Herbs for the Liver

Question 1

Where is the liver located?

Answer 1

located in the upper right quadrant of the abdomen, just below the diaphragm and above the stomach and intestines

Question 2

What is the function of the Hepatic Artery?

Answer 2

To supply the liver with oxygenated blood

Question 3

What is the function of the Hepatic Vein?

Answer 3

To remove deoxygentated blood from the liver

Question 4

What is the function of the Hepatic Portal Vein?

Answer 4

It brings blood from the digestive tract to the liver, where nutrients are metabolized and toxins are removed for excretion. This means that everything gets filtered by the liver before it enters the general circulation

Question 5

How many lobes does the liver have?

Answer 5

The liver is comprised of two lobes, right and left, which are each divided into many smaller functional units, called lobules.

Question 6

What are hepatocytes?

Answer 6

hepatocytes—cells that perform most of the metabolic and digestive functions of the liver.

Question 7

How long does it take for the liver to regenerate into a fully functioning organ when up to 70% is removed?

Answer 7

Hepatocytes have a remarkable ability to regenerate; even if 70% of the liver is damaged or removed, it can still regenerate into a fully functioning organ within two weeks (McCance, 2010).

Question 8

What is the role of the Kupferr cells that line the sinusoids withing the liver?

Answer 8

Each lobule contains a complex vascular network; blood flows between the hepatic veins and arteries through capillary-like sinusoids, which have a highly permeable membrane that allows for maximum exchange of nutrients between blood plasma and hepatocytes. The sinusoids are lined with Kupffer cells, a type of macrophage that serves to protect the liver (and the rest of the body!) from pathogens arriving from the digestive tract via the hepatic portal vein.

Question 9

Where is the location of the gallbladder?

Answer 9

The gallbladder is a very small organ wedged between the liver and the duodenum (the first section of the small intestine).

Question 10

What are the 5 main funcitons of the liver?

Answer 10

Fat digestion and bile secretion
Nutrient metabolism and blood sugar regulation
Manufacture of blood plasma proteins
Detoxification of endogenous and exogenous substances
Storage of vitamins and minerals

Question 11

How many functions does the liver have?

Answer 11

in fact, the liver has more than five hundred distinct functions (Johns Hopkins Medicine, n.d.),

Question 12

The liver mainly functions as part of the digestive system, What other two systems does the liver function within?

Answer 12

Endocrine and circulatory system.

Question 13

What does bile consist out of?

Answer 13

Bile salts - synthesized from cholesterol and required for the emulsification and absorption of dietary fats

Cholesterol and other lipids

Bilirubin - an alkaline, yellow-green fluid, produced from the breakdown of hemoglobin (red blood cells) in the liver and bone marrow

Electrolytes

Water

Question 14

Which organs produce bile?

Answer 14

Liver and gallbladder

Question 15

What gives feces its typical brown color and what is the relationship between the color of stool and liver and gallbladder function?

Answer 15

The presence of bilirubin is what gives feces its typical brown color, light or pale colored stools can sometimes indicate insufficient bile production, linked to gallbladder or liver dysfunction.

Question 16

Which component of bile is recycled back into the liver through enterohepatic circulation?

Answer 16

most bile salts are eventually recycled back into the liver through enterohepatic circulation—that is, through the hepatic portal vein—and may travel between the gut lumen and the liver 10 to 12 times each day (Siddiqui, 2018).

Question 17

What is the function of bile?

Answer 17

Digestion:
It emulsifies fats into smaller particles for absorption

Elimination:
Many waste products, including excess cholesterol, metabolic byproducts, and some toxic compounds, are packaged with bilirubin and secreted into the bile so that they can be eliminated from the body through the colon.

Question 18

Explain the production and storage of bile?

Answer 18

Bile is secreted by the hepatocytes into narrow channels called canaliculi that flow into small bile ducts, which eventually meet up and empty into the common bile duct. About 25% of the bile produced in the liver travels directly into the duodenum; the remaining 75% moves into the gallbladder, where it is concentrated and stored until needed for digestion (Siddiqui, 2018).

Question 19

What triggers the excretion of bile?

Answer 19

Consumption of fats and some proteins triggers the secretion of the digestive hormone cholecystokinin (CCK) by cells within the the duodenum; in response, the gallbladder contracts and releases bile

Question 20

What is the name of the sphincter in the duodenum through which bile is released?

Answer 20

sphincter of Oddi

Question 21

How many times a day are bile salts recycled back into the liver?

Answer 21

10 to 12 times each day

Question 22

What are the concequences of chronicly high blood glucose levels?

Answer 22

When blood glucose is too high, we may notice fewer immediate warning signs, but left unchecked, high blood sugar can progress to insulin resistance and diabetes, with long term effects that include irreparable damage to the blood vessels, kidneys, eyes, and nerves.

Question 23

What are the consequences of low blood suger

Answer 23

When blood glucose is too low, we may start to feel fatigue, dizziness, confusion, and muscle weakness—not to mention hungry, angry, anxious or weepy. Eventually we might lose consciousness

Question 24

Through which pathways are nutrients transported to the liver?

Answer 24

Hepatic portal vein or the lymphatic system.

Question 25

What is the role of the liver in the regulation of blood glocose levels.

Answer 25

Glucose produced from dietary carbohydrates is stored in hepatocytes as glycogen; when blood sugar levels drop, the liver releases glucose (from stored glycogen) into the bloodstream. When blood glucose is high, hepatocytes take up excess glucose and store it as glycogen or fat. The storage and release of glucose and glycogen occurs in the hepatocytes, but it is moderated by the pancreas through a chain of hormonal reactions; glucagon is released when blood sugar levels drop, stimulating conversion of glycogen into glucose, and insulin is released when blood glucose is high, stimulating reuptake of sugars.

Question 26

Are fats transported to the liver via the hepatic portal vein?

Answer 26

No. fats are transported to the liver via the lymphatic system

Question 27

How does stress cause diabetes?

Answer 27

Blood sugar levels both affect and are affected by neuroendocrine hormones. Low blood glucose levels trigger the release of the catecholamine stress hormones epinephrine and norepinephrine, which stimulate the liver to release glucose. These same hormones are released in response to physical or emotional stress—but regardless of the cause, they have the same effect on blood sugar, causing a drop in insulin and a rise in blood glucose.
With the release of epinephrine and norepinephrine, hunger centers are activated and stimulate the anterior pituitary, which is regulated by the hypothalamus, to secrete ACTH (adrenocorticotropic hormone). In turn, ACTH causes the release of another stress hormone, cortisol, from the adrenal glands (Mills & Bone, 2000). These hormones cause a cascade of activity, including release of glucose from the liver. As a short-term response to stress, having more glucose available is a good thing: it means our brains and muscles have access to all the energy they need to respond effectively to the stressor. However, when we’re under long-term stress, we may have chronically elevated cortisol—and that means we may also experience chronically elevated blood glucose. Over time, that leads to insulin resistance and paves the way for development of diabetes, along with a host of other health problems.

