Hepatitis C
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Articles by
Dr. Zhang
TCM and MCM Theory Related to Common Liver Disease Blood Test Markers

Low Dose Interferon Patient Experiment

Hepatitis A Prevention Reminder

Hepatitis: Causes of Pain in Liver Region 

The Need to Monitor Your Chronic Hepatitis

Liver Enzyme Fluctuation during Allergy Season 

What are the Serum Markers of Hepatitis B and What do They Mean?

Enterogenous Endotoxemia in Chronic Hepatitis–
Part 2

Enterogenous Endotoxemia in Chronic Hepatitis–
Part 1

Chronic Hepatitis and "Blood Activating and Stasis Expelling" (BASE) Therapy -
Part 2

Chronic Hepatitis and "Blood Activating and Stasis Expelling" (BASE) Therapy
Part 1

What Causes Gastrointestinal Bleeding in Cirrhotic Liver Disease

Dietary Support for Cirrhotic Liver Diseases

Ascites - A Complication of De-Compensated Liver Cirrhosis

Liver Cirrhosis - Portal Vein Hypertension Complications

Liver Cirrhosis Overview

PG-IFN and Ribavirin Treatments

Antibiotics and Chronic Liver Diseases

Why is Alcohol Harmful for People with Hepatitis?

Co-infections and Super-infections of Viral Hepatitis

Beware of Medications That Can Cause Liver Damage

Bile Retention and Its Clinical Manifestations (MCM) part 4

Modern Chinese Medicine (MCM) Part 3 
Jaundice and Chronic Viral Hepatitis

Modern Chinese Medicine (MCM) Anti-Liver-Fibrosis Treatments - Part 2

Modern Chinese Medicine (MCM) Anti-Liver-Fibrosis Treatments - Part 1

What is Liver Fibrosis and How is It Different from Cirrhosis?

How does the liver change as we get older?

How is that my LFTs are so good when my viral load is seemly so high?

Comprehensive Care for Chronic Viral Hepatitis

What can Cause Liver Inflammation?  

What Are the Major Functions that the Liver Carries?


Enterogenous Endotoxemia in Chronic Hepatitis– Part 1

Enterogenous endotoxemia (EE) is a very common complication in chronic liver diseases. The incidence rate of EE in chronic hepatitis is approximately 50 to 58% with varying degress of severity. In other liver diseases such as acute hepatitis, fulminant hepatitis, and cirrhosis, the approximate ranges are 16% to 43%, 58% to 100%, and 79% to 92%, respectively. From these figures, we can see that EE is an important complication that can worsen the liver’s pathology and promote other disorders. Therefore, preventing and treating EE is an important task in the care of chronic liver diseases.

The endotoxin absorbed from the intestines passes through the barriers of the intestinal mucus membrane, Kupffer cells of the liver, serum detoxification mechanisms and finally into the systemic blood stream of the body. During active liver disease, there is often an accompanying inflammatory bowel disorders that makes the mucus membrane of intestine more penetrable. Hypertension of portal vein causes congestive intestinal disorders, in which the blood congestion, swelling, erosive lesions of mucus membrane in the intestinal wall causes the mucus membrane barrier to leak. In addition, the liver inflammation weakens the Kupffer cells' phagocytosis function, which allows the intestinal endotoxin (IE) to seep through the liver and enter the systemic circulation, bypassing the phagocytosis of Kupffer cells. Studies found that the level of IE in cirrhotic patients' liver vein was 73±110ng/L and 31± 58 ng/L in the systematic vein. The difference was statistically significant (p<0.001 and suggested that the cirrhotic liver could not clear the IE from the portal vein.

Damaged Kupffer cells can further promote liver damage. When large amounts IE enter the liver, it will directly cause liver damage when the Kupffer cells can not clear it. The IE can also trigger the release of cytokines in the damaged Kupffer cells, which will exacerbate the inflammation in the liver.  In the late stage of cirrhosis, there is portal-systemic shunt and the IE can enter the systemic circulation directly, completely bypassing the liver. This is mainly caused by the hypertension of the portal vein, which causes the lymph fluid production in the mesenterium to increase, allowing the IE to easily enter the systemic circulation via lymph circulation. Thus, EE is very common in the advanced stage of the liver disease EE.

In addition to causing direct liver damage and promoting other liver complications, EE can also obstruct bile secretion and cause bile retention. It can cause the blockage of the blood circulation in the liver vein and cause congestion in the liver. The common symptoms of EE are: fevers, failure of gastrointestinal functions, manifestations outside the liver such as kidney injuries, swelling and erosive bleeding of stomach membrane, disseminated intravenous clotting, and lung injuries. In many cases, the EE can also cause ascites and jaundice.
Treating the underlying liver disease and controlling the inflammation of the liver is the fundamental treatment for preventing and treating EE. Maintenance of regular bowel movement is also very important. To suppress the over-growth of bacteria in the intestines, Herbs such as Allicin and Coptin can be very effective. 
Detailed treatment of EE will follow in the next article.



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About HCV
Causes and Transmission

Diagnostic Tests
Viral Load

Viral Genotyping

Major Signs
Liver Inflammation

Peripheral Signs and Symptoms
Bile Retention
Joint Pains and Skin Rashes
Blood Sugar Instability
Portal Vein Hypertension

Important Liver Function Test Markers
PT (Prothrombin Time)
Liver Biopsy
Inflammation Grade
Fibrosis Stage
Interferon Based Treatment
Ideal Candidate
Possible Side-effects
Liver Support with TCM
Liver Enzymes
Serum Albumin
Blood Clotting Factors
Bile metabolism
Dietary Considerations
Essential Fats




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