随着饮食结构及生活方式的转变，代谢相关脂肪性肝病（MAFLD）的全球发病率持续攀升，带来巨大的医疗卫生压力与社会经济负担，然而，目前西医尚缺乏特效治疗手段。中药药对是中药组方配伍的基础单位，也是中药复方的核心构成，具有协同增效、配伍减毒的特点，在MAFLD防治方面发挥重要作用。基于MAFLD“郁-湿-热-痰-瘀”的核心病机，系统梳理归纳现有研究内容，将临床治疗MAFLD的中药药对划分为疏肝解郁、健脾化湿、清热利湿、化痰祛瘀及其他5大类；同时以柴胡-人参、茯苓-白术、黄连-红曲、丹参-泽泻、黄连-黄芪等为代表药对，解析其配伍特点、现代药理通路与临床应用方剂。各类药对可多靶点调控脂质代谢、抑制炎症、抗氧化应激、改善胰岛素抵抗以阻断肝脂沉积与肝损伤进程。相关证据旨在为中医药防治MAFLD提供临床参考与理论支撑。

With changes in dietary patterns and lifestyles, the global incidence of metabolic-associated fatty liver disease (MAFLD) continues to rise, imposing significant healthcare burdens and socioeconomic costs. However, current Western medicine lacks effective therapeutic strategies. Chinese herbal drug pairs serve as fundamental units in traditional Chinese medicine (TCM) formula composition and are core components of compound prescriptions, characterized by synergistic enhancement and toxicity reduction through rational combinations, playing a crucial role in the prevention and treatment of MAFLD. Based on the core pathogenesis of MAFLD—stagnation, dampness, heat, phlegm and blood stasis—this study systematically reviews and categorizes existing research into five major classes of TCM drug pairs used clinically for MAFLD: liver-soothing and depression-relieving, spleen-strengthening and dampness-resolving, heat-clearing and dampness-draining, phlegm-resolving and stasis-removing, and others. Representative drug pairs such as Bupleuri Radix-Panax ginseng, Poria cocos-Atractylodis Macrocephalae Rhizoma, Coptis chinensis-Fermentum Rubrum, Salvia miltiorrhiza-Alismatis Rhizoma, and Coptis chinensis-Astragalus are analyzed in terms of their pairing characteristics, modern pharmacological pathways, and clinical applications. These drug pairs can modulate lipid metabolism via multiple targets, suppress inflammation, alleviate oxidative stress, and improve insulin resistance, thereby interrupting hepatic lipid accumulation and liver injury progression. The evidence presented aims to provide clinical reference and theoretical support for the prevention and treatment of MAFLD using TCM.

R285.5

国家自然科学基金青年基金资助项目（82104772）；中国博士后科学基金资助项目（2022M721067）；河南省自然科学基金资助项目（252300423160）；河南省自然科学基金资助项目（252300423165）