A 41-year-old woman with a diagnosis of moderate fatty liver disease, elevated cholesterol, and chronic fatigue was successfully managed and completely reversed within three months using a Dampness-clearing and Stasis-resolving herbal strategy.

Case ID: CHC-0080

Case Summary

This case describes a 41-year-old woman who presented with moderate fatty liver disease, accompanied by high cholesterol, fatigue, right rib discomfort, and digestive issues. The original report documented a conventional diagnosis of moderate fatty liver and a TCM assessment of Liver Accumulation (Gan Pi) driven by the intertwining of Dampness and Stasis. She was managed by Professor Hu Shiping using his core academic principle of “pushing out the old to bring in the new” (推陈致新). By utilizing a custom herbal decoction that simultaneously strengthened the Spleen, cleared Damp-Heat, and scoured turbid lipids from the blood, the patient’s fatty liver was completely reversed in just over three months.

Patient Presentation

• Patient: 41-year-old female (Surname: Zhou).
• Main Complaint: Right hypochondriac (rib) discomfort, fatigue, sticky and bitter taste in the mouth, poor appetite, eating little, yellow urine, and constipation.
• History: The patient sought her initial consultation on May 23, 2018. Four months prior, an abdominal ultrasound had discovered moderate fatty liver.

Examination and Diagnosis

• Labs & Imaging: Total Cholesterol (TC) was elevated at 6.58 mmol/L, LDL-C was elevated at 4.37 mmol/L, APO-A1 was elevated at 1.771 g/L, and APO-B was elevated at 1.805 g/L.
• Conventional Diagnosis: Moderate fatty liver.
• TCM Tongue and Pulse: The tongue body was enlarged and red, with stasis spots (瘀点) on the edges and a yellow, greasy coating. The pulse was fine and slippery (脉细滑).

TCM Assessment

The original practitioner interpreted the presentation as Liver Accumulation driven by the Intertwining of Dampness and Stasis (肝癖 – 湿瘀互结).

According to the holistic principles of Chinese Medicine, Professor Hu Shiping views metabolic diseases like fatty liver as being primarily caused by “Phlegm, Dampness, and Stasis.” In this patient, underlying Spleen deficiency meant her body failed to properly transform food into usable energy, instead generating internal phlegm and dampness.

This trapped dampness congested the middle Jiao, causing “Earth to congest and Wood to stagnate” (土壅木郁). Over time, this stagnation generated Heat, resulting in a complex knot of Dampness, Stasis, and Heat. This pathology directly caused her sticky/bitter mouth, yellow urine, constipation, and fatigue. The enlarged red tongue with stasis spots and a yellow greasy coating, combined with the fine and slippery pulse, provided textbook objective confirmation of this heavy, turbid damp-heat and congealed blood stasis.

Treatment Approach

The primary treatment principle was to eliminate dampness and resolve stasis (除湿化瘀), guided by the overarching strategy of “pushing out the old to bring in the new” (推陈致新). The strategy aimed to physically clear the pathological waste (turbid lipids, damp-heat, and stasis) while simultaneously supporting the Spleen to restore the body’s natural metabolic generation and transformation.

Interventions and Herbal Formulas

• Initial Herbal Formula (May 23, 2018): A 15-herb decoction designed to clear damp-heat, unblock the intestines, and dissolve blood stasis.
  • Strengthening Spleen and Removing Dampness: Cang Zhu (15g), Bai Zhu (15g), Fu Ling (15g), and Gan Cao (5g) fortify the digestive center so that nutrients are properly dispersed instead of turning into turbid fat.
  • Clearing Damp-Heat: Huang Qin (15g), Huang Bo (15g), and Zhi Zi (15g) aggressively clear the accumulated damp-heat from the Liver, Gallbladder, and lower body.
  • Draining Turbidity: Ze Xie (20g) and Jue Ming Zi (30g) drain the foul turbidity down and out through the intestines and urine, relieving the constipation.
  • Expelling Turbid Lipids from the Blood: Mu Dan Pi (15g), Chi Shao (15g), Dan Shen (20g), and San Qi Powder (6g) strongly cool the blood, resolve stasis, and scour the blood vessels of turbid lipids.
  • Moving Qi and Resolving Accumulation: E Zhu (10g) and Shan Zha (Hawthorn, 30g) move Qi and specifically dissolve fleshy accumulations and lower blood lipids.
  • Administration: 3 doses, water decocted, taken warm after breakfast and dinner.
• Second Visit (June 27, 2018): After the initial course of treatment, the patient’s fatigue was relieved, the sticky and bitter taste in her mouth diminished, and her urination and bowel movements normalized. However, she now reported feeling abdominal bloating after eating.
  • Formula Adjustment: Recognizing that the acute damp-heat had cleared but her Spleen remained slightly weak and burdened by food stagnation, the practitioner removed the bitter and cold Huang Bo. He added Hong Qu (Red Yeast Rice, 6g) to specifically strengthen the Spleen, resolve food stagnation, and powerfully lower cholesterol. (14 doses prescribed, taken as before).

Follow-Up

• The patient continued to be managed and her formula adjusted based on these principles for just over three months.
• Outcome (September 18, 2018): A follow-up abdominal ultrasound showed absolutely no fatty liver. All of her clinical examinations returned to normal, indicating a complete reversal of the condition.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is Professor Hu Shiping’s application of the “Pushing out the old to bring in the new” (推陈致新) philosophy in treating metabolic disorders.

Fatty liver is fundamentally a disease of metabolic waste accumulation. “Pushing out the old” means forcefully eliminating the pathogenic factors (the “phlegm, dampness, and stasis”) using herbs like Jue Ming Zi, Dan Shen, and E Zhu. “Bringing in the new” means stimulating the body’s Righteous Qi and restoring normal blood and fluid metabolism by repairing the Spleen with Bai Zhu, Cang Zhu, and Hong Qu. By strictly adhering to this dual approach, the practitioner not only reversed the disease process and dissolved the fat in the liver, but also ensured that the patient’s innate digestive and metabolic functions were protected and restored, achieving a cure without damaging her core vitality.

Source Original source: Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang) / Traditional Chinese Medicine Bureau of Guangdong Province Original title: 【以案说医】胡世平：脂肪肝病痰湿瘀，推陈致新复生化 Practitioner: Professor Hu Shiping (胡世平) Publication date: August 13, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation