Cirrhosis is a common disease in gastroenterology and accounts for a large proportion of gastroenterology inpatients. In China, the main treatment for cirrhosis is still drugs. However, it should be clear that the main target of gastroenterology treatment for cirrhosis is a wide variety of complications, the most important of which are upper gastrointestinal bleeding, hepatic encephalopathy, ascites, and disorders of electrolyte acid-base balance. It is more appropriate to call it treatment, but actually it is more appropriate to call it resuscitation, because for patients with decompensated cirrhosis, all these complications may take the patient’s life in a short period of time, and even if they pass the dangerous period of complications, most patients with cirrhosis do not live too long, and occasionally there are patients with cirrhosis who have died for more than twenty years from diagnosis, and I have seen a few, but the diagnosis of cirrhosis in these patients is often in doubt. Patients with cirrhosis are like walking down a path with a known, bumpy end. Some are able to walk the not-so-long distance, while others accidentally fall down in potholes and never get up again. The internist, or the various drugs and interventions for the complications of cirrhosis, is merely helping the patient to climb out of the potholes or try to avoid the rough spots. The only way to be able to set the endpoint to resemble a normal person is probably a liver transplant at this point. Nevertheless, when a patient with cirrhosis comes in, we still have to give him the drugs that “treat” cirrhosis. Especially in China, there is a wide variety of drugs for the so-called treatment of cirrhosis. They can be broadly divided into these categories: First, antiviral drugs. Because most cirrhosis in China is post-hepatitis B cirrhosis, antiviral treatment is mainly for the hepatitis B virus. Because most hepatitis B patients in China are assigned to infection or hepatology departments for treatment, as gastroenterologists are rarely exposed to the problem of hepatitis B virus treatment. There is not much experience in this area either. Besides interferon, there are many nucleoside analogues available. Interferons are not available in Chinese and foreign guidelines for patients with cirrhosis. Therefore, the vast majority of antiviral drugs used in patients with cirrhosis are nucleoside analogues, such as lamivudine, entecavir, adefovir, and so on. Since these drugs are relatively new to the market, clinical use is less than a decade old. The earliest lamivudine was approved for marketing in China in 1999, and although most clinical trial reports at home and abroad support their use, it should not be forgotten that these clinical trials are sponsored by the manufacturers. The author did see significant results with lamivudine, but never personally did a large sample of randomized controlled trials. And there is no definitive answer to the problem of resistance to these drugs, or to the problem of taking a course of treatment. The most important point is that antiviral drugs can only slow the destruction of the liver, but they cannot reverse cirrhosis. Two examples to help people understand this are the example of scars that I often give to patients. Small wounds on the skin can disappear completely, but in the case of severe wounds, the resulting scars are unlikely to dissipate. Another one is an old director’s explanation to his patients: If it is a slightly dehydrated apple, you may still be able to save it by taking some measures in a hurry, but if it is an apple that has dried up, it is impossible to make it recover by any method. The second category, drugs belonging to the treatment of complications of cirrhosis, according to my understanding belongs to the emergency drugs. For example, diuretics to help reduce ascites in patients with cirrhosis, vasoconstrictors to treat upper gastrointestinal bleeding, drugs to treat hepatic encephalopathy, etc. These drugs are both cheap and expensive, and have been used for a long time and are just starting to be promoted. The treatment of acute upper gastrointestinal bleeding is safe and effective as long as the indications are strictly controlled and the drugs are used to reduce ascites. Of course, it is not possible for all patients to be effective, for example, some patients with ascites are useless even if they use diuretics to the maximum amount and a combination of diuretics. As for the most common and alarming upper gastrointestinal bleeding, there are cheap and expensive drug treatments. The classic one is posterior pituitary gland, which is so cheap that even the self-paying poor can afford it and the effect is remarkable, but occasionally has some drawbacks because this drug works by acting on the blood vessels to make them constrict and thus stop bleeding, but because of its poor specificity, it acts not only on the blood vessels of the gastrointestinal tract where the doctor wants it to work, but also on the peripheral and cardiac vessels, so patients with coronary heart disease In patients with coronary artery disease or potential coronary artery disease, its use may induce myocardial infarction. In addition, it can promote the peristalsis of the gastrointestinal tract, so a considerable number of patients will keep excreting loose stools, accompanied by abdominal pain, which is more painful. The last point is that the dose adjustment of posterior pituitary hormone is quite troublesome and needs to be increased and decreased slowly, because the concentration of posterior pituitary hormone for the treatment of gastrointestinal