Reporter: As far as I know, the Department of Hepatology II at Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, where you work, has been a leader in basic and clinical research on liver fibrosis in China for many years. Today, I would like to ask you to talk about the diagnosis and treatment of liver fibrosis. Xu Mingming: Thank you for giving me this opportunity. Reporter: We know that there are disease names for chronic hepatitis and cirrhosis, but not for liver fibrosis. So we first want to know what is liver fibrosis? What are the harmful effects of liver fibrosis? Xu Mingming: Liver fibrosis is not a disease name yet, but a pathological concept. Liver fibrosis is a reversible pathological phenomenon of excessive deposition of fibrous tissues in the liver during the repair process of the body after liver damage. The inflammatory stimulation of the liver leads to the activation of stellate cells in the liver, and the activated cells synthesize and secrete a large number of components that form fibrous tissue, resulting in the massive deposition of fibrous tissue in the liver. Once the mechanism of liver fibrosis formation is initiated, it actively progresses and eventually develops into cirrhosis. Therefore, liver fibrosis is accompanied by the development of chronic hepatitis and belongs to the pre-cirrhotic 1 lesion, and the relationship with cirrhosis is quantitative to qualitative change. Reporter: Which common chronic liver diseases can be accompanied by liver fibrosis? Xu Mingming: All kinds of chronic hepatitis can lead to excessive proliferation of fibrous tissue in the liver due to inflammatory stimulation of the liver, and liver fibrosis can occur. The occurrence of liver fibrosis in China is mainly related to chronic hepatitis B and chronic hepatitis C. Liver fibrosis caused by alcoholism is not uncommon nowadays, and liver fibrosis caused by schistosomiasis in the south of China also has a certain proportion. In recent years, liver fibrosis caused by autoimmune liver disease, primary biliary cirrhosis and drug-related liver disease are on the rise. Reporter: How can doctors diagnose whether a patient with chronic liver disease has liver fibrosis? Xu Mingming: The “gold standard” for diagnosing liver fibrosis is liver biopsy (also known as liver biopsy or liver puncture) plus pathology, but this invasive test is difficult to perform routinely because most patients in China are unwilling to accept it. However, this invasive test is not routinely performed because most patients in China are reluctant to undergo it. Domestic medical institutions mostly use ultrasound liver sonogram and four so-called “liver fibrosis serological indicators” to determine the degree of liver fibrosis, the accuracy of which is relatively low. Many domestic and foreign research institutions use some blood biochemical tests to calculate the severity of liver fibrosis by formula. The liver stiffness scanner (FibroScan) has been introduced to China, and it helps to diagnose liver fibrosis and cirrhosis. According to my clinical experience, chronic hepatitis with recurrent attacks for more than 1 year usually has liver fibrosis to a greater or lesser extent. Reporter: If a patient has been diagnosed with liver fibrosis, how should he or she be treated? Xu Mingming: Due to the lack of western drugs that can be used clinically for the treatment of liver fibrosis, China mainly relies on Chinese medicine for treatment. The anti-liver fibrosis drugs being researched abroad are still in the laboratory stage, and the one that can be used clinically is g-interferon, but it is not widely used because of its high price, side effects and lack of efficacy. After more than 30 years of efforts, domestic researchers have developed oral Chinese medicinal preparations with definite therapeutic effects on liver fibrosis, some of which have been approved by the State Food and Drug Administration and are widely used in the clinic, achieving better efficacy. Please remember: for the treatment of liver fibrosis, Chinese medicine has advantages and characteristics. Reporter: Can liver fibrosis be cured? Xu Mingming: Liver fibrosis is a reversible pathological change, so theoretically it can be cured, this has reached a consensus in the international academic community, and there is no lack of clinical precedent. However, whether liver fibrosis can be reversed depends on the severity of liver fibrosis, the presence or absence of the cause, the degree of inflammation in the liver, the efficacy of drugs and the individual differences of patients. Generally speaking, liver fibrosis is continuously progressive, through treatment, liver fibrosis is no longer progressive, and the purpose of treatment is achieved. Reporter: When is it appropriate to start treatment for liver fibrosis in patients with chronic liver disease after the diagnosis of liver fibrosis? How long is the treatment course? Xu Mingming: The earlier the liver fibrosis is treated, the better the outcome. Therefore, patients should be actively treated once they are diagnosed with liver fibrosis. It is important to point out that we often find that some patients are already cirrhotic when they come to the clinic, but patients and doctors should not give up the treatment of liver fibrosis because they think it is too late, but should be more aggressive in anti-fibrosis treatment. We have several cases of cirrhotic patients after active anti-fibrosis, the clinical has taken off the cap of cirrhosis, that is