When diarrhea complicates liver disease, it is called hepatogenic diarrhea, and is one of the common symptoms of liver disease. Because the causative agent is hepatophilic “virus”, it should also be considered as “virus gastroenteritis” (病毒性胃腸炎). Sometimes, diarrhea is the first and chief complained symptom of liver disease. Acute or chronic hepatitis, cirrhosis or carcinoma of liver all may cause diarrhea.
The severity of hepatogenic diarrhea depends on the degree of damage to the liver and intestinal mucosa. More severe is the liver disease, higher is the incidence and also more serious is the diarrhea. Statistical data prints out that 4% to30% of chronic active hepatitis patients have diarrhea and in the compensation stage of cirrhosis of liver, the incidence rate is 10%, in the decompensation stage is 20%; in primary carcinoma of liver, it is as high as 54%.
From the TCM point of view, the pathogenesis of diarrhea lies on gastrointestinal dysfunction. When hepatophilic viruses invade the body, they damage first liver function, causing weakness of the viscera. Inadequate diet and emotional instability lead to diarrhea easily; the site of illness lies on the spleen, stomache, large and small intestines. But the degree of illness is not the same in different chronic hepatitis patients, the disease forms are different and therefore, the condition of diarrhea should be differentiated according to the following:
| (1) coldness (寒) | – loose, watery stools, indigested food particles; |
| (2) heat (熱) | – stools yellowish brown and foul-smelling, diarrheal imminence and burning sensation of anus; |
| (3) deficiency (虛) | – prolonged course of illness, little abdominal pain, willingness to get some pressure and warmness over the abdomen, cold extremities and mental weariness; |
| (4) excessiveness (實) | – pain relieved after diarrhea. |
Due to unequal development of the disease, the course of illness is different in chronic hepatitis patients, and their body conditions are also different. If the method of syndrome differentiation is used, for “hepatogenic diarrhea”, the TCM differentiation point should be put on chronic diarrhea and it should be divided into the following categories*. But clinical practice shows that for the following different categories of patients, the TCM “Qu Gan Du” (驅肝毒) formula is equally effective.
| (1) Overabundance of wetness-heat; dryness of mouth and throat, nocturnal thirst and drinking, yellowish and small amount of urine, wetness-heat stools, tenesmus, burning sensation of anus, abdominal pain and diarrhea, diarrheal imminence, yellowish brown and foul-smelling stools, yellow and smooth tongue coating.
(2) Internal blockage of cold-wetness; dull distention of chest and diaphragm, poor appetite and decrease of food intake, nasal obstruction and headache, chilliness and fever, generalized soreness of body, abdominal pain and borborygmus (腸鳴), frequent passing of flatus, thin white coasting of tongue.
(3) Stasis of ingested food in stomache and intestines: belching and acid regurgitation, abdominal distention, poor appetite and nausea, defecation right after meal, abdominal pain and borborygmus, relief of pain after diarrhea, foul-smelling stools with indigested particles, thick and turbid tongue coating.
(4) Weakness of spleen and stomache; pale yellowish color of face, weakness of limbs, abdominal distention, indigestion of food, and slow absorption of water, intermittent diarrhea, loss of appetite and diarrhea after ingestion of oily food, pale tongue proper and whitish coating.
(5) Disharmony of liver and spleen; distention of chest and hypochondria, belching and decrease of food intake, emotional disturbance causing abdominal pain, diarrhea and redness of tongue.
(6) Weakness of kidney yang: coldness of body and limbs, soreness of loin and ankles, instant diarrhea on the appearance of abdominal pain and borborygmus and feeling of comfort after diarrhea, diarrhea at twilight, tongue pale and coating white.
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The gastrointestinal wetness-heat symptoms of hepatophilic virus disease are varied and apart from the chief gastrointestinal symptoms, one is clear of the degree of wetness-heat through TCM tongue inspection. In wetness-heat, the large intestines are on great heat, which can generally cause constipation, anal fissure, hematochezia (便血) or diarrhea alternated with constipation and symptoms of gastrointestinal hypersensitivity. Therefore, in classification, it seems more appropriate to call them symptoms of virus gastroenteritis.
Introduction of cases (continued)
| Case 5
Leung (code number 1981) female, age 7 years. Her mother had type B hepatitis antibodies positive blood examination results twice during her prenatal visits. The child had her first visit on November 1999. Her mother told the doctor that the child was weak and easily attacked by diseases such as exogenous evils and had frequent episodes of fever, loss of appetite, fatigue and sleepiness. In the recent days, she suffered from abdominal pain, vomiting of indigested food remnants and acid regurgitation. Western medical doctors diagnosed it as common cold involving the stomache, but western medicine did not show effectiveness. Physical examination: the patient showed poor nourishment and underdevelopment, thinness, enlarged tongue, thin white tongue coating, palpable liver at costal margin and percussion tenderness over hepatic region. After 3 parcels of TCM drugs, the vomiting stopped, appetite improved and symptoms were markedly relieved or completely disappeared. When she had taken TCM drugs for 4 weeks, her body weight increased 1.5kg. Clinical cure was obtained after 6 weeks of systemic TCM treatment; medication was then stopped for observation.
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*refer to “Digestive diseases” clinical practice of western and traditional Chinese medicine, edited by Pong Bo. 1997
By Wong Kwok Hung
published on 17th April 2001
(translated by Professor ZHENG Hua En in September 2002)