Traditional Chinese medicine (TCM) syndrome differentiation-based treatment has certain advantages in blocking and reversing hepatic fibrosis and is the source of candidate drugs for hepatic fibrosis in future.This article overviews the origin and current status of TCM treatment of hepatic fibrosis, discusses how to reevaluate the clinical effect and safety of TCM in blocking and reversing hepatic fibrosis in accordance with evidence-based medicine and internationally acknowledged standards for clinical trials, and introduces the latest clinical research findings.It also emphasizes the challenge and significance of the exploration and recognition of TCM in blocking and reversing hepatic fibrosis.

The prevention and treatment of liver fibrosis is an important embodiment of the characteristic advantage of traditional Chinese medicine (TCM) in the prevention and treatment of viral hepatitis.The release of Global Health Sector Strategy on Viral Hepatitis, 2016-2021 and Viral Hepatitis Prevention and Control Plan of China (2017-2020) brings opportunities to TCM prevention and treatment of liver fibrosis.There are still challenges in the research on TCM prevention and treatment of liver fibrosis, including how to improve the outcome of liver fibrosis and the research and development of more effective TCM new drugs for liver fibrosis.With the purpose of improving the clinical effect, we will start from the different stages of the development and progression of liver fibrosis, use the advantages of TCM syndrome differentiation-based treatment, provide early intervention, conduct clinical and basic research with the combination of precision medicine and TCM management of chronic diseases, and further establish and promote the application of the guidelines for clinical diagnosis and treatment of liver fibrosis and the TCM management guidelines for chronic diseases, which are the important contents of TCM prevention and treatment of liver fibrosis in future.

Traditional Chinese medicine (TCM) plays an important role in the treatment of acute pancreatitis (AP) .This article introduces the clinical effects of TCM treatments including gavage, enema, external application of Chinese medicine, intravenous drip, and acupuncture, and points out that early application of Chinese medicine for AP can help alleviate clinical symptoms and signs, reduce complications, and decrease mortality.Combined treatment based on staging and syndrome differentiation is considered more effective for AP.It is suggested that TCM treatment plays a therapeutic role by reducing inflammatory cytokines, improving intestinal function and barrier, regulating immune function, and improving blood circulation to block the progression of inflammation.

Objective To investigate the 8-week mortality rate of patients with hepatitis B virus (HBV) -related acute-on-chronic liver failure (ACLF) complicated by hepatic encephalopathy (HE) treated with integrated traditional Chinese and Western medicine therapy, as well as independent prognostic factors.Methods A total of 125 HBV-ACLF patients with HE who were admitted to 18 hospitals from January 2012 to February 2015 were enrolled and divided into trial group and control group using a randomized controlled design.The patients in the trial group were given integrated traditional Chinese and Western medicine therapy, and those in the control group were given Western medicine therapy alone.The 8-week mortality rate was observed for both groups.The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups; the chi-square test was used for comparison of categorical data between groups; the Kaplan-Meier method and the log-rank test were used for survival analysis; the Cox proportional hazards regression model was used for the analysis of risk factors.Results The 8-week mortality rate was 27.5% in the trial group and 50.0% in the control group (χ2= 5.630, P = 0.018) , the median survival time was 41.2 days in the trial group and 28.4 days in the control group, and the 8-week cumulative probability of survival was 60.4% in the trial group and 32.5% in the control group (χ2= 6.187, P = 0.013) .The Cox regression analysis showed that compared with the control group, the trial group was a protective factor in patients with HBV-ACLF complicated by HE (hazard ratio [HR]= 0.424, 95% confidence interval [CI]:0.208-0.864, P = 0.018) .There were significant differences between the two groups in total bilirubin (TBil) (HR = 1.063, 95% CI:1.002-1.128, P = 0.042) , prothrombin activity (PTA) (HR = 0.942, 95% CI:0.890-0.998, P = 0.044) , ACLF stage (HR = 2.737, 95% CI:1.287-5.818, P = 0.009) , and the presence or absence of gastrointestinal hemorrhage (HR = 5.291, 95% CI:1.736-16.126, P = 0.003) .Conclusion Traditional Chinese medicine treatment can significantly reduce the 8-week mortality rate of HBV-ACLF patients with HE, increase their 8-week survival probability, and prolong survival time.TBil, PTA, ACLF stage, and gastrointestinal hemorrhage are independent prognostic factors.

