Acupuncture Continuing Education

Cirrhosis of the Liver

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Cirrhosis of the liver is a disease characterized by increases in connective tissue and pathological changes in the gross and microscopic makeup of the liver. Cirrhosis of the liver tends to be a slow and progressive illness wherein healthy liver tissue is replaced with scar tissue. During the onset of the disease, the liver may enlarge (hepatomegaly). Long-term liver size may be larger or smaller and there may be abnormal enlargement of the spleen (splenomegaly).

Cirrhosis is a condition in which the liver slowly deteriorates and is unable to function normally due to chronic or long lasting injury. Scar tissue replaces healthy liver tissue and partially blocks the flow of blood through the liver. The liver can regenerate most of its own cells when they become damaged. However, if injury to the liver is too severe or long lasting, regeneration is incomplete, and the liver creates scar tissue. Scarring of the liver, also called fibrosis, may lead to cirrhosis.

Liver Function
The liver plays an important role in metabolism—the way cells change food into energy after food is digested and absorbed into the blood. The liver has many functions, including:

  • taking up, storing, and processing nutrients from food—including fat, sugar, and protein—and delivering them to the rest of the body when needed
  • making new proteins, such as clotting factors and immune factors
  • producing bile, which helps the body absorb fats, cholesterol, and fat-soluble vitamins
  • removing waste products the kidneys cannot remove, such as fats, cholesterol, toxins, and medications

The buildup of scar tissue that causes cirrhosis is usually a slow and gradual process. In the early stages of cirrhosis, the liver continues to function. However, as cirrhosis gets worse and scar tissue replaces more healthy tissue, the liver will begin to fail. Chronic liver failure, which is also called end-stage liver disease, progresses over months, years, or even decades. With end-stage liver disease, the liver can no longer perform important functions or effectively replace damaged cells.

Common Signs and Symptoms
• fatigue
• abdominal pain (especially upper right abdominal pain)
• abdominal distention
• jaundice
• ascites (abdominal fluid accumulation)
• nausea…

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Chinese Medicine Theory

In Traditional Chinese Medicine (TCM), cirrhosis of the liver presents with several differential diagnostics including:

  • Damp-heat
  • Liver qi stagnation
  • Blood stasis
  • Dirty Water Accumulation
  • Heat in the Blood
  • Blood deficiency
  • Spleen and stomach qi deficiency
  • Spleen and kidney yang deficiency
  • Liver and kidney yin deficiency

Chinese Medicine Etiology
Cirrhosis of the liver often starts as an excess condition that creates long-term deficiencies. For example, viral hepatitis or excess alcohol intake may lead to damp-heat in the liver and spleen. This causes qi and blood stasis plus dirty water accumulation, which congeals into palpable masses. In addition, damp-heat and its sequelae damages the liver and kidney yin and also the spleen and kidney yang. As a result, there is a…

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Liver and Gallbladder Modifications

The following are formula modifications of Xue Fu Zhu Yu Tang and Si Ni San for cirrhosis of the liver or gallstones determined by the following differential diagnostic patterns:

  • Blood Stasis with Heat in the Blood
  • Qi and Blood Stasis with Damp-Heat
  • Qi and Blood Stasis and Spleen Qi Deficiency with Dampness

Following this presentation of differential diagnostic combination patterns, a look at specific case studies elucidates treatment strategies for treating cirrhosis of the liver and gallstones.

1. Blood Stasis with Heat in the Blood
This formula modification is for the buildup of masses due to qi and blood stasis in the liver. This formula is also appropriate for the treatment of gallstones. Note the strong blood invigorating herbs in this formula. This formula is contraindicated during pregnancy as are similar formulas containing strong blood invigorating herbs.

Chi Shao          Radix Paeoniae Rubrae      2 – 12 g
Dang Gui          Radix Angelicae Sinensis   3 – 12 g
Chuan Xiong       Radix Ligustici Chuanxiong 3 – 9 g

All the herbs above promote blood circulation. The herbs can be differentiated as follows: Chi Shao cools heat in the blood. Dang Gui nourishes the blood. Chuan Xiong moves the qi in the blood and tends to flow to the body’s surface and upper body. This means that Chuan Xiong has a rapid onset of therapeutic actions and benefits the upper jiao (burner).

Hong Hua          Flos Carthami Tinctorii    3 – 9 g
Tao Ren           Semen Persicae             3 – 12 g

Hong Hua and Tao Ren both break up congealed blood. Hong Hua’s onset of action is faster and stronger. Tao Ren’s action is sustained for a longer period of time and it is able to moisten dryness.

Niu Xi Radix      Achyranthis Bidentatae     3 – 12 g

Niu Xi promotes blood circulation to the legs. It strengthens the liver and kidneys. It also expels wind-dampness to alleviate bi (joint) pain.

Mu Dan Pi         Cortex Moutan Radicis      9 – 15 g
Di Gu Pi          Cortex Lycii Radicis       12 g
Bai Wei           Radix Cynanchi Baiwei      15 g

All of the above herbs cool heat in the blood. Mu Dan Pi promotes blood circulation. Di Gu Pi clears steaming bone syndrome and Bai Wei eliminates heat.

