IV. Western Medical Treatment

The specific treatment method involves clearing heat and promoting diuresis: suitable for liver and gallbladder damp-heat syndrome. The formula includes 40g of Yin Chen, 10g of Zhizi, 10g of Dahuang, 10g each of Chai Hu and Longdan Cao, 20g of Yi Yi Ren, 15g of Fu Ling, 18g of Hua Shi, 9g of Ze Xie, and 20g of Pu Gong Ying. Additionally, 10g of Dan Pi is added, along with 6g of Gan Cao to harmonize all the herbs. For diuresis and clearing dampness, the formula uses Yin Chen Wu Ling San combined with Gan Lu Xiao Du Dan with modifications: 40g of Yin Chen, 10g of Zhizi, 9g of Dahuang, 15g of Huo Xiang, 15g of Bai Kou Ren, and 18g of Hua Shi. If the goal is to clear heat, eliminate dampness, reduce jaundice, and cool the blood while detoxifying, add 8g of Cang Zhu, 15g of Pei Lan, 15g of Fu Ling, and 9g of Ze Xie if jaundice is present. To clear heat and detoxify, add 10g of Huang Qin and 10g of Lian Qiao, 15g of Jin Yin Hua, 10g of Dan Pi, and 5g of Gan Cao. For poor appetite and abdominal distension, add 12g of Shan Zha, 15g of Shen Qu, and 20g of Mai Ya. For spleen-stomach imbalance, the formula uses Xiang Sha Liu Jun Zi Tang with modifications: 12g of Dang Shen, 10g of Bai Shao, 15g of Fu Ling, 10g of Chen Pi, 10g of Jiang Ban Xia, 10g of Mu Xiang, and 8g of Sha Ren. To strengthen the spleen and remove dampness, the formula uses Xiang Sha Liu Jun Zi Tang with modifications: 12g of Dang Shen, 10g of Bai Shao, 15g of Fu Ling, 10g of Chen Pi, 10g of Jiang Ban Xia, 10g of Mu Xiang, and 8g of Sha Ren. To promote diuresis and clear dampness, the formula uses Yin Chen with modifications: 30g of Yin Chen, 20g of Yi Yi Ren, and 10g of Che Qian Zi. If accompanied by rib pain and abdominal distension, add 15g of Zhi Ke, 9g of Zhi Ke, 10g of Yu Cao, and 15g of Gua Lou. For nausea and aversion to oil, add 12g of Jiang Zhu Ru, 15g of Chao Shan Zha, 10g of Bai Dou Kou, and 3g of Gan Cao. To warm and transform cold-dampness, the formula uses Yin Chen Shu Fu Tang with modifications: 30g of Yin Chen, 15g of Chao Bai Shao, 5g of Wu Fu, 5g of Gan Cao. If abdominal fullness and discomfort are present, add 10g of Cang Zhu, 10g of Chen Pi, 9g of Zhi Ke, and 10g of Yu Cao. If you feel nauseous and have poor appetite, add 10g of Sha Ren and 10g of Bai Kou Ren, along with 15g of Huo Xiang. For heavy dampness, add 10g of Qiang Huo, 20g of Yi Yi Ren, 5g of Rou Gui, and 5g of Gan Cao. To soothe the liver and strengthen the spleen to remove dampness, the formula uses Chai Hu Shu Gan San with modifications: 10g of Chai Hu, 30g of Yin Chen, 20g of Yi Yi Ren, 15g of Fu Ling, 10g of Zhi Ke, 15g of Chen Pi, 8g of Chuan, 10g of Dang Shen, 15g of Bai Shao, and 5g of Gan