TCM for Fatty Liver & Cancer Prevention

This form of cancer is insidious and painless, hidden deep within the body; once it manifests, it is invariably at an advanced stage, leaving the patient with a mere six months to live. No one wishes to be stricken with such a dreadful disease—each individual diagnosed is, in effect, condemned to an immediate death sentence. Recently, renowned celebrities such as Shi Shengjie and Zang Tianshuo tragically succumbed to it. It is, of course, liver cancer.

Liver cancer is both subtle and stealthy, its symptoms nearly imperceptible to the average person. By the time it is detected, it has typically advanced to a late stage, and the survival rate is nearly zero—only a scant six months of struggling existence remain. Why is this so? The liver, being a “mute organ,” lacks pain receptors; even when it is severely compromised, it remains silent, giving the false impression that all is well. This is in stark contrast to other vital organs such as the stomach, which reacts at the first sign of discomfort with pain, bloating, or vomiting, or the lungs, which prompt coughing, chest tightness, or shortness of breath, or even the intestines, whose distress reveals itself through changes in bowel movements, diarrhea, constipation, or abdominal pain.

The liver is the epitome of quiet resilience; it will not betray its failing state until absolutely necessary. This is because the liver possesses an extraordinary compensatory capacity—even if 70% of the liver is damaged, the remaining 30% can still function normally. However, once this threshold is exceeded and the organ’s size begins to alter, the expanding tumor eventually irritates the surrounding capsule, at which point pain in the liver area is finally felt—alas, by then it is too late, and the fatal outcome is imminent.

So the question arises: how can ordinary people prevent liver cancer? Is there no method to predict its onset in advance? Western medicine would advise annual check-ups, yet few adhere to such rigorous testing; it is too burdensome, especially for those who feel their liver is functioning normally and thus see no need for yearly examinations.

What about Traditional Chinese Medicine (TCM)? TCM offers significant advantages in preventing liver cancer because it does not wait until liver function is severely impaired before advising remedial measures. Instead, it alerts you when there is even a slight imbalance in the liver system—prompting you to nurture and protect your liver. In truth, the early warning signs of liver cancer are often present long before the disease fully manifests; one of the most notable is fatty liver—the harbinger of liver cancer that will be the focus of today’s discussion.

Many assume that liver cancer typically follows a progression from hepatitis B to cirrhosis to liver cancer. In reality, only 8% of hepatitis B cases evolve into liver cancer; the most likely precursor is hepatitis C, accounting for 48%, while fatty liver disease accounts for 26% and alcoholic liver disease for 14%. Considering that fatty liver and alcoholic liver conditions often coexist, fatty liver alone is responsible for about 40% of liver cancer cases.
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These numbers are alarming. The progression from fatty liver to liver cancer can be envisioned in four steps: fatty liver → steatohepatitis → cirrhosis → liver cancer. In actuality, the process may require merely two steps, as prolonged fatty liver can directly advance to cirrhosis, which is notoriously irreversible, leaving liver cancer as the inevitable consequence.

Thus, a word of caution: do not underestimate fatty liver disease. Do not regard it as a benign, inconsequential condition—it can transform into a ferocious tiger when provoked.

To prevent liver cancer, one must begin with the management of fatty and alcoholic liver disease—by nurturing and safeguarding the liver from the outset.

Today, I will share with you, from a TCM perspective, how to manage fatty liver. What is the primary culprit behind fatty liver disease? Most immediately think of obesity—and rightly so, since fatty liver literally means an excessive accumulation of fat within the liver. The most predisposed individuals are those who are overweight. In TCM, this type of fatty liver is classified as “phlegm-dampness.” While Western medicine posits that the liver metabolizes fat, TCM refers to this function as “dispersing and draining.” When the liver’s dispersing capacity diminishes, surplus fat accumulates, resulting in fatty liver. Overeating rich, greasy foods and a sedentary lifestyle contribute to the generation of phlegm-dampness, which in turn impairs the spleen and stomach’s ability to transform and transport nutrients. Gradually, this phlegm-dampness converges in the liver; when its accumulation surpasses the liver’s dispersing ability, fatty liver is inevitable.

Phlegm-dampness is the primary cause of fatty liver. Yet, its detrimental effects are not confined solely to the liver; when it accumulates on the face, it causes acne; in the throat, it leads to the sensation of a lump (plum pit qi); on the skin, it forms various lipomas or cysts; around the neck, it results in lymph node nodules or thyroid nodules; in the lungs, it can produce nodules; and within blood vessels, it may even precipitate thrombosis. At this point, lean individuals might breathe a sigh of relief—after all, I am slender and assumed I was exempt from fatty liver. But does being slim guarantee immunity from fatty liver? Not necessarily. In slim individuals, fatty liver is most often due to stagnation of liver qi, or what TCM describes as liver qi stagnation.

