bubble_chart Concept

Traditional Chinese Medicine believes that chronic active hepatitis mostly falls under the categories of "jaundice," "hypochondriac pain," and "abdominal mass disease." The etiology and pathology are briefly described as follows:

1. External contraction of epidemic toxin or dampness-heat pathogens: Often due to insufficient healthy qi or improper diet, dampness-heat epidemic toxins take advantage to invade the body, accumulating in the triple energizer, leading to dysfunction of the spleen and stomach in transportation and transformation. Dampness-heat steams in the liver and gallbladder, causing depression and stagnation of qi movement, and gall fel does not follow its normal pathway, overflowing to the skin and face, resulting in jaundice. Alternatively, constitutional deficiency-cold of the spleen and stomach, combined with exposure to dampness-heat pathogens, may lead to disease transformation into cold, with cold-dampness obstructing the middle energizer, impairing the smooth movement of qi and affecting the free flow of gall fel.
2. Improper or inadequate treatment of acute hepatitis, or due to inherent deficiency of healthy qi, allows the pathogens to linger in the body, with dampness-heat accumulating in the liver and spleen or middle energizer, causing depression and stagnation of qi movement, zang-fu organ deficiency, insufficient qi and blood, and in severe cases, qi stagnation and blood stasis, leading to abdominal mass or blood stasis and water retention, resulting in tympanites.

bubble_chart Modern Research

Chronic active hepatitis refers to a chronic progressive inflammatory liver disease characterized by clinical, generation and transformation, pathological morphology, and serological features, often accompanied by immune sexually transmitted disease changes in many organ systems and corresponding immune responses. Therefore, chronic active hepatitis is not actually an independent disease, but rather a syndrome of chronic progressive inflammation primarily involving immune injury to the liver.

Chronic active hepatitis can be caused by various hepatitis viruses, but is mainly caused by the hepatitis B virus. Chronic active hepatitis with positive hepatitis B antigen can result in liver injury due to the occurrence of autoimmune processes (autoimmune chronic active hepatitis); certain drugs can also induce the disease. Some cases of autoimmune chronic active hepatitis with negative hepatitis B antigen cannot rule out previous hepatitis B virus infection; the humoral and cellular immune mechanisms of autoimmunity may also be involved in the occurrence and development of chronic active hepatitis caused by hepatitis B antigen positivity or other reasons. Abnormal immune function is a common feature of chronic active hepatitis caused by any reason and plays an important role in the pathogenesis. Therefore, it is generally believed that chronic active hepatitis is an immune liver disease.

[Diagnosis]

1. The course of the disease exceeds six months, with obvious hepatitis symptoms such as lack of strength, loss of appetite, aversion to oily food, nausea, abdominal distension and fullness, and yellow urine.
2. There is a chronic liver disease appearance, hepatomegaly, liver texture of medium hardness or above, often accompanied by jaundice, splenomegaly, spider angiomas, and liver palms.
3. There are manifestations of extrahepatic damage, such as arthritis, nephritis, vessel inflammation, and dry syndrome.
4. Liver function tests are abnormal or repeatedly abnormal, such as elevated ALT, inverted albumin/globulin ratio, and increased gamma globulin. Some patients have repeatedly or persistently elevated serum bilirubin and positive autoantibodies.
5. Liver biopsy shows histological changes consistent with chronic active hepatitis.

