7. Warming the Kidney and Reversing Qi Rebellion

7. Warming the Kidney and Reversing Qi Rebellion

“The Classified Classic · Supplement to Seeking Correctness · On True Yin” states: “When the primordial yang is deficient… the vital fire of the Mingmen declines, unable to generate earth, leading to spleen-stomach deficiency and cold, reduced food intake, nausea, bloating, or reverse stomach qi and cold… or loose stools, frequent diarrhea, involuntary urination… or cold in the lower jiao causing water-related edema.” This illustrates that kidney yang deficiency can lead to a series of digestive system symptoms. As previously mentioned, the fundamental pathology of chronic nephritis is kidney yang deficiency. When this deficiency progresses to a severe stage, the spleen and stomach are unable to properly digest food, causing turbidity to accumulate in the middle jiao, resulting in symptoms such as nausea, bloating, reverse stomach qi, frequent diarrhea, and involuntary urination—signs of disrupted ascending and descending functions. Further progression can lead to coma, weak pulse, and cold extremities—critical signs of yin-yang separation. These symptoms are completely similar to the clinical manifestations of renal failure in Western medicine. Therefore, when treating this condition with TCM, we should adhere to the principle of warming the kidney and reversing qi rebellion. Warm the kidney to address the root cause, and reverse qi to treat the symptoms. Use processed aconite and cinnamon to warm the kidney, and use rhubarb, raw ochre, ginger, and pinellia to reverse qi. Among them, the combination of processed aconite and rhubarb has shown particularly good clinical efficacy.

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

Published by Hefei Book Publishing House

Case Examples

[Middle Section: Clinical Application]

Published by Hefei Book Publishing House

After taking this formula for over 150 doses, the patient felt energetic and physically strong.

Follow-up Examination in September 1977

Urinalysis was normal, and blood cholesterol was 200 mg/dL. Subsequently, during multiple follow-up visits in 1979–1980, the patient’s general condition remained good. Urinalysis was mostly normal, except for occasional presence of 0–1 white blood cells under low-power microscopy.

Case 2

Ms. Liu, female, 43 years old, supervisor, first visited on November 21, 1980. One year earlier, the patient began experiencing generalized edema, accompanied by frequent urination, urgency, and pain. At the Lanzhou Railway Central Hospital, she was diagnosed with chronic pyelonephritis and hospitalized for over a month. The pus in her urine disappeared, but protein remained at around (++). After discharge, her condition fluctuated, and four months ago, she caught a cold with fever and sore throat, immediately followed by worsening edema. The Gansu Provincial Hospital of Traditional Chinese Medicine admitted her with a diagnosis of chronic nephritis (acute attack) and provided integrated TCM-Western medicine treatment. However, the edema never subsided, and proteinuria remained at (+++). One month ago, the patient voluntarily discharged herself. After discharge, the edema worsened, accompanied by sore throat and cough, loss of appetite, and painful, scanty urination. Therefore, she came to our clinic seeking TCM treatment.

Physical Examination: Body temperature 37°C, pulse 90 beats per minute, blood pressure 17.6/13.1 kPa (132/98 mmHg), normal development, poor nutrition, pale face, moderate generalized edema, red throat, tonsils grade II enlarged, heart border not markedly enlarged, a grade II systolic murmur audible at the apex, lungs (-), abdomen distended, ascites (++).

Pulse: Six pulses are string-like, slippery, and rapid, with slightly weaker pulses at both cun positions.

Tongue: Red body, slightly yellow and greasy coating.

Laboratory Tests: Urinalysis shows protein (++++) and red blood cells (++), with pus cells (+) and granular casts 1–2 under low-power microscopy. Complete blood count: red blood cells 3.1 million/mm³, hemoglobin 9 g/dL, white blood cells 10,000/mm³, neutrophils 79%, lymphocytes 21%. Blood cholesterol 660 mg/dL, total serum protein 3.8 g/dL, globulin 2.2 g/dL, albumin 1.6 g/dL. Ascites examination: clear appearance, protein (±).

Western Medical Diagnosis: Chronic nephritis, nephrotic type, complicated by upper respiratory tract infection.

