III. Treatment of Hepatitis B

Currently, Western medicine and traditional Chinese medicine both offer treatments for hepatitis B. Among Western medications, alpha-interferon and lamivudine are commonly recommended. Over the past decade, clinical trials both domestically and internationally have shown that both drugs have a cure rate of 10%–20%, though they require longer treatment durations and are relatively expensive. Traditional Chinese medicine remains an important method for treating hepatitis B. Twenty years ago, I led the establishment of the "Clinical Research Group on Hepatitis B" at the Gansu Provincial Academy of Medical Sciences. Over the years, we observed 60,000 hepatitis B patients and developed clinical classifications for hepatitis B patients, formulating rational treatment plans based on syndrome differentiation in TCM. Our research was published in medical journals both domestically and internationally, including "Epidemiological Study of 2021 Hepatitis B Patients in Gansu," "Clinical Comparison Report on 135 Cases of Chronic Persistent Hepatitis B," "Clinical Observation Report on 100 Cases of Hepatitis B," and "Clinical Study on Ascites in Cirrhosis," among seven papers. We also developed specialized treatments for hepatitis B, such as "Hepatitis B No. 1," "Hepatitis B No. 2," and "Hepatitis B Health," accumulating extensive clinical experience. Here are some of my experiences:

1. Initial Stage of Qi and Yin Deficiency: These patients are newly infected with the hepatitis B virus, with positive HBsAg, positive HBcAb, and either positive or negative HBeAg—some may be big three positives, others small three positives. Their liver function is normal, with no significant clinical symptoms; some patients only experience mild fatigue or dry mouth, with a red tongue, so this stage is referred to as initial Qi and Yin deficiency. Without a two-and-a-half test, it’s impossible to determine whether a patient is infectious. Typically, these patients are classified as "healthy carriers" or "chronic persistent hepatitis" in modern medical terminology.

My experience shows that these patients account for about two-thirds of all hepatitis B patients and serve as the primary source of hepatitis B transmission. The prognosis is generally good, and some patients may transition to other types of hepatitis B. A common traditional Chinese medicine formula is Sheng Shan Tang with additions: Sheng Ma 3g, Shan Yao 10g, Hong Hua 3g, Bai Shao 15g, Hu Zang 15g, Wu Mei 4 pieces, Bai Zhu 10g, Chan Yi 6g, Ye Hua 15g, Gu Zi 10g, Nu Zhen Zi 10g, Tu Si Zi 10g, Gan Cao 6g, Gua Lou 10g, Ge Gen 20g—boiled and taken as a decoction, one dose per day.

2. Pathogen Invading Shaoyang: The symptoms in this stage are becoming more pronounced; the two-and-a-half test may show either big three positives or small three positives, with varying degrees of liver damage—ALT levels may be elevated, and bilirubin levels may also show changes. Patients often experience bitter taste in the mouth, dry throat, pain in the liver area or both sides of the ribs, bloating in the stomach, loss of appetite, fatigue, a red tongue with a thin, greasy, yellow coating, and a tense, rapid pulse. Some patients may experience mild jaundice, or mild splenic enlargement. These patients are often classified as chronic persistent hepatitis or acute exacerbations of chronic persistent hepatitis in Western medicine, though some patients may also have chronic active hepatitis. A formula using Xiao Chai Hu Tang with additions: Chai Hu 10g, Huang Qin 10g, Ban Xia 10g, Dang Shen 10g, Gan Cao 6g, Sheng Jiang 6g, Da Zao 4 pieces, Dan Shen 20g, Mu Xiang 3g, Cao Kou 3g, Da Huang 3g, Huang Lian 3g, Huang Qi 20g, Dang Gui 10g, Qian Tong 10g, Ban Lan Gen 10g, Ze Xie 10g, Huang Jing 6g, Yuan Hu 10g, Chuan Lian Zi 20g, Zhi Ru Mo 6g—boiled and taken as a decoction, one dose per day.

