TCM perspectives re hep C

[Guest guest]

Traditional Therapies for Chronic Viral Hepatitis

 

Through numerous clinical observations, major symptom patterns in

chronic viral hepatitis have been identified and treatment methods

have been developed. In 1990, the National Hepatitis Conference of

China developed the TCM Scheme for Chronic Viral Hepatitis Prevention

and Treatment. According to this scheme, chronic viral hepatitis is

categorized into the following five TCM symptom patterns: 3,4

 

Gan dan shi re - liver-gallbladder damp-heat

Gan yu pi xu - depressed liver-energy and spleen deficiency

Gan shen yin xu - liver-kidney yin deficiency

Pi shen yang xu - spleen-kidney yang deficiency

Yu xue zu luo - stagnant blood blocks collaterals

 

Gan Dan Shi Re - liver-gallbladder damp-heat

 

Symptom pattern:

 

dull pain in the right hypochondrium (area below the ribs)

stomach flatulence (gas)

nausea

aversion to oil

jaundice or no jaundice

dark urine

difficulty eliminating feces

wet, thick, yellowish tongue coating

fast, slippery pulse

 

Treatment method:

 

Clear the heat and eliminate the dampness. Cool the blood and

resolve the toxin.

 

Formula:

 

Capillaris Combination plus blood cooling and toxin resolving

herbs

 

Gan Yu Pi Xu - depressed liver-energy and spleen deficiency

 

Symptom pattern:

 

distended sensation in the hypochondrium (area below the ribs)

depression and/or anxiety

withered and yellowish complexion

poor appetite

stomach flatulence (gas)

loose stools or diarrhea

pale tongue with white coating

submerged and tight pulse

 

Treatment method:

 

Disperse the depressed liver energy and alleviate the

depression. Invigorate the spleen, and regulate the stomach.

 

Formula:

 

Modified formulas of Bupleurum and Tang-kuei Formula and

Bupleurum and Peony and Six Major Herb Combination

 

Gan Shen Yin Xu - liver-kidney yin deficiency

 

Symptom pattern:

 

vertigo (dizziness)

tinnitus (ringing in the ears)

dry eyes

thirst

dry mouth

insomnia and dreamy sleep

feverish sensation in palms and soles

lassitude of the loins and legs (a heavy feeling)

menstrual problems

red and flaccid tongue with little dry coating

fast, fine, and weak pulse

 

Treatment method:

 

Nourish the blood, liver, and yin, and invigorate the kidney.

 

Formula:

 

Modified Glehnia and Rehmannia Formula

 

Pi Shen Yang Xu - spleen-kidney yang deficiency

 

Symptom pattern:

 

intolerance to cold

cold pain in the lower abdomen, loins, and legs

poor appetite

loose stools and/or diarrhea

indigestion

leg and ankle edema (swelling)

pale and puffy tongue

submerged and fine, slow pulse

 

Treatment method:

 

Invigorate the spleen and nourish the qi. Warm the kidney and

support yang.

 

Formulas:

 

Modified Aconite, Ginseng, and Ginger Combination, and

Gardenia and Hoelen Formula, or Four Major Herb Combination and

Rehmannia Eight Formula

 

Yu Xue Zu Luo - stagnant blood blocks collaterals

 

Symptom pattern:

 

dim and grayish complexion with rashes or reddish spots

enlarged and hardened liver and spleen

liver palm

spider moles

painful and dark menstruation with blood clots

dark purple tongue with petechiae (red or purple spots)

submerged and uneven pulse

 

Treatment method:

 

Activate the blood circulation and dispel the stasis. Disperse

the accumulation, and dredge the meridian passage.

 

Formulas:

 

Modified Persica and Achyranthes Combination and Persica and

Cinidium Combination, or Persica and Eupolyphaga Combination.

 

Different treatment methods and herbal formulas have been developed

for each symptom pattern discussed in this section. Treatments are

changed as symptom patterns change. The herbal composition of the

formulas mentioned in this section can be found in Appendix V, Modern

and Traditional .

 

Treatment of Chronic Viral Hepatitis with Modern

 

MCM uses western medicine's methods to diagnose and monitor disease.

