刘燕池：各位同道、各位在基层各个层面工作的中医工作者，今天很有幸受名医论坛医师学会的委托，我们又一次见面。这个题目是点题的，因为几次的名医论坛或者说主任医师峰会年会，认识了很多的咱们国内国外的一些朋友。普遍的有一些反映，就是说刘老师最近能不能给我们讲一下脂肪肝。所以这个题是命题文章，严格来说脂肪肝不是一种病，大家都说这个脂肪肝，脂肪肝就是现在非常常见的，因为富裕社会富贵病里，有一个很普遍的病症就是高脂血症，这个在西医内科学里和老年病学里，高脂血症是普遍的。但是这个脂肪肝仅仅是高脂血症的中间或者后期的一个病理变化。既然底下的一些同道有这样的愿望，而且确实现实也好，临床也好，脂肪肝太多了，普遍都是，到底怎么办？尤其富裕了以后，生活条件改善了以后，还有一些白领阶层，包括我们从事医务工作的这些各界同道，别看咱们是老中医，你也是老中医从事中医工作，那个脂肪肝弄不好，甘油酸酯也是普遍高的。根据这些问题，收集了一些资料，结合自己的看法和经验谈谈。目前来讲，关于脂肪肝的资料，有关各个杂志有一定的报道，但是大多数是零散的。没有一些什么系统的比较可以参考的，像其他的一些重点的疾病，那么完整的资料很少。书籍，我可能跟各位相比优越一些，无论文献资料还是临床报道比各位多一些，书籍大多数都是写科普的资料，薄薄的小册子谈一下脂肪肝，而且是高脂血症里谈脂肪肝。我们把脂肪肝目前在我们国家社会现在发展阶段，起码来讲2/3国土是处于富裕阶段，应该看到这。邓小平同志提到小康，您就说从中间画一条线，应该把西安、重庆、成都都得划在东边来，你说有多少地方已经超过了小康。这个是我们国家发展的必然趋势，也是好现象。所以今天能够把脂肪肝，原来是一种并病理变化，作为一个专题来看待，我认为也是好事，也说明了我们国家经济的发展和生活各方面的发展。所以跟大家又一次见面，非常高兴。下面我们就谈关于脂肪肝方面的问题。我列了几个标题，首先既然作为病症来谈，就有一个概念和临床意义。它到底价值如何，应该定义内涵应该怎么下？就是这样一个问题。脂肪肝是由多种疾病和病因所引起的肝脏脂肪性病理变化。就这么一句话，严格来说，到目前为止西医并不承认脂肪肝是一种病，只是高脂血症中间的或者偏后期的一种病理变化，但是中医临床，门诊也好，病房也好，都要求治脂肪肝，降血脂脂肪肝，脂肪肝在临床实践中，上升到作为一种病症疾病来看待了，任何事务的认识都不是决然的，刚刚有一个同志我在后面讲，有一个老前辈说，为什么叫传统医学。传统医学不是我们自己起的，我可以给大家解释。这是联合国世界卫生组织传统医学那一部分强给我们安上的。中医不是传统医学，中医在哪一个历史时期都是现代医学，什么叫传统医学，传统医学就是民族医学，就是自古以来传留下来的，和现代科学不能结合的各个民族医学，叫做传统医学。按照这样的定义我们中医符合吗？远远超过这个，我们仅仅是民族医学吗？或者仅仅是一些医疗技术的传留吗？不是这样的。我们紧跟着现代，而且一直服务于基层，怎么是传统医学。可是没有办法，他已经把你规定在传统医学范畴里来了，既使我们自己，包括我有点觉得不合适。可是你要归属于世界的，主要的潮流的话，我们说我们是如何如何否定你这个，对整个WHO来说是不行的。所以前些年，对这个问题我们很反感，现在你叫什么你叫，我们该怎么发展就怎么发展。首先说肝脏，肝脏是重要的消化器官和内分泌器官，这个里面，就是既然是作为一种病症，一种学术的专题来进行讲，那就要把各个方面，咱们都给各位介绍一下。对脂肪类的消化、吸收、气化、分解和转化起着重要的作用。而且在脂肪的气化过程里，是保持着动态平衡的。我这是中医学纯粹的学术报告，而且后面大家都看了，我这个投影，基本上就是那篇文章，但是我结合这个，谈谈我自己的一些看法。在正常的情况下，肝脏是有少量的脂肪的。肝脏不是说一点脂肪没有，一般只占肝脏总湿重的4%到7%左右，其中的中性脂肪，大家知道甘油酸酯占50%左右，就是少量的脂肪里，甘油酸酯占50%，其余是卵磷脂和少量的胆固醇，但是要知道，卵磷脂和胆固醇是有好处的，千万不说要胆固醇有一点也不行，那咱们认识就错了。在某些异常情况下，肝脏内的脂肪含量会增加，当其脂肪含量超过肝脏重量湿重的10%的时候，有个轻度、重度，超过10%的时候就成为脂肪肝了，超过10%到25%，叫做中度脂肪肝，超过25%到50%，就是重度脂肪肝。7%到10%就是轻度脂肪肝。大家可能提出一个想法，轻度也好，中度也好，仅仅从重量上来看，肝脏功能基本正常，千万不要认为脂肪肝了，肝脏功能全不正常了，那不行。为了解释这个问题，我们得延伸一下，人体的脂肪有两大类，一类叫中性脂肪，中性脂肪随着人体营养状况和机体活动多少而变化，你运动的比较多，脂肪就比较少，运动少了，沉积脂肪就多。一类叫做类脂，包括了磷脂、胆固醇和胆固醇脂，你看看这三类是人体细胞膜的重要组成部分。也是是合成我们人体类的胆盐、维生素D、类固醇激素的重要原料。脂肪肝的发病率近年来有上升的趋势，为什么？是不是都是吃的好了？也不完全是。主要由于人们对脂肪肝的认识不断加深，原来仅仅就是认为它是高脂血症中间的一个环节或者叫做病理变化，现在认识到越来越复杂，越来越单独的独立化，同时，由于实验室检测技术的飞速发展，不得不看到，我年轻的时候，没有这么多10项、30项的血液检测，有一些对我们中医临床仅仅具有参考价值，也并不是决然的。从而使脂肪肝更容易被发现或者诊断。就是原来的话，不太容易发现，诊断也有一定的困难，所以脂肪肝比较少。现在脂肪肝越来越多，当然也不可否认吃的各方面也是个问题。一般说来，脂肪肝是由于肝脏本身原因所致的。大多是肝脏脂质代谢其他的毛病，而脂肪肝形成程度的高低，在某些方面，也影响了其他病变的改善或恶化。一个是很多疾病最后能够导致脂肪肝，千万不要局限于我们吃的肥肉多了，不是那样，既使天天吃肥肉，里面某些转化酶，所谓的气化剂不失衡也不会胖。也是这样的道理。应当指出，对于脂肪肝的认识，开始并非认为是一种独立的疾病，只是一种由于各种原因所引起的肝脏脂肪蓄积过多的病理状态。脂肪肝是属于一种病理诊断，随着近年来医学影视显象技术的发展，具体来说就是CT、B超这个技术太发展了，所以发现了脂肪肝在某些人身上，并无明显的其他病变或者诱因。我没有得别的病，为什么突然一下出现了脂肪肝，而且有一定的临床表现，脂肪肝的概念逐渐发展成为疾病诊断而应用于临床，且越来越引起人们的重视。现在要求看脂肪肝的人越来越多。正常的脂肪代谢受到很多因素的影响，如饮酒、高脂肪食物、药物、内毒素、肿瘤坏死因子，无机鳌合物、激素变化和全肠道外营养等因。一般来说，食物脂肪经水解酶消化后被小肠上皮所吸收，其中的乳糜微粒，甘油三酯经分解后，转化为肌肉活动的能源，或者在脂肪组织中，又被转化为甘油三酯作为潜在的能源储存起来。也可被转运到肝脏进而进入代谢过程，通常肝脏内的甘油三酯与脂蛋白结合，以极低密度脂蛋白的形式排出，通过胃肠道排出脂蛋白，假如上述因素导致了甘油三酯的合成及其排泄失衡的时候，该排出的排不出去了，就会导致脂肪蓄积于肝脏而发病。这个病就是现在我们临床上普通的老百姓要求，脂肪肝有四种药，西药，大多数西药吃了以后，除了降脂以外，还有很多副作用，普通老百姓就认定中医能够解决脂肪肝，中医能够解决高脂血。普遍来讲，像高血脂症和脂肪肝是找中医来看，你怎么不找西医，西医也有几种药，但是吃完了以后，总是有这样或者那样的副作用。虽然医学论坛咱们是西医占主要成份，给中医的安排只有我们两个下午，但是我们也应该客观的来说这个东西。第二个标题中医学对脂肪肝的认识。中医没有脂肪肝这个病名，根据临床表现，是属于胁痛、肝着、肝壅、积证、痞满、痰痞等病症范畴。脂肪肝怎么搞成，普遍认为与肝郁痰湿存积有关。如《金匮要略》说心下坚，大如旋盘……积术汤主之。因而指出，肝胆气化失常，是引起气郁、血瘀、痰饮等病症之关键。我们说脂肪肝的病因我不过多引述古代医家的论述了。一般都认为是肝气郁结，疏漏失常，以致气机阻滞，横逆犯胃，气病及血，而致血流不畅，或肝病传脾，脾失运化，水湿贮留，日久生痰，以致痰湿交结。内郁于肝胆而发作本病，而某些肝炎病人，因病后过食肥甘，过分强调休息，亦可滋生痰浊，或因胁痛日久，肝脾肾功能失调，痰浊不能及时排除，羁留于体内，痰浊瘀血滞留于肝脏，从而形成脂肪肝病症。三，脂肪肝的形成原因及分类。脂肪肝的形成原因，主要有如下几方面。第一营养失调。如高脂肪或高胆固醇饮食，蛋白质缺乏，糖摄入量过多，以及某种维生素缺乏等，都是导致营养失调形成脂肪肝。第二是内分泌代谢失常。比如皮质醇增多症，甲状腺机能亢进症，妊娠，糖尿病，高碳酸血症和肥胖病等。第三是感染和炎症。常见的病原菌有结合菌，链球菌及某些厌氧菌等。第四是药物中毒，长期大剂量使用类固醇激素，生长激素等。第五，缺氧，比如心血管疾病，呼吸系统疾病以及严重贫血等。第六，某些先天性代谢疾病。如先天性痴呆综合等。第七，医源性疾病，多见于盲目要求患者进食高热量饮食等等。下面我的论述里，综合了一些材料，关于脂肪肝的分类，到底有哪些脂肪肝呢？