the academic thought and clinical experience of Professor Qian Ying, including the summary of the academic thought of "body and use homology" and "liver disease fixing kidney". This part first summarizes the two important academic ideas of Professor Qian Ying, namely, the body and the liver disease, the body and the use, originally in Chinese ancient philosophy. "A pair of categories. The body, refers to the body, used, and refers to functional activities. The relationship between the body of Chinese medicine and the relationship between the physical material base and the functional activities. The five organs have the body and use. The liver body includes liver and liver yin, and the liver uses liver Yang and liver qi. The process of regulating the physical structure of the liver is damaged, and the functional activity is impaired and the two is not coordinated. Therefore, Professor Qian Ying put forward the same adjustment for the treatment of liver diseases. "The tune" of "body use homology" first refers to the regulation of liver body and liver of the liver, that is, the liver body, the liver blood supplementing the liver and the liver and the liver, for the liver. Providing material conditions, regulating liver use, dispersing liver and liver Yang regulating liver, exerting the normal physiological function of the liver. Secondly, the "tune" of "body with the same tune" also refers to the adjustment of his dirty body involving the liver and his dirty. According to the theory of "liver and kidney origin", Professor Qian Ying's academic thoughts on the disease of the liver, its origin in the kidneys and the kidneys in urgent need. He thinks that the process of chronic hepatitis, liver fibrosis, liver cirrhosis and even liver cancer is the process of false and evil love, which is not the process of evil. The deficiency of positive Qi is fundamentally the deficiency of the congenital kidney essence of the vegetarian body; the liver disease is long, the body is misadjusted, it is bound to steal the mother Qi, and involve the kidney, causing the deficiency of kidney yin and kidney yang. Early fixation of kidney, nourishing kidney yin, invigorating kidney yang to seek Yang in the Yang, Yin in the Yang, or the first tonifying the liver, or the first tonifying the kidney, or reinventing the liver, or again in the liver, or heavy in the kidney, or heavy in the yin or the Yang, and flexibly using the hepatorenal therapy, can deal with the complex and changeable syndrome. In this part, the clinical experience of Professor Qian Ying, including the summary of clinical experience in the treatment of liver disease and the summary of other diseases, was summed up in this part. In the treatment of liver disease, the treatment of chronic severe hepatitis, Fuzheng, detoxification, removing stasis for the treatment of liver cancer and the theory of gasification of triple coke in the treatment of liver diseases The treatment of hepatocirrhosis ascites, dampness, phlegm, detoxification, removing blood stasis to treat jaundice, treatment of chronic hepatitis B, liver and kidney therapy, yin and Yang double complement treatment of hepatic myelopathy, invigorating spleen and dampness, removing phlegm and dredging collaterals to treat fatty liver, removing dampness and eliminating phlegm, removing toxin and removing blood stasis to treat alcoholic liver disease, nourishing qi and nourishing Yin, regulating immunotherapy of autoimmune hepatitis Ten aspects of the treatment of primary biliary cirrhosis, such as Qi Nourishing Yin and nourishing Yin, and blood tonifying kidney. The treatment of other diseases, such as urinary infection, hepatitis B related nephritis, IgA nephropathy, peptic ulcer, and the treatment of plum nuclear gas, was summarized and the third part of the theory of Qian Ying and blood therapy for hepatitis B cirrhosis compensatory period was summarized and carried out in clinical practice. The study of.1, and the theory of blood method for the treatment of liver disease, Professor Qian Ying's influence on the theory of blood syndrome by Chinese medical practitioners, especially his teacher Qin Bowei, the influence of Guan Yu, and the influence of the old Chinese medicine Liu Fengwu. From the cause of the stasis, or the warming medicine to disperse its cold coagulation, or the hyperthermia, it is a prescription method. The influence of the point of view, combined with the physiological and pathological features of the liver, and his profound clinical perception, that the liver blood is not the basis of the liver disease, put forward and the blood method for the treatment of chronic liver disease. "Blood stasis obstructing collaterals" is one of the core syndromes of chronic liver disease, but the treatment should be based on harmonizing Qi and blood as the outline, using the same tone as the keynote, based on the word "and", and blood methods including enriching blood, nourishing blood and activating blood and removing stasis, rather than activating blood and removing blood stasis. The clinical study of liver cirrhosis in the fourth or sixth of the main causes of human death. In China, hepatitis B cirrhosis caused by chronic hepatitis B is the most important cause of liver cirrhosis in China. How to prevent and control hepatitis B in China? Liver cirrhosis, postponing the development of liver cirrhosis, reducing the occurrence of decompensated cirrhosis, reducing the adverse outcome, prolonging the life of the patients, improving the quality of life of the patients, and taking effective medical intervention to the patients, has always been a hot topic in the clinical study of Chinese traditional Chinese medicine. Professor Qian Ying put forward the treatment of chronic liver disease and hepatitis B liver disease with blood method. The patients with sclerotic compensatory period