TCM symptom patterns are assessed to determine each person's unique

disease status. Herbal remedies are chosen based on TCM principles and

knowledge of plant pharmacology. In treating chronic hepatitis C, MCM

uses western medical knowledge about the virus and how it causes harm.

This knowledge is combined with TCM diagnostic tools and herbal

treatments to derive the best from both systems of medicine.

 

The protocols described below were reviewed by me, and are generally

used in Zhang's Clinic in New York, NY. It is important to note that,

because of differences in education and training, every qualified

practitioner develops his/her own way of practicing TCM or MCM. This

approach is only one example of how TCM or MCM can be applied to the

treatment of people with chronic hepatitis C. Anyone considering TCM

or MCM should compare different practitioners' approaches, and then

make an educated decision about whom they should see for treatment.

 

Hepatitis C is a newly defined disease. The pathology is similar to

chronic hepatitis B, so many treatment methods were borrowed from

those used to treat chronic hepatitis B.

 

During the course of HCV infection, many changes occur in the body.

Some of these changes are immune system abnormalities, liver

inflammation, fibrosis, and portal vein hypertension. All of these

changes can have significant effects on disease progression and your

prognosis. Therefore, it is not enough to treat only the virus.

Chinese medicine emphasizes restoring liver function and overall

health (supporting the righteous qi of the body). A healthier body is

better able to control the virus, prevent it from causing further

harm, and possibly eradicate it (dispelling the evil). In treating

chronic hepatitis C, MCM uses western medical knowledge about

diagnosis, the cause of disease, and how the virus causes harm. This

knowledge is combined with TCM diagnostic tools and herbal treatments

to derive the best from both systems of medicine.

 

Treatment Protocol for Chronic Hepatitis C

 

The following protocol for treating chronic hepatitis C has several goals.

 

heal liver inflammation and restore liver function to halt disease

progression

reduce the viral load and/or suppress viral replication

regulate the immune system

improve microcirculation (blood flow to organs and tissues)

promote liver cell regeneration

suppress fibroblastic activity (reduce scarring)

promote bile flow

treat hepatitis C related symptoms and complications to improve

quality of life

 

The protocol consists of seven parts. See Appendix V, Modern and

Traditional for the pharmacology of the major herbs

used in the treatment protocol for chronic hepatitis C.

 

Part 1. Improve or normalize liver enzyme levels and liver functions

 

Inflammation causes fibrosis, which leads to cirrhosis. To stop

this progression, inflammation must be controlled. If the liver is not

actively inflamed, the time for cirrhosis to develop is estimated to

be 80 years, the approximate length of the human life span.5 The

following herbal remedies are used to control inflammation.

 

Hepa Formula No. 2 Capsule

Ligustrin Capsule

Glycyrrhizin Capsule

Circulation P Capsule

 

ALT is an important marker of liver inflammation. After treatment,

if three consecutive ALT tests (done 2-3 months apart) are normal,

liver inflammation is considered to be better controlled.

 

The active ingredients of schizandra and schisandrin B and C have

been tested in clinical trials in China. Studies involving 4,558

patients showed schisandrin B and C reduced and/or normalized ALT

levels in 75% of the cases within 2-3 months.6 Schizandra and

schisandrin B and C are the major ingredients in Hepa Formula No. 2.

 

Oleanolic acid, the active ingredient of Ligustrum fructus, has

also been studied. Out of 153 patients treated, 110 (70%) experienced

normalization of their ALT within 50 days.7 Glycyrrhizin, a licorice

root extract, has been used to treat chronic viral hepatitis in China

and Japan. Studies have shown it to be effective in normalizing ALT in

64% of patients in Japan, and 84.5% of patients in China.8

 

Part 2. Lower and stabilize the HCV viral load

 

Suppressing HCV is achieved by strengthening the immune system and

using antiviral herbal remedies. Herbal treatments may be able reduce

HCV viral load, but cannot eliminate the virus. Antiviral therapy is

the weak point of MCM. More research needs to be done to develop more

effective anti-HCV herbal remedies.

