“截断逆挽法”治疗慢性乙型重型肝炎的研究
|
摘要
钱英教授为我国著名中医肝病专家，他近年提出运用“截断逆挽法”治疗慢性重型肝炎。“截断逆挽法”是“截断法”和“逆流挽舟法”的综合运用，是中医在治疗慢性重型肝炎方面的理论创新。
本文在研究钱英教授“截断逆挽法”治疗慢性乙型重型肝炎学术思想和基于慢性乙型重型肝炎“毒损肝体”理论证候学研究基础上，探讨“截断逆挽法”在治疗慢性乙型重型肝炎中的应用，并进一步进行疗效验证。
第一章钱英教授“截断逆挽法”治疗慢性乙型重型肝炎学术思想研究
目的：研究钱英教授“截断逆挽法”治疗慢性乙型重型肝炎学术思想。
方法：通过探索“截断逆挽法”理论渊源，分析钱英教授“截断逆挽法”治疗慢性乙型重型肝炎的学术观点、临证思辨、应用规律、临床医案和相关文献，研究钱英教授“截断逆挽法”治疗慢性乙型重型肝炎学术思想。
结果与结论：“截断逆挽法”是“截断法”和“逆流挽舟法”的综合运用。钱英教授认为治疗慢性乙型重型肝炎，要抓住疾病发生发展中病机演变、脏腑传变、虚实转化等特殊规律，将辨证与辨病紧密结合，运用中医理论与方法，在疾病发展的各个阶段，灵活运用“截断逆挽法”。
1针对慢性乙型重型肝炎“病急病重”的特点，快速截断为首要治则，其主要治法是：(1)清热解毒是截断的关键(清除病因-疫毒)。解毒不能拘泥于清热解毒一法，要依据“毒邪”的具体性质辨证遣方用药。(2)通腑攻下是截断的转机(净化肠道，阻断二次打击)。(3)凉血化瘀是截断的要点(顿挫病势，防止传入营血)。
2“逆流挽舟法”是针对慢性乙型重型肝炎因虚致病的病机，采用扶正祛邪的方法，强调尽早补肝以扶正，包括滋肝肾之阴、益肝脾之气、温脾肾之阳等。根据肝“体阴而用阳”理论，补肝体与益肝用，体用同调，阴阳兼顾：(1)益肝用与补肝体并重；(2)重用生地黄以养肝阴；(3)疏肝理气与顾护肝体并施。
3注重脏腑传变规律，及时截断逆转。主要涉及脾肾二脏：(1)调理肝脾，以固其本：用大剂量的生黄芪，因本病肝脾气损严重，“重病必重药”，非重剂难以奏效，同时注意补中、健中、理中三法的配合运用。(2)肝肾同治，滋水荣木：肝肾同源，故肝病多伤及于肾，临床多表现为肝阴虚与肾阴虚并见，肝气虚、肝阳虚与肾气虚、肾阳虚兼夹。治疗上必须重视“肝肾同治”。
4分期而治：针对疾病分期中正邪演变规律，”截断法”和“逆流挽舟法”应有偏重。慢性乙型重型肝炎进展期应以“解毒化瘀，截断病势”为主，以达到“留人治病”之目的，但攻逐之法当“衰其大半而止”，不可久施；待病情平稳后或进入恢复期则以扶正为主，以恢复生机，采用“体用同调”、调理肝脾、滋水荣木等法，缓缓久图；但若出现毒瘀与正虚均已严重的局面，则应攻补并重。
第二章基于“毒损肝体”理论及“截断逆挽”治则的证治规律研究
目的：进行慢性乙型重型肝炎基于“毒损肝体”理论的证候学研究，探讨证候规律，从证候学角度分析“截断逆挽法”的合理性；探讨基于“截断逆挽法”治则的证治方案，以应用于临床。
方法：进行260例慢性乙型重型肝炎证候学调查研究，探讨慢性乙型重型肝炎证候分布规律；分析“毒邪”症候要素；结合证候分布规律和“毒邪”症候要素，确立“截断逆挽法”治疗慢性乙型重型肝炎证治方案。
结果与结论：
1证候分布规律：260例慢性乙型重型肝炎基本证型为肝脾血瘀、阴毒内结、阳毒内盛、肝肾阴虚、肝脾肾气虚、肝脾肾阳虚证。基本证型体现了慢性乙型重型肝炎“毒(阴毒和阳毒)损肝体，脾肾气阴或阴阳两伤”的病机特点。证候规律与钱英教授“截断逆挽法”基本原则(清热解毒、通腑攻下、凉血化瘀、滋肝肾之阴、益肝脾之气、温脾肾之阳)完全相符，证候学规律说明了钱英教授应用“截断逆挽法”治疗慢性乙型重型肝炎的合理性。
2“毒邪”症候要素：两大特征性证型为阴毒内结证和阳毒内盛证，兼有阴毒内结和阳毒内盛特征者为阴阳兼证。260例慢性乙型重型肝炎中：阴毒内结110例、阳毒内盛46例、阴阳兼证104例。阳毒内盛证与阴毒内结证基础证：身目尿黄、面色晦暗、倦怠乏力、食欲减退、腹胀、性欲减退、口干；舌红暗或紫、舌有瘀斑，苔厚腻，舌下静脉增粗或迂曲；脉滑、弦、沉、濡等。基础证也反映了慢性乙型重型肝炎之常候“毒(阴毒和阳毒)贯穿始终，肝体用同损，出现肝脾血瘀、肝肾阴虚、肝脾肾气虚、肝脾肾阳虚等病机变化”。舌质红、苔黄腻，滑脉、数脉对辨证阳毒内盛证有意义。下肢浮肿、腰膝酸软、面色晦暗、肝掌、大便稀溏、舌淡红、苔腐等症对辨证阴毒内结证有意义。
141例慢性乙型重型肝炎色诊图片资料分析：采用奥林巴斯2．0数码相机在室内、近焦、闪光灯条件下对慢性乙型重型肝炎患者面部、唇部、手掌、舌象(舌质、舌苔、舌下络脉)进行拍照，将图像输入计算机，在“中医舌诊专家系统”软件(北京普利生公司研制)中检测其RGB值(R为红色，G为绿色，B为蓝色)。(1)面色、唇部、手掌及舌质RGB值均为阳毒内盛证＞阴阳兼证＞阴毒内结证，且阴阳兼证与阴毒内结比较，面色RGB值、唇部RGB值及舌质RG值有显著性差异(P＜0．05)，阳毒内盛与阴毒内结比较，面色R值、唇部RGB值及舌质R值有显著性差异(P＜0．05)；舌苔RGB值特点，阴毒内结证＞阴阳兼证，GB值有显著性差异(P＜0．05)；舌下静脉RGB值特点，阳毒内盛证＞阴阳兼证及阴毒内结证。(2)肝脾血瘀证舌质RGB值均高于非肝脾血瘀证，比较有显著性差异(P＜0．05)；肝脾血瘀证唇部RGB值均低于非肝脾血瘀证，唇部B值比较有显著性差异(P＜0．05)。毒(阴毒和阳毒)与面色、唇部、手掌、舌象RGB值密切相关，肝脾血瘀证与唇部、舌质RGB值密切相关，慢性乙型重型肝炎色诊RGB值可作为辨证阴阳毒证、肝脾血瘀证的参考指标。
3证治方案：以“截断逆挽法”为指导思想，基于阴毒阳毒辨证思路，确立慢性乙型重型肝炎证治方案。
治疗原则：阴毒阳毒兼证，以解毒化瘀、通腑泄浊、清利湿热、调补肝脾肾阴阳为法；阳毒内盛证，以清热解毒、凉血化瘀、通腑泄浊、益气养阴为法；阴毒内结证，易伤阳气，以温阳化湿、化瘀通络、通腑泄浊、温扶脾肾为法。
组方：(1)基础方：叶下珠30克，瓜蒌30克，金钱草30克，莪术6克，生地20克，生黄芪30克，槲寄生30克，丹参20克，三七6克，黒附片15克(先煎30分钟)。(2)灌肠1号方：大黄30克，厚朴30克，枳实30克，生地30克，蒲公英30克。(3)灌肠2号方：黑附片30克，干姜15克，茯苓30克，炙甘草30克，桂枝15克。
阴毒阳毒兼证，基础方1日1剂，水煎300ml，分2次服。灌肠1号方、2号方，150m1灌肠，每日1次，二方交替使用。
阳毒内盛证，基础方中生地加量至35克，加用赤芍15克，紫草10克。以加强解毒、养阴、凉血、化瘀之用。灌肠1号方，150ml，灌肠，1日1次。
阴毒内结证，基础方中黒附片加量至25克，加用桂枝15克，干姜10克。以加强温阳化浊之用。灌肠2号方，150ml灌肠，1日1次。
第三章“截断逆挽法”治疗慢性乙型重型肝炎疗效验证
目的：初步验证“截断逆挽法”治疗慢性乙型重型肝炎方案的有效性。
方法：选择约110例患者，分别进行中西医结合治疗(治疗组)或西医治疗(对照组)，观察有效率、并发症出现率、病死率及主要化验指标的改善情况，初步验证“截断逆挽法”治疗慢性乙型重型肝炎方案的有效性。
结果与结论：有效病例111例，治疗组55例，对照组56例。
1症候积分疗效：治疗1周后，治疗组积分明显下降，治疗前后比较有非常显著性差异(P＜0．01)；治疗2周后，对照组积分明显下降，治疗前后比较有显著性差异(P＜0．05)：治疗1周后，治疗组积分均值下降1．82±3．88，而对照组积分均值下降-0．02±4．18，两组比较有显著性差异(P＜0．05)；治疗8周后，治疗组积分均值下降8．29±7．53，而对照组积分均值下降4．41±9．64，两组比较有显著性差异(P＜0．05)。
2肝功能：(1)胆红素：两组治疗2周后TBIL明显下降，其中治疗组2周后与治疗前比较，有显著性差异(P＜0．05)；治疗组4周后与治疗前比较，有非常显著性差异(P＜0．01)；对照组8周后与治疗前比较，有显著性差异(P＜0．05)。(2)凝血功能：治疗组PTA明显升高，且1周后PTA(43．6％)与治疗前(35．0％)比较有非常显著性差异(P＜0．01)；对照组PTA治疗前后无明显变化；治疗1周后治疗组PTA(43．6％)明显高于对照组(33．4％)，有非常显著性差异(P＜0．01)。
3并发症：(1)肝肾综合征：治疗后出现率治疗组明显低于对照组，治疗4周后治疗组出现率(1例，1．8％)与对照组(8例，14．3％)比较，有显著性差异(P＜0．05)。(2)腹腔感染：两组治疗后腹腔感染出现率均有下降，治疗组8周后腹腔感染出现率(16例，29．1％)明显低于治疗前(25例，45．5％)，有显著性差异(P＜0．05)。(3)肝性脑病、消化道出血、电解质紊乱等并发症两组治疗前后比较及两组比较均无明显差异。
4综合疗效：治疗组有效率(37例，67．27％)高于对照组(30例，53．57％)，两组比较无显著性差异(P＞0．05)；治疗组病死率(5例，9．09％)低于对照组(13例，23．21％)，两组比较有显著性差异(P＜0．05)。
治疗组在改善症状、改善肝功能(退黄、提高凝血酶原活动度等)、防治肝肾综合征等并发症及改善患者预后方面均优于对照组，证实了截断逆挽法治疗慢性乙型重型肝炎方案的有效性。
The study on how to apply the principle of‘truncation andinverse draft’to treatment to chronic severe hepatitis B
Professor Qian Ying,the hepatic specialist of TCM,had recently treatedchronic severe hepatitis B by the principle of‘truncation and inverse draft’,which was the comprehensive use of‘cut-off’and‘pull a boat upstream’.It wasthe theoretical innovation of TCM in treating the disease.