3. Blood Stasis and Qi Deficiency: This stage is more severe; the big three positives or small three positives in the two-and-a-half test are no longer sufficient to determine the severity of the disease. The key is that the liver and spleen of these patients show significant organic changes, indicating chronic persistent hepatitis or early-stage cirrhosis in Western medicine. The spleen becomes enlarged, the portal vein diameter begins to widen, and in addition to significant changes in bilirubin and ALT levels, the albumin-to-globulin ratio starts to shift—albumin levels decrease relative to globulins. Patients may experience bitter taste in the mouth, dry throat, irritability, alternating chills and fever, pain in the liver area and chest/ribs, abdominal distension, and some patients may develop a small amount of ascites. A modified formula using Chai Hu Shu Gan San with additions: Chai Hu 10g, Zhi Shi 10g, Bai Shao 15g, Gan Cao 6g, Chuan Xiong 6g, Dan Shen 30g, Mu Xiang 3g, Cao Kou 3g, Huang Qi 30g, Dang Gui 10g, Qian Tong 10g, Ban Lan Gen 10g, Ze Xie 10g, Huang Jing 6g, Yuan Hu 10g, Chuan Lian Zi 20g—boiled and taken as a decoction, one dose per day.

4. Yang Deficiency and Water Overflow: These patients have entered the late stages of cirrhosis, with impaired liver function and portal hypertension. The body has lost its compensatory mechanisms for liver function, leading to massive ascites and generalized edema. In addition to changes in bilirubin and ALT levels, the most distinctive feature of laboratory tests is the inversion or imbalance in the albumin-to-globulin ratio. Ultrasound imaging reveals a portal vein diameter greater than 14 mm, and spleen thickness exceeding 40 mm. In addition to splenomegaly and ascites, these patients may also experience esophageal varices, ruptured bleeding, and bone marrow hematopoietic disorders (a reduction in the three lineages of peripheral blood cells). Given portal hypertension, the mesenteric vessels within the abdominal cavity are dilated, and the submucosal vessels of the digestive tract may appear congested and dilated. Patients often feel abdominal distension and loss of appetite; some may experience intestinal rumbling and diarrhea, while others may experience heartburn and vomiting, or pain in the upper abdomen. The phrase "When you see liver disease, know that liver disease affects the spleen" in the Golden Chamber Classic accurately reflects the pathogenesis of this condition. After more than 40 years of clinical experience, I’ve come to understand that in the treatment of cirrhosis (compensatory failure), traditional Chinese medicine emphasizes strengthening the spleen and stomach as the primary approach—after all, "when you see liver disease, know that liver disease affects the spleen." My preferred formula is Xiang Sha Liu Jun Zi Tang with additions, which includes Huang Lian, Huang Qin, Gan Jiang, Zhi Shi, and Bai Shao; in fact, Xiang Sha Liu Jun Zi Tang combined with Ban Xia Xie Xin Tang. The Golden Chamber Classic states, "For those who vomit and experience intestinal rumbling, and feel fullness under the heart, the Ban Xia Xie Xin Tang is the primary remedy." This passage illustrates that Zhong Jing’s application of Xie Xin Tang focused on vomiting, rumbling, and fullness under the heart—these symptoms are characteristic of gastrointestinal issues caused by cirrhosis. Xiang Sha Liu Jun Zi Tang was originally designed for treating gastric distension and cold pain in the epigastric region, and it was often chosen as a first-line treatment for chronic gastritis and ulcers. Over the years, I’ve used these two formulas to treat gastrointestinal symptoms in patients with cirrhosis—not only to alleviate symptoms but also to address the root cause. Many patients have taken these formulas for a long time, and their liver function has recovered, their spleen has shrunk, and ascites has disappeared, returning them to a state similar to that of healthy individuals. The treatment of ascites cannot be handled solely by the above formulas; I’ve also developed “Ancient Sage No. 2,” a powerful agent for eliminating water retention. Its main ingredients are derived from the combination of “Niu Shi Ji Shi San” from the Golden Chamber Classic, plus other herbs—produced by the Lanzhou Chinese Medicine Factory and popular in several provinces of Gansu. Known for its remarkable diuretic effects, it became famous in the region. Additionally, the treatment of this condition should also focus on protecting the liver and promoting fibrosis; I’ve developed “Hepatitis B No. 2” and “Hepatitis B Health,” both of which possess these properties. Hepatitis B No. 2 is available as granules, while Hepatitis B Health is available as honey pills. The former is based on the Strong Liver Decoction from the Shanxi Institute of Traditional Chinese Medicine, with added ingredients; the latter is based on the Bie Jia Jian Pill from the Golden Chamber Classic, with additional ingredients. Regular use of these two formulas not only improves liver function but also helps reverse the progression of cirrhosis—typically, after one year of treatment, the liver softens, the spleen shrinks, and liver fibrosis indicators improve accordingly.

