I. Hepatitis A HA

I. Hepatitis A (HA)

Research on HA began in the 1940s. In 1967, Deinhard first isolated HAV, and in 1973, Feinstone observed HAV cultured from patient feces using electron microscopy, confirming that the virus measured 27–30nm in diameter. The clinical onset of this disease is characterized by jaundice, fever, abdominal distension, loss of appetite, discomfort in the liver region, and liver function impairment, with pronounced infectivity. It is typically prevalent in areas with poor sanitation and impoverished living conditions, mainly transmitted through the digestive tract. The antibody detection rate for HAV in African populations reaches as high as 90%, while in China it ranges from 50% to 70%. There was a rising trend in the 1980s, with higher rates in rural areas compared to urban areas; major cities like Shanghai, Beijing, and Tianjin had lower detection rates. The peak season for HA is autumn, with distinct epidemic cycles lasting 2–3 years, followed by intervals of 5–9 years. The disease typically lasts 1–2 months, with a very low mortality rate. With supportive care, including liver protection and rest, most patients recover fully. Although highly contagious, the disease poses little threat to the general population. In China, localized outbreaks occurred in the 1960s, 1970s, and 1980s, but starting in the 1990s, reports of sporadic cases became more common. This is closely related to the government’s extensive efforts to manage water sources, fecal matter, and human waste, providing safe, cooked food, and improving social infrastructure related to these issues.

The specific diagnosis of Hepatitis A relies on detecting HAV antibodies. Currently, two indicators—anti-HAV-IgA and anti-HAV-IgM—are available for diagnosing Hepatitis A. These indicators can confirm the diagnosis in the early stages of the disease, and as the disease progresses, the antibody titers continue to rise.

Currently, antiviral treatments are not commonly recommended for Hepatitis A. This disease is self-limiting, with a good prognosis; patients only need rest, liver protection, and symptomatic treatment, and most cases recover fully. Long-term immunity can also be achieved. Traditional Chinese medicine and Chinese herbal medicine have played a leading role in the treatment of Hepatitis A, and are currently recognized as the preferred approaches for treating Hepatitis A. They are highly effective in alleviating jaundice and protecting the liver, often significantly shortening the treatment duration, reducing patient suffering, and promoting faster recovery. Based on over 40 years of clinical experience, I believe that the basic syndrome differentiation in TCM for Hepatitis A falls under the category of Shaohan Shao Yang, and the Xiao Chai Hu Tang is often used as a foundational formula, combined with clinical syndrome differentiation for treatment. Since jaundice in the early stages of Hepatitis A often reflects internal heat and dampness, Yin Chen, Zhizi, and Dahuang are frequently added to the Chai Hu Tang; to protect stomach qi, Ban Xia Xie Xin is added; for cases with severe cold and heat, Wu Wei Xiaodu Yin is used. Once the fever subsides and jaundice fades, liver protection becomes more important, and the Qiang Gan Tang from the Shanxi Institute of Traditional Chinese Medicine is particularly effective.