Viral hepatitis, caused by hepatitis viruses, can be usually divided into three types: Type A, Type B and Non-A Non-B hepatitis. People are susceptible to the disease. Clinically, the major symptoms are poor appetite, hepatalgia and fatigue. Fever and jaundice may occur. Liver function test shows various degrees of hepatic damage. In TCM, this disease belongs to the categories of  "huang dan" (jaundice), "gan yu" (stagnation of liver-qi), "xie tong" (hypochondriac pain) and "zheng ji" (mass in the abdomen).  

Main Points of Diagnosis

1. Epidemiologic information: The epidemic condition and a history of  close contact with a hepatitis patient, or a history of blood transfusion or receiving blood preparations or immunization injections should be noticed.

2. Clinical features

(1) The onset of the disease in insidious and slow. The patients often complain of fatigue and anorexia. Some have jaundice, but most of them belong of the type of non-icteric or mild hepatitis. Only ten percent of the patients have typical manifestations or jaundice.

(2) patients with hepatitis A often manifest pyrexia, shorter course and rapid recovery; patients with hepatitis B usually have a chronic course and remain HB virus carriers for a long time. A few of them may progress to cirrhosis. The severity of the clinical features of Non-A Non-B hepatitis is between those of hepatitis A and hepatitis B. And its incubation period can be long or short.

3. Physical signs: The liver becomes enlarged, and tender on palpation and is painful on percussion. There is a mild change of liver texture. A small percentage of cases have splenomegaly. In the patients with icterohepatitis, jaundice may be found in the skin and sclera. Hepatic face, vascular spiders and liver palms may be present in chronic active hepatitis. A few patients suffering from fulminant hepatitis may have skin petcchiae, epistaxis and ascites, or even hepatic coma, indicating poor prognosis.

4. Laboratory examination

(1) Liver function: In patients with acute hepatitis, the SGPT is marked elevated up to several hundreds units, even more than one thousand units. In icterohepatitis, the icterus index and the one-minute bilirubin fixed quantity are increased. In severe and chronic active hepatitis, metabolism of protein is disturbed resulting in the change of ratio of serum albumin to globulin. The albumin level lowered but the globulin level elevated, even the ratio may be inverted. Signs of clotting disorder may be present.

(2) The detection of specific antigens and antibodies: It is available to detect the HAAg in filtrate of stools and the anti-HAV of the IgG and IgM class in the serum in the diagnosis of hepatitis A. Three antigen and antibody systems, that is HBsAg, HBcAg and HBeAg with their antibodies, can be detected, which is valuable in the diagnosis and in predicting the severity, infectivity and prognosis of the hepatitis B. Non-A Non-B hepatitis can only be diagnosed by using the exclusive method.

(3) In chronic active hepatitis, tests for cellular immunity, humoral immunity and autoimmunity may be performed to evaluate the host immune mechanisms and severity of the disease so as to give a relevant treatment. Liver biopsy is only indicated for those whose cases defy diagnosis through clinical and laboratory examination.  

Differentiation and Treatment of Common Syndromes    

1. Icterohepatitis

(1) Yang Jaundice (Acute Icterohepatitis)

Main Symptoms and Signs: Bright yellow coloration of the skin and sclera, fever, thirst, feeling of fullness and distension in the epigastrium, anorexia, fatigue, hypochondriac distension and pain, restlessness, nausea, scanty dark urine, dry stools, red  tongue with yellow and greasy fur, taut and rapid pulse.

Therapeutic Principle: Removing pathogenic heat and dampness.

Recipe: Oriental Wormwood Decoction with additional ingredients.

oriental wormwood

capejasmine fruit

rhubarb root

phellodendron bark

honeysuckle flower

forsythia fruit

isatis root

cogongrass rhizome

All the above herbs are to be decocted in water for oral administration.

Some other drugs are often employed for certain symptoms. In case of exhibiting more symptoms and signs of pathogenic heat, 30grams of isatis leaf and 30 grams of dandelion should be added. And in case of exhibiting more symptoms and signs of pathogenic damp, 10 grams of atractylodes rhizome , 10 grams of magnolia bark and 10 grams of alismatis rhizome may be added. Nausea and vomiting can be treated with the addition of pinellia tuber 10g and bamboo shavings 10g. While abdominal distension and anorexia can be treated with the addition of same dosage of 10 grams of parched hawthorn fruit parched malt and parched medicated leaven. To treat the cutaneous pruritus, 15 grams of dittany bark and 15 grams of broom cypress fruit are included.

(2) Yin Jaundice (Chronic icterohepatitis)

Main Symptoms and Signs: Dark yellow coloration of the skin and sclera just like smoky color, poor appetite, feeling of distension in the abdomen, loose stools, general debility, tastelessness in the mouth, whitish thick and greasy fur of the tongue, deep thready and weak pulse.

