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Liver in the Chinese and Western Medicine

Authors:

Abstract

Background: The traditional Chinese medicine (TCM) is based on the 5-element theory, which emphasizes the importance of the dynamic balance among the liver, heart, spleen, lung, and kidney. It is quite confusing that the 5 viscera in TCM share the same names with the organs in Western medicine. Spleen is the only viscus that differs most from the modern concept, while the remaining 4 viscera can all find similarities with the corresponding organs in Western medicine; however, the viscus in TCM is always a broader concept. Key Messages: The 5 major functions of the liver in TCM correspond to the nerve-endocrine-immune network in Western medicine, and all of the functions are associated with emotion.
© 2017 The Author(s)
Published by S. Karger AG, Basel
Review
Integr Med Int 2017;4:39–45
Liver in the Chinese and Western
Medicine
Zhan-Wen Liu
a Jin Shu
a Jia-Ying Tu
a Cui-Hong Zhang
b Jue Hong
b
a Tongren Hospital, Shanghai Jiao Tong University School of Medicine, and
b Shanghai
Research Institute of Acupuncture and Meridian, Shanghai , China
Keywords
Brain · Emotion · High blood pressure · Liver · Digestive system · Circulatory system ·
Reproductive system · Traditional Chinese medicine
Abstract
Background: The traditional Chinese medicine (TCM) is based on the 5-element theory, which
emphasizes the importance of the dynamic balance among the liver, heart, spleen, lung, and
kidney. It is quite confusing that the 5 viscera in TCM share the same names with the organs
in Western medicine. Spleen is the only viscus that differs most from the modern concept,
while the remaining 4 viscera can all find similarities with the corresponding organs in West-
ern medicine; however, the viscus in TCM is always a broader concept. Key Messages: The 5
major functions of the liver in TCM correspond to the nerve-endocrine-immune network in
Western medicine, and all of the functions are associated with emotion.
© 2017 The Author(s)
Published by S. Karger AG, Ba sel
Introduction
As a member of the 5 viscera in traditional Chinese medicine (TCM), the liver is not the
organ in anatomy, but an abstract concept and a dynamic function system based on the
anatomical liver. It is connected to the eyes, tendons and bones, and internal organs via
meridians, with unique physiological functions and pathological manifestations, and simulta-
neously interacts with other Zang-Fu organs. However, the liver in the Western medicine only
refers to the organ in anatomy, not containing the functions of the remaining systems and
organs. We can see that the liver in TCM is more extensive and complicated compared to the
Receive d: November 28, 2016
Accepted after revision: Februar y 27, 2017
Published online: April 8, 2017
www.karger.com/imi
DOI: 10.1159/000466694
This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 Interna-
tional License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribu-
tion for commercial purposes as well as any distribution of modified material requires written permission.
Dr. Zhan-Wen Liu, MD, Ton gr en Hospital
Shanghai Jiao Tong University School of Medicine
No. 1111, Xian xia Road
Changning District, Shanghai 200 050 (China)
E-Mail zhanwenl
@ 163.com
Dr. Cui-Hong Zhang, MD
Shanghai Research Institu te of Acupuncture an d Meridian
Room 301, Building 1, No. 650, South Wanping Road
Xuhui District, Shanghai 20 0030 (China)
E-Mail zjzch
@ 163.com
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DOI: 10.1159/000466694
Liu et al.: Liver in the Chinese and Western Medicine
www.karger.com/imi
© 2017 The Author(s). Published by S. Karger AG, Basel
one in Western medicine. However, during the recent years, more and more studies have
proven that the 2 concepts have something in common [1–3] .
The aim of this article is to analyze the similarities and differences between the “liver” in
the TCM and Western medical systems as a help for future research.
Anatomy of the Liver
Western Medicine
In human beings, the liver is located in the upper right quadrant of the abdomen, below
the diaphragm, in front of the gallbladder and the right kidney, and beyond the stomach. It
weighs 1.23–1.45 kg in male adults and 1.10–1.30 kg in female adults. It is proven that the
size of the liver approaches the maximum in adolescents, but then shrinks while aging,
decreasing 100 g every 10 years after the age of 60 years [4] .
