基于临床对照研究文献探析代谢相关脂肪性肝病证治规律

Analysis of Syndrome and Treatment Rules of Metabolic Associated Fatty Liver Disease Based on Clinical Control Literature

目的:探讨中医药治疗代谢相关脂肪性肝病(MAFLD)的证治规律。方法:在中国知网数据库检索2012年1月1日—2022年1月1日关于中医药治疗MAFLD的中文文献,严格遵循纳入、排除标准进行筛选,得到符合要求的225篇文献,对其证候、证素、治法、用药进行多维度评价。结果:MAFLD临床多见肝郁脾虚证、痰瘀互结证、湿热内蕴证、痰湿内盛证、湿浊内蕴证5个证型;以气滞、气虚、血瘀、湿、痰、热为主要证素;以活血、化湿、健脾、疏肝、化痰为主要治法;常用药物有山楂、茯苓、泽泻、白术、柴胡、丹参、陈皮、决明子、甘草、半夏等,使用剂量多在10~15 g之间;常涉及二陈汤、四逆散、四君子汤、越鞠丸等。结论:气滞、气虚、血瘀、湿是MAFLD发病的关键,以实证和虚实夹杂证为主,攻补兼施是MAFLD的基本治则。

Objective:To explore the syndrome and treatment rules of Chinese medicine for metabolic associated fatty liver disease(MAFLD).Methods:Literature on using Chinese medicine to treat MAFLD from January 1,2012 to January 1,2022 were retrieved from CNKI.The literature were screened strictly following the inclusion and exclusion criteria.A total of 225 literature met the standards were obtained,and their syndromes,syndrome elements,treatment methods and medicinal use were evaluated in a multidimensional manner.Results:Five syndromes of MAFLD were commonly seen in clinical practice,including liver depression and spleen deficiency syndrome,binding of phlegm and stasis syndrome,internal accumulation of damp-heat syndrome,internal exuberance of phlegm-damp syndrome and internal accumulation of damp-turbidity syndrome.Qi stagnation,qi deficiency,blood stasis,dampness,phlegm,and heat were the main syndrome elements.The main treatment methods were invigorating blood,removing dampness,strengthening the spleen,soothing the liver,and resolving phlegm.The commonly used Chinese medicinals included Crataegi Fructus,Poria,Alismatis Rhizoma,Atractylodis Macrocephalae Rhizoma,Bupleuri Radix,Salviae Miltiorrhizae Radix et Rhizoma,Citri Reticulatae Pericarpium,Cassiae Semen,Glycyrrhizae Radix et Rhizoma and Pinelliae Rhizoma,with the dosage between 10 and 15 grams.Erchen Decoction,Sini San Decoction,Sijunzi Decoction and Yueju Pills were often involved.Conclusion:Qi stagnation,Qi deficiency,blood stasis and dampness are the key factors of MAFLD.The main syndromes are excess syndrome and deficiency-excess complex.The basic treatment of MAFLD is both attacking and supplementing.