TCM Differentiation: Pale face, generalized edema, lower back and leg pain, dizziness, bitter taste in mouth, sore throat, cough, flank fullness, scanty and reddish urine, slight chills and fever. Combined with pulse and tongue findings, it indicates kidney deficiency with water overflow and wind-heat invading the lungs.

Prescription: Jisheng Shenqi Tang with added heat-clearing and detoxifying ingredients:

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

Published by Hefei Book Publishing House

After ten doses, the cough and wheezing gradually subsided, the generalized edema slightly decreased, and ascites (+) disappeared.

Second Laboratory Test: Urinalysis shows protein (+++) and red blood cells (+), with granular casts 1–2 under low-power microscopy.

TCM Differentiation: The patient still presents with a pale face, generalized edema, lower back and leg pain, and tinnitus with sensitivity to cold. The pulse remains deep and weak. The tongue is red with a white, greasy coating. The syndrome indicates kidney yang deficiency with water overflow.

Prescription: Remove Two Flowers, Forsythia, Dandelion, Prunella, and Houttuynia from the previous formula, and add 20 g of winter melon peel, 20 g of whole gourd, 10 g of large belly skin, 10 g of kelp, 10 g of kombu, and 15 g of half branch lotus. After taking over 100 doses, the patient’s edema subsided, ascites disappeared, and both mental and physical strength improved significantly compared with before.

Third Laboratory Test: Urinalysis shows protein (+), red blood cells 0–2 under low-power microscopy, and no casts detected. Blood cholesterol 300 mg/dL.

TCM Differentiation: The patient still has a pale face, slight sensitivity to cold, lower back and leg pain, morning facial edema, evening lower limb edema, poor appetite, and occasional fullness in the epigastrium. The pulse is deep and fine, the cun pulse is weak, and the tongue is plump and pale, indicating spleen-kidney yang deficiency.

Prescription: Jisheng Shenqi Tang combined with Baoyuan Tang, with additional ingredients:

After taking 30 doses, the urinalysis showed no abnormalities. Complete blood count: hemoglobin 15 g/dL, red blood cells 4.8 million/mm³, white blood cells 9,800/mm³, neutrophils 68%, lymphocytes 32%. Blood cholesterol 220 mg/dL. The patient’s physical strength recovered, energy increased, and she fully recovered and returned to work.

Middle Section: Clinical Application

Published by Hefei Book Publishing House

Tongue: Red body with tooth marks, thin white coating.

Laboratory Tests: Urinalysis shows protein (+++) and red blood cells (++), with white blood cells 0–2 under low-power microscopy, and transparent casts 1–2 under low-power microscopy. Complete blood count: hemoglobin 12.5 g/dL, white blood cells 11,200/mm³, neutrophils 72%, lymphocytes 27%, monocytes 1%. Blood cholesterol 390 mg/dL, NPN: 146 mg/dL, carbon dioxide binding capacity (CO₂CP) 25 mmol/L, total serum protein 5.5 g/dL, albumin 2.1 g/dL, globulin 3.4 g/dL.

Western Medical Diagnosis: Chronic nephritis complicated by renal failure.

TCM Differentiation: The patient presents with edema, dizziness, lower back and leg pain, and sensitivity to cold with spontaneous sweating; also with loss of appetite, fatigue, nausea, and loose stools—indicating spleen-kidney yang deficiency, dampness stagnating in the middle jiao, and disrupted ascending and descending functions. The treatment principle should be warming the kidney and reversing qi rebellion, combined with strengthening the spleen and promoting diuresis.

Prescription: Jisheng Shenqi Tang with added rhubarb, raw ochre, and small pinellia. After ten doses, the nausea gradually subsided, appetite slightly improved, urine output increased, and generalized edema also slightly improved.

Physical Examination: Blood pressure 20.0/12.0 kPa (150/90 mmHg).

Second Laboratory Test: Urinalysis shows protein (++) and red blood cells 2–5 under low-power microscopy, with transparent casts 1–2 under low-power microscopy. NPN: 122 mg/dL.

Prescription: Remove live turtle shell and ginger from the previous formula, and add 10 g of codonopsis, 6 g of citrus peel, and 3 g of agarwood. After taking 43 consecutive doses, the patient’s mental state and diet improved, edema significantly subsided, and blood pressure dropped to 18.7/12.0 kPa (140/90 mmHg).

