More than 30 million people in China are infected with the hepatitis C virus (HCV).¹ For the most part, China is still a developing country. Expensive drugs such as interferon and ribavirin are not readily available, nor are they affordable. In addition, the success rate of these drugs is not satisfactory and the side effects can be severe. All of this has prompted most Chinese hepatitis patients to use traditional Chinese medicine (TCM), or integrated Chinese and western medicine known as modern Chinese medicine (MCM).

TCM serves more than one billion people in China and Southeast Asia. There are more than one million TCM practitioners in China alone. Five years ago, the Chinese government conducted a national survey on Chinese medicinal substances and found that 11,146 species of plants, 1,581 species of animals, and 80 minerals have been used as TCM remedies.² One-fourth of the world's population uses TCM, the second largest medical system in the world today. In Japan, there are more than 200,000 health care providers prescribing Chinese herbal medicines for their patients. TCM is used to treat almost every disease identified by western medicine. TCM is used in Europe, Canada, and the United States, especially in the western, eastern, and northern parts of the U.S.

There is increasing interest and discussion in the United States about TCM and MCM as treatment options for people living with hepatitis C. Doctors in China have a great deal of experience treating hepatitis with TCM since one-third of the world's hepatitis carriers are in China.

What Is Traditional Chinese Medicine?

TCM is a very old, but still vital health and healing system. It is based on harmony or balance. A healthy person is in complete balance, both with him or herself and with nature. TCM theory states that disease is a deviation from balance, and the purpose of treatment is to restore it. TCM focuses on maintaining health rather than managing disease. TCM is an empirical medicine, meaning it was developed mainly through clinical observations. It is a logical system that summarizes the results of clinical observation and experience to instruct further practice.

TCM has developed unique diagnostic and therapeutic methods such as tongue diagnosis, pulse reading, herbal formulas, acupuncture, tui na (Chinese massage), and qi gong. TCM treats patients holistically, that is as a whole, rather than treating individual parts. This ancient medical system is continuously developing.

What Is Modern Chinese Medicine?

During the past four decades, there has been a new development in TCM. Practitioners have begun integrating TCM and western medicine. This combination of TCM and western medicine has created a new version of integrated medicine, modern Chinese medicine. The marriage of TCM and western medicine has brought great benefits to every patient it serves.

Since the late 1950's, a modernization movement brought TCM into every medical school in China. TCM is taught along with western medicine. Many Chinese health care providers include both TCM and western medicine in their practices. For most clinical conditions, these two medical approaches are used together and the results are usually better than if either approach was used alone. As part of this movement, many western health care providers have devoted large amounts of time and energy to the scientific study of TCM.

Today, there are three kinds of medical practice in China: TCM, western medicine, and MCM.

How Was Chinese Medicine Modernized?

One method used to modernize TCM was the creation of special terms for western mental and physical diagnoses to match the terms TCM uses. This allowed the language barrier between these two medical systems to be overcome.

This modernization made it possible for TCM and MCM to treat some of the newly defined diseases affecting humans such as hepatitis C, HIV/AIDS, and Lyme disease. Although these diseases are not discussed in the traditional TCM literature, their descriptions can be used to find suitable TCM diagnoses and treatments.

With the modernization of TCM, we now use herbs based on both TCM principles and plant pharmacology. We now know the active ingredients of the herbs and their actions in the body. We have learned more about possible toxicities and side effects, proper doses, and treatment courses. These new abilities make MCM a more effective medical approach than TCM. MCM can treat some diseases that are difficult to treat with western medicine, often avoiding the severe side effects that may be caused by many western drugs.

Most states in the U.S. require licensure to practice acupuncture. However, a license is not required to practice herbology, the dispensing of medicinal herbs. Any person with knowledge of herb usage can call him or herself an herbalist. Furthermore, the Food and Drug Administration (FDA) does not regulate herbal products. Their quality, safety, efficacy, and potency are in the hands of the manufacturers, with no governmental oversight. For these reasons, anyone considering the use of herbs should be very careful to find a qualified practitioner and to use reputable products. One way to do this is to ask friends or relatives for referrals. You can also check with professional associations and ask for referrals to qualified practitioners in your area.

