Table of Contents Author Guidelines Submit a Manuscript
Evidence-Based Complementary and Alternative Medicine
Volume 2016, Article ID 6491420, 12 pages
http://dx.doi.org/10.1155/2016/6491420
Review Article

A Review of Western and Traditional Chinese Medical Approaches to Managing Nonalcoholic Fatty Liver Disease

1Division of Hepato-Gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
2Institute of Food Science and Technology, National Taiwan University, Taipei, Taiwan
3School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
4Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
5Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan

Received 6 September 2016; Accepted 9 October 2016

Academic Editor: Menaka C. Thounaojam

Copyright © 2016 Wei-Fan Hsu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. N. Chalasani, Z. Younossi, J. E. Lavine et al., “The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology,” Gastroenterology, vol. 142, no. 7, pp. 1592–1609, 2012. View at Publisher · View at Google Scholar · View at Scopus
  2. E. K. Spengler and R. Loomba, “Recommendations for diagnosis, referral for liver biopsy, and treatment of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis,” Mayo Clinic Proceedings, vol. 90, no. 9, pp. 1233–1246, 2015. View at Publisher · View at Google Scholar · View at Scopus
  3. R. Pais, F. Charlotte, L. Fedchuk et al., “A systematic review of follow-up biopsies reveals disease progression in patients with non-alcoholic fatty liver,” Journal of Hepatology, vol. 59, no. 3, pp. 550–556, 2013. View at Publisher · View at Google Scholar · View at Scopus
  4. S. Singh, A. M. Allen, Z. Wang, L. J. Prokop, M. H. Murad, and R. Loomba, “Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies,” Clinical Gastroenterology and Hepatology, vol. 13, no. 4, pp. 643–654, 2015. View at Publisher · View at Google Scholar · View at Scopus
  5. E. M. Brunt, C. G. Janney, A. M. Di Bisceglie, B. A. Neuschwander-Tetri, and B. R. Bacon, “Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions,” American Journal of Gastroenterology, vol. 94, no. 9, pp. 2467–2474, 1999. View at Publisher · View at Google Scholar · View at Scopus
  6. G. C. Farrell, V. W.-S. Wong, and S. Chitturi, “NAFLD in Asia—as common and important as in the West,” Nature Reviews Gastroenterology and Hepatology, vol. 10, no. 5, pp. 307–318, 2013. View at Publisher · View at Google Scholar · View at Scopus
  7. T.-J. Lin, C.-L. Lin, C.-S. Wang, S.-O. Liu, and L.-Y. Liao, “Prevalence of HFE mutations and relation to serum iron status in patients with chronic hepatitis C and patients with nonalcoholic fatty liver disease in Taiwan,” World Journal of Gastroenterology, vol. 11, no. 25, pp. 3905–3908, 2005. View at Publisher · View at Google Scholar · View at Scopus
  8. C.-H. Chen, M.-H. Huang, J.-C. Yang et al., “Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of Taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults,” Journal of Clinical Gastroenterology, vol. 40, no. 8, pp. 745–752, 2006. View at Publisher · View at Google Scholar · View at Scopus
  9. R. J. Wong, M. Aguilar, R. Cheung et al., “Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States,” Gastroenterology, vol. 148, no. 3, pp. 547–555, 2015. View at Publisher · View at Google Scholar · View at Scopus
  10. C.-S. Hsu and J.-H. Kao, “Non-alcoholic fatty liver disease: an emerging liver disease in Taiwan,” Journal of the Formosan Medical Association, vol. 111, no. 10, pp. 527–535, 2012. View at Publisher · View at Google Scholar · View at Scopus
  11. V. W.-S. Wong, W. C.-W. Chu, G. L.-H. Wong et al., “Prevalence of non-alcoholic fatty liver disease and advanced fibrosis in Hong Kong Chinese: a population study using proton-magnetic resonance spectroscopy and transient elastography,” Gut, vol. 61, no. 3, pp. 409–415, 2012. View at Publisher · View at Google Scholar · View at Scopus
  12. P. Angulo, J. C. Keach, K. P. Batts, and K. D. Lindor, “Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis,” Hepatology, vol. 30, no. 6, pp. 1356–1362, 1999. View at Publisher · View at Google Scholar · View at Scopus
  13. V. Ratziu, P. Giral, F. Charlotte et al., “Liver fibrosis in overweight patients,” Gastroenterology, vol. 118, no. 6, pp. 1117–1123, 2000. View at Publisher · View at Google Scholar · View at Scopus
  14. V. Ratziua, S. Bellentanib, H. Cortez-Pintoc, C. Dayd, and G. Marchesinie, “A position statement on NAFLD/NASH based on the EASL 2009 special conference,” Journal of Hepatology, vol. 53, no. 2, pp. 372–384, 2010. View at Publisher · View at Google Scholar · View at Scopus
  15. M. Feldman, L. S. Friedman, and L. J. Brandt, Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management, Saunders/Elsevier, Philadelphia, Pa, USA, 10th edition, 2016.
