- What it is: A chronic inflammatory liver disease in which an abnormal immune response targets liver cells, more common in women and possible at any age.
- Common symptoms: Fatigue, jaundice, abdominal discomfort, joint pain and loss of appetite, although some people have no symptoms at first.
- Conventional care: Corticosteroids and other immune-suppressing medicines, often long term, with regular blood tests and liver specialist follow-up.
- How integrative care fits: Supportive care for fatigue, stress and sleep, only alongside liver specialist care and with careful screening of any herb.
- Evidence at a glance: None found for acupuncture, Ayurveda or herbs in autoimmune hepatitis itself; some Ayurvedic herbs have been linked to liver injury with autoimmune features.
What is Autoimmune Hepatitis?
Autoimmune hepatitis (AIH) is a chronic inflammatory disease of the liver of unknown cause, in which an abnormal immune response targets the liver's own cells. If it is missed or treated late, it can progress to cirrhosis and liver failure.[1] It is more common in women, can affect people of any age, and needs treatment under a physician.[1]
Common symptoms
Some people have acute hepatitis, sometimes very severe, while others develop the disease slowly or have no symptoms at all.[1] Fatigue, jaundice (yellowing of the skin and eyes), upper right abdominal discomfort, joint aches and loss of appetite are common features of liver inflammation. In advanced disease, fluid in the abdomen, bleeding and confusion can occur.[2]
Causes and risk factors
The cause is unknown. The proposed mechanism is an interplay of genetic predisposition, an environmental trigger, and a failure of the immune system that leaves the liver inflamed.[3] AIH is classified into two types by the autoantibodies found in the blood.[3] Some drugs and supplements can produce a liver injury that looks like AIH, which doctors call drug-induced autoimmune-like hepatitis.[4]
How it is diagnosed and treated conventionally
Diagnosis rests on specific autoantibodies, raised IgG levels and a liver biopsy showing interface hepatitis.[1] Doctors also need to rule out drug-induced injury and other liver diseases.[4]
Treatment uses corticosteroids and other immune-suppressing drugs, and most people respond. The goal is long-term remission of liver inflammation, and most patients need lifelong maintenance therapy with regular follow-up.[1] Treatment can often reverse liver fibrosis, which is why early diagnosis matters.[1] Long-term immunosuppression has adverse effects, and researchers are looking for steroid-sparing options.[5] Liver transplant is reserved for advanced disease.[2]
Why Autoimmune Hepatitis calls for a whole-person approach
AIH involves the immune system, the liver, and the medicines used to control both. Living with a chronic illness and long-term immune-suppressing treatment also affects energy, sleep and mood.
Supportive care can reasonably address those effects. It cannot treat the liver inflammation, and it must never put the liver at additional risk.
The immune response
An abnormal immune response against liver antigens sustains the inflammation.[1] The involvement of T cells, macrophages and plasma cells is complex, which is why treatment focuses on suppressing several inflammatory pathways.[5] For the same reason, supplements marketed to "support" or "modulate" immunity need your hepatologist's review.
The liver and what passes through it
The liver processes medicines and herbal products. Herbal and dietary supplements now account for about 20% of drug-induced liver injury in the United States.[6] Some cases of drug-induced injury mimic AIH, so any new herb or supplement is a reasonable thing to discuss with your liver specialist first.[4]
Medicine side effects
Long-term immunosuppressive therapy is associated with adverse effects, and many patients need it for life.[1, 5] Your physicians monitor these, and supportive care should not interfere with that monitoring.
Fatigue, sleep and stress
Fatigue is a common feature of chronic liver inflammation.[2] We are not aware of studies of fatigue care specifically in AIH. Evidence on fatigue and sleep comes from other conditions, as described below.
Acupuncture as supportive care in Autoimmune Hepatitis
What the research shows
A PubMed search found no clinical trials of acupuncture for autoimmune hepatitis. Nothing is known about whether acupuncture affects liver inflammation or the course of AIH.
