Zou Liangcai Discusses the Treatment of Severe Hepatitis, July 21, 1978

Zou Liangcai Discusses the Treatment of Severe Hepatitis, July 21, 1978

1. Classification of Jaundice and the Importance of Reducing It

Jaundice is divided into two types: yang jaundice and yin jaundice. Yang jaundice indicates acute damage to the liver parenchyma, while yin jaundice is a continuation of yang jaundice. In terms of reducing jaundice, yang jaundice is characterized by more heat than dampness, whereas yin jaundice is characterized by more dampness than heat. The primary prescription for the former is Yinchenhao Tang, while for the latter it is Yinchen Wuling San. Wuling San has the effect of removing dampness; for those with a white, greasy tongue, add Sheng Yiren, Huoxiang, Peilan, Cangzhu, and Kouren. Dahuang is a key medicine for treating the liver. Besides clearing heat and detoxifying, and promoting bowel movements to reduce jaundice, it also has the effect of stopping bleeding and resolving blood stasis. Therefore, this formula is suitable not only for chronic hepatitis but also for acute hepatitis. Recently, Zhang Xichun said, "Dahuang can enter the blood level and break down all blood stasis. Because it has a fragrant aroma, it can also enter the qi level, and even small doses can regulate qi." He also added, "Although Dahuang is powerful, it must be used appropriately according to the specific condition of the patient."

2. Treatment Experiences for Liver Bleeding and Spider Nevi

For nosebleeds, use black gardenia powder; for gum bleeding, boil Di Gu Pi and use the decoction for rinsing; for gastrointestinal bleeding, take Sanqi powder or Baiji powder internally. For spider nevi, adopt methods that clear heat, cool the blood, and promote blood circulation, such as using Ou Jie, Qian Cao, Ye Ming Sha, and Wa Leng. If both qi and yin are damaged, add Erzhi Wan or Yiguan Jian.

3. Promoting the Reduction of Blood Ammonia

An increase in blood ammonia indicates an impending hepatic coma. Boiling 10 grams of water buffalo horn three times daily can help reduce blood ammonia.

4. Enzyme-Lowering Treatment

The enzyme-lowering effect of Wuweizi is beyond doubt and applies to those with mild damp-heat. For those with severe damp-heat, prioritize Xiaokukao and Pugongying. For example, if the liver is very hot, use Longdan, Huangqin, and Dahuang; if the liver meridian is not overly hot, use Qinpi, Tufuling, and Pugongying.

5. The Relationship Between Transaminases and Turbidity

Typically, after reducing transaminases through heat-clearing and dampness-draining methods, turbidity tends to increase. This shows that the treatment approaches for enzymes and turbidity are distinctly different: the former focuses on clearing, while the latter focuses on tonifying. Whether to use tonification for the spleen or the liver depends on the patient's specific condition. For those with insufficient liver yin, focus on tonifying liver yin; for those with weak spleen yang, focus on tonifying spleen yang; for those with both spleen and liver deficiencies, use Chai Shao Liu Jun Tang to balance both. However, note that for "extremely deficient cases with excess symptoms," special attention is required. ("New Journal of Medicine," August 1975)