This thesis studied the Professor’s thoughts and the syndrome of thedisease based on the theory of‘toxin injuring hepatic body’,so as to discusshow to apply the principle to treatment to the disease.More,the thesis reportedthe therapeutic effect evaluation of the principle on the disease.Part one:To study the academic thoughts of Professor Qian Yingabout treating chronic severe hepatitis B by the principle of‘truncation and inverse draft’
Objective:Research the academic thoughts of Professor Qian Ying abouthow to treat chronic severe hepatitis B by the principle of‘truncation andinverse draft’.
Method:To study the academic thoughts of Professor Qian Ying on how totreat chronic severe hepatitis B by the principle of‘truncation and inverse draft’by analyzing his academic view,clinical reasoning and analysis,application ofprinciple,clinical cases,inheritance and innovation,and relative literature and searching the theoretical origin of the principle.
Results and conclusion:The principle is the comprehensive use of‘cut-off’and‘pull a boat upstream’.Professor Qian Ying thought that it wasimportant to be flexible in the use of the principle in the various stage of thedisease.We should catch hold of the special laws of the evolution ofpothogenesis,the transmission of Zang-Fu organs,inter-transformation betweenasthenia and sthenia in the occurrence and development of the disease,and weshould integrate with syndrome differentiation and disease diagnose and managethe theory of traditional Chinese medicine.
1 Aiming at the severe and acute characteristics of the disease,quick cut-offis the primary principle.There are three main treatment measures,such as:①Clearing away heat and virus is the key to cut off(to clear awaypathogeny-viruses).Whereas,we should not rigidly adhere to the measure.Weneed to differentiate syndrome and treat based on the characteristics of the virusexopathogens.②Purging Fu organs is the turn to cut-off.(to purge theintestine and prevent from the secondary hit).③Cooling the blood andremoving blood stasis is the point of cut-off.(to set-back disease progress andprevent from transmission to Yin-Xue).
2 Aiming at the pathogenesis of asthenia,the measures of“pull a boatupstream”are strengthening healthy Qi and eliminating pathogens.We shouldstrengthen healthy Qi by strengthening liver as soon as early,which is,replenishing Yin of liver and kidney,strengthening Qi of liver and spleen and warming Yang of spleen and kidney,etc.Basing on the theory of“liver of yinnature with yang functioning”,we should supply liver-Yin nature and strengthenliver-Yang function,regulate the nature and function,balance between Yin andYang.Such as:1 Strengthening liver-Yang function and supplying liver Yin.2Using more raw rehmannia to replenish liver-Yin.3 Regulating liver Qi andsafeguarding liver body.
3 For the transmission of Zang-Fu organs mainly referring to spleen andkidney,the measures the principle are that:1 To strengthen the root byregulating liver and spleen.For Qi of liver and spleen lost a lot,large dose ofmedicine was necessary to manage severe disease using large dose of rawastragali(100～120g).At the same while we need to strengthen,invigorate andregulate spleen.2 To manage liver and kidney and replenish water to nourishwood.For liver and kidney sharing the same origin,liver disorder involvedkidney.Liver-Yin deficiency and kidney yin deficiency were accompanied,andthe same liver Qi and kidney Qi,liver-Yang and kidney yang.we must treat bothliver and kidney.
4 Treating basing on stage:Aiming at the progress of healthy Qi andpathogen in stages of the disease,the principle should apply flexibly.In theprogression stage we should apply mostly the method of‘removal viruses andblood stasis to cut off the tendency of disease’,so as to treat the disease and savethe patient.And the method of purgation should not be used too long.While thedisease progressed steadily or in the convalescent stage,strengthening healthy Qi is the main therapeutic principle for recovery including regulating the natureand function,regulating liver and spleen and‘replenishing water to nourishwood’,etc.If viruses and blood stasis,and healthy Qi asthenia were all severe,we should pay equal attention to purgation and tonification.Part two:To study chronic severe hepatitis B with its syndrome basedon the theory of‘toxin injuring hepatic body’and the thoughts of‘truncation and inverse draft’
Objetcive:To study the syndrome of the disease based on the theory of‘toxin injuring hepatic body’,to explore the rule of the syndrome,to analyzerationality of the principle based on the syndrome;to explore the scheme of thesyndrome and treatment to the disease based on the principle.It was beneficialto the clinic.
Method:To study the distribution rules of manifestations of 260 cases.Toanalyze syndrome factors of‘the pathogen of toxin’.To establish the schemebased on the principle,the rules and the factors.
Result and conclusion:
1 The rules:The basic syndrome types of the cases were blood stagnationof liver and spleen,superabundance of Yin toxin,superabundance of Yangtoxin,Ying deficiency of liver and kidney,Qi deficiency of liver,spleen andkidney,Yang deficiency of liver,spleen and kidney.The basic types reflectedcharacteristics of pathogenesis of‘toxin injuring hepatic body,Qi-Yin deficiency of spleen and kidney,or Yin-Yang deficiency of spleen and kidney’.It wascompletely meet to the principle.
2.The factors:It has two features of syndrome types,such assuperabundance of Yin toxin and Yang toxin.It was Yin-Yang syndrome whenthere were features of superabundance of both Yin toxin and Yang toxin.Amongthe 260 cases,110 cases were with superabundance of Yin toxin,46 cases withsuperabundance of Yang toxin,104 cases with Yin-Yang syndrome.Commonsymptoms of superabundance of Yin toxin and Yang toxin included that:symptoms which were yellow body,eyes and urine,dim complexion,fatigueand lassitude,poor appetite,abdominal distension,debility of sexuality,drymouth,tongue symptoms which were dark red or purple color of tongue,ecchymosis in tongue body,yellow thick or greasy coat,thickening or varicosehypoglossal vein,pulse symptoms which were slip,string,sinking,bedew,etc.Itwas interesting to distinguish superabundance of Yang toxin for red color oftongue,yellow greasy coat,slippery or pulse rapid pulse etc,and the same assuperabundance of Yin toxin for swollen limbs,waist and knee fatigue,darkcomplexion,liver palms,dilute or loose stool,pale red tongue and curdy coat,etc.
We collected image data about the color inspection of 141 cases among the260 cases.The patients' complexion,lips,palm and tongue including tonguetexture,tongue coating and hypoglossal vein were photoed under the conditionsof indoors,close focus and flash with Olympus 2.0 digital cameras.RGB(three elemental colors,R refers to the red color,G refers to the green color,B refersto the blue color)values were measured by the expert system of tongueinspection of TCM.①Compared in the three groups,the RGB values ofcomplexion,lips,palm and tongue texture of the cases with superabundance ofYang toxin＞those of the cases with Yin-Yang syndrome＞those of the caseswith superabundance of Yin toxin.Compared between the cases with Yin-Yangsyndrome and the cases with superabundance of Yin toxin,the R values ofcomplexion,the RGB values of lips and the RG values of tongue texture weresignificantly different(P＜0.05).Compared between the cases with thesuperabundance of Yang toxin and the cases with the superabundance of Yintoxin,there was significant difference in the R values of complexion,the RGBvalues of lips and the R values of tongue texture(P＜0.05).The RGB values oftongue coat of the cases with superabundance of Yin toxin were higher thanthose of the cases with Yin-Yang syndrome,and there was significant differencebetween then in the GB values(P＜0.05).The RGB values of hypoglossal vein ofthe cases with superabundance of Yang toxin were highest among the threegroups.②The RGB values of tongue texture of the syndrome type of bloodstagnation of liver and spleen were higher than those of the others.There wassignificant difference between the two groups(P＜0.05).The B values of lipsbetween the two groups were significantly different(P＜0.05).From above it canbe said that there was relationship between the toxin including Yin toxin andYang toxin and the RGB values of complexion,lips,palm,tongue manifestation. There was relationship between the RGB values of lips,tongue texture and thesyndrome type of blood stagnation of liver and spleen.So the change of RGBvalues can be a reference target for the syndrome differentiation of chronicsevere hepatitis B.
3 The scheme:To establish the scheme,which was based on the syndromedifferentiation based Yin toxin and Yang toxin,and whose guiding ideology wasthe thoughts.
