Chronic Hepatitis B, Early Cirrhosis Poison Damage The Liver Network Pathogenesis Of The Syndrome Characteristics

Hepatitis B virus (HBV) infection is a worldwide health-threatening problem, chronic hepatitis B and its related diseases cause huge economic burden on the whole society. In recent years, it becomes the hot pot to improve the diagnosis and treatment level of hepatitis B. To date, the therapy with satisfying therapeutic effect is absent, but traditional Chinese Medicine (TCM) exerts a promising future for clinical treatment, with combination of disease and syndrome differentiation, entirely regulation from multiple pathway and multi-strata.This research explores the etiological factors, discipline of the syndrome and pathogenesis of the hepatitis B and early hepatic cirrhosis, employing a prospective multi-center method, on the basis of past researches. The paper can be divided into two parts: theory and clinical research. Part I : Theory study: the theory of "toxin damaging liver meridian"After several-year clinical practice and researches, my advisor and our researching group postulate that the hepatitis B and early cirrhosis should be differentiated and treated according to the "meridian disease" theory, and the key points is "toxin damaging liver meridian". This research proposes and expounds the theory of "toxin damaging the liver meridian", analyzes the characteristics of the occurrence and development of chronic hepatitis B and early cirrhosis.Liver can regulate the physiological function of other organs through its collateral and meridian system. Vise visa, the diseases of the liver can affect other organs by the collaterals and meridians. The meridian system distributes extensively, from upper part to the lower one, from exterior to the interior;with complicated structures and various functions, liver meridian is the important part of the whole collateral and meridian system, which distributes in liver, and constitutes the basic structural and functional unit. It processes not only the characteristics of meridian but also its special physiological and pathological features. Pathologically, liver meridian is the pathway of evil invasion, transmission and stagnating location. External evils easily invade into the liver-blood, liver meridian, transmission along and change, theninducing a series of meridian diseases. Experts have the common sense that damp-heat evil is the etiological factor of the chronic hepatitis B.In terms of the literature study, combined with clinical practice and experimental studies, we concluded the etiological factors and major pathogenesis as following ? The invasion of the damp-heat evil is the initial etiological factor of the two diseases. ?Chronic hepatitis B and early hepatic cirrhosis can be attributed to the "latent evil" category. Its nature easily to be damp and heat;(3) Toxin, dampness, blood stasis, deficiency play a key role in the pathogenesis of the two diseases;the vital Qi combating with the evils, the evil incubating or activation, the diseased recurrent attack and hard to be cured;(4)"Evil damaging liver meridian" is the key point of the pathogenesis of the two diseases. The therapeutic principle suggested to be activated the circulation to discharge the blood stasis, smoothing the meridian, replenishing the essence and detoxicating.The study on the literatures about "meridian diseases", "evil damaging liver meridian"Exploring the clinical manifestation of related syndrome of chronic hepatitis B and early hepatic cirrhosis by studying on the literatures about "meridian diseases", "evil damaging liver meridian", referring to past clinical practice and researches, we found that evil invasion is the etiological factor, disfunction of liver meridian is the internal agent. The clinical manifestations summarized as: hypochondrium pain and distension, jaundice, dirty complexion, dark lips, epigastric pain and distension, subcutaneous varicos vein of abdominal wall, spider telangiectasia, bleeding, liver palm, numbness of limbs, purplish and dark tongue, petechia, ecchymosis, distorted sublingual vein, unslippery pulse Part II: clinical research1 The systematic review of chronic hepatitis B and early hepatic cirrhosis treated with TCM according to the "evil causing disease" theory.In this systematic review, we collected 19 literatures, involved 1865 patients, chose the following therapeutic evaluation indexes: responding rate, the indexeswhich can reflect the hepatic function like ALT\ AST\ TBIL;HBV-DNA, HBV series,etc. Compared with integrated medicine therapy and control group, the therapeutic effect of TCM therapy according to the theory of "evil causing diseases" is superior. It demonstrated that "evil invasion" may be the major etiological factor of chronic hepatitis B from the clinical practice aspect.2. Clinical research on the syndrome characteristics of chronic hepatitis B andearly hepatic cirrhosis.2.1 The baseline material of the chronic hepatitis B and early hepatic cirrhosis patients.The occurrence and activation of the two diseases is caused by multiple factors. Our research suggests that sex, age, duration, season and emotional factors participated in the pathogenesis, especially the season. The study on clinical characteristics provides a reference for clinical prevention and treatment of the two diseases with TCM.2.2 The study on the syndrome distributing characteristics of chronic hepatitis B and early hepatic cirrhosis.We applied frequency and Logistic regression analysis, studied the syndrome difference between chronic hepatitis B and early hepatic cirrhosis, the syndrome difference of chronic hepatitis B different stages.It is suggested that liver and gallbladder dampness-heat syndrome, dampness-heat stagnating the spleen and stomach easily appeared in severe chronic hepatitis B, Liver-yin deficient syndrome, kidney-yin deficient, spleen-Qi deficient syndrome and cold-dampness syndrome easily appeared in mild ones. No significant