26 :Hepatophilic virus disease – TCM classification as “Wetness-heat vaporization form” Common symptoms (3): Hematemesis (Portal Hypertensive gastric disease) I

Yiao (code number 0439) male age 32 years.  He first visited the clinic on November 1997 with the complaint of suffering from oral ulcers and abdominal pain since childhood; the stools often showed wetness-heat, three or more times a day and scanty.  He often had common cold, nasal obstruction, hoarseness, cough with profuse sputum, and even asthma; he also had fatigue, insomnia, stiffness of neck, backache, palpitation, vertigo, polyuria (尿頻) and hair loss.  Seven years ago, he had hemorrhage of the stomache which required hospitalization.  He also had bleeding of the nose and gingivae (牙齦的) and hematochezia (便血) (once he had profuse hematochezia after eating the tail of deer).

On the day of first visit, he chiefly complained of repeated distensive pain (脹痛) of the upper abdomen and wetness-heat of stools which were scanty, three to four times a day with small amount of bright red blood.  Two weeks before, he had exogenous illness, the persisting symptoms of which were nasal obstruction, hoarseness, blood tinged nasal discharge, insomnia, neck and loin pain, fatigue as palpitation (心悸), no family history of liver disease.  Laboratory examinations of liver and kidney showed normal results.  Last year, he received prophylactic type B hepatitis injections which caused blood positive antibodies.  Physical examination: soft abdomen, local tenderness below xiphoid (劍突) process over upper abdomen, liver enlarged to 1.5 cm below costal margin with marked percussion tenderness over hepatic region, (+) pitting edema of lower extremities, pulse 88/min.

After taking 3 parcels of TCM drugs, the liver retracted to the costal margin, but percussion tenderness persisted.  There was no subjective discomfort.  After another 3 parcels of TCM drugs, the liver was normal in size (1.5 cm above costal margin).  The symptoms disappeared after systemic TCM therapy which was discontinued at the attainment of clinical cure and the patient was followed up.

Thereafter, in the following years, the patient had several episodes of discomfort which were relieved by TCM medication every time. He traveled to other places because of working and sometimes he took TCM drugs when he felt tired or had insomnia.  He had a return visit on April 2000 at which time he experienced fatigue, soreness of body after wire drinking and although the stools seemed to be normal, he found the toilet paper he used being tinged with blood at the end of defecation after ingestion of pungent food.  There was so stomache ache and the liver was normal since systemic TCM therapy.

Chan (code number 261) male, age 64 years.  He had hepatitis for many years and first visited our clinic on July 1986 when he complained chiefly of nausea, vomiting, acid regurgitation (噯酸), upper abdominal pain and insomnia for 7-8 years.  The probable diagnosis was peptic ulcer and neurosis.  For the recent decades, he had to take uninterruptedly gastric drugs and sedatives  every day.

Physical examination: lean and senile looking, weak, tongue with many fissures and white coating, lower margin of liver 3 cm above costal margin, liver dullness area only 5 cm.  Ultrasonic examination of liver and spleen revealed chronic hepatitis with decreased size of liver; no splenomegaly (脾未腫大).  Liver function examination: C, C, F, T (++).  gastrointestinal barium meal examination (胃腸鋇劑檢查) showed a large ulcer in the lesser curvature of stomache and the tentative diagnosis was therefore chronic active hepatitis; cirrhosis of liver, early stage, complicated by hepatogenic peptic ulcer (肝源性潰瘍病); neurosis.

Altogether, 33 parcels of TCM drugs were taken and the liver dullness returned to 1.5 cm above costal margin, but the tongue coating was still white and thin, being more prominent at the center.  There was no tenderness over the upper abdomen but belching (噯氣) was still present after drug administration.  There was heaviness in the chest and right hypochondrial pain.  Gastroscopy (胃鏡檢查) with biopsy was done and it confirmed the diagnosis of benign ulcer of lesser curvature of stomache.  He stopped the TCM medication himself half a month later.

He made a return visit four months later complaining of occasional insomnia and abdominal pain.  Physical examination revealed the liver 3 cm above costal margin and ultrasound showed mild persisting hepatitis, the liver slightly shrunk 0-1cm.  X-ray showed marked decrease in size of the peptic ulcer.  The symptoms were relieved after TCM therapy, the liver returned to 1.5 cm above costal margin, and systemic TCM treatment was stopped after a 6-weeks course.

In the following years, while he received repeatedly TCM treatment, he suffered in succession, from myocardinal ischemia (心肌缺血), infection of urinary system, profuse hemorrhage after gallbladder stone operation and hypertension.  These diseases were treated by western and traditional Chinese medication.  The patient’s follow-up continues to the present, extending over a period of 10 more years and he is now nearly 80 years of age, still possessing a good health and no relapse of hepatomegaly (無肝大復發).