Integrated traditional Chinese and Western medicine diagnosis and treatment of liver cirrhosis with diabetes / 临床肝胆病杂志

Hepatogenous diabetes (HD) is a common complication of liver cirrhosis and can reduce survival rate and increase the risk of other complications. It differs from type 2 diabetes in terms of etiology, pathogenesis, and diagnostic methods. There are currently no guidelines for HD treatment in China and globally. Although the understanding of HD in traditional Chinese medicine is gradually deepened, no consensus has been reached on its etiology, pathogenesis, and syndrome differentiation. This article reviews the traditional Chinese and Western medicine research on HD in recent years, so as to provide a reference for clinicians to develop individualized traditional Chinese and Western medicine diagnosis and treatment strategies.

Integrated traditional Chinese and Western medicine diagnosis and treatment of hepatorenal syndrome / 临床肝胆病杂志

As a common complication of end-stage liver disease, hepatorenal syndrome (HRS) is functional acute renal failure that occurs on the basis of severe liver diseases and is a group of clinical syndromes characterized by renal insufficiency, abnormal endogenous vascular substances, and hemodynamic changes of arterial circulation. The ideal treatment method for HRS is liver transplantation or simultaneous kidney transplantation, and optimization of drug and non-drug therapies is the key to the treatment of HRS. This article reviews the current status of the integrated traditional Chinese and Western medicine diagnosis and treatment of HRS.

Integrated traditional Chinese and Western medicine diagnosis and treatment of hepatic encephalopathy: Advances and perspectives / 临床肝胆病杂志

Hepatic encephalopathy is the most common complication of liver cirrhosis and portal hypertension, and a confirmed diagnosis requires the clarification of predisposing factors and disease stage based on neuropsychological tests or clinical symptoms and signs. The treatment of hepatic encephalopathy emphasizes the elimination of predisposing factors, ammonia-lowering treatment, and reasonable and appropriate nutrition support, and integrated traditional Chinese and Western medicine therapy has certain advantages and characteristics in treatment. This article discusses the advances in the integrated traditional Chinese and Western medicine diagnosis and treatment of hepatic encephalopathy, so as to guide clinical practice and select reasonable treatment regimens.

Integrated traditional Chinese and Western medicine diagnosis and treatment of cirrhotic ascites / 临床肝胆病杂志

Ascites is the most common complication of decompensated liver cirrhosis. Recurrent massive ascites seriously affects the quality of life and prognosis of patients, and therefore, effective control of ascites is an important link in the treatment of liver cirrhosis. Based on the clinical reports in recent years, this article reviews the advances in the integrated traditional Chinese and Western medicine diagnosis of cirrhotic ascites, conventional Western medicine treatment such as salt restriction, diuresis, and albumin supplementation, and the application of transjugular intrahepatic portosystemic shunt, ascites pump, and liver transplantation in the treatment of refractory ascites. In addition, this article introduces the application of integrated traditional Chinese and Western medicine combining disease and syndrome with staged treatment and external treatment methods with traditional Chinese medicine characteristics, as well as the perspectives of future research including real-world study.

Research advances in integrated traditional Chinese and Western medicine therapy for liver cirrhosis / 临床肝胆病杂志

The combination of traditional Chinese medicine and Western medicine is an important approach to improve the treatment outcome of liver cirrhosis. Long-term diagnosis and treatment practice and clinical studies of the prevention and treatment of chronic hepatitis B cirrhosis have shown that antiviral drugs targeting the cause of the disease combined with anti-liver fibrosis traditional Chinese medicine can significantly improve the reversal rate of liver fibrosis and cirrhosis, and anti-liver fibrosis therapy can reduce the incidence rates of esophagogastric variceal bleeding and hepatocellular carcinoma in cirrhotic patients and improve the 5-year survival rate of patients with decompensated liver cirrhosis. It is necessary to conduct in-depth studies to clarify the target and mechanism of action of the main effective constituents of compound traditional Chinese medicine, strengthen the research on drug quality control standards, and obtain more high-quality evidence for clinical efficacy, so as to effectively promote the development of integrated traditional Chinese and Western medicine therapy for liver cirrhosis.

