Diagnosing Fatty Liver sa Pamamagitan ng Abnormalities sa Palad
Ang abnormality sa palad ay tumutukoy sa anomalous sensation sa sariling palad, kabilang ang chemical sensation (tulad ng bitter, sweet, salty) at physical sensation (tulad ng pain, cold, greasy). Sa TCM, ito ay binabalanse sa changes sa taste perception at abnormal sensations tulad ng cold, heat, pain, itch sa palad. Ang pagtukoy sa sakit sa pamamagitan ng abnormality sa palad ay may mahalagang implikasyon sa klinikal na praktis. Ako ay nakakita ng ilang mga kaso ng fatty liver sa pamamagitan ng abnormality sa palad, at may konting karanasan.
I. Bitter Palad
Ang pasyente ay nararamdaman ang bitter taste sa palad, 36 na kaso, lahat ay may mataas na lipid at confirmed sa ultrasound. Karaniwan ay may abdominal distension, side pain, vertigo, tinnitus, o constipation, dry mouth, dry throat, white greasy or yellow greasy tongue, wiry and slippery pulse, ngunit marami ay may lang mainit na mouth at constipation lamang. Ang bitter ay nauugnay sa gallbladder, at may kinalaman sa liver's function; ang bitter ay nasa fire, kung marami ang fire, maaaring maging bitter ang mouth. Ayon sa "Suwen·Wei Lun": "Kung ang liver heat ay mataas, ang gallbladder will leak, causing bitter taste"; ayon sa "Ling Shu·Zhang Lun": "Kung ang gallbladder is swollen, there is pain and distension on the side, and bitter taste in the mouth." Ang treatment ay dapat clear heat, promote diuresis, soothe liver, relieve depression: Longdan Xiegan Tang with modifications: Chai Hu, Dang Gui, Ze Xie, Huang Qin, Zhi Zi, Cao Jueming, Da Huang, Bai Shao, Yu Jin, Chuan Lian Zi, Gong Ying, Bai Jiang Cao, Shan Zha, Lai Fu Zi. Ang mga kaso ay nabawasan pagkatapos ng gamot, at lahat ay nalunod sa 2–4 buwan.
II. Sweet Palad
Ang pasyente ay nararamdaman ang sweet taste sa palad, 29 na kaso, lahat ay confirmed sa lipid at ultrasound. Karaniwan ay may gastric distension, poor appetite, nausea, pale yellow complexion, loose stool, fatigue, white greasy or thick tongue, slow or soft pulse, ngunit marami ay walang malaking sintomas, kundi ang sweet taste lang. Ang sweet taste ay nauugnay sa dampness rising up, at malapit sa spleen. Ang spleen ay gustong dry, at nahihirapan sa dampness, na nakakablock sa qi movement, na nakakabawas sa normal metabolism ng lipids, na nagdudulot ng phlegm at stasis, na nakakablock sa liver, na nagdudulot ng fatty liver. Ang treatment ay dapat aromatic to dispel dampness: modify San Ren Tang, Yin Chen Hao Tang: Xing Ren, Yi Ren, Bai Dou Kou Ren, Hou Po, Ban Xia, Yun Ling, Pei Lan, Yin Chen, Hua Shi, Da Huang, Dang Gui, Cao Jueming, Yu Jin, Chi Shao, Tong Cao, Dou Juan, Heo Xiang. Treatment duration: 2–3 months, all cured.
III. Pale Palad
Ang pasyente ay nararamdaman ang lack of taste, o reduced taste sensitivity, karaniwan ay may kinalaman sa spleen and stomach yang not functioning properly. Ayon sa "Ling Shu·Mai Du": "The spleen connects to the mouth; when the spleen is harmonious, the mouth can taste five grains"; ayon sa "Zhongyi Linzheng Bei Yao·Oral Symptoms": "Pale mouth, no taste, loss of appetite." Karaniwan ay may side fullness, poor appetite, vomiting or diarrhea, fatigue, belching, white or greasy tongue, slow or weak pulse, 31 na kaso, lahat confirmed sa lipid at ultrasound. Ang treatment ay dapat strengthen spleen and boost qi: modify Shen Ling Bai Zhu San, Yi Gong San: Dang Shen, Fu Ling, Bai Zhu, Chen Pi, Shan Yao, Bian Dou, Yi Ren, Sha Ren, Mu Xiang, Dang Gui, Cao Jueming, Shan Zha, Lai Fu Zi, Zhi Shi, He Ye. After 2–4 months, 27 cured, 4 improved.