were studied for a long time. According to many years of clinical experience, we created the decoction of blood regulating liver. The purpose of this clinical study was to observe the clinical efficacy and safety of blood regulating liver soup in the treatment of hepatitis B liver cirrhosis. Methods: following the randomized, controlled clinical study principles, 60 cases were conformed to hepatitis B liver hard. The patients diagnosed with blood stasis syndrome were randomly divided into 30 cases in the treatment group and 30 cases in the control group. The treatment group was given 0.5 mg of Entecavir Dispersible Tablets oral and daily oral and blood regulating liver soup, and the control group was given 0.5 mg of Entecavir Dispersible Tablets daily, once a day for 12 weeks. The symptoms and signs of the patients were observed before and after treatment. Liver function, hepatitis B virus DNA, liver fibrosis four, alpha fetoprotein index, portal vein diameter (DPV), portal vein flow velocity (VPV), splenic vein diameter (DSV), splenic vein blood velocity (VSV) before and after treatment, and changes of liver hardness LSM before and after treatment. Blood routine, urine routine, routine of stool, electrocardiogram, kidney before and after treatment. Results: 1. Results: 1, before and after treatment, symptom score comparison: the two groups can improve the effect of clinical symptoms and signs, the treatment group is better than the control group, the two groups have statistical difference (P0.05).2, the curative effect evaluation: the total effective rate of the treatment group is 71.6%, the total effective rate of the control group is 30%, the treatment group is better than the control group, two The group had a statistical difference (P0.05).3, the liver function before and after treatment: the liver function index of ALT, AST in the treatment group and the control group showed a downward trend in the treatment period, and the treatment group decreased more obviously, but compared with the treatment control group, there was no statistical significance P0.05; the total bilirubin (TBIL) in the two groups showed a downward trend, the treatment group under the treatment group. In the treatment of 12W, the two groups were significantly different (P0.01). In the 12 week treatment, prealbumin was increased in the treatment group, while the control group decreased, and the two groups were significantly different (P0.05).4. The four comparison of liver fibrosis before and after treatment: the treatment of 12W, the two groups of serum HA, IV-C, P- III P, LN were all lower than the baseline, and the baseline and 12W in the treatment group. Comparison, the difference was significant P0.01; there was no significant difference between the baseline and the 12W in the control group. The treatment 12W, the comparison between the two groups, P0.05, no significant difference.5, the comparison of alpha fetoprotein before and after treatment: there was no significant change in the alpha fetoprotein in the two groups during the treatment (P0.05).6, and the DNA load comparison of HBV before and after treatment was 12 weeks, There was no significant difference between the two groups of HBV-DNA load (P0.05), and the comparison of B-ultrasound indexes before and after treatment: the treatment of 12W, the internal diameter of the portal vein (Dpv), the internal diameter of the splenic vein (Dsv), the inner diameter of the portal vein (Dpv), the inner diameter of the splenic vein (Dsv), and the significant difference (P0.01); there were significant differences (P0.) before and after the treatment of Dpv and Dsv (P0.) in the treatment group (P0.) 05) and no significant difference (P0.05) before and after treatment of Dpv and Dsv in the control group. The treatment group was treated with 12W, the velocity of portal blood flow (Vpv), the velocity of splenic vein blood flow (Vsv) compared with the control group, the velocity of portal blood flow (Vpv), the velocity of splenic vein (Vsv) slowed, and the two groups were significantly different (P0.05).8, and the liver hardness value LSM changes before and after treatment in the two groups were observed. There were 26 cases in the group and the control group, 30 cases completed Fibroscan, the treatment of 12W, two groups of LSM were lower than the baseline, but the baseline and 12W in the treatment group were significantly different, P0.01, while the control group compared with 12W, there was no significant difference (P0.05). The two groups were compared with LSM, P0.05, significant difference.9, safety index: before treatment: safety index: before treatment: before treatment After blood routine, urine routine, stool routine, electrocardiogram and renal function, there was no significant difference between the two groups (P0.05) and no adverse events. Conclusion: (1) and blood regulating liver soup can improve the clinical symptoms and improve the quality of life of patients with hepatitis B liver cirrhosis. (2) and blood regulating liver soup can improve hepatitis B liver cirrhosis. The liver function of patients in compensatory period is better, especially in reducing total bilirubin and raising serum albumin, reducing portal pressure, slowing down the velocity of portal and splenic vein and reducing the internal diameter of portal vein and splenic vein, and it has significant clinical significance to improve the index of liver fibrosis, but in reducing hepatitis B disease. The effect of toxic DNA load and alpha fetoprotein was not significant. (3) and blood regulating liver soup could improve the liver hardness of the patients with liver cirrhosis and liver cirrhosis. And the decoction of blood regulating liver has the safety of medication.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R259
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