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Type (7) TCM Classification on Hepatitis
Over the past ten years of clinical observation, we have a major understanding that chronic Hepatophilic virus disease is the cause of many diseases. We applied this point of view together with the concept of entirety put forward by traditional Chinese medicine and we are able to explain in details the happening, the development, the progress, the prognosis and the treatment of the chronic hepatophilic virus diseases. It also provides a radical ground to explain the theory of “treatment of different disease with the same method” (異病同治) as put forward by TCM.
It is a very long history that human beings are affected by hepatophilic viruses and caused different types of diseases. It is only with the discovery of electronic microscope that scientists began to identify the different types of viruses and had a better understanding of the development of hepatitis as well as the different syndromes by TCM classification together with the relevant ex-hepato symptoms. It is now important to realize that the non hepatitis virus (ie. non-A non-B non-C type ) which caused pathological changes of the liver may also cause the inflammation of the liver and the change of liver dullness as well as abnormal liver function.
We believe that when a patient undergone a systemic TCM treatment, the inflamed liver boundary can be returned to normal level. His chief complaints and clinical symptoms can be reduced and may disappear and attain the level of clinically cured. The result will help to improve the well being of mankind so that many common and recurring diseases can be treated correctly without delay. The wide-spread of the concept of systemic TCM Treatment is indeed important and may perhaps help to reduce cirrhosis, liver cancer and other ex-hepatic diseases.
(translated by QC in February 2002)
Type (6) The deficiency of both liver and kidney
At the later stage of liver disease, the common consequence of the exuberance of yang (vital function) of the liver would be :
(i) The deficiency of yin (vital essence) of liver & kidneys;
(ii) The exuberance of yang due to deficiency of yin; and
(iii) The deficiency of both yin and yang.
The deficiency of yin (vital essence) of the liver and kidney
It is a morbid condition typically marked by the following symptoms : heat sensation in the chest, palms and soles, dizziness, tinnitus, impairment of hearing, insomnia, palpitation, aching of the loins and weakness of the knees and legs, red and dry tongue with scanty or no coating, dry throat and mouth, swollen and tender gum, reddened tongue with little coating or even cracks, halitosis, ulcer of mucous membrane, dull color of the hair, dull face, thready and rapid pulse.
The exuberance of yang due to the deficiency of yin
It is a morbid condition which incorporate the symptoms of deficiency of yin and the exuberance of yang of the liver.
The deficiency of yin and yang
It is a morbid condition built on the basis of the first condition – the deficiency of yin (vital essence) of the liver and kidney as a result of lost of treatment in time or not taking continuous care of the liver (for example taking anti-liver drugs, alcoholic drinks, infection, or other course of treatment) which increase the mal-functioning of the liver and further the development of liver disease. Clinically, patients are found to have symptoms of both the deficiency of yin and yang of the liver and kidney. In addition to that, patients would increase in weight within a short period of time, known as edema, which can be easily seen on the face, lower limbs, and marked by tiredness, short of breath, somnolence, aching all over the body and the loins (e.g. bony spur, stubborn pain around the waist, gout, rheumatoid arthritis, osteoporostic arthritis). For some serious cases, patients would have difficulty in walking, urine at night, impotence, tongue substance is soft and plump and marked with teeth prints around the border, shedding of loose teeth, thin and heavy pulse.
Patients with poor functioning of the heart and lungs may even have “black jaundice”, with dark face, skin colour and colour pigment at the forelimbs (for the elder, it is known as “senile plaques” and would increase and grow in size).
Such situation would then progress to cirrhosis and even liver cancer later.
