Chinese Herbal Treatment of Hepatitis C

Comments:

This file is a slightly modified version (modified only for readability on multiple computer systems) of a presentation made at the National Herbalists Association of Australia Annual Sydney Seminar, 1995.

This seminar is a practitioner-only seminar; members of the public are not invited. Therefore this file provides information destined for practitioners, and should not be taken as treatment advice. Indeed it is highly recommended by the author, that anybody suffering from hepatitis C, or any health condition, should seek professional care and not self-medicate with herbal medicines.

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Comments to Practitioners:

Ses Salmond its interested in receiving information from fully qualified and practicing complementary and orthodox medical practitioners who are treating patients with diagnosed HepC infection. So if you have any information you feel may be of use to her, please send it via mail to the following mail address ...

Ses Salmond

Leichhardt Women's Health Centre

PO Box 240

Leichhardt NSW 2040

Australia

... or via e-mail to Ian Breakspear (100245,2647), clearly marked for the attention of Ses Salmond re Hepatitis C.

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HEPATITIS C

PRESENTATION TO THE NHAA SYDNEY CONFERENCE

October 1995

by Ses Salmond, D.B.M., Dip Hom, N.D., NHAA and ATMS Member

WHAT IS HEPATITIS C?

Hepatitis is an inflammation of the liver. Inflammation comes from a Latin word meaning to inflame. This hepatitis is caused by a RNA virus from the Flaviviridae (family of viruses). Viruses are like parasites and depend on nutrients inside cells to survive, often affecting the functioning of those cells. Hepatitis C has been around for 25 years and used to be called non-A on-B Hepatitis.

HOW IS HEPATITIS C VIRUS (HCV) TRANSMITTED?

HCV is a blood borne virus, so anything relating to contact with blood forms a high transmission risk

# intravenous drug using (IDU) sharing equipment (previous IDU, present IDU)

# blood transfusions prior to 1990 (when screening for HCV was introduced)

# menstrual blood

# being a haemophiliac

# needle stick injuries and cross infection (issues for health care workers)

# tattoos and barber's razors

VERTICAL TRANSMISSION

Royal Prince Alfred Hospital - Study in progress.

Preliminary results show:-

A woman who is HCV Antibody Positive and PCR RNA negative there is no risk of vertical transmission.

If a woman is viraemic (PCR RNA positive) at the time of delivery the vertical transmission rate is 17.5%. Previously this figure was believed to be 10%.

In regards to breastfeeding it is believed that the benefits of breastfeeding still outweigh the risk.

HEPATITIS C PROGNOSIS

of 100% actually infected with HCV:

20% will get rid of the virus and will be okay

80% will have long term infection over 20 years:

20% will not have symptoms, will have normal LFTs (liver function tests); but will be infectious

40% will have chronic symptoms, with abnormal LFT's; will be infectious; may be signs of liver damage.

20-25% will develop cirrhosis, with scarred liver tissue in another 5-10 years:

5-10% of those people with cirrhosis will experience liver failure or develop liver cell cancer

(CHRONIC MEANS SUSTAINED OR LONG TERM)

(PROGNOSIS MEANS THE FORECAST OF THE COURSE OF A DISEASE)

NOTE: this information is based on the current understanding of the likely prognosis of hepatitis C. As time goes on, this information will be subject to change.

Based on Professor Bob Batey's talk at the public meeting organised by the Hepatitis C Council of NSW. Hunter Support Group on 1 March 1995.

Professor Batey is Associate Professor of Gastroenterology at the John Hunter Hospital in Newcastle, member of the NHMRC/AHMAC Hepatitis C Task Force, theNHMRC Hepatitis C Working Party and the NSW Hepatitis C Taskforce.

PATHOLOGY TESTS FOR HCV

POLYMERASE CHAIN REACTION TEST (PCR)

A specific part of the DNA in HCV is identified and then amplified (like a chain reaction) so multiple copies of the DNA are made and measured in a test tube. This can determine the viral load and is a more accurate and sensitive test.

