Classification and Value of Researches and Tests of Hepatic Dysfunction.
Numerous techniques have been suggested in different times in order to characterise the functional troubles of the liver and specially to put in evidence the insufficiency of the liver. In reality these methods are after deficient and difficult to apply in current practice and even the results given by the tests are far from having an absolute value. A large number of functions of the liver will require numerous biological examinations if one wishes to be complete.
Moreover for each function there are many experiments from which it is difficult to chose one.
1. Biliary Function. It is classical to say that one can put in evidence the troubles of biliary functions by the verification of urobiline in excess in the urine, but at present it is disputable and all the authors do not admit that urobiline is due to a cellular lesion of the hepatics; it is rather due to the obstruction of the biliary duct.
Another test is proposed by Prof. Chiray who recently, with the collaboration of his two collaborators, Milorde Molochewich and Marcel Kipler, has tried to determine the importance of the hepatic cell by studying the variation of biliary salts in the bile sucked out directly by duodenal tubage.
2. Protidic Function. Intestinal diastasis have disintegrated the big molecules of proteins into albumen and in peptones, then into polypeptides and finally into amino acids. It is with these acids hepatic cells may reconstitute the albumen meant for the organism and for the surplus they disintegrate the nitrogenous matters that pass to the phase of dissemination, then by the ammonia phase, in order to become urea one may note the hepatic function by searching in the urine or in the blood the quantity of nitrogenated residues which are not completely transformed into urea. Formerly Albert Robin measured the co- efficient of nitrogen by the formula : nitrogen of urea in the urine divided by total nitrogen of urea. Then he finds out the co-efficient of nitrogen of Maillard and the co-efficient of acidosis of Lanzenberg modified by Derrient and by Feissinger.
Even one can find out the quantity of residual nitrogen in the blood, or even the polypeptides and the amino-acids in the blood. There are a considerable number of examinations proposed for the dosage of all the compounds of nitrogen in the blood.
In order to understand at the same time the functional importance of kidneys and of the liver of almost all the persons suffering from chronic diseases after 40 years of age, I always do systematically chemical examination regarding the quantity of residual nitrogen, uric acid, chlorides, cholesterin and lipides in the urine. It is above all interesting to note the relations that exist between urea and cholesterin, as well between cholesterin and lipide. This helps to understand the so numerous cases of toxaemia due to the slowness of the nutritive function and function of the excretions.
3. The anti-anaphylactic function may be compared with periodic functions, thanks to which the liver holds the incompletely disintegrated proteid substances. Some classical examinations such as digestive hemolysis, examination of the milk, may put in evidence the troubles of that anti-anaphylactic function.
4. Glycogenic and glycopexic function. It helps the liver to transform the glucose into glucocin and to conserve it and to distribute later on according to the need of the organism. One can put in evidence the troubles of this function by different tests, such as provoked hyperglycemia and specially thanks to glycosuria, hinted at first by Bauer. This test has a great importance specially in the research of hepatic insufficiency in surgery.
5. Anti-toxic function. The liver fixes and neutralises the toxins in order to eliminate them in the form of soluble products passing through the kidneys. It is proposed to put in evidence this function by the examination of glycoronuria provoked, or by the measure of the oxydation of urinary Sulphur. These examinations are difficult to realize in current practice.
6. To that anti-toxic function one may compare the chromatogenic function of the liver which consists in the elimination by the liver some colouring substances as for example phenol-tetrachloride, phtalein, carmin-indigo, azoburine, Bengal rose, phenolchloresulpho-nephtaleine.
7. The blood function or function of the liver on the coagulation of blood, is at present disputable. It is not yet known whether fibrinogen is due to hepatic cells.
Some authors distinguish even at present the martial function, formation of the reserves of iron in the liver, in order to distribute it for helping the red globules.
Many clinicians were struck in all the countries by the weaknesses of the experiments on which is based the diagnosis of the hepatic insufficiency (Cheray). However it is necessary to look for the cases of latent hepatics, if not, one may risk submitting the patients to surgical instrumentation which become mortal in cases of undetected hepatic insufficiency. It is for this reason it is necessary to treat before, after the intervention of surgery, the patients who have clear symptoms of hepatic insufficiency found out by different experiments specially by galactosuria.
We are now going to pass in review the important remedies of morbid temperaments of hepatic dysfunction.
3. Remedies of Morbid Temperaments of Hepatic Dysfunction. Let us first of all think about the function of the liver in the organism.
