中医治疗脂肪肝-3课件.ppt

1、The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.The guiding ideology should be guided by Deng Xiaopings theory,the important thoug

2、ht of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.一一脂脂肝脏内的脂肪含量超过肝脏重量肝脏内的脂肪含量超过肝脏重量(湿重湿重)的的5%5%即称为脂肪肝。脂肪肝即称为脂肪肝。脂肪肝他不是一个独立的疾病，它是由多他不是一个独立的疾病，它是由多种因素或疾病引起的肝细胞内脂肪种因素或疾病引起的肝细胞内脂肪过度堆积的代谢性疾病，是肝纤维过度堆积的代谢性疾病，是肝纤维化和肝硬化疾病的过渡

3、阶段化和肝硬化疾病的过渡阶段The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂肪肝1.饮酒 饮酒是引起脂肪肝的常见病因，饮酒致脂肪肝可能是酒精对肝内甘油三酯的代谢有直接的毒性作用。健康者，每日饮酒含乙醇100-2

4、00g，连续10-12天，不论其饮食是否含蛋白质，均可发生脂肪肝，低蛋白质只是一种加重因素。2.高脂血症 当血液中的脂类物质过多，超过了肝脏的处理能力时，脂肪就会蓄积在肝内，引起脂肪肝。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central

5、 Committee.脂肪肝 3.营养不良 由于蛋白质缺乏，而导致极低密度脂蛋白合成减少，这样造成肝转运甘油三酯发生障碍，脂肪在肝内堆积。4.肥胖 50%肥胖者有肝内脂肪浸润，这是由于脂肪组织增加，游离脂肪酸释出增多所致。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of th

6、e 16th CPC Central Committee.脂肪肝 5.糖尿病 约有半数糖尿病病人伴有脂肪肝，这是因为糖尿病病人，葡萄糖不能利用，造成糖、蛋白质、脂肪三大物质代谢紊乱，最终使脂肪酸在肝内存积，引起脂肪肝。6.药物 皮质激素：长期使用激素可使人肥胖并发生脂肪肝。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the t

7、hird Plenary session of the 16th CPC Central Committee.脂脂肪肪肝肝 轻型脂肪肝可以没有任何症状，只有通过B超、CT 或MRI检查才被发现。脂肪肝形成后，有部分患者表现食欲不振、恶心、呕吐、乏力、腹胀、肝区不适或隐痛，ALT及GGT升高，少数病人可出现轻度黄疸。体 检可触及肿大的肝脏表面光滑，边缘圆钝，质地软或中等硬度，可有轻度压痛，部分病人有叩击痛。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three re

8、presents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary se

9、ssion of the 16th CPC Central Committee.The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂肪肝 脂肪肝的诊断主要靠病史、临床表现及实验室检查，特别是B超、CT或MRI可发现

10、早期脂肪肝。1.病史：有长期饮酒、肥胖、糖尿病、营养失调及中毒性肝损害的病史。2.临床表现：食欲不振、恶心、乏力、肝区不适或隐痛。体检时可见肝肿大，表面光滑、边缘圆钝，轻度触痛或叩击痛。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central

11、 Committee.脂肪肝 3.实验室检查 肝功能：ALT正常或升高，有高脂血症表现，甘油三酯升高，血清谷胺转酰肽酶（GGT)升高。4.超声与CT B超显示肝脏增大。CT显示肝密度比其他实质脏器密度低下。B超具有经济、迅速、准确、无创伤等优点，应列为本病的首选方法。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the thir

12、d Plenary session of the 16th CPC Central Committee.脂肪肝 1.1.戒戒 酒：酒：适用于单纯性脂肪肝和以酒精性脂肪肝为主的中毒性肝病，戒酒后，一般在24周肝功能指标可恢复正常。2.2.节节 食：食：食用低脂肪、高蛋白、低糖、低热量和富含纤维的食品，并补充足够的维生素B1、B2、B6以及叶酸、锌、胆碱、蛋氨酸。3.3.运动锻炼：运动锻炼：选择有氧运动为主：The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three re