Among the complications of cirrhosis, the most serious and common is upper gastrointestinal bleeding, often caused by ruptured esophageal veins. When the bleeding volume exceeds 5 ml, occult blood may be detected; when the volume exceeds 50 ml, black stools may appear; when the volume exceeds 500 ml, blood pressure may drop. Western medical treatment principles dictate that for small amounts of bleeding, hemostatic agents such as hexamethylenetetramine, Hemostatin, or Hemostatic Acid can be used; for moderate bleeding, 5–10 units of pituitary posterior lutein can be administered intravenously; for massive bleeding, a three-cavity tube can be used for compression hemostasis, or pituitary injections can also be employed. Some patients still do not respond effectively, and surgical ligation of blood vessels may be necessary. Recently, endoscopic hemostasis has also become an effective treatment option. Traditional Chinese medicine methods for hemostasis… Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: Blood method follows Tang Rongchuan’s theory of Chong Qi, which posits that the Chong Meridian begins in the uterine cavity, extends up to Yangming, and then carries Chong Qi upward.

If Chong Qi flows backward, the blood of Yangming will break through the meridians and be expelled—Yangming is rich in both qi and blood, and it is connected to the uterine cavity via the Chong Meridian.

Because of this connection, bleeding in the stomach can reach such severity as if the heavens were to collapse and the earth were to shift, causing great alarm. In light of this, Tang proposed using large doses of rhubarb to reverse the flow of Chong Qi and balance the Chong Meridian, believing that this was the fundamental principle for treating gastric bleeding accompanied by vomiting. Tang argued that rhubarb’s ability to reverse Chong Qi and balance the Chong Meridian could “push walls down and overturn barriers.” When combined with coptis root and skullcap, this formula became the “Xie Xin Tang,” where “Xie Xin” refers to clearing the heart and “Xie Huo” means stopping bleeding—after all, the heart governs blood, and when blood becomes hot, it may flow abnormally. I often use the “San Huang Xie Xin Tang,” adding cinnamon and raw ochre to it; when used in moderate doses, these ingredients are effective for treating upper gastrointestinal bleeding. Raw ochre helps to reverse Chong Qi and balance the Chong Meridian, while cinnamon strengthens the stomach and balances the Chong Meridian—these two herbs work together to achieve the effect of balancing the Chong Meridian and stopping bleeding, enhancing each other’s efficacy. In earlier times, people referred to the combination of coptis root, rhubarb, and cinnamon as “Bi Hong Dan,” a widely used formula for treating vomiting and bloody stools. Beyond this, patients with severe upper gastrointestinal bleeding should strictly follow dietary guidelines: the primary principle is to eat liquid foods, and during the period of bleeding, it is advisable to abstain from eating and drinking for 24 hours. When fasting or avoiding water, it is essential to provide fluids and blood transfusions, ensuring adequate intake of electrolytes such as potassium, sodium, and calcium. The daily fluid intake should not be less than 2000 ml, with a general guideline of equal amounts of sugar and salt.

Another critical complication of liver cirrhosis is hepatic encephalopathy, also known as hepatic coma. This condition arises when liver function is severely impaired, leading to elevated blood ammonia levels and a lack of dopamine in brain tissue. Patients may become comatose, agitated, and exhibit symptoms like confusion, irritability, and an odor reminiscent of urine. These signs often indicate impending death from liver disease. Modern Western medicine has employed arginine salts, glutamate salts, acetylglutamate amine, potassium magnesium aspartate (Panan Jin), and others to help patients in a coma regain consciousness temporarily—but if treatment measures are continued effectively, some patients can recover from critical conditions. In traditional Chinese medicine, treatment for hepatic encephalopathy is somewhat less advanced than in Western medicine; however, in clinical practice, I have found that using the “Tao Ren Cheng Qi Tang” to address the root cause of the problem has helped some patients regain consciousness. The Tao Ren Cheng Qi Tang consists of rhubarb, mirabilite, coptis root, skullcap, peach kernels, cinnamon twig, and licorice. This formula is a combination of the “Tao He Cheng Qi Tang” from the “Shanghan Lun” and the “Da Huang Huang Lian Xie Xin Tang.” The descriptions in the “Shanghan Lun” for conditions such as “heat blocking the bladder, causing the patient to act wildly,” and “stomach fullness, tender to touch,” provided valuable insights for me. Patients with hepatic encephalopathy often present with altered mental status, abdominal distension, and fullness in the lower abdomen—these symptoms align closely with the description in the “Shanghan Lun.” The mechanism behind the Tao He Cheng Qi Tang lies in its ability to clear the intestines and promote bowel movements; from a modern medical perspective, a strong purgative effect is akin to intestinal dialysis—large amounts of blood ammonia are eliminated from the gut before they enter the bloodstream. At the same time, this process interrupts the liver’s metabolic pathways for ammonia release. I have used this formula to treat numerous cases of toxic dysentery, often helping patients who had been drowsy to regain consciousness quickly. Additionally, I have used this formula in conjunction with treatments for hepatic encephalopathy, achieving equally positive results. This demonstrates that the principles of “clearing the intestines and promoting bowel movements,” “treating the upper symptoms by addressing the lower,” and “drawing out the root cause”—as taught by our ancestors—are truly invaluable.