Therapeutic principle:It was easy to injury Yin and Yang of the cases withYin-Yang Syndrome,so it was important to remove stagnation and cut off thetrend of disease.We can take the methods of clearing away virus and removingstasis,reducing turbid matter by purging Fu organs,clearing away damp-heat,harmonizing liver,spleen and kidney.The cases with superabundance of Yangtoxin were easier to injure Qi and Yin,so it was more important to cut off thetrend of disease.We should take the methods such as clearing away heat andvirus,cooling blood and removing blood stasis,purging Fu organs,supplementing Qi and nourishing Yin.And for the same reason,the cases withsuperabundance of Yin toxin were easier to injure Yang,so this principle couldonly be an assistant,and the more important is the principle of‘pull a boatupstream’,such as warming Yang to reducing turbid matter,removing stasis inblood and collaterals,reducing turbid matter by purging Fu organs,warmingkidney and spleen.
Prescription:1 Basic prescription:phyllanthusnirud linn 30g,trichosanthes fruit 30g,lysimachia 30g,rhizome 6g,dried rehmannia root 20g,astragalus root30g,loranthus mulberry mistletoe 30g,red stage root 20g,notoginseng 6g,prepared aconite branch-root 15g(decocted in advance for 30 minutes).2 Enemaprescription I:rhubarb 30g,magnolia bark 30g,immature bitter orange 30g,dried rehmannia root 30g,dandelion herb 30g.3 Enema prescription II:preparedaconite ranch-root 30g,dried ginger 15g,poria 30g,prepared licorice 30g,cinnamon twig 15g.
The cases with Yin-Yang syndrome had the basic prescription one potionone day,which was decocted to 300ml and taken for two times.In the same time,they had the enema I every other day which dosage was 150ml in singular day,the same as the enema II in even day.
The cases with superabundance of Yang toxin had the basic prescriptionwhich was added some other kind of herb to increase the function on clearingaway virus,nourishing Yin,cooling blood and removing blood stasis,whichwere dried rehmannia root(15g),red peony root(15g)and purple gromwellroot(10g).They also had the enema I every day.
The cases with superabundance of Yin toxin had the basic prescriptionwhich was added some other kind of herb to increase the function on warmingyang to reduce turbid matter,which were prepared aconite branch-root(10g),cinnamon twig(15g),dried ginger(10g).They also had the enemaⅡevery day.
Part three:The therapeutic effect evaluation of the principle of‘truncationand inverse draft' on chronic severe hepatitis B
Objective:To evaluate initially therapeutic effect on the disease accordingto the principle.
Method:About 110 patients were selected and received the treatment ofTCM and western medicine or the treatment of only western medicine,toevaluate initially the effect by the comparison of effective rate,frequency ofcomplication,case fatality rate and the main chemical indexes.
Results and conclusion:There were total 111 patients who got treatment,among which 55 cases were in the treatment group and 56 cases in the controlgroup.
1 The effect on syndrome:After one week's treatment,the integral ofsyndrome in the treatment group dropped remarkably,and the difference was allsignificant compared before treatment with after treatment(P＜0.01).After twoweek's treatment,the integral of syndrome in the control group droppedremarkably,and the difference was significant compared before treatment withafter treatment(P＜0.05).
After one week's treatment,the mean integral dropped by 1.82+3.88 in thetreatment group,and-0.02+4.18 in the control group,and the difference wasremarkably significant(P＜0.05).After eight week's treatment,the mean integraldropped by 8.29+7.53 in the treatment group,and 4.41+9.64 in the control group,and the difference was remarkably significant(P＜0.05)
2 The effect on liver function:①Total bilirubin(TBIL):After two weeks'treatment TBIL of the two groups decreased remarkably.And the difference inthe treatment group was all significant compared TBIL before treatment withafter two weeks' treatment(P＜0.05),four weeks' treatment(P＜0.01)and eightweeks' treatment(P＜0.05).②Blood clotting function:in the treatment groupPTA was significant increased after treatment.And the difference between oneweek's therapy(43.6%)and pretherapy(35.0%)was significant(P＜0.01).But there is no significant difference in the control group.After one week'streatment PTA in the treatment group(43.6%)was higher remarkably than in thecontrol group(33.4%),and the difference was remarkably significant(P＜0.01).
3 The effect on complications:①Hepatorenal syndrome:After therapythe incidence rate in the treatment group was remarkably lower than in thecontrol group.Four weeks' later the incidence rate in the treatment group(1 case,1.8%)was remarkably lower than in the control group(8 cases,14.3%)and thedifference was significant(P＜0.05).②Abdominal cavity infection:In the twogroups the rate of abdominal cavity infection both decreased after treatment.Inthe treatment group after eight weeks' therapy the rate(16 cases,29.1%)waslower than pre-therapy(25 cases,45.5%)and the difference was significant(P＜0.05).③The incidence rates of complications were no remarkablydifference after therapy compared with pre-therapy like hepatic encephalopathy,alimentary tract hemorrhage and electrolyte disturbances,etc in the two groups.
4 The compositive effect:The effective rate(37cases,67.27%)in the treatment group was higher than in the control group(30 cases,53.57%),and thedifference between them was not significant(P＞0.05)..The case fatality rate(5cases,9.09%)in the treatment group was lower than in the control group(13cases,23.21%),and the difference between them was significant(P＜0.05).
The effect in the treatment group was better than in the control group,especially in recoverying syndrome,liver function(such as TBIL,blood clottingfunction),and complications,etc.Which proved the rationality of the principle.
本文在研究钱英教授“截断逆挽法”治疗慢性乙型重型肝炎学术思想和基于慢性乙型重型肝炎“毒损肝体”理论证候学研究基础上，探讨“截断逆挽法”在治疗慢性乙型重型肝炎中的应用，并进一步进行疗效验证。
第一章钱英教授“截断逆挽法”治疗慢性乙型重型肝炎学术思想研究
目的：研究钱英教授“截断逆挽法”治疗慢性乙型重型肝炎学术思想。
方法：通过探索“截断逆挽法”理论渊源，分析钱英教授“截断逆挽法”治疗慢性乙型重型肝炎的学术观点、临证思辨、应用规律、临床医案和相关文献，研究钱英教授“截断逆挽法”治疗慢性乙型重型肝炎学术思想。
结果与结论：“截断逆挽法”是“截断法”和“逆流挽舟法”的综合运用。钱英教授认为治疗慢性乙型重型肝炎，要抓住疾病发生发展中病机演变、脏腑传变、虚实转化等特殊规律，将辨证与辨病紧密结合，运用中医理论与方法，在疾病发展的各个阶段，灵活运用“截断逆挽法”。
1针对慢性乙型重型肝炎“病急病重”的特点，快速截断为首要治则，其主要治法是：(1)清热解毒是截断的关键(清除病因-疫毒)。解毒不能拘泥于清热解毒一法，要依据“毒邪”的具体性质辨证遣方用药。(2)通腑攻下是截断的转机(净化肠道，阻断二次打击)。(3)凉血化瘀是截断的要点(顿挫病势，防止传入营血)。
2“逆流挽舟法”是针对慢性乙型重型肝炎因虚致病的病机，采用扶正祛邪的方法，强调尽早补肝以扶正，包括滋肝肾之阴、益肝脾之气、温脾肾之阳等。根据肝“体阴而用阳”理论，补肝体与益肝用，体用同调，阴阳兼顾：(1)益肝用与补肝体并重；(2)重用生地黄以养肝阴；(3)疏肝理气与顾护肝体并施。
3注重脏腑传变规律，及时截断逆转。主要涉及脾肾二脏：(1)调理肝脾，以固其本：用大剂量的生黄芪，因本病肝脾气损严重，“重病必重药”，非重剂难以奏效，同时注意补中、健中、理中三法的配合运用。(2)肝肾同治，滋水荣木：肝肾同源，故肝病多伤及于肾，临床多表现为肝阴虚与肾阴虚并见，肝气虚、肝阳虚与肾气虚、肾阳虚兼夹。治疗上必须重视“肝肾同治”。
