(a) Dietary principles for patients with liver disease Patients with liver disease have metabolic dysfunction of the liver, abnormal bile synthesis and excretion, and decreased digestive and absorption functions of the gastrointestinal tract. In addition, the liver is an important place for detoxification and transformation of toxins inside and outside the body, and these functions are reduced to varying degrees in liver disease. Therefore, the diet of patients with liver disease should follow the following principles: (1) The composition of nutrients provided is reasonable, and the intake should meet the body’s needs, but not over-nutrition; (2) The composition of nutrients should be conducive to liver cell regeneration and functional recovery, and should not increase the burden on the liver; (3) Attention should be paid to the degree of softness and hardness of food, and the ease of digestion; (4) Different liver diseases and different conditions require different dietary composition and (5) Avoid foods that are toxic to the liver, such as wine and foods containing preservatives, etc. （In the early stage of acute hepatitis, the patient often has obvious nausea, vomiting and loss of appetite, which usually lasts 1-2 weeks. Therefore, at this stage, the patient can eat carbohydrates such as noodles and porridge and other easily digestible, light foods, moderate amounts of vegetables and fruits, small and frequent meals. The diet should be in the amount and frequency that the patient feels comfortable with, and the patient should not be forced to eat more, otherwise it will not only fail to provide sufficient nutrition, but also lead to frequent nausea and vomiting. On the basis of diet, intravenous fluids should be given to supplement glucose, vitamins, water and electrolytes, and the total calories should be sufficient to meet the basic metabolic needs of the patient; for patients with poor basic nutritional status, those who eat very little in a week or elderly patients, appropriate complex amino acids should be given; emphasize that the nutritional intake can meet the metabolic needs of the patient, and avoid “high nutrition “The patient should be given appropriate complex amino acids. During the recovery period of acute hepatitis, when the patient’s nausea and vomiting symptoms disappear and appetite improves significantly, the intake of protein and unsaturated fatty acids should be increased appropriately, and these foods are beneficial to the regeneration and repair of liver cells. Protein sources can choose soybean products, milk, chicken, freshwater fish and other high-quality protein with low fat content, unsaturated fatty acids mainly from vegetable oils, the amount of diet should be increased gradually and gradually, not overnight. In addition, the total amount of calories in the diet during the recovery period of acute hepatitis should be adjusted according to the amount of exercise of the patient to avoid rapid weight gain due to excessive nutrition. (iii) Diet for chronic hepatitis Chronic hepatitis is characterized by recurrent exacerbation and remission of liver inflammation, so the diet plan should be adjusted according to the status of liver function. During the active phase of inflammation in chronic hepatitis, various degrees of gastrointestinal symptoms occur, and the dietary principles at this time are similar to those for acute hepatitis. In the remission phase of chronic hepatitis, liver function tests are close to normal and there are no obvious GI symptoms, so a balanced diet is emphasized at this time. The specific requirements are: 1, to provide appropriate calories: according to the condition and body needs to supply appropriate diet, avoid insufficient or excessive, the past liver disease “high calorie diet” has been proven to be inappropriate, long-term high-calorie diet not only increases the burden on the liver, aggravate digestive dysfunction, and can lead to obesity, and even induce fatty liver, diabetes, and affect the liver function. It can even lead to fatty liver and diabetes and affect the recovery of liver function. On the contrary, insufficient caloric intake will increase the loss of protein in body tissues, leading to negative nitrogen balance and decreased immune function, which is not conducive to the repair and regeneration of damaged liver cells. Therefore, the caloric energy supply for hepatitis patients should be adapted to the patient’s weight, condition and activity level, and adjusted individually to maintain the balance of caloric energy income and expenditure as much as possible and maintain the ideal body weight. It is generally believed that bedridden patients need about 84-105 kJ of energy per kilogram (ideal) body weight per day, while those engaged in light and moderate activities need 126-147 kJ and 147-168 kJ of energy per kilogram (ideal) body weight, respectively. 