13、presents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂肪肝 步行：可以缓步、快步、自由散步等多种形式。慢跑：可以采用慢跑与步行相结合的方法，以不喘粗气，没有头晕等感觉，最高心率120-130/分 太极拳：具有疏通经络、调整气血运行等作用。游泳：水的温度刺激、压力和人的在水中的活动可以使全身功能得到加强，特别是增加心、肺功能和血管舒张、收缩功能，对高脂血症极为有益 爬楼梯：能够降脂减肥，改善心肺功能，降低血

14、压，防止骨质疏松和脱钙。注意适度，每次10-15The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂肪肝 分钟，每日1-2次。运动量：中等量的运动时间每次约45分，每周运动不少于3次，The guiding ide

15、ology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂肪肝 药物：1.减少肝脏脂肪沉积的药物：如多烯磷脂胆碱（易善复）、熊去氧胆酸。2.抗氧化剂：还原型谷胱甘肽、水飞素。3.改善胰岛素抵抗的药物：罗格列酮等。The guiding ideolog

16、y should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂肪肝 对肝脏的危害：可发展为脂肪性肝炎-肝硬化-肝癌。The guiding ideology should be guided by Deng Xiaopings theory,the import

17、ant thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.中医对脂 中医学认为，脂肪肝多属于中医“积证”范畴。正如内经所说：“肝之积，曰肥气”，故也称之肥气病。系指体内肥脂之气过多地蓄积于肝脏。认为由于过食油腻肥甘饮食，食而不运，脂膏留积于肝，从而导致肝脏功能失调，疏泄不利的一系列病症。The guiding ideology should be guided by

18、 Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂肪肝 1 1饮食不节饮食不节 暴饮暴食，喜食油腻肥甘或酒酪之品，胃纳过盛，超过运化能力，以致肥脂湿浊内停，积于肝内，肥气积盛，酿成斯疾。2 2气郁湿阻：气郁湿阻：七情所伤，气机不畅，或外感湿浊或湿邪内蕴，气郁湿阻，正常脂肥之气转运欠畅，遂积而

19、发病。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂肪肝的3 3瘀血内阻：瘀血内阻：外伤或久病瘀血内停，瘀血阻于肝经,气机不畅，肥脂湿邪内蕴，与瘀血相搏，有形之物，阻于肝脏。4 4肝腑虚衰：肝腑虚衰：不论外感

20、风寒湿邪，抑或内伤饮食，房室不节，都可损伤正气，引起脏腑功能失调。尤其是脾肾亏虚，脾虚水湿运化失司，水湿蓄积，气机不畅，痰湿瘀血诸物，均可内停于肝而发病The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂脂肪肪肝肝

21、的的 饮食中的一、二、三、四、五饮食中的一、二、三、四、五一：每日饮一：每日饮1 1袋牛奶，可有效改变钙摄入偏低的现象。对脂肪肝患者袋牛奶，可有效改变钙摄入偏低的现象。对脂肪肝患者来说应改为脱脂牛奶，或用酸奶代替。来说应改为脱脂牛奶，或用酸奶代替。二：每日摄入糖类二：每日摄入糖类250g250g300g300g，相当于主食，相当于主食300300400g400g，根据体重情，根据体重情况酌减。况酌减。三：每日进食三：每日进食3-43-4份高蛋白食物。每份含义：瘦肉份高蛋白食物。每份含义：瘦肉50g50g；或鸡蛋一个；或鸡蛋一个；或豆腐或豆腐100g100g；或鱼虾；或鱼虾100g100g。以鱼

22、类、豆类蛋白为好。以鱼类、豆类蛋白为好。四：即四句话。有粗有细粗粮、细粮搭配；不甜不咸每日摄四：即四句话。有粗有细粗粮、细粮搭配；不甜不咸每日摄盐盐7-8g7-8g；三四五顿总量控制下少食多餐；七八分饱。；三四五顿总量控制下少食多餐；七八分饱。五：每日五：每日500g500g新鲜蔬菜和水果。新鲜蔬菜和水果。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National C