Shorter window period - within two weeks.

ST VINCENTS PATHOLOGY

The PCR test for Hepatitis C is currently undergoing validation studies.

The relationship between Hepatitis C antibody and the presence of viral RNA as detected by PCR, has not yet been fully elucidated. It is believed that a positive PCR result is indicative of active infection. Current opinion suggests that:

Antibody negative, PCR negative ---> indicates no detectable exposure to Hepatitis C virus.

Antibody positive, PCR positive ---> indicates current active infection.

Antibody negative, PCR positive ---> indicates recent active infection which has yet to seroconvert OR active infection in a patient with poor immune response.

Antibody positive, PCR negative ---> indicates past infection OR intermittent or very low level viraemia OR a non-specific (i.e. false positive) antibody result. Further monitoring, every three to six months, is required to clarify this result.

LIVER FUNCTION TEST

ALT (Serum alanine aminotransferase, previously known as SGPT) is an enzyme involved in liver metabolism. Every liver cell has ALT. When a liver cell dies due to the virus attacking the liver, ALT leaks into the bloodstream. Depending on the pathology laboratory ALT levels range between 20-40 and 30-60. According to Bob Batey the average level for HCV is 100-120. ALT levels are of most importance in Hepatitis.

LIVER BIOPSY

This is a procedure where a sharp instrument extracts some of the liver tissue, and assesses the extent of liver damage.

Coagulation studies especially prothrombin time can be used to predict if someone is likely to bleed as a result of a liver biopsy. Prolonged prothrombin time indicates the patient will have a prolonged bleeding time. According to Dr J.J. Chen, the symptom of bleeding gums is a definite indication for coagulation studies, although not all will be abnormal.

ULTRASOUND

An ultrasound of the liver can show size of the liver, masses or stones, hepatoma.

If ALT is normal but virus markers are positive, an ultrasound every six months is recommended.

VIRAL GENOTYPES

The HCV has at least 6 major genotypes. Genotype refers to the fact that every virus has its RNA genome. The RNA virus can lose its proofreading mechanism so it makes mistakes which are repeated in its replication and finally a different genotype emerges. Genotypes have 40% variation and 60% commonality with the HCV. The genotypes localise in geographic areas. Most common genotypes in Australia and Scotland are 1a, 1b, 3a.

The genotype does influence the severity of the disease and the viral load.

Type 1(b) easily progresses to cirrhosis and has a poor response to interferon.

Type 2 and 3 have a better response to interferon especially 3(a).

Dr J.J. Chen believes that the types responding to interferon are also easier to treat with Traditional Chinese Medicine (TCM).

There are also Quasispecies in HCV which are able to change one single chain in the genome of the virus so that the primed antibody can no longer recognise the virus.

TREATMENTS:

INTERFERON

Side Effects

Short Term (i.e. likely to experience in first 6-8 doses):

# Fever

# Flu like symptoms

# headaches

Long Term:

# Reduction in globulin

# Reduction in platelets

# Reduction in WBC count

# Hair loss (can continue up to 2 months after interferon ceased)

# migraines (if had headaches previously)

# severe depression/suicidal.

# immune reactions in the glands i.e. Liver, Kidney, thyroid.

# 1 in 50 get thyroid destruction after long term treatment.

PROFESSOR BOB BATEY - Clinical Trial of Chinese Herbs Professor Batey, Associate Professor of Gastroenterology at John Hunter Hospital in Newcastle (New South Wales, Australia) is conducting a 6 month randomised, controlled trial of 17 Chinese plant extracts in the treatment of the HCV.

In the 6 month trial it is expected to find a general downwards trend towards normal in the ALT levels.

ALCOHOL and HCV

Alcohol has been shown quite clearly to suppress the immune system and to allow viral replication to happen more actively than in non drinkers who have HCV.