Traditional Chinese Medicine
Ling Shu (spiritual pivot, Qin-Han dynasties, B.C. 221 to A.D. 220) says that the liver is
located in the hypochondriac region, below the diaphragm, in front of the right kidney and
the spine. This description generally conforms to that in the Western medicine. According to
Nan Jing (classic of difficult issues, Han dynasty, B.C. 202 to A.D. 220), the liver weighs about
1.084 kg, also similar to the theory of the Western medicine. TCM also conducted a prelim-
inary observation on the change of the liver with aging. Ling Shu reports that usually at the
age of 50, the liver qi starts to decline, the lobes of the liver become thinner, the secretion of
the bile also decreases, and the vision gets blurred. This point of view is very much close to
that of the modern medicine.
The above references indicate that the liver in TCM has a clear morphological foundation,
generally consistent with the modern anatomy. That is to say, the actual organ is part of the
concept of the liver in TCM and is also the material foundation of the common parts between
the Chinese and Western medicine with regard to the liver.
Nevertheless, different recognition methods of the Chinese and Western medicine lead
to different views of the human body and diseases, physiology and pathology. The liver in
TCM, however, is not limited to the anatomical concept. It is a comprehensive system that
consists of various factors including anatomy, logical reasoning, and philosophy, and involving
multiple systems and organs; i.e., TCM uses a much broader definition of the liver compared
to the Western medicine [2] .
Functions of the Liver
According to the Western medicine, with its numerous functions, the liver plays an
important role in digestion, metabolism, detoxification, coagulation, and immune modu-
lation.
In TCM, the function of the liver is connected to that of other internal organs, mainly
covering the subsequent 5 aspects mentioned in what follows.
The liver is in charge of dispersion and dredging: it is mainly responsible for the regu-
lation of emotion, the promotion of digestion and absorption, the maintenance of the circu-
lation of qi, blood, and body fluid, as well as the reproductive function.
The liver houses the hun (our spiritual consciousness, the hun is critical to the spiritual
and psychological dynamic of the individual. The hun loves life and favors the vital spark
within us. It is the tool that motivates our higher desires and our passions. It governs our life
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DOI: 10.1159/000466694
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© 2017 The Author(s). Published by S. Karger AG, Basel
impulses and controls our automatic reflexes by means of our thought process, helping us
control our speech and our actions. It allows for exchange, communication, and the expression
of our desires and ideas. It animates our interpersonal relationships. The hun uses the shen
[spirit] to manifest and show itself in all its grandeur: intelligence, spirituality, intuition,
dreams, introspection, creativity, imagination, respect, love of and enthusiasm for life, ideas,
and speech). The liver is in charge of storing blood and can modulate the blood volume. In a
resting or a static situation, when the human body requires less blood flow, a large amount of
blood is stored in the liver; when working or excited, the body requires more blood and the
liver releases the stored blood to meet the requirements of the body and to maintain normal
function. According to the TCM theory, qi and blood become most active in the gallbladder
and liver meridians from 11 p.m. to 3 a.m., and it is therefore recommended for people to be
in a deep sleep state during this period of time. Otherwise, the liver will fail to get enough
nourishment from the blood and cannot perform well in storing blood and hun spirits, mani-
fested by irritability and distraction.
The liver externally opens into the eyes, controls tendons, and manifests in the nails: by
storing blood, the liver supports the normal functions of the eyes and nails. The liver meridian
is connected to the eyes, and the visual ability mainly relies on the nourishment of liver blood.
Therefore, the eyes can reflect the function of the liver: insufficient liver blood may cause dry
eyes and blurred vision; hyperactivity of the liver fire will lead to pain and swelling of the
eyes. The function of tendons also depends on the nourishment of liver blood. Numb or spastic
limbs will occur when there is not enough liver blood to nourish the tendons. It is said that
the nails are a surplus of the tendons. Plenty of liver blood can maintain the nail beds pink
and nail plates firm; dry, brittle, and deformed nail plates usually indicate insufficient liver
blood.
The liver is related to anger and anger impairs the liver: anger is an intense undesirable
emotion induced by stimulations. The liver is the viscus most closely related to this emotion.
Extreme anger can damage the liver, causing dysfunction in dispersion and dredging and
upward flow of qi and blood, indicated by a red eye and face or even fainting spells, such as a
cerebrovascular accident in modern medicine. Besides, the dysfunction of the liver in
dispersion and dredging can also lead to emotional disorders manifested as irritability.
