1, antiviral treatment process how to choose proprietary Chinese medicine chronic hepatitis B patient’s own immune status and the degree of hepatitis activity is closely related to different patients with different immune status and pathological stages, its treatment program should not be the same, regular monitoring of the patient’s condition, to make clear that it is in a different stage of the disease process, and then to take targeted treatment. Studies have shown that the high level of replication of hepatitis B virus has a greater correlation with progressive liver disease (cirrhosis, liver cancer), so in recent years, antiviral treatment has received more and more attention both at home and abroad. Patients in the immune-clearance period are the best time for antiviral treatment. It is generally believed that interferon (IFN) should be preferred in the antiviral regimen, and long-acting interferon is currently recommended. Interferon has not only direct antiviral effects but also immune-enhancing effects, but its inability to clear HBV cccDNA, narrower indications, more side effects and higher price, as well as lower efficacy (less than 20-35% of complete response rate) have resulted in a narrower range of clinical applications. Our experience is that in the early stage of interferon application (1-8 weeks), oral Qingkailing Oral Liquid is used to clear the camps and cool the blood and detoxify the toxins, Xiaochaihu Chongzhi is used to resolve the Shaoyang, and both can reduce the side effects of interferon, such as fever and gastrointestinal symptoms. If the patient has symptoms of yin deficiency such as fatigue, lumbago and leg weakness, tinnitus, dry eyes, dry mouth, etc., Zhi Bai Di Huang Wan, Liu Wei Di Huang Wan or Qi Ju Di Huang Wan can be used to clear the liver and nourish the kidneys. Studies have shown [2] that Liufei Di Huang Wan has liver protection, two-way immunomodulation, delay aging, anti-tumor and other effects, and has been used as an effective adjuvant drug after tumor radiotherapy, and for the liver disease clinic, liver and kidney yin deficiency is a common pattern that will inevitably appear with the prolongation of the age and course of the disease, so this is the main with the spleen, liver, blood-activating drugs, it is hoped to make the condition of the patients with liver disease tends to be stabilized and reduce the chances of recurrence. Chance of relapse. If jaundice occurs in hepatitis, or there is a tendency of severe hepatitis, or it has been accompanied by cirrhosis, etc., it is not suitable to choose the application of interferon, and the “Guidelines” suggests the use of nucleoside (acid) antiviral drugs, which inhibit the role of viral replication is significant, and it can make the HBV-DNA have a high rate of negative, but a long course of treatment is prone to cause viral mutation or drug resistance, and the conversion rate of the e-antigen is low (it is also difficult to exceed 40% after 3 years of treatment), and it will relapse or be discontinued. However, the long course of treatment may cause viral mutation or resistance, and the e antigen conversion rate is low (even after 3 years of treatment, it is difficult to exceed 40%). Therefore, we combined the use of Chinese patent medicines, either to strengthen the spleen and vital energy, or to nourish the liver and kidneys, or to clear heat and remove toxins and eliminate dampness, or to cool the blood and eliminate blood stasis, to support the positive while eliminating the evil, such as replenishing the middle-energy pill, the quaking spleen pill, the di Huang pill, the wuji baifeng pill, the Jin Shui Bao and so on, and those who have dampness and heat can be added with the patchouli pill and the bitter ginseng to help increase the efficacy of the antiviral therapy. The value of the long-term effects of these combined treatments deserves further study. For those who have HBV replication index and ALT is normal or low level fluctuation, or those who have hidden chronic hepatitis B or HBeAg-negative chronic hepatitis B with poor effect of antiviral therapy, or those who have failed antiviral therapy or relapsed, or those who have limited economic conditions, or those who have other contraindications to antiviral therapy, there are a considerable number of patients with chronic hepatitis whose conditions cannot be effectively controlled, which further cause liver fibrosis. The condition of a considerable number of chronic hepatitis patients cannot be effectively controlled, which further causes liver fibrous tissue proliferation, cirrhosis and cancer. Reasonable hepatoprotective and antifibrotic treatments for these patients are still of great significance. 