IV. Sour Palad
Ang pasyente ay nararamdaman ang sour taste sa palad at mouth, ngunit walang sour fluid, 18 na kaso, confirmed sa lipid at ultrasound. Karaniwan dahil sa spleen dysfunction, undigested food, overeating, spleen injury, food stagnation in intestines, liver-spleen disharmony, rising turbidity. Ayon kay Yu Tuan sa "Yi Xue Zheng Chuan": "Some have sour taste due to weak spleen allowing liver to dominate, causing sour taste"; liver-stomach disharmony, qi stagnation, dampness blockage, phlegm and stasis blocking liver meridians, hence intermittent pain, side distension, desire to vomit, belching, irregular bowel movements, diarrhea with foul smell, thick greasy or yellow tongue, wiry and slippery or deep and solid pulse. Treatment: attack accumulation, guide digestion, move qi, remove stagnation: modify Zhi Shi Dao Zhi Wan, Mu Xiang Bin Lang Wan: Da Huang, Zhi Shi, Shen Qu, Mai Ya, Shan Zha, Yun Ling, Mu Xiang, Bin Lang, Chen Pi, Huang Qin, Ze Xie, Huang Lian, E Zhu, San Leng, Sha Ren, Dang Gui, Cao Jueming, He Ye, Xiang Fu, Yu Jin. All cured after 1–3 months.
V. Salty Palad
Ang pasyente ay nararamdaman ang salty taste, minsan may salty phlegm, 23 na kaso. Ang salty taste ay nauugnay sa kidney, karaniwan ay may kinalaman sa kidney deficiency or cold water rising up. Ayon sa "Tongsu Shanghan Lun": "Salty mouth with white foam indicates cold water rising from kidney"; ayon sa "Zhang Shi Yi Tong": "Salty mouth means kidney fluid rising up"; ang salty taste ay maaaring may kinalaman sa emotions or excess flavors: "Many mouth diseases... may manifest as sour, bitter, sweet, spicy, salty tastes, originally caused by emotional disturbance and overindulgence in flavors" (from "Yi Xue Zheng Chuan·Oral Diseases"). Ang fatty liver ay karaniwan sa middle-aged and elderly, kung saan sila ay nasa physiological kidney deficiency state, o dahil sa overwork, disordered lifestyle, organ damage, eventually affecting the kidney. Kidney essence deficiency, imbalance of yin-yang, water cannot nourish wood and earth, lipid metabolism impaired, leading to hyperlipidemia, blocking liver. Karaniwan ay may back and knee soreness, insomnia, forgetfulness, tinnitus, abdominal fullness. Kung kidney yang deficiency, may cold limbs, premature ejaculation, low libido, or facial edema. Treatment: warm yang, supplement kidney: modify You Gui Wan: Shu Di, Tu Si Zi, Du Zhong, Rou Gui, Zhi Fu Zi, Shan Yao, Gou Qi Zi, Shan Yu Rou, Zhi Shou Wu, Xiang Fu, Zhi Shi, Shan Zha, He Ye, Sang Ji Sheng, Nv Zhen Zi, Lu Jiao Jiao. Kung kidney yin deficiency, may irritability, insomnia, hot flashes, dry mouth, red tongue with little coating, fine or rapid pulse, treatment: nourish kidney yin, use Zuo Gui Wan modification: Shu Di, Dan Pi, Shan Yu Rou, Shan Yao, Ze Xie, Shan Zha, Gui Jiao, Tu Si Zi, Nv Zhen Zi, Zao Lian Cao, Tian Dong, Lai Fu Zi, Dang Gui, Zhi Shi, He Ye. Lahat ng mga kaso ay nakurado sa 2–4 buwan.
VI. Spicy Palad
Ang pasyente ay nararamdaman ang spicy or burning taste, rare cases, 4 na kaso, confirmed sa lipid at ultrasound. May kinalaman sa heart and gallbladder unrest, qi-fire with phlegm turbidity, na sumasalamin sa etiology ng fatty liver. Ayon sa "Tongsu Shanghan Lun": "Spicy mouth means lung heat entering stomach"; si Zhu Dan Xi: "Lung heat causes spicy mouth, treat with Gan Ju Tang, Xie Bai San". Karaniwan ay may gastric fullness, chest tightness, shortness of breath, abundant phlegm, difficulty lying down, even facial edema, loose stool, red tongue with thin greasy coating, wiry and slippery pulse. Treatment: clear lung heat, soothe liver, harmonize stomach: modify Xie Bai San, Chai Hu Shu Gan San: Huang Qin, Ban Xia, Sang Bai Pi, Di Gu Pi, Chen Pi, Lai Fu Zi, Bai Jie Zi, Xiang Fu, Yu Jin, Chuan Lian Zi, Cao Jueming, Ze Xie, Shan Zha. Lahat ng 4 na kaso ay nakurado sa 1–3 buwan.
