TREATMENT OF HEPATITIS C WITH CHINESE HERBAL MEDICINE

Bindi Zhu, Ph.D.

Hepatitis C affects 400 million people worldwide, with 4 million cases in the United States, and 33,000 new case reported annually in this country alone. The hepatitis C virus (HCV) can lead to serious health problems including cirrhosis, liver failure, liver cancer and general immune system problems. Up to 80 percent of HCV infected individuals become chronic carriers and risk developing life threatening liver disease, such as cirrhosis and hepatocellular carcinoma. However, many of these individual can go on to enjoy happy, healthy lives with the help of their network of health care providers, attention to lifestyle choices like diet and exercise, and the support of friends and family.

The Food and Drug Administration (FDA) currently lists ribovirin and alpha interferon as the only approved drugs to treat hepatitis C. About half the population of individuals with hepatitis C qualify as candidates to take alpha interferon, and of those only 20 to 30 percent exhibit long-term remission rates. Treatment with Chinese herbal medicine shows higher remission rates, fewer side effects, and lower cost when compare to alpha interferon and ribovirin.

Traditional Chinese medicine classifies HCV patients into three types of syndromes: 1) damp accumulation in the Liver and Gallbladder, 2) weak Kidney, and 3) stagnation of Liver qi. Therefore, the treatment principles addressing those syndromes correspond with the following: 1) removing dampness from the Liver and Gallbladder, 2) tonifying the Kidney, 3) promoting the movement of Liver qi. In addition, all syndromes associated with HCV require the treatment protocol to reduce toxin accumulation and cool Blood.

In clinical and experimental trials, Chinese herbal medicine appears to inhibit HCV replication, correct disordered microcirculation of the liver, restores aberrant immunologic function, facilitates hepatocyte regeneration, and provides deficient trace elements. In order to assess the best treatment plan for each individual, each patient must undergo a series of exams. Such exams include routine blood work, liver enzyme function, imaging studies (e.g. MRI, CT, ultrasound), and liver biopsy. The exam results plus the Chinese medicine diagnosis define the parameters of the Chinese herbal formulas’ ingredients and dosages.

INTRODUCTION

At least 80 percent of individuals infected with HCV become chronic carriers. The Center for Disease Control (CDC) estimates that HCV accounts for 40 percent of liver disease and causes 25,000 deaths per year worldwide, or approximately one percent of all deaths in the United States. The tenth leading cause of death among adults in the United States, chronic liver disease causes an estimated 8,000–10,000 deaths each year. Statistics like these convey the urgency with which HCV patients should pursue reduction or removal of HCV and optimal liver health.

How is hepatitis C transmitted? Hepatitis C transmission occurs primarily through large or repeated blood contact via direct percutaneous exposures. This event can occur through needle sharing, blood transfusions, from a pregnant woman to her child at birth, sniffing or snorting cocaine, hemodialysis, re-use of infected tools (e.g. tattoo needles, razors, etc), sexual contact, exposure to infected blood on the job (e.g. health care workers), etc. The incubation period for HCV ranges from 12 to 180 days followed by mild, flu-like symptoms.

What are the possible outcomes from contact with the hepatitis C virus? After infection, the course of disease may follow one of the following paths. One may not contract the disease at all, one may carry the disease asymptomatically, one may carry the disease with few symptoms which eventually result in liver damage, or one may carry the disease with noticeable symptoms which progressively worsen over time. In later stages of liver disease these symptoms might include loss of appetite and weight loss, nausea and vomiting (sometimes vomiting blood), jaundice, itching, abdominal swelling (ascites), increasing sensitivity to drugs, mental confusion leading to coma (encephalopathy), and cirrhosis.

How does cirrhosis develop? Progressive liver disease eventually leads to cirrhosis. The histologic hallmark of progressive liver disease, piecemeal necrosis indicates the first stage of cirrhosis. Instead of regenerating itself the way a healthy liver does, the compromised liver responds by generating scar tissue to replace damaged liver cells. With continued loss of hepatocytes, subsequent fibrous septum formation, and accompanied hepatocyte regeneration, cirrhosis occurs. The scar tissue does not have the functionality of normal liver cells and instead blocks the flow of blood to and inside the liver, backing up unfiltered blood into the surrounding veins (portal hypertension).

Conventional treatment options: About half the population of individuals with hepatitis C qualify as candidates to take alpha interferon and ribovirin, and of those only 20 to 30 percent exhibit long-term remission rates. Clinically, the HCV patients who respond best to interferon are at “normal” body weight, female, younger, short duration of infection, and lower iron levels. Of those who respond well to interferon, showing normal liver transaminase tests and reduced hepatocyte inflammation, 60 percent will relapse after several months.

