2. Core Antigen and Its Antibodies

This indicates acute hepatitis B, suggesting that the surface antigen is about to turn negative. In patients with chronic active hepatitis, surface antibodies are usually not produced; if detected, it does not necessarily indicate protective immunity. Some reports suggest that in such cases, the presence of these antibodies may even be harmful to hepatocytes. The chief physician of the original treatment bureau bears responsibility.

2. Core Antigen and Its Antibodies

Distinction: Within the nuclei of hepatocytes from hepatitis B patients, immunoelectron microscopy often reveals spherical structures with a diameter of 27 nanometers. These structures can occasionally also be observed in the cytoplasm of hepatocytes. Subsequently, this structure was named the core antigen (HBcAg). Although the core antigen cannot be detected in the peripheral serum of hepatitis patients, its antibody, namely the core antibody, can be found. The core antibody typically appears soon after infection with the hepatitis B virus, usually detectable 1–2 months after the surface antigen becomes positive, at which point hepatitis symptoms emerge and transaminase levels rise. In acute hepatitis B, the surface antigen is transiently positive; however, before the surface antigen turns negative, the surface antibody often becomes positive first. Approximately four months before the surface antibody turns positive—or sometimes even longer—the core antibody can already be detected. Chronic carriers, although they do not test positive for surface antibodies, almost always test positive for core antibodies. In summary, the appearance of the core antibody indicates that the infection process is still ongoing. This antibody offers no protective effect, cannot prevent reinfection, nor does it signify recovery; rather, it merely reflects an active replication of the hepatitis virus. For individuals whose hepatitis symptoms have not yet resolved but whose surface antigen has already turned negative, if the core antibody is positive, it means that the patient still harbors active hepatitis B virus infection and replication. There is also a positive correlation between the core antibody and DNA polymerase: typically, about 41 days after infection with the hepatitis B virus, DNA-P begins to test positive, and 59 days later the core antibody turns positive. At the same time, most patients exhibit elevated transaminase levels. Once the core antibody appears, it can remain positive for more than five years, serving as the longest-lasting marker of hepatitis B virus presence in the human body.

3. e Antigen and Its Antibodies

In 1972, Swedish researchers led by Magnis, while examining the hepatitis B surface antigen, unexpectedly discovered a new antigen, which they named the e antigen. In 1974, Nielon and others replicated the experiment and conducted e-antigen tests on 500 cases of acute hepatitis B, 100 cases of chronic active hepatitis B, 13 cases of liver cirrhosis, 23 healthy carriers, and 96 individuals with negative surface antigens. The results showed that 10% of acute cases were e-positive, 58% of chronic cases were e-positive, 31% of liver cirrhosis cases were e-positive, and 34% of healthy carriers were e-positive. From these findings, the following conclusions were drawn: ① Individuals who test positive for the e antigen are more likely to develop chronic active hepatitis; ② E-antigen-positive individuals have a higher concentration of Dane particles in their serum; ③ Long-term carriers of the virus have a high rate of e-antigen positivity. In recent years, numerous scholars have demonstrated that the conversion from e-antigen positivity to e-antibody positivity is a very important indicator of improvement in the pathological course of hepatitis B. When initially infected with hepatitis B, approximately 90% of patients see their e antigen turn negative, and these patients generally have a favorable prognosis, rarely progressing to chronic active hepatitis, liver cirrhosis, or liver cancer. Conversely, about 10% of patients never see their e antigen turn negative, resulting in a poorer prognosis; they may develop liver cirrhosis or liver cancer, while most will progress to chronic active hepatitis. Some studies involving liver biopsies of e-antigen-positive patients have revealed that the liver tissue of these patients shows persistent damage, whereas the liver tissue of e-antibody-positive patients exhibits a lower degree of damage. Generally speaking, the transition from e-antigen positivity to e-antibody positivity occurs synchronously. It has also been observed that there is a positive correlation between e-antigen positivity and the titer of the surface antigen, as well as between e-antigen positivity and DNA polymerase activity.