Third Laboratory Test: Urinalysis shows protein (+), blood NPN: 39 mg/dL, CO₂ binding capacity (CO₂CP) 57 mmol/L, blood cholesterol 310 mg/dL, total protein 5.7 g/dL, albumin 3.1 g/dL, globulin 2.6 g/dL. Complete blood count: hemoglobin 13.5 g/dL, white blood cells 9,000/mm³, neutrophils 68%, lymphocytes 32%.

The patient still exhibits paleness, fatigue, dizziness, lower back pain, and sensitivity to cold. Therefore, Jisheng Shenqi Tang combined with Xiangsha Liujun Tang was administered, and after taking over 90 doses, all symptoms resolved, with proteinuria (-).

(From “Gansu Medical Journal,” 1982, supplement)

Reflections on the TCM Treatment of Chronic Pancreatitis by Pei Zhengxue

Chronic pancreatitis is a progressive digestive disease characterized primarily by abdominal pain, abdominal masses, and steatorrhea; in some cases, jaundice, diabetes, and weight loss may also occur. Due to its recurrent nature and tendency to persist without healing, the clinical prognosis is often unsatisfactory. Over the years, I have used TCM and herbal medicine to treat this condition and have accumulated some insights, which I share here for readers’ reference. Any shortcomings are welcome to be criticized and corrected.

Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Cases Published by Hebei Book Publishing House

3. Clearing Heat and Removing Dampness

When the liver is depressed, heat arises; when the spleen is deficient, dampness arises. Dampness and heat combine, resulting in a yellow, greasy tongue coating, a slippery and rapid pulse, loose and foul-smelling stools, and even jaundice. Treatment should focus on clearing heat and removing dampness. In prescriptions for soothing the liver and strengthening the spleen, I often add coix seed, dandelion, prunella, red vine, goldthread, artemisia, and tiger balm.

4. Activating Blood Circulation and Removing Stasis

<!-- translated-chunk:26/39 -->

When the pain of this condition is fixed on the left side of the chest and epigastrium, it indicates that the disease has entered the blood level; prolonged stagnation in the blood level may even form masses or accumulations. The author often adds herbs such as Pu Huang, Wu Ling Zhi, Yuan Hu, processed Ruyi, San Leng, and E Zhu to the formula, which both invigorate the blood and relieve pain, while also removing stasis and dispersing nodules.

5. Unblocking the Bowels and Removing Accumulations

When stagnation in the blood level persists for a long time, on the one hand, masses or accumulations may appear, and on the other hand, the pain in the upper abdomen will worsen. At this point, even if there is loose stool, the method of unblocking the bowels and removing accumulations can still be used. The author often appropriately adds 10 g each of Dahuang and Mangxiao to formulas that soothe the liver and strengthen the spleen, clear heat, and invigorate the blood, which often achieves the effect of relieving pain and dispersing nodules.

---

Part II: Clinical Applications

Published by Hepei Book Publishing House

Traditional Chinese Medicine Syndrome Differentiation: Pulse is wiry, fine, and rapid; tongue body is pale; coating is thin, yellow, and greasy; chest and epigastric distension and pain; poor appetite and loose stools; face is sallow; bitter taste in mouth and dry throat. This is due to stagnation of Liver Qi and Liver Wood overcoming Earth, so the treatment should focus on soothing the liver and regulating qi, strengthening the spleen and benefiting qi.

Prescription: Decoct in water and take one dose daily.

| Bupleurum | 10g | White Peony | 10g | Citrus Aurantium | 10g | Licorice | 6g | Sichuan Lovage | 6g | Costus | 6g | |:---|:---|:---|:---|:---|:---|:---|:---|:---|:---| | Atractylodes | 10g | Poria | 12g | Salvia Miltiorrhiza | 10g | Agarwood | 3g | Amomum | 3g | Coix Seed | 15g | | Red Vine | 30g | Houttuynia | 20g | Prepared Aconite | 6g | Dried Ginger | 6g | Yuan Hu | 6g | Melia | 6g |

After taking this formula for 20 doses, the patient’s general condition improved, chest and epigastric distension and pain lessened, stools became formed, appetite increased, and the tongue coating turned lighter. In the subsequent prescription, Yuan Hu, Melia, Prepared Aconite, Dried Ginger, Coix Seed, Red Vine, and Houttuynia were removed, and instead, 10 g of Codonopsis, 6 g of Pinellia, 6 g of Citrus Peel, 6 g of each of the roasted three treasures, 6 g of Chicken Gizzard Stone, and 10 g of Radish Seed were added. After taking this formula for 10 doses, all symptoms completely subsided, and stool microscopy was normal.

