黎柳，尧忠柳，龙玲，尹周安

    〔摘要〕 乙型病毒性肝炎(簡称乙肝)“伏”与“发”的动态过程符合中医伏邪的发病特点，亦反映免疫状态的变化。“冬伤于寒”(外感)和“冬不藏精”(内因)共同导致病“伏”，此时免疫不应答，疾病暂未发作。正邪相争，即免疫应答活跃，乙肝急性发作，此为疾病转折点和治疗关键。正气极虚时，正虚劳复，伏邪亦可暴发，危及生命。乙肝后期，正邪相争不及，疾病慢性化，免疫炎症反复损伤，久则进展至肝硬化、肝癌等，此过程符合伏邪成巢、久病入络的机制。因此，在治疗上，急性期从少阳(或兼阳明)论治；慢性期从肝脾或肝肾同治，结合补法和托法以透邪外出；后期形质改变，则从痰瘀论治，形气同调，以通络消癥。并列举临床典型案例，以期为乙肝临床证治提供参考与借鉴。

    〔关键词〕 伏邪；免疫；乙型病毒性肝炎；潜伏；发作；发病机制；证治思路；医案

    〔中图分类号〕R256.4? ? ? ?〔文献标志码〕A? ? ? ? 〔文章编号〕doi：10.3969/j.issn.1674-070X.2023.07.022

    Dynamic deconstruction of "incubation" and "attack" and pattern identification and treatment of hepatitis B based on "latent

    pathogenic factor-immunity"

    LI Liu， YAO Zhongliu， LONG Ling， YIN Zhouan*

    Hunan University of Chinese Medicine， Changsha， Hunan 410208， China

    〔Abstract〕 The dynamic process of "incubation" and "attack" in viral hepatitis B (briefly referred to as hepatitis B) is in line with the pathogenic characteristics of latent pathogenic factor in Chinese medicine and also reflects the change of immune status. "Invasion of pathogenic cold in winter" (external contraction) and "failure of kidney to store essence in winter" (internal cause) lead to the "incubation" of disease jointly. Meanwhile ......