Name: Wei.

Sex: Male.

Age: 20 years.

0ccupation: A college-student.

Chief complaint: Diabrosis and festering of left anterior part of neck for more than 1 year, distending pain of both hypochondria for half a year.

History of Present Illness : More than 1 year ago, the patient' s left anterior part of the neck got diabrotic without any obvious causes. The opening of the diabrosis was just like a peanut, aecompanied with a little uncomfortable sensation. There weren't red-swelling, pain and itching. Some white-coloured and thin-textured juice usually flowed out of the opening, there weren't special smell and bleeding and so on. Then he went to the local po1icfinic for treatment, it was diagnosed as " tuberculous ulceration" and was treated with intramuscular injecting "Benzylpenicillin, Streptomycin" and regional debridement in every day. After 2 months' treatment, the juice still flowed out from the opening as before, and the diabrosis couldn't healed. Then the patient was sent to the surgery of a hospital. An attending surgeon in the hospital treated it with regional 0peration,and she considered the diagnosis must be "tuberculous ulceration. "But the result of acid-fast bacillus culture and the pathological report showed there was no acid-fast bacillus. Then the patient came to the local policlinic again and was treated with regional debridment, oral taking " Rifampicin, Isoniazid" and intramuscular injecting "Benzylpenicillin" and "Streptomycin. " After 4 months' such treatment, the diabrosis couldn't be healed yet. Furthermore, the diabrosis extented inside, and then it became a 2.5era deep sinus, from which some thin and clear juice flowed out constantly. Then the illness obliged him to leave the college for treatment. He retured to his hometown£­Handan City, Hebei Province, and got same treatment there. During the treatment, he slowly got a severe distending pain in the both inferocostal regions, which caused he dare not to bend down. Alter having an ultrasonogram examination, it was found there was "hepatosplenomegaly," then the anti-tuberculosis treatment was stopped and he began to accept the treatment of TCM. After land a half months' treatment, the opening of the diabrosis seemed to be healed and there appeared a regional scab, while if the scab was touched upon, it' s not hard and there was white and thin juice {lowing out under the scab. But the patient and his family considered the illness was healed, and then the patient and his father came to Nanjing again for his studying. As they just arrived in Nanjing, the scab became diabrotic again and it quickly became a 2cm deep sinus. Then the patient was sent to a hospital In Nanjing for treatment. A chief physician diagnosed the illness

As "Congenital Branchial Cleft and Fistula. " He treated it with 0ral taking Chinese herbs and applying external drugs. After 3 months' treatment of oral taking more than 70 doses of decoction and external using 7 kinds of external drugs, the illness couldn't be cured yet, furthermore, the sinus became more diabrotic than before with a pungent odor due to corrosion resulted from external using "Nine one Pills. "In addition, during the 3 months' treatment, another chief physician of TCM treated the hepatosplenomegaly with oral taking 20 doses of decoction. After taking the 20 doses, the distending pain in the both inferocostal regions was relieved effectively. But it was found that the hepatosplenomegaly was as same as before through ultrasonogram B examination. Until now, the patient had no curative effect after many treatments and 6 times of operation. Then he and his father came here for treatment on November 28, 1995.

Physical Examination: The patient was conscious with a normal general condition. The lung and the heart were normal. The abdomen was flat and soft. The liver and the spleen could be palpated in the both inferocostal regions. If touched upon, there

was severe tenderness. There was an opening of the diabrosis whose size was 1.0cm X 1.0cm in the anterointernal part of the left sternocleidomastoid muscle, a 2cm long postoperative cicatrix was there below the opening of the diabrosis. The sinus was 2.5cm deep, the opening of the diabrosis was erosive, accompanied with a pungent oder. The pulse was thready, soggy and uneven. The tongue was light red with a greasy layer of white fur. There was not other abnormal sign.

Lab Test: The results of liver function were all in normal limit; the result of blood routine examination was as follow: WBC 8.2¡Á10(9)/L,N 0.7, L 0.3.

Examination of Ultrasonogram B: The left lobe of the liver was 8.2cm long and 6.8cm thick. The right lobe of the liver was 13cm thick, its oblique diameter was 15.8cm. The intercostals thickness of the spleen was 4.6cm, the inferocostal thickness of the spleen was 2.6cm. There was not other abnormal sign.

Diagnosis: ¢Ù Intractable Cervical Sinus. ¢Ú Medicamentous Liver and Spleen Lesion; Hepatosplenomegaly.

Differentiation: This disease, in TCM, belongs to the category of "YinChuang" (Yin-sore). It's caused by the attack of exogenous cold-dampness and endogenous turbid phlegm. Both the endogenous and the exogenous evil got entangled each other and caused the Yin sore. Because the dampness evil was too sticky, heavy and greasy to be removed, then the illness couldn't l tin cured easily. Furthermore, the doctors incorrectly treated the illness with unfit herbs and careless operation. Not only the evils weren't removed, but also it induced the evils' attacking inside. The evils got into the channels from the muscles and attacked liver and spleen along the channels, and then it caused there were accumulation of phlegm-dampness and blood stasis in liver and spleen. So that the patient got the hepatosplenomegaly.

