2. Efficacy Statistics

Out of the 100 cases, 49 were recently cured, accounting for 49%; 50 improved, accounting for 50%; and 1 case was ineffective, accounting for 1%. The total effective rate was 99%. Post-treatment recovery of symptoms and signs is shown in Table 1, improvement of liver function in Table 2, changes in HBsAg and anti-HBC in Table 3, relationship between efficacy and syndrome type in Table 4, and relationship between efficacy and disease course in Table 5. Among the cured cases, 8 took one treatment cycle, 18 took two cycles, 12 took three cycles, 9 took four cycles, and 2 took five cycles. One case was ineffective after five cycles. Notably, among those cured within three cycles, 30 were acute hepatitis B cases, accounting for 78.9% of all cases treated within three cycles.

Table 1: Recovery of Symptoms and Signs Before and After Treatment

<table style="width:93%;"> <colgroup> <col style="width: 20%" /> <col style="width: 7%" /> <col style="width: 7%" /> <col style="width: 7%" /> <col style="width: 7%" /> <col style="width: 7%" /> <col style="width: 7%" /> <col style="width: 7%" /> <col style="width: 7%" /> <col style="width: 7%" /> <col style="width: 7%" /> </colgroup> <tbody> <tr> <td style="text-align: center;"><p>Before and After Treatment</p> <p>Symptoms and Signs</p></td> <td style="text-align: center;">Fatigue</td> <td style="text-align: center;">Poor Appetite</td> <td style="text-align: center;">Bitter Taste in the Mouth</td> <td style="text-align: center;">Abdominal Distension</td> <td style="text-align: center;">Liver Pain</td> <td style="text-align: center;">Hepatomegaly</td> <td style="text-align: center;">Splenomegaly</td> <td style="text-align: center;">Jaundice</td> <td style="text-align: center;">Fever</td> <td style="text-align: center;">Wasting</td> </tr> <tr> <td style="text-align: center;">Number of Cases Before Treatment</td> <td style="text-align: center;">100</td> <td style="text-align: center;">100</td> <td style="text-align: center;">100</td> <td style="text-align: center;">100</td> <td style="text-align: center;">96</td> <td style="text-align: center;">23</td> <td style="text-align: center;">4</td> <td style="text-align: center;">1</td> <td style="text-align: center;">1</td> <td style="text-align: center;">6</td> </tr> <tr> <td style="text-align: center;">Number of Cases After Treatment</td> <!-- translated-chunk:28/57 --> <td style="text-align: center;">1</td> <td style="text-align: center;">1</td> <td style="text-align: center;">1</td> <td style="text-align: center;">4</td> <td style="text-align: center;">2</td> <td style="text-align: center;">1</td> <td style="text-align: center;">2</td> <td style="text-align: center;">0</td> <td style="text-align: center;">0</td> <td style="text-align: center;"><em>2</em></td> </tr> </tbody> </table>

Table 2 Improvement in Liver Function Before and After Treatment

+:--------------:+:----:+:-----:+:----:+:-----:+:-----:+:-----:+:-----:+:-----:+:-----:+ Liver Function | SGPT | Albumin | Globulin | Bilirubin +------+-------+------+-------+-------+-------+-------+-------+-------+-------+-------+-------+ | 100↓ | 100〜 | 200 | 6↓ | 6〜 | 12 ↑ | + | + + | 卅↑ | 12 ↓ | 12〜 | 20 ↑ | | | ↑ | | | | | | | | | | | 200 | | | 12 | | | | | | 20 | Number of Cases Before Treatment | 10 | 25 | 61 | 21 | 53 | 22 | 14 | 11 | 19 | 52 | 35 | 4 Number of Cases After Treatment | 25 | 19 | 2 | 16 | 33 | 1 | 12 | 0 | 0 | 89 | 1 | 0 Note: Some patients did not undergo a particular liver function test.

