Liver Disease
TCM Treatment Of Liver Diseases
I. The Logical Relationship And Pathogenesis In TCM – A Zang-Fu Organ Functional Network Centered On The Liver
The liver governs the free flow of qi and regulates qi movement:
Emotional distress leads to liver qi stagnation, the initial stage of most liver diseases. Stagnant qi movement causes qi stagnation and blood stasis, or the liver qi invading the stomach resulting in disharmony between the liver and stomach, or transforming into fire and disturbing the heart.
The liver stores blood, with a yin nature and yang manifestations:
The liver stores and regulates blood. Pathologically, failure in blood storage may cause bleeding; consumption of yin and blood leads to ascending hyperactivity of liver yang and internal stirring of liver wind.
Inter-promotion and inter-restraint between the liver and other zang-fu organs:
• Liver wood invading spleen earth: Liver diseases most easily affect the spleen and stomach, causing poor appetite, abdominal distension and fatigue.
• Liver and kidney sharing the same origin: Protracted liver diseases inevitably consume kidney essence, leading to liver-kidney yin deficiency.
• Hyperactivity of fire in the liver and heart: The two organs interact with each other, resulting in insomnia and irritability.
The onset of liver diseases starts with disharmony of liver qi, which further generates pathological products such as liver fire, liver wind and liver blood stasis. These products affect other zang-fu organs through the inter-promotion and inter-restraint of the five elements, developing into complex systemic diseases.
II. Common Etiological Factors
Exogenous damp-heat pestilential toxin:
The primary cause, e.g., infectious hepatitis virus, which is categorized as "pestilential toxin" and "damp-heat" in TCM.
Improper diet:
Excessive consumption of greasy, sweet, rich, spicy and roasted foods, or heavy drinking, generates damp-heat, impairs the spleen and stomach, and fumigates the liver and gallbladder.
Internal injury due to emotional disorders:
Prolonged depression and anger easily lead to liver qi stagnation and dysfunction of qi dispersion, the starting point of various diseases.
Immoderate work and rest:
Excessive fatigue (including staying up late) consumes qi, blood, yin and essence; excessive idleness causes stagnation of qi movement.
Pathogen transmission from other diseases or toxic injury by drugs:
Chronic diseases consume vital qi, or the misuse/overuse of liver-damaging drugs causes injury.
III. Pathogenesis – Deficiency of Vital Qi and Pathogen Invasion, Disorder of Qi and Blood
The pathogenesis of liver diseases can be summarized as: deficiency of vital qi makes the body susceptible to invasion by damp-heat pestilential toxin, alcohol, greasy and rich foods, etc., generating "dampness, heat, stasis and toxin". These pathological products further damage the liver parenchyma (liver yin and blood), leading to disorder of qi, blood, yin and yang, obstruction of liver collaterals, and forming a vicious circle of interweaving "stagnation, stasis, phlegm, toxin and deficiency". This results in a protracted and refractory condition with clinical manifestations of intermingling of phlegm and stasis.
IV. Five Stages in the Onset and Progression of Liver Diseases
Stage of Liver Qi Stagnation
The initial stage of the disease with stagnant qi movement, characterized by emotional distress, hypochondriac distending pain, chest distress and belching, commonly seen in the hepatitis stage.
01
Stage of Damp-Heat in the Liver and Gallbladder
Intermingling of dampness and heat fumigates the liver and gallbladder, manifested as jaundice of the skin and sclera, bitter taste in the mouth, nausea, dark urine, and yellow greasy tongue coating, commonly seen in acute hepatitis or chronic active stage.
02
Stage of Liver Stagnation and Spleen Deficiency
Liver disease invades the spleen, with concurrent liver stagnation and spleen deficiency, manifested as hypochondriac pain, abdominal distension, poor appetite, fatigue and loose stools.
03
Stage of Intermingling of Phlegm and Stasis
Protracted disease invades the collaterals, and qi stagnation leads to blood stasis, manifested as dark and sallow complexion, hypochondriac stabbing pain, hepatosplenomegaly, and purple dark tongue with petechiae, corresponding to hepatic fibrosis and early to middle stage liver cirrhosis.
04
Stage of Liver-Kidney Yin Deficiency or Spleen-Kidney Yang Deficiency
The late stage of the disease, with protracted illness affecting the kidney; it may present as yin deficiency (soreness and weakness of the waist and knees, five-center fever, red tongue with little coating) or yang deficiency (chills and cold limbs, tympanites, lower limb edema), corresponding to advanced liver cirrhosis or chronic liver failure stage.