In the final stages of liver cirrhosis, most patients develop hepatorenal syndrome. This condition is characterized by kidney failure occurring alongside liver cirrhosis. The main indicators of kidney failure include elevated blood urea nitrogen levels (>7.1 mmol/L) and elevated serum creatinine levels (>100 mmol/L). At this stage, the glomerular filtration rate is reduced, and the excretion of protein metabolites is impaired, leading to nitrogenemia and uremia—a condition that can be life-threatening. The onset of hepatorenal syndrome often marks the late stage of liver cirrhosis and the final days of a patient’s life. Western medicine can use albumin infusions to slow the progression of the disease and protect the kidneys to a certain extent. The use of high-dose furosemide remains to be observed; typically, 200–400 mg is administered intravenously per day. If acidosis is present (with a decreased carbon dioxide binding capacity), sodium bicarbonate or sodium lactate may be administered. The use of androgens like testosterone and clonazepam can help maintain nitrogen balance. Hemodialysis is the last resort for prolonging life—but given that these patients experience damage to both the legs and the kidneys, dialysis is not particularly beneficial.

Traditional Chinese Medicine offers short-term therapeutic benefits for patients with hepatorenal syndrome. Many patients experience discomfort in the stomach, nausea, loss of appetite, and even edema and diarrhea. TCM believes that this condition often stems from damp-heat stagnation in the middle burner, where clear qi cannot rise and turbid qi cannot descend. Why does damp-heat accumulate in the middle burner? It is often caused by liver stagnation and spleen deficiency, or by spleen-kidney yang deficiency. To treat this condition, we commonly use Gui Fu Ba Wei Wan combined with rhubarb to clear turbid qi, with附片 to lift clear qi, along with raw ochre, fresh ginger, and Pinellia; we also use Motherwort and Plantago to promote diuresis; Houttuynia and Lonicera to clear heat and detoxify; Sanqi and Leeches to activate blood circulation and remove blood stasis; raw oyster powder to strengthen the stomach and absorb intestinal nitrogenous waste while also providing astringency and anti-diarrheal effects. The use of these formulas often slows the progression of renal failure; some patients even see a decrease in urea nitrogen levels and a return to normal serum creatinine levels. Once, a patient named Chen Zhengyuan, a man in his 40s with kidney failure, came to see me in 1970. At that time, he served as the station manager of the Qinan Bus Station in Gansu Province, having suffered from chronic liver disease for many years. Recently, he developed severe edema, small amounts of ascites, and urinary protein (+), occult blood (+), with non-protein nitrogen (NPN) levels of 86 µmol/L—this was the legal diagnostic threshold for kidney failure in the 1980s, but was later abandoned in favor of urea nitrogen. His condition was diagnosed as liver cirrhosis with hepatorenal syndrome. I prescribed him the following formula: Rehmannia Root 12 g, Cornus Fruit 10 g, Dioscorea Rhizome 10 g, Paeonia Bark 6 g, Cinnamon Twig 10 g, Atractylodes Rhizome 6 g, Goji Berries 6 g, Poria 12 g, Alisma 10 g, Rhubarb 6 g, Lonicera Flower 15 g, Houttuynia Herb 15 g, Motherwort 15 g, Plantago Seed 15 g, Raw Oyster 15 g, Leech Powder 3 g (to be taken in divided doses), decocted in water and taken once daily. Afterward, I continued to consult with the Western and Chinese medicine teams at the Gansu Provincial Medical Academy. In September 1982, an elderly man brought a box of pears to my home. As he entered the house, he expressed his gratitude—and upon closer inspection, it was indeed Chen Zhengyuan! He immediately took a prescription from his pocket, which had been pasted onto cardboard over time, its handwriting blurred and barely legible. He said he had taken this formula for more than 600 doses, and now his illness had completely healed; two years ago, he resumed work. He told me that after taking the medicine, his urine output increased and his spirits improved. Because the treatment was effective, he continued taking the medication, feeling better with each dose. He persisted for three years without realizing it—by 1974, his non-protein nitrogen levels had begun to normalize, his appetite had returned, and his physical and mental state were back to normal. The patient then made the decision to prepare the formula into powder, taking 6 g three times a day, dissolved in warm boiled water. The recovery of this patient was truly accidental: he persevered with the medication in despair, and although I had never held much hope at the time, long-term use of the medicine led him to recover from a condition that had seemed incurable. From this case, I learned two important lessons: first, a formula combining kidney-tonifying, yang-strengthening, fire-clearing, and bowel-cleansing therapies is indeed an effective remedy for treating hepatorenal syndrome; second, this formula addresses the root cause of the condition, unlike Western medicine’s dialysis therapy—which merely removes urea nitrogen from the blood, offering only temporary relief. Instead, this approach helps restore liver and kidney function, bringing some degree of improvement to the patient’s condition. I experienced the effectiveness of traditional Chinese medicine in treating this condition, while also realizing that, given the gastrointestinal stress response in patients with kidney failure, long-term use of herbal medicine often proved difficult to tolerate—for most patients, simply seeing traditional Chinese medicine triggered reflexive nausea and vomiting, leading them to abandon treatment halfway. In the future, we should focus on improving the methods of administration.

