Case Study II

Typical cases of abnormal liver dullness caused by
type of virus which is not defined (2)
　

The following cases were traced for its past history of type A, B and C or other types of hepatitis but of no avail.  But the clinical symptoms, the disease course and physical signs of these patients were compatible with the diagnosis of chronic hepatophilic virus disease and they obtained clinical cure after treatment by systemic TCM therapy subsequently.  Therefore, clinically, the diagnositic basis of chronic virus hepatitis should not be confined to the present use of ultrasound and blood examinations, otherwise, treatment would be delayed.

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Introduction of cases

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Wong (computer no. 2120), male, age 74 years.  First visit: April 2000.

Chief complaint: he suffered from repeated migraine since 30 years of age.  From that time onward, he also had repeated exopathy, chronic cough, abundance of sputum and nasal discharge and hypochondriac pain.  Occasionally, the sputum was blood tinged.  Sputum examination and lung X-ray results were negative and he was diagnosed chronic bronchitis.  Repeated TCM and western medical treatment were of no avail.  In the recent 20 years, he experienced repeated constipation, anal fistula and anal prolapse which required manual replacement after defecation.  He also frequently suffered form insomnia and had to take sedative.  Five years ago, he had medical help from western medical doctors because of prolonged flush of face and ears, and feverish sensation of five viscera and he was found to have hypertension.  His blood pressure fluctuated at the range of 150-170/90-100 mmhg and he still had to take hypotensive drugs. 

Physical examination: flush of face, obvious anomaly of hypochondria, percussion tenderness of liver, hepatomegaly of 3 cm, (+) pitting edema of lower extremities, conglomerate telangiectasis on left forearm with fading of color under pressure and no pruritus nor eruptions.  When he was taking the first 3 parcels of TCM drugs, his stools were smooth, the amount was large appearing daily and without pain.  Cough alleviated markedly the amount of sputum decreased and the color turned slightly yellow.  After taking 3 parcels of TCM drugs, the liver was normal on physical examination.  Edema of lower extremities reduced; the blood pressure was 170/100 mmhg (hypotensive drugs were still taken).  After taking 2 weeks of systemic TCM drugs, the patient’s flush of face alleviated; his ocular discharge and cough improved markedly, the sputum was white, transparent and thin; his head was still heavy but sleeping was well.  His liver was normal and pitting edema over pretibial region was slight.  His body weight reduced 3 lbs; the blood pressure was 150/80 mmHg.  It was estimated that after control of liver fire, the hypotensive drugs exerted further action on the suppression of blood pressure.

When TCM drugs were taken for 6 weeks, the clinical symptoms disappeared.  His mental condition was good, there was no more insomnia; fatigue alleviated and his physical motion became light.  He could reduce his one more hour afternoon nap to half of the time.  Flush of face disappeared and the 30 year repeated coughing of chronic bronchitis was cured.  The degree of anal prolapse improved greatly (it was only 1/3 of the previous prolapse and more easily replaced).  He was clinically cured and followed up.

Physician’s comment

This case had significant anomaly of both hypochondria which was due to hepatophilic virus infection during childhood leading to hepatomegaly in the pubescent age.  In a period of several decades, he suffered from liver stagnation and lung dryness, leading to repeated exopathy, hypochondriac pain and chronic cough whish was diagnosed as chronic bronchitis.  Since the age of 30, he had obvious symptoms typical of up flaring of liver yang, for example, repeated paroxysmal migraine, flush of face and ears, feverish sensation of five viscera and prolonged insomnia combined with hypertension.  Because of wetness-heat of lower-jiao and deficiency of qi of middle-jiao, he had, for a long time, constipation, prolapse of anus, anal fistula and hepatic edema.  According to the TCM classification, he was considered to be attacked alternately or in combination by the symptoms caused by the forms: liver stagnation and lung dryness, wetness-heat vaporization and up flaring of liver fire.

It was a torment that he suffered for so many ears from obstinate coughing, long term constipation and fistula and prolapse of anus caused by migraine, hypertension, neurasthenia and chronic bronchitis; but fortunately, after the administration of systemic TCM therapy, his hepatomegaly disappeared and the clinical symptoms improved significantly.  This was again a proof of the unquestionable effectiveness of TCM drugs in hepatophilic virus disease.

