Article by Dr.R.Thayumanavan M.D.(Acu).,
Liver Cirrhosis is scarring of the liver that involves the formation of fibrous (scar) tissue associated with the destruction of the normal organ. It is the result of long-standing injury most commonly due to alcohol in excess but there are a number of other important causes too.
The destruction of the normal Liver structure and the loss of liver cells prevent the liver from functioning normally. It plays an important part in digestion of food but it also has a major role in metabolizing drugs and making proteins, storing of blood and also includes the help for blood clotting.
Cirrhosis is a serious condition. Only 30 per cent of patients with this problem will survive five years after diagnosis and the outlook is worse if the cause is alcohol and the patient continues to drink.
What are the causes of Liver Cirrhosis?
Alcohol excess: The rate of cirrhosis in a country is directly related to the average alcohol consumption in that country. Half of all cases of cirrhosis are due to alcohol excess.
Chronic viral hepatitis: The two important viruses are hepatitis B and hepatitis C. Cirrhosis due to hepatitis B is common in Africa and Asia. Hepatitis C is increasing in importance both in Europe and the US. Hepatitis A (infectious hepatitis) does not cause cirrhosis.
Primary biliary cirrhosis: This is an uncommon disease mainly affecting women. It is not due to alcohol. For some reason the body mounts an attack on the liver in patients with primary biliary cirrhosis.
Autoimmune chronic active hepatitis: Another uncommon condition that results in the body's immune system attacking and destroying liver cells.
Drugs and chemicals: A number of drugs and chemicals can cause liver damage but few cause cirrhosis. Certain specialized drugs need monitoring for their effect on the liver.
Metabolic and inherited disorders: These are a number of uncommon conditions that allow the accumulation of toxins in the liver. The commonest is haemochromatosis, which causes excess deposits of iron in the liver.
Liver Cirrhosis in Acupuncture point of view:
In Acupuncture, we say the Cirrhosis of Liver is primarily due to the chronic stagnation of Liver Yin. Due to the stagnation of Liver Yin, there occurs retention of bile and other fluids in Liver and it leads to deposition of fats in Liver, which causes Fatty Liver. And because of Fatty Liver, it leads to the rise of Liver Yang, where excess heat is produced in the Liver. Due to the excess heat in Liver, all the fluids get completely dried out and the cells & tissues of the liver collapse with each other & spindle like a thin fibre in & around the liver which causes Liver fibrosis. The Liver fibrosis leads to the growth of damaged connective tissues which affects the functions of Liver that leads to shrinking of Liver. Thus Cirrhosis of Liver finally occurs.
What are the symptoms of Liver Cirrhosis?
The symptoms will depend on how much damage has occurred to the liver.
In the early stages there may be no symptoms at all and the disease may be discovered as a result of an investigation for another illness.
As the disease progresses, tiredness, weakness, lack of energy, loss of appetite, nausea and weight loss may develop.
In the later stages the liver is struggling to perform all its functions and any or all of the following symptoms may be present:
Jaundice: This is the yellowing of the skin (jaundice) and the eyes due to the failure of the liver to remove a substance called bilirubin from the blood.
Nail changes: The shape and appearance of the nails may change. They may be more curved (clubbing) and they may be white rather than pink.
Skin changes: About a quarter of patients will have darkening of the skin.
Fluid retention: This is common at some stage in cirrhosis. An important function of the liver is to rid the body of excess fluid through the kidneys and when it fails, fluid gathers in the legs (oedema) or in the abdomen (ascites).
Abnormal blood vessels: The commonest abnormality is a spider naevus, which is a spot surrounded by fine blood vessels. A red face is also common.
Easy bruising: Nosebleeds and easy bruising occur as a result of abnormal blood vessels and delayed clotting because the liver does not make enough clotting proteins.
Enlargement of breasts in men: The liver destroys the female sex hormones and in cirrhosis these accumulate and cause enlargement of the breasts and shrinking of the testes in men.
In the very late stages of the disease, serious complications may occur. These include vomiting of blood, either from ulcers in the stomach or from leaking varicose veins in the lower end of the oesophagus.
The liver is responsible for removing poisonous substances from the blood. In cirrhosis, the blood may bypass the liver and these poisonous substances pass to the brain where they may result in alteration in brain function, causing confusion, drowsiness and finally coma. This is called hepatic encephalopathy.
Usually the course of disease is divided into three stages:
(1) Preascites stage: The symptoms commonly belong to digestive system, such as poor appetite, nausea, vomiting, diarrhoea, etc; the chief clinical sign is hepatomegaly.
(2) Ascites stage: The main symptoms are abdominal distention and fullness, especially after meal, poor appetite, palpition and breathless.
(3) Cachexia stage: Hepatic coma may be occurring.
Treatment methods:
This disease is suitable for compatible application of acupuncture as well as moxibustion.
Acupuncture:
Points: The primary points are divided into two groups:
Group 1: Ren-9, UB-18 and St-36
Group 2: UB-20, Liv-13 and Sp-6
Procedure: Both primary groups of points are used alternately with 10 times of each group. The associated points are used according to the clinical manifestation and 10 times as a course with an interval of 3 to 5 days between two adjacent courses.
Acupuncture points for other symptoms associated with Liver Cirrhosis:
Abdominal distention and fullness : Ren-12 and St-21
Diarrhoea : St-25 and UB-25
Lesser urine : Ren-3
Pain of hypochondrium : GB-34
Palpitation and dyspnoea : P-6 and Ren-17
Moxibustion:
Points: Ren-8, Ren-12, Ren-4 and Sp-15.
Procedure: Allow the patient to lie on one's back. Moxibust the region from Ren-12 to Ren-4 and the region from left-side Sp-15 to right-side Sp-15 with Ren-8 as the centre and with a moxa-cone moving from left side to right side, lasting about one hour. This moving moxibustion therapy is given once a day, 10 times as course with an interval of 3 to 5 days between two adjacent courses.
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