The gland is at the same time purifier, fixer of toxins, and transformer of foods which it degrades to seperate from them the products which are to be excreted and those that will be necessary for the economy of the organism.
It is therefore an organ of the first importance in the cycle run by the substances that the living organism borrows directly or indirectly from the mineral kingdom.
“The living matter is composed of carbon, hydrogen, oxygen, nitrogen, sulphur, phosphorus, to which are added chlorides, potassium, sodium, calcium, magnesium, iron and accessorily the silicum and fluoride (Lambling). The other minerals are less important, at least quantitatively.
The carbon is borrowed by the living matter under the form of carbonic acid, hydrogen in water state, nitrogen from ammonia state, sulphur in the state of sulphuric acid.
As a consequence of the different operations for reduction and synthesis, the living matter builds from the organic substances some complex organic matters, proteins, fat, hydrate of carbon, combined with some mineral substances (chloride, sodium phosphate, potassium, magnesium etc.) for obtaining the immediate principles constituting the tissues and the organs of the living matters. The simple substances will generally be the homoeopathic remedies of the first importance.
Thus we find the three principal minerals, which are the principal remedies of liver : Sulphur, Natrum, sulphuricum and Phosphorus. Besides there are three other remedies.
Lycopodium. A vegetable substance, containing Sulphur and even Natrum sulphuricum in sufficient quantity and also some Phosphorus.
Sepia, Lachesis. Animal products, they are very complex but they are less important than the 4 other remedies.
Ammonium carbonicum. The important remedy of uremia as well as Phosphorus to which it is related, is not a ground remedy because it is hardly prescribed in high dilution, but it is better to mention it here.
Now we will understand well the value of remedies of mineral origin for the treatment of troubles due to hepatic insufficiency. Lycopodium, which contains, Sulphur, Natrum sulph, and some Phosphorus, will be the remedy of the first importance in the hepatic insufficiency.
After these three minerals we may consider that the important remedies of morbid temperament in the dysfunction of the liver are the same as those that will be indicated in all the affections of the lesions of the hepatic cells. Let us mention here that there is not a difference in the degree of intensity of symptoms observed between functional troubles and impairment of the organ.
It is necessary to consider, in my opinion, 6 principal remedies of morbid temperament of the hepatics.
Three minerals : Sulphur, Natrum sulphuricum, Phosphorus.
One vegetable : Lycopodium.
Two animal products : Lachesis and Sepia.
Sulphur does not play in the treatment of the diseases of liver as important a part as that of Lycopodium, Phosphorus, Natrum Sulphuricum. However suits well to some troubles co- existing with an active and transitory congestion of liver, or with general arterial congestion. Arterial hypertension. By extension and localisation, hypertensions in the sphere of veins (portal), veins of the lower cava and of abdominal veins and its branches. This General Abdominal Congestion may be one of the symptoms of a tendency towards cancer with localisation in the abdomen. Bleeding Hemorrhoids, incessant or periodical bleeding, are clear symptoms of Sulphur. This flow of blood is a Real Safety Valve of a Psoric State or often plethoric.
The psora is often expressed by : –Periodic Cutaneous Eruptions, eczema, Urticaria, furuncles and acne. All these eruptions are aggravated by washing.
–Other Possible Phenomena of Eliminations : epistaxis, periodic or continued, diarrhoea.
The sulphur organism should burn. It is the volcano. The mucous membranes are of red colour, specially of the orifices (lips, anus).
It has eruptions as a result of Centrifugal Power of this temperament, if the patient cannot drain himself in any other way. The pains are of Burning Type, specially burning in the gastric region.
–Burning of the feet, The Patient Searches For a Cool Place on the bed. The sensation of combustion is such that the patient cannot fast, fasting is unbearable. Goneness Feeling in the Stomach towards 11 a.m.; must eat at that time, which causes amelioration. No symptom of the liver. The liver is temporarily big and congested, diminishes soon by a high dilution, 200 or M (Korsakov).
The symptoms are general and digestive.
One important symptom Of Proteopexic Troubles. The Milk is very Badly Tolerated. Another symptom : cannot digest eggs (the yellow of the egg contain Sulphur and Phosphorus). Sometimes, sugar, farinaceous foods and starch are not tolerated. (Let us note that the milk and yellow of the egg are cholagogs)
Light cat’s nap, wakes up by the least noise. Insomnia from 2 to 5 a.m.
