VIRAL HEPATITIS, (HEPATITIS A(HAV), B(HBV), C(HCV), D(HDV), E(HEV)

Clinical Manifestations
  • Viral hepatitis is liver inflammation due to a viral infection. It may present in acute form as a recent infection with relatively rapid onset, or in chronic form.

    The most common causes of viral hepatitis are the five unrelated hepatotropic viruses hepatitis A, B, C, D and E

    Hepatitis A or infectious jaundice is caused by hepatitis A virus (HAV), a picornavirus transmitted by the fecal-oral route often associated with ingestion of contaminated food. It causes an acute form of hepatitis and does not have a chronic stage. The patient's immune system makes antibodies against HAV that confer immunity against future infection. People with hepatitis A are advised to rest, stay hydrated and avoid alcohol. Hepatitis A can be spread through personal contact, consumption of raw sea food, or drinking contaminated water. This occurs primarily in third world countries. Strict personal hygiene and the avoidance of raw and unpeeled foods can help prevent an infection. Infected people excrete HAV with their feces two weeks before and one week after the appearance of jaundice. The time between the infection and the start of the illness averages 28 days (ranging from 15 to 50 days), and most recover fully within 2 months, although approximately 15% of sufferers may experience continuous or relapsing symptoms from six months to a year following initial diagnosis.

    Hepatitis B is caused by hepatitis B virus, a hepadnavirus that can cause both acute and chronic hepatitis. Chronic hepatitis develops in the 15% of adults who are unable to eliminate the virus after an initial infection. Identified methods of transmission include contact with blood, blood transfusion (now rare), unsanitary tattoos, sex (through sexual intercourse or contact with bodily fluids), or mother-to-child by breast feeding; there is minimal evidence of transplacental crossing. However, in about half of cases the source of infection cannot be determined. Blood contact can occur by sharing syringes in intravenous drug use, shaving accessories such as razor blades, or touching wounds on infected persons. Needle-exchange programs have been created in many countries as a form of prevention.

    Patients with chronic hepatitis B have antibodies against the virus, but not enough to clear the infected liver cells. The continued production of virus and countervailing antibodies is a likely cause of the immune complex disease seen in these patients. A vaccine is available to prevent infection for life. Hepatitis B infections result in 500,000 to 1,200,000 deaths per year worldwide due to the complications of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Hepatitis B is endemic in a number of (mainly South-East Asian) countries, making cirrhosis and hepatocellular carcinoma big killers.

    Hepatitis C (originally "non-A non-B hepatitis") is caused by hepatitis C virus (HCV), an RNA virus of the family Flaviviridae. HCV can be transmitted through contact with blood (including through sexual contact if the two parties' blood is mixed) and can also cross the placenta. Hepatitis C usually leads to chronic hepatitis, culminating in cirrhosis in some people. It usually remains asymptomatic for decades. Patients with hepatitis C are susceptible to severe hepatitis if they contract either hepatitis A or B, so all persons with hepatitis C should be immunized against hepatitis A and hepatitis B if they are not already immune, and avoid alcohol. The genotype of the virus is the primary determinant of the rate of response to this treatment regimen, with genotype 1 being the most resistant. Hepatitis C is the most common chronic blood-borne infection in the United States.

    The Hepatitis D virus (HDV) or hepatitis delta agent belongs to the genus Deltavirus and causes Type D Hepatitis. It is similar to a viroid as it can only propagate in the presence of the hepatitis B virus, depending on the helper function of HBV for its replication and expression. It has no independent life cycle, but can survive and replicate as long as HBV infection persists in the host body.It can only cause infection when encapsulated by hepatitis B virus surface antigens.

    The Hepatitis E virus (HEV), from the family Hepeviridae, produces symptoms similar to hepatitis A, although it can take a fulminant course in some patients, particularly pregnant women (mortality rate about 20%); chronic infections may occur in immune-compromised patients. It is more prevalent in the Indian subcontinent. The virus is feco-orally transmitted and usually is self-limited.

