Many people with the hepatitis C virus (HCV) and/or the human immunodeficiency virus (HIV) are turning to traditional Chinese medicine (TCM) for treatment. TCM has a long history in the treatment of chronic hepatitis. Hepatitis B and C infections are prevalent throughout China, accounting for the increased risk of liver cancer (hepatocellular carcinoma) in the Chinese population. The Chinese medical system has been dedicated to solving these problems for many years. The Chinese are working to eliminate sources of hepatitis, and to develop treatments for chronic viral hepatitis using both TCM and western medicine.

At the International Symposium on Viral Hepatitis and AIDS held in Beijing, China in April 1991, more than 100 papers on viral hepatitis were presented. Several of these papers documented the positive results of studies involving Chinese herbal medicine. Studies on the use of herbal antivirals, and blood cooling and circulating herbs for liver damage repair were presented. These studies corroborated hundreds of years of treatment experience with Chinese herbs for the symptoms of hepatitis. ^1-3 A 1995 literature review revealed there are at least 55 herbal formulas that can be used to treat hepatitis. ⁴ Some recent herbal studies from China and Australia showed positive results in chronic hepatitis C using herbal formulas similar to those widely used in the United States. ^5-7

In the United States, TCM is a popular complementary and alternative medicine (CAM) therapy among people with chronic liver diseases. Anecdotal reports from one of the largest western medicine hepatology practices in San Francisco suggest that at least 20-30% of patients report use of TCM herbs for hepatitis.⁸ The rate of use of TCM therapies by HIV positive people is believed to be around 40%.⁹ The actual use of TCM may be underestimated because people often choose not to divulge the use of CAM therapies to their western health care providers.

TCM uses nutrition, acupuncture, heat therapies (such as moxibustion), exercise, massage, meditation, and herbal medicine to treat people infected with HCV. Protocols have been developed that have successfully helped people infected with HIV and HCV decrease symptoms, normalize or lower liver enzymes, and slow the progression of liver disease. A 1995 pilot study conducted among people coinfected with HIV and viral hepatitis (B and C) at San Francisco’s Quan Yin Healing Arts Center indicated acupuncture alone may have an effect in lowering and/or normalizing liver enzymes. ¹⁰

Chinese Medicine Philosophy

The primary goals of TCM are to create wholeness and harmony within a person thereby allowing the mind, body, and spirit to heal themselves.

Chinese philosophy states there are two opposing principles of life, yin and yang. Imbalances between yin and yang within a person can manifest as illness because the body is considered a microcosm of the world.

TCM defines the physiological components of illness using the concepts of qi (vital energy), xue (blood), jin-ye (body fluids), jing (essence), shen (spirit), and organ systems. Organ systems are domains within the body that govern particular body tissues, emotional states, and activities.

TCM theory states the key to health is the internal ability of the body to remain strong. According to this theory, people are born with a certain amount of original qi (pronounced “chee”). The qi is easily depleted as energy is used by the body and not replaced. It is difficult to increase the original qi. A person must work hard during life just to retain it. Exercise such as tai chi and qi gong, healthy eating, and good sleep habits are highly recommended for maintaining the original qi. If a person consistently lacks sleep, does not have a healthy diet, abuses drugs or alcohol, and/or has excessive or unsafe sex, he or she becomes qi deficient. When weakened and qi deficient, a person is more susceptible to infection by harmful external elements.

Traditional Chinese Medicine Diagnoses for HIV/HCV

According to TCM literature, people in China have experienced various syndromes associated with both HIV and HCV infection for over 2000 years. This is because TCM diagnoses are based on symptoms, not on detection of antibodies to a specific virus. TCM treatments for these syndromes have been used over the past millennia and are generally considered safe and effective for all patients. Further, TCM recognizes that each person has a unique constitution and pattern of disease that exists in conjunction with the age-old syndromes. TCM contends that the best form of treatment is to modify, alter, or supplement base therapies to create an individualized treatment that meets each patient’s unique characteristics and needs.

Chinese medical theory states that HIV and viral hepatitis are not singular diseases, but are combinations of stages and syndromes. The diagnosis and staging of HIV and HCV are accomplished using tongue diagnosis, pulse diagnosis, and questioning to determine if the patient’s initial western diagnosis is consistent with TCM theory.

According to TCM, the initial organ systems affected by HIV are the spleen and stomach, although all organ systems are involved. The spleen and stomach organ systems influence digestion and appetite, the lymph system, and muscle mass.

In both HIV and HCV infections, toxic heat enters the body. Manifestations of an invasion of heat include feelings of warmth, sweating, agitation, hot sensations, and itching skin. Examination may reveal a fast pulse and a red tongue. Small red spots on the tongue are a likely finding in nearly all cases of chronic infection. A review of over 5,000 tongue slides from HIV infected subjects on a Chinese herbal treatment protocol revealed that small red spots were present in nearly every person, ranging from very obvious to barely noticeable.