2, supply sufficient high-quality protein: an adequate supply of protein can maintain nitrogen balance, improve liver function, is conducive to the repair and regeneration of liver cell damage. Domestic and foreign studies have concluded that patients with chronic hepatitis should be supplied with 1.5 to 2.0 grams of high-quality protein per kilogram of body weight per day, and adult patients need about 80 to 100 g of high-quality protein per day. Or 15-18% of the total daily caloric energy. The so-called high-quality protein means that the ratio of various amino acids in protein is close to the needs of the body, which not only can save protein but also can reduce the burden on the liver. Although animal protein is more reasonable than vegetable protein from this point of view, animal protein is not easily digested and absorbed by patients with chronic hepatitis. Therefore, animal and vegetable proteins can be consumed in half to give full play to their complementary effects. The right amount of carbohydrates can not only ensure the total calorie supply for patients with chronic hepatitis, but also reduce the decomposition of protein in body tissues, promote the utilization of amino acids by the liver, increase the liver glycogen reserve, and enhance the detoxification ability of liver cells. Carbohydrates should be mainly starch, dietary fiber and other natural polysaccharide foods, not too much sucrose, glucose, fructose, etc. Carbohydrate intake in excess of the body’s needs will be converted into fat accumulation, causing hyperlipidemia, fatty liver and obesity, but increasing the burden on the liver, which is not conducive to liver function recovery. About 200 to 400g of carbohydrates need to be supplied daily, the previous claim of “high sugar diet” is incorrect. 4, appropriate restrictions on fat diet: fat is one of the three major nutritional elements, which provides unsaturated fatty acids is the body’s essential nutrients, other foods can not replace, so there is no need to excessively restrict. In addition, the intake of the right amount of fat is conducive to the absorption of fat-soluble vitamins (such as vitamin A, E, K, etc.) and so on. Due to the decreased appetite of patients with chronic hepatitis, often combined with gallbladder disease, fatty food intake is often insufficient, and unsaturated fatty acid deficiency, hypocholesterolemia, and fat-soluble vitamin deficiency are more common in patients with chronic hepatitis. Therefore, patients with chronic hepatitis need to eat appropriate amounts of fatty foods, and excessive fat restriction is inappropriate. The daily supply of fat for patients with chronic hepatitis should be tolerated by them and not affect their digestive function, and vegetable oils containing more essential fatty acids should be used mainly in cooking. For those with fatty liver, hyperlipidemia, chronic hepatitis patients with acute attacks of cholecystitis should limit fat. 5, supplement the right amount of vitamins and minerals: vitamins have an important role in the detoxification of liver cells, regeneration and improve immunity. Experimental studies have shown that the content of many vitamins in the serum and liver tissues of patients with chronic hepatitis is significantly reduced, and clinical studies have also shown that the application of vitamins C, E, K, etc. in patients with chronic hepatitis is beneficial to the recovery of liver function. Therefore, vitamins are often used as adjunctive therapeutic agents for chronic hepatitis. Although vitamins have important physiological functions, they are often needed in small amounts and have limited storage capacity in the body, so if large amounts of vitamins are supplemented, most of them will be excreted in the urine, which not only wastes drugs but also increases the burden on the kidneys. The view of “high vitamin” is not scientific. Therefore, vitamin supplementation is mainly based on food supplementation, but in case of insufficient intake, vitamin supplementation in appropriate amounts is still beneficial. Patients with chronic hepatitis are prone to calcium deficiency and osteoporosis, so it is necessary to insist on drinking milk or taking appropriate calcium supplements. Vitamin D supplementation is beneficial to the absorption and utilization of calcium, while chronic hepatitis patients have varying degrees of vitamin D activation in the liver, taking vitamin D can not achieve the effect, should be supplemented with active vitamin D3 as appropriate. 