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“Cirrhosis of liver” is a kind of chronic progressive liver disease. Clinically, there are manifestations of different degrees of severity of liver function disturbance and portal hypertension. The causes are many but mostly it is the result of prolonged uncured “chronic hepatitis” which gradually changes into “cirrhosis of liver”. In traditional Chinese medicine, cirrhosis of liver is called “abdominal mass”. If the disease progresses to the stage of ascites, it is called “tympanites”. According to the viewpoint of TCM in the early stage of “abdominal mass”, there is stagnation of wetness-heat and disorder of liver and spleen causing distensive fullness or pain of upper abdomen and enlargement of liver and spleen which are comparatively hard on palpation. The patient has palish yellow skin, loss of appetite, belching, fatigue, yellowish red coloured urine, constipation or diarrhea, purplish red tongue or ecchymosis at tongue edge, yellowish greasy tongue coating, rapid and thready pulse and pitting edema of lower extremities. Advance of the disease is due to stagnation of Qi and stasis of blood and retention of water wetness leading to anasarca and ascites; the latter causes drum-like abdominal distension, prominent veins of abdominal skin and sallow complexion; the former causes fullness of hypochondria, scanty urine, loose stools and pitting edema of extremities.
Clinically, it is common to see that chronic active hepatitis progresses into cirrhosis of liver, but actually, there is no strict demarcation between the two. Early clinical diagnosis can be determined by long time blood examinations showing abnormality of liver function, type B sonography showing complex wave or by liver biopsy.
TCM drugs are effective for ‘liver disease’. From clinical observation, we understand that the therapeutic principles for cirrhosis of liver and chronic hepatitis are similar and although cirrhosis of liver is confirmed clinically, the former can still return to the stage of chronic hepatitis under treatment. As long as the individual conforms to personal hygiene regulations after clinical cure and avoids the re-entrance of virus into the body, the chance of relapse is comparatively low. Since the treatment of cirrhosis of liver with TCM drugs has high effectiveness, indicating that it is not an un-curable disease, early diagnosis and early treatment with TCM drugs is measure of imperative necessity.
The occurrence of cirrhosis of liver is due to the delay of treatment after virus infection and alcoholic is the chief cause in the promotion of the disease. Therefore, giving up of drinking is imperative to liver disease. Every molecule of alcohol is detoxified in the liver to become ethyl ester and excreted so that in liver disease (especially when liver function is abnormal) it is absolutely necessary to stop drinking.
The TCM principle of “determination of treatment based on syndrome differentiation” directs therapy of cirrhosis of liver as well as chronic hepatitis with the same effectiveness. The following cases, showing their course of treatment, are indications that cirrhosis of liver is not so difficult to treat as commonly imagined and through effective systemic TCM therapy and patience in its application, usually one can expect a satisfactory result. | Top | Chinese version |
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Introduction of cases
Case 4: 10 years observation of a case of cirrhosis of liver repeatedly treated with TCM drugs. Case 7: liver biopsy still has the risk of “operative accident”. | Top | Chinese version |
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Typical cases of cirrhosis of liver
Case 1: cirrhosis of liver and chronic active hepatitis are rather difficult to differentiate clinically.
Chan (computer no. 48), male, age 50 years. First visit: July 1998.
He chiefly complained that he had liver disease for 8 years and blood examination showed positive type A hepatitis antigen associated with abnormality of liver function. He was confirmed to have cirrhosis of liver in a certain hospital in Guangzhou 5 years ago. Presently, he felt fatigue, soreness of bone all over the body, distension of abdomen and also had yellowish urine, edema, loin pain, loose wetness-heat stools and tenesmus.
Physical examination revealed a sallow complexion, palish yellow skin, edematous looking, thick tongue coasting with palish yellow colour, depression of left hypochondrium and bulging of right hypochondrium, inapparent percussion tenderness of hepatic region, hepatomegaly of 3 cm, (+) edema of lower extremities, no percussion dullness of splenic region and no sign of ascites. After taking 6 parcels of TCM drugs, there was no symptoms of discomfort; liver dullness returned to normal; edema of lower limbs disappeared and the patient stopped the medication by himself.