总的来说就是脂肪肝，但是实际上不然。主要是区分为肥胖性脂肪肝，约有50%肥胖人群有脂肪肝。并不是说一胖就有脂肪肝，比方说我，我就是自己说自己，我从50岁左右以后，这个体重就是160多，到现在174、175没有减过。可是开始的时候，B超等等也曾经给我下过轻度脂肪肝，中度脂肪肝，但是近十几年来，我可以告诉大家，我喝牛奶，生活在大城市北京也好，早上起来总要喝牛奶，而且是高营养的多种维生素补充的。千万在座的各位，咱们都是中医的中坚，您不管是在基层还是在哪工作，保重自己的身体，为中医事业奋斗，在各位身上，包括我，我自己当然也是这样，我说一个现象。我喝蛋奶反酸，吃了奶以后，一上午打嗝什么都是反酸水。认识我的大家知道，我毕业以后，62年到1976年我在内蒙医学院工作，欣赏了蒙古的奶茶，我每天早上好伊利牌的牛奶，谁也没有想到把我的脂肪肝给降下去了。但是这个不是花茶，不是龙井，就是蒙族和藏族每天喝的专茶，当然高级专茶也是非常好的。确实最近几年乃至三四年检查没有脂肪肝，我看了B超反射倾向，确实没有这个密度不同的反射曲线，这就是非常好的现象，说明什么问题？说明某些茶和奶茶这一类对于降脂和脂肪肝，通过营养来解决这个问题，可能是一个途径。这是我现身说法。我也告诉找我看病的某些高级人物，你不愿意喝糖茶，最好喝奶茶，奶茶我开始喝不好，我说慢慢习惯了，习惯了以后缺不了。蒙古族的牧民早晨并不是说天天顿吃肉，哪有那么多，早上就是炒米和奶茶，喝饱了以后，下午三四点钟才四第二顿饭，回来了以后，也不渴也不饿，这是我附带说的一下。第二糖尿病性脂肪肝，占的发病率是5%到60%，而脂肪肝伴有糖尿病者的，则为25%到36.7%，酒精中毒性脂肪肝，有可能发展成为脂肪肝型肝炎和肝硬化，最后一蕾是营养失调性脂肪肝，包括营养不良脂肪肝和营养过剩性脂肪肝。药物性脂肪肝，很多药物通过肝脏发挥作用，用药不当可引发各种类型的肝损害。脂肪肝即是其常见的肝损害之一。还有一个肝炎后脂肪肝，就是目前我们还没有完全攻下来的乙型肝炎最容易发生脂肪肝，乙肝现在发病率很多，尤其是在南方的浙江、福建、广东几个省，高危人群挺多的。实际上这个问题，就是原来无黄胆型肝炎，在五六十年代，那会儿没有病毒分类型，当时就是一个无黄胆型肝炎，当时就是转氨酶降下来以后，肝功能回复正常就好了，现在随着肝脏检验技术的发现，弄了个两对半，这就麻烦了，一三五是急性乙肝，一四六是慢性乙肝，必须把二四五三个抗体搞成阳性，这个太难了，西医干扰素。中医负担太重了。临床上很多人得大三阳，小三阳都找中医，工科乙肝是三变阴，还是一变阴还没有看到准确的报告目前世界上。我提醒各位，临床上绝不打保票对三和一的转阴打保票。我们偶然的个案也是有的，但是你千万不要说是这个，这个说出去就有毛病，起码对现在肝炎发展趋势还不完全了解。肝炎后脂肪肝，妊娠急性脂肪肝是一种少见的预后不良的妊娠合并症，国内外均有报道，多在孕期三个月发病，其临床表现常与爆发性病毒性肝炎相类似。家先机能亢进性脂肪肝，炎症性脂肪肝，此外注入多种化学药物中毒，也是发生脂肪肝的重要原因，而家族性代谢疾病所伴有的肝脏类脂的增加，是形成脂肪肝的重要内在原因，总之，上述病因颇应值得重视和进一步研究。第四个大题目，就是脂肪肝与高脂血症的关系。什么叫高脂血症呢？就是指血浆或者血清中一种或者多种脂质的含量超过正常高限时的病症，一般以总胆固醇，低密度脂蛋白胆固醇增高，高密度脂蛋白胆固醇降低和甘油三酯增高为主要特征，上述血脂代谢的异常，是当前动脉粥样硬化，冠状动脉硬化性心脏病及急性心急梗死等早发的主要危险因素。上世纪90年代我国心脑血管疾病的发病率呈上升趋势，死亡人数约占总死亡人数1/3，其中脑血管病变占45%左右，这个与膳食、环境、心理等多种因素导致的血脂代谢异常密切相关。确实是很重要的。在引发继发性高脂血症的疾病和因素中，肥胖症占首要位置，尤其是40岁以后的肥胖症患者，其甘油三酯TG和极低密度脂蛋白VLDL的水平明显升高，这是导致脂肪肝的普遍因素之一。过去一般认为甘油三酯在肝脏的堆积是形成脂肪肝的原因，而甘油三酯转运出肝脏则有赖于磷脂的作用。也就是说，肝脏合成的内源性甘油三酯，是以极低密度脂蛋白的形式转运出肝脏，若肝脏生成极低密度脂蛋白障碍，则肝内的甘油三酯就不能以脂蛋白的形式运出肝脏，从而造成甘油三酯在肝内的堆积，形成脂肪肝。而磷脂与APO则参与了极低密度脂蛋白的组成，并对其稳定性起作用，所以磷脂及APO在脂肪肝的形成上亦具有一定的意义。我作为综合的简要的介绍一下，总之，脂肪肝是由肝脏极低密度脂蛋白代谢障碍而发生的继发性高甘油三酯血症。临床上还分为四个类型，临床上常见的，第四型高脂血症，叫较前b脂蛋白血症，常见于20多，多为家族性。而更多则是后天因素所引起而发病的。因此，脂肪肝与高脂血症是互为因果，密不可分的，故其两者在临床诊断和治疗方面亦是相互关联的。我事先说明一下，后面介绍的一些检查，从后面列的一些药物，当然是主要是脂肪肝，但是对高脂血症同样有效。第五大题目，脂肪肝的临床诊断和辩证分型论治。脂肪肝的临床诊断，主要依靠病史，临床表现和实验室检查，特别是B超和CT，CT太贵了，B超基本能确诊，确切的脂肪肝诊断，根据现代医学的要求，要求活检，这个病人接受不了，我们也不主张，中医更不主张。活检就来一个穿刺，肝脏上来上一个外伤这个受不了。现代医学不管肾脏病还是其他病就是讲究进行超薄切片，看看到底有什么变化，花了钱，最后也没有治疗方法。我最近就遇到好几个病人，大家知道肾病发展有一个新的类型，叫做系膜型ADA肾病，红血球三个加号到四个加号，但是蛋白很少。有些人胆量大，西医来讲你得了ADA肾炎了，不能生育了。有人你怀孕几个月，活检以后，你住院吧，这就是北京我的一个病人，见了面就哭了，介绍来的人家也是豁出去了，我就要一个孩子，这个话不能跟病人这么说，最后万一出了事我们有责任的。临床门诊病房，我们医务界的人，需要在某些方面保护自己。病史，有一个患病过程，一般没有明确症状，但是有疲劳，食欲降低，肝区不适或隐痛，恶心等等，病者可有长期饮酒史，或者有糖尿病，肥胖，营养不良中毒性肝损伤等病史。部分患者可触及肝肿大，并有轻度压痛或触痛。第二实验室检查，可有血浆球蛋白变化，特别是a1a2a3，及b脂蛋白增高，血消GGT，ALT，AST的活性轻度增高或正常，这些指标均非特异性变化。第三B超和CT检查，脂肪肝B超检查，可见肝实质呈微细致密的强反射广电，深部组织回升减弱，B超对重度脂肪肝的诊断率可达95%，CT扫描，显示肝脏密度比其他脏器等低下，一般认为其准确性优于B超。第四，肝活检，可对脂肪肝作出确诊。脂肪肝中医辨证论治，我根据我的经验，进行了筛选，临床上除了乙肝，甲肝已经基本上没有了。尤其这个生活条件好了以后，对脂肪肝有一个无名的恐惧。第一个是湿热蕴结型。主要是右协胀痛或胀满不舒，口苦咽干，形体肥胖，肢体重着等等，治法是清热利湿，疏肝化痰。方药，龙胆泻肝肠加减。这个我的文章上都有，大家看看就可以了。这个药物治疗肝炎后的脂肪肝，脂肪肝引起的急性肝炎发作。第二个类型叫做痰瘀阻滞型。一般是肝病，糖尿病日久不愈，形体肥胖，面色晦暗，纳呆口渴，肝脏肿大，肝区钝痛或刺痛，舌体胖大，或有瘀斑，舌苔白腻，治法，化痰散结，活血通络。方药，消癗丸合化积丸加减。以前不外乎当大夫的，或者病人一看你这不是马鞭吗？吸血虫的，我吃到胃里受不了，这个早就已经消毒了，泽兰，鸡内金，广郁金等等这些。第二种药物，就是温胆汤合桃红四物汤加减。它有陈皮、法半夏、云茯苓、桃仁等等这些，药物的量是我参考了一些资料和我自己的一些经验。主治脂肪肝性肝硬化，糖尿病性脂肪肝。第三种，肝郁气滞型。主要症状就是胸协胀闷，倦怠乏力，恶心呕吐，纳呆，便米，腹胀，舌质暗红等等，治法，疏肝健脾，理气活血。方药，柴胡舒肝散合金铃子散加减。主治肝炎后脂肪肝，酒精中毒性脂肪肝。第四种，痰湿阻络型。主症，形体肥胖，面有油脂，胸胁隐痛，汗出、乏力、舌质红等等特点。治法：理气化痰，祛湿泄浊。方药，涤痰汤合胃苓汤加减。主治肥胖性脂肪肝，肝炎后脂肪肝。第五种，肝肾阴虚型。主症，形体虚胖，毛发从生，面色油光，身倦乏力，手足心热，四肢微肿，舌质淡胖这些。治法是滋阴补肾，益精补血。方药一贯煎加减。大家可以看到我那篇文章都有，主治，皮质醇增多性脂肪肝，糖尿病性脂肪肝。第六大题，临床常用脂肪肝中药。有一些我们能够知道，有一些我们还不知道，这个药还有这个作用。第一个就是枸杞子，对脂质代谢或抗脂肪肝有比较好的作用。主要是因为其中含有甜菜碱。能在体内甲基供应体的作用。第二泽泻。可以使高胆固醇和高脂肪饮食所造成的家兔模型肝中的脂肪含量明显降低，表明具有抗脂肪肝作用，其提取物中含有胆碱、卵磷脂、甲硫氨酸、维生素B12、生物素、甲酰四氢叶酸以及不饱和脂肪酸等多种去脂物质。第三，菌陈。动物实验表明，治疗组肝细胞肿胀，气球样变，脂肪变性与坏死，均较对照组有不同程度的减轻，肝细胞糖元与核糖核酸含量有所恢复或接近正常，血清谷丙转氨酶活性下降，说明具有保肝作用。