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Preface
Hepatogenic secondary obesity is caused by infection of “hepatophilic virus”. “Hepatic edema” and “hepatogenic secondary obesity” are a pair of twins and are the inevitable pathologic processes of human “hepatophilic virus” infection.
Hepatic edema is frequently the onset of “secondary obesity”. So, if liver disease is detected early and treated with effective systemic TCM therapy, the development of hepatic edema and obesity can be prevented. In our group of 3000 cases of abnormal margin of liver dullness, nearly 40% have “edema” and “obesity” body figure. If it is mistaken for usual obesity and sought for fat reducing, the result would inevitably be impairment of health and waste of money.
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The cause of developing hepatogenic secondary obesity by hepatophhilic virus disease
(1) Characteristics of “fatty liver”
Acute and chronic hepatophilic virus infection can be complicated by fatty liver and secondary obesity: Clinically, it is a common fact that acute hepatitis patients in the stage of convalescence or chronic hepatitis patients in the active stage may be complicated by “fatty liver”. The latter is characterized by the following:
Besides acute and chronic hepatitis, the clinical causes that may induce fatty liver are hunger, malignant malnutrition (malnutrition due to lack of protein and calorie intake), endocrine disorder (including diabetes, adrenocortical hormones, sex hormones, and acute gestational fatty liver), drug intoxication (including alcohol, tetracycline, carbon tetrachloride, yellow phosphorus); these are closely related to adverse effects on liver metabolism. Behind these factors, is there the existence of hepatophilic virus disease in the patient? This deserves investigation.
It is clear that the formation of fatty liver and secondary obesity can not be attributed simply to “over nutrition” or “lack of physical exercise”. Further more, it cannot be treated by “limitation of food” or blindly by “increase of physical exercise” or by administration of “fat reducing drugs”.
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| (2) Nervous system damage often occurs after acute or chronic hepatophilic virus infection
Acute a chronic hepatitis can induce nervous system damage, leading to hepatic encephalopathy (肝性腦病), brain edema (腦水腫), meningitis (腦膜炎) and hepatic neuropsychosis (肝性神經精神病); it can also cause chronic hepato-encephalic degeneration, epilepsy and hepatic myelopathy (肝性脊髓病). Some scholars have pointed out statistically that hepatic disease patients with impaired liver function have a 65% incidence or even more of central nervous system damage and in virus hepatitis patients, 70%-80% have encephalic neural symptoms.
In fact, some reports have denoted that in the human hypothalamus, these are two nuclei which regulate food intake activity, one is the hypothalamicus ventromedialis nucleus (the satiation centre), the second is ventrolateral hypothalamic nucleus (the hunger centre). Animal experiments showed that if the ventromedialis nucleus was destroyed, the animals increased its food intake and became fat. Clinically, these are some patients with encephalitis and meningitis sequelae who present symptoms of polyphagia and obesity as the chief manifestation. Patients in the acute hepatitis convalescent period and chronic hepatitis active stage often manifest clinically secondary obesity and isn’t this condition related to the damage of hypothalamus by hepatophilic virus? At present, reports about this subject are not seen and this topic should really be investigated. There is no doubt that many infections virus disease such as encephalitis, meningitis and hepatitis can induce “malignant obesity”. So it is clear that there is increasing necessity to have patients diagnosed early and treated early with effective systemic TCM therapy for the complete elimination of toxins and antigen-antibody compounds in the body and for the prevention of edema and secondary obesity.
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| (3) Secondary obesity is usually the result of hepatic edema.
Secondary obesity and hepatic edema may not be easily differentiated in clinical practice. In fact, they interpenetrate one another. Chinese people say: “It is difficult to differentiate fatness and edema”; this virtually denotes the difference between “hepatic edema” and “hepatogenic seconding obesity”.
Statistics about patients with “secondary obesity” in our liver disease group showed that in 2925 cases of abnormal margin of liver dullness, physical examination revealed 970 cases of hepatic edema, occupying 33.16% and 191 cases of hepatogenic obesity, accounted for 6.53%. In 1043 male patients, 9% (94 cases) have secondary obesity, but hepatic edema occupied 23.58% (246 cases). In 1882 female patients, only 5.15% (97 cases) have secondary obesity but, in contrast, hepatic edema reached 38.46% (724 cases). It is interesting to find that in secondary obesity male patients are significantly more than female. It is estimated that this is due to a higher incidence of acute hepatitis in male. One the contrary, female patients have a higher incidence of hepatic edema following chronic hepatitis; this is closely related to the physiologic function (menstrual blood loss) characteristic of females. From this, we can see that the possibility of producing hepatic edema and secondary obesity in chronic hepatophilic virus disease patients is high.