Chinese medicine's approach to chronic viral infections is called fu zheng qu xie. The translation of this phrase is, "dispelling evil [the virus] by supporting righteous qi (normal function of the body)." The immune system is a major part of the righteous qi (pronounced chee). Therefore, supporting the immune system is an important part of Chinese medical treatment for hepatitis C. There are many Chinese therapies to help regulate and support the immune system. Chinese medicine asserts that the body itself is the major healing force. Medications and procedures can help the body heal, but they cannot replace the healing function of the body itself. In treating chronic hepatitis C, Chinese medicine focuses first on normalizing liver functions and restoring overall health. With improving health, the body's immune function is strengthened. With the help of antiviral herbal remedies, the hepatitis C virus (HCV) will be suppressed and kept at bay, causing no further harm. The TCM and MCM therapies discussed in this section are based on these principles.

Diagnosing Chronic Viral Hepatitis

TCM diagnosis is based on four basic techniques: inspection (observation), auscultation and olfaction (smelling and listening), interrogation (questioning), and palpation (physical examination). According to TCM, the body is a whole whose parts are both interconnected and interactive. Because of this interconnection, a condition in one part of the body may affect the entire body. Therefore, signs of disease in one organ can be seen in many different parts of the body. The four diagnostic methods are used to look for symptoms and signs of disease, and to determine their cause. The TCM diagnosis is the basis for both determining the cause of an illness and deciding on the appropriate treatment.

Inspection
The TCM doctor inspects (observes) the patient's mental state, complexion, physical condition, and behavior. The practitioner observes the person's vitality (qi), face and skin color, body figure, hair, eyes, lips, teeth, throat, and other features. The most important observation is of the tongue to see its color, size, and coating or "fur."

Auscultation and Olfaction
Auscultation (listening) and olfaction (smelling) are used to detect the health status of the patient. The practitioner listens to the voice, breathing, and coughing. The odors of the patient are also noted. TCM considers these sounds and odors to be reflective of the health status of the various body organs.

Inquiring
Inquiring involves asking the person and his or her relatives about such things as the person's history, symptoms, family history, and previous therapies. Typically, the practitioner will ask the person about the presence of chills and/or fever, excessive perspiration, pain, sleep, diet, thirst, alcohol consumption, other beverage consumption, urination, bowel movements, menstruation, and childhood illnesses.

Palpation
Palpation is a physical examination that includes pulse reading and the use of the hands to touch and press certain areas of the body. Pulse reading is one of most important Chinese diagnostic methods. There are 24 different pulses that can be read from a person's wrists.

Based on all the data obtained from the four diagnostic methods, a differential diagnosis is made according to the eight principal syndromes: yin or yang, exterior or interior, cold or heat, and deficient or excessive.

According to TCM theories, treatment is based on an overall analysis of symptoms and signs. The doctor considers four characteristics in deciding on a treatment.

the cause of the illness
the nature of the illness
location of the illness
the patient's overall physical condition

In this way, treatment is individualized. It may be changed according to changes in the patient's condition during the course of the disease.

Traditional Chinese Medicine Therapies for Chronic Viral Hepatitis

Through numerous clinical observations, major symptom patterns in chronic viral hepatitis have been identified and treatment methods have been developed. In 1990, the National Hepatitis Conference of China developed the TCM Scheme for Chronic Viral Hepatitis Prevention and Treatment. According to this scheme, chronic viral hepatitis is categorized into the following five TCM symptom patterns: ^3,4

Gan dan shi re - liver-gallbladder damp-heat
Gan yu pi xu - depressed liver-energy and spleen deficiency
Gan shen yin xu - liver-kidney yin deficiency
Pi shen yang xu - spleen-kidney yang deficiency
Yu xue zu luo - stagnant blood blocks collaterals

Gan Dan Shi Re - liver-gallbladder damp-heat

Symptom pattern:

dull pain in the right hypochondrium (area below the ribs)
stomach flatulence (gas)
nausea
aversion to oil
jaundice or no jaundice
dark urine
difficulty eliminating feces
wet, thick, yellowish tongue coating
fast, slippery pulse

Treatment method:

Clear the heat and eliminate the dampness. Cool the blood and resolve the toxin.

