Name: Sheng.

Sex: Female.

Age: 54 years.

0ccupation: A worker.

Chief Complaint: Abdominal pain and diarrhea for 1 and a half years after cholecystectomy.

History of Present Illness: One and a half years ago, the patient got a cholecystectomy because of her polypus of gallbladder. After the operation, she got a continuous diarrhea and a distending pain in the both hypochondrium. The pain occurred frequently in every day, accompanied with a continuous diarrhea, which occurred more than 5 times a day. The stool was loose and formless, in which there were many pieces of white or yellow mucus. Sometimes it could be aggravated by weather changing or over-working, the stool then became soup like. As usual, she got a full sensation all over her abdomen, accompanied with frequent bowel sounds. She usually dare not eat fruit and meat, because she would get an immediate diarrhea as soon as she eat it. In the past 1 and a half years, she had been to local hospitals {or treatment, but there were little curative effect on her. Then she came to our hospital for treatment on June 4,1999. After she got the illness, her appetite became poor and she usually got fatigue, lassitude and insomnia. The urination was normal. There wasn't other complaint.

Physical Examination: The patient was weak with a sallow complexion. The pulse was thready and soggy, the tongue was red with a greasy layer of yellow fur. The lungs and heart were all normal. The abdomen was soft and flat without tenderness. The spleen and liver could not be palpated in the inferocostal regions. There wasn't other abnormal sign.

Diagnosis: Intractable Diarrhea After Cholecystectomy.

Differentiation: This disease, in TCM, belongs to the category of "XieXie" (diarrhea). It was caused by the cholecystectomy. According the Five-element theory of TCM, the gallbladder is the exterior of liver, its attribute is Yang wood, it is in charge of the ShaoYang channel of the body and is responsible for dispersing effect in Three-Jiao. Therefore, it disperses the Yangqi all over the body through the ShaoYang channel, which can warm up the body and prevent the Yin evil (includes dampness and phlegm etc). from soaking the body and being retained in the body. But the gallbladder had been cut away, then the qi in ShaoYang channel can not gather together. So that the qi in Three-Jiao can not be normally distributed all over the body and then there appeared stagnant heat in the stomach and spleen; furthermore, the Yin evil can not be restrained effectively by the Yangqi and then there appeared retention of pathogenic dampness-phlegm. Then the pulse and the tongue reflected a vast sheet of the symptom of entanglement between the dampness evil and heat evil, which caused the evils couldn't be easily removed.

Therapeutic Principle: Clearing away the stagnant heat from the stomach and spleen, eliminating the pathogenic dampness-phlegm, destroying the dirty substance and activating the stagnant qi.

Recipe:

DangShen,Pilose Asiabell Root 30g

BaiZhu,Bighead Atractylodes Rhizome 18g

FuLing, Tuckahoe 15g

GanJiang,Dried Ginger 8g

FaBanXia,Pinellia Tuber 10g

HuangLian,Coptis Root 9g

HuangQin,Scutellaria Root 9g

YiYiRen,Coix Seed 30g

BaiTouWeng,Pulsatilla Root 25g

CangZhu,Atractylodes Rhizome 20g

ShanYao,Chinese Yam Rhizome 30g

ZeXie,Oriental Water Plantain Rhizome 25g

ZhiGanCao,Prepared Liquorice Root 10g

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

Effect Observation: After taking the decoction, the patient came back on June 10,1999. She told me the distending pain in the both inferocostal regions was greatly relieved, the diarrhea was stopped. She defecated once or twice a day, there was no white or yellow mucus in the stool. But she was still disturbed by the frequent bowel sounds and the stool was loose and formless. The pulse was deep and soggy, the tongue became light red with A thick layer of white fur. All these signs indicated the stagnant heat in the stomach and spleen had been greatly removed while the pathogenic dampness-phlegm were not removed yet. Then it's necessary to change the prescription to reinforce the strength of destroying the dirty substance and eliminating the pathogenic dampness-phlegm.

Recipe :

DangShen,Pilose Asiabell Root 30g

BaiZhu,Bighead Atractylodes Rhizome 18g

FuLing,Tuckahoe 15g

GanJiang,Dried Ginger 8g

FaBanXia,Pinellia Tuber log

HuangLian,Coptis Root 12g

HuangQin,Scutellaria Root 12g

YiYiRen,Coix Seed 30g

ShanYao,Chinese Yam Rhizome 30g

HuoXiang,Agastache Aerial Parts 12g

PeiLan,Eupatorium 12g

ChaiHu,Bupleurum Root 9g

FoShou,Finger Citron 6g

BaiTouWeng,Pulsatilla Root 25g

ZhiCaanCao,Prepared Liquorice Root fig

All the above drugs were to be decocted in water for oral taking. 10 doses were prescribed. Greasy and hot food was forbidden.

After taking the decoction, she came back and told me there was not uncomfortable sensation on her any more, the stool was formed and normal. The pulse was normal, the tongue was light red with a thin layer of white fur. All these signs showed the illness was cured already. Because her gallbladder had been cut away, the qi of ShaoYang channel couldn't gather together as normal. If the treatment was stopped suddenly, the illness would come back soon. Then she was told to take 2 doses of the above prescription in order to make pills, taking the pills in order to restrain the illness. After 1 year' s follow-up, the illness didn' t recur. Then it' s ending.