Clinical Application of Gan Bing Wan

Huanglian, Huangqin, Huangbai, Shan Zhi, Dang Gui, Bai Shao, Chuan Xiong, Sheng Di, Tao Ren, Hong Hua, Nu Zhen Zi, Han Lian Cao, Da Huang, Ban Xia, Gan Jiang, Dan Shen, Mu Xiang, Cao Kou, Huang Qi, Qin Tiao, Ban Lan Gen, Chai Hu, Dang Shen, Mu Xiang, Cao Kou, Zhuang Qi, Wu Ling, Gan Cao, etc., were ground into powder, mixed with honey to form pills weighing 6 g, taken three times daily, one pill each time, dissolved in warm boiled water. This is Gan Bing Wan.

For patients with chronic liver disease, especially those suffering from liver cirrhosis, the deterioration of liver function leads to the loss of liver’s detoxification abilities. Men may experience higher levels of estrogen, while women may see increased levels of androgen. Over time, the function of the pituitary gland gradually declines, resulting in reduced adrenocorticotropic hormone production and decreased adrenal cortical function—leading to darkening of facial skin pigmentation.

The Huanglian Jie Du Tang formula (Huanglian, Huangqin, Huangbai, Shan Zhi) can reduce congestion in the gastrointestinal mucosa and on the skin surface, while increasing congestion within the skin and mucosal layers, aiding in the resolution of residual jaundice and pigment deposits. The Tao Hong Si Wu Tang formula (Tao Ren, Hong Hua, Dang Gui, Bai Shao, Chuan Xiong, Sheng Di) serves as the primary formula for regulating the liver—regulating both the liver’s qi and blood, as well as the liver’s相 fire. The “相 fire” refers to the nervous system in modern medicine, whose functions extend beyond just smooth muscle tension, encompassing factors such as blood vessel dilation and contraction, and the opening and closing of sweat pores—these mechanisms alone can improve the complexion. According to recent experimental research, the Chai Ling Tang formula indeed possesses the effect of regulating the adrenal cortex; this formula can enhance the function of the adrenal cortical system, preventing the occurrence of adrenocortical insufficiency—a condition characterized by darkening of facial skin pigmentation. In addition to the aforementioned Huanglian Jie Du, Tao Hong Si Wu, and Chai Ling Tang formulas, this formula also includes Yin Chen Wu Ling San and Yin Chen Hao Tang—traditional remedies specifically designed to treat jaundice. The herbs Nu Zhen Zi and Han Lian Cao were historically known as “Er Zhi Wan,” meaning “two journeys to the qi”—recently, these formulas have proven effective in treating various types of orbital spots and other skin issues, becoming popular among women seeking beauty treatments.

