Case 1

Name: Zhao.

Sex: Female.

Age: 22 years.

Occupation: A worker.

Chief Complaint: Pain of right lower abdomen for 1 week.

History of Present Illness: One week ago, the patient got a pain in her right lower abdomen without obvious causes. It' s a sharp prickling pain, accompanied with fever and chill at the beginning. Then she went to the local hospital for treatment. Alter some relative medical examination, it was diagnosed as Acute Appendicitis" and she was treated with intravenous dripping some antibiotic drugs such as "Penicillin G, Gentamycin" and so on. After 6 days' treatment, the fever and the chill disappeared while the pain in the right lower abdomen couldn't be relieved yet.S0 that she was sent to the surgery of other hospital. The surgeon suggested that the illness should be treated by an operation. But the patient herself didn't accept the operation. Then she came to our hospital for treatment on August 30,1999. Alter the illness came on, her appetite got poor and she defecated once every 3 days, the stool was dry and hard in texture, the urine was normal. There was not other complaint.

Physical Examination: The temperature was 37.8¡æ. The patient was weak with a painful complexion. The pulse was thready and soggy. The tongue was pale, tender and teeth-printed with whitish fur. The lungs and the heart were all normal. The abdomen was flat and soft. There were fixed tenderness and rebound tenderness at the right McBurney point, there was muscular tension at the part of the right lower abdomen. There was not other abnormal sign.

Lab Test: WBC 16.8¡Á10(9)/L, N 0.70, L 0.30.

Roentgenogram of Abdomen: Normal.

Diagnosis: Acute Purulent Appendicitis.

Differentiation: This disease, in TCM, belongs to the category of "ChangYong" ( intestinal carbuncle ). As usual, intestinal carbuncle is caused by accumulation of heat evil and fire-toxin in the intestine and its therapeutic principle is clearing away heat and expelling the toxic material. As for this case, it's different from the common cases. Why? Because this patient had been treated with numerous antibiotics. And the pulse, the tongue showed there was accumulation of pathogenic water and dampness in the interior organs. It was caused by numerous antibiotics and a lot of fluid, which were poured into the blood circulation quickly and directly. Not only the momentum of the sickness was immediately defeated but also the functional activities of Yang-qi were restrained. This is the characteristic phenomenon in dime practise named as "A sudden cooling therapy always hurts Yang qi." So that the restrained Yang-qi eouldn't transport the fluid and water effectively as normal it was reflected by the patient's pulse and tongue, which were all different from the common cases. It was just like what a set phrases said: More haste, less speed; a thing negates itself when developed to the extreme. Now the constant prickling pain in the fight lower abdomen showed the heat evil and the fire-toxin which accumulated in the intestine were merely hemmed in, but weren't be annihilated yet.

Therapeutic Principle: It's necessary to use warming therapy and heat-clearing therapy together in order to cope with the pathogenic water and dampness and heat evil at the same time. Warming the middle Jiao and eliminating the phlegm evil in order to clear away the pathogenic water and dampness; clearing away heat to remove toxin in order to annihilate the heat evil and fire-toxin accumulated in the intestine.

Recipe:

ShengDiHuang,Dried Rehmannia Root 18g

MuDanPi,Tree Peony Bark 10g

BaiJiangCan, Batryticated Silkworm 15g

QiYeYiZhiHua, Windpipe Trachea 25g

OanJiang,Dried Ginger 8g

ZhiFuZi,Prepared Aconite Root 8g

DanNanXing,Arisaema with Bile 8g

BaiHuaSheSheCao, Oldenlandia 30g

BanBianLian,Radical Lobelia 15g

BanZhiLian,Barbat Skullcap 15g

PuGongYing,Dandelion Herb 25g

DiLong, Earthworm 15g

BaiJiangCao, Patrinia 25g

ChiXiaoDou,Red Beam 25g

ZhiShi,Immature Bitter Orange 15g

All the above drugs were to be decocted in water for oral taking. 5 doses were prescribed. Cold and cool food was forbidden. She was told to stop the original treatment.

Effect Observation: After taking the decoction, the abdominal pain disappeared. But the patient got cough, rhinorrhea and fever because the weather was becoming cooler in the recent days, furthermore, the stool was dry and hard yet. Physical examination showed her temperature was 38.9¡æ, the pulse was floating and rapid, the tongue was light red with a thin layer of white fur. All these signs showed the pathogenic water-dampness and heat evil accumulated in the intestine had been removed mostly while the lungs were attacked by the exogenous pathogenic wind-heat. Because the lungs are in close relationship with the large intestine, expelling heat and toxic material by purgation should be more suitable for the illness than expelling pathogenic wind and cold and relieving superficies-syndrome, for expelling heat and toxic material by purgation could not only expel the wind-heat to relieve cough and fever but also expel the remnant of evil in the intestine to relieve obstipation. This therapy is called as "treating the lower to cure the upper disease" in TCM.

Recipe :

ShengShiGao,Gypsum 30g (to be decocted earlier)

LuGen,Reed Rhizome 25g

ZhiMu,Windweed Rhizome 12g

ZhiKe,Fruit of Citron 10g

ShengDaHuang,Raw Rhubarb 9g (to be decocted later)

BanBianLian,Radical Lobelia 12g

BanZhiLian, Barbat Skullcap 12g

GanJiang,Dried Ginger 9g

ZhiFuZi,Prepared Aconite Root 5g

ShengDiHuang,Dried Rehmannia Root 15g

MuDanPi,Tree Peony Bark 12g

FanXieYe,Senna Leaf 18g (to be decocted later)

All the above drugs were to be decocted in water for oral taking. 2 doses were prescribed.

