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Input: Gastric, warming the middle and transforming dampness. Prescription: Yin Chen Shu Fu Tang with modifications: Yin Chen 30–60g, Fuzi, Ganjiang, and Gancao each 60g, Fuling 20g, Buxue and Ze Xie each 10g. For those with severe abdominal distension and thick coating on the tongue, add Cang Zhu, Hou Pu, and Da Fu Pi. 4. Severe Hepatitis Acute, subacute, and chronic severe hepatitis are common critical conditions in clinical practice, characterized by complex pathogenic mechanisms, rapid disease progression, and high mortality rates. Based on different complications of severe hepatitis, it can be categorized under traditional Chinese medicine’s categories such as “acute jaundice,” “epidemic jaundice,” “abdominal distension,” and “blood disorders.” Currently, the treatment of severe hepatitis typically employs a combination of traditional Chinese medicine and Western medicine, employing multi-modal, integrated therapies. Depending on the distinct clinical syndromes and related tests, TCM treatment can be divided into various syndromes, including heat-toxin stagnation in the liver, blood stasis due to obstruction, yin deficiency with blood heat, spleen-kidney yang deficiency, phlegm obstructing the heart and orifices, and evil invading and vital energy depleted. For these syndromes, individualized treatment is employed based on the primary complications, focusing on jaundice, ascites, bleeding, coma, and other symptoms. When heat-toxin is rampant, the main symptoms include sudden onset of jaundice that rapidly worsens, high fever with thirst, frequent vomiting, abdominal distension and fullness, pain that is resistant to pressure, constipation, short, red urine, irritability and restlessness, yellowish-brown tongue coating, and a wiry, rapid pulse. Treatment principles include clearing heat and detoxifying, draining fire and reducing jaundice. Prescriptions include Yin Chen Hao Tang, Huang Lian Jie Du Tang combined with Wu Wei Xiao Du Yin with modifications. Yin Chen 60g, Huang Qin, Huang Lian, Zhi Zi, and Da Huang each 10g, Lian Qiao 20g, Ban Lan Gen, Che Qian Cao, Pu Gong Ying, and Jin Yin Hua each 30g. When heat-toxin has invaded internally, the main symptoms include sudden onset, rapid progression, yellow skin like gold, high fever with urinary retention, skin rashes resembling blood, or agitation and restlessness—sometimes even delirium, convulsions, or mental confusion, with a red, deep tongue coated in foul, turbid material, and a wiry, fine, rapid pulse. Treatment principles include clearing heat and detoxifying, cooling the blood and nourishing yin. Prescriptions include Xi Jiao San with modifications. Xi Jiao Powder 3g (to be taken in a single dose), Shi Jue Ming, Sheng Di, Yin Chen, Chi Shao, Lian Qiao, and Ban Lan Gen each 30g, Da Huang and Dan Pi each 15g, Huang Lian and Zhi Zi each 10g. In cases of high fever and coma, administer An Gong Niu Huang Wan, Zhi Bao Dan, or Zi Xue Dan; for bleeding, add drugs that cool the blood and stop bleeding; for dampness and turbidity obstructing the orifices, use Chang Pu Yu Jin Tang combined with Yu Shu Dan and Zhi Bao Dan to clear phlegm and open the orifices. In cases of true deficiency and lingering evil, the clinical manifestations include no obvious discomfort. The diagnostic criteria require that, after excluding all of the above syndromes, if there is no obvious discomfort and liver inflammation viral marker tests are positive, then the condition falls under this syndrome. Western medical diagnosis is: chronic HBV carrier, without need for treatment. Prescription options suitable for all syndromes: Based on the aforementioned diagnostic criteria and in reference to modern medical pathology and laboratory tests, selecting appropriate formulas and medications can help improve therapeutic efficacy.

