Hepatogenic gastric disease or hepatogenic peptic ulcer occurs because of persistence of the liver disease and the peptic ulcers mostly belong to those that are hard to be cured and therapy does not give an ideal result. Its prognosis depends on the degree of severity of the liver disease. The mortality of hepatogenic peptic ulcers is five times of that of that of peptic ulcers in the population*. The cause of death is usually profuse hemorrhage and the second is perforation of the ulcer. When it is complicated with profuse hemorrhage, it may evoke hepatic encephalopathy (肝性腦病) or hepatorenal (肝腎綜合征) syndrome and may aggravate the condition or even cause death of the patient. Effective systemic TCM treatment can result in clinical cure of chronic hepatitis, shorten the course of disease and lower the mortality.
In clinical practice, if the physician encounters typical cases of peptic ulcer, he should also be aware of the coexistence of chronic hepatitis. If it is hepatogenic peptic ulcer, systemic TCM treatment is often quite effective. The “rule of treating the cause” of TCM is far better than simply using anti-acid drugs or anti-spasmodics (解痙的胃藥). In the past years of clinical practice, not a small number of patients, who received gastric drugs for years or decades, had been cured after systemic TCM therapy for liver disease.
Case reports
| Case 2
Jiang (code 1495) male, 21 years of age, his first visit was on Jan 1992, complaining of disorder of the stomache for 7 years and he received western medication for a long time without improvement. In the recent month, he felt tired, dizzy and had acid regurgitation, ozostomia (口嗅), nausea and vomiting. Physical examination: abdomen soft and distended, tenderness over upper abdomen, liver 1.5 cm below costal margin, hepatomegaly 0.5 – 4 cm by ultrasound, final diagnosis being mild hepatitis. After 3 parcels of TCM drugs, he was in good spirits, the stomach ache was relieved and the liver retracted to the costal margin. He took another 5 parcels and a sensation of dry-heat was felt with the appearance of oral ulcer, but the liver was normal, being 1.5cm above costal margin. The medication was stopped after ten more parcels of TCM. His return visits were made on March, April, July, August, October and May of 1993. He had repeatedly chronic hepatitis wetness-heat vaporization symptoms like oral ulcers, fatigue, yellowish urine, wetness-heat pain of abdomen and wetness-heat stools, but neither hepatomegaly nor stomache ache was found. After TCM treatment for elimination of wetness-heat pain of abdomen and wetness-heat stools, but neither hepatomegaly nor stomache ache was found. After TCM treatment for elimination of wetness-heat, the symptoms disappeared. (At that time, the physician of the clinic had not yet the idea of 4 to 6 weeks course of treatment, so the treatment did not persist for such long time). |
| Case 3
Lee (code 1992) female, age 37 years. She suffered from type A acute hepatitis and was hospitalized for 3 weeks 9 years ago. She had repeated stomache ache but western medication did not relieve the pain. Gastroscopy (胃鏡檢查) was performed but it gave normal findings. Besides stomache ache, she had also repeated common cold attacks, diarrhea, prolonged menorrhagia (長期月經量多) and dysmenorrhea (有經痛), menstrual blood clots, fatigue, coldness of the limbs, orthostatic vertigo (起立眩暈), insommia (失眠), distensive pain and tenderness of the right hypoauricular region (右面耳下亦常脹痛), convulsive attacks of the lower limbs and migraine. At the time of visiting, she was suffering from stomache ache, belching and symptoms of exogenous insult such as headache, nasal discharge and coughing. Physical examination: pallor of face, anemic looking, liver enlarged to costal margin, percussion tenderness of hepatic region. After taking 3 parcels of TCM drugs, the stomache discomfort was relieved but throat itching was present and coughing was still severe and occasionally with sputum. Meanwhile, menstruation intervened, being large in amount and bright red in color, but without dysmenorrhea. She also had tiredness, nocturnal coughing, throat itching and poor sleeping, but the liver returned to normal, another 7 parcels of TCM were taken and there was disappearance of fatigue and coughing, but in the morning there was still nasal hypersensitivity and polyuria. After 2 weeks of TCM medication, she had stomache ache and sever left side migraine due to the intake of a kind of soup containing fructus lycii (枸杞子) and duck. She was treated by western doctors (TCM medication continued at the same time). After 4 weeks of systemic TCM treatment, the clinical symptoms disappeared, and after 5 weeks of systemic TCM medication, clinical cure was obtained and treatment was stopped for observation. She received premenstrual TCM medication and followed the program of premenstrual therapy for more than one year and it was found that her health condition improved significantly. Her anemic state was corrected and the stomache illness was cured with no relapse.
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| Case 4
Ju (code 352) female, age 10 years. Her first visit was on December 1995. She was accompanied by her mother who claimed that her daughter had repeated upper abdominal pain, constipation or diarrhea and had been treated by western and TCM doctors for many times. She was diagnosed as stomache ache and took gastric drugs for a long period. She had a past history of repeated common cold and cough, profuse sputum, poor appetite and yellowish urine. Physical examination: malnutrition looking and underdeveloped, anemic and lean; tongue red without coating; liver enlarged to 1.5 cm below costal margin; tenderness below the xiphoid process in the upper abdomen. After 15 parcels of TCM drugs, the liver returned to normal and the clinical symptoms disappeared. She obtained clinical cure after 8 weeks of systemic treatment and stopped TCM medication on March 1996.
Relapses occurred four times, namely, June 1996, September 1997, October 1998 after cessation of TCM medication. It was found that the liver was enlarged to the costal margin every time and in two episodes, the clinical symptoms manifested as common cold with fever (actually liver stagnation and lung dryness) and another two episodes, presented as wetness-heat abdominal pain and diarrhea (wetness-heat vaporization). All these symptoms disappeared after TCM treatment and every time the liver dullness returned to normal after 3-6 days of TCM therapy. She was followed up for two years and her health condition markedly improved, the anemia was corrected and the body weight increased from 52 lbs to 76 lbs. Her last return visit was on January 1998, at which time, her appetite was good, her liver was normal and she had neither stomache ache nor other uncomfortable feelings.
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Written by Wong Kwok Hung
published on 6th March 2001
(translated by Professor ZHENG Hua En in September 2002)