Part 2 Disorders of the Liver - Diagnostics and Herbal Treatments. Tony Reid

Transcription

1 THE LIVER IN TRADITIONAL CHINESE MEDICINE (TCM) Part 2 Disorders of the Liver - Diagnostics and Herbal Treatments (Note: This article builds upon concepts discussed in my previous article on fatigue and chronic fatigue syndrome in ANTA Journal, Issue 26, No.1, March 2011) The Liver is susceptible to injury by the following factors: Emotional strain or over-stimulation Stress Dietary irregularities, such as excessive consumption of deep-fried foods Excessive consumption of alcohol The after effects of a febrile illness The effects of chronic disease Pathogenic Damp-Heat (either exogenous or endogenous) As the Liver plays an important role in storing the Blood, pathologies that affect the Blood may impact on the Liver, e.g. loss of blood and chronic disease, which consume the Yin and the Blood. The signs and symptoms of Liver disorders are related to this organ s primary functions: storing the Blood, maintaining the normal smooth and even flow of the Qi (specifically relating to the emotional state, digestion and the secretion of bile), governing the tendons and ligaments and manifesting in the nails. In addition the eyes are its signaling sense organ and it stores the hun (ethereal soul). Thus, the common distinguishing signs in Liver disorders include: Emotional and psychological manifestations such as irritability, anger, sense of frustration, emotional volatility, depressed mood, restlessness and vivid disturbing dreams. Sense of discomfort and distention in the hypochondrium. Menstrual disorders and disorders that are related to the menstrual cycle. 38 THE NATURAL THERAPIST Volume 26 No.3

2 THE LIVER IN TRADITIONAL CHINESE MEDICINE (TCM) - PART 2 It should also be noted that many of the characteristic signs and symptoms relate to the location of the Liver and Gallbladder Channels, specifically in the areas of the hypochondrium, chest and breasts, the external genitals, the nasopharynx, the eyes, the ears as well as the temporal region and vertex of the head. Thus the following may be seen in Liver or Liver and Gallbladder disorders: Sense tightness or oppressive sensation in the chest, the need to make an effort to take a deep breath, sighing Sensation of distention and pain in the hypochondrium Itching or inflammation of the external genitals Sinusitis, inflammatory disorders of the anterior nares Conjunctivitis Middle ear infections, inflammatory disorders of the external auditory canal Headaches temporal of vertical The clinically important 7 Liver disorders, (generally referred to a syndromes or syndrome-patterns) are: Liver constraint (Liver Qi constraint) Liver Fire Liver Wind Damp-Heat in Liver and Gall Bladder Liver Blood Liver Yin Hyperactivity of the Liver Yang LIVER CONSTRAINT (LIVER QI CONSTRAINT) This refers to the failure of the Liver to maintain the smooth and even flow of the Qi throughout the body, leading to stagnation of the Qi, particularly in the Liver organ and channel. In essence this syndrome is the result of disharmony between the Liver Qi and the Liver Blood, in that the Liver Blood fails to temper and moderate the Liver Qi. While it is very commonly caused by emotional strain or stress, it may also come about through invasion by pathogens (e.g. viral hepatitis), which obstruct the Qi and Blood, placing a critical strain on the Liver s ability to adequately regulate or spread the Qi. In emotion related Liver constraint, Liver function (i.e. the Liver Qi) becomes inhibited leading to what is essentially a type of syndrome. This manifests in a diminution of emotional responses, i.e. depressed mood and irritability with loss of a relaxed and easy-going attitude. There may also be various disturbances along the course of the Liver channel (chest, breasts and hypochondrium), such as mild pain or discomfort with a sense of distention or tightness. Disruption of the Stomach and Spleen generally follows as their functional activities are dependent on a normally functioning Liver. Symptoms such as loss of appetite, craving for sweets or even nausea and vomiting may arise. In summary, this syndrome may progress in several ways: Disruption of Spleen and/or Stomach function (loss of appetite, craving for sweets, pain or discomfort in the