Cao. If you experience flank pain, add 10g of Yuan Hu and 10g of Chuan Lian Zi, along with 15g of Huo Xiang and 15g of Huo Xiang. If you have intestinal rumbling and diarrhea, add 10g of Hou Po, 10g of Bai Dou Kou, and 10g of Gan Cao. To resolve blood stasis and eliminate dampness, the formula uses Fuyuan Huo Xue Tang with modifications: 10g of Chai Hu and 10g of Dang Gui, 6g of Hong Hua, 8g of Chuan Ma, 8g of Dahuang, and for heat-clearing and dampness-resolving, add 30g of Yin Chen, 20g of Yi Yi Ren, 15g of Fu Ling, and 8g of Zhizi. If you want to resolve blood stasis and relieve pain, add 10g of Yu Cao, 5g of San Qi, 15g of Si Gua Luo, and 5g of Gan Cao to help alleviate symptoms. To soothe the liver and remove dampness, the formula uses Dan Zhi Xiao Yang San with modifications: 10g of Chai Hu, 10g of Dang Gui, 15g of Bai Shao, 15g of Bai Shao, 6g of Bo He, 10g of Sheng Bai Shao, and 5g of Gan Cao. If you experience liver qi stagnation, add 10g of Yuan Hu and 10g of Chuan Lian Zi, along with 15g of Huo Xiang and 15g of Huo Xiang. If you feel nauseous and have poor appetite, add 10g of Sha Ren and 10g of Bai Kou Ren, along with 15g of Huo Xiang. For those with heavy dampness, add 10g of Qiang Huo, 20g of Yi Yi Ren, 5g of Rou Gui, and 5g of Gan Cao. To clear excess heat and eliminate dampness, the formula uses Qing Hao Bie Jia San with modifications: 10g of Qing Hao, 20g of Bi Jia, 10g of Chai Hu, 15g of Di Gu Pi, 10g of Dang Gui, 12g of Sheng Di, 18g of Hua Shi, 6g of Bu Bao, and 3g of Gan Cao. If you experience obvious damp-heat, add 40g of Yin Chen, 20g of Yi Yi Ren, and 10g of Zhizi; to support the body’s righteous energy and dispel evil, add 10g of Sheng Huang Qi and 8g of Ren Shen. Treatment outcomes: 42 cases showed significant improvement, 44 cases improved, with an overall effective rate of 100%. (Practical Journal of Traditional Chinese Medicine, 2009.2) IV. Western Medical Treatment (1) Treatment of Chronic Type B Hepatitis The overarching goal of treating chronic type B hepatitis is to maximize long-term suppression or elimination of HBV, reduce hepatocellular inflammation and necrosis, as well as hepatic fibrosis, slow down and prevent disease progression, and decrease and prevent the occurrence of liver decompensation, liver cirrhosis, HCC, and their complications—thereby improving quality of life and extending survival time. Chronic type B hepatitis treatment mainly includes antiviral therapy, immune regulation, anti-inflammatory liver protection, anti-fibrosis therapy, and symptomatic treatment; among these, antiviral therapy is the key component—wherever indicated and when conditions permit, standardized antiviral treatment should be administered.

