Name: Bo.

Sex: Female.

Age: 31 years.

Occupation: A worker.

Chief Complaint: Constant expectoration and intermittent hemoptysis for more than 20 years.

History of Present Illness: More than 20 years ago, the patient got cough and profuse sputum without obvious causes. At the beginning, she coughed frequently while her expectorated sputum was less in amount, light yellow or white in colour, and thin in texture. Later on, the expectorated sputum slowly became more in amount, rich yellow or dark green in colour and thick in texture, accompanied with a special foul smell. She usually expectorated 5 or 6 cups of sputum each day, and weather changing and overworking often aggravated the symptom. In addition, there was intermittent hemoptysis, which was fresh red in colour and less in amount. Usually the hemoptysis was blood-tinged sputum. When she coughed and expectorated severely,

there was occasional asthma. In the past years she had asked many doctors of TCM and Western medicine for treatment, and the illness had been diagnosed as "Bronchiectasis" through some relative examinations. After several years' treatments of anti-inflammatory and hemostasis, the hemoptysis was relieved greatly while her cough and profuse sputum couldn't be relieved all along. In the recent years, her cough and expectorating got worse and worse, she coughed constantly with profuse puric sputum, which was thick in texture and dark green in colour and

was characteristic of a special foul smell. In addition, there were chest depression and obstructed breath. Then she came to our hospital for treatment on October 28,1998. During her illness, her sleeping, appetite, urination and defecation had been all normal. There was not other complaint.

Physical Examination: The patient was conscious with a normal general condition. The pulse was thready and uneven. The tongue was light red, swollen with a thin layer of watery fur. Some dry rales and bubbling sounds could be heard over the both sides of basis pulmonis, the respiratory sounds were harsh. There was not other abnormal sign.

Examination of Chest Roentgenogram: It showed there were large number of shadows which were all wavy and hair-shaped in right lower lung, the lung markings of both sides were increased and disorderly. There was not other abnormal sign.

Diagnosis : Bronchiectasis.

Differentiation: It's heat retention syndrome of lungs and deficiency of spleen-qi, the deficient spleen-qi caused the failure of spleen to conduct transporting the essential substances from water and food normally. So the stagnant essential substances accumulated in lungs and became the pathogenic phlegm, and then the pathogenic lung-heat and pathogenic phlegm got entangled each other, so that there were the profuse thick and foul sputum in lungs. Therapeutic Principle: Clearing away pathogenic heat from lungs and eliminating pathogenic phlegm; invigorating spleen-qi and activating the middle Jiao.

Recipe:

DangShen,Pilose Asiabell Root 30g

BaiZhu,Bighead Atractylodes Rhizome 18g

FuLing, Tuckahoe 12g

SangBaiPi,Mulberry Bark 15g

HuangLian,Coptis Root 6g

HuangQin,Scutellaria Root 6g

QianHu,Pellcedanum Root 12g

DiGuPi, Wolf berry Bark 18g

MaHuang, Ephedra 6g

XingRen,Bitter Apricot Seed 10g

JieGeng,Platycodon Root 18g

BaiJieZi,White Mustard Seed 12g

YiYiRen,Coix Seed 20g

WuWeiZi,$chisandra Fruit 15g

ShengGanCao,Raw Liquorice Root 10g

All the above drugs were to be decocted in water for oral taking, 5 doses were prescried.

Effect Observation: After taking the 5 doses, she came back for reexamination on November 3,1998. She told me the 5 doses had no effect on her at all, her expectorated sputum remained dark green in colour with a special foul smell as before, she still

expectorated 5 or 6 cups of sputum each day. The chest depression and the obstructed breath were as same as before. Then it's necessary for me to recognize this illness again. The differentiation should be that the pathogenic lung heat had got into the collaterals of the lung and lurked in the collaterals so deeply that it could not be removed easily, moreover, the collaterals of the lung had been obstructed by the blood stasis and the stubborn phlegm. It's a serious illness of many years, it couldn't be shaken easily by the common drugs. The original recognition on this illness was superficial, the clinical decision was irresolute and hesitant, the used herbs were weak and incompetent for the illness. All of those are doctor's taboo, if a man--no matter who he is, breaks the taboo, he wilt just run into a stone wall in medical work certainly. Now all of those were all my errors, which caused the original treatment ended in failure! Doctor SunSimiao--an old sage of the past, had said that" a wise doctor should be hawk-eyed and lion-hearted" in the clinical work. So that this illness must be treated with the fiery and vigorous drugs, the therapeutic principle should be striking the blood stasis to clear away obstruction from the collaterals of the lung and eliminating pathogenic phlegm and heat in the lung.

Recipe:

ShengDihuang ,Rehmannia Root 18g

Mi1DanPi.Tree Peonv Bark 12g

QiYeYiZhiHua,Windpipe Trachea 25g

BaiHuaSheSheCao, Oldenlandia 30g

DiLong, Earthworm 5g

BaiJiangCan,Batryticated Silkworm 5g

ZhiShuiZhi,Prepared Leech 5g

DiBieChong,Ground beetle 5g

MaHuang, Ephedra 6g

BaiJieZi,White Mustard Seed 15g

DanNanXing,Arisaema with Bile 9g

QuanGuaLou,Trichosanthes Fruit 18g

HuangLian,Coptis Root 12g

HuangQin,Scutellaria Root 12g

YuXingCao, Houttuynia 25g

All the above drugs were to be decocted in water for oral taking, 5 doses were prescribed.

After taking the 1st dose, the expectorated sputum was decreased greatly in amount, and the expectorated sputum became light yellow in colour, there were totally 3 cups of sputum in a day. All of those signs showed this changed prescription was suitable for this illness. After taking the 5 doses,the patient came to me for reexamination on November 9, 1998. She told me she coughed occasionally without expectoration, chest depression and obstructed breath. It showed this illness had been almost cured. Only anorexia and abdominal distension were there, it showed the deficiency of spleen-qi remained unchanged, then the next therapeutic principle should be invigorating spleen-qi.

Recipe:

DangShen,Pilose Asiabell Root 30g

BaiZhu,Bighead Atractylodes Rhizome 15g

FuLing, Tuckahoe 12g

YiYiRen,Coix Seed 30g

ShanYao,Chinese Yam Rhizome 15g

ZhiHuangQi,Moxa-prepared Milkvetch Root 20g

DangGui,Chinese Angelica Root 6g

ChenPi,Tangerine Peel 15g

ZhiKe,Fruit of Citron 12g

GanCao,Liquorice Root 10g

All the above drugs were to be decocted in water for oral taking, 5 doses were prescribed.

After taking the 5 doses, the anorexia and the abdominal distension disappeared. The patient got a good appetite. Then she was told to take the bolus for strengthening middle-Jiao and benefiting qi to nurse herself. After a year's follow-up, the illness

didn't recur. The reexamination of chest roenthenogram showed there was not large number of hair shaped shadows in right lower lung any more, only some scattered point like shadows were there. It showed the illness was cured. Then it's ending.