| Object: Obstinate icterus is an conception of Traditional Chinese Medicine (TCM) , belonging to "icterus disease". There was recordation of obstinate icterus in classical medical book"Jin-gui-yao-lue". If one patient's course of icterus disease exceed one month, and TBIL≥171umol/L, and TBIL had the tendency to rise after normal therapy, we can call he caught obstinate icterus.There is no this conception in Western Medicine, it includes severegrade chronic hepatitis, acute severe hepatitis, subacute severe hepatitis, chronic severe hepatitis, severe cholestasis hepatitis, and so on. The mechanism of obstinate icterus is complicated, so far there is no normal standard of TCM, project of therapy is various. In clinical practice, we fred a kind of special patients, they don't only show symptom of Tan-zu-xue-yu, but also possess the followed characterization: cholestasis phenomenon is obvious; serum fat shows higher; liver becomes longer. Referring to viewpoint of Western Medicine, we put forward a new hypothesis that"fat denaturalization of liver cell in convalescence result in raise of TBIL", and adopt therapy according to Tan-shi, so we establish the project of Hua-tan-huo-xue.By making records of variety of patient's symptom score, TBIL, PTA, CHOL, video index, et al, so we make sure the effect of Hua-tan-huo-xue to heal obstinate icterus, and how it play an important role in the whole process, as a result, we can explore condition of Hua-tan-huo-xue tharapy to cure obstinate icterus with TCM, and discover a new therapy to deal with obstinate icterus.Methods: We select 13 patients, who caught obstinate icterus and are in Shenzhen Eastlake hospital between March 2005 and December 2006. All patients laboratory index are HBsAg (+) , without other hepatitis virus infection, such as HAV, HCV, HDV, HEV. Among 13 patients, there are 8 patients who had been diagnosed as severegrade chronic viral hepatitis B ( meanwhile, 5 patients incorporated hepatocirrhosis), the other 5 patients had caught with chronic severe viral hepatitis B.AII patients' course of icterus exceed one month, and had undergone about one month' normal therapy before adopting herbs of Hua-tan-huo-xue therapy, the level of TBIL≥171umol/L. When we cure patients, the former therapy project with Western Medicine kept using, meanwhile, we add herbs of Hua-tan-huo-xue to the original therapy project. The herbs of Hua-tan-huo-xue included the followed: Chishao 30～60g, Banxia 12g, Chenpi 15g, Fuling 15g, Houpo 15g, Zhishi 15g, Dahuang 15g, Yinchen30g, Zexie30～60g. All the herbs were mixed, patients need take medicine one dose per day, and one dose should be divided into two groups, each group should be drunk after diet. Alter patients beginning taking herbs, we should take notes of the followed index at the 2nd, 4th, 6th, 8th week: TBIL, DBIL, GGT, CHOL, TG, HDL, LDL, VIA, ALB, ALT, AST and right liver diameter, and so on. We make self-contrast of patients between before-therapy and different kinds of period of treatment, so we can deduce the effect of Huan-tan-huo-xue to cure obstinate icterus.Results: (1) Because 2 patients occured spontaneous peritonitis after the 4th week, they are obliged abandon herbs, The total validity ratio of Hua-tan-huo-xue to reduce TBIL was 81.8%, including 45.5% of good validity ratio and 36.3% of validity ratio.In the 4th, 6th, 8th week, symptom score was lower than the initial score ( P＜0.05～0.01 ). (2) Herbs of Hua-tan-huo-xue had the obvious effect to ruduce TBIL and DBIL in all the period of treatment, DBIL had distinct difference between after-therapy and before-therapy ( P＜0.01 ) , TBIL also had obvious difference between after-therapy and before-therapy ( P＜0.05～0.01 ). DBIL/TBIL was higher than the initial index ( P＜0.01 ), meanwhile, there is distinct difference between after-therapy and before-therapy (P＜0.01). (3) We make the comparion during different kinds of period of treatment, it is only between the 4th week and the 6th week that there was no obvious difference. (4) The level of CHOL,TG,LDL,HDL became higher in before-therapy than the initial index ( P＜0.01 ). Compared to CHOL between the 2nd week and before-therapy, there was no difference, however, the level of CHOL in other periods of treatment was lower than the before-therapy (P＜0.05～0.01) , TG was lower in the 8th week than before-therapy ( P＜0.05 ). ( 5 ) Hua-tan-huo-xue therapy played an important role in improving PTA and GGT (P＜0.05～0.01), In the 8th week, ALT and AST became lower than the before-therapy ( P＜0.01 ) , nevertherless, the herbs had no effect on ALB. (6) The right liver diameter grew longer in before-therapy than the initial index ( P＜0.01 ) , in the 4th , 8th week, it became shorter than before-therapy ( P＜0.01 ).Conclusion: It is suitable for Huan-tan-huo-xue therapy to cure one kind of obstinate interus, These patients had the symptom of quadriplegia, atony, anorexia and liver ache, furthermore, along with some laboratory indexes changed, for example, cholestasis phenomenon was distinct, including DBIL/TBIL and GGT ascendence, serum fat (CHOL,TG,LDL,HDL) also rised up, right liver diameter became longer, some patients showed lipid hepatitis, and so on. So we concluded that when we considered the therapy of obstinate intents with TCM, we can refer to some indexes of Westem Medicine, it would contribute to canonical and impersonal study of TCM' symptom type. Under the premise of distinguishing TCM symptom type, we applied Huan-tan-huo-xue therapy into clinical practice to deal with obstinate interus, the results confirmed that the herbs could reduce TBIL and DBIL, increase PTA, alleviate cholestasis phenomenon, including reduce DBIL/TBIL and GGT, furthermore, it could shorten right liver diameter, so Hua-tan-huo-xue therapy could improve prognosis of obstinate interus. |
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