Hepatophilic virus, the toxic pestilential evil, after invading the human body, induces rapid immunologic response, and in the early clinical stage, inflammatory edema of the liver cells causes extension of the margin of liver dullness. Normal margin of liver dullness is usually 1.5 cm above the costal margin (that is, one finger breadth above the rib). Extension or recoil of the margin of liver dullness is considered to be abnormal.
Recoil of margin of liver dullness : upward recoil of the lower margin of liver dullness is called shrinkage of liver margin. It is usually seen in patients with abdominal distention and intestinal tympanites or in patients with cirrhosis of liver, the size of which has already decreased. The former condition can be treated with traditional Chinese medicinal drugs to drive out the gas inside the intestines and the margin of liver dullness may return to normal. The latter are really patients with cirrhosis of liver, they usually have other signs of liver cirrhosis, and sometimes even the splenic dullness is positive on percussion (splenomegaly).
Extension of margin of liver dullness : downward extension of the lower margin of liver dullness indicates enlargement of the liver; if it reaches coastal margin, the liver enlargement is 1.5 cm, that is, enlarged one finger breadth (commonly called liver enlarged to costal margin). If the lower margin of liver dullness extended to 3 cm, the liver is enlarged to two finger breadth (commonly called liver enlarged to finger breadth below costal margin ) and if the lower margin of liver dullness extended to 4.5 cm, the liver is enlarged three finger breadth (commonly called liver enlarged three finger breadth) and the rest may be inferred by analogy. Marked increase of liver dullness area mostly is due to virus hepatitis, but carcinoma of liver, liver abscess clonorchiases of liver, multiple cysts of liver or other hepatic space occupying lesions and even severe pulmonary emphysema may cause downward extension of the lower margin of liver dullness.
Experienced physicians after times through palpation and percussion, can determine the size, consistency and marginal thickness of the liver. And with the associated examinations of the abdominal skin color, shape of abdomen, symmetry of bilateral ribs, hepatic region percussion tenderness and subcutaneous varicosity, they can make the first impression of the presence or not of chronic hepatitis, cirrhosis of liver or even carcinoma of liver.
Figure 1: Percussion of hepatic region did not give clear sound, audio frequency picture shown by oscillograph, sound waves sparse and broad.
Figure 2: Percussion of hepatic region gave sound of dulness, audio frequency picture shown by oscillograph, sound waves close and narrow. We used oscillograph analysis and found the sound waves were absolutely different. We have begun to apply this principle on researches in making the “diagnostic liver audio frequency generator”.
“Liver dullness normal or not” as objective criteria
Consecutive hepatic region percussion observations are inevitable steps in the diagnosis of chronic hepatitis. In the early stage of practice, we used routine ultrasonic examination, blood liver function test and computer scanning to evaluate the effectiveness of TCM on chronic hepatitis, but the defect is the high cost which the patient is difficult to afford. Out-patients are very difficult to go through all the examinations, and on the other hand, the results of examinations are often in conflict with one another. Patients who were first diagnosed as chronic hepatitis but not able to accomplish the final standard diagnostic procedures, were not few. But the patients who wished to take TCM treatment often found that after administration of the drugs, the liver dullness area returned to normal, and the clinical symptoms were relieved or even cured. On account of this, we decided to use “liver dullness normal or not” as an objective criteria for the observation of TCM therapy in chronic hepatitis.
By WONG Kwok Hung
24th October 2000
(translated by Professor ZHENG Hua En)