on the contrary, the uniqueness of chinese medicine in its interpretation of nafld and the holistic therapeutic approach lead to a promising therapeutic efficacy. hence, understanding the pathogenesis of nafld is necessary for the identification of biomarkers for the prevention and treatment of the disease. for example, the abundance of faecalibacterium prausnitzii is reduced in the patients. studies have demonstrated that nafld is associated with increased gut permeability and the increased permeability appears to be caused by disruption of intercellular tight junctions (44). compared to the healthy, levels of leptin, tnf-α and il-6 are significantly elevated in nafld patients, whereas the adiponectin level is significantly reduced. nowadays, modern pharmacological and experimental studies have elucidated the mechanisms of action of chinese herbal medicine in the treatment of nafld. it is well-known that lxrα trans-activates srebp-1c (119), and srebp-1c is involved in the pathogenesis of nafl and nash. in chinese medicine theory, sns coordinates the functions of liver and spleen, and has been used for thousands of years. indeed, tnf-α plays a pivotal role in the development and progression of nafld. these bacterial families have been shown to promote the development of nafld by increasing liver fat deposition and inflammation. the accumulation of lipids induces oxidative stress and apoptosis (141), which are crucial to the pathogenesis of lipotoxic injury in the liver and accelerates nafld progression. a chinese herbal formula zhi yi xiao (zyx) is found to reduces the expression of visfatin in the liver of nafld rat models (106). the nafld pandemic implies an increase number of patients diagnosed with nafl, nash, liver fibrosis and hcc in the near future. doi: 10.3109/07853890.2010.518623 7. arab jp, arrese m, trauner m. recent insights into the pathogenesis of nonalcoholic fatty liver disease. sex differences in the development of hepatic steatosis in cafeteria diet-induced obesity in young mice. activation and dysregulation of the unfolded protein response in nonalcoholic fatty liver disease. doi: 10.1038/nature01137 23. pierantonelli i, svegliati-baroni g. nonalcoholic fatty liver disease: basic pathogenetic mechanisms in the progression from nafld to nash. doi: 10.1002/hep.26225 31. chen j, thomsen m, vitetta l. interaction of gut microbiota with dysregulation of bile acids in the pathogenesis of nonalcoholic fatty liver disease and potential therapeutic implications of probiotics.
doi: 10.3390/diseases7040058 38. miura k, ohnishi h. role of gut microbiota and toll-like receptors in nonalcoholic fatty liver disease. increased intestinal permeability and tight junction alterations in nonalcoholic fatty liver disease. association between omental adipose tissue macrophages and liver histopathology in morbid obesity: influence of glycemic status. doi: 10.1111/j.1365-2036.2007.03586.x 57. abenavoli l, peta v. role of adipokines and cytokines in non-alcoholic fatty liver disease. hypoadiponectinemia predicts the severity of hepatic fibrosis and pancreatic beta-cell dysfunction in nondiabetic nonobese patients with nonalcoholic steatohepatitis. the effect of pioglitazone on weight, lipid profile and liver enzymes in type 2 diabetic patients. doi: 10.1074/jbc.m109.096107 79. zelber-sagi s, salomone f, mlynarsky l. the mediterranean dietary pattern as the diet of choice for non-alcoholic fatty liver disease: evidence and plausible mechanisms. an in vitro and in vivo study of a 4-herb formula on the management of diet-induced metabolic syndrome. new insights into salvianolic acid a action: regulation of the txnip/nlrp3 and txnip/chrebp pathways ameliorates hfd-induced nafld in rats. alisol a 24-acetate ameliorates nonalcoholic steatohepatitis by inhibiting oxidative stress and stimulating autophagy through the ampk/mtor pathway. a recipe composed of chinese herbal active components regulates hepatic lipid metabolism of nafld in vivo and in vitro. nonalcoholic fatty liver disease: pathogenesis and treatment in traditional chinese medicine and western medicine. effects of chinese herbal medicine jiangzhi granule on expressions of liver x receptor α and sterol regulatory element-binding protein-1c in a rat model of non-alcoholic fatty liver disease. doi: 10.1186/s12906-019-2641-2 123. zhao y, pan y, yang y, batey r, wang j, li y. treatment of rats with jiangzhi capsule improves liquid fructose-induced fatty liver: modulation of hepatic expression of srebp-1c and dgat-2. pivotal role of tnf-α in the development and progression of nonalcoholic fatty liver disease in a murine model. the potential effect of chinese herbal formula hongqijiangzhi fang in improving nafld: focusing on nlrp3 inflammasome and gut microbiota. serum visfatin level as a noninvasive marker for nonalcoholic fatty liver disease in children and adolescents with obesity: relation to transient elastography with controlled attenuation parameter. doi: 10.1007/s13238-018-0596-6 150. huo x, lu f, qiao l, li g, zhang y. a component formula of chinese medicine for hypercholesterolemia based on virtual screening and biology network.
accordingly, the evidenced therapeutic potential suggests that these herbs are promising candidates for prevention and development of new drugs for ald in the future. an in vivo study elucidated the protective effect of smr on chronic alcoholic liver injury employing a mice model (xiong et al., 2005). could alleviate the alcohol-induced fatty degeneration and adiponecrosis of hepatic cells in kunming mice. a recent in vivo study showed the protective effects of gentianae radix methanolic extract (gm) on acute alcohol-induced fatty liver (lian et al., 2010).
the hepatoprotective effects of pr and pf in alcoholic liver damage have been experimentally demonstrated in animal studies (lee et al., 2001). the protective effects of pr on the liver have been demonstrated in rats with alcohol-induced hepatotoxicity. further studies indicated that the polyphenolic extract of trigonellae semen was considered cytoprotective during alcohol-induced liver damage in vitro and in vivo. as shown in table 1, the potentially protective mechanisms of these herbs in alcoholic liver disease are involved in amelioration of enhanced inflammation, reduction of hepatic oxidative stress and lipogenesis, and enhancement of intestinal permeability.
the main constituent herbs in hxhy are salviae miltiorrhizae radix et rhizoma, chuanxiong rhizoma, crataegi fructus, curcumae longae rhizoma, puerariae radix (pr) and puerariae flos (pf) have been used in tcm to counteract problems associated with alcohol drinking and liver injury since ancient times specific chinese and other asian herbal medications implicated in liver injury include: ba jiao lian* (dysosma pleianthum), bol gol zhee (, .
silybum marianum is the herb of silybum marianum (l.) gaertn, the extra of which are widely used as a complementary and alternative treatment of various chinese herbs exhibit a hepatoprotective effect against afld. garlic, ginger, bitter gourd, lychee, ginseng, korean pine, and turuarame extracts or dandelion root: a cleansing, detoxifying herb that cools the blood and nourishes the liver. springtime is the ideal time to drink dandelion tea., .
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