Name: Gong.

Sex: Female.

Age: 42 years.

Occupation: A self employed transportation person.

Chief Complaint: Recurrence of hepatic hemangiomatosis for 3 months after lobectomy of liver.

History of Present Illness: Three years ago, the patient found that there were some size-varied hemangiomas in her liver through physical examination. At that time, it wasn't accompanied by other symptoms. After being treated in local hospitals for almost half a year, it was affirmed as a rule that no drug could cure this illness, only by operation, could it be healed. Then she had to accept an operation named as "lobectomy of liver" 2 years ago in a hospital. After the operation, reexaminations of ultrasonogram B showed that most of the hepatic hemangiomas had been resected, only 3 little hepatic hemangiomas scattered in the right lobe. Additionally, there was not uncomfortable sensation any more. Then she considered the illness had been healed completely. 3 months ago, she slowly got a distending-pain in the right inferocostal region, accompanied with chest oppression, shortness of breath, fatigue and lassitude. Then she went to hospitals again and it was found that there were 9 size-varied hepatic hemangiomas in the right lobe. It was diagnosed as ¡°Recurrence of Hepatic Hemangiomatosis. "After consultation of physician and surgeon, it was still considered that no drugs could cure this illness. Furthermore, the patient herself lost any faith in operation. Then she came here for treatment on January 8,1999 through somebody.

Physical Examination: The patient was conscious with a fresh red complexion. She was fat. The pulse was thready and uneven, the tongue was dark red with a thin layer of white fur. HR was 88beats/min. No murmur could be heard. The respiratory sounds were harsh, no rale could be heard. The abdomen was soft and flat. There was slight tenderness in the right inferocostal region. The liver and the spleen could not be palpated in the both inferocostal regions. There was not other abnormal sign.

Examination of Multicoloured Ultrasonogram: It showed there were 9 masses of high echo in the right lobe of liver, size of the biggest one was 2.2cm¡Á2.lcm, diameters of the others were all from 0.5cm to 1.5cm. All these signs indicated it was hepatic hemangiomatosis.

Diagnosis: Hepatic Hemangiomatosis.

Differentiation: This disease, in TCM, belongs to the category of "GanZhengJia"(hepatic mass). It's syndrome of qi stagnation and blood stasis in liver. The liver's attribute is Yin wood according to the Five element theory of TCM, it controls the dipersive effect of the body. Under normal conditions, the liver promotes the functional activities of the monarch fire and restrains the functionless activities of the dampness-soil. However, there had been stagnation of liver qi and stasis of liver blood. So that the liver couldn't promote the functional activities of the heart and there was deficency of heart-qi, then the patient got the chest oppression and shortness of breath, furthermore, the liver couldn't restrain the functionless activities of the spleen too, then the pathogenic dampness phlegm was accumulated in the body and the patient got much fat, fatigue and lassitude. This case should be treated with some qi-activating drugs and some blood-circulation activating and blood stasis removing drugs at the beginning of the sickness, unfortunately, it was treated by the operation. Although it got a success at that time, actually, it left a harm for the future. For cutting and severing couldn't activate qi and remove blood stasis, it could only hurt the collaterals of liver. So that not only the original stagnation hadn't been removed; but also the new stasis had been caused. It was just the reason why the illness came back again.

Therapeutic Principle: Striking the blood stasis to exterminate the masses, activating the stagnant liver qi and invigorating spleen-qi, eliminating the pathogenic dampness-phlegm.

Recipe:

ZhiHuangQi, Moxa-prepared Milkvetch Root 30g

DangGui,Chinese Angelica Root 12g

WuLingZhi,Trogopterus Dung 15g

DiBieChong,Ground Beetle 3g

XiangFu,Nutgrass Flatsedge Rhizome 9g

ChaiHu,Bupleurum Root 8g

ShuiZhi, Leech 3g

WuZhuYu,Evodia Fruit 5g

GanJiang,Dried Ginger 9g

ZaoJiaoCi,Chinese Honeylocust Spine 15g

XiaKuCao,Prunella Spike 25g

DanNanXing,Arisaema with Bile 3g

DanShen,Red Sage Root 30g

WuGong, Centipede 2g

YuanHu,Corydalis Tuber 8g

HuangQin,Scutellaria Root 9g

All the above drugs were to be decocted in water for oral taking. 15 doses were prescribed. Greasy and hot food was forbidden. In addition, she should take the capsule for wrecking mass. Recipe :

A' Wei, Asafetida

HuPo, Amber

(Each herb was taken just the proper amount. )

All the above drugs were to be ground into powder. She should mix the powder together and then fill the powder into the large-sized capsules. She should take 2 pieces each time, twice a day. At the same time, she was told to begin having exercise, more than 30 minutes each time, twice a day.

