Treatment of Viral Hepatitis with Chinese Medicine

Viral Hepatitis

There are several types of viral hepatitis, caused respectively by different hepatitis viruses. People are susceptible to the disease. Clinically, the chief complaints include poor appetite, hepatalgia and fatigue. There could also be fever and jaundice as well as damage of liver function in various degrees. In TCM, this disease is classified to the categories of ``Huangdan'' (jaundice), “Ganyu'' (stagnation of liver Qi), “Xietong'' (hypochondriac pain) and “Zhengji” (masses or lumps in the abdomen).

Key Points of Diagnosis

l. Epidemiologic information: The epidemic condition and a history of close contact with a hepatitis patient, or a history of blood transfusion ,or that of administering blood products, or that of immunization injections should be noticed.

2. Clinical features:

(l) The onset of the disease is insidious and slow. Patients often complain of fatigue and anorexia. Some would have jaundice, but the majority might suffer from the nonicteric and mild hepatitis. Only ten percent of the patients could be the typical or icteric hepatitis.

2) Patients with hepatitis A often have manifestations of pyrexia, shorter course of disease and sooner recovery; while patients with hepatitis B usually have a chronic course and remain as HB virus carriers for long time. A small number of them may progress to cirrhosis.

3. Physical signs: There is hepatomegaly associated with tenderness on palpation and pain on percussion, and a mild change of liver texture. Some patients may have splenomegaly as well. In icterohepatitis, jaundice could be found in the skin and sclera. Hepatic complexion, vascular spiders and liver palms could be present in chronic active hepatitis. A small number of patients suffer from fulminant hepatitis featured by skin petechiae, epistax, ascites, and even hepatic coma, indicating an unfavorable prognosis.

4.Laboratory examinations

1) Liver function: In acute hepatitis, the SGPT could be elevated to several hundreds units, even over one thousand units. In icterohepatitis, the icterus index and the one-minute bilirubin fixed quantity are increased. In severe and chronic active hepatitis, the metabolism of protein is lessened resulting in the dropped or even inverted ratio of serum albumin to globulin i.e. the albumin level lowered but the globulin level elevated. Dysfunction of blood coagulation could be present.

2) The test of specific antigens and antibodies: To diagnose hepatitis A, the HAAg in filtrate of stools and the anti-HAV of the IgG and IgM class in the serum could be measured. Three antigen and antibody systems, i.e. HBsAg, HBcAg and HBeAg with their antibodies can be tested, which is devoted to ensuring the diagnosis and evaluating the severity, infectivity and prognosis of hepatitis B.

3) In chronic active hepatitis, tests for cellular immunity, humoral immunity and autoimmunity should be performed to evaluate the host immune mechanisms and the progress severity of the disease so as to offer appropriate treatment accordingly. Liver biopsy is only indicated for those who are unable to be diagnosed through clinical and laboratory examinations.

Syndrome Differentiation:

1.Icterohepatitis

l) Yang-yellow (Acute icterohepatitis)

Chief Symptoms and Signs: There are such manifestations as yellow-stained skin and sclera which look as bright as orange, fever, thirst, fullness and distension in the epigastrium, anorexia, sluggishness and fatigue, subcostal distension and pain, irritability, nausea, concentrated urine, and dry stools. The tongue is reddish with yellow-sticky coating and the pulse is wiry-rapid.

Treating Principle: To eliminate pathogenic damp-heat.

Formula: “Yinchenhao Tang (Oriental Wormwood Decoction)” (modified):

Oriental wormwood 30g, capejasmine fruit 10g, rhubarb root 6g (decocted for shorter time), phellodendron bark 10g, honeysuckle flower 30g, forsythia fruit 15g, isatis root 30g, and cogongrass rhizome 80g.

All the above materials are decocted in water for oral administration.

When there is excessive pathogenic heat, 30 grams of both isatis leaf and dandelion are added.

When there is excessive pathogenic dampness, atractylodes rhizome, rnagnolia bark and alismatis rhizome, 10 grams for each are combined. When the nausea and vomiting are remarkable, 10 grams of both pinellia tuber and bamboo shavings are combined.

When to treat poor appetite and abdominal distension, the combination with parched hawthorn fruit, parched malt, and parched medicated leaven, 10 grams for each is made.

When to treat cutaneous pruritus, 15 grams of both dittany bark and broom cypress fruit are supplemented.

2) Yin-yellow (Chronic icterohepatitis)

Chief Symptoms and Signs: yellow-stained but dull skin and sclera looking as being smoked, poor appetite with abdominal distention, loose stools, lassitude and fatigue, tastelessness in mouth, white-thick-sticky tongue coating, and deep- thready- weak pulse.

Treating Principle: To activate the transportation function of spleen so as to eliminate dampness, and warm Yang.

