慢加急性肝衰竭（ACLF）是指在慢性肝病基础上出现急性肝功能恶化，以肝脏和肝外器官衰竭为主要特征的复杂综合 征，其诱因复杂，发病机制不清，致死率高。目前西医治疗该病缺乏特效药物，中医药在改善其临床症状方面有着独特的 优势。周小舟教授认为，ACLF的基本病机为湿、热、毒、瘀、郁互结，脾虚水湿壅盛，强调脾虚贯穿疾病的始终。临证分 期治疗ACLF方法如下：早期之湿热发黄证，可治以清热祛湿退黄之法，方选茵陈五苓散加减；早期之瘀热发黄证，可治以 活血化瘀、清热退黄之法，常以茵陈蒿汤加减；中期之气虚瘀黄证，可治以益气健脾、活血化瘀之法，采用自拟健脾利湿 养肝方加减治疗；晚期之阳虚发黄证，可治以扶阳培土、利湿退黄之法，拟以茵陈术附汤加减治疗。分期论治的同时，均 需顾护脾胃、化湿养肝，根据不同阶段侧重于不同治法，总以清热退黄、凉血化瘀、补益肝肾为原则。周小舟教授治疗 ACLF的临床经验可为中医药防治ACLF提供参考。

Acute-on-chronic liver failure （ACLF） is a complex syndrome characterized by acute hepatic decompensation superimposed on chronic liver disease， manifesting as hepatic and extrahepatic organ failure. Triggered by multiple factors， ACLF has unclear pathogenesis and high mortality. Till now， current western medicine lacks specific therapeutic agents for ACLF， while traditional Chinese medicine （TCM） demonstrates unique advantages in alleviating its clinical symptoms. Professor Zhou Xiaozhou proposed that ACLF’s fundamental pathogenesis involves the intertwinement of dampness，heat，toxin，stasis and stagnation，with spleen deficiency and water-dampness accumulation persisting throughout disease progression. His approaches to staging treatment are as follows：（1） For early-stage damp-heat jaundice syndrome，it is recommended to adopt the therapies of clearing heat and resolving dampness to eliminate jaundice using modified Yinchen Wuling San；（2）For early-stage stasis-heat jaundice syndrome， it is suggested to utilize the therapies of activating blood circulation and resolving stasis， and clearing heat to eliminate jaundice with modified Yinchenhao Decoction；（3） For intermediate-stage qi-deficiency-stasis jaundice syndrome， it is recommended to adopt the therapies of reinforcing qi and fortifying spleen， and activating blood circulation and resolving stasis using self-formulated Jianpi Lishi Yanggan Formula；（4） For late-stage yang-deficiency jaundice syndrome，it is suggested to utilize the therapies of supporting yang and strengthening earth， and resolving dampness to eliminate jaundice with modified Yinchen Zhu Fu Decoction. Across all stages， methods of protecting the spleen-stomach， resolving dampness and nourishing liver should be also taken into account. Therapeutic principles of clearing heat and eleminating jaundice， cooling blood and resolving stasis， and tonifying liver-kidney should be applied differentially based on disease progression. Professor Zhou’s clinical experience can provide valuable references for TCM-based ACLF management.

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