Summary
In the presently collected 2237 cases, which were diagnosed primarily and finally as liver diseases, 265 cases had decrease of the area of liver dullness during primary diagnosis (accounting 11.8%), 681 cases hepatomegaly of 1.5 cm (30.4%), 1032 cases heaptomegaly of 3 cm (46.1.%), 142 cases hepatomegaly of ≧4.5cm (6.3%), 117 cases (5.2%) with normal area of liver dullness. (That is, these patients clinically had typical symptoms of chronic hepatitis or laboratory examination results indicating chronic hepatitis and a small number of patients showed hepatomegaly during the course of TCM treatment).
Figure 1 : Statistical data of 2237 cases primarily and finally diagnosed as liver disease
Over ten years of practice proved that our selection was correct. From the observation of more than two thousand cases of liver dullness examination, we summarize as follows :-
- Abnormality of region of liver dullness is a very sensitive body response. Hepatophilic virus once invaded the body, and with the appearance of clinical symptoms, physical examination may show downward extension of the lower margin of liver dullness (hepatomegaly).
- Abnormal liver dullness had marked relative stability. If not treated by TCM “elimination of wetness-heat” therapy, few cases may show recovery of the area of liver dullness. Follow-up of cases not treated by TCM for one year or more, showed abnormal area of liver dullness persisted, but after administration of 3 parcels of TCM, the area of liver dullness instantly returned to normal.
- The time for recovery of abnormal area of liver dullness can be used to estimate the effectiveness of different TCM formulas in the treatment of chronic hepatitis. Through over ten years of screening, it is possible now to use a fixed basic formula to shorten the above time from several weeks to more than ten days and finally to three or more days. This aspect of clinical observation has great significance in the evaluation of the effectiveness of TCM drugs in treating chronic hepatitis.
- Based on the practice of treating chronic hepatitis by TCM and the observation of changes in the area of liver dullness, we found that there were some rules in this kind of therapy ; that is, when you use TCM to treat chronic hepatitis, you must obey the regulation of “continuity” and “systematization” (that is, take one parcel of TCM every day and continue this treatment for 4 to 6 weeks as a course of treatment.
- TCM therapy for liver diseases can not be used as preventive medicine. In the course of treatment, there were individual cases who happened to eat raw fish, unripe seashell kind of food, take drugs harmful to the liver (especially anti-inflammatory drugs) and receive post-operative drug therapy. Frequently, together with the appearance of clinical symptoms, the lower margin of liver dullness of these patients might show downward extension (hepatomegaly).
Learn to do “self-examination”
In fact, examination of the area of liver dullness can be done by oneself or done between people with intimate relationships. The above mentioned method of examination to detect the presence or not of “hepatomegaly” has proved to be of high accuracy, and a part of the patients after undergoing several visits, can already do self-examination and may come to the clinic if enlargement of the liver is discovered.
Method of Self-examination
| 1 | Place the left had flatly over the skin at the right upper part of the umbilicus. |
| 2 | Use the perpendicularly flexed right mid-finger tip to percuss intermittently the second joint of middle finger of the left hand, through the movement of the right wrist to make out sound. |
| 3 | The percussion can be moved gradually upwards at the right axillary region until a sound of dullness can be heard which is the lower margin of the liver dullness. |
| 4 | If the dullness is heard two finger breadth above costal margin, the liver is normal. |
By WONG Kwok Hung
31st October 2000
(translated by Professor ZHENG Hua En)