In TCM classification of chronic liver disease, gastrointestinal wetness-heat vaporization often leads to retention of sputum-heat inside the pharynx; moreover, prolonged course of the disease causes deficiency of energy and also embarrassment of passion causes unsmooth passing through the esophagus and trachea, producing “globus hystericus”. Its symptoms include sensation of something, in the shape of a plum nut, obstructing the pharynx which can neither be swallowed nor vomited out and also no sputum can be coughed out. There is a sensation of obstruction within the chest and heart; something, there is a feeling of relief and sometimes of aggravation. If the channels are blocked, then pain arises in the chest and the condition is called “obstructive globus hystericus”. These cases are not scarce in chronic virus hepatitis and in fact, it belongs to the category of “gastro-esophageal regurgitation disease” of modern medicine.
Virus hepatitis can affect any part of the gastrointestinal tract, including the esophagus. As mentioned in the previous article, chronic virus hepatitis may lead to rupture and hemorrhage of esophageal venous varicosities and to hematemesis from portal hypertension gastric disease. “gastro-esophageal regurgitation disease” is not rare, but it is known only by few people. In hepatophilic virus disease, if the degree of erosion is severe, it may result in hemorrhage of the esophageal erosive mucosa which can further produce ulcerative inflammation of the esophagus, stomache and colon. Through endoscopic examination of the upper and lower digestive tract and operations of the stomache, one may find, from time to time, multiple superficial erosive and ulcerative hemorrhages of the gastric and intestinal mucosa caused by virus inflection. This is a very common picture and is a usual cause of digestive tract hemorrhage.
Introduction of cases
| Case 1
Lin (code number 2247), male, 49 years of age. Date of first visit: Oct 2000. He had a history of type A virus hepatitis. Since childhood, he was often attacked by disease such as common cold and frequently had tiredness, nocturnal urination and sensation of foreign body in the pharynx which could not be coughed out. For seven years, he suffered from hypertension and hyper-cholesterolemia, the blood pressure at one time above 160/90mmHg and he had to take anti-hypertensive drugs for long period. Physical examination: nutrition and development satisfactory, sclera yellowish and turbid, skin dark in color, tongue somewhat enlarged with teeth prints, abdomen tympanitic, liver enlarged to costal margin with percussion tenderness, lower extremities with (±) pitting edema. After 3 parcels of TCM drugs, symptoms of exopathy were relieved and there was improvement of the sensation of a mass occupying the chest and the liver was normal. A week later, there were large amounts of loose stools, being 1-2 times a day. There were mild symptoms of exopathy; abdominal distention markedly improved but globus hystericus occurred occasionally. The blood pressure dropped to 102/76 mmHg and anti-hypertension drugs were therefore discontinued. After 2 weeks of TCM drugs, there was still mild globus hystericus and occasional coughing without sputum and nocturnal urination did not occur. The blood pressure at that time was 130/90 mmHg. After 3 weeks of medication, globus hystericus disappeared and anti-hypertension drugs were stopped for observation. TCM drugs were stopped at the end of 24 parcels medication because of going to America to meet his relatives. The interval of discontinuation of drugs was 10 days and he felt no discomfort after returning to Hong Kong. Globus hystericus and nocturnal urination did not occur and sleeping was good. Physical examination: blood pressure 130/90 mmHg, pulse 76 per minute, liver normal. A total of 6 week TCM therapy was given to complete the course of systemic treatment at which time clinical cure was obtained and the patient was then followed up.
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| Case 2
Lee (code number 292) female, age 26 years. Her first visit was on August 1993, when she complained chiefly of repeated loss of appetite, nausea after breakfast in the morning, abdominal distention and pain and diarrhea for 3 more years. For many times, she was diagnosed as cute gastroenteritis and gastrointestinal hypersensitivity and she could not take mile, eggs, and may other kinds of food. She had marked dysmenorrhea and also menorrhagia which were irresponsive to treatment. Repeated blood examination die not show hepatitis. Physical examination: thin and markedly anemic in appearance, mal-nutritional state and underdeveloped, abdomen distended, liver enlarged to 3 cm with percussion tenderness over hepatic region. After taking 9 parcels of TCM drugs, she began to feel hungry and did not experience nausea in the morning. Drinking of milk did not cause any discomfort and the lower margin of liver retracted to costal margin. After nearly 3 months of TCM treatment, the liver eventually returned to normal, being 1.5cm above costal margin. Anemia improved gradually and she said that she began to develop, her dysmenorrhea disappeared and the amount of menstrual blood decreased significantly.
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Written by WONG Kwok Hung
published on 19th June 2001
(translated by Professor ZHENG Hua En in December 2002)