bubble_chart Pattern Analysis

1. Liver Qi Depression︰Hypochondriac distending pain, more pronounced on the right side, epigastric distension and fullness, chest tightness, dry mouth with bitter taste, aversion to greasy food, poor appetite, dizziness, and lack of strength. Tongue coating thin white or thin yellow, wiry pulse. Treatment principle: soothe the liver and relieve depression, supplemented by fortifying the spleen. Modified Peripatetic Powder: Bupleurum 10g, Peony Root 15g, Chinese Angelica 10g; Poria 12g, White Atractylodes Rhizome 10g, Chinaberry Fruit 10g, Curcuma Root 10g, stir-fried Hawthorn Fruit 15g, Germinated Rice and Germinated Barley 30g each. For marked dry mouth with bitter taste, add Moutan Bark and Gardenia 10g each; for severe constipation, add raw Rhubarb Rhizome 6g (to be decocted later).
2. Liver and Spleen Disharmony︰The right pulse is distended and uncomfortable, with epigastric fullness, poor appetite, nausea, aversion to greasy food, mental fatigue and lack of strength, and loose, thin stools. The tongue coating is white and greasy, and the pulse is wiry and thin. The treatment involves invigorating the spleen and harmonizing the stomach, supplemented by soothing the liver. Modified Chai Shao Liu Jun Zi Decoction is prescribed: Bupleurum 10g, Peony Root 15g, Tangshen 15g, White Atractylodes Rhizome 10g, Indian Bread Tuckahoe 10g, Areca Peel 15g, Germinated Barley 15g each, Hawthorn Fruit 15g, Villous Amomum Fruit 6g (to be decocted later), Canton Love-pea Vine 15g, Prepared Liquorice Root 6g, Curcuma Root 10g, Virgate Wormwood 15g, Atractylodes Rhizome 10g. For those with a dull complexion and significant mental fatigue and lack of strength, add Coix Seed 30g and Astragalus Root 15g.
3. Qi Stagnation and Blood Stasis︰Fatigue and weakness, poor appetite, abdominal distension and fullness, hypochondriac pain, nausea, persistently or repeatedly elevated transaminase levels, significant liver function impairment, hepatosplenomegaly, and in severe cases, jaundice, hematemesis, liver palms, and spider angiomas may occur. The tongue is red or dark with thin, greasy coating, and the pulse is wiry and thin. Treatment involves soothing the liver and regulating qi, invigorating blood, and resolving stasis. Modified Peripatetic Powder combined with Infradiaphragmatic Stasis-Expelling Decoction is used. Ingredients include Bupleurum 6g, Chinese Angelica 10g, Peach Kernel 10g, Moutan Bark 10g, Red Peony Root 15g, Lindera 10g, Corydalis Tuber 10g, Sichuan Lovage Rhizome 10g, Carthamus 6g, Virgate Wormwood 20g, Christina Loosestrife 30g, Chicken's Gizzard-Skin 10g, and Goldhair Hedyotis Herb 30g. For pronounced spleen deficiency, add White Atractylodes Rhizome and Villous Amomum Fruit 15g each. For yin deficiency, add Dendrobium and Ophiopogon Tuber 20g each. For severe dampness with a white, greasy tongue coating, add Atractylodes Rhizome 10g and Magnolia Bark 6g. For hematemesis, add charred Lotus Rhizome Node 15g and charred Skullcap Root 10g. For liver palms and spider angiomas, add processed Turtle Carapace 10g and Zedoary Rhizome 10g. For marked jaundice, add Canton Love-pea Vine 20g and Gardenia 10g.
4. Liver-kidney Yin Deficiency︰Low-grade fever or feverish sensation in the palms and soles, dry mouth and throat, red tongue with little or no coating, thin and rapid pulse. Nourish the liver and kidney. Modified All-Along Decoction: Rehmannia 30g, Chinese Angelica, Peony Root, Ophiopogon Tuber, Barbary Wolfberry Fruit, Yerbadetajo Herb, Glossy Privet Fruit 10–15g each, Chinaberry Fruit 6–10g, Curcuma Root 10g, Bupleurum 5g, Hedyotis 30g. For cases with qi stagnation and blood stasis, presenting with distending or stabbing pain in the right hypochondrium, hepatosplenomegaly, or purplish spots on the tongue, add Peach Kernel, Carthamus, Zedoary Rhizome, and Sparganium Rhizome 10g each. For cases with ascites, add Areca Peel 30g, Poria and Polyporus 30g each.
5. Spleen-stomach Weakness︰The complexion and skin appear yellow and dull, with weak limbs and lack of strength, poor appetite, palpitation, shortness of breath, loose and thin stools, epigastric distension and fullness. The tongue coating is thin and white, and the pulse is thin and weak. The treatment involves tonifying qi, nourishing blood, regulating qi, and invigorating the spleen. Modified Astragalus Center-Fortifying Decoction is used: Astragalus Root 30g, Peony Root 15g, Tangshen 15g, White Atractylodes Rhizome 10g, Poria 15g, Hyacinth Bean 10g, Chinese Date 7 pieces, Prepared Liquorice Root 6g, Dried Tangerine Peel 6g, Areca Peel 15g, Finger Citron 10g, Canton Love-pea Vine 15g, Stringy Stonecrop Herb 15g, Germinated Barley 15g each. For cases with blood stasis, add Curcuma Root and Peach Kernel 10g each; for ascites, add Poria 30g, Coix Seed 30g, Alisma 15g, Zedoary Rhizome 10g; for pale and lusterless complexion, add Chinese Angelica 10g and Prepared Rehmannia Root 15g.