epigastrium). The stagnated Liver Qi may develop into Heat or Fire (extreme irritability, sleep disturbance, red tongue tip and/ or edges). Disruption of fluid metabolism, giving rise to Damp or Phlegm-Damp (nausea, vomiting, thick tongue coat) Depressed mood, irritability Discomfort in the hypochondrium and/ or chest Menstruation disorders (e.g. PMS) Aggravation of symptoms by emotional strain Depressed mood, sense of frustration, repressed anger, irritability Sense of tightness or oppressive sensation in the chest, the need to make an effort to take a deep breath, sighing Sensation of distention with mild pain in the hypochondrium, chest, and/or abdominal region Symptoms that come on or are aggravated by emotional strain Muscular tension, particularly in the trapezius and lower thoracic paraspinal muscles Menstruation disorders: PMS with distending pain in the breasts, irregular cycle, dysmenorrheal, amenorrhea Digestive system symptoms: loss of appetite, reflux, belching, excessive borborygmi, loose stools or constipation, epigastric or abdominal distension or discomfort Sensation of a lump in the throat with difficulty in swallowing, which comes and goes according to the emotional state Tongue body is usually normal Pulse is wiry Soothe the Liver Qi and relieve constraint. Xiao Yao San (Bupleurum&Danggui Formula) - Liver Qi constraint with Jia Wei Xiao Yao San (Bupleurum& Peony Formula) - Liver Qi constraint with Heat or Fire Chai Hu Shu Gan Wan (Bupleurum&Cyperus Combination) - Liver Qi constraint with no signs of CHINAMED PMS FORMULA - Liver Qi constraint with PMS CHINAMED STRESS RELIEF 2 FORMULA (same formula as Xiao Yao San, above) CHINAMED STRESS RELIEF FORMULA (same formula as Jia Wei Xiao Yao San, above) CHINAMED MOOD-UPLIFT 2 FORMULA - Liver constraint with Heart Qi and Blood, for depressed mood with poor memory and concentration, fatigue, etc. LIVER FIRE This is an excess condition with many of the signs and symptoms relating to the course of the Liver channel in the upper body. There are several causes of this condition that may occur singly or in combination: Fire that develops from Liver constraint, exogenous pathogens that attack the Liver and transform into Fire, intense emotional strain, or excessive consumption of alcohol. Here again we see the emotional disturbance that is the hallmark of many Liver syndromes, together with signs of intense Heat in the upper body, particularly along the course of the Liver and Gallbladder Channels, and signs of Fire damaging the Body Fluids. Extreme irritability or angry outbursts Headache with dizziness Red face Red eyes Tongue red with a yellow coat Extreme irritability with outbursts of anger Temporal headache (distending or splitting headache), dizziness, red face, red eyes, conjunctival congestion Sleep disturbance Sudden onset of tinnitus (high pitched) or hearing loss THE NATURAL THERAPIST Volume 26 No.3 39

3 THE LIVER IN TRADITIONAL CHINESE MEDICINE (TCM) - Part 2 Bitter taste in mouth Dry throat Constipation with dry stools Dark scanty urine Bleeding signs: epistaxis, hematemesis, hemoptysis Tongue is red with a dry yellow coat Pulse is wiry and rapid Clear the Liver and drain Fire Long Dan Xie Gan Tang (Gentiana Formula) CHINAMED ANTI-INFLAMM. FORMULA (same as above formula) LIVER WIND (INTERIOR WIND) The Chinese name for this syndrome refers to the fact that the Wind is internally generated and is not due to the exogenous pathogen. Thus, the term Interior Wind is used interchangeably with Liver Wind. It arises secondary to one or more of the following: extreme Heat or Fire in the Liver, Liver Yin with Yang hyperactivity, Liver Blood or severe Heat that has developed in the course of a febrile illness. Thus there are clinical features of the underlying disorder along with the characteristic signs of Interior Wind. Tremor Convulsion Spasm, tic Dizziness or vertigo Numbness, paralysis Signs and symptoms of one of the following syndromes: Heat excess, Liver Fire, Liver Yin with hyperactivity of the Liver Yang or Liver Blood Extinguish Interior Wind (also resolve the underlying syndrome) Tian Ma Gou Teng Wan (Gastrodia&Gambir Formula) - Interior Wind due to hyperactive Liver Yang with Liver and Kidney Yin Yang Yin Jiang Ya Wan (Achyranthes& Cassia Seed Formula) Interior Wind with hypertension