基于“土壅木郁”理论辨治非酒精性脂肪性肝病的临床经验

Clinical Experience in Differentiating Syndromes and Treating Non-Alcoholic Fatty Liver Disease Based on the Theory of “Earth Stagnation Causing Wood Depression”

摘要: 非酒精性脂肪性肝病(non-alcoholic fatty liver disease, NAFLD)是临床常见的代谢应激性肝损伤。本文系统阐述《黄帝内经》“土壅木郁”理论指导下辨治NAFLD及其活动期非酒精性脂肪性肝炎(nonalcoholic steatohepatitis，NASH；现亦称代谢相关脂肪性肝炎，MASH)的临床经验，提炼病机规律、辨证分型、治法方药与验案要点。方法以经典理论为纲，结合现代指南对NAFLD/MASH疾病谱、危险分层与生活方式干预的认识，归纳辨证治疗经验；从“脾土壅滞–肝木郁滞–痰瘀互结–肝络不利”的病机链条出发，总结运脾消壅、疏肝达木、化痰祛瘀、泄浊清肝等治法，并以示意性医案说明辨治思路。从“土壅木郁”论治NAFLD/MASH，重视肝脾同调与痰瘀并治，符合中医整体观和慢病管理特点；但仍需以规范证候标准、客观疗效指标与前瞻性研究进一步验证。

Abstract: Non-alcoholic fatty liver disease (NAFLD) is a common metabolic stress-induced liver injury in clinical practice. This paper systematically elaborates the clinical experience in diagnosing and treating NAFLD and its active stage, non-alcoholic steatohepatitis (NASH; currently also termed metabolic dysfunction-associated steatohepatitis, MASH), under the guidance of the “earth stagnation causing wood depression” theory from Huangdi Neijing (The Yellow Emperor’s Inner Classic), and summarizes the pathomechanistic patterns, syndrome differentiation and classification, therapeutic methods and formulas, and key points of case reports. Methods: Taking classical theory as the framework and integrating modern guidelines’ understanding of the NAFLD/MASH disease spectrum, risk stratification, and lifestyle intervention, the experience in syndrome differentiation and treatment was summarized. Starting from the pathomechanistic chain of “spleen earth stagnation—liver wood depression—mutual binding of phlegm and blood stasis—impaired liver collaterals,” therapeutic methods such as fortifying the spleen and resolving stagnation, soothing the liver and unblocking wood, transforming phlegm and dispelling blood stasis, and draining turbidity and clearing the liver were summarized, with an illustrative medical case to demonstrate the diagnostic and therapeutic approach. Treating NAFLD/MASH from the perspective of “earth stagnation causing wood depression” emphasizes the simultaneous regulation of the liver and spleen and the concurrent treatment of phlegm and blood stasis, which aligns with the holistic view of traditional Chinese medicine and the characteristics of chronic disease management. However, further verification through standardized syndrome criteria, objective efficacy indicators, and prospective studies is still required.