Five months later, that was in December 1988, he had a return visit and complained that he again had loin pain, dryness of month, distension of abdomen and in the recent days, fever, coughing with scanty white sputum and yellowish urine. Physical examination revealed redness and ecchymosis of tongue edge, thick coating of tongue with a grayish white posterior part. The body temperature was normal, skin still palish yellow, puffy looking, abdomen distended and full, hepatic region showing percussion tenderness and a hepatomegaly of 1.5 cm. After taking 3 parcels of TCM drugs, the loin pain disappeared, sputum as scanty; there was no fever but he still felt pain over right hypochondrium after working. Physical examination: tongue coating thick and white marked percussion tenderness over hepatic region but liver size normal. He completed a 4 week course of systemic TCM therapy, at the end of which clinical cure was obtained and he was followed up.
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Physician’s comment
When the patient visited the clinic, the diagnosis had been confirmed to be cirrhosis of liver associated with abnormality of liver function. The clinical manifestations were symptoms belonging to the TCM forms of liver stagnation and lung dryness, wetness-heat vaporization, blockage of channels and stasis of blood and deficiency of liver and kidney. He had typical gastrointestinal wetness-heat, repeated exopathic fever, hepatic edema, hepatic osteal malnutrition, long time generalized pain of bones and loin pain symptoms. Because the patient had hepatomegaly of 3 cm and no retraction of hepatic dullness, had no dullness of splenic region (spleen not palpable and no sign of shifting dullness to prove the existence of ascites, so the diagnosis of cirrhosis of liver was not entirely compatible. If the presence of cirrhosis of liver was ascertained, it should only be the early stage.
Clinically, the diagnostic boundary between chronic active hepatitis and early stage of cirrhosis of liver is hard to define. Therefore, confirmation of the diagnosis relies on further observation and tissue biopsy if necessary. But liver biopsy still has the risk of internal hemorrhage and, at the present time, the result of systemic TCM therapy is fairly good, so it seems there is no need only for the confirmation of diagnosis to do liver biopsy.
In this case, the result of TCM therapy was ideal. Clinically, the symptoms of chronic active stage were rather typical, but the two relapses of hepatomegaly subsided only after several parcels of TCM drugs and the symptoms at the same time alleviated greatly. TCM treatment was based on the clinical symptoms and confirmation of the diagnosis of cirrhosis of liver did not make much difference. When the patient took TCM drugs for the first time, he stopped the treatment by himself without finishing the systemic therapy prescribed by doctor and that caused a relapse in a short time. Clinical cure as attained when the systemic TCM therapy was completed and this course was entirely similar to the usual cases of chronic active hepatitis.
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Case 2: A case illustrating the change of cirrhosis of liver to “chronic hepatitis” by repeated systemic TCM therapy.
Yuan (computer no 496), male, age 30 years. First visit: August 1988.
His chief complaint was a history of positive type B hepatitis surface antigen. He frequently suffered from stomache ache, loin pain, fatigue and a sensation of heat. He realized that he had premature aging, alopecia, pale yellowish color of skin and his liver function result showed abnormalities in SGPT, TTT and CCFT. Type B ultrasound showed marked dense microwave and typical complex wave. Physical examination at the first visit revealed retraction of margin of liver dullness (3 finger breadth above costal margin) by percussion, and the splenic region was clearly defined. The diagnosis was early stage of cirrhosis of liver, hepatogenic upper respiratory tract infection, hepatogenic peptic ulcer, viral gastrointestinal disease, hepatic osteal malnutrition. After taking TCM drugs for 4 weeks, the clinical symptoms disappeared and re-examination of liver function showed normal results, but at the cessation of drug treatment, the retracted area of liver dullness did not change. After stoppage of medication, he took some TCM drugs at times.