---

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

Published by Hepei Book Publishing House

Prescription: Decoct in water and take one dose daily.

After taking this formula for 5 doses, a large amount of black stool was passed, and pain in the epigastrium and flank, as well as abdominal distension, markedly decreased. Jaundice subsided, and the yellow coating on the tongue became thinner. In the subsequent prescription, Mangxiao was removed, and Coptis and Agarwood were added. After taking this formula for another 8 doses, pain in the epigastrium disappeared, the abdomen was slightly distended, bowel movements were regular, and microscopic examination showed no abnormalities. The tongue coating turned thin white with a slight yellow tinge, the pulse became deep, fine, and wiry, and palpation revealed no obvious mass in the upper abdomen. In the subsequent prescription, Yuan Hu, Melia, Pu Huang, Wu Ling Zhi, Houttuynia, Red Vine, and Dahuang were removed, and instead, 10 g of Codonopsis, 10 g of Atractylodes, 12 g of Poria, 6 g of Pinellia, 6 g of Citrus Peel, 3 g of Amomum, were added to improve the formulation. After taking this formula for 10 doses, all symptoms completely subsided, and the patient recovered and resumed work.

(“Gansu Medical Journal” 1982·Supplement)

Case of Chronic Pancreatitis Complicated with Gallstones Treated by Pei Zhengxue

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

After taking two doses, pain in both flanks gradually disappeared, the bitter taste in the mouth and dry throat resolved, but there was still distension and pain in the chest and epigastrium radiating to the left shoulder, with relief upon pressing and warmth, and diarrhea decreased to 3–4 times per day, presenting as yellow, loose stools.

TCM Syndrome Differentiation: White, greasy tongue coating, wiry and fine pulse—still indicating disharmony between the liver and stomach, along with deficiency of middle qi. Therefore, the treatment should focus on soothing the liver and harmonizing the stomach, while tonifying the middle and benefiting qi.

Prescription: Decoct in water and take one dose daily.

A total of 73 doses were taken, and all symptoms greatly diminished. On March 25, 1964, cholecystography revealed that the shadow of gallstones had disappeared.

TCM Syndrome Differentiation: Two-inch pulse is weak and feeble, combined with hidden pain in the chest and epigastrium, and loose stools—this indicates deficiency of qi and blood, as well as stagnation of the liver and weakness of the spleen. Therefore, the treatment should focus on strengthening the spleen and harmonizing the stomach, while tonifying qi and blood.

Prescription: Decoct in water and take one dose daily.

After taking 95 doses, abdominal pain and chest tightness disappeared, diarrhea stopped, appetite increased, energy levels rose, and the patient was discharged after recovery. Follow-up for 14 years showed no recurrence.

[Note] Although Western medicine provided effective comprehensive treatment during the acute phase of this disease, later, when it became chronic, traditional Chinese medicine was used for treatment. Although the course of treatment was longer, it ultimately succeeded in expelling the gallstones and curing chronic pancreatitis.

Although TCM does not have a specific name for this disease, through syndrome differentiation it falls under the category of stagnation of Liver Qi and deficiency of Spleen and Stomach. Therefore, both the first and second prescriptions are based on the formula Xiaoyao San, which soothes the liver and strengthens the spleen. Since there is also damp-heat, Moneywort is added to clear heat and drain dampness. After nearly a hundred doses, the condition improved, demonstrating that proper syndrome differentiation and targeted treatment are crucial. The third prescription focuses on strengthening the spleen and harmonizing the stomach, supplemented by herbs that regulate qi and soothe the liver, emphasizing the principle of reinforcing the body's vital energy while eliminating pathogenic factors.