Formula:

Capillaris Combination plus blood cooling and toxin resolving herbs

Gan Yu Pi Xu - depressed liver-energy and spleen deficiency

Symptom pattern:

distended sensation in the hypochondrium (area below the ribs)
depression and/or anxiety
withered and yellowish complexion
poor appetite
stomach flatulence (gas)
loose stools or diarrhea
pale tongue with white coating
submerged and tight pulse

Treatment method:

Disperse the depressed liver energy and alleviate the depression. Invigorate the spleen, and regulate the stomach.

Formula:

Modified formulas of Bupleurum and Tang-kuei Formula and Bupleurum and Peony and Six Major Herb Combination

Gan Shen Yin Xu - liver-kidney yin deficiency

Symptom pattern:

vertigo (dizziness)
tinnitus (ringing in the ears)
dry eyes
thirst
dry mouth
insomnia and dreamy sleep
feverish sensation in palms and soles
lassitude of the loins and legs (a heavy feeling)
menstrual problems
red and flaccid tongue with little dry coating
fast, fine, and weak pulse

Treatment method:

Nourish the blood, liver, and yin, and invigorate the kidney.

Formula:

Modified Glehnia and Rehmannia Formula

Pi Shen Yang Xu - spleen-kidney yang deficiency

Symptom pattern:

intolerance to cold
cold pain in the lower abdomen, loins, and legs
poor appetite
loose stools and/or diarrhea
indigestion
leg and ankle edema (swelling)
pale and puffy tongue
submerged and fine, slow pulse

Treatment method:

Invigorate the spleen and nourish the qi. Warm the kidney and support yang.

Formulas:

Modified Aconite, Ginseng, and Ginger Combination, and Gardenia and Hoelen Formula, or Four Major Herb Combination and Rehmannia Eight Formula

Yu Xue Zu Luo - stagnant blood blocks collaterals

Symptom pattern:

dim and grayish complexion with rashes or reddish spots
enlarged and hardened liver and spleen
liver palm
spider moles
painful and dark menstruation with blood clots
dark purple tongue with petechiae (red or purple spots)
submerged and uneven pulse

Treatment method:

Activate the blood circulation and dispel the stasis. Disperse the accumulation, and dredge the meridian passage.

Formulas:

Modified Persica and Achyranthes Combination and Persica and Cinidium Combination, or Persica and Eupolyphaga Combination.

Different treatment methods and herbal formulas have been developed for each symptom pattern discussed in this section. Treatments are changed as symptom patterns change. The herbal composition of the formulas mentioned in this section can be found in Appendix V, Modern and Traditional Chinese Medicine.

The protocols described below were reviewed by me, and are generally used in Zhang's Clinic in New York, NY. It is important to note that, because of differences in education and training, every qualified practitioner develops his/her own way of practicing TCM or MCM. This approach is only one example of how TCM or MCM can be applied to the treatment of people with chronic hepatitis C. Anyone considering TCM or MCM should compare different practitioners' approaches, and then make an educated decision about whom they should see for treatment.

Hepatitis C is a newly defined disease. The pathology is similar to chronic hepatitis B, so many treatment methods were borrowed from those used to treat chronic hepatitis B.

During the course of HCV infection, many changes occur in the body. Some of these changes are immune system abnormalities, liver inflammation, fibrosis, and portal vein hypertension. All of these changes can have significant effects on disease progression and your prognosis. Therefore, it is not enough to treat only the virus. Chinese medicine emphasizes restoring liver function and overall health (supporting the righteous qi of the body). A healthier body is better able to control the virus, prevent it from causing further harm, and possibly eradicate it (dispelling the evil). In treating chronic hepatitis C, MCM uses western medical knowledge about diagnosis, the cause of disease, and how the virus causes harm. This knowledge is combined with TCM diagnostic tools and herbal treatments to derive the best from both systems of medicine.