4分期而治：针对疾病分期中正邪演变规律，”截断法”和“逆流挽舟法”应有偏重。慢性乙型重型肝炎进展期应以“解毒化瘀，截断病势”为主，以达到“留人治病”之目的，但攻逐之法当“衰其大半而止”，不可久施；待病情平稳后或进入恢复期则以扶正为主，以恢复生机，采用“体用同调”、调理肝脾、滋水荣木等法，缓缓久图；但若出现毒瘀与正虚均已严重的局面，则应攻补并重。
第二章基于“毒损肝体”理论及“截断逆挽”治则的证治规律研究
目的：进行慢性乙型重型肝炎基于“毒损肝体”理论的证候学研究，探讨证候规律，从证候学角度分析“截断逆挽法”的合理性；探讨基于“截断逆挽法”治则的证治方案，以应用于临床。
方法：进行260例慢性乙型重型肝炎证候学调查研究，探讨慢性乙型重型肝炎证候分布规律；分析“毒邪”症候要素；结合证候分布规律和“毒邪”症候要素，确立“截断逆挽法”治疗慢性乙型重型肝炎证治方案。
结果与结论：
1证候分布规律：260例慢性乙型重型肝炎基本证型为肝脾血瘀、阴毒内结、阳毒内盛、肝肾阴虚、肝脾肾气虚、肝脾肾阳虚证。基本证型体现了慢性乙型重型肝炎“毒(阴毒和阳毒)损肝体，脾肾气阴或阴阳两伤”的病机特点。证候规律与钱英教授“截断逆挽法”基本原则(清热解毒、通腑攻下、凉血化瘀、滋肝肾之阴、益肝脾之气、温脾肾之阳)完全相符，证候学规律说明了钱英教授应用“截断逆挽法”治疗慢性乙型重型肝炎的合理性。
2“毒邪”症候要素：两大特征性证型为阴毒内结证和阳毒内盛证，兼有阴毒内结和阳毒内盛特征者为阴阳兼证。260例慢性乙型重型肝炎中：阴毒内结110例、阳毒内盛46例、阴阳兼证104例。阳毒内盛证与阴毒内结证基础证：身目尿黄、面色晦暗、倦怠乏力、食欲减退、腹胀、性欲减退、口干；舌红暗或紫、舌有瘀斑，苔厚腻，舌下静脉增粗或迂曲；脉滑、弦、沉、濡等。基础证也反映了慢性乙型重型肝炎之常候“毒(阴毒和阳毒)贯穿始终，肝体用同损，出现肝脾血瘀、肝肾阴虚、肝脾肾气虚、肝脾肾阳虚等病机变化”。舌质红、苔黄腻，滑脉、数脉对辨证阳毒内盛证有意义。下肢浮肿、腰膝酸软、面色晦暗、肝掌、大便稀溏、舌淡红、苔腐等症对辨证阴毒内结证有意义。
141例慢性乙型重型肝炎色诊图片资料分析：采用奥林巴斯2．0数码相机在室内、近焦、闪光灯条件下对慢性乙型重型肝炎患者面部、唇部、手掌、舌象(舌质、舌苔、舌下络脉)进行拍照，将图像输入计算机，在“中医舌诊专家系统”软件(北京普利生公司研制)中检测其RGB值(R为红色，G为绿色，B为蓝色)。(1)面色、唇部、手掌及舌质RGB值均为阳毒内盛证＞阴阳兼证＞阴毒内结证，且阴阳兼证与阴毒内结比较，面色RGB值、唇部RGB值及舌质RG值有显著性差异(P＜0．05)，阳毒内盛与阴毒内结比较，面色R值、唇部RGB值及舌质R值有显著性差异(P＜0．05)；舌苔RGB值特点，阴毒内结证＞阴阳兼证，GB值有显著性差异(P＜0．05)；舌下静脉RGB值特点，阳毒内盛证＞阴阳兼证及阴毒内结证。(2)肝脾血瘀证舌质RGB值均高于非肝脾血瘀证，比较有显著性差异(P＜0．05)；肝脾血瘀证唇部RGB值均低于非肝脾血瘀证，唇部B值比较有显著性差异(P＜0．05)。毒(阴毒和阳毒)与面色、唇部、手掌、舌象RGB值密切相关，肝脾血瘀证与唇部、舌质RGB值密切相关，慢性乙型重型肝炎色诊RGB值可作为辨证阴阳毒证、肝脾血瘀证的参考指标。
3证治方案：以“截断逆挽法”为指导思想，基于阴毒阳毒辨证思路，确立慢性乙型重型肝炎证治方案。
治疗原则：阴毒阳毒兼证，以解毒化瘀、通腑泄浊、清利湿热、调补肝脾肾阴阳为法；阳毒内盛证，以清热解毒、凉血化瘀、通腑泄浊、益气养阴为法；阴毒内结证，易伤阳气，以温阳化湿、化瘀通络、通腑泄浊、温扶脾肾为法。
组方：(1)基础方：叶下珠30克，瓜蒌30克，金钱草30克，莪术6克，生地20克，生黄芪30克，槲寄生30克，丹参20克，三七6克，黒附片15克(先煎30分钟)。(2)灌肠1号方：大黄30克，厚朴30克，枳实30克，生地30克，蒲公英30克。(3)灌肠2号方：黑附片30克，干姜15克，茯苓30克，炙甘草30克，桂枝15克。
阴毒阳毒兼证，基础方1日1剂，水煎300ml，分2次服。灌肠1号方、2号方，150m1灌肠，每日1次，二方交替使用。
阳毒内盛证，基础方中生地加量至35克，加用赤芍15克，紫草10克。以加强解毒、养阴、凉血、化瘀之用。灌肠1号方，150ml，灌肠，1日1次。
阴毒内结证，基础方中黒附片加量至25克，加用桂枝15克，干姜10克。以加强温阳化浊之用。灌肠2号方，150ml灌肠，1日1次。
第三章“截断逆挽法”治疗慢性乙型重型肝炎疗效验证
目的：初步验证“截断逆挽法”治疗慢性乙型重型肝炎方案的有效性。
方法：选择约110例患者，分别进行中西医结合治疗(治疗组)或西医治疗(对照组)，观察有效率、并发症出现率、病死率及主要化验指标的改善情况，初步验证“截断逆挽法”治疗慢性乙型重型肝炎方案的有效性。
结果与结论：有效病例111例，治疗组55例，对照组56例。
1症候积分疗效：治疗1周后，治疗组积分明显下降，治疗前后比较有非常显著性差异(P＜0．01)；治疗2周后，对照组积分明显下降，治疗前后比较有显著性差异(P＜0．05)：治疗1周后，治疗组积分均值下降1．82±3．88，而对照组积分均值下降-0．02±4．18，两组比较有显著性差异(P＜0．05)；治疗8周后，治疗组积分均值下降8．29±7．53，而对照组积分均值下降4．41±9．64，两组比较有显著性差异(P＜0．05)。
2肝功能：(1)胆红素：两组治疗2周后TBIL明显下降，其中治疗组2周后与治疗前比较，有显著性差异(P＜0．05)；治疗组4周后与治疗前比较，有非常显著性差异(P＜0．01)；对照组8周后与治疗前比较，有显著性差异(P＜0．05)。(2)凝血功能：治疗组PTA明显升高，且1周后PTA(43．6％)与治疗前(35．0％)比较有非常显著性差异(P＜0．01)；对照组PTA治疗前后无明显变化；治疗1周后治疗组PTA(43．6％)明显高于对照组(33．4％)，有非常显著性差异(P＜0．01)。
3并发症：(1)肝肾综合征：治疗后出现率治疗组明显低于对照组，治疗4周后治疗组出现率(1例，1．8％)与对照组(8例，14．3％)比较，有显著性差异(P＜0．05)。(2)腹腔感染：两组治疗后腹腔感染出现率均有下降，治疗组8周后腹腔感染出现率(16例，29．1％)明显低于治疗前(25例，45．5％)，有显著性差异(P＜0．05)。(3)肝性脑病、消化道出血、电解质紊乱等并发症两组治疗前后比较及两组比较均无明显差异。
4综合疗效：治疗组有效率(37例，67．27％)高于对照组(30例，53．57％)，两组比较无显著性差异(P＞0．05)；治疗组病死率(5例，9．09％)低于对照组(13例，23．21％)，两组比较有显著性差异(P＜0．05)。
治疗组在改善症状、改善肝功能(退黄、提高凝血酶原活动度等)、防治肝肾综合征等并发症及改善患者预后方面均优于对照组，证实了截断逆挽法治疗慢性乙型重型肝炎方案的有效性。
The study on how to apply the principle of‘truncation andinverse draft’to treatment to chronic severe hepatitis B
Professor Qian Ying,the hepatic specialist of TCM,had recently treatedchronic severe hepatitis B by the principle of‘truncation and inverse draft’,which was the comprehensive use of‘cut-off’and‘pull a boat upstream’.It wasthe theoretical innovation of TCM in treating the disease.
This thesis studied the Professor’s thoughts and the syndrome of thedisease based on the theory of‘toxin injuring hepatic body’,so as to discusshow to apply the principle to treatment to the disease.More,the thesis reportedthe therapeutic effect evaluation of the principle on the disease.Part one:To study the academic thoughts of Professor Qian Yingabout treating chronic severe hepatitis B by the principle of‘truncation and inverse draft’
Objective:Research the academic thoughts of Professor Qian Ying abouthow to treat chronic severe hepatitis B by the principle of‘truncation andinverse draft’.
Method:To study the academic thoughts of Professor Qian Ying on how totreat chronic severe hepatitis B by the principle of‘truncation and inverse draft’by analyzing his academic view,clinical reasoning and analysis,application ofprinciple,clinical cases,inheritance and innovation,and relative literature and searching the theoretical origin of the principle.
Results and conclusion:The principle is the comprehensive use of‘cut-off’and‘pull a boat upstream’.Professor Qian Ying thought that it wasimportant to be flexible in the use of the principle in the various stage of thedisease.We should catch hold of the special laws of the evolution ofpothogenesis,the transmission of Zang-Fu organs,inter-transformation betweenasthenia and sthenia in the occurrence and development of the disease,and weshould integrate with syndrome differentiation and disease diagnose and managethe theory of traditional Chinese medicine.
1 Aiming at the severe and acute characteristics of the disease,quick cut-offis the primary principle.There are three main treatment measures,such as:①Clearing away heat and virus is the key to cut off(to clear awaypathogeny-viruses).Whereas,we should not rigidly adhere to the measure.Weneed to differentiate syndrome and treat based on the characteristics of the virusexopathogens.②Purging Fu organs is the turn to cut-off.(to purge theintestine and prevent from the secondary hit).③Cooling the blood andremoving blood stasis is the point of cut-off.(to set-back disease progress andprevent from transmission to Yin-Xue).
2 Aiming at the pathogenesis of asthenia,the measures of“pull a boatupstream”are strengthening healthy Qi and eliminating pathogens.We shouldstrengthen healthy Qi by strengthening liver as soon as early,which is,replenishing Yin of liver and kidney,strengthening Qi of liver and spleen and warming Yang of spleen and kidney,etc.Basing on the theory of“liver of yinnature with yang functioning”,we should supply liver-Yin nature and strengthenliver-Yang function,regulate the nature and function,balance between Yin andYang.Such as:1 Strengthening liver-Yang function and supplying liver Yin.2Using more raw rehmannia to replenish liver-Yin.3 Regulating liver Qi andsafeguarding liver body.
3 For the transmission of Zang-Fu organs mainly referring to spleen andkidney,the measures the principle are that:1 To strengthen the root byregulating liver and spleen.For Qi of liver and spleen lost a lot,large dose ofmedicine was necessary to manage severe disease using large dose of rawastragali(100～120g).At the same while we need to strengthen,invigorate andregulate spleen.2 To manage liver and kidney and replenish water to nourishwood.For liver and kidney sharing the same origin,liver disorder involvedkidney.Liver-Yin deficiency and kidney yin deficiency were accompanied,andthe same liver Qi and kidney Qi,liver-Yang and kidney yang.we must treat bothliver and kidney.