This case was not confirmed as liver disease although many times of examination were done; but typical symptoms of chronic hepatitis persisted for a long period and clinical effectiveness was shown through administration of TCM drugs for chronic hepatitis.  This condition further certified that clinical diagnosis should not depend only on examination results.

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Hui (computer no. 2136), male, age 8 years, first visit: May 2000.

The mother said that the child had repeated attacks of rubella and pruritus since infancy and was brought to hospital once for emergency treatment because of rubella.  He was susceptible to common cold, sorethroat, perspiration, ozostomia, aphtha and constipation.  Recently, he defecated only once in a week.  He also had difficulty to fall asleep and even had insomnia, he could not sleep calmly and could be easily awakened.

Physical examination : color face pale yellowish, puffy appearance, dark orbital coloring, conspicuous eye-bags, normal tongue, prominent blood vessels over chest wall and skin of lower extremities, abdomen soft and distended, positive percussion tenderness over hepatic region, hepatomegaly of 3 cm.

After taking 3 parcels of TCM drugs, the liver was normal.  He continued the TCM medication; oral ulcerations occurred repeatedly.  But his perspiration, appetite and sleeping all improved.  His bowel movements were once in 3 to 4 days.  After two weeks of TCM treatment, he could have bowel movements every day.  His sleeping was good, he had the feeling of hunger.  His appetite and mental condition were good.  Perspiration diminished significantly, rubella and oral ulcerations did not relapse.  He took totally 6 weeks of TCM drugs and obtained clinical cure.  He was followed up.

Physician’s comment

The patient had repeated common cold, sorethroat and constipation, these symptoms belonged to liver stagnation and lung dryness; he also had symptoms of large intestine heat, ozostomia, aphtha and rubella, these could be grouped under wetness-heat vaporization.  Although his age was small, but he already had deficiency of heart blood and abundance of heart fire which caused obvious insomnia and perspiration from deficiency of yang.  Through TCM treatment, hepatomegaly rapidly disappeared and the clinical symptoms subsided.  Systemic TCM therapy lasted for 6 weeks and he was clinically cured with satisfaction.  In fact, pediatric chronic hepatitis is extremely common, but many parents do not pay enough attention to this and they seek for medical help only when the child has symptoms and they neglect the importance of seeking therapy to treat the fundamental.  In this case, the child’s chronic hepatitis had developed into the stage of showing neural system symptoms like insomnia, perspiration and prominent veins, indicated the formation of early collateral circulation in hepatic vein hypertension.  If these typical symptoms and signs of comparatively late stage of chronic hepatitis were not relieved and terminated, it was extremely likely that it would develop into cirrhosis of liver or carcinoma of liver.

The child’s mother also had hepatomegaly and she received treatment at the same time and obtained clinical cure.  But the type of hepatitis virus was similarly not determined.  So we have to tell people to pay attention to chronic hepatitis because correct diagnosis can not be relied only on blood or ultrasound examination.  It is a better choice to accept systemic TCM therapy early when there are typical symptoms and abnormality of liver dullness.

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Wu (computer no. 2114), female, age 68 years, first visit: April 2000.

She complained that she was attacked repeatedly by exopathic fever.  Now she suffered from sorethroat, cough, abundance of sputum, loin pain and generalized soreness of body for the recent 10 more days.  She had history of constipation alternated with diarrhea.  She had to seek for physical therapy because of prolonged back and loin pain.  She had received appendectomy and two hemorrhoidal operations and also tubal ligation.  In addition, she suffered from hypercholesterolemia, hypertension, coronary heart disease, hypothyroidism, anasarca and venous varicosities of lower extremities.  She had now taken western medical drugs for a long time but without obvious effectiveness.

Physical examination : abdomen full and distended, anomaly of hypochondria, umbilicus deviated to left, liver still showing percussion tenderness, hepatomegaly of 3 cm, edema of lower extremities, (++) pitting edema of pretibial region, multiple conglomerate telangicetasic and venous varicosities over skin of lower extremities.  The diagnosis was chronic hepatitis complicated with hepatic upper respiratory tract catarrh, viral gastroenteritis, hepatic edema, hepatic osteodystrophy, hypertension of portal vein and inferior vena cava, arteriosclerosis, coronary heart disease, hepatic endocrine disorder (hypothyroidism), hemorrhoids.

