Viral hepatitis can be classified into three types: hepatitis A, hepatitis B, and non-A, non-B hepatitis. All are caused by hepatitis viruses and are common in the general population. When making a diagnosis, it is important to consider the prevalence of hepatitis in the community, whether the patient has a history of close contact with hepatitis patients, and whether they have received blood transfusions, blood product infusions, or vaccinations.
Hepatitis has an insidious and gradual onset, with common symptoms including loss of appetite, abdominal distension, fatigue, and loose stools. Some patients develop jaundice, but most do not; typical or icteric hepatitis accounts for only 10% of cases.
It is generally believed that hepatitis A exists only in acute and subclinical forms, with no chronic form. It is often accompanied by fever at onset, has a relatively short course, and is easily resolved. Hepatitis B, in addition to acute and subclinical forms, also has a chronic form. The course is often protracted; patients may remain viral carriers for a long time, and in a small number of cases, the disease may progress to cirrhosis. The clinical course of non-A, non-B hepatitis is often similar to that of hepatitis B but milder; its incubation period can vary in length.
I. General Examination
Patients with icteric hepatitis exhibit yellowing of the skin and sclera, an enlarged liver accompanied by tenderness and percussion pain, and mild changes in liver consistency; some patients may also have an enlarged spleen. If the condition progresses to chronic active hepatitis, patients may exhibit a “hepatitic facial appearance,” spider angiomas, and palmar erythema. In a small number of patients, the condition may become critically severe and progress to fulminant hepatitis, presenting with petechiae, epistaxis, hematemesis, ascites, and even impaired consciousness—hepatic coma.
II. Laboratory Tests
1. Abnormal liver function: In most cases of acute hepatitis, elevated alanine aminotransferase (ALT) levels are observed, which can reach several hundred units or even exceed 1,000 units. In patients with icteric hepatitis, an elevated jaundice index and increased one-minute bilirubin output may be observed. In chronic active hepatitis and severe hepatitis, albumin levels decrease, globulin levels increase, and the albumin-to-globulin ratio decreases or becomes inverted. Coagulation disorders may occur.
2. Specific Antigen and Antibody Testing: For hepatitis A, hepatitis A antigen can be measured in fecal filtrate, and immunoglobulins—specifically, anti-hepatitis A virus antibodies—can be detected in serum; for hepatitis B, three antigen-antibody systems can be tested: surface antigen, core antigen, and E antigen, along with their corresponding antibodies. These three antigen-antibody systems are of great value for confirming a diagnosis of hepatitis B and assessing the disease’s infectivity and prognosis; Non-A, non-B hepatitis is primarily diagnosed through a process of elimination. Therefore, it is crucial for patients with hepatitis B to undergo regular laboratory testing at the hospital so that physicians can assess the severity of their condition and implement appropriate treatment measures. Reports indicate that the seroprevalence of HBsAg in patients with liver cancer is significantly higher than in the general healthy population, suggesting a link between the hepatitis B virus and a high incidence of liver cancer.
Chronic hepatitis is classified into two types: chronic persistent hepatitis and chronic active hepatitis. The primary cause is the hepatitis B virus, and both types can develop from acute hepatitis, although the acute phase may be mild or even unremarkable. If the course of acute hepatitis exceeds 6 months to 1 year, and symptoms persist or liver function tests remain abnormal, the condition is considered to have entered the chronic stage. The course of chronic persistent hepatitis is benign; in most patients, after many years, the condition improves, stabilizes, liver function returns to normal, and clinical remission is achieved. Only a very small number of cases progress to chronic active hepatitis. Chronic active hepatitis is a complex condition that may involve autoimmune mechanisms and may be accompanied by cirrhosis; it ultimately progresses to cirrhosis and has a poor prognosis. Statistics indicate that 30% to 50% of cases of cirrhosis are complicated by hepatocellular carcinoma. Therefore, patients with hepatitis should undergo regular checkups and seek prompt, active treatment to prevent viral hepatitis from progressing to chronic hepatitis.
III. Treatment of Viral Hepatitis
1. Patients with acute viral hepatitis should be isolated for at least 30 days from the onset of symptoms. If the disease remains active after 30 days, isolation should be continued.
2. Emphasis should be placed on rest, diet, and nutrition. The diet may be appropriately enriched with carbohydrates and protein, along with a small amount of fat. Greasy foods should be avoided, while vegetables, fruits, and fruit juices should be consumed in greater quantities. Treatment with liver-protecting medications, antiviral drugs, and immunomodulators may also yield certain therapeutic benefits.
3. Traditional Chinese Medicine (TCM) Treatment: Based on the pattern differentiation of Traditional Chinese Medicine (TCM), various treatment methods are employed for viral hepatitis, including clearing heat and draining dampness, regulating the liver and strengthening the spleen, tonifying the liver and kidneys, and promoting blood circulation to remove blood stasis. These approaches are effective in alleviating jaundice, lowering transaminase levels, restoring liver function, enhancing the body’s immune function, inducing seroconversion of hepatitis B surface antigen, and promoting the return of an enlarged liver and spleen to normal size. Therefore, herbal medicine treatment is beneficial for individuals with hepatitis B.