One year later, that was, in 1989, ultrasound again showed comparatively dense microwaves and a few complex waves, but examination of liver function was normal. Physical examination revealed retraction of margin of liver dullness 4 finger breadth above costal margin (i.e. 6 cm) and he also had frequent insomnia, oral ulcerations, repeated exopathy, cough and catarrhal symptoms of the upper respiratory tract. The disease presented many relapses in the following 3 to 4 years and TCM drugs were used to treat the repeatedly occurring symptoms. Under this condition, the margin of liver dullness seemed to have a tendency to improve.
In July 1993, percussion of liver dullness revealed a hepatomegaly of 1.5 cm. After taking 7 parcels of TCM drugs, the liver was normal. He completed a 4 week course of systemic therapy and achieved clinical cure, at which time there was significant subsidence of the symptoms. Observation persisted to January 1995 and no abnormality of the margin of liver dullness was found. Liver function examination also did not show any abnormality.
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Physician’s comment
Clinical examination of this case showed that the patient had retraction of margin of liver dullness for 5 years, the greatest retraction being 4 finger breadth above costal margin (6 cm). After repeated TCM therapy, the margin of liver dullness returned to normal, the last time of relapse was a hepatomegaly of 1.5 cm similar to one of chronic hepatitis. The liver was normal after systemic therapy and through an observation of 2 years, the margin of liver dullness did not show any abnormal change. The patient had a positive antigen of type B hepatitis and abnormal liver function, repeated chronic hepatitis symptoms and significant retraction of margin of liver dullness and type B ultrasound examination showed complex wave and dense microwave, so the diagnosis of active type B hepatitis complicated with early stage of cirrhosis of liver should have no objections. This patient’s liver could return to its normal size by administration of TCM drugs indicated that the superior effectiveness of TCM therapy was a matter of no doubt.
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Case 3: A case of cirrhosis of liver complicated with cholelithiasis in which clinical observation showed that the margin of splenic dullness returned to normal.
Wong (computer no. 2723) female, age 71 years. First visit : December 2001.
An occasional examination of blood revealed that she was a carrier of type B hepatitis virus and her liver function test of GGPT was 155 unit. She was diagnosed as cirrhosis of liver, multiple gallbladder stones and thrombocytopenia in a certain hospital. When she first came to our clinic, her chief complaint was frequent pain of right hypochondrium, repeated dermal pruritus and subcutenous ecchymosises. Her appetite was good and bowel movements normal. She had received gastroscopy for 4 times because of stomache ache and abdominal pain.
Physical examination revealed that the patient was lean and had pale yellowish skin with many pigmentations. She had hypochondriac anomaly showing depression of left hypochondrium, protrusion of hypochondriac angles and marked asymmetry of both hypochondria; percussion tenderness was showed over hepatic region and hepatomegaly of 3 cm was present. There was splenic dullness (3 cm below costal margin) and edema of lower extremities showing a (+) degree and also prominence of veins of these parts.
After taking 3 parcels of TCM drugs, the liver was normal but the splenic dullness was still present. The patient felt tired and had diarrhea 3~4 times a day with abdominal pain. The stools were paste-like and watery. Dermal pruritus alleviated. She continued the TCM therapy, but bowel movements still amounted to 4 times a day, the stools paste-like appearance. Her urine was yellowish and slight pain was present on the right hypochondrium; splenic dullness was detected 3 cm below costal margin. After 9 days of medication, the splenic dullness was 1.5 cm above costal margin and after 18 days, the splenic region was clear on percussion. Later, the clinical symptoms gradually subsided; there was not hepatic pain, dermal pruritus nor edema of lower limbs. She said that her skin was more clean and white, the pigmentations became paler and subcutaneous ecchymoses did not appear since TCM therapy. Systemic TCM therapy lasted for 6 weeks and clinical cure was attained. She was followed up after cessation of medication and was arranged to have re-examination of liver function and hepatitis antigens one month later.
