It is extremely common that Hepatophilic virus disease patients come to the clinic with tympanites as the chief complaint. Inflammation caused by virus directly injuries the stomache and intestines producing gastrointestinal mucosal congestion, edema, erosion or even ulceration, and the latter conditions lead in turn to digestive and absorptive functional disorders of gastric and intestinal mucosa. Therefore, some patients may develop, clinically, emaciation, malnutrition, hypoalbuminemia, electrolyte imbalance, lack of vitamins and all kinds of symptoms derived from these conditions.
In addition, there are often loss of appetite, nausea belching, ozostomia, distention and pain of abdomen, especially after meal, defecation right after eating, increase of peristalsis, flatulence, abdominal discomfort, pain of abdomen before defecation, tenesmus, sensation of incomplete evacuation of bowels, alternational of diarrhea and constipation. It may also be associated with coating of tongue, edema of lower extremities (often accompanied by hepatic edema and variable degrees of pitting with finder pressure), secondary obesity, various kinds of mucosal (such as virus labial mucosal disease, vaginal and anal mucosal disease) and dermal injury, formation of skin eruptions, pruritus, coarseness and desquamation.
The occurrence of tympanites is extremely common in virus hepatitis. This is due to inflammatory edema and circulatory disturbances of the hepatic tissues causing hypertension of the back flowing hepatic veins and inferior vena cava. There is blood stasis of the gastrointestinal mucosa and decrease intestinal peristalsis; bacteria inside the intestines grow rapidly and ferment; it causes wetness-heat and gas retention of the intestinal lumen, and in this way, tympanites is produced. The distended abdomen if severe, is frog like in appearance, the distention extending towards the left, right and also to the front. In clinical practice, during percussion examination for chronic hepatitis patients, one may encounter “decrease of area of liver dullness” which is in fact a false impression. In this case, hepatomegaly is concealed by gaseous distention of the intestines. The absolute majority of patients with shrinkage of liver margin, if treated with TCM “drive wind out” therapy, could regain a normal liver or recover an enlarged liver margin (except that in cirrhosis when the liver size is really smaller than normal).
The so called “fat of happiness of the middle age” is often the consequence of prolonged development of chronic hepatophilic virus disease resulting in secondary obesity and tympanites. Further more, it is an obvious sign of regression of visceral function induced by hepatophilic virus disease, because the appearance of marked abdominal distention and hepatic edema (rapid increase of body weight in a short time) indicates the approach of weakness of kidney and also multiple organic disease which are the result of overload of heart, lung and kidney function. Systemic effective TCM therapy can drive out the wetness-heat and gases retained inside the intestinal lumen, eliminate rapidly abdominal distention and tympanites, stop the development of secondary obesity and also can change the enlarged size of liver to normal, decrease the abdominal circumference and attain clinical cure.
Introduction of cases
| Case 1
Li (code number 2192) female, age 61 years. Her first visit was on November 2000, with the complaint of having a history of gallbladder stone and for long periods, she had fatigue, hypochondrial pain, abdominal distention, belching, flatulence, constipation, daily requirement of laxatives, vulnerableness to exopathy, nasal discharge, sputum of large amount and morning nasal hypersensitivity. Physical examination revealed pale yellowish color of skin, mild generalized edema, senile hyper-pigmentation of both parietal regions, tongue reddish and enlarged with marginal teeth prints, abdomen distended and full, tympanites, liver enlarged to costal margin, and (+) pitting edema of lower extremities, after taking 3 parcels of TCM drugs, the liver returned to normal and abdominal distention much decrease. Urination was smooth and she could move the bowels daily without taking laxatives. After TCM medication, she felt the abdomen not so markedly distended and the abdominal wall became relaxed. During the course of therapy, she was tailoring a pair of trousers and the waist circumference had to be altered smaller as much as 3 inches. After taking 4 weeks of TCM drugs, her body weight decreased six pounds, the waist circumference nearly 2 inches and the circumference of her buttocks more than 1 inch. Clinical cure was obtained after 6 weeks of TCM therapy.
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| Case 2
Leung (code number 526), male, age 46 years. His first visit was on July 1994, complaining of dryness of eyes, sleepiness fatigue, abdominal distention, flatulence soreness of loins, edema, loose stools, ozostomia and borborygmus. Physical examination revealed enlargement of tongue with teeth prints, reddish tongue proper with thick white coating, abdomen distended with tympanites, reduction of hepatic boundary, inferior margin of liver dullness 4.5 cm above costal margin, splenic area percussion suspected dullness, (+) edema of lower extremities. After 20 parcels of TCM drugs, the liver was palpable at costal margin. After another 2 weeks of medication, the liver was normal. During the course of therapy, there was wetness-heat of stools, being 2-3 times a day, in small amounts, and he also experienced, flatulence, fatigue and hyperhidrosis. At the end of the 8-week course of TCM therapy, clinical cure was obtained and medication was stopped. He said that abdominal distention was significantly relieved and the waist circumference reduced 4 inches. He had return visits monthly, for 3 months, and during this interval, no abnormality was found. |
| Case 3
Dun (code number 2217), male, age 40 years. He had his first visit on August 2000 with the complaint of right hypochondrial distensive pain for several years. Recently, had had marked increase of body weight, being 12 pounds in the recent year and 8 pounds in the recent half year. He felt tiredness, short breath, generalized soreness of body, distensive pain of right hypochondrial region, abdominal distention and fullness and frequent diarrhea. Physical examination revealed a robust figure, body weight 170 pounds, tongue enlarged and reddish with marked teeth prints at the tip, percussion tenderness over hepatic region, liver enlarged to costal margin and edema of lover extremities. After 3 parcels of TCM drugs, the liver was normal and he also had marked relief of abdominal distention; but he still experienced belching, flatulence, loose watery stools of 2-3 times daily and bowel movements right after eating. After taking 16 parcels of drugs, abdominal distention disappeared, the stools were formed being 1-2 times a day. After 2 weeks of TCM medication, his mental condition was good, generalized soreness disappeared, urine was yellowish in color and although he had to void his bladder 1-2 times a night, sleeping was satisfactory. Systemic medication totaled 6 weeks, at the end of which clinical cure was obtained and treatment was stopped for observation.
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By WONG Kwok Hung
published on 29th May 2001
(translated by Professor ZHENG Hua En in December 2002)