中医防治非酒精性脂肪性肝病研究进展(1)
摘 要：非酒精性脂肪性肝病是以肝实质脂肪贮积以及细胞变性为特征，且无过量饮酒史的临床病理综合征，它与遗传易感和胰岛素抵抗有密切相关性。在中医古籍中，该病则属于“肝癖”、“肝著”、“痞滿”等范畴。随着现代生活水平不断的提高，非酒精性脂肪性肝病的发病率迅速攀升，占据我国慢性肝病的主导地位之一，对人们的健康造成严重威胁。中医在诊治非酒精性脂肪性肝病的领域中，展现了独特的优势，对非酒精性脂肪性肝病进行分类和早期干预，充分体现了“不治已病治未病”及“救治于后不若摄生于先”的思想。
关键词：非酒精性脂肪性肝病；中医；治未病
中图分类号：R256.4 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.15.010
文章编号：1006-1959(2018)15-0025-04
Progress in Prevention and Treatment of Nonalcoholic Fatty Liver Disease by TCM
, 百拇医药
ZHENG Ying1，SUN Hua-sheng1，MAO Qian-guo2
(1.Fujian University of Traditional Chinese Medicine，Fuzhou 350100，Fujian，China；
2.Liver Disease Center of Xiamen Traditional Chinese Medicine Hospital，Fuzhou 361009，Fujian，China)
Abstract：Nonalcoholic fatty liver disease is a clinicopathological syndrome characterized by liver parenchyma fat storage and cell degeneration，with no excessive drinking history，which is closely related to genetic susceptibility and insulin resistance.In the ancient books of traditional Chinese medicine，this disease belongs to the category of "liver addiction"，"stagnancy of liver-qi and blood"and"distention and fullness".With the continuous improvement of the modern living standard，the incidence of nonalcoholic fatty liver disease is rising rapidly，which occupies one of the leading positions of chronic liver disease in China and poses a serious threat to people's health.In the field of diagnosis and treatment of nonalcoholic fatty liver disease，traditional Chinese medicine has shown unique advantages.The classification and early intervention of nonalcoholic fatty liver disease，it fully embodies the idea of"Prevention is always better than treatment"and“The best cure is to drive away the disease before it happens".
, 百拇医药
Key words：Nonalcoholic fatty liver disease；Traditional Chinese medicine；Prevention
非酒精性脂肪性肝病(nonalcoholic fatty liver disease，NAFLD)是指除外酒精和其他明确的损肝因素所致的肝细胞内脂肪过度沉积为主要特征的临床病理综合征，与胰岛素抵抗和遗传易感性密切相关的获得性代谢应激性肝损伤，随着现代生活水平不断的提高，NAFLD的发病率迅速攀升，具有全球化流行趋势，占据中国富裕地区及其他发达国家慢性肝病的主导地位之一，已成为除病毒性肝炎之外的第1大肝病，对人们的健康造成严重威胁。而中医药治疗无论是在改善临床症状还是修复肝功能或调整血脂或阻止肝脏纤维化进一步进展等方面，均有较大多向调节的优势，故本文根据不同NAFLD中医药治疗方法的研究进展进行综述，现报道如下。
1 NAFLD中医病因病机
, http://www.100md.com
在中医古籍中并无“脂肪肝”这一说法，而是据患者临床症状，将该病归于“痰浊”、“肥气”、“胁痛”等病证范畴，《难经》对该病就早有描述，如“肝之积，名曰肥气”，故称之肥气病。多数医家认为NAFLD是因嗜食肥甘厚腻或情志失调，导致肥胖过度或脾胃虚弱、肾气不足，使脾脏运化失常，肝失条达，疏泄不畅，而致湿浊内结，瘀血内生，阻碍足厥阴肝经之气机，终成肝郁脾虚、痰瘀互结之病机。其病位在肝、脾、肾，病理因素复杂，以气郁、湿热、痰浊、瘀血为主，以痰浊最为常见，《丹溪心法》有云“凡人上中下有结块者，多是痰”，痰属湿邪，常因脏腑功能失调导致由内而生，《临证指南医案》则有“但湿从内生者，必其人膏梁酒醴过度”的说法，进一步指出导致该病的病因往往为饮食失调，病机为湿从内生。病性以中焦脾胃虚弱为本，以气血津液输布、代谢及排泄异常，痰湿热瘀停滞为标[1]。亦有医家认为肾与NAFLD的病理机制相关，可能以下焦肾气同中焦脾胃之气均虚为本，周正龙等[2]认为肾气不足，肾与膀胱的藏精及气化功能失调，无法蒸化津液，脾失健运，则清阳不升，且浊阴不降，积聚于肝脏则成病；或由肾精亏虚，导致膏脂不藏，成浊入血，痰浊血瘀互结，则血脂水平上升，终沉积于肝脏而病[3]。, 百拇医药(郑颖 孙华胜 毛乾国)
