Hepatitis C

Chief Complaint: Fatigue

Western diagnosis: Hepatitis C

Medical History: Patient contracted HCV, genotype 1a, 30+ years ago. His liver enzymes are elevated and fibrosis level on biopsy shows stage 3 bridging fibrosis.

Questioning exam: The patient has a very positive outlook towards life in general, but feels weighed down by overwhelming fatigue. He also suffered from diarrhea and nausia. Fatigue did not improve with exercise.

Pulse exam: The pulse was wiry, slippery and rapid on both sides. The main hara finding was oketsu, or stuck blood.

Tongue exam: At first the tongue was very pale, fat with teeth marks and a greasy yellow coating in the back. As the patient improved the tongue body became more dusky/purple and the coating receded.

OM Diagnosis: The patient first presented with spleen qi deficency with damp and heat stagnation. As the patient improved the liver qi and blood stagnation began to show in the tongue.

Treatment Principle: Tonify spleen qi, clear dampheat and move qi and blood, modulate the immune system.

Point Prescription: Acupucture treatments included a combonation of the following:
LV 3, 14
GB 34, 24
LI 4, 10 11
ST 36, 37, 25
Oketsu
Immune
CV 17, 12, 6, 4
SP 4, 6, 7
LU 7
Moxa was often done on CV 6, ST 36, SP 6, Right LV 14, GB 24 and sometimes CV 8

Herbal Formula: First we began with Health Concern's Cordeseng which includes:
Cordecepts, Si Yang Shen, Huang Qi, Ling Zhi, Ginger, GAn Cao

This formula was used to tonify the spleen, stomach and kidney, modulate the immune system and support the normal.

Then Health Concerns Hepatoplex 1 was added which includes:
Wu Wei Zi, Huang Qi, Lian Qiao, Tao Ren, Chi Shao, Dan Shen, Qing Pi, Zhi Zi, Gan Jiang and Gan Cao.

This formaula has anti viral effects and was used to move Liver Qi and clear damp heat.

Then Health Concern's Hepatoplex 2 was added to increase microcirculation in the liver and move liver blood:
Yin Chen Hao, Hong Hua, Dang Gui, Chi Shao, Dan Shen, Zhi Zi, Fo Shou, Tao Ren, Chuan Xiong, Gan Cao.

Lifestyle prescription: When this patient came to see me he trying to decide if he was going to take Western treatment. Interferon and ribavirin are the current treatment for HCV. In older men with advanced fibrosis the likelyhood of clearing the virus from the blood is less than 50%. The treatment takes one year and for most patients the side effects are moderate to severe.

Results: Because of the advanced degree of fibrosis, and the fact that the chances that TCM would clear the virus are very small, the patient decided to go on Western therapy. TCM may decrease the fibrosis level, but if we were not sucessful, he would probably advance to cirrosis. My role then became to help him manage the side effects of treatment, thus enabling him to finish therapy.

Synopsis: The patient started therapy a few weeks ago. His M.D. is amazed at how well he is coping with treatment. I think this is a good example of how Western and Eastern medicine can work together to produce the best results for the patient.