Are there any side effects? This powerful drug has many side effects, some quite debilitating, such as fatigue, flu-like symptoms, muscle pain, insomnia, depression, hair loss, seizures, suicidal tendencies, diarrhea, and suppression of bone marrow. Additionally, a relatively high proportion of patients treated with alpha interferon showed an increase of serum ALT during or after therapy, suggesting that alpha interferon may induce liver damage in some people.

Treatment options with traditional Chinese medicine: With one third of all HCV cases found in China, Chinese scientists have done extensive research on different treatment modalities to treat this disease. Physicians in China employ an integrated approach to treat HCV, using conventional laboratory tests, Chinese medical diagnosis, a thorough history and physical examination to arrive at an accurate diagnosis.

HCV patients who use Chinese herbal medicine can show liver enzyme test results in the normal range or close to it. Experimental and clinical observations show these herbal prescriptions to produce anti-viral, anti-inflammatory, and anti-fibrotic effects. Chinese herbal medicine helps clear jaundice, heal damaged liver cells, stops and even reverses, the progression of cirrhosis.

Classification of hepatitis C in traditional Chinese medicine: Traditional Chinese medicine correlates different presentation of hepatitis C to syndrome classifications. A syndrome is made up of a certain set of symptoms. Usually people don’t fall neatly into sydrome classification, but might show some overlapping symptoms. Based on the clinical presentation, each patient receives a treatment tailored to their individual needs. Furthermore, treatments are also modified at different stages of the patient's disease. Based on my experience, chronic HCV falls into three general classifications.

1) Damp pathogen accumulation in Liver and Gall Bladder: HCV causes obstruction of qi, especially in the Liver and Gall Bladder, which leads to illness. Although HCV functions as a toxic pathogen, it does not have the hot thermal nature associated with most toxic pathogens. The HCV pathogen has a yin, toxic, damp nature that directly enters Yin and Blood levels. HCV has the obstructing nature of dampness and the congealing nature of pathogenic yin. It accumulates to become toxic, blocking collaterals, damaging qi and obstructing flow of yang qi. This is evident by knotted mass under ribs, telangiectasis, and darkened face, as well as a weak pulse and pale, puplish tongue with a thick white coating.

2) Weak Kidney: Weak Kidney and Jing qi, weak qi and blood, and less efficient channel and collateral circulation occur with aging. Therefore, when yin du (contagious pathogen, like HCV) enters yin xue (nutritive Qi and Blood level), it obstructs the yin and blood in the zang fu organs (viscera), and resides stubbornly deep within body. This effect will be emphasized in an elderly person. An effective treatment will tonify the Kidney, restore energy, and nourish blood.

Kidney deficient patients, especially those in middle or old age, are easily infected by HCV. Studies in China showed a positive correlation between age and HCV, with patients in the 60-70 age group most affected. Studies in Japan showed similar results. It has been found that predominantly damp-heat cases were mainly associated with pathological manifestations of mild hepatitis, whereas those with predominantly stagnation-related conditions were almost all chronic hepatitis or liver cirrhosis, and every case in the patient was over 40 years of age.

The most common subtype of this group is Kidney qi deficiency and Kidney yang deficiency, followed by Kidney yin deficiency. A judicious amount of Kidney yang tonics should be applied by taking Peonia lactiflora Pall., Trigonella foenum-graecumL., Epimedium macranthum Morr. Et Decne., Curculigo orchioides Gaertn., Cuscuta chinensis Lam., and Schisandra chinensis Baill. Some Kidney yin tonics should be added in order to seek yang from within yin. In general, less Kidney tonics should be used in acute mild cases, and more kidney tonic should be used in chronic cases. Large dose of raw Astragalus membranaceus (Fisch.) Bge. (30g) can be very effective to treat HCV, counteracting HCV’s nature to congeal yin, damage qi and block yang.

