More than ten years ago, I went to Beijing Medical University for further study of infectious diseases, Mr. Tian Gengshan lectured to us, mentioned “fatty liver disease has two kinds, one is fat liver fat, not a big problem; one is fat liver fat, not a small problem”. What is the reason, the teacher did not further discuss, the reason is that at that time, we did not have sufficient research, and secondly, it does not belong to the teacher’s research direction. After years of study, I gradually realized that this sentence is the most concise discussion of fatty liver disease. Like chronic hepatitis B, fatty liver disease is also very complicated, involving many concepts such as leptin, lipotoxicity, metabolic syndrome, etc. The various discussions are rather confusing, which is not conducive to theory-guided clinics; if summarized according to the order of the emergence, change and disappearance of fatty liver disease, it will have the effect of outlining the main points and will be exactly manifested in the sentence of Mr. Tian. As we all know, the cause of fatty liver disease can be divided into non-alcoholic mainly obesity and alcohol, two categories, in layman’s terms: “let the good stuff to support, let the good stuff to fill. Let’s look at “let the good stuff support” this category: when the intake of nutrients is too much, more than the human body to consume, it will be stored in the body, fat direct excess, sugar excess conversion, etc., can lead to an increase in fat in the body; when the normal adipose tissue can not accommodate, it will be through the blood transit, ” overflow” to non-fat tissues such as the liver (when the fat content of the liver exceeds 5% of its wet weight, it is called “fatty liver”), is the process of the gradual failure of the body’s “leptin” and other regulatory mechanisms; excessive fat affects the structure and function of the liver, called “fatty liver”; excessive fat affects the structure and function of the liver, called “fatty liver”. Excessive fat affects the structure and function of the liver, which is called “lipotoxicity”, and as the disease continues to progress, the liver will gradually harden and manifest itself as fat to thin, and as the liver function decreases, the human body will gradually weaken and manifest itself as fat to thin; due to the adaptive ability of the human liver, the progress of the lesion is usually slower, and the patient will often manifest other complications of obesity, such as Diabetes mellitus, hyperlipidemia, cardiovascular and cerebrovascular diseases, etc., called “metabolic syndrome”; by regulating the diet and exercise, gradually reduce the excessive fat in the body, is the best measure for the treatment of this kind of steatohepatopathy, the drugs such as hepatoprotective drugs are usually only an auxiliary means. In this case, Mr. Tian said “fat liver, fat people, not a big problem”. Of course, this is only a general rule, for an individual, the problem is not big enough to what extent, need to be based on the relevant examination, case-by-case analysis, to make an accurate judgment. With the above basis, and then look at the “let the good stuff to pour” this category, it is relatively simple: alcohol has hunger, hypnotism, warmth, etc., in Arabic, meaning “the best thing”, easy to get drunk due to excess, drunk and satisfied, leading to excessive drinking and damage to health, including damage to the liver. The liver is the center of alcohol metabolism, and converts alcohol through many ways, but there are certain limits. When the intake of alcohol is too much, or the ability of the liver to resolve alcohol decreases, the concentration of alcohol in the blood will increase, and the metabolism of the liver will be impaired in many ways; the decrease in fat metabolism will lead to the accumulation of fat in the liver, and the formation of steatohepatopathy, and the relative lack of subcutaneous fat due to the lack of replenishment, which manifests itself in the form of fatty liver disease, and the lack of fatty liver disease. The relative lack of subcutaneous fat is due to the lack of supplementation, manifesting the phenomenon that the liver is fatter and the patient is thinner, which is a part of “visceral obesity”; in this case, the starting lesion is complicated, the toxin is accumulated, the nutrition is lacking, the influence is extensive and in-depth, and the harm to the body is great, and the human body’s adaption to this is very insufficient, and the lesion progresses rapidly, and the undesirable situation that the liver is thin and the person is also thin will occur very easily. The adverse consequences of liver thinning and human thinning will easily occur; patients will consult the doctor for various liver diseases such as alcoholic fatty liver, alcoholic hepatitis, alcoholic cirrhosis and so on, collectively called “alcoholic liver disease”; in this regard, while emphasizing on abstinence from alcohol, liver-protecting medicines and supportive and symptomatic treatments should be given actively to stop the progression of the disease as soon as possible, so as to reduce the harms to the human body, and should not rely solely on abstinence from alcohol. In this regard, it is emphasized that the progress of the disease should be blocked as soon as possible to reduce its harm to the human body. This kind of situation is what the teacher said, “the liver is fat and the person is thin, the problem is not small”. As for the extent of the problem, it is necessary to patiently inquire about the medical history, conduct detailed examination and make dynamic assessment. The naked eye can see the body’s fat and thin, ultrasonography can find the liver’s fat and thin, the human fat and thin and the liver’s fat and thin to compare, you can roughly determine the ins and outs of steatohepatitic liver disease. When I studied “Fatty Liver Disease”, I felt that its discussion was too trivial, so I thought of Mr. Tian’s sentence, and after careful consideration, I felt quite good.