Hepatitis B is a common and frequent disease in China, the infection rate in our population is as high as 50%, and the HBsAg positive rate used to be as high as about 10%, with the long-standing immunization of newborns against hepatitis B, the infection rate of HBsAg in China has been reduced to 7.18% in recent years, but China still accounts for nearly half of the more than 300 million slow hepatitis B infected people in the world. Hepatitis B is a contradictory unity of the interaction between the hepatitis B virus and the human body, and the result of their interaction determines the occurrence, development and final outcome of the disease, which contains a rich philosophical connotation. When humans are infected with hepatitis B virus, the following different conditions can occur due to the amount of infected virus and the immune status of the body: occult infection, acute hepatitis, severe hepatitis (liver failure), chronic hepatitis, asymptomatic carriers, etc. Chronic hepatitis B is defined as a person who has a history of hepatitis B or HBsAg positivity for more than 6 months and is still positive for HBsAg and/or HBV DNA, has persistent or recurrent elevation of serum ALT, or has hepatitis lesions on liver histological examination, of which those with positive serum HBsAg, HBV DNA and HBeAg and negative anti-HBe are called ‘ HBeAg-positive chronic hepatitis B’; those with positive serum HBsAg and HBV DNA, persistent negative HBeAg and positive or negative anti-HBe are called ‘HBeAg-negative chronic hepatitis B’. The number of patients with chronic hepatitis is large and dangerous, and if the treatment and control is unfavorable, it can turn into severe hepatitis (liver failure) or further develop into cirrhosis or liver cancer, thus endangering the patient’s life. Therefore, chronic hepatitis B is the highest priority in the treatment of hepatitis B. In this paper, we use the principles of Marxist philosophy, combined with some experiences of ourselves and others in the treatment of hepatitis B, to make a little superficial philosophical analysis of the antiviral treatment of chronic hepatitis B. A, good at grasping the main contradiction Dialectical materialism believes that the main contradiction in the system composed of a variety of contradictions in things play a leading and decisive role in the development of things, to provide or influence the existence and development of other contradictions; while secondary contradictions are in a subordinate position and does not play a decisive role. The main contradiction and the non-main contradiction are in a unified relationship of opposition and unity, distinguishing each other, interacting with each other, and transforming each other under certain conditions. Therefore, only by grasping the main contradiction can we facilitate the solution of the problem. Hepatitis B is the result of the interaction between the hepatitis B virus and the human immune system. Hepatitis B virus is a typical hepatophilic virus, which enters the body through the blood and then reproduces and replicates in the liver. The virus itself does not directly cause damage to the liver, and its lesions are mainly caused by cellular immunity. The virus reaches the liver and replicates in the hepatocytes on the one hand, and expresses antigenic components such as HBsAg and HBeAg on the hepatocyte membrane on the other hand. These two antigens are recognized and bound by natural killer cells (NK cells) and cytotoxic T lymphocytes (CTL cells) in the presence of HLA-I molecules in the hepatocyte membrane, causing damage to the hepatocytes while killing the virus. Fundamentally, without the presence of hepatitis B virus there would be no resulting immune damage, and there would be no existence and development of chronic hepatitis B. Therefore, only by grasping the hepatitis B virus as the main contradiction and taking active and effective antiviral treatment to remove and inhibit the hepatitis B virus can we cure and slow down the development of the disease to the maximum extent and achieve the purpose of clinical treatment. Second, specific analysis of specific problems Marxist philosophy believes that contradiction has both universality and specificity, the universality of contradiction is common, the specificity is individuality, the universality resides in the specificity and is expressed through the specificity, there is no universality without the specificity; the specificity is also inseparable from the universality, the specificity that does not contain the universality is also absent. The principle of the particularity of contradiction requires us to analyze specific problems in concrete terms. The so-called concrete analysis of specific problems is to analyze the particularity of contradiction in concrete terms under the guidance of the principle of the universality of contradiction, which is the basis for people to understand things correctly and is an important principle and soul of Marxist philosophy. Hepatitis B is the result of the interaction between the hepatitis B virus and the body’s immune system, the degree of virus replication and the body’s immune status