Reading guide in this issue
Miao Jing: The hands and feet are clammy and cold, and the palms are damp, beware of cold and dampness, and spleen-type fatty liver
Expert Profile
/ Prof. Miao Jing /
Chief physician of Tianjin Second People's Hospital, deputy director of the Department of Traditional Chinese Medicine, and supervisor of master's students.
He is the successor of the sixth batch of academic experience of national old Chinese medicine experts, and the person in charge of Jia Jianwei's National Famous Old Chinese Medicine Inheritance Studio.
Member of the Standing Committee of the Hepatobiliary Disease Professional Committee of the Chinese Association of Chinese Medicine
Member of the Infectious Disease Professional Committee of the Chinese Association of Integrative Medicine
Member of the Standing Committee of the Beijing-Tianjin-Hebei Infection Professional Committee of the Beijing Association of Integrative Medicine
Member of the Standing Committee and Secretary-General of the Infectious Disease Professional Committee of Tianjin Association of Integrative Medicine
Member of the TCM Liver Disease Professional Committee of Tianjin Association of Traditional Chinese Medicine
Member of the editorial board of the Journal of Integrative Medicine and Hepatology
He presided over the general project of the National Natural Science Foundation of China, participated in the national "13th Five-Year Plan" major scientific research projects, and published many SCI and Chinese papers.
Q: What is the pathogenesis and causes of fatty liver disease?
In recent years, the number of patients with fatty liver disease has increased year by year, and the patient population is getting younger and younger. At present, the pathogenesis of fatty liver is relatively complex and not fully understood, but the widely accepted theory is now the "second blow theory" or "multiple blow theory", which mainly involves the imbalance of fat deposition and fatty acid metabolism in the liver.
However, TCM has different understandings of the pathogenesis of fatty liver, and TCM focuses on syndrome differentiation and causal treatment, so it is necessary to first distinguish and classify the syndrome and adopt corresponding treatment strategies according to different etiologies.
For example, in addition to the common types of fatty liver type 4 or 5, there is also a type of cold-damp spleen-trapped fatty liver in traditional Chinese medicine, which is more common in clinical practice, especially in young people, but does not account for the majority. The main causes of such patients are usually related to lifestyle habits and poor diet, such as excessive intake of greasy and cold food, cold and evil in the internal organs to inhibit spleen yang; Staying up late in bed, long-term lack of sunlight, consuming yang energy; Blowing the cold air of the air conditioner directly, so that the cold evil is depressed and suppresses the yang energy. These undesirable methods inhibit the body's yang energy and can even damage the true yang of the spleen.
After the spleen yang is inhibited, the spleen cannot be cleared, and a series of phlegm and dampness symptoms will occur, such as the patient may have clammy hands and feet, damp palms, sweaty soles of the feet, and feel cold when touching the navel or less abdominal area of the patient's abdomen. Patients may complain of fatigue, heaviness in the limbs, and lack of energy. The typical appearance of tongue coating is cold and wet.
Based on these clinical manifestations, we may consider cold-damp spleen-trapped fatty liver, which is a general understanding of the pathogenesis of fatty liver disease in both Chinese and Western medicine.
Q: What are the principles of TCM treatment for fatty liver?
Regarding the principles of TCM treatment of fatty liver, there are many methods for different etiology and pathogenesis, syndrome differentiation and treatment. In addition to routine diet and lifestyle interventions, it is also necessary to take into account the situation of qi and blood, which mainly involves regulating the function of the spleen and stomach. Professor Jia Jianwei in our team is a disciple of Guan Youbo and Guan Lao, and we pay great attention to the movement and conditioning of spleen, stomach, qi and blood. Therefore, we also paid attention to the cold-damp spleen-type fatty liver that we just discussed. For this type of patient, in clinical treatment of this type of fatty liver, we will differentiate the syndrome and use Lingguishu Gantang and other prescriptions.
In addition, on this basis, due to the understanding of the pathogenesis just shared, Chinese medicine mainly believes that the spleen and yang are contained, so we usually use some traditional Chinese medicine to adjust accordingly on the basis of Ling Guishu Gantang. Some experts may believe that the situation of such patients is more complicated, and sometimes there are various conditions such as upper heat and lower cold are intertwined, so in clinical practice, it is also necessary to distinguish between syndromes and treatments, flexibly use methods such as dampness and phlegm, blood circulation and blood stasis, and guidance according to the situation to drive away evil spirits and clear yang, and skillfully use the Xinwen Tongyang method and the warm yang method to fix yang. We will add or subtract treatment according to the specific situation of each patient to achieve better results.
Q: Which Chinese medicines are widely used in the treatment of fatty liver?
In addition to conventional hepatoprotective drug therapy, lifestyle and behavioral interventions are the most important for patients with fatty liver disease. Therefore, we usually need to instruct patients to change their unhealthy lifestyle and eating habits. On this basis, appropriate drug intervention can be carried out, and some dietary therapy methods can also be used. For example, cassia and hawthorn can be used as appropriate in dietary therapy. In addition, we sometimes add or subtract ingredients such as orange (tangerine peel) and almonds according to the medicinal taste. In Ling Guishu Gantang, Poria cocos and cinnamon branch also play an important role, Poria cocos has the effect of pushing through the old and bringing forth the new, and the cinnamon branch has the effect of promoting yang in the basic medicinal taste, so it is often used as a representative prescription for fatty liver treatment in clinical practice. In the process of prescription medication, it is also necessary to pay attention to the dryness of Tongyang drugs, prevent dryness and hurt yin, and use adjuvants such as wheat dong and schisandra chinensis well, so as to achieve both rigidity and softness in medicine
In addition, there are also small recipes for dietary therapy, for such patients, we like to use ginger, brown sugar and jujube to boil water. However, if the patient has high blood sugar, dates and brown sugar are not suitable for use. After the application of this small tea recipe, there will be a significant improvement in gastrointestinal discomfort symptoms such as cold hands and feet and abdominal distension in patients with cold, dampness and spleen type.