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?


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


Liver fibrosis is not an independent disease but rather a histological change caused by liver inflammation. Liver damage causes liver stellate cells to be over active and triggers the extra cellular matrix (ECM) synthesis to increase. More than normal amounts of collagen fiber deposits in the extra-cellular spaces of the liver cells and causes the liver cells to lose blood infusion and to be hardened.


Chronic viral hepatitis B and C are the most common causes of liver fibrosis. During the chronic hepatitis course, fibrosis is a part of the inflammation activities. In the fibrosis stage, there is no lobular regeneration and this distinguishes it from cirrhosis.  When fibrosis advances to cause fibrostic separations (or bridging) between the portal areas or between the portal area, the center vein, and the formation of pseudo-lobule, fibrosis enters the final stage, which is cirrhosis.


Histological (biopsy) diagnosis classifies the severity of fibrosis into five stages, S0 to S4.

S0 means no fibrosis. S4 is cirrhosis. In between, S1 is a mild fibrosis only seen at the portal area. S2 is a moderate stage of fibrosis, between portal areas, but without the destruction of the lobular structure. S3 is severe fibrosis.  At this stage, there is fibrostic bridging between portal areas and between portal areas and center veins. At S4, in addition to S3's changes, there are pseudo-lobules formed and this stage is the final stage, cirrhosis.


Liver fibrosis is the net result of the imbalance between the collagen fiber synthesis and decomposition. When fiber synthesis is very active and the decomposition is suppressed, fibrosis will progress. Vise versa, fibrosis can be reversed if the driver, inflammation, is controlled. When fibers form, at the early stage, it can be decomposed with water or weak acid. These are soluble fibers. Older fibers deposited for long time, becomes thicker and harder and cannot be decomposed by water or weak acids. Only collagen enzymes can decompose it.  With anti-fibrosis herbal treatment, there is possibility to suppress the HSC, enhance the activities of collagen enzymes and to promote the decomposition of the fibers, reducing ECM.    


Cirrhosis is always developed from fibrosis. Although, fibrosis and cirrhosis are different, they are closely related. They are two distinguished pathological conditions. At the fibrosis stages, the amount of collagen increases and the ratio of fibro-connective tissue verses liver cellular tissue increases. But at this stage, the liver lobular structures are intact. There is no pseudo-lobule formation. Cirrhosis consists of two pathological features: fibro-connective tissue hypertrophy and pseudo-lobule formation. At the cirrhosis stage, the liver's fundamental structure is deformed, and the framework of the liver begins collapse. Thus, reversal is more difficult at this stage.


Right now a liver biopsy is the most accurate way to diagnose the fibrostic stages. Some blood chemical measurements can also provide a referential diagnostic marker of fibrosis. The chemical markers that can be used to assess the fibrostic activities are: HA (hyaluronic acid), LN (Laminin), CIV(collagen IV), PCIII (procollagen type III) etc. They can show the activities of fibrosis, but can't classify stages of fibrosis.


Patients should also know that most chronic Hepatitis cases will not lead to Cirrhosis. Only a very small percentage does and it happens usually without proper treatment, allowing fibrosis to go on for years.

The body has amazing healing capabilities of its own and the liver is one of the most “re-generable” organs in the body. Because fibrosis is the result of the inflammation, halting or reversing fibrosis by controlling inflammation is the key. Special anti-fibrosis treatments have been developed in modern Chinese medicine and we will discuss these in next two weeks.  


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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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