4 Treating basing on stage:Aiming at the progress of healthy Qi andpathogen in stages of the disease,the principle should apply flexibly.In theprogression stage we should apply mostly the method of‘removal viruses andblood stasis to cut off the tendency of disease’,so as to treat the disease and savethe patient.And the method of purgation should not be used too long.While thedisease progressed steadily or in the convalescent stage,strengthening healthy Qi is the main therapeutic principle for recovery including regulating the natureand function,regulating liver and spleen and‘replenishing water to nourishwood’,etc.If viruses and blood stasis,and healthy Qi asthenia were all severe,we should pay equal attention to purgation and tonification.Part two:To study chronic severe hepatitis B with its syndrome basedon the theory of‘toxin injuring hepatic body’and the thoughts of‘truncation and inverse draft’
Objetcive:To study the syndrome of the disease based on the theory of‘toxin injuring hepatic body’,to explore the rule of the syndrome,to analyzerationality of the principle based on the syndrome;to explore the scheme of thesyndrome and treatment to the disease based on the principle.It was beneficialto the clinic.
Method:To study the distribution rules of manifestations of 260 cases.Toanalyze syndrome factors of‘the pathogen of toxin’.To establish the schemebased on the principle,the rules and the factors.
Result and conclusion:
1 The rules:The basic syndrome types of the cases were blood stagnationof liver and spleen,superabundance of Yin toxin,superabundance of Yangtoxin,Ying deficiency of liver and kidney,Qi deficiency of liver,spleen andkidney,Yang deficiency of liver,spleen and kidney.The basic types reflectedcharacteristics of pathogenesis of‘toxin injuring hepatic body,Qi-Yin deficiency of spleen and kidney,or Yin-Yang deficiency of spleen and kidney’.It wascompletely meet to the principle.
2.The factors:It has two features of syndrome types,such assuperabundance of Yin toxin and Yang toxin.It was Yin-Yang syndrome whenthere were features of superabundance of both Yin toxin and Yang toxin.Amongthe 260 cases,110 cases were with superabundance of Yin toxin,46 cases withsuperabundance of Yang toxin,104 cases with Yin-Yang syndrome.Commonsymptoms of superabundance of Yin toxin and Yang toxin included that:symptoms which were yellow body,eyes and urine,dim complexion,fatigueand lassitude,poor appetite,abdominal distension,debility of sexuality,drymouth,tongue symptoms which were dark red or purple color of tongue,ecchymosis in tongue body,yellow thick or greasy coat,thickening or varicosehypoglossal vein,pulse symptoms which were slip,string,sinking,bedew,etc.Itwas interesting to distinguish superabundance of Yang toxin for red color oftongue,yellow greasy coat,slippery or pulse rapid pulse etc,and the same assuperabundance of Yin toxin for swollen limbs,waist and knee fatigue,darkcomplexion,liver palms,dilute or loose stool,pale red tongue and curdy coat,etc.
We collected image data about the color inspection of 141 cases among the260 cases.The patients' complexion,lips,palm and tongue including tonguetexture,tongue coating and hypoglossal vein were photoed under the conditionsof indoors,close focus and flash with Olympus 2.0 digital cameras.RGB(three elemental colors,R refers to the red color,G refers to the green color,B refersto the blue color)values were measured by the expert system of tongueinspection of TCM.①Compared in the three groups,the RGB values ofcomplexion,lips,palm and tongue texture of the cases with superabundance ofYang toxin＞those of the cases with Yin-Yang syndrome＞those of the caseswith superabundance of Yin toxin.Compared between the cases with Yin-Yangsyndrome and the cases with superabundance of Yin toxin,the R values ofcomplexion,the RGB values of lips and the RG values of tongue texture weresignificantly different(P＜0.05).Compared between the cases with thesuperabundance of Yang toxin and the cases with the superabundance of Yintoxin,there was significant difference in the R values of complexion,the RGBvalues of lips and the R values of tongue texture(P＜0.05).The RGB values oftongue coat of the cases with superabundance of Yin toxin were higher thanthose of the cases with Yin-Yang syndrome,and there was significant differencebetween then in the GB values(P＜0.05).The RGB values of hypoglossal vein ofthe cases with superabundance of Yang toxin were highest among the threegroups.②The RGB values of tongue texture of the syndrome type of bloodstagnation of liver and spleen were higher than those of the others.There wassignificant difference between the two groups(P＜0.05).The B values of lipsbetween the two groups were significantly different(P＜0.05).From above it canbe said that there was relationship between the toxin including Yin toxin andYang toxin and the RGB values of complexion,lips,palm,tongue manifestation. There was relationship between the RGB values of lips,tongue texture and thesyndrome type of blood stagnation of liver and spleen.So the change of RGBvalues can be a reference target for the syndrome differentiation of chronicsevere hepatitis B.
3 The scheme:To establish the scheme,which was based on the syndromedifferentiation based Yin toxin and Yang toxin,and whose guiding ideology wasthe thoughts.
Therapeutic principle:It was easy to injury Yin and Yang of the cases withYin-Yang Syndrome,so it was important to remove stagnation and cut off thetrend of disease.We can take the methods of clearing away virus and removingstasis,reducing turbid matter by purging Fu organs,clearing away damp-heat,harmonizing liver,spleen and kidney.The cases with superabundance of Yangtoxin were easier to injure Qi and Yin,so it was more important to cut off thetrend of disease.We should take the methods such as clearing away heat andvirus,cooling blood and removing blood stasis,purging Fu organs,supplementing Qi and nourishing Yin.And for the same reason,the cases withsuperabundance of Yin toxin were easier to injure Yang,so this principle couldonly be an assistant,and the more important is the principle of‘pull a boatupstream’,such as warming Yang to reducing turbid matter,removing stasis inblood and collaterals,reducing turbid matter by purging Fu organs,warmingkidney and spleen.
Prescription:1 Basic prescription:phyllanthusnirud linn 30g,trichosanthes fruit 30g,lysimachia 30g,rhizome 6g,dried rehmannia root 20g,astragalus root30g,loranthus mulberry mistletoe 30g,red stage root 20g,notoginseng 6g,prepared aconite branch-root 15g(decocted in advance for 30 minutes).2 Enemaprescription I:rhubarb 30g,magnolia bark 30g,immature bitter orange 30g,dried rehmannia root 30g,dandelion herb 30g.3 Enema prescription II:preparedaconite ranch-root 30g,dried ginger 15g,poria 30g,prepared licorice 30g,cinnamon twig 15g.
The cases with Yin-Yang syndrome had the basic prescription one potionone day,which was decocted to 300ml and taken for two times.In the same time,they had the enema I every other day which dosage was 150ml in singular day,the same as the enema II in even day.
The cases with superabundance of Yang toxin had the basic prescriptionwhich was added some other kind of herb to increase the function on clearingaway virus,nourishing Yin,cooling blood and removing blood stasis,whichwere dried rehmannia root(15g),red peony root(15g)and purple gromwellroot(10g).They also had the enema I every day.
The cases with superabundance of Yin toxin had the basic prescriptionwhich was added some other kind of herb to increase the function on warmingyang to reduce turbid matter,which were prepared aconite branch-root(10g),cinnamon twig(15g),dried ginger(10g).They also had the enemaⅡevery day.
Part three:The therapeutic effect evaluation of the principle of‘truncationand inverse draft' on chronic severe hepatitis B
Objective:To evaluate initially therapeutic effect on the disease accordingto the principle.
Method:About 110 patients were selected and received the treatment ofTCM and western medicine or the treatment of only western medicine,toevaluate initially the effect by the comparison of effective rate,frequency ofcomplication,case fatality rate and the main chemical indexes.
Results and conclusion:There were total 111 patients who got treatment,among which 55 cases were in the treatment group and 56 cases in the controlgroup.
1 The effect on syndrome:After one week's treatment,the integral ofsyndrome in the treatment group dropped remarkably,and the difference was allsignificant compared before treatment with after treatment(P＜0.01).After twoweek's treatment,the integral of syndrome in the control group droppedremarkably,and the difference was significant compared before treatment withafter treatment(P＜0.05).
After one week's treatment,the mean integral dropped by 1.82+3.88 in thetreatment group,and-0.02+4.18 in the control group,and the difference wasremarkably significant(P＜0.05).After eight week's treatment,the mean integraldropped by 8.29+7.53 in the treatment group,and 4.41+9.64 in the control group,and the difference was remarkably significant(P＜0.05)
2 The effect on liver function:①Total bilirubin(TBIL):After two weeks'treatment TBIL of the two groups decreased remarkably.And the difference inthe treatment group was all significant compared TBIL before treatment withafter two weeks' treatment(P＜0.05),four weeks' treatment(P＜0.01)and eightweeks' treatment(P＜0.05).②Blood clotting function:in the treatment groupPTA was significant increased after treatment.And the difference between oneweek's therapy(43.6%)and pretherapy(35.0%)was significant(P＜0.01).But there is no significant difference in the control group.After one week'streatment PTA in the treatment group(43.6%)was higher remarkably than in thecontrol group(33.4%),and the difference was remarkably significant(P＜0.01).
3 The effect on complications:①Hepatorenal syndrome:After therapythe incidence rate in the treatment group was remarkably lower than in thecontrol group.Four weeks' later the incidence rate in the treatment group(1 case,1.8%)was remarkably lower than in the control group(8 cases,14.3%)and thedifference was significant(P＜0.05).②Abdominal cavity infection:In the twogroups the rate of abdominal cavity infection both decreased after treatment.Inthe treatment group after eight weeks' therapy the rate(16 cases,29.1%)waslower than pre-therapy(25 cases,45.5%)and the difference was significant(P＜0.05).③The incidence rates of complications were no remarkablydifference after therapy compared with pre-therapy like hepatic encephalopathy,alimentary tract hemorrhage and electrolyte disturbances,etc in the two groups.