1. Antiviral Therapy: The causative agent of hepatitis B is HBV. Based on the etiology and pathogenesis of hepatitis, the first principle of treatment should be antiviral therapy. Traditional Chinese medicines such as Yin Chen Hao, Sheng Jiang, Huo Tan Mu, Zhu Ling, Sang Ji Sheng, Dan Shen, Hu Zhang, Ban Lan Gen, Ku Shen, Xu Chang Qing, Wu Wei Zi, and Kǔ Wei Ye Xia Zhu have been shown to inhibit the hepatitis B virus. Meanwhile, Long Dan Cao, Huang Qin, Shan Dou Gen, Zhi Zi, and Ku Shen effectively suppress the replication of hepatitis C virus RNA. Various heat-clearing and detoxifying herbs, such as Guan Zhong, also have anti-free radical effects, promote cellular and humoral immunity, induce interferon production, stimulate the release of multiple cytokines within the body, enhance the phagocytic function of macrophages, and exhibit anticancer properties. Herbal remedies like Chai Hu, Huang Qin, Ban Xia, Huo Xiang, Fuling, Long Dan Cao, Hu Zhang, and others can strengthen T cell receptor (TCR) VB gene expression, leading to higher HBV-DNA and HBeAg conversion rates, and improving symptoms and liver function to varying degrees. Other herbs such as Xian Ling Mi, Dong Chong Xia Cao, Ba Ji Tian, Ren Shen, Dang Shen, Sha Shen, Mai Dong, Xiang Gu, Bai Zhu, Zhu Ling, Chuang Ping, and Yu Xing Cao can also be utilized. Formulas like Huang Lian Jie Du Tang, Sheng Ma Ge Gen Tang, and Wu Wei Xiao Du Yin are all worthy of further research.
2. Immunomodulatory Therapy: The focus of immunomodulation is to enhance immune function and support the body’s inherent defenses. Herbs like Huang Qi, Ling Zhi, He Shou Wu, Nu Zhen Zi, Xian Ling Mi, and others can increase the T cell CD4/CD8 ratio, promote lymphocyte transformation, and enhance cellular immune responses. Many traditional Chinese medicinal polysaccharides possess antioxidant properties, boost cellular and humoral immunity, stimulate interferon production, induce the generation of various cytokines within the body, enhance the phagocytic function of macrophages, and exhibit anticancer effects. Herbal remedies that promote dampness elimination, such as Chai Hu, Huang Qin, Ban Xia, Huo Xiang, Fuling, Long Dan Cao, Hu Zhang, and others, can strengthen T cell receptors (TCR) VB gene expression, thereby increasing the rate of HBV-DNA and HBeAg conversion, improving symptoms and liver function to varying degrees. Other herbs like Xian Ling Mi, Dong Chong Xia Cao, Ba Ji Tian, Ren Shen, Dang Shen, Sha Shen, Mai Dong, Xiang Gu, Bai Zhu, and others can also be used. Formulas like Tao Hong Si Wu Tang, Da Huang Chong Wan, and Fu Yuan Huo Xue Tang can be employed.
3. Promoting Liver Tissue Recovery, Improving Liver Function, and Anti-Fibrosis: Microcirculatory disorders in the liver are the pathological basis underlying the pathogenesis of viral hepatitis. Herbal remedies that promote blood circulation and eliminate stagnation, such as Chi Shao, Dan Shen, and Ge Gen, can dilate intrahepatic vessels, increase hepatic blood flow, and improve blood supply to hepatocytes, thereby reducing hepatocellular necrosis, accelerating lesion repair, and promoting hepatocyte regeneration. These blood circulation-promoting herbs also have immunosuppressive effects: for those with heavy damp-heat and elevated ALT, choose Pei Pen Cao and Shan Dou Gen; for those with mild damp-heat, opt for Wu Wei Zi preparations. Once enzyme levels return to normal, gradually reduce the dosage and continue taking the medication for 2–3 months before discontinuing, to avoid rebound effects. To improve protein metabolism, focusing on replenishing qi, nourishing blood, and nourishing yin, select Ren Shen, Huang Qi, Dang Shen, Ling Zhi, Dong Chong Xia Cao, Dang Shen Wan, Wu Ji Bai Feng Wan, and He Che Da Zao Wan.
