Autoimmune liver diseases usually include: autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). These three diseases are all autoimmune reactions to liver injury, with different pathological changes and different clinical manifestations; AIH manifests mainly with liver inflammation, PBC with bile duct damage and cholestasis, and PSC with progressive inflammation, occlusion and fibrosis of the intra- and extra-hepatic bile ducts. These three diseases can exist separately or can manifest an overlapping syndrome between any two of them. In terms of treatment, Western medicine is clear – immunosuppressive drugs (hormones, etc.) as well as drugs that are biliary and promote the secretion and excretion of bile from hepatocytes, anti-fibrosis and symptomatic treatment. Because of the complexity of autoimmune liver disease and poor prognosis, its treatment needs to be long-term, a year or even more than several years, in addition to the long-term use of large amounts of hormones, causing clinical water and sodium retention, hypertension, osteoporosis and other side effects greatly affect the physical and mental health of patients. According to the clinical manifestations of autoimmune liver disease: tiredness and weakness, poor appetite, epigastric distension and discomfort, dull pain in the ribs, itchy skin or yellow eyes, yellow body, yellow urine and other major clinical manifestations, the disease can be attributed to the Chinese medicine
The disease can be classified under the categories of “hypochondriac pain”, “jaundice”, “depression”, and “deficiency labor” in Chinese medicine. At present, it is mostly believed that its etiology and pathogenesis can be summarized into four major aspects: dampness, toxicity, deficiency and stasis. The patient’s deficient body, combined with external epidemic toxicity and emotional disorders, leads to the loss of liver circulation, spleen health, and liver and kidney deficiency, resulting in the evidence of blood stasis and obstruction. It can involve multiple internal organs such as spleen, stomach, liver and gallbladder. After years of clinical practice, we believe that the etiology of this disease is divided into internal and external causes. The age of onset of autoimmune liver disease is characterized by a bimodal period (i.e., female puberty and menopause), with adolescent females being the most common abroad and our clinical observation that menopausal females are the most common. According to the theory of Chinese medicine, the kidney qi is not yet full in youth; the kidney qi gradually decreases in menopause, so the internal causes are mainly insufficient endowment, kidney qi deficiency, clinical manifestations of liver and kidney yin deficiency for more people. The external causes are external evil, especially wind-heat, which is a yang evil, easily consuming fluid and hurting yin; and the disease is predominant in women, according to the characteristics of women, they are more worried and good at feeling, easily injured by the “seven emotions”, “women are good at conceiving and more depressed”, resulting in emotional disorders, liver depression and qi stagnation. This can further aggravate the pathological changes of Yin deficiency. Yin deficiency generates internal heat, and wind heat and deficiency heat add up to fire, which burns the liver ligaments, thus causing liver damage. Therefore, in the pathogenesis of autoimmune liver disease, deficiency of liver and kidney endowment is the root cause, while wind-heat external evil and liver qi stagnation are the symptoms and causative factors. Therefore, nourishing the liver and kidney should be carried out all the time. In the formula, raw earth, dogwood and chasteberry are used to nourish the liver and kidney; Chai Hu and Bai Shao are used to clear the liver and relieve depression in the midst of yin and moisten the liver to achieve the function of “sparing wood in water”; whole worm, Tribulus terrestris, Radix Gentianae Macrophyllae, Semen Nobilis, Cao He Che, Salviae Miltiorrhizae, Radix Rehmanniae, Radix Rehmanniae Miltiorrhizae and Dampi are used to dispel wind and detoxify blood stasis. The long-standing disease of yin loss and yang, appearing spleen and kidney yang deficiency, plus Xian Ling spleen, Baji Tian, in the “yang seeking yin”. In addition, you can also dialectical treatment. Liver stagnation and qi stagnation (mostly seen in the early stage of AIH): distension and pain in the chest and hypochondrium, depression, belching or good breath, reduced diet, worrying and worrying, distension and pain in the abdomen, irregular bowel movements, irregular menstruation, premenstrual breast swelling and pain, or even amenorrhea in women. The tongue is light red, the coating is thin, and the pulse is string. Treatment: Diversify the liver and regulate qi, prescription: Chai Hu Shu Liver San plus or minus. Damp-heat obstruction (mostly seen in the early stage of AIH): dampness, distension and stuffiness, reduced diet, nausea and aversion to oil, vomiting at times, or yellowing of the body and eyes, vivid color, sticky and bitter mouth, thirst for drinking or not much drinking, heavy limbs, tiredness and weakness, sticky and foul stools, yellow urine or like thick tea, yellow and greasy tongue coating, string or smooth pulse. Treatment: Clearing heat and relieving dampness, harmonizing the stomach and resolving turbidity. Prescription: Artemisia Inchi Tang or Ganlu Disinfectant Dan plus or minus. Spleen qi weakness (mostly seen in the middle stage of AIH): general weakness, loss of appetite, or even very poor diet, abdominal distension especially after lunch, or mild swelling, or fatigue and fear of cold, tasteless mouth, insubstantial or loose stools, clear and long urine, light and fatty tongue, thin moss, slow and weak pulse. Treatment: Strengthening the spleen and benefiting Qi. Prescription: Si Jun Zi Tang or Ping Gastric San or Wu Ling San plus or minus. Yin deficiency of liver and kidney (mostly seen in the late stage of AIH) is often accompanied by liver cirrhosis: irritable fever or low fever, dry mouth and throat, dizziness and tinnitus, vague pain in the right side, soreness and weakness of the waist and knees, tendon and flesh p, dry eyes, insomnia and dreaminess, hot flashes or five heartburn, night sweating, emaciation of the body, or see a dark complexion, hair that does not glory, epistaxis, liver palm, spider mole, spermatorrhea in men, scanty menstruation or even amenorrhea in women, thin tongue, red and vivid tongue with cracks, flower Peeling moss or less moss or light red without moss, thin and feeble pulse. Treatment: Nourishing the liver and kidney. Prescription: Consistent decoction or Liu Wei Di Huang Wan plus or minus. Yang deficiency of the spleen and kidney (mostly seen in the late stage of AIH) is often accompanied by cirrhosis of the liver: cold fear, swelling, mental fatigue, white face, cold pain in the lower abdomen, waist and knees, poor appetite, abdominal distension and loose stools, or morning discharge, incomplete transformation of grain, or even slippery incontinence, unfavorable urination or incontinence of the remaining leachate, or frequent incontinence of urination, or even water drum, impotence in men, amenorrhea in women, or menstruation with little color, light fat tongue with teeth marks, white or greasy or slippery moss, sunken and weak pulse or sunken and late pulse. Weak pulse. Treatment: Warming the spleen and kidney. Prescription: Zhen Wu Tang or Radix Rehmanniae Sinensis Tang with addition and subtraction. Blood stasis blocking the ligaments (mostly seen in the late stage of AIH, often coexisting with liver-kidney yin deficiency or liver-kidney yang deficiency): dark face, facial capillary dilation, liver palm, spider nevus, enlarged liver and spleen with hard texture, abdominal pain during menopause in women, dark menstrual fluid with lumps, dark tongue or purple spots, sunken and thin pulse. Treatment: Removing blood stasis and promoting circulation, softening hardness and dispersing nodules. Prescription: Add reduction to Diaphragmatic Expulsion of Blood Stasis Soup.