关键词：非酒精性脂肪性肝病；中医；治未病
中图分类号：R256.4 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.15.010
文章编号：1006-1959(2018)15-0025-04
Progress in Prevention and Treatment of Nonalcoholic Fatty Liver Disease by TCM
, 百拇医药
ZHENG Ying1，SUN Hua-sheng1，MAO Qian-guo2
(1.Fujian University of Traditional Chinese Medicine，Fuzhou 350100，Fujian，China；
2.Liver Disease Center of Xiamen Traditional Chinese Medicine Hospital，Fuzhou 361009，Fujian，China)
Abstract：Nonalcoholic fatty liver disease is a clinicopathological syndrome characterized by liver parenchyma fat storage and cell degeneration，with no excessive drinking history，which is closely related to genetic susceptibility and insulin resistance.In the ancient books of traditional Chinese medicine，this disease belongs to the category of "liver addiction"，"stagnancy of liver-qi and blood"and"distention and fullness".With the continuous improvement of the modern living standard，the incidence of nonalcoholic fatty liver disease is rising rapidly，which occupies one of the leading positions of chronic liver disease in China and poses a serious threat to people's health.In the field of diagnosis and treatment of nonalcoholic fatty liver disease，traditional Chinese medicine has shown unique advantages.The classification and early intervention of nonalcoholic fatty liver disease，it fully embodies the idea of"Prevention is always better than treatment"and“The best cure is to drive away the disease before it happens".
, 百拇医药
Key words：Nonalcoholic fatty liver disease；Traditional Chinese medicine；Prevention
非酒精性脂肪性肝病(nonalcoholic fatty liver disease，NAFLD)是指除外酒精和其他明确的损肝因素所致的肝细胞内脂肪过度沉积为主要特征的临床病理综合征，与胰岛素抵抗和遗传易感性密切相关的获得性代谢应激性肝损伤，随着现代生活水平不断的提高，NAFLD的发病率迅速攀升，具有全球化流行趋势，占据中国富裕地区及其他发达国家慢性肝病的主导地位之一，已成为除病毒性肝炎之外的第1大肝病，对人们的健康造成严重威胁。而中医药治疗无论是在改善临床症状还是修复肝功能或调整血脂或阻止肝脏纤维化进一步进展等方面，均有较大多向调节的优势，故本文根据不同NAFLD中医药治疗方法的研究进展进行综述，现报道如下。
1 NAFLD中医病因病机
, http://www.100md.com
在中医古籍中并无“脂肪肝”这一说法，而是据患者临床症状，将该病归于“痰浊”、“肥气”、“胁痛”等病证范畴，《难经》对该病就早有描述，如“肝之积，名曰肥气”，故称之肥气病。多数医家认为NAFLD是因嗜食肥甘厚腻或情志失调，导致肥胖过度或脾胃虚弱、肾气不足，使脾脏运化失常，肝失条达，疏泄不畅，而致湿浊内结，瘀血内生，阻碍足厥阴肝经之气机，终成肝郁脾虚、痰瘀互结之病机。其病位在肝、脾、肾，病理因素复杂，以气郁、湿热、痰浊、瘀血为主，以痰浊最为常见，《丹溪心法》有云“凡人上中下有结块者，多是痰”，痰属湿邪，常因脏腑功能失调导致由内而生，《临证指南医案》则有“但湿从内生者，必其人膏梁酒醴过度”的说法，进一步指出导致该病的病因往往为饮食失调，病机为湿从内生。病性以中焦脾胃虚弱为本，以气血津液输布、代谢及排泄异常，痰湿热瘀停滞为标[1]。亦有医家认为肾与NAFLD的病理机制相关，可能以下焦肾气同中焦脾胃之气均虚为本，周正龙等[2]认为肾气不足，肾与膀胱的藏精及气化功能失调，无法蒸化津液，脾失健运，则清阳不升，且浊阴不降，积聚于肝脏则成病；或由肾精亏虚，导致膏脂不藏，成浊入血，痰浊血瘀互结，则血脂水平上升，终沉积于肝脏而病[3]。, 百拇医药(郑颖 孙华胜 毛乾国)