(translated by QC in February 2002)
Type (5) Exuberance of yang (vital function) of the liver
The nature of the liver is rigid and firm. According to the theory of the Five Evolutive Phases[1], it corresponds to wood and stores the ministerial fire (versus the king fire from the heart). It favors moistness but is intolerant of dryness. It avoids or abstains from pathogenic heat and scorching hot. If the pathogenic heat already hides in the liver, it will be difficult to get rid of. The deficiency syndrome of the kidney would mean a deficiency of yin (vital essence) and yang (vital function) of the kidney and is caused by the consumption of fluid and the essence of the kidney in chronic diseases. This results in the deficiency of yang in the liver and flaming-up of the liver fire. The exuberance of yang (vital function) of the liver would lead to the deficiency of yin (vital essence) of liver and kidney, the exuberance of yang due to deficiency of yin and deficiency of both yin and yang.
The clinical symptoms of this form vary and it depends on the damages of the internal organs caused by the hepatitis viruses. In fact, as the symptoms are interchangeable at different stages, it is difficult to diagnose exactly the pathogensis of the disease. But as the principles of treatment for the deficiency of yin and exuberance of yang and the deficiency of yin and yang are basically the same, therefore, it is necessary to observe the reaction result of treatment in order to determine the ways of recuperation.
The exuberance of yang (vital function) of the liver is a morbid condition due to hyperactivity of the liver. It is further manifested by dizziness, distending pain in the head, headache, sudden break out migraine, fidgety, mental irritability, weakening of memory, dislike heat and like cold, insomnia, dreamfulness. Patients may have difficulties in getting asleep, easily awake, scarlet red sides of the tongue with yellow or little coating, flushed face, blood-shot eyes, high blood pressure, spider nevus, liver palm, taut and rapid pulse, with scanty dark urine and dry stools. When the patients approach the age of 55-65 for male and 45-55 for female, the above symptoms would be more severe.
(translated by QC in February 2002)
Type (4) The Blood Stasis at the Meridians and Collaterals form
The hepatitis viruses invade the body in the form of wetness-heat and hide in the blood system and eventually would result in heat in the blood system and hurt the yin, causing the deficiency of the yin. As the body fluid in the blood is insufficient, the blood become thick, dense and inactive. The blood density of the patient is high, thick, and forming blood stasis blocking various channels and collaterals and affecting the internal organs of the body. The pathology and the cause of blood stasis can be interpreted as the retention of the immunity compounds inside the body, which lead to the change the pathology of the body. This explains the development, the changes and different forms of TCM classification caused the chronic hepatitis. As the onset and the process of blood stasis are more emphasis on the blood system, therefore this state of illness is more serious.
The typical cause of blood stasis at the meridians and collaterals is DIC (Disseminated intravascular coagulation 播散性血管內凝血) which is a blood clotting problem found in heavy hepatitis, particular in acute icteric hepatitis especially in heavy hepatitis which leads to death. As the problem of blood stasis is commonly found in chronic hepatitis patients, the symptoms found at different parts of the body vary and would depend on the seriousness of blood stasis. Female patients who are infected by hepatitis viruses would have heat in the blood causing deficiency for yin. The heat hurt the blood stream and caused imbalance of blood and qi. The blood become unclear and inactive and affects the production of the new blood cells. The imbalance of blood system causes irregular menstruation. If the heat and water in the kidneys lose balance, the blood would be overheated and caused advanced menstruation with massive discharge. If the Thoroughfare and Conception Vessels cannot give nutrition to the blood, then the blood flow would cause irregular bleeding. This type of massive and repeated blood loss in the form of irregular menstruation is one of the causes of the deficiency in blood for female and is one of the common factors of female secondary obesity.
It is because the Thoroughfare Vessel[1] and Conception Vessel[2] or the meridians and collaterals are not functioning properly and that the blood and qi are thicken and densify, it will easily lead to liver depression, qi stagnation, blood stasis. If the heat is persistent and cannot be released due to the blockage by the wetness for a long period of time, it will result in the deficiency of the qi and blood causing irregular menstruation or abdominal pain. It is often characterized by headache, breast distension, touch pain, stabbing pain in the lower abdomen with tenderness, waist pain, chest and ribs discomfort, occurring before and during menstruation with massive or little discharge. The pain is alleviated after discharge of blood clots, which are usually dark red or brown red in color.