The liver is the source of endurance: good endurance indicates good function of the liver,
and vice versa, which is consistent with the saying in modern medicine that patients with
hepatic diseases easily feel fatigue.
Interaction between TCM and Western Medicine
Despite the similarities and differences in the concept of the liver between the TCM and
the Western medicine, numerous pieces of evidence from the modern medicine can support
the liver function theories of TCM. The relations between the 2 medical systems with regard
to the liver are shown in Figure 1 .
The Liver Storing Blood
Histologically, the liver is a blood bank that consists of hepatic sinusoids, which should
be the histological foundation of the liver in storing blood [5, 6] . Under static conditions, the
hepatic blood flow usually accounts for 1/4 of the cardiac output [7] . In right ventricular
failure or whole heart failure, the congested liver enlarges its blood flow volume and thus
reduces the venous return to the heart, which is significant in relieving the heart’s burden. In
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Integr Med Int 2017;4:39–45
DOI: 10.1159/000466694
Liu et al.: Liver in the Chinese and Western Medicine
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© 2017 The Author(s). Published by S. Karger AG, Basel
a lying position, the venous return increases by 50% compared to that in a standing position.
According to the TCM theory, blood goes back to the liver in a lying position. Hence, the liver’s
function of storing blood is important in restricting the venous return and protecting the
cardiopulmonary function [8] .
In the embryo, the liver is the organ for producing blood. In adults with severe anemia,
the liver is able to partially restore its ability of producing blood. Thus, we say, the liver
storing blood also refers to the relationship between the liver and the total blood flow volume
and coagulation.
Besides, Fei Zhao-Fu found that people with a wiry pulse often present with an abnormal
rheohepatogram, while people with a moderate or slippery pulse usually have a normal rheo-
hepatogram, hence a wiry pulse should be associated with a dysfunction of the liver in storing
blood [9] .
The Liver in Charge of Dispersion and Dredging
The liver in charge of dispersion and dredging first of all refers to the fact that the liver
regulates the qi activities and emotions, promotes digestion and absorption, maintains the
normal flow of qi and blood, modulates water metabolism, and regulates the thoroughfare
and conception vessels to adjust the sexual and reproductive functions. A large amount of
studies suggest that the liver in TCM should be related to the nerve-endocrine-immune
Qi-blood most active in the
liver meridian during 1–3 a.m.
Joining the governor vessel
on the vertex
Belonging to the liver and
connecting with gallbladder
Starting from the top
of the big toe
Going upwards along the inner
side of the thigh, until reaching
the pubic region, then circulating
around the external genitalia and
entering the lower abdomen
Surrounding the stomach
Conneting with the eyes
Storing
blood
Housing
Hun (spirits)
Controlling
dispersion
and dredging
Opening into
eyes
Controlling
tendons
Manifesting
in nails
Nervous
system
Endocrine
system
Digestive
system
Circulatory
system
Reproductive
system
Nerve-
endocrine-
immune
network
Hemorrhagic diseases,
hypertension
Insomnia,
mental disorders
Cerebrovascular
accidents
Peptic ulcer, dyspepsia,
irritable bowel syndrome
Dry eye syndrome,
nyctalopia
Dry and brittle nails
Impotence, hernia,
irregular menstruation,
dysmenorrhea
Hyperplasia of
mammary glands,
hypochondriac pain,
cholecystitis,
cholelithiasis
Emotion
Modern diseasesOccidental functions Oriental liver Liver meridian
Fig. 1. Correspondence between the occidental and the oriental medicine regarding the liver functions (in-
cluding the liver meridian). All the functions are associated with emotion.
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Integr Med Int 2017;4:39–45
DOI: 10.1159/000466694
Liu et al.: Liver in the Chinese and Western Medicine
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© 2017 The Author(s). Published by S. Karger AG, Basel
network and that it governs the qi-blood activities via the nerves and endocrine [10] , which
is similar to Western medicine, according to which the liver regulates the whole body through
metabolic function. For example, in TCM, the liver regulates the qi activities, similar to homeo-
stasis emphasized by modern medicine; in TCM, the liver modulates emotions, which are
considered to be closely related to the central neurotransmitters in modern medicine [11–
15] ; the liver governs dispersion and dredging, which conforms to the digestion and absorption
theory in the Western medicine; in TCM, the liver maintains the normal qi activities, which is
essential for the blood circulation [15, 16] ; the dispersion and dredging function of the TCM
liver is also closely associated with the water metabolism and reproductive function [17, 18] .