Treatment Protocol for Chronic Hepatitis C

The following protocol for treating chronic hepatitis C has several goals.

heal liver inflammation and restore liver function to halt disease progression
reduce the viral load and/or suppress viral replication
regulate the immune system
improve microcirculation (blood flow to organs and tissues)
promote liver cell regeneration
suppress fibroblastic activity (reduce scarring)
promote bile flow
treat hepatitis C related symptoms and complications to improve quality of life

The protocol consists of seven parts. See Appendix V, Modern and Traditional Chinese Medicine for the pharmacology of the major herbs used in the treatment protocol for chronic hepatitis C.

Part 1. Improve or normalize liver enzyme levels and liver functions

Inflammation causes fibrosis, which leads to cirrhosis. To stop this progression, inflammation must be controlled. If the liver is not actively inflamed, the time for cirrhosis to develop is estimated to be 80 years, the approximate length of the human life span.⁵ The following herbal remedies are used to control inflammation.

Hepa Formula No. 2 Capsule
Ligustrin Capsule
Glycyrrhizin Capsule
Circulation P Capsule

ALT is an important marker of liver inflammation. After treatment, if three consecutive ALT tests (done 2-3 months apart) are normal, liver inflammation is considered to be better controlled.

The active ingredients of schizandra and schisandrin B and C have been tested in clinical trials in China. Studies involving 4,558 patients showed schisandrin B and C reduced and/or normalized ALT levels in 75% of the cases within 2-3 months.⁶ Schizandra and schisandrin B and C are the major ingredients in Hepa Formula No. 2.

Oleanolic acid, the active ingredient of Ligustrum fructus, has also been studied. Out of 153 patients treated, 110 (70%) experienced normalization of their ALT within 50 days.⁷ Glycyrrhizin, a licorice root extract, has been used to treat chronic viral hepatitis in China and Japan. Studies have shown it to be effective in normalizing ALT in 64% of patients in Japan, and 84.5% of patients in China.⁸

Part 2. Lower and stabilize the HCV viral load

Suppressing HCV is achieved by strengthening the immune system and using antiviral herbal remedies. Herbal treatments may be able reduce HCV viral load, but cannot eliminate the virus. Antiviral therapy is the weak point of MCM. More research needs to be done to develop more effective anti-HCV herbal remedies.

Most herbal antiviral studies were done with the hepatitis B virus (HBV), not HCV. The herbs Polygni cuspidati rhizoma, Houttuyn herbaiae, Rhei rhizoma, and Blechni rhizoma have been found to suppress HBV in the laboratory. Another group of herbs, Salviae miltiorrhziae radix, Prunellae spica, Gardeniae fructus, and Montan radicis cortex, have been found to reduce HBV replication by over 50% in the laboratory.⁹ Studies of HBV patients treated with this herbal combination found 30-40% became negative for HBV surface antigens (laboratory indicators of HBV in the body).¹⁰ Some of these herbs are included in various formulas of this protocol.

Most patients' viral load can be reduced and/or stabilized below one million. The following herbs have been used to lower viral load.

Glycyrrhizin Capsule
Olive leaves Decoction
Olivessence Capsule

Part 3. Regulate the immune system

HCV causes liver damage mainly by causing the immune system to react abnormally. An inadequate immune response allows HCV to invade and damage or kill liver cells. Without an adequate immune response, HCV infection becomes chronic.

In response to HCV, the immune system makes large quantities of proteins called gamma globulins. These proteins form larger molecules called soluble immune complexes (SIC). When SIC is deposited in the liver, joints, skin, and other areas, it causes inflammation. Other abnormalities in the immune system allow this inflammation to persist. Ongoing inflammation can eventually lead to fibrosis and/or cirrhosis.

Glycyrrhizin and AI #3 Capsule are used to suppress gamma globulin production. Blood activating and stasis expelling herbs such as Circulation P Capsules are used to clear SIC. Cordyceps sinensis, Sophorae subprostratae radix, and Polyporus umbellatus pers are used to regulate other immune functions.

