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TCM and MCM Theory Related to Common Liver Disease Blood Test
TCM has no objective diagnostic laboratory testing parameters, using
Western medical testing results to gauge use of herbal remedies is a
common practice in Modern Chinese Medicine (integrated Chinese and Western
Based on clinical experiences of many MCM doctors’ practices, the
following abnormal markers in liver function tests can be effectively
regulated by Chinese herbs and herbal formulas.
and AST level
ALT and AST elevation is an indication of liver cell damage or necrosis.
The degree of elevation can also represent the severity of the liver
inflammation. Generally, ALT and AST are good indicators for liver
inflammation. Once inflammation is reduced, the progression of liver
fibrosis can be held or even reversed. Thus, anti-inflammation therapy is
effective anti-liver fibrosis treatment.
cases of mild chronic persistent hepatitis, the level of these two enzymes
is approximately 50% to 100% above the normal range (range is indicated by
the testing facility, usually a number between 0 and 50). If they are
elevated to three times or higher than the normal range, the inflammation
is considered moderate or severe.
In cases of acute hepatitis or chronic active hepatitis, ALT and AST
levels can reach as high as 20 to 30 times the normal range. At those
levels, the inflammation in the liver is involved with very active immune
reactions and is often seen in autoimmune hepatitis and medication induced
hepatitis cases. Because the immune system plays such a major role in the
inflammatory process, treatment must not only focus on protecting the
liver but also regulate immune reactions.
Sometimes liver enzyme levels are not always parallel with the severity of
the liver inflammation. In the cirrhosis stage, when a biopsy indicates
piecemeal necrosis (grade III to IV inflammation), enzymes could be in
normal range or is only slightly elevated. This phenomenon is caused by
the dramatic decrease in the total number of the liver cells. Even if
highly inflamed, they are not producing enough enzymes to indicate
liver inflammation herbal treatments can prevent liver cell degeneration,
necrosis and bring ALT and AST level down to the normal range. The
following herbs are commonly used to control liver inflammation and
protect liver cells: Wu Wei Zi (Schizandrae Fructus), Gan Cao (Glycyrrhiza
uralensis), Shui Fei Ji (Silybum marianum), Ku Shen (Sophorae
Radix), Chui Pen Cao (Sedi sarmentosi herba), Chai Hu (Bupleuri
Radix). The liver protective effects of these herbs have been tested
by animal models and clinically in China. Modern Chinese medicine uses the
more potent and stable isolated active ingredient compounds, such as
Schisandrin, Glycyrrhizin, Silymarin, Oleanolic acid, Oxymatrine, and
Saikosaponin A and D.
the liver inflammation is quite active with ALT and AST levels three times
higher than the normal range, immune regulatory herbs are used to suppress
liver is the only place albumin is synthesized. When liver functions are
compromised and damage accumulates, the level of albumin drops. Thus, the
level of albumin and other laboratory markers can also be used as a
predictive indicator in the prognosis of cirrhotic patients. However, a
low albumin level alone is not a specific indicator for chronic liver
disease. Albumin leakage into extra-vascular, inadequate nutritional
intake, poor absorption in the digestion system, over-catalysis of albumin
caused by infections, fever, cancer, and abnormal loss from chronic
diarrhea and kidney dysfunctions are among some of the other causes. In
cirrhosis, the increase of g-globulin
can also suppress albumin synthesis. Therefore, it is important to observe
the overall “picture” and other lab markers of the patient to choose
the correct herbal remedies.
treatment consists of two routes: direct supplementation of albumin and
functional improvement of liver synthesis.
supplement can be done with TCM remedies made from animal sources, such
as, Ze He Che (dried placenta) Guong di long (Pheretima aspergillum), LiYu
(Cyprinus carpio), Bai Jiang Can (Bcauveria bassiana), Gui Ban (shell of
ahinemys reevesii), E Jiao (Skin gelatin made from Equus asinus).
improve the albumin synthesis: Dong Cuon Xia Cao (Cordyceps sinensis),
Gui (Angelicae Radix), Dang Shen (Codonopsis Pilosulae Radix), Huang
Qi (Astragali Radix), Ling zhi cao (Ganoderma japonicum),
Gou qi zi (Lycium barbarum), Nu Zhen Zi (Ligustrum lucidum
Ait), Di Haung (Rehmanniae Radix), Dan Shen (Salviae
Miltiorrhziae Radix), Ji Xue Teng (Mucunae Caulis), San Leng (Sparganii
Rhizoma), E Zhu (Zedoariae Rhizoma), Xian mao (Curculiginis
rhizoma), and Ba Ji Tian (Morindae officinalis radix).