CHINAMED TREMOR EASE FORMULA Interior Wind with essential tremor CHINAMED PRESSURE DOWN FORMULA Interior Wind with hypertension CHINAMED SETTLE THE EMOTIONS FORMULA - Interior Wind with Liver Qi and Blood and Phlegm, specific for emotional instability in dementia and night terrors in children DAMP-HEAT IN THE LIVER AND GALL BLADDER This syndrome may arise due to either exogenous or endogenous causes, which include: exogenous Damp and Heat (which enters via the mouth, through the consumption of contaminated food or water), excessive consumption of alcohol, dietary imbalance (e.g. over consumption of rich, fatty and sweet foods, which causes endogenous Damp), or Spleen and Stomach dysfunction. Damp-Heat, whether externally contracted or internally generated, generally affects the Stomach & Spleen (organs that are particularly susceptible to Damp), as well as the Liver and Gallbladder. The signs and symptoms relate to the physical organs (right hypochondrium), the Spleen and Stomach (digestive disturbance) as well as the course of the Liver channel (chest, eyes and external genitalia). This syndrome-pattern closely correlates with various liver and/or gall-bladder diseases of Western medicine, e.g. hepatitis, fatty liver, cholecystitis, gallstones. Fever or alternating fever and chills Fullness and pain in the hypochondrium (mainly right side) Nausea and loss of appetite Dark or yellow urine, scanty amount Tongue is red with a greasy yellow coat Heat signs: fever (or alternating fever and chills), scanty dark urine, bitter taste in the mouth Sensation of fullness and pain of the chest and hypochondrium (mainly right side) Loss of appetite, nausea, vomiting, abdominal distention Thirst with inability to drink much fluid Jaundice Vaginal discharge, vaginal itching Pain, hot sensation and swelling of the scrotum Skin lesions in the groin Tongue is red with a yellow greasy coat Pulse is wiry and rapid or slippery and rapid Clear Damp-Heat, soothe the Liver and discharge the Gallbladder. Yin Chen Hao Wan Jia Wei (Artemisia & Rhubarb Combination) cholecystitis, fatty liver Li Dan Pai Shi Wan (Lysimachia& Artemisia Formula) gallstones CHINAMED LIVER FUNCTION FORMULA acute hepatitis CHINAMED LIVER TONIC FORMULA chronic stage hepatitis or hepatitis C CHINAMED GYNE FUNCTION 2 FORMULA vaginitis, cervicitis, salpingitis LIVER BLOOD DEFICIENCY The Liver plays an important role in storing the Blood and sending it to the muscles and uterus as needed. Liver Blood may occur when there has been excessive blood loss, or when the Spleen does not produce sufficient Qi and Blood, or when the Blood and Yin have been consumed by a chronic illness. Moreover, prolonged or intense emotional strain may also lead to depletion of the Liver Blood. The key features include those of general Blood as well as specific Liver signs related to the eyes, muscles and tendons, finger nails and menstrual flow. Dry eyes and blurred vision Scanty menstrual bleeding or amenorrhea General signs of Blood Dry eyes, blurred vision, spots in the field of vision, possibly night blindness Postural dizziness Insomnia Tingling or numbness of the limbs, muscular stiffness, cramps, spasms or twitching Scanty menstrual bleeding or amenorrhea Complexion is dull and pale or sallow, pale lips Fingernails are brittle and the nail beds are pale Tongue is pale and may also be dry Pulse is thready and wiry 40 THE NATURAL THERAPIST Volume 26 No.3

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5 THE LIVER IN TRADITIONAL CHINESE MEDICINE (TCM) - Part 2 Nourish the Liver Blood Si Wu Wan (Dang-gui Four Combination) also for general Blood CHINAMED NOURISH THE BLOOD FORMULA (same formula as above) (Generally one of the above formulas would be used in conjunction with one of the formulas listed above under Liver Constraint ) LIVER YIN DEFICIENCY This may be considered as an extreme form of Liver Blood. The Liver Yin (which includes the Liver Blood) may be impaired following a febrile illness, or due to Fire that has developed from Liver constraint (i.e. emotion-related disorder), or Fire due to of the Kidney Yin. In addition, when the Kidney Yin is deficient, the Liver Yin also tends to become deficient due to the reciprocal relationship between the Kidney (Water) and the Liver (Wood). The signs and symptoms include those