从“六郁”论代谢相关脂肪性肝病的理论与临床实践

童光东; 孙屿昕

doi:10.12449/JCH241004

从“六郁”论代谢相关脂肪性肝病的理论与临床实践

DOI: 10.12449/JCH241004

童光东^{1, 2, , ,},
孙屿昕^{1, 2}

1.
广州中医药大学附属第四临床医学院，广东深圳 230038
2.
南京中医药大学附属深圳市中医院肝病科，广东深圳 230038

基金项目:

深圳市重点实验室计划 (ZDSYS20210623092000002);

广东省基础与应用基础研究基金重点项目 (2022B1515120034);

广东省名中医传承工作室建设项目 (Project of Guaugdong Province TCM 2020.1)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：童光东负责拟定文章思路，修改并最终定稿；孙屿昕负责查阅文献，参与论文修改。

详细信息

通信作者:
童光东， tgd755@163.com （ORCID： 0000-0002-8577-574X）

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- 文章访问数: 22
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- 被引次数: 0
出版历程
- 收稿日期: 2024-06-08
- 录用日期: 2024-08-01
- 出版日期: 2024-10-25

Theoretical and clinical practice of metabolic associated fatty liver disease based on the theory of “six stagnation diseases”

Guangdong TONG^{1, 2
, ,
,},
Yuxin SUN^{1, 2}

1.
The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine，Shenzhen，Guangdong 230038
2.
Department of Hepatology，Shenzhen Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine，Shenzhen，Guangdong 230038，China

Research funding:

Shenzhen Key Laboratory Program (ZDSYS20210623092000002);

Key Project of Basic and Applied Basic Research Foundation of Guangdong Province (2022B1515120034);

Project of Guangdong Province Traditional Chinese Medicine Inheritance Studio Construction (Project of Guaugdong Province TCM 2020.1)

More Information

Corresponding author: TONG Guangdong， tgd755@163.com （ORCID： 0000-0002-8577-574X）

摘要

摘要: 代谢相关脂肪性肝病已成为全球第一大肝病，包括单纯性脂肪变性，脂肪性肝炎，纤维化/肝硬化与肝癌，常与代谢综合征相关。其病理复杂，国内尚无新药上市。既往中医认识或从食，或从痰湿，或从湿热，或从肝郁脾虚等论治，但细致分析其疾病的病理过程与中医“六郁”理论相吻合。本文简要介绍了六郁致病理论的源流、导致脂肪肝的“六郁”病变特点，辨治要点与临床实践等，以期通过对代谢相关脂肪肝中医病机的深入认识，促进临床治疗进展。
- 非酒精性脂肪性肝病 /
- 郁证 /
- 中医病因和病机
Abstract: Metabolic associated fatty liver disease （MAFLD） has become the most common liver disease in the world， including simple hepatic steatosis， steatohepatitis， liver fibrosis/cirrhosis， and liver cancer， and it is often associated with metabolic syndrome. MAFLD has complex pathological manifestations， and there are still no new drugs on the market in China. In the past， traditional Chinese medicine often treated this disease from the perspective of food， phlegm-dampness， damp-heat， or liver depression and spleen deficiency， but a detailed analysis showed that the pathological process of the disease was consistent with the theory of “six stagnation diseases” in traditional Chinese medicine. This article briefly introduces the origin of the pathogenic theory of “six stagnation diseases”， the pathological features of the “six stagnation diseases” leading to fatty liver disease， the key points of syndrome differentiation and treatment， and clinical practice， so as to promote clinical treatment through an in-depth understanding of the traditional Chinese medicine pathogenesis of MAFLD.
- Non-alcoholic Fatty Liver Disease /
- Melancholia /
- Etiological Factors and Pathogenesis （TCM）

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参考文献(22)

