Question Details
Lymphocytic Hepatitis
by
Lauren Chattigre
-
February 13, 2010
Replies
by
Lauren Chattigre
February 13, 2010
Forgot to tell you, he has no symptoms yet related to his hepatitis. He also has a mild amount of inspissated bile and a few polypoid lesions in his GB, and renal cortical cysts and a cystic calculus. It occurred to me to consider Dang Gui Shao Yao San as well as it would help with phlegm but I don't know if it would be a strong enough liver qi mover. And Xiao Yao San isn't as strong for phlegm as DGSYS. His tongue wasn't greasy but he's definitely obese. ??? Thanks!
by
naturevet
February 14, 2010
Hi Lauren,
I like your analysis. XCHT is what I'd start with. In addition, the obesity and neoplasia are undoubtedly connected, most likely by insulin resistance or metabolic syndrome. Our best formula to start undoing that is Si Miao San, which may help with lymphoma, elevated liver enzymes (esp. given the inspissated bile), and tendency to weight gain. It's an anti-Damp formula, and is quite specific to inflammation within the liver along the bile canaliculi, thus helping to promote normal bile formation. So it fits with what you're seeing and is where I'd start.
XCHT alone might be able to help with PLN, but SMS should aid the XCHT here, too. They're the first things I'd try, together with the obvious diet change toward something anti-inflammatory (home-cooked, raw).
Hope that helps!
Steve
I like your analysis. XCHT is what I'd start with. In addition, the obesity and neoplasia are undoubtedly connected, most likely by insulin resistance or metabolic syndrome. Our best formula to start undoing that is Si Miao San, which may help with lymphoma, elevated liver enzymes (esp. given the inspissated bile), and tendency to weight gain. It's an anti-Damp formula, and is quite specific to inflammation within the liver along the bile canaliculi, thus helping to promote normal bile formation. So it fits with what you're seeing and is where I'd start.
XCHT alone might be able to help with PLN, but SMS should aid the XCHT here, too. They're the first things I'd try, together with the obvious diet change toward something anti-inflammatory (home-cooked, raw).
Hope that helps!
Steve
by
Lauren Chattigre
February 15, 2010
Thanks!!
by
mikemesley
February 15, 2010
Would Qin Jiao addition be of benefit given PLN Steve? Or would addition of SMS have a similar lower burner antiinflammatory influence?
by
Lauren Chattigre
February 16, 2010
Hey Steve, I just read in your Natural Veterinary Medicine text that Xiao Chai Hu Tang has been associated with liver damage. I just prescribed it for two patients with hepatitis; the one discussed above, and a 8yr black lab with lymphocytic/eosinophilic hepatitis (no symptoms, waxing/waning elevations in ALT and ALP, tongue sides lavender, pulses difficult to appreciate due to obesity, lipomas, retained BL19). Am I going to run into trouble here? Should it not be used longterm, and if not, which formula should I follow up with? Thanks!
by
bannink
February 16, 2010
Hi Lauren,
In an attempt to give Steve a hand on this heavy inquiry day, this is what his response has been in the past:
"That note was included in the text at Susan Wynn's behest, who heard it from Dr. Xie of Chi Institute fame. It doesn't appear to be based on any scientific research. Indeed, if you look up Bupleurum in the medical literature (e.g. pubmed), you'll find the opposite - namely 30 or 40 studies lauding its benefits in liver disease.
Myself, I would have to side with the scientific literature. I've never seen it cause liver disease. Any formula can aggravate liver disease, I believe, if it induces the wrong hemodynamic (e.g. brings blood to an acutely inflammed liver). But apart from this general impact which any formula could have, we haven't seen the slightest potential for problem with the use of Xiao Chai Hu Tang in liver disease."
To add to that,
I have used this long term myself in many cancer patients and have not had any trouble with liver toxicity to date. However, generally the patients I will use it in have wiry pulses and active GB points. Tongue on these guys can be quite variable. You should be okay in these cases, unless you have extremely high liver enzymes or Damp Heat signs which might indicate that something like Si Miao San might be a better choice, or at least part of the treatment, as Steve mentioned above.
Xiao Chai Hu Tang has actually been shown to be hepatoprotective and increases bile secretion. Additionally, clinical indications for this formula include hepatitis, hepatic fibrosis, cholecystitis, and hepatic carcinoma. I always monitor bloodwork on my liver disease patients, and this will give you further assurance that you are having the desired effect.
Erin
In an attempt to give Steve a hand on this heavy inquiry day, this is what his response has been in the past:
"That note was included in the text at Susan Wynn's behest, who heard it from Dr. Xie of Chi Institute fame. It doesn't appear to be based on any scientific research. Indeed, if you look up Bupleurum in the medical literature (e.g. pubmed), you'll find the opposite - namely 30 or 40 studies lauding its benefits in liver disease.
Myself, I would have to side with the scientific literature. I've never seen it cause liver disease. Any formula can aggravate liver disease, I believe, if it induces the wrong hemodynamic (e.g. brings blood to an acutely inflammed liver). But apart from this general impact which any formula could have, we haven't seen the slightest potential for problem with the use of Xiao Chai Hu Tang in liver disease."
To add to that,
I have used this long term myself in many cancer patients and have not had any trouble with liver toxicity to date. However, generally the patients I will use it in have wiry pulses and active GB points. Tongue on these guys can be quite variable. You should be okay in these cases, unless you have extremely high liver enzymes or Damp Heat signs which might indicate that something like Si Miao San might be a better choice, or at least part of the treatment, as Steve mentioned above.
Xiao Chai Hu Tang has actually been shown to be hepatoprotective and increases bile secretion. Additionally, clinical indications for this formula include hepatitis, hepatic fibrosis, cholecystitis, and hepatic carcinoma. I always monitor bloodwork on my liver disease patients, and this will give you further assurance that you are having the desired effect.
Erin
by
Lauren Chattigre
February 17, 2010
Thank you so much!
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