 

Most herbal antiviral studies were done with the hepatitis B virus

(HBV), not HCV. The herbs Polygni cuspidati rhizoma, Houttuyn

herbaiae, Rhei rhizoma, and Blechni rhizoma have been found to

suppress HBV in the laboratory. Another group of herbs, Salviae

miltiorrhziae radix, Prunellae spica, Gardeniae fructus, and Montan

radicis cortex, have been found to reduce HBV replication by over 50%

in the laboratory.9 Studies of HBV patients treated with this herbal

combination found 30-40% became negative for HBV surface antigens

(laboratory indicators of HBV in the body).10 Some of these herbs are

included in various formulas of this protocol.

 

Most patients' viral load can be reduced and/or stabilized below

one million. The following herbs have been used to lower viral load.

 

Glycyrrhizin Capsule

Olive leaves Decoction

Olivessence Capsule

 

Part 3. Regulate the immune system

 

HCV causes liver damage mainly by causing the immune system to

react abnormally. An inadequate immune response allows HCV to invade

and damage or kill liver cells. Without an adequate immune response,

HCV infection becomes chronic.

 

In response to HCV, the immune system makes large quantities of

proteins called gamma globulins. These proteins form larger molecules

called soluble immune complexes (SIC). When SIC is deposited in the

liver, joints, skin, and other areas, it causes inflammation. Other

abnormalities in the immune system allow this inflammation to persist.

Ongoing inflammation can eventually lead to fibrosis and/or cirrhosis.

 

Glycyrrhizin and AI #3 Capsule are used to suppress gamma globulin

production. Blood activating and stasis expelling herbs such as

Circulation P Capsules are used to clear SIC. Cordyceps sinensis,

Sophorae subprostratae radix, and Polyporus umbellatus pers are used

to regulate other immune functions.

 

Glycyrrhizin Capsule

AI #3, Capsule

Circulation P Capsules

Cordyceps Capsule

 

Part 4. Improve microcirculation, promote liver regeneration, and

suppress fibroblastic activity

 

Patients with chronic hepatitis C often have microcirculation

disorders. This means blood flow to organs and tissues is abnormal. In

MCM, a microcirculation disorder is called blood stagnancy. Typically,

patients with blood stagnancy have liver palms, spider moles, cold

hands and feet, purplish tongue, dark lips, a dark ring around each

eye, and/or an enlarged spleen. Studies in China found the severity of

a person's microcirculation disorder is a good indicator of the

severity of liver inflammation and damage.11 Microcirculation

disorders in the liver can keep it from getting the proper oxygen and

nutrients. This promotes the process of fibrosis. If microcirculation

in the liver is improved, liver cell regeneration will be promoted and

the progression of fibrosis will be suppressed. To improve all of

these symptoms, a blood-activating and stasis-expelling herbal formula

such as Circulation P Capsule is used.

 

Circulation P Capsule

 

Part 5. Facilitate secretion and excretion of bile

 

People with chronic viral hepatitis can have thickened bile that

may become blocked by inflamed liver tissue. This often causes

jaundice, gall bladder inflammation, and gallstones. Bile blockage can

also injure the liver and promote fibrosis. This leads to an increase

in liver enzymes and bilirubin in the blood. Therefore, improving bile

secretion is very important. The following formulas can effectively

release blocked bile and clear jaundice. These formulas can also be

used for gallbladder inflammation and gallstones.

 

Gall No. 1 Capsule

Capillaris Combination

 

Part 6. Lower portal vein pressure and suppress fibroblastic

activities

 

Portal vein hypertension is the main cause of many of the

complications of advanced liver disease. Portal hypertension is

usually present only in people with cirrhosis. It can cause ascites

(the accumulation of fluid in the abdomen), spleen enlargement,

varices (the ballooning of veins), hemorrhoids, and edema (abnormal

swelling, especially in the feet and lower legs). Reducing portal

pressure is very important for people with advanced liver disease

because this condition can cause severe bleeding.

 

In China, herbs used to treat the fibrosis seen with the disease

miner's lung have also been used to treat early-stage cirrhosis.

Controlled animal studies found cirrhotic animals treated with these

herbs had lower levels of liver collagen (the material that makes up

fibrotic tissue) than untreated animals.12

 

Cordyceps sinensis, Persicae semen, Salvia miltiorrhziae, and

glycyrrhizin have been found to soften the liver, promote the

breakdown of collagen, and enhance liver cell regeneration.

