Case 3

Liu, female, 33 years old, supervisor, first visit on December 13, 1983. Two months prior, she developed low-grade fever, weight loss, aversion to oily foods, fatigue, fullness and distension in the chest and flanks, nausea, discomfort in the stomach, and restlessness in the heart. She had a history of exposure to hepatitis B.

Physical Examination: Body temperature 37.9℃, no jaundice, red throat, tonsils grade II enlarged, heart and lungs unremarkable. Abdomen flat and soft, liver palpable 4cm below the xiphoid process, spleen not palpable, soft texture, obvious tenderness.

Laboratory Tests: Hemoglobin 12g. Jaundice index 7 units, TFT (-), TTT 10 units, GPT 1200 units. Total plasma protein 6.8g, albumin 4.8g, globulin 2g, HBsAg 1:1024, Anti-HBc positive.

Western Medical Diagnosis: Viral hepatitis, Type B, acute.

TCM Syndrome Differentiation: Patient has a string-like rapid pulse, red tongue with yellow greasy coating, combined with chest and flank pain, restlessness and nausea, and bitter taste in the mouth—these symptoms indicate invasion of pathogenic factors into Shaoyang, with damp-heat in the liver and gallbladder.

Prescription: Use Compound Chaihu Tang for 5 doses.

Follow-up visit: Pain in the chest and flanks, bitterness, nausea, and other symptoms have all decreased, the tongue coating has become thinner. Due to poor appetite, added 6g of Chicken gizzard and 10g of roasted hawthorn, followed by another 10 doses.

Fourth visit: All symptoms have completely disappeared, GPT 120 units, TTT 6 units, HBsAg negative, Anti-HBc negative.

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Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Case Studies, with Four Illustrations, Published by Hepei Publishing House

The patient has recovered; treatment should follow the principle of reinforcing vital energy. The main herbs in Shanshan Baige Decoction—such as Atractylodes, Mountain Ginseng, Kudzu Root, and other tonifying herbs—are the principal ingredients for strengthening qi. In the early stages of chronic hepatitis B, most patients present with flank pain, abdominal distension, irritability, bitter taste in the mouth, and dry throat. These symptoms indicate pathogenic factors invading the Shaoyang channel, so treatment should focus on harmonizing Shaoyang. The compound Chaihu Decoction combines Xiaochaihu Tang and Danshen Yin into one formula, which helps to soothe the liver, harmonize the stomach, and balance Shaoyang. For long-standing hepatitis B, when hepatosplenomegaly, emaciation, and bone-steaming occur, it usually indicates advanced chronic hepatitis or active chronic hepatitis, characterized by qi stagnation and blood stasis, with prolonged stagnation leading to heat accumulation. Treatment should focus on invigorating blood circulation, removing blood stasis, clearing heat, and eliminating steaming. In the late stage of hepatitis B, especially when accompanied by cirrhosis and ascites, the condition often falls under the category of yang deficiency with water overflow. At this point, the battle between righteous qi and pathogenic factors has largely ended due to severe depletion of righteous qi, so treatment should aim to reinforce vital energy and regulate the middle jiao using formulas such as Liujun Pingwei, gradually achieving therapeutic effects. In treating hepatitis B, the above-mentioned primary formulas are often supplemented with herbs like Polygonum cuspidatum, Artemisia capillaris, Isatis tinctoria, Solanum nigrum, and wild chrysanthemum, which clear heat, detoxify, and remove dampness. This is because patients with hepatitis B often exhibit a slippery and rapid pulse, along with a yellow and greasy tongue coating, indicating that the pathogenic factor is primarily damp-heat. Adding these herbs addresses the root cause of the disease.

TCM syndrome differentiation and treatment have a significant effect on the disappearance of hepatitis B symptoms (Table 1), improvement of liver function (Table 2), and conversion of the pathogen to negative (Table 3), demonstrating that TCM syndrome-based treatment for hepatitis B is not merely symptomatic therapy but fundamentally treats the disease at its root. This embodies the TCM academic view that “what exists internally will inevitably manifest externally” and reflects the TCM spirit of “treating disease by addressing its root.” Tables 4 and 5 show that patients with yang deficiency and water overflow, as well as those whose illness has lasted more than a year, tend to have poorer treatment outcomes, indicating that the later the stage of the disease, the harder it is to cure. As stated in the “Suwen: Discussion on Regulating the Spirit According to the Four Seasons”: “If one waits until the disease has already developed before administering medicine, or waits until chaos has already set in before trying to restore order, it is like digging a well only when one is thirsty or forging an awl only when one is already fighting—how late is that!” Therefore, early diagnosis and early treatment are crucial components of hepatitis B management.