After taking 3 parcels of TCM drugs, the liver was normal.  Abdominal distension reduced greatly but percussion tenderness of liver was still present.  She still experienced insomnia and cough which showed blood tinged sputum occasionally.  After taking TCM drugs, abdominal pain before defecation relieved.  While she was taking the second parcel of drugs, she had diarrhea, the stools being six times a day, amount large and loose and foul smell.  Physical examination revealed a red dry tongue with white thin coating, marked reduction of edema of lower extremities showing (±) on pressure.  She continued the medication and many of the symptoms were relieved.  But while she was taking the 10^th parcel of drugs, she had fever, headache, violent coughing with slightly yellow sputum.  She persisted in TCM treatment and the fever subsided 3 days later; coughing and sputum also decreased.  Bowel movements were 2-3 times a day, the stools black in color, loose and large in amount; she had a burning sensation in the anus.  The tongue coating became loose, though thick, the color yellowish white and it detached partly.  The liver was normal.  19 parcels of TCM drugs were administered and then she stopped the medication because of some reasons of her own.

Picture 3 : telangiectasis of lower extremities

Physician’s comment

The disease of this case was complicated but it was not difficult to explain with the course run by hepatophilic virus disease.  The patient’s chronic hepatitis was in late stage which displayed clinical symptoms and signs of liver stagnation and lung dryness, wetness-heat vaporization, blood stasis and blockage of channels, up flaring of liver fire and deficiency of liver and kidney, but the existence of the sign, anomaly of hypochondria was enough to demonstrate that the disease began at her childhood.  Prolonged course of liver disease caused abnormality of liver function which led arteriosclerosis, hypertension, coronary heart disease, portal hypertension and repeated hemorrhoidal bleeding; the telangiectasis, prominent venous varicosities and edema of lower extremities indicated hypertension of the portal systemic and inferior vena cava.  The cardiovascular diseases were the result of long term chronic hepatitis and could be considered as complications of virus hepatitis.  It was important that the patient accepted TCM therapy for hepatophilic virus disease which resulted in relief of the clinical symptoms and signs and disappearance of hepatomegaly as well as edema of lower limbs.  All these indicated the good effects of TCM therapy.  It was unfortunate that the patient was not able to finish the course of systemic therapy and not followed up.

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Yang (computer no. 2111) female, age 27 years, first visit: April 2000.

She complained of repeated acne, especially over the back since beginning of development; her sebaceous secretion was exuberant with many black head at the face and back of chest; the eruptions were somewhat protruding.  She was hairy especially obvious over the forearm, armpit and legs, and had to shave 2-3 times a week.  The right cheek still showed many acne.  From the age of 17, she experienced prolonged gastric disease; she frequently suffered from distension of stomache, distensive gastric pain after meal, belching, acid regurgitation and constipation.  She had gastroscopy examination last year with normal result.  Her menstruation usually delayed and irregular, sometimes once in 2-3 months, but eh usual pattern was a delay of one week.  She also had dysmenorrhea.

In the recent two months, she suffered from common cold and fever, hoarseness of voice, cough, abundance of sputum.  She had a foreign body sensation in the throat and her coughing intensified at night, interfering sleep.  She was treated with TCM and western drugs with no avail. 

Physical examination: poor nourishment and development, height 152 cm,body weight 43.18 k, BMI = 18.69.  Tongue enlarged with slight teeth prints, obvious hypochondriac anomaly, percussion tenderness of hepatic region, hepatomegaly of 3 cm, prominent veins over subcutaneous tissue of both legs, edema not present.  The diagnosis was chronic hepatophilic virus disease (liver stagnation and lung dryness, wetness-heat vaporization, deficiency of qi and blood, stasis of blood and blockage of channels forms).

After taking 3 parcels of TCM drugs, coughing alleviated but foreign body sensation in throat was still present; she felt dryness of mouth and throat, bowel movements being once a day, showing dry stools.  The liver returned to normal.  She took another 6 parcels of TCM drugs and the cough was cured.  There was some distensive pain of stomache after meal and there was belching, dryness and bitterness of mouth and the stools were hard.  She took another five parcels of TCM drugs, and her bowel movements were smooth, regular, the stools large in amount.  She still had belching and distensive pain of stomache, especially after taking cheese and Italian noodle which evoked gastric discomfort and sub-xiphoid tenderness.