 

Circulation P Capsule

Cordyceps Capsule

Glycyrrhizin Capsule

 

Part 7. Treatments for Hepatitis C Related Conditions

 

Herbal treatments to alleviate HCV related symptoms might improve

patients' quality of life. Some of these symptoms and their herbal

treatments are discussed in this section.

 

Fatigue

 

The liver is the major powerhouse of the body. When liver function

deteriorates, fatigue often results. The elimination of fatigue relies

mainly on the improvement of liver function. If fatigue is the major

problem, it can be treated with the following formula.

 

Cordyceps Capsule

 

Insomnia

 

Sleep disorders are a common complaint among people living with

hepatitis C. Prescription sleep medications can be addictive and cause

side effects such as morning drowsiness. They may also be toxic to the

liver. The following herbal formula addresses this problem

successfully with no harmful effects on the liver.

 

HerbSom Capsules

 

Joint Pain, Skin Rashes, Vasculitis, Psoriasis, Sjogren Syndrome

 

Many people with hepatitis C also have autoimmune symptoms and

syndromes such as those listed above. These are the extrahepatic

(outside the liver) symptoms of the abnormal immune response caused by

HCV infection. Since the underlying cause of these different problems

is the same, so is the treatment.

 

AI #3 Capsule

Circulation P Capsule

 

Diabetes

 

One of the liver's many functions is regulating blood sugar. The

amount of sugar in the blood increases after eating. Excess sugar is

turned into glycogen and is stored in the liver. When the blood sugar

drops, the glycogen in the liver is broken down into sugar again and

is released into the blood. This process is sometimes disrupted in

people with chronic hepatitis C causing blood sugar abnormalities. HCV

can also cause blood sugar abnormalities by damaging the cells of the

pancreas that produce insulin, the hormone that controls blood sugar

levels. HCV-related blood sugar abnormalities can often be controlled

with an herbal remedy.

 

BM (Bitter Melon) Capsule

 

Infections

 

During the course of chronic hepatitis C, people may get other

infectious illnesses such as sore throats, sinusitis, colds, and

bronchitis. Many health care providers use antibiotics to treat these

conditions. However since many of these illnesses are caused by

viruses, antibiotics are often ineffective and may injure the liver.

Herbs can be used to fight these infections. The most important herbal

remedy for infections is Allicin, which is the essence of garlic.

Coptin and Rhubarbin Tablets may also be used to fight infections.

 

Allicin Capsule

Coptin Capsule

Rhubarbin Capsule

 

Ascites and Edema

 

Ascites (fluid in the abdomen) and edema (swelling of the feet, legs,

and hands) can occur with cirrhosis and liver failure. If these

symptoms occur, salt and protein intake should be limited. At the same

time, an herbal formula can be used to expel excess water.

 

Tiao Ying Yin Formula

 

Bleeding

 

Cirrhotic patients may be at risk for bleeding varices. This is

bleeding from abnormally large and thin-walled veins around the

stomach and the esophagus (the food pipe leading to the stomach). This

kind of bleeding is accompanied by vomiting blood and/or passing

black, tar-like stools. Bleeding from varices is a medical emergency.

If this happens, you need to go to an emergency room immediately.

 

Bleeding from the gums or nose are more common and less serious forms

of bleeding that can occur with liver failure. The following herbal

formula is used to treat these less serious types of bleeding.

 

Yunan Pai Yao Capsule

 

Diarrhea

 

Diarrhea is a common complaint of people with chronic hepatitis C.

Diarrhea often improves as liver function improves. If diarrhea lasts

and becomes severe, the following formula can be used.

 

Ginseng and Atractylodes Formula

 

Nausea and Vomiting

 

Nausea is more common than vomiting in people with chronic hepatitis

C. It can occur when bile secretion is blocked as this affects

digestion. If these complaints become persistent, the following

formula can be used.