Question 28

What role does the liver play in the production of blood plasma proteins?

Answer 28

Hepatocytes within the liver synthesize many of the blood plasma proteins that are necessary for normal clot formation, circulatory transport of hormones, and maintenance of plasma pressure and volume. This includes the clotting proteins prothrombin, fibrinogen, and antithrombin, and albumins, which maintain isotonic pressure in blood plasma, helping to balance fluid levels between the intracellular and extracellular environments.

Question 29

What role does the liver play in “detoxing”?

Answer 29

The liver transforms potentially damaging substances into compounds that can be removed from the body through the colon or kidneys, usually through multiple enzymatic reactions.

This happens in two stages. In the first phase, large molecules are broken down into smaller components; in the second phase, they are conjugated (joined) with other molecules so they can be excreted through the colon or kidneys, in the feces or urine.

It’s important for the two detoxification phases to work in balance, as they do in a healthy, well-functioning liver. Phase one metabolic processes can create unstable, highly reactive intermediate compounds that can cause cellular damage, and in some cases may be even more toxic than the substance from which they were formed. When the liver is functioning well and metabolism is in balance, these reactive compounds are swiftly conjugated into stable compounds through phase two metabolism—but if the liver is poorly functioning, or key cofactors are missing, the detoxification process gets “stuck” in the first phase, leaving reactive or toxic substances to hang around longer than they should, wreaking havoc on the cells and tissues of the body (Jeffrey, 2006).

Question 30

What is the role of the liver in the storage of vitamins and minerals?

Answer 30

The liver stores the fat-soluble vitamins (A, D, E, and K) as well as iron and copper. Similar to its storage and release of glucose, the liver will store these nutrients and release them as needed. In some cases, the liver can store these substances for months or even years. Because an excess of these nutrients are stored, rather than excreted, it is possible for them to overaccumulate in the cells and tissues, leading to a variety of symptoms of toxicity (see Unit 2, Lesson 1). Except in the case of genetic disorders that cause hyperaccumulation of iron and copper, this kind of overload doesn’t usually occur due to dietary overconsumption, but it can result from excessively high doses of vitamin and mineral supplements.

Question 31

What kinds of substance are readilly found in our food that requires metabolic detoxification?

Answer 31

Pesticides, Herbicides, growth hormone,

Question 32

which catalysts are required by the liver in order for it to perform it’s metabolic detox function?

Answer 32

Sulfur
Methyl
Antioxidants

Question 33

explain the sulphation detoxification pathway of the liver.

Answer 33

The sulfation detoxification pathway involves the attachment of a sulfur group to compounds that can then be eliminated through the bile. Compounds excreted using this pathway include acetaminophen and other pharmaceutical drugs and hormones, such as estrogen and testosterone (Liska et al., 2004).

Question 34

What are Brassicas?

Answer 34

Brassicaceae (mustard) family, including broccoli, cabbage, cauliflower, kale, collard greens, arugula and other mustard greens, and Brussels sprouts.

Question 35

How does consuming Brassicas aid the sulphation detoxification pathway in the liver?

Answer 35

These foods are high in glucosinolates, a type of sulfur compound that has several beneficial effects on liver detoxification. Glucosinolates support the body’s production of glutathione, which is necessary for both phase one and phase two metabolic detoxification; they also support methylation, a separate detoxification pathway (Liska et al., 2004). There are multiple enzymatic pathways that rely on glutathione, which is one reason it’s sometimes called the “master detoxifier.” While our body does make glutathione, stores can easily be depleted, triggering impaired detoxification or an imbalance between phase one and phase two metabolism (Jeffery, 2006).

Question 36

Which foods are a good source of sulphur for the liver?

Answer 36

Brassicas and Aliums

Question 37

What are Alliums?

Answer 37

Alliums (garlic, leeks, shallots, and onions)

Question 38

What is the concern with eating too much raw Brassicas?

Answer 38

Raw Brassicas have an iodine inhibiting effect, which can suppress thyroid function leading to hypothyroidism, and should be avoided by people with thyroid disease.

Question 39

Explain the role of methyl donors in the methylation detoxification pathway of the liver?

Answer 39

Many substances are transformed in the liver through the methylation pathway, in which methyl groups are transferred between molecules. Just as sulfation relies on the availability of sulfur groups, methylation relies on the presence of methyl donors, and their absence contributes to inhibited detoxification and liver function.

Question 40

what are the key methylation nutrients that support the liver’s detoxification pathways?

Answer 40

Some of the key methylation nutrients are vitamins B6, B12, folate (B9), and betaine, which can all be obtained from whole foods:

Question 41

What is the name for the first phase of the detoxification process of the liver?

Answer 41

bioactivation

Question 42

What is the role of antioxidants during the detoxification process of the liver?

Answer 42

help protect cells from oxidative damage during bioactivation by providing ample antioxidants.

Question 43

What is the role of antioxidants during the detoxification process of the liver?

Answer 43

help protect cells from oxidative damage during bioactivation.

Question 44

What is Shiitake’s effect on the liver?

Answer 44

Shiitake (Lentinula edodes) mushroom is a great tonic food for the liver. Shiitake has hepatoprotective (liver-protective) activities and in a clinical trial on the effect of shiitake supplementation in athletes prior to exercise trials, a dose of 1,400 mg/day for 10 days was shown to have an antioxidant effect (Zembron-Lacny et al., 2013).

Question 45

What is the main constituent in Milk thistle that makes it hepatoprotective?

Answer 45

Milk thistle (Silybum marianum) seed contains silymarin, a potent hepatoprotective that can help hepatocytes regenerate after damage and can protect cells from oxidative stress during bioactivation.

Question 46

Which trace minerals are cofactors in phase one of metabolic detoxification and also compete with heavy metals for absorption into cells?

Answer 46

selenium, zinc, copper, and magnesium, are important cofactors in phase one metabolism; additionally, they may compete with heavy metals for absorption into the cells, meaning trace mineral deficiency could allow for greater uptake of toxic heavy metals like cadmium and mercury (Minich, 2017).

Question 47

How does exercise and saunas help decrease the burden on the liver?

Answer 47

Exercise and sweating may also aid the liver in detoxification. Exercise in increments of 20 minutes or more can boost endogenous glutathione production (Hyman, 2010). Since some xenobiotic compounds are eliminated through the skin when we sweat, sweating can help decrease the burden on the liver; some research suggests that sweating may be the most efficient route of elimination for certain compounds, particularly some heavy metals, pesticides, and pharmaceuticals (Crinnion, 2006). The use of a standard or infrared sauna can be a helpful tool to promote detoxification through the skin; however, it’s important for individuals to know their own limits or check with a healthcare provider, since sauna use is contraindicated in some cases.

