B. Pleural effusion
It is a condition of collection of fluid within the pleural cavity as a result of heart failure, bleeding (hemothorax), infections, excessive or decreased fluid volume, etc.
B.6.1. Treatments in conventional medicine perspective
B.6.1.3. Liver disease (cirrhosis)
Treatments of cirrhosis depend not only on the underlined causes but also the stages of the diseases
A.1. Alcohol causes of cirrhosis
If the the disease is caused by excessive alcohol drinking, patients will be asked to stop drinking. with help from the professional teams and certain medication. The long-term management of alcoholic liver disease stresses the following(82).
(1) Abstinence of alcohol (Grade 1A), with referral to an alcoholic rehabilitation program;
(2) Adequate nutritional support (Grade 1B), emphasizing multiple feedings and a referral to a nutritionist; (3) Routine screening in alcoholic cirrhosis to prevent complications;
(4) Timely referral to a liver transplant program for those with decompensated cirrhosis;
(5) Avoid pharmacologic therapies, as these medications have shown no benefit.
But according to the study by the Catholic University of Rome, in the intervention to achieve alcohol abstinence represents the most effective treatment for alcohol-dependent patients with liver cirrhosis by investigating the effectiveness and safety of Baclofen, is a GABA(B) receptor agonist in achieving and maintaining alcohol abstinence in patients with liver cirrhosis, showed that baclofen is effective at promoting alcohol abstinence in alcohol-dependent patients with liver cirrhosis. The drug is well tolerated and could have an important role in treatment of these individuals(83).
A.2. Obesity and Fatty liver
The prevalence of overweight and obesity are increasing in World wide, especially in the Emerging world, as a result of recently economic prosperity.
Obesity is defined as a medical condition of excess body fat accumulated overtime. Overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a BMI of over 30 is an indication of obesity. In US, 68% of population are either overweight or obese. According to the study by Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, for age-specific subgroup analyses, both overweight and obesity increased more rapidly in the toddler stage than in other developmental stages. Toddlers and urban boys were at particularly high risk; the prevalence in these groups increased more rapidly than in their counterparts(84).
The Obesity Society and the American Society of Hypertension agreed to jointly sponsor a position paper on obesity-related hypertension to be published jointly in the journals of each society(2). Other researchers suggested that in light of the worldwide epidemic of obesity, and in recognition of hypertension as a major factor in the cardiovascular morbidity and mortality associated with obesity(85).
Recent study showed that evidence has emerged for an association between genetic variability at the APOA5 locus and increased risk of obesity and metabolic syndrome(86).
Fatty liver disease is defined as a condition of accumulation of fat in the liver, including people who drink little or no alcohol (Non alcohol fatty disease) or who are excessive alcohol drinking (Alcohol fatty liver disease). The disease can even occur after a short period of heavy drinking (acute alcoholic liver disease). More than 15 million people in the U.S. either abuse or overuse alcohol with fatty liver diseases with fat makes up 5-10 percent of liver weight.
Non-alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of clinical conditions, actually representing an emerging disease of great clinical interest(87)
There is no standard treatment in conventional medicine. If you are obese, you are advised to lose weight. If excessive drinking alcohol is the cause, you are advised to stop drinking.
Some researchers suggested that Vitamin E plus C combination treatment is a safe, inexpensive and effective treatment option in patients with fatty liver disease, with results comparable to those obtained with ursodeoxycholic acid(88). But some researchers suggested that Neither vitamin E nor metformin was superior to placebo in attaining the primary outcome of sustained reduction in ALT level in patients with pediatric NAFLD(89).
In traditional Chinese medicine, fatty liver is associated closely to obesity, as a result of over intake of “bad” fat and excessive alcohol drinking. Even though fatty liver is a result of too much fat, but trying to eliminate all fats from the diet won’t help to prevent or relieve the disease as malnutrition can also trigger fatty liver as fat and protein stored elsewhere in the body move to the liver for storage and conversion to energy as needed. That’s why some women who eat almost nothing but vegetables can also develop fatty liver(90).
Many traditional Chinese medicine practitioners believe, no way that one can lose weight if fatty liver diseases are not cured. Syndromes of fatty liver could be typed into 4 TCM types of the asthenia Pi-Shen with Gan-stagnation type, the asthenia Pi-Shen type, the asthenia Pi with phlegm-heat type and the unclassified type. Among them the asthenia Pi-Shen with Gan-stagnation type was the commonest one, which accounted to 62.32%(91).
Dr. Liu T, and the research team at the Shanghai University of Traditional Chinese Medicine, in the study to explore the pathogenesis of nonalcoholic fatty liver (NAFL) in traditional Chinese medicine (TCM) by comparing the therapeutic efficacy of methods for fortifying the spleen and replenishing qi, warming yang and fortifying the spleen and warming yang to move water, showed that body weight, liver and epididymal fat indexes and liver TAG level of rats all significantly increased in the model group as compared with the normal group (P<0.05). Hepatic fatty infiltration, TAG concentration and the levels of serum TAG and ALT were significantly decreased in the LGZG and SZ groups when compared to those in the model group (P<0.05). Method of warming yang or moving water can promote the lipid metabolism. It may be an effective strategy in preventing and treating NAFL by treating with warming yang and moving water together(92)
Other studies showed that Zhi Zi has a very strong inhibitory action on lipidosis and inflammatory injury in the rat model of NAFLD. This mechanism may possibly be related to the inhibition of the free fatty acid metabolism pathway(93)).
In the study to investigate the effect of Cigu Xiaozhi pills on expression of tumor necrosis factor alpha (TNF-alpha) in rat with nonalcoholic steatoheptatitis (NASH), found that Cigu Xiaozhi pills can effectively treat experimental nonalcoholic steatohepatitis in rats, and its mechanism may be associated with ameliorating hepatocellular steatosis, removing the free radicals and enhancing the capability of anti-oxidation and anti-inflammatory(94).
Most people with fatty liver disease are experience no symptoms at all, but Fatty liver disease is associated with high blood pressure, heart disease and diabetes can, in time, cause life threatening cirrhosis of the liver. According to the article By Donald Norfolk, "Today, as a direct effect of the obesity plague, it's reckoned that one in five British adults is now suffering from fatty liver disease, unconnected with virus infections or heavy drinking. This malady, known medically as steatosis, is believed to affect 90 per cent of morbidly obese patients, in whom it may remain totally symptomless for many years"(95).
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