  16. K. Cusi, “Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: pathophysiology and clinical implications,” Gastroenterology, vol. 142, no. 4, pp. 711–725.e6, 2012. View at Publisher · View at Google Scholar · View at Scopus
  17. S. W. P. Koppe, “Obesity and the liver: nonalcoholic fatty liver disease,” Translational Research, vol. 164, no. 4, pp. 312–322, 2014. View at Publisher · View at Google Scholar · View at Scopus
  18. C. Duval, U. Thissen, S. Keshtkar et al., “Adipose tissue dysfunction signals progression of hepatic steatosis towards nonalcoholic steatohepatitis in C57Bl/6 mice,” Diabetes, vol. 59, no. 12, pp. 3181–3191, 2010. View at Publisher · View at Google Scholar · View at Scopus
  19. R. Stienstra, F. Saudale, C. Duval et al., “Kupffer cells promote hepatic steatosis via interleukin-1β-dependent suppression of peroxisome proliferator-activated receptor α activity,” Hepatology, vol. 51, no. 2, pp. 511–522, 2010. View at Publisher · View at Google Scholar · View at Scopus
  20. W. L. Holland, B. T. Bikman, L.-P. Wang et al., “Lipid-induced insulin resistance mediated by the proinflammatory receptor TLR4 requires saturated fatty acid-induced ceramide biosynthesis in mice,” Journal of Clinical Investigation, vol. 121, no. 5, pp. 1858–1870, 2011. View at Publisher · View at Google Scholar · View at Scopus
  21. K. Cusi, S. Kashyap, A. Gastaldelli, M. Bajaj, and E. Cersosimo, “Effects on insulin secretion and insulin action of a 48-h reduction of plasma free fatty acids with acipimox in nondiabetic subjects genetically predisposed to type 2 diabetes,” American Journal of Physiology—Endocrinology and Metabolism, vol. 292, no. 6, pp. E1775–E1781, 2007. View at Publisher · View at Google Scholar · View at Scopus
  22. C. P. Day and O. F. W. James, “Steatohepatitis: a tale of two ‘hits’?” Gastroenterology, vol. 114, no. 4, pp. 842–845, 1998. View at Publisher · View at Google Scholar · View at Scopus
  23. S. S. Choi and A. M. Diehl, “Hepatic triglyceride synthesis and nonalcoholic fatty liver disease,” Current Opinion in Lipidology, vol. 19, no. 3, pp. 295–300, 2008. View at Publisher · View at Google Scholar · View at Scopus
  24. M. M. Yeh and E. M. Brunt, “Pathological features of fatty liver disease,” Gastroenterology, vol. 147, no. 4, pp. 754–764, 2014. View at Publisher · View at Google Scholar · View at Scopus
  25. D. E. Kleiner, E. M. Brunt, M. Van Natta et al., “Design and validation of a histological scoring system for nonalcoholic fatty liver disease,” Hepatology, vol. 41, no. 6, pp. 1313–1321, 2005. View at Publisher · View at Google Scholar · View at Scopus
  26. P. Bedossa, A. Burt, A. Gouw et al., “Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis, activity, and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease,” Hepatology, vol. 60, no. 2, pp. 565–575, 2014. View at Publisher · View at Google Scholar · View at Scopus
  27. G. C. Farrell, S. Chitturi, G. K. K. Lau, and J. D. Sollano, “Guidelines for the assessment and management of non-alcoholic fatty liver disease in the Asia-Pacific region: executive summary,” Journal of Gastroenterology and Hepatology, vol. 22, no. 6, pp. 775–777, 2007. View at Publisher · View at Google Scholar · View at Scopus