(“Research on Integrated Chinese and Western Medicine,” 1987.1)

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Clinical Analysis Report on 2021 Cases of Hepatitis B in Lanzhou Region, by Cheng Hao and Zhong Xu

The incidence of hepatitis B in China is very high. The HBsAg-positive rate is approximately 6–26%, and the overall infection rate is no less than 60%. To further understand the characteristics of this disease and provide a basis for its prevention and control, we conducted an analysis of 2021 HBsAg-positive patients treated by our hepatitis B research group from May 1984 to February 1988.

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Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Case Studies, with Four Illustrations, Published by Hepei Publishing House

Middle Volume, Page 181

Out of 346 cases, 87.2% showed statistically significant differences (P<0.05), indicating that vertical transmission does not play a significant role in acute hepatitis B infections, while contact transmission—i.e., horizontal transmission—is relatively more important.

Among the 2021 hepatitis B patients, only 201 had jaundice indices exceeding 6 units, accounting for just 10.0% of all cases; clinically evident jaundice was observed in only 101 cases, representing 4.6% of the total. This shows that jaundice does not play a major role in the symptoms of hepatitis B. Gamma-globulin levels were elevated above 20% in 739 cases, with chronic active hepatitis accounting for 382 of them, or 51.7%, indicating that elevated gamma-globulin levels are important for diagnosing chronic active hepatitis. All 2021 cases of various types of hepatitis B tested positive for HBsAg, followed by 1463 cases positive for anti-HBc, accounting for 72.3%. Only 129 cases were positive for anti-HBs, representing 6.4%. Among acute hepatitis B cases, 349 were positive for anti-HBs, accounting for 88.1%, highlighting the importance of this marker in diagnosing acute hepatitis B. The anti-HBe positivity rate was highest among carriers (98.6%), followed by chronic persistent hepatitis (68.6%), reflecting the “protective significance” of this marker. The HBV-DNA-P positivity rates, from highest to lowest, were chronic active hepatitis (67.8%), cirrhosis (60.3%), acute hepatitis (53.6%), chronic persistent hepatitis (24.5%), and carriers (21.5%). These results are broadly consistent with reports by Hiroshi Suzuki and also demonstrate the “protective significance” of this marker.

We divided the cases into mild and severe groups based on the severity of the condition and observed the relationship between various indicators and disease severity.

1. HBsAg positive or anti-HBe negative;
2. Liver function showing flocculation ++ or higher, turbidity above normal, or SGPT over 300;
3. Obvious subjective symptoms and physical signs.

If two out of these three criteria are met, the case is classified as “severe.”

1. HBeAg negative or anti-HBe positive;
2. Liver function showing flocculation + or -, turbidity within normal limits, or SGPT below 300;
3. Unobvious subjective symptoms and physical signs.

If two out of these three criteria are met, the case is classified as “mild.”

Subjective symptoms and physical signs being “obvious” or “unobvious” are determined based on the following indicators: among fatigue, liver pain, abdominal distension, and hepatomegaly, if three of these four are present, the condition is considered “obvious”; otherwise, it is considered “unobvious.” The relationship between hepatitis B severity and age is shown in Table 3, the relationship between hepatitis B severity and HBsAg ratio in Table 4, the relationship between hepatitis B severity and anti-HBe in Table 5, and the relationship between hepatitis B severity and HBV-DNA-P in Table 6.

Table 3 shows that among different age groups, elderly patients aged 46 and above have a higher proportion of severe cases, with statistically significant differences. Could this be due to the weakened immunity of elderly patients? However, since the incidence of this disease is low among elderly patients, what explains this phenomenon? Further research is needed. Table 4 shows that there is no significant difference in hepatitis B severity across different HBsAg ratio ranges, suggesting that there is no positive correlation between the ratio and the severity of hepatitis B. Persich et al. reported that HBsAg concentration decreases in the order of chronic active hepatitis < chronic persistent hepatitis < carriers, which seems to indicate a negative correlation, but this characteristic was not found in our study. Although HBsAg concentration cannot reflect disease severity, higher concentrations do mean greater infectivity, a view widely accepted by scholars. Table 5 shows that patients positive for anti-HBe tend to have milder conditions, while those negative for anti-HBe tend to have more severe conditions, with highly significant statistical differences, further confirming the protective effect of anti-HBe. Table 6 indicates that

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Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Case Studies

Among patients positive for HBV-DNA-P, there are fewer mild cases and more severe ones; among those negative for HBV-DNA-P, there are fewer severe cases and more mild ones, with statistically significant differences, suggesting that measuring the activity of hepatitis B virus DNA polymerase is important for determining the severity of hepatitis B.

