Clinical Observation Of Shugan Tiaozhi Decoction In The Treatment Of Non-Alcoholic Fatty Liver Disease Of Liver Depression And Spleen Deficiency

[Objective]:Through clinical experiment,observe and compare the improvement of clinical symptoms such as flank rib fullness before and after the treatment of patients with non-alcoholic fatty liver disease(NAFLD)of liver-qi stagnation and spleen-deficiency type with self-prepared Shugan Tiaozhi Decoction and diammonium glycyrrhizinate entericcoated capsule,and then observe and compare the changes of laboratory inspection indicators(liver function indicators ALT,AST),and evaluate its clinical efficacy and safety,To explore the method of improving the clinical symptoms of nonalcoholic fatty liver disease(NAFLD)with liver depression and spleen deficiency by oral administration of Chinese medicine,so as to improve the quality of life of patients with NAFLD.[Methods]:Refer to the Western diagnostic criteria for non-alcoholic fatty liver disease and the traditional Chinese diagnostic criteria for liver depression and spleen deficiency formulated in the Guidelines for Prevention and Treatment of Non-alcoholic Fatty Liver Disease(2018 Updated version)and the Expert Consensus on the Diagnosis and Treatment of Traditional Chinese Medicine for Non-alcoholic Fatty Liver Disease(2017).A total of 88 NAFLD patients admitted to the gastroenterology Department of Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine from December2021 to December 2022 were collected as the object.However,8 cases of NAFLD patients fell off due to non-compliance,abandonment of treatment and sudden arrhythmia during treatment.The patients were divided into observation group and control group by random number table method.There were 40 patients in each group.Both groups received general treatment,including health education,dietary guidance,aerobic exercise,etc.The control group was treated with enteric-soluble capsules of diammonium glycyrrhizinate,and the observation group was treated with self-designed Shugan Tiao Zhi decoction.Both groups completed the treatment for 4 weeks.The efficacy of TCM syndromes,total scores of TCM syndromes,individual scores of TCM syndromes,liver enzymology indexes(ALT,AST)and drug safety were compared between the two groups.After sorting out the collected data,statistical software SPSS26.0 was used for analysis and comparison,so as to evaluate its clinical efficacy.[Results]:1.Case inclusion and completion: In this study,88 cases that met the exclusion criteria were enrolled,the clinical trial procedures were informed to the patients and informed consent was signed.80 cases were actually enrolled,8 cases were excluded and dropped off,and 4 cases were dropped off in each group.In the observation group,2 patients terminated medication due to tedious oral decoction,1patient had sudden heart disease,and 1 patient was lost to follow-up.In the control group,3 patients did not follow the prescribed course of medication,and 1 patient did not follow the diet required by the doctor during medication,and there was alcoholism.2.General data comparison results: Among the 80 patients included in this clinical observation,the gender,age,course of disease and fatty liver grade of the collected cases showed that male patients were more than female patients,and the age distribution was concentrated in the young and middle-aged group,while the elderly group was less.The course of disease is also concentrated in 1-3years;Most of the patients had moderate fatty liver.3.Comparison results of TCM syndrome efficacy: the total effective rate of the observation group was 92.50%,while the total effective rate of the control group was 72.50%,and the curative effect of TCM syndrome(Z=2.957,P=0.003)and the total effective rate(χ2=5.541,P=0.019)in the observation group were better than those in the control group.4.Comparison results of total scores of TCM syndroms: Before treatment,there was no significant difference between the observation group and the control group in total scores of TCM syndroms,P>0.05.After treatment,the total score of TCM syndrome in observation group and control group decreased compared with that before treatment,and the difference was statistically significant(P<0.05).After treatment,the total score of TCM syndrome in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05);5.Results of single integral comparison of TCM syndrome: Before treatment,there was no significant difference between the observation group and the control group in the right flank and cob swelling or walking pain,abdominal distension,loose stool,abdominal pain and diarrhea,fatigue,chest tightness and excessive breath,P>0.05.After treatment,the levels of distension or running pain,abdominal distension,loose stool,abdominal pain and diarrhea,fatigue,chest tightness and excessive breathing in the observation group and control group were decreased compared with those before treatment,and the difference was statistically significant(P<0.05).After treatment,the right flank and costal distension,abdominal distension,loose stool,abdominal pain and diarrhea,fatigue,chest tightness and excessive breathing in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).6.Comparison of liver enzymology indexes(ALT and AST): Before treatment,there was no significant difference in AST and ALT between the treatment group and the control group,P>0.05.After treatment,AST and ALT in both treatment group and control group were decreased compared with before treatment,and the difference was statistically significant(P<0.05).After treatment,AST and ALT in the treatment group were lower than those in the control group,and the difference was statistically significant(P<0.05).7.Comparison results of recurrence rate: Four weeks after the end of the experiment,except for the invalid cases,the number of follow-up survey was conducted.The number of follow-up in the observation group was 37,and the number of return visits in the control group was 29,and there was no significant difference in the recurrence rate between the two groups,P=0.262(>0.05).8.There was no statistical difference in the incidence of renal dysfunction,nausea and vomiting,abnormal blood routine,diarrhea,constipation and arrhythmia between the two groups,P=0.33(>0.05).[Conclusion]:1.Combined with self-designed Shugan Tiao Zhi Decoction on the basis of enteric capsules of diammonium glycyrrhizinate,it can reduce TCM syndrome scores,improve clinical efficacy,and help to improve patients’ liver function level,thus improving patients’ quality of life;2.Enteric-soluble capsules of diammonium glycyrrhizinate combined with self-designed Shugan Tiao-zhi decoction in the treatment of NAFLD have high safety,and the recurrence rate is low after the follow-up,which is worthy of promotion and application.3.Self-designed Shugan Tiaozhi Decoction fully reflects the advantages of TCM syndrome differentiation and can provide a new idea for the treatment of NAFLD patients with liver depression and spleen deficiency.