第四蒲公英。对四氯化碳肝损伤动物模型，有较明显地降低血清谷丙转氨酶和减轻肝脂肪变形的作用。第五，柴胡。对用伤寒疫苗引起的动物模型肝功能障碍，有较明显的改善作用。第六，垂盆草，对大鼠或小鼠四氯化碳所造成的肝损伤及坏死，有一定的保护作用，其脂肪变性及纤维化的程度，均较对照组为轻。第七，地骨皮，动物实验证明，地骨皮浸膏可使血清胆固醇下降，与对照组相比有显著差异，其所含的甜菜碱有抗脂肪肝作用。第八，山楂。可减轻脂类在器官内的沉积，其醇提取物有明显降低兔血清胆固醇含量的作用。第九，甜瓜蒂。具有降转氨酶，抗脂肪变性作用。具有防止肝硬化的作用。关于葫芦素B能否促进胶原酶的活性，促进胶原纤维降解和吸收，则有待进一步研究。第十人参。对动物和高脂血症患者的高密度脂蛋白胆固醇的增加和脂肪肝有明显改善作用，其机理可能与人参促进肝中甘油三酯的降解有关。第十一大蒜。大蒜汁和大蒜油，有效地降低高脂血症患者的血脂水平，新大蒜的抗脂肪作用较为明显。第十二绞股兰，实验证实，绞股兰具有明显的降血脂作用。第十三蒲黄。临床应用及实验证实，蒲黄能明显降低高血脂病人的胆固醇，降低甘油三酯，降脂作用可能是通过抑制食物中的胆固醇的吸收所致，以生用为宜。第十四，姜黄。具有降血脂，降胆固醇和抗动脉粥样硬化作用，曾有报道，用姜黄治疗高血脂症90例，其降低血清胆固醇和甘油三酯的有效率，分别为95.5%和100%。第十五，就是决明子。具有明显的降血脂作用，可能是与其所含的大黄素成份有助于促进肠蠕动，抑制了胆固醇的吸收有关，一般用决明子25g，水煎服，每日一次，即能取效。第十六，月见草。含有丰富的亚麻酸，亚油酸，油酸，硬脂酸等。具有明显的降血脂作用，尤以降甘油三酯为最佳。并能提高高密度脂蛋白和胆固醇浓度。第十七何首乌，何首乌粉剂可使高脂动物血清胆固醇，甘油三和b脂蛋白下降，还可使血清游离脂肪酸和肝脏过氧化脂质显著下降。故常用于各种脂肪肝和病毒性肝炎的治疗。何首乌是好药。此外不是光介绍17种就完了，通过临床和实验研究，其他如虎杖，灵芝、金银花、绿差、三七、大黄、海藻、昆布、葛根、郁金、女贞子等药物也有某些降脂疗效。我所掌握的这些资料，不足以上这17种，也许以后这里可能能够出现几个高的效果比较好的，那以后再说。第七，也是凡听讲者，大多知道药物以后，您最好给我几张方子，我回去在临床上应用应用。这是可以理解的，通过综合资料提出这么几个。一，降脂益肝汤。后面有应用，以及出处都有的。这个用的泽泻20g到30g。生首乌15g到20g，草决明15到20g，丹参15g到20g等等，这个上面都有。功能清热利湿，活血通络，主治肥胖性脂肪肝。它的这个临床观察38例，治疗四个月，临床治愈19例，总有效率94.7%，出处是中医杂志1985年，目前某些杂志在它的疗效上有夸大之嫌，中医写文章有水分，经常老怕认为我这套东西是无效的。其实不然，这是1985年这是较前的。这就有可信之处。当然后面还有92年、94年，九几年的也可以。第二是软肝消积散，这组药物就不说了，这里有一个白花蛇舌草，还有一个川山甲，这里还有一个猫人参，其实生首乌、决明子、山楂本身泡茶就可以降脂。猫人参就是我们现在吃的猕猴桃的根，民间草药，功能清热解毒。临床观察肝病脂肪肝98例，2至5个疗程，治愈82例，总有效率为96.9%。出自浙江中医杂志。第三个是祛脂汤。这组药大家可以看到，山楂15g，草决明15g。浙贝姆是一个非常好的药，还有化脂散等等这些，功能去除痰祛瘀，清肝消脂。主治肝炎后脂肪肝。临床观察治疗脂肪肝32例，有效率百分之一百。这个资料我当时就想用不用，用的话有用的弊病，一听有效率百分之一百，就全能好，不过可以理解，因为脂肪肝严格来说，并不是要死要活病，只要有效率，有效率降一点也可以。第四宋氏自拟方。这个是宋福印河北中医杂志1991年的。这个是用的这样一些药物。第五大黄虫丸，功能活血化瘀，主治肥胖兼有瘀血性脂肪肝，临床观察肥胖体制合并脂肪肝患者70例，总有效率94.3%，这是出自四川中医1990年。第六这个韩吴氏自拟方，这个是发表在1988年的天津中医杂志。这个有效率是85%。第七，消脂散，主治肝炎后脂肪肝，临床观察18例，总有效率94.5%，取自实用中医药杂志1994年。第八，降脂调肝汤。这个里面有一个药生大黄3g，3克大黄干什么用？3克大黄是降气积，作为临床经验来讲，我可以告诉各位，你不管是虚湿寒热什么体制，只要大便不太通畅，或者大便不怎么太合适，首先问一下大便拉完了以后，肚子是不是非常舒服，如果还想拉，就再来一点，起作用还是不错的。主治肥胖性脂肪肝，临床观察30例，显效17例，有效9例，总有效率86.66%，出自江苏中医1996年。
第九，关幼波经验方。功能祛湿化痰，舒肝利胆，活血化瘀。主治肝炎后脂肪肝。取自关老临床经验集。第十仙胃苓汤加味。这个就是生山楂，熟山楂各120克，30克是一两，120克是四两，生山楂4两，熟山楂4两，加在一起就是8两。这个也了不得，有它的特殊性，所以才选的。主要治疗脂肪肝性肝硬化。第十一邢锡波经验方，主要功能是治脂肪肝。功能疏肝理气，祛痰通络。出自邢锡波医案选。第十二李普经验方，功能健脾利湿，温阳益气。主治肝肾阴虚型脂肪肝。出自医案丛书肝病。第十三化脂通络汤。这是刘艳娇自拟方，这个功能是化脂消痰，主治肥胖性脂肪肝。第十四脂必妥。这是成药，中医成药往往有这样一些毛病，开始时候红火一时，最后完了以后，中间有一个低潮，甚至无声无息，自销自灭。这是中药成药发展的一个现象。主要成份为红曲0.35g/片，每服3片，每日三次口服，连用6周为一疗程，聂辉用脂必妥临床观察脂肪肝42例，显效26例，有效12例，总有效率为90.5%。第十五。柴胡疏肝散加减方，这个功能是疏肝理气，活血化瘀，主治酒精性脂肪肝，临床观察60例，治愈32例，显效8例，有效18例，总有效率为96.7%。有关方和药就给大家介绍到这。第八脂肪肝的预后及预防脂肪肝的常用视疗和药膳。脂肪肝的预后一般良好，凡单纯性脂肪肝，一般不会发展成肝硬化或肝癌。但若合并慢性肝炎，酒精性肝炎，中毒性肝炎者，则有可能引发肝硬化。有些病人到我这来看了以后，谈到这样的现象，我这已经治疗了好长时间了，我是外地的什么地方的，我从来都是这样，哪些人开的方子你不用告诉我，也不要让我来评估，哪些方子对错的问题，这有一个医德问题，但是病人有这样说，说是这个脂肪肝的问题，我已经是中度了，我会发展成重度，有人就说我已经肝硬化了，以后非得肝硬化不可，以后非得得肝癌不可。有这样一些现象。我请各位同道，今天共同探讨的各位同道，咱们不说这个话。就是一般的情况下，单纯脂肪肝是很少发展成为肝硬化或者肝癌的，你说一例没有，我也不保险，但是文字为证，我敢这么写就是有出处。发生肝硬化的机率，大约需要10年时间，关于肝癌到目前为止尚未见到脂肪肝癌变的报道。中医是现代科学，我们不是传统的，民族的。民族的是没有体系的，没有理论的，仅仅是偏方偏药，关于脂肪肝的预防，祛除病因和调整饮食，至关重要。消除病因是防治脂肪肝的根本原则，如酒精性脂肪肝在于首先要戒酒，糖尿病性脂肪肝，在于积极治疗糖尿病，肥胖性脂肪肝，在于有效控制体重，营养失调脂肪肝，在于调整营养物质的供给。同时应避免各种有毒物质对肝脏的损害，轻度脂肪肝，大多数在祛除病因后，即可获得好转。关于中药的食疗。常用的具有降脂作用的中药，如决明子，山楂等等可影响与胆固醇代谢有关的酶及抑制肝内甘油三酯的合成，从而降低血中总胆固醇，改善肝脏脂肪代谢，可多食用。它如枸杞子，葛根、马兰等多具有保肝祛脂作用，也可较多食用。常用蔬菜中有祛脂作用者，如大蒜，大蒜是好东西，尤其欧洲北欧把大蒜作为一个大蒜节来看待，芹菜、紫菜、香菇、还贷等，也可在饮食中，增加其食入量。而食品类如燕麦、荞麦玉米等均有降脂降胆固醇作用，番薯有利于润肠通便，可将肠道内过多的脂肪、糖、毒素等排出体外，从而起到降脂作用，宜多食用。一般听到这的，都是说你给我介绍几种，画龙点睛，也不是这四种就是最好的。你给介绍几种。关于对肥胖型高脂血症和脂肪肝预防有效的药膳，则介绍如下有几种。
