I Rest

(I) Rest
In the early stages of acute hepatitis, hospitalization or local isolation and rest are recommended. For chronic hepatitis, appropriate rest is advised; once the condition improves, a balance of rest and activity should be maintained, gradually increasing physical activity during the recovery phase, but avoiding overexertion to facilitate recovery. HBsAg carriers need regular follow-up and can continue working.

(II) Diet
Patients with acute hepatitis often have poor appetite and should consume light, easily digestible foods rich in vitamins. If appetite significantly decreases and vomiting occurs, intravenous infusion of 10%–20% glucose solution and vitamin C may be administered. Patients with chronic hepatitis are advised to follow a high-protein diet, but care should be taken not to overeat to prevent fatty liver and other complications. Alcohol consumption is strictly prohibited for hepatitis patients.

(III) Pharmacotherapy

1. Acute hepatitis
   (1) Type A and Type E: Generally do not progress to chronic forms; treatment mainly involves supportive care and symptomatic management. Localities can select Western or traditional Chinese medicines based on drug availability and local conditions, but misuse should be avoided. Pregnant women with Type E hepatitis should be closely monitored to prevent severe hepatitis.
   (2) Type B: Differentiate between true acute hepatitis B and acute exacerbation of chronic hepatitis B.

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For the former, treatment is the same as for Type A; for the latter, treat as chronic hepatitis B (especially antiviral therapy).
(3) Type C: Early diagnosis is difficult in some cases; suspected cases are treated as Type A hepatitis, and those who do not improve after 6 months are treated as chronic Type C hepatitis.
2. Chronic hepatitis (including Types B, C, and D): Treatment should be tailored to the patient’s specific condition, employing integrated TCM-Western medicine approaches such as antiviral therapy, immune modulation, hepatocyte protection, prevention of liver fibrosis, improvement of liver function, and enhancement of microcirculation.
3. Severe hepatitis: Intensified nursing care and close monitoring are required. Measures should include blocking further hepatocellular necrosis, promoting hepatocyte regeneration, improving hepatic microcirculation, and preventing and treating various complications (such as hepatic encephalopathy, cerebral edema, massive hemorrhage, renal insufficiency, secondary infections, electrolyte disturbances, ascites, hypoglycemia), along with strengthened supportive therapy.

Scan All-in-One Created Chapter 2: TCM Differential Diagnosis and Treatment of Viral Hepatitis
Western medicine’s classification and diagnosis of viral hepatitis are based on experimental research and microscopic understanding; TCM, on the other hand, is based on macroscopic differentiation and holistic concepts, providing unified, comprehensive differential diagnosis and treatment for Types A, B, C, D, E, and G hepatitis. At first glance, this may seem somewhat haphazard, but it truly reflects TCM’s characteristic of “treating the internal through external manifestations” and is an important feature of TCM scholarship.

I. Differential Diagnosis and Treatment
Viral hepatitis varies greatly among individuals depending on their physiological state; post-infection recovery depends on the vitality of the patient’s immune system, and any deficiency in the immune system can lead to chronic infection. Therefore, rebuilding immune function and clearing the virus require comprehensive treatment. Consequently, TCM’s prescription and medication based on individual clinical presentations and disease course reflect overall systemic regulation, aligning with the inherent principles of treating this disease. On the other hand, the objectification of syndrome differentiation and standardization of differential diagnosis and treatment go hand in hand, providing a more objective basis for TCM treatment of viral hepatitis.
In recent years, numerous different syndromes have been identified through differential diagnosis and treatment of viral hepatitis, but the most common ones are as follows. The main clinical manifestations and primary prescriptions for each syndrome are described below.

(I) Liver-Gallbladder Damp-Heat
Main symptoms: Pain in both flanks, bitter taste in mouth and dry throat, chest tightness and poor appetite, nausea and aversion to oil, jaundice of eyes and body or no jaundice, yellowish-red urine, greasy yellow tongue coating, and wiry, slippery, rapid pulse. Treatment principle: Clear damp-heat from liver and gallbladder, cool blood,
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detoxify. Prescription: Modified Danzhi Xiaoyao San. Ingredients: 6 g of Danshen, 10 g of Shan Zhi Zi, 15 g of Bai Shao, 10 g of Dang Gui, 10 g of Chai Hu, 12 g of Fu Ling, 10 g of Bai Zhu, 6 g of Gan Cao, 30 g of Dan Shen, 30 g of Huang Qi, 15 g of Qin Jiao, 15 g of Ban Lan Gen, 15 g of Er Hua, 15 g of Lian Qiao, 15 g of Gong Ying, 15 g of Bai Jiang.
Clinical report: Used Xiaoyao San as the main treatment for 253 cases of non-jaundiced hepatitis. Common symptoms included pain in the liver region, bitter taste in mouth and dry throat, fatigue, chest tightness and shortness of breath, nausea and loss of appetite. Results: 36 cases achieved normal liver function, 139 cases improved, with an overall effectiveness rate of 68.8% (as reported in the August 1960 issue of Guangdong Traditional Chinese Medicine).