Affiliations of the Liver
The liver controls the tendons and manifests in the nails, which refers to the fact that the
tendons and fascia all rely on the nourishment of liver blood and the condition of the nails can
reflect the level of liver blood. Someone observed the microcirculation of the nails and found
that the indexes in the hepatic disease group were significantly abnormal compared to those
in the nonhepatic disease group [19] . In patients with liver diseases, the imbalanced inacti-
vation of estrogen may lead to an increase in melanin in skin cells, causing dark complexion,
brown streaks on nail plates, and liver palms. It is proven that vitamin D is related to the
function of muscles, tendons, and nails; the bile, secreted by the liver, can promote the
absorption of vitamin D in bowels [20] . In hepatic encephalopathy, due to hypoglycemia,
nitrogen poisoning and false neurotransmitters and other factors, cranial nerve dysfunction
may develop, presenting asterixis.
Vitamin A is associated with nyctalopia and dry eye syndrome. The liver not only produces
but also stores vitamin A. TCM often uses lamb or pork liver, which are rich in vitamin A, to
treat nyctalopia and dry eye syndrome and can achieve a satisfactory result [21] . Besides,
collecting blood from eyeballs of healthy mice is an effective method used in animal experi-
ments, which somehow indicates that the eyes are very much dependent on blood [22] . It is
said that at least 40% of eye diseases are related to the dysfunction of the liver [23] . Peng
Qing-Hua also believes that there should be a specific relation between eye diseases and the
liver [24] . There is a special genetic relationship between the liver and the eye regarding the
embryonic development. When transplanted into the blastocyst cavity, adult liver tissues can
lead to the formation of eyes [25] , which provides further evidence for the theory that the
liver opens into the eyes.
TCM holds that the liver is related to anger and anger may damage the liver, possibly
inducing a cerebrovascular accident. According to the modern medicine, anger can lead to
shortness of breath, increase the amount of erythrocytes in the blood, and promote coagu-
lation, causing tachycardia, which will not only impair the cardiovascular system, but also
affect the health of the liver. Therefore, irritated people run a high risk of both coronary heart
disease and hepatic disease.
Conclusion
Taking into account the above references, we can say that the liver in TCM is morpho-
logically based on the actual liver organ, and the physiological and pathological concepts are
also somehow developed from the organ; the physiological and pathological understandings
are involved in the construction of the visceral manifestations theory in TCM. However,
despite these similarities, the content of the liver in TCM surpasses that of the liver organ in
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DOI: 10.1159/000466694
Liu et al.: Liver in the Chinese and Western Medicine
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© 2017 The Author(s). Published by S. Karger AG, Basel
the Western medicine, involving multiple systems and organs. Via the meridian system, the
liver in TCM connects to the hypothalamus, reticular structure, limbic system, eyes, visual
pathways, proprioceptive pathways, vestibular system, cochlear and auditory pathways, and
motor conduction pathways, as well as the visceral sensory nerves dominating the liver, the
gallbladder, the stomach, the esophagus, the splenic flexure of the colon, the pancreas, the
lung, the colon, the pleura, and the nerves in charge of the reproductive system.
The differences in understanding the liver between the oriental and occidental medicine
are based on the different cognition methods. TCM obtains knowledge above all through
clinical observations and experiences, while the Western medicine through anatomy, physi-
ology, and biochemistry. While TCM observes the human beings by combining the nature and
society as a whole, the Western medicine separates the human beings from nature and society,
and observes them in isolation. TCM recognizes the human body as a whole based on the
5-element theory, while the Western medicine focuses on the analysis of structures such as
organs and tissues. TCM emphasizes the macroscopic relationships and general principles,
while the Western medicine holds the microscopic structure and topical features. TCM thinks
highly of reasoning, differentiating, and comprehending, but ignores morphological structure
and solid evidences; on the other hand, the Western medicine gradually brings the under-
standing of the human body to a microscopic level by combining medical theories and novel
natural scientific techniques and results.
