TCM Treatment of Alcoholic Cirrhosis
Alcoholic cirrhosis is a severe form of alcoholic liver disease. In European and American countries, it accounts for 50-90% of all cirrhosis cases. Because China is a country with a high burden of hepatitis B, hepatitis B-related cirrhosis predominates. In addition, owing to China's previously lower living standards, long-term drinkers were not as numerous as in Europe and America, so in the past alcoholic cirrhosis did not account for as large a proportion among Chinese cirrhosis patients as it does in Western countries. But in recent years, as Chinese residents' living standards have risen, more people drink long-term, and the number of Chinese patients with alcoholic cirrhosis has been gradually increasing.
Most patients with alcoholic cirrhosis are asymptomatic in the early stage, or have only symptoms such as lassitude, fatigue, poor appetite, and unformed stools, which are easily delayed. Many patients with alcoholic cirrhosis are only discovered after they develop hepatic ascites and abdominal distension. Therefore, long-term drinkers should have regular check-ups of liver function and liver B-ultrasound.
Most patients with alcoholic cirrhosis have a history of relatively heavy drinking for 5-10 years; a few have malnutrition, anemia, spider angiomas, liver palms, neuritis, muscle atrophy, gynecomastia, testicular atrophy, and other symptoms. Those who develop hepatic ascites have mostly entered the decompensated stage of liver function and may simultaneously develop portal hypertension, hepatosplenomegaly, edema, coagulation disorders, bleeding tendency, jaundice, and esophagogastric varices and other relatively serious complications. Those who develop ascites early are often accompanied by peptic ulcer disease.
TCM pattern differentiation for alcoholic cirrhosis is mainly based on liver-gallbladder damp-heat; some patients have liver qi stagnation and qi stagnation with blood stasis, while advanced patients often simultaneously present with liver-kidney yin deficiency. The basic treatment principles are clearing and draining damp-heat, promoting diuresis and reducing swelling, activating blood and resolving stasis, and softening the liver and strengthening the spleen. However, when using the blood-activating and stasis-resolving method, one must carefully check the patient's coagulation function. Because patients with hepatic insufficiency lack coagulation factors and have low platelets, they bleed extremely easily; improper use of blood-activating, stasis-resolving herbs may cause the patient to die from massive hemorrhage.
Yin Chen Hao Tang (Artemisia Decoction), Zhu Ling Tang (Polyporus Decoction), Wu Ling San (Five-Ingredient Powder with Poria), Wei Ling Tang, Si Ling Tang, Longdan Xiegan Wan (Gentian Drain the Liver Pill), Bie Jia Ruan Gan Pian, Renshen Biejia Jian Wan, Dangfei Liganning Capsule, and others are the most commonly used formulas and patent medicines in TCM for cirrhotic ascites. For severe abdominal distension, they are often combined with Muxiang Shunqi Wan and Zhizhu Kuanzhong Capsule. For accompanying peptic ulcer, Wu Ji San may be used together. For liver-kidney yin deficiency with dry mouth and tongue, five-center heat, epistaxis, and scanty dark urine, Liuwei Dihuang Wan, Zhibai Dihuang Wan, and Erzhi Wan are often combined. For liver qi stagnation with stabbing hypochondriac pain, Chaihu Shugan San and Xiaoyao Wan are often combined. For severe blood stasis, Xuefu Zhuyu Capsule, Dahuang Zhechong Wan, and Taohong Siwu Tang are often combined. For hepatic insufficiency, Hugan Pian, Dangfei Liganning Capsule, and bicyclol are often combined. For severe ascites, Western spironolactone tablets may be combined; for especially severe ascites unresponsive to diuretics, a small amount of ascitic fluid may be drained regularly (no more than 1000 ml per drainage).
When alcoholic liver disease has progressed to cirrhotic ascites, the condition is serious, but if treated properly, the patient's life can still be prolonged. For simple cirrhosis without liver cancer, with proper treatment and successful abstinence, survival can exceed ten years. But complete cure is unlikely because alcoholic cirrhosis is an irreversible process. Besides normal treatment, patients should also take glutathione tablets, vitamin C, vitamin E, and folic acid to help improve liver function and anemia.
Bie Jia (Carapax Trionycis) is the most effective herb for softening the liver; Danshen (Salviae Miltiorrhizae Radix) has a certain effect on hepatic fibrosis and cirrhosis; Yin Chen (Artemisin Scopariae Herba) is a specific herb for treating jaundice; Xianhecao (Agrimoniae Herba) can raise platelets and reduce bleeding probability; Huangqi (Astragali Radix) has the effects of boosting qi, strengthening the spleen, and promoting diuresis. These are the most commonly used herbs for alcoholic cirrhosis.