How to Treat Elevated Liver Enzymes: Insights from Traditional Chinese Medicine - Traditional Chinese Medicine

Dr. Lin Qingzhong reply Traditional Chinese Medicine

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Dear Mr.
Huang / 25 / Online User,
Your questions are answered as follows:
1.
Fatty liver should be treated from the perspective of liver health.
2.
My clinic hours are Monday to Saturday mornings, Monday afternoons, and Thursday afternoons.
Please come fasting.
3.
For fatty liver, exercise, weight loss, and stress reduction are essential.
Both Traditional Chinese Medicine (TCM) and Western medicine have their unique treatment methods and medications, and it is best to combine both approaches for optimal results.
4.
The definition of fatty liver is when the fat content in liver cells exceeds 5%.
Diagnosis should be confirmed through Western medical examinations such as abdominal ultrasound.
Many factors can cause fatty liver, including hepatitis B and C, alcohol consumption, overwork, obesity, hyperlipidemia, diabetes, and improper medication use.
These factors can lead to fat accumulation and fibrosis in liver cells, and in severe cases, may progress to cirrhosis.
Currently, the prevalence of fatty liver among adults in Taiwan is approximately 25%, significantly higher than that of hepatitis B and C, making it the most common liver disease in the country.
If diagnosed with fatty liver disease, treatment is necessary to prevent progression to cirrhosis.
Treatment should address the underlying causes.
For example, if caused by excessive alcohol consumption, abstinence is required; if due to hepatitis B or C, those conditions should be treated; if obesity is the cause, weight control is necessary.
Although there is no direct equivalent term for fatty liver in TCM, it can be associated with clinical manifestations of pain and distension in the liver area seen in end-stage cirrhosis, categorized as "hypochondriac pain" or "accumulation." TCM attributes the causes to external pathogenic factors (wind, cold, heat, dryness, fire—i.e., viral infections) and internal emotional disturbances (joy, anger, worry, thought, sadness, fear, shock—i.e., chronic stress and emotional tension), or excessive consumption of rich foods or alcohol.
Due to the damage fatty liver inflicts on the liver, gallbladder, spleen, and stomach, TCM considers the pathogenesis to involve disharmony between the liver and gallbladder, dysfunction of the spleen and stomach, damp-heat phlegm obstruction, and qi stagnation with blood stasis.
This means that patients, due to unrestrained eating and drinking, have harmed their liver, gallbladder, spleen, and stomach, leading to dysfunction in the spleen and stomach, resulting in dampness and phlegm accumulation, impaired blood circulation, and the interaction of phlegm and qi stagnation, which accumulates in the liver area.
In TCM, the treatment principles for fatty liver focus on addressing the characteristics of qi and blood stagnation and phlegm-damp obstruction, emphasizing liver soothing, gallbladder benefiting, spleen and stomach harmonizing, phlegm resolving, and dampness eliminating, with a primary focus on lipid reduction and liver protection.
TCM treatment for fatty liver should be tailored based on the patient's clinical manifestations and syndrome differentiation, which can be categorized as follows:
1.
Qi Stagnation Type: Patients often experience fatigue, discomfort in the right hypochondrium, and emotional distress.
Treatment should aim to soothe the liver, relieve depression, and promote qi circulation.
Formulas like Chai Hu Shu Gan San may be used, with additional herbs like Chuan Lian Zi, Yuan Hu, and Ze Xie for qi regulation.

2.
Blood Stasis Type: Patients may experience fatigue, chest tightness, stabbing pain in the liver area, and a dark purple tongue or visible bruises.
Treatment should focus on nourishing blood and promoting blood circulation.
Formulas like Xue Fu Zhu Yu Tang may be used, with additional herbs like Cao Jue Ming, Wu Ling Zhi, Dan Shen, and Shan Zha.

3.
Damp-Heat Type: Patients may experience fatigue, hypochondriac distension, abdominal fullness, poor appetite, a thick greasy tongue coating, heaviness in limbs, and loose stools.
Women may have increased vaginal discharge and pale complexion.
Treatment should aim to aromatically transform dampness and clear turbidity.
Formulas like Gan Lu Xiao Du Dan may be used, with additional herbs like Cao Jue Ming, Huang Jing, and Shu Wu.
The herbs Shan Zha, Ze Xie, Cao Jue Ming, Huang Jing, and Shu Wu in the above formulas have lipid-lowering and anti-fatty liver effects, acting on various aspects of fat metabolism.
Herbs like Dang Gui, Dan Shen, Yu Jin, and Chai Hu can improve liver microcirculation and reduce liver size, making them clinically applicable for treating fatty liver.
TCM believes that patients with fatty liver should pay attention to daily lifestyle adjustments:
1.
Emotional cultivation: TCM holds that the liver governs the smooth flow of qi throughout the body.
Fatty liver patients should regulate their emotional activities, engage in proper leisure activities, and maintain a cheerful disposition to support liver health.
Anger can harm the liver, and only love and tolerance can mitigate anger.
Otherwise, "violent anger harms the liver," exacerbating fatty liver conditions.
2.
Adequate sleep and balanced activity: TCM states, "When a person lies down, blood returns to the liver." Work should be suitable, and good sleep is essential for liver recovery, reducing the chances of recurrent inflammation in fatty liver.
3.
Self-massage: Alternating hand massages on the liver area and abdomen in a clockwise direction for 10 minutes each morning upon waking and before sleeping can help regulate liver qi, improve blood circulation in the liver area, and promote gastrointestinal motility and digestion.
4.
Careful dietary adjustments to protect the spleen and stomach: The liver's function is closely related to the spleen and stomach.
Fatty liver patients should consume "light and nutritious" foods such as rice, noodles, poultry, eggs, vegetables, and congee.
Alcohol should be avoided, and meals should be small and frequent to aid digestion and support spleen function.
Depending on the symptoms, dietary recommendations may include warming foods for spleen qi deficiency (e.g., red dates, longan, lentils, lamb, hairtail fish, quail meat, ginseng congee) or nourishing foods for liver and kidney yin deficiency (e.g., Huang Qi, Sheng Di, Goji berries, Dang Shen, Huai Shan, Chen Pi) to strengthen the body and eliminate pathogens.
Foods like watermelon, watermelon rind, red beans, and carp can help with dampness and diuresis.
Peach kernel congee and hawthorn congee can invigorate blood circulation and soften masses, treating liver and spleen enlargement.
Patients with liver disease should avoid "spicy, hot, dry, and rich foods," especially those with cirrhosis and esophageal varices, who should avoid hard, fried, and high-fiber foods.
When cirrhosis presents with edema, moderate protein supplementation is necessary.
Patients with chronic hepatitis and fatty liver should receive tailored dietary therapy from qualified TCM practitioners, complemented by medicinal meals, ensuring that nutrition is neither excessive (which would burden the liver) nor insufficient (which would lower resistance and lead to complications).
Avoid excessive tonics that increase the burden on the liver and spleen.
Fatty liver can evolve into cirrhosis over the years.
However, through proactive treatment from either Western or TCM approaches, there is a chance to improve inflammatory liver function indices and reduce the risk of cirrhosis.
Therefore, both TCM and Western medicine have their unique characteristics and preferred patient populations, and the best treatment approach is to combine both.
Finally, I wish you good health.
Dr.
Lin Qingzhong
Director of the TCM Department, Fengyuan Hospital
Assistant Professor, Nursing Department, Hungkuang University

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Reply Date: 2011/07/13