Question 48

How do castor oil packs support the liver?

Answer 48

to increase circulation, move stagnation, and ease inflammation.

Question 49

What are xenobiotics

Answer 49

xenobiotics (bioactive foreign substances)

Question 50

How does alcohol effect the liver?

Answer 50

Alcohol is effectively toxic to hepatocytes; while a moderate amount of alcohol can be processed by a healthy liver without too much trouble, when alcohol consumption exceeds our liver’s ability to process it, liver damage begins to occur. Over time, this can contribute to the development of hepatitis, fatty liver disease, and cirrhosis.

Question 51

what are some exogenous chemicals that need to be processed through the liver?

Answer 51

alcohol, toxins from polution, medication and drugs, smoke, chemicals from cleaning products, cosmetic chemicals.

Question 52

In Ayurveda, which dosha is associated with the liver?

Answer 52

the liver is considered to be a pitta organ and the seat of the fire element (Frawley, 2000).

Question 53

In Ayurveda, what is the association between the liver and agni?

Answer 53

The primary digestive fire, or agni, is called jatharagni, and is located in the gut. However, there are also five elemental agnis, called bhutagnis, that exist in the liver. These five agnis of the liver are named after the five elements: earth, water, fire, air, and ether. The function of the bhutagnis is to convert food molecules into an even more refined and further digested substance that eventually goes to nourish each dhatu (body tissue) (Halpern, 2012a). In a more obvious way, the liver plays a key role in digestion by producing bile (also closely linked to pitta), storing vitamins, producing crucial enzymes, and storing excess glucose in the form of glycogen (Halpern, 2012b).

Question 54

In Ayurveda, what is the primary function of the liver?

Answer 54

Root of circulatory system
Liver and Spleen are the root of raktavaha srota (the srota, or channel, that carries blood) (Halpern, 2012a).

Store blood:
The liver is a major storehouse for blood and

Color of blood:
Ayurveda teaches that it is the site of ranjaka pitta, one of the pitta subdoshas. Ranjaka pitta is responsible for giving color to the body. Thus, a yellowish skin tone, as in the case of jaundice, is linked to a disturbance of the liver (Halpern, 2012b).

Prevention of pitta disorders:
The liver is also responsible for detoxifying the blood by filtering out substances that are harmful or useless to the body, also known as ama in Ayurveda. When the liver becomes sluggish or inflamed, its ability to effectively cleanse the blood is inhibited, and a pitta imbalance in the blood may result (Halpern 2012b). Furthermore, heated pitta disorders such as ulcers and hyperacidity are also considered to be the outcome of a compromised or inflamed liver (Frawley, 2000).

Vitallity through Healthy blood:
Healthy blood is the result of both proper nourishment and proper filtration, and when the liver is disturbed, there is an interference in these processes and overall vitality is negatively affected. “Living creatures are endowed with strength, complexion, happiness and longevity due to pure blood. Blood plays a vital role in the sustenance of elan vital” (Dash & Sharma, 2014, p. 403).

Question 55

In Ayurveda, what is the relationship between the liver and emotional health?

Answer 55

it is also a key player in emotional health. Fiery pitta emotions such as irritability, anger, and jealousy are linked to liver imbalance. Positive pitta emotions include courage, confidence, and enthusiasm. When the liver is functioning well, it is able to process the hormones and chemicals that are related to these strong emotions and feelings pass through the psychological sphere rather than hanging around or festering. However, if the liver is disturbed, there may be a build up of emotions, causing a heated, frustrated, angry state. A build up of pitta emotions and heat in the liver may also give rise to other pitta related problems (Frawley, 2000).

Question 56

In Ayurveda, which herbs are used to cool down the blood and the liver, by pacifying pitta.

Answer 56

management of the liver is often similar to pacification of pitta dosha. For cooling down the blood and liver, bitter herbs are suggested, such as gentian (Gentiana lutea) root, barberry (Berberis vulgaris) root, aloe (Aloe vera) leaf, burdock (Arctium lappa) root, and dandelion (Taraxacum officinale) root. Raw, green juices and leafy greens may also be called for. In addition, if the disturbance of the liver has emotional roots, seeking out ways to process and release emotions is generally advised (Frawley, 2000).

Question 57

In TCM, What happens when the wood element is imbalanced?

Answer 57

Wood element, associated with the Liver, invades (“insults”) or over-controls (“destroys”) the Earth element, digestive ailments such as acid reflux, poor digestion, and gastrointestinal conditions occur.

Question 58

Which element is associated with the liver and gallbladder in TCM?

Answer 58

Wood

Question 59

In TCM, which emotions weaken the liver?

Answer 59

Prolonged depression or stress and fits of anger will weaken the Liver and contribute to physiological issues

Question 60

In TCM, what is the main funciton of the liver?

Answer 60

The Liver is responsible for storing blood and for the smooth flow of blood and qi (vital energy) throughout the body.

Question 61

In TCM, what happens when the Liver or Gall Bladder is disrupted?

Answer 61

Both the Liver and Gall Bladder preside over the smooth, harmonious flow of energy in the body. When either is disrupted, an individual can experience depression, frustration, and/or anger. Low energy, hormonal issues, digestive upset, lung imbalance, and/or other disruptions to health can also result, depending on the individual.

Question 62

In TCM, what happens when the Liver or Gall Bladder is disrupted?

Answer 62

Both the Liver and Gall Bladder preside over the smooth, harmonious flow of energy in the body. When either is disrupted, an individual can experience depression, frustration, and/or anger. Low energy, hormonal issues, digestive upset, lung imbalance, and/or other disruptions to health can also result, depending on the individual.

The Liver also relates to our ability to hold and plan a vision for our life, while the Gall Bladder is implicated in our ability to make decisions. So a disruption can cause stagnation in life, or the inabillity to move forward.

Question 63

In TCM, What lifestyle activities improve liver function?

Answer 63

Liver health is particularly enhanced through regular rhythms of eating, exercise, and other routines of life. The Wood element relates to Spring and benefits from walks in nature and a diet that includes fresh fruits and vegetables. A well-balanced diet, organic food, and water-cooked vegetables all enhance Liver health. An unbalanced diet, consumption of processed foods, or an excess of sour foods will all cause imbalance in the Liver.

Question 64

In TCM, which qualities promote healthy liver function

Answer 64

The quality of the Liver relates to harmony in all realms. Cultivating the qualities of benevolence, kindness, and equanimity supports Liver health and balanced function

Question 65

What are Hepatics?