difference was found in other syndrome. Compared with hepatitis B, early hepatic cirrhosis has more spleen deficient dampness stagnation syndrome, blood stasis, spleen-Qi deficient syndrome, kidney-Qi deficient syndrome, spleen-yang deficient syndrome, cold-dampness stagnation and kidney-yin deficient syndrome. Damp-heat, deficiency, blood stasis are more prominent in early hepatic cirrhosis. It is suggested that the occurrence and development of chronic hepatitis B are related to the toxin and vital-Qi.3 The study on the clinical characteristics of "evils evade, liver meridian injured" 3.1 Multivariate analysis of the clinical materials from four methods of examination about chronic hepatitis B and early hepatic cirrhosis.We analyzed the results according to the TCM differentiation of symptoms and signs and modem meridian-disease theory, employing the clustering and principal component analysis methodsWhich generally exists in both hepatitis B and early hepatic cirrhosis patients, but more prominent in the latter.Chronic hepatitis B "toxin damaging the liver meridian" related syndrome can be summarized as: meridian stagnating syndrome, meridian deficient toxin stagnating syndrome, evil damaging meridian syndrome;correspondingly, early hepatic cirrhosis "toxin damaging liver meridian" related syndrome has meridian blood stagnating syndrome, meridian deficient dampness excessive syndrome and meridian deficient stagnating syndrome.The syndrome characteristics of chronic hepatitis B and early hepatic cirrhosis is coexistence of excess and deficiency, evil excess manifested as dampness, damp-heat, Qi stagnation and blood stasis;vital deficiency manifested as both Qi and Yin deficiency. So we concluded that the vital-Qi deficiency is an internal agent in the process of occurrence and development of both diseases. The invasion of damp-heat exerts the etiological factor, which can cause the meridian stagnation.Compared the two diseases, deficient syndrome is prominent in early hepatic cirrhosis patients, including Qi deficiency, Yang deficiency and Yin deficiency, referring to the following Zang-Fu organs as: spleen, liver, kidney;manifesting as liver meridian diseases;meridian blood stasis and stagnation is prominent in chronic hepatitis B patients.By clinical research combined with literature study, we conclude that the clinical manifestation of the liver meridian diseases caused by evils invasion is dirty and dark complexion, dark lips, jaundice, hypochondrium pain and distention, liver palm, spider telangiectasia, numbness of the limbs, skin itching, epigastric distention, distorted sublingual vein, purplish and dark tongue, with petechia or ecchymosis. 3.2 Exploring the relation of the "toxin damaging liver meridian" related syndrome and the clinical investigating indexes. 3.2.1 Exploring the symptoms and signs of'toxin damaging liver meridian"related syndromeWe analyzed the symptoms and signs of toxin damaging liver meridian" related syndrome of chronic hepatitis B and early hepatic cirrhosis by employing the Logistic regression, combined with the results of various syndrome's principal component analysis. We preliminary explore the diagnostic criteria of "toxin damaging liver meridian" related syndrome of chronic hepatitis B and early hepatic cirrhosis.Meridian stagnating syndrome: hypochondrium pain and distension, dirty complexion, fatigue, easy to sign, liver palm, spider telangiectasia, distorted sublingual vein, purplish and dark tongue, abdominal bloating, string pulse.Meridian deficient toxin stagnating syndrome: dirty complexion, hypochondrium distension, yellowish eyes, dizziness, heaviness sensation of head and body, mouth stickiness and greasiness, poor appetite, spider telangiectasia, yellow and dark urine, pale tongue, yellowish, thick and greasy coating.Toxin evil injuring meridian syndrome: dirty complexion, dark lips, yellowish eyes, mouth bitterness, stickiness and greasiness, liver palm, hypochondrium pain, poor appetite, spider telangiectasia, easy to sign, irritate, distorted sublingual vein, string or immerse pulse.Meridian blood stagnating syndrome: dark complexion, jaundice, hypochondrium pain, distention and pain of the breasts, easy to sign, irritate, tantrum, heaviness sensation of head and body, mouth bitterness, stickiness and greasiness;spider telangiectasia, liver palm, loose stool, distorted sublingual vein, purplish and dark tongue or with petechia and ecchymosis, greasy and yellowish coating.Meridian deficient and dampness excessive syndrome: dark lips, hypochondrium pain, dispirit, reluctant to speak, fatigue, heaviness sensation the head and body, jaundice, mouth stickiness and greasiness, sour and feeble of the loin and knees, nausea, vomiting, disliking greasiness, spider telangiectasia, liver palm, distorted sublingual vein, swollen tongue, pale tongue, immerse pulse.Meridian deficient and stagnating syndrome: dirty complexion, dispirit .reluctant to speak, fatigue, irritate, tantrum, sour and feeble of the loin and knees, hypochodrium pain,distention and pain of the breasts, spider telangiectasia, liver palm, distorted sublingual vein,pale tongue, white coating, deep and fine pulse.3.2.2 Exploring the relation of the "toxin damaging liver meridian" related syndrome and the clinical investigating indexes.After clustering analysis, this research compared the common clinical indexes related to various syndromes of chronic hepatitis B and early hepatic cirrhosis, we consider that the inflammation of the hepatocyte, hepatocyte injury, disordered bilirubin and bile acid (BA) metabolism may be the pathological basis of liver meridian diseases, in which the evil excess is prominent, in this aspect we made a preliminary exploration and found some tendency, which still need to be verified by more intensive and extensive researches, we try to find the relation between the syndrome and the micro-index by collecting clinical material, provide references for the clinical practice.