HEPATITIS C:
Update 2001
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.
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.
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 HCV-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:
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 HCV 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.
May 2001