4. Anti-Fibrosis Therapy: Traditional Chinese medicine possesses efficacy in anti-fibrosis treatment that surpasses that of Western medicine. Recent studies have demonstrated that traditional Chinese medicine not only exhibits significant anti-fibrotic effects but also has the potential to reverse early-stage liver cirrhosis. The active ingredient kushenol in traditional Chinese medicine can significantly inhibit the proliferation of fibroblasts and the expression of type III collagen mRNA. Oxidized kushenol may suppress inflammatory processes, inhibit the activation of hepatic stellate cells, and inhibit fibroblast proliferation, thereby achieving anti-fibrotic effects. Ligustrazine (found in plants like Ligusticum chuanxiong and Curcuma longa) improves microcirculation, protects hepatocytes, combats lipid peroxidation, and exerts anti-fibrotic effects. Danshen can inhibit the proliferation of hepatic stellate cells, reduce their collagen synthesis and secretion, and thus exert anti-fibrotic effects. Sanqi can significantly alleviate hepatocellular necrosis, promote hepatocyte repair and regeneration, and reduce liver changes. Cordyceps mycelium can enhance the body’s immune function, strengthen the body’s ability to clear viruses and other pathogens, protect hepatocytes, and indirectly inhibit the occurrence and progression of liver fibrosis. Chi Shao inhibits collagen fibers, improves serum markers of liver fibrosis, and alleviates pathological changes in liver tissue. The amygdalin in peach kernels is an important active component for anti-fibrosis, promoting the degradation of collagen and fibronectin within the liver. Peach kernels, along with red flowers, Danshen, Sanqi, Lily, Mountain Oyster Mushroom, Chai Hu, Turtle Shell, and others, also demonstrate significant anti-fibrotic effects. The treatment principles of these formulas combine disease identification with syndrome differentiation, supporting righteous qi while eliminating evil, and employing multi-level, holistic regulation. In recent years, numerous studies across China have explored the application of traditional Chinese medicine in the treatment of hepatitis. It is generally believed that employing multiple methods, combining syndrome differentiation with formula selection, better reflects the characteristics of holistic regulation, yields superior therapeutic outcomes, and facilitates scientific research. Pei Zheng Xue’s research on hepatitis B treatment involved 429 cases of chronic active liver disease, classified by syndrome, with a total effective rate of 87.52%, an HBsAg conversion rate of 39.9%, and an anti-HBe conversion rate of 68.57%, significantly outperforming the control group. One case was characterized by initial depletion of qi and yin, presenting with fatigue, poor appetite, hot flashes, feeling of emptiness and restlessness, a red tongue with a pale coating, and a slow, fine pulse. This type of symptom is relatively mild; treatment focuses on “Sheng Shan Bai Ge Tang” (Sheng Ma 6g, Shan Yao 10g, Bai Zhu 10g, Huang Qi 20g, Dan Shen 20g, Ge Gen 10g, Qin Tiao 10g, Hong Hua 3g, Hu Zhang 10g, Tu Gang 10g, Wu Mei 4 pieces, Bai Shao 10g, Chan Yi 6g, Ye Hua 10g, Yu Jin 6g). Another case was characterized by invasion of the Shaoyang meridian: presenting with bitter mouth, dry throat, flank pain, abdominal distension, restlessness, a slightly yellowish-greasy tongue coating, and a wiry, rapid pulse. This type of symptom is more pronounced; treatment focuses on “Fu Fang Xiao Chai Hu Tang” (Chai Hu 10g, Huang Qin 10g, Ban Xia 