Hepatogenic pulmonary disease means that during virus hepatitis, the hepatophilic viruses give rise to pulmonary pathologic changes or complications.
In the course of chronic active hepatitis, because of the prolonged virus infection, the viruses are in a state of continuous generation and the immune response of the human body can uninterruptedly produce clinical symptoms of respiratory tract infection. Due to the production of antibodies, there is a sedimentation of the antigen-antibody complex in the body; and for counter action, the body retains a certain amount of inflammatory fluid inside and outside the tissue cells as diluent to prevent over concentration of the sediments which may stimulate the tissues. Therefore, the retention of inflammatory fluid inside and outside of the tissue cells often leads to edema of body tissues that is the so called hepatogenic edems. In chronic liver diseases, therefore, there is pulmonary interstitial edema, increase of vascular shunt in the lung and decrease of pulmonary elasticity; and these may easily evoke acute or chronic complications such as bronchitis or pulmonary infection causing poor ventilation of lung and pulmonary dysfunction. These manifestations are more marked in cirrhosis of liver.
Clinically, besides nasal hypersensitivity and repeated common cold symptoms caused by liver stagnation and lung dryness, there are often disturbing chronic throat itching paroxysmal choking cough, profuse sputum, globus hystericus [“méi hé qì”] (a subjective symptom as if a foreign body stuck in the throat, unable to be coughed out or swallowed down) and fatigue of variable degrees. The patient often feels shortness of breath, heaviness in the chest, headache, dizziness, numbness of extremities, sluggishness in locomotion (shortness of breath in climbing upstairs or during exercise). If the patient has a past history of chronic cough due to tracheal hypersensitivity, chronic bronchitis, senile chronic bronchitis coughing from cigarette smoking and bronchiectasis, and a diagnosis of hepatic disease or a physical examination of hepatomegaly, the treatment should first be laid on liver disease and the above symptoms may then be relieved rapidly.
The symptoms of interstitial pneumonia are often more acute and serious. At the beginning, often there are marked signs of common cold and fever. Because the course of disease is prolonged and the cough is choking and severe, the patient may even have pain in the chest or blood tinged sputum, hemoptysis and insomnia. Treatment is often ineffective and clinically, it is easily misdiagnosed as pulmonary tuberculosis, bronchiectasis or pulmonary carcinosis (肺癌病), but chest x-ray or repeated bronchoscopy examinations may reveal no abnormality. If the patient has a history of hepatophilic virus disease or has repeated pulmonary dysfunction after antituberculotic drug treatment (抗癆藥), one should consider the possibility of hepatic interstitial pneumonia. The first choice is systemic TCM treatment which removes liver stagnancy and eliminates fire of the lung. Satisfactory therapeutic results can often be obtained after systemic TCM treatment.
Typical Case Study
Case 1
Tong (code number 270) male, age 28. His first visit was on August 1997 with the chief complaint of coughing for two months. He was treated with western medicine as well as traditional Chinese medicine, but with no avail. Pulmonary disease was suspected but X-ray examination was negative. The coughing was severe, especially at day time; there was no sputum, the throat being dry and itching. The stools were hard and there was blood at the end of defecation. Physical examination revealed enlargement of tongue with white coating and pressure pitting from teeth. There was percussion tenderness of liver which enlarged to 1.5 cm below coastal margin.
After taking 5 parcels of TCM, there was relief of coughing, but the liver was still 1.5cm below costal margin and percussion tenderness of hepatic region persisted. Another 5 parcels of TCM brought the liver back to 1.5cm above costal margin; the stools were normal and the coughing stopped. After administration of systemic TCM for five weeks, the wetness-heat of internal organs was eliminated. Therapy was then stopped and the patient was followed up. Examination of the liver was done at 3 months and 5 months after treatment with neither hepatomegaly nor other discomforts.
| Case 2
Wan (code number 23) female, age 65. She was diagnosed as pulmonary tuberculosis in 1973 and due to severe hemoptysis (咯血) and a lung shadow of indefinite nature, she received left lobectomy (左側部分肺葉切除手術) in 1985 but biopsy did not find abnormality. In the postoperative ten more years, she still suffered from chronic repeated coughing of severe degree with occasional blood tinged sputum or profuse hemoptysis. On June 1998, she had her first visit to our clinic with the complaint of repeated coughing, profuse sputum, shortness of breath and hemoptysis. There was constipation alternated with diarrhea, and she often felt dryness and bitterness of month and had to drink at night due to thirsty. In the recent three years, the left knee showed repeated redness, pain and swelling, associated with functional disability. Physical examination : patient extremely thin, tongue coating thick and white, liver dullness 4.5 cm below costal margin, left knee joint slightly swollen with marked tenderness on its medial side; lower extremities “+” pitting edema. After taking 6 parcels of TCM, there was less coughing, the sputum was white and lesser in amount. The liver was normal. Hemoptysis occurred on the next day of the second return visit, but the color was bright red and not large in amount. X-ray examination had no abnormal finding. The TCM therapy continued and two days afterwards, the hemoptysis ceased. The course of therapy ended at 6 weeks, at which time she had neither coughing nor sputum, and the knee joint was normal. She could squat on rising up, she felt slight pain in the knee joint. Follow-up continues to the present, there were four return visits due to exogenous insults but no coughing or hemoptysis. The liver did not show enlargment and no relapse of arthritis of the knee joint occurred.
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By WONG Kwok Hung
19th December 2000
(translated by Professor ZHENG Hua En in April 2002)