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中医药治疗乙型肝炎肝纤维化研究进展
DOI: 10.12449/JCH251001
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：李丽负责检索文献，分析资料，拟定写作思路，撰写论文；徐春军负责课题设计，修改论文，指导撰写文章并最后定稿。
Research advances in traditional Chinese medicine treatment of chronic hepatitis B-associated liver fibrosis
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摘要: 慢性乙型肝炎相关肝纤维化是疾病进展至肝硬化甚至肝细胞癌的关键病理环节。虽然抗病毒治疗能够有效抑制HBV复制，但肝纤维化的逆转仍是当前临床面临的重大挑战，部分患者仍存在病情持续进展的风险。中医药凭借其“多靶点、整体调节”的独特优势，在该领域逐渐形成了融合传统理论支持与现代科学证据的综合防治策略。“正虚血瘀”作为肝纤维化的核心病机，贯穿疾病发展全过程，治疗上应注重分期辨证、标本兼顾。近年来，相关临床与基础研究取得了显著进展。本文系统综述了经典名方（如鳖甲煎丸、大黄䗪虫丸、小柴胡汤等）、现代中成药及核心中药（如丹参、黄芪、柴胡）在抗肝纤维化方面的临床疗效与作用机制，分析了当前在证据质量、精准用药等方面存在的挑战，并对未来研究方向提出展望，建议通过深化“病-证-方-效-靶”关联机制研究、开展高水平临床试验与真实世界研究，进一步发挥中医药在肝病防治中的重要作用。
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关键词:
- 乙型肝炎 /
- 肝纤维化 /
- 抗肝纤维化药（中药） /
- 治疗学
Abstract: Chronic hepatitis B-associated liver fibrosis is the key pathological stage in disease progression to liver cirrhosis and even hepatocellular carcinoma. Although antiviral therapy can effectively inhibit HBV replication， reversal of liver fibrosis remains a significant challenge in contemporary clinical practice， and some patients still face the risk of disease progression. With the distinctive advantages of “multiple targets and holistic regulation”， traditional Chinese medicine （TCM） has gradually formed a comprehensive prevention and treatment strategy integrating traditional theories and modern scientific research evidence. “Weakened body resistance and blood stasis” are the core pathogenesis of liver fibrosis and exist throughout the course of the disease， and therefore， the treatment of this disease should focus on stage-specific differentiation and address both the symptoms and root causes. In recent years， significant progress has been achieved in both clinical and basic research. This article systematically reviews the clinical effect and mechanism of action of classic TCM prescriptions （such as Biejia Decoction Pill， Dahuang Zhechong Pill， and Xiaochaihu Decoction）， modern Chinese patent drugs， and core TCM drugs （such as Salvia miltiorrhiza， Astragalus membranaceus， and Bupleurum chinense） in the treatment of liver fibrosis. It also analyzes the current challenges in evidence quality and precise medication and proposes future research directions. It is recommended to enhance the role of TCM in the prevention and treatment of liver diseases by deepening research on the “disease-syndrome-prescription-effect-target” association and conducting high-level clinical trials and real-world studies.-
Key words:
- Hepatitis B /
- Hepatic Fibrosis /
- Anti-Hepato Fibrosis Agents （TCD） /
- Therapeutics
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表 1 常用抗肝纤维化中成药的主要成分及适用情况
Table 1. Main components and clinical applications of commonly used Chinese patent medicines for anti-hepatic fibrosis
药物名称 主要成分 核心中医证型 关键临床症状/体征 主要临床特征 主要治则 扶正化瘀片/胶囊 丹参、桃仁、松花粉、
绞股蓝、五味子等气虚血瘀证 神疲乏力，食欲不振，胁肋
隐痛或刺痛，面色晦暗，舌
淡紫，脉细涩肝纤维化中期以上，患者
乏力症状突出，体质偏弱扶正活血，化瘀通络 复方鳖甲软肝片 鳖甲、莪术、赤芍、
当归、三七、党参、
黄芪等瘀血阻络，
气阴两虚证胁下痞块（肝脾肿大），质
地较硬，面色黧黑，形体消
瘦，口干肝纤维化中晚期，门静脉
高压趋势（如脾肿大）明
显者软坚散结，化瘀解毒，
益气养血安络化纤丸 地黄、三七、水牛角浓
缩粉、僵蚕、地龙等阴虚瘀热证 胁肋灼痛，口干咽燥，五心
烦热，手掌发红（肝掌），舌
红苔少活动性肝炎控制后，肝纤
维化持续，伴有“干燥”表
现者健脾养阴，活血软坚 鳖甲煎丸 鳖甲胶、大黄、土鳖虫、
桃仁、鼠妇虫、凌霄
花等痰湿瘀毒
互结证胁下癥块坚硬，胀痛或刺
痛，面色晦暗，舌质紫暗，
苔腻肝纤维化晚期，肝脾肿大
明显，体质尚实者活血化瘀，软坚散结 强肝胶囊 茵陈、板蓝根、当归、
白芍、丹参、郁金、
黄芪、党参等肝郁脾虚，
湿热内蕴证胁肋胀痛，情绪抑郁或烦
躁，食少纳呆，口苦，苔
黄腻肝炎活动期伴早期肝纤
维化，ALT水平反复升
高，伴情绪问题清热利湿，补脾养血，
疏肝解郁小柴胡颗粒 柴胡、黄芩、半夏、
党参、甘草、生姜、
大枣少阳证 往来寒热（忽冷忽热），胸
胁苦满，不欲饮食，心烦喜
呕，口苦慢性肝病迁延，低水平炎
症活动，消化道症状明
显者和解少阳，疏肝和胃 肝爽颗粒 柴胡、白芍、当归、
茯苓、白术、枳壳等肝郁脾虚，
瘀热互结证胁肋胀痛，脘腹胀满，食欲
不振，舌暗红苔黄慢性肝炎伴肝纤维化，肝
功能异常，肝区不适明
显者疏肝健脾，清热散瘀 六味五灵片 五味子、女贞子、连
翘、莪术、苣荬菜等肝肾阴虚，
瘀血阻络证胁痛隐隐，腰膝酸软，口干
咽燥，手掌赤痕，舌红少苔肝纤维化中期，伴有慢
性疲劳、口干等体征者滋补肝肾，活血解毒 
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