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Small Book

Integrated Chinese and Western Medicine Treatment of Liver Diseases Edited by Pei Zhengxue Compiled by Xue Wenhan and Li Min

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Pei Zhengxue, male, born in February 1938, from Wushan, Gansu Province, graduated from Xi’an Medical University in 1961. He is a professor and chief physician, and a renowned expert in integrated Chinese and Western medicine in China. His major works include “Commentary and Explanation on Blood Disorders,” “Selected Works on Rhubarb,” “New Compilation of Warm Disease Studies,” “Practical Internal Medicine of Integrated Chinese and Western Medicine,” and others. The first monumental work on internal medicine of integrated Chinese and Western medicine in contemporary times—“Practical Internal Medicine of Integrated Chinese and Western Medicine”—edited by him, won the “International Gold Award for Outstanding Contribution” at the Third World Congress of Traditional Medicine held in the United States in April 1996. He himself was also honored as one of the “Top 100 Stars of National Medicine in the World.” In 1997, the State Administration of Traditional Chinese Medicine recognized him as one of the 500 most famous senior TCM doctors nationwide. Professor Pei’s “sixteen-character principle” for integrated Chinese and Western medicine has attracted attention from the medical community across the country and has become an important school of thought in the field of TCM today.

CamScanner Created Series on Integrated Chinese and Western Medicine Treatment of Common Diseases: Integrated Chinese and Western Medicine Treatment of Liver Diseases, Edited by Pei Zhengxue; Compiled by Xue Wenhan and Li Min. Published by Gansu Science and Technology Press. CamScanner Created Book Cataloging Data (CIP) Integrated Chinese and Western Medicine Treatment of Liver Diseases / Edited by Pei Zhengxue; Compiled by Xue Wenhan and Li Min. Lanzhou: Gansu Science and Technology Press, September 2000. (Series on Integrated Chinese and Western Medicine Treatment of Common Diseases / Edited by Pei Zhengxue) ISBN 7-5424-0734-1 I. Liver... II.①Pei...②Xue...③Li... III. Liver Diseases - Integrated Chinese and Western Medicine Therapy IV.R575.05 China Version Library CIP Data Verification No. (2000) 42895

Integrated Chinese and Western Medicine Treatment of Liver Diseases (Series on Integrated Chinese and Western Medicine Treatment of Common Diseases) Author: Edited by Pei Zhengxue Editor-in-Charge: Chen Xuexiang Cover Design: He Wei Layout Design: Shi Yang

Publication: Gansu Science and Technology Press (No. 296 Binhe East Road, Lanzhou) Distribution: Distribution Department of Gansu People’s Publishing House (No. 123 First New Village, Lanzhou) Sales Agents: Xinhua Bookstores nationwide Printing: Gansu Geological Printing Factory (No. 357 Fuli West Road, Xigu District, Lanzhou) Format: 850mm × 1168mm, 1/32 Number of Printing Sheets: 3.875 Word Count: 91,000 Edition: First Edition, September 2000; First Printing, September 2000 Print Run: 1–4,120 copies ISBN: 7-5424-0734-1/R ·200 Price: 5.40 yuan ◎If any books published by Gansu Science and Technology Press are

damaged or missing pages, please contact the printing factory directly for replacement ●All rights reserved. Reproduction prohibited. CamScanner Created

Series Editorial Committee Editor-in-Chief: Pei Zhengxue Associate Editors: Li Yongshou and Wang Xinshun Committee Members: Li Yanyi, Li Min, Dai Enlai, Qiu Yumei, Xue Wenhan