(“Shaanxi Traditional Chinese Medicine” 1981.2)

Report on 73 Cases of “Hair Loss” Treated with Traditional Chinese Medicine by Zhong Xu

“Hair loss” is a common condition. Apart from physiological hair loss, the most common diseases causing hair loss are early baldness and alopecia areata. Early baldness, commonly known as “high forehead” or “thinking head,” is more prevalent among young and middle-aged people, and some patients also suffer from seborrheic alopecia. Alopecia areata, commonly known as “ghost-shaved head” or “oil wind,” is referred to as circular alopecia in Western medicine. From 1978 to 1984, the author treated 73 cases of “hair loss” with traditional Chinese medicine, achieving fairly satisfactory results.

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

Published by Hefei Book Publishing House

Three Efficacy Standards and Treatment Outcomes

Efficacy is classified into three categories: cured, effective, and ineffective. Cured: new hair grows normally; effective: new hair grows, but the result is unsatisfactory; ineffective: no new hair grows.

Treatment outcomes: 24 cases were cured, including 18 cases of alopecia areata and 6 cases of early baldness; 14 males and 10 females; 4 cases under 10 years old, 16 cases between 10 and 30 years old, and 4 cases over 30 years old. 40 cases were effective, and 9 cases were ineffective, including 8 cases of early baldness and 1 case of alopecia areata; 5 males and 4 females; 7 cases over 40 years old and 2 cases under 40 years old. Among the cured cases, 15 were due to deficiency of Spleen and Stomach Qi, 8 were due to stagnation of Liver Qi and deficiency of Kidney Qi, and 1 was due to deficiency of both Qi and Yin. Among the cured cases, 3 took one course of treatment, 6 took two courses, 11 took three courses, and 4 took four courses.

Prescription: Formula

Use Prescription I, one dose daily, and additionally boil 60 g of Platycladus leaves in water to wash the hair once daily. After taking 20 doses, fine hairs began to grow all over the head; after another 20 doses, the fine hairs turned black and thicker. Three months later, the patient’s entire head was covered in black hair, indistinguishable from ordinary people.

Case 2

Ms. Xu, 16 years old, from Gansu Province, a middle school student, first visited the clinic in early March 1978.

One year ago, she developed hair loss, initially losing all her hair at the occipital region and the crown of her head.

Physical Examination: Nutrition is adequate, development is good, heart and lungs show no abnormalities, abdomen is flat, and liver and spleen are not palpable. The forehead and crown of the head are completely bare, with smooth scalp and no wrinkles.

Indistinguishable from ordinary people, and after three years of follow-up, there has been no recurrence.

Mr. Ning, 38 years old, from Gansu Province, first visited the clinic in early April 1983. Half a month ago, due to marital discord at home, he was in a heavy mood. One day, he discovered a patch of hair loss about the size of a fingernail at the occipital region, which gradually expanded over half a month until his entire scalp and eyebrows were completely bald, leaving his scalp shiny and feeling slightly itchy.

Physical Examination: Face is sallow, nutrition is poor, heart and lungs show no abnormalities, abdomen is flat, and liver and spleen are not palpable.

Western medical diagnosis: Alopecia areata.

TCM Syndrome Differentiation: Deep, fine pulse, red tongue with light coating, symptoms include fatigue, dry mouth, and deficiency—indicating dual deficiency of Qi and Yin, along with insufficient nourishing blood, leading to hair loss. The treatment should focus on tonifying Qi and nourishing Yin, while heavily replenishing nourishing blood.

Prescription: Use Prescription III, one pill twice daily, dissolved in hot water; additionally, use Prescription I, one dose daily; simultaneously, boil 60 g of Platycladus leaves and 3 g of ginger in water to wash the hair twice daily.

On December 1983, the patient’s entire head was covered in black hair, with eyebrows and beard fully grown, indistinguishable from ordinary people. He claimed to have endured 45 doses of herbal decoctions and two courses of pills, along with two months of washing treatments. In April 1985, a follow-up letter indicated no recurrence.

