# Alternative treatment approaches in advanced fatty liver disease (MASH)
Traditional Chinese Medicine (TCM) – herbal preparations
In China and East Asia, various TCM formulations are being investigated for fatty liver disease and liver damage. Animal studies show that preparations such as Tao-Hong-Si-Wu-Tang and Jiuwei Xiaozhi Decoction can reduce inflammatory substances and influence fat breakdown in the liver. These components are tested in laboratory settings, but evidence from clinical studies in humans remains very limited. Some TCM workshops in China report experiences with patients, but systematic research into long-term safety and effectiveness is lacking. Many of these preparations contain multiple plant substances whose active components are not fully understood.
ResearchediPositive results in clinical studies, not yet standard treatment
Astragaloside IV
This is an isolated substance from the Astragalus plant, which shows protective effects in animal models on various liver diseases. It could suppress inflammatory reactions and reduce cell damage. To date, these are mainly in-vitro and animal tests. Human studies are virtually absent.
ExperimentaliOngoing in study setting, outcome still unknown
Ginkgo biloba
This plant is used in many herbal preparations because of its presumed antioxidant action. Research has been conducted on Ginkgo biloba for blood vessel and heart protection, but specific effectiveness in fatty liver disease has not been demonstrated. There are also known safety concerns, particularly when used alongside blood thinners.
ResearchediPositive results in clinical studies, not yet standard treatment
Momordica charantia (bitter melons)
This vegetable herb is used in traditional medicine for metabolic conditions. Animal experiments suggest effects on weight and fat metabolism. For fatty liver disease specifically, clinical data are very scarce. Its use in patients with advanced liver damage has not been studied and may carry risks.
ResearchediPositive results in clinical studies, not yet standard treatment
Gut microbiota modulation through diet and herbs
Recent research suggests that TCM formulations and certain nutrients can influence the composition of gut bacteria, which in turn could affect inflammatory reactions and fat metabolism in the liver. This remains largely experimental; mechanisms are being discovered, but effectiveness and safety in practice remain unclear.
ExperimentaliOngoing in study setting, outcome still unknown
Acupuncture
Traditionally, acupuncture is sometimes applied to liver conditions and digestive problems. Scientific evidence for effectiveness specifically in MASH/NASH is not available. Some studies look at effects on metabolic parameters, but these are small and not conclusive.
UnproveniNo scientific evidence that it works
Fat fasting, intermittent fasting and strict dietary regimens
Preventing fat accumulation in the liver works primarily through weight loss and adjustment of eating patterns. Some alternative approaches promote extreme fasting or highly restrictive dietary protocols. These can be dangerous in patients with advanced liver damage (poor protein retention, blood sugar fluctuations). They require medical supervision and cannot be applied independently.
Advised againstiProven ineffective or harmful, or dangerous in combination with your treatment
(without professional supervision)
Supplements with vitamin E and antioxidants
Vitamin E has been tested in some studies for NASH. Results are mixed; high doses can cause side effects in some patients. For advanced stages, safety studies are lacking. Other antioxidants (selenium, zinc, CoQ10) are sometimes offered, but evidence for effectiveness is weak to absent.
ResearchediPositive results in clinical studies, not yet standard treatment
(vitamin E); others: **Unproven**
Probiotics and prebiotics
The benefit of specific probiotic strains in fatty liver disease is being investigated, because healthy gut flora can limit inflammatory reactions. Results to date are cautious but not conclusive. Many commercial preparations lack clinical evidence.
ResearchediPositive results in clinical studies, not yet standard treatment
Herbal teas and extracts (Ginkgo, green tea polyphenols, turmeric)
These are often used independently with the idea of fighting inflammation. Green tea contains substances that can inhibit cell damage in the laboratory. Turmeric (curcuma) is used traditionally but evidence for liver protection in MASH is limited. All of these remedies can have interactions with regular medications and with the liver disease itself.
ResearchediPositive results in clinical studies, not yet standard treatment
(green tea polyphenols); other: **Unproven**
Physiotherapy and intensive physical exercise
Regular exercise is a recognized part of treatment and helps achieve weight loss. This is not an 'alternative' but a standardized measure. Special training protocols for liver diseases are being investigated, but evidence is still limited. Intensive exercise can be harmful in severe liver failure.
ProveniIncluded in official guidelines, or approved by EMA or FDA
(mild to moderate exercise as a supplement)
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Final note
For all alternative approaches mentioned above: research is still in an early stage, usually outside clinical applications. With advanced fatty liver with emerging liver failure, portal hypertension or other complications, many of these remedies may provide insufficient protection and cause interactions. Some can interfere with the effects of regular medications or place extra strain on the liver.
**Important:** combination with regular treatment should only happen under the supervision of your doctor, because risks can be significant. This applies especially to herbs, supplements and fasting schedules.
_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._