莲子萝卜薏仁粥。功能健脾利湿。下气消痰，适用于肥胖型高脂血症和脂肪肝。第二莱菔子粥，功能下气消痰，养胃健脾，适用于痰湿阻滞型高脂血症和脂肪肝。第三苦芹菊花汤。功能清热降压，消脂降糖，适用于肥胖型高脂血症脂肪肝，尤宜伴有高血压患者。第四就是魔芋精粉。魔芋粉富含葡萄甘露聚糖纤维，热能很低，并有较大的膨胀性，可取代部分热源食物，增加饱腹感，每日用10g魔芋精粉，制成食品食用，功能减肥降脂，适用于超重肥胖型高脂血症及中度或重度脂肪肝。有关杂志的报道就没有整个写进去，因为这是一个专题讲座稿，并不是要发表的一个什么东西。我给各位介绍中医学对于脂肪肝的治疗和预防就到此，谢谢各位。and work. Many classes established the duty monitor system, let every students have class member services and for the class the opportunity to work, this is not a fixed position of the monitor system of rotation, which not only can let the monitor on duty in a day's work for class service work, also can let students know more of the solution in the class, every student can learn. And the class cadre conference held regularly. Pay attention to class and major incidents in the recent, Concerned about the class need to help students and make the class committee work plan and the new division.A good class of 4..Each class in the formulation of the goal, the class of the Convention at the same time, pay more attention to the class a good class construction work class. The class construction is the pillar industry of class education work, to perform the correct public opinion guide guide, schools, teachers' education intent can be more smoothly issued, strict execution. Discipline, clean environment, learning atmosphere, most students with emotional attachment and collective identity, and consciously safeguard the collective honor and so on. We must first establish a collective concept, the formation of "we are the best", and "I win glory for the class" collective concept, then do the selection of class cadres Appointment work. Finally, we must adhere to the positive guidance, set up the correct example in the class.5 class warm atmosphere to create a warm atmosphereRegularly engage in various small activities in the class, such as class members birthday, so these usually small activities can become the lubrication class work, the formation of heavy important part of team cohesion.B, material carrier1, classroom environmentOne of the material carrier class culture in the classroom environment, custody arrangement and class a variety of hardware facilities and perfect, the following is the class certificate, notice.Concise typeThe classroom inside decoration small, quiet harmony learning environment. The usual props: students of their own creation painting and excellent articles and class certificates, inform the knowledge.Warm typeIn the classroom can make the class more decorative ornaments, a warm warm feeling of home. Every member of all will participate in the layout and landscaping of the process to use props: collective action. Photos, photos of various kinds of students, small decorations, potted plants and so on.Festival typeA simple method and warm, usually a simple layout of the classroom clean, but in every festival or major activities will be arranged and re decoration cloth on the classroom. The usual props: Jie Qingqing theme decorations, blackboard, ribbon, Christmas tree, window and so on.2, class slogan, logo, class, class songEach class for their struggle direction and goal force and put forward the corresponding slogan, emblem, subject to production class and class song creation is one students of various class loading to highlight the personality mode.3, class logIn the class log records every class of what happened, the true sense of the expression of feelings and thoughts, the exchange of thoughts and feelings. The class log has authenticity, communication flow and rich and colorful, so this to create a healthy, positive class culture and public opinion atmosphere is very important.4, class team, class small band and so on.The students practice according to their own strengths, not only in class, to show a variety of school activities in the skill, but also enhanced the mutual affection and friendship, but also cultivate interest interest and ability, and excellent to enrich students' campus life, this is the students' independent development, very good way to self management.5, class teachingThe formation of