基于痰湿瘀理论探究非酒精性脂肪肝辨治思路

Exploration of Diagnosis and Treatment Strategies for Non-Alcoholic Fatty Liver Disease Based on the Theory of Phlegm-Dampness and Blood Stasis

摘要: 非酒精性脂肪肝(NAFLD)是临床多见的代谢综合征之一，其定义为排除过量饮酒及其他明确肝损伤因素后，以肝细胞内脂肪过度蓄积为核心特征的临床病理综合征。该疾病具有较强的隐匿性，易被大众忽视，却会对人类健康构成严重威胁——不仅会累及肝胆系统，随着病情进展，还可累及心脑血管与血液系统，进而诱发动脉粥样硬化、高脂血症等并发症。非酒精性脂肪肝在中医范畴多归属于“肝癖”、“脂满”、“胁痛”等，其核心病机多与肝脾失调、痰湿瘀阻密切相关。现代社会中，过量饮酒、嗜食肥甘等不良生活习惯易致脾胃运化失常，膏脂堆积肝脏，使痰湿瘀等病理产物成为该病发病的主导因素。本文基于痰湿瘀理论溯源，结合现代人群致病特点，分析痰湿瘀理论与非酒精性脂肪肝的内在关联，并从痰、湿、瘀三种证型切入，探讨其辨证论治思路，以期为临床治疗提供新的理论参考与实践方向。

Abstract: Non-alcoholic fatty liver disease (NAFLD) is one of the common metabolic syndromes in clinical practice. It is defined as a clinicopathological syndrome characterized by excessive fat accumulation in hepatocytes, after excluding excessive alcohol consumption and other definite causes of liver injury. The disease is highly insidious and easily overlooked by the public, yet it poses a serious threat to human health. It not only affects the hepatobiliary system, but also can involve the cardiovascular and cerebrovascular systems as well as the blood system, with the progression of the disease, thus inducing complications such as atherosclerosis and hyperlipidemia. In traditional Chinese medicine (TCM), NAFLD is mostly categorized into the scopes of “Gan Pi (Liver Hypochondriac Lumps)”, “Zhi Man (Fat Stagnation)”, and “Xie Tong (Hypochondriac Pain)”, etc. Its core pathogenesis is closely related to liver-spleen disharmony and obstruction of phlegm-dampness and blood stasis. In modern society, unhealthy living habits such as excessive alcohol intake and indulgence in greasy and sweet foods tend to impair the transportation and transformation functions of the spleen and stomach, leading to the accumulation of grease and fat in the liver. Consequently, pathological products, including phlegm, dampness, and blood stasis, have become the dominant pathogenic factors of this disease. Based on tracing the origin of the theory of phlegm-dampness and blood stasis, combined with the pathogenic characteristics of modern populations, this paper analyzes the internal correlation between the theory of phlegm-dampness and blood stasis and NAFLD. Moreover, it explores the strategies of syndrome differentiation and treatment from three syndrome types—phlegm, dampness, and blood stasis, aiming to provide new theoretical references and practical directions for clinical treatment.