Treating Lean Metabolic Associated Fatty Liver Disease from the Perspective of "Spleen Failing to Disperse Essence and Kidney Failing to Transform Qi"
10.13288/j.11-2166/r.2026.13.015
- VernacularTitle:从“脾失散精、肾失化气”论治瘦型代谢相关脂肪性肝病
- Author:
Xingrong LI
1
;
Haihang DONG
1
;
Huiqin ZHANG
1
;
Ya YOU
1
;
Yuying TU
1
;
Yinqiang ZHANG
1
Author Information
1. Xiyuan Hospital，China Academy of Chinese Medical Sciences，Beijing，100091
- Publication Type:Journal Article
- Keywords:
metabolic associated fatty liver disease;
spleen and kidney deficiency;
liver constraint;
phlegm stasis;
lean
- From:
Journal of Traditional Chinese Medicine
2026;67(13):1446-1450
- CountryChina
- Language:Chinese
-
Abstract:
It is considered that lean metabolic associated fatty liver disease （MAFLD） is characte-rized by a state of "lean body but fatty liver". From the perspective of the pathomechanism evolution of "spleen failing to disperse essence， while kidney failing to transform qi"， the disease is systematically treated under the principle that spleen and kidney deficiency as the root and liver constraint with phlegm stasis as the branch. Spleen deficiency with impaired transformation and transportation leads to failure in the distribution of refined substances， initiating lipid turbidity accumulation and obstruction. Kidney dysfunction in qi transformation results in insufficient essence and blood， forming the root of bodily malnourishment. Over time， this further gives rise to liver constraint and loss of dispersing function， disorder in the movement of essential substances， and congealing of phlegm and stasis within hepatic collaterals. The dysfunction of three organs including spleen， kidney and liver constitutes the pathological basis of metabolic disturbances involving qi， blood， body fluids and essence. Treatment should follow the principle of "nourishing the healthy qi leads to spontaneous resolution of pathogenic accumulation"， with three approaches. First， fortifying the spleen and eliminating dampness， using Sini Powder （四逆散） and Erchen Pingwei Powder （二陈平胃散） to restore the transport and transformation function of the middle jiao （焦）， thereby guiding essential substances back to their proper physiological pathways. Second， tonifying the kidney and resolving turbidity， using Jinkui Shenqi Pill （金匮肾气丸） and Effective Integration Decoction （一贯煎） to replenish the lower jiao， promoting the restoration of essence and the transformation of turbid pathogen. Third， soothing the liver and resolving stasis， using Liujunzi Decoction （六君子汤） and Xiaozhi Qinggan Decoction （消脂清肝汤） to vent qi and blood stagnation， thereby interrupting disease progression. Together， these three methods reinforce healthy qi while eliminating pathogen， facilitating the restoration of proper essence transformation and the resolution of lipid turbidity.