CamScanner Created Preface The treatment of common diseases is a matter of great importance to the national economy and people’s livelihood; the health and well-being of the people, the prosperity of the nation, and the prevention and control of common diseases are all closely related. Both traditional Chinese medicine and Western medicine have their own unique characteristics in the prevention and treatment of common diseases. From the perspective of overall efficacy, each has its strengths and they are evenly matched; from the standpoint of concepts and methods, they exhibit obvious complementarity. Traditional Chinese medicine views diseases from a macro perspective, emphasizing holistic regulation and the body’s reactivity; Western medicine, on the other hand, approaches diseases from a micro perspective, focusing on local treatment and the pathogenicity of the causative agent. Generally speaking, there are two key factors in the onset of disease: first, the pathogenicity of the causative agent; second, the body’s reactivity. If either factor is lacking, disease cannot arise. From the clinical manifestations of disease, there are also two aspects: one is local changes, the other is systemic manifestations; if either is missing, the disease cannot occur. Whether it is the “two factors of onset” or the “two aspects of symptoms,” both traditional Chinese medicine and Western medicine occupy one end, thus forming a clear complementarity. It is no wonder that diseases which Western medicine cannot treat often respond very well to traditional Chinese medicine, while diseases that traditional Chinese medicine cannot cure often show excellent results under Western medical treatment. This fully demonstrates the necessity of integrating Chinese and Western medicine. As early as 40 years ago, Comrade Mao Zedong, with his far-sighted vision, called for “integrating Chinese and Western medicine to create a new unified national pharmacology.” Over the past 40 years, both domestically and internationally, there has been a surge in the study of traditional Chinese medicine among Western medical practitioners, and a number of highly skilled experts in integrated Chinese and Western medicine have emerged. Their research achievements and experience summaries are widely acclaimed in the medical community, shining brightly and pushing the clinical efficacy of medicine to new heights. In order to further develop this discipline and bring greater benefits to humanity, the author edited China’s first large-scale monograph on integrated Chinese and Western medicine—“Practical Internal Medicine of Integrated Chinese and Western Medicine”—eight years ago. After the publication of this book, it was widely welcomed by medical professionals at both senior and intermediate levels at home and abroad. However, a large number of letters from grassroots medical workers indicated that the content of the book was rather advanced and not suitable for rural doctors and self-learners to use as a reference. Therefore, we formulated the purpose, outline, format, and detailed rules for compiling this series and organized the editorial committee for the Series on Integrated Chinese and Western Medicine Treatment of Common Diseases. This series

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is intended for grassroots doctors and self-learners, and can also serve as a reference for patients’ self-care. We hope that the publication of this series will benefit grassroots doctors and patients alike. Bixin Xue, May 1, 2000 8th edition, revised and checked Internal strictness, Western and Chinese integration, --- - special combination Reduced, widespread praise, 1 saint, to the middle, big combination, good quality, original text & output, out of the groove, year of trial, change of ten, still respect the combination, etc. CamScanner Created

Table of Contents [Chapter 1: Western Medical Types and Diagnosis of Viral Hepatitis (1)] Section 1: Hepatitis A (1) Section 2: Hepatitis B (3) Section 3: Hepatitis C (7) Section 4: Hepatitis D (9) Section 5: Hepatitis E (10) Section 6: Hepatitis G (12) Section 7: Diagnostic Criteria for Viral Hepatitis (12) [Chapter 2: Traditional Chinese Medicine Differentiation and Treatment of Viral Hepatitis (24)] [Chapter 3: Western Medical Treatment of Viral Hepatitis (35)] Section 1: Liver Protection Treatment (35) Section 2: Immunomodulation and Antiviral Treatment (37) Section 3: Symptomatic Treatment (40) [Chapter 4: Nursing Care for Viral Hepatitis (44)] Section 1: Adequate Rest (44) Section 2: Reasonable Diet (45) Section 3: Positive Mental Attitude (45) [Section 4: Family Care (46)] [Chapter 5: Prevention of Viral Hepatitis (47)] Section 1: Handling the Source of Infection (47) [Section 2: Cutting Off the Routes of Transmission (48)] Section 3: Use of Hepatitis B Vaccine and Hepatitis B Immunoglobulin (48) [Chapter 6: Post-Hepatitis Cirrhosis (50)]