[1]	YOUNOSSI ZM, KOENIG AB, ABDELATIF D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes[J]. Hepatology, 2016, 64( 1): 73- 84. DOI: 10.1002/hep.28431.
[2]	MAN S, DENG YH, MA Y, et al. Prevalence of liver steatosis and fibrosis in the general population and various high-risk populations: A nationwide study with 5.7 million adults in China[J]. Gastroenterology, 2023, 165( 4): 1025- 1040. DOI: 10.1053/j.gastro.2023.05.053.
[3]	Diagnosis and Treatment Center of Hepatology of South China Alliance of TCM, National Administration of Traditional Chinese Medicine. Diagnosis and treatment scheme of Ganpi(non-alcoholic steatohepatitis)[J/CD]. Chin J Liver Dis Electron Version, 2021, 13( 1): 1- 9. DOI: 10.3969/j.issn.1674-7380.2021.01.001. 国家中医药管理局华南区中医肝病诊疗中心联盟. 肝癖(非酒精性脂肪性肝炎)诊疗方案[J/CD]. 中国肝脏病杂志(电子版), 2021, 13( 1): 1- 9. DOI: 10.3969/j.issn.1674-7380.2021.01.001.
[4]	WANG WJ. Prevention and treatment of metabolic syndrome with integrated traditional Chinese and western medicine[J]. J Chin Integr Med, 2004, 2( 5): 390- 395. DOI: 10.3736/jcim20040524. 王文健. 代谢综合征的中西医结合防治[J]. 中西医结合学报, 2004, 2( 5): 390- 395. DOI: 10.3736/jcim20040524.
[5]	WEI ZP, GUO HM. Depression and blood stasis in metabolic syndrome[J]. Liaoning J Tradit Chin Med, 2006, 33( 7): 803- 804. DOI: 10.13192/j.ljtcm.2006.07.39.weizhp.026. 魏治鹏, 郭宏敏. 代谢综合征中的郁和瘀[J]. 辽宁中医杂志, 2006, 33( 7): 803- 804. DOI: 10.13192/j.ljtcm.2006.07.39.weizhp.026.
[6]	ZHANG AL. Qi stagnation and phlegm stasis is the basic pathogenesis of metabolic syndrome[EB/OL].( 2006-12-15)[ 2024-09-20]. http://www.100md.com/html/DirDu/2006/12/15/31/86/84.htm. http://www.100md.com/html/DirDu/2006/12/15/31/86/84.htm 张安玲. 气滞痰瘀是代谢综合征的基本病机[EB/OL].( 2006-12-15)[ 2024-09-20]. http://www.100md.com/html/DirDu/2006/12/15/31/86/84.htm. http://www.100md.com/html/DirDu/2006/12/15/31/86/84.htm
[7]	TONG XL, ZHANG ZY. Understanding and treatment of metabolic syndrome in traditional Chinese medicine[J]. J Tradit Chin Med, 2002, 43( 9): 708- 709. DOI: 10.13288/j.11-2166/r.2002.09.052. 仝小林, 张志远. 中医对代谢综合征的认识和治疗[J]. 中医杂志, 2002, 43( 9): 708- 709. DOI: 10.13288/j.11-2166/r.2002.09.052.
[8]	ZHAO TY, DUAN J, TONG XL. New thinking of treating diabetes with traditional Chinese medicine[J]. J Tradit Chin Med, 2002, 17( 5): 12- 13. DOI: 10.3969/j.issn.1003-8914.2002.05.009. 赵天豫, 段军, 仝小林. 中医治疗糖尿病的新思路[J]. 光明中医, 2002, 17( 5): 12- 13. DOI: 10.3969/j.issn.1003-8914.2002.05.009.
[9]	HU SP. Discussion on treating fatty liver from six stagnation diseases[J]. J Pract Tradit Chin Med, 2015, 31( 12): 1184- 1185. 胡四平. 浅述从六郁论治脂肪肝[J]. 实用中医药杂志, 2015, 31( 12): 1184- 1185
[10]	PAN XM. Pathogenesis and clinical investigation of metabolic syndrome based on six stagnation theory[D]. Jinan: Shandong University of Traditional Chinese Medicine, 2009. 潘小梅. 基于六郁理论对代谢综合征的病机探讨与临床调研[D]. 济南: 山东中医药大学, 2009.
[11]	TANG FR. Clinical observation on 62 cases of fatty liver treated with Chaihu Shugan powder[J]. J Sichuan Tradit Chin Med, 2008, 26( 4): 82- 83. 唐方荣. 柴胡疏肝散加减治疗脂肪肝62例临床观察[J]. 四川中医, 2008, 26( 4): 82- 83.
