Traditional Chinese Medicine (TCM) treatment for fatty liver is increasingly explored by UK patients seeking complementary approaches to non-alcoholic fatty liver disease (NAFLD), now termed metabolic dysfunction-associated steatotic liver disease (MASLD). Affecting up to a third of UK adults, fatty liver disease represents the nation's most common liver condition. Whilst NICE guidance emphasises lifestyle modification and metabolic risk management as the cornerstone of treatment, some individuals consider TCM modalities including herbal medicine, acupuncture, and dietary therapy. This article examines how TCM approaches fatty liver, the evidence base, safety considerations, and how such therapies might integrate with conventional NHS care under appropriate medical supervision.

Understanding Fatty Liver Disease and TCM Approaches

Fatty liver disease, medically termed hepatic steatosis, occurs when excess fat accumulates in liver cells. In the UK, non-alcoholic fatty liver disease (NAFLD)—increasingly referred to as metabolic dysfunction-associated steatotic liver disease (MASLD)—affects approximately a quarter to a third of adults, making it the most common liver condition nationally. The spectrum ranges from simple steatosis to non-alcoholic steatohepatitis (NASH), which involves inflammation and potential progression to cirrhosis.

Conventional management focuses on lifestyle modification, weight reduction, and metabolic risk factor control. NICE guidance (NG49) emphasises dietary changes, increased physical activity, and management of associated conditions such as type 2 diabetes and dyslipidaemia. At the time of writing, no pharmacological treatment is licensed specifically for NAFLD in the UK, though clinical trials of emerging therapies are ongoing. This prompts some patients to explore complementary approaches.

Traditional Chinese Medicine (TCM) represents a holistic system practised for millennia, viewing health through the lens of energy flow (Qi), organ systems, and balance between opposing forces (Yin and Yang). TCM practitioners approach fatty liver not as an isolated pathology but as a manifestation of systemic imbalance. Treatment modalities may include herbal medicine, acupuncture, dietary therapy, and lifestyle recommendations tailored to individual constitutional patterns.

Patients considering TCM for fatty liver should understand that whilst this approach has historical precedent and growing research interest, it should complement rather than replace evidence-based conventional care. The MHRA regulates herbal medicines in the UK through the Traditional Herbal Registration (THR) scheme, which assures quality and safety but does not assess efficacy; many practitioner-prepared TCM prescriptions are unlicensed and fall outside this framework. Any complementary therapy should be discussed with your GP or hepatologist to ensure safe, coordinated care and appropriate monitoring.

UK assessment pathway: Your GP will assess for underlying causes (alcohol, viral hepatitis, metabolic syndrome) and calculate your fibrosis risk using the FIB-4 score. If risk is indeterminate or high, an Enhanced Liver Fibrosis (ELF) blood test or FibroScan may be arranged. High-risk cases are referred to hepatology. Alcohol consumption should be kept within UK Chief Medical Officers' guidelines (≤14 units per week); consider abstinence if you have steatohepatitis or cirrhosis.

Red flags requiring urgent assessment: Contact your GP the same day or call 999 if you develop jaundice (yellowing of skin or eyes), confusion, vomiting blood, black tarry stools, severe abdominal pain, or rapidly increasing abdominal swelling.

How Traditional Chinese Medicine Views Fatty Liver

Traditional Chinese Medicine does not recognise 'fatty liver' as a distinct diagnostic entity in classical texts, as the condition was not historically described in these terms. However, TCM practitioners interpret the pathophysiology through established diagnostic frameworks, typically identifying patterns involving the Liver, Spleen, and Kidney organ systems—which differ conceptually from their Western anatomical counterparts and should not be confused with biomedical organ function.

In TCM theory, fatty liver commonly reflects Liver Qi stagnation combined with Spleen deficiency and Dampness accumulation. The Spleen (in TCM terms) governs transformation and transportation of nutrients; when deficient, it fails to metabolise food essence properly, leading to Dampness and Phlegm accumulation. The Liver system regulates the smooth flow of Qi throughout the body; stagnation here may manifest as abdominal distension, irritability, or—in TCM theoretical terms—metabolic dysfunction. Over time, Dampness may transform into Phlegm or Heat, which practitioners view as metaphorically analogous to inflammation.

Practitioners conduct diagnosis through four examination methods: observation (including tongue appearance), listening and smelling, questioning (about symptoms, diet, emotions, sleep), and palpation (particularly pulse diagnosis). A patient with fatty liver might present with a greasy tongue coating, a slippery pulse quality, fatigue, abdominal bloating, and poor appetite—signs interpreted as Spleen Qi deficiency with Dampness retention.