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Section 1: Viral Hepatitis and Post-Hepatitis Cirrhosis (50) Section 2: Manifestations and Diagnosis of Cirrhosis (51) Section 3: Traditional Chinese Medicine Treatment of Cirrhosis (55) Section 4: Western Medical Treatment of Cirrhosis (57) Section 5: Treatment of Complicated Upper Gastrointestinal Bleeding (63) Section 6: Treatment of Hepatic Encephalopathy (67) Section 7: Treatment of Hepatorenal Syndrome (74) [Section 8: Prognosis of Post-Hepatitis Cirrhosis (79)] Section 9: Case Examples (80) [Chapter 7: Primary Liver Cancer (84)] Section 1: Pathology (84) Section 2: Clinical Manifestations Limited ... ... ... ... ... (86) [Section 3: Laboratory and Physical Examinations FR: ...............(88)] [Section 4: Diagnosis h Limited ... ... ( 9 0 )] Section 5: How to Detect Early in the Context of This Inflammation............ (92) Section 6: Western Medical Treatment (93) Section 7: Traditional Chinese Medicine Treatment of Primary Liver Cancer (97) [Section 8: Prognosis of Primary Liver Cancer Not ... ... ( 1 0 2 )] [Chapter 8: Severe Hepatitis Responds to Central China Dry ... ... ( 1 0 4 )] Section 1: Clinical Manifestations P.........( 104) Section 2: Western Medical Treatment ( 105) Section 3: Traditional Chinese Medicine Treatment ( 107) Section 4: Prognosis ( 107) Section 5: Case Examples ( 108) Chapter 9: Adjunctive Treatment for Patients with Liver Disease ( 109) Section 1: Dietary Therapy for Patients with Liver Disease ( 109) Section 2: Other Folk Remedies for Liver Disease ( 113)

CamScanner Created Chapter 1: Types and Diagnosis of Viral Hepatitis

Viral hepatitis is a common and frequently occurring disease that seriously endangers the physical and mental health of the people and has become a social issue attracting attention from all sectors. To date, six types of viruses have been found to cause hepatitis, each represented by a letter—A, B, C, D, E, and G—which correspond to hepatitis A, B, C, D, E, and G in Chinese.

Section 1: Hepatitis A

Hepatitis A, commonly referred to as Type A hepatitis, is the earliest type of hepatitis discovered because it has an acute onset, and most patients exhibit obvious jaundice. Initially, it was called acute icteric hepatitis, but it wasn’t until 1940 that people realized it was liver damage caused by a virus. In the early 1960s, after the discovery of the hepatitis B virus, the aforementioned liver damage was officially named hepatitis A. The first successful experimental infection of animals with the hepatitis A virus occurred in 1969, when it was tested on rhesus monkeys, followed by the discovery that chimpanzees were also susceptible. In 1979, the hepatitis A virus was successfully cultured in tissue, marking the official distinction between hepatitis A and hepatitis B.

There is no obvious seasonal correlation with the onset of hepatitis A, but poor hygiene habits and unsanitary conditions can easily lead to infection or cause localized outbreaks. Once drinking water becomes contaminated, it can trigger a widespread epidemic. This disease is distributed worldwide, and China is a high-incidence area for hepatitis A. It mainly affects children and adolescents. CamScanner Created

