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Hepatitis : Treatment
   
Western Medicine
Chinese Medicine

Hepatitis A
Most patients are treated at home with supportive therapy that includes bed rest and avoidance of alcohol. Most patients recover completely within three to six months from the onset of infection.

Hepatitis B
There is no cure for hepatitis B. There are two drugs used to treat patients with chronic hepatitis B infection. Both of these drugs are used to slow down the progression of hepatitis B infection and possibly prevent the onset of cirrhosis and development of liver cancer.

Lamivudine, an oral drug, is indicated for patients with chronic hepatitis B infection with evidence of viral replication (virus multiplying as a result of active infection), and active liver inflammation (evidence of active liver disease). It is usually well tolerated with few side effects. It is currently the drug of choice for persons with chronic hepatitis B who have evidence of active viral replication.

Interferon, a drug that is injected, is indicated for treatment of chronic hepatitis B infection in people 18-years-old and up. However, less than half the persons treated will respond to interferon. Furthermore, once interferon is discontinued, relapse can occur. It is given subcutaneously (under the skin into the fatty tissue) or intramuscularly (in the muscle) daily or three times per week depending upon the patients' response to the drug. Since many people find therapy hard to tolerate, premature cessation of therapy may result. Common side effects include flu-like symptoms, such as fever, chills, fatigue, muscle aches, nausea and vomiting. More serious side effects include blood disorders, depression, and thyroid disease. Because of the side effects, this drug is usually not used in persons with serious liver disease, such as patients with cirrhosis and complications.

Liver transplantation is indicated in patients with life-threatening acute liver failure. Unfortunately, the newly transplanted liver will eventually be re-infected with the hepatitis B virus because the person is unable to completely eliminate the virus even after the infected liver is removed. The time frame for re-infection varies, and drugs such as lamivudine and hepatitis B immune globulin can be taken to prevent the reoccurrence of hepatitis B after the liver transplant.

The benefit of a liver transplant is that it can prolong a person's life and decrease the complication as associated with hepatitis.

Hepatitis C
Like hepatitis B, there is no cure. In the United States, there are two different drug therapies approved for chronic hepatitis C: interferon and combination therapy with interferon and ribavirin. The combined drug regimen is the therapy of choice for persons with chronic hepatitis C virus because of a prolonged response. At present, interferon is only used as a single therapy in person who cannot tolerate ribavirin. Ribavirn is an oral drug that was recently approved by the Food and Drug Administration (FDA) to be used in combination with interferon. The main side effects of ribavirin are blood disorders such as a hemolytic anemia. Because ribavirn can cause deformity in fetuses, it should not be used during pregnancy.

More recently, a new formulation of interferon was approved. The improved formulation allows injections to be given only once per week, compared to three times per week with standard interferon. Studies using this new formulation of interferon with ribavirin are underway.

Liver transplantation is the therapy of choice in people with cirrhosis, although re-infection of the new liver is inevitable. While having a liver transplant does not provide a cure for the hepatitis C infection it does enable an individual to live longer with a better quality of life.





 

From the viewpoint of TCM, the greatest harm that viral hepatitis causes is the retention of dampness and heat evils, which results in liver and gall bladder damage, stagnation of liver-qi, or liver and spleen malfunction. Therefore treatment depends on the clinical stages and disharmony patterns an individual displays. The therapeutic goals include clearing away heat and dampness evils, eliminating toxic materials, dispersing the liver-qi, relieving the blood stasis, invigorating the spleen, regulating stomach function for proper digestion, restoring proper liver function and nourishing yin. Below lists some examples of treatment options for the disharmony patterns most associated with viral hepatitis.

Stagnation of dampness-heat evil in middle-burner

Prescription:
yinchenhao decoction plus addition or deduction with erchen decoction and sanhuang decoction
yin chen oriental wormwood
shan zhi cape jasmine fruit
huang qin baical skullcap root
huang lian golden thread
huang bai amur cork-tree
cang shu atracylodes root
ban xia pinellia tuber
chen pi dried tangerine peel
gan cao liquorice root
chuan qun rhubarb
che qian zi plantain seed

In this prescription, oriental wormwood and cape jasmine fruit expels yellow coloring; baical skullcap root, Chinese goldthread and amur cork-tree clears away damp-heat evils in the triple burner; atractylodes root, pinellia tuber and tangerine peel removes dampness evils and regulates stomach function; liquorice root coordinates the actions of the drugs in the prescriptions; rhubarb and plantain seed expels disease and toxins from the body.

Stagnation of live-qi and spleen deficiency

Prescription: xiaoyao powder plus addition or deduction with jinhua power
huang qin baical skullcap root
huang lian golden thread
huang bai amur cork-tree
tian ji huang hyperici japonici herb
chai hu Chinese tororwax root
zhi qiao orange fruit
mi yan coix seed
che qian zi plantain seed
chuan qun rhubarb
gan cao liquorice root

In this prescription, baical skullcap root, Chinese goldthread, amur cork-tree and hyperici japonici herb clear away damp-heat evils in the triple burner; Chinese thorowax and orange fruit regulate the circulation of liver-qi; coix seed invigorates the spleen and dispels dampness evils; plantain seed and rhubarb expel heat-toxin evils from the body. Liquorice root coordinates the actions of the drugs in the prescriptions.

Yin deficiency in liver and kidney

Prescription: xiaoyao powder plus zishui qinggan drink
chai hu Chinese tororwax root
zhi qiao orange fruit
sha shen fourleaf ladybell root
mai dong dwarf lilyturf tuber
sheng di dried rehmannia root
gui ban tortoise shell
shan yu rou cornus fruit
sang shen zi mulberry fruit
shou wu fleece flower root
nu zhen zi glossy privet fruit

In addition, for individuals who suffer from shortness of breath and weakness:

huang qi milkvetch root
bai zhu large head atractylodes rhizome
shan yao common yam root

In this prescription, Chinese thorowax and orange fruit regulate the circulation of liver-qi; fourleaf ladybell root, dwarf lilyturf root, rehmannia root and tortoise shell nourishes yin and clears away heat evils; taro pulp invigorates the spleen; mulberry, fleece flower root and glossy privet fruit nourish the kidney. Milkvetch root, largehead atractylodes and Chinese yam can replenish qi.

Obstruction of the collaterals by blood stasis

Prescription: Yiguan decoction plus addition or deduction with Huayu decoction
shi hu dendrobium stem
sha shen coastal glehnia root
bai zhi large head atractylodes rhizome
ji jin chicken's gizzard skin
fu ling Indian bread
mi yan coix seed
bai shao white peony root
xiang fu nutgrass flatsedge root
xia ku cao spike of prunella
bie jia turtle shell
dan shen red sage root
hai zao seaweed

In this prescription, dendrobium and coastal glehnia root nourishes yin and clears away heat evils; large head atractylodes, chicken's gizzard skin, Indian bread and coix seed invigorates the spleen and disperses dampness evils; white peony root and nutgrass flatsedge disperses liver-qi and relieves pain; spike of prunella, turtle shell, red sage root and seaweed activates the blood circulation and dissipates blood stasis.

Excessive heat and toxin

Prescription: Anying niuhuang pill plus lingyangjiao powder for emergency treatment.

It is recommended that an individual with this type of disharmony pattern be treated with a blend of both TCM and Western medicine.