Glycyrrhizin Capsule
AI #3, Capsule
Circulation P Capsules
Cordyceps Capsule

Part 4. Improve microcirculation, promote liver regeneration, and suppress fibroblastic activity

Patients with chronic hepatitis C often have microcirculation disorders. This means blood flow to organs and tissues is abnormal. In MCM, a microcirculation disorder is called blood stagnancy. Typically, patients with blood stagnancy have liver palms, spider moles, cold hands and feet, purplish tongue, dark lips, a dark ring around each eye, and/or an enlarged spleen. Studies in China found the severity of a person's microcirculation disorder is a good indicator of the severity of liver inflammation and damage.¹¹ Microcirculation disorders in the liver can keep it from getting the proper oxygen and nutrients. This promotes the process of fibrosis. If microcirculation in the liver is improved, liver cell regeneration will be promoted and the progression of fibrosis will be suppressed. To improve all of these symptoms, a blood-activating and stasis-expelling herbal formula such as Circulation P Capsule is used.

Circulation P Capsule

Part 5. Facilitate secretion and excretion of bile

People with chronic viral hepatitis can have thickened bile that may become blocked by inflamed liver tissue. This often causes jaundice, gall bladder inflammation, and gallstones. Bile blockage can also injure the liver and promote fibrosis. This leads to an increase in liver enzymes and bilirubin in the blood. Therefore, improving bile secretion is very important. The following formulas can effectively release blocked bile and clear jaundice. These formulas can also be used for gallbladder inflammation and gallstones.

Gall No. 1 Capsule
Capillaris Combination

Part 6. Lower portal vein pressure and suppress fibroblastic activities

Portal vein hypertension is the main cause of many of the complications of advanced liver disease. Portal hypertension is usually present only in people with cirrhosis. It can cause ascites (the accumulation of fluid in the abdomen), spleen enlargement, varices (the ballooning of veins), hemorrhoids, and edema (abnormal swelling, especially in the feet and lower legs). Reducing portal pressure is very important for people with advanced liver disease because this condition can cause severe bleeding.

In China, herbs used to treat the fibrosis seen with the disease miner's lung have also been used to treat early-stage cirrhosis. Controlled animal studies found cirrhotic animals treated with these herbs had lower levels of liver collagen (the material that makes up fibrotic tissue) than untreated animals.¹²

Cordyceps sinensis, Persicae semen, Salvia miltiorrhziae, and glycyrrhizin have been found to soften the liver, promote the breakdown of collagen, and enhance liver cell regeneration.

Circulation P Capsule
Cordyceps Capsule
Glycyrrhizin Capsule

Part 7. Treatments for Hepatitis C Related Conditions

Herbal treatments to alleviate HCV related symptoms might improve patients' quality of life. Some of these symptoms and their herbal treatments are discussed in this section.

Fatigue

The liver is the major powerhouse of the body. When liver function deteriorates, fatigue often results. The elimination of fatigue relies mainly on the improvement of liver function. If fatigue is the major problem, it can be treated with the following formula.

Cordyceps Capsule

Insomnia

Sleep disorders are a common complaint among people living with hepatitis C. Prescription sleep medications can be addictive and cause side effects such as morning drowsiness. They may also be toxic to the liver. The following herbal formula addresses this problem successfully with no harmful effects on the liver.

HerbSom Capsules

Joint Pain, Skin Rashes, Vasculitis, Psoriasis, Sjogren Syndrome

Many people with hepatitis C also have autoimmune symptoms and syndromes such as those listed above. These are the extrahepatic (outside the liver) symptoms of the abnormal immune response caused by HCV infection. Since the underlying cause of these different problems is the same, so is the treatment.

AI #3 Capsule
Circulation P Capsule

Diabetes

One of the liver's many functions is regulating blood sugar. The amount of sugar in the blood increases after eating. Excess sugar is turned into glycogen and is stored in the liver. When the blood sugar drops, the glycogen in the liver is broken down into sugar again and is released into the blood. This process is sometimes disrupted in people with chronic hepatitis C causing blood sugar abnormalities. HCV can also cause blood sugar abnormalities by damaging the cells of the pancreas that produce insulin, the hormone that controls blood sugar levels. HCV-related blood sugar abnormalities can often be controlled with an herbal remedy.

BM (Bitter Melon) Capsule

Infections

During the course of chronic hepatitis C, people may get other infectious illnesses such as sore throats, sinusitis, colds, and bronchitis. Many health care providers use antibiotics to treat these conditions. However since many of these illnesses are caused by viruses, antibiotics are often ineffective and may injure the liver. Herbs can be used to fight these infections. The most important herbal remedy for infections is Allicin, which is the essence of garlic. Coptin and Rhubarbin Tablets may also be used to fight infections.