Clinical manifestation of HCV is adversely affected by regular alcohol intake i.e. more than 1 drink a day.

HCV patients with ALTs around 150-200 while regularly consuming small amounts of alcohol, have liver enzymes which stabilise when alcohol consumption is discontinued.

USEFUL HERBAL MEDICINES (***** Patients with HCV should only take these herbal medicines under guidance from a qualified medical herbalist or naturopath who is monitoring your progress *****)

BOTANIC NAME Astragalus membranaceus

COMMON NAME Astragalus (Huang Qi)

PARTS USED Root

KNOWN ACTIVE CONSTITUENTS

# triterpenoid saponins

# Astragalosides 1-VIII, isoflavonoids, polysaccharides

ACTIONS

# immunostimulant, tonic, cardiotonic, diuretic, hypotensive

DOSAGE

# 1:2 liquid extract 1.5-3mL tds

MEDICINAL USES

# Chronic viral infections, hepatitis, especially if debility and spontaneous sweating are present

# Oedema

# Common cold

# Influenza

WHAT IT DOES

# In Chinese medicine Astragalus raises vitality, stops debilitating sweating, promotes healing and tissue regeneration.

# Increases phagocytic activity and levels of antibodies.

# Increases the function of Natural Killer cells.

# In vitro, augments interferon response to viral infection and acts synergistically with administered interferon.

# Cases of chronic persistent hepatitis showed a 86% response rate after Astragalus injection.

BOTANIC NAME Berberis vulgaris

COMMON NAME Barberry

PARTS USED Root bark

KNOWN ACTIVE CONSTITUENTS

# Alkaloids - berberine, oxycanthine, palmatine, columbarine

# chelidonic acid, tannins

ACTIONS

# cholagogue, choleretic, bitter, antimalarial, antiemetic, immunostimulant, gut antibiotic

MEDICINAL USES

# Cholecystitis, cholelithiasis

# Biliary infection

# Constipation

# Splenic enlargement

# Debilitated condition, marked by poor digestion, e.g. history of alcohol/diet, abuse, or suffered from excessive exposure to drugs, chemicals or industrial pollutants

# Inflammatory bowel disease

CAUTION

# Avoid in pregnancy

DOSAGE

# 1:2 liquid extract 0.5-1mL tds

BOTANIC NAME Bupleurum falcatum

COMMON NAME Bupleurum

PARTS USED Root

KNOWN ACTIVE CONSTITUENTS

# Saikosaponins

ACTIONS

# Antiinflammatory, hepatoprotective, hepatic mild sedative, adaptogen, antitussive

DOSAGE

# 1:2 liquid extract 1.5-3mL tds

MEDICINAL USES

# Chronic Hepatitis

# Hepatomegaly with pain in the upper right quadrant

# Splenomegaly

# Chemical liver damage

# Liver stasis or liver congestion

# Depression

# Irregular menstruation

WHAT IT DOES

# Increases protein synthesis in the liver.

# Reduces inflammation by inhibiting prostaglandin (PGE2) production.

# Protects the liver against toxic liver damage.

# Improves liver function after 2-3 months treatment.

# Clinical trials show it can reduce or remove HBeAg.

# In 1994 76.7% of patients with HCV improved in short term on Xiao

Chai Hu Tang (Minor Bupleurum) and Gan Yan Chong Ji (China).