During the recent years, the existence of meridian phenomena has been proven by
relevant research, revealing the specific relationship between meridians and the corre-
sponding Zang-Fu organs. Therefore, it is further suggested that the liver in TCM should be a
regulatory chain with the liver organ as the center [26, 27] . This regulatory chain is featured
by passing along the liver meridian, and the organic and functional changes can cause patho-
logical changes along the meridian. The knowledge about the liver according to TCM benefits
the health preservation of patients with liver diseases, e.g., guaranteeing sufficient sleep;
following a bland diet and keeping away from cigarettes and alcohols; falling asleep before
11 p.m., as it is the self-healing period for the liver and gallbladder from 11 p.m. to 3 a.m.;
frequently closing one’s eyes for nourishing the spirit to prevent overuse of the eyes and
consumption of liver blood.
In conclusion, the function of the liver in TCM is indeed complicated; however, we can
find corresponding explanations in modern medicine, indicating that the liver theories of the
2 medical systems are connected. Furthermore, the TCM liver theory is beneficial to health
cultivation in modern times.
Acknowledgement
This work was supported by the Scientific Research Project of the Shanghai Health
Bureau for Young Scholars (No. 20134Y148).
Disclosure Statement
This review is not under consideration by any other journal. All authors have seen and
approved the final version of the manuscript and there is no conflict of interest with respect
to financial arrangements or affiliations with any company.
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DOI: 10.1159/000466694
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© 2017 The Author(s). Published by S. Karger AG, Basel
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... Therefore, the 'liver-skin axis' has a vital role and intricate key relationship to protect our body. However, the application of the liver-skin axis and method of treatment for patients with eczema has been uncertain to many practitioners [17]. There is a shred of limited evidence showing the presence of such an axis. ...
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Background: Premenstrual syndrome is a highly prevalent cyclical disorder among women of childbearing age which interferes with daily activities, mood, and quality of life. Purpose: To evaluate the effects of a foot reflexology protocol on relieving premenstrual syndrome symptoms in nursing students. Setting: Nursing School, São Paulo University, Brazil. Participants: A convenience sample of 17 nursing students, diagnosed with moderate-to-severe premenstrual syndrome as assessed by the Premenstrual Symptoms Screening Tool (PSST). Research design: A pre-post pilot intervention study. Intervention: The intervention consisted of eight reflexology sessions lasting 30 minutes for eight weeks. Main outcome measure: Evaluation of the participants by the PSST applied at the beginning and at the end of the study. Results: The participants had an average age of 21.7 (±2.6) years, ranging from 19 to 28 years; all were single, and most were in the third year of the course (58.8%); 75.6% lived with their family; 82.4% do not use contraceptives; 64.7% reported regular menstrual flow with an average duration of 5.1 (±1.1) days, and an average menstrual cycle interval of 29.3 (±4.9) days. The intervention significantly reduced the premenstrual symptoms assessed by the PSST (p<.017) with a pre-post difference of 10.2 points in the overall score, and the items score decreased between 1.2 to 3.4 for difficulty concentrating, insomnia, hypersomnia, feeling overwhelmed, muscle/ joint pain, bloating, weight gain; and between 3.5 to 5.2 to anger/irritability, anxiety/ tension, tearful, depressed mood, decreased interest in daily activities, fatigue, overeating, and breast tenderness. There was a significant decrease regarding the functional impact of premenstrual symptoms domain in the overall score with a pre-post difference of 10.7, and between 1.7 and 3.0 for all of the items (p<.04), except for the item "your home responsibilities". Conclusion: Foot reflexology has shown promising results in reducing premenstrual syndrome symptoms.
... Shi Jiesheng mentioned in the "Plain Discussion of Traditional Chinese and Western Medicine" that "medicine is only classified as new or old not as Chinese or Western, and according to academic progress, it is not limited by national boundaries" [4]. Traditional Chinese medicine began in Qihuang, and Western medicine was established by Asclepius of Egypt. ...