After taking the 1st dose, the patient could move her stool smoothly and then her temperature got normal. After taking the 2nd dose, all the uncomfortable sensation disappeared, there were not tenderness and rebound tenderness at the right McBurney point. The result of blood routine examination was as below: WBC 7.2 ¡Á 10(9)/L, N 0.68, L 0. 32. All the signs indicated the illness was cured completely.

After 2 months' follow-up, the illness didn't recur, then it's ending.

Case 2

Name: Zhang.

Sex: Male.

Age: 32 years.

0ccupation: A brick-layer.

Chief Complaint: Metastatic pain of right lower abdomen for 2 days.

History of Present Illness: Two days ago, the patient got a pain in the upper abdomen due to immediate working after his lunch. At the beginning it was a dull pain and occurred sometimes mildly and sometimes severely. Then he thought it might be a stomachache, and he had a rest and took some pills for relieving stomachache by himself. But the pain couldn't be relieved and slowly transferred to the regions around his navel. Moreover it became a constant distending pain and occurred obviously severelier than before, accompanied with nausea and chill. 1 day ago, the pain then transferred to the right lower abdomen and became a sharp prinkling-like pain which got worse and worse quickly and caused he couldn' t stand or sit at ease.

Furthermore he got high fever, chill, nausea and vomiting. Then he went to the surgery of a hospital on June 7, 2000. After physical examination, it was diagnosed as "Acute Appendicitis and he was suggested that the illness should be treated by an operation. But the patient was poor and he couldn't afford the operation. Then he came to me for non-operational treatment. After the illness came on, he lost his appetite and didn' t have a meal in the past 2 days. Furthermore he got bad sleeping due to the severe abdominal pain. His defecation and urination were all normal. There was not other complaint.

Physical Examination: The temperature was 38. 2¡æ. The patient was conscious with an acute painful complexion. He groaned and moaned constantly. The pulse was thready and floating, the tongue was light red with a thin layer of white map-like fur. HR was 92beats/rain, the cardiac rhythm was regular. There weren't systolic murmur and diastolic murmur. The respiratory sounds were clear, no rales could be heard in lungs. The abdomen was soft and flat, the liver and the spleen couldn't be palpated in the inferocostal region. There was muscular tension in the right lower abdomen, there were fixed tenderness and rebound tenderness at the right McBurney point. There was not other abnormal sign.

Lab Test: WBC 9.8¡Á10(9)/I., N 0.88. L 0.12.

Diagnosis: Acute Appendicitis.

Differentiation: This disease, in TCM, belongs to the category of "ChangYong" (intestinal carbuncle). It was caused by the accumulated heat-toxic in the intestine, which attacked the intestinal wall and caused the intestinal carbuncle, then the patient got the abdominal pain. As for why the abdominal pain was a metastatic pain, it was caused by the different pathogenesis in the different stage. At the beginning of this illness, the accumulated heat toxic in the intestine disturbed the normal functional activities of intestine-qi, then there appeared the intermittent dull pain in the upper abdomen. With the illness was going along, the accumulated heat-toxic continuously disturbed the functional activities of intestine-qi and there slowly appeared stagnation of intestine-qi, then the intermittent dull pain slowly became the constant distending-pain, finally blood stasis was formed in the affected part of intestine, then there appeared the fixed prinkling-like pain and tenderness at the affected part. In addition, the accumulated heat toxic continuously fumigated and evaporated the intestinal fluid, then there was deficiency of Yin, it was reflected by the map like fur; the toxic fire flamed upward and disturbed the functional activities of stomach-qi, then the stomach-qi traveled upward reversely, it was reflected by the poor appetite, nausea and vomiting; when the heat-toxic diffused into the blood circulation, there appeared the high fever and chill

Therapeutic Principle: Clearing away heat and removing toxic from the intestine; nourishing Yin and cooling blood; activating blood to eliminate stagnation; invigorating spleen qi.

Recipe:

ShengDiHuang,Dried Rehmannia Root 18g

MuDanPi,Tree Peony Bark 12g

PuGongYing,Dandelion Herb 15g

BaiHuaSheSheCao, Oldenlandia 25g

DangShen,Pilose Asiabell Root 25g

BaiZhu,Bighead Atractylodes Rhizome 15g

BanBianLian, Radical Lobelia 15g

BanZhiLian,Barbat Skullcap 15g

DanShen,Red Sage Root 18g

TaoRen,Peach Seed 15g

BaiJiangCan, Batryticated Silkworm 15g

MaChiJian,Portulaca Herb 30g

ShuiZhi, Leech 5g

ZhiKe,Fruit of Citron 20g

8hengDaHuang,Raw Rhubarb 10g (to be decocted later)

All the above drugs were to be decocted in water for oral taking. 5 doses were prescribed. Hot and greasy food was forbidden during the treatment. He should take the decoction in morning, afternoon and evening separately.

Effect Observation: After taking the 1st dose, the patient excreted a lot of foul and black stool immediately, the abdominal pain was relieved greatly and his temperature lowered to 37.8¡æ. After 3 days' treatment, the abdominal pain disappeared at all, there wasn't uncomfortable sensation any more, the nausea and vomiting disappeared too, he got good appetite. Then he was told to continue taking the 2 doses in order to eliminate the remnant of the evils. After taking the 2 doses, he got well completely. After 1 month's follow-up, the patient was in good health all along. Then it' s ending.