Table 3 Changes in HBsAg and Anti-HBc Before and After Treatment

+:--------------:+:---------:+:---------:+:----------:+:---------:+:-----------:+ Before After Comparison | HBsAg | Anti-HBc Positive +-----------+-----------+------------+-----------+ | Negative | 1 ： | 1 ： | 1 ： 512↑ | | | (8〜64) | (128〜512) | | Number of Cases Before Treatment | 0 | 39 | 48 | 13 | 86 Number of Cases After Treatment | 46 | 13 | 31 | 0 | 37 Table 4 Efficacy and Syndrome Differentiation

+:---------:+:---------:+:---------:+:---------:+:---------:+ Efficacy | Qi-Yin Deficiency | Pathogenic Factors Invading Shaoyang | Qi Stagnation and Blood Stasis | Yang Deficiency with Water Overflow | | | | Differentiation | | | | +-----------+-----------+-----------+-----------+ | 3 cases | 53 cases | 40 cases | 4 cases Cure | 2 | 29 | 18 | 0 Improvement | 1 | 23 | 22 | 4 No Effect | 0 | 1 | 0 | 0 Table 5 Efficacy and Disease Duration

+:------------:+:--------:+:--------:+:--------:+:--------:+ Efficacy | Within 3 months | 3–6 months | 6 months to 1 year | Over 1 year | | | | Disease Duration | （18 | （35 | （28 | （19 | cases） | cases） | cases） | cases） Cure | 18 | 20 | 10 | 1 Improvement | 0 | 15 | 18 | 18 No Effect | 0 | 0 | 0 | 0

IV. Typical Cases

[Case 1] Lei ××, female, 24 years old, accountant. First visit on June 28, 1983. The patient had experienced fatigue, poor appetite, right flank pain, abdominal distension two years prior. Liver function tests revealed significant impairment, HBsAg positive. A hospital diagnosed her with hepatitis B. Over the past two years, she had tried Western medicines such as Coenzyme Q10, Yunzhi Gantai, Zhuan Yi Yin, and other liver-protective therapies, but with no obvious effect; her condition continued to relapse. In the past half month, her condition worsened, with additional symptoms of nausea, low-grade fever, and loose stools. She had a history of exposure to hepatitis B. Physical examination: body temperature 37.9°C, emaciation, no jaundice of sclera, spider angiomas found on the anterior chest skin. Heart and lungs were normal, liver palpable 3 cm below the xiphoid process and 1 cm below the ribs, medium hardness with tenderness, spleen palpable 0.5 cm below the ribs, shifting dullness in the abdomen (-), no edema in the lower limbs. Laboratory tests: hemoglobin 8 g/dL, red blood cells 2.8 million/mm³, platelets 110,000/mm³, liver function: bilirubin index 4 units, TFT++, TTT 17 units, GPT over 500 units. Total plasma protein 5.8 g/dL, albumin 2.9 g/dL, globulin 2.9 g/dL. HBsAg 1:256, anti-HBc positive. Western medical diagnosis: viral hepatitis B, chronic (active). Traditional Chinese Medicine differentiation: patient had flank pain, fullness in the epigastrium and abdomen, dark complexion, hepatosplenomegaly, wiry and rapid pulse, tongue with red spots and yellow greasy coating. Syndrome identified as qi stagnation and blood stasis, prolonged stagnation leading to heat transformation. Prescription: Compound Yinyin Decoction with added ingredients: Achyranthes root 10 g, Salvia miltiorrhiza 20 g, Ophiopogon japonicus 10 g, licorice 6 g, Rehmannia glutinosa 12 g, Paeonia lactiflora 15 g, Ligusticum chuanxiong 6 g, Angelica sinensis 10 g, Atractylodes lancea 6 g, Solanum nigrum 15 g, Polygonum cuspidatum 10 g, Corydalis yanhusuo 6 g, Coptis chinensis 6 g, Curcuma wenyujin 20 g, Citrus reticulata leaves 30 g. After taking 10 doses, flank pain and abdominal distension both alleviated, complexion became slightly rosy, pulse remained wiry and rapid, tongue still showed red spots and yellow greasy coating, but the coating turned lighter. Added Prunella vulgaris 10 g to the formula, continuing treatment for another 30 doses. Follow-up visit: all symptoms resolved, red spots on the tongue disappeared, complexion turned rosy, liver function improved to TFT+, TTT 6 units, GPT 80 units, HBsAg negative, anti-HBc negative. Advised to take Xiaoyao Wan twice daily, one pill each time. One month later, liver function tests showed all indicators within normal range.