The organ systems primarily disturbed in hepatitis are the liver and spleen. These disturbed organ systems affect digestion and energy. According to TCM, acute viral hepatitis is generally associated with excess damp heat or damp cold conditions. While a few people acutely infected with HCV may have symptoms, this is rare. The TCM stage at which one is diagnosed with hepatitis C is usually either the chronic stage of qi stagnation, or the stage of qi and yin deficiency. Advanced chronic disease includes development of the patterns of xue stagnation and xue deficiency. All HCV infection is associated with toxic heat or the li qi (the pestilence/epidemic factor).

Traditional Chinese Medicine Therapy for HIV/HCV

In western medicine, extremely harmful external elements include severe bacterial or viral infections such as HIV and HCV. However, those terms are inappropriate in TCM. Instead, Chinese medicine, “…recognizes the existence of Pestilences called li qi or yi qi. These are diseases that are not caused by the climatic factors of Heat, Cold, Wind, Dampness, or Summer Heat dryness, but by external infectious agents … that are severely toxic because they strike directly at the interior of the body.” ¹¹

In the case of HIV and/or HCV, the particular pestilence is identified as toxic heat. Toxic heat is considered by TCM to be both an epidemic factor (something that is seen in a number of patients) and its own individual, treatable syndrome. However, HIV and HCV are not identical invasions of toxic heat. They are each characterized by a different set of syndromes, involving toxic heat.

The various modalities of TCM therapy include diet, massage, heat therapies, exercise, meditation, and acupuncture. Heat therapies include the use of moxibustion. Moxibustion is the burning of the herb mugwort over certain areas of the body to stimulate or warm these areas. Exercise therapy ranges from martial arts to more subtle forms of movement such as tai chi and qi gong. Acupuncture is perhaps the most well-known form of TCM in the United States. It is the art of inserting fine, sterile, metal filiform needles into acupuncture points on the body in order to control the flow of energy (qi). Acupuncture therapy can include electrostimulation and/or hand stimulation. This form of therapy is most appreciated for its ability to relieve pain. However, acupuncture is also able to help change body energy patterns, which promotes the body’s ability to heal itself of disease syndromes and symptoms. In these treatments, TCM often does not distinguish energetic effects from physiologic effects.

The different modalities of TCM have different aims. Some focus on balancing the body’s energy, while others focus on building the physical body and adding substances to both balance and change the body materially. For example, the Enhance^® herbal preparation used in HIV and HCV contains herbs to tonify the spleen qi, and build xue. Qi tonification increases the amount of energy available for certain bodily function. Qi tonic herbs often have the specific effect of increasing digestion and food absorption. This increases the quality of the blood (xue).

Acupuncture is associated with balancing the body’s energy levels, while herbal substances are more like drugs or foods in that they have specific physical effects. Breathing exercises are known to strengthen qi. One meaning of the Chinese word qi is air. By learning how to breathe correctly, more oxygen is made available to enter the bloodstream. Specific Chinese therapies are discussed below.

Chinese Herbal Medicine

TCM treatment for HIV/HCV coinfection depends on the stage of the disease and the syndromes involved. Herbal medications in conjunction with rest and dietary recommendations can treat the symptoms of acute hepatitis fairly rapidly. Chronic hepatitis C is more difficult to treat. Research and experience both from China and from TCM clinics in the United States suggest that a one-year course of TCM therapy is the minimum needed to alter the progression of hepatitis C. In our clinics, TCM therapy for chronic hepatitis C usually includes combinations of herbal preparations, which are often specifically designed for the disturbed organ system patterns. For example, the combination of Enhance^® and Clear Heat^® herbal formulas were developed for the treatment of HIV and other chronic viral disease. These formulas were tested in an herbal study at San Francisco General Hospital. Hepatoplex One^®, Hepatoplex Two^®, and other herbal formulas have been designed specifically for the treatment of chronic hepatitis and related problems.

A few Chinese medicine practitioners in the U.S. have developed specific treatments for HCV and HIV infections. Two such practitioners are Dr. Subhuti Dharmananda of Portland, Oregon and Dr. Qing-Cai Zhang of New York, New York. (See Chapter 14, Modern and Traditional Chinese Medicine for additional information on Dr. Zhang’s protocol.) My own experience treating people with HIV and/or HCV led me to develop the following herbal formulas. The formulas shown in Table 1 can be recommended and prescribed by licensed TCM practitioners who have been trained through the Quan Yin Healing Arts Center’s Hepatitis C Professional Training Program.

Table 1: Chinese Herbal Formulas Used for HIV and/or HCV at Quan Yin Healing Arts Center

Hepatoplex One^® is used for acute and chronic hepatitis symptoms. It may be used when liver enzymes are elevated. It can be used with Clear Heat^® to increase the Clear Heat^® toxin effect. It is designed to regulate qi, vitalize xue, clear heat, and clean toxin.