Answer 65

Hepatics are a broad class of herbs that support the function of the liver in a range of ways; the term hepatic is best understood as a description of a general function, rather than a specific mechanism of action. Hepatics are often further classified by specific effects on liver function—for example, choleretics and cholagogues affect the production and secretion of bile, respectively, while hepatoprotectives prevent damage at the cellular level. All of the herbs discussed throughout this lesson are considered hepatics because they have beneficial effects on liver health and function.

Question 66

What are hepatoprotectives?

Answer 66

hepatoprotectives prevent damage at the cellular level

Question 67

What are liver tonics?

Answer 67

help restore healthy function of the liver

Question 68

Which herbs are considered true liver tonics?

Answer 68

dandelion (Taraxacum officinale) root, 
Oregon grape (Berberis aquifolium) root, 
yellow dock (Rumex crispus) root, 
milk thistle (Silybum marianum) seed, 
artichoke (Cynara scolymus) leaf, 
schisandra (Schisandra chinensis) fruit.

Question 69

What is the botanical name for Schisandra?

Answer 69

Schisandra – Schisandra chinensis (Schisandraceae) –

Question 70

Which part of Schisandra is used?

Answer 70

Fruit

Question 71

What are the herbal actions of Schisandra?

Answer 71

Adaptogen, antidepressant, antioxidant, anti-inflammatory, antiviral, astringent, anxiolytic, cardiotonic, emmenagogue, expectorant, hepatic, nervine tonic, nervine stimulant

Question 72

What are the herbal energetics of Schisandra?

Answer 72

Warming, drying

Question 73

What are the specific indications for Schisandra?

Answer 73

Schisandra is a great example of an herb that is both hepatic and hepatoprotective. Multiple studies have shown that it improves liver function, with benefits that extend after its use is discontinued; clinical trials have shown benefit to liver function parameters in viral hepatitis (Bone, 2003) and in fatty liver disease (in combination with sesamin, a lignan derived from sesame seeds) (Chiu et al., 2013). Hepatoprotective lignans in schisandra have been shown to increase hepatocyte regeneration, decrease oxidative damage during biotransformation, and increase intracellular glutathione levels (Ali et al., 2018). Schisandra particularly supports the detoxification processes of the liver, and can boost both phase one and phase two biotransformation pathways (Bone, 2003).

Schisandra is also used as an adaptogen, helping to increase work capacity, innate immune response, focus, and endurance (Bone, 2003). In Chinese medicine, it is indicated for weak lungs, digestion, liver, or immune response, yin deficiency with night sweats, extended diarrhea, or general deficiency and inability to hold moisture in the body (Tilgner, 2009).

The majority of commercially available schisandra is produced in China, but it is also grown in some regions of the United States. Schisandra is traditionally prepared in a decoction, but can also be used as tincture; some practitioners suggest eating the berry after decocting it in order to obtain the broadest range of phytochemicals. With its unique, intense flavor, schisandra also makes a delicious and potent sweet-sour tonic when prepared as an infused honey or a solid extract.

Question 74

What are the safety considerations for Schisandra?

Answer 74

Schisandra is contraindicated in pregnancy because of its uterine stimulant action. In Chinese medicine, it is contraindicated in individuals with acute viral or bacterial infections, such as the flu, colds, bronchitis, or pneumonia, and in the early stages of skin rashes (Holmes, 2007; Winston & Maimes, 2007). Schisandra may interfere with opiates, warfarin, and any drugs metabolized by CYP3A, CYP1A2, and CYP3A4 enzymes, counteracting their effectiveness or removing them from the system more quickly than intended (Gardner & McGuffin, 2013).

Question 75

What is the local name for Schisandra in Chinese?

Answer 75

wu wei zhi (five-flavor berry).

Question 76

Which compounds found in plants are considered bitter tasting?

Answer 76

Bitter-tasting compounds found in plants include iridoids, sesquiterpenes, alkaloids, and monoterpenes

Question 77

What effect does bitter tasting herbs have on the body.

Answer 77

In response to bitter tastants, these receptors set off a chemical-signaling pathway, mediated by the vagus nerve, that results in the release of digestive hormones and a consequent range of beneficial effects:

Appetite stimulation;
Increased secretion of digestive enzymes and bile;
Coordination of gastric emptying and gut motility;
Improved insulin sensitivity and blood glucose regulation; and
Enhanced metabolic detoxification (Hoffmann, 2003; Masé, 2013).

Question 78

Which herbs are considered to be ‘bitters’?

Answer 78

yarrow (Achillea millefolium) aerial parts, mugwort (Artemisia vulgaris) aerial parts, wormwood (Artemisia absinthium) aerial parts, gentian (Gentiana lutea) root, hops (Humulus lupulus) strobile, and artichoke (Cynara scolymus) leaf. Some bitters are quite mild, like chamomile (Matricaria chamomilla) flower, while others, such as wormwood and gentian, are very potent,

Question 79

Why are bitters always prepared in a way that allows it to be ‘tasted’?

Answer 79

because the effect of bitters is due to it’s bitter taste, which is innitiated through a reflex via the vagus nerve.

Question 80

What is the difference between choloagogues and choleretics?

Answer 80

cholagogues stimulate the flow or release of bile from the liver and gallbladder, while choleretics stimulate the production of bile in the liver.

Question 81

When are bitters contraindicated?

Answer 81

they are contraindicated in the presence of acute gallstones; forcing gallbladder contraction when gallstones are present can be extremely painful and can cause bile duct obstruction, a serious condition that may require surgical intervention.

Question 82

Which herbs are considered good cholagogues and choleretics?

Answer 82

celandine (Chelidonium majus) aerial parts, Oregon grape (Berberis aquifolium) root, fumitory (Fumaria officinalis) aerial parts, gentian (Gentiana lutea) root, fringetree (Chionanthus virginicus) bark or root bark, and wild yam (Dioscorea villosa) rhizome.

Question 83

What is the botanical name for wild yam?

Answer 83

Wild yam – Dioscorea villosa (Dioscoreaceae) –

Question 84

Which part of Wild yam is used

Answer 84

Rhizome

Question 85

What are the herbal energetics of wild yam?

Answer 85

Slightly warming

Question 86

What are the herbal actions of wild yam?

Answer 86

Anti-inflammatory, antispasmodic, cholagogue, hepatic

Question 87

What are the specific indications for wild yam?

Answer 87

Wild yam is, unfortunately, the subject of an “herban legend”—namely, the mistaken belief that it contains “natural progesterone.” It does contain a number of steroidal saponins that can be used to synthesize progesterone, but there is no evidence that these can be converted into progesterone within the human body (Hoffmann, 2003). However, it is an excellent antispasmodic and cholagogue; in conjunction, these actions make it a natural fit for helping to ease gallbladder colic and restore normal biliary function. It also functions as a smooth-muscle antispasmodic throughout the body and can be a useful herb for menstrual cramps, ovarian pain, biliary colic, and intestinal spasm or cramping.