CAUTION

# It may increase bowel movements and flatulence (wind).

BOTANIC NAME Chelidonium majus

COMMON NAME Greater Celandine

PARTS USED Above ground parts

KNOWN ACTIVE CONSTITUENTS

# Isoquinoline alkaloids (chelidonine, sanguinarine, chelerythrin, protopine)

# bitter substances, essential oil

ACTIONS

# Cholagogue, Laxative, diuretic, bitter, spasmolytic to gallbhaldder and bronchi.

MEDICINAL USES

# Hepatitis (stitch in the liver, pain radiating to shoulder areas and headaches).

# Gallstones, conditions involving gall bladder and bile ducts.

# Intestinal Putrefaction.

WHAT IT DOES

# Improves the detoxifying functions of the liver and bowel clearance.

# Stimulates the secretion of bile and pancreatic juices.

# Reduces spasms.

DOSAGE

# 1:2 liquid extract 0.35-0.75mL tds

CAUTIONS

# Large doses are toxic

BOTANIC NAME Cynara scolymus

COMMON NAME Globe Artichoke

PARTS USED Leaves

KNOWN ACTIVE CONSTITUENTS

# Bitter sesquiterpene lactones - cynaropicrin,

# flavonoids, coumarins, phenolic acids, cynarin

ACTIONS

# Bitter tonic, choleretic, cholagogue, diuretic, hepatoprotective,

hepatic trophorestorative.

MEDICINAL USES

# Liver diseases, jaundice

# Liver damage, fatty degeneration of the liver.

# Ascites from portal stasis.

# Gallstones, Kidney stones.

# Sluggish digestion, nausea, anorexia.

# Chronic constipation.

# High cholesterol and triglycerides.

# Arthritis.

WHAT IT DOES

# Increases bile flow from the liver.

# Stimulates antitoxic activity of the liver.

# Lowers plasma cholesterol.

# Stimulates urine flow.

DOSAGE

# 1:2 liquid extract 0.75-1.5mL tds

BOTANIC NAME Desmodium ascendens

COMMON NAME Desmodium

FAMILY Papillonaceae

PARTS USED Non flowering parts, stems and leaves, harvested after flowering.

HABIT Southern Sierra-Leone, North of Liberia in the equatorial forests of Africa.

ACTIONS

# hepatoprotective

# hepatorestorative

# antihepatotoxic

# antiallergic

# antiinflammatory

MEDICINAL USES

# Viral hepatitis

# toxic hepatitis - accidental or due to drug addiction

# hepatic lesions of alcoholic origin

# hepatic lesions due to chemotherapy

# autoimmune diseases - asthma, allergies

# cirrhosis prevention

# nausea

# fatigue

# loss of appetite

# rapid disappearance of icterus and asthenia (between 2 and 7 days)

HOW IT WORKS Desmodium without any toxicity, does not work by antiviral action, but by regenerating and protecting the hepatic cells. It has a protective effect against lysis of the hepatocyte. It can lead to the normalisation of transaminases and the prevention of cirrhosis by alleviating antiinflammatory attacks.

DIRECTIONS FOR USE

# Acute hepatitis

# All varieties of viral hepatitis. Boil 8-10 grams of the dried plant (without roots) for approximately 15 minutes in 1.5 litres of water. Filter. Drink decoction within 24 hours. If treated early in the disease, a normalisation of transaminases can occur in 1-6 weeks, disappearance of icterus, and a return to the general state of health.

# Toxic hepatitis, Accidental or due to drug addiction. Same preparation and dosage as above.

#Prevention of hepato-digestive side effects of chemotherapy ---> 2 days prior and 5 days after chemotherapy, 7-8grams of the plant in decoction as above every day.

HOW IT WORKS

Toxic hepatitis generated by carbon tetrachloride is much better tolerated when

Desmodium ascendens is administered.

BOTANIC NAME Hypericum perforatum

COMMON NAME St John's Wort

PARTS USED Above ground parts

KNOWN ACTIVE CONSTITUENTS

# Hypericin, pseudo-hypericin, flavonoids, tannins, resin, essential oil, xanthones

ACTIONS

# Antidepressant

# antiviral/antiretroviral

# diuretic, antineoplastic

MEDICINAL USES

# HIV, Hepatitis B and C, herpes, depression, anxiety, stress, diarrhoea, gastroenteritis, sciatica, headaches.

HOW IT WORKS

# Scientific research demonstrates a potent activity against retroviruses (HIV, human immunodeficiency virus) and enveloped viruses (Hepatitis

B, C not A), herpes family of viruses, influenza, togaviruses.

