Name: Zhang.

Sex: Female.

Age: 52 years.

Occupation: A retired worker.

Chief Complaint: Swelling-pain of left shank for 6 days.

History of Present Illness: Six days ago, there was a red small furuncle whose size was like a broad bean on the patient' s left shank, accompanied with slight itching sensation. Then the patient herself scratched it and pressed it inside with her fingers. After several times of pressing, the furuncle disappeared while she got a severe swelling pain in the middle and lower region of the left tibia. It' s a progressive swelling-pain and got more and more severe within a short time. Then she was obliged to go to the department of orthopedics of a hospital in Jiangyin City for treatment. Through some relative medical examination, it was diagnosed as "Acute Osteomyelitis. "Then she was treated with intravenous dripping "Cefradine, Benzylpenicillin" and so on. But the treatment could not prevent the illness from being worse and worse. Not only the pain was not relieved, but also it progressively intensified. The skin of the medial and lower region of the left tibia got severely dropsical and purplish red in colour, accompanied with severe ostealgia, chill and lassitude. Her left leg couldn't stand and walk at all because of the severe 0stealgia. Then she came to our hospital for treatment on December 1, 1999. After the sickness came on, she kept her urination ,defecation and appetite normal all along, while she got bad sleeping due to the severe ostealgia, which prevented her from sleeping as normal throughout night. There wasn't other complaint.

Physical Examination: The patient was conscious with an acute painful complexion. The pulse was taut and rapid, the tongue was dark red with a thick layer of white fur. The chest and the abdomen were all normal. The skin of the middle and lower region of the left tibia was severely dropsical and semitransparent. There were many large pieces of purplish red maculae on the surface of the affected regions. The whole left shank was swollen severely, accompanied with deep tenderness. The movement and shape of the left knee joint and ankle joint were all normal. There weren't other abnormal signs.

Lab Test: The result of blood routine examination was as follow: WBC 17.5¡Á10(9)/L, N 0.88, L 0.12.

Examination of" Roentgenogram: There were some moth eaten destructive areas in the osteoepiphysis of the lower region of the left tibia. This sign indicated it' s acute osteomyelitis.

Diagnosis: Acute Purulent Osteomyelitis.

Differentiation: It's attack of exogenous wind-heat, which gathered together under the skin and formed the furuncle. Because the furuncle was pressed inside with external force, the wind-heat directly got into the vessels and the bone from the skin and interstices. When the wind heat accumulated in the bone marrow, a toxaemia broke out; as a result of the evils diffusing into the bone marrow, the patient got the insufferable ostealgia; as a result of the evils diffusing outside into the channel and bone, the shank got severely swollen; as a result of the evil diffusing into the blood-circulation, the patient got chill, fatigue and lassitude.

Therapeutic Principle: It's necessary to use external treat-ment and internal treatment together. Applying some external herbs onto the affected region in order to pull out the toxic from the affected bone; oral medicating some blood-circulation activating and blood stasis removing herbs, heat clearing and channel unobstructing herbs in order to clear away heat from the blood and channel. In addition, because the evils deeply lurked in the bone marrow, the common herbs could not run through the bone and got close to the evils lurked in the bone marrow. So that it's most important to use some insect drugs in order to run through the bone and search, exterminate the evils lurked in the hone marrow.

Recipe:

ShengHuangQi,Raw Milkvetch Root 30g

DangGui,Chinese Angelica Root 10g

NiuXi,Achyranthes Root 25g

WuShaoShe,Black-tail Snake 15g

DiLong, Earthworm 18g

BaiJiangCan,Batryticated Silkworm 15g

HanFangJi,Tetrandra Root 10g

RenDongTeng, Honeysuckle Stem 25g

SuMu,Sappan Wood 15g

ShengGanCao,Raw Liquorice Root 8g

LuoShiTeng,Chinese Starjasmine 25g

DiBieChong,Ground Beetle 15g

All the above drugs were to be decocted in water for oral taking. 3 doses were prescribed. Hot and greasy food was forbidden during the treatment. During the same period, she should take the capsule of Scorpion and Centipede.

Recipe:

QuanXie, Prepared Scorpion

WuGong, Centipede

(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 capsules with the mixed powder, taking 3 capsules each time, 3 times a day. During the same period, she was told to apply the external herb plaster onto the lower and middle part of the left tibia in order to pull out the heat evil hidden in the bone marrow.

Recipe:

ShengDaHuang, Raw Rhubarb

SheXiang, Musk

HuangLian, Coptis Root

ChanSu, Toad Venom

BingPian, Borneol

XiongHuang, Realgar

(Each herb was taken just the proper amount. )

All the above drugs were to be ground into powder, she should mix the powder together with some vinegar and honey to make drug plaster. She was told to apply the herb-plaster onto the lower and middle region of the left tibia, cover the plaster with a hot water-bag in order to have fomentation, doing it once a day.

Effect Observation: After 3 days' treatment, the patient came back for reexamination. She told me the ostealgia was relieved greatly, her left leg could stand and walk, but she would got a swelling-pain when she walked about. The swelling of the left shank was greatly relieved too, the colour of the affected surface was purplish red too, but it got obviously lighter than before. All these signs showed the decoction was suitable for the patient. Then the followed therapeutic principle should be reinforcing the strength of clearing away heat and dredging the obstructed channel, activating blood to resolve stasis.

Recipe:

ShengHuangQi,Raw Milkvetch Root 30g

DangGui,Chinese Angelica Root 10g

RenDongTeng, Honeysuckle Stem 25g

LuoShiTeng,Chinese Starjasmine 25g

HongHua, Safflower 12g

TaoRen,Peach Seed 15g

WuShaoShe,Black-tail Snake 18g

HaiFengTeng,Futokadsura Stem 25g

NiuXi,Achyranthes Root 25g

BaiJiangCan,Batryticated Silkworm 15g

LaoGuanCao, Herb of Common Heron's Bill 30g

GuSuiBu,Drynaria Rhizome 20g

SuMu,Sappan Wood 18g

YiYiRen,Coix Seed 30g

DiBieChong, Ground Beetle 12g

All the above drugs were to be decocted in water for oral taking. 7 doses were prescribed. Dietetic restraint, applying external herbs and taking the capsule of Scorpion and Centipede were all as same as before.

After 7 days of the above treatment, the ostealgia in her left shank disappeared at all. The patient could stand and walk as normal without any uncomfortable sensation. Reexamination of roentgenogram showed the shape and structure of the left tibia were all normal. The results of blood routine examination were all in normal limit. All these signs showed the sickness had been cured completely. Because the evil hid in the bone marrow too deep to be removed completely, if they could not be eliminated completely, there would be no end of trouble for the future. Then she was told to take 3 doses of the original prescription, all the drugs were to be ground into powder, she should mix the powder with some water for making pills and take the pills for eliminating the remnant of the evils, After half a year's follow-up, the illness didn't recur, then it's ending.