Indeed, liver qi stagnation is the second most common cause of fatty liver, frequently seen in lean individuals and women. The liver is inherently meant to be free and expansive, much like an innocent child who freely expresses emotions without constraint—eating, sleeping, or even crying as desired. The liver, by nature, dislikes suppression. To ensure that the liver functions optimally, one must allow it to operate unimpeded; suppressing it by harboring negative emotions such as melancholy, anger, or bottled-up frustration is tantamount to placing a straitjacket on the liver, confining it within a cage. When the liver ceases to function properly, even minimal fat deposits will gradually accumulate, eventually manifesting as fatty liver, simply because the liver loses its ability to disperse or metabolize fat. Therefore, if you are a slim woman who is diagnosed with fatty liver, it is imperative to consider whether liver qi stagnation might be at fault.

In addition to phlegm-dampness and liver qi stagnation, another major contributor to fatty liver is blood stasis resulting from qi stagnation. This concept is rather intuitive: regardless of whether the underlying issue is phlegm-dampness or liver qi stagnation, the root problem is one of blockage. Prolonged illness inevitably leads to blood stasis—a state in which the liver becomes an isolated island, severed from the smooth circulation of qi and blood, with flow that is sporadic at best. Of course, traumatic injuries—such as those sustained in a vehicular accident or physical altercation—that damage the liver can also result in qi stagnation and blood deficiency, though such instances are comparatively rare.

Having thoroughly examined the etiology of fatty liver, we now turn to its treatment. Let us concoct a prescription together. Since phlegm-dampness is the principal cause of fatty liver, we begin with Er Chen Tang, the venerable formula known for resolving phlegm. This formulation employs Chen Pi and Ban Xia. Recognizing that phlegm originates from dampness—which in turn arises from the spleen and stomach—we must address the root of the problem by tonifying the spleen and expelling dampness, thereby enhancing the spleen and stomach’s ability to separate the pure from the impure. For this purpose, Bai Zhu and Fu Ling are indispensable: Bai Zhu strengthens the spleen, while Fu Ling dispels dampness, a perfect harmony of upward and downward movement.

Given the presence of liver qi stagnation, we must also soothe the liver and regulate qi to restore its natural exuberance. The herb Chai Hu is the unequivocal choice here; it is the premier remedy for dispersing liver qi, and it possesses the added benefit of guiding the medicinal properties directly to the liver. Alternatives such as Yu Jin, Mu Xiang, or Xiang Fu are available, but they never quite match the efficacy of Chai Hu.

Prolonged qi stagnation can ignite internal heat, and persistent phlegm-dampness may eventually transform into fire. To dispel liver fire, Gentian (Long Dan Cao) is the herb of choice, capable not only of clearing liver fire but also of eliminating damp-heat from the liver and gallbladder. However, Long Dan Cao is a potent herb, so it should be used sparingly, as clearing liver fire is not the primary objective in treating fatty liver.

As for the lingering issue of blood stasis, a simple remedy of Danshen will suffice.

Finally, no treatment is complete without reinforcing the body’s vital energy. Once the body’s righteous energy is robust, it is far easier to expel pathogenic factors. Thus, we must nourish the liver blood and replenish its yin. A well-nourished liver is akin to a well-oiled lamp—radiant and resplendent. For fortifying liver blood, Dang Gui is unrivaled; it is the most essential herb in the Four-Substance Decoction and an indispensable remedy for nurturing liver blood.

In summary, the following formula for regulating fatty liver has been devised:

  • Chai Hu 9 g
  • Chen Pi 12 g
  • Ban Xia 9 g
  • Danshen 9 g
  • Long Dan Cao 3 g
  • Bai Zhu 9 g
  • Fu Ling 12 g
  • Dang Gui 6 g
  • Gan Cao 6 g

I have named this formulation “Xiao Zhi Jiu Wei Tang” (Nine-Ingredient Fat-Reducing Decoction). It is designed to comprehensively address all manifestations of fatty liver. If you trust my guidance, you may consider taking it. Do not inquire about the duration of treatment—since each individual’s condition varies, I can only suggest that a typical course of decoction lasts seven days, and usually three courses are required. Begin with one course and monitor your body’s response.

If you remain skeptical of this herbal approach, fret not—TCM also offers ready-made patent medicines for managing fatty liver. For those with a phlegm-dampness type, Jiawei Baohe Wan and Xiangsha Liu Jun Wan are recommended. For the liver qi stagnation type, Chaihu Shugan San combined with Jiawei Baohe Wan may be used. For the blood stasis type, Jiawei Baohe Wan with Sanqi powder is advisable. Additionally, you may prepare a tea by steeping lotus leaf, Chen Pi, and hawthorn. The lotus leaf fortifies the spleen and expels dampness, Chen Pi transforms phlegm and soothes liver qi, and hawthorn aids digestion while reducing fat and resolving stasis. A small handful each day will suffice.

Lean in and listen closely: a friend of mine in Dali once prepared his own enzyme drink, consuming it for three months, and successfully eliminated his fatty liver! This method is both simple and practical—something you might well consider trying.