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

Published by Hefei Book Publishing House

Therefore, when treating “hair loss,” attention must be paid to the manifestation of “stagnation of Liver Qi and deficiency of Kidney Qi.” Among the 73 cases, a total of 24 fell into this category. Patients with this type often exhibit symptoms such as depression and irritability, similar to what Western medicine calls neurasthenia. Patients whose “hair loss” has persisted for a long time often show signs of dual deficiency of Qi and Yin, and these patients tend to respond poorly to treatment. Among the 10 patients, only 1 was cured, indicating that Qi and blood are the source of nourishing blood production, and when both are deficient, the source of nourishment dries up, making it difficult for hair to grow. Among the 9 ineffective cases, 7 were over 40 years old, suggesting that the older the patient, the more difficult it is to regulate Qi and blood as well as internal organs compared to younger patients—this is consistent with general physiological changes.

(“Chinese Medicine Journal” 1987.7)

Opportunity to Treat Primary Immune Thrombocytopenic Purpura with Self-Formulated Shenqi Sanhuang Decoction

Peng Xiang Zhong Xu

Since 1980, we have used a self-formulated Shenqi Sanhuang decoction to treat primary immune thrombocytopenic purpura, achieving satisfactory results. Here, we report 24 cases confirmed by bone marrow examination for reference by colleagues.

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

Published by Hefei Book Publishing House

257

Published by Hefei Book Publishing House

After taking 10 doses, systemic purpura and bleeding symptoms significantly improved. Dizziness, fatigue, spontaneous sweating, lower back pain, tinnitus, sensitivity to cold, and palpitations also improved. In the subsequent prescription, broken paper and dodder seeds were removed, and one dose was taken daily. After 21 doses, all symptoms completely subsided, platelet count rose to 120,000/mm³, bleeding time and clot contraction returned to normal. Bone marrow examination also returned to normal. Red blood cells were 4.8 million/mm³, hemoglobin 14 g/dl.

Case 2

Ms. Hua, 5 years old, first visited the clinic on February 17, 1984. Six months earlier, after a cold, she developed nosebleeds and systemic purpura. She was diagnosed at a certain hospital with “primary immune thrombocytopenic purpura” and had previously received hormone-based Western medicine treatment, which temporarily raised her platelet count, but systemic purpura and nosebleeds continued to recur. Over time, she became increasingly thin and pale, accompanied by fatigue, thirst, spontaneous sweating, poor appetite, dry stools, and palpitations, with rectal bleeding during defecation.

Physical Examination: Body temperature 38.9°C, blood pressure 10.7/6.7 kPa (80/50 mmHg), face is pale, and various-sized bleeding spots can be seen on the chest, back, and limbs, which do not fade upon pressure. Heart border percussion shows no enlargement, and no murmurs are heard in any valve area. Lungs (-), liver is palpable 2 cm below the xiphoid process, soft in texture, without tenderness, and spleen is not palpable.

Laboratory Tests: Platelets 17,000/mm³, red blood cells 4.6 million/mm³, hemoglobin 12 g/dl, white blood cells 5,600/mm³, neutrophils 78%, lymphocytes 21%, acidophils 1%, bleeding time 6 minutes, 24-hour clot contraction poor, bone marrow examination shows that the number of megakaryocyte forms is still within normal range, but the number of platelet-forming megakaryocytes is reduced.

TCM Syndrome Differentiation: The patient’s tongue is red, with scattered ecchymoses, and the coating is slightly yellow and thick. Pulse is deep, slippery, and rapid, with both cun pulses being deep and fine. Combining symptoms such as emaciation, pallor, fatigue, spontaneous sweating, poor appetite, thirst, palpitations, fever, and dry stools, the illness is considered to be a dual deficiency of Qi and blood, with Qi failing to control the blood. When Qi is deficient, Yang becomes deficient, leading to dampness; when blood is deficient, blood stasis occurs, leading to fire.

Deficiency is the root cause, while damp-heat is the symptom. The treatment should address both root and symptom.

Prescription: Add ingredients to Shenqi Sanhuang decoction, decoct in water, and take one dose daily.

After taking five doses, the patient’s fever subsided, thirst stopped, spontaneous sweating and fatigue eased, and systemic purpura and nosebleeds also improved significantly. In the subsequent prescription, gypsum and fairy grass were removed, and after another 22 doses, all symptoms disappeared, and the patient looked like an ordinary person. Platelet count reached 91,000/mm³, red blood cells 4.8 million/mm³, hemoglobin 14.5 g/dl, white blood cells 6,200/mm³, neutrophils 71%, lymphocytes 28%, monocytes 1%. Bleeding time and 24-hour clot contraction were both normal. Bone marrow examination showed that the number of platelet-forming megakaryocytes was close to normal.