Effect Observation: After 15 days' treatment, the patient came back for reexamination on January 23, 1999. She told me she became energetic. Before the treatment, she ususlly got asthma and chest oppression as she was running upstairs to the 2nd floor, but now, she could easily run upstairs to the 6th floor without asthma and chest oppression. Physical examination showed her complexion became pinkish, the pulse was thready and uneven, the tongue was light red with a thin layer of white fur. All these signs indicated the used prescription was suitable for the illness, so that the original treatment should be continued. Because the pathogenic dampness phlegm had been greatly eliminated, so that the key point of the treatment should be striking blood stasis and exterminating the mass.

Recipe:

ZhiHuangQi, Moxa prepared Milkvetch Root 30g

DangGui,Chinese Angelica Root 12g

DangShen,Pilose Asiabell Root 30g

DiBieChong,Ground Beetle 5g

DanShen,Red Sage Root 30g

QiangLang,Dung Beetle 5g

YuJin,Curcuma Root 15g

JiNeiJin, Membrane of Chicken' s Gizzard 18g

XiangFu,Nutgrass Flatsedge Rhizome 9g

ChaiHu,Bupleurum Root 8g

DiLong, Earthworm 12g

BaiJiangCan,Batryticated Silkworm 12g

ShuiZhi, Leech 5g

XiaKuCao,Prunella Spike 25g

ZhiGanCao,Prepared Liquorice Root 12g

All the above drugs were to be decocted in water for oral taking. 20 doses were prescribed. Dietetic restraint and exercise were idem, taking the capsule for wrecking mass continuously.

After taking the decoction, the patient came back for reexamination on February 12,1999. She told me there was no uncomfortable sensation on her. Reexamination of multi-coloured ultrasonogram showed there were 2 hemangiomas in the right lobe of liver, the size of the bigger one was 2.2cm¡Á2.0cm, the size of the smaller one was 0.3cm¡Á0.5cm. There wasn't other abnormal sign. All these signs indicated the treatment was predominantly effective, for the original 7 hemangiomas among the 9 hemangiomas had been removed. Physical examination showed the pulse was thready and soggy. The tongue was pale with a thick layer of white fur. It indicated the blood stasis in liver had been mostly removed, while spleen-Yang was so deficient that the pathogenic water-dampness couldn't be effectively eliminated. Then the original treatment should be continued with some middle warming drugs.

Recipe:

ShengHuangQi,Raw Milkvetch Root 30g

DangGui,Chinese Angelica Root 10g

DangShen,Pilose Asiabell Root 30g

FuLing, Tuckahoe 25g

GanJiang,Dried Ginger 9g

ZhiFuZi,Prepared Aconite Root 8g

WuZhuYu,Evodia Fruit 6g

ShuiZhi, Leech 5g

DiBieChong,Ground Beetle 5g

QiangLang,Dung Beetle 5g

YuJin,Curcuma Root 15g

JiNeiJin,Membrane of Chicken's Gizzard 15g

BaiJiangCan,Batryticated Silkworm 12g

DiLong, Earthworm 12g

ZhiGanCao,Prepared Liquorice Root 12g

All the above drugs were to be decocted in water for oral taking. 10 doses were prescribed. Dietetic restraint and exercise were idem, taking the capsule for wrecking mass as before.

