A Preliminary Study Of Integration Of Chinese And Western Medicine Therapy To Treat Chronic Liver Disease

Objective:There are a lot of difficulty in the treatment of chronic liver disease in the medical professione, specially the low E antigen-negative rate of chronic hepatitis B, difficulty of early detection of liver cancer and high incidence of cirrhosis and HCC recurrence, etc, which is a serious threat to health and life of patients with liver disease. My mentor achieved better efficacy in clinical medicine through the Integration of Chinese and Western medicine(ICWM) treatment methods to treatment the liver diseases related to the above. But so far,we haven’t seen the report on treatment chronic liver disease with the system therapy of ICWM. Therefore, the purpose of this paper is the first to integrate medicine applied to treatment chronic liver disease, and then build concept and programs of the ICWM, expect to reach the purposes of people-oriented, patient-centered, to improve the quality of life and efficacy of patients and reduce health care costs.Methods:For the contents and information of the ICWM is very large, so this paper includes the following parts.1.In history as a mirror: summarize the current status of Medicine, find out the drawbacks of modern medicine, analysis the limitations and contradictions in development of medical technology, then form the concept of ICWM.2.Reserve knowledge:Rich understanding of Chinese medicine holistic medicine concept by integrating academic thought of TCM masters; learning the historical development of “integrated medicine”, then come to understand the integration medicine in the past, present and future; learning system knowledge related liver disease, and non-specialist knowledge such as social medicine, psychology, etc. Final, we built the system framework to treatment liver disease by ICWM.3.Related investigations and research,provide relevant elements for program development of treatment chronic liver diseases by ICWM.(1)Integration of chronic liver pathology in clinical applications: By analyzing all the information of patients with chronic HBV infection come from Third People’s Hospital in Shenzhen in analysis of 10 years, all of them have liver biopsy. Study the evlution rules of hepatic fibrosis in the different stages of the natural history of chronic HBV-infection by 637 cases of patient data; compare liver inflammation with fibrosis in patients of chronic hepatitis B(CHB),then evaluate its ability to predict antiviral efficacy by 365 cases of patient data; observed different degrees of fibrosis on morphological changes of liver sinusoid byelectron microscopy.2.Guidance of evidence-based medicine,through literature analysis to learn the commonly used Chinese medicine which has a role with anti-liver fibrosis: Select the Chinese Biomedical Literature Database(CBMDISC), With “ liver fibrosis and cirrhosis, Liver Cirrhosis, Hepatitis B, Chronic” as key words, retrieve clinical literature on liver fibrosis in chronic hepatitis B, published abroad in 1994 to April 2013, selected clinical reports on the use of traditional chinese medicine treatment. Recording data on the type of medicine, case number, type of research, whether or not combined with antiviral therapy, observed indicators and efficacy.(3)Research related to the integration of social psychology factors in patients with liver disease: To use random sampling method, analyze patients’ habits, self-power, economic status, compliance and psychological needs by 279 cases with chronic hepatitis B.4.Through the Reserve knowledge and research theory above, we propose the cogitation of integration of medical, and then make a treatment plan of ICWM.5.Illustrates treatment of chronic hepatitis B with ICWM therapy in clinical practice, clarify the specific application of ICWM.Results:1. The results of theoretical study:(1) Ancient physicians attach great importance to learning general, not only specializes in internal medicine, surgery, gynecology, pediatrics, but also understand the “health of the art”, “Kanemichi number by the” emphasis on preventive health care, medical ethics training.(2)Through learning the relevant specialist knowledge, learnedsocial medicine, psychology, nursing, philosophy and so on the diagnosis and treatment of diseases are closely related.(3) Comprehensive specialist knowledge learned that Chinese medicine education to focus on the overall concept is the basis for the integration of medical theory; and Western medicine on the liver physiology, pathology, anatomy-depth understanding of the microscopic point of elucidating the physiological function of the liver and pathological states.2.Survey information obtained social factors:(1)For the assessment of quality of life, there are 48% the patients with chronic hepatitis B are dissatisfied, 76.7% of them have problems caused by disease in work, family, friends, communication and so on.(2)On lifestyle, 40.9% of patients almost never exercise; 53.8% of the patients sleep less than seven hours; 22.2% of patients had history of drinking. These bad habits are likely to have an impact on chronic hepatitis B treatment.(3)In terms of treatment, only a small number of people will choose to continue treatment at a hospital, and nearly one-third of the patients will choose to visit the hospital more than two; in terms of medication, 47.7% of patients adhere to medication regimens according to hospital, 25.4% did not receive regular treatment.