hepatitis is a special inflammatory disorder of the liver where the liver
shows chronic active inflammation. The presence of autoimmune antibodies
and high-level gamma globulin in the serum and piecemeal necrosis of liver
cells are its characteristic histological features.
are three types of autoimmune hepatitis: Type I, classic AH, is mostly
present in females. The serum ANA (+) and ASM (+) are its characteristic
markers. Type II is mostly seen in children and exhibits anti-liver and
anti-kidney micro-some antibodies. Type III shows anti-liver soluble
antigen antibodies as its major characteristic.
The prognosis of AH is related to the genetic features of the
patients and also the activities of the inflammation. For severe cases, if
left untreated, the mortality rate is around 90% within ten years. For genetic
marker MLADR3 positive patients, the onset age is younger, the
inflammation is more serious and liver failure is more common without
onset of the disease is usually a subtle and gradual process. During the beginning
stage, there may be some joint pain, low grad fever, fatigue, skin
rashes, and amenorrhea (pauses in menstruation). The systematic
extra-liver manifestations of the disease may mislead diagnosis. It is
often misdiagnosed as rheumatoid arthritis, connective diseases disorder,
or menstruation disorders. The disease is usually correctly diagnosed when jaundice
occurs. About 20 to 30% of patients will have an onset of acute viral
hepatitis and the diagnosis should be distinguished from chronic active
hepatitis B and C. It does not have serum titles of the anti-viral
antibodies and instead show multiple autoimmune antibodies in the serum.
Alcohol and drug related hepatitis should also be excluded from the
diagnosis. The standard for a definite diagnosis of this disease is a
medical treatments mainly use immune suppressive therapies. These methods
can improve the symptoms but do not change the disease course. The immune
suppressive treatments are often hard on the liver and can cause adverse
reactions that make long-term treatment unavailable. MCM has developed
many liver protective and immune regulatory herbal treatments that can
alter the course of the disease and can also be safely used for the
This disease is more
often seen in females than males, the ratio is around 4 ~ 6 :1. Incidence
peaks around the childhood period. For females,
the post-menopausal period may become another peak period of incidence. This disease has
obvious racial and genetic tendencies. The Northern European, English,
Irish, and Jewish populations have a higher incidence rate compared to
other racial groups.
manifestations are the characteristics of AH
recurrent vacillate arthritis: it usually affects major joints, causes
pain, stiffness, but without deformation. This can often be
misdiagnosed as rheumatic or rheumatoid arthritis.
grad fever, skin rashes, inflammation of skin and blood vessels, and
system dysfunction: Round moon-like face, acne, hair overgrowth,
amenorrhea in females, breast development in males, Hashimoto disease,
hyperthyroidism, and diabetes.
acid tubal nephropathy, and immuno-globulin deposit in the kidney.
bowel diseases (Crohn’s disease and ulcerative colitis) and
Sjogren’s syndrome in about half of the patients.
light anemia, low WBC and platelet counts. The mal-functioning of the
spleen and the effects of autoimmune anti-WBC and Anti-platelet
antibodies cause Low WBC and platelet counts.
lung inflammation, lung fibrosis, and hypertension in the lung artery.
tests for AH diagnosis
LFTs: Persistent ALT and AST elevation, usually is three to five times
higher than the normal range. ALT > AST in the early stage and
AST>ALT during the later stages. GGT and AKP are usually elevated,
albumin is usually normal and gamma-globulin is dramatically elevated.
The elevation of IgG is greater than IgM and IgA. bilirubin total and
direct are greatly elevated.
autoimmune serum factors are the characteristic features of this
positive in about 60 to 80% of the patients;
antibodies positive in about 30% of the patients.
antibodies positive in about 30% of the patient.
cell membrane antibodies, LSP and LMA antibodies positive.
general treatment during the active liver inflammation period, bed
rest is advisable. Physical activities should be limited. Abstain from
alcohol and maintain a well-balanced diet. Any chronic infections such as
gum diseases, sinusitis, bronchitis etc, should also be treated.
medicine, the main medications used are steroids such as prednisone; it might
improve the symptoms will not prevent cirrhosis from occurring. If the
blood counts are within normal range, prednisone plus Azathioprine (AZP) could be used.
After biochemical parameters have improved, treatment should last for one
year. AZP should be used until prednisone use has completely stopped.
About 65% of patients can enter remission within three years of treatment.
When the treatment has stopped, about 50% patients may relapse within six
months. The same treatment can be repeated and will still be effective,
but the likelihood of relapse will also increase. For a patient with one
relapse, a small maintenance dose is necessary. For those who did not
respond to the treatment, increasing the dosage might increase the
response rate. Other therapies include Cyclosporin, FK-506. The problem
for conventional treatment is that the drugs themselves are toxic to the
liver. AZP is toxic to the liver and can cause bile retention and necrosis
of the liver cells. In severe cases, it even can cause liver failure. With
AH, the liver function of the patient is already compromised so this type
of treatment may cause further damage to the liver. Other side effects
include hair loss, gastrointestinal dysfunctions, mouth and skin
inflammation, fever and pancreatitis. Long-term use can weaken the immune
system and render the patient vulnerable to opportunistic infections.
Chinese Medicine immune regulatory treatments:
the pathogenesis of AH, suppressing the production of auto-antibodies is
the main goal of treatment. We use immune regulatory herbs to reduce
auto-antibody production and reduce the gamma-globulin level. A
circulation promoting formula used to promote phagocytosis of
macrophages and removal of immune complex. Herbs with anti-inflammatory effects
are used to help reduce inflammation in the
liver. Controlling the inflammation is the primary measure in stopping the
progression of liver fibrosis.
liver protective treatments:
anti-fibrosis herbs to control liver cell
inflammation and necrosis, and reduce the level of ALT and AST.
retention releasing treatments:
For elevated GGT, Bilirubin AKP, and jaundice, herbs can be used for facilitating bile secretion to bring down bilirubin levels
and eliminate itching of the skin.
can be combined with symptomatic treatments. Herbal sleep aids can
help improve sleep and infections can be treated with the
anti-microbial formulas, fatigue with energy enhancing herbs, etc.