If there is diarrhoea, aggr. at 5 a.m.;the patient must make haste.
The stools may be colourless, diarrhoeic or not.
Painful tension in the region of liver. This symptom is rarely spontaneous, often it does not exist, caused only by pressure.
The complementaries and drainers of Sulphur will be : Nux Vomica. For the intestines.
Aloe. For the rectum (It is choleretic), Dr. Nabel’s canalizer of this organ.
Podophyllum. Choleretic for Charbol in ponderable dose. Elective action on the duodenum and secondarily on the rectum.
Magnesia sulphurica. Very powerful cholagog and choleretic in heavy doses.
Anacardium. When the sensation of empty feeling in the stomach is better by eating.
Mercurius has humid mouth with thirst, aggr. by the heat of the bed. Sweats do not ameliorate.
Has also close relation with Lycopodium (the vegetable Sulphur) and with phosphorus (troubles of the composition of blood).
Sepia. (Portal hypertension)
Natrum Sulphuricum. Hydrogenoid constitution. Phosphorus is distantly related to it.
Natrum Sulphuricum. suits specially to hydrogenoid patients.
Natrum Sulphuricum and Magnesia carbonicum are good choleretics (Charbol), therefore acting on the production of bile from the interstitial lymph and laminary system.
Aggr. during humid times and in humid places, in marshy lands and in unhealthy places. Better by humid heat (Ipecac). Retention of water by the liver and by the tissues. (peri- visceral oedema). Gouty constitution (possibility of uricemia).
Hepatic Symptoms. Sensation of pressure on the region of liver.
–Pain caused by palpation.
–Fullness in the region of liver; aggr. by the least pressure by a belt and by any tight itching on the body (Lachesis).
–A possible blood-symptom : diminution of the viscosity of blood.
–Chloride retention (blood, urine) but very frequently Hyper-cholesterinemia with a hydrogenoid state, needing water to saturate chloride. –It acts on water metabolism. Troubles of thyroid and lymphophysery glands.
Tongue greenish-gray, salty taste of gastric and pharyngeal mucous.
Voracious appetite, followed by regurgitations and loss of appetite. Nausea in the morning.
Flatulence. Thirst for very cold, icy drinks.
Borborygmus. Intestinal gas that one cannot expel.
Pressing diarrhoea, after break-fast, yellowish, with gas Intestinal pains, aggr. while lying on the left side (Sepia). Tendency to warts.
Natrum sulphuricum is therefore a very good remedy of the liver. It is related to : –China. Acts on the excess of cholesterinemia.
–Cholesterinum. Same (high dilutions)
–Lecithin. Antagonist of cholesterin. To be used in gross dose as a cholagog.
–Podophyllum. Choleretic; morning diarrhoea, yellowish stool. Action on the duodenum and rectum.
–Calcarea carbonica. May act also in hydrogenoids or persons suffering from cholesterinemia.
–Dulcamara. Hydrogenoid constitution. Gout alternates with digestive symptoms.
Nux Vomica. A drainer of Natrum sulphuricum. Hydrogenoid for the intestines.
Kali carbonicum. Pricking pain in the liver as if from needles. Pain in kidneys. Weakness. Acts like Vichy water.
As a ground remedy Natrum sulphuricum is related to : Sulphur. Congestion of liver.
Lycopodium. Has Natrum sulphuricum in its composition.
Phosphorus. Action of cholesterin.
Sepia. May sometimes be hydrogenoid.
Like Sulphur, Natrum sulphuricum has a clear centrifugal action : elimination.
Action on the biliary function. It is to be noted that one of the biliary salts, Taurocholate contains at the sametime Sulphur and Sodium like Natrum Sulphuricum, which itself is choleretic, therefore acting by the formation of bile salts in the tissues.
Phosphorus. Very important remedy of the liver, not very well known by homoeopaths, because it is thought to be dangerous.
In fact, it is dangerous only in tuberculosis of the lungs and of the larynx. It is a remedy of degeneration of fat. (Kali bichromicum and phloridine). Therefore it suits less to ordinary insufficiency of the liver. It is rather a remedy of cirrhosis, deep, acute insufficiency of the liver (serious kinds of jaundice) or chronic affection (with cholecystitis)
Thirst for very cold water. Hungry immediately after meals. Sour taste and eructations after meals.
