T/CACM 1318.25-2019 Digestive System Common Diseases Chinese Traditional Medicine Guideline Part 25: Non-alcoholic Fatty Liver Disease (Basic Medical Practitioner Version)

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Main technical content: Nonalcoholic fatty liver disease (NAFLD) is characterized by fatty degeneration of the liver detected by imaging or histological examination, and requires the exclusion of other chronic liver diseases that can cause fatty liver, including alcoholic liver disease (ALD), viral hepatitis, autoimmune liver diseases, and metabolic or genetic liver diseases. Epidemiological studies show that daily alcohol intake exceeding 30g for men and 20g for women can lead to ALD. Therefore, to diagnose NAFLD, it is first necessary to ensure that the patient's alcohol intake is below the above-mentioned dosage. NAFLD is associated with obesity, diabetes, dyslipidemia, and hypertension, and is considered a liver manifestation of metabolic syndrome. NAFLD includes two pathological diagnoses with different prognoses: nonalcoholic simple fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). Generally, NAFL is considered benign and non-progressive, while NASH can progress to cirrhosis and even hepatocellular carcinoma (HCC). The definitive diagnosis of NASH relies on liver biopsy, and its histological characteristics include fatty degeneration of hepatocytes, accompanied by hepatocyte injury (ballooning degeneration) and inflammation. In addition to excessive energy intake, endocrine diseases, severe malnutrition, and adverse drug reactions can also cause NAFLD [1,2]. NAFLD is currently the most common chronic liver disease worldwide, not only causing liver-related disability and death, but also closely associated with a high incidence of metabolic syndrome (MetS), type 2 diabetes (T2DM), atherosclerotic cardiovascular disease, and colorectal tumors, making NAFLD a very important public health issue [3-6]. The exact pathogenesis of NAFLD in Western medicine remains incompletely understood, and there is a lack of ideal drugs. Traditional Chinese medicine has been widely chosen for the treatment of NAFLD. In 2010, the Chinese Society of Gastroenterology and Hepa

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