Effect of Liangxue Jiedu decoction on intestinal flora in patients with hepatitis B virus-related acute-on-chronic liver failure: An analysis based on high-throughput sequencing / 临床肝胆病杂志

Objective To investigate the effect of Liangxue Jiedu decoction on intestinal flora in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods The patients who were hospitalized and diagnosed with HBV-ACLF in Beijing Ditan Hospital from October 2018 to October 2019 were enrolled, and healthy individuals were enrolled as HP group. High-throughput sequencing was used to screen for the differences in bacterial diversity and species between HBV-ACLF patients and healthy individuals, and differentially expressed bacteria between the two groups were screened out at the phylum and genus levels. With the help of in vitro simulated fermentation experiment, fecal samples were collected from the patients with HBV-ACLF and were then cultured in the medium containing different concentrations of Liangxue Jiedu decoction (0, 10%, 50%, and 100%) for 24 hours, and the changes in intestinal flora were analyzed and compared between the HBV-ACLF treatment group, the HBV-ACLF non-treatment group, and the HP group at the genus level. 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. Results A total of 10 HBV-ACLF patients were enrolled, with 5 in the HBV-ACLF treatment group and 5 in the HBV-ACLF non-treatment group, and there were 15 individuals in the HP group. Compared with the HP group, the HBV-ACLF non-treatment group had significant reductions in the diversity and abundance of intestinal flora. At the phylum level, Bacteroidetes and Firmicutes were mainly observed in the samples of the HP group, while the HBV-ACLF non-treatment group had a significant reduction in Bacteroidetes and significant increases in Fusobacteria , Proteobacteria , and Fibrobacteres. At the genus level, compared with the HP group, the HBV-ACLF non-treatment group had significant reductions in Ruminococcus, Blautia , and Eubacterium and significant increases in Parabacteroides, Lactobacillus, Fusobacterium , and Streptococcus . The in vitro fermentation experiment showed that compared with the HBV-ACLF non-treatment group, the HBV-ACLF treatment group had significant increases in Ruminococcus, Lachnospira, Bacteroides , and Genusgenus and significant reductions in Fusobacterium and Proteobacteria (all P < 0.05). Conclusion Liangxue Jiedu decoction can regulate intestinal flora disturbance, restore the diversity of intestinal flora, increase dominant bacteria, and reduce pathogenic bacteria, which may be one of its important mechanisms of action in the treatment of HBV-ACLF.

Breakthrough points and difficulties in traditional Chinese medicine treatment of primary liver cancer / 临床肝胆病杂志

Primary liver cancer is one of the most common malignant tumors in China, and most patients are in the advanced stage at the time of diagnosis, with a short survival time and poor prognosis. In recent years, traditional Chinese medicine has shown its unique advantages in the prevention and treatment of primary liver cancer and has achieved a marked clinical effect in improving quality of life, enhancing immunity, and prolonging the life of patients with liver cancer. This article reviews the current status of traditional Chinese medicine and Western medicine in the treatment of primary liver cancer and proposes the breakthrough points and difficulties in traditional Chinese medicine treatment based on the features of clinical treatment, in order to provide a reference for the clinical treatment of primary liver cancer.

Pay attention to the early recognition of severe digestive system infection and the treatment of integrated traditional Chinese and western medicine / 中国医师杂志

Digestive tract is one of the biggest contact surfaces between human body and environmental factors.It has a large number of microorganisms from the environment.Once bacteria transfer and release into the blood,it will cause sepsis and endanger life.Therefore,we should pay more attention to the infectious diseases of digestive system.This paper reviews six articles published in this journal,and expounds the etiology and early recognition methods of severity of three common infectious diseases of acute digestive system,namely,acute diarrhea,acute cholangitis and acute pancreatitis,and puts forward potential targets for the treatment of sepsis from the perspective of neurohumoral and integrated traditional Chinese and western medicine.Therefore,we should pay attention to the early recognition of the severity of infectious diseases of digestive system and the treatment of integrated traditional Chinese and western medicine.

Application of minimally invasive integrated traditional Chinese and Western medicine therapy based on the SELECT concept in the diagnosis and treatment of biliary and pancreatic tumors / 临床肝胆病杂志

Among digestive malignancies, compared with gastrointestinal tumors, biliary and pancreatic tumors are difficult to diagnose in the early stage and have fewer opportunities for radical surgical resection, with a shorter survival time and poorer quality of life, and the clinical diagnosis and treatment of such tumors remain a difficult issue that needs to be solved urgently in clinical practice. Based on the different locations and features of biliary and pancreatic tumors, the SELECT concept selects the optimal combination of minimally invasive endoscopies (laparoscopy, choledochoscopy, duodenoscopy, Spyglass, and endoscopic ultrasound) and applies traditional Chinese medicine treatment in the perioperative period, so as to achieve early diagnosis and treatment, prolong the survival time with tumor, improve quality of life, and strive to realize the goal of cure.