  28. P. Angulo, J. M. Hui, G. Marchesini et al., “The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD,” Hepatology, vol. 45, no. 4, pp. 846–854, 2007. View at Publisher · View at Google Scholar · View at Scopus
  29. A. Vallet-Pichard, V. Mallet, B. Nalpas et al., “FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and fibrotest,” Hepatology, vol. 46, no. 1, pp. 32–36, 2007. View at Publisher · View at Google Scholar · View at Scopus
  30. S. A. Harrison, D. Oliver, H. L. Arnold, S. Gogia, and B. A. Neuschwander-Tetri, “Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease,” Gut, vol. 57, no. 10, pp. 1441–1447, 2008. View at Publisher · View at Google Scholar · View at Scopus
  31. P. Calès, F. Lainé, J. Boursier et al., “Comparison of blood tests for liver fibrosis specific or not to NAFLD,” Journal of Hepatology, vol. 50, no. 1, pp. 165–173, 2009. View at Publisher · View at Google Scholar · View at Scopus
  32. V. Ratziu, J. Massard, F. Charlotte et al., “Diagnostic value of biochemical markers (FibroTest-FibroSURE) for the prediction of liver fibrosis in patients with non-alcoholic fatty liver disease,” BMC Gastroenterology, vol. 6, article 6, 2006. View at Publisher · View at Google Scholar · View at Scopus
  33. V. W.-S. Wong, G. L.-H. Wong, A. M.-L. Chim et al., “Validation of the NAFLD fibrosis score in a Chinese population with low prevalence of advanced fibrosis,” American Journal of Gastroenterology, vol. 103, no. 7, pp. 1682–1688, 2008. View at Publisher · View at Google Scholar · View at Scopus
  34. J. Raszeja-Wyszomirska, B. Szymanik, M. Ławniczak et al., “Validation of the BARD scoring system in Polish patients with nonalcoholic fatty liver disease (NAFLD),” BMC Gastroenterology, vol. 10, article 67, 2010. View at Publisher · View at Google Scholar · View at Scopus
  35. Y. Sumida, M. Yoneda, H. Hyogo et al., “Validation of the FIB4 index in a Japanese nonalcoholic fatty liver disease population,” BMC Gastroenterology, vol. 12, article 2, 2012. View at Publisher · View at Google Scholar · View at Scopus
  36. G. Sebastiani, R. Alshaalan, P. Wong et al., “Prognostic value of non-invasive fibrosis and steatosis tools, hepatic venous pressure gradient (HVPG) and histology in nonalcoholic steatohepatitis,” PLoS ONE, vol. 10, no. 6, Article ID e0128774, 2015. View at Publisher · View at Google Scholar · View at Scopus
  37. S. Dasarathy, J. Dasarathy, A. Khiyami, R. Joseph, R. Lopez, and A. J. McCullough, “Validity of real time ultrasound in the diagnosis of hepatic steatosis: a prospective study,” Journal of Hepatology, vol. 51, no. 6, pp. 1061–1067, 2009. View at Publisher · View at Google Scholar · View at Scopus
  38. R. Hernaez, M. Lazo, S. Bonekamp et al., “Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis,” Hepatology, vol. 54, no. 3, pp. 1082–1090, 2011. View at Publisher · View at Google Scholar · View at Scopus
  39. R. Kwok, Y.-K. Tse, G. L.-H. Wong et al., “Systematic review with meta-analysis: non-invasive assessment of non-alcoholic fatty liver disease-the role of transient elastography and plasma cytokeratin-18 fragments,” Alimentary Pharmacology and Therapeutics, vol. 39, no. 3, pp. 254–269, 2014. View at Publisher · View at Google Scholar · View at Scopus