The early Thomsonians, Physiomedicalists, and Eclectics referred to wild yam as colic root or rheumatism root (Beach, 1852; Cook, 1869; Howard, 1854). This suggests that the focus of the materia medica of this species during the American Botanical movement of the late 18th through early 20th century was on its usefulness for spasm, pain, and inflammation. Horton Howard (1854), who is given credit for being the first to incorporate wild yam into the Thomsonian and Physiomedical materia medica (Cook, 1869), suggests the use of the infusion of the rhizome in bilious colic as well as the use of the tincture as an expectorant, diaphoretic, and emetic. Cook (1869) used Dioscorea to relax the muscular fibers and soothe the nerves of the intestinal tract, female reproductive system, and respiratory system (for example, in cases of spasmodic croup).

The Eclectics of North America spoke of wild yam’s efficacy specifically in regards to spasmodic irritation of the mucous membranes (Felter & Lloyd, 1898), whereas the Physiomedicalists believed that this soothing and antispasmodic action was due largely to the herb’s influence over the nervous system (Cook, 1869). Modern herbal therapeutics have combined these two perspectives stating that in general, and in regards to all body systems, wild yam seems best suited to irritable and excitable conditions of the mucous membranes, and less efficient in conditions due to lack of tone (McIntyre, 1994). This would suggest that the herb’s overall action is as the Physiomedicalists perceived—its main action is to relax smooth muscles, tissues, and nerves rather than to tone them.

Question 88

What are the safety considerations for wild yam?

Answer 88

As with all cholagogues, use is contraindicated in cases of gallbladder stones or bile duct pathology. High doses may cause vomiting (Gardner & McGuffin, 2013).

Question 89

Which herbs are considered good hepatoprotectives?

Answer 89

Herbal hepatoprotectives include turmeric (Curcuma longa) rhizome, schisandra (Schisandra chinensis) berry, licorice (Glycyrrhiza glabra) root, ashwagandha (Withania somnifera) root, gentian (Gentiana lutea) root, Chinese peony (Paeonia lactiflora) root, sarsaparilla (Smilax spp.) root, and milk thistle (Silybum marianum) seed.

Question 90

When are hepatoprotectives indicated?

Answer 90

Hepatoprotectives are particularly indicated when an individual has been exposed to potentially hepatotoxic substances such as solvents, mycotoxins, environmental pollutants, or some pharmaceuticals. They may also be appropriate any time the liver is chronically overburdened, for example from alcohol abuse or long-term inadequate nutrition.

Question 91

How do hepatoprotective herbs protect the liver?

Answer 91

Hepatoprotective herbs, also sometimes referred to as hepatoprotectants or antihepatotoxics, support the liver by protecting the cells or the organ as a whole from damage. Some hepatoprotective herbs act to inhibit oxidative damage, either by increasing the amount or availability of antioxidant molecules, such as glutathione, or by decreasing the production of damaging oxidative metabolites by altering liver enzyme pathways (Kumar et al., 2013). Other herbs may keep damaging compounds from entering liver cells by altering the cellular membrane or stimulating cellular regeneration (Hoffmann, 2003).

Question 92

What is the botanical name for Turmeric

Answer 92

Turmeric – Curcuma longa (Zingiberaceae)

Question 93

Which part of Turmeric is used?

Answer 93

Rhizome

Question 94

Where does Turmeric get it’s yellow color from?

Answer 94

Turmeric root gets its vibrant yellow color from a group of polyphenolic compounds called curcuminoids

Question 95

What is the primary anti-inflamatory compound found in Turmeric?

Answer 95

Curcuminoids have received a substantial amount of research attention, and are sometimes considered to be the primary anti-inflammatory compound in turmeric. However, other compounds have also been shown to have bioactivity and clinical relevance (Bone & Mills, 2000) and the argument for synergy of the numerous compounds in whole-plant extract may eventually have both science and tradition on its side.

Question 96

What are the herbal actions of Turmeric?

Answer 96

Anti-inflammatory, antioxidant, carminative, cholagogue, hepatic, hypolipidemic, hypoglycemic

Question 97

What are the herbal energetics of Turmeric?

Answer 97

Warming

Question 98

What are the specific indications of Turmeric?

Answer 98

Turmeric is best known as a musculoskeletal anti-inflammatory; however, its anti-inflammatory, antioxidant, and immune regulatory effects extend throughout the body, and have some specific beneficial effects in the liver.

As a hepatic and hepatoprotective, turmeric and its constituents act by inhibiting inflammatory pathways and decreasing lipid accumulation and oxidative damage (Bengmark et al., 2009; Vera-Ramirez et al., 2013). Some clinical research has shown turmeric to reduce elevated liver enzymes (Kim et al., 2013), suggesting it improves hepatic detoxification and/or regulates balance between the phases of biotransformation. Another clinical trial found that supplementation with turmeric improved blood glucose and insulin regulation in patients with non-alcoholic fatty liver disease (Navekar et al., 2017).

Turmeric is also an effective cholagogue that has been demonstrated to stimulate gallbladder contraction (Rasyid & Lelo, 1999). These hepatic and cholagogic effects may underlie its ability to lower low-density lipoprotein (LDL) cholesterol levels, which has been confirmed through multiple clinical trials and a meta-review (Qin et al., 2017). Smaller studies have shown that turmeric or curcuminoids may also boost high-density lipoprotein (HDL) and lower serum triglycerides (Panahi et al., 2017).

Other uses for turmeric include managing inflammation in the gastrointestinal tract, particularly in inflammatory bowel diseases and gastric ulcers.

Question 99

What are the safety considerations for Turmeric?

Answer 99

Contraindications: Congestive heart failure, Bile duct
obstruction, Surgery

Congestive heart failure:
Large doses of turmeric (greater than 15 g/day) should not be taken long term by those with congestive heart failure (Mills & Bone, 2005).

Bile duct obstruction:
Individuals with bile duct obstruction should avoid the use of turmeric.

Surgery
Because turmeric has slight anti-platelet activity, stop using turmeric 2 weeks before surgery

Herb/Drug interaction:
Due to anti-platelet activity, avoid if using anticoagulant or antiplatelet medications (Gardner & McGuffin, 2013).

Question 100

What is the botanical name for Sarsaparilla?

Answer 100

Sarsaparilla – Smilax spp. (Smilacaceae)

Question 101

What part of Sarsaparilla is used?

Answer 101

Root

Question 102

What are the herbal actions of Sarsaparilla?

Answer 102

Alterative, antirheumatic, diuretic, hepatoprotective

Question 103

What are the herbal energetics of Sarsaparilla?

Answer 103

Warming and moistening

Question 104

What are the Specific indications for sarsaparilla?

