(3) Characteristics of liver stagnation and lung dryness form
The clinical symptoms of the liver stagnation and lung dryness form of chronic hepatophilic virus disease are often similar to the symptoms produced by respiratory infection caused by invasion of other biogenic pathogens. The liver and lung dryness form is observed clinically and found to have the following characteristics :-
- Coincidence of symptoms from multiple systems of the body with long persistence and marked manifestations
Clinically, there may exist simultaneously symptoms of multiple systems. Besides symptoms of the respiratory systems, there may be association of symptoms of chronic hepatitis, such as prolonged tiredness, headache, general malaise, weakness, anxiety, insomnia, dreamfulness, dryness and discomfort of eyes, redness of eyes, dry and red lips, darkish red color of tongue, thick tongue coating with yellowish white or even blackish color. There may appear usually coldness of shoulders and back, loss of appetite, ozostomia, nausea, flatulence, diarrhea after eating, wetness-heat causing abdominal pain, alteration of diarrhea and constipation, right costal pain, small and rapid pulse, but commonly there are no rise of temperature or chilliness. Symptoms may aggravate or repeatedly occur after overloaded tiredness, loss of menstrual blood or operative trauma.
- Result not ideal if treated with TCM or western medicine according to “exogenous insult”
Treatment of chronic hepatitis with TCM or western medical drugs for common cold or bronchitis usually gives poor results. The disease usually relapses repeatedly until treatment for hepatophilic virus disease is given and cure is attained after the wetness-heat is completely eliminated. If drugs harmful to the liver, like anti-inflammatory, analgesic and antipyretic drugs are given inadvertently, the disease may aggravate. Therefore, some patients or their family members use western medical drugs to control the symptoms in the early acute phase of “exogenous insult”, and in the next step, they use TCM to soothe the liver, relieve the stagnation and eliminate wetness-heat; this may yield much better results and the chance of relapse can be significantly reduced.
The symptoms of liver stagnation and lung dryness may be stubborn and severe, and even after TCM treatment the wetness-heat may be stirred up and the lung fire may flare up and symptoms may aggravate. If the sputum is not purulent, usually antibiotics are not recommended. Although western medical treatment is used, the TCM therapy should not be interrupted (TCM drugs can be used at the interval between two courses of western medicine) because medical treatment should be continued without delay.
3. Generally, no abnormal findings are shown from laboratory and X-ray examinations
Laboratory and X-ray examinations usually reveal no abnormality and patients with persistent symptoms may also show normal findings with tracheoscopy. Blood examination for liver disease may show antigen and antibody of this particular form in some patients and others may show positive findings in liver function test or hepatomegaly and hepatitis wave in ultrasonic examination. Most of the patients, although undergone blood and ultrasonic examinations, however, can not get enough support for the final diagnosis of chronic hepatitis.
4. Positive local findings of the liver are often revealed through abdominal physical examinations practiced by western medical doctors, presenting as pale yellowish color of skin, prominent subcutaneous venous congestion of chest and abdomen, non-symmetrical appearance of axillary ribs, percussion tenderness of hepatic region and abnormality of margin of liver dullness (enlargement or shrinkage of liver size). Abnormality of liver dullness in clinical practice is often the criteria for the diagnosis of chronic hepatophilic virus disease and therefore it must be examined carefully. But it must be remembered that absence of hepatomegaly can not completely rule out chronic hepatophilic virus disease because in cirrhosis of liver the size of liver may decrease. On the other hand the patient may have flatulence and the air inside the intestines may interfere with the accuracy of percussion. If necessary, the patient may be observed and examined repeatedly or treated with TCM to observe the clinical result; and it is only after these necessary procedures that the diagnosis can be made.
5. Chronic hepatophilic virus disease is a generalized infectious disease
The past history and family history of the patient are of much help in the diagnosis. The patient’s past health condition, his (her) past symptoms or illness, the marital partner or direct relatives suffered or not form hepatitis, carcinoma of liver or Hepatophilic virus related diseases, all these play important role in diagnosis. Therefore, according to the past history, especially that of liver disease, clinical symptoms, physical examination, the presence or not of liver percussion tenderness and hepatomegaly, blood examination showing or not antigen and antibody and changes in liver function, one may make a comprehensive analysis of the disease of the patient. And after doing all this, it is not likely to miss the diagnosis and let the patient lose the opportunity of treatment.
The development of chronic virus hepatitis is slow and insidious. Under the current therapeutic attitude of quick eagerness and instant benefit, basing mainly on symptoms, the concept of treatment of the fundamental of virus hepatitis is often neglected. When chronic virus hepatitis has proceeded dangerously to the extra-hepatic systems, active clinical treatment of the fundamental may only show that it is too late.
By WONG Kwok Hung
21st November 2000
(translated by Professor ZHENG Hua En)