10g, Dang Shen 10g, Gan Cao 6g, Sheng Jiang 6g, Da Zao 6g, Yin Chen 10g, Dan Shen 20g, Huang Qi 20g, Qin Tiao 10g, Ban Lan Gen 10g, Hu Zhang 15g, Tong Li Zi 10g, Cheng Xiang 10g, Chuan Lian Zi 10g, Chuan Lian Zi 10g, Chuan Lian Zi 10g). A third case was characterized by qi stagnation and blood stasis: presenting with darkened facial complexion, a pressing sensation in both flanks, severe right flank pain, abdominal distension and fullness, bleeding, a red tongue with bruising spots, and a wiry, rapid pulse. This type of symptom is severe; treatment focuses on “Yi Yin Jian Jia Wei” (Chuan Niu Xi 10g, Dan Pi 10g, Dan Shen 20g, Mai Dong 10g, Sheng Di 10g, Bai Shao 10g, Huang Qi 20g, Ban Lan Gen 6g, Dang Shen 10g, Chuan Lian Zi 10g, Qin Tiao 10g, Yuan Hu 6g, Chuan Lian Zi 10g). A fourth case was characterized by yang deficiency and water accumulation: presenting with fatigue, exhaustion, abdominal fullness, ascites, edema, chills, spontaneous sweating, a swollen tongue with a pale coating, and a slow, fine, slippery pulse. This type had progressed to late-stage liver cirrhosis; treatment focused on “Fu Fang Liu Jun Zi Tang” (Dang Shen 10g, Bai Shao 10g, Fu Ling 10g, Gan Cao 6g, Ban Xia 6g, Dan Shen 30g, Huang Qi 30g, Qin Tiao 10g, Dang Shen 10g, Bai Shao 10g, Chuan Lian Zi 10g, Ze Xie 10g, Da Fu Pi 10g, Hu Lu Pi 15g, Ting Li Zi 15g, Qing Chen Pi 10g, Che Qian Zi 19g). All of these formulas were prepared by decocting in water, one dose per day, with 20 doses constituting a course of treatment. Over many years, the author has studied the combination of traditional Chinese medicine and Western medicine in the treatment of hepatitis, formulating three series of traditional Chinese medicine formulas for hepatitis, based on the principles of clearing heat, promoting diuresis, detoxifying, regulating the liver, strengthening the spleen, nourishing qi, nourishing blood, cooling the blood, and resolving blood stasis. The first series is a liver-clearing formula composed of Yin Chen, Dang Shen, Da Huang, Long Dan Cao, Yu Jin, Fu Ling, Che Qian Zi, etc., primarily treating acute jaundice hepatitis, active chronic hepatitis, and decompensated liver cirrhosis in cases of yang jaundice. The second series is a liver-dissolving formula composed of Chi Shao, Zhi Zi, Da Huang, etc., primarily treating severe hepatitis and severe jaundice in hepatitis, in cases of acute jaundice. The third series is a liver-regulating formula composed of Dan Shen, Dang Shen, Huang Jing, Bai Shao, Yu Jin, Long Dan Cao, Turtle Shell, etc., primarily treating hepatitis recovery periods, chronic hepatitis, and liver cirrhosis in cases of true deficiency and evil. These three formulas can be used individually, in combination, or in rotation, depending on the specific type and stage of hepatitis and liver cirrhosis. Among them, 232 cases of chronic hepatitis showed an effective rate of 94%; 148 cases of severe hepatitis had a survival rate of 60%; and 107 cases of decompensated hepatitis with liver cirrhosis achieved an effective rate of 66%. The therapeutic outcomes were superior to the control group, with no side effects. The combination formulas, through basic medical research, exhibited bile-promoting, hepatocyte damage-repair, and immune-regulatory effects. Immune regulation manifested in enhanced phagocytic function, cytotoxic activity, and superoxide dismutase (SOD) activity; humoral immunity was suppressed, and lipid peroxidation (LPO) levels decreased; moreover, they endowed blood cells with the potential to induce interferon production.