Currently, the prevalence of alcoholic liver disease is steadily increasing, and the incidence of non-alcoholic fatty liver disease is rising, and the incidence of the disease is becoming younger and more popular. Fatty liver has become the number one liver disease in the world, including China, and more and more fatty liver occurs in patients with other types of chronic liver diseases, including chronic viral hepatitis. What is fatty liver? Fatty liver is a heterogeneous disease characterized by hepatocellular vesicular steatosis, i.e., excessive accumulation of intrahepatic fat caused by various reasons, including alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), and special types of fatty liver such as chronic hepatitis C (CHC). Alcoholic fatty liver disease (ALFLD) is caused by long-term heavy drinking, generally more than 5 years, the amount of ethanol ≥40g/d for men and ≥20g/d for women, or a history of heavy drinking within 2 weeks, the amount of ethanol 〉80g/d; the amount of ethanol (g) = the amount of alcohol consumed (ml) × the amount of ethanol content (%) × 0.8. Severe cases can develop into alcoholic hepatitis, liver fibrosis and cirrhosis. Severe alcoholism can induce extensive hepatocellular necrosis and even liver failure. Non-alcoholic fatty liver disease Metabolic liver damage related to insulin resistance and genetic susceptibility, including primary and secondary. Primary due to insulin resistance, metabolic disorders, obesity and metabolic syndrome, secondary due to malnutrition, drugs, toxins and so on. Second, the common clinical manifestations of fatty liver Most of the early fatty liver does not have any symptoms, the most common symptom is to feel tired, fatigue, some patients will have abdominal distension or pain and other manifestations. Severe fatty liver patients may have itchy skin, poor appetite, nausea or vomiting and other symptoms. If the disease progresses further to cirrhosis, serious complications such as ascites and bleeding can occur. About 50% of patients will have enlarged liver, which can be touched in the right upper abdomen. Third, when should we screen fatty liver 1, ultrasound found that there is fatty liver disease or liver lipid deposition; 2, there are unexplained liver function abnormalities; 3, obesity, hyperlipidemia, type 2 diabetes mellitus and long-term excessive alcohol consumption and other high-risk groups. Fourth, pay attention to regular monitoring routine test items ① complete blood count; ② liver function biochemical indicators; ③ complete set of blood lipids; ④ fasting blood glucose and glycated hemoglobin, fasting blood glucose ≥ 5.6 mmol / L and no history of diabetes mellitus should be 75g glucose tolerance test; ⑤ blood uric acid. Optional reference indicators ① insulin level to assess the risk of diabetes mellitus; ② whole blood viscosity, urine microalbumin, blood homocysteine and other components of the metabolic syndrome; ③ ultrasound carotid artery intima-media thickness and plaque; routine or dynamic electrocardiography, if necessary, exercise platelet test, coronary artery CT or imaging to assess the risk of cardiovascular disease; ④ serum ferritin, ultrasensitive protein, tumor necrosis factor, interleukin (interleukin), serum ferricin, ultra-sensitive reactive protein, tumor necrosis factor, and serum ferritin. (iv) Serum ferritin, hypersensitivity protein, tumor necrosis factor, interleukin (11)-6, lipocalin, leptin, and cytokeratin-18 to assess the degree of hepatic inflammation. It is recommended that NAFLD patients measure body mass, waist circumference, blood pressure, liver function, blood lipids and blood glucose every 3-6 months, and have an ultrasound examination of the upper abdomen including the liver, gallbladder and spleen every year. V. How to deal with fatty liver 1. Exercise Moderate aerobic exercise (such as cycling, fast walking, swimming, dancing, etc.), more than 4 times a week, with a cumulative time of at least 150-250min, and a target heart rate of >170-age after exercise. Light or moderate resistance muscular exercise (dumbbell lifting, push-ups, etc.) is preferred 2 times per week for greater metabolic improvement. A combination of diet and exercise therapy should be emphasized. Excessive exercise is contraindicated in people with fasting blood glucose >14-16 mmol/L, large fluctuations in blood glucose, acute metabolic complications of diabetes, and serious complications of the heart, kidneys, and other organs. Be alert to the possibility that rapid weight loss (weight loss of more than 5 kg per month) may lead to subacute non-alcoholic steatohepatitis and liver failure. Diet Patients with fatty liver disease who are overweight/obese should control