Name: Yang.

Sex: Female.

Age: 25 years.

0ccupation: A worker.

Chief Complaint: Damage and malformation of fingernails for 1 year and a half.

History of Present Illness: One and a half years ago, the patient's fingernails of 2 hands got damaged and malformed without any obvious causes. The surface of the fingernails became uneven and rough. They were different from the normal fingernails obviously, for they were all malformed in appearance and dark in colour. In the past times, she had separately been to dermatological department of several hospitals for treatment, the sickness was suspected as "Onychomycosis" and she was treated with external applying many kinds of ointment and lotion such as "Huatuo Gao, Dyclonine" and oral taking some unknown western medicine and Chinese herbs, but there was no effect on her at all, the affected fingernails were as same as before. But there weren't redness, swelling, pain, itching and exudate. Then she came here for treatment on October 13,1998 through somebody.

Physical Examination: The patient was conscious with a normal general condition. The pulse was thready and uneven. The tongue was dark red with a thin layer of white fur. The index fingernail, the middle fingernail and the ring fingernail of the right hand were all damaged severely, the surfaces were all uneven, rough and black, each length of the damaged part of the right affected fingernails was separately 8mm, 6mm and 8mm. The big fingernail, the index fingernail, the middle fingernail and the ring fingernail of the left hand were all damaged too, the surfaces were all uneven, rough and black too, each length of the damaged part of the left affected fingernails was separately 6mm, 8mm,Smm and 8ram. There were 7 damaged fingernails of two hands totally, and there weren't indication of growing of them at all. No new nail could be found on the affected fingernails. There wasn't other abnormal sign.

Lab Test: The result of blood routine examination was: Hb 13.5g/L, WBC 7.8 )< 109/L, N 0.78, L 0.22.

Diagnosis: Damage and Malformation of Fingernails.

Differentiation: It's the syndrome caused by stagnation of liver-qi and stasis of liver-blood. According to the theory of TCM, liver is an office of storing up blood, it controls the activity of the tendon, and the nails as mirrors of liver reflects the function of liver. In this case, there had been stagnation of qi and blood stasis in liver, so that the nails mirrors of liver, became withered, for they couldn't be nourished well by qi and blood.

Therapeutic Principle: Dispersing the stagnated liver-qi and activating qi, removing blood stasis and softening liver.

Recipe :

DangGui,Chinese Angelica Root 12g

ChuanXiong, Chuanxiong Rhizome 10g

GuiZhi,Cinnamon Twig 15g

ZhiHuangQi,Moxa-prepared Milkvetch Root 30g

XiXin,Asarum Herb 9g

ChaiHu,Bupleurum Root 8g

TaoRen,Peach Seed 12g

JiXueTeng,Spatholobus Stem 25g

ChiShao,Red Peony Root 12g

DanShen,Red Sage Root 15g

ShuiZhi, Leech 5g

DiBieChong, Ground Beetle 5g

GanJiang,Dried Ginger 6g

HongHua, Safflower 10g

NiuXi,Achyranthes Root 15g

All the above drugs were to be decocted in water for oral taking. 12 doses were prescribed. Greasy and acid food was forbidden. In addition, because the evils were located at the fingernails, where couldn't be easily attacked by the common qi activating medicines and blood stasis removing and blood circulation promoting medicines. Then it's necessary to use some insect drugs, which could rapidly search and exterminate the evils which hid deeply and remotely in the tiny place.

Recipe: Powder of Scorpion and Centipede.

QuanXie, Scorpion

WuGong, Centipede

(Each herb was taken just proper amount)

All the above drugs were to be ground into fine powder and mixed together, taking 0. 8g of the mixed powder each time, 3 times a day in morning, afternoon and evening separately.

Effect Observation: After 12 days of the above treatment, the patient came back for reexamination. The tongue was light red with a thin layer of white fur. The pulse was thready and deep, the damaged parts of the affected fingernails were as same as before. No obvious change could be seen there, but there were very tiny new nails whose lengths were all from lmm to 2mm at the root of each affected fingernail. It showed the stagnated liver-qi had been dispersed, and the blood stasis of liver had been removed too. Because the evils were located at the end of the fingers, qi and blood couldn't nourish there rapidly. Then the followed therapeutic principle should be elevating qi and blood to the end of the finger and continuing to promote blood circulation and soften liver.

Recipe:

DangGui,Chinese Angelica Root 15g

DanShen,Red Sage Root 15g

ChuanXiong,Chuanxiong Rhizome 10g

ZhiHuangQi, Moxa prepared Milkvetch Root 30g

GuiZhi, Cinnamon Twig 12g

XiXin,Asarum Herb 9g

GanJiang,Dried Ginger 6g

JiXueTeng, Spatholobus Stem 25g

BaiShao,White Peony Root 25g

ShuiZhi, Leech 5g

HongHua, Safflower 10g

DiBieChong,Ground Beetle 5g

TaoRen,Peach Seed 10g

ChaiHu,Bupleurum Root 8g

ShengGanCao,Raw Liquorice Root 6g

All the above drugs were to be decocted in water for oral administration. 20 doses were prescribed. Taking the powder of Scorpion and Centipede was idem. Dietetic restraint was idem too.

After taking the 20 doses, the patient came back for reexamination. It showed the lengths of the damaged parts of the affected fingernails became shorter than before, and it could be seen that some new fingernails had replaced some damaged parts of the 7 affected fingernails. All these signs showed the treatment was obviously effective, the flowing of liver-qi and liver-blood became easy and smooth, and the affected fingernails could have been nourished well. Because the growing of the nails was very slowly and the patient's family was very poor, then I stopped the treatment to observe growing of nails. 3 months later, the patient came to me with her family member for expressing their thanks on March 5,1999. It showed each affected fingernail was as same as normal. Then it's ending.