cirrhotic compensated stage without ascites, aside from regular cirrhosis
treatments (see cirrhosis section), low albumin treatment with the above
herbs must be used with care. The stomach stimulating and lapactic effects
of Dang Gui and Di Haung. The
heat of the following herbs should also be carefully balanced: Dang Shen,
Huang Qi, Gou qi zi, Xian mao, and Ba ji tian. Among these herbs, Dang Gui,
Huang Qi, and Dan Shen have the best therapeutic effects.
de-compensated cirrhosis patients, direct supplementation of albumin is
recommended. At the same time, diuretic herbs should also be used. The
herbs commonly used are Ze He Che, Guong di long, Dang Gui, Huang Qi, and
Dan Shen, and formulas such as Wu Ling San (Hoelen Five Herb Combination)
and Wu Pi Ying (Decoction Containin Five Kinds of Peel).
diseases are the common causes of blood clotting dysfunction. The Liver
makes six blood clotting factors: I (fibrinogen), II (Prothrombin), IV, V,
VI, and VII. Whenever there is a decrease in any of them, Prothrombin time
(PT) will become abnormally prolonged. Therefore, PT can be used as an
indication of liver synthesis function or dysfunction. In acute liver cell
diseases, if PT prolonged, it usually indicates severe liver cell necrosis
and a poor prognosis. In chronic liver diseases, if PT is prolonged to
more than five seconds and there is no response to vitamin K injection,
this usually suggests extensive liver damage and the long-term prognosis
is usually poor. In about 60% of death cases caused by alcoholic liver
diseases, PT was prolonged to more than four seconds.
when we evaluate the result of the PT test, it is important to know
whether patient has active bleeding. If there is blood in the stool, the
herbal remedies used are Yunan Bai Yao Capsule, Xian He Cao (Herba
agremoniae), and Qian Cao (Rubiae radix). If there is black
stool and vomiting with blood, Bai Ji (Bletillae rhizoma) and San
Qi (Panax notoginseng) should be used.
treating PT/PA disorder, in MCM terms, treatment is not only focused on
preventing and stopping localized bleeding. The TCM theory behind this is
to supplement Qi and prevent liver failure. For severe liver inflammation,
such as fulminant hepatitis, TCM theory is to treat the “noxious heat
and viral qi exhaustion” with
strong herbal formulas such as An Gong Niu Huang Wan (Bolus of Calculus
Bovis for Resurrection), Wu Wei Xiao Du Yin (Decoction of Five Ingredients
for Antiphologistic), and Zi Xue Dan (Purple-Snow Pellet).
From a conventional medical standpoint, the stoppage of bleeding is
the main objective.
bleeding is the most common cause of death in advanced cirrhotic patients.
In cases of stable compensated cirrhosis, even small amounts of toxins
such as alcohol or other disturbances (including emotional stress) can
still trigger bleeding. Thus, patients must pay careful attention to all
aspects of diet and stress management.
acid is synthesized in the liver. Its metabolism in the body is mainly
controlled by the liver and can therefore reflect its functional status.
Everyday, the liver processes more than 18 to 24 grams of bile acid, which
is 100 times more than bilirubin. Its serum level elevates to the highest
levels in viral hepatitis and extra-liver bile duct stenosis. For chronic
hepatitis patients, serum bile acid level usually elevates before the
elevation of ALT and AST. After treatment, if the level of serum bile acid
continues to elevate even as the histological markers in a liver biopsy
improve, the possibility of relapse is still high. In bile retention liver
diseases, such as PBC and PSC, serum bile acid level is usually obviously
fatty liver or mild chronic hepatitis, bile acid change is usually not as
sensitive as changes in ALT and AST markers. But in serious liver
diseases, such as cirrhosis, bile acid is more sensitive than the enzymes.
The enzymes only reflect the liver cell damage at the moment while bile
acid can also reflect the absorption and secretion abilities of the
intestines and the liver, and possible existence of portal-systemic
circulation bypasses. In predicting liver failure, serum bile acid is a
more sensitive indicator than bilirubin.
when using Chinese herbal medicine to treat bile acid abnormalities, both
Qi and blood should be treated according to TCM theory. When there is
bilirubin elevation, it is usually accompanied by ALT and AST elevation.
