Non-alcoholic fatty liver disease (NAFLD is considered as one of the prominent causes of cryptogenic cirrhosis and chronic liver disease in developed countries. Obesity, insulin resistance and diabetes mellitus, hyperlipidaemia, and hypertension cardiovascular disease increase the risk of developing NAFLD which can range from simple steatosis to non-alcoholic steatohepatitis (NASH). Various critical pathological events involved in the development of NAFLD includes insulin resistance, lipid metabolism dysfunction, oxidative stress, inflammation, apoptosis, and fibrosis. The mainstay of NAFLD revolves around amelioration of steatosis and inflammation. Various studies have shown efficacy of herbal medicine in managing NAFLD, due to its potential of improving hepatic steatosis by altering multiple mechanisms involved lipid metabolism and inflammation. 

Excessive production of free fatty acids (FFAs) is the main cause of hepatic steatosis as increased production causes the delivery from the adipose to the liver which further results in the intrahepatic pool expansion of FFAs in the form of triglycerides. This excess accumulation triggers hepatic lipo-toxicity, which simulates liver cells to release pro-inflammatory cytokines, which in turn causes oxidative stress and hepatic stellate cell activation, resulting in hepatic inflammatory injury. Thus, amelioration of fatty acid metabolism is considered to be a potent approach for the treatment of NAFLD. Plethora of studies have highlighted the favorable role of herbal medicine on patients with liver dyslipidemia. The phytochemicals of medicinal plants are known to improve lipid metabolic parameters such as reducing the levels of triglycerides (TG), total cholesterol (TC) and low-density lipoprotein (LDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), as well as increasing the production of high-density lipoprotein (HDL-C). Besides, the propitious role of herbal medicine in regulating fatty acid production, it can also depress the hepatic lipogenesis by reducing the expression of the key transcriptional factors and lipogenic enzymes like sterol regulatory element binding protein 1c (SREBP-1c), peroxisome-proliferator-activated receptor γ (PPAR-γ), acetyl-coa carboxylase (ACC), fatty acid synthase (FAS) and SCD1. 

Source: Xu Y, Guo W, Zhang C, et al. Herbal Medicine in the Treatment of Non-Alcoholic Fatty Liver Diseases-Efficacy, Action Mechanism, and Clinical Application. Front Pharmacol. 2020;11:601. Published 2020 May 12.