The treatment of alcoholic liver disease (ALD) is a serious challenge for both the alcoholic/alcohol dependent person and the physician. Abstinence from alcohol or reduction of alcohol intake, nutritional support and comprehensive treatment remain the basic strategies for the treatment of alcoholic liver disease. 1. alcohol abstinence measures Alcohol abstinence in ALD patients can improve histology, prevent disease progression and improve survival. 30% of patients who abstain from alcohol early in the disease can recover completely. 7-year survival rates for ALD patients who abstain from alcohol and continue to drink are 80% and 50%, respectively. As an etiologic treatment, abstinence is the primary and most basic measure, as well as the most effective and difficult approach. Treatment for alcohol abstinence includes behavioral and pharmacological interventions. For passive drinkers and those with mild alcohol dependence, they should be fully informed and aware of the hazards of excessive drinking, and quit drinking completely through the help of friends and relatives as well as psychological counseling and correction of bad life behaviors. For heavy drinkers and those with severe alcohol dependence, they can gradually reduce the amount of alcohol consumed, control the amount of alcohol intake <20g/d, follow up liver function and maintain transaminases in a basically normal range. For patients who cannot abstain from alcohol or reduce alcohol intake by the above measures, pharmacological intervention is an option. Disulfiram, an inhibitor of acetaldehyde dehydrogenase, prevents the conversion of acetaldehyde to acetic acid and encourages the patient to establish an aversive reflex to drinking, thus increasing the success rate of abstinence. Also abstinence from alcohol sulfur is a dopamine beta hydroxylase that exerts its therapeutic effects by affecting the dopamine and noradrenaline systems. Because the drug can cause acetaldehyde to accumulate in the body and has some toxic effects, hepatotoxicity and liver failure have been reported during the use of abstinence sulfur, and therefore, it must be used under the supervision of a physician. Multicenter randomized placebo-controlled clinical trials have shown that naltrexone and topiramate (topiramate) are effective in reducing alcohol dependence in alcoholics, alleviating the desire to drink alcohol and reducing alcohol intake. Baclofen (baclofen) is the only drug reported to be used for alcohol withdrawal in patients with alcoholic cirrhosis. A randomized placebo-controlled trial observed the efficacy in 84 patients with alcoholic cirrhosis. After 12 weeks of baclofen treatment and 4 weeks of follow-up, 71% of patients significantly reduced alcohol dependence or remained in abstinence, compared to 29% in the placebo group. Acamprosate, a water-soluble taurine derivative, alleviated withdrawal syndrome and improved abstinence rates by inhibiting the neurotransmitter glutamate, with only mild diarrhea as an adverse effect. The results of meta-analysis showed that the abstinence rate was about 36% compared with placebo, and the efficacy could be maintained for 1 year after stopping the drug. All of the above drugs can improve the abstinence rate to varying degrees, but there is a lack of large-scale randomized double-blind clinical studies, and there are varying degrees of adverse effects, so they must be used under the guidance of a doctor. Attention should be paid to the occurrence of withdrawal syndrome in the process of alcohol withdrawal. 2. Nutritional support Due to insufficient intake, poor digestion and absorption, decreased appetite, and inadequate liver nutrient reserves lead to different degrees of malnutrition in ALD patients. Nutritional status is related to the occurrence of complications of ALD (hepatic encephalopathy, ascites, hepatorenal syndrome), infections and survival rate, so it is very important to maintain positive nitrogen balance, replenish energy and sufficient vitamins and trace elements. Several clinical studies suggest that nutritional support can improve the liver function index and medium and long-term morbidity and mortality rate of ALD patients, but has no effect on the recent morbidity and mortality rate. 3, treatment of alcoholic hepatitis Glucocorticoids are the most effective drugs for the treatment of severe alcoholic hepatitis (discriminatory function DF ≥ 32 and/or patients with hepatic encephalopathy). Multiple randomized controlled trials and Meta-analyses have shown that glucocorticoids improve survival in patients with severe alcoholic hepatitis (85% in the treatment group and 65% in the placebo group). A lower bilirubin level on day 7 of treatment than on day 1 of treatment is an important indicator of hormonal efficacy. However, treatment outcomes remain controversial, and patients with combined gastrointestinal bleeding, acute infection, and hepatorenal syndrome are not suitable. Tumor necrosis factor (TNFα) has an important role in the pathogenesis of ALD. Hexaconitine is a non-specific phosphodiesterase inhibitor that inhibits the gene transcription and synthesis of TNFα and exerts therapeutic effects by reducing the expression of its downstream effector inflammatory factors. Hexoketococcinol improves short-term survival in patients with severe alcoholic hepatitis by reducing the development of hepatorenal syndrome. Infliximab, a human-mouse chimeric antibody targeting TNFα, has been shown in a few pretests to improve Maddrey's discriminant function values and biochemical parameters in severe alcoholic hepatitis. However, the results of infliximab for severe alcoholic hepatitis are inconsistently reported and academically controversial, i.e., basal levels of TNFα are required for liver regeneration and treatment should aim at downregulating TNFα activity rather than completely blocking TNFα. 4. Other treatments Metadoxine is a compound of vitamin B6 and pyrrolidone carboxylic acid, an activator of acetaldehyde dehydrogenase. It accelerates the clearance of alcohol from the serum and helps to improve the symptoms of alcoholism and behavioral abnormalities. A multicenter, large sample, randomized double-blind trial in China showed that metadoxine improved the serology of alcoholic liver disease significantly more than the control group, but the difference was not statistically significant for the improvement of the degree of fatty liver on imaging. S-adenosylmethionine has antioxidant properties, reduces inflammatory factors such as TNF, maintains mitochondrial function, converts to glutathione formation, reduces morbidity and mortality in ALD, and reduces the need for liver transplantation. Although polyenyl phosphatidylcholine cannot improve the histology of ALD patients, it can increase the efficiency of treatment of ALD patients, improve their clinical symptoms and signs, and has a tendency to reduce the early morbidity and mortality rate and prevent the histological deterioration of patients. Glycyrrhetinic acid preparations, silymarin analogs, reduced glutathione and other drugs have different degrees of antioxidant, anti-inflammatory and anti-fibrotic effects, and their clinical application can improve liver biochemical indexes. However, they should be used rationally and should not be applied simultaneously with multiple anti-inflammatory and liver-protective drugs. In the treatment of ALD, Chinese medicine is mostly at the stage of clinical observation and summary, lacking in controlled and large-sample prospective studies, and lacking unified criteria for determining efficacy. It should be combined with modern medical understanding of the etiology and pathogenesis of ALD to screen prescriptions with good clinical reproducibility and high efficacy for adjuvant treatment. 5. Complication management Complications of ALD, such as portal hypertension, esophagogastric fundic varices, spontaneous bacterial peritonitis, hepatic encephalopathy and hepatocellular hepatocellular carcinoma, should be managed according to the corresponding guidelines. For end-stage ALD, liver transplantation can be considered if indications are available, and alcohol must be abstained for 3 months before transplantation.