[12]	SU JC. Clinical observation on treatment of fatty liver with Gexia Zhuyu decoction[J]. Heilongjiang J Tradit Chin Med, 2006, 35( 4): 35- 36. 苏建超. 膈下逐淤汤治疗脂肪肝的临床观察[J]. 黑龙江中医药, 2006, 35( 4): 35- 36.
[13]	CHEN YL, CHANG JG. Jiawei Weiling Decoction in treating 56 cases of hyperlipidemia of spleen deficiency, phlegm dampness and middle stagnation[J]. J Sichuan Tradit Chin Med, 2008, 26( 11): 85. 陈佑林, 常建国. 加味胃苓汤治疗脾虚痰湿中阻型高脂血症56例[J]. 四川中医, 2008, 26( 11): 85.
[14]	ZHANG AL. Discussion on the formation of phlegm-heat and it’s causative mechanism[J]. China J Basic Med Tradit Chin Med, 2005, 11( 5): 388- 390. DOI: 10.3969/j.issn.1006-3250.2005.05.027. 张安玲. 痰热的形成与致病机理述要[J]. 中国中医基础医学杂志, 2005, 11( 5): 388- 390. DOI: 10.3969/j.issn.1006-3250.2005.05.027.
[15]	OUYANG L. Treating 47 cases of fatty liver with Jiawei Baohe pill[J]. Chin J Integr Tradit West Med Liver Dis, 2005, 15( 2): 109- 110. DOI: 10.3969/j.issn.1005-0264.2005.02.018. 欧阳亮. 加味保和丸治疗脂肪肝47例[J]. 中西医结合肝病杂志, 2005, 15( 2): 109- 110. DOI: 10.3969/j.issn.1005-0264.2005.02.018.
[16]	YANG DQ. 50 cases of severe fatty liver treated by Longdan Xiegan decoction combined with acupoint application therapy[J]. Guangming J Chin Med, 2008, 23( 3): 306- 307. DOI: 10.3969/j.issn.1003-8914.2008.03.028. 杨德全. 龙胆泻肝汤结合穴位贴敷疗法治疗重度脂肪肝50例[J]. 光明中医, 2008, 23( 3): 306- 307. DOI: 10.3969/j.issn.1003-8914.2008.03.028.
[17]	TANG HH, WEI CS, ZHENG YJ, et al. Evaluating the clinical effect of modified Shugan Xiaozhi Decoction in treating nonalcoholic fatly liver disease based on fibro scan technique[J]. J Tradit Chin Med, 2018, 59( 7): 594- 598. DOI: 10.13288/j.11-2166/r.2018.07.014. 唐海鸿, 魏春山, 郑颖俊, 等. 基于FibroScan技术评价疏肝消脂方加减治疗非酒精性脂肪性肝病的临床疗效[J]. 中医杂志, 2018, 59( 7): 594- 598. DOI: 10.13288/j.11-2166/r.2018.07.014.
[18]	YANG HL, FENG L, XU LY, et al. Intervention of Shugan Xiaozhi Decoction on nonalcoholic fatty liver disease via mediating gut-liver axis[J]. Biomed Res Int, 2022, 2022: 4801695. DOI: 10.1155/2022/4801695.
[19]	XING YF, ZHANG Z, FU WJ, et al. Shugan Xiaozhi Decoction attenuates nonalcoholic steatohepatitis by enhancing PPAR α and L-FABP expressions in high-fat-fed rats[J]. Evid Based Complement Alternat Med, 2016, 2016: 7870189. DOI: 10.1155/2016/7870189.
[20]	YANG R, YANG HL, JIANG DS, et al. Investigation of the potential mechanism of the Shugan Xiaozhi decoction for the treatment of nonalcoholic fatty liver disease based on network pharmacology, molecular docking and molecular dynamics simulation[J]. PeerJ, 2022, 10: e14171. DOI: 10.7717/peerj.14171.
[21]	CHEN MT, HUANG FR, CHEN BH, et al. A classical herbal formula alleviates high-fat diet induced nonalcoholic steatohepatitis(NASH) via targeting mitophagy to rehabilitate dysfunctional mitochondria, validated by UPLC-HRMS identification combined with in vivo experiment[J]. Biomedecine Pharmacother, 2023, 168: 115831. DOI: 10.1016/j.biopha.2023.115831.
[22]	WANG S, CHEN BH, DU RL, et al. An herbal formulation“Shugan Xiaozhi decoction” ameliorates methionine/choline deficiency-induced nonalcoholic steatohepatitis through regulating inflammation and apoptosis-related pathways[J]. J Ethnopharmacol, 2024, 329: 118127. DOI: 10.1016/j.jep.2024.118127.