  40. M. L. Palmeri, M. H. Wang, N. C. Rouze et al., “Noninvasive evaluation of hepatic fibrosis using acoustic radiation force-based shear stiffness in patients with nonalcoholic fatty liver disease,” Journal of Hepatology, vol. 55, no. 3, pp. 666–672, 2011. View at Publisher · View at Google Scholar · View at Scopus
  41. J. Cui, E. Heba, C. Hernandez et al., “Magnetic resonance elastography is superior to acoustic radiation force impulse for the Diagnosis of fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease: a prospective study,” Hepatology, vol. 63, no. 2, pp. 453–461, 2016. View at Publisher · View at Google Scholar · View at Scopus
  42. D. Festi, R. Schiumerini, L. Marzi et al., “Review article: the diagnosis of non-alcoholic fatty liver disease—availability and accuracy of non-invasive methods,” Alimentary Pharmacology and Therapeutics, vol. 37, no. 4, pp. 392–400, 2013. View at Publisher · View at Google Scholar · View at Scopus
  43. J. Foucher, L. Castéra, P.-H. Bernard et al., “Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations,” European Journal of Gastroenterology and Hepatology, vol. 18, no. 4, pp. 411–412, 2006. View at Publisher · View at Google Scholar · View at Scopus
  44. M. L. Palmeri, M. H. Wang, J. J. Dahl, K. D. Frinkley, and K. R. Nightingale, “Quantifying hepatic shear modulus in vivo using acoustic radiation force,” Ultrasound in Medicine and Biology, vol. 34, no. 4, pp. 546–558, 2008. View at Publisher · View at Google Scholar · View at Scopus
  45. A. G. Shah, A. Lydecker, K. Murray, B. N. Tetri, M. J. Contos, and A. J. Sanyal, “Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease,” Clinical Gastroenterology and Hepatology, vol. 7, no. 10, pp. 1104–1112, 2009. View at Publisher · View at Google Scholar · View at Scopus
  46. S. Singh, R. Khera, A. M. Allen, M. H. Murad, and R. Loomba, “Comparative effectiveness of pharmacological interventions for nonalcoholic steatohepatitis: a systematic review and network meta-analysis,” Hepatology, vol. 62, no. 5, pp. 1417–1432, 2015. View at Publisher · View at Google Scholar · View at Scopus
  47. E. A. Klein, I. M. Thompson Jr., C. M. Tangen et al., “Vitamin E and the risk of prostate cancer: the selenium and vitamin E cancer prevention trial (SELECT),” JAMA-Journal of the American Medical Association, vol. 306, no. 14, pp. 1549–1556, 2011. View at Publisher · View at Google Scholar · View at Scopus
  48. G. Bjelakovic, D. Nikolova, and C. Gluud, “Meta-regression analyses, meta-analyses, and trial sequential analyses of the effects of supplementation with beta-carotene, vitamin A, and vitamin E singly or in different combinations on all-cause mortality: do we have evidence for lack of harm?” PloS ONE, vol. 8, no. 9, Article ID e74558, 2013. View at Google Scholar · View at Scopus
  49. J. A. Dormandy, B. Charbonnel, D. J. A. Eckland et al., “Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial in macroVascular Events): a randomised controlled trial,” The Lancet, vol. 366, no. 9493, pp. 1279–1289, 2005. View at Publisher · View at Google Scholar · View at Scopus
  50. P. D. Home, S. J. Pocock, H. Beck-Nielsen et al., “Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial,” The Lancet, vol. 373, no. 9681, pp. 2125–2135, 2009. View at Publisher · View at Google Scholar · View at Scopus
