Chronic Viral Severe Hepatitis B Pathogenesis And Syndromes Law Study

Part I Study of TCM etiology, pathogenesis and treatment of chronic severe hepatitis BThe pathogen of toxin is one of the etiology which has violent characteristic and can induce fierce reaction and special symptoms related to the severe disorder of the body function. Diseases induced by the pathogen of toxin has the common characteristics: acute and rampant, rottenness of body structure and vital QI of entrails, complicated and danger of the pathogenetic condition, intractable and incurable, infectivity with pestilence.The main characteristics of chronic severe hepatitis B(CSHB) are extremely fatigue, durative deep jaundice, severe poor appetite, abdominal distention like drum. It happens abruptly and the pathogenetic condition is dangerous and intractable. The death rate is high. It has infectivity as well as the common characteristics of pestilence.The pathogen of toxin of CSHB origin from two aspects, one is exogenous pathogenic factors like damp-heat and pestilence, the other is endogenic turbid pathogenic factor of muddy toxin such as endotoxin. The basic pathogenesis are, damp-heat and pestilence injure the liver, toxin and stagnation damage the liver, which induce the hepatic essence and function rottenness, body and function all turn failure. 'toxin injure the liver body' may induce the spleen QI and Yang deficiency, transportation and transformation and unifying blood dysfunction. It can also lead the kidney Ying and Yang damaged that will manifest as 'liver and kidney ill together'. It can also damage heart, gallbladder and stomach and will induce noxious dampness, stasis toxin and the like.The therapeutic train of thoughts based on the theory of 'toxin injure hepatic body' etiology and pathogenesis stands for heavy drugs to severe disease, promptly cut off, multiple method used together, focal the point. Progression stage may adopt deintoxication and removing stagnation and cut off the trend of disease method. Stationary phase or convalescence stage may adopt regulation of body and function together, regulation liver and kidney, treating live and kidney together. If the toxic stasis and healthy energy deficiency are severe, we may assail and reinforce together.Part II Clinical study to the principle of Chronic severe hepatitis B with its syndrome1 Clinical characteristics analysis of CSHBObjective: to find the clinical characteristic of CSHB and provide the evidence for prevention and treatment of CSHB by analyzing 201 cases with their general information, history characteristics, the marks of virus and gene mutation of pre-C area.Method: a descriptive statistical method of SPSS 12.0 was adopted to analyze the data as well as compared with chronic hepatitis B.Result and conclusion: CSHB patients mostly are 40 to 55 years,male , worker and peasant, secondary school, with percentage 58.7%,83.6%, 50.6%, 58.6% respectively. The positive rate of HBeAg, HBV DNA is 59.7%, 59.2% respectively. Excessive exertion, drugs and unhealthy life events happening as the motivation was 25.8%, 6.5%,7.5% respectively. The total gene mutation rate of pre-C area is 34.6%, the pure mutation rate is 33.3%.2 Symptoms and signs analysis of CSHBObjective: to understand common symptoms and signs of CSHB by analyzing 201 cases.Method: a descriptive statistical method was adopted to sum up the probability of symptoms and signs.Results and conclusions: the common symptoms of CSHB are body, jaundice, lack of appetite, nausea, abdominal distention, sticky stool , insomnia and dreaminess , forgetful, dry mouth, rhinorrhagia, dark complexion, subconjunctival capillaries, liver palm, lassitude and weak, waist-knee fatigue, dry-eyes, burning sensation of five centres, decreased libido. The common signs of CSHB are red tongue, dark tongue, hypoglossal vein thickening, tongue coating thick thickening, dry coated tongue, greasy fur on tongue, yellow coated tongue, deep pulse, prompt pulse, string pulse, micro pulse, deficiency pulse and so on. The frequency of occun-ence of them are up to 50%.3 Analysis of the syndrome distribution characteristics of CSHBObjective: to find the syndrome distribution law and the basic syndrome and core syndrome by analyzing 201 cases.Method: to sum up the possibility of symptom and sings by a descriptivestatistical method.Results and conclusion: the basic syndrome of this disease can be summed up as : blood stagnation of liver and spleen, Ying deficiency of liver