脂肪肝中医证型流行病学调查及其中医病因病机初探

目的 据流行病问卷发现脂肪肝常见证型及各型所占比例，探讨各证型与客观指标的关系。方法 流行病问卷调查全国范围内脂肪肝患者503例，观察记录中医证候、体重指数(body mass index，BMI)、腹围／臀围、肝功能、血脂、B超或CT结果。结果 流行病学调查脂肪肝症状共46种，出现频率最高的前10位症状依次是乏力、体胖、口干、头晕、胁胀(痛)、腰酸痛、神疲、口苦、膝癀软、腹胀。舌象脉象分别以舌质淡胖、淡暗；舌苔白腻、黄腻；脉象弦细、弦滑多见。据聚类分析统计，脂肪肝中医证型为4类，分别是脾肾亏虚兼肝郁、脾肾亏虚、脾虚痰热、未定型，其中以脾肾亏虚兼肝郁最多见，占62．32％。结论 脾肾亏虚兼肝郁为脂肪肝最多见证型。脂肪肝病机为本虚标实，肾虚为本，涉及脾土，痰浊为标，兼有瘀血。

Epidemic Survey on TCM Syndrome Typing and Preliminary Discussion on TCM Etiology and Pathogenesis ofFatty Liver

To investigate the common TCM syndrome types of fatty liver by way of epidemic questionnaire, their occurrence ratio, and the correlation between various syndrome types and objective indexes. Methods A total of national wide 503 subjects with fatty liver were enrolled, the TCM syndromes, body mass index (BMI), abdominal perimeter/hip circumference, liver function, blood lipids, B ultrasonic examination and CT in them were observed and recorded. Results In the 46 symptoms investigated in total, the first ten symptoms in order of appearing rate were lassitude, obese, oral dryness, vertigo, hypochondriac distending pain, soreness and pain in loin, spiritlessness, oral bitterness, aching and weakness in knee and abdominal distention. The mostly appeared tongue figures were pale and corpulent or pale dim tongue proper, white greasy or yellow greasy tongue coating, and the mostly appeared pulse figures were taut, taut-thin and taut slippery. Statistical cluster analysis showed that syndromes of fatty liver could be typed into 4 TCM types, the asthenia Pi-Shen with Gan stagnation type, the asthenia Pi-Shen type, the asthenia Pi with phlegm-heat type and the unclassified type. A mong them the asthenia Pi-Shen with Gan-stagnation type was the commonest one, which accounted to 62.32 % . Conclusion The mostly appeared syndrome type of fatty liver was asthenia Pi-Shen with Gan-stagnation type. The TCM pathogenesis of fatty liver was deficiency of origin, mainly deficiency of Shen, involving Pi, with excess superficiality, the turbid-phlegm and blood stasis.