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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, ¦Ã-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.
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