In long run, the blood stasis in the meridians and collaterals would cause frequent menstruation. Such massive discharge will result in the deficiency of qi and blood, the depression of both the liver and kidneys. The symptoms that can be seen are irregular discharge, either indefinite discharge or once every several months. This may lead to quarterly discharge where the qi in the kidneys – the genuine vital function still exist). If the liver qi is depressed for quite a long time, this may lead to amenorrhea.
If female patients continuously have blood stasis, causing the deficiency in qi and the deficiency of blood, the fire in the heart and the kidneys would eventually extinguish. The uterus will become weak, cold, and unable to retain and gather together the blood. Such coldness of the uterus will often lead to infertility. However, TCM would be able to warm the uterus and cure the chronic hepatitis as well as recover the fertility function.
The pathology of blood stasis usually leads to irregular menstruation, amenorrhea and infertility. It is the main cause of various bleeding diseases (e.g. nose bleeding, stomach bleeding, subcutaneous tissue bleeding, hematochezia, haematuria) as result of the failure of blood clotting mechanism.
Blood stasis is also a tempting factor for a change of the pathology for the heart and blood vessels, especially high blood pressure, coronary heart disease and embolic vasculitis. If at the early stage the problem of blood stasis can be put under control, it will help to prevent as well as to relax the development of such diseases. As a matter of fact, patients having such diseases often consult doctors at a later stage. The morbid condition is often marked by the exterior syndromes – the deficiency of yin and yang, which will be discussed in the later part.
Apart from the above, the problem of blood stasis is often highly related to the formation of benign (malignant) tumour
Tumour may develop at different parts of the body (e.g. thyroid gland, breast, ovary, oviduct, uterus, etc) namely cyst, adenoma, uterus tumour and the addition of new glands. In some cases, the tumour stopped growing and even disappeared after the patients received systematic TCM treatment. Other cases also showed that after receiving clinical treatment, the tumour did not continue to grow further. Therefore, the uterus tumour, which leads to massive menstrual discharge and anemia as a result of blood loss, can be cured if the patient received TCM treatment for hepatitis.
It is commonly acknowledged that the onset and the process of blood stasis resulted in cirrhosis and liver cancer. At present, people who have cirrhosis and liver cancer tend to be younger. This implies that people are commonly invaded by the hepatitis viruses at an earlier stage. It is therefore very important to note the prevention and treatment of chronic hepatitis for young people, especially at infant stage and pre-school age.
Clinically, patients who are in the blood stasis form usually have the following common symptoms: thin, look pale with chest distension, stabbing pain around the ribs, hepatomegaly, marked by yellowish urine, have difficulty in excretion with dry or sticky loose stools, redden tongue or purple tongue, with whitish coating or yellow coating, redden palm (liver palm), spider nevus, heavy pulse, the veins in the abdomen cavity become visible and increase in size and even bend.
(translated by QC in February 2002)
Type (2) The wetness-heat evaporation form
In this type of classification, when the hepatitis viruses invade into the body as a pathogenic disease, it is regarded as a somewhat pathogenic factor (pathogenic factor of yin nature) from the traditional Chinese medical point of view. As wetness is apt to impair the spleen while the stagnation of the liver qi is apt to override the earth spleen, the transporting and transforming function of the spleen will be impaired leading to the deficiency of the spleen. From then the wetness created and accumulated while the liver qi is also heated resulting in the accumulation of wetness-heat in the body and cannot be cleared away easily. This will restrain the yan qi of the body mechanism.
The wetness-heat will also penetrate into the blood system; internal organs as wells as the meridians and collaterals, leading to different syndromes caused by steaming of the wetness-head and body symptoms. The steaming of wetness-heat often have clinical symptoms like wetness-heat occupied in stomach, large intestine and lungs, and pass through the Yangming Meridian to the skin and become skin diseases. As the wetness and heat are hiding and are difficult to find out and clear, so the course of disease is often very long and repeatable and may persistent over years with unstable situation. Infant patients are often overlooked and cannot receive treatment in time until they become adults.