6, abstain from alcohol, avoid the intake of substances that damage the liver: ethanol can cause damage to liver cells, chronic hepatitis patients with reduced detoxification capacity of the liver to ethanol. Even a small amount of alcohol can aggravate liver cell damage, leading to aggravation of liver disease, so hepatitis patients should abstain from alcohol. Chronic hepatitis patients have a reduced detoxification capacity of the liver, and toxins in moldy foods, preservatives and coloring agents added to foods can increase the burden on the liver, so chronic hepatitis patients should avoid these foods. Patients with chronic hepatitis should follow the above basic principles, and the choice of food should be varied and should not be partial in order to achieve a balanced diet. Food should be easy to digest, light, small in quantity and quality, and a balance of animal and vegetable proteins. The main food should be mainly soft foods such as rice and noodles, more fresh vegetables and fruits, and appropriate animal foods such as beef, mutton, pork and eggs. It is not advisable to eat more stimulating food, such as onion, ginger, garlic and fried food. To do less and more meals, regular diet, do not overeat. (d) Diet of severe hepatitis It is difficult to ensure adequate dietary intake in patients with severe hepatitis, and hypoproteinemia, hypoglycemia and hypolipidemia are common. In addition to providing nutritional support, the importance of diet (or gastrointestinal nutrition) is to maintain the function of the gastrointestinal tract, reduce intestinal flora dysbiosis and ectopic, reduce endotoxin production and absorption, and prevent the occurrence of stress ulcer bleeding. Therefore, as much as possible, appropriate food should be provided to patients as their condition allows, and even patients who cannot eat should strive for gastrointestinal nutrition through gastrointestinal tube nasal feeding. The diet should be based on carbohydrates, provide sufficient water-soluble vitamins, and appropriately supplement dietary fiber, glutamine, branched-chain amino acids and other preparations. Limit the intake of protein and fatty foods to avoid aggravating or causing hepatic encephalopathy. The supply of salt and water should be restricted for patients with the presence of ascites and edema. Diet should be small and frequent, with easily digestible soft and semi-liquid food as the main food. Severe hypoglycemia often occurs at night, which is extremely detrimental to hepatocyte regeneration, so meals should be added 2-3 times at night, and foods with high sucrose, glucose or fructose content can be consumed appropriately. The principles of nutritional support during the recovery period of severe hepatitis are the same as those for chronic hepatitis. (E) Diet for cirrhosis Cirrhosis is the continuation of chronic hepatitis, malnutrition is more prominent, liver function is fully impaired, and a variety of complications appear. Therefore, the diet of cirrhotic patients places more emphasis on individualized programs. Patients with cirrhosis put more emphasis on the principle of small and frequent meals, especially in patients with ascites. Patients with esophageal varices should eat soft and less stimulating food, avoid hard nuts and coarse fiber vegetables, avoid too cold or too hot food, be careful when eating spiny fish and meat with bones, chew slowly to prevent hemorrhage from varices rupture. When there is ascites, the fluid should be limited with low salt. Daily sodium intake should not exceed 500 mg, and fluid intake should be limited to about 500-1500 ml depending on the degree of ascites. For patients with cirrhosis without hepatic encephalopathy, nutrients can be provided according to the dietary principles of chronic hepatitis. Although protein malnutrition is common in patients with cirrhosis, the main reason for this is that liver function is severely impaired and cannot utilize protein from food, and an oversupplemented protein diet will only increase the burden on the liver. Patients with cirrhosis have insufficient hepatic glycogen reserves and reduced glucose tolerance, and are prone to hypoglycemia and diabetes, which require special attention for evaluation. Most cirrhotic patients with recurrent hepatic encephalopathy cannot tolerate the normal physiological requirements of protein, so protein diet should be strictly limited during the attack of hepatic encephalopathy, while protein intake should be gradually increased from a small amount after the remission of hepatic encephalopathy. The protein catabolic capacity can be reduced by intravenous supplementation of essential amino acid preparations containing branched-chain amino acids and increasing the proportion of carbohydrates in the diet as appropriate. (6) How to consume “supplements” for patients with liver disease is more controversial. “Tonic” can be divided into “dietary supplement” and “medicinal supplement”, but it is difficult to distinguish dietary supplement from medicinal supplement in Chinese medicine. Chinese medicine believes that acute hepatitis and chronic hepatitis are mostly related to dampness and heat, which is contained in the liver and leads to qi blockage. It is not uncommon for patients with liver disease to take “tonic” products indiscriminately, which can aggravate their condition. From the perspective of current nutrition, the nutritional value of these things is not better than that of commonly used foods. Therefore, you should not believe in “tonic” and “medicinal food” and take tonic blindly. If you wish to take “tonic”, it is recommended to consult an experienced herbalist.