23、ongress and the third Plenary session of the 16th CPC Central Committee.脂脂肪肪肝肝的的饮饮 1.主食的吃法：控制总量，减少精米、精面比例，增加粗粮、杂粮。避免各类油炸主食，如油条、油饼、麻花等。2.蔬菜的吃法：可增加蔬菜的摄入，种类，可用西红柿、黄瓜等蔬菜代替水果。避免腌制或不新鲜的蔬菜。3.水果的吃法：水果最好选在餐前或两餐之间饥饿时食用。4.豆类的吃法：建议食用绿豆、红豆、黑豆，以及简单加工过的豆制品，如豆腐、豆浆、豆腐皮等。5.禽肉类的吃法：可适量食用瘦猪肉、瘦牛肉、肌肉等，避免动物内脏、肥肉及各种油炸肉类。The

24、 guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂脂肪肪肝肝的的饮饮 5.鱼类、海鲜的吃法：可食用各种常见鱼类、虾类、贝类等水产品。避免油炸鱼类和海鲜，避免食用含胆固醇较高的鱿鱼等。6.蛋类的吃法：每天最多一个鸡蛋或鸭

25、蛋，可蒸、煮或水煮蛋、蛋羹，避免油煎蛋。7.奶类的吃法：建议脱脂奶、酸奶，避免食用奶油、黄油等含脂肪多的食物。睡前别喝奶，以免导致热量过剩，可把牛奶或豆浆放到早餐时引用。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committ

26、ee.脂肪肝的1、肝肾阴虚 此型多见于老年人和消瘦体型者;常见嘴干，愿意喝凉的;手心、脚心发热，下午时两颧也会发热，且手汗、脚汗比别人多;腰膝常感酸软，足跟痛;伴有头晕耳鸣等不适。肝肾阴虚产生的原因常因阴精耗损太过所致，如劳累太过、房事不节、年老体虚等等。故养生更应注意保养肝肾阴精，做到劳逸结合、适时休息，同时可常服补养肝肾之阴的六味地黄丸或一贯煎等中成药。饮食宜清淡，忌燥烈之品。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and

27、 the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂肪肝的 2、痰湿互结 此类体质的人群比例最高，达64%。这类人外表有着公认的“丰满”体型，平时不愿意活动;嘴里总是“黏黏”的，不喜欢喝水;喉咙里好像有东西堵着;一遇到下雨天就觉得浑身不舒服;特别容易拉肚子;女性朋友则有白带比一般人多。因肥甘厚味之品能助湿生痰，故饮食调理应以清淡为主，少食肥甘厚味，多吃蔬菜、水果等具有健脾利湿、化痰祛湿的食物，如白萝子、紫菜、海带、洋葱、枇杷、

28、白果、大枣、扁豆、薏米、红小豆、蚕豆、包菜等。若能坚持服用中药如化痰祛湿的二陈汤则效果更佳。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂肪肝的 3、肝郁脾虚 这类人性格相对内向，心情容易抑郁不舒，情绪易波动

29、，工作时易感疲乏，气短胸闷，不想说话;自觉免疫力极低，易感冒;食欲差，大便不规律，有时便秘，却也容易拉肚子。此类体质的人应注意精神调养，应主动寻求快乐，如多参加社会活动、集体文娱活动;多听轻快、开朗、活泼的音乐;多读积极的、鼓励的、展现美好生活前景的书籍，以培养开朗、豁达的意志。肝郁脾虚体质的人群胃肠功能相对低下，故饮食调理可食小米、黄米、大麦、山药、马铃薯、大枣、胡萝卜、茯苓等健运脾胃的食物。而中药则可选用逍遥散以疏肝养血，健脾理气。The guiding ideology should be guided by Deng Xiaopings theory,the important tho

30、ught of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂肪肝的 4、湿热内蕴 目前年轻人脂肪肝的患病率呈快速上升趋势，这主要是因为年轻人中湿热内蕴体质增多，表现在平素性情急躁易怒，易于激动;口干口黏，口苦;便秘或大便不爽，小便黄。这类体质的人阳气偏盛，性情较急躁，故平日要加强道德修养和意志锻炼;在工作上对非原则性问题，少与人争，尽量用理性克服情感上的冲动。此类人平素可常服薏苡

31、仁、赤小豆、苦丁茶等以解湿热。饮食应忌辣椒、姜、葱等辛辣燥烈食物。对于牛肉、狗肉、羊肉、鹿肉等温阳食物宜少食用;可多食水果蔬菜如香蕉、柿子、西瓜、西红柿、莲藕等。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.脂

