慢性乙型肝炎论治
Discussion the Therapy of Chronic Hepatitis B

肝为将军之官，谋虑出焉。肝藏天三之木震、地八之木艮，震藏于艮，动寓于止，待巽宣令而作，故曰将军之官。
Liver is the Organ of General and is responsible for strategy. It is matched with Zhen and Gen diagram. The Gen hides Zhen and the stillness contains movement and they will take action when commanded by Xun. So we call liver as the Organ of General
足厥阴巽卦出入权衡于动止之间，故曰谋虑出焉。足少阳胆经震为足厥阴肝经巽作决断，行纲纪。
The Xun diagram of Foot Jueyin moves in and out and balances between movement and stillness. So it is responsible for strategy. Zhen, the Gallbladder Meridian of Foot-Shaoyang decides and disciplines Xun, the Liver Meridian of Foot-Jueyin.
这个震与肝中所藏之震同源，从火化则为肝胆火。肝中所藏之艮又与足太阴脾经之艮同气相求，并受湿气所化。故肝病直接关联胆、脾。
This Zhen is of the Same Origin as the Zhen hidden in liver. It will turn to fire of liver and gallbladder when heated. The Gen in liver and the Spleen Meridian of Foot-Taiyin is also from the same origin. They are affected by dampness, so the disease in liver has direct relations with gallbladder and Spleen.
慢性乙肝病机是在湿热胶结于肝，湿土致巽木之气受郁，又有热化火，于是肝阳（或肝火）兴。
The pathogenesis of Chronic Hepatitis B is that the dampness and heat cements in the liver. Damp earth stagnates the Qi of wood and the heat turns to fire. So the fire of liver rises up.
肝炎病毒就是这个震性病毒，属相火性质。其与艮纠葛难分。艮震为颐，在此养奸，得势则小过而躁动。小三阳震不胜艮，而见萎靡之象。大三阳震反胜艮，而见躁扰之象。总之是因巽木受艮湿侮，肝火代兴，欲发其郁。
The virus of Hepatitis is this one of Zhen exactly which belongs to property of ministerial fire. It is tangled with Gen and then the evil is produced. It becomes rash and restless when it has advantage. Small three positive (positive HBsAg, HBeAb, HBcAb) shows a weary appearance because Zhen can not defeat Gen. Great three positive (positive HBsAg, HBeAg, HBcAb) indicates an impetuous behave because Zhen defeats Gen. All in all, the Xun wood is counterrestricted by Gen damp. The fire of liver thrives to let off the stagnation.
艮主懈惰，疲惫之、拖累之，震兴则又燃火耗木，两者相加，其势将从火作纤维化，从艮作坚多节，久之必致肝硬化。
Gen governs slack, exhausting and cumbering. The prosperous of Zhen lights the fire and consumes wood. The both cause fibrosis. Since Gen is hard and with many knots, it may lead to liver cirrhosis.
若削去震，艮更无制而郁巽木，震还是要兴助。若去艮，去艮往往要借震力，震得资助而作一派亢阳。
If Zhen is razed out, Gen will make Xun wood stagnating unlimitedly, so we still need to help with Zhen. If we would like to remove Gen, we need to turn to Zhen but Zhen will excessive if assisted.
乙肝就是肝胆火窜犯于脾胃而见症。且震卦阳象究不利于肝，燃火耗木，使肝不足，从洛书。
Chronic Hepatitis B is because that the fire in liver and gallbladder offend spleen and stomach. Besides, the Yang of Zhen is not good for liver. It lights the fire and consumes wood which make the liver insufficient.

乙肝之人睡眠不安，是因为水政藏令不足，相火又为妄扰，使人难得地雷复卦以走向日新一路。
Chronic Hepatitis B sufferer can not sleep well because the water is not enough and the disturbed ministerial fire which make it difficult for people to get the Deleifu diagram and refreshment.

