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Hepatic Hemangiomatosis

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 2.2cm2.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
dispersive 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:
Zhi Huang Qi, Moxa-prepared Milkvetch Root 30g
DangGui,Chinese Angelica Root 12g
WuLingZhi,Trogopterus Dung 15g
DiBie Chong,Ground Beetle 3g
Xiang Fu,Nutgrass Flatsedge Rhizome 9g
Chai Hu,Bupleurum Root 8g
Shui Zhi, Leech 3g
Wu Zhu Yu,Evodia Fruit 5g
Gan Jiang,Dried Ginger 9g
Zao Jiao Ci,Chinese Honeylocust Spine 15g
Xia Ku Cao,Prunella Spike 25g
Dan Nan Xing,Arisaema with Bile 3g
Dan Shen, Red Sage Root 30g
Wu Gong, Centipede 2g
Yuan Hu, Corydalis Tuber 8g
Huang Qin,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
Hu Po, 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:
Zhi Huang Qi, 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 multicoloured ultrasonogram showed there were 2 hemangiomas in
the right lobe of liver, the size of the bigger one was
2.2cm2.0cm, the size of the smaller one was 0.3cm0.5cm.
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 waterdampness 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.
2cm2.0era. 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 dampnessphlegm. 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 2.0cm1.8cm. 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.