Non-Alcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a form of metabolic stress-related liver injury closely associated with insulin resistance (IR) and genetic susceptibility. Its pathological changes resemble those of alcoholic liver disease (ALD), but affected individuals have no history of excessive alcohol consumption. The disease spectrum includes nonalcoholic simple fatty liver (NAFL), nonalcoholic steatohepatitis (NASH), and related cirrhosis and hepatocellular carcinoma. The condition is often asymptomatic. A small number of people may experience nonspecific symptoms such as fatigue, mild discomfort in the right upper abdomen, a dull ache in the liver area, or upper abdominal distension and pain. Severe fatty liver disease may cause jaundice, loss of appetite, nausea, and vomiting. In traditional Chinese medicine (TCM), this condition is categorized under “hypochondriac pain” (xietong), “masses and accumulations” (jiju), “liver distension” (ganzhang), “liver accumulation” (ganpi), “liver obstruction” (ganzhu), and “fat accumulation” (feiqi).

TCM Pattern Identification and Medication Reference

|Common Symptoms

Clinical Description:

Discomfort in the liver area; distending pain in both hypochondria; low mood and irritability; chest tightness and frequent sighing; occasional belching; reduced appetite; irregular bowel movements; irregular menstruation; breast distension and pain; a red tongue with a thin white coating; and a wiry-slippery or wiry-thin pulse.

In Plain Language:

  • There may be discomfort in the liver area, with distension and pain along both sides of the ribs.
  • You may feel down, irritable, or emotionally unsettled.
  • Your chest may feel tight or uncomfortable, and you may sigh frequently without realizing it.
  • You may belch from time to time.
  • Your appetite may decrease, and you may have less interest in food.
  • Bowel movements may be irregular in timing or consistency.
  • Menstruation may be irregular in timing or cycle length.
  • You may feel distension and pain in the breasts, causing discomfort.
  • The tongue may look redder than usual.
  • The tongue coating may be thin and white.
  • The pulse may feel taut and slippery, or taut and thin.

|Treatment Approach

Clinical Description:

Soothe the liver and relieve constraint; regulate Qi and alleviate pain.

In Plain Language:

  • TCM methods that promote the flow of Liver Qi and ease constraint aim to help Qi flow more smoothly and relieve discomfort such as distension and pain along the ribs, chest tightness, low mood, irritability, and frequent sighing.
  • Methods that regulate obstructed Qi and ease pain aim to gradually relieve upper abdominal fullness, distension or dull pain, while addressing issues such as belching, acid reflux, hiccups, and poor appetite.

|Related Products

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

|Common Symptoms

Clinical Description:

Distension and tightness in the hypochondria; low mood; fatigue and lack of strength; abdominal pain with an urge to have diarrhea; abdominal distension and discomfort; poor appetite; nausea and urge to vomit; occasional sighing; a pale-red tongue with a thin white or white coating and teeth marks along the edges; and a wiry-thin pulse.

In Plain Language:

  • The area along both sides of the ribs may feel tight, distended, or uncomfortable.
  • You may feel down or emotionally unsettled.
  • You may feel sleepy, low in energy, and physically weak.
  • Your abdomen may hurt, and you may feel an ongoing urge to have diarrhea.
  • Your abdomen may feel swollen, tight, or uncomfortable.
  • You may have a poor appetite and feel nauseated, with an urge to vomit.
  • You may sigh involuntarily from time to time, as if needing to let out a breath.
  • The tongue may look pale red, slightly lighter in color than usual.
  • The tongue coating may appear thin and white, or white.
  • Teeth marks may be visible along the edges of the tongue.
  • The pulse may feel taut and thin.

|Treatment Approach

Clinical Description:

Soothe the liver and relieve constraint; strengthen the spleen and regulate Qi.

In Plain Language:

  • TCM methods that promote the flow of Liver Qi and ease constraint aim to improve the flow of Qi and relieve discomfort such as distension and pain along the ribs, chest tightness, low mood, irritability, and frequent sighing.
  • Methods that support digestion and regulate Qi aim to improve digestive function and help with issues such as poor appetite, post-meal abdominal distension, upper abdominal fullness, belching, acid reflux, loose stools, or incomplete bowel movements.

|Related Products

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

Xiaoyao San

|Common Symptoms

Clinical Description:

Obesity; discomfort or distension in the right hypochondrium; a heavy feeling throughout the body; sticky, unsatisfactory bowel movements; epigastric and abdominal distension; fatigue and weakness; poor appetite; dizziness and nausea; a pale tongue with a white, greasy coating; and a deep, slippery pulse.