Some research looks at symptoms that AIH patients may share with others. A systematic review of 16 studies in 1,346 people with chronic fatigue syndrome found that acupuncture gave a better overall response than sham acupuncture and reduced fatigue scores compared with other treatments. Most studies were of low quality, the certainty of the evidence was low, and the authors said no firm conclusion could be reached.[7] A meta-analysis of 24 trials found that acupuncture improved sleep scores in insomnia compared with medication, with results mainly appearing after three weeks of treatment, but the trials showed large differences from one another.[8] These findings are for other conditions, not AIH.
How acupuncture may work
How acupuncture might act on the liver or the immune attack in AIH has not been studied, and we do not claim that it does.
What treatment involves
We ask that your condition is under medical management and that your treating team knows you are receiving complementary care. Sessions use fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, with reassessment after a short course of visits.
In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.[9] Tell the practitioner first if you have a bleeding disorder or low platelet count (which can occur in advanced liver disease), take blood thinners, are pregnant, or have a pacemaker. Immune-suppressing medicines can raise infection risk, so tell us if you take them.
Ayurvedic medicine as supportive care in Autoimmune Hepatitis
The Ayurvedic view
Ayurveda has no classical diagnosis that matches autoimmune hepatitis. Liver disorders were traditionally described in terms of the liver (yakrit) and imbalance of Pitta, the principle said to govern digestion and metabolism. These are traditional frameworks, not biomedical diagnoses, and they do not guide treatment of an autoimmune disease.
Therapies that may be used
Supportive Ayurvedic care is limited to gentle, individualized measures:
- Regular meals, sleep and daily routine, and stress-reducing practices such as breathing exercises
- Gentle oil massage for relaxation
- Herbs, only if your hepatologist agrees and your liver tests are monitored
Panchakarma procedures, including therapeutic purgation, are not appropriate with active liver inflammation, cirrhosis, acute illness, frailty or pregnancy.
What the research shows
No clinical trials of Ayurvedic treatment for autoimmune hepatitis were found. The research that does exist is a warning. In a study of 43 patients in India, guduchi (Tinospora cordifolia, also called giloy), promoted as an immune booster, was associated with liver injury that had autoimmune features. It could also unmask AIH in people with silent AIH-related chronic liver disease.[10] An expert report on drug-induced autoimmune-like hepatitis also lists Tinospora cordifolia among the implicated supplements.[4] Ayurvedic scholars have argued that the products involved may have contained the wrong species, since adulteration is common in herbal markets, and called for better surveillance.[11] Either way, guduchi and similar "immune-boosting" herbs are best avoided in AIH.
Herbal medicine as supportive care in Autoimmune Hepatitis
Herbs and formulas that have been studied
No human trials of herbal medicine for AIH were found. A review of Chinese medicine in AIH summarizes mainly animal-model studies of Chinese medicine-based therapies and discusses their limitations.[12] Milk thistle is a well-known liver herb, but its trials are in alcoholic and viral liver diseases, not AIH.[13]
What the research shows
The evidence for AIH is absent in people. The animal research reviewed for Chinese medicine cannot show benefit in patients, and the review itself discusses current limitations.[12] A Cochrane review of 13 trials of milk thistle in alcoholic or viral hepatitis found that the trials were of low methodological quality and that, based on high-quality trials, it did not seem to significantly change the course of those diseases. This does not apply to AIH.[13]
Safety and herb-drug interactions
Safety is the main issue. Herbal and dietary supplements account for about 20% of drug-induced liver injury in the United States, and the ingredient responsible is often hard to identify.[6] Some cases look like AIH.[4] Do not start any herb or supplement without your hepatologist's approval, and stop and call your physician if you develop jaundice, dark urine or severe fatigue.
Herbs can also interact with your medicines. St. John's wort lowered levels of ciclosporin and tacrolimus, with organ rejection reported in some cases, and ginkgo has been reported to cause bleeding with warfarin or aspirin.[14] In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.[15] Tell us if you take steroids, azathioprine, mycophenolate or other immune-suppressing medicines, are pregnant or breastfeeding, or have cirrhosis or kidney disease.