VII. Burning Painful Palad
Ang pasyente ay nararamdaman ang burning pain like fire on the tongue, 6 na kaso, karaniwan dahil sa internal fire. Karaniwan kasama ang red tip of the tongue, mouth sores, lalo na sa alcoholic fatty liver. Kasama ang chest and epigastric heat, nausea, poor appetite, constipation, red eyes, dizziness, red tongue with little coating or dry, wiry and fine or large pulse. Treatment: clear heat and detoxify, soothe liver and relieve stagnation: modify Bai Hu Tang, Liang Ge San: Sheng Shi Gao, Zhi Mu, Sheng Di, Bai Shao, Da Huang, Zhi Zi, Ze Xie, Chi Shao, Dan Pi. After adjustment, 5 na kaso ay nakurado sa 2 buwan, 1 na kaso ay nakabuti sa 3 buwan.
VIII. Numb Palad
Ang pasyente ay nararamdaman ang numbness at decreased sensation, kahit na i-scratch, i-poke, o i-tap, ang numbness ay hindi nawawala, 7 na kaso. Ang numbness ay karaniwan dahil sa blood deficiency, liver wind, or phlegm obstruction. Ayon sa "Bian She Zhi Nan": "Numbness means blood deficiency. If numbness and cannot extend, it is internal wind with phlegm... should nourish blood, soften, calm wind. With phlegm, also expel phlegm, promote phlegm dispersion." Kung may blood deficiency sa fatty liver dahil sa stress, worry, sudden anger, yang blood is depleted. Karaniwan ay may dizziness, blurred vision, palpitations, night sweats, feverish feeling, sallow complexion, thin white coating, pale tongue or tooth marks, fine or rapid pulse. Treatment: nourish blood, activate meridians: modify Si Wu Tang, Er Zhi Wan: Shu Di, Dang Gui, Bai Shao, Chuan Xiong, Nv Zhen Zi, Zao Lian Cao, Zhi Shou Wu, Cao Jueming, Zhi Shi, Ze Xie, Shan Yu Rou, Shan Zha. Kung may phlegm, may fatigue, abdominal fullness, nausea, poor sleep, thin greasy coating, wiry and slippery pulse. Treatment: transform phlegm, relieve depression: modify Xiao Yao San, Wen Yang Tang: Chai Hu, Dang Gui, Yun Ling, Bai Zhu, Yu Jin, Ban Xia, Zhu Ru, Zhi Shi, Chen Pi, Huang Qin, Lai Fu Zi, Bai Jie Zi, Shan Zha, Da Huang, Xiang Fu, Cao Jueming, Bin Lang.
IX. Swollen Palad
Ang pasyente ay nararamdaman ang swelling of the tongue, pero hindi talaga lumalaki, 9 na kaso. Ang mga pasyente sa fatty liver ay karaniwang may liver qi stagnation, which turns into fire over time, causing fire to rise up, hence the sensation of swelling. Karaniwan kasama ang insomnia, palpitations, chest and side fullness, hard mass under the heart, frequent belching, pale tongue with thin coating, wiry and strong pulse. Treatment: soothe liver, regulate qi, clear heat and resolve stagnation: modify Da Chai Hu Tang, Chai Hu Shu Gan San: Chai Hu, Huang Qin, Bai Shao, Ban Xia, Zhi Shi, Da Huang, Xiang Fu, Yu Jin, Chuan Xiong, Chen Pi, Huang Lian, Lian Qiao, Lai Fu Zi, Cao Jueming, Shan Zha. Lahat ng 9 na kaso ay nakurado sa 1–4 buwan.
X. Dry Palad
Ang pasyente ay nararamdaman ang feeling like eating raw persimmon, karaniwan kasama ang dryness, dahil sa dry heat damaging fluids, 14 na kaso. Karaniwan dahil sa yang excess in zang-fu organs, qi-fire rising up, or dry heat damaging fluids, causing dry tongue. Ayon kay Chen Wu Zhe sa "San Yin Fang·Oral Disease": "Annoyance and dryness cause dryness"; si Tang Rong Chuan sa "Xue Zheng Lun·Oral": "Dry tongue is due to wind-heat, treat with Tong Sheng San without Mang Xiao and Da Huang". Ang dryness sa fatty liver ay may kinalaman sa kidney deficiency, imbalance in water regulation and qi transformation. Sa ganitong sitwasyon, water cannot nourish wood, spleen loses its function, fluids not distributed, phlegm and stasis block blood vessels. Karaniwan ay may dry throat, dry mouth, side distension and pain, afternoon fever, tinnitus, constipation, red tongue with little coating or central peeling resembling a map tongue, fine or wiry pulse. Treatment: nourish yin, moisten dryness, transform phlegm, relieve depression: modify Zeng Ye Tang, Xiao Yao San: Xuan Shen, Sheng Di, Mai Dong, Shi Hu, Bei Sha Shen, Dang Gui, Bai Shao, Chai Hu, Zhi Zi, Tian Dong, Chen Pi, Xiang Fu, Yu Jin, Cao Jueming, He Ye, Zhu Ye. Lahat ng mga kaso ay nabawasan o nakurado sa 1–4 buwan.