When she had taken two weeks of drugs, she still had belching and distensive pain of stomache.  Her facial sebaceous secretion was excessive and acne was present.  At the 3^rd week of medication, menstruation appeared which was regular in time and showing bright red color; the amount reduced and it was not associated with dysmenorrhea and blood clots.  Acne disappeared after 4 weeks of medication.  The second menstrual period came 28 days afterwards and it was smooth, bright red, without dysmenorrhea and not large in amount.  It lasted 6 days.  Besides having a small amount of stools and some tenesmus, she had no other discomfort.  She obtained clinical cure and was followed up and told to make a premenstrual return visit later.

Physician’s comment

This is a typical case manifesting multiple system symptoms in a young female, nowadays, suffering from hepatophilic virus disease.  Although she did not have a history of confirmed hepatitis but her nourishment and development was poor, her height 1.52 m, weight 43.18 kg, BMI = 18.69 (approaching the malnutrition standard 18.5).  She had obvious hypochondriac anomaly; the left hypochondrium depressed, right hypochondrium full and protruding.  This demonstrated that the patient was poorly nourished and developed.  The past history showed 10 more years of repeated attacks of acne, dermal wetness-heat and endocrine disorder which were manifestations of hepatophilic virus disease.  It was considered that her hypochondriac anomaly was due to infection of hepatophilic virus during childhood, significant hepatomegaly in the prepubescent stage and also due to the subsequent long course of the disease.  Since 17 years of age, she experienced prolonged distensive pain of stomache, gastrointestinal wetness-heat and aphtha; these conditions were considered as viral gastroeuteritis.  She had also prolonged blood stasis and blockage of channels symptoms such as menstrual irregularities (delay of one week and even once in 2-3 months), heavy menses, abundance of blood clots and obvious dysmenorrhea.

She had hepatogenic malnutrition and poor development, disturbance of absorption of nutritious substances and anemia, resulting in deficiency of heart blood and frequent insomnia and neurastheniac symptoms.

In addition, she had symptoms of liver stagnation and lung dryness and large intestine heat which manifested as repeated common cold, fever, hoarseness of voice, cough, constipation and yellowish urine.  These were in fact caused by immunologic responses following repeated virus replication of the hepatophilic virus infection.

The physical examination findings, showing poor nourishment and development, enlarged tongue with teeth prints, hepatomegaly, percussion tenderness of hepatic region, prominent veins of lower extremities, were all signs of chronic hepatophilic virus disease.

In this case, clinical symptoms disappeared after 7 weeks of systemic TCM therapy, and medication was stopped when she obtained clinical cure.  Her menstruation became normal and she still took some premenstrual TCM drugs for regulation.  Here one could see the complexity, obstinateness and multi-systemic character of the symptoms of chronic hepatophilic virus disease; they might attack repeatedly or simultaneously.  To treat from the fundamental, systemic TCM therapy must be administered.  We could see that the patient’s acne, viral gastrointestinal disease, menstrual disorders, dysmenorrhea, hepatic upper respiratory tract infection and neurasthenia were alleviated or cured.  This result strongly proved the superior effectiveness of TCM drugs and it broke free from the conventional thinking that liver disease could not be cured by drugs.

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Hsu (computer no. 293), male, age 55 years, first visit: October 1993.

Chief complaint: repeated migraine occurred for many years and when severe, it was complicated with nausea and vomiting, he had to take analgesics in every attack but the result was not good.  He had history of hypertension, the blood pressure around 168/120 mmhg and he took antihypertensive drugs for a long time.  In the recent three years, he suffered from repeated dermal pruritic eruptions which were diagnosed by specialists as dermal hypersensitivity, but treatment was not effective.  On visiting, he complained of pricking headache, occasional vertigo, poor sleeping, yellowish urine, scanty hard stools, hemorrhoilds with occasional bleeding (history of operation for internal hemorrhoids and appendicitis). 