(II) Liver Stagnation and Spleen Deficiency
Main symptoms: Flank pain predominantly of distending nature, migratory and unpredictable, worsening or alleviating with emotional changes, sallow complexion, reduced appetite, bland taste, loose stools, pale tongue with thin coating, and deep, wiry pulse. Treatment principle: Soothe the liver and resolve stagnation, strengthen the spleen and harmonize the middle burner. Prescription: Modified Chai Shao Liu Jun Zi Tang. Ingredients: 10 g of Chai Hu, 15 g of Bai Shao, 10 g of Zhi Shi, 6 g of Gan Cao, 15 g of Dang Shen, 10 g of Bai Zhu, 12 g of Fu Ling, 6 g of Gan Cao, 30 g of Dan Shen, 30 g of Huang Qi, 20 g of Huang Jing, 6 g of Yu Jin, 10 g of Dang Gui, 15 g of Ban Lan Gen, 15 g of Qin Jiao, 6 g of Chen Pi, 10 g of Xiang Fu.
Clinical report: Zhao used methods to soothe the liver and resolve stagnation, strengthen the spleen and boost qi to treat 50 cases of post-hepatitis cirrhosis. The prescription combined Chai Shao Liu Jun Zi Tang with Wu Ji Bai Feng Wan and Da Huang Ying Chong Wan, administered for 3 months, achieving an overall effectiveness rate of 88% (as reported in the June 1988 issue of Jiangsu Traditional Chinese Medicine Journal).

(III) Liver-Kidney Yin Deficiency
Main symptoms: Flank pain, dry mouth and throat, inner heat and irritability, dizziness and vertigo, tinnitus, red tongue with little coating, and fine, wiry, rapid pulse. Treatment principle: Nourish the blood and soften the liver, nourish yin and tonify the kidneys. Prescription: Modified Yi Guan Jian. Ingredients: 15 g of Bei Sha Shen, 10 g of Mai Dong, 10 g of Dang Gui, 12 g of Sheng Di Huang, 10 g of Gou Qi Zi, 20 g of Chuan Lian Zi, 10 g of Yuan Hu, 30 g of Dan Shen, 30 g of Huang Qi, 15 g of Bai Shao, 15 g of Qin Jiao.
Clinical report: Zhang ××, male, 44 years old, government official. Ill for one year, with persistent liver enlargement 2.5–3 cm below the ribs, spleen not palpable. Liver function tests showed no significant abnormalities. Chief complaints: Pain in both flanks, more pronounced on the right side, abdominal fullness and distension, fatigue and weakness. Previously tried prescriptions to soothe the liver, regulate qi, remove dampness, and dispel stasis, totaling over 80 doses, but symptoms persisted, body became emaciated, leading to bitter taste in mouth, dry throat, dizziness, insomnia, worsening flank pain, and constipation. Pulse diagnosis revealed weak and thin pulses in the guan and chi positions, with a dark, cracked tongue coating. This indicated yin deficiency and blood dryness, as well as liver stagnation and rebellious qi. Treatment should focus on clearing and nourishing, softening the rigidity and irritation of qi. Prescription: 4 qian of Bei Sha Shen,
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5 qian of Sheng Di Huang, 3 qian of Mai Dong, 4 qian of Gou Qi Zi, 1.5 qian of Dang Gui, 1.5 qian of Wei Chuan Lian Zi, 3 fen of Chuan Lian, 4 qian of Zao Ren, 5 qian of Bai Zi Ren, 1 liang of Sheng Da Mai Ya, and 5 qian of Kuai Lou Ren (dīng). After taking 5 doses, bowel movements became smooth, flank pain significantly reduced, and other symptoms also subsided. Following the original formula with adjustments, continued treatment for over a month, taking more than 20 doses, clinical symptoms basically disappeared, and liver enlargement shrank to 1.5 cm. (As reported in the October 18, 1963 issue of the Young Traditional Chinese Medicine Journal.)

