Repeated attacks of oral eruptions and labial mucosa virus disease are frequently early digestive symptoms of Hepatophilic virus disease. Recurrent oral ulcers and ozostomia (口嗅), obstinate tongue coating, enlargement of tongue with teeth-prints, tongue fissures and tongue ecchymosis (舌部瘀斑) all are gastro-intestinal wetness-heat which presents itself at the oral cavity and tongue.
Patients with labial mucosa virus disease mostly have oral and labial mucosa lesions; the common manifestations are mucosal edema, hypertrophy or coarseness of the upper and lower lips, protrusion of labial tubercle, sinking or even fissure formation of labial groove, desquamation, pain or erosion of angulus oris, oral eruptions. Labial mucosa virus disease are often symptoms of the active phase of virus hepatitis; clinical cure of the hepatitis by systemic TCM therapy frequently results in quiescence of the oral eruptions and labial mucosa virus disease.
| Figure 1 Typical labial manifestation of virus mucosal disease
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| Figure 2 Labial manifestation of lupus erythematosis (紅斑狼瘡)
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Case 1
Liu (code number: 2113) male, age 52 years. His first visit was on April 2000, with the complaint of obstinate erosions of the angle of mouth and oral eruptions for 10 years. Several years before, he received gastroscopy examination because of stomache ache, acid regurgitation, belching (噯氣) and morning diarrhea. He was told that the gastric mucosa was congested and edematous; spirobacteria (螺旋菌) was found and the diagnosis was chronic gastritis. The disease was cured by administration of anti-inflammatory drugs, but on visiting he had still repeated attacks of oral ulcers associated with labial and tongue mucous membrane ulcerations, erosion, pain and fissure of angulus oris, difficulty in eating and occasional stomache ache, fatigue and gastric discomfort after a large meal or improper diet.
Physical examination, anemic, old and lean, tongue enlarged with teeth-prints, fissure at angel of mouth, hypochondriac skin showing conglomerate telangiectasis (毛細血管擴張), costal anomaly (異常), liver 1.5cm below costal margin, percussion tenderness over hepatic region.
After taking 3 parcels of TCM, percussion tenderness of liver was still present, but liver dullness became normal. Ulcer was present at the lower labial mucosa, but erosion of angle of mouth decreased; the tongue was purplish red and enlarged with teeth-prints. Another 6 parcels were taken and the erosion at the angle of mouth together with the oral eruptions were cured and the liver was normal. Two weeks of medication caused disappearance of all the symptoms; the mucosa of the lips and tongue were normal. No elapse occurred after the healing of the oral ulcers. Medication was stopped after 4 weeks of systemic TCM treatment and the patient was followed up.
Case 2
Jiang (code number 2116) male, age 8 years. The first time he was brought by his grandmother to the clinic on April 2000. The complaint was substituted by his grandmother who said that the patient was susceptible to diseases since infancy at which time he had recurrent vomiting of milk and could not ingest fruits or soybean milk. At the time of visiting, he frequently suffered from oral eruptions, edema, erosion and desquamation of lips and tongue mucosa. He had recurrent cough from exogenous insults, profuse sputum, vomiting, diarrhea and passing stools two to three times a day. He had no appetite, felt tired and weak and hard to fall asleep.
Physical examination: pulse 120/min, the upper and lower lips swollen, the mucosa showing fissures and desquamation; tongue coating thin and white, significant veins seen on the chest and abdominal walls; the liver presenting percussion tenderness; hepatomegaly 1.5cm below the costal margin. Another 3 parcels brought the liver to normal (totally 6 parcels). The mental state was fine, sleeping was good and the appetite increased greatly. The oral eruptions healed up and there were no edema, desquamation (脫屑) or erosion of the lips, but the thin, whitish tongue coating was still present. Four weeks of systemic TCM treatment resulted in clinical cure of the disease. Thereafter, therapy was stopped for observation.
| Figure 3 Enlarged tongue with ecchymosis (舌伴瘀斑) | |
| Figure 4 Thick yellowish coating with teeth-prints |
Case 3
| Lee (code number 2088) male, age 62 years. His first visit was on March 2000, complaining of fissure and desquamation of the lips for several years with repeated bleeding and pain of the lesions. There were constant oral eruptions and the urine was deep in color. He also had nocturia (夜尿), average more than 3 times a night, so that sleeping was affected. He suffered frequently form migratory arthritis and both knees were painful in going up or down stairs. He was slow in standing up while sitting and there was difficulty in walking.
