Editor’s Note: According to statistics, there are currently over 400 million people in China suffering from various liver diseases, with approximately one in three people having chronic liver disease. Hepatitis B patients account for about 24% of this number. Liver diseases have become one of the most prevalent threats to people’s health. Chronic liver diseases, such as chronic viral hepatitis, liver cirrhosis, and non-alcoholic fatty liver disease, if not treated in a timely and standardized manner, can eventually progress to liver failure or even liver cancer, posing a serious threat to human life and health. With the advancement of medicine, the integration of traditional Chinese and Western medicine in China has opened new avenues for the diagnosis and treatment of chronic liver diseases by complementing each other’s strengths. Recently, at the 25th National Academic Conference on Traditional Chinese Medicine for Hepatobiliary Diseases organized by the Hepatobiliary Disease Branch of the Chinese Association of Traditional Chinese Medicine, Professor Yueqiu Gao addressed the advantages and shortcomings of traditional Chinese medicine in treating chronic hepatitis. Hepatology Digest has compiled this discussion for its readers.
Hepatology Digest: What are the advantages of traditional Chinese medicine (TCM) in treating chronic hepatitis? In your view, how can TCM’s advantages be better utilized in the treatment of chronic hepatitis and other liver diseases?
Professor Yueqiu Gao: Traditional Chinese medicine is a valuable heritage from our ancestors, having made significant contributions to the health of our people. In the prevention and treatment of chronic hepatitis B, before the advent of nucleoside analogs and interferons, we primarily relied on TCM.
TCM has historically played a major role in the prevention and treatment of hepatitis B in China. Many hepatoprotective and enzyme-lowering drugs are derived from traditional Chinese medicine, such as bifendate extracted from schisandra and glycyrrhizic acid from licorice. TCM also plays a leading role in antifibrotic and cirrhosis treatments.
It is well known that the clearance of the hepatitis B virus is related to the body’s immune system. How TCM regulates the immune system to improve the cure rate of hepatitis B warrants further research. The immune response to hepatitis B is complex, and it is unrealistic to rely on a single drug to solve this intricate network problem. Multicomponent and multitarget therapies are necessary to achieve effective immune regulation for hepatitis B.
Additionally, TCM has another significant advantage in treating hepatitis B – it can effectively alleviate common symptoms such as anxiety, insomnia, depression, fatigue, and liver area pain, thus improving the quality of life for patients.
With the improvement of living standards, the disease spectrum of liver diseases has changed, with the incidence of non-alcoholic fatty liver disease (NAFLD) increasing. TCM has unique advantages in preventing and treating NAFLD.
Since the time of the “Huangdi Neijing”, TCM has recognized the relationship between fatty liver, obesity, and irregular diet and lifestyle. Therefore, the first step in preventing fatty liver is to adopt health concepts, maintaining regular lifestyle habits and a balanced diet.
From a treatment perspective, TCM believes that the primary pathology of fatty liver is spleen deficiency, with phlegm, dampness, and blood stasis as secondary factors. By invigorating the spleen, resolving phlegm, and promoting blood circulation, TCM can improve disorders of glucose and lipid metabolism, thereby ameliorating fatty liver.
Hepatology Digest: So far, what breakthroughs have you and your team made in the diagnosis and treatment of chronic hepatitis? What research directions will you focus on in the future?
Professor Yueqiu Gao: We have made some explorations in the field of hepatitis B diagnosis and treatment.
Our team has established a compound treatment for chronic hepatitis B, “tonifying the kidney and spleen, clearing heat, and eliminating dampness.” Through major national infectious disease prevention and control projects during the 12th and 13th Five-Year Plans, we have demonstrated that TCM can reduce the titer of hepatitis B surface antigen to some extent and improve the cure rate of chronic hepatitis B, although the efficacy is not yet significant. In the future, we need to explore more “special effective drugs” for hepatitis from folk remedies or ancient texts and verify their efficacy through more standardized clinical research, explaining their immune mechanisms through modern biological research.
Additionally, our team has conducted research on antifibrotic and cirrhosis treatments. For chronic hepatitis B patients, antiviral treatment targeting the underlying cause is crucial, but many patients still progress to cirrhosis despite antiviral treatment. Dual therapy, combining antiviral drugs with TCM for antifibrotic treatment, has shown efficacy in delaying and even reversing cirrhosis.
One of our future research focuses will be to combine TCM with antiviral treatment to help decompensated cirrhosis patients achieve recompensation. Through a single-center retrospective study and two prospective studies, we found that TCM compounds can improve the prognosis of cirrhosis patients, reducing the incidence of decompensation and liver cancer. However, we only have two years of data from our prospective studies, and we hope to obtain 5 or even 10 years of data to further confirm the efficacy of TCM in improving the prognosis of cirrhosis patients.
Hepatology Digest: What challenges and shortcomings does TCM currently face in treating chronic hepatitis and other liver diseases?
Professor Yueqiu Gao: First, the biggest challenge in TCM treatment for chronic liver disease is achieving a breakthrough in clinical efficacy. On the basis of existing treatments for chronic liver disease, how to better integrate ancient and modern TCM experiences to enhance the clinical efficacy of TCM is a significant issue.
Second, the mechanisms of action of TCM are not yet clear and require in-depth research.
Third, further research is needed on the long-term safety of using TCM. Like any medication, the rational use of TCM is crucial, as improper use can also lead to liver damage. Our team has found, after nearly a decade of research, that the incidence of liver toxicity from Polygonum multiflorum is 0.3%. TCM classifies people into nine types of constitutions, one of which is an allergic constitution. People with an allergic constitution are more prone to side effects from taking TCM, similar to how some people are more likely to have allergic reactions to seafood.
Hepatology Digest: You studied under Professor Lingtai Wang, the first renowned TCM doctor in Shanghai, and now you have become a leading figure in TCM and have been selected as a Qihuang Scholar. What have you learned from Professor Wang? What qualities do you value most in your students?
Professor Yueqiu Gao: This year marks 32 years since I started following Professor Wang. Professor Wang had a background in Western medicine, and through his passion for TCM and self-study, he became a renowned TCM doctor. He was well-versed in TCM classical theories and fundamentals. What impressed me most about him, besides his humble character, was his relentless pursuit of learning.
From him, I learned the importance of diligent study, keen thinking, and practical application. His love for TCM, ability to think critically, and dedication to practice have greatly contributed to the development of TCM hepatobiliary studies.
The three qualities I value most in my students are diligence, critical thinking, and a love for the medical profession with a spirit of dedication to saving lives.