of general Yin together with specific Liver signs. This syndrome generally develops over the long term and thus requires a relatively long treatment period. Dry eyes, blurred vision General signs of Yin CHINAMED CLEAR VISION FORMULA (same as the above formula) Ming Mu Di Huang Wan (Rehmannia Formula to Brighten the Eyes) Liver Yin and Blood with more severe ocular symptoms) Gan Mai Da Zao Wan - Jia Wei (Wheat & Jujube Combination) Liver and Heart with extreme emotional volatility and sleep disturbance. Jin GuiSuan Zao Ren Tang (Zizyphus Combination) Liver and Heart with some Heat for anxiety, insomnia, restlessness, irritability. HYPERACTIVE LIVER YANG This condition may arise due to Liver Yin (or Liver and Kidney Yin ) that develops in chronic illness. It may also be caused by prolonged or intense Liver constraint that develops Fire. The Fire depletes the Blood and Yin, leading to failure of the Yin to restrain the Yang. Thus the Yang Qi rises to the upper body while the lower body exhibits signs of Yin. Clinically, this is generally a long term or chronic condition in contradistinction to Liver Fire, which is usually a short term disorder. The main features relate to Yin of the Kidney and Liver (i.e. in the lower body) and excessive Yang in the upper body. This pattern is commonly seen in migraine sufferers. Distinguishing Features: Low back pain and weakness Dark scanty urine Constipation Tongue is red (especially on sides) possibly with a yellow coat Pulse is wiry and may also be thready, forceful or rapid Calm the Liver and subdue the (Liver) Yang, nourish the (Liver and/or Kidney) Yin Tian Ma Gou Teng Wan (Gastrodia&Gambir Formula) with Interior Wind Ping Gan Xi Feng Tou Tong Wan (Gastrodia&Vitex Formula) variant of the above formula specifically for headaches CHINAMED HEADACHE RELIEF FORMULA variant of the above formulas, specific for headaches References 7. By clinically important disorders I am referring to those that are both commonly seen and readily treatable with Chinese herbal formulas. This list is therefore incomplete. Sydney Institute of Traditional Chinese Medicine CRICOS 01768k NTIS 5143 Dry eyes, blurred vision Possibly tremors (usually in the hands) Afternoon fever, tidal fever or low-grade fever (subjective or objective) Dry mouth and throat (not much relieved by taking fluids) Night sweating Sensation of heat in the hands, soles of the feet and centre of the chest Dry, hard stools Urine is dark and scanty Tongue is red and dry with a scanty or absent coat Pulse is thready, wiry and rapid Nourish the Liver Yin (possibly also reduce the Fire) Qi Ju Di Huang Wan (Lycium, Chrysanthemum & Rehmannia Formula) for general Liver Yin and Blood with mild ocular symptoms Headaches (severe and recurrent) Irritability, angry outbursts Red face and eyes Clinical Manifestations: Headache (usually a distending pain in the temples and behind the eyes) Facial flushing, red ears, red eyes Dizziness Insomnia Irritability, outbursts of anger Tinnitus Nowadays alternative medicine practitioners are all learning Acupuncture and Chinese Herbal Medicine Enrol into Sydney Institute of Traditional Chinese Medicine (SITCM) 2012 New semester commences on 20th Feb 2012 Open days: 23 July, 17 Sep and 19th Nov 2011 from 10am to 2pm VET FEE HELP Delivering practical courses: Delivering practical courses: Advanced Diploma of Traditional Advanced Chinese Diploma Medicine of Traditional 91133NSW Chinese Medicine 91133NSW (double modalities of acupuncture and (double modalities of acupuncture and Chinese Chinese herbal herbal medicine) medicine) Accredited by Accredited VETAB, Approved by VETAB by AUSTUDY, Recognized Approved by major by Health AUSTUDY, Funds and Recognized TCM professional by major associations. Health Funds and TCM professional associations. 28 years since establishment with graduates successfully practicing nationally and abroad with employment rate over 90%. TCM national registration on 1 July Government support TCM & WM integrated medical centre will be opening in Sydney. Limited seat for international students. We are in the city: Level 5, 545 Kent St., Sydney NSW 2000 Tel: Administration@sitcm.edu.au Level 5, Harbor Web: Plaza, WWW. 25 sitcm.edu.au Dixon St. Sydney 2000 Tel: (02) administration@sitcm.edu.au 42 THE NATURAL THERAPIST Volume 26 No.3