Gastric pains amel. by cold foods. Hiccough, sensation of emptyness in the stomach, great sensitiveness in the epigastrium.
Liver big and painful Icterus. Colourless stool, grayish white stool.
Grave jaundice. Haemorrhages. Retarded Menstruation Diminution of Coagulability.
Action on the blood-function of the liver (perhaps action on the formation of fibrinogens)
Purpura (no other action on the skin)
Sensation of emptyness and coldness in the abdomen.
Acts on the pancreas. Acute or chronic pancreatitis.
Sometimes constipation of hard, dry and narrow stools. Sometimes weakening diarrhoea, painless, mixed with small solid white particles. Acts on hepatic insufficiency of olds suffering from bile stone, or from cholecystitis, with chronic pancreatitis.
Action of uremia. Acts more on endocrinal liver than on exocrinal liver.
Action also on Alcoholism (Sulphur, Lachesis, Lycopodium, Nux vomica):
Action on bones; organic fat; walls of blood vessels, parenchymas, nerve cells.
Relations : As complementary, related to :
–China. Reinforces Phosphorus. Has action like Phosphorus on cholesterin.
–Berberis. Drains Phosphorus towards urines.
–Ricinus Communis. Excellent action on nausea.
–Bryonia. According to the modalities.
–Digitalis. Cardiac liver, and accordeon liver, with China and Phosphorus.
–Chelidonium. For cholesterinemia. Should be given in M or
–Lecithin. In ponderable doses. Antagonist of cholesterin.
–Lutein. Cholecystitis and lithiases of women during menopause or during pregnancy.
–Arsenicum album. Restlessness and prostration, better by heat.
–Crot. horridus. Grave jaundice. A remedy of yellow fever.
–Chloroforme. In grave icterus.
–Kali bichromicum. In fatty degeneration.
–Phlorizine. In fatty degeneration.
As ground remedy compare with : –Lycopodium. Insufficient, small liver. A remedy of “bitter” of the bile than of the “sugar”.
–Sulphur. Very distant.
–Natrum Sulphuricum. Cholesterinemia.
–Lachesis. Similar action on blood. General insufficiency. Forms cholesterin.
–Sepia. Distant relation. Portal hypertension.
Lycopodium. Classical insufficiency of the liver with more or less discrete phenomena of Retention of Bile. It is also a remedy of ground of familial cholemia of Gilbert (with China)
Hereditary Syphilitics, which creates some tenacious troubles of liver function, has the need for Lycopodium as much as Luesinum, Aurum metallicum and the salts of Mercury.
We have shown sometimes ago that Lycopodium, with Sepia were the ground remedies corresponding very often to the Infantile Anorexia. This affection, is sometimes called mental, really has some clear symptoms of hepatic insufficiency corresponding to the symptoms of this remedy.
Lycopodium is also a habitual remedy of hepatic insufficiency caused by alcoholism and of Laennec’s Atrophic Cirrhosis : cirrhosis with sclerosis==Lycopodium; Cirrhosis with degeneration==Phosphorus.
It is now classic to compare the spores of Lycopodium with the anatomic representation of hepatic lobule. The similarity is striking.
Lycopodium is a mass of which the spores are inert, and considered with reason as such in Allopathy in gross doses, are capable of becoming, when diluted and dynamised, an extremely active remedy; so active that it is dangerous to prescribe in high dilution even in the 30th, to patients having torpid liver (general insufficiency, cirrhosis, cholecystitis, acute or chronic grave jaundice). On the contrary in habitual cases of hepatic insufficiency, Lycopodium is the best remedy.
In fact Lycopodium seems to be a remedy par excellence for overworked liver. It is for this reason it is a remedy of the “bilious” type to whom corresponds its mental characteristics.
Mentally : apprehension, weakness of memory, forgets words and syllables while writing. Very irritable. Becomes easily angry. Frequent underlining of phrases, in letters that the writes.
Likes to write in violent terms or even in obscene terms, if they are expressive.
Sad in the morning while waking up (contrary, Sulphur).
Jaundice after anger (Colocynth, Chamomilla). The liver is the gland of anger.
Digestive Tract. Dry mouth without thirst. Weak digestion. Incomplete burning eructations rising up to the pharynx.
Prefers hot food and drink (Chelidonium and Arsenic; contrary Phosphorus and often Sulphur). Gastric and intestinal distension. Retention or emission of abundant intestinal gas.