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As one of the many traditional Chinese medicine journals in the Republic of China (ROC) era, the journal "Chinese Medicine Pillar Monthly" had been published for 11 consecutive years. It has rich content and covers a wide range of topics. It has important reference value for studying the direction of cultural development, political dynamics, and development trends of Chinese and Western medicine during the ROC era, and the journal was intended to spread the classics and clinical experience of traditional Chinese medicine, making it a medical treasure house. This paper mainly introduces the current status of the journal, the date of its inception, and its main content, features and contributions.
... " [It] is in charge of dispersion and dredging; it is mainly responsible for the regulation of emotion, the promotion of digestion and absorption, the maintenance of the circulation of qi, blood, and body fluid, as well as the reproductive function." (Liu, Shu, Tu, Zhang, & Hong, 2017). In TCM, several emotional disorders and syndromes are connected to the Liver, e.g., insomnia, depression, amentia, irritability, and dizziness. ...
... According to the TCM patterns including LGDH, DLTF, and RDH, the liver is the main disease location of breast cancer, while dampness and heat were the main pathological mechanisms. According to TCM theory, the liver is related to the nerve-endocrine-immune network, it is responsible for the regulation of emotion, the promotion of digestion and absorption, and the maintenance of qi and blood circulation via the nerves and endocrine (Liu et al., 2017). In TCM theory, "fire" is the advanced status of "heat" in severity, while "toxin" indicates faster transmission of heat and worsening condition. ...
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Background and PurposePattern differentiation is a critical element of the prescription process for Traditional Chinese Medicine (TCM) practitioners. Application of advanced machine learning techniques will enhance the effectiveness of TCM in clinical practice. The aim of this study is to explore the relationships between clinical features and TCM patterns in breast cancer patients.Methods The dataset of breast cancer patients receiving TCM treatment was recruited from a single medical center. We utilized a neural network model to standardize terminologies and address TCM pattern differentiation in breast cancer cases. Cluster analysis was applied to classify the clinical features in the breast cancer patient dataset. To evaluate the performance of the proposed method, we further compared the TCM patterns to therapeutic principles of Chinese herbal medication in Taiwan.ResultsA total of 2,738 breast cancer cases were recruited and standardized. They were divided into 5 groups according to clinical features via cluster analysis. The pattern differentiation model revealed that liver-gallbladder dampness-heat was the primary TCM pattern identified in patients. The main therapeutic goals of the top 10 Chinese herbal medicines prescribed for breast cancer patients were to clear heat, drain dampness, and detoxify. These results demonstrated that the neural network successfully identified patterns from a dataset similar to the prescriptions of TCM clinical practitioners.Conclusion This is the first study using machine-learning methodology to standardize and analyze TCM electronic medical records. The patterns revealed by the analyses were highly correlated with the therapeutic principles of TCM practitioners. Machine learning technology could assist TCM practitioners to comprehensively differentiate patterns and identify effective Chinese herbal medicine treatments in clinical practice.
... Synthetic forms of ATX have been manufactured and we can easily get the compound ingredient for the wet-lab experiments. Our approach suggests ATX belongs to the liver Meridian that stores blood for regulating the blood volume of the body based on the five elements theory [41]. Currently, there are no studies paying attention to the function of the ATX in vascular smooth muscle cells (VSMCs). ...
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... The You Gu Wu Yun was early proposed as a kind of dialectical understanding of thought in the Plain Questions, with the explanation of that "If you have any disease, your sick body will absorb it as the medicine, otherwise your healthy body will absorb it as the poison." [7] It reminds us to consider the individual status and disease when assessing the safety of H&TM. When H&TM works on healthy bodies rather than suitable patients with specific syndromes, even if conventional deemed "nontoxic" medicines, it will be more possibilities to induce injuries. ...
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The safety issue on herbal and traditional medicines (H&TM) is one of the most challenging problems and serious concern worldwide. With scientific endeavor and further exploration, we came to realize that there are great differences between H&TM and synthetic drugs in many aspects, such as medical theory, medication experience, compatibility, processing, toxicological characteristics, and safety evaluating requirements. In the current preclinical models for synthetic drugs, the safety assessment results of some conventional deemed “nontoxic” H&TM were not well consistent with clinical situations, which resulted in major difficulties to understand the mechanisms and guide the safe and rational uses of these H&TM. Thus, based on the traditional Chinese medicine toxicity theory called You Gu Wu Yun, this paper introduces a novel safety assessment strategy for H&TM, named as disease-based toxicology. It aims to cognize the relativity and susceptibility of the toxicity of H&TM, and then to enhance controllability in new drug development and clinical applications. It also provides a theoretical practice for the traditional Chinese medicine toxicity theory and a methodological promotion for the future development of the precision toxicology for H&TM.
