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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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