Objective To investigate the changes in the serum levels of interleukin-32 (IL-32) and interleukin-10 (IL-10) and their clinical significance in patients with HBV-related acute-on-chronic liver failure (HBV-ACLF) .Methods A total of 38 HBV-ACLF patients who were hospitalized and treated in The First Affiliated Hospital of Soochow University from September 2012 to March 2014 were enrolled as HBV-ACLF group, as well as 20 patients with chronic hepatitis B (CHB) (CHB group) and 20 healthy controls (healthy control group) .ELISA was used for dynamic monitoring of the changes in the serum levels of IL-32 and IL-10.The serum levels of IL-32 and IL-10 were compared between early-, middle-, and late-stage HBV-ACLF groups, between infection group and non-infection group, and between survival group and death group.The t-test was used for comparison of continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for further comparison between two groups.Results Compared with the CHB group and the healthy control group, the HBV-ACLF group had significantly higher levels of IL-32 (500.98 ± 152.33 pg/ml vs 281.72 ± 99.28 pg/ml and 178.16 ± 50.54 pg/ml, both P < 0.05) and IL-10 (4.82 ± 1.03 pg/ml vs3.15 ± 0.98 pg/ml and 1.62 ± 0.43 pg/ml, both P < 0.05) .Dynamic monitoring of IL-32 level in the HBV-ACLF group showed that the early-stage HBV-ACLF group had a significantly higher level than the middle-stage HBV-ACLF group (540.69 ± 155.71 pg/ml vs 498.43 ± 135.56 pg/ml, P < 0.05) , and the middle-stage HBV-ACLF group had a significantly higher level than the late-stage HBV-ACLF group (498.43 ± 135.56 pg/ml vs 450.77 ± 102.33 pg/ml, P < 0.05) ; as for the level of IL-10, the early-stage HBV-ACLF group had a significantly lower level than the middle-stage HBV-ACLF group (1.94 ± 0.44 pg/ml vs 2.83 ± 0.97 pg/ml, P < 0.05) , and the middle-stage HBV-ACLF group had a significantly lower level than the late-stage HBV-ACLF group (2.83 ± 0.97 pg/ml vs 3.69 ± 1.23 pg/ml, P < 0.05) .The HBV-ACLF infection group had a significantly higher level of IL-32 than the non-infection group (553.41 ± 158.65 pg/ml vs 482.54 ± 110.16 pg/ml, P = 0.021) .Compared with the HBV-ACLF death group, the HBV-ACLF survival group had a significantly lower level of IL-32 (481.95 ± 100.67 pg/ml vs 540.62 ± 112.45 pg/ml, P = 0.011) and a significantly higher level of IL-10 (4.21 ± 1.27 pg/ml vs 3.61 ± 1.05 pg/ml, P = 0.038) .Conclusion The cytokine network plays an important role in the pathogenesis of HBV-ACLF.Serum IL-32 and IL-10 may be involved in disease progression, and dynamic monitoring of their levels helps with prognostic prediction.

Objective To investigate the serum levels of M30 and CCL20 and their association with short-term (3-month) prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) , as well as their clinical significance.Methods A total of 51 patients with HBV-ACLF who were diagnosed and treated in Hunan Provincial People's Hospital from October 2014 to January2017 were enrolled as HBV-ACLF group; 30 patients with chronic hepatitis B (CHB) who were hospitalized or followed up in the outpatient service were enrolled as CHB group; 30 healthy individuals who underwent physical examination were enrolled as control group.The patients with HBV-ACLF were followed up for 3 months, and according to the results of follow-up, these patients were divided into survival group and death group.ELISA was used to measure the serum levels of M30 and CCL20 in peripheral blood before treatment and after two weeks of treatment.The t-test was used for comparison of continuous data between two groups, and an analysis of variance was used for comparison between multiple groups.Results There were significant differences in the serum levels of M30 and CCL20 before treatment between the HBV-ACLF group, the CHB group, and the control group (M30:591.54 ± 262.06 U/L vs 241.58 ± 120.33 U/L vs 114.35 ±52.09 U/L, F = 22.75, P < 0.05; CCL20:386.51 ± 55.12 pg/ml vs 177.11 ± 27.51 pg/ml vs 33.95 ± 11.62 pg/ml, F = 51.47, P <0.05) .After two weeks of treatment, the HBV-ACLF death group had a significantly higher level of M30 than the HBV-ACLF survival group (648.17 ± 285.55 U/L vs 426.43 ± 217.64 U/L, t = 2.37, P < 0.05) and a significantly lower level of CCL20 than the HBV-ACLF survival group (232.28 ± 39.28 pg/ml vs 352.29 ± 52.43 pg/ml, t =-2.35, P < 0.05) .After 2 weeks of treatment, there were significant differences in the change rates of the serum levels of M30 and CCL20 between the two groups (M30:0.08 ± 0.04 vs 0.27 ± 0.12, t =2.49, P < 0.05; CCL20:0.39 ± 0.06 vs 0.11 ± 0.02, t = 2.54, P < 0.05) .Conclusion Patients with HBV-ACLF have significant increases in the serum levels of M30 and CCL20, which can accurately reflect cell apoptosis and inflammation in the liver.Patients with a significant reduction in CCL20 during treatment tend to have high mortality, and patients with a significant reduction in M30 tend to have good prognosis.Dynamic changes in M30 and CCL20 levels have a certain value in predicting the short-term prognosis of patients with HBV-ACLF.