2.1 Proprietary Chinese medicines with single active ingredient as the main ingredient and with the effect of liver-protecting and enzyme-lowering are suitable for patients with chronic hepatitis B and cirrhosis, patients with contraindications to antiviral drugs, patients who are not suitable for antiviral therapy, or those who are ineffective in antiviral therapy or those who have abnormalities of liver function and need to be combined with liver-protecting therapy in the course of antiviral therapy. At present, there are many varieties of hepatoprotective drugs in clinical application around the world, and it is known that these drugs do not have many side effects, and most of them have the comprehensive effects of hepatoprotection, enzyme lowering, yellowing, anti-inflammation, anti-fibrosis and so on, which are the main varieties of clinical application in liver disease at present, but all of them have the problems of rebound after stopping the drugs in varying degrees, which need to be confirmed by strict double-blind, randomized, controlled trials to confirm the efficacy of these drugs. There are many varieties of these drugs, but the main components and mechanisms of action are similar, we believe that it is not advisable to use the same type of pCms with similar composition to be applied to the same patient at the same time. The representative of this kind of drugs are as follows: 2.1.1 Glycyrrhiza glabra extract Glycyrrhiza glabra sweetener is the main component in the traditional Chinese medicine Glycyrrhiza glabra, and glycyrrhiza glabra hypoglycolic acid is the main active part of the drug, which has the effects of anti-inflammation, anti-allergy, protection of the stability of the hepatocyte cell membranes, immunomodulation, antiviral and antitumor effects, etc. [3]. In recent years, studies at home and abroad have shown that this drug: ① reduces liver injury by blocking the production of various cytokines caused by NF-kB activation. ② Potential for use in anti-hepatic fibrosis treatment. ③ Long-term clinical studies have found that long-term use in chronic hepatitis patients, with the goal of maintaining normal liver function, can significantly reduce the incidence of cirrhosis and hepatocellular carcinoma. The main drugs in this class are Qianglianin injection (licorice sweetener), Ganlixin injection (capsule), and Menexin injection (capsule). This kind of drugs through the inhibition of inflammatory reaction to achieve the effect of yellowing, lowering the enzyme, the clinical has been applied for many years, the efficacy is accurate. However, the aminotransferases are prone to rebound when the drug is stopped too quickly, so it should be gradually reduced to stop the drug to prevent rebound, or used in combination with immunomodulators and antiviral drugs. 2.1.2 Schisandra chinensis extract Schisandra chinensis mainly contains schisandra chinensis C, A, B, Schisandra chinensis alcohol A and so on. There are many kinds of proprietary Chinese medicines with Schisandra chinensis as the main ingredient, such as biphenyl bilobal drops, five ester capsule, baiseno tablets, compound liver spirit tablets, liver plus Xin tablets, liver protection tablets and so on. These medicines are effective in lowering AST with fast decrease, but less effective in AST. Most of them think that biphenyl bilipid drop pills have significant effect in lowering gammaglutaminase, but their effect on gammaglutaminase and hepatoprotection is weaker, so they should not be abused. Compound liver spirit tablets, liver plus Xin tablets, liver protection tablets containing Schisandra chinensis compound Chinese patent medicine has a certain hepatocyte injury antagonism, which is conducive to promoting hepatic glycogenesis and protein synthesis and metabolism, and is conducive to the recovery of hepatocyte function. Chinese medicine believes that schizandra is acidic, easy to stagnate dampness and astringent evil, jaundice or dampness-heat symptoms are obvious people should not be selected, the simple transaminase elevation should be used for a long time, or with other treatments, to reduce the chances of rebound. 2.1.3 Others: Yi Liver Spirit Tablets, Compound Yi Liver Spirit Tablets, Cilipinamide Tablets, etc. contain silymarin. This kind of Chinese patent medicine has a stabilizing effect on cell membrane structure and cell metabolism, which can counteract hepatocellular necrosis, reduce steatosis and inhibit transaminase elevation [5]. It is suitable for patients whose transaminases hover around 100U /L. Among them, Compound Liver Ling Tablet contains both silymarin and pentosanol, which has relatively good enzyme-lowering effect. The main raw material of the pituitary herb, pituitary flush, has a better effect of lowering ghrelin transaminase [6], which has the effect of clearing away heat, inducing diuresis, detoxifying and eliminating yellowness, etc. The increase of clinical dose seldom causes side effects, and it can be used in patients with liver injury accompanied by jaundice. Above several types of enzyme-lowering drugs, Schisandra preparations are typical of treating the symptoms but not the root cause, if the combination of immune diseases, the first licorice preparations, inhibit the inflammatory response, prevention and treatment of hepatic fibrosis, etc., especially preferred. 