Name: Tan.

Sex: Female.

Age: 34 years.

0ccupation: A teacher.

Chief Complaint: Pain of left lower abdomen for 4 and a half years.

History of Present Illness: Four and a half years ago, the patient got a pain in her left lower abdomen without any obvious causes. It's a dull pain and occurred intermittently, not accompanied with {ever, chill, nausea, vomiting and so on. She had been to a hospital in ChongQing for treatment. Through some medical examination it was diagnosed as " Oophoritic Cyst. "Then she was treated with intravenous dripping some antibiotics and oral taking Chinese herbs. In the past 4 years, the abdominal pain was relieved under the treatment. But after many times of such treatment, the curative effect became more and more faint. Furthermore, through many times of examination of ultrasonogram B, it was found that not only the ovarian cyst wasn't removed but also it became from rice-like originally to egg-like recently. Then she had separately been to the hospitals in Jiangyin, Wuxi and Suzhou for treatment, but the cyst couldn't be removed yet. The doctors who she had asked all suggested that the cyst should be removed by an operation, but the patient herself refused the suggestion firmly, she only maintained it with Chinese herbs and western medicine usually. A week ago, the abdominal pain came back again, then she came here for treatment on October 31, 1999 through somebody. 6 years ago the patient accepted an operation named as "resection of uterus and left adnexa" became of her "Chorioepithelioma Malignum. " In the past 6 years she have got repeated reexamination for it, all the results of reexamination indicated there wasn't recurrence of the illness. After the "Ovarian Cyst" came on, she got aching-pain in the lumbosacral portion, dryness of stool, poor appetite, lassitude and fatigue as usual. The urination and sleeping were all normal. There wasn't other complaint.

Physical Examination: The patient was thin and weak with a dark grey complexion. The skin of her forehead and eye-sockets was darker than normal. The skin of her face was coarse and lusterless. The heart and the lungs were all normal. The abdomen was soft and flat, there was tenderness in the left lower abdomen, there weren't rebound tenderness and muscular tension. The pulse was slow, thready, uneven and soggy, the tongue was red with a thick layer of white fur. There was not other abnormal sign.

Examination of Ultrasonogram B: Her uterus and right adnexa couldn't be explored. Volume of the left ovary was 5.6cm¡Á5.2cm¡Á5. 3cm, where a cystiform mass whose volume was 4.6cm¡Á4.6cm¡Á4.3cm was explored, in which there were spot-like and segmented echos. It showed there was a cystiform mass in the left adnexal area.

Diagnosis: Ovarian Cyst.

Differentiation: This disease, in TCM, belongs to the category of "ShaoFuZhengJia"(mass in lower abdomen). It was caused by blood stasis in lower abdomen, which was accumulated in lower abdomen for months and years, finally it became a mass in lower abdomen. In this case, although the patient looked as if she had been in poor health, actually this is a sthenic syndrome with much accumulated evil. It was just as if what an ancient medical instruction said: "A much sthenic pathogenesis always appears much catheretic. " it just refers to such case. In fact, this case is a syndrome of exterior deficiency and interior excess.

Therapeutic Principle: It's cardinal therapy to pare the hard-ness, strike blood stasis and dredge the obstructed meridian, it's auxiliary therapy to invigorate qi, promote blood circulation and eliminate damp-heat.

Recipe:

BieJia,Fresh-water Turtle Shell 30g (to be decocted earlier)

MuLi,Oyster Shell 30g (to be decocted earlier)

DangShen,Pilose Asiabell Root 30g

BaiShao,White Peony Root 20g

XiaKuCao,Prunella Spike 25g

DiBieChong,Ground Beetle 5g

TaoRen, Peach Seed 15g

ChiShao,Red Peony Root 15g

LongDanCao,Gentian Root 12g

DiCuPi,Wolfberry Bark 18g

DanShen,Red Sage Root 25g

ShuDiHuang,Prepared Rehmannia Root 18g

ShuiZhi, Leech 5g

NiuXi,Achyranthes Root 25g

FuLing, Tuckahoe 20g

All the above drugs were to be decocted into water for oral taking. S doses were prescribed. Hot and greasy food was forbidden during the treatment. In the same period, she was told to take the capsule for wrecking mass.

Recipe:

HuPo,amber

A'Wei, Asafetida

(Each herb was taken just the proper amount)

All the above drugs were to be ground into powder, the 2 kinds of powder should be mixed together, filling the large sized capsules with the mixed powder. She was told to take 2 pieces of the capsule each time, 3 times a day in morning, afternoon and evening separately.

Effect Observation: After taking the decoction, reexamination of ultrasonagram B showed volume of the left adnexa was reduced to 4. 6cm¡Á4. Ocm¡Á3. 8cm, the left adnexal cyst was reduced too, its volume became 3. 4cm¡Á2. 9cm¡Á3. lcm. All these signs showed the left ovary and the oophoritic cyst had been greatly reduced in size. Furthermore, the patient said there weren't aching-pain in the lumbosacral portion and the abdominal pain All these signs showed the used prescription was suitable for her illness. So that the followed therapeutic principle should be continuing to pare the hardness, strike blood stasis and strengthening to dredge the obstructed meridian.

Recipe:

BieJia,Fresh-water Turtle shell 30g (to be decocted earlier)

MuLi,Oyster Shell 30g (to be decocted earlier)

DangShen,Pilose Asiabell Root 30g

BaiShao,White Peony Root 20g

XiaKuCao,Prunella Spike 25g

DiBieChong,Ground Beetle 5g

TaoRen, Peach Seed 15 g

ChiShao,Red Peony Root 15g

DanNanXing,Arisaema with Bile 10g

ShuiZhi, Leech 5g

NiuXi,Achyranthes Root 25g

DiLong, Earthworm 10g

DanShen,Red Sage Root 25g

FuLing, Tuckahoe 25g

GanCao,Liquorice Root 10g

All the above drugs were to be decocted in water for oral taking. She was told to take 5 doses of the above prescription. The dietetic restraint and taking the capsule for wrecking mass were all as same as before.

After taking this 5 doses, the patient came back on November 11,1999. She told me all the uncomfortable sensation disappeared, she felt she was much energetic, her appetite got better than before. Reexamination of ultrasonogram B showed volume of the left adnexa was 2.9cm¡Á2.8cm¡Á2.7cm,there was no cyst in the left adnexal area. All these signs showed the ovarian cyst had been removed completely, volume of the left ovary had been normal already. Furthermore the patient's complexion became ruddy and lustrous. Then she was told to take some qi invigorating drugs and blood circulation promoting drugs in order to nurse herself well. After 2 years' follow-up, the illness didn' t recur. Then it' s ending.