Physical examination: strong build, dark skin color, back and lower abdomen showing conglomerate maculopapular eruptions which was considered to be sweat dermatitis, skin impairment showing symmetric local neurodermatitis over the dorsal thumb side of both hands, abdomen full and distended, percussion tenderness of liver, lower border of liver dullness 4.5 cm above costal margin, posterior protrusion of thoracic vertebral column, blood pressure 150/110 mmhg, (+) pitting edema of lower limbs.

He had a return visit when 3 parcels of TCM drugs were taken and it was found that the gases inside the intestines were expelled and the liver, on examination, was enlarged to 3 cm ; there was still percussion tenderness of hepatic region.  He took another 26 parcels of TCM drugs and the liver returned to normal (1.5 cm above costal margin).  Blood pressure was 120/86 mmhg.  There was no relapse of migraine, sleeping was well, hemorrhoidal attacks did not appear and the skin of trunk had no pruritic eruptions.  Neurodermatitis was basically cured with remaining pigmentation.

Several years of observation indicated the attainment of clinical cure.  He did not take antihypertensive drugs any more, but occasionally required regulation with TCM drugs to eliminate wetness-heat.  Antihypertensive drugs were taken only for one time when the blood pressure exceeded the normal limit.   Sleeping was not so good sometimes and he might feel tired.  There was slight headache when the blood pressure was high, but was relieved by TCM drugs every time. There was no typical relapse of disease in many years.

Physician’s comment

This case was observed for 8 years.  On the first visit, the margin of liver dullness was retracted, but after 3 parcels of TCM drugs, the gases inside the intestines were expelled and a hepatomegaly of 3 cm was revealed.  This phenomenon was not uncommon in clinical practice.  Therefore if liver enlargement is not found in physical examination and if there is tympanites, the patient should take TCM drugs to expel the intestinal gases and then have the liver re-examined to reveal the actual condition.  This case was treated in the early period of our practice when we were not so experienced so that 26 parcels of TCM drugs were needed for the recovery of liver.

This patient for a very long time had neurasthenia which led to insomnia, hypertension, repeated typical paroxysmal migraine, obstinate dermal pruritius, multiple local neurodermatitis and hemorrhoids.  For several decades, he was treated by different specialists and he took many TCM and western medicine but of no avail.  After making the diagnosis of hepatophilic virus disease and instituting systemic TCM therapy, the disease was clinically cured.  In fact, the different disease of the various systems, could all be explained by hepatophiliic virus disease.  This was a case of chronic hepatophilic virus disease, the 3 forms of TCM classification involved were up flaring of liver fire, wetness-heat vaporization showing skin manifestations and blood stasis and blockage of channels.

The typical clinical symptoms in this case of hepatophilic virus disease could be traced to one common origin; this understanding was compatible with the TCM principle “the concept of wholism”.  Although the type of hepatitis virus was not found out in this case, yet the typical chronic symptoms and the hepatomegaly were enough for the determination of clinical diagnosis and as the grounds for TCM treatment.  Now, the result of TCM therapy confirmed the correctness of diagnosis and the patient was clinically cured by such treatment.

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Li (computer no. 2135), female, age 30 years, first visit: 24^th May, 2000.

Her elder brother died of carcinoma of intestines and her elder sister underwent an operation of breast carcinoma.  The patient’s eyes were turbid and yellow tinged since childhood.  Her development was abnormal; the chest showed serious funnel shape anomaly, the vertebral column curving laterally, the hypochondria also anomalous.  The female secondary sexual characteristics were poorly developed and she was also hairy.  She had prolonged insomnia and general soreness of the body.  In three years, she had to take alcoholic drinks and hypnotics to assist sleeping; she usually took two tins of beer first at night and then hypnotics as auxiliary.  She was diagnosed by psychiatrists as nervous tension.  In recent five years, she had repeated migraine attacks, and when severe, there was nausea and vomiting.  The menses were usually pre-date with large amount of blood clots, dark red and lasting for a week.  She had dysmenorrhea when young.  Now she experienced palpitation, shortness of breath, fatigue, restlessness and insomnia. 

Physical examination: tongue enlarged with teeth prints, tongue coating thin and white, anomaly of chest and vertebral column, liver 3 cm, below costal margin, percussion tenderness of hepatic region, (±) pitting edema of lower limbs.