After taking the 10 doses, the patient came back for reexamination. The pulse was thready and soggy. The tongue was red with a thick layer of white fur. There wasn't other complaint. Reexamination of multi-coloured ultrasonogram showed only one hemangioma was there. Its size was 2. 2cm¡Á2.0era. It was at the top of the right lobe of liver. The other hemangioma had disappeared. In view of the last hemangioma's position was under the diaphragmatic surface, at the top of the right lobe of liver and was nestling closely to the Glisson's capsule, the flowing of qi and blood couldn't easily reach there, so that the efficacy of oral taking decoction couldn't easily reach there either. Then oral taking decoction should cooperate with acupuncture and moxibustion to lead flowing of qi and blood to the last hemangioma, by such way, maybe could the inveterate mass, which hid deeply and separately, be removed. Because the pulse and the tongue indicated the Yangqi had been invigovated, while spleen was deficient and there was retention of pathogenic dampness-phlegm. Then it's necessary to change the above prescription to invigovate spleen and eliminate the pathogenic damp phlegmmore effectively.

Recipe:

ShengHuangQi,Raw Milkvetch Root 30g

DangGui,Chinese Angelica Root 10g

DangShen,Pilose Asiabell Root 30g

FuLing, Tuckahoe 25g

ZeXie,Oriental Water Plantain Rhizome 15g

YiYiRen,Coix Seed 25g

ShuiZhi, Leech 5g

DiBieChong,Ground Beetle 5g

QiangLang, Dung Beet le 5 g

YuJin,Curcuma Root 15g

JiNeiJin,Membrane of Chicken's Gizzard 15g

BaiJiangCan,Batryticated Silkworm 12g

DiLong, Earthworm 12g

ChaiHu,Bupleurum Root 9g

ZhiOanCao,Prepared Liquorice Root 8g

All the above drugs were to be decocted in water for oral taking. 20 doses were prescribed. Dietetic restraint and exercise were idem, taking the capsule for wrecking mass continuously. In addition, point injection and moxibustion with medicinal cake were used. I mixed 4ml of injection of HuangQi(Milkvetch Root) with 2ml of injection of DangGui (Chinese Angelica Root) together,and injected 6ml of the mixed liquid into the points of Riyue(GB24 ) ; Zhangmen ( LR 13 ) ; Qimen ( LR14 ) separately, 2 ml each point, once every other day. The prescription of the herb cake was as follows:

DingXiang, Cloves 20g

XiaoHuiXiang,Common Fennel Fruit 20g

HongHua, Safflower 30g

ChuanXiong,Chuanxiong Rhizome 30g

ChuanWu,Sichuan Aconite Root 50g

CaoWu,Wild Aconite Root 50g

All the above drugs were to be ground into fine powder, the powder were mixed with some water and flour to make herb cake which was as big as a coin, putting the herb cake onto the 3 points to have moxibustion with medicinal cake, 25 pieces of moxa cones were used each time, twice a day, in morning and evening separately.

After 20 days of the above treatments, reexamination of multi-coloured ultrasonogram showed the hemangioma in the right lobe of liver became wedge-like, the upper part of the hemangioma was big while the lower part of the hemangioma was sharp, its size was 2.0cm¡Á1.8cm. There wasn't discomfort any more. Her complexion became ruddy and lustrous, the body became well-proportioned. Her delayed menstruation and dysmenorrhea which had existed for many years had disappeared too. All these signs showed the stagnation of liver had been removed mostly. If I still continued striking the last hemangioma with attacking drugs for many days, the healthy qi would be hurt sooner or later. Then it's necessary to make pills to remove the hemangioma slowly. And the patient was told to continue taking exercise and have moxibustion with medicinal cake. The prescription of the pills was as follows:

ZhiHuangQi,Moxa prepared Milkvetch Root 30g

DangGui,Chinese Angelica Root 10g

DangShen,Pilose Asiabell Root 30g

YiYiRen,Coix Seed 30g

ShuiZhi, Leech 5g

ZaoJiaoCi,Chinese Honeylocust Spine 5g

QiangLang,Dung Beetle 5g

DanShen,Red Sage Root 30g

DiBieChong,Ground Beetle 5g

ChaiHu,Bupleurum Root 10g

XiangFu,Nutgrass Flatsedge Rhizome 8g

Wugong, Centipede 3g

BaiShao,White Peony Root 18g

FangFeng,Ledebouriella Root 10g

ZhiganCao,Prepared Liquorice Root 10g

Two doses were prescribed. All the drugs were to be ground into powder and mixed with some water to make pills. She was told to take 8g of the pills each time,3 times a day. After 2 years' follow-up, the illness didn't recur. Then it's ending.