4. Hepatitis B Virus DNA and DNA Polymerase. Ver.

① Hepatitis B virus DNA (HBV-DNA) is the fundamental substance that constitutes the virus; a positive result in serum testing indicates viral replication. Using molecular medicine dot-blot hybridization technology to test for hepatitis B virus DNA is one of the most advanced methods today and is currently considered the most sensitive method. DNA polymerase (DNA-P) is an indicator of viral replication. During the acute phase of acute hepatitis B, DNA-P is mostly positive; some cases of chronic active hepatitis may also show positive results. It is generally believed that this enzyme exists in the body for a relatively short period—about 2–4 weeks during the acute phase, but longer during the chronic phase. III. Routes of Transmission of Hepatitis B. Feed The traditional view held that the main routes of transmission for hepatitis B were bloodborne, including blood transfusions, blood products, injections, and vaccinations. However, according to many recent studies by scholars, only 2–4% of infections resulted from these bloodborne transmissions. The largest proportion of infections actually occurs through the gastrointestinal tract, a mode of transmission known as horizontal transmission, accounting for approximately 55% of all hepatitis B infections. Because most people infected through horizontal transmission can successfully clear the virus from their bodies, current scholars believe that the prevalence of hepatitis B virus infection in China is around 70% of the population, while the incidence rate is only about 5–25%. This indicates that among actual hepatitis B patients, horizontal transmission does not constitute the majority; vertical transmission—that is, when a mother carries HBV—is far more common. If the mother is HBeAg-positive, 90% of her children will become infected; if the mother carries HBV but is HBeAg-negative, 20% of her children will still be infected. Vertical transmission is much less likely to be cleared by the body itself, leading to the development of hepatitis B patients. Therefore, the prognosis for vertical transmission is completely different from that of horizontal transmission. According to surveys, there are approximately 100 million HBsAg carriers in China. Recent liver biopsies have revealed that 90.14% of these carriers exhibit varying degrees of pathological changes in their liver tissue, while only 9.80% show no obvious pathological changes. Among the former, 68.23% have chronic liver disease, 10.4% have chronic active hepatitis, and only 11.46% show mild changes; some patients even exhibit signs of liver cirrhosis. This suggests that so-called "healthy carriers" are merely chronic hepatitis B patients with inconspicuous clinical symptoms. Some follow-up studies on "healthy carriers" have shown that about 5% of these carriers experience symptom exacerbation over the course of a year due to factors such as fatigue, alcohol consumption, and emotional stress. Such activated hepatitis B should not be classified as acute hepatitis B. Hepatitis B primarily affects children and young adults, with fewer cases among the elderly. According to domestic and international statistics, the male-to-female ratio is approximately 2:1. IV. Diagnosis of Hepatitis B Debate

The diagnosis of hepatitis B should be based on a comprehensive analysis of epidemiological data, symptoms, physical signs, changes in liver function, and pathogenetic examinations, while ruling out other diseases. Although liver biopsy provides more accurate results, its widespread clinical application is difficult; therefore, the diagnosis of hepatitis B mainly relies on the aforementioned methods. In December 1984, the Nanning Conference on Viral Hepatitis revised the "Plan for the Prevention and Treatment of Viral Hepatitis," stating that the diagnostic nomenclature for viral hepatitis should include both pathogenetic classification and clinical classification—for example, viral hepatitis type B, acute non-jaundiced type; viral hepatitis type B, chronic active non-jaundiced type. River

1. Epidemiological Data Big Bo Shi

Family history, contact history, history of unhygienic injections, mother-to-child transmission, etc.—especially maternal illness within the family and mother-to-child transmission—are particularly significant from an epidemiological perspective. Pregnant women who test positive for the surface antigen have an infection rate of over 80%, and in some cases even 100%, for their newborns.