Application of minimally invasive integrated traditional Chinese and Western medicine therapy based on the SELECT concept in the treatment of acute pancreatitis / 临床肝胆病杂志

Acute pancreatitis (AP) is one of the common digestive diseases. With the advances in technology, the treatment concept of AP has changed, more and more minimally invasive techniques have been applied in the treatment of AP, especially severe acute pancreatitis (SAP). Although there are various different minimally invasive treatment methods for AP, no reliable clinical studies have reported that one technique is significantly better than others. The therapeutic effect of integrated traditional Chinese and Western medicine therapy in acute pancreatitis (AP) has been widely recognized. In recent years, our team has accumulated rich experience in integrated traditional Chinese and Western medicine therapy for AP and has proposed the innovative SELECT concept (Spyglass, ERCP, Laparoscopy, EUS, Choledochoscopy, and Traditional Chinese Medicine) for diagnosis and treatment. The optimal combination of various endoscopies is SELECTed based on the severity and etiology of AP, and traditional Chinese medicine treatment can be used as well to realize the advantages of minimally invasive integrated traditional Chinese and Western medicine therapy in the treatment of AP. This article elaborates on the minimally invasive treatment methods for each clinical stage of SAP based on the SELECT concept.

Application of minimally invasive integrated traditional Chinese and Western medicine therapy based on the SELECT concept in the diagnosis and treatment of hepatobiliary and pancreatic diseases / 临床肝胆病杂志

Hepatobiliary and pancreatic diseases are common and frequently occurring diseases in the digestive system, and several hepatobiliary and pancreatic diseases are difficult to diagnose and treat, with a high incidence rate of complications. With the development of minimally invasive devices and instruments and the application of various laparoscopic/endoscopic techniques, most hepatobiliary and pancreatic diseases can be diagnosed and treated by minimally invasive techniques. Traditional Chinese medicine plays an important synergistic role during the perioperative period for hepatobiliary and pancreatic diseases and can accelerate the recovery of patients. The team of Liaoning Provincial Center for Integrated Traditional Chinese and Western Medicine Therapy for Biliary and Pancreatic Diseases led by the authors has mastered various laparoscopic and endoscopic techniques and proposed the concept of SELECT (Spyglass, ERCP, Laparoscopy, EUS, Choledochoscopy, and traditional Chinese medicine) by summarizing the successful experience in the treatment of hepatobiliary and pancreatic diseases in recent years. The optimal combination of minimally invasive multi-endoscopic techniques is selected based on the features of different hepatobiliary and pancreatic diseases, and traditional Chinese medicine treatment is also applied in the perioperative period, so as to achieve minimally invasive, individualized, and precise integrated traditional Chinese and Western medicine therapy for hepatobiliary and pancreatic diseases.

Research advances in integrated traditional Chinese and Western medicine therapy for hepatorenal syndrome / 临床肝胆病杂志

Hepatorenal syndrome (HRS) is a common complication of severe liver disease, with severe conditions and poor prognosis, and causes a great burden to both patients’ family and society. HRS has a complex pathogenesis, and Western medicine treatment has a limited therapeutic effect; therefore, integrated traditional Chinese and Western medicine therapy is a feasible treatment method with a good clinical effect. This article reviews the advances in the diagnosis and treatment of HRS in both modern and traditional medicine, so as to overcome this challenge as early as possible.

Pay attention to the early recognition of severe digestive system infection and the treatment of integrated traditional Chinese and western medicine / 中国医师杂志

Digestive tract is one of the biggest contact surfaces between human body and environmental factors. It has a large number of microorganisms from the environment. Once bacteria transfer and release into the blood, it will cause sepsis and endanger life. Therefore, we should pay more attention to the infectious diseases of digestive system. This paper reviews six articles published in this journal, and expounds the etiology and early recognition methods of severity of three common infectious diseases of acute digestive system, namely, acute diarrhea, acute cholangitis and acute pancreatitis, and puts forward potential targets for the treatment of sepsis from the perspective of neurohumoral and integrated traditional Chinese and western medicine. Therefore, we should pay attention to the early recognition of the severity of infectious diseases of digestive system and the treatment of integrated traditional Chinese and western medicine.

Advances in drug therapy for primary biliary cholangitis / 临床肝胆病杂志

Primary biliary cholangitis (PBC) is a cholestatic liver disease with unclear etiology and pathogenesis. Ursodeoxycholic acid and obeticholic acid are the therapeutic drugs for PBC approved by the US Food and Drug Administration, both of which have the effect of alleviating intrahepatic cholestasis. However, some patients still have poor biochemical response to them, and it is urgent to explore new therapeutic drugs or methods. Fibrates, immunosuppressants, and traditional Chinese medicine have a certain effect in the treatment of patients with PBC, but further studies are needed to analyze their clinical safety and mechanism of action.