# Inactivates human retroviruses (HIV).

# Interferes with the assembly or processing of viral components by an infected cell thereby reducing the production of mature viral particles.

# Reduces fluid retention and hastens the elimination of toxins in the urine.

# Xanthones inhibit Mono-amine oxidase (MAO) enzyme systems.

DOSAGE

# 1:2 High Grade liquid extract 0.75-2mL tds

BOTANIC NAME Larrea mexicana

COMMON NAME Chaparral

PART USED Leaves

KNOWN ACTIVE CONSTITUENTS

# 8% lignan

# NDGA - nor-dihydroguaretic acid (one of the best natural antioxidants

known)

ACTIONS

# antioxidant, anticancer, antiinflammatory

MEDICINAL USES

# cancer, chemotherapy (synergistically)

HOW IT WORKS

# 5 lipoxygenase inhibitor.

# inhibitor of anaerobic glycolysis which the cancer cell relies on for energy.

DOSAGE

# 1:2 liquid extract 0.5-1.25mL tds

CAUTION

# May cause hepatitis

# May stimulate tumour growth

# Five cases of acute or subacute hepatitis following the ingestion of chaparral (Larrea tridenta) capsules or tablets have been reported. (Herbal Gram No.28, 38, 1993)

# No compounds thus far discovered in chaparral are noted for their hepatotoxicity.

BOTANIC NAME Picrorrhiza kurroa

COMMON NAME Picrorrhiza

PARTS USED Root

KNOWN ACTIVE CONSTITUENTS

# Iridoid glycosides (picrosides I, II, III and kutkoside)

# Cucurbitacin glycosides (bitterness of root)

ACTIONS

# Hepatoprotecive, antiinflammatory, anti allergic, immunostimulant,

bitter tonic, choleretic.

MEDICINAL USES

# Viral liver disease especially Hepatitis B Virus

# Toxic liver damage, liver infections

# Acute and chronic infections, weakened immunity

# Auto-immune disease

# Asthma, Vitiligo

# Fevers

HOW IT WORKS

# Mops up free radicals (antioxidant).

# Boosts all aspects of immunity (T lymphocytes, B lymphocytes) and

phagocytes.

# Causes a rapid fall in bilirubin levels and quicker recovery in infective hepatitis.

# Increases protein synthesis in the liver.

# Has marked anti-Hepatitis B surface antigen activity.

DOSAGE

# 1:2 liquid extract 0.3-1.4mL tds

CAUTION

Large doses can cause diarrhoea, flatulence, griping, skin rash.

BOTANIC NAME Phyllanthus amarus

COMMON NAME Phyllanthus

PARTS USED Leaves or herb

KNOWN ACTIVE CONSTITUENTS

# Lignans - phyllanthin and hypo-phyllanthin, flavonoids, alkaloids and invitro antiviral agent geraniin (tannin).

ACTIONS

# Antiviral, hepatoprotective, hypoglycaemic

MEDICINAL USES

# Viral liver diseases including acute hepatitis and chronic persistent

hepatitis

# Jaundice

# Diabetes

WHAT IT DOES

# Inhibits DNA polymerase (the enzyme that Hepatitis B-like viruses need for replication of the virus).

# Lancet 1988 - 59% of those treated (compared to 4% in the placebo group) had lost HBsAg in first 15-20 days. Up to 9 months later

HBsAg had not returned.

