Hey, it's Nicholas! 👋

Do you have patients coming in with liver fibrosis?

Did you know that there's a modern patent medication that can treat it—and it even has research behind it?

Well let me introduce you to the formula
​Fuzheng Huayu...

You might not know this, but historically hepatitis B has been a major problem in China, and liver fibrosis is a downstream consequence.

Mother-to-child transmission was the primary driver, and a universal free vaccination program didn't exist until 2002.

(One of my Chinese teachers had a habit I didn't understand at first: during a new patient intake, she'd take the pulse and look at the tongue, but then also palpate just below ribs. It turns out in her generation, liver cirrhosis was so common checked for it with every new patient.)

Because of this, researchers in Shanghai started developing an herbal solution and came up with Fuzheng Huayu (扶正化瘀).

This formula came out of 1990s government-funded research at Shanghai University of TCM, went through rat models, got Chinese FDA approval, and then became the first TCM formula ever to complete FDA Phase II trials for liver disease in the US.

So what is this formula made of?

Inside the Formula

Fuzheng Huayu contains six ingredients:

• Dan Shen (salviae miltiorrhizae radix)
• Dong Chong Xia Cao (cordyceps)
• Tao Ren (persicae semen)
• Jiao Gu Lan (gynostemmatis rhizoma seu herba)
• Song Hua Fen (pinus massoniana)
• Wu Wei Zi (schisandrae fructus)

The formula is designed to treat a pattern of Liver-Kidney Deficiency with Blood Stasis.

The idea here is that when the upright qi (Zheng qi) becomes deficient, the blood can no longer circulate properly, and blood stasis develops.

(This explains the name of the formula: 扶正 (fú zhèng) means "support the upright [qi]" and 化瘀 (huà yū) means "transform stasis".)

So this formula treats both the root and the branch: herbs like Dan Shen and Tao Ren invigorate blood, while herbs like Dong Chong Xia Cao tonify deficiency.

(Many of these ingredients also have modern research behind them: many are adaptogenic, hepatoprotective, inhibit TGF-β1 expression, or reduce inflammation.)

That also means that Fuzheng Huayu is better for chronic deficiency-related cases rather than excess cases due to things like damp heat.

Two Herbs You May Not Recognize

There are two unusual ingredients here that you may not have heard of: Jiao Gu Lan and Song Hua Fen. These are herbs that we don't typically learn in school and they don't really show up in classical formulas.

Jiao Gu Lan

Jiao Gu Lan is Southern Ginseng. It grows in the far south of China, so it wasn't included in many formulas that were developed in central China. It was traditionally used by farmers in the mountainous regions for energy, so it was regarded more as a folk herb.

In this formula it's being used to tonify qi, but it also has adaptogenic properties and reduces inflammation.

Song Hua Fen

Song Hua Fen is pine pollen, and it's just not used very often in classical formulas (it doesn't show up in our textbooks either). Some books put it in the Bi syndrome category, while others emphasize its action of stopping bleeding.

But here it's being used to support the liver.

What the Research Says

As we said, Fuzheng Huayu has some research behind it, and the numbers are promising:

In China, most studies were done on hepatitis B-induced fibrosis. A 2024 meta-analysis of 25 trials found histological inflammation improvement in 75.56% versus 42.22% (controls), Ishak fibrosis improvement in 67.90% versus 40.91%, mean liver stiffness decrease of 3.43 kPa at 48 weeks, and significant improvements in all four serum fibrosis markers (HA, LN, PC-III, IV-C). https://pubmed.ncbi.nlm.nih.gov/39788588/​

In the US, studies are more focused on liver fibrosis due to chronic hepatitis C infection. A US Phase II trial (118 patients) demonstrated particular efficacy in patients with baseline Ishak F3-F4 fibrosis, with qFibrosis analysis confirming regression across all hepatic zones. https://onlinelibrary.wiley.com/doi/10.1155/2022/4494099​

Use in Your Clinic

So if you have patients with liver fibrosis, Fuzheng Huayu may be an option, especially if you're seeing patterns of blood stasis with underlying deficiency.

(Keep in mind that in the studies, patients were on the formula for 48 weeks.)

Now, we do have classical formulas for the Liver, like Xiao Yao San and Yi Guan Jian, but neither of them has the blood-invigorating properties to treat fibrosis.

What About Patients Without Hepatitis?

You'll notice that Fuzheng Huayu was developed specifically to treat liver fibrosis related to HBV and HCV infection, but what about patients with liver disease who don't have hepatitis?

That's what my friend Patrick was seeing in his clinic: patients were coming in with labs showing elevated liver enzymes or with a diagnosis of liver fibrosis, but their condition wasn't related to hepatitis. For them it was more about diet and lifestyle.

So Patrick created his own herbal formula based on Fuzheng Huayu to address the patterns he was seeing in his clinic.

And that's something we talk about in our course, Gallbladder Sludge and Liver Fibrosis: An Herbal Approach.

If you'd like to learn more about the formula that Patrick created and how he uses it, be sure to sign up for the waiting list for our upcoming course about Gall Bladder Sludge and Liver Fibrosis.

Treating Prostate Issues

Switching gears completely, do you ever see patients with prostate issues like prostatitis or BPH?

Well, Patrick created an herbal formula for this, and he's really excited about the results he gets. Watch a teaser here:

​

This was recorded after our conversation about gallbladder sludge. It didn't really fit in with the rest of the course, so I decided to add it on as a free bonus.

So when the course comes out if you sign up within the first week, you'll also get this bonus video about a formula for prostate issues.

So be sure to sign up for the waiting list to get notified as soon as the course is available

I need to take a bit of a break from work to file my taxes.

After that, I'm thinking about starting a course that's a deep dive in to Xiao Yao San–formula construction, modifications, when you should choose other formulas like Chai Hu Shu Gan San, etc.

Is there anything you want to know about Xiao Yao San?

Hope you had a nice Easter,

Nicholas

This is a weekly newsletter to let you know about the weekly updates like livestreams, office hours, and Q&A's. It's also a way to share whatever little TCM tidbit is on my mind. If you prefer not to receive this each week, you can unsubscribe from just the newsletter. You'll still receive major updates when new videos are added, you just won't get this newsletter.