    Primary Stage: (This is mostly applicable to hepatitis A, in the early stage of the disease.)
    Fatigue
    Occasional jaundice (Damp-Heat Stage affecting the Blood)
  • If the disease is cured at this stage, there will be no further manifestations.
  • If the disease is not cured at this stage: (This stage is not seen in hepatitis C.)
    Fever and chills
    Nausea
    Gas
  • Hepatitis C: is a disease of the Blood rather than the Liver or Spleen. Symptoms happen once the Liver cells are damaged.
  • The main symptom is extreme fatigue
  • Middle Stage: This stage can last two to twenty years and is the most common.
    Spleen Qi and Yang Deficiency
    Yin
    Deficiency with Blood Stagnation
  • Late Stage:
    Liver and Kidney Yin and Jing Deficiency
    Damp-Stagnation
    Blood Stagnation
    Phlegm Stagnation
    Liver Cancer
    Liver Cirrhosis
Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • Fatigue
  • Abdominal tenderness
  • Nausea/queasiness
  • Lack of appetite
  • Muscle weakness
  • Loose stools
  • T: Pale and swollen with toothmarks
  • P: Deficient
Treatment Principle
  • Tonify the Spleen
  • Tonify Qi
Herb Formulas
Points
Etiology
  • Damp Accumulation Blocking the flow of Qi leading to Blood Stagnation
Clinical Manifestations
  • Fatigue
  • Dizziness
  • Anorexia
  • Nausea
  • Occasional vomiting
  • Abdominal bloating
  • Gas due to Cold-Dampness
  • Emotional depression
  • Pale and often puffy face
  • Swollen hands, especially in the morning
  • Sighing
  • Hiccup
  • T: Pale with teeth marks
  • C: White or gray and moist
  • P: Soft and soggy, especially in the Stomach and Spleen positions
  • Over time Blood Stagnation with become more obvious with a darker tongue and face
  • The following symptoms may be dominant after too much work or stress:
    Depression, sometimes to the point of suicide
    Anxiety
    Insomnia
    T: Dark
  • C: Little or none
  • P: Deep and soggy
Treatment Principle
  • Strengthen the Spleen
  • Drain Dampness
  • Dredge the Liver
Herb Formulas
Points
Clinical Manifestations
  • Bright yellow face
  • Abdominal pain and distention
  • Nausea
  • Jaundice
  • Fever
  • Decreased appetite
  • Loose stools
  • General debility
  • Tastelessness in the mouth
  • T: Red
  • C: White or Yellow and greasy
  • P: Slippery or Deep, thready and weak
Treatment Principle
  • Warm and strengthens the Spleen
  • Transform Dampness
  • Reduce jaundice
Herb Formulas
Points
Clinical Manifestations
  • Dry eyes
  • Dry nails
  • Dry throat
  • Dry mouth
  • Fatigue
  • Blurred vision
  • Dizziness
  • Muscle spasms
  • Malar flush
  • Red eyes
  • Numb extremities
  • Quick temper
  • Dull pain in the hypochondrium
  • Five-Sole-Heat
  • T: Red
  • C: Thin or None
  • P: Thin, Deficient, wiry and rapid
Treatment Principle
  • Nourish Liver and Kidney Yin
Herb Formulas
Points
Clinical Manifestations
  • Fatigue
  • Costal pain
  • Abdominal fullness
  • Nausea
  • Flatulence
  • Bloating
  • Increased liver enzymes
  • Hepatosplenomegaly
  • T: Purplish or Normal
  • C: White
  • P: Wiry
Treatment Principle
  • Regulate Liver Qi
Herb Formulas
Points
Clinical Manifestations
  • Bright yellow face and eyes
  • Fever
  • Costal pain
  • Jaundice
  • Nausea
  • Sticky and smelly stool
  • incomplete passing of the stool
  • A feeling of incomplete evacuation
  • T: Red
  • C: Yellow and greasy
  • P: Wiry
Treatment Principle
  • Clear Heat
  • Resolve Dampness
  • Reduce jaundice
Herb Formulas
Points
Clinical Manifestations
  • Fatigue
  • Anxiety
  • Easily agitated
