Hepatic - Professional herbal treatment of the liver

by Christopher Hedley, M.N.I.M.H.

Medical Herbalism 10(1-2):1,3,5-9

Liver congestion is the basic condition underlying more serious pathologies. It can be difficult to separate from other causes of general malaise. One method of diagnosing liver problems is to run down a check list and treat the liver if a significant number of the signs and symptoms are present. Another method is to treat the liver anyway. As my teacher said “If in doubt, use Dandelion root.”

Diagnostic check list

Indigestion of all kinds, especially epigastric fullness after meals, intolerance of fatty foods, and nausea without vomiting.

General aches and pains from toxins not clearing. Full headaches.

Low energy and lethargy, especially if worse in the morning.

Aches and pains over the liver area.

Gall bladder problems, from poor and too thick bile flow, leads to pains around the right shoulder blade and tenderness on palpating the gall bladder.

Bile flow congestion leading to jaundice, yellow skin and conjunctiva, bitter taste in the mouth, generalized itching, and chronic constipation.

Blood protein imbalance leading to generalized water retention.

Venous return blockage leading to hemorrhoids, pelvic congestions, and a heavy, erratic menstrual flow.

Heat accumulation leading to hot skin and rashes

Lack of joy, irritability, and quick anger.

Intolerance of alcohol

Drug taking, medical or recreational, strains the liver.

Blood sugar imbalances including reactive hypoglycemia and diabetes (Type II).

Allergies and food sensitivities can arise from liver congestion or may cause it. Skin rashes, migraines, abdominal bloating, and colic.

Tongue softness on the right side.

Restoring and cleansing

A good liver treatment consists of both cleansing and restoring herbs in proportion to suit the case. Heavy cleansing of a congested liver can make the patient dramatically worse. In an otherwise healthy patient, this can be taken as a cleansing crisis. In an otherwise weak person, it can weaken them further.

Table 1 lists some restoring and cleansing herbs. Garlic and acid fruits are also liver cleansing. The proportion of herbs in a formula depends on the individual case. I was taught to base prescriptions on taraxacum and berberis as a starting point, and to modify according to the case.

Table 1

Liver restoring herbs

Taraxacum officinalis (Dandelion root)

Milk thistle seed (Carduus marianus; Silybum marianum)

Liver cleansing herbs (in order of strength, from the weaker to the stronger)

Rosmarinus off. (Rosemary)

Berberis spp (Barberry)

Rumex crispus (Yellow dock)

Artemisia spp. (Wormwood)

Liver flushes

There are many versions of liver flushes around. My favored method is to give liver strengthening and cleaning herbs for six to eight months. This may be enough in itself. Then a few weeks on apple juice, 3-4 cups daily, followed by a flush using garlic, olive oil, and grapefruit juice, processed together, one large glass first thing in the morning. Details vary between patients. I use it only for gall stones, and have found it to be a successful treatment. Nausea, headaches, and digestive disturbances following a too-enthusiastic liver flush is one of the more common side effects of the heroic approach.

Heating and Cooling.

Heating and cooling are basic concepts found in all forms of traditional medicine. They are simple but very powerful tools. Liver heating or cooling herbs are chosen according to the apparent need for heating or cooling in the digestive system or in the blood. Table 2 shows some herbs that either heat or cool the liver and blood.

Table 2

Liver-heating herbs

Angelica spp. (angelica)

Inula helenium (elecampane)

Liver-cooling herbs

Reduce anger

Rosa spp. (rose)

Viola spp. (violet)

Arctium spp. (burdock)

Clear hot rashes

Berberis spp. (barberry)

Arctium spp. (burdock)

Clear hot rash, constipation with dryness

Rumex spp. (yellow dock)

The accompanying case studies are not a blueprint for practice. They are given as examples of the general principles of modern British practice and as a basis for the discussion of herbal treatments and strategies. All patients are individual and they provided me with far more information that the bare bones outline given here.

Case 1

Liver Strengthening

Male 37 years old, general aches and pains, leg cramps, tendency to diarrhoea or constipation, nausea, erratic appetite, occult blood in stools, indigestion with colicky pains low energy, prone to minor infections, several lymph nodes swollen, lumps on skin inc fatty nodule, skin puffy and somewhat greyish. Overweight. “I need to make some changes, would like to detoxify.” Generally an anxious and obsessively hard-working person. Tongue covered with thick, greyish fur. Prone to sinusitis.

Medical history

Hepatitis A 2 years previous, adenoids removed as child. Otherwise nothing dramatic. Liver enzymes normal, kidney function OK, blood profile normal except neutrophils slightly depressed.