Physical examination: the patient showed secondary obesity, skin color dark, tongue proper purplish red with thin whitish tongue coating. There was mild venous varicosity of the abdominal wall, the abdomen significantly distended with bulging of the right costal region (右肋脅膨隆) and depression of the left hypochondrium (左脅下陷). The hepatic region showed mild percussion tenderness; the liver margin retracted to 4.5 cm above costal margin. The lower extremities were markedly edematous with (++) on pitting. The medial side of both knees showed fixed tenderness; the right knee joint was swollen with marked tenderness. He was diagnosed as hepatophilic virus disease, wetness-heat vaporization, yin deficiency of liver and kidney. According to western doctors, the diagnosis should be decrease of liver size, to be investigated; oral eruptions, virus gastrointestinal disease; secondary obesity, hepatic edema, hepatic osteo-malnutrition (肝性骨營養不良), gout. After taking 3 parcels of TCM the therapy was compelled to stop because of obstinate hiccup. A return visit was taken a week later, at which time the liver was at the costal margin. Another 6 parcels of TCM were given and the liver returned to normal. Through the effect of another 6 parcels, the oral eruptions healed but the lips still showed desquamation. On walking, he felt no pain of the knee joints but milder tenderness at the medial aspect of the joints was still present. Shortness of breath and abdominal distention showed marked improvement. After 3 weeks of TCM treatment, no pain of the knee joints was felt on walking, but localized tenderness of the medial side of knee joint was present. There was tightness of the loin, nocturnal urination 3 times a night, the lips still showed desquamation and the tongue enlarged with teeth-prints. The lower extremities presented (+) pitting edema; the liver was normal the stools were smooth, being once a day. The systemic treatment continued for 6 weeks and the symptoms eventually disappeared. Clinical cure was achieved and medication was stopped for observation.
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Case 4
| Chan (code number 2026) male, age 42 years. He first came to the clinic on December 1999 with the complaint of repeated oral eruptions, defecation preceded by abdominal pain, tenesmus (里急後重), passing stools 3-5 times a day, painless hematochezia (便血) with large amount of bright red blood. He often felt tired and sleepy and dripping of urine at end of urination, paroxysmal paralysis of the medial side of the thighs, loin tiredness (腰倦) and frequent nocturia (夜尿). Physical examination revealed an enlarged disc like tongue with marginal teeth-prints, fixed tenderness over the left thumb joins, (+) pitting edema of lower extremities, a distended but soft abdomen and liver 4.5 cm above costal margin. After taking 3 parcels of TCM drugs, the liver returned to normal; after 7 parcels, the oral ulcers healed. When TCM had been given for 3 weeks, a lesion at the right side of the tongue, which was affected by the oral ulcer, was cured in 3 days. One to two hours following TCM taking, he would have diarrhea, stools loose but large in amount, belching and frequently passing of flatus. Clinical cure was obtained after 6 weeks of systemic TCM treatment and then therapy was stopped. The half year follow-up did not show relapse of the oral ulcers.
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Case 5
| Cheng (code number 2252), female, 52 years of age. Her first visit was on October 2000 and she complained chiefly of repeated oral eruptions for several decade. She had often times tiredness, ptosis (下垂) of the eye lids, somnolence, hot sensation of the oral cavity; pain and swelling of the gingivae (牙肉腫痛), loose stools, hemorrhoids, anal fissure, blood stained tissue paper after defecation, pruritus ani.(肛門搔痒) She had prolonged coarseness of the hands, skin itching with roughness, fissure and desquamation. The oral ulcers were painful and affect food eating.
Physical examination; she was obese, weighing 173 lbs, height 5 feet; abdominal wall pale yellowish, abdomen full and distended; liver enlarged to the costal margin; lower extremities (++) edema. She was diagnosed as chronic hepatophilic virus disease with symptoms of wetness-heat vaporization (gastrointestinal and dermal wetness-heat) and blockage of channels and stasis of blood form. After taking 3 parcels of TCM, the liver returned to normal, the pain form oral ulcers disappeared and the sensation of burning heat and tiredness decreased. But the stools were not smooth, being twice a day with tenesmus (里急後重). Sleeping was not good. Another 3 parcels of TCM drugs, caused recovery of sleeping, cessation of fatigue and healing of oral ulcers. After 2 weeks of TCM therapy, the tongue was dry with slight pain. The oral cavity and perianal region (肛周) had a burning and itching sensation. Stools were passed out 1-2 times a day, the color black, amount scanty and showing wetness-heat. These symptoms disappeared after 3 weeks, and neurodermatitis (神經性皮炎) at the base of right thumb showing dermal coarseness and hyperpigmentation (色素沉著) had all significantly regressed. The TCM therapy was continued; there are occasional loose stools and wetness-heat abdominal pain, but skin itching disappeared. Totally, 40 parcels of TCM drugs were given resulting in clinical cure of the disease. Medication was stopped for further observation.
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Written by Wong Kwok Hung
published on 20th February 2001
(translated by Professor ZHENG Hua En in August 2002)