Cholestatic Liver Disease

Cholestasis is a pathological condition in which bile formation, secretion, or excretion is impaired for various intrahepatic or extrahepatic reasons, preventing bile from flowing normally into the duodenum and causing it to enter the bloodstream. Clinical manifestations may include itching, fatigue, dark urine, and jaundice. Early on, elevated serum ALP and GGT levels may be the only findings. As the condition progresses, hyperbilirubinemia may develop; severe cases can lead to liver failure and even death. Hepatobiliary diseases in which liver disease caused by various factors is primarily characterized by cholestasis are collectively known as cholestatic liver diseases. Cholestasis itself may also further aggravate liver damage.

TCM Pattern Identification and Medication Reference

| Common Symptoms

Clinical description:

Marked yellow discoloration of the body and eyes; fever and thirst; restlessness and nausea; fullness and distension in the epigastrium and abdomen; reduced appetite; scant, dark urine; constipation; yellow, greasy or dry, rough tongue coating; a red tongue body; and a wiry, rapid or slippery, rapid pulse.

In plain language:

  • The skin and whites of the eyes are noticeably yellow, with a bright, vivid color that is readily apparent.
  • There may be fever and thirst, along with restlessness and a feeling of nausea.
  • The upper abdomen and belly may feel full, distended, and uncomfortable, with reduced interest in food.
  • Urine may be scant and yellowish-red in color.
  • Stools may be dry and hard to pass, with less frequent and difficult bowel movements.
  • The tongue coating may be yellow and greasy, or yellow and dry and rough.
  • The tongue may appear red.
  • The pulse may feel taut and rapid, or smooth and rapid.

| Treatment Approach

Clinical description:

Clear heat and transform dampness; soothe the Liver and promote bile flow.

In plain language:

  • Intended to clear internal heat and resolve dampness, and may ease discomforts such as fever, restlessness, bitter taste, poor appetite, chest tightness, abdominal bloating, scant dark urine, or a thick, greasy tongue coating.
  • Intended to soothe Liver qi and promote bile flow, and may ease manifestations such as distending pain in the flanks, nausea, acid regurgitation, poor appetite, or yellowing of the eyes and skin.

| Related Products

The products below are provided for informational purposes only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.

| Common Symptoms

Clinical description:

Yellowing of the body and eyes with a dull appearance; low-grade fever; heaviness of the head and body; chest and epigastric oppression and fullness; reduced appetite; no thirst or little desire to drink; loose, unsatisfactory stools; scant yellow urine; a thick, greasy or mixed yellow-and-white tongue coating; and a soggy, moderate or wiry, slippery pulse.

In plain language:

  • The body and whites of the eyes look yellow, but the color is dull rather than bright.
  • The body may feel warm, but there is no pronounced or high fever.
  • The head may feel heavy and the whole body tired and sluggish, making it difficult to move around or do things.
  • The chest and upper abdomen may feel stuffy, blocked, full, and uncomfortable.
  • Appetite may be reduced, with little interest in food.
  • There may be little thirst and little desire to drink water.
  • Stools may be loose and difficult to pass comfortably, with a lingering sense of incomplete evacuation.
  • Urine may be scant and yellow.
  • The tongue coating may be thick and greasy, or yellow and white in patches.
  • The pulse may feel soft and slow, or taut and somewhat slippery.

| Treatment Approach

Clinical description:

Promote urination and resolve dampness; clear heat and reduce jaundice.

In plain language:

  • Intended to help remove excess dampness and resolve turbid pathogens, and may ease heaviness of the body, a heavy or foggy feeling in the head and body, or difficulty urinating.
  • Intended to clear internal heat and reduce jaundice, and may ease bitter taste, poor appetite, restlessness, thirst, and yellowing of the skin and eyes.

| Related Products

The products below are provided for informational purposes only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.

Yinchen Wuling San

| Common Symptoms

Clinical description:

Jaundice and flank pain; high fever and restlessness; bitter, dry mouth; poor appetite; nausea and vomiting; abdominal fullness and distension; constipation; scant, dark urine; a yellow, dry, rough tongue coating; and a wiry, slippery, rapid pulse.

In plain language:

  • The skin and whites of the eyes may look yellow, along with pain in the flanks that may worsen with movement or pressure.
  • There may be a high fever and marked restlessness, with difficulty relaxing even when still.
  • The mouth may feel bitter and dry, with noticeable dryness when speaking or swallowing.
  • Appetite may be poor, and eating may feel unappealing or difficult.
  • Nausea and retching may occur, sometimes with vomiting; vomiting may not bring immediate relief.
  • The abdomen may feel full, distended, and blocked, with persistent discomfort when sitting or lying down.
  • Stools may be dry and hard to pass, with difficult and less frequent bowel movements.
  • Urine may be scant and yellowish-red.
  • The tongue coating may be yellow, dry, and rough in appearance.
  • The pulse may feel taut and slippery, and rapid.

| Treatment Approach

Clinical description:

Clear the Liver and promote bile flow; resolve dampness and reduce jaundice.