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Physician’s comment
This patient was a carrier of type B hepatitis virus with abnormal liver function and finding of multiple stones in the gall bladder region from ultrasound B examination. She had typical chronic clinical symptoms such as repeated stomache and upper abdominal pain and undergone several times of gastroscopic examinations but no peptic ulcer was found. In one episode, there was mild disseminated gastric mucosal erosion, (viral gastroenteritis).
Physical examination revealed hypochondriac anomaly, enlargement of area of hepatic and splenic dullness, percussion tenderness of hepatic region, repeated subcutaneous ecchymoses, prominent veins and edema of lower extremities. The diagnosis was early stage cirrhosis of liver complicated by cholelithiasis, hypertension of inferior vena cava, subcutaneous hemorrhage from thrombocytopenic coagulopathy, pruritus cutis, hepatic edema. According to TCM chronic hepatic classification, it belonged to the form of wetness-heat vaporization, blockage of channels and stasis of blood and deficiency of liver and kidney form.
The liver was normal after taking 3 parcels of TCM drugs. The patient’s splenic dullness was rather typical but from the beginning to the end, the spleen was not palpable and ascites was not detected. The clinical symptoms disappeared along with the continuation of TCM therapy; the margin of dullness of the enlarged spleen gradually reduce and finally disappeared. The therapeutic result of this case was satisfactory.
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Case 4: clinical observation of a case of cirrhosis of liver repeatedly treated with TCM drugs for nearly 10 years.
Tsui (computer no. 209), male, age 47 years. First visit: 7th August 1993.
His chief complaint was that two years ago, in a blood examination, he was found to have positive type B hepatitis antigen (HbsAg +), and abnormality of liver function (SGPT 532 unit). He had ultrasound B examination in a certain hospital and was diagnosed as cirrhosis of liver. He also had yellowish urine, fatigue, flush of face, and dysphoria with smothery sensation in the five viscera. Physical examination revealed margin of liver dullness 4.5 cm above costal margin. At the time of first visit, his type B hepatitis surface antigen was still positive and SGPT 264 unit.
After taking 9 parcels of TCM drugs, the hepatomegaly was 1.5 cm. Another 12 parcels of TCM drugs were taken and the liver was normal but still SGPT was 339 unit. He took TCM drugs interruptedly. In April 1994, he had type B hepatitis anti-bodies was 91.5 (normal 20).
In August 1994, he had the first relapse of hepatomegaly which was 1.5 cm. After taking 10 parcels of TCM drugs, the liver returned to normal. After this, he took TCM drugs interruptedly. He had liver function tests but no abnormality was found.
In 1997, the second relapse of hepatomegaly occurred. The margin of liver dullness was 1.5 cm below the costal margin (hepatomegaly of 3 cm). He took 10 parcels of TCM drugs and the liver was normal again. He then received systemic TCM therapy in our clinic. In 1998, the liver function test showed, in January to be SGPT 53 unit, in August 55 unit (normal 5-40 unit) and the other examination items were normal.
On 21st July, 1999, the third relapse of hepatomegaly occurred and the liver returned to normal after taking 3 parcels of TCM drugs. In August, he had computer screening in a certain large hospital and was told to have early cirrhosis of liver with abnormal liver function SGPT 254 u/L. He received systemic TCM therapy which completed on 6 December 1999. At that time, the liver function was normal, SGPT 74 unit (normal up to 78 unit). He persisted on TCM therapy for 6 months and then stopped the medication.
The patient was under observation; hepatomegaly and abnormal liver function was not found.
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Physician’s comment
According to data, the diagnosis of this case should be defined as chronic type B hepatitis and cirrhosis of liver. His chronic hepatitis symptoms were not marked, but through 10 years of clinical observation, the margin of liver dullness and liver function tests showed relapses. The patient had three relapses of hepatomegaly during the recent ten years and obtained clinical cure by TCM therapy with satisfactory result. We do not mind taking the trouble to list the details, just hoping people to understand that for early cirrhosis of liver, close observation and timely TCM therapy can stop progression of the disease and avoid aggravation. This patient accepted our clinical advices and adhered to the TCM therapy, so it provided for us precious experiences.