In Plain Language:

  • You may have a larger body build or appear overweight.
  • The right side of the ribs may feel uncomfortable, tight, or distended.
  • Your whole body may feel heavy and sluggish, including when moving around.
  • Stools may be sticky and difficult to pass cleanly, leaving you feeling that your bowel movement is incomplete.
  • Your upper abdomen and abdomen may feel full, tight, and uncomfortable.
  • You may feel tired and low in energy, with weakness in your limbs.
  • You may have a poor appetite and little interest in food.
  • You may feel dizzy and nauseated, with an urge to vomit.
  • The tongue may look pale.
  • The tongue coating may be white and greasy in appearance.
  • The pulse may feel deep and slippery, and become more noticeable when pressed.

|Treatment Approach

Clinical Description:

Strengthen the spleen and boost Qi; transform phlegm and dispel dampness.

In Plain Language:

  • Methods that regulate digestion and support Qi aim to improve digestive function and help ease symptoms such as poor appetite, post-meal abdominal distension, upper abdominal fullness, fatigue, loose stools, or watery stools.
  • Methods that transform thick phlegm and dampness and promote the removal of dampness aim to help clear phlegm and reduce a sticky, heavy feeling. They are used in TCM to address issues such as chest tightness, cough, phlegm or a foreign-body sensation in the throat, a thick greasy tongue coating, and reduced urination.

|Related Products

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

|Common Symptoms

Clinical Description:

Distending pain in the right hypochondrium; a heavy feeling throughout the body; epigastric and abdominal fullness or pain; sticky, unsatisfactory bowel movements; yellowing of the skin and eyes; dark-yellow urine; a sticky sensation in the mouth; dry, bitter taste in the mouth; a red tongue with a yellow, greasy coating; and a wiry-slippery or soggy-rapid pulse.

In Plain Language:

  • You may feel distension and pain on the right side near the ribs.
  • Your whole body may feel heavy and sluggish, including when moving around.
  • Your upper abdomen and abdomen may feel full and tight, or may be painful.
  • Stools may be sticky and difficult to pass cleanly, leaving you feeling that your bowel movement is incomplete.
  • Your skin and eyes may look yellow.
  • Your urine may appear yellow.
  • Your mouth may feel sticky or coated.
  • Your mouth may feel dry and have a bitter taste.
  • The tongue may look redder than usual.
  • The tongue coating may be yellow and greasy in appearance.
  • The pulse may feel taut and slippery, or soft and rapid.

|Treatment Approach

Clinical Description:

Clear heat and toxins; promote urination and resolve turbidity.

In Plain Language:

  • TCM methods intended to clear internal “heat” and toxins aim to reduce symptoms described as heat or toxicity, such as feeling feverish and restless, a sore throat, mouth ulcers, red and swollen skin with pain, and a bitter or dry mouth.
  • Methods that promote urination, dispel dampness, and resolve turbidity aim to ease a sticky or heavy feeling. In TCM, they are used to address issues such as heaviness and fatigue, chest tightness, nausea, poor appetite, a sticky feeling in the mouth, a thick greasy tongue coating, scanty dark urine, or sticky, unsatisfactory bowel movements.

|Related Products

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

|Common Symptoms

Clinical Description:

Stabbing or dull pain in the hypochondria; a lump beneath the ribs; a dull complexion; obesity; chest and epigastric fullness; coughing or expectorating phlegm; poor appetite and aversion to greasy foods; heaviness in the limbs; a dark-red tongue with purple spots, a swollen tongue with teeth marks along the edges, a greasy coating; and a wiry-slippery or choppy pulse.

In Plain Language:

  • You may feel a stabbing pain or dull ache around the ribs.
  • The area beneath the ribs may feel blocked or tight, and you may feel something lump-like when touching it.
  • Your complexion may look dull or dark, and you may appear generally unwell.
  • You may have a larger body build or appear overweight.
  • Your chest and upper abdomen may feel blocked, tight, and full.
  • You may cough up or spit out phlegm.
  • You may have a poor appetite and dislike greasy foods.
  • Your arms and legs may feel heavy.
  • The tongue may look dark red, with purple spots.
  • The tongue may appear swollen, with teeth marks along its edges.
  • The tongue coating may look greasy or sticky.
  • The pulse may feel taut and slippery, or uneven and choppy.

|Treatment Approach

Clinical Description:

Invigorate blood and resolve stasis; transform phlegm and dissipate nodules.

In Plain Language:

  • Methods intended to promote blood flow and disperse blood stasis aim to support the movement of Qi and blood and ease symptoms such as stabbing pain or pain in a fixed location, tenderness when pressed, localized hardness, or purple bruising.
  • Methods intended to transform thick phlegm and dampness and disperse accumulations aim to gradually soften lumps or firm swellings and address issues such as a foreign-body sensation in the throat, difficulty clearing phlegm, localized distension or pain, or a sensation of a lump.

|Related Products

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

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