Answer 104

Sarsaparilla is an alterative, an herb that acts to improve the body’s ability to assimilate and use nutrients and eliminate metabolic waste. Alteratives are often understood to be restorative, as they often improve nutrient assimilation or improve elimination; this decreased detoxification burden can have either a direct or indirect effect of supporting liver function.

Not all alterative herbs act on the liver, as sarsaparilla does; this affinity makes it particularly useful for supporting metabolic detoxification and in addressing many of the systemic imbalances that are associated with poor liver function, such as autoimmune disorders and hypersensitivity reactions (Hoffmann, 2003). Sarsaparilla may be specifically indicated for “chronic metabolic toxicosis that is underpinned by metabolic and/or nutritional and/or endocrine insufficiencies” (Holmes, 2006, p. 370), which certainly includes poor hepatic function associated with insufficient metabolic detoxification processes.

Sarsaparilla also has hepatoprotective properties, probably due to antioxidant effects associated with its saponins and flavonoids (Hua et al., 2018).

Question 105

What are the safety considerations for Sarsaparilla?

Answer 105

There are no case reports of adverse events or pharmaceutical interactions. Although it was reported that sarsaparilla may interact with digitalis glycosides, this has not been substantiated by pharmacologic or clinical evidence (Gardner & McGuffin, 2013).

Question 106

What happens to the liver when it can no longer keep up with it’s detoxification burden?

Answer 106

When the liver can’t keep up with its detoxification burden, inflammation and damage to hepatocytes can result. Over time, this cellular stress on the liver can progress to overt liver damage or disease (Vera-Ramirez et al., 2013).

Question 107

What are indications of liver stagnation or hypofunction

Answer 107

Poor digestion, especially of fats and proteins;
Pain in the upper right abdominal quadrant or below the right shoulder, especially with fatty meals;
Tendency to skin rashes and/or allergic reactions;
Tendency to muscle and joint pain/stiffness;
Unexplained morning nausea;
Malaise and lethargy that is worse in the morning;
Irritability; and
Constipation (Bergner, 2001; Hedley, 2001).

Question 108

What are indications of liver stagnation or hypofunction

Answer 108

Poor digestion, especially of fats and proteins;
Pain in the upper right abdominal quadrant or below the right shoulder, especially with fatty meals;
Tendency to skin rashes and/or allergic reactions;
Tendency to muscle and joint pain/stiffness;
Unexplained morning nausea;
Malaise and lethargy that is worse in the morning;
Irritability; and Constipation (Bergner, 2001; Hedley, 2001).

Other conditions that may be associated:

Allergies, food sensitivities, environmental sensitivities;
Migraine headaches, especially associated with food intolerance or chemical sensitivity;
Tendency to blood sugar imbalance;
Acne, rosacea;
Hormonal imbalances, premenstrual syndrome (PMS); and
Autoimmune disorders (Bergner, 2001; Hedley, 2001).

Question 109

Which herbal actions are used to support a congested liver?

Answer 109

Alteratives, including burdock (Arctium lappa) root and yellow dock (Rumex crispus) root

Antioxidants, including schisandra (Schisandra chinensis) berry and milk thistle (Silybum marianum) seed;

Bitters, including vervain (Verbena spp.) aerial parts, burdock (Arctium lappa) root, and dandelion (Taraxacum officinale) root;

Cholagogues and choleretics, including mugwort (Artemisia vulgaris) aerial parts and wild yam (Dioscorea villosa) rhizome; and

Hepatoprotectives, including dandelion (Taraxacum officinale) root, vervain (Verbena spp.) aerial parts, and milk thistle (Silybum marianum) seed.

Question 110

What is the botanical name for Vervain?

Answer 110

Vervain – Verbena hastata or V. officinalis (Verbenaceae)

Question 111

Which part of Vervain is used?

Answer 111

Aerial parts

Question 112

What are the herbal actions of vervain?

Answer 112

Anti-inflammatory, antispasmodic, anxiolytic, bitter, diaphoretic, diuretic, emmenagogue, galactagogue, hepatic, immunostimulant, liver stimulant, mild sedative, nervine tonic, vulnerary

Question 113

What are the herbal energetics of vervain?

Answer 113

cooling

Question 114

What are the specific indications for vervain?

Answer 114

In contemporary herbalism, vervain is primarily used as a bitter hepatic and a relaxing nervine trophorestorative (tonic). Although not a powerful sedative, it has a relaxing effect on both the nervous and musculoskeletal systems; this makes it a natural ally for the high-strung, overdriven individual who has difficulty turning off their brain or taking “down time.” As a digestive bitter, vervain is useful for those with poor digestion in general, particularly poor fat digestion, and a tendency to blood glucose instability. Historically, vervain has also been used as an anticonvulsant, a vulnerary, and a urinary and renal antilithic (Culpeper, 1814), and as an herb for asthma and migraine headache.

Vervain is a great example of a seeming paradox in herbal practice: an herb that can be described as relaxing, stimulating, or both. While it helps to relax the muscles and has a calming effect on the mind, it stimulates the flow of bile; it has a dispersive quality, stimulating both the physical blood and the energy of the body to move more freely by relaxing the nervous system and the muscles.

In the Chinese materia medica, vervain is used to clear heat, dispel stasis, and cool and move the Blood (Bensky & Gamble, 2004). From a five phase perspective, vervain is associated with harmonizing the Wood element; it can relieve the Liver tension associated with excess Wood, helping “Woody people” to be more flexible and calm. This combination of effects makes it a good herb to consider for those with irritable PMS, particularly if they also have muscular tension, sugar cravings, or blood sugar dysregulation.

Question 115

What are the safety considerations for vervain?

Answer 115

Blue vervain is contraindicated during pregnancy, particularly early pregnancy, because of its emmenagogue action (Brinker, 2010). The herb is also emetic in high doses (Holmes, 2007).

Question 116

What is Jaundice?

Answer 116

Jaundice is caused by a buildup of bilirubin in the blood; this may be due either to decreased bile flow (cholestasis) out of the liver or gallbladder or to decreased production of bile.

Question 117

What are some causes of Jaundice?

Answer 117

It can appear as a symptom of most liver diseases, including hepatitis and cirrhosis, or as a consequence of obstruction of a bile duct, which might be caused by gallstones or inflammation. Jaundice always occurs as a consequence of another dysfunction, so any herbal therapeutics must take into consideration the underlying cause.

Question 118

Which herbal actions are used to support Jaundice?

Answer 118

Bitters, including vervain (Verbena spp.) aerial parts, Oregon grape (Berberis aquifolium) root, and dandelion (Taraxacum officinale) root.

Cholagogues, including wild yam (Dioscorea villosa) rhizome and turmeric (Curcuma longa) rhizome.