  • Thin, cracked and dry hair
  • Low back pain
  • Dizziness
  • Tinnitus
  • Scanty or late menstruation
  • Low sexual desire in men
  • Dark and dry complexion like snake skin or tree bark
  • Night sweats
  • Hot flashes
  • Bone steaming fever
  • Blurred vision
  • Spermatorrhea
  • This type easily moves into Liver cirrhosis
  • T: Dark red gradually becoming darker, may become dry and cracked and may have purple spots on the edge or Enlarge vessels on the bottom.
  • C: Little or none
  • P: Thready and rapid or Soggy and choppy or Sticky
Treatment Principle
  • Nourish Blood, Yin and Jing
  • Invigorate Qi and Blood
  • Clear Heat
  • Drain Damp
Herb Formulas
Points
Clinical Manifestations
  • Fatigue
  • Malar flush
  • Night sweats
  • Afternoon fevers
  • Hot flashes
  • Restlessness
  • Waking up during the night
  • T: Red
  • C: Little or None
  • P: Thready, Deficient , and rapid
Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • Pain that is fixed, stabbing and /or severe or
  • Pains that move around
  • Distention
  • Depression
  • Irritability
  • Stabbing pain in the right hypochondrium
  • Hepatomegaly or
  • Splenomegaly
  • Pain is worse with pressure
  • Abdominal distention
  • anorexia
  • Dark complexion
  • Fixed, palpable masses
  • Bleeding with clots
  • Purple lips
  • Purple nails
  • Dry skin
  • Blue, dark or purplish discoloration of skin in small or large areas of the face
  • Varicose and spider veins
  • Cold hands and feet
  • Tendency to hemorrhage dark blood or clots
  • T: Purple, possible purple or red spots
    Red purple if there is Heat
    Blue purple if there is Cold
  • C: White
  • P: Choppy or Wiry and choppy or Tight an choppy
Treatment Principle
  • Invigorate the Blood
  • Move Qi
  • Break up Stagnation
  • Soften the Liver or Spleen
Herb Formulas
Points
Clinical Manifestations
  • Fatigue
  • Abdominal pain
  • Bleeding (e.g. purpura)
  • Leg edema
  • Ascites
  • T: Pale and swollen
  • P: Deficient
Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • Amnesia
  • Palpitations
  • Feverishness
  • Anorexia
  • Emaciation
  • Pale face
  • Insomnia
  • Dyspnea on mild exertion
  • Fatigue
  • Shortness of breath.
  • Weight loss
  • Dry skin
  • Dry mouth
  • Dry throat
  • Dry lips
  • Uterine bleeding
  • Irregular menstruation
  • May suddenly lose consciousness
  • Slack jaw
  • Restless at night
  • Lassitude
  • Tendency toward being frightened easily
  • Weakness
  • Sallow complexion
  • Dizziness
  • Tremors in the limbs
  • Spontaneous perspiration
  • Fever and severe chills
  • General debility
  • Mental instability
  • Coughing and gasping.
  • Night sweats
  • Amnesia.
  • Diarrhea
  • Turbid urine
  • Nocturnal emission
  • Impotence
  • Constipation
  • Feeble breathing.
  • Tired limbs.
  • T: Pale
  • C:White
  • P: Thready and weak or thready, rapid and weak or Deep and weak
Treatment Principle
  • Tonify Qi
  • Nourish the Blood
  • Strengthen the Spleen and Lungs
  • Nourish the Heart
  • Calm the Shen
Herb Formulas
Points
Clinical Manifestations
  • Pale and lusterless face
  • General dryness
  • Normalized enzymes
  • Shrunken liver
  • T: Pale
  • P: Deficient and thready/hollow (with blood loss)
Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • Sharp, stabbing costal pain
  • Abdomen hurts with movement
  • T: Purple or Purple edges
  • P: Choppy or Wiry (with pain)
Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • Itching
  • Sensations of Heat
  • Agitation
  • T: Red with red spots
  • P: Rapid
Treatment Principle
Herb Formulas
Points