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

258

Published by Hefei Book Publishing House

Research Progress on Hepatitis B by Pei Zhengxue

Since the discovery of the hepatitis B virus in the 1960s, the incidence and prevalence of hepatitis B have attracted widespread attention worldwide. Chinese scholars have conducted extensive epidemiological surveys and research since the 1970s, confirming that the prevalence of hepatitis B in China is also very serious. According to different figures reported from various regions, the current prevalence of hepatitis B in China is estimated to be between 5% and 25%. Therefore, further understanding of the research progress on hepatitis B is essential for every medical worker.

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

Published by Hefei Four Provinces Publishing House

Original; large particles are intact hepatitis B viruses. At that time, because people had not yet recognized the pathogenic characteristics of these particles, they were called Dane particles. Later, people successively discovered that core antigens exist in the nucleus of liver cells, while surface antigens exist in the cytoplasm of liver cells.

In the mid-1970s, Hirshman proposed a hypothesis about the replication of the hepatitis B virus. He believed that after the virus enters the cytoplasm of liver cells, it loses its outer layer, at which point the circular DNA of the viral particle begins to expand, especially after entering the nucleus, where host DNA also participates in the replication process to form the core. The host DNA infiltrated into the viral core quickly turns into circular DNA and produces DNA polymerase, thus forming the core antigen. At the same time, the shell protein synthesized in the endoplasmic reticulum of liver cells (i.e., the surface antigen) can combine with the core antigen to form a complete pathogenic particle, which then leaves the cell.

1. Surface Antigen and Its Antibody

Generally, it appears in the patient’s serum before the onset of liver inflammation symptoms or abnormal biochemical indicators. The earliest detection can occur three months before the onset of the disease, while in individual cases it may only be detected after the onset. Most acute hepatitis B patients have a 100% positive rate for surface antigen at the time of onset, which drops to around 25% after three months, and further decreases to about 6.4% after twelve months. This indicates that the surface antigen of acute hepatitis B is transient. If the surface antigen remains positive for several years, it suggests that the patient is not in the acute phase and may have progressed to chronic active hepatitis or chronic persistent hepatitis. The ratio of surface antigen is usually not clearly positively correlated with the severity of hepatitis B, nor with the level of transaminases. Therefore, some patients have no symptoms and their transaminase levels are not high, but their surface antigen remains positive for a long time, even staying at a high level. These patients were once considered healthy carriers, but recent extensive data prove that most of them have varying degrees of liver damage. Therefore, whether the term “healthy carrier” is accurate still needs further investigation.

Acute hepatitis B patients rarely produce surface antibodies at the same time as the surface antigen is positive. Once the antibody is detected as positive, it indicates that the patient has acute hepatitis B, meaning the surface antigen is about to turn negative. In chronic active hepatitis patients, surface antibodies are usually not produced. If they are detected, it does not necessarily indicate protective effects. Some reports suggest that the presence of such antibodies may actually harm liver cells.

2. Core Antigen and Its Antibody

In the nucleus of liver cells of hepatitis B patients, immunoelectron microscopy usually reveals spherical structures with a diameter of 27 nanometers. Sometimes these structures can also be seen in the cytoplasm of liver cells. Later, these structures were named core antigens (HBcAg). Core antigens cannot be detected in the peripheral blood serum of hepatitis patients, but their antibodies, i.e., core antibodies, can be detected. Core antibodies can appear soon after infection with the hepatitis B virus, usually 1–2 months after the surface antigen becomes positive, at which point hepatitis symptoms appear and transaminase levels rise. In acute hepatitis B, the surface antigen is transiently positive, but before the surface antigen turns negative, surface antibodies often become positive. About four months before the surface antibodies turn positive, or even earlier, core antibodies can be detected. Chronic carriers, although they cannot detect surface antibodies, almost 100% can detect core antibodies. In short, the appearance of core antibodies indicates that the infection process is still ongoing. These antibodies have no protective effect, cannot prevent reinfection, nor are they a sign of recovery—they are merely a reaction showing that the hepatitis virus is actively replicating.