teachers, students, teachers in teacher-student interaction scenarios. Understanding the teacher teaching or spare time, and teachers can become friends. When students listen carefully, assiduously, extracurricular foreign teachers and students as a friends sincere exchange flow. Whether it is learning, work is life, have the interaction between teachers and students, enhance the students, friendship, understanding and cooperation.6, class pageThe enthusiasm of the class web fully class students, their photos, photo, articles, etc. according to the information of interest, hobbies, aesthetic beauty and other factors constitute the class of "out with style, encourage each class in the school web game, in the game communicate with each other by the exchange of learning, to explore for expertise in web design students, and excellent web page links to the school homepage, showing the flow characteristics and style of each class, for all to enjoy.7, publicity column, black blackboard newspaperEach class in the classroom layout, beautification process will be in the publicity column, some innovation and breakthrough in the process of the blackboard. Some classes will be used in the social practice, military training, basketball, sports in the photos posted on the bulletin board or blackboard, some students will learn calligraphy class the works, for exchange and appreciation to the students in the publicity column and blackboard. In addition, the class blackboard design also create new styles. There are some things some classes, the class in recent writing on the blackboard, there will be some class class slogan, the objectives of painting in the struggle on the blackboard.C, specific activity1 regular class activitiesMany classes will often organize class class in the holiday party, to be in nervous at ordinary times more than learning can easily more, better communication and communication between each other, in order to increase the understanding and feelings, enhance the class cohesion setting.2 class volunteersMany organizations volunteer to class activities, every holiday, the class of alternate students will go to some communities, the elderly, some school or kindergarten, primary school to carry out volunteer service. Or to help the community, street cleaning cleaning, filing, board newspaper publicity and other things. Some of the class is arrange the students to go to kindergarten or small school compulsory counselling, usually with classes, extracurricular knowledge to help more students in lower grades have difficulties or learning difficulties of the students, and the students actively participate in the city, District, the volunteer activities organized by our school.3 loving actionPart of the class and the poor old man, or that some poor students in poor areas became trapped on the poor peers, as well as students are free on the streets to raise money or sponsored charity in the campus and other activities to help the people who need help.4 warm classEvery holiday or with the classmate's birthday, the class held a simple ceremony to celebrate the birthday of the students, give blessing and birthday gifts, not only enhance the students understanding between the solution and feelings, is a good method of class cohesion cohesion and class culture.5 autonomous learningSome classes than pay more attention to the common progress of students academic performance in the class, to help each other in school or holiday period, autonomous learning. Take "one to one" structure for learning methods, to achieve common progress with the purpose and effect. And the establishment of students' autonomous learning class adviser asked group, a real school self learning and learning