Navigating chronic liver disease: a homeopathic outlook for holistic management

Dr Hanamanth

Abstract:
Chronic liver disease (CLD) stands as a predominant contributor to global mortality and morbidity. Chronic liver disease is a global disorder that occurs in all ages, genders, regions, and races. The major causative factors for CLD encompass persistent infections from alcoholic liver disease, non-alcoholic fatty liver disease, hepatitis B and C viruses, and autoimmune hepatitis. Notably, hepatitis B and hepatitis C are increasingly recognized as pivotal factors leading to hepatocellular carcinoma and cirrhosis, affecting a staggering 200 million individuals worldwide.  Non-alcoholic fatty liver disease (NAFLD) has emerged as a predominant cause of chronic liver issues, particularly in developed nations characterized by sedentary lifestyles. This highlights the pressing demand for comprehensive approaches to navigate and tackle the complications associated with these primary causes of liver-related health issues on a global scale. The Homoeopathy system of medicine has been proven to be effective in the treatment and prevention of complications in early-detected cases of CLD.

Keywords: chronic liver disease, cirrhosis of liver, Homoeopathy, Non-alcoholic liver disease

Introduction:
As the largest organ in the human body, the liver is a central player in maintaining overall metabolic and physiological balance. CLD is a continuous process of inflammation, destruction, and regeneration of liver parenchyma. John Browne (1642- 1700) was an English surgeon who first described cirrhosis in 1685, as the “liver appearing glandulous”. Chronic liver disease is a progressive deterioration of liver function for more than six months, which includes the synthesis of clotting factors, other detoxification of harmful products of metabolism, proteins, and excretion of bile.

Chronic liver disease is a common clinical condition in developed countries, where alcohol abuse for a long period, genetic, metabolic disorders, toxins, infection, and autoimmune disease are emerging causative factors for CLD. cirrhosis is the final stage of CLD which is characterized by the destruction of liver normal architecture and formation of nodules and neovascularisation, neoangiogenesis, and deposition of the extracellular matrix.

According to the National Vital Statistics Report 2017 from the Center for Disease Control and Prevention, approximately 4.5 million adults had chronic liver disease and cirrhosis. 47,473 deaths were recorded due to CLD and cirrhosis.

Aetiology:

1. Chronic viral hepatitis: it’s more common in East Asia and Sub-Saharan Africa.

• Hepatitis A
• Hepatitis B
• Hepatitis D
• Hepatitis C: if it is not treated it leads to carcinoma.

2. Autoimmune hepatitis: The female ratio is more than the male. Where the destruction of the liver parenchyma by autoantibodies.

• Autoimmune hepatitis: (AIH) in this condition, autoantibody levels will be elevated.
• Primary biliary cirrhosis (PBC): destruction of intrahepatic biliary channels and portal inflammation and scarring.
• Primary sclerosing cholangitis (PSC): decrease the size of intrahepatic and extrahepatic bile ducts because of inflammation.

3. Alcoholic liver disease: alcoholic fatty liver with or without hepatitis.

• Alcohol hepatitis: it’s reversible (acute ingestion)
• Chronic hepatitis: irreversible (prolonged abuse of alcohol)

4. Genetic causes:

• Wilson disease: copper accumulation
• Hemochromatosis: a disorder of iron absorption from the intestine.
• Alpha 1 antitrypsin deficiency: common in children

5. Non-Alcoholic Fatty Liver Disease: metabolic syndrome is a major contributor to NAFLD.

• Obesity
• Hyperlipidaemia
• Diabetes mellitus

Other causes: smoking, Budd Chiari syndrome, steatosis, thyroid disease, cytomegalovirus, medication (isoniazid, methotrexate, and phenytoin)

The above-discussed aetiologies represent the major causative factors in progressive hepatic disease which can eventually lead to cirrhosis and its complications, which include hepatic carcinoma.

Pathophysiology:

• Due to etiological factors (hepatitis, fatty liver)
• Development of the scar tissue that replaces the normal parenchyma
• This fibrosis blocks the portal circulation
• Activates of hepatic stellate cells which increase the fibrosis by producing myofibroblast
• Formation of micro and macro nodules separated by fibrous bands
• Decreases the blood flow
• Portal hypertension

Clinical presentation:
CLD features can be non-specific such as anorexia, weight loss, fatigue,

Signs to identify CLD
Muehrcke nails, Dupuytren contracture (alcohol), parotid gland enlargement, Scratching, itching, bruising, nail Clubbing, Palmar erythema, Spider nevi, Testicular atrophy, Gynecomastia, feminizing hair distribution, Petechial rash, caput medusae, anaemia, Drowsiness, hyperventilation, asterixis, jaundice, peripheral edema

Complications:

Portal hypertension:

• Ascites
• Hypersplenism
• Lower oesophageal varices and rectal varices

Synthetic dysfunction

• Coagulopathy
• hypoalbuminemia

Encephalopathy

Hepato-renal syndrome

Hepatocellular carcinoma

Diagnosis of CLD:

• Viral hepatitis B and C: serology, PCR
• Liver function test:
• AST > ALT (chronic alcohol intake)
• ALT > AST (NAFLD)
• Raised alkaline phosphate (PBC)
• Elevated Serum iron and ferritin decreased TIBC(hemochromatosis)
• ANA, ASMA (autoimmune hepatitis)
• Complete blood count, clotting profile
• Ultrasound of the abdomen and pelvis (size, echogenicity nodularity of the liver)
• Elevated urine copper, decreased Ceruloplasmin (Wilson disease)
• liver biopsy (hepatic necrosis with polymorph nuclear infiltration)
• CT scan (show a lesion in the liver or obstruction of biliary channel)
• Fibro scan and transient electrography (detects early stages of cirrhosis)
• Endoscopy (esophageal varices)
• Doppler study (patency of portal and hepatic vein)