Therefore, most chronic hepatitis patients who belong to this type of classification often have symptoms like tiredness, somnolence, insomnia, dizziness, short of breath, thin, obesity in the lower limbs, plump tongue with teeth prints at the lower borers and loss of energy and aching of the legs.
The Wetness-Heat Evaporation form may have the following five types of clinical symptoms:
1. Loss of appetite over long period of time, marked by nausea, belching, feeling sick after eating, stomach full or distension, bitterness in the mouth, halitosis, fester of the lips, tongue and gums, dryness of the oral cavity, excessive thirst (polydipsia), xxx, much wind, abdominal distension (especially after eating), increase in waist. Only few young patients may have bleeding of the gastric cavity, yellowish and greasy tongue coating or thick white tongue, plump tongue with teeth prints at the lower borders, wetness accumulated in the stomach that lead to obesity of the membrane in the mouth. The patient will easily bite himself forming oral ulcer.
2. Easy to have sudden abdominal pain, diarrhea after eating, interchangeable constipation and diarrhea, sometimes wetness-heat in defecation and few in volume and feeling tenesmus (have the bowel intention but unable to defecate), sometimes marked with a scorching hot at the anus after defecation. This type of patients is also sensitive in stomach and intestines and will have abdominal distension, pain, diarrhea, or indigestion after eating. In some cases, the patients may feel dull pain over a long period of time at the right part of the ribs. When they are tired or exhausted, the situation is more serious.
3. If the large intestine is always accumulated by pathogenic heat, it will lead to constipation in the long run. Faeces are in hard pellet form with a scorching hot anus, marked by hemorrhoids and anal fissure and even repeated bleeding. Situation of chronic and long-term nature is the inducing factor to the development of deficiency of blood and qi.
4. When wetness accumulated in the liver or heat occupied in the lungs and stomach, such heat will be transferred to the Yangming Meridian and onpass to the skin forming different skin diseases. No matter female or male, the sebaceous glands on the head and face will increase and undergo trichomadesis or having acnes on faces, breast or back of the skin, or even eczema or thrush. For adults, the wetness and heat would be a pathogenic source of sensitive diseases e.g. urticaria, eczema, neurodermatitis, frequent-occurring oral ulceration. The stubborn acnes for young people are often highly related to chronic hepatitis.
Due to the deficiency of qi (vital energy) of the spleen, the wetness accumulated. The pathogenic elements in the qi of the liver cannot be evacuated and is forced to rise to the head in the form of heat energy when pathogenic wind exists. This type of pathogenic heat (known as liver fire or phlegm-fire) presses up to the head and disturbs the sober and clam qi. This will change or transform to dizziness. When someone is over-fatigue, affected by the seven emotional factors (joy, anger, melancholy, brooding, sorrow, fear and shock) and six desires, or has been sick for a long time, both the blood and the qi (vital energy) are inadequate and large quantity of water is required to reimburse the loss. If the patients take in too much cold drinks, it may lead to dizziness, tinnitus, nausea. It is usually diagnosed as the imbalance of ear fluid.
(translated by QC in February 2002)
Type (1) The Stagnation of the Liver qi (vital energy) and Lung-Dryness Form
The main clinical symptoms are various symptoms found in common diseases like repeated nasal sensitivity, common cold, tonsillitis, tracheitis, and asthma. Other common symptoms are: bleez, having a running and stuffy nose, bleeding in nose, dryness in month, thirst, dryness of the nasal cavity and pharynx, sore throat, dry cough, hemoptysis, globus hystericus, hoarseness, abdominal pain, short of breath, yellowish urine, stubborn constipation, hematochezia, etc.
For this type of classification, when the hepatitis viruses (i.e. the viruses of epidemic diseases) invade into the body, the flow of vital energy will be blocked and the liver qi will be stagnated which will then be transformed into a kind of “pathogenic heat”. The heat will hide in the liver and is difficult to be removed. The blood in the liver is heated and the pathogenic heat is subsided and hided in the blood system. The heat in the liver is the heat in the blood system. When the heat moves up to the lungs, it will cause dryness of the lung. At the early stage, a series of symptom on common cold can be resulted. Dryness of the lungs can be seen at a later stage of chronic hepatitis where the liver and kidneys become deficient. It is because the body fluid is inadequate and it leads to the deficiency of yin (vital essence) of the lungs.