After taking 3 parcels of TCM drugs, the liver was normal but percussion tenderness was present.  Pulse 100 per minute.  But following TCM administration, she was attacked by migraine of left side; there was pain over left temporal region and association of nausea, gaseous distension of stomache, belching and burning sensation of the palms, soles and chest.  But she was calm and at the doctors bidding, stopped the drinking before sleeping, the latter became better and the dose of hypnotics was reduced.  After another 4 parcels of TCM drugs, headache disappeared, the stools were larger in amount, being once a day with some burning sensation of the anus.  She still had insomnia and nausea; the tongue coating was thin, pale yellowish and white and detached partly.  She finally stopped the hypnotics.  Pulse was 100 per minute.  The liver was normal but with percussion tenderness; edema of lower limbs reduced.

She took another 3 parcels of TCM drugs and her sleeping improved greatly and she could fall asleep in the bed in 15 minutes and wake up at 7 o’clock in the morning.  She stopped the medication for 2 days after taking 11 parcels of drugs.  She had nasal discharge, sneezing, vesicles of hot character on left lower lip, sciatic pain of left buttock, burning sensation and pricking pain of upper mandible.  Pulse was 80 per minute.  She could sleep for 4 hours.  Her tongue edge was red, tongue coating loose and white.  Her liver was normal; the edema of lower extremities disappeared.  She continued the TCM treatment; the above symptoms disappeared and the vesicular eruptions subsided.  There was no more pain during menstruation; the menstrual blood was large in amount and clots were expelled during urination.  It lasted 6 days.

She continued to take 32 parcels of TCM drugs and stopped the treatment on account of a travel to Singapore and Malaysia.  Her general condition was good at the time of termination of the medication, besides a temporary insomnia after taking a ginseng fibril soup, and in general, she could sleep normally, being over 6 hours every night.

Physician’s comment

This is patient, during childhood had rickets, funnel shape chest, anomaly of hypochondria, lateral curvature of spinal column and underdevelopment of female secondary sexual characteristics.  These were in fact the result of childhood virus hepatitis which led to osteodystrophy (that is the deficiency of liver and kidney form in TCM ).

Tracing her disease history, it was found that she suffered from prolonged abdominal pain, diarrhea, poor appetite, nausea, belching, abdominal distension, bowel movements 3-4 times a day and burning sensation of anus which should be ascribed to viral gastrointestinal disease (that is the wetness-heat vaporization form in TCM ).

For a long time, she had neurastheniac symptoms such as palpitation, shortness of breath, insomnia, restlessness and burning sensation and in the recent five years, she was frequently attacked by migraine (the symptoms of deficiency of qi and blood form and up flaring of liver fire form).  The patient had menstrual disorders, dysmenorrhea, the menstrual blood abundant, dark red and with many clots.  These symptoms belonged to the blood stasis and blockage of channels form.  The diagnosis, based on the past history and the present symptoms was completely compatible with the six forms of chronic hepatitis.  Further more, the presence of hepatomegaly of 4.5 cm (lower margin of liver dullness 3 cm below costal margin) made it easy to give a clinical diagnosis of hepatophilic virus disease.  The good result after systemic TCM therapy was in fact a matter of anticipation.  Because of an attack of herpes happened during the course of TCM treatment, it could not rule out that the virus causing chronic virus hepatitis was that of herpes.

It could not be ascertained that the patient’s hepatophilic virus infection in childhood was directly related to the post-operation condition of breast cancer of her elder sister or to the death of her elder brother from intestinal carcinoma.

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Cheung (computer no. 2147), female, age 48 years.  First visit: June 2000.

She complained of menstrual disorders, prolonged severe dysmenorrhea, repeated headache and sleepiness.  She gave birth to a daughter 15 years ago and suffered from repeated paroxysmal vertigo 3-4 times a year.  During attacks, she usually experienced simultaneously diarrhea, nausea, vomiting and inability in going down from the bed.  She was diagnosed by western doctors as imbalance of auricular fluid and had to take drugs during the attacks.  In the recent several months, she had loin pain, deepening and spreading apart of facial pigmentation.  She therefore asked for TCM treatment.