3) Stagnation of Liver Qi: The congealing nature of HCV pathogen can cause Liver qi stagnation. A common expression of HCV Liver qi stagnation can lead to Liver and Spleen disharmony. This occurs when the Liver “overacts” on the Spleen within the Five Element paradigm. This syndrome may present with low-grade heat symptoms, qi blockage, damp obstruction and phlegm formation, with stagnant blood blocking the collaterals. In Liver qi stagnation due to HCV, toxicity, stagnation, phlegm and damp occur and they amplify each other. The treatment modality moves Liver qi, transforms phlegm by using the following herbs to invigorate the movement of qi: Bupleurum chinense DC, Citrus reticulata Blanco (chen pi), Citrus reticulata Blanco (qing pi), Cyperus rotundus L., and Magnolia officinalis Rehd. Et Wils. Depending on the presentation, the above herbs should be combined with following phlegm cutters: Pinellia ternata (Thunb.) Breit., Fritillaria verticillata Willd. var. thunbergii Baker, and Ecklonia kurome Okam. Any formula design should account for any possibility to exacerbate congealing and obstructing. Two commonly formulas used to reduce phlegm accumulation are er chen tang (Two-Cured Decoction), and xiao xian xiong jia zhi shi tang (Minor Sinking Into the Chest Decoction plus Fructus Aurantii Immaturus).

4) Moving and cooling blood and reducing toxin accumulation: When any pathogen, such as HCV, enters the blood level, herbs that enter the blood level must be used. However because the HCV pathogen tends to congeal yin and become toxic, these so-called blood herbs should not be too cold, sticky, or passive. The dictum, zou er bu shou, “move the blood to open the collaterals,” aptly describes the principle of moving without staying.

When the HCV pathogen does not respond to the treatment, it is usually because the illness has entered collaterals, rather than channels. Collateral-opening herbs are then needed to reach this area to clear the pathogen. Millettia reticulata Benth. both nourishes and moves blood, and opens the collaterals, effectivly addressing this situation. Anti-toxin herbs, which can reduce toxic accumulation, move blood and open collaterals, are listed below: Oldenlandia diffusa (Willd.) Roxb., Peonia lactiflora Pall., Rheum palmatum L., Polygonum multiflorum Thunb., Salvia miltiorrhiza Bunge, Peonia suffruticosa Andr., Arnebia euchroa (Royle) Johnst, and Curcuma aromatica Salisb.

One method of bringing the HCV pathogen to the surface in order to reduce its toxicity is to vent heat from yin out to qi. This method is frequently used when treating febrile diseases. The heat can be more easily dispersed, followed from the qi out to the surface. By leading the heat out from its deep position in the body to a more superficial location, it prevents the illness from worsening. This technique should only be used on HCV patients with mild symptoms and no history of IV drug use or blood transfusion. Use small amounts of herbs to assist yang and reduce toxicity in order to bring the pathogen out to the surface.

Chinese herbal medicine: Virus elimination depends on the patient’s immune system. Herbal extracts that help normalize liver function include Acanthpanax gracilistylus W. W. Smith, Epimedium macranthum Morr. Et Decne., Polygonum multiflorum Thunb., and Lonicer japonica Thunb. Taraxacum mongolicum Hand.-Mazz. reinforces the mononuclear-macrophage system. Astragalus membranaceus (Fisch.) Bge., Atractylodes macrocephala Koidz, Scophularia ningpoensis Hemsl. Panax Ginseng C. A. May, Codonopsis Pilosula (Franch.) Nannf., Ganoderma lucidum (Leyss. Ex Fr.) Karst, and Lycium chinense Mill. support the immune system. These herbs facilitate the reparation of injured hepatocytes caused by a dysfunctional immune system. More immunity regulating herbs include Glycyrrhiza uralensis Fisch., Oldenlandia diffusa (Willd.) Roxb., Scutellaria baicalensis Georgi, and Millettia reticulata Benth. can suppress aberrant auto-immunity in chronic active hepatitis.

Another group of herbs exists that effectively reduce liver inflammation and normalize elevated ALT and AST within eight to twelve weeks. These herbs, Schisandra chinensis Baill., Silybum marianum and Cynara scolymus L., Asteraceae, stabilize damaged liver cell membranes, thus reducing the amount of AST and ALT released into the bloodstream. After using these herbs, 75 percent of patients with elevated ALT and AST tested in the normal range and 84 to 94 percent showed reduced ALT and AST results, bringing them closer to the normal range.

By applying a formula consisting of extracts of Schisandra chinensis Baill., Silybum marianum and Cynara scolymus L. as principle ingredient together with Salvia miltiorrhiza Bunge, Ganoderma lucidum (Leyss. Ex Fr.) Karst, and Glycyrrhiza uralensis Fisch., I have experienced a high success rate in normalizing liver function enzymes within three months. To clear jaundice, especially during acute stage of HCV, use an herbal prescription containing Artemisia capillaris Thunb., Gardenis jasminoides Ellis, and Rheum palmatum L.