Allicin Capsule
Coptin Capsule
Rhubarbin Capsule

Ascites and Edema

Ascites (fluid in the abdomen) and edema (swelling of the feet, legs, and hands) can occur with cirrhosis and liver failure. If these symptoms occur, salt and protein intake should be limited. At the same time, an herbal formula can be used to expel excess water.

Tiao Ying Yin Formula

Bleeding

Cirrhotic patients may be at risk for bleeding varices. This is bleeding from abnormally large and thin-walled veins around the stomach and the esophagus (the food pipe leading to the stomach). This kind of bleeding is accompanied by vomiting blood and/or passing black, tar-like stools. Bleeding from varices is a medical emergency. If this happens, you need to go to an emergency room immediately.

Bleeding from the gums or nose are more common and less serious forms of bleeding that can occur with liver failure. The following herbal formula is used to treat these less serious types of bleeding.

Yunan Pai Yao Capsule

Diarrhea

Diarrhea is a common complaint of people with chronic hepatitis C. Diarrhea often improves as liver function improves. If diarrhea lasts and becomes severe, the following formula can be used.

Ginseng and Atractylodes Formula

Nausea and Vomiting

Nausea is more common than vomiting in people with chronic hepatitis C. It can occur when bile secretion is blocked as this affects digestion. If these complaints become persistent, the following formula can be used.

Pinellia and Hoelen combination

Clinical Outcomes of the Protocols

More than 2,000 patients at Zhang's Clinic in New York City have used these protocols. In January 2000, we had test results on file for over 400 patients. A scientific analysis was conducted by reviewing the medical records of 75 patients for whom both pre- and post-treatment ALT levels were available. ALT was used to determine whether the protocols were effective. The average before treatment ALT level was 128 (±114), and the average after-treatment ALT level was 47(±42). Of these 75 patients, 77% experienced normalization of their ALT, and 93% experienced ALT improvement.¹³ All patients reported improvement in their symptoms. Four patients had liver biopsy results available before and after herbal treatment. Three of the four patients experienced regression of liver fibrosis from stage III to stage I after herbal treatment.

Reasons for Using TCM or MCM Therapies and Who May Benefit

Chinese herbal treatments for HCV have many positive features.

effective
time-honored
easy to take
affordable (15-20 times less expensive than western medication)
virtually nontoxic
largely side effect free
work life-long

However, Chinese remedies do not necessarily eradicate HCV. Chinese herbal treatments provide an alternative for people who are unwilling or unable to use western medicine treatment options. Some examples of situations in which TCM or MCM may be chosen are listed below.

Many people are afraid of the side effects of prescription medicines. For them, TCM or MCM may be a viable alternative. "In the US, it is likely that more patients with hepatitis C use nonprescription agents of unproven effectiveness than use interferon-based therapy."¹³

For the approximately 50% of people who do not respond to western treatment, TCM or MCM can be used to help improve liver function and overall quality of life.

For those who cannot take interferon and/or ribavirin, TCM or MCM may provide an alternative treatment option. Conditions that may make the use of interferon or ribavirin impossible include decompensated cirrhosis, persistently normal ALT, active alcohol or illicit drug use, a history of major depression, leukopenia (low white blood cell count), hyperthyroidism, renal transplant, and/or evidence of autoimmune disease.

For those who cannot tolerate western treatment, TCM or MCM may provide an alternative.

Individuals who initially respond to interferon and/or ribavirin but then relapse may have a recurrence of liver disease. TCM and MCM can be used to treat this recurrence.

TCM or MCM therapies can be used to treat damage already caused by chronic hepatitis C.

TCM or MCM used in conjunction with interferon-based treatments may make them easier to tolerate and decrease associated side effects.

Reasons for Not Using TCM or MCM

Common reasons given for not using TCM or MCM are described below:

It is not intended to eradicate HCV, so it is not a "cure."

The concept of "cure" in TCM and MCM is different than it is in western medicine.

TCM and MCM herbal remedies are unproven. They have not gone through rigorous scientific testing.

