It is considered that lean metabolic associated fatty liver disease （MAFLD） is characte-rized by a state of "lean body but fatty liver". From the perspective of the pathomechanism evolution of "spleen failing to disperse essence， while kidney failing to transform

qi

"， the disease is systematically treated under the principle that spleen and kidney deficiency as the root and liver constraint with phlegm stasis as the branch. Spleen deficiency with impaired transformation and transportation leads to failure in the distribution of refined substances， initiating lipid turbidity accumulation and obstruction. Kidney dysfunction in

qi

transformation results in insufficient essence and blood， forming the root of bodily malnourishment. Over time， this further gives rise to liver constraint and loss of dispersing function， disorder in the mov

ement of essential substances， and congealing of phlegm and stasis within hepatic collaterals. The dysfunction of three organs including spleen， kidney and liver constitutes the pathological basis of metabolic disturbances involving

qi

， blood， body fluids and essence. Treatment should follow the principle of "nourishing the healthy

qi

leads to spontaneous resolution of pathogenic accumulation"， with three approaches. First， fortifying the spleen and eliminating dampness， using

Sini Powder

（四逆散） and

Erchen Pingwei Powder

（二陈平胃散） to restore the transport and transformation function of the middle

jiao

（焦）， thereby guiding essential substances back to their proper physiological pathways. Second， tonifying the kidney and resolving turbidity， using

Jinkui Shenqi Pill

（金匮肾气丸） and

Effective Integration Decoction

（一贯煎） to replenish the lower

jiao

， promoting the restoration of essence and the transformation of turbid pathogen. Third， soothing the liver and resolving stasis， using

Liujunzi Decoction

（六君子汤） and

Xiaozhi Qinggan Decoction

（消脂清肝汤） to vent

qi

and blood stagnation， thereby interrupting disease progression. Together， these three methods reinforce healthy

qi

while eliminating pathogen， facilitating the restoration of proper essence transformation and the resolution of lipid turbidity.