Translating traditional medicine into modern biological language
This section is interpretation, not equivalence. Chinese medicine often describes liver conditions as stagnation of liver qi or damp-heat, and Ayurveda describes aggravated Pitta in the liver. Researchers studying such ideas look at immune cell activity and liver inflammation in animal models, not at patterns.[12]
No study has shown that a TCM pattern or a dosha corresponds to the autoimmune process in the liver. The cases of herb-related liver injury also show that a "traditional" remedy is not safe merely because it is old.[10]
How this care fits with your medical care
Supportive care is complementary and starts only once AIH is under medical management. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Do not stop or change prednisone, azathioprine or any other prescribed medicine, and keep your blood-test and specialist appointments.
We do not diagnose or manage the disease. Please bring your diagnosis, recent liver test results, a full list of medicines and supplements, and the name of your hepatologist.
When to seek urgent medical care
AIH can flare or lead to complications, and some of these are emergencies.[1]
- Yellowing of the skin or eyes that is new or getting worse
- Vomiting blood or passing black, tarry stools
- Confusion, severe drowsiness or marked change in behavior
- Rapid swelling of the abdomen or legs
- Severe abdominal pain or fever, especially while taking immune-suppressing medicines
- Easy bruising or bleeding that does not stop
If any of these occur, call 911 or go to the nearest emergency department.
Frequently asked questions
What is autoimmune hepatitis?
Autoimmune hepatitis is a chronic liver disease in which the immune system attacks liver cells and causes inflammation. It is more common in women and can occur at any age. Symptoms may include fatigue and jaundice, though some people have none at first. It is treated by physicians, usually with steroids and other immune-suppressing drugs, to protect the liver from scarring.
Can acupuncture help people with autoimmune hepatitis?
No trials have tested acupuncture for autoimmune hepatitis, so we cannot say it helps the disease. Studies of fatigue and insomnia in other conditions show possible benefit, but the quality is low. At most, acupuncture is a supportive option for fatigue, stress or sleep, once your liver specialist knows about it.
Do Ayurvedic or herbal medicines work for autoimmune hepatitis?
No Ayurvedic or herbal treatment has been shown to help autoimmune hepatitis. Some products promoted as immune boosters, including guduchi, have been linked to liver injury with autoimmune features. Herbs and supplements can harm the liver or interact with immune-suppressing medicines, so ask your hepatologist before using any.
Can I stop my steroids or other medicines if I have complementary care?
No. Complementary care is not an alternative to your medicines or your liver specialist’s plan. Stopping treatment can allow the disease to relapse. Do not stop or change prescribed medicines without your prescriber, and tell your physicians about any herbs or supplements you use.
What should I bring to a first visit?
Bring your diagnosis, recent liver blood test results, any biopsy or imaging reports, and a full list of your medicines and supplements. Also bring the name of your hepatologist or treating physician. We ask that your treating team knows you are receiving complementary care.
Does insurance cover acupuncture for autoimmune hepatitis?
It may. Netra Integrative Health Clinic accepts most major insurance plans that include out-of-network acupuncture benefits, for example Aetna, Blue Cross Blue Shield, Cigna and UnitedHealthcare, and offers a free benefits check. HSA and FSA cards and CareCredit are also accepted. Call (908) 402-7301 to ask about your plan.
References
- Muratori L, Lohse AW, Lenzi M. Diagnosis and management of autoimmune hepatitis. BMJ. 2023;380:e070201. PMID 36746473. BMJ review of AIH diagnosis and management covering presentation, immune mechanism, diagnostic hallmarks, response to corticosteroids and lifelong maintenance therapy.
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of autoimmune hepatitis. J Hepatol. 2025;83(2):453-501. PMID 40348684. EASL 2025 clinical practice guideline on autoimmune hepatitis, covering its spectrum from asymptomatic to acute liver failure and management of cirrhosis and transplantation.
- Linzay CD, Sharma B, Pandit S. Autoimmune Hepatitis. StatPearls [Internet]. 2023. PMID 29083819. StatPearls chapter on autoimmune hepatitis describing it as chronic liver inflammation of unknown cause, the proposed mechanism, and the two types defined by autoantibodies.