4 The compositive effect:The effective rate(37cases,67.27%)in the treatment group was higher than in the control group(30 cases,53.57%),and thedifference between them was not significant(P＞0.05)..The case fatality rate(5cases,9.09%)in the treatment group was lower than in the control group(13cases,23.21%),and the difference between them was significant(P＜0.05).
The effect in the treatment group was better than in the control group,especially in recoverying syndrome,liver function(such as TBIL,blood clottingfunction),and complications,etc.Which proved the rationality of the principle.
引文
1 毛德文，李兴刚．肝衰竭的中医证治浅识．湖南中医药导报，2003，9(02)：6-7．
2 张秋云，刘绍能，李秀惠，等．乙型慢重肝“毒损肝体”病因病机及治疗思路探讨．辽宁中医杂志，2005，32(12)：1246-1248．
3 张秋云，刘绍能，李秀惠．慢性病毒性乙型重型肝炎病因病机探讨．北京中医，2006，25(1)：48-50．
4 朱清静，盛国光．重型肝炎的中医证治浅识．中医药学刊，2006，24(4)：662-663．
5 刘洁，邱华，毛德文．重型肝炎的中医治疗进展．云南中医中药杂志，2007(05)．
6 薛博瑜，周仲瑛．论病毒性肝炎与湿、瘀、毒．江苏中医药，1993(01)：31-32．
7 李和平，李莲．关于界定现行统编教材《中医诊断学》中阴黄的临床研究．中国中医药现代远程教育，2008，6(09)：1002-1003．
8 聂广，余绍勇，江福生．重型肝炎中医辨证分型标准的初步研究．中国中西医结合急救杂志，2001，8(03)：172-176．
9 余绍勇，聂广．重型肝炎之中医辨证分型研究．中西医结合肝病杂志，2000，10(02)：56-58．
10 张秋云，李秀惠，王融冰，等．慢性病毒性乙型重型肝炎中医证候分布及组合规律研究．北京中医药，2008，23(02)：87-90．
11 张秋云，李秀惠，刘绍能，等．慢性病毒性乙型重型肝炎中医证候分布特点分析．中国中医基础医学杂志，2006，12(12)：929-930．
12 张秋云，李秀惠，刘绍能，等．慢性病毒性乙型重型肝炎中医辨证与舌诊客观化指标的关系探讨．天津中医药，2006，23(05)：365-367．
13 李筠．慢性重型肝炎中医辨证与临床分期及预后分析．中西医结合肝病杂志，2007，17(06)：343-344．
14 毛德文，邱华，胡振斌，韦新．重型肝炎中医证型相关文献统计分析文献．中华中医药学会第十三届内科肝胆病学术会议论文汇编，中华中医药学会第十三届内科肝胆病学术会议论文汇编，杭州，2008年4月，2008．119-122．
15 邱华，毛德文，胡振斌，等．慢性重型肝炎中医综合治疗方案的多中心临床研究．中西医结合肝病杂志，2008，18(05)：260-262，276．
16 张健．茵陈消黄汤治疗重型黄疸性肝炎32例．陕西中医，2008，29(03)：303-305．
17 王台，杨延玲，徐光华，等．清热解毒汤配合综合疗法治疗重症肝炎倾向61例．陕西中医，2006，17(10)：1236-1237．
18 金妙文，周仲瑛，薛博瑜，等．凉血解毒法治疗重型病毒性肝炎的临床研究．南京中医药大学学报，1996，12(04)：14-17．
19 薛博瑜．凉血解毒法治疗重型病毒性肝炎的临床研究．医学信息，1997，10(01)：35．
20 薛博瑜．凉血解毒法治疗重型病毒性肝炎的临床研究．中国中医急症，1996，5(02)：51-54．
21 薛博瑜，张恩虎．清肝解毒注射液治疗重型肝炎临床疗效观察．江苏中医，1996，17(8)：9-11．
22 薛博瑜，周眠．清肝解毒注射液对急性肝衰竭大鼠免疫功能的影响．中西医结合肝病杂志，2002，12(3)：147-149．
23 熊学涛，宗亚力．清热解毒凉血活血为主治疗重症肝炎高胆红素血症28例．中西医结合肝病杂志，1998，8(01)：39-40．
24 沈翔．中西医结合治疗慢性重型倾向性肝炎36例．江苏中医，1995，16(03)：7-8．
25 沈翔．中西医结合治疗重症肝炎49例．陕西中医，1996，17(01)：1-2．
26 曾莉，王陆军．凉血化瘀法治疗重型肝炎的作用机理探析．中医药学刊，2003，21(1)：87-88．
27 汪承柏．中西医结合治疗重症淤胆型肝炎的思路方法．传染病信息，1998，11(3)：110-111．
28 汪承柏．中西医结合治疗重症淤胆肝炎、慢性重型肝炎思路方法与用药研究．中西医结合肝病杂志，1998(S1)：4-7．
29 贺江平，汪承柏．非肝实质坏死性慢性重型肝炎的中西医结合治疗．中医杂志，1999，38(08)：477-479．
30 刘宇．重用赤芍治疗重度黄疸肝炎86例．新中医，2000(12)：40．
31 喻洪伟，杨志超．清热利湿活血解毒法为主治疗重症肝炎疗效观察．辽宁中医杂志，2003，30(05)：365．
32 刘友章，王昌俊．重症肝炎中医治疗思路与方法．中医药通报，2005，4(4)：17-21．
33 连粤湘，吴婉芬．中药健脾祛湿为主治疗慢性重症肝炎25例．中西医结合肝病杂志，1998，8(S1)：90．
34 罗欣拉．中西医结合治疗慢性重型肝炎湿热内蕴型35例．中西医结合肝病杂志，2001，11(3)：178-179．
35 孙克伟，陈斌，黄裕红，等．凉血解毒、清热化湿和凉血解毒、健脾温阳法治疗慢性重型肝炎的临床观察．中国中西医结合杂志，2006(11)：981-983．
36 佘万祥．温阳活血利湿解毒法治疗慢性重症肝炎30例．实用中西医结合杂志，1998，11(04)：323-324．
37 张建军，张赤志．温阳活血退黄方治疗阴黄证的疗效观察．湖北中医杂志，2001，23(06)：29-30．
38 连粤湘，吴婉芬．双草退黄汤治疗慢性重型肝炎的临床研究．中华实用中西医杂志，2000，13(1)：93-94．
39 张伟成．祛瘀利湿助阳汤治疗重症淤胆型肝炎34例．中国中医急症，2005，14(03)：244．
40 张伟成．解毒利湿活血助阳法治疗重症淤胆型乙型肝炎黄疸30例——附西药治疗30例对照．浙江中医杂志，2004(11)：474．
41 谢炳国，谢智悠．慢性重型肝炎的辨证施治．中国中医急症，2006，15(5)：509-509，517．
42 周仲瑛．重症肝炎辨治述要．新中医，2002，34(3)：3-6．
43 罗国钧．肝功能衰竭的辨证施治探要．中医药学刊，2003，21(8)：1382-1383．
44 王今达．脓毒症：感染性MODS的预防．中国危重病急救医学，1999，11(08)：453-455．
45 王今达．回顾开拓中西医结合急救专业的历程，展望世纪之交的未来．中国中西医结合杂志，1999，19(02)：67-68．
46 王今达．开展中西医结合急救的思路和方法．天津中医，2002，19(06)：8．
47 李筠．内毒素对肝脏的二次打击及中医药治疗．北京中医药，2008，27(02)：94-95．
48 姜春华．时代要求我们对治疗温病要掌握截断方药——答复沈仲圭先生．中医杂志，1978(12)：(总611)3．
49 姜春华．叶天士的温病、杂病的理论与治疗．中医杂志，1978(08)：8-13．
50 黄古叶，毛德文，胡国平，等．大黄煎剂配合西药治疗慢性重型肝炎肠源性内毒素症疗效观察．辽宁中医杂志，2006，18(12)：9-10．
51 李凌，杨大国，吴其恺，聂广，陶艳艳．赤芍承气汤对重型肝炎内毒素血症的影响．浙江中西医结合杂志，2002，12(09)：538-540．
52 邓欣，杨大国，吴其恺，陶艳艳，聂广．赤芍承气汤治疗慢性重型肝炎近期疗效观察．中西医结合肝病杂志，2004，14(02)：67-69．
53 来要良，李秀惠，钱英．清肠养肝方灌肠治疗慢性重型乙型肝炎临床观察．中西医结合肝病杂志，2007，17(02)：71-72．
54 蔡春琳，钟凤英．结肠透析与常规灌肠治疗重型病毒性肝炎临床疗效观察．现代诊断与治疗，2007，18(02)：83-84．
55 王融冰，王宪波，孙凤霞，等．解毒凉血法治疗慢性乙型重型肝炎．北京中医药，2008，27(02)：83-85．
56 刘文童．中西医结合治疗重型肝炎内毒素血症．湖北中医杂志，2002，24(11)：41-41．
1 姜春华．时代要求我们对治疗温病要掌握截断方药——答复沈仲圭先生．中医杂志，1978(12)：(总611)3．
2 姜春华．叶天士的温病、杂病的理论与治疗．中医杂志，1978(08)：8-13．