and kidney, heat and toxin flourishing of liver and gallbladder, Qi deficiency of liver and spleen, Qi deficiency of kidney. The core syndrome are blood stagnation of liver and spleen, heat and toxin flourishing of liver and gallbladder and Ying deficiency of liver and kidney.4 Analysis of syndrome differentiation highlight to the basic syndromes ofCSHBObjective: to determine the yndrome differentiation highlight to the basic and principal syndromes of CSHBMethods: a factor-analysis method was used to extract the principal component of each syndrome which was regarded as syndrome differentiation highlight. If factor-analysis method was not available, speciality knowledge was used to determine syndrome differentiation highlight.Result and conclusion:Heat and toxin flourishing of liver and gallbladder syndrome: heavy jaundice, severe fatigue, high anorexia, abdominal distention and heat flourishing were seem together.Blood stagnation of liver and spleen syndrome: dark colour of tongue or ecchymosis, hypoglossal vein thickening, circuity or the small collaterals like purple mesh or bead, red silk (or spider telangiectasia), liver palm, subcutaneous varicose veins of abdominal wall, uneven pulse. Two of these signs will help to diagnose the syndrome.Ying deficiency of liver and kidney: common symptoms: burning sensation of five centres, dry-mouth and pharynx, red tongue with little fur, thin or thin-prompt pulse. Symptoms of liver-yin deficiency: dry-eyes, creeping or trembling limbs. Symptoms of kidney-yin deficiency: waist-knee fatigue, dark complexion, insomnia and dreamful sleep, forgetful. Diagnosis will be made if the patient has 2 common symptoms of yin deficiency and 1 symptom of each liver-yin deficiency and kidney-yin deficiency.Qi deficiency of liver and spleen: severe fatigue, serious enorexia and abdominal distention, depression and symptoms of spleen-Qi deficiency seem together.Kidney-Qi deficiency syndrome: common symptoms of Qi deficiency:fatigue and lassitude, weak pulse, pale tongue. Symptoms of kidney-Qi deficiency: waist and knee fatigue, debility sexualis, swollen limbs, frequency of micturition or nocturia. Diagnosis will be made if the patient has 2 common symptoms of Qi-deficiency and 3 symptoms of kidney-Qi deficiency. 5 Patterns of syndrome combination principal rule of CSHBObjective: to disclose the principle rule of syndrome combination of CSHB. To compare the cumulative score between CSHB and other accompanied symptoms and signs. To explore the glossoscopy characteristics and to understand the relation between CSHB and other test marks so that to provide evidence for clinical syndrome differentiation.Methods: cluster analysis and descriptive statistical methods were used to summarize the syndrome combination rule. ANOVA method was used to analyze the difference among groups.Results and conclusion: cluster analysis show that there are three syndrome marks of CSHB: heat and toxin flourishing of liver and gallbladder syndrome, heat-toxin with Yang deficiency syndrome and noxious dampness congested and grievous syndrome. The accumulative scores of accompanied symptoms and signs of heat-toxin with Yang deficiency syndrome were the highest among these three groups showing the pathological changes were severest. The accumulative scores of Qi and Yang deficiency between heat and toxin flourishing of liver and gallbladder syndrome and noxious dampness congested and grievous syndrome had no difference but they all lower than those in the heat-toxin with Yang deficiency syndrome group showing the Qi deficiency of latter was severer than the others. The cumulative scores of spleen Qi deficiency all higher than normal, this indicate that all of CSHB has severe liver and spleen Qi deficiency. We use tongue diagnostic specialist system to study the rule of tongue diagnosis of disease-syndrome combination. The result indicate that R value of tongue body was highest in heat and toxin flourishing of liver and gallbladder syndrome group, next is heat-toxin flourishing group, they all had a statistical difference when compared withnoxious dampness congested and grievous syndrome group. So the increasing of R value of tongue body can be regarded as one of the marks of heat and toxin. At the same time, the R, G and B values of tongue coating among the three groups were not significant. The relation study of test marks of three groups show that all cases of these groups had high AST/ALT, TBIL and DBIL value, but the heat-toxin...