不减艮，不疏震，不布巽，非其治也。乙肝标实故泻，本虚故补，多种因素胶葛，非知机之人不能理治。致其成郁之由，由于艮湿独盛，巽木不济，震兴而雷风恒与，欲发其郁。
Decreasing Gen, scattering Zhen and dispersing Xun are methods of treatment. We reduce if it is excess in superficiality and reinforce when deficiency in origin. With many factors cemented, Chronic Hepatitis B can not be managed by people who do not realize the pathogenesis. The stagnation is caused by excessive damp of Gen and insufficient wood of Xun as well as the rising thunder of Zhen.
甲肝之暴发，是肝木得震反胜于脾土之艮，是木之报复。乙肝急性暴发，则是木之郁发。其慢性者，在欲发郁却又内耗之中。
Hepatitis A happens because Zhen helps liver to defeat Gen of spleen, and it is the revenge of wood. Hepatitis B breaks out urgently as removing the stagnation of wood. The chronic Hepatitis B is because the stagnation of wood has not removed yet and caused internal consumption,
肝为将军之官。犹疑为将之第一大败，故不当困于艮湿。又不可躁动、萎靡，震不安位，必丧军。
Liver is the Organ of General. Hesitation is the biggest weakness of General. Neither can it be hindered by damp of Gen, nor can it be impetuous or listless. If the Zhen can not secure his position, the army will lose with no doubt.
应当权衡决断、深谋远虑。故乙肝病人其肝大违将军之德。把这样的“人”打造成一个将军，没有一番折冲决不可成。不是简单加以培植就行的，得费一番锻炼。
General should be resolved and foresighted. But the liver of Hepatitis B disobeys the virtue of General. This kind of people can not be a General without negotiation of repeating contradicts and compromises. It needs exercising instead of mere implantation.
我国乙肝病人这么多是有其因缘的。正气萎靡，世风浮躁，巽木失德，焉能不昌此病。又是东方国土，龙之传人，故皆有震，胆气不正，肝气内变。
There are reasons why we have so many Hepatitis B patients here in china. With listless vital qi , impetuous public morals , Xun losing its virtue, how can we avoid suffering this disease? China is in the east and Chinese are the offspring of dragon. Both contain Zhen. If the Qi in gallbladder is not upright, the Qi in liver will rebel.
锤炼之法，要历苦寒，归于谋事主军，这样才能把一个败家子打造成一个将军。取法天之相人的道路。
The chastening method is to experience bitterness and coldness. A black sheep can be turned into a General in this way. This is also how the heaven harden people.
观于前人治此之经验，大致有两点。对付其炎症是要贯穿终始的。另外，肝病先实脾，脾不化运则肝木难调，否则就是躁萎二种幻相交替而欺骗于医者。
Referring to the preceding experience in this treatment, there are two main points. To deal with the inflammation is permeated through. In addition, reinforce spleen firstly if the liver is ill. The spleen failing in transport and transformation makes it difficult to regulate the liver. Otherwise the alternate phantom of impetuousness and listlessness will cheat doctors.

乙肝治法大三阳和小三阳不同。肝气内变，是因为受了湿热的侮郁，胆之罪责极大。胆为中正之官，决断出焉，为决曹之吏。肝要么萎靡，要么急躁易怒，是胆使其中正的。
The treatment of Small three positive differs from that of Great three positive. Qi in liver rebels as it is stagnated by damp. The gallbladder should be blamed. It is the organ similar to an official of justice and is responsible for making decision Liver will be either impetuous or listless; it is the gallbladder that makes it balance.
乙肝本是木郁之病，譬如百姓受了冤屈，由于主持公道者的失职，百姓怀怒在心，民变在内酝酿。这就是小三阳。到了民变酿成，已经起义，就是大三阳了。
Hepatitis B is a disease caused by stagnated wood. It is like the common people who are miscarriage of justice for the breach of duty of people who should redress the scales. The common people feel angry and brew a plot to rise up. This is Small three positive. When they have already revolted, it is Great three positive.
在民变未成之时，处理冤狱之官，抚慰百姓，使百姓伸冤泄恨，就能平复。民变已成，就得剿抚并用了，已经是战争形态。其必掠食而犯仓廪，故须先实脾土。
Before the rebellion, if the official who deals with the unjust charge can comfort common people and help them to redress grievances, it can be calmed down. After the rebellion has begun, suppressing and comforting should be used together. It is a state of war; the storehouse must be preyed, so the spleen needs reinforcing.
必须捣毁其根据地，发直入之兵围剿肝区，并虚留去路。如果其已癌变，兆示起义者有了精神纲领，中有蛊惑者，这样的草寇是最危险的。须加辟蛊之品。
We should destroy their base and send soldiers to suppress the liver area with some outlet left. If it is canceration, it eindicates the riser has had a spirit creed with a demagogue. This kind of robber is the most dangerous. We need increase some other solution to break depraved matters.
其为肝火性质，最善游击，是游寇性质，所以仅仅荡涤根据地是没有意义的。早就转入外线了，在少阳、三焦等地，伺机回车。故应在扫荡其盘踞的根据地后，于其转折途中逐步衰减之，并行招安之策。
It belongs to the property of liver fire, which is good at guerrilla tactics, so they are guerrilla enemies. It is meaningless just to clean up the base. The enemies have transferred to exterior line such as Shaoyang and Shanjiao and waited for carriage return. Therefore, we should weaken them gradually in their return way after cleaning up the base area and .execute amnesty policy meantime.

