Liver cirrhosis.

If liver disease is suspected, diagnosis can be made using several of the following tests: serum albumin and prothrombin time, liver biochemistry, serum electrolytes, especially low sodium and serum a-fetoprotein, and in young patients serum copper and serum a -antitrypsin. A differential diagnosis may be haemochromatosis or other genetic markers, so total iron-binding capacity and ferritin plus genetic markers may be tested also. Liver biopsy may be necessary to confirm the severity of the condition. (Kumar & Clark, 2002, p. 365)

Short-term aims are to manage the complications, and test at regular intervals for hepatocellular carcinoma. Aspirin, NSAIDs, salt and other aggravating factors, such as alcohol should be avoided. (Kumar & Clark, 2002, p. 365)

Longer-term aims are to restore functioning of the damaged liver as much as possible by utilising a healthy lifestyle and diet, and herbal treatment focusing on hepatic trophorestoratives.

Phytotherapeutics, their Actions and Therapeutic Ranges:

• Schisandra - Adaptogenic, antitussive, antioxidant, hepatoprotective, mild antidepressant, nervine tonic. (Bone, 2003, p. 405)

Range: 2.0 g 3-4 times/day (as part of a Schisandra/Milk thistle/Rosemary complex tablet.) (Bone, 2003-2004 Mediherb Catalog, p. 43)

• Milk thistle - Antioxidant, cholagogue, choleretic, demulcent, hepatic trophorestorative, hepatoprotective, galactogogue. (Hoffmann, 2002. p. 144) (Fugh-Berman, 2003, p. 222) (Bone, 2003, p. 326)

Range: 4-9 g/day of the seed or 1-2 tablets of 200 mg extract (standardised to 140 mg silymarin) taken 1 or 2/day. (Mills & Bone, 2000, p. 553)

 

• Barberry - Antimicrobial, antiemetic, bitter, cholagogue, choleretic, mild laxative. (Mills & Bone, 2000. p.286)

Range: 1-2g t.i.d. dried bark. (British Herbal Medicine Association, 1983, p. 40)

• Globe artichoke - Anticholestatic, antiemetic, bitter, cholagogue, choleretic, depurative, diuretic, hepatic trophorestorative, hepatoprotective, hypocholesterolaemic, hypolipidaemic. (Mills & Bone, 2000, p. 433) (Newall, et al., 1996. p. 36)

Range: 1.5-4g/day dried leaves. (Mills & Bone, 2000, p. 434)

Synergistic compounding:

Three of the four herbs in the formula have hepatoprotective effects: Schisandra, Milk thistle and Globe artichoke. This is highly desired in cirrhosis in order to attempt to prevent any further liver damage. Also important is hepatic trophorestorative, and two of the herbs, Milk thistle and Globe artichoke, have that action. This will ensure the body has the best possible chance of restoring function to areas of the damaged liver. (Bone, 2003, p. 240, 326, 405)

Dosage: As the most common cause of liver cirrhosis is alcohol damage, liquid tinctures of alcohol would be contraindicated in the majority of cases of cirrhosis. For the purpose of this exercise, however, a theoretical 105 ml liquid tincture for one week would comprise the following:

 Therapeutic range (1:2, except Milk thistle - 1:1)

• Schisandra - 25 ml (25-60 ml/wk)  (Bone, 2003, p. 480)
• Milk thistle -  35 ml (30-60 ml/wk)  (Bone, 2003, p. 479)
• Barberry - 20 ml (20-40 ml/wk)  (Bone, 2003, p. 476)
• Globe artichoke - 25 ml (20-55 ml/wk)  (Bone, 2003, p. 478)

Suggested daily dosage is 5 ml 3 times per day.

I have chosen the minimum therapeutic dosages for Schisandra and Barberry as their list of actions does not include hepatic trophorestorative, although Schisandra is hepatoprotective. I have given slightly more than the minimum therapeutic range of Milk thistle and Globe artichoke as they are both excellent hepatoprotective and hepatic trophorestorative herbs. The only limitation on even higher doses of these two herbs was the fact that all 4 of the phytotherapeutics in the formula are medium to high dose herbs.

I have chosen to include Barberry for its mild laxative effect, which may help alleviate some of the systemic toxicity the liver will have to cope with, especially if the intestines have any dysbiosis that may cause deconjugation of bile salts, for example. (Mills & Bone, 2000, p. 187) The second reason is that plasma tyramine concentrations are high in liver cirrhosis patients, and this may cause neurological and cardiovascular complications. Uncontrolled studies have shown normalisation of tyramine levels after oral administration of berberine. Therapeutic levels may have been higher than those administered in this case, so careful patient monitoring and formula adjustment as required would be advisable. (Mills & Bone, 2000, p. 293-294)

4.0 Conclusion

This was a report on the phytotherapeutic applications for treating digestive system disorders. 30 common herbs were documented, but there are many more herbs that may be used. Next the report focused on four common disorders affecting the digestive system and an appropriate herbal formula to treat that disorder. These disorders were intestinal worm infestation, gallstones, gastro-oesophageal reflux and liver cirrhosis