摘要:
近年来非酒精性脂肪性肝病(nonalcoholic fatty liver disease, NAFLD)的患病率不断升高，且已呈低龄化趋势。中医药是治疗NAFLD的重要手段，探索NAFLD的中医病因病机，规范中医治则治法，可为中医药治疗NAFLD提供思路及方向。本文通过对近几年的研究进行综述，将NAFLD的中医病因归纳为饮食失宜、劳逸失度、情志失调、高龄肾虚、体质因素、他病迁延及外感邪气；并根据标本虚实论从肝、脾、肾三脏功能失调及病理产物痰、湿、瘀三因来阐明本病发病机制。根据病因病机，将治则治法归纳为以治本为主的疏肝健脾、温阳利水、疏肝解郁、温肾升阳法与治标为主的化痰祛浊、活血化瘀法，以及标本同治的疏肝健脾，活血化瘀；疏肝解郁，清热利湿；清肝利胆，化痰祛瘀；健脾益气，化痰祛瘀；健脾益肾，祛瘀化浊五法。
Abstract:
In recent years, the prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing with a low-age tendency. Traditional Chinese medicine (TCM) is regarded as an effective therapy of NAFLD. The study on its etiology, pathogenesis, therapeutic principles and methods can provide new perspectives for the TCM treatments. This paper summarizes the progress in etiology of NAFLD with TCM in recent years, which can be concluded in the improper diet, overwork, emotional disorder, kidney asthenia of the elderly, TCM constitution, delayed disease progression and six exogenous pathogenic factors. Based on the theory of deficiency as primary and excess as secondary, the pathogenesis of NAFLD is related to dysfunctions of the liver, spleen as well as kidney and pathological products of the phlegm, dampness and stagnant blood. In terms of the pathogenesis and etiology, the therapeutic principles and methods can be divided into three points. Firstly, treating the primary focuses on soothing the liver and fortifying the spleen, warming yang for di-uresis, dispersing liver qi for relieving qi stagnation, warming kidney for elevating yang. Secondly, treating the secondary puts emphasis on resolving phlegm and eliminating turbid, activating blood and resolving stasis. Thirdly, treating both primary and secondary concentrates on soothing the liver and fortifying the spleen combined with activating blood and resolving stasis, dispersing liver qi for relieving qi stagnation combined with eliminating dampness and heat, purging liver and gallbladder combined with dissipating phlegm and removing blood stasis, strengthening spleen and replenishing qi combined with dissipating phlegm and removing blood stasis, invigorating spleen and kidney combined with resolving phlegm and eliminating turbid.