Editor's Note: Liver fibrosis is a common pathological process in various chronic liver diseases and is closely related to disease progression. It is a critical factor influencing the prognosis of liver diseases and increasing the risk of hepatocellular carcinoma (HCC). Early fibrosis is reversible, but without timely intervention, it can worsen into cirrhosis or even HCC. Therefore, the prevention and treatment of liver fibrosis are of great significance. Recently, Dr. Junhong Liu, a renowned traditional Chinese medicine (TCM) practitioner from Gansu Province, gave a detailed report titled "Advantages and Unique Features of TCM in the Treatment of Liver Fibrosis" at the 4th Jincheng Liver Disease Forum. The Hepatology Digest has summarized his insights as follows.Current Status and Limitations of Western Medicine in Treating Liver Fibrosis
The primary strategy for treating liver fibrosis in Western medicine is to control and cure the underlying disease and minimize tissue damage. In the early stages, timely and effective treatment of the root cause can significantly improve and even reverse liver fibrosis. For example, addressing infections with antiviral therapy, protecting the liver, reducing inflammation, suppressing immune responses, and utilizing antioxidant and anti-apoptotic treatments are common approaches. In cases of schistosomiasis, eliminating parasites is necessary, while bile duct obstructions may require surgical interventions.
However, in some cases, even after successful treatment of the underlying cause, such as the reduction of inflammation, virus replication, and improvement in biochemical markers, liver fibrosis persists or continues to worsen in certain patients. This highlights the limitation of symptomatic treatment alone, as it does not directly address fibrosis. A key to treating liver fibrosis is inhibiting the activation and deposition of extracellular matrix (ECM) in the liver.
Unique Features of TCM in Treating Liver Fibrosis
In TCM, liver fibrosis is primarily understood as a condition caused by “damp-heat toxins, qi stagnation, deficiency, and blood stasis.” The main treatment principles are to “expel pathogens, soothe the liver, strengthen vital energy, and remove stasis.” The classical medical text Yizong Bidu·Jiju describes the approach as “frequent attacking and nourishing, aiming for balance,” emphasizing that the treatment should be a combination of both attacking and replenishing, with an appropriate balance based on different stages of the disease. TCM focuses on integrating treatment of the disease, symptoms, and patient constitution, applying a multi-faceted and holistic approach.
In the early stages of liver fibrosis, a deficiency in vital energy is the main internal factor, while damp-heat toxins trigger the initial formation of fibrosis. In the early stage, patients typically exhibit patterns of damp-heat in the liver and gallbladder, so treatment focuses on clearing heat and expelling dampness, supplemented with methods to strengthen vital energy. In the mid-to-late stages of liver fibrosis, as the struggle between pathogenic and healthy energy intensifies, the body’s vital energy is significantly weakened. Common patterns include qi and yin deficiency, blood stasis, and liver-kidney yin deficiency. Treatment at this stage emphasizes supporting vital energy and removing blood stasis, with the addition of pathogen-expelling methods when necessary.
TCM often combines internal and external treatments. Alongside herbal therapies, external treatments such as acupuncture, acupoint application, and acupoint injection play a significant role. By stimulating acupuncture points and meridians on the body’s surface, TCM can clear damp-heat, soothe the liver and spleen, promote blood circulation, nourish qi and yin, and support the liver and kidneys. This comprehensive regulation ensures a balanced approach, addressing both the root cause and symptoms.
Advantages of TCM in Treating Liver Fibrosis
In recent years, increasing numbers of scholars both domestically and internationally have been focusing on the study of TCM in the treatment of liver fibrosis. Given the complex pathogenesis of liver fibrosis, TCM offers multiple advantages, including its multi-target and multi-pathway therapeutic mechanisms. Liver fibrosis has a complicated mechanism, and Western medicine has yet to identify a specific anti-fibrotic drug. However, TCM’s molecular mechanisms are related to various signaling pathways, providing broader therapeutic possibilities. Compared to Western medicine’s antivirals, anti-inflammatories, and immunosuppressive therapies, TCM is generally safer and, when combined with Western medicine, can enhance the body’s immunity and reduce the toxic side effects of pharmaceuticals. In some cases, TCM can even sensitize and enhance the efficacy of Western drugs, improving the patient’s overall quality of life.
Under the unique guidance of TCM’s theoretical framework—from etiology, pathogenesis, syndrome differentiation, and treatment principles to prescription formulation—significant progress has been made in TCM research on liver fibrosis. This highlights the multi-target, multi-pathway, and multi-dimensional advantages of TCM. However, further studies are needed to apply the findings from animal models, particularly regarding targeted pathways, to clinical research. The development of more effective compound prescriptions is essential. Many scholars are exploring integrated approaches to preventing and treating liver fibrosis, emphasizing that combining TCM and Western medicine should aim for synergistic effects, rather than merely adding them together. Achieving the goal of “1+1 > 2” requires multidisciplinary, multi-field, and multi-team cooperation to drive high-quality clinical and research advancements in liver fibrosis treatment in China.
