(2) Pathological development of “liver stagnation and lung dryness” and its harmfulness
The symptoms of the liver stagnation and lung dryness form of chronic hepatitis are virtually the early and mid-stage symptoms of “hepatogenic lung disease”. Infection due to hepatophilic virus and other biological pathogens may similarly induce immune response and upper respiratory tract infection symptoms of the body.
When virus hepatitis has already formed, chronic virus infection may produce repeated clinical symptoms according to the condition of the body at that time. The pathological condition of the liver changes as time goes by and may gradually turn into the late stage, leading to more serious organic alterations such as pulmonary interstitial edema, increase of pulmonary shunt vessels and decrease of pulmonary elasticity. These changes gradually cause pulmonary dysfunction, hyperventilation, hypoxemia and pulmonary edema. If cirrhosis of liver is formed, pulmonary dysfunction will be more marked. Therefore, early administration of TCM therapy to avoid the development of chronic active hepatitis into cirrhosis of liver is the only method to prevent pulmonary dysfunction.
The chief clinical manifestations of early stage chronic hepatitis -“liver stagnation and lung dryness” form are symptoms caused by repeated nasal hypersensitivity, common cold, tonsilitis, bronchitis, asthma. These symptoms include repeated dysphoria with feverish sensation in five viscera, coldness of shoulders and back, headache, insomnia, sneezing, nasal obstruction, nasal discharge, dryness of mouth, thirsty, drinking in night time, dryness and itching of throat, hoarseness of sound, throat ache, sensation of foreign material in throat, profuse sputum, stubborn coughing, paroxysmal severe coughing, chest pain, backache, quickness and shortness of breath, blood tinged sputum, hemoptysis, wheezing. Dark yellowish urine, stubborn constipation and hematochezia (bleeding per rectum) are usually caused by lung dryness and heat of the large intestines.
If liver stagnation and lung dryness is not treated early with TCM and the pathologic process of chronic hepatitis persists, late stage cardiac and pulmonary functional damage may be gradually produced and the condition of the disease my become more serious.
- If the illness has developed into hepatogenic pulmonary dysfunction (including hepatic hypoxemia, hyperventilation syndrome, pulmonary dysfunction), clinically these patients may show dizziness, headache, nimbness of the limbs, increase of breathing frequency, fatigue, anoxia, heaviness in the chest, asthma, orthotic dyspnea, inconvenience in locomotion. In severe cases, dyspnea or even cyanosis may occur. Pulmonary arterial hypertension and right heart dysfunction may also appear.
- If the disease presents hepatogenic pulmonary vascular pathologic changes (including pulmonary arterial hypertension secondary to portal hypertension, hepatic intra-pulmonary shunt vessels, and right heart failure caused by portal shunt vessels), often clincally the patient may show difficulty in breathing, syncope, cyanosis, chest pain (pulmonary embolism), precordial pain (decrease of coronary arterial blood supply), right heart failure (varicosity of neck veins, positive hepato-jugular reflux sign, ascites, edema of lower extremities, rales heard at base of lung, cardiac enlargement, cardiac murmur), and even hepatic failure complicated by pulmonary edema (showing sensation of heaviness in the chest, dyspnea, cyanosis, orthopnea, rapid and small pulse, pink tinged frothy sputum).
- Hepatic pathologic changes of lung may evoke:Hepatic fulminating fatal pneumonia : usually occurs after splenectomy for hypersplenosis caused by cirrhosis of liver; in infants and children suffering from chilliness and high fever after operation associated with respiratory symptoms and shock; the prognosis is poor and mortality rate is high.
Lung damage in hepatic disease drug administration: in cirrhosis of liver, the use of sodium morrhuate, azathiopurine, cyclosporin, penicillin may lead to lung damage and various pulmonary symptoms. - Endotoxemic pulmonary pathologic changes : when there are hepatic pathologic changes, the liver loses its barrier function and once endotoxemia occurs, the lung may be the first injured. In the early stage, hyperventilation causes respiratory alkalosis which may be followed by pulmonary arterial hypertension and further by hypoxia, acidosis, congestive pulmonary atelectasis and finally adult respiratory distress syndrome. Some data revealed that in chronic liver diseases, diagnostic endo-toxic test such as “limulus test” can show 93.3% positive result.
- Hepatic interstitial pneumonia – patients with cirrhosis of liver present symptoms of respiratory tract, fever, progressive dyspnea, cyanosis, clubbing of fingers, restrictive ventilatory functional disturbance; if no treatment is given, the patient usually dies within 2 to 4 years.
- If hepato-renal syndrome is formed, there may be metabolic disorder of calcium and phosphorus and it may lead to calcium deposit in the lung. The lung tissues may become hard, calcification occurs in the wall and interior of the lung vesicles and fibrosis appears in the interstitial tissues of the lung, with the result of diminution of lung capacity. Usually, the patient may show leanness, shortness of breath, dyspnea, cyanosis, patchy infillration under X-ray. Wide spread lesions may cause respiratory failure and death.
Conclusion
Although the above introduction is uninteresting and too professional, it can give the reader some idea that the developmental changes of chronic hepatitis are by no means harmless. It is the result of progressive development of chronic virus hepatitis which will produce definitive influence to the heart and lung, and is often the direct cause of human death. The moribund patients are usually diagnosed as heart failure and respiratory failure. But how many people have really considered the effect of hepatophilic virus infection in a man’s life and the damage that it has done and perhaps it is one of the direct causes of human death ? It should attribute to the recognition of the hazard of hepatophilic virus disease that some patients have begun to seek for early and correct diagnosis and receive timely TCM treatment. Think of your family members and yourself, do they have any of the similar symptoms?
(The above contents partly selected from “Liver disease and systemic diseases” edited by Wong Wing Chi)
By WONG Kwok Hung
14th November 2000
(translated by Professor ZHENG Hua En)