is different antiviral treatment, so not all patients with hepatitis B are suitable for antiviral treatment, and because of the limitations of human understanding, even if the hepatitis B patients currently considered suitable for antiviral treatment are not all able to achieve the expected results, so specific problems should be Therefore, specific problems should be analyzed and the objective rules should be matched to the maximum extent possible in order to achieve the best treatment results. In China, chronic hepatitis B is mostly caused by vertical infection at birth and in early childhood before the age of 5 years, with a small proportion being caused by infection after adulthood, which is different from Western countries. The majority of patients before adulthood due to the imperfect development of the immune system, easy to form a state of immune tolerance against the hepatitis B virus, no obvious liver cell damage and the formation of asymptomatic carriers, this period of patients generally do not need antiviral and other treatment. As the body’s immune tolerance is gradually lifted with age, a significant proportion of patients begin to develop immune damage and develop disease. Whether or not this part of the patient requires antiviral treatment should be analyzed on a problem-specific basis. Currently, there are two major categories of internationally recognized anti-hepatitis B virus drugs: alpha-interferon (common alpha-interferon and Peg-alpha-interferon) and nucleoside/nucleotide analogues (currently approved for clinical use in China: lamivudine, adefovir, entecavir, telbivudine, etc.). The mechanism of action of α-interferon is to stimulate the body to produce antiviral proteins, degrade viral mRNA and inhibit the synthesis of hepatitis B virus. The efficacy of α-interferon is therefore closely related to the immune status of the body and the replication status of the virus. First of all, the best target of α-interferon treatment is patients with active viral replication and inflammatory activity, i.e. HBVDNA positive (here mainly refers to HBeAg positive chronic hepatitis B, the treatment of HBeAg negative chronic hepatitis B is discussed below), liver function status can indirectly reflect the immune activity of the body, under the premise of excluding factors such as alcohol consumption, drugs, etc. The higher the serum ALT level indicates the stronger the immune response of the body and the better the therapeutic effect. In addition, the patient’s age (younger age is better), gender (women are more effective than men?), status at the time of infection (adult age is better than men), and the patient’s condition. In addition, the patient’s age (younger patients have better results), gender (women have better results than men?), status at the time of infection (infection in adulthood is better than infection at birth), HBVDNA load (the lower the baseline viral load, the better the efficacy), duration of disease, severity of liver fibrosis (lighter patients have better results), compliance with treatment, and the presence of HCV, HDV or HIV co-infection are all important influencing factors. The pre-treatment HBV DNA and ALT levels are the main factors to predict the efficacy. In addition, the presence of contraindications (patients who are allergic to interferon, those with significant jaundice TBIL>51μmmol/L, patients with cirrhosis, especially decompensated cirrhosis, patients with various autoimmune diseases, active diabetes mellitus and patients with a family history of psychiatric disorders should be contraindicated or used with caution) and the general condition of the patient (if the patient has severe gastrointestinal symptoms, it should be used with caution even if the above conditions are met) should be considered. All of these factors should be taken into consideration. Only by combining the above factors and analyzing the specific problems can we target and achieve satisfactory results. Nucleoside/nucleotide analogues mainly act on the reverse transcriptase of hepatitis B virus to inhibit the synthesis of viral DNA, terminate the extension of the DNA chain and inhibit viral replication. Like α-interferon, nucleoside/nucleotide analogues are also suitable for patients with active and replicating virus (HBVDNA-positive) in chronic hepatitis B. Since their main mechanism of action is to inhibit viral replication without inducing a strong immune response, nucleoside/nucleotide analogues can be used to treat even severely active chronic hepatitis with rapid and obvious efficacy. Therefore, nucleoside/nucleotide analogs have a wider scope of application than alpha-interferon and relatively fewer side effects (but the effects of adefovir on renal function and of tibivudine on skeletal muscle should also be monitored regularly during treatment). If the patient’s condition is suitable for both α-interferon and nucleoside/nucleotide analogues, the pros and cons of both should be weighed and considered. For example, the conversion rate of α-interferon for HBeAg (HBeAg-positive slow hepatitis B) is greater than that of nucleoside/nucleotide analogues, and the course of treatment