HEPATITIS C:
http://www.itmonline.org/arts/hepc2k1.htm


Update 2001

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine,
Portland, Oregon

This report provides additional and new information to the May 2000 article
Update on hepatitis C treatment. The year 2000 report includes information
about possible drug interactions between Chinese herb formulas and
interferon treatment and other important information that is not repeated
here.

1. THE DISEASE, ITS PREVALENCE, AND MODERN MEDICAL TREATMENTS
Much progress has been made in recent years to understand the nature of
hepatitis C infection. It is now possible to determine subtypes of hepatitis
C virus that help estimate the risk of disease progression and the
likelihood of response to interferon therapy. If a patient undergoes such
testing, they can more readily make a decision about whether to try the
modern therapy.

The number of cases of hepatitis C was reported in the media to be 4 million
or more in the U.S. several years ago (which would mean about 5 million
cases by now). It is actually now estimated to be about 2.7 million, or
about half what was guessed before. The cumulative total number of U.S.
cases may be about 4 million, but many people who had carried the infection
since it was introduced here about 40 years ago have died, usually of causes
other than hepatitis. This same situation-excessive estimates of disease
incidence-occurred with the HIV epidemic in the U.S., where the media
reported that there were a million people with the infection in the U.S. at
a time when the actual number was far lower. The figure of one million was a
high estimate of how many total cases there had ever been, including many
who were deceased.

Most of the hepatitis C cases in the U.S. are among injection drug users who
share used needles (1), with infection rates estimated to be 90% (possibly
higher in subgroups that do not attempt drug withdrawal procedures, such as
methadone replacement therapy). Those dependent on opioids, mainly heroin,
may account for about 2 million of the cases. Only a small fraction of those
infected by hepatitis C in the U.S. acquired the virus either by blood
transfusions (before 1990, when the prevalence of hepatitis C was still low,
perhaps fewer than 1 million in the U.S.) or by other routes of transmission
(mainly involving some form of blood to blood contact).

It is still estimated that, of those infected by hepatitis C, only 20% will
go on to suffer from significant liver disease (cirrhosis, fibrosis, and
possible liver cancer); about half of those might require liver
transplantation as a therapy due to life-threatening complications. Of those
who suffer the adverse developments of hepatitis C, the disease progression
may be partly the result of behaviors that contribute to liver damage (such
as abuse of alcohol, excessive consumption of fatty foods) or from long-term
infection that has not been treated by any effective method. Therefore,
persons who get an early diagnosis and take reasonable steps to protect
their liver from controllable sources of damage may have far less than a 20%
risk of developing severe liver damage.

There are new forms of interferon (2, 3) that have been developed that may
increase the likelihood of complete viral inhibition by this method of
therapy (six month intervention with interferon), which would then reduce
the possible need for constant vigilance over lifestyle factors. Even when
interferon fails to reduce the viral load, there is evidence that it reduces
liver inflammation and may protect against liver cancer developing later.

2. CHINESE MEDICAL THERAPIES
The use of salvia to reduce liver fibrosis that can occur as viral hepatitis
progresses has been a continuing subject of investigation (4, 5, 6).
Attention has focused on one of the active components, salvianolic acid A
(also called Tanshinone A). Salvia was reported to reverse fibrosis in test
animals that had chemically-induced liver damage. Herb formulas with salvia
and other blood-vitalizing herbs have been claimed to halt the development
of fibrosis and even reverse it; however, these clinical results need to be
confirmed under more stringent conditions.

Traditional Chinese medical (TCM) therapies for hepatitis C are mainly
derived from those used for hepatitis B, an infection that has received far
more research attention. In a summary of Chinese language publications (6),
it was reported that an open trial of 2,000 hepatitis (B or C) patients
using various TCM methods showed improvement of symptoms in 83% and
normalization of serum ALT in 82%. In a controlled study of 107 patients
with hepatitis-B related diseases, before and after liver biopsies showed
that the fibrosis reversal rate following 6 months treatment with Compound
861 (a formula of ten herbs including salvia as a main ingredient) was 78%
in stage 2, 82% in stage 3 (precirrhotic stage) and 75% in Stage 4 (early
cirrhosis).

A report on hepatitis B treatment administered in Tianjin that was first
published at the end of 1996 recently became available in English
translation (7). The base formula, prepared as a decoction given daily for
three months, was: astragalus 30 grams, tang-kuei 10 grams, red peony 15
grams, salvia 15-30 grams, hu-chang 15 grams, bupleurum 10 grams, polygonum
fruit (shui honghua zi) 30 grams, and rubia 15 grams. Notoginseng (tien-chi
ginseng; sanqi) powder was also administered (3 grams/day). The decoction
formula was modified by adding extra herbs as follows:

for qi deficiency  add codonopsis, white atractylodes, polygonatum
(huangjing)
for yin deficiency  oyster shell, tortoise shell, raw rehmannia
for qi stagnation  add cyperus, curcuma, chih-ko
for spleen qi deficiency  add white atractylodes, hoelen, codonopsis
for damp heat  add abrus, oldenlandia, capillaris
for yang deficiency  add curculigo, morinda

The authors commented on the use of polygonum fruit as follows: Polygonum
fruit is said to eliminate stasis, break down masses, build spleen qi, and
disinhibit damp. According to traditional texts, it treats enlarged liver
and spleen, ascites, stomach pain, poor appetite, bloating, infected eyes,
carbuncles, and lymphatic swelling. The herb can be used in the treatment of
chronic hepatitis, liver cirrhosis with ascites, lymph tuberculosis,
enlarged spleen, poor digestion, abdominal bloating, stomach pain, food
accumulation in children, and conjunctivitis.

