| Objective:1.The purpose of this study is to investigate the distribution of constitution types of Singapore’s non-alcoholic fatty liver disease(NAFLD)by questionnaire.At the same time,through the measurement of body mass index(BMI),biochemical index and liver B-ultrasound image,the correlation between Traditional Chinese Medicine(TCM)constitution type,susceptible constitution type and BMI,biochemical index and liver B-ultrasound image of NAFLD in Singapore was discussed,and the internal relationship between them was analyzed and summarized,so as to provide a theoretical basis for the combination of TCM constitution theory and clinical treatment.At the same time,we used TCM characteristics of "preventive treatment of disease" to prevent the occurrence and development of NAFLD in Singapore.2.On the basis of summarizing the diagnosis and treatment of NAFLD with traditional Chinese and western medicine,and summarizing the clinical experience of my tutor in the treatment of NAFLD for many years,combined with the physical characteristics of TCM of NAFLD in Singapore,starting from the etiology and pathogenesis of "Qi deficiency,phlegm dampness and blood stasis" of NAFLD,the clinical efficacy and adverse reactions of YIQIJIANPIXIAOZHI Decoction on NAFLD with syndrome of liver stagnation,spleen deficiency and phlegm dampness and blood stasis in Singapore were observed.We evaluated the efficacy and safety of TCM intervention in NAFLD from BMI,biochemical indexes,liver B ultrasound image and clinical syndrome score.Methods:1.Theory research1.1 Western medicine:starting from the macro level of western medicine’s understanding of NAFLD,this paper systematically analyzed the research progress of western Medicine on the etiology,pathogenesis,diagnosis,treatment and development trend of NAFLD,and deeply discussed the advantages and disadvantages of western medicine’s understanding of NAFLD so that it can provide theoretical basis for the prevention and treatment of NAFLD.1.2 TCM:starting from the ancient and modern understanding of NAFLD in TCM,this paper focuses on sorting out the relevant treatises on NAFLD in the important ancient books of TCM in the past dynasties and studied its academic origin and rules.In addition,this paper summarized the experience of modern Chinese medicine literature in the prevention and treatment of NAFLD in recent 10 years and made a comparative analysis with ancient medical books to find out the similarities and differences between them.At the same time,the research on the constitution of TCM of NAFLD was carried out.Guided by the ancient and modern literature of TCM of NAFLD and the constitution theory of TAM,the prescription principles of YIQIJIANPIXIAOZHI Decoction were established.2.Clinical research2.1 500 cases Singapore’s NAFLD were selected,through a questionnaire survey,we tested body mass index,biochemical index and B ultrasound result of liver on non-alcoholic fatty liver disease within Chinese patients in Singapore.After collecting data,we collected them to SPSS 20.0 statistical software to establish a database,we concluded the relationship between index cases of TCM constitution with BMI and other index,such as gender,blood lipid and liver function.2.2 I divided 100 qualified patients coming from questionnaire survey into 2 groups:there were 50 cases in therapy group,and they were treated with YIQIJIANPIXIAOZHI Decoction for 3 months.There were 50 cases in control group,and they were treated with Evening Primrose Soft gel for 3 months.Results:1.The patient’s normal circumstances within 500 selected cases.The most patients had one kind of constitution types,some people had two types,the others seldom had 1 or 3 types.Nonalcoholic fatty liver disease distributed regular pattern in Singapore that is directed by Wang Qi professor’nine TCM constitution types.The result of the percentage of the different constitution types was as follows:phlegm dampness>qi deficiency>damp heat>qi stagnation>yin deficiency>yang deficiency qualitative>blood stasis>gentleness constitution>special intrinsic quality.The total cholesterol(TC),triglyceride(TG),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were higher than the normal values.The patients with increased or decreased low density lipoprotein(LDL),high density lipoprotein(HDL)and glutamyl transpeptidase(GGT)were all present.After analyzing the correlation between the