# inhibits HIV reverse transcriptase in vitro.

DOSAGE

# 1:2 liquid extract 0.75-2mL tds higher end of dose for acute states.

BOTANIC NAME Schisandra chinensis

COMMON NAME Schisandra

PARTS USED Berries

KNOWN ACTIVE CONSTITUENTS

# Lignans - schizandrins

ACTIONS

# bacteriostatic, hepatoprotective, cardiotonic, sedative.

MEDICINAL USES

# chronic hepatitis with elevated serum transaminase

# Liver damage

# Fatigue

# Night sweats

# Insomnia

# Excessive stress

# Forgetfulness

# Heart palpitations

# chronic diarrhoea

HOW IT WORKS

# Improves protein synthesis in the liver

# Elevates liver microsomes which increases the liver's ability to detoxify foreign substances in the body.

# Stimulates central nervous system.

# Accelerates repair of liver function.

DOSAGE

# Decoction - 3-9 gram/day

# 1:2 liquid extract1.25-3mL tds

BOTANIC NAME Silybum marianum

COMMON NAME St Mary's Thistle

PARTS USED Seeds

KNOWN ACTIVE CONSTITUENTS

# Flavonolignans known as silymarin.

Silymarin contains silybin, silydiamin and silychristin

# Flavonoids (quercetin)

ACTIONS

# Hepatoprotective, hepatic trophorestorative, antioxidant, choleretic.

MEDICINAL USES

# All types of hepatitis; acute, infective, chronic

# Cirrhosis of the liver

# Fatty degeneration of the liver

# Toxic liver damage

# Jaundice

HOW IT WORKS

# Stabilises and protects the cell membrane of the hepatocytes.

# Improves regeneration of liver cells (increases protein synthesis).

# Enhances the detoxifying and secreting functions of the liver.

# Corrects glutathione deficiency

# Prolongs survival rates in alcoholic cirrhosis.

# Mops up free radicals (antioxidant).

DOSAGE

# 1:1 liquid extract 1.5-3mL tds

BOTANIC NAME Taraxacum officinale

COMMON NAME Dandelion root

PARTS USED Root

KNOWN ACTIVE CONSTITUENTS

# Bitter - taraxacin, pentacyclic steroids- taraxasterol, taraxarol, inulin, vitamins A,B,C,D, minerals - potassium, calcium.

ACTIONS

# Bitter, mild laxative, hepatic tonic, cholagogue.

MEDICINAL USES

# Hepatitis, liver disease, jaundice, dyspepsia

# Sluggish liver, e.g. tiredness, irritability, skin problems, headaches

# Gall bladder disease, gallstones

# Anorexia nervosa

# Constipation

# Arthritis

HOW IT WORKS

# Increases the secretion of bile thereby promoting the self cleansing and reparative ability of the liver.

# Promotes digestive secretions and the appetite - which leads to improved digestion, absorption and assimilation of nutrients.

# Increases the elimination of toxins, wastes and pollutants through the liver and kidneys.

DOSAGE

# 1:2 liquid extract1-2mL tds

CASE STUDY - First Visit 26th May 1995

A 35 year old woman diagnosed with non A-non B Hepatitis 15 years ago and Hepatitis C 6 years ago.

Presenting symptoms: tiredness, difficulty putting on weight, headaches, nausea, swollen cervical glands when ALT is increasing, stress, chronic depression, coughing hurts the liver, generalised body aches, dermatitis of the inner ear, current viral infection and bronchitis, constipation, cigarette smoker.

26th April 1995 ALT 125 AST 94.

21 months ago prior to interferon treatment ALT 385. While on interferon for 6 months liver enzymes returned to normal. One week after treatment ceased ALT 196.

Side effects from interferon: weight loss (7.5 stone to 5 stone), became chronically depressed requiring antidepressants (Prozac) which she is still on, flu like symptoms, headaches, sweats, lethargy and fatigue. 15 months ago, Liver biopsy had shown minimal damage to the Liver, no scar tissue, one week after ceasing interferon.

23 May 1995 Liver biopsy - chronic active hepatitis C fibrosis of the liver (next stage down from cirrhosis).

Advised by medical profession to go back on interferon to stop the virus attacking the liver further.

