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Hepatic - Herbal treatment of functional liver disease

by Paul Bergner

Medical Herbalism 12-31-93 5(4): 1,4

The liver is one of the most important organs in the body; a patient with liver failure can die within a day or two. The liver regulates many aspects of sugar, fat and protein metabolism, synthesizes and regulates essential hormones, detoxifies the blood, and secretes bile. Conventional medicine concerns itself primarily with structural or inflammatory diseases of the liver and gall bladder, such as cirrhosis, hepatitis, fatty infiltration, or gallstones. Lower grade functional disorders, however, are viewed with great importance by systems of natural healing. The most important functional disorder involves stagnancy of the liver. Such congestion can affect the entire metabolism or any part of it, leading to a cascade of vague problems.

Some conditions possibly related to liver stagnancy

indigestion

pain in the gall bladder area

pain in liver meridians

headache

constipation

food sensitivities

environmental sensitivities

skin problems, acne

fat intolerance

impaired glucose tolerance

depression

hormonal imbalances

premenstrual syndrome

chronic fatigue

joint pain, stiffness

hemorrhoids

Anatomy and physiology

A review of the anatomy and physiology of the liver will help clarify the nature of liver stagnancy. A large portion of the output of the heart (about one-third) flows to the digestive system. This blood returns, rich with nutrients and digestive impurities, to the liver through the veins of the portal circulatory system. The liver vascular system is expandable and compressible, and can store large quantifies of blood. It normally contains about one-tenth of the blood volume in the body, but can, under certain disease conditions, expand to hold up to a fourth of the body’s blood. Under conditions of stress, on the other hand, its veins can contract so it holds only a thirtieth of the body’s’ blood. Thus the liver blood volume can potentially vary by a factor of more than seven.

About three-fourths of the blood coming into the liver comes from venous circulation; only about a fourth comes directly from the heart through the arteries. Arterial blood is moved under force, being pumped by the heart, normally under pressure ten to fifteen times that of the blood in the portal veins. Thus most of the blood in the liver is not moved through it by arterial pressure and has a natural tendency to stagnate. The liver is also extremely permeable to fluids, such that they flow freely into its lymphatic system; the lymph derived from the liver accounts for from one-half to two-thirds of the total lymph in the body. Finally, the liver secretes bile into the small intestine, after storage in the gall bladder. Bile helps to digest fat and is a key player in the symphonic action of the enzymes and hormones that coordinate digestion. Thus the liver is an expandable and contractible reservoir of blood, lymph, and bile. Because it has only weak arterial circulation, these fluids have a tendency to become stagnant and the liver to become congested.

Exercise is the best liver tonic

Circulation in the liver is greatly aided by the action of the abdominal muscles and the diaphragm, the thick musculature that divides the chest from the abdomen and expands the chest cavity. As the diaphragm expands the chest, it compresses the abdominal cavity. The liver sits just under the rib cage and is attached to the diaphragm with ligaments. With every breath, the liver is gently compressed, aiding the circulation of all the fluids through it. This movement is essential to the liver circulation, the production and movement of bile into the gall bladder, and for the circulation of lymph. This can account for some of the well-known health benefits of aerobic exercise or of deep yogic breathing.

Functional disorders

Functional disorders of the liver-bile system are common causes of indigestion and “heartburn.” Symptoms can include bloated stomach, sensation of fullness after meals, and belching, with or without pain. Pain from the bile ducts and gallbladder closely resemble, both in quality and location, the pain of peptic ulcers. These symptoms are unfortunately often not viewed as signs of liver and gall bladder dysfunction, and may be self-treated with over-the-counter antacids, which are generally ineffective, because acid is not the cause. The result is that the functional disorder progresses to a structural one, such as gall stones.

Lifestyle treatments

Herbal therapy for the liver should be given in the context of:

- Regular mild-to-moderate exercise such as walking or low-impact aerobics

- Alternating whole-body hot and cold hydrotherapy, such as alternating showers, hot tub or sauna

- A low-fat diet, rich in fruits and vegetables, avoiding excessive protein

- Eating in a relaxed state and relaxing after meals (stress depletes the blood flow to the liver)

- Bitter foods and herbs in the diet.

Herbs

The most important classes of herbs for functional liver disease are cholagogues (increase bile flow), choleretics (increasing bile production) and carminatives (expelling gas and antispasmodic). Cholagogue plants usually have a bitter flavor, and all bitter plants are cholagogic to some degree. Some important traditional cholagogues are dandelion (Taraxacum officinalis), greater celandine (Chelidonium majus), and wormwood (Artemesia absinthum). Use cholagogues in functional liver and gall bladder disease only after full examination has ruled out organic disease. They are not used during an acute attack of gall stones, gall bladder pain, or other abdominal inflammation. There is some controversy about whether cholagogues may promote a crisis in a patient with gall stones, i.e. whether stimulation of bile may cause a stone to move into the ducts, blocking them. Take wormwood or celandine as a tea or tincture for 2-3 weeks, or take dandelion in any form for 4-6 weeks. Dandelion may be taken in a tea or tincture, or even better, use the leaves in salads, cooked as greens, or juiced.

Carminatives are important complements in liver and gall bladder formulas. They are high in essential oils that promote the expulsion of gas and bloating from the intestines and also help reduce spasm. Important carminatives are caraway, fennel, anise, and peppermint.

Chamomile and valerian, two herbs best known for their sedative and antispasmodic effects, contain both carminative volatile oils and bitter principles, and may be useful in liver and gall bladder formulas. The chamomile preparations generally available in tea bags do not yield the full medicinal properties of this herb. You haven’t really experienced the medicinal effects of chamomile until you’ve prepared it by a method like the following: Take a pint or quart canning jar, and fill it about two-thirds with loose chamomile flowers; fill the jar with boiling water and immediately put the lid on. Let it cool to room temperature. It should then be somewhere between the color of Scotch and bourbon whiskey, and will have a very bitter flavor. This form is an excellent digestive tea with antispasmodic and mild cholagogue properties.

A classical formula for functional liver and gall bladder disease will include cholagogues, carminatives, and/or antispasmodics. The following formula is predominantly carminative, for symptomatic use after meals for gas, bloating, belching, or a heavy feeling:

Carum carvi seed (caraway)         1 part

Foeniculum vulgare seed (fennel)     1 part

Mentha piperita leaf (peppermint)    2 parts

Matricaria recutita leaf (chamomile)     2 parts

Valeriana officinalis root (valerian)     2 parts

This formula contains two carminatives and the very-bitter wormwood. It can be used, three times a day, for two or three weeks, then used occasionally as needed (equal parts):

Carum carvi seed (caraway)

Foeniculum vulgare seed (fennel)

Artemesia absinthum leaf (wormwood)

Another carminative cholagogue:

Carum carvi seed (caraway)        1 part

Mentha piperita leaf (peppermint)     2 parts

Artemesia absinthum leaf (wormwood)    2 parts

Taraxacum officinale root (dandelion)    3 part

Finally, this is a bitter cholagogue formula (equal parts):

Mentha piperita leaf (peppermint)

Traxacum officinale root (dandelion)

Silybum marianum seed (milk thistle)