| In the past10years, the prevalence rate of fatty liver disease, especially non-alcoholic fatty liver disease(NAFLD)had obviously increased. The prevelence rate of fatty liver disease in parts of China and in foreign countries is close. In western countries, fatty liver disease has become the most common liver disease. In China, fatty liver disease also has replaced viral hepatitis as the most common liver disease trends. However, the clinical significance of hepatic steatosis is controversial. A long time, people think fatty liver disease is a kind of disease with good prognosis, especially when these fatty liver patients with normal serum aminotransferase. But in recent years, more and more studies have found fatty liver disease are closely related with many life-threatening diseases.Non-alcoholic fatty liver disease(NAFLD)is a chronic liver disease ranged from simple hepatic steatosis to non-alcoholic steatohepatitis(NASH), and insulin resistance plays a key role on the pathogenesis of NAFLD. High-fat diet is a single risk factor leading to insulin resistance and type2diabetes, also named as"lipotoxicity", which is characterized by increased body weight, elevated plasma FFA levels and abnormal accumulation of fat in insulin target organs, such as skeletal muscles, liver and adipocytes. Although both epidemiological and experimental researches have demonstrated the effects of high-fat exposure on insulin resistance in several insulin target organs, including skeletal muscles, liver and adipocytes, and the roles of insulin resistance on NAFLD, but the precise mechanism has not been fully elucidated yet.Non-alcoholic fatty liver and obesity are closely related. The study found that liver fat metabolism has related with the metabolites, hormones, cytokines and nerve media such as tumor necrosis factor-a, leptin, adiponectin and so on. Metabolism of fatty liver is not only the undesirable result of dysbolism, it can also trigger signal makes the normalization of liver fat metabolism. But it inevitably also changed the activity of cytokines, hormones and neural in the other organizations. These factors interact to cause neurohumoral and immune system dysfunction, leading to insulin resistance and metabolic syndrome happen.To date, both in vivo and in vitro studies have demonstrated that high-fat induced insulin resistance is accompanied with impaired activity or expression of several insulin signal moleculars, such as insulin receptor, insulin receptor substrate and GluT4etc, and this was proposed as possible contributors to high-fat induced insulin resistance. However, the upstream mechanism underlying such impaired insulin signaling caused by high-fat exposure remains unclear.The first part was to explore traditional Chinese medicine theory. Firstly, the nor-alcohol made the occurrence of fatty liver and physical endowments, and also link to weak spleen and stomach, diet and other factors. The weakness and diet irregularly may affect the occurrence of the disease, and the prognosis. Secondly, spleen deficiency and loss of transportation is the intrinsic disease-oriented basis, phlegm and blood stasis among pathological changes became the key to this disease, loss of health delivery spleen, liver qi catharsis deficiency, heat of spleen and stomach, endogenous phlegm, qi-stagnancy and blood stasis, which eventually lead to stagnation of qi, phlegm, blood stasis, plot in flank, disease in the liver and spleen, and kidney-related. Its pafhogenesis can be summarized as loss of liver qi catharsis, blood stasis; spleen dysfunction, kidney qi deficiency. Third, a help for the treatment of Yishen Yunpi Dafa, the disease is asthenia in origin and not asthenia in superficiality, it surely should nourish kidney, tonify spleen, activate blood circle and resolve the phlegm.The second part of clinical research. Objective:To observe the effects of Polyunsaturated phosphatidylcholine with Yishen Yunpi treating Non-alcoholic fatty liver (NAFL). Methods:90cases of Non-alcoholic fatty liver patients were randomly divided into three groups, which combines group1,30cases of Chinese medicine, group2,30cases of western medicine group, group3,30cases of Western and Chinese medicine treatment, three groups of patients were received treatment combined with general treatment. Group1was given Yishen Yunpi alone, group2with Polyunsaturated phosphatidylcholine; group3with Western medicine and Yishen Yunpi capsule. And evaluate the efficacy of three groups. Results:The combination of Chinese and Western medicines clinically cured30cases of group6cases,13cases of effective and ineffective in11cases, total effective rate of63.3%. Chinese medicine in30cases of group3cases of clinically cured,9cases of valid and invalid in18cases, total effective rate of40.0%. Western medicine group of30cases of clinical cure in2cases,11cases of valid and invalid in17cases, total effective rate of43.3%. Efficient compared three groups there was a significant difference significance, P<0.05. Conclusion:group3was comprehensively effective than western medicine and Chinese medicine alone, with significant improvement in clinical symptoms and reduce the effects of blood lipids.The third part is about experimental study. Objective:To investigate the mechanism of Yishen Yunpi decoction combined with Polyunsaturated phosphatidylcholine treating Non-alcoholic fatty liver disease. Methods:rats with Non-alcoholic fatty liver were randomly divided into normal control group, the experimental model group, treatment group of Chinese medicine, Western medicine in the treatment group and traditional Chinese medicine and western medicine combining group, respectively, observed rat serum lipids, liver body weight ratio liver pathological changes, insulin resistance and leptin. Results:Polyunsaturated phosphatidylcholine combined with Yishen Yunpi decoction can improve liver pathological circumstances in fatty liver rat model, reducing liver steatosis, lowering serum ALT, AST, TG and T-CH content, lowering weight, lowering leptin levels and improving insulin resistance index, we found that there was significantly superior to traditional Chinese medicine or Western medicine alone in the treatment group. Conclusion:Yishen Yunpi decoction combined with Polyunsaturated phosphatidylcholine may be related to lipid lowering to reduce liver fat deposition, protecting liver cells and improve the microcirculation of the liver.Through the clinical and experimental research, Yishen Yunpi Dafa and Yishen Yunpi Dafa combined with Polyunsaturated phosphatidylcholine were proved of good complex Non-alcoholic fatty liver disease curative effect, and to a certain extent, the mechanism was discussed. This study provides a new way and method, is worthy of further research and extension.
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