TREATMENT:

Hypericum perforatum (H/G) 40mL

Silybum marianum 40mL

Taraxacum officinale 40mL

Hydrastis canadensis 20mL

Larrea mexicana 30mL

Euphrasia officinalis 30mL

Flavouring mixture 10mL

210mL

DOSE: 7mLs in water before meals b.d.

Pharmafoods PharmaLiv 2 tablets b.d.

Bach Flowers Crabapple, Hornbeam, Olive

Second Visit 16 June 1995

Cervical glands gone down, headaches improved - 8 in previous month, 2 in last 3 weeks, constipation improved, dysmenorrhoea had eased, dermatitis in inner ear improved. Still experiencing nausea, coughing, chest congestion, weight loss. Diet improved eating fish, chicken, no tea or coffee. Craving chocolate and feeling stressed.

TREATMENT:

Picrorrhiza kurroa 30mL

Hypericum perforatum (H/G) 70mL

Larrea mexicana 30mL

Phyllanthus amarus 40mL

Echinacea angustifolia 30mL

Flavouring mixture 10mL

210mL

DOSE: 7mLs in water before meals b.d.

Mediherb Silymarin 1 tablet tds

MediHerb Withania and Ginseng 2 tablets b.d.

Third Visit 7 July 1995

After 6 weeks treatment ALT 68 (prev.125) AST normal (prev.94).

"I haven't had readings like this since I was on the interferon treatment" Only felt nauseous once in the last 3 weeks. Her doctor confirmed chest clear of congestion, still coughing, weight loss still an issue. Has had no cigarettes for the last 3 weeks.

TREATMENT:

Picrorrhiza kurroa 30mL

Phyllanthus amarus 40mL

Hypericum perforatum (H/G) 50mL

Larrea mexicana 30mL

Bupleurum falcatum 10mL

Hydrastis canadensis 20mL

Glycyrrhiza glabria 20mL

DOSE: 7mLs in water before meals tds

Mediherb Silymarin 1 tablet tds

Practitioner: Ses Salmond, Arkana Therapy Centre, 8 Shepherd Street, Chippendale NSW 2008

CASE STUDY - First Visit April 1994

A 34 year old woman with HCV who had been an ID user (heroin) for 19 years. Presenting Symptoms: constipation, intestinal colic/spasm especially when stressed, acne around chin. History of and current bladder infections, right lymphatic congestion around the breast area. Has had both Hep A & B in the past and is in a stressful job. Smoking marijuana (4 bongs a day).

IRIS

thick, dark nerve rings over the Liver

distended hepatic flexure

radii solaris throughout iris, thin nerve wreath.

TREATMENT:

Silybum marianum 40mL

Chamomilla recutita H/G 40mL

Rumex crispus 40mL

Picrorrhiza kurroa 30mL

Echinacea angustifolia 40mL

Zingiber officinale 10mL

200mL

DOSE: 4mLs with water before meals tds

Buchu Tea 1 cup b.d.

Slippery elm to be taken as needed.

Second Visit May 94

No Kidney problems or burning. Everything improved until a work deadline when the symptoms of colic, burning pain in abdomen, intestinal spasm and pain between the shoulder blades accompanied with constipation returned.

TREATMENT:

EMERGENCY MIX:

Dioscorea villosa 40mL

Althaea officinalis radix 40mL

Chamomilla recutita HG plus Bach Flowers 20mL

100mL

DOSE: 4mLs before meals qid.

MAIN MIXTURE:

Silybum marianum 40mL

Picrorrhiza kurroa 20mL

Rumex crispus 40mL

Chamomilla recutita H/G 40mL

Dioscorea villosa 40mL

Phyllanthus amarus 10mL

Zingiber officinale 10mL

200mL

DOSE: 4mLs before meals tds.

Third Visit June 1994

All symptoms improved, some pre-menstrual breast tenderness.

LIVER FUNCTION TEST: ALT 32, AST 32, Total protein raised in the Liver.

