Case 1: He××, female, 67 years old, housewife. initial diagnosis on Feb. 3, 2007
Complaint: History of cirrhosis for 5 years, abdominal distension, low urine for more than 3 months, abdominal distension as large as a drum, with cough for 1 week.
History: The patient was diagnosed in 2002 with wasting, weakness, and oliguria, abnormal liver function, antinuclear antibody 1:400, antimitochondrial antibody (+), IgG 1980 mg/dl. ultrasound indicated: cirrhotic ascites. He was diagnosed with autoimmune hepatitis and primary biliary cirrhosis. He was hospitalized 3 times for cirrhotic ascites and treated symptomatically with liver-protective diuretics. Later, the patient had recurrent ascites, intermittent oral hepatoprotective diuretics and herbal tonics, etc. He came to the clinic on February 3, 2007, with cold, cough, yellow mucous sputum, slight asthma for 1 week, accompanied by abdominal distension, low urine, low sodium, constipation, no fever, no abdominal pain. Liver function was abnormal, A/G, 34.2 g/L /35.6 g/L, ALT33.6 u/l, AST45.2 u/l, g-GT428.6 u/l, ALP361.4 u/l, TBIL16.4 umol/L, liver and biliary ultrasound suggested cirrhosis, massive ascites. Physical examination: clear consciousness, thin body, bone loss, extreme exhaustion, coarse respiratory sounds in both lungs, no dry rales, occasional sputum, abdomen distended like a drum, ascites sign (＋＋＋＋), thin limbs like wood, no edema in both lower limbs, red tongue, thin yellowish greasy coating, thin and smooth pulse. The diagnosis is bulging and coughing and wheezing. The evidence belongs to cough and asthma due to lung-heat, failure to promote and descend, spleen deficiency and internal stagnation of water-dampness. Treatment: To clear lung-heat, strengthen the spleen and relieve dampness, prescription: roasted mulberry peel 10g, guavas 15g, orris 10g, roasted ephedra 5g, almond 10g, raw gypsum 15g, scape bark 10g, fried lycopodium 10g, raw rhubarb 5g (later), thick park 10g, hedgehog shell 10g, big belly skin 15g, fried betel nut 10g, poria 15g, poria 15g, atractylodes 15g, zedoary 15g Decoction with water: one dose daily, divided into morning and evening. Combined with Western diuretics Antiseptic 60mg Bid, Furosemide 20mg Bid. After taking 5 doses, the patient’s cough was relieved, a small amount of white sputum was coughed up, no wheezing, stool was passed, urine output increased significantly, and abdominal distension was reduced significantly. Cui Li’an, Department of Hepatobiliary Medicine, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine
Analysis: Ascites in liver cirrhosis is classified as “bulging” in Chinese medicine, also known as “water compulsion”, “compulsion swelling”, “spider compulsion “, “single abdominal compulsion” and so on. The medical practitioners of the past generations regarded the bulge as one of the four persistent diseases of “wind, consumption, drum and diaphragm”, which is difficult to treat. The cause of this disease is mostly due to the lack of alcohol and food, emotional and moral injury, insect poison infection and jaundice, accumulation of delayed and become, and the main cause is the deficiency of vital energy and lack of qi and blood. The mechanism of the disease is injury to the liver, spleen and kidneys, and the accumulation of qi, blood and water, resulting in the abdomen becoming enlarged and bulging. Due to the dysfunction of liver, spleen and kidney, the deficient organs become more and more deficient, the Qi, blood and water are congested in the abdomen, the water-dampness does not transform, the real one becomes more and more real, so the original deficiency and the symptoms are real, and the deficiency and reality are mixed. The patient has advanced cirrhosis, stubborn ascites, recurrent attacks, extreme exhaustion, thin limbs like firewood, only abdominal distension as large as a drum. According to Chinese medicine, “the real situation has win-like symptoms, and the deficiency has a Sheng-li syndrome”. The patient’s weakness is so extreme that he feels external evil and shows the manifestation of Sheng-li syndrome, such as coughing and wheezing, yellow sputum, ascites and constipation. Therefore, the Chinese medicine diagnosis of this deficiency and the symptoms of the deficiency of the body for a long period of time, external cough, abdominal distension such as drums for the symptoms of the real, treatment should not be seen in the long-standing failure of the disease simply to be supplemented and the emergency is to treat the symptoms, according to the “Nei Jing” “open the door of the ghost, clean the house, remove the Ivana Chen s” treatment principle, to be roasted mulberry peel, Gua Pou, ephedra, almonds, etc. to clear the heat of the lung, to Fu Ling, white atractylodes, large abdominal bark, thick. The treatment was based on the principle of “open the demon gate, cleanse the house, and remove the Heterophyllous Chen’s s” in Nei Jing.