Most TCM and MCM remedies are customized to meet the specific needs of the client, taking into account other conditions and limitations. It is very difficult to conduct clinical trials with herbal remedies because TCM and MCM do not subscribe to the "one size fits all" approach of western medicine. In many cases, this means clinical trials would be invalid because they would be comparing "apples to oranges."

The National Center for Complementary and Alternative Medicine (NCCAM) Internet page "Hepatitis C: Treatment Alternatives" labeled TCM and MCM as having "no research to a limited amount of research." Because most of the published research on TCM and MCM is written in Chinese, this issue is further complicated.

The FDA does not regulate herbal products, so using herbs can be dangerous. You may not get what you are supposed to get.

This can be true, especially if the herbalist is not well versed in the plant pharmacology and toxicity data. Because of this potential danger, it is important to verify the credentials of any herbalist you decide to consult.

The Internet site at www.consumerlab.com is privately owned, and monitors the quality of nutritional supplements and herbs. You may find this site useful. If you choose to take herbal products, it is very important to confirm the quality of the herbs or products.

Herbal medicines are not stable with respect to their active essence because species, collecting seasons, and production sites vary.

The method of preparation (drying, steaming, and decocting) can dilute the active essence of an herb. It is also argued that herbal medicines are inconvenient to prepare for ingestion. Finally, herbal medicines can be perceived to be bitter and unpleasant to ingest.

These drawbacks can be alleviated through scientific preparation procedures to achieve a consistent amount of active ingredients. In addition, herbal extracts can be concentrated so that the daily dosage is small and requires no special preparation. Since capsule, tablet, and granular forms of herbal preparations are placed on the tongue and swallowed with a large glass of water, poor taste need not be a deterrent.

The numbers of different chemicals in herbs make it hard to control their interactions with conventional drugs.

If you are taking any herbal products, you need to tell your western doctor. He or she will be able to advise you about any possible interactions. Your herbalist can also advise you about this.

An anecdotal story is one that is not based on a controlled, clinical trial, but on an individual's personal experience. Whether or not the results of anecdotal stories have value is up to you. Below are two stories of success and two stories of failure based on cases from my clinic in New York City. Patient names have been changed.

Joseph V.
Joseph V. is a New Jersey firefighter. He was diagnosed with hepatitis C in 1996. When he saw me in 1997, he was on disability and his ALT was quite high (above 300). He felt tired and could not work. Two months after herbal treatment, his liver enzyme levels normalized and he went back to active duty as a firefighter.

His western health care provider suggested he try interferon, and he did not want to lose the chance to try this FDA approved therapy. He stopped taking herbs and went on interferon for eight months. During this time, he went back on disability and felt very sick. When the treatment was finished, his ALT went up to 380. At that point, his western doctor suggested the combination of interferon and ribavirin. He refused. He came back to me for treatment and resumed herbal therapy. Within two months, his liver function tests normalized. He has since returned to active duty as a firefighter and has married. He told me the herbal treatment helped him to put his life together and gain the confidence to build a family.

Lorraine D.
Lorraine D., 41, works for a large pharmaceutical company that produces interferon. She was diagnosed with hepatitis C in 1997. She might have contracted the virus seven years earlier. In March 1998, she stopped a seven-month course of interferon treatment. At that time, her liver function tests were normal. However, the side effects of interferon forced her to discontinue treatment. Her platelet count dropped to a dangerously low level. She often had bruises on her skin. She was diagnosed with idiopathic thrombocytopenia purpura (ITP), an autoimmune disease. She was put on steroids to treat the ITP. Her thyroid gland was also not functioning well. She was given synthetic thyroid hormone to correct her thyroid function. The steroids helped her platelet count increase in two months, but they triggered a relapse of liver inflammation. She came to see me in May 1998 after this relapse. Her ALT and AST were both abnormal. Her viral load was at 27 million, much higher than before interferon treatment. Lorraine was very tired and had pain in her liver area and joints, dark urine, and occasional diarrhea with pale stool. Her skin and conjunctiva (the skin around the inside of the eyes) were yellowish. In addition, she had a pituitary tumor as an underlying condition, which made her situation quite complicated. Her western health care provider recommended interferon and ribavirin, but she refused.

