3. Liver Function and Pathogen Testing

All 2,021 hepatitis B patients underwent liver function tests, plasma protein electrophoresis, and testing for the three hepatitis B markers—HBV DNA, HBeAg, and HBsAg. Liver function and gamma-globulin results are shown in Table 1, while changes in serum pathogens for each type of hepatitis B are shown in Table 2.

Table 1 Changes in Liver Function and Gamma-Globulin among 2,021 Cases

+:----:+:----:+:-----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+......<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 ↑ | + | + + | 30↑ | 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 Yinzi, 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 showed no abnormalities; the liver was palpable 3 cm below the xiphoid process and 1 cm below the ribs, moderately firm with tenderness; the spleen was palpable 0.5 cm below the ribs; mobile dullness on abdominal percussion (-); no edema in the lower extremities. 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, type B, chronic (active). Traditional Chinese medicine differentiation: the patient had flank pain, fullness in the epigastrium and abdomen, dark complexion, hepatosplenomegaly, wiry and rapid pulse, tongue with red spots and greasy yellow coating. The syndrome was qi stagnation and blood stasis, with prolonged stagnation turning into heat. The prescription was Compound Yiyin Decoction with added ingredients:牛膝10克ヽ丹参20克、麦冬10克、甘草6克生地12克白芍15克、川弓6克当归10克、苍术6克、龙葵15克虎杖10克元胡6克、川棟子6克、郁金20克、橘叶30克。 After taking 10 doses, the flank pain and abdominal distension both eased, the complexion became slightly rosy, the pulse remained wiry and rapid, but the tongue still showed red spots and greasy yellow coating. The formula was then adjusted by adding夏枯草10克，维应30剂。At the follow-up visit, all symptoms had subsided, the red spots on the tongue disappeared, the complexion turned rosy, liver function showed TFT+ , TTT 6 units, GPT 80 units, HBsAg(-), anti-HBc negative. The patient was instructed 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. The patient had started experiencing fatigue, weight loss, loss of appetite, and epigastric distension six months earlier. She was admitted to a hospital for treatment of hepatitis B and received Yunzhi Gantai, Coenzyme QⅡo, Poly-Cytosine, 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 experienced 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, a grade II 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 mobile dullness, and no edema in the lower extremities. 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, type B, protracted. Traditional Chinese medicine differentiation: the patient had a pale face, fatigue, loss of appetite, dizziness, irritability, palpitations, pulse deep and fine, tongue red with thin coating. The syndrome was qi-yin deficiency. The prescription was Shengshan Baige Tang with added ingredients:升麻6克、山药10克、白术10克、葛根10克、女贞子10克、枸杞子10克、柏子仁10克、瓜蒌10克、乌梅4枚、虎杖10克、野菊花10克、蝉衣6克. After taking 10 doses, the symptoms greatly reduced, but she still had irritability, palpitations, pulse deep and fine, tongue red with slight yellowish greasy coating. The formula was then adjusted by removing瓜蒌 and adding黄连3克, followed by another 20 doses. At the follow-up visit, all symptoms had subsided, TTT 8 units, TFT(-), GPT 120 units, HBsAg 16, anti-HBc positive. The patient was instructed 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 were all within normal ranges.

[Case 3] Liu ××, female, 33 years old, cadre. First visit on December 13, 1983. Two months earlier, the patient 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 grade II, heart and lungs normal. Abdomen flat and soft, liver palpable 4 cm below the xiphoid process and 3 cm below the ribs, soft and tender 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, type B, acute. Traditional Chinese medicine differentiation: the patient had a wiry and slippery pulse, red tongue with yellowish greasy coating, combined with chest and flank pain, irritability, urge to vomit, and dry mouth and throat—symptoms indicative of pathogenic factors invading Shaoyang, with damp-heat in the gallbladder. The prescription was Compound Chaihu Tang:柴胡10克、黄芩6克、半夏6克、党参10克甘草6克丹参10克木香3克、草蔻3克、虎杖10克、茵陈10克、板蓝根15克、威灵仙10克、晚蚕砂6克木瓜10克、香附6克. After taking 5 doses, the chest and flank pain, bitter taste, and urge to vomit all lessened, the tongue coating became thinner, but due to poor appetite, the formula was adjusted by adding鸡内金6克、焦山楂10克, followed by another 10 doses. At the fourth visit, all symptoms had completely subsided, GPT 120 units, TTT 6 units, HBsAg negative, anti-HBc negative.

In the early stages of hepatitis, most cases present as 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 "Suwen·On the Evaluation of Febrile Diseases," "Where pathogenic factors gather, the body's qi must be deficient." When the body's qi is initially weakened, it indicates that pathogenic factors have already gathered, so treatment should focus on reinforcing the body's qi. The herbs in Shengshan Baige Tang—mountain yam, kudzu root, and other qi-tonifying ingredients—are the main components of the formula. 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, so 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, weight loss, and bone-steaming symptoms appear, it usually indicates advanced-stage or chronic active hepatitis, with syndromes of qi stagnation and blood stasis, where prolonged stagnation turns into heat. Treatment should focus on promoting blood circulation, resolving stasis, clearing heat, and eliminating steaming. For late-stage hepatitis B complicated by cirrhosis and ascites, the syndrome is often yang deficiency with water overflow, marking the final stage of the battle between the body's qi and pathogenic factors, where treatment should focus on strengthening the body's qi through formulas like Liujun Pingwei Tang to gradually restore balance. Medications for hepatitis B often include herbs such as tiger balm, artemisia, indigo plant, dragon fruit, and wild chrysanthemum, which clear heat, detoxify, and remove dampness. This is because hepatitis B patients often have a wiry and slippery pulse, and their tongue coatings are often yellowish and greasy, indicating damp-heat. Adding these herbs helps address the root cause of the disease.

Traditional Chinese medicine's syndrome-based treatment has a significant effect on eliminating hepatitis B symptoms (Table 1), improving liver function (Table 2), and achieving negative conversion of the pathogen (Table 3), demonstrating that TCM's syndrome-based treatment for hepatitis B is not merely symptomatic therapy, but rather addresses the root cause of the disease. This aligns with TCM's academic principle that "what is inside will inevitably manifest externally," as well as its 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, generally have poorer outcomes, indicating that the later the stage of the disease, the harder it is to cure. As stated in "Suwen·On the Regulation of the Four Seasons and the Spirit of the Gods," "If you wait until the disease has fully developed before treating it, or wait until chaos has already set in before trying to restore order, it's like digging a well only when you're thirsty or forging an arrow only when you're fighting—both are too late!" Therefore, early diagnosis and early treatment are crucial for managing hepatitis B effectively.

(From "Research on the Integration of 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 control, 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