Physical examination : pulse was 80 per minute.  Blood pressure 86/50 mmhg.  Percussion tenderness over hepatic region, hepatomegaly of 3 cm, (+) edema of lower extremities.

After taking 3 parcels of TCM drugs, the liver was normal and edema of lower extremities alleviated.  She continued the medication to the 7^th and the menses appeared.  Dysmenorrhea relieved somewhat, the amount was less, but still with many clots and cleared up in five days.  During treatment, the feces were rather large in amount, showing wetness-heat character; there was tenesmus with a confusive sensation of defecation.  Loin pain disappeared and edema reduced.  Blood pressure was 100/60 mmhg.  When menstruation came at the 5^th week of medication, she still had mild right side migraine and vague abdominal pain.  Her menstruation was regular, the amount decreased, color bright red and with scanty clots.  The brown patches on the face became lighter in color.  She was ascertained clinical cure because of the significant improvement of clinical symptoms.  Her systemic TCM therapy totalled 38 parcels of drugs.  She was followed up and told to take some drugs to regulate the menses and supplement the kidney.

Physician’s comment

The symptoms in this case were relatively simple; they were ascribed to wetness-heat of stomache and intestines, to imbalance of auricular fluid and to stasis of blood and blockage of channels which led to menstrual disorders and severe dysmenorrhea.  Here recent repeated loin pain and pigmentation of skin showed that deficiency of kidney was becoming worse and measures should be taken immediately to nourish the kidney and terminate the advance of deficiency of liver an kidney as a radical TCM institution after chronic hepatitis.

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Chan (computer no. 765), female, age 30 years.  First visit: April 1999.

Her husband was a carrier of type B hepatitis virus for a long time; he was treated but of no avail.  Recently, she had blood examination for the liver, but did not find hepatitis antigens or antibodies.  However, she received type b hepatitis preventive injection.

Her chief complaint was : history of repeated dermal pruritus, abundance of menstrual blood clots, urine yellowish, headache, wetness-heat stools, tenesmus and 9 years marriage with birth of a son, one more year of age.

Now she experience repeated common cold, sorethroat, abundance of nasal discharge, dreamfulness and poor sleep for more than 20 days.  Physical examination: tongue enlarged with teeth prints, anomaly of hypochondria, percussion tenderness over hepatic region, hepatomegaly of 4.5 cm.

        After taking 3 parcels of TCM drugs, the liver was normal.  During the course of medication, she had abdominal pain, diarrhea, loose stools, being 3 times a day, sleepiness and dreamfulness.  After another 3 parcels of drugs, she had dryness of threat, dreamfulness but there was fading of the yellow color of urine, pruritus of skin diminished and after another 5 parcels, the clinical symptoms disappeared and there was no discomfort.  She continued the systemic TCM therapy; there was occasional migraine, tinnitus, mild vertigo and pruritus.  The menses decreased in amount as well as the blood clots.  Nocturual urination also improved.  She took totally 6 weeks of TCM drugs and obtained clinical cure.  She was followed up.

Physician’s comment

This case might evoke controversy among people with different opinions about hepatitis.  According to the old standard, the patient’s husband could be confirmed as carrier of type B hepatitis virus because his blood examination showed “the small three positives”.  The patients showed negative blood examination result and received preventive injection for type B hepatitis; such routine management gave no cause for much criticism, but her practical clinical condition revealed a typical picture of chronic virus hepatitis, manifesting the signs of anomaly of hypochondria, hepatomegaly and percussion tenderness of hepatic region and although the symptoms were mild, according to TCM classification, they could still be grouped under the 3 forms: liver stagnation and lung dryness, wetness-heat vaporization, stasis of blood and blockage of channels.  If the patient was not diagnosed chronic hepatitis merely because of normal blood examination results, her treatment would be delayed.  But fortunately, she was correctly given systemic TCM therapy on the basis of the diagnosis of active chronic hepatitis according to the symptoms and signs revealed by physical examination.

Practical evidence proved that systemic TCM therapy gave this patient clinical cure.  Her husband received systemic TCM therapy afterwards and also obtained clinical cure.

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Written by WONG Kwok Hung in 2002

Translated by Professor ZHENG Hua En in December 2006