05
V. A Unique Therapy for Liver Diseases in Our Hospital – Sequential Application of the Four Methods: Clearing, Resolving, Soothing and Tonifying
Based on an in-depth understanding of the above progression rules of liver diseases, our hospital has summarized and refined a diagnosis and treatment system centered on the four methods of Clearing, Resolving, Soothing and Tonifying, emphasizing stage-based treatment and dynamic adjustment.
Theoretical basis: Targeting "damp-heat pestilential toxin", the core pathogen of liver diseases. In the active stage of liver diseases, exuberant pathogenic toxin is the key contradiction. "Clearing" refers to the use of bitter-cold or sweet-cold medicinals (e.g., Artemisia Scopariae, Gardeniae Fructus, Taraxaci Herba, Polygoni Cuspidati Rhizoma et Radix) to directly reduce fire intensity, eliminate internal latent heat-toxin and damp-toxin, and control inflammatory activity – a process analogous to "extinguishing fire and reducing inflammation" for the liver.
Theoretical basis: Damp pathogen is sticky and lingering, an important factor for the protracted course of liver diseases. "Resolving" involves eliminating dampness through mild diuresis (e.g., Poria Cocos, Alismatis Rhizoma) and aromatic medicinals (e.g., Agastaches Herba, Eupatorii Herba), providing a pathway for damp pathogen to be eliminated through urine. Combined with the Clearing Method, it significantly alleviates jaundice, abdominal distension, thick greasy tongue coating and other symptoms, creating a "dry" internal environment for the liver.
Theoretical basis: Closely aligning with the physiological characteristic of "the liver governing the free flow of qi". Liver diseases are invariably accompanied by stagnation, and protracted diseases inevitably lead to stasis. "Soothing" has two connotations: first, soothing liver qi with Bupleuri Radix, Cyperi Rhizoma, Curcumae Radix to regulate emotions and qi movement; second, unblocking liver collaterals with Salviae Miltiorrhizae Radix et Rhizoma, Persicae Semen, Notoginseng Radix et Rhizoma to improve hepatic microcirculation and resist fibrosis. This method is applied throughout the entire treatment course and is the key to breaking the vicious circle of "stagnation and stasis".
Theoretical basis: Following the principles of "protracted diseases leading to deficiency" and "treating the root cause of the disease". In the late or remission stage of the disease, or for patients with physical deficiency, deficiency of vital qi becomes the main contradiction. "Tonifying" is not blind supplementation but flexible application based on the insufficiency of zang-fu organs:
• Nourishing the liver parenchyma: Nourishing liver yin and blood with Angelicae Sinensis Radix, Paeoniae Radix Alba, Lycii Fructus.
• Tonifying the spleen: Invigorating the spleen and replenishing qi with Astragali Radix, Atractylodis Macrocephalae Rhizoma, Codonopsis Radix to tonify the spleen and nourish the liver.
• Tonifying kidney essence: Nourishing the kidney to tonify the liver with Ligustri Lucidi Fructus, Ecliptae Herba, Corni Fructus.
The application of the Tonifying Method aims to strengthen vital qi, repair damaged liver cells, regulate immune function, and enhance disease resistance and repair capacity.
The four methods (Clearing, Resolving, Soothing and Tonifying) are not used in isolation but as an organically integrated dynamic therapeutic strategy. Generally, in the active stage of the disease, the Clearing and Resolving Methods are the mainstay, assisted by the Soothing and Tonifying Methods; in the remission or chronic stage, the Soothing and Tonifying Methods are dominant, along with clearing and resolving residual pathogens. Through flexible compatibility and sequential application of these four methods, we achieve the goal of "eliminating pathogens without injuring vital qi, and tonifying vital qi without retaining pathogens", and systematically realize comprehensive curative effects including antiviral, anti-inflammatory, anti-fibrotic, immunomodulatory and overall functional recovery – this is the core advantage of TCM treatment for liver diseases in our hospital. Through Multi-disciplinary Team (MDT) consultation, we adopt individualized integrated Chinese and Western medicine treatment methods, including oral Chinese herbal decoctions, Chinese herbal granules, acupoint application of heated Chinese herbal packs, as well as appropriate TCM techniques such as acupuncture and moxibustion, infrared therapy and foot bath, combined with hepatic cell growth factor therapy, splenectomy and other treatments to better correct complications and improve the long-term prognosis of patients.
VI. Precautions During the Treatment of Liver Diseases
Maintain a regular diet and daily routine; keep warm and avoid cold; maintain a pleasant mood; take soft and liquid foods as the main diet and eat small and frequent meals; keep bowel movements unobstructed; receive regular examinations; take medicines regularly and in a standardized manner; do not stop or reduce the dosage without medical advice.
Shijiazhuang Medical College Hospital is one of the best hospitals for liver disease in China. With abundant experience, we provide high quality liver disease treatment service and specialist doctors for foreigners and international patients. Contact us for more details.