 

Pinellia and Hoelen combination

 

Clinical Outcomes of the Protocols

 

More than 2,000 patients at Zhang's Clinic in New York City have used

these protocols. In January 2000, we had test results on file for over

400 patients. A scientific analysis was conducted by reviewing the

medical records of 75 patients for whom both pre- and post-treatment

ALT levels were available. ALT was used to determine whether the

protocols were effective. The average before treatment ALT level was

128 (±114), and the average after-treatment ALT level was 47(±42). Of

these 75 patients, 77% experienced normalization of their ALT, and 93%

experienced ALT improvement.13 All patients reported improvement in

their symptoms. Four patients had liver biopsy results available

before and after herbal treatment. Three of the four patients

experienced regression of liver fibrosis from stage III to stage I

after herbal treatment.

 

Intended Endpoints of Chinese Medical Treatment: How to Define Cure

with TCM and MCM

 

Chinese medicine defines cure as the body's return to balance and

normal functioning. The ultimate goal of Chinese health care is to

restore a person's health, full function, and a normal life

expectancy. Eliminating the virus and controlling inflammation are

methods for reaching this goal. The goals of Chinese medical treatment

for hepatitis C are to arrest the virus, and reverse of the impact of

the virus. This results in improved or normal liver function. In turn,

quality of life improves and there is a reasonable expectation for a

normal life span. However, long-term ongoing treatment may be

required. By utilizing this approach, we can buy sufficient time for

patients to wait for new developments and better treatments for

hepatitis C.

 

Reasons for Using TCM or MCM Therapies and Who May Benefit

 

Chinese herbal treatments for HCV have many positive features.

 

effective

time-honored

easy to take

affordable (15-20 times less expensive than western medication)

virtually nontoxic

largely side effect free

work life-long

 

However, Chinese remedies do not necessarily eradicate HCV. Chinese

herbal treatments provide an alternative for people who are unwilling

or unable to use western medicine treatment options. Some examples of

situations in which TCM or MCM may be chosen are listed below.

 

Many people are afraid of the side effects of prescription

medicines. For them, TCM or MCM may be a viable alternative. " In the

US, it is likely that more patients with hepatitis C use

nonprescription agents of unproven effectiveness than use

interferon-based therapy. " 13

 

For the approximately 50% of people who do not respond to

western treatment, TCM or MCM can be used to help improve liver

function and overall quality of life.

 

For those who cannot take interferon and/or ribavirin, TCM or

MCM may provide an alternative treatment option. Conditions that may

make the use of interferon or ribavirin impossible include

decompensated cirrhosis, persistently normal ALT, active alcohol or

illicit drug use, a history of major depression, leukopenia (low white

blood cell count), hyperthyroidism, renal transplant, and/or evidence

of autoimmune disease.

 

For those who cannot tolerate western treatment, TCM or MCM may

provide an alternative.

 

Individuals who initially respond to interferon and/or ribavirin

but then relapse may have a recurrence of liver disease. TCM and MCM

can be used to treat this recurrence.

 

TCM or MCM therapies can be used to treat damage already caused

by chronic hepatitis C.

 

TCM or MCM used in conjunction with interferon-based treatments

may make them easier to tolerate and decrease associated side effects.

 

Re

[Guest guest]

Chinese Traditional Medicine , " Rob " <emeerob> wrote:

> Traditional Therapies for Chronic Viral Hepatitis

>

> Through numerous clinical observations, major symptom patterns in

> chronic viral hepatitis have been identified and treatment methods

> have been developed. In 1990, the National Hepatitis Conference of

> China developed the TCM Scheme for Chronic Viral Hepatitis Prevention

> and Treatment. According to this scheme, chronic viral hepatitis is

> categorized into the following five TCM symptom patterns: 3,4

>

> Gan dan shi re - liver-gallbladder damp-heat

> Gan yu pi xu - depressed liver-energy and spleen deficiency

> Gan shen yin xu - liver-kidney yin deficiency

> Pi shen yang xu - spleen-kidney yang deficiency

> Yu xue zu luo - stagnant blood blocks collaterals

 

(snip)

 

Rob, I want to thank you for a lot of in-depth info on TCM and chroni

viral hepatitis.

 

For healers interested in bookmarking the info, this is a reply to

message 7405. There are several in-depth messages on this topic in the

area of the message base.