Then 2. Symptom Curve, Sister "Emotion"

Acute hepatitis B is most commonly the acute non-jaundiced type, accounting for about 90%. In chronic hepatitis B, patients with chronic migratory liver disease and virus carriers often lack obvious symptoms; therefore, hepatitis symptoms serve only as reference indicators in the diagnostic process. Common symptoms include fatigue, weakness, loss of appetite, nausea, aversion to oil, abdominal distension, liver pain, and susceptibility to colds. Pediatric patients often present with fever, rash, and joint pain.

3. Physical Signs

The liver is often enlarged recently, and it is important to observe the dynamic changes in liver enlargement. Tenderness upon palpation, moderate hardness, and sharp margins are typical. Some patients also exhibit splenomegaly. Palmar erythema and spider angiomas are indicators of chronic active hepatitis and early-stage liver cirrhosis.

4. Changes in Liver Function

Abnormalities in alanine aminotransferase (SGPT) often suggest acute or chronic active hepatitis, but since this indicator is not specific to hepatitis B, it must be evaluated in conjunction with a full-body examination and other indicators. Abnormalities in the turbidity test, inverted albumin/globulin ratio, and increased gamma-globulin electrophoresis often indicate chronic active changes in hepatitis B. Most patients with chronic migratory liver disease have normal liver function, while those in the active phase may show mild abnormalities.

5. Pathogenetic Examination

T is the most important basis for diagnosing hepatitis B. Since the symptoms of hepatitis A, B, and non-A/non-B hepatitis are basically the same, without disease

One dose. ⑤ Yang deficiency with water overflow: Symptoms include fatigue, exhaustion, abdominal distension, ascites, lower limb edema, chills, spontaneous sweating, deep and fine pulse, plump tongue body, and pale coating. The formula used is the Compound Six Gentlemen Decoction (Hepatitis B No. 4): Dangshen, Baizhu, Fuling, Gancao, Banxia, Danshen, etc., decocted in water and taken once daily.

III. Treatment Methods and Medication Adjustments

(1) Treatment Group: Based on syndrome differentiation, add 10 grams of Yuanhu and 10 grams of Chuandongzi for patients with liver pain; additionally add 3 grams each of processed Rumei and 3 grams of Jiaozhisan for those with poor appetite; add 6 grams each of Jiaosanxian and 6 grams of Jineijin for those with reduced food intake; add 10 grams of Zhishi, 10 grams of Houpu, and 3 grams of Dahuang for those with abdominal distension; increase the dosage to 20 grams each of Dafupi and Hulupi for those with edema and ascites. (2) Control Group: Regardless of the type, administer two tablets of Ganbifu three times daily by mouth, along with 20 grams of Huangqi powder twice daily after breakfast and dinner. (3) Both the treatment group and the control group consider a 20-day medication course as one treatment cycle. (4) Patients in the treatment group discontinue herbal decoctions after symptoms disappear and liver function returns to normal, then switch to a maintenance treatment using the formulated granules prepared from the agreed-upon prescription for one month.

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1. Efficacy criteria (referencing the standards set at the Nanning Conference in December 1984).

(1) Near cure: Self-reported symptoms disappear, liver and spleen enlargement stabilizes or shrinks without tenderness, all liver function indicators return to normal, HBsAg (negative), HBeAg (negative), HBV-DNA-P (negative), and none of the above items show recurrence during maintenance treatment or over a year of observation. (2) Improvement: Self-reported symptoms improve, liver function tests show significant improvement compared to before treatment, or HBsAg count decreases, or HBV-DNA-P turns negative, or HBeAg turns negative. (3) Ineffectiveness: Neither self-reported symptoms nor liver function, nor the HBV-DNA-P system show any improvement.

