Clinical Research For The Treatment Of Fatty Liverby Invigorating Spleen And Soothing Liver As Well As Eliminating Phlegm Dampness

Background:With the transform of people's living habits and diet, fatty liver has been a common clinical disease. It has risen up to as the world's largest liver disease in place of viral hepatitis. The disease is more hidden, leading to liver fibrosis and cirrhosis, and even liver cancer. Therefore, it's of great clinical significance to detect and treat fatty liver as early as possible. Besides, more and more attention has been drawn from Chinese and Western medicine academy. Currently, it has been treated by modern medicine by means of diet control, weight loss and exercise therapy plus lipid-lowering drugs such as fibrates, statins, bile acid, methionine, nicotinic acid, etc., the effects of which are uncertain and even some of which are detrimental to liver functions. Today, there still lacks targeted drugs for fatty liver. Though no equivalence of fatty liver can be found in the dictionary of traditional Chinese medicine, there are quite a fewexpositions concerningetiology and pathogenesis and syndrome differentiation and treatment of fatty liver, which involve a wealth of theoretical studies and practical experiences. According to expositions made by ancient and modern physicians, the etiology of the disease lies in internal damp evil, phlegm accumulation, heat stagnation, stagnation of qi activity and stasis of liver collateralscaused byspleen failure, liver dysfunction, deficiency of kidney essence due to improper diet, inappropriateness of work and rest, emotional disorders and insufficiency of natural endowment. The disease is located in the liver related to dysfunction of spleen and kidney, presented by phlegm, dampness-heat, qi stagnation and blood stasis. Clinically, the disease is treated by soothing liver and strengthing spleen, removing heat and dampness, promoting blood and qi circulation, and good results have been achieved by a variety of therapies.Doctor Chen Fulai, the instructor of the author, has engaged in clinical work in traditional Chinese medicine for over 50 years. On the basis of previous theories and experiences, years of clinical practice has bestowed him with a wealth of clinical experience in medical treatment of fatty liver. He insiststhe disease is located in the liver, and spleen deficiency and liver stagnationare the basis of pathogenic mechanism, and sputum, wet and stasis are pathological factors, stressing that spleen plays a key role in development and progression of fatty liver. Professor Chen believes that the liver and spleen two dirty living in the coke, the spleen is the source of qi and blood, the main transport of water cereal essence, catharsis liver function depends on the spleen is normal or not. Stomach health movement, the normal transport of water cereal essence, the business of blood biochemical active, then the wood was raised, air reached, catharsis and orderly; if spleen deficiency, have no right to transport, soil obstruct wood Yu, stuffed phlegm wet, blocking liver network. Liver dispersion, bar qi, regulating the body's blood and body fluids lost cloth, to help transport and spleen. Catharsis liver function is normal, the human diet digestion, water metabolism and many other physiological activities capable of functioning; if catharsis liver function disorders, qi stagnation, wood is not sparse soil, spleen qi tribulations, spleen fails, transportation of blood and body fluids of metabolic disorders, tallow phlegm endogenous and the formation of fatty liver.According to dialectical thinking of simultaneous onset ofliver and spleen discomfort as well asspleen deficiency as the foundation, Chen stresses the principle of priority given to treatment of spleen by invigorating spleen and soothing liver and eliminating phlegmdampness. According to him, this disease is treated by tonifying spleen first supplemented by relieving the depressed liver andresolving phlegm and disinhibiting turbidity, combined with promoting circulation and removing stasis as well as removing heat and dampness, so as to achieve normal functioning of spleen, relieving the depressed liver, dissipating phlegm-dampness and eliminating stagnation and restoring fat metabolism.We also found a higher incidence of fatty liver in the region in the clinical work, and so it's of great practical implication to prevent and treat fatty liver in the region by further probing into his research ideas and clinical experiences in treating fatty liver with traditional Chinese medicine.Objective:To explore effective methods for treatment of fatty liver by clinical medicine by invigorating spleen and soothing liver as well as eliminating phlegm and dissipating dampness as the basis, and further exploring his dialectical thinking based on the efficacy of fatty liver treated by Chen's empirical recipe.Methods:60 patients were received by Yancheng Hospital of TCM from June,2014 to June,2015. Ultrasonography revealed all cases showed fatty liver at diverse degrees, presented by spleen deficiency and liver stagnation as well as phlegm dampness accumulation. The patients were randomly divided into treatment group and control group. They were asked to stop taking any other lipid-enzyme-lowering drugs, go on light diet, keep away from alcohol and have adequate exercise. The treatment group adopted invigorating spleen and soothing liver as well as eliminating phlegm and dissipating dampnessand applied Chen's prescription (Codonopsis 15g, Atractylodes 10g, Poria 10g, Pinellia 10g, tangerine peel 10g, Bupleurum 10g, Cyperus 10g, Polygonatum 10g, Cassia 10g, lotus leaf 30g, hawthorn 15g, salvia miltiorrhiza 30g), adjusted appropriately according to state of illness. The control group took polyene phosphatidylcholine 2# tid orally. Course of treatment:30 days for a course, a total of three courses. Main symptoms, serum biochemical parameters, improved conditions detected by B ultrasound as well as general safety indicators were observed before and after treatment, and results were analyzed by means of statistical methods.Results:Both groups were not statistically different (P> 0.05) in terms ofage, gender, disease duration, distribution and severity. The overall differences in efficacy after treatment in the two groupswere statistically significant (P<0.05), with efficiency of 86.7% in the treatment group better than the control group. Total scores of main symptoms were improved in both groups while improvement in the treatment group was superior to that of the control group (P<0.05). After treatment, hypochondriac pain, fatigue and abdominal distension in the treatment group were significantly improved (P<0.01) while the control group after treatment was improved to a certain degree (P<0.05); hypochondriac pain, fatigue and abdominal distension in the treatment were more improvedthan that of the control group (P<0.05). ALT was sharply lowered and significantly different in both groups (P<0.01) while no statistically different lay in the two groups after treatment (P>0.05). TC and TG in the treatment group were significantly differentbefore and after treatment (P<0.01), and TC and TG in the control group were statistically different (P<0.05), and TC and TG in the two groups werestatistically different after treatment (P<0.05). Analysis of efficacy detected by B ultrasound in both groups after treatment:total efficacy was 83.3% in the treatment group, and56.7% in the control group, and differences in efficacy in the two groups after treatment were statistically significant (P<0.05), and the treatment group was superior to the control group. Safety indicators among patients of both groups such as blood routine, urine routine, electrocardiogram, renal function tests showed no abnormality before and after treatment, without significant adverse reactions or side effects.Conclusion:Treatedby invigoratingspleen and soothing liver and eliminating phlegm dampness with the prescription made by Doctor Chen, clinical symptoms score and ultrasound image classification as well as serum biochemical indicators were significantly improved in the treatment group, therapeutic effect of which was superior to that of the control group. Significant adverse reactions or side effects were not found during the treatment; the clinical treatment of fatty liver was safe and effective.