Case 2
Lao (code number 250) male, age 47 years.
He had the history of positive type B hepatitis antibodies. He first came to our clinic on December 1998 with the chief complaint of asthma and left side migraine since childhood and was often times disturbed by right hypochondriac pain (hepatic pain). In the recent three months, cough became worse, but sputum was sparse. He also felt shortness of breath, sorethroat, dryness of month, oppression over the chest, headache and was suspected for pulmonary tuberculosis. X-ray showed normal findings but he repeatedly received anti-inflammatory drugs, hormones and anti-asthmatic spray.
Physical examination: tongue enlarged, tongue proper purplish red with fissure in the center, geographic tongue coating. Abdomen full and slightly frog-like, significant veins seen on abdominal wall, percussion tenderness over hepatic region, liver dullness 3 cm above costal margin and questionable dullness over splenic region.
After 3 parcels of TCM, the sorethroat was relieved and although respiration showed some tightness, but no asthmatic breathing was heard. There was occasional coughing. The margin of tongue was red, the coating thick, part of which had detached. The abdomen was still distended; there was slight venous varicosity over the abdominal wall. Percussion tenderness was still present over the hepatic region and the lower margin of liver was 1.5 cm below costal margin. (The first examination 3 cm above costal margin was actually due to tympanites (鼓腸). After TCM medication, the real size of liver in fact was 1.5cm below costal margin. This condition is common in clinical practice and therefore, liver dullness percussion should be examined very carefully to avoid misdiagnosis).
Another 4 parcels of TCM were administered. The patient had still dry cough, shortness of breath, dryness of month, but migraine was relieved greatly and the liver returned to normal (altogether 10 parcels taken). During TCM medication, besides hypochondriac pain, other clinical symptoms gradually disappeared. Sleeping was satisfactory, and after 2 months of TCM treatment, the general condition was good and therapy was stopped after 80 parcels of TCM administration.
Follow-up examination was carried on at 3 months, 6 months and 9 months. Hepatomegaly was not found. One more year later, that is, on February 2000, at return visiting, he complained of soreness over the neck and back, with occasional fatigue and somnolence. Right hypochondriac distention was felt after drinking beer. The skin was dry, tongue dry with thin coating and tongue proper red. There was no coughing. He said that since TCM treatment of liver disease, asthma attack did not occur. The vital capacity was examined in Elizabeth Hospital, showing good pulmonary function and increase of vital capacity (increase from 320 to 370). The liver was slightly tender on percussion and its margin was 1.5 cm above costal margin.
At that time, he scarcely needed asthmatic spray. The pulse was 76/min. He asked for more TCM to eliminate the remaining heat in the body and therefore another 4 weeks of TCM medication was administered. On finishing the systemic treatment, medication was stopped.
Case 3
So (code number 188), male, age 77 years.
His first visit was on June 1997 with the chief complaint of leanness, fatigue, profuse sputum, right hypochondriac pain, habitual constipation, going to stool once in several days. Physical examination: malnutrition, underdeveloped, tongue color dark red, tongue proper belonging to that of the elderly with many fissures and tongue coating pale yellowish. The pulse rate was 84/min, hepatic region showing percussion tenderness, liver 3 cm below costal margin. He had six return visits within six months but because he did not accept continuous TCM treatment. The liver remained enlarged to 1.5 cm below costal margin. He did not receive systemic treatment.
After cessation of TCM treatment for almost a year, he had a return visit on November 1998 with the chief complaint of dyspnea (呼吸困難) for several days associated with shortness of breath, profuse sputum and had to use much effort to breathe. He was diagnosed as asthma and pulmonary emphysema (肺氣腫) by western medical doctors and hospitalized.
Physical examination: lean body, dark skin color; dyspneic but able to lie flat; pulse 112/min, respiration 24/min; barrel chest, heart sound distant, respiration weak; tongue edge red, coating very thick and yellowish white with an upper layer of dark yellowish color; abdomen navicular (舟狀腹), lower margin of liver dullness 3 cm below costal margin; lower extremities edematous, pitting edema (+).
He had his return visit after taking 3 parcels of TCM drugs, and told that he went to stool four times a day after medication, the amount was large but defecation was smooth. On that morning of the return visit, his respiration suddenly became easy. He could sleep and felt hungry and the mental condition was good. On physical examination, there was no dyspnea; the tongue was red, the coating detached; the abdomen was distended and the liver edge was at the costal margin. Another 9 parcels of TCM drugs were administered and the liver was normal. He received a systemic TCM treatment for 5 weeks and stopped.
On March 1999, he had a return visit due to fever, tastelessness in the month, coughing with sputum, short breathe for several days, tongue coating was yellowish and dark, tongue edge red, liver relapsed to 1.5 cm below costal margin. Nine parcels of TCM drugs were taken and the liver returned to normal.
Case 4
Yuen (code number 1978), male 8 years of age.
His first visit was on 7th November 1999, complaining that since infancy there was repeated asthma attacks and in the near half year, the use of spray was indispensable. He repeatedly suffered from coughing caused by exogenous evils and often times had bronchial allergy. He needed repeated hospitalization and had still symptoms like nasal obstruction, profuse sputum, yellowish urine and loss of appetite. During the near week, he had asthma induced by common cold and still coughed with sputum, short breath and wheezing. Drugs of western medicine and TCM were given with no avail.
Physical examination: the patient underdeveloped and malnutrition, lean; tongue pale white; pulse 96/min; abdomen soft, liver 1.5 cm below costal margin with percussion tenderness of hepatic region.
The liver was normal after 3 parcels of TCM drugs but there were still yellowish sputum and nasal discharge, nasal obstruction and loss of appetite. After another 3 parcels, the cough decrease and totally stopped after two weeks. During TCM medication, the tongue coating was yellow and thick; the abdomen was painful associated with diarrhea, tenesmus (里急後重), wetness-heat of stools, the frequency of which might reach five times a day. After systemic treatment for 6 weeks, all symptoms disappeared; the patient was cured clinically and followed up.
written by WONG Kwok Hung,
23rd January 2001
(translated by Professor ZHENG Hua En, May 2002)