2. Efficacy statistics, Mo s a-TE B ultrasound

Among 429 cases, the treatment group had 289 cases, with 101 near-cures, accounting for 34.94%; 152 improved, accounting for 52.59%; and 36 ineffective, accounting for 12.47%. The overall effective rate was 87.53%, with an HBsAg negative rate of 39.9% and an anti-HBe positive rate of 68.57%. The control group had 12 near-cures, accounting for 8.57%; 52 improved, accounting for 37.14%; and 76 ineffective, accounting for 54.28%. The treatment group's cure rate and improvement rate were both higher than the control group's. Statistical analysis showed P<0.01, indicating a highly significant difference. Changes in symptoms and physical signs before and after treatment are shown in Table 1; improvements in liver function are shown in Table 2; changes in the three systems and HBV-DNA-P are shown in Table 3; the relationship between efficacy and syndrome classification is shown in Table 4; the relationship between efficacy and disease course is shown in Table 5; and the relationship between efficacy and treatment duration is shown in Table 6.

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Case 1: Zhang Yi ×, female, 29 years old, teacher, first visit on October 28, 1984. The patient began experiencing fatigue, loss of appetite, right flank pain, abdominal distension, and bitter taste in the mouth a year ago. Liver function tests revealed significant damage, with HBsAg positive. Local hospital diagnosed her with hepatitis B. Over the past year, she had tried transfer factor, Yunzhi Gantai, Coenzyme Q10, and other Western hepatoprotective drugs, but with no obvious therapeutic effect; her condition continued to relapse. In the past month, her condition worsened, with additional symptoms of nausea, low-grade fever, and loose stools. She has a history of hepatitis B exposure, as her younger sister is also a hepatitis B patient. Physical examination: Body temperature 37.9°C, emaciation, no jaundice of sclera, three spider angiomas found on face and neck. Heart and lungs appear normal, liver palpable 3 cm below the xiphoid process and 1 cm below the ribs, moderately hard with tenderness; spleen palpable 0.5 cm below the ribs, mobile dullness in abdomen (negative), no edema in lower limbs.

2

Report on Comparative Observation of Traditional Chinese Medicine Syndrome Differentiation and Treatment for 429 Cases of Chronic Active Hepatitis B by the Clinical Group of the Hepatitis B Research Project at the Gansu Provincial Institute of New Medicine: Pei Zhengxue, Cheng Jiechen, Zhong Xu, Min Wei, Peng Youjia, Zhang Yusheng, Zhang Huifang, Li Naixiang Laboratory: Han Duxin, Ji Jianjun, Yao Baicheng

There is currently no specific cure for chronic active hepatitis B. Since our institute established the hepatitis B research project in May 1984, up until February 1988, we have treated 429 cases of chronic active hepatitis B using traditional Chinese medicine syndrome differentiation, while simultaneously setting up a control group for comparative observation, achieving satisfactory therapeutic effects.

I. Case Selection

All 429 cases were confirmed patients with chronic active hepatitis B (according to the diagnostic criteria outlined in the 1983 National Plan for the Prevention and Treatment of Viral Hepatitis). Random grouping was employed, with 289 cases assigned to the treatment group and 140 to the control group. The two groups were carefully matched in terms of age, gender, disease course, and severity of illness to ensure comparability. Treatment group: 163 males, 126 females. 36 under 15, 91 aged 16–30, 121 aged 31–45, 40 aged 46–60, and 1 over 60. Disease course ranged from 1–2 years in 127 cases, 2–3 years in 86 cases, and over 3 years in 76 cases. Control group: 78 males, 62 females, 10 under 15, 53 aged 16–30, 48 aged 31–45, 27 aged 46–60, and 2 over 60. Disease course ranged from 1–2 years in 66 cases, 2–3 years in 49 cases, and over 3 years in 25 cases. All cases underwent liver function tests, three-system checks, HBV-DNA-P tests, protein electrophoresis, and other examinations upon admission, and met the diagnostic criteria for chronic active hepatitis B.

II. Traditional Chinese Medicine Syndrome Differentiation and Prescribed Formulas