Chronic hepatitis classification according to traditional Chinese medicine is, in fact, a stage in the entire developing process of hepatophilic virus disease. The severity of clinical symptoms depends on the degree of functional damage of visceral organs caused by the invading viruses. The dysfunctional systems and organs in the body may influence one another and the condition may become more and more serious as time goes by. Every form of the disease would lead to death of the patient. In general, virus hepatitis patients have fire exuberance of the heart, liver and lung, and heat of the colon would eventually lead to weakness of the liver and kidney. Therefore, it is undoubtedly true that these classified forms are the fatal steps of hepatophilic virus disease.
| Liver-energy stagnation and lung dryness May finally die from pulmonary dysfunction, pathologic changes of pulmonary blood vessels and hepatic pulmonary lesions. |
| Wetness-heat evaporation Often causes portal hypertensive gastric disease, hepatogenic peptic ulcer leading to profuse digestive tract hemorrhage. |
| Weakness of energy and blood deficiency Causes anemia 70%, aplastic syndrome 90%, coagulopathy * 85% |
| Channel blockage and stasis of blood Hepatogenic portal hypertension, cardiac disease, embolic vasculitis etc. |
| Abnormal rise of liver-yang Such as hypertension, apoplexy, carcinoma of liver, early stage of colonic carcinoma |
| Weakness of liver and kidney Hepatitis B nephritis, hepatorenal syndrome, cardiac arrhythmia due to hepatogenic hypokalemic nephrophathy, sudden death caused by cardiac failure. |
| Cirrhosis of liver, carcinoma of liver |
It is an unshakable fact that hepatophilic virus infection of the human body can result in virus hepatitis. Virus hepatitis is divided into acute and chronic forms, the former has an acute onset, appearing more serious and riskful; in the fulminating type and severe cases, the mortality is high and easily draws the attention of the family and medical staff. But chronic virus hepatitis usually does not arouse attention of the patient, his family or the medical staff, because most of the cases are extremely concealed in onset and their clinical symptoms are very insignificant.
Let us take the most widely studies and commonly encountered hepatitis B as an example; according to investigation, after hepatitis B virus infection, the patients with clinical symptoms account only 1 in 40 cases, that is, in forty hepatitis B patients, only one has comparatively evident clinical symptoms and most of the infected patients pass through a silent course. There are not few physician get used to “treatment according to symptoms” and usually they do not recognize the variability and complexity of the clinical manifestations of chronic hepatitis. In addition, virus hepatitis is customarily considered a disease without effective treatment, so that, although the diagnosis is made, the physician feels useless, and whatever he can do is only palliative.
Hepatophilic virus disease is systemic disease
Chronic virus hepatitis is now considered a systemic disease; the hepatitis virus as an antigen can arouse immune reactions in the human body and cause antibody production forming multiple clinical symptoms, such as rhino-hypersensitivity, repeated common cold attacks, tracheal hypersensitivity, gastro-enteral hypersensitivity, skin hypersensitivity, hepatitis B nephritis etc. When there are more and more antibodies combine with antigens to form “antigen-antibody complex”, the liver cells are more likely to be destroyed by antibodies and inflammation is produced; when the condition is prolonged, the normal liver function is damaged. When these combined “antigen-antibody complex” have accumulated in many systems, organs or cells in large amounts for long periods, pathologic changes will be produced in various systems. In different stages of life, various complicated and variable clinical symptoms may appear after the damage of these systems.
Clinically, some surgical, gynecological, obstetrical, pediatrical, ophthalmic, auricular, nasal, pharyngeal and dermatological common and frequently encountered diseases are in fact caused by hepatophilic viruses. If we still use the topical concept to explain the relation between the symptoms of chronic hepatitis and the disease itself, we shall be certainly “discarding the fundamental and seeking for the trifle”.
Therefore, after infected by hepatophilic virus, cirrhosis and carcinoma of liver are not invariably the cause of death of every patient, and more causes of death are severe acute icteric hepatitis in early stage of infection, intravascular disseminated coagulation (DIC), sudden death from virus myocarditis, cardiovascular disease (including coronary heart disease, apoplexy in late stage of hypertension), respiratory and digestive tract hemorrhage and failure of hepatorenal function leading to death. It is regretful that there are still many physicians and patients who do not give enough attention to the above condition.
* Hepatitis aplastic anemia syndrome
In 1968, Rubin suggested that this occurs in 90% of hepatitis patients within I year from the onset and occurs usually after the acute icteric form, amounting to 88.5% of the cases. Young and adolescent patients have a higher incidence. The clinical manifestations are anemia, significant decrease of blood platelets, bleeding, infection of the oral cavity, pharynx and lung; death may be due to septicemia.
* Hepatogenic coagulopathy
The normal liver generates all the coagulation factors and diseases of the liver are usually associated with coagulative disorders. 85% of patients with liver diseases have more than one item of abnormal coagulation laboratory result, 15% of the patients have bleeding, chiefly of the skin and mucous membrane. In severe cases, there are digestive tract and urinary tract hemorrhage, and if the amount is profuse, marked anemia, shock and even death may result.
By WONG Kwok Hung
10th October 2000
(Translated by Professor ZHENG Hua En)