  51. B. A. Neuschwander-Tetri, R. Loomba, A. J. Sanyal et al., “Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial,” The Lancet, vol. 385, no. 9972, pp. 956–965, 2015. View at Publisher · View at Google Scholar · View at Scopus
  52. M. Wang, R. Zhao, W. Wang, X. Mao, and J. Yu, “Lipid regulation effects of Polygoni Multiflori Radix, its processed products and its major substances on steatosis human liver cell line L02,” Journal of Ethnopharmacology, vol. 139, no. 1, pp. 287–293, 2012. View at Publisher · View at Google Scholar · View at Scopus
  53. H. Kang and S. Koppula, “Houttuynia cordata attenuates lipid accumulation via activation of AMP-activated protein kinase signaling pathway in HepG2 cells,” The American Journal of Chinese Medicine, vol. 42, no. 3, pp. 651–664, 2014. View at Publisher · View at Google Scholar · View at Scopus
  54. M.-R. Lee, H.-Y. Lee, G.-H. Lee et al., “Ixeris dentata decreases ER stress and hepatic lipid accumulation through regulation of ApoB secretion,” American Journal of Chinese Medicine, vol. 42, no. 3, pp. 639–649, 2014. View at Publisher · View at Google Scholar · View at Scopus
  55. O. H. Kang, S. B. Kim, Y. S. Seo et al., “Curcumin decreases oleic acid-induced lipid accumulation via AMPK phosphorylation in hepatocarcinoma cells,” European Review for Medical and Pharmacological Sciences, vol. 17, no. 19, pp. 2578–2586, 2013. View at Google Scholar · View at Scopus
  56. O.-H. Kang, S.-B. Kim, S.-H. Mun et al., “Puerarin ameliorates hepatic steatosis by activating the PPARα and AMPK signaling pathways in hepatocytes,” International Journal of Molecular Medicine, vol. 35, no. 3, pp. 803–809, 2015. View at Publisher · View at Google Scholar · View at Scopus
  57. J. Yin, Y. Luo, H. Deng et al., “Hugan Qingzhi medication ameliorates hepatic steatosis by activating AMPK and PPARα pathways in L02 cells and HepG2 cells,” Journal of Ethnopharmacology, vol. 154, no. 1, pp. 229–239, 2014. View at Publisher · View at Google Scholar · View at Scopus
  58. H.-Y. Song, L. Zhang, J.-L. Pan, L.-L. Yang, and G. Ji, “Bioactivity of five components of Chinese herbal formula Jiangzhi granules against hepatocellular steatosis,” Journal of Integrative Medicine, vol. 11, no. 4, pp. 262–268, 2013. View at Publisher · View at Google Scholar · View at Scopus
  59. S.-D. Chen, J. Li, H.-H. Zhou et al., “Study on effects of Zhi Zi (Fructus gardeniae) on non-alcoholic fatty liver disease in the rat,” Journal of Traditional Chinese Medicine, vol. 32, no. 1, pp. 82–86, 2012. View at Publisher · View at Google Scholar · View at Scopus
  60. H.-Y. Quan, H.-D. Yuan, M. I. S. Jung, S. K. Ko, Y. G. Park, and S. H. Chung, “Ginsenoside Re lowers blood glucose and lipid levels via activation of AMP-activated protein kinase in HepG2 cells and high-fat diet fed mice,” International Journal of Molecular Medicine, vol. 29, no. 1, pp. 73–80, 2012. View at Publisher · View at Google Scholar · View at Scopus
  61. D. Dong, Y. Qi, L. Xu et al., “Total saponins from Rosa laevigata Michx fruit attenuates hepatic steatosis induced by high-fat diet in rats,” Food and Function, vol. 5, no. 12, pp. 3065–3075, 2014. View at Publisher · View at Google Scholar · View at Scopus
