基于“脾虚浊凝”理论探讨非酒精性脂肪性肝病辨治思路  

Discussion on Syndrome Differentiation and Treatment of Non-alcoholic Fatty Liver Disease Based on the Theory of “Spleen Deficiency and Turbid Coagulation”

作　　者：林军[1] 苏林红[1] 叶小丹[1] 朱小区[1] LIN Jun;SU Linhong;YE Xiaodan(Wenzhou Hospital of Traditional Chinese Medicine,Wenzhou 325000,China)

机构地区：[1]温州市中医院,浙江温州325000

出　　处：《浙江中医药大学学报》2022年第10期1156-1160,共5页Journal of Zhejiang Chinese Medical University

基　　金：温州市科技局基础性医疗卫生科技项目(Y20180771,Y20190720)。

摘　　要：[目的]基于“脾虚浊凝”理论探讨非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)辨治思路。[方法]通过中医古籍理论溯源和现代医学文献研究,总结古今医家对于NAFLD“脾虚浊凝”病机观的认识,提炼NAFLD特色辨治思路及现代生物学机制。[结果] NAFLD大多归属于中医学“痞满”“胁痛”范畴,根据“见肝之病,当先实脾”的指导思想,其主要病机应责之于肝脾受损、脾失运化,导致痰浊瘀毒皆从中生,阻于肝络故而发病,“脾虚浊凝”贯穿NAFLD病程始终,临床上运用健脾化痰、健脾降浊、健脾祛瘀等特色治法效果卓然。NAFLD治疗的现代生物学机制涵盖调整肠道稳态、延缓肝脏纤维化、改善脂类代谢、降低炎症因子表达等方面。[结论]通过深入挖掘从“脾虚浊凝”理论辨治NAFLD临证特色和现代生物学机制,可为今后中医药治疗NAFLD提供更为广阔的思路和方法。[Objective] To explore the syndrome differentiation and treatment of non-alcoholic fatty liver disease(NAFLD) based on the theory of “spleen deficiency and turbid coagulation”. [Methods] Based on the theory of ancient books of traditional Chinese medicine and modern medical literature research, this paper summarized the ancient and modern physicians’ understanding of the pathogenesis of“spleen deficiency and turbid coagulation”, and refined the characteristics of NAFLD. [Results] NAFLD mostly belongs to the category of“distention, fullness” and “hypochondriac pain” in traditional Chinese medicine. According to the guiding ideology of “sighting the liver disease, the spleen should be firmed first”, the main pathogenesis of NAFLD is the damage of the liver and spleen and failure of the spleen in transformation, resulting in phlegm turbidity and blood stasis, obstruction in liver collaterals, “spleen deficiency and turbid coagulation” runs through the course of NAFLD. The clinical application of invigorating the spleen to remove phlegm, invigorating the spleen to reduce turbidity, invigorating the spleen to remove blood stasis has achieved remarkable results. Modern biological mechanisms of treatment include adjusting intestinal homeostasis, delaying liver fibrosis, improving lipid metabolism and reducing the expression of inflammatory factors. [Conclusion] Through in-depth excavation of the clinical characteristics and modern biological mechanism of syndrome differentiation and treatment of NAFLD by the theory of “spleen deficiency and turbid coagulation”, it can provide a broader idea and method for the future treatment of NAFLD with traditional Chinese medicine.

关 键 词：非酒精性脂肪性肝病 脾虚浊凝 中医 临证特色 现代生物学机制 辨证论治 

分 类 号：R575[医药卫生—消化系统]