其所经行都是深山老林、交界之处，也就是膜原之间，只能透散招降而无法清肃。以上是人事比类。
The routes they passed are all remote mountains and common boundaries, that is, between pleurodiaphragmatic spaces. We can only disperse instead of clearing completely. The above are an analogy of human beings.

就医理而言，小三阳湿热侮肝，木郁达之就是治则。肝木不足，湿热，治本之道在补肾。又火邪伏于下焦，当思搜剔。大三阳火淫于下，按内经治以咸寒，佐以苦辛，以酸收之，以苦发之。两相参照，而立治法：
As for the medical knowledge, the reason of Small three positive is that damp and heat counterrestricts liver. Facilitating the Stagnant Wood is the principle of treatment. The wood is insufficient with damp and heat, the permanent Way is invigorating Kidney. The evil of fire ambushes in lower-Jiao, we should search and expel it. The fire of Great three positive offend excessively below, we cure it with salty cold, assisting acrid and bitter drugs, constringing with sour and dispersing with bitter ones. Referring these two methods, the treating criteria are established.

小三阳
Small three positive
第一步，用龙胆泻肝汤减量（药方1）。前段时间闹龙胆泻肝汤事件，使一名方蒙冤。一干医师不识大体，用此去实火之剂大剂量常服，能不出问题么。关木通不过代罪。当然，关木通有入肾的过错，致使连肾火一并受泻，迅速肾衰。若是大三阳，方可多用，小三阳用几剂随即不用，仅作先导。
First step is with decreased Decoction of Radix Gentianae for Purging Liver-fire (Prescription 1). This famous prescription was treated unjustly because of an event some time ago. This prescription should be used for removing excess fire, but a few physicians ignore the general situation and used this decoction in large dosage and long period, Can there be no problem? Caulis Aristolochiae Mansshuriensis is just a scapegoat. It is certainly faultful for entering kidney to purge the fire in kidney and makes kidney failure quickly. For Great three positive, this prescription can be used many times. For Small three positive, the prescription can be used only a few dosages as a precursor.

第二步，木郁达之，可用逍遥散（药方2）。加茵陈，以最得春木之力为之清利先导，加强疏发之力。又加胆南星以正其胆。若胁痛加延胡索。
Second step is facilitating the Stagnant Wood. Use Ease powder Rambling Powder (Prescription2) with Artemisia capillaris Thunb to clear up and guide, strengthening the power of dispersing, with arisaema cum bile to modify the gallbladder, adding yanbusuo if there is costal pain,.
第三步，补肝血安魂。木显舒畅之后，当顺势进补厥阴，加以培植。用青蒿、鳖甲、郁金、赤芍、夏枯草、龙骨、益母草、当归、茯苓、生地。青蒿、鳖甲透出其中伏邪，郁金、赤芍以泄其愤（药方3）。
Third step is to enrich blood and comfort soul. When the wood is smooth, we should take advantage of the opportunity to enrich Jueyin. With sweet wormwood, turtle shell, Radix Curcumae, unpeeled root of herbaceous peony, selfheal, fossil fragments, motherwort, Chinese angelica, Tuckahoe and. fresh root of rehmannia. Sweet wormwood and turtle shell eliminates pathogenic factors. Radix Curcumae and unpeeled root of herbaceous peony release the anger. (Prescription3)
These methods should be used alternately till the disease is healed.
交替使用，直至平复。