to say, cirrhosis has also reversed. I think the exact course of treatment varies from person to person, and the goal is for the liver to stop producing fibrous tissue. The main mechanism of action of the currently listed anti-liver fibrosis herbal medicines may be to inhibit the formation of liver fibrosis. Since liver stellate cells, the key cells that produce fibrous tissue components in liver fibrosis, will activate themselves once they are activated, until drugs are available that can make activated liver stellate cells apoptotic and thus stop producing fibers, for the time being we have to inhibit the production of fibrous tissue by liver stellate cells, so patients need to take medication for a long time. Reporter: Do patients with chronic liver disease need anti-fibrotic treatment after the cause is removed, for example, after virus clearance or alcohol cessation? Xu Mingming: It depends on the formation mechanism of liver fibrosis. As I mentioned earlier, the activation of hepatic stellate cells is the key to liver fibrosis, and the activation comes from 2 kinds of stimuli, one is the inflammatory stimulation of the liver caused by the etiology, and the other is the self-activation of hepatic stellate cells. If we compare the self-activation of hepatic stellate cells to a pot of fire, removing the cause of disease is equivalent to not pouring oil on the fire, but the fire is still burning, so patients with chronic liver disease who have removed the cause of disease generally still need anti-fibrotic treatment. Reporter: Do patients with chronic liver disease whose cause cannot be eliminated need anti-fibrotic treatment? Xu Mingming: I’ll use the analogy above to explain. If the cause of the disease cannot be removed, the fire will be fueled by oil, and the “fire” of liver fibrosis will become more and more intense. At this time, simple anti-fibrotic treatment can not put out the “fire”, but it can reduce the “fire”, although it can not achieve the ideal effect, but it is much better than doing nothing in front of the fire, allowing the fire to spread and doing nothing. The anti-fibrotic treatment at this time is not likely to reverse liver fibrosis, but it is still possible to slow down the progress of liver fibrosis or stop its development. Reporter: I found that most of the anti-liver fibrosis treatments used in Chinese medicine are “helping to correct the stasis”, what does it mean? Xu Mingming: The so-called “helping the righteous” refers to helping the righteous and replenishing the deficiency; “removing stasis” refers to activating blood circulation and removing stasis. According to Chinese medicine, patients with chronic liver disease suffering from liver fibrosis have a weak righteousness after a long period of illness; while the cirrhotic liver is an accumulation of blood stasis, so helping the righteousness and replenishing the deficiency is the opposite treatment. Explained by modern medical theory: the herbal medicine of supporting the righteousness and tonifying the deficiency can adjust the immune dysfunction in patients with chronic liver disease, and the herbal medicine of activating blood stasis has proven to have anti-liver fibrosis efficacy. Experiments have shown that when the two are combined, the anti-liver fibrosis efficacy of the herbal remedies can be better than that of the herbal remedies used to “help the righteous” or “remove blood stasis” alone. Reporter: What is the clinical efficacy of herbal medicine against liver fibrosis? Xu Mingming: At present, the western medicine that can be used to treat liver fibrosis is g-interferon, our clinical observation found that its pathological reversal of slow hepatitis B liver fibrosis is about 30%, and there are certain side effects. In contrast, our new anti-liver fibrosis drug, Fu Zheng Hua Yu Capsules, reverses 52% of slow hepatitis B liver fibrosis pathologically and has no significant side effects. The efficacy for patients with cirrhosis is mainly in promoting the increase of serum albumin content, reducing portal hypertension, and can prevent bleeding from ruptured esophageal veins. Reporter: I heard that western medicine antiviral treatment can also treat cirrhosis, so do patients taking anti-hepatitis B virus drugs need to use Chinese medicine anti-fibrosis treatment at the same time? Xu Mingming: In liver fibrosis, there is a pathological feature called “hepatic sinusoidal capillarization”. This pathological change affects the blood supply to the hepatocytes from the hepatic sinusoids, thus impairing the exchange of substances between the hepatocytes and the hepatic sinusoids. Anti-fibrosis can inhibit or even reverse “hepatic sinusoidal capillarization”, improve liver blood microcirculation, improve blood supply to hepatocytes, and also enable more and better contact with hepatocytes of anti-viral drugs and liver-protective and enzyme-lowering drugs absorbed in the blood, so as to exert drug effects. The effective antiviral results in reduced inflammation in the liver and reduced damage to hepatocytes, thus reducing the activation of hepatic stellate cells. Patients with both antiviral and antihepatic fibrosis have proven to be stable and have satisfactory clinical outcomes. Most of the patients who persist in long-term treatment have normalized their liver function and their previously enlarged spleen has shrunk. Reporter: Thank you, Professor Xu, for accepting my interview. I have taken up a lot of your precious time and learned a lot. Goodbye.