Hepatocirrhosis is the final outcome of diffuse inflammation
of the liver, degeneration and necrosis of the hepatic cells and proliferation
of fibrous tissue induced by various causes. Of the causes of the disease, posthepatitic
cirrhosis is the most common one, second ones are the cardiac, biliary and alcoholic
cirrhosis. Nodular cirrhosis is closely related to liver carcinoma. In TCM, this
disease is included in the categories of "gan yu" (stagnation of liver-qi),
"zheng ji" (mass in the abdomen), "pi kuai" (hepatosplenomegaly),
"gu zhang" (tympanites), etc.
Main Points of Diagnosis
1.
Compensatory Phase: Clinical manifestations include fatigue, loss of appetite,
nausea, abdominal fullness and other symptoms of digestive tract. Slight edema
and bleeding tendency may be present due to reduced liver function. The findings
of physical examination are mild hepatomegaly with slight hardness, splenomegal,
spider nevi and liver palms.
2. Decompensatory Phase
(1) Portal hypertension
syndrome: Splenomegaly with hypersplenism, esophageal and gastric fundal venous
varices which may result in hemorrhage of the upper digestive tract.
(2) Impaired
liver function syndrome: Fatigue and symptoms of the digestive tract are aggravated,
low fever, jaundice, edema and ascites are often present. Patients may have eminent
bleeding tendency, darkish complexion and endocrine disorder. In severe cases
complications such as hemorrhage of the upper digestive tract and hepatic coma
may take their place.
3. Laboratory Examination
(1) Liver function test:
It is found that icteric index has increased, A/G Ratio decreased or reversed,
?-globulin increased. Flocculation-turbidity test presents a positive; SGPT, transpeptidase
and MAO, too elevated. The prothrombin time is often elongated.
(2) Ultrasonography
(A and B Mode), liver scan, CT scanning and liver puncture are helpful in confirming
the diagnosis and type of the disease. They are also valuable in differentiation
from other liver disease such as hepatic carcinoma and liver abscess.
Differentiation
and Treatment of Common Syndromes
1.Stagnation of the Liver-Qi and Deficiency
of the Spleen
Main Symptoms and Signs: Anorexia, abdominal distress and distension,
vague hypochondriac pain, lassitude and fatigue, or nausea and loose stool, whitish
coating of the tongue, and taut pulse.
Therapeutic Principle: Relieving the
depressed liver-qi and invigorating the spleen, promoting blood circulation to
remove blood stasis.
Recipe: Modified Ease Powder.
bupleurum root
Chinese
angelica root
white peony root
white atractylodes rhizome
poria
cyperum
tuber
finger citron
red sage root
chicken's gizzard
prepared licorice
root
All the above herbs are to be decocted in water for oral administration.
Besides, 10 grams of atractylodes rhizome and 10 grams of magnolia bark ought
to be administered for the case with thick coating f pathogenic dampness; 12 grams
of codonopsis root and 12 grams of wolfberry fruit administered for the case with
obvious fatigue.
2. Obstruction of the Liver-Blood
Main Symptoms and Signs:
Hepatomegaly and splemomegaly, twinge or distress in the hypochondrium, distension
of the abdomen, anorexia, dim complexion, or accompanied with spider nevi and
liver palms, deep-red tongue or with ecchymoses, taut and thready pulse.
Therapeutic
Principle: Promoting blood circulation to remove move blood stasis, softening
hard hepatosplenomegaly to remove obstruction in the liver-channel.
Recipe:
Modified Decoction for Removing Blood Stasis.
Chinese angelica root
red
sage root
peach kernel
safflower
curcuma root
bupleurum root
green
tangerine peel
fresh-water turtle shell
pangolin scales
oyster shell
white
atractylodes rhizome
prepared licorice root
All the above herbs are to be
decocted in water for oral administration.
In addition, the administration
of codonopsis root 2g and astragalus root 15g is for patients with symptoms of
deficiency of qi; dried rehmannia root 12g and dendrobium 10g for patients with
manifestations of impairment of yin.
3. Retention of Water within the Body
Main Symptoms and Signs: Tympanites which is firm and full when pressed, epigastric
distress, anorexia, scanty urine, red tongue, taut and thready pulse.
Therapeutic
Principle: Regulating the flow of qi to induce diuresis, removing blood stasis
to soften hard hepatosplenomegaly.
Recipe: Modified Stomach Decoction with
Poria.
atractylodes rhizome
white atractylodes rhizome
magnolia bark
poria
umbellate
pore lungus
water-plantain tuber
shell of areca nut
plantain seed
(wrapped in a piece of cloth for decoction)
aucklandia root
red sage root
fresh-water turtle shell
peach kernel
prepared licorice root
All
the above herbs are to be decocted in water for oral administration.
If the
case is complicated with deficiency of the liver-yin and kidney-yin marked by
abdominal distension with dry mouth and lips, hot sensation in the palms and soles,
deep-red pulse, the treatment should be concentrated on nourishing the liver and
kidney, and nourishing yin and inducing diuresis. The modified Decoction for Nourishing
the Liver and Kidney is preferable for the very treatment. The compositions are:
glehnia root 100g, ophiopogon root 10g, dried rehmannia root 15g, wolfberry fruit
12g, umbellate pore-fungus 15g, water-plantain tuber 15g, poria 15g, tale 12g,
oyster shell 30g, red sage root 15g, fresh-water turtle shell 15g. All the herbs
are to be decocted in water for oral administration.
Dr. Ming's TCM Medical
Center,
Hua Xi Xiao Yuan, Hutian Developing Area,
Huaihua city, Hunan province
China