bleeding is relatively high in the drip, and the volume per minute is relatively low, which is called “high concentration, low dose”. stopwatch to adjust. At present, many hospitals in China and abroad mostly use growth inhibitors and their analogues to treat upper gastrointestinal bleeding caused by portal hypertension in patients with cirrhosis. Its mechanism of action is also to stop bleeding by constricting the visceral blood vessels and inhibiting the peristalsis of the gastrointestinal tract, but it has fewer side effects compared to the specific site of action of posterior pituitary hormone. The application of albumin should be mentioned here. In the past and nowadays, many doctors consider hypoalbuminemia and portal hypertension as the two main causes of ascites in cirrhosis, so for ascites patients with severe hypoproteinemia, the application of diuretics along with active albumin supplementation is considered as a routine treatment. However, studies in recent years have concluded that there is no conclusive evidence for this claim. Because of the high price of albumin and the fact that it is extracted from human blood, coupled with the Chinese culture of tonicity, albumin was once considered to be a great tonic. Even some doctors think that albumin is the so-called great tonic. In fact, the main role of albumin is to maintain the body’s colloid osmotic pressure to regulate the balance of fluid inside and outside the blood vessels, in his main physiological role, there is no so-called nutritional value. Many patients with cirrhosis are accompanied by hypoproteinemia due to the decreased synthetic capacity of the liver. Therefore, in patients with cirrhosis, especially those with ascites, albumin supplementation has been a classic part of textbooks. However, in the guidelines for the treatment of ascites in cirrhosis published in 2006 in Gut, a leading international journal of gastroenterology, there is not a single word about the application of albumin, and there are two main mechanisms for the formation of ascites in cirrhosis: portal hypertension and water-sodium retention. The Internal Medicine before the seventh edition had been portal hypertension and hypoproteinemia, and the seventh edition changed to decreased colloid osmotic pressure, but the main meaning is still hypoproteinemia. Perhaps this is still an issue that is in controversy. However, if we want domestic doctors to change the usual thinking of supplementing albumin in cirrhotic ascites, it is not only a question of professional knowledge, but also, I am afraid, a consideration of domestic medical ethics. How to convince a patient who has been seen repeatedly and has been sick for a long time that the expensive albumin that most people use and that he used to use regularly may actually be ineffective is difficult for both the patient and the patient to accept. I am afraid that even the textbook writers also feel difficult. The third category, numerous so-called liver-protective and anti-liver fibrosis drugs. Whether it is the regular intravenous medication in Chinese hospitals or the oral medication in outpatient clinics, the so-called liver-protective drugs are the dosage and cost of a huge amount of drugs. Doctors prescribe them every day, patients take them every day, and no one thinks there is anything wrong with them. Even the patient will take the initiative to ask the doctor if he can give some additional liver-protective drugs. There are so-called western drugs, Chinese herbs and proprietary Chinese medicines, very cheap general category A drugs, slightly more expensive medical insurance category B drugs, and many very expensive self-pay drugs. Regardless of the type of drug, one thing is clear: none of them have been proven to be effective in rigorous randomized, controlled, double-blind tests to date. Some of the more rigorous trials have found that these so-called liver-protective drugs do not help at least to prolong the survival of patients with cirrhosis. There have been a number of papers published in China claiming that certain liver-protective drugs are effective, but many of the authors of these papers are the developers and producers of the drugs they declare effective, or are funded by the developers and producers to conduct the so-called studies. A careful reading of these papers reveals that many of them do not follow the principle of randomized control at all, the conditions of the trial and control groups are not comparable (in most cases the trial group is less severe, so that the natural treatment effect seems to be better than the control group), and the observed indicators are either subjective feelings of the patients or tests with poor specificity, sensitivity and reproducibility. Few internationally recognized indicators of high value such as survival, mortality, disability, and pathological changes have been observed. In particular, some articles in professional TCM journals often come out with a cure rate in a muddled manner, probably because TCM has its own interpretation of the medical term cure. I once came across a TCM practitioner online who implied that he was superior to Western medicine, and his understanding of cure was that the patient felt better on his own. The so-called anti-fibrotic drugs are still basically at the stage of catching the wind and catching the light. At present, the observation indicators of many so-called anti-fibrotic treatments are the molecules related to fibrin metabolism in the serum, and the correlation between the serum concentration of these molecules and the actual liver fibrosis cannot be confirmed yet.