  62. W. Li, Y. Li, Q. Wang, and Y. Yang, “Crude extracts from Lycium barbarum suppress SREBP-1c expression and prevent diet-induced fatty liver through AMPK activation,” BioMed Research International, vol. 2014, Article ID 196198, 10 pages, 2014. View at Publisher · View at Google Scholar · View at Scopus
  63. T.-Y. Lee, H.-H. Chang, W.-C. Lo, and H.-C. Lin, “Alleviation of hepatic oxidative stress by Chinese herbal medicine Yin-Chen-Hao-Tang in obese mice with steatosis,” International Journal of Molecular Medicine, vol. 25, no. 6, pp. 837–844, 2010. View at Publisher · View at Google Scholar · View at Scopus
  64. M. Fujimoto, K. Tsuneyama, M. Kainuma et al., “Evidence-based efficacy of Kampo formulas in a model of non alcoholic fatty liver,” Experimental Biology and Medicine, vol. 233, no. 3, pp. 328–337, 2008. View at Publisher · View at Google Scholar · View at Scopus
  65. L. Zhang, J. Xu, H. Song, Z. Yao, and G. Ji, “Extracts from Salvia-Nelumbinis naturalis alleviate hepatosteatosis via improving hepatic insulin sensitivity,” Journal of Translational Medicine, vol. 12, no. 1, article 236, 2014. View at Publisher · View at Google Scholar · View at Scopus
  66. S. Chen, H. Zhou, M. Lin, R. Mi, and L. Li, “Decoction vs extracts-mixed solution: effect of yiqihuoxue formula on non-alcoholic fatty liver disease in rats,” Journal of Traditional Chinese Medicine, vol. 33, no. 4, pp. 513–517, 2013. View at Publisher · View at Google Scholar · View at Scopus
  67. A. Suzuki, K. Lindor, J. S. Saver et al., “Effect of changes on body weight and lifestyle in nonalcoholic fatty liver disease,” Journal of Hepatology, vol. 43, no. 6, pp. 1060–1066, 2005. View at Publisher · View at Google Scholar · View at Scopus
  68. L. Azoulay, H. Yin, K. B. Filion et al., “The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes: nested case-control study,” British Medical Journal, vol. 344, no. 7862, Article ID e3645, 2012. View at Publisher · View at Google Scholar · View at Scopus
  69. C.-H. Tseng, “Pioglitazone and bladder cancer in human studies: is it diabetes itself, diabetes drugs, flawed analyses or different ethnicities?” Journal of the Formosan Medical Association, vol. 111, no. 3, pp. 123–131, 2012. View at Publisher · View at Google Scholar · View at Scopus
  70. J. D. Lewis, L. A. Habel, C. P. Quesenberry et al., “Pioglitazone use and risk of bladder cancer and other common cancers in persons with diabetes,” JAMA-Journal of the American Medical Association, vol. 314, no. 3, pp. 265–277, 2015. View at Publisher · View at Google Scholar · View at Scopus
  71. M. J. Armstrong, P. Gaunt, G. P. Aithal et al., “Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study,” The Lancet, vol. 387, no. 10019, pp. 679–690, 2016. View at Publisher · View at Google Scholar · View at Scopus
  72. M. J. Armstrong, D. Hull, K. Guo et al., “Glucagon-like peptide 1 decreases lipotoxicity in non-alcoholic steatohepatitis,” Journal of Hepatology, vol. 64, no. 2, pp. 399–408, 2016. View at Publisher · View at Google Scholar · View at Scopus
