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Abstract: The patient had recurrent abdominal distension for 8 months with a recurrence of 1 week. He had recurrent abdominal distension, scanty urination, and enlarged abdominal circumference due to heavy alcohol consumption, with dizziness and discomfort, peripheral heaviness, bilateral lower extremity edema, low urine volume, loose stools, pale tongue, white greasy coating, and smooth pulse. On the basis of Western medicine to protect the liver and lower enzymes, combined with Chinese medicine to identify the evidence of cold and dampness trapped in the spleen, we used Shizhi Spleen Drink plus reduction to warm the middle of the spleen, strengthen the spleen, move Qi and promote water, and obtained better results.
Basic information】Female, 84 years old
Type of Disease】Cold-dampness trapped in the spleen
Hospital】The First Affiliated Hospital of Nanchang University
Date of consultation】May, 2020
Treatment plan】Oral and injectable medications (reduced glutathione tablets + vitamin B tablets + compound glycyrrhizin tablets + human albumin) + Chinese herbal soup treatment (Dagongpi + Cao Guo Ren + dry ginger + Mu Xiang + Hou Pu + Bai Zhu + Poria + Mu Gua + Dagong Zi + Made of Euphorbia + Ginger + Licorice + Yin Chen + Da Huang + Coix Seed + Mudan Pi + Yu Jin + Chicken Nei Jin)
Treatment Period】Outpatient treatment for more than 1 month
Treatment effect] Improvement of ascites
I. Initial consultation
Grandma Xiang, aged 84, was admitted to the hospital with recurrent abdominal distention for 8 months and recurrence for 1 week. After drinking a lot of alcohol 8 months ago, the patient developed abdominal distension and urine loss at home, and cirrhotic ascites was detected. This time, after drinking alcohol 1 week ago, he again developed abdominal distension, low urine output and increased abdominal circumference, accompanied by dizziness and discomfort, body heaviness, bilateral lower limb edema, low urine output, loose stools, light tongue, white greasy coating and smooth pulse. On examination, the abdomen was found to be enlarged, the liver was not reached under the ribs, the spleen was 2 fingers below the ribs, the mobile turbid sound was positive, and the bilateral lower extremities were moderately depressed edema. Ancillary CT examination revealed cirrhosis with portal hypertension, splenomegaly and ascites, nodular dense shadow in the lower esophagus, small stones and cysts in the right kidney, and gallbladder stones with cholangitis. Therefore, Western medicine diagnosed alcoholic cirrhosis with loss of compensation, ascites, portal hypertension and splenomegaly, and Chinese medicine diagnosed cold and dampness trapped spleen evidence.
II. Treatment history
Western medicine gave reduced glutathione tablets for liver protection and vitamin B1 tablets for symptomatic treatment, while limiting water and sodium intake. The patient’s TCM diagnosis was cold-dampness trapped in the spleen, and the treatment chosen was to warm the middle of the body, strengthen the spleen, and move Qi and water. The prescription was given for Dagongpi, Cao Guo Ren, Gan Jiang, Mu Xiang, Hou Pu, Bai Zhu, Fu Ling, Mu Gua, Dagong Zi, Shu Zi, Ginger and Licorice.
The patient’s follow-up examination in 1 week indicated that abdominal distension was present, urine volume was low, coldness was reduced, swelling of both lower limbs was reduced, the body and eyes were gradually yellowed, stools were dry, liver function was checked ALT: 190U/L, AST: 169U/L, ALB: 29g/L, γ-GT: 901U/L, TBIL: 108μmol/L, compound glycyrrhizin tablets were given to lower enzymes, human albumin was given intravenously, and at the same time, the original prescription was supplemented with Yin Chen and Da Huang Zi. The patient was given compound glycyrrhizin tablets to lower enzymes and intravenous human albumin, while adding Yin Chen and Da Huang to the original formula.
At the third consultation in 2 weeks, the swelling of both lower extremities was no longer obvious, abdominal distension was reduced, urine output was acceptable, fatigue and dizziness were reduced, the yellowish staining of the body and eyes was not aggravated, the stool was clear, the tongue was light, the moss was yellowish and greasy, the pulse was smooth, and the liver function was basically stable. On the fourth consultation, the patient’s abdominal distension was relieved, urine output was still acceptable, the yellowish staining of the body and eyes was no longer obvious, the yellowish coating of the tongue was seen to have melted, the stool was clear, and the food intake was slightly poor.
Treatment effect
In this formula, the spleen drink is made up of Radix et Rhizoma Pseudostellariae and Ginger, which warm the Yang of the spleen and kidneys, and the large abdomen bark, Mu Xiang, Hou Pu and Cao Guo Ren, which move Qi, dampness and water, and Poria and Atractylodes, which strengthen the spleen and dry dampness. The jaundice appeared in the course of treatment, which was considered to be caused by cold and dampness in the liver and gallbladder, and derangement of drainage, and was strengthened with Yin Chen to warm the yang and remove dampness. Jaundice is a disease of the liver and spleen, and the formation of ascites is also in the liver and spleen, so the treatment does not leave the liver and spleen, that is, the so-called real spleen, some experts advocate real spleen to clear dampness and heat, so that the qi is smooth and the liver and spleen are self-regulating.
IV. Notes
We are glad that after treatment, the patient’s discomfort has been relieved. Patients are very prone to anxiety and negative emotions due to the lingering ascites, therefore, patients should not only have confidence in the treatment, actively cooperate with the treatment, as well as appropriate psychological intervention when necessary to help the recovery of the disease. For patients with cirrhosis, the prohibition of alcohol is the most important thing, the patient in this case is a long-term addiction to alcohol and drink again and lead to the relapse of the disease, once the ascites, the diet should be limited sodium intake, can eat high vitamin food, reasonable supplement protein and calories. Long-term cirrhotic patients are prone to esophageal varices, so they should try to eat soft and easy-to-digest food, avoid hard and rough food, and pay attention to the monitoring of weight and abdominal circumference after discharge.
V. Personal insight
In this case, the patient presented with lower limb swelling and ascites, which is considered by TCM to belong to the spleen. Under physiological conditions, after water and grain enter the stomach, the spleen can transport and transform it into qi and fluid, which is then distributed through the large and small intestines and the bladder to facilitate gasification and discharge. If water-dampness flows in the skin of the couples, it will be swelling, and if it overflows or is retained in the internal organs, chest and abdomen, it will be phlegm and water-drink. Therefore, the root of the solution lies in the spleen and stomach, by strengthening the spleen and benefitting the qi, improve the spleen, stomach down the transport function, so that the body of water and damp transport smooth, life is commonly used to regulate the qi and strengthen the spleen mainly to sweet and warm qi products, such as Chen Pi, Mu Xiang, sand, spleen and damp products, such as barley, lentils, yams, gorgonians, etc., caution with bitter cold laxative damp products, so as to avoid the retention of damp.