Hepatitis - defined as liver inflammation. Hepatitis can be caused by a virus that may be communicable in various ways. Other types, such as autoimmune hepatitis and hepatitis triggered by drugs and chemicals cannot be spread to other people.
Types of Hepatitis:
Transmission: Usually contracted by eating foods or drinking water contaminated with fecal material. The virus may remain active on a utensil for 3-4 hours. Other routes for infection include kissing and oral/anal sex. Contaminated needles shared between IV drug users are another possible source. One third of Americans show evidence of past contamination to HAV.
Incubation period: 15-50 days
Symptoms: fatigue, jaundice, fever, nausea, abdominal pain, light stools, dark urine
Recommended for individuals traveling in developing countries or those with HBV, HCV, HIV/AIDS.
Course of disease: Once recovery occurs an individual is immune. Severe liver disease or death is rare. For individuals with hepatitis or AIDS mortality rate can be as great as 40%.
Transmission: Spreads by bloodborne, sexual, and perinatal exposure. Sexual contact is the most common mode of transmission in adults. The disease is 100X more infectious than HIV. 30X more likely to contract HBV from a contaminated needle than HCV. Infants born to HBV mothers are at high risk to contract the virus.
Incubation period: 50-180 days
Symptoms: onset of infection is usually insidious and characterized by abdominal pain, fatigue, loss of appetite
Recommended for all infants, children 11-12 years of age, sexually active teens, healthcare workers, diagnosis of HCV or HIV/AIDS.
Disease course: Between 5-10% of people infected with HBV will develop chronic hepatitis.
The CDC estimates 1.25 million people in the US have chronic HBV infection and 4000-5000 people die annually from HBV related chronic liver disease or liver cancer.
Transmission: Requires the presence of HBV
Transmission: Spread through contaminated food and water
Incubation: 30-40 days
Vaccine: Not available
Disease Course: Rarely found in the US, primarily found in developing countries. The main difference between HAV and HEV is the high mortality rate in pregnant women.
Incubation period: 20-90 days
Symptoms: Many patients are asymptomatic, or report nausea, vomiting, abdominal discomfort or flu-like symptoms.
Vaccine: Not available. Unstable virus, 6 different genotypes.
Disease Course: Affects more than 4 million people in the US, 150-170 million people worldwide. Between 75- 85% of cases become chronic, leading to liver disease, cirrhosis, liver cancer and liver failure. The virus can persist for 20 or more years without noticeable symptoms. Over the last few years has become the leading cause of liver disease and has become the leading cause for liver transplants. 20% of patients develop cirrhosis over a 20-30 year period and of this number 5% will die of liver disease.
Functions of the liver - Western
Functions of the liver - Traditional Chinese Medicine (TCM)
The spleen - the liver's partner.
Liver function tests - AST(SGOT)/ALT (SGPT); elevation is an indication of liver inflammation
ELISA II - can detect antibody to HCV
Viral Load - HCV RNA by PCR and HCV RNA by branched DNA assay
Is There A Cure?
Some western treatments reduce the viral load to undetectable levels. This is sometimes interpreted as a cure. In China, there is a history of effective treatment for liver disease, but the approach is different than Western Medicine. Herbs protect the liver from damage and hold the virus in check.
Interferon (by injection) - 3 million units, 3 times per week for one year.
Interferon and Ribavirin - 1 year for genotype 1a and 1b, 6 months for genotype 2,3,4. 1a and 1b are the most common forms in the US and the cure rate is about 27%. The response rate for 2,3, 4 is about 70-80%.
Pegylated interferon - currently in clinical trials. Seems to have a 10% better response rate for 1a and 1b.
Individuals are more likely to clear HCV if the viral load is <2 million copies, female sex, shorter duration of infection, younger age and mild to moderate disease. After 12 weeks of antiviral treatment, a 2-log drop in virus or elimination of virus is predictive of a successful end of treatment response.
Treatment by Chinese Medicine
The Chinese Medicine practitioner completes a comprehensive evaluation and arrives at a Chinese Medicine diagnosis for you and will plan an individualized treatment plan for you that includes acupuncture, herbal formulas, dietary guidelines and other lifestyle changes. Common Chinese Medicine diagnosis include: liver qi stagnation, spleen qi deficiency, liver yin deficiency, liver/GB damp heat.
ChineseMedicinecanbehelpfulintreatingthesideeffectsexperiencedbywesternmedicinetreatment. The combination is beneficial for many people.
Eating Well: General Considerations According to Chinese Medicine
Additional guidelines are given according to your Chinese Medicine diagnosis.
Basic Dietary Guidelines According to Western Medicine
Prescription and over the counter medications that can affect liver function
Acetaminophen (Tylenol) alpha-methyldopa (Aldomet) amiodarone (Cordarone)
Chlorzoxazone (Parfon Forte) Fluconazole or ketoconazole (Diflucan, Nizoral)
Hydralazine (Apresoline) ibuprofen (Motrin) isoniazid (NIH)
Nitrofurantion (Macrodantin phenytoin quinidine (Cardoquin)
Rifampin Sulfa medications (Septra or Bactrim)
Vitamin A (in doses >5000 units/day)
Herbal patent medicines, tonics, elixirs and prepackaged solutions can be risky for anyone, whether they have liver disease or not. Ingredients labels may be incomplete. Avoid self-prescribed premixed preparations, rely on a trained and experienced herbalist who can individualize your herbal therapy and monitor your reactions.
Important: You should discontinue taking any drug or herb if you experience a skin rash, substantial nausea, bloating, fatigue and/or aching in the area of the liver, yellowing of the skin or pale feces.