Hepatoprotectives, including turmeric (Curcuma longa) rhizome, vervain (Verbena spp.) aerial parts, and milk thistle (Silybum marianum) seed.

Question 119

Recipe for Jaundice tincture?

Answer 119

This formula incorporates hepatoprotectives, cholagogues, and bitters. It is appropriate for a presentation that includes heat and gallbladder involvement.

Ingredients

20 mL (0.67 fl oz) dandelion (Taraxacum officinale) root tincture
10 mL (0.3 fl oz) vervain (Verbena spp.) aerial parts tincture
10 mL (0.3 fl oz) milk thistle (Silybum marianum) seed tincture
10 mL (0.3 fl oz) wild yam (Dioscorea villosa) rhizome tincture

Directions

Combine all tinctures in a 60 mL (2 fl oz) glass bottle.
Suggested usage is 2.5-5 mL, 3x/day.

Question 120

What is Hepatitis?

Answer 120

Hepatitis is inflammation of the liver with cellular necrosis. It may be acute or chronic (lasting more than six months); it can be self-limiting, or may progress to widespread tissue damage, cirrhosis, or cancer.

Question 121

What are common causes of Hepatitis?

Answer 121

Hepatitis is most commonly caused by viral infection with one of five specific viral strains (hepatitis A-E), but may also be caused by use of alcohol or some pharmaceutical drugs, exposure to other hepatotoxic substances, or a pre-existing liver condition, particularly non-alcoholic steatohepatitis (also called fatty liver disease) (Rutherford, 2018).

Question 122

What are the symptoms of accute viral hepatitis?

Answer 122

there is typically rapid onset of symptoms that may include anorexia, nausea and vomiting, fatigue and malaise, upper right-quadrant abdominal pain, and fever; this is generally followed by development of jaundice.

Question 123

Which hepatitis strains are transmitted through contaminated water and food?

Answer 123

Hepatitis strains A and E,

Question 124

Which hepatitis strains are transimitted through bodily fluids?

Answer 124

B, C, and D

Question 125

Which strains of hepatitis is more likely to become chronic hepatitis?

Answer 125

B,C, and D

Question 126

Which strains of hepatitis infections are most likely to “self-resolve”?

Answer 126

A and E

Question 127

Which herbs can be used to support the liver during acute hepatitis?

Answer 127

For accute hepatitis:

Immune stimulants, such as echinacea (Echinacea spp.) root;
Antivirals, such as St. John’s wort (Hypericum perforatum) aerial parts and elder (Sambucus canadensis and S. nigra) berry;
Hepatoprotectives, such as milk thistle (Silybum marianum) seed, shiitake (Lentinula edodes) mushroom, and turmeric (Curcuma longa) rhizome.

Herbs can also include therapeutics for specific symptom presentation:

Cholagogues and alteratives, such as dandelion (Taraxacum officinale) root, wild yam (Dioscorea villosa) root, and turmeric (Curcuma longa) rhizome, are appropriate to manage jaundice;

Diaphoretics, such as yarrow (Achillea millefolium) aerial parts or elder (Sambucus canadensis or S. nigra) flower may help manage initial fever;

Antiemetics and smooth muscle antispasmodics, such as ginger (Zingiber officinale) rhizome and skullcap (Scutellaria lateriflora) aerial parts, may help with nausea and vomiting.

Question 128

What is a typical formula used for accute hepatitis?

Answer 128

Adapted from Principles & Practices of Phytotherapy by Simon Mills and Kerry Bone (Mills & Bone, 2000).

Ingredients

35 mL (1.18 fl oz) echinacea (Echinacea spp.) root tincture
25 mL (0.85 fl oz) St. John's wort (Hypericum perforatum) aerial parts tincture
20 mL (0.67 fl oz) milk thistle (Silybum marianum) seed tincture
20 mL (0.67 fl oz) wild yam (Dioscorea villosa) rhizome tincture

Directions

Combine all herbs in a 60 mL (2 fl oz) glass bottle.
Suggested usage is 5 mL 4x/day.

Question 129

Which herbal actions are used to treat chronic hepatitis?

Answer 129

Hepatoprotectives, such as milk thistle (Silybum marianum) seed, shiitake (Lentinula edodes) mushroom, and turmeric (Curcuma longa) rhizome.

Alteratives, such as dandelion (Taraxacum officinale) root and fringetree (Chionanthus virginicus) bark, to support eliminative functions of the body, due to the increased burden of chronic liver hypofunction;

Antivirals, such as St. John’s wort (Hypericum perforatum) aerial parts and elder (Sambucus canadensis and S. nigra) berry, in the case of chronic viral hepatitis;

Immunomodulants, such as astragalus (Astragalus membranaceus) root and eleuthero (Eleutherococcus senticosus) root, can be helpful in clearing up the debris of cellular inflammation; and

Adaptogens, such as schisandra (Schisandra chinensis) and eleuthero (Eleutherococcus senticosus) root, can help support immune function and provide stamina and may be helpful in managing the stress of chronic illness.

Question 130

What is a typical formula for chronic hepatitis?

Answer 130

Adapted from Medical Herbalism by David Hoffmann (Hoffmann, 2003).

Ingredients

35 mL (1.2 fl oz) dandelion (Taraxacum officinale) root tincture
35 mL (1.2 fl oz) milk thistle (Silybum marianum) seed tincture
17 mL (0.6 fl oz) astragalus (Astragalus membranaceus) root tincture
17 mL (0.6 fl oz) mugwort (Artemisia vulgaris) aerial parts tincture
17 mL (0.6 fl oz) fringetree (Chionanthus virginicus) bark tincture

Directions

Combine all herbs in a 120 mL (4 oz) glass bottle.
Take 2.5-5 mL 3x/day.

Question 131

What is Cirrhosis?

Answer 131

Cirrhosis occurs as a consequence of chronic liver injury, when cellular inflammation progresses to permanent fibrotic damage and development of non-functional bands of scar tissue within the liver. Cirrhosis is an advanced stage of fibrosis, which has typically been present for an extended period of time before cirrhosis is diagnosed.

Question 132

What causes Cirrhosis?

Answer 132

Alcohol abuse and chronic hepatitis C infection are the primary causes of fibrotic liver disease and cirrhosis in the United States, but it can also result from other viral infections, chronic solvent exposure, and some extrahepatic disease processes (Civan, 2018).

Question 133

What are the symptoms and clinical featurs of Cirrhosis?

Answer 133

The most notable clinical features of cirrhosis are jaundice, ascites (retention of water in the abdominal cavity), and portal hypertension due to blockage in the hepatic vasculature; however, cirrhosis can also affect hormone balance, musculoskeletal function, and metabolism (Schuppan & Afdhal, 2008). Cirrhosis is a profoundly damaging disease, which has largely been understood to be irreversible and ultimately fatal without liver transplant.