mode.6 art activitiesClass art, sports and other activities are also very rich and colorful, the students will arrange spare time to rehearse chorus, recitation, aerobics, gymnastics, the activities in the school to get good grades but also to show their talents and efforts, such as the positive class team in the basketball game. Not only can eliminate the fatigue and tension of learning, can enhance students, between teachers and students together.The 7 main theme class meetingEach class regularly held open meaningful theme class meeting, through the distinctive theme, rich and colorful activities, the interaction between teachers and students in the ideological education to students ideological purpose, and the theme class meeting of written materials, pictures, data file.8 group activitiesRegularly organize students to watch the same movie, visit the museum and so on, so that the students in the rich extracurricular life, an increase of knowledge. There are often organized class activities, including condolences to solitary elderly, participate in various activities such as neighborhood living, have played a very good self education effect.Parent committee1, organizationThe parent committee is composed of representatives from each class of students' parents, and is the supreme authority of the Council. It is set up by the Standing Committee and the grade group.The Standing Committee shall be elected by the members of the parent committee of the year grades, and the director shall be elected one, 22 deputy directors and 10 members.Parent Committee Liaison Office: XX City No. 1 middle school moral education office, Tel:: 369266872, ,The members of the parents Committee have the right to participate in the activities of the school's parent committee.The members of the Committee of the parents have their views and suggestions on the work of the school, and the right to supervise and improve.Under the arrangement of the Senate, the members of the parents Committee have the right to observe the school education and to carry out the work of teaching and learning.A member of the Standing Committee members attended the meeting at the parents long school staff congress right3,The members of the board of parents have the obligation to cooperate with the school to carry out education and teaching activities.The members of the board of parents have the obligation to help other parents raise their children's level of education.The parents' committee members have the obligation to collect other parents' opinions and suggestions, and to feed back to the school.The members of the Committee of the parents have the responsibility to coordinate the relationship between parents and school.Arrangement of major activities in schools1, make the activity with specific programs. Implement the activity of specific content, time, responsible person, clear all the offices of the division of labor, make the responsibilities clear, play their respective roles.2, do the activities of the mobilization work. For the school teachers and students of the week Monday activities of the "speech" under the flag, and a specific solution to each class under various activities, to attract attention to teachers and students, encourage students to actively participate in excitation. At the same time held a class meeting, specifically to do requirements and arrangements for the class activities. Use classes will be described for the students, and in the moving process, to guide the students.3, arrange the details of the activities of the activities of the day. The day of the event such as the rules say leadership class admission order, class teacher evaluation, administrative leadership column in