In summary, although the composition of Gan Bing Wan is diverse, its underlying philosophy is clear: it combines Chai Ling to regulate the endocrine system, Tao Hong Si Wu to regulate the liver and promote blood circulation, Huanglian Jie Du to clear heat and detoxify, Er Zhi Wan to harmonize qi and blood, and Yin Chen to eliminate jaundice. Given that this formula requires regular use, frequent consumption can lead to stomach discomfort; therefore, we added Ban Xia Xie Xin Tang, as well as Dan Shen, Mu Xiang, and Cao Kou to nourish the stomach and regulate the middle burner. This formula is often effective for patients with liver cirrhosis or chronic liver disease who suffer from dull skin tones, helping to refine my series of liver treatments!

Treatment of Liver Cirrhosis: A New Approach

In the winter of 2000 (Gengchen year), I treated Bai Li, a 35-year-old employee of the Lanzhou Electric Motor Factory. Five years earlier, she had been diagnosed with decompensated liver cirrhosis, accompanied by ascites and jaundice, and had experienced multiple episodes of vomiting. Her peripheral blood count showed hemoglobin levels between 8–11 g/L, white blood cells at 2–3 × 10^9/L, and platelets at 10–30 × 10^9/L. Six months prior, she had traveled to Xi’an for surgery, but due to the lack of surgical indications, she returned to Lanzhou. The journey was exhausting and bumpy, her jaundice worsened, she experienced persistent pain in the liver region radiating to both flanks and the back. Reviewing her recent lab results, her total bilirubin level had reached 87 µmol/L, direct bilirubin 50 µmol/L, alanine aminotransferase 105 U/L, aspartate aminotransferase 73 U/L, and urea nitrogen 9.3 mmol/L. In October 2001, she came to see me again. Her body was covered in yellow discoloration, her abdomen was distended, her face appeared dull, and she reported pain in both flanks, accompanied by discomfort. She occasionally felt nauseous, had poor appetite, fatigue, dizziness, and was unable to care for herself. Her spleen was enlarged by four fingers below the ribs, her liver by two fingers below the ribs, both hard to the touch, and she exhibited signs of ascites. Diagnosis: ① cholestatic type of liver cirrhosis (decompensated), ② hepatorenal syndrome. TCM diagnosis: red tongue, thick yellow greasy coating, wiry, large, slippery, rapid pulse. Liver stagnation and spleen deficiency, damp-heat accumulation, yang deficiency and water retention. Treatment principles included soothing the liver and strengthening the spleen, clearing heat and eliminating dampness, warming the kidneys and tonifying yang. The formula used was Chai Hu Shu Gan San combined with San Huang Xie Xin Tang, modified as follows: Chai Hu 10 g, Zhi Shi 10 g, Bai Shao 15 g, Gan Cao 5 g, Xiang Fu 6 g, Chuan Xiong 6 g, Qing Pi 6 g, Ginger Turmeric 6 g, Cinnamon 3 g, San Ling 10 g, E Jiu 10 g, Rhubarb 6 g, Huang Lian 6 g, Huang Qin 10 g, Yuan Hu 10 g, Chuan Lian Zi 20 g, Yin Chen 20 g, Shan Zhi 10 g, Dang Jiang 15 g, Yin Chen Hao 15 g, Ban Xia 6 g, Chen Pi 6 g, Poria 12 g, Dry Ginger 15 g, Raw Oyster 15 g, all prepared as a decoction, taken once daily.

After taking the above formula for 20 doses, the patient’s spirits improved, her appetite increased, the pain in both flanks and in the liver region significantly diminished, her jaundice noticeably subsided, and her total bilirubin dropped below 17 µmol/L. Alanine aminotransferase and aspartate aminotransferase both returned to normal levels. While taking the formula, the patient continued to use the ancient prescriptions “Gusheng I” and “Gusheng II,” which were formulated to protect the liver and promote jaundice resolution. Both formulas were based on the “Nitro Stone and Rock Powder” from the “Jin Kui” tradition, with additions of other herbs. The rapid efficacy of this case was truly inspiring. I realized that this condition was caused by liver qi stagnation—when qi stagnates, it can generate dampness, and when qi stagnates for too long, it can turn into heat; when dampness and heat combine, jaundice occurs. Long-term spleen deficiency, stemming from qi deficiency and even yang deficiency, leads to water retention! We focused on using Chai Hu Shu Gan San to soothe the liver, employing San Huang to clear heat, using Er Chen to strengthen the spleen and eliminate dampness, and using Yin Chen Hao to promote jaundice resolution. Some of the herbs in the formula—San Ling, E Jiu, Qing Pi, Ginger Turmeric, Yuan Hu, Chuan Lian Zi, and the preparation of Lu Mo—primarily serve to relieve pain. However, for liver cirrhosis, these herbs can also soften the liver and dissolve fibrosis, making them the most appropriate treatments for preventing further fibrosis. Even after the acute phase, continued use of these formulas can help treat the root cause of the condition.

