Name: Cao.

Sex: Female.

Age: 60 years.

Occupation: A retired worker.

Chief Complaint: Chest oppression and shortness of breath for more than 30 years, accompanied with palpitation, pain of chest and back for half a year.

History of Present Illness: More than 30 years ago, the patient got chest oppression and shortness of breath because she got "Rheumatic Arthritis" at that time. Usually when the pain of her joints was more severe, the chest oppression and shortness of breath were more obvious. During the next years, the swelling-pain of her joints slowly got better and better under the treatment of TCM and Western medicine, but the chest oppression and shortness of breath were there persistently. They could be easily aggrevated by over working or mental tension. In the past years, she has been to many famous hospitals in Jiangsu Province and Shanghai for treatment. Through many times of examination of electrocardiogram and multicoloured ultrasono-gram, the illness was confirmed as "Rheumatic Valvular Heart Disease: Serious Aortic Stenosis. " Every hospital she asked all suggested her have an operation for the illness. But the cost of the operation was so expensive that she couldn't afford it. Then she had to get the conservative treatment of TCM and Western medicine. In the past many years, the used drugs of Western medicine mostly belonged to vasodilator, the used Chinese herbs mostly belonged to qi invigorating and body-resistance strengthening drugs and the blood-circulation promoting drugs. After many years of thus treatment, the curative effect became more and more faint. The chest oppression and shortness of breath got more severe in the recent several years, it prevented her doing some common daily working such as going upstairs, going to the market to buy food by herself and so on. 2 years ago, examination of multicoloured echocardiogram showed VEL (velocity of blood flow through aortic valve) was 380cm/s and PG(peak instantaneous pressure gradient through aortic valve) was 65mmHg;1 year ago, examination of echocardiogram showed VEL was 495cm/s and PG was 88mmHg; now examination of echocardiogram showed VEL was 537cm/s and PG was 115mmHg. Furthermore, in the recent half year, she felt the illness getting worse and worse, not only there were persistent chest oppression and shortness of breath, but also she got a palpitation and expressing pain in her chest and back, accompanied with fatigue and lassitude, after many times of conservative treatment in some famous hospitals, her sufferings from the illness couldn't be relieved at all. The severe palpitation and the expressing-pain in the chest and back caused she couldn't do any common daily working. Then she came here for treatment on November 20,1999. After the illness came on, she kept her appetite, urination and defecation normal all along, while she got a bad sleeping due to the severe palpitation and expressing-pain during the recent half year. There wasn't other complaint.

Physical Examination: The patient was weak with purplish-red lips and murky grey complexion. The pulse was deep, thready and uneven, the tongue was dark red with a thick layer of white fur. The pharynx was normal. The respiratory sounds were clear in the lungs, some scattered dry tale could be heard occasionally. HR was 88beats/rain. The cardiac rhythm was regular. The 3^rd grade systolic rumbling murmur could be heard at the hearing areas of aortic valve, it wasn't accompanied with conduction. The abdomen was soft and flat, there weren't tenderness and rebound tenderness. The liver and the spleen couldn' t be palpated. There was not other abnormal sign.

Examination of Echocardiogram: The result on November 20, 1999 showed VEL was 537cm/s, PG was 115mmHg. It indicated there was " Serious Aortic Stenosis" and " Left Ventricular Hypertrophy. "

Diagnosis: Rheumatic Valvular Heart Disease: Serious Aortic Stenosis.

Differentiation: It's accumulation of blood stasis and stubborn phlegm in heart, which obstructed the normal passage of blood flowing and disturbed the normal blood flowing. So that there were blood stasis of the heart and stagnation of the heart-qi. The stagnation of the heart qi caused the patient got the chest oppression and shortness of breath; in addition, the blood stasis and the stubborn phlegm in heart could directly cause the patient got the expressing-pain in the chest and back.

Therapeutic Principle: Striking the blood stasis and dredging the collaterals, eliminating the phlegm evil and keeping the heart cavity unobstructed, removing stagnation of heart-qi and regulating the functional activities of the heart qi, soothing the chest and comforting the heart.

Recipe:

DangShen,Pilose Asiabell Root 30g

BaiZhu,Bighead Atraetylodes Rhizome 18g

FuShen,Poria with Hostwood 20g

ShengShanZha,Raw Hawthorn Fruit 15g

DanShen,Red Sage Root 25g

TanXiang, Sandalwood 9g

XieBai,Macrostem Onion 15g

BaiJieZi,White Mustard Seed 12g

GuiZhi,Cinnamon Twig 9g

ChiShao,Red Peony Root 15g

ShuiZhi, Leech 3g

GuaLouPi,Trichosanthes Fruit 25g

ZhiShi,Immature Bitter Orange 15g

TaoRen,Peaeh Seed 15g

ZhiGanCao,Prepared Liquorice Root 10g

All the above drugs were to be decocted in water for oral taking. 7 doses were prescribed. During the same time, she should take the capsule for wrecking mass.