Poor; take-aways, café meals, coffee and alcohol. Occasional bouts of multivitamins.

Herbal treatment


Taraxacum officinalis (dandelion root)

Salvia off. (Sage)                20 ml

Calendula off. (Marigold)        20 ml

Sambucus nigra (elder flowers)        20 ml

Thuja occidentalis (thuja)         120 ml

Phytolacca decandra (poke root)    5 ml

Sig 15 ml twice a day.

The sage and the thuja were for general energy and to strengthen the immune system. The elder flower was for sinusitis. The marigold and poke root were for skin and lymphatic cleansing.

Other treatment

10 days of brown rice and vegetables only, followed by daily vegetable juices, avoid alcohol and reduce bread.


Steady and good. Replaced sage with Oregon grape (Mahonia aquifolium, Berberis aquifolium) after one month to push the liver a little. At which time his tongue got a little dirty again. After three months, the tongue cleared up, he lost weight, lymph nodes smaller, skin tone much better, energy improved, but then got worse again. “Feels less stress” and sleeping better. His digestion was still bad and colicky pains more regular until I added a simple of wormwood tincture 20 drops before meals, which was an effective strategy.


Cleansing diets are a good start to any liver treatments

Case 2

Liver Cleansing

Female 51 years old. West Indian. Bloated, heavy and swollen abdomen, general joint pains, muscles very tight especially across the shoulders, poor appetite, small stools, frequent urination, very overweight. Sensitive to alcohol (headaches). Can’t eat in the mornings. Whole flesh tight and swollen. Gets easily overheated. Sleeps poorly, worried about her son who is keeping bad company. Rejected by her family, although she says she has some to terms with this.


Acute nephritis as a child. Menopausal with heavy sweating at first, now better. A few small fibrils on scan. Four children, pregnancies OK. Menstrual bleeding was always regular and light. Touch of sickle cell anemia. Hospital thinks “hormones” but all tests OK, except estrogen a bit low. On HRT 6 weeks, with no difference.


Infusion of equal parts

Zea mays stigmata (corn silk)

Gallium aparine (cleavers)

4 or 5 cups daily.


wormwood (Artemisia absinthum)     2 parts

Phytolacca decandra (poke root)     1 part

Sig 15 drops before meals.


Good, over six months. She came off the HRT after three months. In the hot weather I added I part convallaria majalis (lily-of-the-valley) to her tincture to improve cardiac function as she was getting breathless with exertion. She started regular visits to a massage therapist, which she found of great benefit.


the root of the problem seems to be kidney weakness but the tone of the flesh was excessively tight. The signs belong to both kidney and liver. This is a common finding. Another good “constitutional” remedy for kidney/liver weakness is Berberis spp. (Barberry) and Zea mays (corn silk) equal parts of the tincture taken 10 ml daily for six months. This will improve general health and provides a useful background for more symptomatic treatments.

Case three

Liver cleansing

Professional woman age 27, constant catarrh, abdominal bloating, chronic vaginal thrush, digestion sluggish, “food gets stuck,” metallic taste in mouth, recent history of reactions to foods (rashes, bloating, heaviness), menstrual bleeding heavy and painful. Tongue coating thin and a touch dirty, swollen to right side.

Medical history

Tonsils removed as a child. Otherwise fit. Exercises regularly.


Basically good but likes rich food and alcohol. Does a lot of entertaining in her business.

Herbal treatment


Wormwood (artemisia absinthum)    10 ml

Lady’s mantle (Alchemilla vulgaris)    45 ml

Yellow dock (Rumex crispus)        45 ml

Sig: 5 ml three times a day

Also: cut out all milk products, tea, coffee, and alcohol, for the time being


This patient had a strong reaction – headaches and nausea – which went when she stopped the medication. She was not upset as she felt it was a cleansing reaction. After one month, she was much better and her tongue had mostly cleared up. Her motions were regular, soft and formed, and of good color.


This is a much more classic case of liver congestion. The patient was basically fit, and tolerated the strong reaction well. She felt that the experience had taught her to tighten up her lifestyle and was pleased with the result. It may have been better to give decoctions here although, generally, the small amount of alcohol in tinctures is well tolerated and we get better compliance in taking medication.

Case four

Hepatitis C

Female, 51, a housewife with constant infections, especially bronchitis, and severe fatigue. Hepatitis C diagnosed 3 years previously. Some cirrhosis. Liver swells from time to time. Enzymes not known. Doesn’t wish to take drugs or go back to her doctor. Tongue: thick grey coat. The hospital gave her ten years to live.