is relatively short, but its side effects such as fever, bone marrow suppression, hair loss, induction and aggravation of psychiatric symptoms are significantly However, the side effects such as fever, myelosuppression, alopecia, induction and aggravation of psychiatric symptoms are significantly stronger than those of nucleoside analogues, and some patients often discontinue the drug in the middle of treatment due to intolerable side effects. In contrast, nucleoside/nucleotide analogs have the advantages of easy administration, fast onset of action, strong patient compliance, low side effects and wide applicability, but they have a relatively long course of treatment, relatively high cost, and can have disadvantages such as viral mutation and drug resistance during treatment. Therefore, the best choice of drug should be based on the patient’s condition, age, fertility status, affordability, and ability to tolerate the side effects of the drug. For example, for young patients, patients who are not yet of childbearing age or close to childbearing age, patients who have reached the indication of antiviral therapy for the first time, patients with short duration of disease and good liver function, if there are no other contraindications, interferon therapy can be preferred. Those who have a long history of antiviral therapy, those who have a long history of liver fibrosis or early cirrhosis, those who cannot tolerate the side effects of interferon or those who have contraindications to its use may prefer nucleoside/nucleotide drugs. Of course, the above indications are relative and should be chosen in clinical work. The combination of two types of drugs may achieve better efficacy in some cases. HBeAg-negative chronic hepatitis B is a special type of chronic hepatitis B. It is a minority in China and other Asian countries, but its incidence has been increasing in recent years. HBeAg-negative chronic hepatitis B patients are generally older (mostly between 40 and 55 years of age), more common in men, with low HBVDNA replication levels, persistent abnormal liver function and very difficult to remit on their own, than They are more likely to progress to cirrhosis than HBeAg-positive chronic hepatitis B. Because of the low HBVDNA replication levels (generally ≤107 copies/ml), the long duration of disease onset and the fact that a significant proportion of patients have progressed to the cirrhotic stage at the time of diagnosis, most nucleoside/nucleotide drugs are suitable for treatment. Therefore, short-term treatment is very easy to relapse, and only adherence to long-term treatment or lifelong treatment can lead to satisfactory results. Therefore, the choice of low resistance rate of adefovir and entecavir is more appropriate. In recent years, the efficacy of α-interferon, especially Peg-α-interferon, in treating HBeAg-negative chronic hepatitis B has been recognized differently at home and abroad. Therefore, Peg-alpha interferon in combination with nucleoside/nucleotide analogs is one of the most promising treatment options for HBeAg-negative chronic hepatitis B. For each patient, the choice of drugs, the combination of drugs, the increase or decrease of drugs during treatment and the length of treatment should be decided according to the patient’s condition, economic status, awareness of drug side effects and ability to tolerate them, and more importantly, by observing the changes in HBeAg and HBsAg titers during the treatment process, so that the specific problems can be analyzed. Third, adhere to the developmental point of view, timely treatment of problems arising in the course of treatment Marxist philosophy believes that everything is movement and development, rather than static and unchanging. In the process of antiviral treatment with the treatment, will continue to appear this and that problem, so should learn to use the developmental point of view to look at the problem, take timely measures, in order to make the treatment can be carried out smoothly, and to avoid unnecessary losses. In the early stages of interferon treatment many patients will experience side effects such as high fever, headache, generalized muscle pain, etc. Therefore, giving patients appropriate antipyretic and analgesic drugs in the early stages of treatment can significantly reduce the occurrence of side effects and increase patient compliance. Patients with reduced leukocytes and/or platelets during treatment should be checked repeatedly to determine whether the reduction of leukocytes and platelets is persistent, progressive or temporary, or self-limiting, and to decide whether to discontinue, temporarily discontinue, or give leukostatic/platelet-raising drugs according to the degree of bone marrow suppression. The vast majority of patients can continue their treatment with aggressive management, but timely discontinuation of treatment is necessary for some patients with poor tolerance. There are very few patients who are overly sensitive to interferon and may have a strong immune response, inducing severe hepatitis (liver failure) or a tendency to severe hepatitis, so the patient should be closely monitored for changes