Mention the word liver toxicity and our ears perk up! Within our circle we are aware that liver toxicity induced by Chinese Herbal Medicine is a potential reality.

So what are the signs and symptoms of a liver problem? Initial symptoms are; fever, tiredness, general malaise (i.e. a feeling of being unwell). The liver is often tender and may be slightly enlarged. A skin rash may be present indicating hypersensivity reaction. Special attention should be paid to the following patients:

   “Sensitive” patients, i.e. Those who are very sensitive in nature.
   Patients on long term medication for epilepsy.
   Patients taking medication for along time (e.g. for arthritis, asthma, diabetes etc).
   Patients on multi drug regimes.
   Patients with skin problems
   Elderly patients.
   Patients with renal or hepatic impairment (including chronic alcohol abusers).

Pregnancy, cigarette smoking and poor nutrition may effect the capacity of the liver to metabolise drugs efficiently and put the patient at risk of developing liver damage. There are signs of a liver problem that sometimes manifest on the hands or face of the patient. Pay close attention to colour of the palms, shape and colour of the figure tips, colour distribution of the nails especially the thumb and index finger and the presence of spider naevus (small capillary- like red vessels seen on the surface of the skin which turn white when the centre is touched) especially on the face. All these indicate an existing liver problem. If the liver becomes inflamed, dark urine, pale stools, nausea, vomiting And sometimes-itchy skin is associated symptoms. The way forward, I believe, is to compare Chinese Herbal Medicine with pharmaceuticals.

Residual Pathogenic Factor

A Residual pathogenic factor develops during an invasion of Wind, usually at the Qi level. When one suffers an invasion of Wind, there are two possible outcomes: either the Wind is expelled from the body and you recovers completely, or the pathogenic factor progresses to the Qi level and becomes internal (usually in the form of Heat, Phlegm-Heat or Damp-Heat). After this progression, there are two possible outcomes: either the pathogenic factor is cleared and the body recovers without any residual effect, or the body appears to recover but there is left-over Heat, Phlegm-Heat or Damp-Heat, of which are examples of residual pathogenic factors.

Why does a residual pathogenic factor develop? In body, this is due three possible factors: a weak constitution, improper feeding or eating during the acute illness, or improper use of antibiotics. Antibiotics are the most common cause of residual pathogenic factor in body because, although they kill bacteria, they do not expel Wind, clear Heat or resolve Phlegm or Dampness; moreover, they are not effective against viruses and, in spite of this, they are frequently (and improperly) used in viral infections. Thus if body has an acute, febrile illness from a bacterial infection, the antibiotics will eliminate the fever by killing the bacteria, but the body may be left with Heat, Phlegm-Heat or Damp-Heat. The body appears to recover and goes back to work, but improper eating often continues and the residual pathogenic factor will predispose the body to a further infection. The body falls ill again with a fever, more antibiotics are administered and the residual pathogenic factor is only strengthened: thus, a vicious circle is installed and the body becomes chronically unwell.

The main patterns appearing as residual pathogenic factors are as follows.


Irritability, dry cough, slight thirst, restless sleep, red cheeks “floating “red on white complexion, tongue red in front part.

Lung Phlegm-Heat

Cough with sputum, tightness or feeling of oppression of the chest, irritability, restless sleep, catarrh, slight wheezing, thin-yellow tongue coating in Lung area, pulse Slippery.

Spleen Damp-Heat

Nausea, vomiting, diarrhoea, epigastric pain/fullness, smelly stools, bad breath, lassitude, night-sweating, sticky-yellow tongue coating.

Damp-Heat in Head

Sinusitis, blocked nose or constantly runny nose, swollen adenoids, prone to ear infections, irritability, restless sleep, dull frontal headache, catarrh, swollen glands in neck, prone to colds, sticky-yellow tongue coating.