Therapeutic Principle: Promoting the blood-circulation and removing blood stasis from liver and spleen, invigorating qi and nourishing blood, softening and resolving hardness to induce subsidence of swelling and reduce liver and spleen. After the evils in liver and spleen were removed, the flowing of qi and blood would become normal and regular. At that time, the cervical sinus would disappear without treating. Because the evil can n,)t invade in when the healthy qi is full inside the body, this is a piece of important law of TCM.

Recipe:

DangShen,Pilose Asiabell Root 30g

ShuDiHuang,Prepared Rehmannia Root 30g

BaiShao,White Peony Root 25g

FuLing, Tuckahoe 25g

ZhiBieJia,Fresh-water Turtle Shell 25g (to be decocted earlier)

ShengMuLi,Oyster Shell 25g (to be decocted earlier)

XiaKuCao,Prunella Spike 20g

ChuanShanJia,Pangolin Scale 5g (to be decocted earlier)

DanShen,Red Sage Root 25g

ChiShao,Red Peony Root 15g

ShuiZhi, Leech 3g

TaoRen,Peach Seed 15g

DiLong, Earthworm 10g

DiBieChong,Ground Beetle 6g

GanCao,Liquorice Root 10g

All the above drugs were to be decocted in water for oral taking. 7 doses were prescribed. Hot, greasy and aromatic food was forbidden. During the same period, I covered the opening of the diabrosis with a piece of gauze soaked in rivanol liquid, once a day.

Effect Observation: After taking the 7 doses, the distending pain in the both inferocostal regions disappeared. Examination of ultrasonogram B showed the left lobe of the liver was 7.5cm long and 6.5cm thick; the right lobe of the liver was 11.0cm thick, its oblique diameter was 15. 2cm. The intercostal thickness of the spleen was 4.0cm, the spleen couldn't be found below the costale. All these signs indicated the volume of the liver and the spleen became smaller than before. In addition, there were red and fresh granulation in the sinus, it seemed that the sinus would be healed soon. Then I decreased ChuanShanJia(Pangalin Scale) from 5g to 3g; omited 30g of DangShen(Pilose Asiabell Root)and 25g of FuLing (Tuckahoe), added 15g of DangGui (Chinese Angelica Root)and 30g of ShengHuangQi(Raw Milkveteh Root) in the original recipe. Dietetic restraint was as same as before, regional dressing change should be done once in every other day. l-le should take 5 doses of the changed prescription. All the herbs were to be decocted in water for oral taking.

After taking the 5 doses, reexamination of ultrasonogram B showed the left lobe of the liver was 6. 2era long and 6. 0era thick, the right lobe of the liver was 10. 0era thick, its oblique diameter was 14.0era. The intercostal thickness of the spleen was 3. Sere, the spleen couldn't be explored below the costale. All these signs indicated the volume of the liver and the spleen had been normal. In addition, the cervical sinus had been healed already and its opening scabbed. Then I stopped the original treatment and began to use moxibustion with medicinal cake, the recipe of the herb-cake was as follows.

Recipe:

ShengHuangQi,Raw Milkvetch Root 20g

SuHeXiang, Storax 20g

All the above herbs were to be ground into fine powder, he should mix the powder with some water and flour to make herb cake which was as big as a coin, putting the herb-cake onto the scab to have moxibustion with medicinal cake, 10 pieces of the moxa cones were used each time, 3 times a day. Having such moxibustion with medicinal cake could expel the regional pathogenic cold and eliminate the regional phlegm-dampness.

After 3 days of having moxibustion with medicinal cake, the scab scaled. Because the patient' s tongue was still pale with a thick layer of white fur and the pulse was thready and soggy, then it's necessary to warm the middle Jiao, eliminate the dampness phlegm and invigorate qi.

Recipe:

DangShen,Pilose Asiabell Root 15g

BaiZhu,Bighead Atractylodes Rhizome 25g

CangZhu,Atractylodes Rhizome 20g

ZhiFuZi,Prepared Aconite Root 15g

GanJiang,Dried Ginger 15g

FaBanXia,Pinellia Tuber 8g

FuLing, Tuckahoe 25g

YiYiRen,Coix Seed 25g

TaoRen,Peach Seed 15g

H0ngHua, Safflower 15g

ZhiKe,Fruit of Citron 15g

DangGui,Chinese Angelica Root lOg

ZhiHuangQi,Moxa-prepared Milkvetch Root 30g

GanCao,Liquorice Root lOg

YunMu,Mica 20g

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

After taking the 5 doses, the patient's tongue became red with a thin layer of white fur, the pulse was normal and regular, the original opening of the diabrosis was replaced by normal skin. All these, signs indicated the illness was cured completely. After 4 years follow-up, the illness didn' t recur. Then it' s ending.