Constipation of insufficient stools. Painful Hemorrhoids.
The action of Lycopodium in constipation is very mysterious.
Very often in the lower dilutions (3, 6, 12), Lycopodium ameliorates constipation (when it is indicated to Lycopodium).
Very often, in high dilutions or in medium dilutions (30, 200, M) Lycopodium aggr. the constipation (when it is indicated by the symptoms)
The phenomena exists also in China, Chelidonium, Myrica, Nux vomica etc…
What is the cause?
Here is how we can interpret it.
The lower dilution of Lycopodium will act as a cholagog, and will eliminate the bile in the intestine more actively. Bile which slows down the heart in the cases of jaundice, on the contrary Increases the Rapidity of the intestinal transit, whence amelioration of constipation, but possibly also diminution of assimilation.
Inversely the intestinal transit would be slowed down, but with augmentation of the power of assimilation, in the case of hepatic insufficiency, ameliorated by Lycopodium in high dilutions. Whence the possible antagonism between the speed of elimination of bile and the power of assimilation, function of the liver cells.
Constipation in a person who has bad assimilation which is perhaps a defence reaction. Perhaps, the liver, by the help of bile, itself regulates the speed of transit exactly necessary to the necessity of assimilation? It requires study.
Besides, we often see the bile extract, capable to overwork the liver and to cause some hepatic troubles either because of overwork or because of the insufficiency, perhaps because by activating the intestinal transit; intestines can no more bring back to the liver the biliary salt for recuperation (according to some authors)
Appetite of Lycopodium. Soon satisfied; by a mouthful only. Dyspnoea caused by cabbage, greasy and farinaceous foods.
Aversion to bread. Desire for sugar (Argentum nitricum, action on the glycogenic function cannot tolerate shellfish).
Liver. Sensitive and painful, small often hard (Big liver Digitalis, China, Phosphorus, Kali carbonicum etc..). Hepatic pain Aggravated by touch; while breathing, painful and heavy sensation on the liver. Point of Weihe, or painful point of Lycopodium is between the 2nd right or left intercostal space, at a distance of 2 cm from the border of sternum.
Yellow patches of the skin on the liver region.
Urine. Brick red sediment. Sometimes excess of uric acid, diminished or precipitated. Lycopodium will act on gouty diathesis like Natrum sulphuricum and Lithium carbonicum.
May go towards uremia, like Ammonium carbonicum, Carbo veg., Arsenicum album, Phosphorus. A good sign of Lycopodium : Urobilinuria. Has action also on acetonemy and acetonuria (Senna).
Circulation. Tendency to aneurysm, specially aortic.
Venous circulation. Naevi.
One foot cold, the other hot.
Sleep. Cannot sleep on the right side (contrary Sepia)
General aggravation from 4 to 8 p.m. (from 4 to 5 a.m the urea in the urine increases.
Very marked Rightsidedness.
Relation of Lycopodium with.
Chelidonium. Very much similar. Bitter taste in the mouth. Pain in the scapulo-vertebral angle (right), into the point of scapula.
Myrica. Resembles to Chelidonium.
Chenopodium. Anthelmintic action on the labyrinth, deafness. Scapulo-vertebral pain like Chelidonium. Vertigo.
Overwork -(>) Dysfunction -(>) Insufficiency -(>) Degenerscence Chionanthus. In jaundice.
Mercurius solubilis, Mercurius dulcis, more or less disputable cholagogs.
China. It is antidote and complementary. Distention of the abdomen, generalised meteorism of the whole abdomen. Big liver, big spleen.
Arsenicum album. Complementary of Lycopodium and of Phosphorus.
Bryonia. According to the modalities. Better lying down on the painful side. Aggravation by respiration, like Lycopodium.
If aggr. caused by Lycopodium think of China (meteorism), or Colocynthis (pain after anger).
With ground remedies.
Sulphur and Natrum sulphuricum, very slight on the liver Phosphorus. Deeper action (rather right-sidedness)
Sepia is between Sulphur and Lycopodium. Lachesis between Phosphorus and Lycopodium (Lachesis, left-sidedness)
The following schema may show the general action of Lycopodium and Phosphorus compared.
In schematising, let us say that Lycopodium acts on the whole field of hepatic lobule, probably on the protoplasma of hepatic cells and bile duct.
Phosphorus has for its field of action on hepatic cell, specially its nucleus (abundance of phosphorus in the nucleus).