Literrature Review And Evaluation Of Literature Quality Of Fatty Liver Disease

Background:The standard of living increases with rapid economical development. The basic food pattern changes towards food consumption of high protein and high fats leading to the incidence of fatty liver disease increasing in regions with high economic development. Trend of younger age of onset is increasing. Other factors include work stress and lack of healthy nutrition. It has become the second largest liver disease, next to viral hepatitis. Therefore, this health risk requires more attention as the primary disease of the metabolic syndrome. Hence, the use of traditional Chinese medicine (TCM) treatment and positive control of Non-alcoholic fatty liver (NAFL) has an important significance.Objectives:Literature review of randomised controlled clinical trials treatment for NAFL in China. An evaluation of literature quality for each trial is carried out through individual assessment of research status, inherent problems and research methodology.Literature review of on clinical symptoms, patterns of syndromes and TCM treatment of Fatty liver diseases in China.This thesis aims to raise the standard of TCM treatment for fatty liver diseases and NAFL; as well as to provide reference for clinical practices and future research studies.Methods:Literature search covers China's large-scale Bibliographic Databases including CNKI, VIP, CBM. CMCI. The on-line search spans publications related to clinical symptoms, syndrome patterns, fatty liver disease, as well as TCM treatment for NAFL, published in the period between1995to2012. This literature search is further supplemented by manual search for other related studies. Chinese language is used in the search and keywords used include "Fatty liver","fat related liver disease"."TCM""treatment". Further cross search are carried out using the above keywords to avoid any omission. The search also includes articles quoted in reference section of the publications. The standard inclusion and exclusion criterion are applied to sill out unrelated literature.A literature information data collection form is designed to capture information such as article title, author's name, clinical symptoms, syndrome patterns, principle of TCM treatment, prescribed herbs, etc. Microsoft Office Excel2003software is used to create database on literature record tracking. Microsoft Office Access2010is used for statistical analysis. The literature quality evaluation follows the principles of clinical epidemiology and evidence based medicine (EBM).Results:1. Literature review of randomised controlled clinical trials treatment for NAFL in China.Out of a total collection of1055articles,849are eliminated due to repetition or irrelevance.39out of the206articles are obtained after applying the inclusion and exclusion criterion. The statistical analysis and evaluation of literature quality is carried out on15trials which adopt stringent randomised controlled clinical trial methodology. The analysis found that the common problems encountered in the literature include:repetitive studies, small sample size, lack of standardization for diagnosis and treatment measures, wrong method used in randomization, absence of follow-up observations on long term effect of treatment, lack of literature on assessment of side effects and incomplete statistics. The above factors greatly affect the creditability of the trial results due to low credibility and unconvincing data. Hence, there is a need for future research design for randomised controlled clinical trials to conform principles of clinical epidemiology and evidence based medicine.2. Literature review of on clinical symptoms, patterns of syndromes and TCM treatment of Fatty liver disease in China.Out of total collection of568articles,154articles are selected after discarding repetition or irrelevance applying the inclusion and exclusion criterion. Among these articles,152articles are related to treatment with TCM medicines;37articles record various syndromes between one to eight patterns;71articles studies the cause nature with49reporting excessive in nature,11on deficiency in nature,11on combination of both. The seven main syndrome types are internal dampness heatiness; qi deficiency/blood stasis; qi stagnation/liver stagnation; liver/kidney weakness; internal phlegm dampness; phlegm/blood stasis and liver stagnation/weak spleen. Other syndromes appear frequency less than10times.The statistical analysis of152articles on frequency of various herbs used in treatment shows among248herbs used in the treatment of fatty liver disease,15most frequently used of herbs are:"shan za","dang shen","ze xie","chai hu","fu ling","yujin","bai shu","ban xia","juemin zi","chen pi","dang gui","bai shao","da huang","he shou wu","yin chen hao". Main TCM syndrome patterns are liver stagnation/spleen wea,liver stagnation/qi stagnation,liver stagnation/blood stasis,spleen dampness,liver kidney/yin deficiency,spleen kidney/yang deficiency. The next12commonly used herbs are:"yan hu suo","zhi qiao","gan cao","huang qi","xiang fu","hu zhang","chi shao","cang shu","dang sheng","yi yi ren","chuan lian zi","hou pu". These herbs are mainly used for clearing of heatiness, blood stasis, dissolving of phlegm in cough/asthma. Also, there are other herbs used for qi nourishment, yin nourishment, qi management, clearing water dampness, external heatiness and wind dampness.In conclusion, there are many causes of fatty liver, most are due to a combination of excessive and deficiency in nature. The pattern of syndromnes is mainly due phglem/blood stasis, liver stagnation/weak spleen, internal dampness/heatiness, liver stagnation/qi stagnation, liver/kidney weakness. Hence the main TCM treatment principles would include liver soothing/strengthening spleen, improving blood flow/clear blood stasis, clearing of heatiness/dampness, nourishment of kidney and liver. Depending on individual's conditions, other supplementary methods include the clearing of phlegm, soothing of qi and promoting food digestion, etc.