【摘要】 代谢功能障碍相关性脂肪变性肝病(metabolic dysfunction-associated steatotic liver disease,MASLD)发病初期邪气尚浅，以食郁、气郁为主，理气化积便可消解;中期邪气渐入肌腠，以火郁、湿郁为主，清热利湿尚可除之;日久邪气深入脏腑，以痰郁、血郁为主，惟开痰行血方可扭转。除针对不同阶段主要病机的治疗之外，节饮食、理气机均应贯穿治疗始终。食、气、火、湿、痰、血“六郁”，既可单独致病，彼此又互为因果、相兼为病，一郁常由他郁引发。丹溪所设越鞠丸统治六郁，但君臣佐使的配伍并非一成不变，用药亦不应拘泥于此方。直须以六郁为纲，辨明主要郁邪的性质，再依证型不同灵活用药设方，有所侧重并兼顾他郁，定能效如桴鼓。更多还原

【Abstract】 Metabolic dysfunction-associated steatotic liver disease(MASLD) in its early stage is characterized by shallow pathogenic factors,mainly food stagnation and Qi stagnation,which can be resolved by regulating Qi and transforming accumulation. In the middle stage,the pathogenic factors gradually enter the muscles and collaterals,mainly presenting as Fire stagnation and Dampness stagnation,which can still be treated by clearing Heat and relieving Dampness. Over time,the pathogenic factors penetrate the internal Zang and Fu,mainly as Phlegm stagnation and blood stagnation,which can only be reversed by formulas that can dredge Phlegm and invigorate blood. In addition to treatments targeting the primary pathogenesis at different stages,dietary regulation and Qi management should be maintained throughout the treatment. The Six Yu-food,Qi,Fire,Dampness,Phlegm,and blood-can independently cause disease,but they also act as cause and effect for each other,often leading to combined pathologies,with one stagnation frequently triggering another.Yuejü Pill,prescribed by Zhu Danxi,can addresses all the Six Yu,but the ministerial and assistant roles in the formula are not fixed,and the use of herbs should not be strictly confined to this prescription. The key is to take the Six Yu as the guiding principle,clarify the nature of the predominant stagnation,then flexibly design prescriptions according to different syndrome types,focusing on the primary stagnation while also considering the others,which can definitely achieve effective results.更多还原