How does the hepatitis A virus transmit to humans? Fecal contamination is an important route of transmission. That is, after the hepatitis A virus is excreted in the patient’s feces, it contaminates water, vegetables, fruits, or food through human hands and flies. When people consume contaminated food, the virus enters the body, multiplies in the digestive tract, then spreads into the bloodstream and reaches the liver, where it grows within liver cells and causes disease. One to two weeks before the onset of illness, the virus is released from liver cells into surrounding tissues and bile ducts, while some of it is excreted through the digestive tract, creating new sources of infection. Very few people can contract hepatitis A through blood transfusion, usually because the donor was not thoroughly screened and happened to be an hepatitis A patient, or because he appeared healthy but his blood already carried the hepatitis A virus. Such blood, once transfused into another person, becomes another route of infection. Maternal hepatitis A does not infect the fetus, nor does it cause fetal malformations; antibodies produced by pregnant women who have hepatitis A provide protective effects for the fetus. In 1950 and 1978, Sweden and Ningbo in China both experienced outbreaks of hepatitis A due to consumption of mud clams; reports of hepatitis A outbreaks caused by eating shellfish seafood have frequently appeared in newspapers in the United States, Canada, Mexico, and Australia; in 1979, Shanghai experienced a major outbreak of hepatitis A due to eating drunken crabs, and in 1988, another large outbreak occurred due to eating Manila clams. These incidents clearly demonstrate the special role of Manila clams and other shellfish products in spreading hepatitis A. Can hepatitis A develop into chronic hepatitis? Generally speaking, the vast majority of cases of hepatitis A are self-limiting, with a good prognosis. Most patients recover within 2 to 4 months, though a small number may have prolonged or recurrent courses, but ultimately all recover and do not progress to chronic hepatitis. The clinical manifestations of hepatitis A are quite typical, and the onset is usually quite acute. (1) Prodromal phase (1–5 days). Symptoms include fever, loss of appetite, abdominal pain, diarrhea, sore throat, and joint pain. Subsequently, patients experience marked fatigue, loss of appetite, nausea, vomiting, abdominal pain, diarrhea, and pain in the liver region or generalized jaundice. The acute phase typically lasts 2–4 weeks, though in a few cases jaundice persists longer, but it usually resolves completely within 2–3 months. Clinically, it is divided into acute icteric type and acute non-icteric type. The former has more severe symptoms; in addition to the above, scleral and generalized skin jaundice may occur, the liver enlarges and becomes tender in 80% of patients, about 10% develop splenomegaly, and a small number show a tendency toward skin and mucosal bleeding. On the other hand,

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the acute non-icteric type includes many patients without clinical symptoms, known as subclinical (latent) type, which is an important potential source of infection. Some cases of hepatitis A tend to resolve on their own and do not progress to chronic hepatitis. (2) In acute hepatitis A patients, serum tests show positive anti-hepatitis A virus immunoglobulin M (anti-HAV-IgM). During the acute phase and recovery phase, the titer of total anti-hepatitis A virus antibodies (anti-HAV) increases by at least fourfold. Hepatitis A virus ribonucleic acid (HAV-RNA) can be detected in serum or stool. During the acute phase, electron microscopy of stool reveals hepatitis A virus particles (HAV), or enzyme-linked immunosorbent assay (ELISA) detects hepatitis A virus antigen (HAV-Ag). Meeting any one of these four criteria is sufficient for diagnosis. Liver function may show varying degrees of abnormality, with elevated alanine aminotransferase being the most common finding in acute hepatitis A patients. Section 2: Hepatitis B

Hepatitis B, commonly referred to as Type B hepatitis. The complete viral particle of the hepatitis B virus (HBV) has a diameter of 42 nanometers, also known as Dane particles, and is divided into two parts: the envelope and the core. The protein on the envelope is the hepatitis B surface antigen, which was discovered in 1963 by American scholar Blumberg and others and was then named “Australian antigen.” In 1970, the Fourth International Conference on Liver Diseases decided to rename the “Australian antigen” as the hepatitis-related antigen (HAA). In September 1972, at the United Nations conference on viral hepatitis, it was decided to abolish the name “related antigen” and instead call it “hepatitis B antigen” (HBAg). In 1979, the National Academy of Sciences of the United States convened a conference on viral hepatitis and separately proposed names such as hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg). The hepatitis B surface antigen is synthesized within liver cells and released in large quantities into the bloodstream, but it itself is not infectious. The core antigen (HBcAg) and e antigen (HBeAg) in the core part are the main components responsible for viral replication. The hepatitis B virus is highly resilient, able to withstand temperatures of 60°C for 4 hours and ordinary concentrations of disinfectants. Boiling for 10 minutes, heating at 65°C for 10 hours, or steam sterilization under pressure can kill it.