constitution of phlegm dampness,dampness heat and special intrinsic quality and BMI,it was found that the constitution of phlegm dampness,dampness heat and special intrinsic quality had increased BMI(P<0.05),and the risk of NAFLD was also increased in overweight and obese people.Those showed that special intrinsic quality,phlegm dampness and damp heat constitution had relationship with HDL lowering(P<0.05).Qi deficiency constitution had relationship with TG lowering(P<0.05).Qi Stagnation constitution,blood stasis constitution,damp heat constitution,phlegm dampness constitution and yin deficiency type’s AST were elevated(P<0.05).Blood stasis,damp heat,qi deficiency and yin deficiency’s ALT was elevated(P<0.05).Damp heat,Phlegm dampness and Qi deficiency’s GGT was elevated(P<0.05).It showed that patients with biased constitution often had elevated liver and serum transaminase,and the changes of AST,ALT and GGT were different due to the difference of TCM constitution classification.Qi deficiency was more common in women,phlegm dampness and dampness heat were more common in men.Phlegm dampness and yin deficiency were correlated with the severity of B-ultrasound,and phlegm dampness was more common in mild and moderate NAFLD(P<0.05).2.The total effective rate of the YIQIJIANPIXIAOZHI decoction group was 92%,and that of the Evening Primrose Soft gel group was 78%,both groups comparison’s difference is significant(P<0.05).it indicates that the overall efficacy of YIQIJIANPIXIAOZHI Decoction was better than Evening Primrose Soft gel.After treatment,the TCM syndrome scores of the two groups were both improved(P<0.001).The TCM syndrome scores of therapy group were better than those of control group(P<0.05).The clinical symptoms of two groups were both improved by treatment(P<0.05),and the therapy group was significantly better than the control group in improving the symptoms of heavy sensation in the limbs and body,distending pain in hypochondrium,abdominal fullness and distention,lack of appetite,loose stool and thin stool(P<0.05).After treatment,the body weight of therapy group was significantly lower than that of control group(P<0.05).After comparing the blood lipid levels(TC,TG,LDL)and liver and serum transaminase indexes(ALT,AST,GGT)of both groups before and after treatment,it was found that the two groups had significant regulating effects on reducing blood lipid,protecting liver and reducing enzyme(P<0.05),and the blood lipid and liver function of therapy group were lower than those of control group after treatment(P<0.05).After treatment,the severity of liver lesions in two groups were improved compared with that before treatment(P<0.05);After treatment,the score of liver B-ultrasound image in therapy group was better than that in control group(P<0.05).Conclusion:1.In the cases collected in this questionnaire survey,the distribution of TCM constitution types was as follows:phlegm dampness>qi deficiency>damp heat>qi Stagnation>yin deficiency>yang deficiency qualitative>blood stasis>gentleness constitution>special intrinsic quality.Phlegm dampness and dampness heat were common in men,while Qi deficiency was common in women.The patients with phlegm dampness and dampness heat syndrome had increased BMI,and the patients with overweight and obesity also had increased risk of NAFLD.HDL in phlegm dampness and dampness heat was lower than normal.The decrease of TG was often seen in Qi deficiency.Biased constitution was often accompanied by the increase of liver function index,but the increase of AST,ALT and GGT was not the same in different TCM constitution types.Phlegm dampness and yin deficiency were correlated with the severity of B-ultrasound,and phlegm dampness was more common in mild and moderate NAFLD patients.2.The two groups went through 3 months’ treatment.The result showed that YIQIJIANPIX-IAOZHI Decoction was better than Evening Primrose Soft gel in treating NAFLD caused by liver depression and spleen deficiency with Phlegm-dampness and blood stasis.YIQIJIANPIXI-OZHI decoction had better effects in reducing clinical symptom value,body weight,liver function,blood fats.It also improved the patient’s liver pathological change under B ultrasound test.YIQIJIANPIXIAOZHI decoction can dispel body fat plus enhance liver function and lower the ammonia enzyme.YIQIJIANPIXIAOZHI decoction is an effective Chinese medicine on treating NAFLD in Singapore. |