On the first visit, the margin of liver dullness retracted, the lower margin being 3 finger breadth (4.5 cm) above costal margin and it was not sure whether it was the real liver margin or gas inside the lumen of the transversely placed intestine that caused shrinkage of liver dullness. Therefore, in the early stage, we used Cortex Magnoliae Officinalis and Percearpium Arecae Oriental Wormwood decoction to drive out the retained gas in the intestines and to eliminate wetness-heat. A total of 9 parcels of TCM drugs were taken, after which, the liver dullness was detected to be 1.5 cm larger than normal. The patient continued to take 20 parcels of TCM dugs. And the liver eventually became normal. (It was 1993 at that time, the TCM formulae needed more time to achieve shrinkage of liver). The course of treatment was enough to prove that the patient’s liver had no practical reduction.
The three episodes of hepatomegaly afterwards did not reveal the cause of relapse. For the sake of a better therapeutic effect and for the avoidance of relapses the patient persisted in TCM treatment for half a year, but the result was still speculative. Presently he made regular visits and examinations. Besides a rising tendency of blood pressure (160-170/90 mmHg), he had no other discomforts. Blood examination in June 2001 revealed the following results : SGOT/AST 39 u/L; SGPT/ALT 51 u/L, cholesteral 400 (up to 200), cholesterol 227 < 200.
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Case 5: Typical multiple extraheptic clinical manifestations in a case of cirrhosis of liver.
Lee (computer number 261), male, age 64 years.
The patient had history of hepatitis and had his first visit on 27th July, 1986 with the chief compliant of nausea, acid regurgitation, upper abdominal pain and insomnia for seven or eight years. He was once diagnosed as peptic ulcer and neurasthenia and was, for a long time, uninterruptedly treated with gastric drugs and hypnotics.
Physical examination: lean, senile and weak appearance, tongue showing multiple linings and white and thin coating, lower margin of liver 3 cm above costal margin, area of liver dullness only 5 cm. Ultrasound examination of liver and spleen: chronic hepatitis, decreased size of liver, splenomegaly not detected. Liver function test: CCFT (++), gastrointestinal barium meal examination revealed large ulcer in gastric lesser curvature, early stage cirrhosis of liver complicated with hepatogenic peptic ulcer, neurasthenia.
After taking 33 parcels of TCM drugs, the margin of liver dullness was 1.5 cm above costal margin, tongue coating still thin and white, especially at the centre, no tenderness was detected in the upper abdomen. Another 8 parcels of TCM drugs were taken and the enlarged liver was palpable at the costal margin. After taking food at meal time, he experienced belching, heaviness of chest, and right hypochondriac pain. He had gastroscopy examination and gastric biopsy which confirmed the diagnosis of gastric lesser curvature peptic ulcer. He took another 18 parcels of TCM drugs and the liver retracted to 1.5 cm above costal margin. The medication was stopped half a month later.
Four months after cessation of therapy, he made a return visit, saying that he had occasional insomnia and epigastric pain. Percussion showed that the lower margin of liver was 3 cm above costal margin and ultrasound examination revealed mild persisting hepatitis with a 0.1 cm retraction of liver. X-ray barium meal revealed significant reduction of the gastric ulcer. TCM therapy was reapplied and the clinical symptoms gradually relieved and the liver returned to normal. Systemic TCM therapy continued for 6 weeks.
In the following years, he took TCM drugs at times. He had suffered from myocardial ischemia, urinary system infection, post-operative hemorrhage after cystolithectomy and hypertension. He received TCM therapy in the course of these happenings. It had been 10 more years since the administration of systemic TCM therapy and he had no apparent abnormality thereafter. He was now 78 years of age and appeared healthy.