Question 134

What are the primary herbal considerations for Cirrhosis?

Answer 134

The primary herbal considerations here are, of course, hepatoprotective and hepatic trophorestoratives or tonics. Cholagogues and choleretics can also be helpful to maintain bile production and release, which can help prevent development of jaundice and eliminate metabolic waste, as can alteratives and bitters. In conjunction with hepatoprotectives, vulnerary herbs, such as calendula (Calendula officinalis) flower and gotu kola (Centella asiatica) leaf may also play a role in preventing further accumulation of scar tissue.

Question 135

What are some considerations for the type of herbal preperations used for cirrhosis?

Answer 135

All hepatotoxic substances should be avoided in cirrhosis, including even the small amounts of alcohol found in tinctures; glycerites, capsules, teas, and food preparations are all better options here. If tinctures must be used, they can be added to hot water or very briefly simmered in order to evaporate some of the alcohol (Hoffmann, 2003).

Question 136

What is the botanical name for milk thistle?

Answer 136

Milk thistle – Silybum marianum (Asteraceae)

Question 137

Which part of milk thistle is used?

Answer 137

Seed

Question 138

What are the herbal actions of milk thistle?

Answer 138

Anti-inflammatory, antioxidant, cholagogue, galactagogue, hepatic, hepatoprotective

Question 139

What are the herbal energetics of milk thistle?

Answer 139

cooling

Question 140

What are the specific indications for milk thistle?

Answer 140

Milk thistle is perhaps one of the best-known herbal hepatoprotectives, and has been researched for its ability to both protect and regenerate hepatocytes in the face of damage from mycotoxins, pharmaceuticals, solvents, alcohol, and viruses (Hoffmann, 2003). There is an abundance of clinical data showing the efficacy of silymarin, a complex of the lignan constituents of milk thistle seed, as a hepatoprotective; some of its known effects include stabilization of cellular membranes, promotion of cellular regeneration and protein synthesis, and prevention of oxidative damage to hepatocytes (Vargas-Mendoza et al., 2014). In controlled clinical trials, silymarin increased resolution time and clinical symptoms in patients with acute hepatitis (El-Kamary et al., 2009) and significantly reduced fibrosis and elevated liver enzyme counts in patients with steatohepatitis (Kheong et al., 2017).

The ability of milk thistle and its constituents to promote hepatocyte function and regeneration makes it a key herb in many liver conditions, notably hepatitis and cirrhosis, but it is also an excellent tonifying herb that can safely be used to help avoid damage to the liver in the face of everyday environmental stressors. As a hepatic tonic, milk thistle seed may be appropriate in helping to manage blood glucose dysregulation and blood lipid levels, and is often used in formulas for conditions related to liver congestion, such as PMS, gallstones, and other consequences of poor detoxification.

Milk thistle seed has also traditionally been used as a galactagogue.

Question 141

What are the safety considerations for milk thistle?

Answer 141

GRAS

Question 142

What is a typical formula for cirrhosis?

Answer 142

Herbal support for cirrhosis can include milk thistle seed (hepatic and antihepatotoxic), burdock root (lymphatic, aperient, alterative), gotu kola leaf (vulnerary), dandelion root (cholagogue, aperient, alterative), and schisandra berry (hepatic).

Ingredients

2 g (0.07 oz) powdered milk thistle (Silybum marianum) seed
2 g (0.07 oz) powdered burdock (Arctium lappa) root
2 g (0.07 o) powdered gotu kola (Centella asiatica) leaf
1 g (0.04 oz) powdered dandelion (Taraxacum officinale) root
1 g (0.04 oz) powdered schisandra (Schisandra chinensis) berry

Directions

Combine all powders together.
Suggested usage is 8 g (0.3 oz) powder/day mixed in milk of choice, nut butter, water, or a smoothie.

Question 143

What is Cholelithiasis?

Answer 143

Cholelithiasis is the presence of calculi (stones) in the gallbladder. These may be extremely small—sometimes called “gravel”—or they can be large enough to occlude the bile duct, and may require surgical removal, in which case the entire gallbladder is typically removed (Siddiqui, 2018). Ultrasound is required to conclusively determine the size and presence of calculi.

Question 144

What do gallstones consist out of?

Answer 144

The most common type of gallstones are formed from cholesterol and bile pigments, particularly when bile is supersaturated with cholesterol

Question 145

What are the risk factors for developing gallstones?

Answer 145

Risk factors in the development of gallstones include familial predisposition, rapid weight loss, obesity, pregnancy, and use of oral contraceptives or estrogen replacement (Hoffmann, 2003). Certain diseases can also predispose one to development of gallstones, including diabetes, obesity, cystic fibrosis, and some parasitic infections (Siddiqui, 2018).

Question 146

How does gallstones develop?

Answer 146

Gallstones are believed to be very common, and can often be asymptomatic; they can originate as biliary sludge, a thickened form of bile that is associated with gallbladder stasis, and develop over time into small gravel or larger stones.

Question 147

What is the most common symptom of cholelithiasis?

Answer 147

The most common symptom of cholelithiasis is biliary colic, a painful spasm triggered by the movement of calculi into the bile ducts, which can present as pain in the upper right abdominal quadrant, sometimes extending to the back or arm (Siddiqui, 2018).

Question 148

Why should strong bitters and cholagogues not be used with gallstones or biliary colic?

Answer 148

Biliary sludge and small gravel are amenable to herbal interventions. However, caution is warranted when stones or biliary colic are present; the use of bitters and strong cholagogues can worsen spasms or even cause bile duct obstruction by increasing gallbladder contractions. Instead, antilithics can help to move or dissolve stones, while antispasmodics and carminatives can help ease the spasticity that causes biliary colic.

Question 149

Which herbal actions are used for gallbladder hypofunction or stasis without stones?

Answer 149

For those who have gallbladder hypofunction or stasis without stones, mild bitters and cholagogues are appropriate to help restore tone and normal activity.

Question 150

Which herbal actions are used for biliary colic and gallstones?

Answer 150

antilithics can help to move or dissolve stones, while antispasmodics and carminatives can help ease the spasticity that causes biliary colic

Question 151

Which herbs are useful for treating gallstones and biliary colic?

Answer 151

fringetree (Chionanthus virginicus) bark or root bark and balmony (Chelone glabra) whole plant, both of which are antilithic, mildly cholagogue, and hepatic; fumitory (Fumaria officinalis) herb, an alterative and gallbladder trophorestorative; and wild yam (Dioscorea villosa) rhizome, an antispasmodic with particular affinity for the abdominal organs.

Question 152

What are the stages of liver disease?

Answer 152

Inflamation
Fibrosis
Cirrhosis
End stage liver disease (ESLD)