Objective To investigate the dynamic change of platelets in patients with acute-on-chronic liver failure (ACLF) , the association of platelet count and its change with patients' prognosis, and the cause of thrombocytopenia, since severe thrombocytopenia is often seen in patients with liver failure.Methods A total of 54 patients with ACLF who were hospitalized in Beijing You' an Hospital, Capital Medical University, from September 2014 to September 2016 were enrolled, and their clinical data were collected.An automatic blood analyzer was used to measure platelet count, and ELISA was used to measure the level of thrombopoietin (TPO) .The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups.The univariate and multivariate logistic regression analyses were used for prognostic parameters, and the receiver operating characteristic (ROC) curve was used to analyze the value of the change in platelet count in the diagnosis of liver failure.Results A total of 18 ACLF patients died before discharge, resulting in a mortality rate of 33.3%.These patients had a mean platelet count of 80.0 × 109/L [range (36.0-334.0) ×109/L], which was significantly lower than the normal value.The death group had a significantly greater reduction in platelet count than the survival group [ (-43.4 ± 58.9) × 109/L vs (-11.5 ± 29.1) × 109/L, t =-2.827, P = 0.041].With -27.5 × 109/L as the cut-off value of the change in platelet count, there was a significant difference in mortality rate between the platelet count change >-27.5 × 109/L group and the platelet count change ≤-27.5 × 109/L group (22.2% vs 72.2%, χ2= 12.623, P < 0.01) .The univariate analysis showed that platelet change, prothrombin time activity, and fasting blood glucose were influencing factors for patients' prognosis, and the multivariate analysis showed that platelet change was an independent influencing factor for the prognosis of ACLF patients, with an area under the ROC curve of0.743.The plasma level of TPO was measured for 24 patients, among whom 8 died before discharge, resulting in a mortality rate of 33.3%.There was no significant difference in the level of TPO between the survival group and the death group (91.8 ± 39.8 pg/ml vs 93.3 ± 46.5 pg/ml, t = 0, P = 0.938) .Conclusion Baseline platelet count in ACLF patients is significantly lower than the normal value.The reduction in platelet count is an independent risk factor for death before discharge in ACLF patients.Thrombocytopenia may not be associated with the reduction in TPO.

Objective To investigate the distribution features of traditional Chinese medicine (TCM) syndromes types and syndrome elements of primary biliary cholangitis (PBC) via literature research, and to provide a basis for further research on PBC syndromes and features.Methods CNKI, CBM, CQVIP, Wanfang Data, and Pub Med were searched for articles on PBC published up to August 31, 2017.Note Express2.0 was used for the screening of articles on PBC syndromes, and SPSS19.0 was used for statistical analysis.Results A total of 11 articles with 849 cases were included, and 19 PBC syndrome types and 18 syndrome elements were identified.A statistical analysis was performed from the aspects of the frequency of syndromes and the constituent ratio of cases, and the results showed that the core syndrome types of PBC were liver-kidney yin deficiency syndrome and the syndrome of stagnation of liver qi and spleen deficiency; major syndrome elements of disease location were the liver, the spleen, and the kidney; major syndrome elements reflecting the nature of disease included qi deficiency, dampness, yin deficiency, qi stagnation, blood stasis, and heat.Major syndrome types in the clinical symptom stage included stagnation of liver qi and spleen deficiency, liver-kidney yin deficiency, and deficiency of spleen qi and stomach qi, and major syndrome elements reflecting the nature of disease included qi deficiency, qi stagnation, yin deficiency, and dampness.Major syndrome types of decompensated cirrhosis included liver-kidney yin deficiency, deficiency of liver and kidney, and dampness and blood stasis; major syndrome elements of disease location were the liver and the kidney; major syndrome elements reflecting the nature of disease included yin deficiency, dampness, blood stasis, and deficiency of essence.Conclusion Distribution features of common syndrome types and syndrome elements of PBC summarized in this article lay a foundation for the development of the standards for TCM syndrome differentiation of PBC.

