中医治疗肝衰竭60年： 从临床洞见到科学发现

扈晓宇

doi:10.12449/JCH250603

中医治疗肝衰竭60年：从临床洞见到科学发现

DOI: 10.12449/JCH250603

扈晓宇^, ,

成都中医药大学附属医院肝病/感染科，成都 610075

基金项目:

国家自然科学基金 (81973840);

国家自然科学基金 (81273748)

利益冲突声明：本文不存在任何利益冲突。

详细信息

通信作者:
扈晓宇， xiaoyuhu@aliyun.com （ORCID： 0009-0002-7184-3278）

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出版历程
- 收稿日期: 2025-03-27
- 录用日期: 2025-05-15
- 出版日期: 2025-06-25

Traditional Chinese medicine treatment of liver failure for 60 years： From clinical insights to scientific discoveries

Xiaoyu HU^{,
,}

Department of Hepatology and Infectious Diseases，The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine，Chengdu 610075，China

Research funding:

National Natural Science Foundation of China (81973840);

National Natural Science Foundation of China (81273748)

More Information

Corresponding author: HU Xiaoyu， xiaoyuhu@aliyun.com （ORCID： 0009-0002-7184-3278）

摘要

摘要: 肝衰竭作为高致死率的临床危重症，其治疗面临巨大挑战。本文系统回顾、梳理了我国中医药治疗肝衰竭领域60年传承创新的成果。临床研究方面：早期探索阶段，发现茵陈蒿汤联合西医治疗效果明显，灌肠疗法初显成效，为后续研究奠定基础；循证医学时代，基于对肝衰竭“本虚标实”的认识，创新构建“脾虚邪陷发黄”“气虚瘀黄”“脾肾阳虚发黄”等中医病机理论；基于中医证候动态演变研究，发现HBV相关慢加急性肝衰竭呈现“早实晚虚”的证型特征，据此建立分期辨治框架：早期祛实（解毒化瘀）、晚期补虚（温阳固脱）。技术创新层面：人工肝联合中药、结肠灌洗及针灸凸显多靶点协同优势。基础研究方面：揭示茵陈蒿汤通过肠道菌群-代谢轴调控肝功能，赤芍-附子药对重塑巨噬细胞极化，五味子木脂素与五味子多糖靶向GSH/GPX4调节脂质稳态，电针刺激足三里（ST36）激活肝再生信号等，阐明“清热解毒”“温阳固脱”等治则的分子机制。当前面临的挑战包括临床证据异质性、证候-生物标志物关联不足及前沿技术整合瓶颈。未来需构建“临床-基础”双向闭环研究范式，聚焦肠道微生态-免疫-能量代谢网络，推动中医药精准化治疗升级。
- 肝功能衰竭 /
- 中医药疗法 /
- 中西医结合疗法 /
- 针灸疗法
Abstract: Liver failure is a critical illness with a high fatality rate， and its treatment still faces great challenges. This article systematically reviews the achievements of inheritance and innovation in the field of traditional Chinese medicine （TCM） treatment of liver failure in China for the past 60 years. As for clinical research， it was found in the early exploration stage that Yinchenhao decoction combined with Western medicine treatment had a marked therapeutic effect， and enema therapy had shown a certain therapeutic effect， laying a foundation for subsequent research. In the era of evidence-based medicine， the TCM pathogenesis theories were established based on the understanding of “deficiency in origin and excess in superficiality” in liver failure， such as “jaundice due to spleen deficiency and invasion of pathogenic factors”， “Qi-deficiency and blood-stasis jaundice”， and “jaundice due to spleen-kidney Yang deficiency”. Based on the dynamic evolution of TCM syndromes， it is found that HBV-related acute-on-chronic liver failure presents the characteristics of “early excess and late deficiency”， and a framework of staged syndrome differentiation-based treatment has been established as removing excess in the early stage （detoxicating and resolving stasis） and tonifying deficiency in the late stage （warming Yang and securing collapse）. As for technological innovation， artificial liver combined with TCM， colonic lavage， and acupuncture and moxibustion has highlighted the advantages of the synergistic effect between multiple targets. Basic research has revealed that Yinchenhao Decoction regulates liver function through the intestinal flora-metabolism axis， the drug combination of Radix Paeoniae Rubra-Radix Aconiti Lateralis Preparata reshapes macrophage polarization， Schisandra chinensis lignans and Schisandra polysaccharides target GSH/GPX4 to modulate lipid homeostasis， and electroacupuncture stimulates ST36 （zusanli） to activate liver regeneration signal， thereby clarifying the molecular mechanism of the treatment principles such as “clearing heat and detoxicating” and “warming Yang and securing collapse”. Current challenges include the heterogeneity of clinical evidence， insufficient association between syndromes and biomarkers， and the bottleneck of cutting-edge technology integration. In the future， it is necessary to establish a two-way closed-loop research paradigm for clinical and basic research， focus on the intestinal microecology-immunity-energy metabolism network， and promote the upgrading of precise TCM treatment.
- Liver Failure /
- Traditional Chinese Medicine Therapy /
- Integrated Chinese Traditional and Western Medicine Therapy /
- Acupuncture Moxibustion Therapy

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参考文献(78)

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