Sheng Di Huang     Radix Rehmanniae Glutinosae 3 – 15 g

Sheng Di Huang cools blood heat, nourishes the blood, and moderates the function of the stronger blood-regulating herbs. It is difficult to digest.

Bai Shao           Paeoniae Radix Alba         12 g
Chai Hu            Radix Bupleuri              3 – 6 g
Zhi Ke Fructus     Citri Aurantii              3 – 12 g
Jie Geng           Radix Platycodi Grandiflori 3 – 15 g

All the above herbs regulate qi. Chai Hu regulates liver qi and promotes its flow upward through the body. Bai Shao stables the liver yang and nourishes the liver yin. Zhi Ke opens the chest and moves the qi. Jie Geng regulates lung qi and opens the lungs. It also guides the other herbs to the upper body.

Jin Qian Cao       Lysimachiae Herba           15 – 30 g
Xiang Fu           Rhizome Cayperi Rotunda     9 – 12 g

Jin Qian Cao and Xiang Fu help discharge gallstones. Jin Qian Cao promotes urination and clears damp-heat. Xiang Fu promotes blood circulation and stops pain.

E Zhu              Rhizoma Curcumae Ezhu         9 – 15 g
San Leng           Rhizoma Sparganii Stoloniferi 9 – 15 g

E Zhu and San Leng both break up masses caused by congealed blood due to stasis. E Zhu’s action is stable and sustained longer. San Leng has a faster onset of effective actions and breaks up qi stagnation affecting blood.

Zhi Gan Cao        Radix Glycyrrhizae Uralensis  3 g

Zhi Gan Cao harmonizes the other herbs in the formula. Zhi Gan Cao is the honey-fried preparation of the herb.


2. Qi and Blood Stasis with Damp-Heat
This modification treats cirrhosis with jaundice or concomitant chronic hepatitis. The addition of Yi Chen Hao, Huang Qin…

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Case Studies

1. Cirrhosis with Hepatitis B
A male, age 33, was diagnosed with chronic hepatitis B and cirrhosis of the liver. Total duration of illness to date: five years. His ALT (liver enzyme) was 140 and he had pain in his liver. His liver had enlarged 2 cm under his rib. He had a poor appetite, belching, and a bloated abdomen. He had red and purple spider angiomas on his chest and neck, which indicated his blood circulation was impaired from the cirrhosis of the liver. His tongue was purple and his pulse was wiry and full.

  • Inflamed or injured liver cells leach elevated quantities of substances, including liver enzymes, from within cells to the bloodstream. Normally, these substances are contained within cells. The leakage into the bloodstream from cells results in elevated levels of liver enzymes in blood tests. Typically, this includes the enzymes Alanine transaminase (ALT) and Aspartate transaminase (AST).
  • Hepatomegaly, swelling of the liver beyond its normal size, is caused by many conditions including primary biliary cirrhosis and hepatitis A, B, and C. Hepatomegaly may also result from alcohol abuse, cancer, leukemia, steatosis of the liver (fatty liver), Reye syndrome, congestive heart failure, and glycogen storage related diseases.
  • Normal ALT levels are approximately 10 – 40 units per liter (U/L) for males and 7 – 56 U/L for females.
  • 90% of infants exposed to hepatitis B virus (HBsAg) develop chronic hepatitis B infections
  • Up to 50% of children between the ages of 1 – 5 years develop chronic hepatitis B infections
  • 5 - 10% of infected adults develop chronic hepatitis B infections
  • A blood test is used for a definitive diagnosis of hepatitis B


Qi and blood stasis in the liver, food stagnation

Treatment Strategy

Promote and regulate qi and blood circulation in liver

Base Formula
Xue Fu Zhu Yu Tang modified with Bao He Wan
This modification of Xue Fu Zhu Yu Tang addresses food stagnation and its effects on digestion.

Chi Shao Radix            Paeoniae Rubrae      12 g
Chuan Xiong Radix         Ligustici Chuanxiong 9 g

Chi Shao and Chuan Xiong promote blood circulation. The herbs can be differentiated as follows: Chi Shao cools heat in the blood. Chuan Xiong moves the qi in the blood and tends to flow to the body’s surface and upper body.

Hong Hua Flos             Carthami Tinctorii   9 g
Tao Ren                   Semen Persicae       12 g

Hong Hua and Tao Ren both break up congealed blood. Hong Hua’s action is faster and stronger. Tao Ren’s action is sustained for a longer period of time and it is able to moisten dryness. This paired set of herbs is a classic combination. As in many classic paired herbs…

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TCM Dietetics

Now, we’ll take a look at traditional Chinese medicine dietetics as it relates to the liver. At the Healthcare Medicine Institute, we offer many courses on Chinese medicine dietetics. Let’s take a brief look at some of the traditional approaches to healthy eating that affect the liver and benefit patients with cirrhosis:

Huangdi Neijing Suwen
According to the Huangdi Neijing (The Yellow Emperor’s Inner Classic), five element theory specifies that several flavors are contraindicated for specific differential diagnoses per the control cycle. If the liver is deficient, avoid spicy foods. If the lungs are weak, avoid bitter foods. If the spleen and stomach are weak, avoid sour foods. If the heart is sick, avoid salty foods. If the kidneys are deficient, avoid sweet foods. Following these guidelines prevents…

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