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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