Prognosis:

1. The Child pugh score
2. MELD (Model of end stage liver disease)

Management:

• lifestyle modification
• abstinence of alcohol
• salt and fluid restriction
• fat restriction (reduces abdominal obesity)
• Loss of 3–5% of body weight in obese individuals
• Vitamin E 800 IU/day (prevents NASH)
• Bariatric surgery (patients with a BMI > 35
• Liver transplantation (advanced cases of cirrhosis due to NASH)

Homoeopathic perspective on chronic liver disease

Several literature and studies proved that the homoeopathy system of medicine is effective in the treatment and prevention of CLD and its complications (early stages)

Asculus hip: congestion of liver and portal system. Tenderness and dull aching pain in the right lobe of the liver. Pain radiates to the back of inspiration. < by walking or riding. Associated with constipation.

Argentum nitricum: cirrhosis of the liver from malaria cachexia. Stiches in the liver come on as with jerk, periodical dull aching pain anterior surface of the liver. Hepatic affection ending in fatal dropsy. < by walking

Arum met: Hepatic congestion consecutive to cardiac disease. Chronic hepatitis with suicidal melancholy, jaundice with pain in the liver, greenish-brown urine, ashy white color stool, cutting and burning pain in right hypochondrium region ending in cirrhosis and fatty degeneration with dropsy.

Bryonia: it acts on all serous membranes and viscera they contain. perihepatitis with sharp stitches in the right hypochondrium < motion > lying on the right side. Swelling of the liver, bitter taste in the mouth, yellow coated tongue. Burning pain in the liver region is worse by pressure and coughing.

Berberis vulgaris: hepatic affections with promote the flow of bile. It acts well in fleshy persons and has good livers. Stitching pain in front of kidneys extending to the liver. Pain is worse by standing.

Cardus mur: cachexia of miners working deep underground. Portal hyperemia, gallstone, catarrh of the biliary ducts. The hepatic region is sensitive to pressure. Stitching, drawing pain in the liver, < by pressure, lying on the left side. Dropsical disease, depending on organic affections of the liver. Jaundice with a dull headache, bitter taste, tongue white in the center, tips and edges red. Nausea with vomiting of an acrid green fluid. Stools pasty, clayer, urine golden yellow.

Chelidonium: a prominent liver remedy. Jaundice due to hepatic and gall bladder obstruction. Liver enlarged. Stitches pain in liver, and spleen region. Jaundiced skin and especially the constant pain under the inferior angle of the right scapula. Abdomen distended and sensitive to pressure. > by eating.

Chelone glabra: a remedy in affection with pain or soreness of the lobe of the liver extending downwards. Dyspepsia with hepatic torpor. Jaundice.

Chionanthus: indicated for hepatic derangements. Hypertrophy of the liver. Clay-coloured stool, also soft, yellow, and constipation. Great emaciation with jaundiced skin. Soreness in the region of the liver with a weak pulse. Chronic jaundice with reoccurrence in every summer. Aching pain umbilical region.

Cobaltum: stitches running down the thighs from the liver. Shooting type of pain in the hepatic region. And sharp pain in spleen. < deep inspiration. Fullness in the abdomen after a slight meal.

Digitalis: jaundice with heart disease. Enlarged liver, even dropsy from organic heart disease. Soreness and hardness with sensitivity to pressure in cardiac and hepatic regions. Violent vomiting of water and bile. Aversion to food and drinks.

Lachesis mutus: one of the good remedies for cirrhosis of the liver. Craving for alcohol. Empty swallowing is more painful than solid food. Liver region sensitive, can not bear anything around the waist. Abdomen tympanic, sensitive, painful.            Constipated offensive stool.

Lycopodium: This remedy adapted more especially to ailments gradually developing, functional power weakening with failure to digestive powers. Liver function is seriously disturbed. Ascites in liver disease. The Lycop patient is thin, withered, full of gas, and dry. The sensation of blotted abdomen immediately after a meal. Hepatitis, atrophic from of nutmeg liver. Pain shooting across lower abdomen from right to left.

Magnesium mur: a liver remedy with pronounced characteristic constipation. Chronic liver affection with tenderness and pain, extending to the spine and epigastric, worse with a long history of indigestion. Pressing pain in the liver. Worse on lying on the right side. Yellow tongue.

Myrica cerifera: marked action on the liver. With jaundice and mucous membranes. Dull pain in the region of the liver with bronze-yellow skin. Loss of appetite. Fullness in stomach and abdomen.

Nux vomica: it’s pre-eminently the remedy for many conditions in modern life. Mainly indicated for digestive disturbance and portal congestion. Liver engorged, with stitches and soreness. Colic with upward pressure causing short breath.

Podophyllum: it is especially adapted to persons of bilious temperament. It chiefly affects the liver. Jaundice, portal engorgement with hypogastric pain. Distended abdomen. The liver region is painful better by rubbing part.

Conclusion: Homeopathy, a leading holistic medical system, selects remedies based on individualization and symptom similarity, employing a comprehensive approach. Several remedies are indicated for chronic liver disease based on the cause, sensation, and modalities. As homoeopathy can prevent the complication and also treat with route cause.

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Dr Hanamanth
MD Part II
Department of Practice Of Medicine
Father Muller Homoeopathic Medical College And Hospital, Mangalore