(IV) Spleen-Kidney Yin Deficiency
Main symptoms: Fear of cold and preference for warmth, lower abdominal cramping and cold pain. Abdominal distension and lower limb edema, difficulty digesting grains, even diarrhea and incontinence, lower limb edema, pale and swollen tongue, and deep, thin, weak pulse. Treatment principle: Strengthen the spleen and boost qi, warm the kidneys and invigorate yang. Prescription: Modified Si Jun Zi Tang combined with Jin Gui Shen Qi Wan, with adjustments. Ingredients: 10 g of Dang Shen, 12 g of Fu Ling, 6 g of Gan Cao, 12 g of Sheng Di Huang, 10 g of Shan Yao, 6 g of Shan Yu Rou, 6 g of Dan Pi, 10 g of Ze Xie, 10 g of Gui Zhi, and 6 g of Fu Zi.
Clinical report: Zhang ×, male, 30 years old, first visit on January 30, 1961. Medical history: For the past two years, often experienced bitterness in mouth, poor appetite, post-meal abdominal distension, right flank pain, fear of cold and cold limbs, abdominal bloating, reduced urination, loose stools 1–5 times daily. Lower limb edema. Hospital examination revealed spleen enlarged 3 cm below the ribs, hard texture, positive ascites sign, concave edema in both lower limbs, jaundice index of 12u. Diagnosed as cirrhosis complicated by ascites. Had acute Type B hepatitis 13 years ago, recovered after hospitalization, but for over 10 years often felt fatigued and had poor appetite. Three years ago underwent duodenal drainage, biliary tract imaging, and liver biopsy. Diagnosed as cirrhosis and chronic cholecystitis. Physical examination showed emaciation, dull and yellowish complexion, abdominal bulge, bilateral lower limb edema, red tongue, thin yellow coating, and wiry, sticky pulse. Syndrome differentiation: Spleen-kidney yang deficiency, liver stagnation and qi blockage. Treatment principle: Tonify the kidneys and strengthen the spleen, soothe the liver and regulate qi. Prescription: 3 qian of Shan Yao, 3 qian of Shan Yu Rou, 1 liang of fried Zao Ren, 8 qian of Sheng Tu Si Zi, 3 qian of Qing Pi, 3 qian of Bu Gu Zi, 3 qian of Dang Shen, 3 qian of Sha Ren, 4 qian of Bai Zhu, 4 qian of Fu Ling, 3 qian of Xiang Fu. February 15th visit: After taking 4 doses, urine output increased significantly, abdominal distension and edema lessened, appetite improved, bowel movements became once daily, no longer loose. Added 3 qian of Nei Jin to the original formula and continued taking. March 1st visit: After taking over 10 doses, ascites resolved, slight abdominal distension remained, right flank pain still present, tongue coating and pulse unchanged. Added 4 qian of Yu Jin and 4 qian of Sheng Huang Qi to the original formula, prepared and taken as before. December 2nd letter: After taking dozens of doses, condition steadily improved, no more ascites, back to work for over six months (as reported in the Selected Cases of Dr. Liu Huimin).

(V) Blood Stasis Blocking Collaterals
Main symptoms: Dull complexion, enlarged and hardened liver and spleen, spider angiomas, palmar erythema, menstrual pain in women, dark-colored menstrual flow with clots, dark purple or bruised tongue, and deep, thin, sticky pulse. Treatment principle: Activate blood circulation, dissolve stasis, disperse knots, and unblock collaterals. Prescription: Modified Xuefu Zhu Yu Tang or Ge Xia Zhu Yu Tang, with additions: 10 g of Tao Ren, 3 g of Hong Yao, 12 g of Sheng Di Huang, 10 g of Chi Shao, 10 g of Dang Gui, 6 g of Yu Jin, 6 g of Dan Pi, 6 g of Da Huang, 10 g of Ze Lan, 6 g of Xiang Fu, 10 g of Zhi Ke, 10 g of Shan Jia, 5 g of Bie Jia, 15 g of Yi Mu Cao.
Clinical report: In addition to the aforementioned two formulas for activating blood circulation, dissolving stasis, and unblocking collaterals, the Hebei Provincial Institute of Traditional Chinese Medicine used blood-activating and stasis-dissolving methods to treat chronic hepatitis, employing Dan Shen, San Qi, Dang Gui, Hong Yao, Yu Jin, and other herbs, achieving an overall effectiveness rate of 91.6%, while also improving liver function, enhancing immunity, inhibiting viral replication, and exerting bidirectional regulatory effects on hemorheology and other indicators (as reported in the 1985 issue of the Heilongjiang Journal of Traditional Chinese Medicine, page 26).

II. Disease-Based Prescription
Disease-based prescription is an organic combination of traditional treatment methods and modern research, that is, based on Western medical classification, referencing the most common clinical manifestations of each subtype to formulate prescriptions according to TCM syndrome differentiation. In treating viral hepatitis, one can follow Professor Pei Zhengxue’s “Sixteen-Character Principle,” namely “Western diagnosis, TCM differentiation, TCM as the mainstay, Western medicine as the auxiliary,” setting prescriptions under Western classifications such as acute jaundice hepatitis, chronic migrating hepatitis, chronic active hepatitis, etc., and adopting the principle of “clear heat when hot, warm when cold, purge when excess, tonify when deficient” for specific medications. Sometimes multiple methods can be used in combination, incorporating heat-clearing and detoxifying, blood-activating and stasis-dissolving, spleen-and-kidney-tonifying, liver-soothing and spleen-strengthening, and other aspects within a single prescription. From the perspective of modern Western medicine, these principles encompass key elements such as inhibiting viruses, regulating immunity, improving liver function, and combating liver fibrosis. For example, heat-clearing and detoxifying has the effect of inhibiting viral replication, reducing inflammation, and improving liver function; blood-activating and stasis-dissolving drugs help combat liver fibrosis, improve hepatic blood supply, reduce turbidity, and alleviate jaundice; spleen-and-kidney-tonifying helps regulate immune system function and correct immune deficiencies; and liver-soothing and spleen-strengthening can restore balance to the body’s immune system.