大三阳
Great three positive

第一步，泻肝实脾。用龙胆泻肝汤（药方1）。若脾已肿大，再加白芍土中泻木。并接着用大补脾汤去干姜加山药护养脾气。交替应用，直至使脾获安，脾肿大消除，食欲恢复。
First step is eliminating pathogens from lung for invigorating spleen (Prescription 1). For enlarged spleen, add white peony root to purge wood from the earth. Then use Greatly Tonifying spleen Decoction removing dried ginger while adding Chinese yam to nourish spleen Qi. This therapy can be used by turns till the enlarged spleen is eliminated and patients regain appetite.
第二步，攻肝邪。当用青皮、龙骨、牡蛎、鳖甲、醋大黄、丹皮、败酱草、赤芍、牛膝、车前子、木通。肝癌肝硬化还可加用少量青黛、僵蚕。此方是强劲搜火邪之方（药方5）。对有根据地之游寇，有镇有攻，有直捣巢穴，有接应。
Second step is counteracting pathogenic factors in liver. We can resort to dried green orange peel, fossil fragments,oyster, turtle shell, vinegar rhubarb, Cortex Moutan, Patrinia villosa, unpeeled root of herbaceous peony, Achyranthes Bidentata, plantain seed and Aristolochiae Manshuriensis. As for hepatocarcinoma and hepatic cirrhosis, we can use a few indigo and bombyx batrycatus. This prescription has a strong ability to clear fire evil. (Prescription 5)
It can press down and attack the hideout of enemies who have had a base.
第三步，透散三焦。用青蒿、鳖甲加枯黄芩、焦山栀、玄参、夏枯草、知母、甘草，稍加薄荷助透散（药方6）。
Thirdly: relieving and eliminating 3-jiao. With sweet wormwood, turtle shell adding withered scutellaria, coked capejasmine, root of Zhejiang figwort, selfheal, rhizome of wind-weed, licorice root, and a little peppermint to help with dispelling and promoting. (Prescription 6)
第四步，招安怀柔。用 白芍、牛膝、生地、蛰虫、珍珠母、天门冬、黄精、女贞子、墨旱莲（药方7）。久用取效。
Last step is amnestying and placating, with white peony root, Achyranthes Bidentate, rehmanniae radix, Eupolyphaga Seu Steleophaga, pearl shell, lucid asparagus, solomonseal, fruit of glossy privet and Eclipta prostrate (Prescription 7). Long-term use shows effectiveness.
交替应用，有时穿插大补脾汤，屡攻屡安，渐次衰减邪气。肝癌病人，决胜则在所吃食物的增加上，直至正气重占主权。
When used alternately with Greatly Tonifying spleen Decoction, it can weaken the evil influence by attacking and comforting repeatedly. As for the hepatocarcinoma, the decisive key is that the patients can eat more gradually till vital Qi dominates again.

文中主要药方：
Main prescription:
药方1：龙胆泻肝汤
Prescription 1: Decoction of Radix Gentianae for Purging Liver-fire
药方2：逍遥散加茵陈 9 克 、胆南星 6 克
Prescription 2: Ease powder Rambling Powder with 9g Artemisia capillaris Thunb and 6g arisaema cum bile.

药方3：青蒿 6 克 、鳖甲 9 克 、郁金 6 克 、赤芍 6 克 、夏枯草 12 克 、龙骨 3 克 、益母草 6 克 、当归 6 克 、茯苓 6 克 、生地 6 克
Prescription 3: 6g Sweet wormwood, 9g turtle shell, 6g Radix Curcumae, 6g unpeeled root of herbaceous peony, 12g selfheal, 3g fossil fragments, 6g motherwort, 6g Chinese angelica, 6g Tuckahoe and. 6g fresh root of rehmannia.
药方4：人参 9 克 、炙甘草 9 克 、山药 9 克 、白术 3 克 、麦冬 3 克 、五味子 3 克、丹皮 3 克

Prescription 4:
9g Ginseng, 9g fried licorice root, 9g Chinese yamg, 3g large-headed atractylodes, 3g Ophiopogon japonicus, 3g schisandra fruit and 3g Cortex Moutan.
药方5：青皮 6 克 、龙骨 9 克 、牡蛎 9 克 、鳖甲 9 克 、醋大黄 6 克 、丹皮 9 克 、败酱草 12 克 、赤芍 6 克 、牛膝 6 克 、车前子 6 克 、木通 6 克
Prescription 5:
6g Dried green orange peel, 9g fossil fragments, 9g oyster, 9g turtle shell, 6g vinegar rhubarb,
9g Cortex Moutan, 12g Patrinia villosa, 6g unpeeled root of herbaceous peony, 6g Achyranthes Bidentata, 6g plantain seed and 6g Aristolochiae Manshuriensis.

药方6 ：青蒿 6 克 、鳖甲 9 克 、枯黄芩 6 克 、焦山栀 6 克 、玄参 9 克 、夏枯草 12 克 、知母 6 克 、甘草 3 克 、薄荷 1 克
Prescription 6:
6g Sweet wormwood, 9g turtle shell, 6g withered scutellaria, 6g coked capejasmine, 9g root of Zhejiang figwort, 12g selfheal, 6g rhizome of wind-weed, 3g licorice root and 1g peppermint.
药方7：白芍 9 克 、牛膝 3 克 、生地 9 克 、蛰虫 3 克 、珍珠母 6 克 、天门冬 6 克 、黄精 6 克 、女贞子 6 克 、墨旱莲 6 克
Prescription 7:
9g White peony root, 3g Achyranthes Bidentate, 9g rehmanniae radix, 3g Eupolyphaga Seu Steleophaga, 6g pearl shell, 6g lucid asparagus, 6g solomonseal, 6g fruit of glossy privet and 6g Eclipta prostrate.