attendance, specific activities and activities in a project person in charge of the arrangements.4, with the school general office to do logistics service work, and to defend, the Communist Youth League Committee for safety management.5, do a good job in the activities of the propaganda work.. organization campus reporter, youth volunteers, such as the use of campus radio, publicity, publicity banners, campus network, to conduct a comprehensive campaign to create a good atmosphere.6, do a good summary of the activities report. All teachers and students to complete a summary of this event by Monday "under the flag of the speech", pointed out the advantages and disadvantages, in order to show the model. And at the same time for School Leadership Award, let the students experience to show the pride and joy of success. A happy ending.Campus cultural construction1, keep the school clean and beautiful appearance of the whole campus environment, beautiful landscaping, greening, cleaning, to form a thick green atmosphere for education;2, starting from the establishment of the motto, the actual school school school school spirit, teaching style, study style, making its flag, emblem, flag and class ";;3, the establishment of a fixed position of education, such as the school honor room, the team activities, the office of mental health counseling room;;4, the establishment of a fixed position, such as the national flag under the flag speech, publicity column, the radio room, by the special management, planning to use these fixed positions to carry out the development of educational activities;5, according to the school education arrangements, combined events, major festivals, anniversaries, combined with the routine education of students, to determine the main content of the theme class meeting;6, the positive pole of XX local culture and school Liuliushiduo years of school history, finishing, mining, the formation of the school in the history of rescue in the spirit of culture;7, in a series of compilation <xx >, established the Alumni Association, editor <xx reported. safety education A, student's birthday is often safe1, out of the school gate to consciously get off, to enter the school gate to the required parking.2, out of the classroom, not urgent, not crowded.No, teach in laboratory teaching, chasing and running off the corridor, to avoid slipping and falling., it is forbidden to climb the walls of any one of the schools, doors and windows, fences, trees, and the ball.Are not allowed to carry flammable, explosive, toxic substances and flammable, weapon into school.If the electric fan, lighting and electrical failure, shall not exclude private private hands, teachers should report or the general office, the electrical troubleshooting by the school, do not open the distribution box, touch switch. Fire fighting equipment without permission, not free to move., pay attention to the safety of cleaning, the glass window on the high, do not scrape wipe., are not allowed to go out for a swim., students are not allowed to be outside the public places for entertainment, sports and any form of fun activities. Any private party, you must obtain the consent of the parents.10, doing a civilized student, do not have any intention to harm others, steal the behavior of other people's property, not allowed to participate in any place in the fight.11, to detect any unsafe factors and should always report for teachers. In order to ensure the preservation of their calm, safe, not quite reckless impulse.12, on the experimental class to strictly comply with the safety requirements of the laboratory to complete the experiment.113, extracurricular activities and physical exercise, according to the