Medical history

Gallstones removed some years ago. Menopausal with severe hot flashes.


Excellent. She has cleaned up her diet and lifestyle since the diagnosis. Exercises regularly.

Herbal treatment

Initial tincture

Echinacea (Echinacea purpurea)        2 parts

Milk Thistle seed (Carduus marianus)        1 part

Oregon grape root (Berberis aquifolium)    1 part

By decoction: 3 or 4 cups daily.


Also garlic tablets, 6 daily

Infusion of sage (Salvia off.) And motherwort (Leonurus cardiaca) taken as required for hot flushes.


Her immune system picked up quickly but her general fatigue took longer. In the end I settled on a long term prescription of:

Milk thistle seed (Carduus marianus)        2 parts

Echinacea (Echinacea purpurea)        1 part

Oregon grape root (Berberis aquifolium)    1 part

Licorice (Glycyrrhiza glabra)            1 part

Elecampane (Inula helenium)            1 part

Artists bracket (Ganoderma appalanatum)    1 part

Her energy picked up noticeable after the last two herbs were added. Elecampane was used for central warmth and the Artists bracket for immune function.

The sage and motherwort did not control her hot flushes and I had to take a more hormonal approach using:

Chaste tree berry (Vitex agnus-castus)

Black cohosh (Cimicifuga racemosa)

St Johnswort (Hypericum perforatum)

Which she took for six months


Her health has remained very good on this regime. The prescription is fairly typical for my hepatitis C patients. I don’t expect to ‘cure’ the disease, but simply to strengthen the patient so that their life expectancy is the same as anyone else. They are all on the whole in good health, even those who go on injecting drugs! It is difficult to persuade patients to have regular blood testing in the UK, since this would mean going back to the hospital. I would have to arrange for it myself but this would be too expensive for many patients. Hepatitis C would make a good subject for a controlled trial of treatments.

Case five

Liver herbs in pregnancy

Strong liver cleansing herbs are generally contraindicated in pregnancy. They are excessively cooling and downward-moving. Strategies in pregnancy should concentrate on building up with gentle warming and gentle cleansing where appropriate. If liver cleansing is needed, dandelion root (Taraxacum officinalis) is the herb of choice. Yellow dock (Rumex crispus) root is the strongest herb I use, in this category. Yellow dock also has a traditional reputation for helping conception.


A woman of 28 years with chronic constipation. Feels “stuck in life at the moment.”

Medical history

Bulemia, vaginal thrush, severe PMS made worse by the contraceptive pill, irregular cycle, lumpy breasts, generalized water retention, depression, anxiety, insomnia, cystitis triggered by sexual activity, poor skin tone with lots of spots. Tongue pale, soft, and wobbly. Cold.


Mostly vegetarian, occasional fish, no milk, occasional bread. Modified after following an anti-candida diet for some years. Supplements included acidophilus and evening primrose oil.


This patient originally presented with depression and anxiety. There were obviously issues arising around her history to be dealt with. She had taken a psychology degree, “in order to understand myself better,” which didn’t work. The liver is not the only organ affected here, but plays a central role in reestablishing proper bowel function.


Initial prescription

Aloe (Aloe vera) leaf

Rhubarb (Rheum officinalis)

Tincture, 20-35 ml per week

On these and other herbs she showed slow but steady improvement in all her symptoms, over a period of three years. Her life then had improved enough for her to consider motherhood.

New prescription


Dandelion root (Taraxacum officinalis)

Yellow dock (Rumex crispus)

She became pregnant very quickly, and her constipation rapidly got worse. After some experimentation with dosage we settled on a tincture mixture of:

Mallow (Althea officinalis)                20 ml

Yellow dock (Rumex crispus)                40 ml

Dandelion root (Taraxacum officinalis)            40 ml

Sweet fennel essential oil (Foeniculum vulgare)        1 drop

Dose: 5 mls three times a day, increasing to 15 mls if necessary

Her average dose over her pregnancy was around 20 ml/day


Fennel oil is contra-indicated in pregnancy, but this dosage level is OK. I often use it with dock or rhubarb root tinctures. It improves the flavor, takes the edge off their coldness, and relieves griping.
  Copyright 2001 Paul Bergner

click medherb.com below to search site

Medical Herbalism. Introductory, Advanced, Clinical. CE Available.

FIRST COURSE IN MEDICAL HERBALISM With Resources Kit. Learn 14 herbs, Make your own herbal medicines.

CLASSROOM EDUCATION Medical Herbalism. Advanced and Clinical Programs. Occupational Certification.

Mountain Rose Herbs. A Herbs, Health and Harmony C