3 荀运浩，过建春，施军平，等．从“治未病”理论入手论治慢性肝病．中华中医药学刊，2009，27(01)：131-132．
4 曹吉宪，李配方．运用中医体质理论防治乙型肝炎病毒携带者证治探讨．浙江中医杂志，2007，42(11)：628-629．
5 龙富立，黄古叶，毛德文，等．中医治未病思想在慢性乙型肝炎防治中的应用．辽宁中医药大学学报，2008，10(12)：144-146．
6 崔德广，李素云，王生跃．截断疗法治疗病毒性肝炎的对照研究．河南医药信息，2000，8(06)：51-52．
7 谌宁生，孙克伟．重症肝炎从快速截断论治．新中医，2001，33(1)：3-4．
8 毛德文，邱华，龙富立．中医治未病思想在重型肝炎防治中的应用研究．中医药导报，2008，14(04)：8-9．
1 姜春华．时代要求我们对治疗温病要掌握截断方药——答复沈仲圭先生．中医杂志，1978(12)：(总611)3．
2 姜春华．叶天士的温病、杂病的理论与治疗．中医杂志，1978(08)：8-13．
3 王佩芳．姜春华学术思想和临床经验．中医杂志，1994，35(10)：597-599．
4 贝润浦，徐敏华．试论姜春华教授的“截断扭转”学术思想．上海中医药杂志，1983(01)：16-17．
5 崔德广，李素云，王生跃．截断疗法治疗病毒性肝炎的对照研究．河南医药信息，2000，8(06)：51-52．
6 谌宁生，孙克伟．重症肝炎从快速截断论治．新中医，2001，33(1)：3-4．
7 毛德文，邱华，龙富立．中医治未病思想在重型肝炎防治中的应用研究．中医药导报，2008，14(04)：8-9．
8 崔霞．逆流挽舟法配伍风药机理浅探．中医研究，2005，18(01)：10-11．
9 姚晓东．逆流挽舟法寻源及配伍风药内涵考辨．山东中医药大学学报，2004，28(04)：262-263．
10 李秀惠．钱英教授“截断逆挽法”治疗慢性重型肝炎的思路与方法．上海中医药杂志，2007，41(01)：1-4．
11 钱英．截断逆挽法治疗慢性重型肝炎．北京中医药，2008，27(2)：85-87．
12 薛博瑜，张恩虎．清肝解毒注射液治疗重型肝炎临床疗效观察．江苏中医，1996，17(8)：9-11．
13 王台，杨延玲，徐光华，等．清热解毒汤配合综合疗法治疗重症肝炎倾向61例．陕西中医，2006，17(10)：1236-1237．
14 孙克伟，陈斌，黄裕红，等．凉血解毒、清热化湿和凉血解毒、健脾温阳法治疗慢性重型肝炎的临床观察．中国中西医结合杂志，2006(11)：981-983．
15 周仲瑛．重症肝炎辨治述要．新中医，2002，34(3)：3-6．
16 来要良，李秀惠，钱英．清肠养肝方灌肠治疗慢性重型乙型肝炎临床观察．中西医结合肝病杂 志，2007，17(02)：71-72．
17 汪承柏．中西医结合治疗重症淤胆型肝炎的思路方法．传染病信息，1998，11(3)：110-111．
18 汪承柏．中西医结合治疗重症淤胆肝炎、慢性重型肝炎思路方法与用药研究．中西医结合肝病杂志，1998(S1)：4-7．
19 贺江平，汪承柏，于海波，等．非肝实质坏死性慢性重型肝炎的中西医结合治疗．传染病信息，1999，38(02)：477-479．
20 李秀惠，杨华升．钱英“截断逆挽法”治疗慢性重型肝炎的经验．中西医结合肝病杂志，2006，16(6)：362-365．
21 张秋云，刘绍能，李秀惠，等．乙型慢重肝“毒损肝体”病因病机及治疗思路探讨．辽宁中医杂志，2005，32(12)：1246-1248．
22 钱英．钱英肝病经验传承体会．中华中医药学会第十三届内科肝胆病学术会议论文汇编，中华中医药学会第十三届内科肝胆病学术会议论文，杭州，2008-4．中华中医药学会内科肝胆病专业委员会，2008．12-18．
1 张秋云，刘绍能，李秀惠，等．乙型慢重肝“毒损肝体”病因病机及治疗思路探讨．辽宁中医杂志，2005，32(12)：1246-1248．
2 张秋云，刘绍能，李秀惠．慢性病毒性乙型重型肝炎病因病机探讨．北京中医，2006，25(1)：48-50．
3 张秋云，李秀惠，刘绍能，等．慢性病毒性乙型重型肝炎中医证候分布特点分析．中国中医基础医学杂志，2006，12(12)：929-930．
4 张秋云，钱英，姚乃礼．中医药诊治慢性病毒性重型肝炎现状分析．陕西中医，2005，26(01)：91-92．
5 张秋云，李秀惠，王融冰，等．慢性病毒性乙型重型肝炎中医证候分布及组合规律研究．北京中医药，2008，27(02)：87-90．
6 孙克伟，陈斌，黄裕红，等．凉血解毒、清热化湿和凉血解毒、健脾温阳法治疗慢性重型肝炎的临床观察．中国中西医结合杂志，2006(11)：981-983．
7 付滨，王宝娟，高常柏．“阴阳毒”考略．天津中医药，2007，24(2)：130-132．
1 王融冰，王宪波，孙凤霞，等．解毒凉血法治疗慢性乙型重型肝炎．北京中医药，2008，27(02)：83-85．
2 贺江平，汪承柏．非肝实质坏死性慢性重型肝炎的中西医结合治疗．中医杂志，1999，38(08)：477-479．
3 胡建华，李秀惠，勾春燕，等．清肠利肝方灌肠治疗慢性重型肝炎小结．中华实用中西医杂志，2006，19(15)：1808-1810．
4 来要良，李秀惠，钱英．清肠养肝方灌肠治疗慢性重型乙型肝炎临床观察．中西医结合肝病杂 志，2007，17(02)：71-72．
2 张秋云，刘绍能，李秀惠，等．乙型慢重肝“毒损肝体”病因病机及治疗思路探讨．辽宁中医杂志，2005，32(12)：1246-1248．
3 张秋云，刘绍能，李秀惠．慢性病毒性乙型重型肝炎病因病机探讨．北京中医，2006，25(1)：48-50．
4 朱清静，盛国光．重型肝炎的中医证治浅识．中医药学刊，2006，24(4)：662-663．
5 刘洁，邱华，毛德文．重型肝炎的中医治疗进展．云南中医中药杂志，2007(05)．
6 薛博瑜，周仲瑛．论病毒性肝炎与湿、瘀、毒．江苏中医药，1993(01)：31-32．
7 李和平，李莲．关于界定现行统编教材《中医诊断学》中阴黄的临床研究．中国中医药现代远程教育，2008，6(09)：1002-1003．
8 聂广，余绍勇，江福生．重型肝炎中医辨证分型标准的初步研究．中国中西医结合急救杂志，2001，8(03)：172-176．
9 余绍勇，聂广．重型肝炎之中医辨证分型研究．中西医结合肝病杂志，2000，10(02)：56-58．
10 张秋云，李秀惠，王融冰，等．慢性病毒性乙型重型肝炎中医证候分布及组合规律研究．北京中医药，2008，23(02)：87-90．
11 张秋云，李秀惠，刘绍能，等．慢性病毒性乙型重型肝炎中医证候分布特点分析．中国中医基础医学杂志，2006，12(12)：929-930．
12 张秋云，李秀惠，刘绍能，等．慢性病毒性乙型重型肝炎中医辨证与舌诊客观化指标的关系探讨．天津中医药，2006，23(05)：365-367．
13 李筠．慢性重型肝炎中医辨证与临床分期及预后分析．中西医结合肝病杂志，2007，17(06)：343-344．
14 毛德文，邱华，胡振斌，韦新．重型肝炎中医证型相关文献统计分析文献．中华中医药学会第十三届内科肝胆病学术会议论文汇编，中华中医药学会第十三届内科肝胆病学术会议论文汇编，杭州，2008年4月，2008．119-122．
15 邱华，毛德文，胡振斌，等．慢性重型肝炎中医综合治疗方案的多中心临床研究．中西医结合肝病杂志，2008，18(05)：260-262，276．
16 张健．茵陈消黄汤治疗重型黄疸性肝炎32例．陕西中医，2008，29(03)：303-305．
17 王台，杨延玲，徐光华，等．清热解毒汤配合综合疗法治疗重症肝炎倾向61例．陕西中医，2006，17(10)：1236-1237．
18 金妙文，周仲瑛，薛博瑜，等．凉血解毒法治疗重型病毒性肝炎的临床研究．南京中医药大学学报，1996，12(04)：14-17．
19 薛博瑜．凉血解毒法治疗重型病毒性肝炎的临床研究．医学信息，1997，10(01)：35．
20 薛博瑜．凉血解毒法治疗重型病毒性肝炎的临床研究．中国中医急症，1996，5(02)：51-54．
21 薛博瑜，张恩虎．清肝解毒注射液治疗重型肝炎临床疗效观察．江苏中医，1996，17(8)：9-11．
22 薛博瑜，周眠．清肝解毒注射液对急性肝衰竭大鼠免疫功能的影响．中西医结合肝病杂志，2002，12(3)：147-149．
23 熊学涛，宗亚力．清热解毒凉血活血为主治疗重症肝炎高胆红素血症28例．中西医结合肝病杂志，1998，8(01)：39-40．
24 沈翔．中西医结合治疗慢性重型倾向性肝炎36例．江苏中医，1995，16(03)：7-8．
25 沈翔．中西医结合治疗重症肝炎49例．陕西中医，1996，17(01)：1-2．
26 曾莉，王陆军．凉血化瘀法治疗重型肝炎的作用机理探析．中医药学刊，2003，21(1)：87-88．
27 汪承柏．中西医结合治疗重症淤胆型肝炎的思路方法．传染病信息，1998，11(3)：110-111．
28 汪承柏．中西医结合治疗重症淤胆肝炎、慢性重型肝炎思路方法与用药研究．中西医结合肝病杂志，1998(S1)：4-7．
29 贺江平，汪承柏．非肝实质坏死性慢性重型肝炎的中西医结合治疗．中医杂志，1999，38(08)：477-479．