1. General Indications for Antiviral Therapy: ① HBV-DNA ≥ 10⁵ copies/ml (for HBeAg-negative patients, ≥10⁴ copies/ml); ② ALT ≥ 2 ULN; when using interferon therapy, ALT should be ≤ 10 ULN, and total serum bilirubin levels should be < 2 ULN; ③ If ALT is < 2 ULN, but histological examination of liver tissue reveals Knodell HAI ≥ 4, or ≥ G₂ inflammatory necrosis, patients who meet criteria ① and ② or ③ should undergo antiviral treatment; for those who do not meet the above treatment standards, monitoring of disease progression is necessary—when HBV-DNA remains positive and ALT remains abnormal, antiviral treatment should also be considered.

2. Antiviral Medications ① Interferon: The sustained response rate to standard interferon therapy is only 10%–47%. Currently, polyethylene glycol interferon (PegIFN) α-2a or α-2b is more commonly used. International multi-center randomized controlled clinical trials have shown that after 48 weeks of treatment for HBeAg-positive chronic type B hepatitis (87% of patients were Asian), followed by 24 weeks of follow-up, the HBeAg seroconversion rate was 32%; for HBeAg-negative patients (60% were Asian), after 48 weeks of treatment and 24 weeks of follow-up, 43% of patients had HBV DNA < 10⁴ copies/ml, and 42% remained at this level after 48 weeks. PegIFN has been approved in China for the treatment of chronic type B hepatitis. ② Nucleoside analogs: Currently, nucleoside analogs used in China for the treatment of hepatitis B include lamivudine, adefovir dipivoxil, entecavir, telbivudine, among others. These medications have the advantage of significantly suppressing HBV, but they require long-term use—and for patients with liver cirrhosis or decompensated liver function, it is especially important not to discontinue medication lightly. Long-term use can lead to the emergence of drug-resistant strains, and some patients may experience relapse after stopping medication; this is a drawback of nucleoside analogs.

3. Immune Regulation Therapy Immune regulation therapy is one of the important approaches in the treatment of chronic type B hepatitis, though there is currently a lack of hepatitis-specific immune therapies. Thymosin α1 can enhance non-specific immune function, with minimal adverse reactions and safe usage. For patients who meet antiviral indications but cannot tolerate or are unwilling to receive interferon or nucleoside analog therapy, Thymosin α1 can be used under certain conditions, administered at 11.6mg twice weekly via subcutaneous injection for a course of 6 months.

4. Anti-inflammatory and Liver Protection Therapy Hepatic inflammation and necrosis, as well as the resulting hepatic fibrosis, form the primary pathological basis for disease progression; therefore, effectively suppressing hepatic tissue inflammation may reduce hepatocellular damage and slow the progression of hepatic fibrosis. Active ingredients such as glycyrrhizic acid preparations and silymarin-based products have been clearly identified, exhibiting varying degrees of anti-inflammatory, antioxidant, and protective effects on hepatocellular membranes and organelles, and their clinical applications can improve liver biochemical indicators. Compounds like benzyl ester and biciclohexanol can also lower serum aminotransferase levels, particularly ALT. Anti-inflammatory and liver protection therapy is only part of comprehensive treatment and cannot replace antiviral therapy. For patients with markedly elevated ALT or those with significant hepatic tissue inflammation, anti-inflammatory and liver protection medications can be appropriately selected in addition to antiviral treatment. It is not advisable to use multiple anti-inflammatory and liver protection medications simultaneously, as this may increase the burden on the liver and cause adverse effects due to drug interactions.

5. Anti-fibrosis Therapy: Studies have shown that after antiviral treatment with IFN-like agents, hepatic tissue pathology often reveals reduced fibrosis and even liver cirrhosis. Therefore, antiviral treatment serves as the foundation for anti-fibrosis therapy. Based on traditional Chinese medicine theory and clinical experience, liver fibrosis and liver cirrhosis fall within the category of Zheng Xu Xue Yu syndrome. Consequently, the treatment of liver fibrosis and early liver cirrhosis in chronic type B hepatitis often focuses on benefiting qi and nourishing yin, activating blood circulation to resolve blood stasis, while also nourishing blood and softening the liver or tonifying liver and kidney. Reports indicate that several traditional Chinese medicine formulas designed by domestic institutions for anti-liver fibrosis have demonstrated certain therapeutic efficacy. In the future, we should conduct large-scale, randomized, double-blind clinical trials in accordance with evidence-based medicine principles and the new guidelines for clinical research management (GCP), while paying close attention to histological findings of liver tissue to further validate the anti-liver fibrosis efficacy of various traditional Chinese medicine formulas.

