Name: He.

Sex: Female.

Age: 35 years.

0ccupation: A worker.

Chief Complaint: Lump and swelling pain of right arm for 24 days.

History of Present Illness: Twenty-Four days ago, the patient Found there was a lump in the median part of her right elbow without any obvious causes. There was an uncomfortable sensation of being involved by the activities of the right elbow. Then the patient thought it was caused by her excessive work. But after 1 week' s rest, the uncomfortable sensation was there as before, furthermore, there appeared a swelling-pain in the right shoulder, upper arm and armpit, and the lump in the median part of right elbow became as big as a duck' s egg. So that it' s difficult for her to put on clothes and comb her hair. Then she went to a hospital and was treated with intravenous dripping antibiotic drugs and oral taking "Cap's Cefradini" and "Tab. Erythromycini Ethylsuccinatis" and so on. After half a month's treatment, the swelling-pain in the right upper arm, shoulder and armpit was relieved a little while the lump in the median part of the right elbow was as same as before, the patient couldn' t hold up her right hand and abduct her right arm. Then she went to the surgical department of other hospital for treatment. After a series of medical examinations, the sickness was diagnosed as "Infective Myositis, Intermuscular Abscess," and the surgeon suggested that the sickness should be treated by an operation. Because the patient was afraid of the operation, then she came here for treatment on November 25,1998. After the sickness came on, the patient kept her urination, defecation, sleeping and appetite normal all along.

Physical Examination: The patient was conscious with a normal general condition. The skin and muscle of the right upper arm and shoulder swelled diffusely. The right upper arm became thicker than normal. There was tenderness on the affected region. A lump which was as big as a duck's egg could be palpated in the median region of the right elbow. It' s tenacious in texture. There was waving-sensation around the lump. The pulse was thready and taut. The tongue was dark red with a thick layer of white fur. There was not other abnormal sign.

Examination of Ultrasonogram B: There was a mass of low echo in the median region of right elbow, whose size was 1.5cm¡Á1.2cm,its shape was regular, its edge was smooth. There was opaque dark area of fluid around the mass. All these signs showed there was an inflammatory mass in the median region of the right elbow.

Diagnosis: Intermuscular Abscess.

Differentiation: This disease, in TCM, belongs to the category of "LiuZhu" (multiple abscess). It's caused by the exogenous damp-heat, which attacked the defensive mechanism and constructive mechanism of the body, and got into the muscle and then lurked in the meridian deeply. So that the abscess was formed. Furthermore, the damp-heat was lurking in the meridian so deeply that it couldn't be removed by the common heat-clearing medcines and the common anti-inflammatory medcines, for the efficacy of those medicines couldn' t get into the affected meridian where the damp-heat was lurking. It was just the reason why the treatment of using the Western anti-inflammatory medcines was ended in failure.

Therapeutic Principle: It's most important to use some powerful evil-expropriating and meridian dredging drugs to strike the abscess directly and effectively. In addition, it' s helpful to use some heat-clearing drugs. Because the evils were located in the meridian, it's necessary to apply some external drugs onto the affected region to soften the mass and induce subsidence of swelling.

Recipe:

ShengDiHuang,Dried Rehmannia Root 15g

MuDanPi,Tree Peony Bark 8g

BanBianLian,Radical Lobelia 18g

BanZhiLian,Barbat Skullcap 18g

GuiZhi,Cinnamon Twig 15g

SangZhi,Mulberry Twig 12g

WeiLingXian,Clematis Root 12g

JiangHuang, Turmeric Rhizome 15g

DiLong, Earthworm 18g

ShuiZhi, Leech 5g

LuoShiTeng,Chinese Starjasmine 20g

RenDongTeng, Honeysuckle Stem 25g

LianQiao,Forsythia Fruit 10g

QiangHuo,Notopterygium Root 18g

BaiJiangCan, Batryticated Silkworm 15g

All the above drugs were to be decocted in water for oral taking. 5 doses were prescribed. Greasy and hot food was forbidden during the treatment. In the same period she should apply the external drugs onto the affected region.

Recipe:

DingXiang, Cloves 20g

XiaoHuiXiang,Common Fennel Fruit 20g

HongHua, Safflower 30g

ChuanXiong,Chuanxiong Rhizome 30g

ChuanWu,Sichuan Aconite Root 50g

CaoWu,Wild Aconite Root 50g

All the above drugs were to be ground into powder, she should mix the powder together and add them into some white vinegar and honey to make herb-plaster, applying the plaster onto the affected region, once a day.

Effect Observation: After 1 day' s treatment, the swelling-pain in the right shoulder and arm disappeared, after 2 days' treatment, the swelling of the right arm and shoulder disappeared too, the lump in the median region of the right elbow became smaller than before. After 5 days' treatment, reexamination of ultrasonogram B showed the lump in the median region of right elbow had disappeared. But the patient said there appeared a swelling-pain in the lateral region of the right breast. The physical examination showed the lateral region of the right breast was red and swollen, the pulse was slippery and soggy, the tongue was pale with a greasy layer of white fur. The movement of the right arm and elbow were as same as normal. The examination of ultrasonogram B showed there was an inflammatory mass in the laternal region of the right breast. All these signs indicated the evils which hid in the meridian deeply had been routed while the remnants of the routed evils fled into the right breast where was suited for evils' lurking, for the tissue of breast is very loose. As the remnants of the routed evils lurked into the breast, they gathered together and caused the inflammatory mass. In addition, the heat-clearing drugs in the original prescription turned the pus into the pathogenic water dampness, which was reflected by the patient's tongue and pulse--the tongue was pale with a greasy layer of white fur, the pulse was slippery and soggy. Then the followed therapeutic principle should be invigorating spleen qi, eliminating pathogenic water-dampness, clearing away heat removing toxin materials and pura, activating blood to resolve stasis.

Recipe:

ShengHuangQi,Raw Milkvetch Root 30g

DangGui,Chinese Angelica Root 12g

QuanGuaLou,Trichosanthes Fruit 30g

LongDanCao,Gentian Root 18g

ZeXie,Oriental Water Plantain Rhizome 18g

ShuiZhi, Leech 5g

PuGongYing,Dandelion Herb 20g

XiaKuCao,Prunella Spike 25g

GanJiang,Dried Ginger 8g

BaiFuZi,Prepared Aconite Root 8g

ChiXiaoDou,Red Bean 18g

DiBieChong,Ground Beetle 6g

ZaoJiaoCi,Chinese Honeylocust Spine 6g

YiYiRen,Coix Seed 30g (fried)

YuXingCao, Houttuynia 18g

All the above drugs were to be decocted in water for oral taking. 5 doses were prescribed. Dietetic restraint was idem. In lame period, she should apply the same external drugs onto fight breast, once a day.

After 2 days' treatment, the swelling-pain in the right breast disappeared. After 5 days' treatment, no mass could be palpated in the right breast, reexamination of ultrasonogram B showed there was no abnormal sign in the right breast. The right elbow, upper arm and shoulder were all normal.

After 1 month's follow-up, the patient was well all along, then it s ending.