Name: Jiang.

Sex: Male.

Age: 12 years.

0ccupation: A pupil.

Chief Complaint: Emptiness of sinister scrotum for 12 years.

History of Present Illness: The patient's sinister scrotum had been empty since he was born. There was nothing inside the sinister scrotum that could be touched. His parent took it for granted that the sinister testicle would grow out in the scrotum with his age, so that they didn't care for it in the past 12 years. They weren't anxious about it until last week, because a neighbour told them this illness would affect their son's ability of reproduction in their talking. Then the patient' s father led him to surgery a hospital in JiangYin for treatment. After a series of physical examination, the surgeon diagnosed the illness as ",Cryptorchism" and told them this illness must be treated by an operation. But the father was afraid that the anaesthesia would affect his son's intelligence. Then he refused the surgeon's advice and came to our hospital for treatment on May 31,1998. After the illness came on, the patient kept his appetite, sleeping, urination and defecation normal all along. 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 red with a thin layer of white fur. Nothing could be palpated in the sinister scrotum. A peanut-like node could be touched at the point 2.5era above the sinister annulus ingulnalis subcutaneus, if touched upon, there was slight tenderness, it's divided from the adjacent tissue clearly and couldn't be moved at all. A normal testicle was palpated in the dextral scrotum, but it could be pushed into the dextral inguinal canal easily. There was not other abnormal sign.

Examination of Multicoloured Ultrasonogram: The dextral

testicle was in the scrotum, its volum was 2. 0cm ¡Á 1. 2cm ¡Á 1.0cm;the sinister testicle was at the centre of the sinister inguinal canal, its volum was 1.5crux 1.0crux 0.8cm.

Diagnosis: Cryptorchism; Congenital Atrophy of Sinister Testicle.

Differentiation: It's deficiency of the congenital primordial-Yang. It caused the generation and transformation of qi was weakened, then the deficient qi could not flow smoothly and normally. Therefore, it's difficult for the deficient qi to push the testicle into the scrotum as normal. This disease is called "TianHuan"(natural eunuch) in TCM.

Therapeutic Principle: Building up the primordial essence and nourishing kidney-Yang, promoting the blood circulation and nourishing qi, regulating qi and eliminating the phlegm evil. When the recipe was formed, it should be noticed that the patient was only an infant boy, then it must be slowly and softly to invigorating kidney-Yang, and it should be done after the undescended testicle descended into the scrotum. It shouldn't be overanxious for a quick success, otherwise the undescended testicle would cancerate.

Recipe:

SuGeng,Perilla Stem 6g

ZhiKe,Fruit of Citron or Trifoliate Orange 6g

BaiShao,White Peony Root 12g

JiXueTeng,Spatholobus Stem 18g

XuDuan, Teasel Root 15g

NiuXi,Achyranthes Root 10g

JuHe,Tangerine Seed 12g

LiZhiHe,Lychee seed 12g

ShengHuangQi,Raw Milkvetch Root 25g

DangGui,Chinese Angelica Root 10g

DangShen,Pilose Asiabell Root 20g

ChuanLianZi,Toosendan Fruit 8g

DanShen,Red Sage Root 15g

TaoRen,Peach kernel 12g

DuZhong,Eucommia Bark 12g

All the above drugs were to be decocted in water for oral taking, 5 doses were prescribed. Cold and greasy food was forbidden during the treatment.

Effect Observation: After taking the 5 doses, the patient's mother led him to me for reexamination on June 5,1998. Physical examination showed the undescended testicle had fallen into the scrotum, when it was touched upon, its movement was freely. But it remained too small in size, only like a peanut, and it's very easy to be pushed into the sinister inguinal canal.

All the above signs showed the above recipe was suitable for this illness, so that it should be continue using the above recipe. Because the undescended testicle had descended into the scrotum, then it's necessary to begin invigorating kidney-Yang and building up primordial qi. So that 25g of BuGuZhi, Psoralea Fruit and 25g of RouCongRong, Desertliving Cistanche were used instead of 20g of DangShen, Pilose Asiabell Root and 18g of JiXueTeng, Spatholobus Stem in the original recipe. All these herbs were to be decocted in water for oral taking, 7 doses were prescribed. Dietetic restraint was idem. Because it's very easy for both testis to go into the inguinal canals, then the patient was to1d to press downward softly with his hands along both groins 200 times in the morning and evening separately in order to relax the regional tendon.

