吕兆镒　张月平　茹清静

[摘要] 通过整理茹清静教授对非酒精性脂肪肝病的病机、病理演变特点的认识及遣方用药等方面，探讨茹教授的学术思想及诊治经验。茹教授提出，非酒精性脂肪肝证候多属本虚标实，病位虽在肝，却与脾胃密切相关，治疗时当以健脾运脾，疏理肝气为大法，辅以利湿、化痰、活血等治法祛已成之邪，以求标本兼治。

[关键词] 非酒精性脂肪肝；茹清静；中医药；临床经验

[中图分类号] R259 [文献标识码] B [文章编号] 1673-9701（2018）10-0139-04

Clinical experience of professor Ru Qingjing in the treatment of non-alcoholic fatty liver disease

LV Zhaoyi1，2 ZHANG Yueping2 RU Qingjing2

1.The Second Clinical Medicine College， Zhejiang Chinese Medicine University， Hangzhou 310053， China； 2.The Second Affiliated Hospital of Zhejiang Chinese Medicine University， Hangzhou 310005， China

[Abstract] We discussed the academic thoughts and treatment experience of Professor Ru Qingjing， through the study of his understanding of pathogenesis of non-alcoholic fatty liver disease and pathological evolution， and the prescription use. Professor Ru put forward that non-alcoholic fatty liver syndrome is mostly asthenia in origin and sthenia in superficiality. Although the disease is located in the liver， it is closely related to the spleen and stomach. The major method of treatment should be tonifying and activating spleen， liver-qi regulation， supplemented by removing dampness， reducing phlegm and invigorating the circulation of blood， in order to treat both manifestation and root cause of disease.

[Key words] Non-alcoholic fatty liver； Ru Qingjing； Traditional Chinese medicine； Clinical experience

非酒精性脂肪肝病（non-alcoholic fatter liver disease，NAFLD）是一种除外酒精及其他明确的肝损害因素所致，以脂肪在肝细胞异位沉积为主要特征的临床病理综合征，疾病谱包括非酒精性单纯性脂肪肝、非酒精性脂肪性肝炎，及其相关的脂肪性肝纤维化、肝硬化及肝细胞癌[1]。NAFLD无对应的中医专属病名，但根据其临床表现可归为“胁痛”、“肝癖”、“积聚”、“肥气”等范畴[2]，其病因主要是过食肥甘厚味和缺乏运动锻炼[3]。21世纪随着人们生活水平提高和生活方式改变，NAFLD已成为全球重要的公共健康问题，且发病年龄呈低龄化趋势。

茹教授系国家级名老中医学术继承人，首批浙江省省级青年名中医，从事肝病及脾胃病临床研究近30载，在诊治非酒精性脂肪肝病方面积累了丰富的临床经验，余有幸随师侍诊，受益匪浅，现将其治疗非酒精性脂肪肝病的学术思想和临床经验总结如下。

1 病因病机

中医认为脂肪即膏脂，为水谷入胃受中焦脾胃之气所化生而成，是人体的营养物质，其正常代谢有赖于中焦脾胃的健运，在其他脏腑共同作用下输布充养周身。……