Table 3: Relationship Between Hepatitis B Severity and Age

Explanation: There is no significant difference in severity across age groups, but when 45 and older are grouped together as the elderly and those under 45 are grouped as middle-aged and young adults, the comparison shows a highly significant difference, with P<0.01, meaning the elderly have more severe cases than the middle-aged and young adults.

Table 4: Relationship Between Hepatitis B Severity and HBsAg Ratio

HBsAg | > Mild | > Severe | > Total | > P-value 1:(16–64) | > 402 | > 360 | > 762 | > P>0.05 | > | > | > | > P>0.05 1:(128–256) | > 351 | > 336 | > 687 | > P>0.05 | > | > | > | 1:256 | > 273 | > 289 | > 562 |

Table 5: Relationship Between Hepatitis B Severity and Anti-HBe Negative Status

Mild | > Severe | > Total | > P-value | Positive 933 | > 363 | > 1296 | > P<0.01 | > | > | > P<0.01 Negative 224 | > 501 | > 725 |

Table 6: Relationship Between Hepatitis B Severity and HBV-DNA-P Positive/Negative Status

Number of Cases | > Positive/Negative | > Mild | > Severe | > Total | > P-value | | | | | | Mild/Severe | | | | | | Positive | > Positive | > 202 | > 601 | > 803 | > P<0.01 Negative | | > | > | > | > P<0.01 | | > 817 | > 401 | > 1218 |

Middle Section: Clinical Application

3. Conclusion

Through epidemiological and clinical observations of 2021 hepatitis B patients, this paper concludes that, in addition to the commonly recognized routes of transmission such as blood transfusion, injection, and vaccination, contact transmission remains an important epidemiological factor, particularly mother-to-child transmission within families (vertical transmission), which carries even greater significance. Given that many married couples live together without one partner ever developing hepatitis B, it can be inferred that the body’s immune system plays a crucial role in preventing the onset of hepatitis B. The serological pathogenic indicators of various types of hepatitis B in this study are broadly consistent with most domestic and international reports. There is no obvious relationship between the severity of hepatitis B and age or the level of HBsAg, with no statistically significant differences; however, there is a clear relationship between anti-HBe and HBV-DNA-P positivity/negativity and disease severity, with statistically significant differences.

(“Gansu Medical Journal,” 1989.4)

① Wu Xiaosu, “Journal of Suzhou Medical College,” 1986, Vol. 1, p. 95

② Liu Fengju et al., “Materials from the Fifth National Conference on Viral Hepatitis,” 1987, Vol. 11

③ Zhang Guangshu, “Military Medical Journal,” 1986, Vol. 3, p. 210

④ Zhao Ruohui et al., “Chinese Journal of Epidemiology,” 1984, Vol. 1, p. 16

⑤ Liang Ruilin, “Chinese Journal of Epidemiology,” 1984, Vol. 6, p. 372

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Comparative Observation Report on TCM Syndrome Differentiation Treatment of Diabetes in 76 Cases

Li Wei and Chen Ling

Although there are many Western medical treatments for diabetes, they often lead to drug dependence, resulting in few cases of complete cure. The authors used TCM syndrome differentiation treatment for 76 cases of this disease and compared them with a control group of 28 patients treated with phenformin, tracking their progress for two years. The results show that TCM syndrome differentiation treatment achieved satisfactory therapeutic effects.

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Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Case Studies

Published by Heji Book Publishing House

Middle Section: Clinical Application

Published by Taiji Book Publishing House

Table 1: Comparison of Symptom Recovery Before and After Treatment Between Treatment and Control Groups (Percentage)

| | > Polydipsia | > Polyuria | > Polyphagia | > Fatigue | > Emaciation | | Treatment Group | > Before Treatment | > 69(90.8)△ | > 70(92.1)△ | > 53(69.7) | > 76(100)△ | > 43(56.6) | | | | > 12(15.8)* | > 9(11.8) | > 5(6.6)* | > 12(15.8) | > *20(26.3) | | N=76 | | > 23(82.1) | > | > | > 27(96.4) | > 13(46.4) | | | | > | > 24(85.7) | > 18(75.1) | > 12(42.8) | > 10(35.7) | | | | > 20(71.4) | > 19(67.8) | > | | | | | | | | > 15(53.6) | | | | | > After Treatment | | | | | | Control Group | > Before Treatment | | | | | | N=28 | | | | | | | | > After Treatment | | | | |

△: Statistical analysis before treatment for both the treatment and control groups, P>0.05.