[Case 2] Ye ××, female, 23 years old, worker. First visit in early August 1982. Six months prior, she began experiencing fatigue, weight loss, loss of appetite, and epigastric distension. She was admitted to a hospital for hepatitis B and treated with Yunzhi Gantai, Coenzyme Q10, Polyinosinic acid, etc., after which her condition improved and she was discharged. In the past month, in addition to worsening fatigue, loss of appetite, and epigastric discomfort, she also reported dizziness, palpitations, irritability, and hot flashes. She had a history of exposure to hepatitis B. Physical examination: body temperature 36.6°C, pale face, no jaundice of sclera, II grade systolic murmur heard at the apex, lungs (-), abdomen flat and soft, liver palpable 2 cm below the xiphoid process, soft and tender, spleen not palpable. Abdominal percussion showed no shifting dullness, no edema in the lower limbs. Laboratory tests: hemoglobin 9 g/dL. Bilirubin index 6 units, TTT 9 units, TFT+, GPT 780 units, HBsAg 1:256, anti-HBc positive. Total plasma protein 7.2 g/dL, albumin 4.9 g/dL, globulin 2.3 g/dL. Western medical diagnosis: viral hepatitis B, chronic. Traditional Chinese Medicine differentiation: patient had pale face, fatigue, loss of appetite, dizziness, irritability, palpitations, pulse deep and fine, tongue red with thin coating. Syndrome identified as initial qi-yin deficiency. Prescription: Shengshan Baige Tang with added ingredients: Cimicifuga foetida 6 g, Dioscorea opposita 10 g, Atractylodes macrocephala 10 g, Pueraria lobata 10 g, Ligustrum lucidum 10 g, Lycium barbarum 10 g, Platycladus orientalis 10 g, Trichosanthes kirilowii 10 g, Prunus mume 4 pieces, Polygonum cuspidatum 10 g, Chrysanthemum indicum 10 g, Cicada exuviae 6 g. After taking 10 doses, symptoms greatly reduced, but still had irritability, palpitations, pulse deep and fine, tongue red with slight yellow greasy coating. Removed Trichosanthes kirilowii from the formula and added Coptis chinensis 3 g, continuing treatment for another 20 doses. Follow-up visit: all symptoms resolved, TTT 8 units, TFT(-), GPT 120 units, HBsAg 16, anti-HBc positive. Advised to take Guipi Wan twice daily, one pill in the morning and one in the evening, for two months. Subsequent liver function, HBsAg, and anti-HBc tests all returned to normal.

[Case 3] Liu ××, female, 33 years old, cadre. First visit on December 13, 1983. Two months prior, she developed low-grade fever, heaviness in the body, aversion to oily foods, fatigue, fullness in the chest and flanks, nausea and urge to vomit, discomfort in the stomach, and restlessness in the heart. She had a history of exposure to hepatitis B. Physical examination: body temperature 37.9°C, no jaundice, red throat, tonsils swollen to II degree, heart and lungs normal. Abdomen flat and soft, liver palpable 4 cm below the xiphoid process and 3 cm below the ribs, soft texture with obvious tenderness, spleen not palpable. Laboratory tests: hemoglobin 12 g/dL, bilirubin index 7 units, TFT(-), TTT 10 units, GPT 1200 units. Total plasma protein 6.8 g/dL, albumin 4.8 g/dL, globulin 2 g/dL, HBsAg 1:1024, anti-HBc positive. Western medical diagnosis: viral hepatitis B, acute. Traditional Chinese Medicine differentiation: patient had wiry and slippery pulse, red tongue with yellow greasy coating, combined with chest and flank pain, irritability and urge to vomit, dry mouth and bitter taste—symptoms indicative of pathogenic factors invading Shaoyang, gallbladder damp-heat. Prescription: Compound Chaihu Tang with added ingredients: Bupleurum chinense 10 g, Scutellaria baicalensis 6 g, Pinellia ternata 6 g, Codonopsis pilosula 10 g, licorice 6 g, Salvia miltiorrhiza 10 g, Agarwood 3 g, Amomum villosum 3 g, Polygonum cuspidatum 10 g, Artemisia capillaris 10 g, Isatis tinctoria 15 g, Clematis armandii 10 g, late silkworm excrement 6 g, papaya 10 g, Cyperus rotundus 6 g. After taking 5 doses, follow-up visit: chest and flank pain, bitter taste, and urge to vomit all significantly reduced, tongue coating became thinner, but due to poor appetite, added Chicken gizzard 6 g and roasted hawthorn 10 g, continuing treatment for another 10 doses. Fourth visit: all symptoms completely resolved, GPT 120 units, TTT 6 units, HBsAg negative, anti-HBc negative.