Liver is the target organ of many important hormones and is also the chief site of degradation, transformation, inter-conversion, storage and excretion of hormones. Liver can synthesize hormone-like substances itself such as sodium excretory factor, angiotensinogen (血管緊張素原) and erthropoietinogen (促紅細胞生成素原), so it can also be regarded as an endocrine organ. Hepatitis is often followed by hepatic dysfunction, leading to disturbance of hormonal metabolism and abnormality of endocrine hormones, e.g. hypothyroidism (甲狀腺機能減低) causing myxedema (粘液性水腫), increase of growth hormone and insulin, hyper-glucagonemia (高胰升血糖素血症) causing hepatogenic diabetes or hypo-glycogenemia (低血糖) in which patients may experience “susceptibility to hunger” and “polyphagia” (多食) the latter conditions tend to produce secondary obesity. In liver disease (especially after the early stage of cirrhosis of liver), there are evidences showing hyper-estrogenemia (高雌激素血症) or male hormone insufficiency where a certain number of male patients with liver disease have feminine breast development and change of body figure to the female type. Some patients may show male sexual hypo-function, which, in childhood, is prone to change the boy into a fat lump, and, besides, the external genitalia may reveal apparent underdevelopment.
Therefore, when chronic hepatitis is complicated with other diseases which can induce water and sodium retention, malnutrition, protein deficiency and accumulation of mucous material, the result would be edema, increase of body weight and disfigurement. In addition, in the hepatophilic virus disease patient, there is a gradual increase of concentration of the accumulated “antigen-antibody compounds” as time elapses. Hepatic edema and seconding obesity is produced following the retention of inflammatory fluid in tissue spaces. TCM drugs can eliminate edema and reduce fat; clinical study shows that TCM drugs increase excretion of “antigen-antibody compounds”. Several parcels of TCM drugs can cause shrinkage of liver dullness to normal position and this is a convincing evidence.
From the statistical data of TCM from of hepatogenic secondary obesity, we find that the complication of “deficiency of both liver and kidney” accounts for 40% (76/191 cases) which is significantly higher than the usual record 23.6% (692/2934 cases) of the “deficiency of both liver and kidney” form. This indicates that “deficiency of both liver and kidney” is the chief pathological basis of hepatic obesity and it is entirely impossible to obtain fat reduction by the administration of several pills of “fat reducing drug”. So, quite a number of specialists have made the conclusion that majority of the fat reducing projects are not effective. Although the subjects have lowering of body weight, yet their fat figures would reappear in not a long time.
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| (4) Avoid over-dosage or prolonged use of hormones; first choice is effective systemic TCM therapy
Over-dosage or prolonged use of hormones is main cause of secondary obesity. Since the appearance of steroids in the world, numerous patients suffering from acute and serious diseases were saved, and because of its outstanding clinical effectiveness, abuse of the drugs by physicians as well as patients had become popular. Aiming at superficial effectiveness but not basic cure, not a few patients indulge at prolonged use of hormones to treat common hepatogenic symptoms and diseases, such as hepatic respiratory treat disease, chronic bronchitis, hepatic pulmonary disease, asthma, gout, various types of dermal diseases, astral malnutrition induced osteoarthritis diseases, lupus erythematosus (紅斑狼瘡) and various allergic diseases, Abuse of steroids may cause retention of water and sodium, full moon face and secondary obesity, so one must be careful in using hormone to treat patients with history of liver disease. For hepatic obesity, it is necessary to treat the fundamental and TCM drugs are more effective in this aspect. If possible, seek for physicians who are able to “treat by syndrome differentiation” and can use the effective systemic TCM therapy as the first choice of therapy without aimless application of hormones.
(5) Acute or chronic blood loss is often the including factor of hepatic obesity
Liver participates in many coagulation mechanisms of the human body; besides vitamin K, it can also synthesize fibrinogen and prothrombin (凝血酉每 原). Blood coagulability is impaired when there is hypo-function of the liver. Clinically one may at times encounter purpura (紫癜), epistaxis (鼻衄), hemorrhoidal bleeding and menorrhagia. Especially in females, when they have chronic hepatitis and stagnation of liver qi, they would present symptoms of menstrual irregularity, excessive menstrual blood, deep color menstruation with numerous clots and dysmenorrheal. Excessive loss of blood during menstruation of repeated, prolonged bleeding can result in hemorrhagic anemia.
Besides, abnormal clotting of blood after certain hepatogenic diseases may lead to hemorrhage (e.g. peptic ulcer, portal hypertensive gastric disease, biliary hemorrhage, cystic hemorrhage), or large amount of blood loss may occur during operation or delivery. These conditions can lead to hepatic edema and hepatic obesity in the post-convalescence period. In clinical practice, causes of secondary obesity can usually be detected. Therefore, early diagnosis of liver disease and early treatment with TCM drugs and elimination of the opportunity of prolonged loss of blood, early healing of liver disease after a blood loss episode and effective correction of anemia with TCM and western medicine combined method, are the best measures in preventing secondary obesity.