Case 2.
Ma ××, male, 45 years old, worker. initial diagnosis on June 8, 2005
Complaint: Hepatitis B virus carrier for 15 years, cirrhosis for 2 years, abdominal distension, urinary insufficiency, yellow urine and weakness in recent January.
History: Hepatitis B cirrhosis for 2 years, history of alcohol consumption for more than 20 years. Two years ago, he was hospitalized in our hospital due to malaise, yellow urine, abnormal liver function and cirrhotic ascites. Later, he was hospitalized again for ascites. He came to our hospital on June 8, 2005, and felt bloating, low urine, yellow urine, weakness, and loose stools for 1 month, and had abnormal liver function tests, A/G, 28.0/34.6 g/L, ALT 53.7 u/l, AST 64.2 u/l, .TBIL 44.7 umol/L, five items of hepatitis B “1, 4, 5 “positive, HBV-DNA <1000, hepatobiliary ultrasound, cirrhosis, ascites formation, splenomegaly. Physical examination, clear consciousness, dawn black face, dilated facial capillaries, visible liver palm, distended abdomen like a drum, mild edema of lower extremities, dark red and fat tongue, fissured tongue, thin and moist moss, sunken and slow pulse. The diagnosis of bulging is due to residual evil of damp-heat, spleen deficiency, dampness, heat, phlegm, stasis, and internal stagnation of water and dampness. The treatment is to strengthen the spleen, relieve dampness and activate blood circulation to resolve blood stasis. Prescription: Yin Chen 30 g (posteriorly), Fu Ling 30 g, Bai Zhu 15 g, Ze Di 30 g, Pig Ling 15 g, Cinnamon 10 g, Che Qian Zi 20 g, Gua Zhu Pi 30 g, Scapularia 10 g, Fang Qi 15 g, Sheng Huang Qi 30 g, Sheng Oyster 30 g (first decoction), Roasted Turtle A 15 g (first decoction), Curcuma 15 g, Ze Lan 30 g, Lycopodium 20 g, Roasted Licorice 10 g, Pumping Gourd 30 g, with The patient's ascites disappeared and liver function improved significantly, with A/G 36.5/31.9, AG 33.3, AST 58.1, Tbil 25.8, γ-GT 50.4, AKP 97.4. Afterwards, the patient insisted on taking the medication for 2 years, with regular laboratory tests and follow-up for 4 years. Liver function was stable, no further ascites and no further hospitalization.
Analysis: Liver cirrhosis ascites is one of the most common complications of liver cirrhosis, which belongs to the category of “bulging” in traditional Chinese medicine, with complex, lingering and recurrent disease, and is a clinically intractable disease, seriously affecting patients’ quality of life. In China, hepatitis B virus is the main cause of chronic hepatitis and cirrhosis ascites, and the pathological mechanism of ascites formation is portal hypertension, hypoproteinemia, excessive lymphatic fluid production, secondary aldosterone increase, antidiuretic hormone increase, insufficient effective circulating blood volume, infection induced, etc. can cause excessive retention of water and sodium and ascites formation. In Chinese medicine, the pathogenesis is considered to be dysfunction of the liver, spleen and kidneys, with stagnation of qi, blood stasis, phlegm, and water and drink in the abdomen. As the ancient physician Yu Jiayan said in his treatise on the law of the medical profession and the disease of flatulence, “The disease of flatulence is also no different from water retention, gas stagnation and blood stasis.” The evidence is a deficiency of the root and the symptoms are real, and the deficiency is mixed with the real, so in the treatment process, do not attack too aggressively, but should target the disease mechanism, taking into account the symptoms and the root, taking care of the spleen and stomach. This patient had chronic hepatitis B for many years, which, together with a long history of alcohol consumption, aggravated liver damage and developed into cirrhosis. Chinese medicine identified spleen deficiency and dampness, so the main treatment is to benefit the qi and spleen, and to benefit the dampness, with Wu Ling San plus Sheng Huang Qi and Fang Qi to benefit the qi and strengthen the spleen, and to transform the qi and move the water. According to the principle of “treating water first and treating qi, qi moves and water is self-controlled” and “qi moves blood, qi stagnates blood stagnation”, add raw astragalus, lycopodium, curcuma longa, zelenium, raw oyster, roasted turtle nail, etc. to replenish qi, move qi, invigorate blood, soften blood to promote blood movement, blood movement is In addition, we add Gua Pao and Scapularia scabra to promote the lung, dissolve phlegm and open up the upper source of water. The whole formula works to benefit Qi, strengthen the spleen, relieve dampness, and activate blood circulation to resolve blood stasis.