After taking the 7 doses, the mother led him to me again on June 14,1998. Physical examination showed that the 2 testis were all in the scrotum and they couldn' t be pushed into the inguinal canals easily but the sinister one remained small, then the above recipe should be changed to stengthen invigorating kidney Yang.

Recipe:

YinYangHuo,Shorthorned Epimedium Herb 18g

XuDuan,Teasel Root 15g

SuGeng,Perilla Stem 6g

ZhiKe,Fruit of Citron 6g

BuGuZhi,Psoralea Fruit 25g

R0uGui,Cinnamon Bark 4g

DangShen,Pilose Asiabell Root 20g

BaiShao,White Peony Root 12g

JiXueTeng,Spatholobus Stem 18g

DanShen,Red Sage Root 25g

NiuXi,Achyranthes Root 10g

DuZhong, Eucommia Bark 12g

LiZhiHe,Lychee Seed 12g

JuHe,Tangerine Seed 12g

ChuanLianZi,Toosendan Fruit 8g

All these drugs were to be decocted in water for oral taking, 7 doses were prescribed. Dietetic restraint was idem, hand-pressing was idem too. In the same period, he was told to take the bolus of six drugs including Rehmannia,4. 5g a time, 3 times a day.

After 7 days of the above treatment, his mother led him to me on June 21,1998. After physical examination,it showed the 2 testis were all in the scrotum, they couldn' t be pushed into the inguinal canals easily, the sinister one was as big as the dextral one. Examination of multicoloured ultrasonogram showed both testis were in the scrotum, volume of the dextral testicle was 2.0cm¡Á1. 4cm ¡Á 1. 0cm, volume of the sinister testicle was 2.0cm¡Á1.3cm¡Á 1. lcm. Opaque dark area of fluid whose depth was 1.3cm was explored in the sinister vaginal casvity. It indicated there was hydrocele of tunica vaginalis. The position and structure of both testis were all normal. These signs showed the above treatment was notable effective on the pateint. As for the hydrocele of tunica vaginalis, it was caused by too much force of hand pressing. Then the followed therapeutic principle should be invigorating spleen qi for expelling dampness and pathogenic water, and reinforcing kidney.

Recipe:

LuJiaoJiao, Deerhorn Glue 9g (to be melted in the decocted tecoction)

GuiBanJiao, Tortise Plastron Glue 9g (to be melted in the decocted decoction)

DangShen,Pilose asiabell Root 20g

BaiZhu,Bighead Atractylodes Rhizome 9g

YinYangHuo,Shorthorned Epimedium Herb 20g

BuGuZhi,Psoralea Fruit 20g

FuLing, Tuckahoe 12g

ShanYao,Chinese Yam 15g

JiXueTeng,Spatholobus Stem 20g

QianNianJian,Obscured Homalomena Rhizome 18g

ZhiKe,Fruit of Citron 12g

JuHe,Orange Kernel 8g

LiZhiHe, Lychee Seed 8g

YiYiRen,Coix Seed 18g

NiuXi,Achyranthes Root 12g

All the above drugs were to be decocted in water for oral taking, 5 doses were prescribed. He was told to stop hand pressing. Dietetic restraint was idem. Taking the bolus of six drugs including Rehmannia was idem too.

After 5 days of the above treatment, the patient and his mother came to me for reexamination on June 27,Reexamination of multicoloured ultrasonogram showed the 2 testis were all in the scrotum, volume of the dextral one was 2. 2cm¡Á 1. 5cm¡Á1. 2cm, volume of the sinister one was 2.2cm¡Á 1.5cm¡Á1.2cm. Furthermore, there wasn't hydrocele of tunica vaginalis any more. All these signs showed the illness was cured completely. After 3 years' follow up, the boy was in good health all along. Then it' s ending.