*: Statistical analysis after treatment for both the treatment and control groups. Except for the emaciation item, where P<0.05, all other items have P<0.01.

Table 2: Comparison of Pre- and Post-Treatment Laboratory Indicators Between Treatment and Control Groups (Percentage)

| | Treatment Group N=76 | | Control Group N=28 | | |-------------|-----------------------|----------|------------| | | Before Treatment | After Treatment | Before Treatment | After Treatment | | Urine Sugar(+) | +～++ | 0(0)△ | 36(47.4)* | 0(0) | 2(7.1) | | +++ | | 33(46.4)* | | | | | 49(64.5)△ | 7(9.2)* | 19(69.8) | 21(75.0) | | | 27(35.5)△ | | 9(32.1) 0(0) | | | | 0(0)△ | 33(43.4)* | | 7(25.0) | | | | 29(38.1)* | 18(64.2) | | | | 42(55.3)△ | 14(18.4)* | 10(35.7) 0(0) | 1(3.6) | | | 34(44.7)△ | 34(44.7)* | | | | | 0(0)△ | 24(31.8)* | 16(57.1) | 21(75.0) | | | | 38(23.7)* | 12(42.8) | | | | 38(50.0)△ | | | 6(21.4) | | | 58(50.0)△ | | | 1(3.6) | | | | | | 18(64.3) | | | | | | 9(32.1) | | Fasting Blood Glucose(mg) | 130↓ | | | | | | 130～250 | | | | | | 250↑ | | | | | | 200↓ | | | | | | 200～300 | | | | | | 300↑ | | | | | Postprandial 2-Hour Blood Glucose(mg) | | | | |

△: Statistical analysis before treatment for both the treatment and control groups. P>0.05. *: Statistical analysis after treatment for both the treatment and control groups. Except for the fasting blood glucose item at 250↑, where P<0.05, all other items have P<0.01.

[Table 3] Comparison of Treatment Effects Between Treatment and Control Groups by Type

Note: Effective Cases = Cured + Improved.

Table 4: Comparison of Treatment Effects and Disease Duration Between Treatment and Control Groups

188

Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Case Studies

Published by Taiwan Commercial Press

Middle Section: Clinical Application Published by Heji Book Publishing House

Example 2

Zhao, male, 29 years old, teacher. First visited the clinic in early March 1986. The patient had been suffering from diabetes for five years, with unsatisfactory results from multiple treatments. He had taken Yuquan Pills, hypoglycemic drugs, and glimepiride, and had even been hospitalized for intramuscular insulin injections. His urine sugar consistently remained between + and +++ . He came to our outpatient clinic upon a friend’s recommendation. The patient presented with frequent urination, fatigue and spontaneous sweating, dizziness and tinnitus, lower back pain and leg weakness, and sensitivity to cold.

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Physical Examination: Body temperature 36°C, pallor of the face, no ulceration or suppurative infection observed on the skin and mucous membranes, no abnormalities detected in the heart and lungs, and no palpable liver or spleen.

Laboratory Tests: Hemoglobin 13 g, red blood cells 4.1 million/mm³, platelets 7.16 million/mm³, white blood cells 11,000/mm³, neutrophils 72%, lymphocytes 28%, urine glucose ++++, urine ketones (-), fasting blood glucose 360 mg/dL, blood ketones 3 mg/dL, postprandial (2-hour) blood glucose 520 mg/dL, blood urea nitrogen 16 mg/dL.

Western Medical Diagnosis: Diabetes mellitus.

Traditional Chinese Medicine Syndrome Differentiation: Pulse is deep, wiry, and fine; the pulse at the cun position is weak; the tongue body is enlarged with tooth marks and a thin white coating. Combined with clinical manifestations such as dizziness, lower back pain, spontaneous sweating, and aversion to cold, the syndrome is identified as kidney yang deficiency, requiring warming and tonifying kidney yang.

Prescription: Modified Gui Fu Ba Wei Wan. Decocted in water and taken once daily. After 10 doses, the patient's symptoms significantly improved, urine glucose decreased to +, and fasting blood glucose dropped to 140 mg/dL. The original formula was then supplemented with 30 g of Astragalus, and after continuing for another 30 doses, all symptoms completely resolved.

Follow-up Laboratory Tests: Urine glucose (-), fasting blood glucose 100 mg/dL, postprandial (2-hour) blood glucose 180 mg/dL. Follow-up through the autumn of 1989 showed stable condition with no recurrence.