In plain language:

  • Intended to clear Liver heat and promote bile flow, and may ease flank pain and fullness, bitter taste, dry throat, nausea, and poor appetite.
  • Intended to resolve internal dampness and reduce jaundice, and may ease heaviness of the body and scant, dark urine, as well as yellowing of the skin and eyes.

| Related Products

The products below are provided for informational purposes only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.

| Common Symptoms

Clinical description:

Yellowing of the body and eyes with a dull appearance; a dark, sallow complexion; distending pain and masses below the ribs; fine red lines visible on the skin; a purplish tongue or purple stasis spots; and a wiry, choppy or thin, choppy pulse.

In plain language:

  • The body and whites of the eyes may look yellow and dull, without much luster.
  • The complexion may look dark and sallow, with an overall dull appearance.
  • Lumps may be felt below the ribs, with distending pain that may worsen with pressure or movement.
  • Fine red, threadlike lines may be visible on the surface of the skin.
  • The tongue may look purple, or show dark purplish spots of blood stasis.
  • The pulse may feel taut and rough, or thin and rough.

| Treatment Approach

Clinical description:

Invigorate blood and resolve stasis; soothe the Liver and reduce jaundice.

In plain language:

  • Intended to promote blood circulation and resolve stasis, and may ease fixed, stabbing pain, bluish-purple bruising, or localized distending pain.
  • Intended to soothe Liver qi and reduce jaundice, and may ease yellowing of the eyes and body, scant dark urine, flank fullness, or poor appetite.

| Related Products

The products below are provided for informational purposes only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.

| Common Symptoms

Clinical description:

Yellowing of the face, eyes, and skin, with a relatively pale yellow color; yellow urine; weak, tired limbs; palpitations and shortness of breath; poor appetite and loose stools; a pale tongue with a thin coating; and a soggy, fine pulse.

In plain language:

  • The face and skin may look yellow, but the color is pale rather than bright.
  • Urine may look yellow and less clear.
  • The limbs may feel weak, with easy fatigue throughout the body.
  • There may be an uncomfortable pounding heartbeat and shortness of breath when speaking or being active.
  • Appetite may be poor, with loose, unformed stools that are difficult to pass comfortably.
  • The tongue may look pale, with a thin coating.
  • The pulse may feel soft and fine, with reduced strength but still perceptible.

| Treatment Approach

Clinical description:

Harmonize the Liver and Spleen; tonify qi and nourish blood.

In plain language:

  • Intended to regulate Liver qi and coordinate Spleen and Stomach function, and may ease chest and flank fullness, emotional discomfort, poor appetite, abdominal bloating, or loose stools.
  • Intended to replenish qi and blood, and may ease a pale complexion, fatigue, shortness of breath, dizziness, or palpitations.

| Related Products

The products below are provided for informational purposes only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.

| Common Symptoms

Clinical description:

Sudden onset of jaundice that rapidly deepens; high fever and intense thirst; frequent vomiting; fullness and distension in the epigastrium and abdomen; pain with refusal of pressure; constipation; scant urine; restlessness; a yellow, dry, rough tongue coating; red tongue edges and tip, dry to the touch; and a wiry, rapid or forceful, surging pulse.

In plain language:

  • Yellowing begins suddenly, with the body and whites of the eyes becoming noticeably yellow soon afterward.
  • The yellow discoloration deepens quickly, becoming increasingly pronounced over a short period.
  • There may be a high fever and intense thirst, with drinking providing little relief.
  • Frequent nausea and vomiting may cause considerable stomach discomfort.
  • The upper abdomen and belly may feel full, distended, and blocked.
  • Pressure on the abdomen may worsen the pain, and the area may be very tender to touch.
  • Stools may be dry and hard to pass, making bowel movements difficult.
  • Urine may be scant and passed in small amounts.
  • There may be restlessness and difficulty sitting still or calming down.
  • The tongue coating may be yellow, dry, and rough, without a moist appearance.
  • The edges and tip of the tongue may look especially red.
  • The tongue may feel dry to the touch and lack a moist sheen.
  • The pulse may feel taut and rapid, or forceful and surging, as well as rapid.

| Treatment Approach

Clinical description:

Clear heat and resolve toxins; drain fire and reduce jaundice.

In plain language:

  • Intended to clear internal heat and resolve toxins, and may ease fever, restlessness, sore or swollen throat, or red, swollen sores.
  • Intended to drain excessive fire and reduce jaundice, and may ease bitter taste, thirst, yellowing of the eyes and body, or scant, dark urine.

| Related Products

The products below are provided for informational purposes only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.

References

  1. E. Kuntz，H. D. Kuntz. Hepatology: Principles and Practice（2nd）[M]. Heidelberg：Springer Medizin Verlag，2006.
  2. D. M. Bortolini，P. Almasio，G. Bray，et al. Multicentre Survey of the Prevalence of Intrahepatic Cholestasis in 2520 Consecutive Patients with Newly Diagnosed Chronic Liver Disease[J]. Drug Investigation，1992，4(4 Supplement)：83-89.
  3. Cao Xunxun，Gao Yueqiu，Zhang Wenhong，et al. A survey of the prevalence of cholestasis among hospitalized patients with chronic liver disease in Shanghai[J]. Chinese Journal of Hepatology，2015，23(8)：569-573.
  4. E. A. F. T. Liver. EASL Clinical Practice Guidelines: management of cholestatic liver diseases[J]. J Hepatol，2009，51(2)：237-267.