Objective To evaluate the association between the rapidity of response and progression to cirrhosis in patients with autoimmune hepatitis (AIH) , and to analyze the influencing factors for the rapidity of response.Methods A retrospective analysis was performed on 61 AIH patients with long-term follow-up, who visited The General Hospital of Tianjin Medical University from November 2001 to May 2017.These patients were divided into five groups according to the time for transaminase to decrease to a normal level:< 3 months group, 3-6 months group, 6-12 months group, 12-24 months group, and > 24 months group.The chi-square test was used to compare the rate of progression to cirrhosis and sustained response rate between these groups.One-way analysis of variance and the two-independent-samples t test were used to analyze the influencing factors for the rapidity of response.The two-independent-samples t test was used for comparison of normally distributed continuous data between two groups, and one-way analysis of variance was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between two groups, and the contingency table chi-square test was used for comparison between multiple groups.Results The < 3 months group had the lowest proportion of patients with progression to cirrhosis (20%) ; all of the two patients in the > 24 months group progressed to cirrhosis; and 62.5% of the patients in the 12-24 months group progressed to cirrhosis.The rate of progression to cirrhosis was significantly lower in the patients who showed response within 3 months than in those who showed no response within 3 months (20% vs 48.15%, χ2= 5.067, P < 0.05) .The rates of progression to cirrhosis for the < 3 months group, 3-6 months group, 6-12 months group, 12-24 months group, and > 24 months group were 20%, 41.7%, 20%, 62.5%, and 100%, respectively, and the < 3 months group had a significantly lower rate of progression to cirrhosis than the 12-24 months group and > 24 months group (χ2= 5.546 and 6.400, both P < 0.05) .The sustained response rate of the < 3 months group was significantly higher than that of the 12-24 months group and > 24 months group (χ2= 4.322, P < 0.05) .Conclusion For AIH patients, the rapidity of response is associated with progression to cirrhosis; a rapid response reduces the rate of progression to cirrhosis.Responding within 3 months may indicate a good outcome, while responding beyond 1 year may indicate a poor outcome.Initial alanine aminotransferase level, and therapeutic drugs may influence the rapidity of response.

Objective To investigate the pulmonary function changes in patients with nonalcoholic fatty liver disease (NAFLD) and their clinical significance.Methods A total of 275 NAFLD patients who underwent physical examination in Physical Examination Center of Daping Hospital, Army Medical University, from September 2016 to May 2017 were enrolled as NAFLD group, and 276 non-NAFLD patients were enrolled as control group.Pulmonary function data were analyzed for both groups, including forced vital capacity (FVC) , forced expiratory volume in the first second (FEV1) , and FEV1/FVC ratio, and pulmonary function parameters were compared between NAFLD patients with elevated alanine aminotransferase (ALT) and those with normal ALT.The two-independent-samples t test was used for comparison of continuous data with homogeneity of variance between groups, and the non-parametric Wilcoxon rank-sum test was used for comparison of continuous data with heterogeneity of variance between groups.The chi-square test was used for comparison of categorical data between groups.Results Compared with the control group, the NAFLD group had significantly lower FVC (3.60 ± 0.87 L vs 3.87 ± 0.80 L, t =-3.78, P < 0.01) and FEV1 (2.97 ± 0.79 L vs 3.17 ± 0.82 L, t =-2.87, P < 0.01) .The NAFLD group had a slightly lower FEV1/FVC ratio than the control group (82.06% + 13.88% vs 82.88% ± 13.0%, P > 0.05) .Compared with those with normal ALT, the NAFLD patients with elevated ALT had lower FVC (3.53 ± 0.82 L vs 3.69 ± 0.92 L, P > 0.05) , FEV1 (2.72 ± 0.80 L vs 3.06 ± 0.79 L, P > 0.05) , and FEV1/FVC ratio (81.21% ± 13.00% vs 82.69% ± 12.92%, P > 0.05) .Conclusion NAFLD patients may have pulmonary function damage, which may be associated with metabolic disorder and liver inflammation.