For this condition, the treatment method should be “heat clearing and
dampness eliminating.” The commonly used herbal formulas are Yin Chen Wu
Ling San (Capillaris and Hoelen Five Formula) and Wu Wei Xiao Du Yin
(Decoction of Five Ingredients for Antiphologistic).
When these formulas are used, large doses of Yin Chen Hao (Artemisiae
Capillaris), and medium to small doses of Jin Qian Cao (Desmodii
Herba) and Da Huang (Rhei Rhizoma) should also be used.
bilirubin elevation is accompanied by bile acid and GGT elevation,
treatment must also focus on improving blood circulation and anti-fibrosis
actions. The herbs must have both jaundice clearing and blood activating
effects. Examples are: Hu Zhang (Polygoni Cuspidati Rhizoma), Qian
Cao (Rubiae radix), Yin Chen Hao (Artemisiae Capillaris), Da
Huang (Rhei Rhizoma).
Transaminase (GGT), or g-Glutamyl
cells synthesize GGT and serum GGT mainly originates from the liver. Under
the stimulation of inflammation, bile retention, or cancer, the synthesis
of GGT in liver cells will increase. Clinically, its significance is
similar to that of ALP, but even more sensitive.When
GGT is elevated in cases of acute hepatitis or moderate liver disorders,
besides using “heat clearing and toxin dissolving” and “heat
clearing and dampness eliminating” anti-inflammation herbal treatments,
some “blood activating and stasis expelling” herbs should be added:
Dan Shen (Salviae Miltiorrhziae Radix), Qing Pi (Citri Immaturi
Pericarpium), Chen Pi (Citri Pericarpium), Ze Lan (Lycopi herba),
and Yin Xin Ye (Ginkgo
GGT elevation could be seen in about 90% of chronic liver and gall bladder
disease patients. It is especially obvious in bile retention and cancer
patients. In early stages of acute hepatitis, mild chronic hepatitis, and
inactive cirrhosis, GGT is usually not elevated. At the peak stage of the
acute hepatitis, pre-cirrhotic chronic hepatitis, fatty liver, kidney
damage, pancreatitis, diabetes, and heart muscle injuries, GGT it may
increase to one to two times above the normal range.
In following conditions, GGT could elevate to two to four times above the
normal range: chronic moderate to severe hepatitis, active cirrhosis,
alcoholic hepatitis and fatty liver, acute pancreatitis, acute blood
stasis in the liver, localized liver cancer damage, acute cardio
infarction, and incomplete stenosis of bile ducts.
following conditions, it could elevate to five to ten times or higher than
the normal range: intra liver bile retention, biliary cirrhosis, and liver
GGT is sensitive, it is not as specific as ALP. Thus, testing with ALP
together offers a more complete assessment. When GGT is elevated and ALP
is normal, it may be a toxin related. Toxins include alcohol and a number
of medications including anti-seizure medications, Coumadin. If both GGT
and ALP are elevated, extra-hepatic bile duct stenosis may be the
GGT elevation should also be evaluated together with ALT. If there is
slight elevation of both, liver damage is probably light. The severity of
the GGT elevation is directly correlated to liver damage.
there is obvious bile duct stenosis, then following “Li dan tong chang”
(normalizing the secretion and discharge of bile) and “Po xue qu
yu” (removing blood stasis with potent medicine) herbs should be used:
San Leng (Sparganii Rhizoma), E Zhu (Zedoariae Rhizoma), Bie
Jia (Amydae Flos), Da Huang (Rhei Rhizoma), Dan Shen (Salviae
Miltiorrhziae Radix), Ji Xue Teng (Mucunae Caulis), and Shui
Zhi (Hirudo nipponica, Leech). These herbs should be used together
with “heat clearing and toxin dissolving” and “heat and jaundice
summery, GGT elevation is an indication of blood stasis in TCM. Whenever
there is elevation of GGT, “blood activation and stasis expelling”
herbs should be used in the formulation of the herbal remedies.
YL et al., Premary Discusion on the Use of Chinese Medicine According to
Blood Tests, CJITWM, Jan 2003, 23(1):54-55]