Name: Carrie.

Sex: Female.

Age: 26 years.

0ccupation: A student.

Chief Complaint : Red maculopapules of cheeks for more than 3 years, accompanied with chill, cough and expectoration.

History of Present Illness: More than 3 years ago, the patient got some red maculopapules on her both cheeks, there were many groups of miliary papules in the red patch, occasionally accompanied with itching sensation. If scratched about, there was flow of some thin and clear juice. But there weren't special smell and pus and so on. In addition, the patient usually got chilly severely. Even in the midsummer, the very hot weather couldn' t make her sweat at all. Moreover she dare not be blown by the fan. Additionally, she usually coughed with expectoration, which was profuse-amounted, white coloured and thick textured. She had gotten many kinds of treatment in Canada and India, but there was no obvious curative effect on her. Then she asked me for treatment on July 2, 1999. After the illness came on, she kept her appetite, sleeping and spirit well all along. The urine was abundant and white, the stool was loose and watery. There wasn't other complaint.

Physical Examination: The patient was conscious with a normal general condition. The pulse was thready, deep and uneven, the tongue was pale with a thin layer of white fur. There were some patches of macular eruptions in which there were many groups of miliary papules on the both cheeks. The maculopapules were all dark red in colour. There weren't pus, swelling and erosion. The respiratory sounds in lungs were clear, some big wet rales could be heard occasionally. There wasn't other abnormal sign.

Diagnosis: ¢Ù Acne Vulgaris. ¢Ú Chronic Bronchitis.

Differentiation: It's syndrome caused by deficiency of Yang. Because Canada is a high and cold country in North America, just like the east of the pass between mountain and sea(Shah Hal Guan) the northeast of China, they are all high and cold area with accumulated snow all the year round. In such environment, the pathogenic cold soaked the human body usually, as a result of many years of it, the Yangqi must be restrained, so that the patient got the deficiency of Yang. The deficient Yangqi couldn't promote the defensive-qi's flowing effectively, then the defensive-qi's flowing became slow and unsmooth. As a result of it, the pore of sweat duct in the skin couldn't open and close normally (because the defensive-qi is responsible for normal function of the pore of sweat duct under normal conditions) ,then the patient got chill and couldn't sweat as normal even in very hot weather of midsummer. When the pore of sweat duct in the face couldn't open and close normally, it caused the dirt in interstices couldn't be cleaned effectively and the sweat couldn't volatilize normally. Then there was an accumulation of the dirt and the sweat under the skin. As a result of long time of it, the acne was formed. In addition, the deficiency of Yang could cause the deficiency of spleen-Yang, which couldn't transport the phlegm in the lung effectively, so that there was an accumulation of the cold phlegm evil in lung and the patient got cough and expectoration. Although the patient is out of our country, the chinese traditional medical science is the most broad and the most extensive medical knowledge. No cause of disease can be out of the rang of Six evils, no pathogenesis cart be out of the rang of Eight Principal Syndroms. A wise doctor should be good at thinking deeply in clinic work in order to choose the most suitable recipe and the most suitable herbs; he should take measures suited to local condition, vary with each individual. Then he can cure the difficult disease by the most simple way within the shortest time, as if hitting the target only with one shot.

Therapeutic Principle: Invigorating Yangqi and spleen qi; warming middle-Jiao and clearing away the pathogenic cold; activating qi and eliminating the phlegm evil.

Recipe :

DangShen,Pilose Asiabell Root 30g

BaiZhu,Bighead Atractylodes Rhizome 15g

ZhiFuZi,Prepared Aconite Root 8g

GanJiang,Dried Ginger 12g

ZhiShi,Immature Bitter Orange 8g

ChenPi,Tangerine Peel 8g

ChaoMaiYa,Germinated Barley (fried) 9g

JiaoShanZha,Hawthorn Fruit (fried) 9g

FaBanXia,Prepared Pinellia Tuber 12g

ZhiGanCao,Prepared Liquorice Root 9g

Two doses were prescribed, all the herbs were to be ground into fine powder, I mixed the powder with some water to make pills. She was told to take 6g of the pills each time, 3 times a day, taking the pills before eating, cold and greasy food was forbidden during the treatment.

Effect Observation: After 1 week's treatment, the patient came to me, she showed me her face, on which the ache had disappeared. The skin of her face became smooth and lustrous. Then she was told to continue the treatment, 1 week later, she to1d me her cough, chill and expectoration disappeared too. After 2 months' follow-up, the patient was well all along. Then it's ending.