The resulting symptoms are: dry throat and dry tongue, marked by globus hystericus or itchy throat. Patients will suffer from choking with sputum, short of breath, hot in the palms, sweating, night sweating. Although various viruses and bacteria may also infect the upper respiratory system, the hepatitis viruses once invade into the body system and cause dryness of the lungs and stagnation of the liver would indicate that the duplication of viruses is frequent. This means the chronic hepatitis is obviously active. It is different from common cold, tonsillitis or tracheitis. Sometimes because of the existence of symptoms like coughing, short of breath, abundant expectoration or repeated hemoptysis, it may be misdiagnosed as pulmonary tuberculosis or bronchiectasis.
The symptoms caused by stagnation of the liver qi and lung-dryness form are as follows:
- The symptoms occur continuously on the entire body and over long period of time. These include headache, ache all over the body, loss of energy, agitated, insomnia, dreamfulness (dream-disturbed sleep), weak eyes with red eyeballs, red and dry lips, reddened tongue with yellowish and white coating, often accompanied by anorexia, halitosis, nausea, abdominal distension, diarrhea after eating. Sometimes a patient may have stomachache caused by the wetness-heat, or may have interchangeable diarrhea and constipation, sudden pain around the ribs, taut pulse, generally no high fever, creeping chills. These symptoms will be exaggerated and recurring when the patients are over-exhausted or after menstruation for female.
- In case a patient receive western medicines treatment and was diagnosed as having common cold or tracheitis, the result is not satisfactory in general; the effect will not be good and the symptoms will recur again and again unless the wetness-heat inside the patients’ body is cleared thoroughly. If antibiotics and anodyne are used without care, the situation will be intensified. Therefore, many patients usually take western medicines at the acute stage in order to take control of the situation (e.g. to bring down a fever). Then they would consult Chinese practitioners for TCM treatment in order to clear away the wetness-heat and relieve the stagnancy of qi (vital energy) of the liver. The possibility of recurring is obviously reduced.
- Generally, the laboratory test and X-ray test usually show no positive result (i.e. negative). However, when the patients undergo blood tests for liver, only some of them may find antigen or antibody inside their bodies. Nor would liver function tests result change to positive. If they do ultra-sound test, the result may show that the livers are inflamed (hepatomegaly) and there are waves of hepatitis. Although many patients even go through blood tests and ultra-sound tests, the diagnosis for chronic hepatitis cannot be concluded.
- When undergo physical check-up, that is by percussion to examine the liver, the patient may feel painful around the percussion zone. It is often found that the liver is inflamed – bigger than normal size. In clinical terms, the liver size is a decisive factor to determine the existence of chronic hepatitis and a careful examination is required. On the other hand, it is important to note that if the size of the liver is not inflamed, it does not mean that the patient is free from chronic hepatitis. This is because the liver may undergo to cirrhosis stage and therefore the size of the liver is reduced. Or may be the patient is suffering from abdominal distension, and much gas is retained inside the body which affect the accuracy of percussion. Therefore, it is necessary to examine again and again, to apply the Chinese medicines, and to observe the patient’s situation before making diagnosis.
- Chronic hepatitis is an epidemic disease that affects the entire body. The past history and family history of a patient is important and helpful in making a diagnosis. The patient’s state of health, past symptoms, diseases relating to chronic hepatitis, the spouse’s state of health or whether immediately family members have liver cancer or hepatitis are all important and useful information. It is not easy to make a doubtful diagnosis or incorrect diagnosis if the information of the past history, family members’ liver history, clinical symptoms, result of body examination, inflamed liver, percussion result, blood test results on antigen and antibody, liver function test, etc can be supplied and relied on.
(translated by QC in February 2002)
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