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Physician’s comment
The diagnosis of this case was early stage of cirrhosis of liver, chronic active hepatitis, hepatogenic peptic ulcer, hepatic coagulopaty, hepatic neurastrhenic, hepatocardiac syndrome myocardial ischemia, hypertension, cystolithiasis, urinary system infection. Before systemic TCM therapy, he took gastric drugs for stomache ache and hypnotics for insomnia for a long time. Although this treatment alleviated the symptoms for over 10 years but the liver disease progressed to the early stage of cirrhosis of liver and formation of large peptic ulcer of the gastric lesser curvature. The liver disease began to show relief after TCM therapy and stomache ache and insomnia also improved markedly. Prolonged abnormality of liver function caused dysfunction of many organs, so that, clinically, extra-hepatic diseases appeared in succession.
Through combined TCM and WM treatment the patient’s health condition improved greatly and presently is still in good health. From this, we can see that patients with liver disease can expect recovery of health by combined TCM and WM treatment.
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Case 6: Splenomegaly of patients with cirrhosis of liver treated by systemic TCM therapy cannot recover in a small number of cases
Yeung – (computer no. 490) male, 45 years of age. First visit: January 1986.
He complained that he lived with his father, a vegetable grower, since childhood and suffered from hepatitis together with his elder and younger sisters. His elder sister committed suicide at the age of twenty because of cirrhosis of liver and repeated hematemesis; his younger sister suffered from chronic active type B hepatitis.
The patient was confirmed to have cirrhosis of liver with splenomegaly. He was first treated in our clinic and resulted in a reduction of the area of liver dullness. After taking 32 parcels of TCM drugs the liver dullness returned to normal and clinical symptoms disappeared but splenomegaly was still present, being 3 cm below costal margin. In December 1992, he suffered from tearing of the calf muscles leading to local swelling and pain and he also had subcutaneous hemorrhage over the ankles. Physical examination: liver palpable at the costal margin, spleen felt 3 cm below costal margin. He took 10 parcels of TCM drugs, but the liver did not retract to normal and he stopped the medication by himself.
In May 1993, he made a return visit complaining that he had dizziness and heaviness of head; he felt chilly and had aversion to wind. The liver was found to be enlarged 3 cm. He took 13 parcels of TCM drugs, but sopped the medication when the liver had not returned to normal.
In November 1994, he had a return visit complaining chiefly of right hypochondriac and liver pain and also hepatomegaly of 4.5 cm splenomegly of 4.5 cm. He took 19 parcels of TCM drugs, after which the liver returned to normal while the spleen was still palpable 3 cm below left costal margin. He took TCM drugs for 6 weeks to eliminate wetness-heat of the five zang-organs and six fu-organs.
Afterwards, in June 1995, his emotional condition was affected by familial misfortune and in April 1996, he was attacked by generalized urticaria (causative factor no clear). During these days, he had two relapses of hepatomegaly, each time being 1.5 cm and the spleen was still palpable 3 cm below left costal margin, but through TCM treatment clinical cure was obtained.
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Physician’s comment
This was a typical family in which the “whole family was infected” by type B hepatitis virus. In the three siblings, two had typical symptoms of cirrhosis of liver and the younger sister suffered from chronic active hepatitis complicated with secondary amenorrhea.
This case was found to have reduction of liver size and splenomegaly by ultrasound and also by percussion of liver dullness, typical of cirrhosis of liver. Through systemic TCM therapy, the liver dullness returned to normal and in the following years, the liver enlarged several times, manifesting the activity of chronic hepatitis. The liver returned to normal each time by TCM treatment but the splenomegaly remained unchanged for 10 more years. The latter was palpable at the left costal margin, hard in consistency, the edge clear and without tenderness. It was estimated that the portal hypertension in early cirrhosis of liver caused congestive splenomegaly which afterwards progressed into an irreversible pathological condition. The patient’s first visit was at a comparatively early period in the establishment of our clinic when the concept of systemic TCM therapy had not been formed. So it took 32 days for the liver dullness to return to normal and the patient was not requested to complete a 4-6 week course.
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Case 7: Liver biopsy still implicates the possibility of “operative accident”.
Wong (computer no. 2065), female, age 63 years. First visit: February 2000.