Treatment principles aim to strengthen Spleen function, resolve Dampness and Phlegm, regulate Liver Qi, and clear Heat if inflammation is present. This individualised approach means two patients with identical ultrasound findings might receive different herbal formulae based on their unique pattern presentation.

Important: TCM diagnostics are traditional theoretical frameworks and are not substitutes for medical assessment, blood tests, imaging, or fibrosis risk scoring. All patients considering TCM should maintain standard NHS investigations and monitoring for fatty liver disease.

Common TCM Treatments for Fatty Liver in the UK

In the UK, TCM practitioners registered with professional bodies such as the British Acupuncture Council or the Register of Chinese Herbal Medicine may offer several therapeutic modalities for fatty liver management. Chinese herbal medicine represents the primary treatment approach, typically prescribed as individualised formulae combining multiple herbs to address the patient's specific pattern.

Commonly used herbal ingredients include:

• Yin Chen Hao (Artemisia capillaris) – traditionally used to clear Liver Heat and promote bile flow

• Shan Zha (Crataegus pinnatifida, hawthorn) – traditionally thought to reduce food stagnation; some preliminary evidence for lipid effects

• He Shou Wu (Reynoutria/Polygonum multiflorum) – used to nourish Liver and Kidney systems; caution: associated with drug-induced liver injury (DILI) in susceptible individuals; should only be used under expert supervision with regular liver monitoring and never self-prescribed

• Dan Shen (Salvia miltiorrhiza) – believed to invigorate blood circulation and reduce stasis

• Ze Xie (Alisma species) – employed to drain Dampness; correct botanical identification is essential to avoid toxic substitutes

These herbs may be dispensed as raw materials for decoction (boiling), concentrated granules, or tablets. Formulae are typically modified over time as the patient's condition evolves. Botanical identification should follow pharmacopoeial standards to reduce misidentification risk. Avoid products containing banned substances such as Aristolochia species.

Acupuncture may be offered as adjunctive therapy, with practitioners selecting points believed to regulate Liver and Spleen function, such as Liver 3 (Taichong), Spleen 6 (Sanyinjiao), and Stomach 36 (Zusanli). Sessions typically occur weekly initially, then less frequently. Acupuncture should use single-use sterile needles; inform your practitioner if you take anticoagulants or have a bleeding disorder, as needling carries a small risk of bruising or bleeding. Infection control standards must be maintained.

Dietary therapy forms an integral component, with recommendations to avoid greasy, fried, and excessively sweet foods whilst emphasising easily digestible options like congee, steamed vegetables, and adequate protein intake. If you have advanced fibrosis or cirrhosis, seek specialist dietetic advice; protein restriction is generally not recommended and higher protein intake may be needed to prevent muscle loss (sarcopenia). Practitioners may also suggest Qi Gong exercises to promote Qi circulation and support metabolic function.

Patients should ensure their TCM practitioner is appropriately qualified and registered with a recognised professional body, ideally one accredited by the Professional Standards Authority (PSA). Verify that the practitioner holds professional indemnity insurance. For over-the-counter herbal products, look for the THR logo, which indicates the product meets MHRA quality and safety standards. Avoid purchasing herbal medicines from unregulated online sources or overseas suppliers, as these may be contaminated, adulterated, or contain undeclared pharmaceutical ingredients.

Evidence and Safety Considerations for TCM Therapy

The evidence base for TCM in fatty liver disease remains limited and of variable quality. Systematic reviews have identified numerous Chinese studies suggesting potential benefits of herbal formulae on liver enzymes, hepatic fat content, and metabolic parameters. However, methodological concerns—including small sample sizes, inadequate blinding, publication bias, and heterogeneous interventions—limit confidence in these findings. High-quality, large-scale randomised controlled trials conducted to UK or European standards are scarce, and many herbal efficacy claims remain speculative.

Some individual herbs have shown promise in laboratory and animal studies. Silymarin (milk thistle), whilst not traditionally Chinese, is sometimes incorporated into practice and has modest evidence for hepatoprotective effects. Berberine-containing herbs demonstrate lipid-lowering properties in some clinical trials. However, translating these findings to clinical practice requires caution, as herbal medicine involves complex multi-ingredient formulae rather than isolated compounds.

Safety considerations are paramount. Herbal medicines are not inherently safe simply because they are 'natural'. Potential risks include:

• Hepatotoxicity – certain herbs, particularly He Shou Wu (Reynoutria/Polygonum multiflorum), have been associated with drug-induced liver injury in susceptible individuals. Other herbs may also cause liver damage.

• Drug interactions – herbs may affect cytochrome P450 enzymes, altering metabolism of conventional medications including statins, anticoagulants, and antidiabetic drugs. Always inform your GP and pharmacist about all herbal medicines you are taking.

