基于“态靶理论”辨治代谢相关脂肪性肝病  

Experience in Treating Metabolic Fatty Liver Disease Based on"State Target Theory"

作　　者：郝琦 卢晨霞 李晓东 肖明中[2,3,4] HAO Qi;LU Chenxia;LI Xiaodong;XIAO Mingzhong(School of Clinical Traditional Chinese Medicine,Hubei University of Chinese Medicine,Wuhan Hubei China 430065;The Affiliated Hospital of Hubei University of Chinese Medicine,Wuhan Hubei China 430061;Department of Hepatology of Hubei Provincial Hospital of Traditional Chinese Medicine,Hubei Key Laboratory of Theory and Application Research of Liver and Kidney in Chinese Medicine,Wuhan Hubei China 430061;Hubei Province Academy of Traditional Chinese Medicine,Wuhan Hubei China 430074)

机构地区：[1]湖北中医药大学中医临床学院,湖北武汉430065 [2]湖北中医药大学附属医院,湖北武汉430061 [3]湖北省中医院肝病科/中医肝肾研究及应用湖北省重点实验室,湖北武汉430061 [4]湖北省中医药研究院,湖北武汉430074

出　　处：《中医学报》2023年第10期2080-2084,共5页Acta Chinese Medicine

基　　金：国家自然科学基金项目(82274352);湖北省自然科学基金创新群体项目(2020CFA023)。

摘　　要：代谢相关脂肪性肝病(metabolism-related fatty liver disease,MAFLD)基本病机为脾失健运,水谷运化失调,气血生化乏源,导致肝体不养,肝“用”不足。脾胃为气机升降之枢纽,中焦气机阻滞,不能助肝疏泄,则可致肝郁气滞,最终导致“土壅木郁”。根据“态靶理论”,可将MAFLD归纳为“郁壅、湿热、瘀虚”三态,着眼于患者临床表现与异常检查指标,分别辨识症靶和标靶,将“宏观辨证”与“微观打靶”相结合,探讨各态势阶段相应的靶方靶药:“郁壅态”患者选用健脾化湿之法,常用健脾渗湿汤或苓桂术甘汤加减;“湿热态”患者应以泻热解郁,利湿化浊为主;“瘀虚态”患者治疗当以健脾益肾,活血祛瘀为主。The basic pathogenesis of metabolic-related fatty liver disease(MAFLD)is that the Spleen losing its healthy transport,the transport of Water and grain being out of balance as well as the lack of biochemical sources of Qi and blood,which leads to the liver's lack of nourishment and"dysfunction".Spleen and Stomach are the hinge of the ascending and descending Qi,and the obstruction of Qi in the Middle Jiao can not help the Liver to disperse Qi,which can lead to Liver depression and Qi stagnation,and finally lead to"stagnation of Earth and Wood".According to the"state target theory",MAFLD can be classified into three states:stagnation,Damp-Heat as well as deficiency and blood stasis.Focusing on the patient's clinical manifestations and abnormal examination indicators,the target and the syndrome are identified respectively,and the corresponding target drugs in each stage are discussed by combining"macro-syndrome differentiation"with"micro-targeting":for the patients in"stagnation state",the method of invigorating the Spleen and eliminating Dampness can be chosen,with Jianpi Shenshi Decoction Linggui Zhugan Decoction being used;patients in"Damp-Heat state"purging Heat to relieve depression and achieve diuresis to eliminate turbidity;the treatment of patients with"blood stasis deficiency",invigorating Spleen and Kidney,promoting blood circulation and removing blood stasis hould be focusd on.

关 键 词：代谢相关脂肪性肝病 态靶理论 郁壅态 湿热态 瘀虚态 靶药 

分 类 号：R259.751[医药卫生—中西医结合]