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Anatomy is an early researched discipline of natural science. Ancient civilizations (e.g., Greece, Egypt, Mesopotamia, and China) made significant contributions to our current understanding of medicine, including human anatomy. However, in modern China (from 1912 to the present), some contemporary scholars prefer to overlook the fact that anatomy was studied before modern China. Therefore, the author chronologically lists typical hallmark events and publications related to human anatomy before modern China, summarizes the influences of anatomy on traditional Chinese medicine, and analyzes the reasons for the slow progression of anatomy before modern China. The purpose is to better understand the history and culture of anatomy before modern China, serving as the first step of anatomical education for medical students in mainland China.
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Introduction According to traditional Chinese medicine (TCM), anger is closely related to the liver. This review was conducted to comprehend liver-associated patterns that manifest as anger syndromes in TCM. Methods Data regarding preclinical and clinical studies extracted from the China National Knowledge Infrastructure were reviewed to investigate whether it is justifiable and possible to define liver-associated patterns as anger syndrome. TCM patterns from two standard data sources—the World Health Organization standardization of terminologies in TCM and the pattern diagnosis standards of TCM—were analyzed for liver-associated patterns with the anger symptom. The direction, duration, and severity of anger symptoms of the extracted patterns were classified according to the TCM theory concepts such as yin and yang and excess and deficient by two independent authors. Results Among 18 liver-associated patterns involving anger symptoms from the two data sources, 12 were associated with outward-focused anger (tendency to express anger verbally and/or behaviorally), four with inward-focused anger (tendency to suppress anger), and two with both outward-focused and inward-focused anger (a problem of anger control). All studies retrieved from the database were examined for the relationship between the liver and anger, with few or no studies examining the relationship between the other four viscera and anger. Conclusions This review suggests that using liver-associated patterns in TCM may be a useful strategy for understanding and managing anger syndromes. However, because this study presents only a theoretical framework and preliminary review, further studies linking liver-associated patterns with various anger states are warranted.
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Hepatopulmonary syndrome (HPS) is characterized by abnormalities in blood oxygenation caused by the presence of intrapulmonary vascular dilations (IPVD) in the context of liver disease, generally at a cirrhotic stage. Knowledge about the subject is still only partial. The majority of the information about the etiopathogenesis of HPS has been obtained through experiments on animals. Reported prevalence in patients who are candidates for a liver transplantation (LT) varies between 4% and 32%, with a predominance of mild or moderate cases. Although it is generally asymptomatic it does have an impact on their quality of life and survival. The diagnosis requires taking an arterial blood gas sample of a seated patient with alveolar-arterial oxygen gradient (AaO2) ≥ 15 mm Hg, or ≥ 20 mm Hg in those over 64 years of age. The IPVD are identified through a transthoracic contrast echocardiography or a macroaggregated albumin lung perfusion scan (99mTc-MAA). There is currently no effective medical treatment. LT has been shown to reverse the syndrome and improve survival rates, even in severe cases. Therefore the policy of prioritizing LT would appear to increase survival rates. This paper takes a critical and clinical look at the current understanding of HPS, as well as the controversies surrounding it and possible future research. © The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
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The theory of Chinese medicine believes rage harms normal liver function, namely 'raged impairing liver' in short. The purpose of this study is to investigate the impact of acute stress on liver lipid metabolism in rats.Methods and results: Comparison of liver function indicators, serum lipid level of rats under acute stress and normal rats, as well as detection of liver tissue in the SR - BI, ABCG5 and ABCG8 protein and gene expression changes. Acute stressed rats had shown a lower serum levels of albumin (P<0.01) , HDL- cholesterol (P<0.01) than normal rats, with higher serum levels of globulin (P<0.01) and LDL-cholesterol (P<0.05). Acute stressed rat's liver tissue exhibited a lower protein expression of ABCG5 (P<0.05) , ABCG8 (P<0.01) and a higher level of SR-BI(P<0.05), compared with to normal rats. Furthermore, liver gene expression of ABCG5 (P<0.01) and ABCG8 (P<0.05) were lower in acute stressed rats than in normal rats, while SR-BI was higher in acute stressed rats than in normal rats (P<0.01). Acute stress had a direct influence on rat's liver lipid metabolism.
