| 1. ObjectiveThis dissertation mainly concerned about the syndrome classification of clinical symptoms of non-alcoholic fatty liver disease (NAFLD) in Taiwan under the guidance of traditional Chinese medicine, in order to support the diagnosis and treatment in the clinic practice and lay a foundation for the further research. The syndrome classification has been concluded on the epidemiological investigation including Traditional Chinese Medical Four Diagnostic Information of patients with NAFLD in Taiwan. Compared with Qinggan Wan in the control group, the clinical efficacy of Modified TiaoganTang in treating liver qi stagnation, accumulation of phlegm-heat and blood stasis syndrome of NAFLD has been evaluated.2. Contents and methodsThe thesis consists of the following three parts:summaries of documents, clinical syndrome research, and a clinical control study on the treatment of NAFLD by the method of clearing heat, resolving phlegm, regulating Qi and activating blood.Two summaries have reviewed the research progresses of pathogenesis, diagnosis and treatment of non-alcoholic fatty liver disease in Western and Chinese medicine. And we can fully understand the results achieved and inadequate awareness of the research on Chinese and Western Medicine in non-alcoholic fatty liver disease and receive more information of the awareness of the disease so that the basis can be provided to draft out a case report table more scientifically and treat NAFLD by the method of clearing heat, resolving phlegm, regulating Qi and activating blood.In clinical syndrome research, clinical survey form has been developed by reference TCM Guidelines for diagnosis and treatment of digestive disease, the Guiding Principle of Clinical Research on New Traditional Chinese Drugs, Guidelines for diagnosis and treatment of non-alcoholic liver diseases (revised in February 2006) and the clinical experience of my tutor. The form includes the past history, tobacco and alcohol habits, medication history, weight, height, waist circumference, body mass index and Traditional Chinese Medical Four Diagnostic Information. After the information on statistical method of factor analysis, Fisher exact test and entropy-reactor of complex systems, the following conclusions have been drawn.In clinical control study on the treatment of NAFLD by the method of clearing heat, resolving phlegm, regulating Qi and activating blood,60 patients with NAFLD who are differentiated into liver qi stagnation, accumulation of phlegm-heat and blood stasis are randomly divided into two groups. The patients of therapeutic group are given Tiaogan Tang and those in the control group are received Qinggan Wan. The indexes of TC, TG, ALT, AST and scores of symptoms and B-Ultrasound examination have been analyzed.3. Results 3.1 In 247 patients of this research of non-alcoholic fatty liver disease, men account for 58.704%, while 41.296% of women. The ratio of male to female ratio is 1:0.703, more men than women. The average onset age is 44.64 years old with the range from 15 years old to 80 years old, and most people are aged between 30 and 49 years. The course ranges from 2 months to 15 years. The patients of between 5 and 10 years course reach 68.18% at top, compared to those of between 10 and 15 years course with only 14.98%.3.2 In many dietary factors of non-alcoholic fatty liver disease, the spicy food accounts for the highest proportion, followed by the fried food, excessive fatty and sweet food. Obesity, hypertension, diabetes and hyperlipidemia are more common in many diseases which are associated with non-alcoholic fatty liver disease.3.3 The meaningful and positive symptoms, tongue and pulse of Non-alcoholic fatty liver disease are:weakness and flatigue, dysphoria, sallow complexion, enjoying sighing, red urine, chest distress, heavy head like wrapped, dizziness, irritability and agitation, bitter taste and dry throat, burning sensation of five centres, intolerance to cold and cold limbs, distending or channeling pain in hypochondrium, loose stool, obesity, poor appetite, eructation, tinnitus and deafness, nocturia, steaming heat, constipation, sexual hypofunction, fixed stabbing pain in hypochondrium, dark and gloomy face, red tongue, pale tongue with teeth prints, purlish tongue, pink tongue, greasy fur, yellow fur, less or no moss, wiry pulse, slow pulse, feeble pulse, thready pulse, slippery pulse, rapid pulse, unsmooth pulse.3.4 Factor analysis has been used to analyse four diagnostic information, and results in 12 common factors. Entropy-reactor of complex systems was used to classify 29 groups syndromes of NAFLD in Taiwan, which are liver stagnation and soleen deficiency, accumulation of damp and heat, kidney yang deficiency, spleen-deficiency and retention of dampness, accumulation of phlegm-heat and blood stasis, phlegm-damp retention, yin deficiency inner heat, deficiency of spleen and kidney, qi stagnation and blood stasis, liver-kidney yin deficiency, damp-heat in the liver-gallbladder, asthenia kidney yin, stagnation of liver-qi, the deficiency of kidney-yin and kidney-yang.4. Conclusions4.1 The pathogenesis of NAFLD in Taiwan is complicated. Most patients are manifested as compound type, while single syndrome type is less seen.4.2 The pathogenesis of Non-alcoholic fatty liver disease is characterized deficiency in origin and excess in superficiality. Phlegm, damp, heat, blood stasis and qi-stagnation belong to branch excess. In Taiwan, branch excess of patients with NAFLD is mainly manifested as damp, heat and qi-stagnation, especially heat more common. And root deficiency is mainly manifested as spleen deficiency.4.3 The course of NAFLD is long. In the beginning stage, most patients are manifested as liver depression and spleen deficiency, accumulation of damp-heat, spleen-deficiency and retention of dampness, stagnation of liver-qi. With the course approaching, vital qi Deficiency types are increasing such as deficiency of the kidney-yang, asthenia kidney yin, liver-kidney yin deficiency, deficiency of spleen and kidney. Although the types of qi stagnation and blood stasis, accumulation of phlegm-heat and blood stasis are few in Taiwan, both types are also growing. 4.4 BothTiaogan Tang and Qinggan Wan can clear heat, resolve phlegm, regulate qi and activate blood. The slightest difference in the specific drugs of both formulas leads to the different effects, and modified Tiaogan Tang is better, which is demonstrated by relevant pharmacological research and literature reports.5. Innovation5.1 Factor analysis and Entropy-reactor analysis of complex system are used to receive the Chinese medical syndromes of non-alcoholic fatty liver disease in Taiwan by collecting the relevant information.5.2 Selecting a fixed syndrome and similar Chinese Patent Medicine as a control group, is more favorable for therapeutic evaluation of the decoction in treatment group of NAFLD.6. The shortcomings and solutions.6.1 The results of this research are different from those in Mainland China. In addition to Taiwan's unique geographical environment and living and eating habits of Tanwan's people, Small samples and limited patients are also the causes. A large sample, multi-center, random epidemiological investigation of NAFLD is lack in Taiwan. Therefore, we should increase the number of samples and expand the selected area in order to further improve the research.6.2 The results of this research are not completely consistent with clinical practice in Taiwan, which is the same as that of Mainland China. For example, the syndrome of accumulation of phlegm-heat and blood stasis is rare. Therefore, the idea of combination of disease and syndrome should be used in the future research of the syndrome of non-alcoholic fatty liver disease to make research results more accurately reflect the actual situation.6.3 In the clinical control study on modifiedTiaogan Tang treating the type of liver qi stagnation, accumulation of phlegm-heat and blood stasis in NAFLD, the difference of drugs between the treatment group and control group should be narrowed to refine the effects of drugs.
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