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| (6) “Eat less, more physical exercise” is the principle of fat reducing, but mind the “fat reducing pitfall” People usually think that for “over weight” or “obesity”, the management is no other than “eat less” and “do more physical exercise”. Therefore, the conventional use of various food control methods and the aimless increase of physical exercise have become the undoubtedly correct measures of reducing fat. It fact, such popularity conversely let people drop into the “fat reducing pit face”, because hepatic obesity is entirely different from simple obesity.
Although the method of reducing calorie in the food control method, despite of not doing physical exercise, can lead to decrease of body weight in a short time, but it can be really effective only if maintained for a long period. But hepatic obesity is a “pathologic type” of obesity, the patient has already nutritional disorder, so that limitation of caloric intake undoubtedly aggravates the liver disease and the result is the complication of acute, sub-acute, or chronic “hepatogenic hypoglycemia” which is induced with certainty at every episode of fasting, meal delay, missed meal time, limited carbohydrate intake or increase of muscular activity. Therefore, due to the longing of reducing fat and the limitation of caloric intake by “eating less” and “doing more physical exercise”, fat in the body is consumed and the individual would have hunger, palpitation, pallor of face, nausea, abdominal pain, intention of defecation, perspiration, tremor of hands or even arrhythmia. Aggravations of the disease may further induce central nervous system symptoms such as vertigo, headache, blurring of vision, sluggish responses or even coma and there is no choice but to stop the fat reducing project.
On the other hand, people undergoing fat reduction, for the sake of treating hypoglycemia (低血糖症) or arrhythmia (心律不整) may take more food and the body weight may increase to a level higher than that before fat reducing and, besides, limitation of food blindly may cause “anorexia”(厭食症). All these are “pitfalls of fat reducing”.
We should know that once the food intake is limited, the body is inevitably affected in many aspects. The calories provided by fat are four times of carbohydrates, but females going after beauty do not know that fat is very important in the normal development of the body. Some scholars pointed out that without 17% of body weight amount of fat, females would not menstruate, and when the amount is less than 20% of body weight, females can not fertilize or undergo normal delivery. In females, development, pregnancy, delivery, breast feeding, all require an adequate degree of calorie support. If your body weight is above standard but at the same time you are suffering from chronic liver disease, it is certainly a vain hope to reduce fat. It is only when effective systemic TCM therapy is applied to obtain clinical cure of the liver disease, and when the endocrine functions have returned to normal, that the development of a fat body figure can be stopped.
On the country, from clinical experience, we find that in the TCM treatment of hepatogenic secondary obesity, if the patient takes a regular diet with high protein nutrients (such as eggs, milk, pork liver and lean meat soup, beef soup, “yin nourishing and kidney supplement” soup), after a condition of “fitness” can be obtained, because enough proteins and amino acid is essential in treatment of hepatoganic malnutrition and anemic and in regulation of colloidal permeability in the body. In addition, hepatic edema may subside more easily and sometimes “keeping fit” may reduce as much as 5-30 lbs of body weight and 3-5 inches of abdominal circumference. But, from the viewpoint of TCM treatment of liver disease, this extra-reward should not be listed as an aim of the therapy.
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| Introduction of cases
Case 2 Lin (code number 2257), male, age 41 years. His mother died 13 years ago from nasopharyngeal cancer (鼻咽癌). He became fat since 16 years of age. Now his height is 1.62m, weight is 81 kg, BMI = 30.86. He complained of pruritus of skin since childhood, especially after perspirations. Repeated pain over left elbow and right knee persisted for ten more years and now he often had swelling of gingivae, aphthae, vague pain over right hypochondrium, fatigue, sleepiness and tiredness and heaviness of lower limbs.
Physical examination: tongue enlarged and thick with thin white coating, hepatomegaly of 1.5 cm, (++) edema of lower limbs. The diagnosis was hepatophilic virus disease (herpes, EB virus infection?) with TCM classification of wetness-heat and vaporization, deficiency of both lever and kidney with hepatic osteal malnutrition, hepatic obesity.
After TCM therapy, acne was more marked and diarrhea occurred; but after 5 parcels, the liver returned to normal. In the second week of treatment, there was flush of the abdominal skin and also purities and herpes which disappeared after TCM administration. In the 3rd week of treatment, he felt apparent lightness; edema of lower limbs decreased, there was feeling of hunger and the appetite improved. The loosened teeth became stable, the lips turned red and enlargement of the tongue decreased. TCM therapy continued for 6 weeks and medication was stopped after the attainment of clinical cure. The patient was followed up.
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By WONG Kwok Hung Published on 29th August 2002 Translated by Professor Zheng in January 2005 |
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