中醫學對非酒精性脂肪肝的認識及治療對策.docVIP

中醫學對非酒精性脂肪肝的認識及治療對策 謝麗玉1黃賢樟2 （1香港中醫藥管理委員會註冊中醫師2香港註冊中醫學會副會長） 【摘要】目的：通過文獻研究形式，以深入探討非酒精性脂肪肝（簡稱NAFLD）的中醫病名，病因，病機，常見症狀，舌脈及證型；常用辨病及辨證論治治則，用藥及用藥配伍，常用辨病論治方劑以及中醫的療效等，並且了解單味/複方中藥實驗研究進展及其他中醫的治療方法，以較全面而系統地掌握中醫學對NAFLD的認識及治療對策。方法：查閱從2001年至2009年間的中文科技期刊數據庫和中國期刊全文數據庫，以「脂肪肝」及「非酒精性脂肪肝」為主題詞進行檢索。應用統計學方法，對符合納入及排除標準的文獻數據進行綜合歸納分析。結果：經統計分析，NAFLD最常見症狀為肝區不適。以「痰涎肝」為病名較為適合。最常見證型乃痰瘀互結。本病的病因主要與飲食不節，過逸少勞及情志不調有關，導致肝氣鬱結，脾氣虛弱，脾失健運，水穀水濕不能運化，濕聚成痰，內阻於肝，日久氣滯血瘀，形成痰瘀互結，同時可夾有濕熱。治則以活血，化痰，去濕，健脾益氣，疏肝理氣為主。基本方可用逍遙散合二陳湯(方中芍藥用赤芍)，再隨證加減用藥，並可配合針灸或肝病治療儀進行治療。結論：目前中醫藥治療NAFLD有一定優勢，但在治療及研究上仍有不足，今後宜加強進行中醫病因、病機、證型的流行病學研究及採用隨機、對照、雙盲的方法進行中醫療效的研究，規範實驗研究的操作，改良中醫劑型，對針灸推拿的療效進行深入的研究等，以進一步提高中醫藥治療NAFLD的療效，造福廣大市民。 【Summary】Objective：Through doing a literature review, an in-depth summary of the etiology, diagnosis, naming, pathology and treatment of Non-alcoholic fatty liver disease (NAFLD) is made. Method：According to literature search in China Journal Net and VIP from 2001-2009, 「Fatty liver」 and 「Non-alcoholic fatty liver disease」 were used as keywords. 139 literatures from the two databases were included in this study. Those literatures which met the selection criteria were under statistical analysis. Results：After statistical analysis, Abdominal discomfort was the most common symptom. NAFLD could be named as 「Phlegm liver」. Syndrome of intermingled phlegm and blood stasis was most commonly seen. Having unhealthy diet, bad mood and lack of exercises led to impeded flow of liver qi, deficiency of spleen qi and dysfunction of spleen in transport, resulting in the formation of the dampness and phlegm, which in turns leading to qi stagnation and blood stasis. In serious case, intermingled phlegm and blood stasis would be resulted. At the same time, damp heat might exist. Promoting blood circulation to remove stasis, resolving phlegm, eliminating dampness, invigorating the spleen and qi, soothing the liver and regulating qi might help to solve the problem. The basic formula could be the compound formula of Xiao Yao San and Er Ch