<!-- translated-chunk:27/39 -->

The symptoms of hepatitis B have not yet disappeared, but the surface antigen has already turned negative. If the core antibody is positive, it indicates that the patient still has an infection and replication of the hepatitis B virus. There is also a correlation between the core antibody and DNA polymerase; typically, about 41 days after infection with the hepatitis B virus, DNA-P becomes positive, and after 59 days, the core antibody turns positive. At the same time, the transaminase levels in most patients may be higher than normal. Once the core antibody appears, it can remain positive for more than five years, serving as the longest-lasting marker of the hepatitis B virus in the human body.

3. e Antigen and Its Antibody

In 1972, Swedish scholars Magnis et al., while examining the hepatitis B surface antigen, accidentally discovered a new antigen, which they named the e antigen. In 1974, Nielon et al. repeated 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 who were surface antigen-negative. The results showed that 10% of the acute cases were positive, 58% of the chronic cases were positive, 31% of the liver cirrhosis cases were positive, and 34% of the healthy carriers were positive. From this, it was concluded that individuals positive for the e antigen are more likely to develop chronic active hepatitis, and their serum contains more Dane particles. Long-term virus carriers also have a high rate of e-antigen positivity.

In recent years, numerous scholars have proven that the conversion of the e antigen to e antibody positivity is a very important indicator of improvement in the pathological process of hepatitis B. When initially infected with hepatitis B, approximately 90% of patients will see their e antigen turn negative, and these patients generally have a good prognosis, rarely progressing to chronic active hepatitis, liver cirrhosis, or liver cancer. Conversely, about 10% of patients never see their e antigen turn negative, and these patients have a poorer prognosis, potentially developing liver cirrhosis or liver cancer, with most eventually becoming chronic active hepatitis. Some have performed liver biopsies on patients positive for the e antigen and found persistent damage to the liver tissue, with the e antigen turning negative and the e antibody turning positive often occurring simultaneously. Others have observed a positive correlation between e-antigen positivity and surface antigen concentration, as well as between e-antigen positivity and deoxyribonucleic acid polymerase activity.

4. Hepatitis B Virus Deoxyribonucleic Acid and Deoxyribonucleic Acid Polymerase

Hepatitis B virus deoxyribonucleic acid (HBV-DNA) is the basic 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 deoxyribonucleic acid is one of the advanced methods of today and is currently considered the most sensitive method.

Hepatitis B deoxyribonucleic acid polymerase (DNA-P) is an indicator of viral replication. It is mostly positive during the acute phase of acute hepatitis B, and some cases of chronic active hepatitis may also be positive. Generally, it is believed that this enzyme exists in the body for a relatively short period—about 2–4 weeks during the acute phase and longer during the chronic phase.

---

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

Published by Hefei Four Provinces Publishing House

Most people infected through horizontal transmission can successfully clear the virus from their bodies, so scholars believe that the hepatitis B virus infection rate in China is about 70% of the population. However, the incidence rate is only around 5–25%, indicating that among actual hepatitis B patients, horizontal transmission does not account for the absolute majority; vertical transmission is the dominant form. That is, if the mother is an HBV carrier and HBcAg is positive, 90% of her children can be infected; if the father is an HBV carrier, 20% of his children will be infected. Vertical transmission is often difficult to clear on its own, leading to the development of hepatitis B patients, so the prognosis of 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 show 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 migratory hepatitis, 10.4% have chronic active hepatitis, and only 11.46% have mild changes; some patients even show signs of liver cirrhosis. This shows that so-called “healthy carriers” are merely chronic hepatitis B patients with inconspicuous clinical symptoms.

Some have followed up with “healthy carriers,” and about 5% of them experience worsening conditions within a year due to factors such as fatigue, alcohol consumption, and emotional stress. Such active hepatitis B should not be regarded as acute hepatitis B. Hepatitis B is more commonly seen in children and young adults, with fewer cases in elderly patients. Domestic and international statistics show a male-to-female ratio of about 2:1.

---

Middle Section: Clinical Applications

Published by Hefei Four Provinces Publishing House