She complained that her several children were carriers of type B hepatitis virus 10 years ago. The patient had coronary heart disease and received cardiac catheterization. Three months ago, she was examined to have positive type B hepatitis virus in a certain large hospital and her liver function was also abnormal. She received liver biopsy; the first operation did not show abnormality, but several days afterwards, the second operation resulted in an accident which was suspected to have hurt the lung, leading to cough, shortness of breath and pulmonary fluid retention, aspiration of the latter revealed large amount of bloody fluid. The diagnosis was said to be fatty liver and cirrhosis of liver. She was hospitalized for 18 days and received 3 parcels of blood for transfusion.
At her visit, she complained of feeling of weakness, dryness of mouth, heaviness of heart, shortness of breath, and uninterrupted coughing. Physical examination: weak constitution, dispirited, appearance of suffering from a chronic and serious disease, tongue enlarged with teeth prints, coating thin and yellowish, (++) pitting edema of lower extremities, marked percussion tenderness of hepatic region, hepatomegaly of 1.5 cm, no dullness over splenic region and no apparent sign of ascites.
After taking 3 parcesl of TCM drugs, the stools became black and large in amount. She had diarrhea 2 hours after each time of taking the drug decoct. But after 3 parcels of TCM drugs, the margin of liver dullness was normal, edema of lower extremities alleviated, coughing disappeared and shortness of breath improved. After another 3 parcels of TCM drugs, her mouth was still dry, abdomen had vague pain of wetness-heat, heaviness of heart and tongue coating disappeared. The lower extremities showed (+) edema. The liver was normal but slight percussion still produced pain. She continued the systemic TCM therapy for totally 6 weeks, after which the clinical symptoms subsided. The patient’s appetite was good and could take a bowl of rice in a meal; her state of mind was good, her breathing smooth, lower extremities (+) edema and bowl movements once a day with formed stools. MRI scan did not show carcinoma of liver; liver transaminase was 70u.
In the following period, she took some TCM drugs and sometimes she felt numbness of fingers and tenesmus but other discomforts were not found. She had the sensation of hunger, her appetite good, tongue still enlarged and lower extremities showing (+) edema. She totally took 107 parcels of TCM drugs and obtained clinical cure and then she was followed up.
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Physician’s comment
This was a typical family in which “the members of the whole family suffered from type B hepatitis. Some of the patient’s children had history of actue icteric hepatitis and several were found in blood examination to have positive type B hepatitis surface antigen. It was not a surprise to find that the patient had positive type B hepatitis surface antigen and abnormal liver function three months ago in blood examination. It might be necessary to perform a liver biopsy, but the accident following the second operation was unexpected.
After discharge from the hospital, the patient’s clinical symptoms were still rather serious, but the effect of TCM drugs was ideal. At the initiation of TCM therapy, the patient passed out large amount of wetness-heat stools, and three days later hepatomegaly disappeared and coughing, shortness of breath, cardiac discomfort and edema alleviated. At the end of 6 weeks of therapy, her condition was good. MRI scan showed no carcinoma of liver and the transaminase was 70 u. On the request of the patient, TCM therapy was continued and a total of 107 parcels were administered; after this, she was followed up.
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Case 8: The symptoms of “wetness-heat vaporization” form and “deficiency of liver and kidney” form in patients with cirrhosis of liver.
Lam (computer no. 2622), male, age 60 years. First visit: August 2001.
The patient complained that he was attacked by acute icteric hepatitis in 1967 and later it turned into chronic hepatitis in spite of TCM and WM treatment. Right hypochondriac pain occurred frequently in 10 more years. In 1988, he had upper abdominal pain which was thought to be gastric illness; but he was later diagnosed as cholesystitis in a hospital. Within 5 years, he received 7 times of endoscopic examination. In 1995, he had the 8th gastroscopy operation which did not reveal any positive findings. He was hospitalized in July 2000 because of anasarca, marked abdominal distension, nausea, constipation, loss of appetite, numbness of tongue, pain of lower jaw, limitation of opening of mouth and spastic convulsion of limbs and he was diagnosed as cirrhosis of liver.