Biochemical response and integrated traditional Chinese and Western medicine therapy for primary biliary cholangitis / 临床肝胆病杂志

Primary biliary cholangitis (PBC) is an immune-mediated chronic and progressive intrahepatic cholestasis disease. Treatment with ursodeoxycholic acid (UDCA) can significantly improve the prognosis of patients with PBC, but some patients still have poor response to UDCA, which is the main risk factor for disease progression. Several evaluation models and scoring systems based on biochemical response have been applied to screen out patients with poor response in clinical practice. Integrated traditional Chinese and Western medicine therapy for PBC has certain advantages in improving the symptoms, liver biochemistry, fibrosis indices, and biochemical response rate of PBC patients and thus holds promise for clinical application; however, further improvement is needed for experimental design and efficacy evaluation.

Prediction of acute-on-chronic liver failure and integrated traditional Chinese and Western medicine therapy / 临床肝胆病杂志

Acute-on-chronic liver failure (ACLF) is a reversible and complex clinical syndrome caused by various factors in patients with pre-existing chronic liver diseases, with the clinical features of acute liver function decompensation and high short-term mortality rate. ACLF has a complex pathogenesis, rapid progression, and a dangerous prognosis, and early and accurate prediction of prognosis is of vital importance. At present, there is still no ideal therapy for ACLF, and in recent years, integrated traditional Chinese and Western medicine therapy has achieved a certain effect in the treatment of this disease. This article reviews the advances in prognostic evaluation and integrated traditional Chinese and Western medicine therapy for ACLF, in order to provide guidance to prognostic evaluation of ACLF and selection of the regimens of integrated traditional Chinese and Western medicine therapy.

Current status and perspectives of integrated traditional Chinese and Western medicine therapy for hepatobiliary and pancreatic diseases / 临床肝胆病杂志

Integrated traditional Chinese and Western medicine therapy is important feature and advantage of clinical medicine in China. This article reviews the recent advances in the clinical and basic research on hepatobiliary and pancreatic diseases, with a focus on the common diseases such as liver fibrosis, nonalcoholic fatty liver disease, chronic cholecystitis and cholelithiasis, and critical diseases including severe pancreatitis, liver cirrhosis, and pancreatic cancer. We hope to objectively reflect the understanding of hepatobiliary and pancreatic diseases in traditional Chinese medicine, the current status and development trend of integrated traditional Chinese and Western medicine therapy, and existing problems, in order to provide a reference for further improvement of clinical therapeutic level.

Research advances in the role of intestinal flora regulation in the traditional Chinese and Western medicine therapy for nonalcoholic fatty liver disease / 临床肝胆病杂志

Recent studies have shown that intestinal flora can play a role in the treatment of nonalcoholic fatty liver disease (NAFLD), and intestinal flora regulation can provide new thoughts for the treatment of NAFLD. This article reviews the research advances in the role of intestinal flora regulation in traditional Chinese and Western medicine therapy for NAFLD and explores the current situation of probiotics, fecal flora transplantation, antibiotics, and traditional Chinese medicine therapy in regulating intestinal flora and improving NAFLD, so as to provide a basis for clinical practice.

Improving the diagnosis and treatment of hepatobiliary & pancreatic diseases based on clinical evidence of advantages of integrated traditional Chinese and Western medicine / 临床肝胆病杂志

This issue of Journal of Clinical Hepatology focuses on integrated traditional Chinese and Western medicine and has invited the experts who are engaged in the diagnosis and treatment of hepatobiliary & pancreatic diseases using integrated traditional Chinese and Western medicine.With reference to their clinical practice of diagnosis and treatment and related studies,the special topics introduce how to give full play to the advantages of both traditional Chinese and Western medicine to improve patients'benefits and related developmental issues and show the perspectives of the development of integrated traditional Chinese and Western medicine.

Integrated traditional Chinese and Western medicine therapy for acute and chronic cholecystitis / 临床肝胆病杂志

Acute and chronic cholecystitis is often complicated by gallstones.With the rapid development of modern surgery,especially the renovation in surgical concepts,techniques,and methods represented by noninvasive surgery,surgery becomes the most important method for the treatment of such disease.However,surgical treatment is also limited by different disease stages,disease onset status,and individual factors.As an indispensible part of the whole treatment system for such disease,non-surgical treatments,especially integrated traditional Chinese and Western medicine therapy,still have unique advantages.This article briefly summarizes the history of the treatment of acute and chronic cholecystitis and related hot topics and controversies,as well as the concepts and methods of integrated traditional Chinese and Western medicine therapy.