While there are herbs to help protect the digestion in Hepatoplex One^®, this formula is usually used in conjunction with formulas that protect the spleen and stomach, as there are a number of herbs that are cooling or cold and vitalize xue. For example, to increase the effects of tonifying qi and yin, this formula can be taken with Cordyseng^®. If there is spleen dampness and deficiency with loose stools, add Shen Ling®. If there is liver invading spleen, a common scenario in chronic hepatitis patients, you may add Shu Gan^®.

To protect the yin in liver disease and specifically in chronic hepatitis, you may use Ecliptex^®. For immunodeficiency disorders, you may add Enhance^® or Tremella American Ginseng^®.

For xue stagnation including liver fibrosis, cirrhosis, and decreased blood circulation, add Hepatoplex Two^®.

For xue deficiency and xue stagnation, or to protect the bone marrow during interferon plus ribavirin treatment, chemotherapy, or radiation, add Marrow Plus^®.

In chronic hepatitis, you may also add the individual formulations Licorice 25^® and olive leaf extracts.

Hepatoplex Two^® is designed to vitalize xue. When used in chronic hepatitis, it should be used in conjunction with other herbal formulas. Its special uses are for liver fibrosis and cirrhosis, and to decrease the size of an enlarged liver. It may also have an effect on splenomegaly (an enlarged spleen). As Hepatoplex Two^® is a formula designed to vitalize xue, it should increase circulation of the blood and improve microcirculation in the capillaries.

Cordyseng^® is used as an adjunct to other herbal formulas to increase the function of qi tonification and increase energy. The formula tonifies both yin and yang. It primarily strengthens the spleen, stomach, kidney, and lung, and helps digestion. It is especially good for the chronic fatigue found in chronic hepatitis and AIDS.

Case Study Example

A person presents with HIV and chronic hepatitis C with stage III fibrosis and grade II inflammation. The patient is fatigued. The tongue and pulse configuration match the Chinese diagnoses of toxic heat, qi and xue stagnation, and possible qi and xue deficiency. The recommended herbal protocol for this patient would be:

Cordyseng^® or Enhance^®
Hepatoplex One^®
Hepatoplex Two^®

Acupuncture Therapies

TCM uses acupuncture extensively in the treatment of chronic hepatitis. Though some of the herbal theories already discussed may apply to acupuncture, the primary goal of acupuncture treatment is to readjust the body’s qi in order to enable the body to heal itself. Therefore, acupuncture treatment can be used to treat both specific symptoms, and a general epidemic pattern. After a TCM diagnosis is given for a patient infected with HIV and HCV, an acupuncture treatment plan is developed by considering the epidemic nature of the disease, the individual's complaints, and any underlying constitutional TCM patterns of illness. On a symptomatic level, acupuncture treatments for HIV and HCV infections address digestive functions, appetite, energy level, stress, anxiety, depression, pain, and skin complications. Acupuncture has also been used to lower elevated liver enzymes as part of a chronic hepatitis protocol using special acupuncture points.

Moxibustion

An important part of TCM treatment in HCV/HIV coinfection is the use of moxibustion. Moxibustion is the burning of the herb mugwort (called moxa in Chinese) over certain points or areas of the body that correspond to acupuncture points. Moxa is rolled into a cigar-like stick or used loose over protected skin to create warmth and tonification. In Chinese studies, moxa has been shown to increase digestive function, white blood cell and platelet counts, and may have an effect on the transformation of T-cells (one type of immune cell). Moxibustion is often used for pain syndromes and areas that appear or feel cold on the body. It is often prescribed for home use in treating both HIV and HCV infections.

Qi Gong

Qi gong meditation and exercise is a common practice in China. It is growing in popularity in the United States among people who have HIV and other life-threatening illnesses such as cancer. Many studies from China, Japan, Germany, and the United States show the positive effects of qi gong on immune function. Quan Yin Healing Arts Center and many other locations around the United States offer medical qi gong classes specifically designed for people infected with HIV and HCV.

Dietary Therapy

A healthy diet is considered a key part of maintaining qi and harmony in the body. Most TCM practitioners recommend that their HIV infected clients eat a cooked, warm diet. Other recommendations are based on the specific organ pattern diagnosis. For example, those suffering from chronic diarrhea may be advised to eat white rice (not brown rice) daily, especially in the form of an easy-to-make rice porridge called congee or jook.

Combining Eastern and Western Therapies

If you decide to use a combination of eastern and western therapies, you must discuss all of your treatment approaches with both your eastern and western practitioners. The use of some herbal therapies in conjunction with interferon-based therapy may be inappropriate. However, in my experience Chinese medicine can be highly effective for the management of side effects from drug therapy. TCM is used as an alternative to western drug therapy in some cases.