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Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Cases

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Case 3

Mr. Wang, male, 62 years old, retired worker. First visit in early March 1982. The patient had been suffering from diabetes since 1978; despite multiple treatments, the efficacy was unsatisfactory, with urine glucose consistently ranging from ++ to ++++, and fasting blood glucose between 200–300 mg/dL. Clinical manifestations included excessive thirst and drinking, increased appetite and hunger, weight loss and fatigue, dizziness and tinnitus, blurred vision, lower back pain and leg weakness, irritability and insomnia, and heat in the palms and soles.

Physical Examination: Body temperature 36.5°C, blood pressure 22.7/14.7 kPa (170/110 mmHg), flushed face, no conjunctival congestion, no scleral icterus, equal-sized and round pupils with intact light reflex, fundus examination showing grade II arteriosclerosis, auscultation of heart and lungs unremarkable, a grade II systolic bruit audible at the apex, flat abdomen, no palpable liver or spleen, and no deformities of the limbs or spine.

Laboratory Tests: Hemoglobin 10.2 g, red blood cells 3.52 million/mm³, platelets 120,000/mm³, white blood cells 10,000/mm³, neutrophils 79%, lymphocytes 21%, urine glucose ++++, weakly positive urine ketones, fasting blood glucose 490 mg/dL, blood ketones 8 mg, postprandial (2-hour) blood glucose 580 mg/dL, blood urea nitrogen 20 mg, CO₂-CP 65 volume, blood cholesterol 270 mg, β-lipoproteins 1,100 mg, triglycerides 200 mg, fundus showing grade I arteriosclerosis.

Western Medical Diagnosis: ① Diabetes mellitus; ② Hypertension with arteriosclerosis; ③ Bilateral cataracts.

Traditional Chinese Medicine Syndrome Differentiation: Tongue is red with little fluid and stasis spots, thick yellow coating, pulse is wiry and rapid. Considering the above symptoms, the syndrome is determined to be long-term disease invading the collaterals, transforming into internal fire that scorches body fluids. Treatment should focus on activating blood circulation to remove stasis and clearing heat to eliminate excess vapor.

Prescription: Modified Huayu Zengye Tang. Decocted in water and taken once daily.

Rehmannia 12g, Scrophularia 10g, Ophiopogon 10g, Red Peony 10g, Chuanxiong 6g, Safflower 3g, Agarwood 10g, Salvia 20g Moutan Bark 6g, Kudzu Root 10g, Anemarrhena 6g, Phellodendron 6g, Atractylodes 6g, Coptis 6g, Pollen 10g, Rheum 3g

The patient, a retired worker, took the prescription back to his hometown for continued use. In September 1983, he returned for a follow-up visit, stating that due to the good therapeutic effect, he had persisted in taking the medication regularly, totaling over 200 doses. All previously mentioned symptoms had disappeared, his physical strength had recovered, and he was able to resume normal work.

Follow-up Laboratory Tests: Urine glucose (+), fasting blood glucose 100 mg/dL, postprandial (2-hour) blood glucose 170 mg/dL, triglycerides within normal range, blood pressure 20.0/12.0 kPa (150/90 mmHg).

He was advised to continue taking the original prescription, with an additional pill of Gui Fu Ba Wei Wan daily. In March 1985, a follow-up letter reported that all symptoms had completely subsided, with both urine glucose and blood glucose returning to normal levels.

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Clinical Application in the Middle Section

Published by Heji Book Publishing House

According to "Rumen Shiqin," Zhang Zihe often achieved remarkable results by using large doses of Coptis to treat diabetes. The experience of predecessors provided important reference for the author's treatment of this disease, and the main prescriptions for the two types of Yangming heat excess and kidney yang deficiency originated from this. Through long-term clinical application, the author found that patients with advanced diabetes complicated by arteriosclerosis often presented with blood stasis and internal heat. Using Guanxin No. 2 combined with liquid-replenishing therapies yielded obvious therapeutic effects, thus forming the third type of syndrome differentiation described in this article. By employing the above syndrome differentiation method, various types of diabetes with different syndromes can be effectively treated. Although there are still some limitations, the clinical efficacy is undoubtedly good.

(“Research on the Integration of Traditional Chinese and Western Medicine,” December 1990)

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Old Master Pei’s Experience in Treating Leukemia with Traditional Chinese Medicine—Pei Zhengxue

Regarding the treatment of leukemia, some advocate moving beyond the current chemotherapy-focused approach that primarily suppresses tumor cells, and instead focusing on regulating and promoting normal cellular functions, fully mobilizing the body’s own anti-disease capabilities. This view is quite similar to the traditional Chinese medical principle of “strengthening the body to dispel pathogenic factors.” Over the years, Old Master Pei has applied this principle in treating leukemia with good results. The following is a summary of his experience in this area:

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Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Cases

Published by Hefei Book Publishing House