Liver-blood deficiency manifestations

If there is obvious Liver-Qi stagnation but the cause is unclear, it is most likely caused by Liver-blood deficiency. In that situation, the Liver-blood is too weak to nourish the Liver, so the Qi moves slowly and tends to become stagnant. The syndrome of Liver-blood deficiency manifests as dizziness, vertigo, headache, migraine, tiredness, pale complexion, brittle nails and hair, irregular menstruation, irritability and mood swings. 

In this syndrome, each of the three factors (Liver-Qi stagnation, Liver-blood deficiency and Spleen-Qi deficiency) can influence, or be influenced by, the other two. This may lead to disharmony between the functions of the Liver and Spleen and cause related manifestations. 

E Jiao is sweet and neutral, and enters the Liver and Kidney meridians. It is able to tonify the Liver-blood and the Kidney-essence. This substance is moistening in nature and can nourish the Yin as well as moisten the dryness. It is particularly suitable for use where the Yin, blood and essence are all deficient, which manifests as dry skin, cracked nails, lusterless hair, scanty menstruation and constipation. 

Herbs that tonify the blood form the main part of this formula, indicating the close relationship between the Yin and blood of the Liver. This also suggests that this formula is particularly suitable to be applied at the initial and second stages of Liver-Yin deficiency, which manifest as dizziness, blurred vision or decreased vision, numbness and tingling of the limbs, and cramp of the muscles. A red, dry tongue and a wiry, thready pulse are often observed in this condition. 

Fructose-1,6-bisphosphatase deficiency, first describ ed by Baker and Winegrad in 1970, has now been reported in approximately 30 cases. It is more common in women and is inherited as an autosomal recessive disorder. Initial manifestations are not strikingly dissimilar from those of glucose-6-phosphatase deficiency. Neonatal hypoglycemia is a common presenting feature, associated with profound metabolic acidosis, irritability or coma, apneic spells, dyspnea, tachycardia, hypotonia and moderate hepatomegaly. Lactate, alanine, uric acid and ketone bodies are elevated in the blood and urine [11]. The enzyme is deficient in liver, kidney, jejunum and leukocytes. Muscle fructose-1,6-bisphosphatase activity is normal. 

Bai Shao Yao is bitter, sour and slightly cold, and enters the Liver and Spleen meridians. It particularly tonifies the substantial part of the blood and increases the Yin. It is often used in the syndrome of blood and Yin deficiency that manifests as palpitations, restlessness, stiffness and cramping pain of the limbs, dry eyes, blurred vision and scanty menstruation due to deficiency of the blood and Yin of the Heart and Liver. 

Tian Ma is sweet and neutral, and enters the Liver meridian. It has a moderate and moist nature. It is the first-line choice to extinguish Liver-wind because it not only pacifies the Liver and extinguishes wind, and treats the manifestations (dizziness, headache, dry and tired eyes), but also treats the cause (deficiency of Liver-Yin and blood). It can remove wind-phlegm and open the collaterals, and is used to treat dizziness with nausea and vomiting. If it is combined with herbs that promote the Qi movement and blood circulation, it can treat stiffness, pain, numbness and tingling of limbs, such as in the sequelae of cerebrovascular accident. 

Altered vitamin A homeostasis, primarily manifested as decreased hepatic storage of vitamin A, is another established effect of PBBs in animals. Vitamin A is essential for normal growth and cell differentiation, particularly differentiation of epithelial cells, and some PBB-induced epithelial lesions resemble those produced by vitamin A deficiency. Because it is the primary storage site for vitamin A, the liver has a major role in retinol metabolism. Esterification of dietary vitamin A, hydrolysis of stored vitamin A, mobilization and release into the blood of vitamin A bound to retinol-binding protein, and much of the synthesis of retinol-binding protein occurs in the liver. 

The anticoagulant coumarins show certain structural similarities to vitamin K and probably as anti-metabolites their effects are manifested as a vitamin K depletion. As in vitamin K deficiency, the administration of warfarin depressed the synthesis of factor Vll in the liver. The action of this coumarin or lack of vitamin K is specific. These treatments have no general effect on hepatic protein synthesis, reducing only the synthesis of factor VII. Furthermore, the effect was only reversed by the administration of vitamin K [421], These changes occur mo coumarins have no effect on blood clotting when added in vitro. 

Gout has been observed occasionally in young patients with glucose-6-phosphatase deficiency and glycogen deposition in liver and kidney. In these cases, the symptoms of gout are unresponsive to therapy, and the patient dies at an early age. Whether the increase in blood lactate levels influences the manifestation of gout is not certain. 

Vitamin Bu, the antipemicious anemia factor, has the structural formula shown in Fig. 8. It is synthesized by bacteria and filamentous molds but not by animals or green plants. The vitamin was first recognized through studies of pernicious anemia, a disease in which the ability of the individual to absorb vitamin Bu is lost as a result of failure of the stomach to secrete a substance termed intrinsic factor. This substance is present in normal gastric juice and appears to be essential for the transport of vitamin B12 from dietary sources across the intestinal wall into the blood stream. Pernicious anemia is therefore the manifestation of a deficiency of vitamin Bu as caused by a failure to absorb the vitamin from the digestive tract. The disease, which occurs only in human beings, must be treated by injection of the vitamin, formerly obtained from liver extract and more recently from special fermentations. A deficiency of vitamin B12 may also arise from a lack of the substance in the diet, especially in the case of farm animals. 

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