in gastrointestinal symptoms and changes in bilirubin, transaminases, prothrombin time and albumin at the beginning of treatment. Patients who respond well to interferon therapy tend to show a continuous rise in transaminases in the early stage of treatment (within the first two months), which peaks with a rapid decline in transaminases and a negative turn in HBeAg; while patients who respond poorly are in the opposite situation, with no significant rise in transaminase levels in the early stage and a delayed turn in HBeAg. In this case, we should analyze the specific problem and decide whether to stop the drug, increase the dose of interferon, switch to other types of interferon or supplement with other drugs, and extend the course of interferon appropriately, etc. A considerable number of patients can still achieve satisfactory results after appropriate treatment. The emergence of the five quantitative tests for hepatitis B has provided a reliable theoretical basis for individualizing interferon therapy. If patients have early seroconversion of HBeAg (HBeAg→HbeAb) and negative HBVDNA, a six-month to one-year course of interferon therapy is generally sufficient. However, for those patients who have a significant decrease in HBVDNA and HBeAg titer at an early stage but have repeated fluctuations with the progress of treatment and delayed HBeAg negative conversion and seroconversion, the causes should be actively investigated and appropriate measures should be taken. First of all, in the early stages of interferon therapy, we should try to exclude all drugs that have an impact on the immune effect of interferon, such as glycyrrhetinic acid preparations, the so-called ‘liver-protecting and enzyme-lowering’ effect of Chinese and Western drugs, etc. Clinicians use such drugs in the early stages only because they are worried about the excessive increase in ALT caused by interferon and aggravate the disease. In fact, in most cases, the increase in ALT (provided that there is no significant increase in bilirubin) is only a temporary process that helps to achieve the seroconversion of HBeAg and the eventual recovery of liver function, and if there is a real concern, it can be combined with polyphosphocholine drugs at an early stage to protect the liver from excessive damage without affecting the efficacy of interferon. In addition, in most cases, the dose of interferon is closely related to the efficacy, and the dose of interferon should be increased to the maximum that the patient can tolerate (some of the patients I have treated have used up to 8 or 10 million units/every other day intramuscular injection, and Peg-α interferon should be chosen at the maximum dose possible); in addition, appropriate extension of the treatment course and supplementation with immunomodulatory drugs (such as α1 thymidine) etc. can help to improve the efficacy. For example, in some patients, the duration of treatment is extended to one year, one and a half years or even two years to receive satisfactory results (HBeAg seroconversion); and in a small number of young patients, if HBeAg seroconversion and negative HBVDNA occur early in treatment, the change in HBsAg titer should be further observed, and if there is a substantial decrease in HBsAg titer (e.g. If the HBsAg titer shows a significant decrease (e.g., an order of magnitude change) and a trend of gradual decrease, it is possible to receive an unexpected effect by extending the course of treatment, i.e., negative conversion of HBsAg and seroconversion (HBsAg → HBsAb), and achieve the goal of clinical cure. The main clinical characteristics of 14 patients with chronic hepatitis B who achieved negative HBsAg and seroconversion through interferon therapy are summarized as follows: young age (8 cases aged 10-20 years, 3 cases aged 20-30 years, 3 cases aged 30-40 years), low baseline HBVDNA level (11 cases less than 108 copies/ml, 3 cases more than 108 copies/ml), good response to early treatment (Most of the HBeAg seroconversions were achieved within 3 months or 6 months, and one case had HBsAg seroconversion in about 5 months), long duration of treatment (one and a half to 2 years in most patients), and good patient compliance (no interruption of treatment due to adverse effects or other factors). Patients who do not achieve negative HB eAg and seroconversion despite increased interferon doses or appropriately extended courses and whose liver function is near normal or fluctuates repeatedly at low levels should promptly discontinue the drug and switch to other treatments. Nucleoside/nucleotide analogs are relatively less side effects, safe, fast-acting, and widely applicable, but viral mutation is a problem that cannot be avoided, and the treatment of viral mutation and drug resistance runs through the treatment process. The treatment of drug resistance best reflects the developmental perspective in Marxist philosophy and reflects the progress of the human cognitive process. The early treatment of drug resistance is to continue single-drug use after lamivudine resistance; then it developed to switching to adefovir after the occurrence of biochemical breakthrough and clear