relevant safety rules.14, in the school on the way back home, we should pay attention to traffic safety, road to strictly abide by the traffic rules.15, participate in the school organization's outdoor collective activities, activities must strictly abide by the discipline, are not allowed to leave the individual actions.16, the accommodation must be strictly abide by the rules and regulations of the safety management of accommodation.17, give full play to the student's self management ability, students are responsible for the preservation of students' characters, should be careful to do a good job security..B, classroom safety1, the doors and windows of the classroom must be kept in good condition all the year round, no one can not be deliberately damaged.2 doors and windows, the window was found damaged, the teacher has the responsibility to take measures to prevent and repair timely, and its prevention measures.Key to the door of the classroom, the key class should appoint a special person to keep the door every day, on duty at any time to close the doors and windows to implement Suosuo., in addition to the students' desks, books and textbooks, school supplies, not allowed to store any other valuablesStudents are not allowed to play, slapstick chase in the classroom, just move the desk, chair.On the desk, students are not allowed to write to write graffiti, but not scratches traces with the tool.In the classroom, mustn't Lara to connect the power supply device, socket, arbitrary charge.Students are not allowed to, without security protection measures in the case without climbing outdoor window glass wash scrub, to prevent accidents and accidents.C, teachers and students out of the activities of security1, the organization division of teachers and students go out to develop a detailed activity plan and safety measures, the programme of activities must be approved by the leaders of the school case review sign meaning before implementation. The organization to the field or far activities required by the Education Bureau deputy director in charge of the pipe safety approval.22, each event should have a specific responsibility, pay attention to the age of the staff, the body state of the match., the activities of the line, location, prior to the field survey should be carried out.Hand tools and traffic activities, shall submit to the Department of specialized transportation rent rent, required to comply with the safety requirements for operation, before the Department of inspection and repair of the car., each event has to have security, security, accident emergency plan.Have a picnic, hiking, picnic, and pay attention to fire prevention, prevent food poisoning, prevent fall accident, there is a river near the event, the reservoir, there is no organizational measures or do not have the safety conditions, can not let school students into the water., who go out to participate in various activities, school leaders and safety team members must be on the activities of the whole process of monitoring., in the activities of the implementation of accountability system, such as the case of security incidents, the responsibility of everyone to be held accountable.D, fire safety1, strengthen fire safety education for teachers and students. According to the "Fire Law > requirements, so everyone has to maintain the fire protection An Anquan, fire facilities, fire prevention, fire alarm reporting obligations. To do so that everyone knows that the fire alarm call 119, everyone is familiar with the fire from anti self knowledge and safe escape skills.2, the protection of the various kinds of fire fighting facilities in the school is good. To ensure regular inspection, maintenance,