This formula has proven effective and has been tested repeatedly in clinical settings. Based on this formula, the Lanzhou Chinese Medicine Factory developed a generic drug in “granule formulation,” naming it “Hepatitis B No. II,” which was approved as a prescription-based medicine with satisfactory therapeutic outcomes.

Further Discussion on Chronic Pancreatitis

Chronic pancreatitis is quite common. For most patients experiencing left upper abdominal pain that radiates to the left chest, left flank, or lower back, and which worsens after consuming fatty or meaty foods, or even when their mood is low, it is often chronic pancreatitis. The onset of this condition is frequently associated with cholecystitis and gallstones—because inflammation in the bile ducts can block the pancreatic duct, which joins the bile duct and opens into the duodenum. Clinically, approximately 80% of cases of pancreatitis are found to be linked to gallbladder diseases. The most specific indicators for diagnosing pancreatitis are serum amylase and urine amylase levels: typically, serum amylase exceeds 500 U (Sue’s standard) or 128 U (Wen’s standard), while urine amylase exceeds 1024 U (Sue’s standard) or 128 U (Wen’s standard), allowing for a definitive diagnosis. However, serum amylase returns to normal within 3 days after an episode, while urine amylase usually returns to normal within 1 week after an episode. Therefore, in most cases of chronic pancreatitis, both serum and urine amylase levels remain within the normal range, making it difficult to establish reliable diagnostic criteria. In recent years, CT scans and ultrasound have become widely used in clinical practice, providing positive findings for most cases of chronic pancreatitis—but for some patients, no positive findings are detected, often leading to misdiagnosis. The reasons for this can be summarized in three key aspects: ① The pancreas is located deep behind the stomach and directly behind the transverse colon, lying parallel to it and overlapping with it; the stomach and transverse colon are often filled with a large amount of gas, especially the hepatic flexure and splenic flexure of the transverse colon, where gas tends to accumulate, often affecting the imaging quality. ② Early-stage chronic pancreatitis often shows little histological difference; ultrasound and CT scans reveal no obvious abnormalities, but in the mid-to-late stages, fibrous tissue proliferation often occurs, with characteristic changes visible in the posterior regions. ③ The early symptoms of chronic pancreatitis often resemble those of gastric disorders or even chronic gastritis; some patients, after undergoing gastroscopy and being diagnosed with chronic superficial or atrophic gastritis, continue to take gastric medications without ever considering the pancreas. As a result, despite repeated treatments, they still fail to undergo relevant pancreatic examinations. Given this, the misdiagnosis rate for chronic pancreatitis is relatively high. When I was young, I myself suffered from this condition, treated by my father—who was a renowned physician from Longshan—and personally prescribed a formula for me. I took over 280 doses of medicine over a year, and eventually recovered. Later, building on my father’s prescriptions, I refined my clinical practice over decades, developing the following formula: Chai Hu 10 g, Zhi Shi 10 g, Bai Shao 15 g, Chuan Xiong 6 g, Xiang Fu 6 g, Gan Cao 6 g, Dan Shen 10 g, Mu Xiang 10 g, Cao Kou 10 g, Rhubarb 10 g, Huang Qin 10 g, Huang Lian 6 g, Yuan Hu 10 g, Chuan Lian Zi 20 g, Lu Mo 6 g, Dry Ginger 6 g, Herba Astragalus 15 g, Herba Verbena 15 g—taken in a decoction, once daily. After more than 40 years of practicing medicine, I have treated countless patients with chronic pancreatitis using this formula. Due to its remarkable efficacy, patients with chronic pancreatitis from all over the country have come to seek treatment. During the course of treating this condition, I discovered three characteristics of chronic pancreatitis—characteristics that have not yet been fully recognized by the public, nor included in textbooks, nor reported in journals.