- Andrade RJ, Aithal GP, de Boer YS, et al. Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report. J Hepatol. 2023;79(3):853-866. PMID 37164270. Expert report on drug-induced autoimmune-like hepatitis, which can mimic AIH, listing implicated drugs and supplements including Tinospora cordifolia.
- Reau NS, Lammert CS, Weinberg EM. Autoimmune hepatitis: Current and future therapies. Hepatol Commun. 2024;8(6). PMID 38836863. Review of current and future AIH therapies noting immunosuppressant adverse effects, complex pathogenesis and the need for steroid-sparing approaches.
- Navarro VJ, Khan I, Björnsson E, et al. Liver injury from herbal and dietary supplements. Hepatology. 2017;65(1):363-373. PMID 27677775. Hepatology review of liver injury from herbal and dietary supplements, which account for about 20 percent of drug-induced liver injury in the United States.
- Zhang Q, Gong J, Dong H, et al. Acupuncture for chronic fatigue syndrome: a systematic review and meta-analysis. Acupunct Med. 2019;37(4):211-222. PMID 31204859. Meta-analysis of 16 studies (1,346 subjects) of acupuncture for chronic fatigue syndrome with low-certainty evidence and no firm conclusion.
- Kim SA, Lee SH, Kim JH, et al. Efficacy of Acupuncture for Insomnia: A Systematic Review and Meta-Analysis. Am J Chin Med. 2021;49(5):1135-1150. PMID 34049475. Meta-analysis of 24 trials of acupuncture for insomnia finding improved sleep scores, mainly after three weeks, with high heterogeneity.
- Bäumler P, Zhang W, Stübinger T, et al. Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies. BMJ Open. 2021;11(9):e045961. PMID 34489268. Systematic review of 21 prospective studies finding minor acupuncture reactions in about 9 percent of patients and serious events in about 1 per 10,000.
- Kulkarni AV, Hanchanale P, Prakash V, et al. Tinospora Cordifolia (Giloy)-Induced Liver Injury During the COVID-19 Pandemic-Multicenter Nationwide Study From India. Hepatol Commun. 2022;6(6):1289-1300. PMID 35037744. Multicenter Indian study of 43 patients with liver injury linked to Tinospora cordifolia (giloy), with autoimmune features and unmasking of silent AIH.
- Panneer Selvam K, Payyappallimana U, Ravikumar K, et al. Can Guduchi (Tinospora cordifolia), a well-known ayurvedic hepato-protectant cause liver damage?. J Ayurveda Integr Med. 2023;14(1):100658. PMID 36400639. Ayurvedic review of guduchi safety arguing that adulteration or wrong species may explain reported liver injury and calling for better surveillance.
- Liu J, Ma Z, Li H, et al. Chinese medicine in the treatment of autoimmune hepatitis: Progress and future opportunities. Animal Model Exp Med. 2022;5(2):95-107. PMID 35263512. Review of Chinese medicine in AIH summarizing animal-model research and its limitations.
- Rambaldi A, Jacobs BP, Iaquinto G, et al. Milk thistle for alcoholic and/or hepatitis B or C liver diseases--a systematic cochrane hepato-biliary group review with meta-analyses of randomized clinical trials. Am J Gastroenterol. 2005;100(11):2583-91. PMID 16279916. Cochrane review of 13 trials of milk thistle in alcoholic or viral liver disease finding no significant effect on disease course in high-quality trials.
- Hu Z, Yang X, Ho PC, et al. Herb-drug interactions: a literature review. Drugs. 2005;65(9):1239-82. PMID 15916450. Literature review of herb-drug interactions, including ginkgo with warfarin or aspirin and St. John's wort with ciclosporin and tacrolimus.
- Saper RB, Phillips RS, Sehgal A, et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008;300(8):915-23. PMID 18728265. JAMA study finding detectable lead, mercury or arsenic in about one fifth of Ayurvedic medicines purchased over the Internet.
This page is for general education and is not medical advice. Acupuncture, Ayurvedic medicine and herbal medicine are complementary therapies; they do not replace diagnosis or treatment by your physician. Do not stop or change prescribed treatment without talking to your prescriber. In an emergency call 911.
