Liver cirrhosis treatment ideas and cases

  I became a national disciple of Mr. Guan Youbo, a famous expert in Chinese medicine and a leading expert in liver disease, in 1997. During the years of clinical study under the teacher, Mr. Guan Youbo taught me by example and taught me by heart, and I learned a lot from him and was diligent in clinical practice. The treatment of chronic hepatitis is one of the most important aspects of Guan’s clinical practice. Chronic hepatitis treatment is Guan’s clinical specialty and his main topic, and his treatment of liver cirrhosis is even more effective. Here are my thoughts and experiences on the treatment of liver cirrhosis through the process of learning from my teacher, clinical practice and research.  Guan Lao believes that chronic hepatitis and cirrhosis is a disease of the blood, and the basic pathogenesis is positive deficiency and evil love, qi deficiency and blood stagnation. The basic pathogenesis of chronic hepatitis cirrhosis is the deficiency of Qi and blood, and the basic pathogenesis is the deficiency of Qi and blood. The deficiency of Qi is caused by the deficiency of spleen qi throughout the whole course of the disease, so the support of the positive emphasizes on nourishing the spleen qi to restore the source of Qi and blood biochemistry. We summarized the experience of Guan Lao’s academic thought and combined with clinical practice experience, we established the basic legislation of benefiting Qi, invigorating Blood, resolving phlegm and resolving phlegm, and used 30g of raw Astragalus, 10g of Huang Jing, 10g of White Peony, 10g of Xia Ku Cao, 10g of Orange Red, 15g of Cao He Che, 20g of Xiao Ji, 20g of Ze Lan as the basic formula, and conducted clinical research and observation on chronic hepatitis C cirrhosis. The results showed that it could significantly improve clinical symptoms, improve quality of life, restore liver function and significantly alleviate the degree of liver fibrosis. After that, animal experimental studies on the preventive and therapeutic effects of dimethylnitrosamine (DMN)-induced liver fibrosis in rats were conducted. The results suggested that both prophylactic and therapeutic administration of Yi Qi detoxification and blood circulation formula could inhibit collagen proliferation and suppress the formation and development of liver fibrosis. The conclusion of the study proved the effectiveness of the basic legislation of treating liver cirrhosis by benefiting Qi, detoxifying Blood, and resolving phlegm, and scientifically verified the correctness of exploring the etiology of chronic hepatitis and liver cirrhosis and establishing the therapeutic rules from the ideas of Qi and Blood identification, phlegm and stasis theory and complex disease.  Through continuous clinical practice and research, my theoretical and clinical level of liver disease has been continuously improved, and my understanding and experience of the diagnosis and treatment of chronic viral hepatitis has been gradually improved, and the efficacy of treatment has been further improved on the basis of my predecessors, forming my own unique insights. I propose to explore the etiology and pathogenesis of chronic hepatitis from the perspective of the theory of luo disease, based on the universality of the theory of luo disease and the specificity of the relationship between liver disease and liver luo. It is believed that chronic liver disease is based on the basis of liver ligament disease in which the evil and toxicity are caused by Qi and blood, and the deficiency causes stasis, and the phlegm and stasis evil and toxicity are intertwined and stay in the ligament. When the phlegm and stasis evils turn into toxins over time, they damage the liver ligaments, and when the liver ligaments are out of order, qi, blood and fluids cannot be transmitted and passed through, the liver body loses nourishment, gradually withers and becomes hard, forming early liver fibrosis and eventually developing into liver cirrhosis. The deficiency, stasis, phlegm and toxicity of liver ligaments are the common etiology of chronic hepatitis cirrhosis and the result of basic pathological changes, which determines the basic treatment principle of supporting the righteousness, activating blood, detoxifying phlegm and opening the ligaments. Qi is the prime mover of the internal organs, outreach to the limbs and joints, through the upper and lower surfaces, circulating Qi, blood and fluids, and infiltrating the tissue function of the internal organs, the deficiency of the luo is focused on the benefit of Qi, often using raw Astragalus; the location of the disease in the liver luo, phlegm, stagnation and toxicity blockage, dispel the evil focus on the blood to open the luo, commonly used to activate the blood, cool the blood, dissolve phlegm and disperse nodules, dampness and detoxification of drugs, with a small amount of whole worms or centipede, chicken blood vine, etc. to open the luo. In the case of the main evidence, the treatment methods are often flexible, such as benefitting the Qi and nourishing the Blood, strengthening the Spleen and soothing the Liver, nourishing the Liver and Kidney, strengthening the Spleen and tonifying the Kidney, benefiting the Qi and invigorating the Blood to resolve phlegm, clearing heat and dampness to detoxify, and softening and dispersing nodules. At present, the clinical efficacy of TCM for chronic hepatitis and cirrhosis needs to be further improved, and the treatment is guided by exploring the etiology and pathogenesis of the disease from the theory of complex disease, looking for commonalities and exploring new entry points for treatment, which effectively improves the clinical efficacy.  Case example: Zhang Moumou, male, 48 years old, from Tongzhou, Beijing. Date of consultation: June 28, 1999 Complaint: weakness, poor appetite for more than one year, aggravated for three months, with abdominal distension and little yellow urine.  The patient had no clear history of liver disease in the past. One year ago, he developed fatigue and weakness without any obvious cause, and was unable to eat or drink, sometimes accompanied by leg swelling. He was diagnosed with chronic hepatitis B cirrhosis at Ditan Hospital. He was treated with a variety of Chinese and Western medicines with poor results. Recently, his symptoms worsened three months ago, with severe fatigue, shortness of breath when moving, abdominal distension as large as a drum, stomach blockage and inability to eat, yellow and red urine in small amounts, blood in the nose and teeth, and swelling of both lower limbs. He had been treated in several hospitals in and outside the city without any improvement, and was referred to the clinic. Physical examination: yellow sclera, scattered spider nevus, liver palm, 4CM below the spleen ribs, and swelling of both lower limbs. The tongue is dark, with yellowish white thick and greasy coating, and the veins under the tongue are purple and dark and varicose. The pulse is thin and stringent. Laboratory tests: ALT:123U/L, AST:205U/L, ALB:30.7g/L, TP:75.6g/L, TBIL:74.9umol/L, R1:58.6%, PlT:71G/L. Ultrasound: cirrhosis, splenomegaly, portal hypertension, moderate amount of ascites. The evidence belongs to Qi deficiency and blood stagnation, phlegm stasis and ligament obstruction, and water-dampness non-transportation. The treatment is to benefit the Qi, invigorate the blood and promote the flow of water. After one week, the ascites subsided, food intake increased, and jaundice subsided slightly. The liver function returned to normal after four months. After continuing treatment for three months, the spider nevus and liver palm subsided, the diameter of portal vein and splenic vein was normal, and the platelet was greater than 100 G/L. The patient was treated with strengthening the spleen, tonifying the kidney, benefiting the qi and nourishing the blood, and activating the blood circulation. One year later, the patient was already engaged in moderate field work and has been followed up for seven years, and his condition has been stable.