While the result of the herbal treatment of 264 patients having hepatitis
for at least one year was not a cure for the viral infection, fibrotic
changes of the liver were reported to be successfully averted or improved
while liver inflammation and hepatitis symptoms were alleviated. The
treatment is somewhat similar in therapeutic approach to Qing Tui Fang,
described as highly effective for hepatitis C in a 1994 report (8).

Dr. Zhang Qingcai, working in New York City, has been treating patients with
HIV and/or hepatitis C for many years using Chinese herbal materials. He
recently published a book, Healing Hepatitis C with Modern Chinese Medicine
(9), about the herbs that he uses. The book includes an extensive section on
the extracts (e.g., glycyrrhizin capsule, derived from licorice) and
formulations (e.g., modified Persica and Achyranthes Combination) he
administers to patients, some of which he personally formulated. Based on
his experience and understanding of Chinese medicine, he stated that "The
realistic aim of Chinese medical treatment for hepatitis C is the arrest and
reversal of Hepatitis C Virus-related problems, resulting in improved or normal function
and a reasonable expectation of an average life span. Following are his
views on the situation that currently exists, where most patients can not
entirely remove the virus from their systems though they are relieved of
their viral symptoms:

"Pure water has no fish"
Many patients worry that they are carrying a virus and have not been cured.
Although their liver functions are normalized and they have a normal or
near-normal quality of life, they feel uneasy that they still have Hepatitis C Virus in
their body. I tell them that everybody carries certain viruses in his or her
body. It is abnormal not to have viruses in our bodies. Some viruses have
names and can be tested; some have no names and can't be tested. Viruses
were the first living things on Earth and are one of the major causes of
mutation. Bad mutations die off and good mutations become higher living
things. We human beings are the highest living things on Earth-thanks to the
virus. In millions of years of evolution, the human body has adopted
mechanisms to deal with viruses. Given enough time, it will learn how to
coexist with a newly invading virus. Gradually, our immune system can
control it, keep it at bay, and prevent if from further harm.

No living things are pure. There is a Chinese saying: "Pure water has no
fish." Why do we want our bodies to be so pure, without viruses? Worrying
can only weaken the immune system and make the virus stronger. From the
experiences of many of our HIV patients, we have seen the coexistence with
the virus is possible. After coexisting for a sufficiently long time, the
virus becomes less harmful and finally becomes harmless, while at the same
time our body becomes stronger and can contain the virus better.

This description freely intermixes the situation that exists within an
individual and what happens over a very long time in relation to the entire
population. Yet, it helps to address one of the key problems noted with
American patients who seek out Chinese medical therapies for hepatitis C:
they are very anxious and worried about having the virus even if it is
producing no evident adverse symptoms or notable liver damage. One of Dr.
Zhang's formulations is called HC Virostatic Formula, used to suppress the
virus and lower the viral load. It contains sophora subprostrata (this is a
source of the anti-viral alkaloid oxymatrine), hu-chang (a broad-spectrum
anti-viral agent), isatis root and leaf, and houttuynia.

It is not always possible to clearly differentiate the use of one formula
from another in cases of hepatitis C. However, a patient evaluation should
include determination of the extent of liver inflammation (as revealed by
liver enzyme levels), to determine the need for liver-protecting substances
(such as antioxidants); the viral load (as revealed by PCR test), to
determine the need for anti-viral substances; the extent of liver damage
(fibrosis and cirrhosis, usually determined by liver biopsy), to determine
the need for blood-vitalizing and lipid regulating herbs; and the
symptomatic presentation (TCM analysis), to determine the need to treat
conditions such as damp-heat and spleen-qi deficiency.

REFERENCES
Koch M and Banys P, Liver transplantation and opioid dependence, Journal of
the American Medical Association, 2001; 285(8): 1056-1058.
Zeuzem S, et al., Peginterferon Alfa-2a in patients with chronic hepatitis
C, New England Journal of Medicine, 2000; 343(23): 1666-1672.
Heathcote EJ, et al., Peginterferon Alfa-2a in patients with chronic
hepatitis C and cirrhosis, New England Journal of Medicine, 2000; 343(23):
1673-1680.
Hu YY, et al., Actions of salvianolic acid A on CCl4-poisoned liver injury
and fibrosis in rats, Chinese Herb News, 1997 18(5): 478-80.
Wasser S, et al., Salvia miltiorrhiza reduces experimentally-induced hepatic
fibrosis in rats, Journal of Hepatology 1998; 29(5):760-71.
Wang BE, Treatment of chronic liver diseases with traditional Chinese
medicine, Journal of Gastroenterology and Hepatology, 2000; 15 Suppl(3):
E67-70.
Zhang Junfu, Cui Lian, and Yuan Shufang, A clinical analysis of treating 264
cases of chronic hepatitis B with the blood-moving method, Shanghai Journal
of Traditional Chinese Medicine and Pharmacology, 1996.
Li Hougen, et al., Qingtui Fang applied in treating 128 cases of chronic
hepatitis C, Chinese Journal of Integrated Traditional and Western Medicine
for Liver Diseases, 1994; 4(2): 20.
Zhang Qingcai, Healing Hepatitis C with Modern Chinese Medicine, 2000
Sino-Med Institute, New York.
Dharmananda S, A Bag of Pearls, 2000, Institute for Traditional Medicine,
Portland, OR.



May 2001