32、肪肝的 5、气滞血瘀 气滞血瘀体质也较常见，表现为胸部胀闷，好像有东西压着不舒服;面色偏黑;舌和唇色紫暗;常伴有各种疼痛，女性朋友则出现痛经等。此类患者要注意情绪调摄、运动锻炼、饮食调养。如日常生活中注意培养乐观和豁达的情绪，精神愉快则气血和畅，营卫流通，有利气滞血瘀体质的改善。反之，郁闷、忧郁情绪则会加重气滞血瘀倾向。饮食多食能行气活血的食物，如佛手、陈皮、刀豆等以及活血的桃仁、山楂、丹参、当归、益母草等。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three

33、represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.治疗脂肪 血脂康胶囊：除湿祛痰、活血化瘀、健脾消。2粒/次，2次/日，口服。松龄血脉康：平肝潜阳、镇心安神。3粒/次，3次/日，口服。脂必妥片：健脾消食、除湿祛痰、活血化瘀。3片/次，2次/日，口服。绞股蓝总甙胶囊：益气健脾 益气和血 祛痰降脂 降血脂。1粒/次，3次/日，口服。The guiding ideology should be guide

34、d by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.单味中药 山楂：消食化积，行气散瘀。现代药理研究证明山楂能增强心肌收缩力，增加心输出量，减慢心率，扩张冠状血管，具有降血压、降血脂的作用。可使用山楂糕、山楂果，每次10g左右，每日2次，饭后服。The guiding ideology

35、should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.单味中药 何首乌-功效：补益精血、解毒、润肠通便，现代研究发现本品含有卵磷脂、粗脂肪、糖类等具有调节血脂和抗动脉粥样硬化的作用。用法：每次10-15g煎汤服，每日1-2次。The guiding ideol

36、ogy should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.单味中药 绞股蓝-功效：清热解毒、补气生津、健脾安神，本品含有50多种皂苷能降低血脂，降低血压，增加冠状动脉血流量。枸杞子-功效：补肝肾、明目、润肺，现代研究证实本品具有降低血糖、血脂，抗肿瘤等多种

37、药理作用。用法：每次10-15g，冲泡代茶饮。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.单味中药 泽泻：利水消肿，渗湿、泄热。实验研究表明，泽泻的甲醇提取物对各种原因引起的脂肪肝均有良好的效应，能抑制肝内脂

38、肪堆积，改善肝功能。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.药膳 双花绿茶：菊花、槐花、绿茶各3g 三味药放入瓷杯中，沸水冲泡，盖闷5min 山楂陈皮茶：鲜山楂30g、陈皮6g 二味药放入瓷杯中，沸水冲泡

39、，盖闷15min 二子降脂茶：枸杞子30g、女贞子30g 将两味药洗净晒干，装入纱布袋，放入瓷杯中，沸水冲泡，盖闷15minThe guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.归纳四点消 饮食疗法：是改变脂肪肝最有效

40、的方式。以进食富含高蛋白（鸡蛋类、鱼类、瘦肉、牛奶等动物蛋白质为主），低糖，适量脂肪（植物油为主），大量维生素（以新鲜蔬菜、水果为主）的饮食适宜。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.归纳四点消 病因治

41、疗：酗酒、肥胖、糖尿病、高脂血症、肝炎及药物是引起脂肪肝的主要原因。因此，针对不同病因进行戒酒、运动减肥，饮食及药物调整血脂，停止服用对肝脏损害的药物。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.归纳四点消

42、药物治疗：主要是去脂药物，但对肝功能有影响的去脂药物应尽量避免使用，大部分降脂西药对肝功能有一定影响。因此，选用中医中药（比如脂必妥、血脂康、绞股蓝）进行调理更有利于脂肪肝的治疗和康复。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central

43、 Committee.归纳四点消 运动疗法：对肥胖型患者应采取适当锻炼治疗，运动量可以从小逐渐增大，每天坚持有氧运动半小时以上，如步行、爬楼梯、慢跑、骑自行车、游泳等各类健身运动。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.谢谢 谢谢 !