In 2001, he often had to be given enema cleansing of intestines because of constipation and to take for a long time dehydration pills to reduce the ascites until enuresis appeared. In the recent 8 months, he had hoarseness of voice, aphonia, shortness of breath, chicken voice, ozostomia associated with fatigue and sleepiness. He was not satisfied even if he had slept for 12 hours. He was absent-minded and felt that he was listless because of taking dehydration pills for too long a time.
Physical examination revealed an alteration of the patient’s voice pitch, swelling and tenderness of right lower maxillary joint, limitation in opening the mouth, marked abdominal distension, prominent veins over the abdominal wall, but no shifting dullness was detected. His both hypochondria were anomalous and the hepatic region showed percussion tenderness. There were also hepatomegaly of 1.5 cm and (++) edema of lower extremities. Blood examination revealed high transaminase.
After taking 3 parcels of TCM drugs, the liver was normal, the tongue coating became loose, the edema of lower limbs reduced to (+) but the patient still had catarrhal symptoms of nasal discharge, sneezing, cough, dryness of tongue and bitterness of mouth (these might be immune response evoked by virus). He continued the TCM therapy during which time he experienced fatigue, dimness of eyesight, yellowish urine, frequent nocturia, dreamfulness and heaviness of chest. He often had wetness-heat diarrhea one hour after taking decoct. There was still pain of the inferior maxillary joint on opening the mouth. After 3 weeks of TCM medication, the tongue coating detached entirely, edema of lower extremities was (+) and it totally disappeared after 4 weeks. The blood pressure was 100/70 mmHg; the tongue was clean.
After 6 weeks of therapy, blood examination revealed normal liver function. He felt painful when the mouth opened a bit too wide but its opening was not limited. The knee joints were weak, sore and not comfortable when going up and down the stairs. He took TCM drugs for 5 months totally; dryness of mouth alleviated and there was no more nocturia. Re-examination by ultrasound gave normal results and liver function by blood examination was normal. Type B hepatitis antigen test was negative (not infective). There were small stones in the gall bladder. The patient took TCM drugs from time to time.
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Physician’s comment
This patient had 30 years history of liver disease, the clinical symptoms of which were chiefly of the wetness-heat vaporization and deficiency of liver and kidney forms. The wetness-heat vaporization form symptoms and the diseases produced were prolonged hepatic peptic ulcer, viral gastroeuteritis, tympanites, hepatic edema, chronic cholecystitis and cholelithiasis. In the deficiency of liver and kidney form, the chief manifestations were hepatic osteal malnutrition, redness, swelling, hotness and pain of right lower maxillary joint, limitation of mouth opening, dysphagia, soreness and weakness of both knee joints causing marked pain in going up and down stairs.
Physical examination of the patient revealed hepatic anasarca, marked tympanities but shifting dullness and splenomegaly was not detected. When systemic TCM therapy began, elimination of heat and excretion of wetness was a rather obvious response. Besides upper respiratory catarrhal symptoms produced by immune response from the setting free of virus during the initial period of TCM treatment, in the comparatively long period of TCM drug administration, there was wetness-heat diarrhea following taking TCM drugs, and, if severe, the number of bowel movements would be several times daily and the urine might be tea coloured and turbid. There was occasional constipation due to large intestine heat, nocturnal drinking and thirst and also migraine. These symptoms were caused by fire in the lung, liver and large intestine, but they gradually subsided with the continuation of TCM therapy.
In this case, the diuretics were stopped at the beginning of TCM treatment. This indicated that the effect of TCM drugs in elimination of edema was ideal; the anasarca disappeared after 3-4 weeks. Redness, swelling, tenderness of the lower maxillary joint and limitation in opening the mouth, all these arthritis symptoms, did not require the use of anti-inflammatory drugs, analgesies or hormonal agents, but through administration of TCM drugs, they were clinically cured.
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Written by WONG Kwok Hung in 2002 Translated by Professor ZHENG Hua En in May 2006
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