• Contamination and adulteration – products sourced outside regulated channels may contain heavy metals, pesticides, or undeclared pharmaceutical ingredients.

• Misidentification – incorrect botanical identification can lead to inadvertent exposure to toxic species, including banned substances such as Aristolochia.

The MHRA advises purchasing herbal medicines only from registered practitioners or reputable UK suppliers. For over-the-counter products, look for the THR logo. Patients should inform all healthcare providers about TCM use to enable appropriate monitoring and avoid interactions.

Monitoring: Regular monitoring is essential. NICE recommends non-invasive fibrosis risk assessment using the FIB-4 score; if indeterminate or high, an Enhanced Liver Fibrosis (ELF) blood test (threshold ≥10.51 indicates high risk of advanced fibrosis) or FibroScan may be arranged. Liver function tests (LFTs) alone may be normal even in advanced fibrosis and are insufficient for monitoring disease progression. Herbal therapy could theoretically mask disease progression or cause additional hepatic stress.

Reporting adverse reactions: If you experience jaundice, severe abdominal pain, dark urine, pale stools, unexplained symptoms, or any suspected side effect whilst taking herbal medicine, discontinue use immediately and contact your GP. Report suspected adverse reactions to herbal medicines or supplements via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

Special populations: Most herbal medicines are not recommended in pregnancy, breastfeeding, or for children unless prescribed by a specialist with appropriate expertise. Always inform your healthcare provider if you are pregnant, planning pregnancy, or breastfeeding.

Integrating TCM with Conventional Fatty Liver Management

An integrated approach combining evidence-based conventional management with carefully selected complementary therapies may offer the most pragmatic strategy for patients interested in TCM. NICE guidance (NG49) for NAFLD emphasises lifestyle intervention as the cornerstone of treatment, recommending gradual, sustainable weight loss of 7–10% body weight for those overweight or obese. Avoid crash diets or rapid weight loss, which may worsen liver inflammation.

Dietary advice should follow a Mediterranean-style pattern—emphasising whole grains, vegetables, fruit, legumes, nuts, olive oil, and fish—as recommended by the British Liver Trust and international liver societies. The UK Chief Medical Officers' Physical Activity Guidelines recommend at least 150 minutes of moderate-intensity physical activity weekly for adults. Alcohol consumption should remain within UK CMO low-risk drinking guidelines (≤14 units per week, spread over at least three days); consider abstinence if you have steatohepatitis or cirrhosis.

TCM dietary principles—emphasising whole foods, reducing excessive fat and sugar intake, and promoting digestive health—align substantially with these recommendations. The TCM emphasis on mindful eating, regular meal times, and avoiding late-night consumption may support behavioural changes conducive to metabolic health. Acupuncture, whilst lacking robust evidence for direct hepatic effects, may offer modest support for stress reduction and treatment adherence, though evidence for weight management benefits remains uncertain and should not be relied upon as a substitute for lifestyle measures.

Patients should maintain open communication with their NHS healthcare team when pursuing TCM. Your GP or hepatologist should be informed about all supplements and herbal medicines, enabling them to:

• Monitor for potential interactions with prescribed medications

• Interpret blood tests appropriately, distinguishing disease progression from treatment effects

• Coordinate care and avoid conflicting advice

• Ensure appropriate investigation of underlying causes (metabolic syndrome, alcohol use, viral hepatitis)

• Arrange fibrosis risk stratification using FIB-4, ELF, or FibroScan as per NICE guidance

For patients with advanced fibrosis or cirrhosis, specialist hepatology input is essential, and any complementary therapy should be discussed with the consultant. Those with NASH may be eligible for clinical trials of emerging pharmacological treatments, which could be compromised by concurrent herbal medicine use.

1. UK assessment and referral pathway:
2. GP assesses for causes and calculates FIB-4 score
3. If FIB-4 indeterminate or high, request ELF blood test (per NICE DG34) or arrange FibroScan
4. ELF ≥10.51 or high FibroScan result indicates high risk of advanced fibrosis
5. Refer high-risk cases to hepatology for specialist assessment and management

Ultimately, no complementary therapy should delay or replace proven interventions. Weight reduction, diabetes control, cardiovascular risk management, and alcohol moderation remain the evidence-based priorities. TCM may serve as an adjunct for motivated patients seeking a holistic approach, provided safety is carefully considered and conventional care remains the foundation of management. If considering TCM, seek practitioners registered with recognised professional bodies (ideally PSA-accredited) and maintain regular NHS follow-up with appropriate fibrosis risk monitoring.

Frequently Asked Questions