clinical resistance diagnosis, and then to the addition of adefovir; now it has moved forward to the concept that drug intervention should be added when virological breakthrough occurs, i.e., early drug addition; then it has moved forward to the concept that virological breakthrough or even resistance gene variation has not occurred recently, but only the early virological response is unsatisfactory, and it is predicted that the future may When drug resistance is predicted to occur in the future, the early time point is to adjust and optimize the treatment regimen to reduce and delay the occurrence of drug resistance in the future. Advances in the recognition and management of drug resistance have effectively extended the effective treatment time of drugs and greatly improved the therapeutic effect of nucleoside analogues. Some patients have achieved seroconversion of HBeAg and negative HBVDNA and long-term normal liver function through long-term treatment, and a small number of patients have achieved the ideal treatment goal of negative HBsAg and seroconversion. And most of the patients through the continuous inhibition of hepatitis B virus, reduce and control the inflammation of the liver, slow down, inhibit, and even reverse the occurrence and development of liver fibrosis and cirrhosis. Fourth, pay attention to the role of external factors in the development of chronic hepatitis and the impact on antiviral therapy, emphasizing humanistic medicine with a human face Discriminative materialism believes that internal causes are the unity of opposites of elements contained in things themselves, that is, internal contradictions. External causes are the unity of opposites between one thing and other things, i.e. external contradictions. The development of any specific thing is the result of the joint action of internal and external contradictions. The internal contradiction or internal cause is the fundamental cause of the development of things, and the external contradiction or external cause is the second cause of the development of things. The external cause is the condition of change, the internal cause is the basis of change, and the external cause acts through the internal cause. In the development of chronic hepatitis, the interaction between the virus and the human immune system is the internal cause, while the patient’s mental, emotional, dietary habits, labor conditions and other external factors can lead to the aggravation of the disease by affecting the human immune function, so the role of the above factors must not be ignored while emphasizing antiviral treatment. So, how can we minimize the influence of the above-mentioned adverse factors so as to turn the disadvantages into advantages? This is a real problem that modern medicine should seriously face. Medicine is essentially humanistic, and it is concerned with people who are struggling with illnesses and need the most care and help. Therefore, medicine is considered to be the most humanistic discipline, and doctors are the most humane profession. With the development of medicine, people are increasingly aware of the overall connection between various medical disciplines and between medical technology and humanities and social sciences, and it is more clear that the technical development of medicine and humanistic care are inseparable. Specifically in the treatment of chronic hepatitis, it is not enough to emphasize the role of drugs alone. The long-term, recurrent nature of chronic hepatitis treatment and the occurrence of various serious consequences (cirrhosis, hepatocellular carcinoma) can cause great mental stress to patients, and many patients suffer from anxiety, insomnia, depression and other symptoms, and some even break the can, which not only seriously reduces the patient’s compliance with drug therapy, but also affects the body’s immune function through the neuroendocrine system causing repeated fluctuations in the disease This can lead to a vicious circle. As a doctor at this time should have a high degree of compassion and superb behavior, language art, in addition to the pathogenesis of the patient to understand the treatability and controllability of the disease, so that the patient to establish confidence to overcome the disease, more importantly, from the perspective of humanistic medicine to care for the patient, let the patient feel the warmth of others and society, feel that he is not abandoned by society and others or as an alien, but the same as others This is essential to completely release the patient’s mind and bad habits, so that he can actively cooperate with the doctor’s treatment. In conclusion, the process of cognition is a process of discriminative movement, and the process of human cognition is never-ending, a unity of forwardness and tortuousness. In recent years, with the development of medical science, especially the development of molecular biology, people’s understanding of the disease has risen to the molecular level. It is believed that with the continuous improvement of human understanding, these problems will be completely solved and the complete cure of hepatitis B will be in the near future.