Liver Support with TCM
Bile Metabolism |
This information is
for educational purposes only.
Materials regarding herbs have not been evaluated by the
U.S. Food & Drug Administration and are not in any way a
replacement or substitute for professional medical diagnosis and
treatment. Persons with specific medical illnesses are advised
to seek professional care. |
Bile 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 elevated.
In 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.
Clinically, when using TCM 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)
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.
If 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).
[Liu YL et al., Premary Discusion on the Use of Chinese Medicine
According to Blood Tests, CJITWM, Jan 2003, 23(1):54-55]
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