Formula: “Yinchen Zhu Fu Tang (Decoction of Oriental Wormwood, Bighead Atractylodes and Prepared Aconite)”(modified):

oriental wormwood 30g, bighead atractylodes rhizome 12g, dangshen 12g, poria 15g, coix seed 30g, prepared aconite root 6g, tangerine peel 10g, hawthorn fruit 10g , malt 10g, and medicated leaven 10g.

All the materials are decocted in water for oral administration.

When to treat the complaining of aversion to cold and cold extremities, 10 grams of dried ginger are combined.

When to treat the hepatomegaly or splenomegaly 15 grams of both fresh-water turtle shell and red sage root are supplemented.

When there is ascites, and 15 grams of both shell of areca nut and plantain seed (wrapped in cloth when being decocted) are recommended.

2.Anicteric hepatitis

1) Dampness and heat in liver and gallbladder

Chief Symptoms and Signs: There are manifestations of stuffiness in chest, irritability associated with feverish sensation, subcostal pain, abdominal distension, lassitude and general weakness, anorexia with dislike to greasy food, bitter-tasted and dry mouth, dark-yellow urine, and dry stools. The tongue is red with yellow-stick coating and the pulse is wiry- rapid or rolling-rapid.

Treating Principle: To eliminate damp-heat.

Formula: the modified combination of “Yinchenhao Tang (Oriental Wormwood Decoction)” and “Longdan Xie Gan Tang (Decoction of Gentian Root for Purging Liver-fire)”:

oriental wormwood 30g, capejasmine fruit 10g, scutellaria root 10g, gentian root 10g, isatis root 30g, patrinia 30g, curcuma root 12g,plantain seed 10g (wrapped in cloth in the decocting), red sage root 12g, poria 10g, and magnolia bark 10g.

All the above materials are decocted in water for oral administration.

When easing the remarkable pain in the hypochondrium 12 grams of Sichuan chinaberry and 10 grams of corydalis tuber are added.

When treating the marked distension and stuffiness in epigastric region 10 grams of both amomum fruit and bitter orange are combined. When treating the poor appetite 15 grams of hawthorn fruit and 10 grams of membrane of chicken's gizzard skin are supplemented.

2) Stagnation of liver Qi with hypofunction of spleen

Chief Symptoms and Signs: There are manifestations of dull pain in the right side of hypochondrium, general sluggishness and weakness, anorexia, loose stools, thin-white tongue coating, and deep- wiry pulse.

Treating Principle: To disperse the stagnation of liver Qi and to reinforce the function of spleen.

Formula: “Xiao Yao San (Ease Powder)” (modified):

bupleurum root 10g, Chinese angelica root 10g, white peony 10g, dangshen 12g, white atractylodes rhizome I0g, poria 10g, curcuma root 12g, tangerine peel 10g, red sage root 12g, Chinese yam 15g, hawthorn fruit 15g, medicatcd leaven 12g, and prepared licorice root 6g.

All the above materials are decocted in water for oral administration.

When there are manifestations of dryness of eyes, dizziness and vertigo, dull pain in the hypochondrium, heat sensation in palms and soles, sore and weak back and knees, dry and red tongue with a little coating or no coating, and wiry-thready pulse, it is a syndrome of liver Yin deficiency. The treatment is devoted to nourishing liver Yin. “Yi Guan Jian (Decoction for Nourishing Liver and Kidney Yin)”(modified) is prescribed, including:

glehnia root 12g, ophiopogon root 12g, dried rehmannia root 12g, wolfberry fruit 15g, Chinese angelica 10g, Sichuan chinaberry 10, fresh-water turtle shell 15g, curcuma root 12g, and dendrobium 12g.

3) Stagnation of Qi and blood

Chief Symptoms and Signs: There are manifestations of dull complexion, stabbing pain in the right hypochondrium, lumps or masses found in the subcostal region, abdominal distension, poor appetite, spider-like telangiectasia in the face and neck, and liver palms. The tongue is dark purple or marked with stasis spots and the pulse is wiry-choppy.

Treating Principle: To promote blood circulation, disperse the stagnation and stasis, and soften the lumps and masses.

Formula: “Tao Hong Si Wu Tang (Decoction of Four Ingredients Supplemented with Peach Kernel and Safflower)”(modified):

Chinese angelica 12g, white peony root 12g, chuanxiong rhizome 10g, peach kernel 10g, safflower 10g, red sage root 20g, fresh-water turtle shell 15g, pangolin scales 6g, zedoary 10g, spatholobus stem 30g, cyperus tuber 10g, finger citron 10g, and prepared licorice root 10g. All the materials are decocted in water for oral administration.

When there appear the symptoms of lassitude and weakness, 12 grams of dangshen and 15 grams of astragalus root are added.

In above-mentioned syndromes, if the test of SGPT is higher than normal, powder of schisandra fruit is taken at meanwhile, 3 grams for each time and 3 times a day. Or stringy stonecrop powder could be taken as well, 50 mg for each time and 3 times a day. Or any of the following ingredients in appropriate amount could be extraly taken: bistort rhizome, giant knotweed rhizome, and Japanese St. Johns wort

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