Urine test shows leucocytes and epithelial cells.

TREATMENT: - Emergency Mix is Repeated

Vitex agnus castus - 30 drops in water on rising from Day 14 to menstruation.

MAIN MIXTURE:

Silybum marianum 40mL

Picrorrhiza kurroa 10mL

Chamomilla recutita H/G 40mL

Echinacea angustifolia 40mL

Dioscorea villosa 40mL

Phyllanthus amarus 30mL

Zingiber officinale 5mL

205mL

DOSE: 4mLs in water before meals tds.

Repeats of Vitex, Emergency Mix and main mixture given.

Fourth Visit October 1994

Liver function test - normal.

Full blood count - normal.

Right lymphatic breast area swollen, breast pain reduced.

TREATMENT: - Emergency Mix, Vitex, Main Mixture repeated.

Fifth Visit February 1995

Lump in Right breast found - referred to a doctor who removed the cyst. A haematoma developed from cyst GIT symptoms associated with HCV had calmed down.

Repeats given in the intervening period.

Sixth Visit May 1995

Breast healing well, hardness around scar tissue. Has reduced marijuana intake almost entirely.

Repeats of all mixtures given.

Seventh Visit August 1995

Feeling well on the herbs and wants to stay on herbs.

No soreness in breast.

18 months since last ID use.

Uses emergency mix where necessary.

Practitioner: Ree Van Galen, Shop 4, Alexander Street, Fairy Meadow NSW 2519.

CASE STUDY - First Visit 30 September, 1993

A 32 year old woman diagnosed with Hepatitis B six years ago, and Hepatitis C in January 1993. Intravenous Drug User (IDU) of heroin for 14 years.

Presenting symptoms: nausea, oesophageal reflux, tiredness, dysmenorrhoea, bloating, PMT, irritability, stressed, anxiety. Worse for fatty meats, chilli, oil, sweets. Feels tired 20-30 minutes after meals, aching joints.

TREATMENT:

Silybum marianum 40mL

Rehmannia glutinosa 30mL

Bupleurum falcatum 30mL

Filipendula ulmaria 30mL

Hypericum perforatum 40mL

Vitex agnus castus 30mL

200mL

DOSAGE: 7mLs in water before meals b.d.

Two repeats of the above formula given.

Second Visit 11 November, 1993

Reported that she felt fantastic, energy levels had improved, no aching in the joints associated with hepatitis, no reflux, no pain in the liver, depression had lifted, no nausea, no dysmenorrhoea, not needing to sleep in the afternoon, not tired.

Practitioner: Ses Salmond, LWCHC, 55 Thornley Street, Leichhardt NSW 2040.

EPIDEMIOLOGY

70% Intravenous Drug Use (IDU) - sharing equipment.

20-25% Recipients of contaminated blood products; Blood Transfusions prior to February 1990; Haemophiliacs; Dialysis.

5% Unknown; Tattoos, needle stick injuries, razors from barber shops,

sexual transmission. Domestic transmission - sharing of razors, toothbrushes.

Source: AHMAC National Hepatitis C Plan - October 1994.

NRMRC Hepatitis C Epidemiology, Natural History, Control and Treatment 1994.

Note: ACMERC - 40% of patients - source of HCV infection is unknown.

ACKNOWLEDGMENTS

Jenny Adams

Jean-Francois Astier

Professor Bob Batey

Kerry Bone

Nick Burgess

Dr. Bob Buist

Dr. J.J. Chen

Deb Cheney

Lynette Collins

Denele Crozier

Coco Daley

Angela Dick

Dr. Nyrie Dodd

Ree Van Galen

Eleanor Hatch

Paul Harvey

Jennifer Holmes

Stuart Loveday

Tanya Majzoub

Brendan Perwarden

Dr. Merelyn Rae

Deni Sevenoaks

Kirketon Road Centre

NSW Hepatitis C Council

HepC BC