Objective To investigate the effect of the liver-regulating and spleen-strengthening method on lipid metabolism and expression of microtubule-associated protein light chain 3 B (LC3B) in a rat model of nonalcoholic fatty liver disease (NAFLD) , as well as the mechanism of this method in the treatment of NAFLD.Methods A total of 30 clean male Sprague-Dawley rats were randomly divided into control group, model group, and liver-regulating and spleen-strengthening group, with 10 rats in each group.The rats in the model group and the liver-regulating and spleen-strengthening group were given high-fat diet for 12 weeks.The rats in the liver-regulating and spleen-strengthening group were given liver-regulating and spleen-strengthening prescription 2 ml·100 g-1·d (five times the dose for adults) by gavage, and those in the control group were given normal diet and an equal volume of normal saline by gavage.The rats were sacrificed at the end of week 12, and blood and liver samples were collected to measure the serum levels of alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , triglyceride (TG) , total cholesterol (TC) , high-density lipoprotein cholesterol (HDL-C) , and low-density lipoprotein cholesterol (LDL-C) .HE staining was performed to observe hepatic steatosis, and immunohistochemistry was used to measure the change in the expression of LC3B in liver tissue.A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups; the Kruskal-Wallis H test was used for comparison of ranked data between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups.Results HE staining showed that there were significant differences in the degree of hepatocyte fatty degeneration and score of inflammatory activity between the model group and the control group (both P < 0.001) ; compared with the model group, the liver-regulating and spleen-strengthening group had significant reductions in the degree of hepatocyte fatty degeneration and score of inflammatory activity (both P < 0.01) .Compared with the control group, the model group had significant increases in the serum levels of ALT, AST, TG, TC, HDL-C, and LDL-C (all P < 0.001) ; compared with the model group, the liver-regulating and spleen-strengthening group had significant reductions in the serum levels of ALT, AST, TG, TC, and LDL-C (all P < 0.05) .Compared with the control group, the model group had a slight increase in the expression of LC3B in liver tissue (χ2= 1.250, P > 0.05) ; compared with the model group, the liver-regulating and spleen-strengthening group had a significant increase in the expression of LC3B in liver tissue (χ2= 5.051, P < 0.05) .Conclusion The liver-regulating and spleen-strengthening method can improve liver function and blood lipids in experimental male Sprague-Dawley rats with NAFLD, possibly by increasing the level of autophagy in liver tissue.

Objective To investigate the clinical features of patients with hepatic amyloidosis.Methods A retrospective analysis was performed for the clinical data of 12 patients with hepatic amyloidosis who were hospitalized in Department of Hepatology, 302 Hospital of PLA, from January 2011 to December 2016, including general information, clinical symptoms, signs, laboratory findings, imaging features, and pathological features.Results Of all 12 patients, there were 11 male patients (91.7%) and 1 female patient (8.3%) , aged 40-67 years (mean 53.0 ± 8.5 years) , and 2 (16.7%) had AA hepatic amyloidosis and 10 (83.3%) had AL hepatic amyloidosis.Major clinical symptoms included weakness in 7 patients (58.3%) , poor appetite in 5 patients (41.7%) , hepatic discomfort and pain in 9 patients (75.0%) , and proteinuria in 8 patients (66.7%) .Imaging examination showed liver cirrhosis in 12 patients (100%) , hepatomegaly in12 patients (100%) , and splenomegaly in 8 patients (66.7%) .Laboratory examination showed reduced albumin in 8 patients (66.7%) , abnormal liver function in 11 patients (91.7%) , increased total bilirubin in 7 patients (58.3%) , increased gamma-glutamyl transpeptidase (GGT) in 12 patients (100%) , and increased alkaline phosphatase (ALP) in 11 patients (91.7%) .Conclusion Hepatic amyloidosis mainly occurs in middle-aged men.The possibility of hepatic amyloidosis should be considered in case of liver cirrhosis, hepatomegaly, proteinuria, abnormal liver function, and increased ALP and GGT in clinical practice.Liver biopsy helps to make a definite diagnosis.There are still no effective therapies for this disease, but early diagnosis and intervention and timely treatment of complications can improve patients' prognosis.

With the action of various chronic factors for liver injury, hepatic stellate cells (HSCs) are activated and transformed to myofibroblasts (MFBs) and then migrate to the injured part and secrete a large amount of extracellular matrix (ECM) .Excessive deposition of ECM in the liver causes liver fibrosis.The elimination of factors for liver injury or effective treatment helps to achieve liver fibrosis regression.This article introduces the types of cells involved in liver fibrosis regression.MFBs play an important role liver fibrosis regression via senescence, apoptosis, and inactivation; macrophages exert an anti-fibrosis effect by accelerating ECM degradation and inducing MFB senescence; liver sinusoidal endothelial cells help to achieve liver fibrosis regression by maintaining its normal phenotype; natural killer cells are involved in liver fibrosis regression by killing the early activated HSCs and senescent MFBs.