Eruptive virus diseases and liver disease (Part II)
Besides the above mentioned “eruptive viral” diseases – measles, German measles, varicella and herpes, currently, a number of virus induced diseases that can lead to liver damage, fever and skin eruptions have been found. From the view point of “wetness-heat” in TCM, the invasion of pestilential evil often produces damage of liver and subsequently injury of the skin, for example, cytomegalovirus, EB virus, human herpes virus type 6, coxsackic virus, ECHO virus, etc. Therefore, patients with the following listed common pediatric virus disease usually have hepatomegaly when infected, but can be cured rapidly through treatment with effective TCM drugs. The possibility that these viruses may cause the clinical “non-A”, “non-B” and “non-C” types of hepatitis cannot be ruled out. For example:
| Infantile acute eruptions: the causative pathogen is human herpes virus type 6 (HNV-6) it attacks mainly infants of six months to two years of age, occurring usually in sporadic fashion, in Spring. The onset is sudden and it may be associated with high fever, mild common cold symptoms or with diarrhea. The fever subsides after 3 to 5 days at which time bright red macular eruptions or maculopapular eruptions appear.
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| Cytomegalovirus infection: this disease occurs widely in the world. In our country, 76% pregnant woman have positive antibodies, one fourth of them may have infection of the fetus through the placenta and if forms one of the major causes of congenital anomaly. Some of them may terminate in abortion, stillbirth, premature labor or overt infection. Clinical manifestation of overt infection may be hepatitis, jaundice, hepatomegaly, purpura, encephalitis, pneumonia, microcephalic anomaly or inguinal hernia (腹股溝疝). The survivors mostly have permanent intellectual disturbance, deafness, epilepsy or blindness. If the infection occurs during the perinatal period, then, within three months, pneumonia or hepatitis may appear. Infection during childhood or adult life may present as infections monocytosis, autoimmune hemolysis, thrombocytopenic purpoura, gastrointestinal ulcer, intestitial pneumonia or hepatitis.
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| EB virus infection: at the onset, there may be mild common cold symptoms but prolonged incubation within B lymphocytes may induce infections monocytosis, lymphoma or nasopharyngeal cancer. If it is chronically active, there may appear hepatitis, splenomegaly, aplastic anemia, meningitis or myocarditis. 10% of the patients have light red maculopapular eruptions and repeated aphthae. |
| Herpetic pharyngitis (泡疹性咽炎) (termed “suffocating eruptions” in TCM) and hand-foot-and-mouth disease. It is usually caused by coxsackic A16 virus and occasionally seen in B group and ECHO virus infections. The new intestinal 71 type virus may also induce fulminant epidemics. The former presents high fever, sorethroat and chiefly limited in the anterior pillar of the throat, the soft palate, tonsils and uvula. These are grayish white popular eruptions or herpes with reddish surroundings which become ulcers afterwards. (Occasional female infants may have herpes over the vaginal mucosa). The latter has a milder course, low fever, sorethroat, painful scattered small herpes in the oral cavity or over the gingival, tongue and pharynx. They rapidly disrupt to form shallow ulcerations with red and swollen edges and over the hands and feet, there are maculopapular eruptions and herpes. |
| Eruptive fever and infantile diarrhea: it is caused by intestinal ECHO virus and occurs chiefly in infants and children. Most of the diseased infants have common cold, fever, aphthae (the 9 and 16 types) and dermal eruptions (different types of virus cause different forms of eruptions). |
Introduction of cases
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Case 18 Chan (code no. 281), male, age 10 years. His maternal grandfather died of carcinoma of liver ten years ago and a number of his maternal relatives were carriers of hepatitis B virus. The child was diagnosed as chronic hepatitis in 1994 because of hepatomegaly, prolonged constipation, repeated common cold and secondary obesity. In the recent two years, there were four relapses of hepatomegaly but all were cured by TCM. In October 1999, he had high fever, sorethroat, herpetic erosions of the oral cavity accompanied with angles of mouth, shortness of breath, sever coughing and jaundice of eyes and skin, and was hospitalized and isolated. He was diagnosed by a certain large hospital in Hong Kong as EB virus infection. He did not take western medicine during hospitalization but was treated by Chinese medicine brought to him by his mother. After two parcels of medicine, the fever subsided and the transaminase dropped from 700 to 200 unit. Six days after hospitalization, examination of the liver showed hepatomegaly of 1.5cm. Anthor four parcels of TCM drugs brought the liver to normal. After 6 weeks of systemic TCM treatment, clinical cure was attained. |
| Case 19
Lee (code no. 2242), male, age 23 months. The child had repeated common cold and fever, aphthae, tongue coating, epistaxis and hepatomegaly and was diagnosed as chronic hepatitis in April this year when he first visited the clinic. He received systemic TCM treatment and was clinically cured. His return visit was in October when his mother said that the child had fever for 3 days. The subsidence of which revealed skin eruptions and his tongue showed thick yellowish coating associated with ulcerations of the oral cavity. The body and limbs presented disseminated red dermal macular eruptions and the liver enlarged to 1.5 cm. The disease was diagnosed as infantile acute eruptions. Three parcels of TCM drugs were taken (in the course of 6 days). The liver became normal. The skin eruptions subsided with mild desquamations. Medication was stopped after another 3 parcels of TCM drugs. A return visit was paid after 40 days and the mother complained that during western medication, the child had repeated exopathy, fever and cough. Physical examination revealed hepatomegaly of 1.5 cm. After taking 3 parcels of TCM drugs, the liver returned to normal and systemic treatment led to clinical cure.
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By WONG Kwok Hung
published on 18th December 2001
(translated by Professor ZHENG Hua En in 2003)