(4) On the economic front, 56.6% of patients can not afford more than ￥ 600 cost of treatment every month.(5) 84.9% of patients hope treatment with Integrative Medicine.3.Medicine antifibrotic data analysis:There are 58,665 cases of liver fibrosis patients treated with traditional Chinese medicine in 1124 the literature on the treatment of liver fibrosis,the efficiency is 99.3%. In effective herbal preparations, the topfive types of drugs are Huayu drugs(93 species, a total of 232 documents), effectiveness of anti-hepatitis B virus type(12 species, a total of 89 documents), Ruangan category(30 species, a total of 68 documents), protect the liver and drop transaminases class(20 species, a total of 67 documents), integrated efficacy class(40 species, a total of 60 documents).4.The results of studies of liver tissue(1)Total of 637 patients(501 males and 136 females) with chronic HBV infection in the natural history were recruited in this study,divided them into four phases. The immune tolerant phase has 101 patients, and 248 patients of the immune clearance phase were analyzed, 119 patients of the low or non-replicative phase were detected, 169 patients of the reactivation phase were included. The significant difference was determined in the liver tissue inflammation, especially the immune clearance phase and the reactivation phase were much active(χ2=150.424, p<0.0001). The frbrosis stage among the four stages in the natural history of the HBV infection also had significant difference, and gradually increased(χ2=141.682, p<0.0001).(2)There were 365 patients divided into four groups, according to different damage of liver inflammation and fibrosis, patients were divided into four groups: groupⅠ(the grade of inflammation< G2 and the stage of fibrosis < S2), group Ⅱ(the grade of inflammation≥G2 and the stage of fibrosis<S2), group Ⅲ(the grade of inflammation<G2 and the stage of fibrosis≥S2), group Ⅳ(the grade of inflammation≥G2 and the stage of fibrosis≥S2). There are 167 cases in group I, 107 cases in group II, 48 cases in group III and 43 cases in groups IV. The group I have 18 cases withALT≥4ULN,and 7 patients in group II,11 patients in group III, 17 patients were included in group IV. The percentage of comply ALT≥4ULN or/and HBVDNA≤6.55 log10 copies/ml in four groups were 31.7%, 22.9%, 57.0% and 65.1%. There were no statistical difference in group I and II, group III and group IV by chi-square test. but significant differences were observed among any remainder two groups(p<0.001).(3)Examination by Electron microscopy in 10 patients,we found that SEC apertures to reduce, or even appear basement membrane with the aggravation of liver fibrosis, which suggests that the SEC change into vascular endothelial cells, but also began to be converted into a continuous sinusoid type capillaries.5.Developed a preliminary plan(draft) of the specific content with ICWM therapy:(1)The thinking patterns of integration medical:Including the integration of pathogenic microorganisms and human factors(psychological factors, social factors, environmental factors), the integration of the existing infrastructure and life-related fields for each of the most advanced medical discovery, integration of existing clinical experience with liver-related specialties, changes in thinking the treatment of liver disease from linear single fixed non-linear to divergent philosophical.(2)The programs of ICWM(including six pairs of integrated solutions):TCM integrate Western medicine, Chinese medicine to maintain that balance the overall concept of yin and yang(macro) and Western maintaining immune homeostasis in the(micro) integration; integrate basic and clinical; integrate psychology(counseling, survival desire) and self-care(livinghabits.); integrate social(humanistic, ethical) and family factors(tie); integrate e basic treatment(cause) and symptomatic treatment(elimination of symptoms); integrate follow-up and monitoring. Through the above pairwise integration, we formed a full range of ICWM treatment options.6.Illustrates treatment of chronic hepatitis B with ICWM therapy, we should focus on the patient and the specific liver disease, the need to develop a patient-centered individual program under the common scheme. The clinical efficacy display that E antigen negative rate of chronic hepatitis B patients was 60.6% for7.Results of previous studies in our team showed that:(1) significant clinical effect manifested in the treatment of decompensated cirrhosis ICWM the first six years of remarkable efficiency, total efficiency can reach 73.2%, respectively, 92.7%, than the cost of follow-up group therapy literature reported significantly reduced.(2) clinical remission rate of 90% after ICWM perioperative liver cancer treatment, quality of life has significantly improved measurement profiles(p < 0.05), the survival rate of follow-up group and reported significant differences compared with the group(p<0.05). Significantly lower than the cost of follow-up group literature groups.Conclusion:Use ICWM to treat chronic liver disease is an innovative approach, we first established a preliminary program ICWM. After nearly 10 years of clinical application, it proved able to significantly improve the efficacy, improved quality of life and reduce health care costs in the treatment of patients with chronichepatitis B, cirrhosis and liver cancer recurrence prevention, the study results suggest that, ICWM the treatment of chronic liver disease have good efficacy and safety advantages, but also has good social and economic benefits of reducing health care costs.