6. Other Treatments: In recent years, research on cytokines such as interferon (IFN), hepatocyte growth factor (HGF), and lymphokine-activated killer cells (LAK cells) has made significant progress. These proteins, which possess diverse biological functions, are believed to coordinate bodily functions and play crucial roles in resisting infection, combating tumors, addressing immune deficiencies, and managing autoimmune diseases. Further research into these areas remains worthwhile. Intravenous high-nutrition therapy for hepatitis, drainage and reinfusion of ascites in liver cirrhosis, surgical procedures for portal hypertension, as well as artificial liver and liver transplantation—though they sometimes provide symptomatic relief, their effectiveness is often limited because pathogenetic treatment has not fundamentally addressed the underlying causes of the disease. Additionally, the traditional Chinese medicine compound berberine, extracted from the medicinal herb coptis, has been developed into intravenous and intramuscular injections, as well as oral formulations. Clinical studies in China have shown that this drug improves liver biochemical indicators and exhibits certain anti-HBV effects. However, its precise anti-HBV efficacy still requires further expansion of case numbers and rigorous multi-center randomized controlled clinical trials to verify its effectiveness.

7. General Care for Hepatitis ① Rest: Acute hepatitis requires local isolation and rest; chronic hepatitis should be adequately rested, with a combination of activity and rest after improvement, and avoiding overexertion during the recovery period. Carriers of the virus need regular follow-up visits and do not require complete rest. ② Diet: Acute hepatitis benefits from easily digestible, vitamin-rich, light diets; when nausea and vomiting occur or when calorie intake is insufficient, glucose supplementation is recommended. Chronic hepatitis should adopt a high-protein diet, with portion sizes kept moderate to prevent fatty liver; alcohol consumption is prohibited for hepatitis patients.

(2) Treatment of Hepatitis C (1) The goal of antiviral treatment for hepatitis C is to eliminate or sustainably suppress the presence of HCV in the body, thereby improving or alleviating liver damage, preventing progression to liver cirrhosis, liver failure, or HCC, and enhancing patients’ quality of life.

(2) Effective antiviral medications: Interferon-α (IFN-α) is an effective drug against HCV, including standard IFNα, composite IFN, and polyethylene glycol (PEG)-modified interferon α (PEG-IFNα). The combination of PEG-IFNα and ribavirin is currently the most effective antiviral treatment regimen; followed by standard IFNα or composite IFN combined with ribavirin, both of which outperform single-use IFNα. Recent international clinical trial results show that when PEG-IFNα-2a (180μg) or PEG-IFNα-2b (1.5μg/kg) are administered once weekly via subcutaneous injection, combined with oral ribavirin treatment for 48 weeks, the sustained virological response (SVR) rate can reach 54%–56%; standard IFNα (3MU) administered intramuscularly three times weekly in combination with ribavirin for 48 weeks had a slightly lower SVR rate of 44%–47%; single-use PEG-IFNα-2a or standard IFNα treatment for 48 weeks yielded SVR rates of only 25%–39% and 12%–19%, respectively. Therefore, unless there are contraindications to ribavirin, combination therapy should always be employed.

(3) Treatment of Other Types of Hepatitis Other types of hepatitis, being localized infections, generally do not develop into chronic conditions. Aside from basic care—such as isolating and resting during acute hepatitis, and allowing chronic hepatitis to recover with a balance of rest and activity, avoiding overexertion during the recovery period—patients should eat easily digestible, vitamin-rich, light meals. When nausea and vomiting occur or when calorie intake is insufficient, glucose supplementation is recommended. Carriers of the virus need regular follow-up visits and do not require complete rest. Drug treatment should focus primarily on symptomatic treatment; active ingredients such as glycyrrhizic acid preparations and silymarin-based products have been clearly identified, exhibiting varying degrees of anti-inflammatory, antioxidant, and protective effects on hepatocellular membranes and organelles, and their clinical applications can improve liver biochemical indicators. Compounds like benzyl ester and biciclohexanol can also lower serum aminotransferase levels, particularly ALT. Except for particularly severe cases of hepatitis, most patients can recover within a short period of time.