March 18 is our Liver Care Day. When I was trying to think of something to write about this day, two outpatients visited me and opened my mind. The first patient, surnamed Zhang, had a history of hepatitis B for more than 10 years, and his liver function had been normal for many years, but after an ultrasound test last year, he was diagnosed with “cirrhosis”. He was worried because his mother and sister had both died of cirrhosis. He took out a Fibro Scan report and pointed to “8.4 Kpa” and asked me if it was indicative of cirrhosis. The second patient was Mr. Pei, who had lived in the United States for many years. He was diagnosed with early cirrhosis by liver puncture in the United States in 2002, and had been taking tenofovir anti-hepatitis B virus treatment for the past two years. However, the American doctor only advised him to pay attention to nutrition and rest, and thought that there was no medicine available to treat cirrhosis. This time when he returned to Shanghai to visit his family, he learned that there are anti-liver fibrosis drugs in China, so he came to seek medical advice. However, his question was, if he received anti-fibrotic treatment, would he still need to undergo liver aspiration to observe the efficacy? The concerns of these two patients can actually be summarized as follows: 1) How to diagnose cirrhosis and 2) How to evaluate the efficacy of anti-fibrotic therapy? The diagnosis of cirrhosis is still mainly based on the pathological examination of liver aspiration combined with the patient’s medical history and clinical manifestations. Patients with cirrhosis usually have a history of chronic hepatitis for many years (but sometimes they are ignored because the manifestations are not obvious); clinical manifestations of abnormal liver function such as jaundice and low albumin content; signs of portal hypertension such as spider nevus, liver palm, splenomegaly and esophageal varices; and liver pathological examination showing fibrosis at stage 4 (S4). The clinical diagnosis of cirrhosis is easier if complications such as ascites, vomiting blood and black stools, and hepatic coma are present. However, early cirrhosis lacks specific symptoms or is asymptomatic, making it difficult to make a definitive diagnosis. It is not yet possible to discern the degree of liver fibrosis by conventional imaging tests such as ultrasonography, CT and MRI, thus making the diagnosis of early cirrhosis difficult. The so-called four indicators of fibrosis serology, such as hyaluronic acid (HA), are meaningful for determining whether fibrosis is active (fiber formation or fiber degradation), but they also do not reflect the actual degree of fibrosis in the liver. The liver fibrosis scanner, introduced from abroad in recent years, emits low frequency and low amplitude (50Hz, 2mm) elastic waves by vibrating a probe placed on the skin of the liver area, which enters the body and propagates through the tissues, while the ultrasound transducer on the probe performs continuous ultrasound acquisition to track the propagation of the elastic waves and measure their speed, and uses specific algorithms to convert the rate into a hardness value, thereby The degree of liver fibrosis is diagnosed and can partially replace liver puncture for the diagnosis of cirrhosis. If the hardness value is below the value of 5 Kpa, the liver is mostly normal; 15 Kpa in hepatitis B patients and 17 Kpa or more in hepatitis C patients are generally considered to have cirrhosis; values between normal and sclerotic livers are mostly suggestive of liver fibrosis. The first patient mentioned above had normal liver function for many years, no clinical symptoms, liver fibrosis scan result of 8.4 Kpa, and imaging showed no splenomegaly, so it did not meet the diagnostic points of cirrhosis, and might still be in the pre-cirrhotic stage, i.e. liver fibrosis. Cirrhosis is developed from liver fibrosis. The basic treatment for cirrhosis should be anti-fibrosis (inhibit formation and promote dissipation). Since the pathogenesis of liver fibrosis is quite complex, developed countries have devoted decades of efforts, but have not been able to find effective chemical drugs against liver fibrosis and biological drugs that can be used clinically. Our researchers have tapped into the treasury of Chinese medicine and have developed several anti-liver fibrosis Chinese medicines in the past decade or so, which are widely used in clinical practice with national approval. Our research results have gained the attention of the international medical community and are expected to go global. With the wide clinical application of anti-liver fibrosis drugs, it brings the problem of how to judge the efficacy. In smaller-scale clinical trials, the efficacy can be judged by comparing the changes in the degree of liver fibrosis by means of liver puncture before and after treatment. In the case of large-scale clinical applications, such an invasive periodic examination cannot be promoted. How to solve this problem? The liver fibrosis scanner is non-invasive and painless, easily accepted by patients, and suitable for repeat examinations to assess the efficacy of liver fibrosis. We have applied the liver fibrosis scanner to evaluate the anti-liver fibrosis efficacy of more than 100 outpatients with liver fibrosis and cirrhosis in our hospital after taking Fu Zheng Hua Yu capsules for 1 year. A decrease in liver stiffness values was found in 59.7% of patients, which is close to the results of a clinical trial we concluded late last year. In that trial, patients with early stage cirrhosis were treated with Fu Zheng Hua Yu Tablets for 1 year, and liver puncture examinations before and after treatment showed that 66.7% of patients had varying degrees of reduction in liver fibrosis. The reduction in the degree of liver fibrosis indicated that cirrhosis had been reversed. The rate of change in liver stiffness values detected by the liver fibrosis scanner was similar to that of liver puncture pathology, suggesting that the liver fibrosis scanner can be used instead of liver puncture to assess the efficacy of anti-liver fibrosis. The reduction in the degree of liver fibrosis is also closely related to the patient’s perception and repair of liver function. Patients with reversal of liver fibrosis as shown by the liver fibrosis scanner mostly feel as normal without significant discomfort, and liver function tests also show a trend towards normalization. The largest reversal so far has been from 66 Kpa before treatment to 29.4 Kpa one year after treatment, which is still cirrhosis, but to a lesser extent. There are several patients who no longer need treatment or are on consolidation therapy because their liver stiffness values have fallen below 5 Kpa. In view of our practical experience mentioned above, I asked the second patient to undergo a liver fibrosis scanner and suggested him to take Fuzheng Huayu tablets against liver fibrosis for a long time along with anti-hepatitis B virus. I hoped that he would come back to our hospital in 1 year when he returned to Shanghai to visit his family to review his treatment with the liver fibrosis scanner to assess the efficacy. He gladly accepted. On this National Liver Care Day, I urge all readers to love and protect the liver so that the tree of life will always be green. Patients with chronic liver disease should be checked regularly and treated aggressively to prevent liver fibrosis from progressing to cirrhosis. At present, cirrhosis is no longer an incurable disease, early cirrhosis patients should have confidence that the development of the disease can be stopped or even reversed through anti-fibrosis treatment.