the total amount of dietary calories, and it is recommended to reduce the daily calorie diet by 500kcal, aiming to reduce body mass by 5%~10% within half a year. Nonalcoholic fatty liver disease patients low sugar and low fat balanced diet, reduce sucrose or fructose-containing beverages as well as the intake of saturated fats (animal fats and palm oils, etc.) and trans fats (fried foods), and increase the content of dietary fiber (legumes, cereals, vegetables and fruits, etc.). Very low calorie diets for obesity need to be supervised by a clinical dietitian. Combined with malnutrition in patients with fatty liver disease, need to be under the guidance of a nutritionist to ensure that the caloric nitrogen quality is balanced, and supplemental vitamins and trace elements. 3, alcohol Excessive alcohol drinkers need to quit drinking or significantly reduce the amount of alcohol consumption and prevention and treatment of withdrawal syndrome. Chinese medicine has a multidirectional regulation effect, which has certain advantages in improving liver function, regulating and lowering blood lipids, and blocking the evolution of liver fibrosis. Non-alcoholic fatty liver disease is categorized into the following types in TCM. Liver depression and qi stagnation type The main manifestations are discomfort in the liver area, distension and pain in both hypochondriacs, depression and boredom, chest tightness, and liking to sigh. It may be accompanied by belching, reduced eating, irregular bowel movements, and in women, menstrual disorders, breast swelling and pain, etc. The tongue is red, the moss is white and thin, and the pulse is slippery or fine. Available remedies: Chai Hu Shuo Liver Essence plus subtractions (Xiang Fu, Chen Pi, Ze Xie, Citrus aurantium, Faxia, Ul Jin, Bai Shao, Rhubarb, Hawthorn, Glycyrrhiza Uralensis) Liver Depression and Spleen Deficiency Type: Commonly characterized by distension and tightness of the coarseness and ribs, depression, tiredness, abdominal pain and desire for diarrhea, which may be accompanied with abdominal distension, poor appetite, nausea, vomiting, and sighing, with a pale red tongue, thin white or white moss with tooth marks, and a fine stringy pulse. Available remedies: Loose powder plus and minus (Radix Bupleurum Chinense, Rhizoma Atractylodis Macrocephalae, Mentha piperita, Radix Paeoniae Alba, Radix Angelicae Sinensis, Poria, Hawthorn, Ginger, Radix et Rhizoma Glycyrrhizae) Phlegm-Dampness Internal Obstruction Obesity, discomfort or distension of the right side of the body, heavy and heavy body, sticky stools, distension in the epigastric region, fatigue, poor appetite, dizziness and nausea, tongue with light fur and white greasy coating, and a smooth and sedentary pulse. Available remedies: Er Chen Tang Plus Minus (Fahan Xia, Chen Pi, Poria, Ze Xie, Lai Tai Zi, Hawthorn, Pueraria Mirifica, Huang Jing, Atractylodes Macrocephalae, Huo Xiang, Glycyrrhiza Uralensis) Damp-Heat Conjugation Type: distension and pain of the right hypochondrium and ribs, heavy and heavy body, distension and pain of the epigastrium and abdomen, mucus and unpleasant stools, accompanied by yellowish color of the eyes and eyes, yellowish color of urine, mucus and stagnation of the mouth, dryness and bitterness of the mouth, reddish fur on the tongue with yellowish greasy coating, and slippery stringy or moistened pulse. Available prescription: Yin Chen Artemisia Tang Plus Reduction (Yin Chen, gardenia, rhubarb, tiger’s stick, thick park, plantain, Poria, atractylodes, poria, Ze Xie Diarrhea) Phlegm and stasis interconnection type Thoracic and rib stinging pain or dull pain, dark color, obese, may have chest and epigastric plumpness, sputum, anorexia of oil, tongue dark red, petechiae, tongue body fat, edge with teeth marks, greasy moss, smooth string or astringent pulse. Available prescriptions: diaphragm under the blood stasis and two Chen Tang Tang plus subtractions (Chai Hu, Angelica sinensis, peach kernel, five lingzhi, andrographis paniculata, dandelion, red peony, abdominal cortex, Poria cocos, Atractylodes macrocephala, Chen Pi, half-summertime, Citrus aurantium) Tips: Chinese medicine treatment emphasizes the four diagnostic and diagnostic, taking into account the body quality, tongue and pulse, symptoms, signs, the four times of the day and the climate, the five transport and six qi and other factors, so do not blindly take medication, it is best to be in the guidance of a medical professional to identify and dispense the prescription, and follow the symptoms and the treatment. It is better to be guided by a specialist physician to identify the evidence and make prescriptions, add or subtract according to the evidence, and apply flexibly.