2.2 has clear heat and promote dampness, retreat yellow effect of Chinese patent medicine chronic liver disease liver and gallbladder damp-heat or spleen and stomach damp-heat evidence very much, clear heat and promote dampness method is acute and chronic hepatitis one of the most important treatments. Such as Yin gardenia yellow, bitter yellow injection, liver su punch, double tiger clear liver particles, li hepatic long punch, hepatitis b punch, clear liver and bile tablets, choling tablets and so on, most of these medicines contain Yin Chen, gardenia, scutellaria baicalensis, rhubarb, silver flower, tulip and other traditional Chinese medicines, all have certain effect of retreating yellow, lowering enzyme, preserving the liver and strengthening the spleen. Other drugs such as compound danshen injection, hemosiderin injection, chuanxiongxizine injection, shandan injection, etc. can also play a certain role in reducing yellowness by activating blood circulation and removing blood stasis, improving hepatic microcirculation, and unblocking the tiny capillary bile ducts, and can be applied to the people who have silt and gallbladder-type hepatitis or whose jaundice is prolonged and does not go away. 2.3 Proprietary Chinese medicines with different degrees of virus inhibition In addition to certain hepatoprotective, choleretic and yellowness-reducing effects, these proprietary Chinese medicines also inhibit viral replication. Therefore, they can be used in combination with western antiviral drugs, and are expected to have synergistic effects to enhance their efficacy. Currently, there are two categories with the most research reports: one is Picrasin, which contains bitter bean seed extract-oxidized Picrasinine [7]. This drug is currently recognized as the first choice of antiviral proprietary Chinese medicine, can effectively inhibit viral replication, so that the serum indicators of viral infection partially or completely eliminated, but also anti-fibrotic, ascending leukocytes, regulating immune function, with small side effects, suitable for almost all HBV -DNA-positive patients; the second category is the leaves containing the leaves under the bead of the bead tablets, leaves under the bead of the bead of the bead of Chinese medicine, which is a single antiviral efficacy of the Chinese medicine is relatively good, in which Gallic acid is the main active substance with antiviral effects. However, the results reported in multi-center clinical trials are not consistent and deserve further study. 2.4 Proprietary Chinese medicines with holistic and immunomodulatory effects Immunomodulatory therapy is one of the important means of chronic hepatitis B treatment, which is one of the hotspots of current research. However, there is still a lack of hepatitis B-specific immunotherapy. Chinese polysaccharides have various functions such as immunomodulation, antitumor, anti-inflammatory, antiviral, antioxidant, antiradiation, hypoglycemic, hypolipidemic, hepatoprotective, etc., of which immunomodulatory activity and antitumor effects have attracted much attention [8]. Such as poria mushroom polysaccharide treatment of chronic hepatitis B HBeAg conversion rate of about 20% ~ 30%. Others include Yunzhi polysaccharide and Yunzhi Hepatite Punch. However, the most clinically adopted preparation is Cordyceps sinensis related preparation, such as Jinshui Bao oral has the effect of enhancing immunity and preventing organ fibrosis, widely used in the treatment of liver fibrosis and renal fibrosis. According to the theory of Chinese medicine, proprietary Chinese medicines can be chosen for overall conditioning and gradual stabilization of the condition, including hepatitis B carriers, after the cessation of antiviral treatment, and various other conditions. These proprietary Chinese medicines include both classical Chinese medicine prescriptions and effective empirical prescriptions developed by modern Chinese medicine practitioners, the latter generally have clinical and pharmacological evidence of liver disease, and should be selected under the principle of diagnosis and treatment. For example, for those who are weak and tired, have little breath and lazy speech, dizziness and dizziness, qi deficiency can be used to replenish qi with Astragalus Extract Oral Liquid, tonifying the middle