Recipe:

HuPo, Amber

A' Wei, Asafetida

(Each herb was taken just the proper amount. )

All the above drugs were to be ground into powder. She should mix the 2 kinds of powder together and fill the large sized capsules with the mixed powder, taking 2 pieces of the capsule each time, 3 times a day, avoiding eating fat and greasy food during the treatment.

Effect Observation: After 7 days' treatment, the patient came back for reexamination. She told me the expressing-pain in her chest and back disappeared, the palpitation was relieved greatly, but there were shortness of breath and chest oppression yet. All these signs indicated the recipe was suitable for the illness, the followed therapeutic principle should be reinforcing the strength of eliminating the phlegm-evil and keeping the heart cavity unobstructed. Recipe :

DangShen,Pilose Asiabell Root 30g

YuanZhi,Polygala Root 15g

DanShen,Red Sage Root 25g

ShiChangPu,Grassleaved Sweetflag Rhizome 15g

ShuiZhi, Leech 5g

ChiShao,Red Peony Root 15g

GuiZhi,Cinnamon Twig 9g

ShengShanZha,Raw Hawthorn Fruit 15g

TanXiang, Sandalwood 8g

FaBanXia,Prepared Pinellia Tuber 9g

TaoRen,Peach Seed 15g

BaiJieZi,White Mustard Seed 12g

XiaKuCao,Prunella Spike 25g

BaiJiangCan,Batryticated Silkworm 15g

XieBai,Macrostem Onion 15g

ZhiShi,Immature Bitter Orange 18g

All the above drugs were to be decocted in water for oral taking. 15 doses were prescribed. Dietetic restraint and taking the capsules for wrecking mass were as same as before. She was told to avoid over-working.

After 15 days' treatment, the patient came back for reexamination on December 12,1999. She told me the palpitation and the expressing pain in her chest and back disappeared at all, the chest oppression and shortness of breath were relieved greatly. She didn't feel chest oppression and shortness of breath when she was quiet. Only when she was going upstairs to the 4^th floor, the chest oppression and shortness of breath would came back again. Some common daily working could be done by herself without any uncomfortable sensation, the lassitude and fatigue disappeared too. Reexamination of echocardiogram showed VEL was 497cm/s, PG was 99mmHg. The pulse was thready and uneven, the tongue was red with a thin layer of white fur. All these signs indicated the used capsules and decoction were greatly effective to cure the illness. Because this illness had been existing for more than 30 years, the evils hid in the heart couldn't be removed completely within a short time, it' s necessary to use pills slowly and permanently in order to restrain the illness effectively.

Recipe:

DangShen,Pilose Asiabell Root 30g

BaiZhu,Bighead Atractylodes Rhizome 15g

FuShen,Poria with Hostwood 20g

DanShen,Red Sage Root 25g

TanXiang, Sandalwood 10g

XieBai,Macrostem Onion 18g

GuiZhi,Cinnamon Twig 10g

DiBieChong,Ground Beetle 5g

ShuiZhi, Leech 5g

YuanZhi,Polygala Root 15g

ShiChangPu,Grassleaved Sweetflag Rhizome 18g

SanLeng,Burreed Tuber 10g

E'Zhu,Zedoary Tuber 10g

BaiJiangCan,Batryticated Silkworm 15g

DiLong, Earthworm 12g

GuaLouPi,Trichosanthes Fruit 20g

BaiJieZi,White Mustard Seed 15g

ZhiShi,Immature Bitter Orange 18g

ShengShanZha,Raw Hawthorn Fruit 20g

XiaKuCao,Prunella Spike 25g

ChuanXiong, Chuanxiong Rhizome 15g

TaoRen,Peach Seed 15g

ZhiGanCao,Prepared Liquorice Root 12g

3 doses were prescribed. All the drugs were to be ground into powder, she was told to mix the powder with some water together to make pills, taking 8g of the pill each time, 3 times a day. During the same period, taking the capsule for wrecking mass and dietetic restraint were all as same as before. She should avoid over-working and take proper exercise every day.

After a long time of follow up, the patient kept taking the pills all along, her illness was in a calm too. The pain in her chest and back didn' t recur any more. Only during the time of weather changing, the chest oppression and shortness of breath would recur to her. Usually she didn't get uncomfortable sensation. Many times of reexamination of echocardiogram showed VEL and PG did not increase any more. All these signs showed the illness was restrained effectively. Then it's ending.