In the early stages of hepatitis, most cases present as initial qi-yin deficiency, with symptoms such as fatigue, loss of appetite, and occasional hot flashes and irritability (at this stage, liver pain is often not obvious). According to "Plain Questions: Discussion on Febrile Diseases," "Where pathogenic factors gather, qi must be deficient." When righteous qi is initially weakened, it indicates that pathogenic factors have already gathered; therefore, treatment should focus on reinforcing righteous qi. Among the herbs in Shengshan Baige Tang, mountain yam, kudzu vine, and bupleurum are the main ingredients that strengthen qi and reinforce righteous qi. For those with prolonged, unresolved hepatitis B, symptoms such as flank pain, abdominal distension, irritability, bitter taste, and dry throat often appear. This is evidence of pathogenic factors invading Shaoyang; treatment should aim to harmonize Shaoyang. Compound Chaihu Tang combines Xiao Chaihu Tang and Dan Shen Yin into one formula, working to soothe the liver and stomach while harmonizing Shaoyang. For long-standing hepatitis B, when hepatosplenomegaly, wasting, and bone-steaming occur, it usually indicates advanced-stage chronic active hepatitis, with syndrome of qi stagnation and blood stasis, prolonged stagnation leading to heat transformation. Treatment should focus on promoting blood circulation, removing blood stasis, clearing heat, and eliminating steaming. For late-stage hepatitis B complicated by cirrhosis and ascites, most cases fall into the category of yang deficiency with water overflow. At this point, the battle between righteous qi and pathogenic factors has essentially ended, with righteous qi severely depleted; treatment should focus on strengthening righteous qi through formulas like Liujun Pingwei Tang, aiming for gradual improvement. Medications for hepatitis B often include tiger's claw, artemisia, indigo plant, solanum nigrum, and wild chrysanthemum—herbs that clear heat, detoxify, and remove dampness. This is because hepatitis B patients often have wiry and slippery pulses, and their tongues frequently show yellow greasy coatings, indicating that pathogenic factors are mostly damp-heat. Adding these herbs helps address the root cause of the disease.

Traditional Chinese medicine’s syndrome differentiation treatment has a significant effect on eliminating hepatitis B symptoms (Table 1), improving liver function (Table 2), and turning the pathogen negative (Table 3), demonstrating that TCM’s syndrome-based treatment for hepatitis B is not merely symptomatic therapy, but rather treats the disease at its root. This aligns with TCM’s academic principle that “what exists internally will inevitably manifest externally,” as well as the TCM spirit of “treating disease by addressing its root.” Tables 4 and 5 show that patients with yang deficiency and water overflow, or those whose illness has lasted more than a year, generally have poorer outcomes, indicating that the later the stage of the disease, the harder it is to cure. As stated in “Plain Questions: Discussion on the Regulation of the Four Seasons,” “If you wait until the disease has fully developed before prescribing medicine, or wait until chaos has already set in before trying to restore order, it’s like thirsting and then digging a well, or fighting and then casting an arrow—both are too late!” Therefore, early diagnosis and early treatment are crucial for hepatitis B, representing the key to effective management of this disease.

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

Hepatitis B in Lanzhou Region: 2,021 Cases

Clinical Analysis Report

Pei Zhengxue, Cheng Jiechen, Zhong Xu

The incidence of hepatitis B in China is very high. The HBsAg positivity rate is approximately 6%–26%. The infection rate is no less than 60%. To further understand the characteristics of this disease and provide a basis for its prevention and treatment, we conducted an analysis of 2,021 HBsAg-positive patients treated by our hepatitis B research group from May 1984 to February 1988.

I. Data