  73. Y.-F. Ng, P. C.-T. Tang, T.-T. Sham, W.-S. Lam, D. K.-W. Mok, and S.-W. Chan, “Semen Astragali Complanati: an ethnopharmacological, phytochemical and pharmacological review,” Journal of Ethnopharmacology, vol. 155, no. 1, pp. 39–53, 2014. View at Publisher · View at Google Scholar · View at Scopus
  74. J.-G. Fan, H.-Y. Liu, Y.-Z. Yuan et al., “Evaluating the efficacy and safety of Danning Pian in the short-term treatment of patients with non-alcoholic fatty liver disease: a multicenter clinical trial,” Hepatobiliary and Pancreatic Diseases International, vol. 3, no. 3, pp. 375–380, 2004. View at Google Scholar · View at Scopus
  75. S.-J. Zhang, Z.-X. Chen, K.-P. Jiang, Y.-H. Cheng, and Y.-L. Gu, “The effect of QuYuHuaTanTongLuo Decoction on the non-alcoholic steatohepatitis,” Complementary Therapies in Medicine, vol. 16, no. 4, pp. 192–198, 2008. View at Publisher · View at Google Scholar · View at Scopus
  76. M. Fujimoto, K. Tsuneyama, H. Kinoshita et al., “The traditional Japanese formula keishibukuryogan reduces liver injury and inflammation in patients with nonalcoholic fatty liver disease,” Annals of the New York Academy of Sciences, vol. 1190, pp. 151–158, 2010. View at Publisher · View at Google Scholar · View at Scopus
  77. Z. L. Liu, L. Z. Xie, J. Zhu, G. Q. Li, S. J. Grant, and J. P. Liu, “Herbal medicines for fatty liver diseases,” The Cochrane Database of Systematic Reviews, vol. 8, Article ID CD009059, 2013. View at Google Scholar · View at Scopus
  78. J. E. Donnelly, S. N. Blair, J. M. Jakicic, M. M. Manore, J. W. Rankin, and B. K. Smith, “Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults,” Medicine and Science in Sports and Exercise, vol. 41, no. 2, pp. 459–471, 2009. View at Publisher · View at Google Scholar · View at Scopus
  79. K. Hallsworth, L. Avery, and M. I. Trenell, “Targeting lifestyle behavior change in adults with NAFLD during a 20-min consultation: summary of the dietary and exercise literature,” Current Gastroenterology Reports, vol. 18, no. 3, article 11, 2016. View at Publisher · View at Google Scholar
  80. H.-Y. Song, Z.-M. Mao, L.-L. Yang et al., “Dangfei liganning capsules attenuate the susceptibility of rat nonalcoholic fatty liver to carbon tetrachloride toxicity,” Journal of Traditional Chinese Medicine, vol. 31, no. 4, pp. 327–333, 2011. View at Publisher · View at Google Scholar · View at Scopus
  81. WHO, “WHO Traditional Medicine Strategy: 2002–2005,” http://www.who.int/medicines/publications/traditionalpolicy/en/
  82. Y. Chen, T.-H. Jiang, W.-Z. Ru, A.-W. Mao, and Y. Liu, “Objective tongue inspection on 142 liver cancer patients with damp-heat syndrome,” Chinese Journal of Integrative Medicine, vol. 20, no. 8, pp. 585–590, 2014. View at Publisher · View at Google Scholar · View at Scopus
  83. P.-Y. Huang, W.-C. Lin, B. Y.-C. Chiu, H.-H. Chang, and K.-P. Lin, “Regression analysis of radial artery pulse palpation as a potential tool for traditional Chinese medicine training education,” Complementary Therapies in Medicine, vol. 21, no. 6, pp. 649–659, 2013. View at Publisher · View at Google Scholar · View at Scopus
  84. A. de Sá Ferreira and A. J. Lopes, “Pulse waveform analysis as a bridge between pulse examination in chinese medicine and cardiology,” Chinese Journal of Integrative Medicine, vol. 19, no. 4, pp. 307–314, 2013. View at Publisher · View at Google Scholar · View at Scopus