The liver’s strong ability to regenerate has a strong correlation with the intake of trace elements, such as zinc and strontium. HCV patients using a formula including Schisandra chinensis Baill., Silybum marianum and Cynara scolymus L. show significantly higher percentage of trace elements in the blood and hair than in tests done before taking the herbs. Astragalus membranaceus (Fisch.) Bge., Atractylodes macrocephala Koidz, Codonopsis Pilosula (Franch.) Nannf., Bupleurum chinense DC, and Lycium chinense Mill. also supplement trace minerals.

Herbs of Angelica pubescens Maxim, Salvia miltiorrhiza Bunge, Prunus armeniaca L., and Curcuma aromatica Salisb. effectively break down excess collagen and promote liver cell regeneration. These herbs then can be used to normalize liver function and prevent cirrhosis.

Studies show HCV patients have obvious microcirculation disorders, which include increased abnormal vascular loops and diminished, or completely obstructed, blood flow in capillaries in the liver and in other tissues. Impaired circulation corresponds with the theory of blood stagnation in traditional Chinese medicine, expressed by purplish tongue, dark under-eye circles, enlarged capillaries, body aches, and a choppy pulse. Salvia miltiorrhiza Bunge, Millettia reticulata Benth, Achyranthes bidentata Blume, Ligusticum wallichii Franch, and Panax pseusoginseng Wall. var. notoginseng (Burk) Hoo et Tseng invigorate circulation thereby removing blood stasis.

Dietary changes: Eat a low-protein, low-fat diet. Digesting protein puts an inordinate workload on the liver, so I recommend strongly limiting your intake of concentrated protein foods, such as meat, fish, and diary products. One ounce serving of tofu will give you all the protein you need for the day. Eat plenty of starches, vegetables and fruits.

Nutritional supplements: Take an antioxidant formula. You can help your immune system fight the hepatitis C virus by taking the supplemental formula I recommend to all my patients: 1,000 to 2,000 mg vitamin C at breakfast; 400 to 800 IU vitamin E and 200 mg at lunch; and 1,000 to 2,000 mg vitamin C at dinner.

Strictly avoid all alcohol and tobacco and other poisons. Alcohol is toxic to the liver and can accelerate liver disease, while smoking takes a major toll on the immune system.

Lifestyle changes: Try to avoid all drugs, whether prescribed, over-the-counter, or illegal. All drugs are metabolized by the liver. Even common painkillers such as acetaminophen, when combined with alcohol, have been shown to cause severe liver damage.

Drink plenty of water. Flushing your liver and kidneys with lots of good-quality water will allow your body’s purification system to do its job and take some of the workload of detoxification off of the liver.

Take frequent steam baths or saunas. Sweating helps the body eliminate toxins and also reduces the liver’s workload. Be sure to replace lost fluids by drinking plenty of pure water at the same time.

Get plenty of rest. Give your immune system an edge by cutting down on unnecessary expenditures of energy, while maintaining a gentle exercise regime.

Manage stress. Effectively coping with stress is considered to be a crucial component in managing viral and autoimmune chronic hepatitis. Connect with nature through practicing TAI CHI CHUAN,

APPENDIX:

BLOOD TESTS IN HEPATITIS C

Detection of hepatitis:

ALT (SGPT) / AST (SGOT)
These tests are indicators of the extent of inflammation in liver. In acute hepatitis, the enzyme level in blood can be up to thousand units in chronic hepatitis. Patterns of ALT (single peaks, double peaks and multiple peaks) reflect progress of HC and its prognosis. The pattern of ALT peaking and then gradually reducing indicates remission. If within the first 3 months of the disease, there are more instances of double peaks or multiple peaks of ALT activity, there is a tendency to be chronic.

Alkaline phosphatase/Gamma GTP
These tests are indicators of inflammation in the bile ducts. They can be elevated in hepatitis.
Gamma globulin. It is elevated in hepatitis. The first of these four tests are sometimes referred to as liver function tests.

Detection of `hepatitis C.
RIBA II.
Viral RNA (Measuring hepatitis C virus in the blood. It is more sensitive than RIBA II is.

Tests for functioning of the liver
Protime (PT)
Measuring ability of blood to coagulate. It is elevated when the liver does not synthesize enough of the ingredients that cause blood to coagulate.
Albumin
A serum protein synthesized by the liver. It is low when a damaged liver is not able to keep up with its synthesis.

KEY WORDS:

Du/toxin: a pathogen which has accumulated locally so that its influence is intense"; it has no relation to "dirtiness
Qi: Energy.
Differentiation: an analysis of characteristics of individual patient.

REFERENCES
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Capitalization of organ names refers to organ system classification according to Chinese medical theory, not necessarily to the physical organ.
http://www.cdc.gov/ncidod/diseases/hepatitis/c_training/edu/Intro/default.htm

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