Hepatocirrhosis (cirrhosis) is the irreversible end result of the fibrous scarring and hepatocellualr regeneration that consti-tute the major responses of the liver to a variety of longstand-ing inflammatory, toxic, metabolic, and congestive insults. In cirrhosis, the normal hepatic lobular architecture is replaced by interconnecting bands of fibrous tissue surrounding nodules de. rived from loci of regenerating hepatocytes.
Regenerative nodules may be small (<3 ram, micronodu-lar cirrhosis), a typical feature of alcoholic cirrhosis, or large (>3 ram, macronodular cirrhosis). The latter, also termed postnecrotic cirrhosis, is more commonly seen as a sequel to chronic active hepatitis. The pathologic features of cirrhosis determine its natural history and clinical manifestations. Thus, fibrous scarring and disruption of the hepatic architec-ture distort the vascular bed and lead to portal hypertension and intrahepatic shunting. Normal hepatocyte function is dis-turbed by the resulting inadequacy of blood flow and ongoing direct toxic, inflammatory, and/or metabolic damage to hepa-tocytes.
Diagnosis in Traditional Chinese Medicine
In traditional Chinese medicine, hepatocirrhosis is includ-ed in the categories of "gan yu ", " zheng ji ", "pi kuai", "gu zhang", etc.
1. Compensatory Phase: Clinical manifestations include fatigue, loss of appetite, nausea, abdominal fullness and other symptoms of digestive tract. Slight edema and bleeding ten-dency may be present due to reduced liver function. The find-ings 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 symp-toms of the digestive tract are aggravated, low fever, jaun-dice, 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.
Differetiation and Treatment of Common Syndromes in Traditional Chinese Medicine
1. Stagnation of the Liver-qi and Deficiency of the Spleen:
Clinical manifestations: 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 method: Relieving the depressed liver-q/and invigorating the spleen, promoting blood circulation to remove blood stasis.
Recipe: Modified Ease Powder.
Ingredients,:
Radix Bupleuri 15g
Radix Angelicae Sinensis 15g
Radix Paeoniae Alba 15g
Rhizoma Atractylodis Macrocephalae 9g
Poria 9g
Endothelium Corneum Gigeriae Galli 6g
Radix Glycyrrhizae Praeparata 9g
Rhizoma Cyperi 12g
Fructus Cirri Sarcodactylis 15g
Radix Salviae Miltiorrhizae 12g
Administration: All the above drugs are to be decocted in water to get 200-300ml of decoction. Take equal portions in the morning and in the evening.
Modification: In case of thick coating of the tongue and distension of the abdomen due to abundance of pathogenic
dampness, add
Rhizoma Atractylodis 10g
Cortex Magnoliae Officinalis 10g
In case of obvious fatigue, add
Radix Codonopsis Pilosulae 12g
Fructus Lycii 12g