and benefiting qi pills; for those who are not in tune with the spleen and liver, Easy Pill can be used; for those who are cold and have cold limbs, depressed and have loose stools, yang deficiency can be used to replenish yang with Compound Xuanjiu Oral Liquid, Chaoyang Pill, etc.; for those who are thin and weak, have night sweating, have a dry mouth and dry pharynx, yin deficiency can be used to replenish yin with Liuweidi Huangwan, or Liver B Yinyin and Blood Enhancing Punch; for those who are cold and have yang deficiency, Golden Kidney Pills can be used. For those with yang deficiency, Jin Gui Ren Qi Pills are used; for those with deficiency heat, Zhi Bao Bai Di Huang Wan is used; and for those with positive deficiency and evil fetish, Yi Liver Punch and Detoxifying Liver Punch are used. This kind of drugs is characterized by precise and gentle action, and can be used for a long time without side effects on the basis of correct diagnosis. 2.5 Proprietary Chinese medicines for preventing and treating liver fibrosis Early liver fibrosis is reversible, antiviral treatment is the basis of antifibrotic treatment, and supplemented with Chinese medicines, it can get better curative effect, such as Salvia divinorum, Cordyceps Sinensis, Momordica charantiae, Han Fangji, Licorice and other single medicines, as well as Compound turtle shell soft liver tablets, Fuzheng Huayu Capsules, Rheumatoid Vworm Pill, and Compound 861 etc., all of them are proved to have definite anti-hepatic fibrosis effect, which is recognized by experts in liver diseases at home and abroad. All of them have been proved to have definite anti-hepatic fibrosis effects, which have been recognized by liver disease experts at home and abroad, and they are the most promising drugs in the field of liver disease in Chinese medicine in the future. Among them, Compound Tetramethylene Soft Liver Tablet is the first new drug for treating liver fibrosis and liver cirrhosis in China. The whole formula has the functions of softening and dispersing knots, resolving blood stasis and detoxification, and benefiting qi and nourishing blood, and it can be used for chronic hepatitis liver fibrosis and early cirrhosis with the evidence of stasis and blood stasis, qi and blood deficiency, as well as the evidence of non-exhaustion of heat and poison, The disease mechanism is characterized by deficiency of positive blood and blood stasis, dampness, heat and toxin not yet exhausted. There are similar drugs such as rhubarb stinging insect pill, turtle shell decoction pill, etc. Fuzheng Huayu capsule is composed of danshen, peach kernel, wormwood, schizandra, etc., which is mainly used to support the correctness and eliminate the stasis of the blood, and can be used for chronic hepatitis liver fibrosis, cirrhosis of the liver, jaundice is not deep, and so on. 3.Conclusion From the current clinical application of pCms in liver disease and feedback from pharmacies, there are the following problems: ① There are many varieties containing the same or similar components of traditional Chinese medicines, with varying quality and efficacy, which causes difficulties for clinicians to choose. ② part of the role of the compound ingredients are not clear, most do not indicate the characteristics, indications and contraindications, etc., the specific dosage and duration of treatment is difficult to grasp; ③ part of the drug does not contain antiviral effect, but the manufacturers of product introduction and publicity arbitrarily add the word with a “conversion”, or even contain “so-and-so factors However, some of the drugs do not contain antiviral effects, but manufacturers arbitrarily add the words “turn negative” or even “so-and-so factor” in the product introduction and publicity, which seriously misleads doctors and patients to objectively evaluate the effects of pCms. Like other types of pCms, there is a lack of long-term tracking studies on pCms for liver disease, with unknown evidence of long-term efficacy, not to mention a lack of large-sample, randomized, controlled clinical trials, so the credibility of the efficacy is greatly reduced and is worth reflecting on. ⑤ The selection of proprietary Chinese medicines should be combined with the diagnosis and treatment, there is the evidence to use is the drug, and the drug does not have to be all labeled for liver disease of proprietary medicines, many classic proprietary Chinese medicines have good and accurate clinical efficacy, should not be ignored. Finally, it should be clear that the role of traditional Chinese medicine is characterized by overall regulation, never single-target effect, so, combined with the constitution, condition, diagnosis and treatment, adherence to the use of medication, flexible combination of choices, is the best strategy!