30 刘宇．重用赤芍治疗重度黄疸肝炎86例．新中医，2000(12)：40．
31 喻洪伟，杨志超．清热利湿活血解毒法为主治疗重症肝炎疗效观察．辽宁中医杂志，2003，30(05)：365．
32 刘友章，王昌俊．重症肝炎中医治疗思路与方法．中医药通报，2005，4(4)：17-21．
33 连粤湘，吴婉芬．中药健脾祛湿为主治疗慢性重症肝炎25例．中西医结合肝病杂志，1998，8(S1)：90．
34 罗欣拉．中西医结合治疗慢性重型肝炎湿热内蕴型35例．中西医结合肝病杂志，2001，11(3)：178-179．
35 孙克伟，陈斌，黄裕红，等．凉血解毒、清热化湿和凉血解毒、健脾温阳法治疗慢性重型肝炎的临床观察．中国中西医结合杂志，2006(11)：981-983．
36 佘万祥．温阳活血利湿解毒法治疗慢性重症肝炎30例．实用中西医结合杂志，1998，11(04)：323-324．
37 张建军，张赤志．温阳活血退黄方治疗阴黄证的疗效观察．湖北中医杂志，2001，23(06)：29-30．
38 连粤湘，吴婉芬．双草退黄汤治疗慢性重型肝炎的临床研究．中华实用中西医杂志，2000，13(1)：93-94．
39 张伟成．祛瘀利湿助阳汤治疗重症淤胆型肝炎34例．中国中医急症，2005，14(03)：244．
40 张伟成．解毒利湿活血助阳法治疗重症淤胆型乙型肝炎黄疸30例——附西药治疗30例对照．浙江中医杂志，2004(11)：474．
41 谢炳国，谢智悠．慢性重型肝炎的辨证施治．中国中医急症，2006，15(5)：509-509，517．
42 周仲瑛．重症肝炎辨治述要．新中医，2002，34(3)：3-6．
43 罗国钧．肝功能衰竭的辨证施治探要．中医药学刊，2003，21(8)：1382-1383．
44 王今达．脓毒症：感染性MODS的预防．中国危重病急救医学，1999，11(08)：453-455．
45 王今达．回顾开拓中西医结合急救专业的历程，展望世纪之交的未来．中国中西医结合杂志，1999，19(02)：67-68．
46 王今达．开展中西医结合急救的思路和方法．天津中医，2002，19(06)：8．
47 李筠．内毒素对肝脏的二次打击及中医药治疗．北京中医药，2008，27(02)：94-95．
48 姜春华．时代要求我们对治疗温病要掌握截断方药——答复沈仲圭先生．中医杂志，1978(12)：(总611)3．
49 姜春华．叶天士的温病、杂病的理论与治疗．中医杂志，1978(08)：8-13．
50 黄古叶，毛德文，胡国平，等．大黄煎剂配合西药治疗慢性重型肝炎肠源性内毒素症疗效观察．辽宁中医杂志，2006，18(12)：9-10．
51 李凌，杨大国，吴其恺，聂广，陶艳艳．赤芍承气汤对重型肝炎内毒素血症的影响．浙江中西医结合杂志，2002，12(09)：538-540．
52 邓欣，杨大国，吴其恺，陶艳艳，聂广．赤芍承气汤治疗慢性重型肝炎近期疗效观察．中西医结合肝病杂志，2004，14(02)：67-69．
53 来要良，李秀惠，钱英．清肠养肝方灌肠治疗慢性重型乙型肝炎临床观察．中西医结合肝病杂志，2007，17(02)：71-72．
54 蔡春琳，钟凤英．结肠透析与常规灌肠治疗重型病毒性肝炎临床疗效观察．现代诊断与治疗，2007，18(02)：83-84．
55 王融冰，王宪波，孙凤霞，等．解毒凉血法治疗慢性乙型重型肝炎．北京中医药，2008，27(02)：83-85．
56 刘文童．中西医结合治疗重型肝炎内毒素血症．湖北中医杂志，2002，24(11)：41-41．
1 姜春华．时代要求我们对治疗温病要掌握截断方药——答复沈仲圭先生．中医杂志，1978(12)：(总611)3．
2 姜春华．叶天士的温病、杂病的理论与治疗．中医杂志，1978(08)：8-13．
3 荀运浩，过建春，施军平，等．从“治未病”理论入手论治慢性肝病．中华中医药学刊，2009，27(01)：131-132．
4 曹吉宪，李配方．运用中医体质理论防治乙型肝炎病毒携带者证治探讨．浙江中医杂志，2007，42(11)：628-629．
5 龙富立，黄古叶，毛德文，等．中医治未病思想在慢性乙型肝炎防治中的应用．辽宁中医药大学学报，2008，10(12)：144-146．
6 崔德广，李素云，王生跃．截断疗法治疗病毒性肝炎的对照研究．河南医药信息，2000，8(06)：51-52．
7 谌宁生，孙克伟．重症肝炎从快速截断论治．新中医，2001，33(1)：3-4．
8 毛德文，邱华，龙富立．中医治未病思想在重型肝炎防治中的应用研究．中医药导报，2008，14(04)：8-9．
1 姜春华．时代要求我们对治疗温病要掌握截断方药——答复沈仲圭先生．中医杂志，1978(12)：(总611)3．
2 姜春华．叶天士的温病、杂病的理论与治疗．中医杂志，1978(08)：8-13．
3 王佩芳．姜春华学术思想和临床经验．中医杂志，1994，35(10)：597-599．
4 贝润浦，徐敏华．试论姜春华教授的“截断扭转”学术思想．上海中医药杂志，1983(01)：16-17．
5 崔德广，李素云，王生跃．截断疗法治疗病毒性肝炎的对照研究．河南医药信息，2000，8(06)：51-52．
6 谌宁生，孙克伟．重症肝炎从快速截断论治．新中医，2001，33(1)：3-4．
7 毛德文，邱华，龙富立．中医治未病思想在重型肝炎防治中的应用研究．中医药导报，2008，14(04)：8-9．
8 崔霞．逆流挽舟法配伍风药机理浅探．中医研究，2005，18(01)：10-11．
9 姚晓东．逆流挽舟法寻源及配伍风药内涵考辨．山东中医药大学学报，2004，28(04)：262-263．
10 李秀惠．钱英教授“截断逆挽法”治疗慢性重型肝炎的思路与方法．上海中医药杂志，2007，41(01)：1-4．
11 钱英．截断逆挽法治疗慢性重型肝炎．北京中医药，2008，27(2)：85-87．
12 薛博瑜，张恩虎．清肝解毒注射液治疗重型肝炎临床疗效观察．江苏中医，1996，17(8)：9-11．
13 王台，杨延玲，徐光华，等．清热解毒汤配合综合疗法治疗重症肝炎倾向61例．陕西中医，2006，17(10)：1236-1237．
14 孙克伟，陈斌，黄裕红，等．凉血解毒、清热化湿和凉血解毒、健脾温阳法治疗慢性重型肝炎的临床观察．中国中西医结合杂志，2006(11)：981-983．
15 周仲瑛．重症肝炎辨治述要．新中医，2002，34(3)：3-6．
16 来要良，李秀惠，钱英．清肠养肝方灌肠治疗慢性重型乙型肝炎临床观察．中西医结合肝病杂 志，2007，17(02)：71-72．
17 汪承柏．中西医结合治疗重症淤胆型肝炎的思路方法．传染病信息，1998，11(3)：110-111．
18 汪承柏．中西医结合治疗重症淤胆肝炎、慢性重型肝炎思路方法与用药研究．中西医结合肝病杂志，1998(S1)：4-7．
19 贺江平，汪承柏，于海波，等．非肝实质坏死性慢性重型肝炎的中西医结合治疗．传染病信息，1999，38(02)：477-479．
20 李秀惠，杨华升．钱英“截断逆挽法”治疗慢性重型肝炎的经验．中西医结合肝病杂志，2006，16(6)：362-365．
21 张秋云，刘绍能，李秀惠，等．乙型慢重肝“毒损肝体”病因病机及治疗思路探讨．辽宁中医杂志，2005，32(12)：1246-1248．
22 钱英．钱英肝病经验传承体会．中华中医药学会第十三届内科肝胆病学术会议论文汇编，中华中医药学会第十三届内科肝胆病学术会议论文，杭州，2008-4．中华中医药学会内科肝胆病专业委员会，2008．12-18．
1 张秋云，刘绍能，李秀惠，等．乙型慢重肝“毒损肝体”病因病机及治疗思路探讨．辽宁中医杂志，2005，32(12)：1246-1248．
2 张秋云，刘绍能，李秀惠．慢性病毒性乙型重型肝炎病因病机探讨．北京中医，2006，25(1)：48-50．
3 张秋云，李秀惠，刘绍能，等．慢性病毒性乙型重型肝炎中医证候分布特点分析．中国中医基础医学杂志，2006，12(12)：929-930．
4 张秋云，钱英，姚乃礼．中医药诊治慢性病毒性重型肝炎现状分析．陕西中医，2005，26(01)：91-92．
5 张秋云，李秀惠，王融冰，等．慢性病毒性乙型重型肝炎中医证候分布及组合规律研究．北京中医药，2008，27(02)：87-90．
6 孙克伟，陈斌，黄裕红，等．凉血解毒、清热化湿和凉血解毒、健脾温阳法治疗慢性重型肝炎的临床观察．中国中西医结合杂志，2006(11)：981-983．
7 付滨，王宝娟，高常柏．“阴阳毒”考略．天津中医药，2007，24(2)：130-132．
1 王融冰，王宪波，孙凤霞，等．解毒凉血法治疗慢性乙型重型肝炎．北京中医药，2008，27(02)：83-85．
2 贺江平，汪承柏．非肝实质坏死性慢性重型肝炎的中西医结合治疗．中医杂志，1999，38(08)：477-479．
3 胡建华，李秀惠，勾春燕，等．清肠利肝方灌肠治疗慢性重型肝炎小结．中华实用中西医杂志，2006，19(15)：1808-1810．
4 来要良，李秀惠，钱英．清肠养肝方灌肠治疗慢性重型乙型肝炎临床观察．中西医结合肝病杂 志，2007，17(02)：71-72．