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Background: Since, to our knowledge, there is no report on age-related changes in the patterns associated with anxiety and mood disorders, a large-size case-control study was conducted. Methods: A total of 914 new cases were assessed at a psychosomatic clinic of a tertiary medical care center. The severity of visceral patterns was analyzed according to the main symptoms described and a comprehensive questionnaire. Patterns of the liver (three), heart (four), and kidney (one) as well as dual deficiency of the heart and spleen were assessed. Results: In females under 40 years of age, liver qi depression and phlegm fire harassing the heart were associated with generalized anxiety disorder. Liver fire flaming upward was associated with all forms of anxiety disorders in this group. Phlegm fire harassing the heart was associated with depression and all forms of mood disorders in females over 40 years of age, while it was inversely associated in males over 40 years of age. Conclusion: The order of the traditional Chinese patterns resulting in anxiety or mood disorders was consistent with the development of liver qi depression into liver fire flaming upward or phlegm fire harassing the heart according to the traditional Chinese theory. The patterns associated with depression and all forms of mood disorders vary according to age and sex.
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Background: There is no report on traditional Chinese patterns associated with stress-related disorders such as eating disorder, pain disorder, primary insomnia, functional dyspepsia, irritable bowel syndrome, hyperventilation syndrome, bronchial asthma, and dystonia. Therefore, a large-size case-control study was conducted. Methods: A total of 914 new cases were assessed at a psychosomatic clinic of a tertiary medical care center. The severity of visceral patterns was analyzed according to the main symptoms described and a comprehensive questionnaire. Three patterns of the liver, four of the heart, and one of the kidney as well as dual deficiency of the heart and spleen were assessed. Results: Multiple logistic regression analysis revealed that liver qi depression, liver fire flaming upward, phlegm clouding the pericardium, and dual deficiency of the heart and spleen were associated with bulimia nervosa in females. Liver fire flaming upward and phlegm turbidity were associated with primary insomnia and pain disorder, respectively, in males. An excess pattern was associated with irritable bowel syndrome, while dual deficiency of the heart and spleen was associated with functional dyspepsia in females. On the other hand, the deficiency-excess pattern was reverse in males. Phlegm fire harassing the heart was associated with hyperventilation syndrome in females. Phlegm clouding the pericardium and two kinds of yin deficiency were associated with dystonia in females. Conclusion: Primary insomnia, pain disorder in males, gastrointestinal disorders, and hyperventilation syndrome are each attributed to a single individual pattern. The pattern is different between both sexes. Bulimia nervosa and dystonia are attributed to a few patterns respectively.
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Methods and thoughts of the further research on central neurobiological mechanisms of Gan in taking charge of dispersion and regulating emotion are discussed. By applying the holistic approach and homeostasis theory, combined with modern psychological stress theory, the authors put forward their hypothesis of study. They offered that the TCM theory of "Gan takes charge of dispersion and could regulate emotion" is affirmatively to have certain mechanisms of central neurobiology. So, cut-in from the point of psychological stress reaction, adopting the research thoughts of "prescription-syndrome-therapeutic effectiveness--essence of Zang-Fu function", a model of chronic psychological stress reaction (CPSR) for imitating the process of comprehensive pathologic change due to Gan fails to take charge of dispersion and leads to emotional disorder was established. It is considered based on analysis of materials obtained from previous studies, that the central neurobiologic mechanism of so called dispersion, which Gan in charge of, is related to the regulation of hypothalamus-pitutary-adrenal gland axis. Concretely, the function of Gan in TCM may be, in the gross, related with the changes of multiple neurotransmitters and their synthetase produced in the process of CPSR (emotional disorder) regulation, such as neuropeptides, hormones, cyclic necleotide system and Fos protein expression, showing the characteristics of multiple links, multiple levels and multiple targets, with the effects involve several brain regions including various clusters of nuclei in hypothalamus, hippocampus and amygdala, etc.
On microscopic and macroscopic substance of liver manifestation in TCM
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