The TCM forms “liver stagnation and lung dryness” and “wetness-heat vaporization”, in chronic hepatitis are often complicated with heat retention of the large intestines. The former is caused by the superficial-interior relationship of lung and large intestines, so, in the early stage of liver stagnation and lung dryness, the large intestines may show gathering of heat, which induces constipation, formation of fecal hard particles, burning sensation of anus, and also hemorrhoids, anal fissures or even repeated hemorrhage. The latter form occurs in patients with wetness-heat of the lower-jiao, presenting symptoms like : prolonged burning sensation of anus, increase of times of defecation and decrease of fecal amount, tenesmus, sensation of incomplete evacuation of bowels, abdominal pain before defecation or sensation of bowel movement right after eating, abdominal distention following food ingestion and hematochezia after taking dry-heat diets (such as fried or acrid food, over reinforcement by drugs like radix ginseng, cornu cervi pantotrichum, deer tail or chicken soup, mutton, fructus ziziphi jujubae, fouctus lycii). If the patient had deficiency of middle warmer energy, postpartum prolapse of anus or rectum may be produced. This kind of chronic, prolonged and repeated hematochezia is the main cause in the development of deficiency of blood and energy.
Among the 2499 cases of abnormality of margin of liver dullness in Hong Kong, we encountered 219 cases (8.76%) had hematochezia from rectal varicosities and hemorrhoids as shown by computer. The number of female was 136 in these cases (occupying 5.44%) and male 83 cases (3.22%). This indicates that hematochezia is very common in chronic virus hepatitis patients. If the patient has repeated gastrointestinal wetness-heat and hematochezia, one must be alert at the possibility or actual existence of liver disease, because the patient is extremely necessary to be treated systematically and effectively by fundamental treatment of TCM. Medical measures using sitz both with simple drugs, ointment smearing or taking anti-inflammatory and hemostatic drugs are usually applied, but the results are only superficial. On the other had, the patients, not knowing attacked by liver disease, might have their chronic hepatitis illness expanding recklessly and under no resistance.
From the TCM point of view, “hematochezia” is a comparatively advanced stage in the TCM forms of chronic hepatitis; it belongs no more to the common wetness-heat vaporization form nor the simple liver stagnation and lung dryness form. Prolonged and repeated hematochezia indicates that the liver disease had already deepened into the blood portion. Progression of the disease in the body results in damage of the channels and stasis of blood, heating of the large intestines and abnormal blood flow. Due to chronic and prolonged loss of blood, the patient gradually steps into the stage of deficiency of blood and energy, and this aggrevates functional disorders of other visceral organs so that cirrhosis of the liver is insidiously formed.
Introduction of cases
| Case 1
Lee (code number 2073) male, age 51 years. His first visit was on February 2000, when he complained of a history of type B hepatitis virus carrier. In the recent 5 years, he had repeated hematochezia and was examined by modern medical doctors as having 3 hemorrhoids and operative treatment was advices. For several years, hemorrhage during defecation was large in amount and became more and more frequent. In the recent year, he had to sue water for cleaning after defecation instead of toilet paper. Often times, he felt a mass prolapsing from the anus after passing stools. With a mirror, he could see that it was intestinal tissue which could retract by itself. He was an alcoholic. His urine was yellowish and bad in odor. His had showed tined manuum, fissures and desquamation. Physical examination: tongue red, smooth without coating; (+) edema of lower extremities; liver 3 cm below costal margin. Anal examination showed mixed hemorrhoids, a larger one size of a fova bean on the right, its inflammatory mucosa stained with blood; on the left, from 2-5 o’clock, another hemorrhoid of garden pea size. After taking 3 parcels of TCM drugs, the liver returned to normal. It was said that the hemorrhage stopped after only 1 parcel and the use of toilet paper did not cause bleeding. Bowel movement was once a day and the stools were soft. After 10 parcels of drugs, the passing of stools was smooth and with no bleeding, but anal prolapse was still present. There was intermittent coughing with somewhat clear sputum. The urine was yellowish. The tinea manuum on both palms showed marked improvement. After taking TCM drugs for 2-3 weeks, there was one episode of severe cough which ceased following continuation of TCM treatment. Systemic TCM therapy totaled 6 weeks, at the end of which, hematochezia was not present, the stools were normal, being once a day. Anal prolapse was minimal and could recover by itself in about 3 hours. The skin over the palms with tinea manuum became softened, desquamated and healed. Observation was arranged after cessation of therapy and the patient was told to add large amounts of radiz astragali to his food for the purpose of reinforcing his middle-warmer energy and correcting his anal prolapse.
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| Case 2
Chan (code number 906) male, age 34 years. His first visit was on November 8, 1996 when he complained of thick white tongue coating, flatulence, wetness-heat stools and tenesmus since childhood. He frequently suffered from hemorrhoids and also from repeated inflammation, bleeding and pain of anal fistula. Operation was performed two years ago but still hemorrhoidal bleeding persisted. He had also episodes of nasal bleeding associated with paroxysmal vertigo and tremor of the hands. In the recent five years, he lost 30 pounds of weight. Phyroid examination showed no abnormality and therefore the diagnosis was chronic hepatitis, wetness-heat vaporization, blockage of channels and congestion of blood with disturbance of coagulative function. Physical examination: bulging of right hypochondrium, percussion tenderness of hepatic region, liver 4.5 cm above costal margin at first visit and (±) edema of lower extremities. After 3 parcels of TCM drugs, lower margin of liver dullness actually located at 1.5 cm below costal margin; and after another 11 parcels, the liver was normal and all symptoms disappeared. |
By WONG Kwok Hung
published on 5th June 2001
(translated by Professor ZHENG Hua En in December 2002)