Therapeutic principle: Activating the function of the spleen inducing diuresis and warming yang.

Recipe: Modified Decoction of Oriental Wormwood and Bighead Atractylodes and Prepared Aconite.

oriental wormwood

bighead atractylodes rhizome

codonopsis root 

poria

coix seed

prepared aconite root

tangerine peel

hawthorn fruit

malt

medicated leaven

All the above herbs are to be decocted in water for oral administration.

Apart from the ingredients in the above recipe, 10 grams of dried ginger should be prescribed for those who complain of aversion to cold and cold limbs; 15 grams of fresh-water turtle shell for those with hepatosplenomegaly; and 15 grams of shell of areca nut and 15 grams of plantain seed ( wrapped in a piece of cloth during decocting ) for those with ascites.

2. Anicteric Hepatitis

(1) Dampness and Heat in the Liver and Gallbladder

Main symptoms and Signs: Chest stuffiness, dysphoria with feverish sensation, pain in the hypochondrium, abdominal distension, lassitude and weakness, anorexia with aversion to greasy food, bitter taste and dry mouth, scanty dark urine, dry stools, reddened tongue with yellow and greasy fur, taut and rapid or smooth and rapid pulse.

Therapeutic Principle: Removing pathogenic heat and dampness.

Recipe: Modified prescription of Oriental Wormwood Decoction combined with Decoction of Gentian for purging liver-fire.

oriental wormwood

capejasmine fruit

scutellaria root

gentian root

isatis root

patrinia

curcuma root

plantain seed (wrapped in a piece of cloth during decocting)

red sage root

poria

magnolia bark

All the above herbs are to be decocted in water for oral administration.

In addition, 12 grams of Sichuan chinaberry and 10 grams of corydalis tuber are added for treating cases with prominent pain in the hypochondrium; 10 grams of amomum fruit and 10 grams of bitter orange are added for cases with obvious epigastric distension and stuffiness; 15 grams of hawthorn fruit and 10 grams of membrane of chicken's gizzard skin added for cases with poor appetite.

(2) Stagnation of the Liver-qi with Deficiency of the Spleen hypochondrium, general debility, anorexia, loose stools, thin and whitish fur of the tongue, deep and taut pulse.

Therapeutic Principle: Relieving the depressed liver-qi and reinforcing the function of the spleen.

Recipe: Modified Ease Powder.

bupleurum root

Chinese angelica root

white peony

codonopsis root

white atractylodes rhizome

poria

curcuma root

tangerine peel

red sage root

Chinese yam

hawthorn fruit

medicated leaven,

prepared licorice root

All the above herbs are to be decocted in water for oral administration.

If the disease is characterized by dryness of the eyes, dizziness, dull pain in the hypochondrium, hot sensation in palms and soles, soreness and weakness in the loins and knees, dry and red tongue coated with a little fur or no fur at all, taut and thready pulse, which is caused by deficiency of the liver-yin, nourishing the liver-yin should dominates the treatment. The given recipe is Decoction for Nourishing the Liver and Kidney with additional ingredients:

glehnia root

ophiopogon root

dried rehmannia root

wolfberry fruit

Chinese angelica

Sichuan chinaberry

fresh-water turtle shell

curcuma root

dendrobium

(3) Stagnation of Qi and Blood Stasis

Main Symptoms and Signs: Gloomy complexion, stabbing pain in the right hypochondrium, hepatomegaly or splenomegaly, abdominal distension, anorexia, some telangiectases in the skin of face and neck with vascular spiders, liver palms, dark purple tongue sometimes marked with ecchymoses, taut and uneven pulse.

Therapeutic Principle: Promoting blood circulation, removing blood stasis and softening hard hepatiomegaly or splenomegaly.

Recipe: Modified Decoction of Peach Kernel and Safflower with Other Four Ingredients.

Chinese angelica

white peony root

ligusticum root

peach kernel

safflower

red sage root

fresh-water turtle shell

pangolin scale

zedoary

spatholobus stem

cyperus tuber

finger citron

prepared licorice root

All the above herbs are to be decocted in water for oral administration.

Apart from the above ingredients, codonopsis root and astragalus root are added for those with symptoms of lassitude and weakness.

For all types of clinical manifestations mentioned above, if SGPT is higher than normal, powder of schisandra fruit may be taken at the same time, 3 grams are taken each time and 3 times a day; or additional intake of stringy stonecrop powder 50 mg are taken each time and three times a day; or choose any of the appropriate amount of the following ingredients for extra intake: bistort rhizome, giant knotweed rhizome and Japanese St. Johns wort.   

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