I first focused on her liver inflammation. Her ITP and thyroid gland abnormality showed that her liver inflammation had autoimmune involvement. I emphasized anti-autoimmune therapy. She began taking Hepa Formula No. 2, Glycyrrhizin Capsule, Ligustrin Capsule, AI Capsule No. 3, Circulation Tablet No. 1, and Formula R6379 (for hypothyroidism). One month later, her blood tests showed that all liver enzyme levels had normalized. Her platelet count increased and her thyroid tests normalized. She was ecstatic because the treatment had normalized her ITP and rid her of hypothyroidism and liver inflammation in only one month. Her liver enzyme levels have been normal since that time, except once in reaction to a drug treatment for edema in her ankles. She is now on a maintenance protocol. All of her symptoms are gone.

Anecdotal Stories of Treatment Failure with TCM and MCM

About 10% of the patients using Chinese medicine protocols do not get favorable results.

Doug F.
Doug F., 50, visited my office in August 1999. He was first diagnosed with non-A, non-B hepatitis (hepatitis C) in 1977 after a blood transfusion. He was a heavy drinker from age 17 to 29. His liver enzymes were very high (ALT 426, AST 155). His viral load was 48,000. He had genotype 1a HCV. He occasionally felt fatigued, his urine was golden yellow, and he sometimes had diarrhea. After approximately one month on the herbal treatments Hepa F. #2, Ligustrin, Glycyrrhizin, AI #3, and Circulation #1, his ALT and AST decreased, but his viral load went up to 200,000. He was very happy with these results. Approximately one month later, his ALT and AST levels went back up. Although his ALT level went back down approximately one month later, his AST continued to rise. He was very depressed and felt more fatigued. From then on, the results on his liver enzyme tests were continuously worse. In January 2000, he had a liver biopsy and found grade II inflammation and stage II fibrosis. His ALT and AST continued to be markedly elevated, and his viral load was greater than one million. I tried using second-line herbal remedies and switched the Hepa F. #2 to Hepa F. #1a. In March 2000, his ALT and AST dropped, but he lost confidence in herbal treatment and went on western therapy.

Bruce D.
Bruce D., 61, was diagnosed with hepatitis C in 1984 as non-A, non-B hepatitis. He might have become infected in 1975. His HCV genotype was 1b. Before he started an herbal protocol in December 1998, his baseline liver function tests were ALT 389, AST 192, and viral load 2.6 million. His liver biopsy showed stage II-III fibrosis with marked, active, ongoing inflammation (grade III). His blood clotting studies were slightly abnormal. He had been an alcohol drinker, but stopped drinking four years earlier. Clinically, he had a gassy stomach, loose stools, and slightly yellowish skin, but no other obvious symptoms.

He started a first line protocol of Hepa F. #2 Capsule, Ligustrin Capsule, Glycyrrhizin Capsule, AI #3 Capsule, and Circulation #1 Capsule. In the first year (1999), his ALT levels improved. Once in July 1999, when his ALT went up to 276, I added a new herb, Paniculate Tablet, which brought the ALT back down. His viral load was sometimes very high. In 2000, his ALT shot up again. Beginning in March 2000, I switched him to a second line protocol, which included using Hepa F. #1a to replace Hepa F. #2. This change did not generate any significant positive effect.

Summary

TCM has been used for thousands of years by millions of people to promote health and provide therapy when health is impaired. TCM and MCM use observation and deduction to identify those areas of the body that are out of balance. TCM and MCM use a variety of therapeutic approaches such as herbs, acupuncture, and massage to help the body overcome the effects of disease and regain a healthy balance.

Each practitioner of TCM or MCM uses his or her own herbal formulations, and approaches the treatment of disorders such as hepatitis C based on his or her training and background. If you are currently seeing a TCM practitioner or are considering TCM as a treatment option, be sure to check your practitioner's training and qualifications. The Resource Directory at the back of this manual provides information on locating a TCM practitioner.

Regardless of what options you decide to pursue in the treatment of your hepatitis C, be sure to inform all of those in whom you entrust your health care of all the approaches you are using.