Usually we think that “big three yang” patients have more virus in their bodies and are more contagious, while “small three yang” patients have less virus in their bodies and are less contagious, so some people feel that “big three yang” is serious and “small three yang” is fine. “This is actually a misconception. Some patients with “small threeyang” have a low viral load and no or little liver inflammation (as assessed by ALT or liver histopathology), so their condition is stable and does not require treatment. However, in some cases, the viral load is maintained at a high level and the inflammation in the liver is heavy, which requires active antiviral treatment. Although the viral replication of patients with “small triple-positive” is not as high as that of patients with “large triple-positive” and the transaminases are often mildly abnormal, most of them are older and have previous inflammation of the liver, which can easily develop into cirrhosis or liver cancer when liver damage occurs again. Therefore, we should not judge the severity of the disease by the “major triplet” or “minor triplet” alone, but in combination with other test results such as liver function and hepatitis B virus DNA.