Name: Zhang.

Sex: Female.

Age: 22 years.

0ccupation: A college-student.

Chief Complaint: Redness and swelling of lower extremeties for half a month after being bit by an insect.

History of Present Illness: Half a month ago, when the patient was sleeping, an insect whose name was unknown bit her dextral foot. Immediately her legs got severe swelling, accompanied with strong itching, many large pieces of red maculae appeared on the skin of her feet and legs. Especially the dextral foot where the insect bit was so severe swelling that she couldn't wear sock and shoe. Then the patient went to the local polielinic and was treated by using "VitC, Green Ointment" and "Chlorphenamine Maleate Tabiets, "but the treatment couldn't prevent the illness from aggravating, many large pieces of red maculae extended the affected regions to neck, chest, back and waist, accompanied with strong itching sensation. Then she was sent to the dermatological department of a hospital in Jingsu Province and was treated by 3 kinds of drugs named as "Xiaofeng granule, dermatitis granule and KeMingNeng" for 1 week, but there was no curative effect on her either. The large pieces of red maculae which spreaded all over the body couldn't disappear yet, the swelling of the legs became more and more severe than before, accompanied with intolerable itching sensation, furthermore, 3 big blisters appeared on the skin of the dextral dorsum pedis where the insect bit, accompanied with severe pain. Then the patient came to me for treatment on July 8,2007.

Physical Examination: The patient was conscious with a flesh-red complexion. The pulse was floating and rapid. The tongue was red with a thick layer of white fur. Many irregular large pieces of red maculae were seen on the skin of neck, chest, back, groins, waist and both legs. Some bands of scratched marks were seen on the affected skin. There were 3 big blisters on the skin of dextral dorsum pedis, each diameter of them was separately 4em,a,. 5em,6em. There was not other abnormal sign.

Diagnosis: Insect Dermatitis.

Differentiation: It was caused by insect poison, which got into the patient's blood and turned into virulent fire-evil. The virulent fire-evil led dampness-evil into interstices and then prevented qi and blood from descending and ascending as normal. Then there was blood stasis in interstices, by which the red macular was formed, furthermore, there was retention of damp-heat too, by which the swelling of the legs was formed.

Therapeutic Principle: Clearing away heat to eliminate toxin, drying dampness-evil and inducing subsidence of the swelling, expelling superficial evil and dispelling wind to relieve itching.

Recipe :

ShengDiHuang,Dried Rehmannia Root 30g

ZiCao,Arnebia Root 25g

TuFuLing, Smilax Glabra Rhizome 25g

JinYinHua, Honeysuckle Flower 20g

MuDanPi,Tree Peony Bark 25g

QinPi,Ash Bark 15g

BaiXianPi,Dittany Bark 20g

DiFuZi,Broom Cypress Fruit 20g

HuangBai,Phellodendron Bark 10g

LianQiao,Forsythia Fruit 15g

FangFeng,Ledebouriella Root 15g

Boric, Peppermint 15g

NiuXi,Aehyranthes Root 15g

ShanZhi,Capejasmine Fruit 15g

GanCao,Liquorice Root 10g

All the above drugs were to be decocted in water for oral taking. 5 doses were prescribed. Hot and greasy food was forbidden during the treatment. In the same period, I pricked the point of Geshu(BL17,both sides) with a 2.5tun needle and kept the needle in the point for 15 minutes each time, after acupuncture, I had a cupping on the point of Geshu immediately, maintaining it for 20 minutes each time, once a day. In addition, the 3 big blisters were treated by cutting to expose the erosion inside and applying the powder of external drugs onto the erosion once a day. The prescription of external drugs was:

HuangBai,Phellodendron Bark 30g

BaiJi, Hyacinth Bletilla 30g

TuFuLing,Smilax Glabra Rhizome a0g

ZiCao,Arnebia Root 30g

All the above drugs were to be ground into powder, the powder should be mixed with some vinegar and honey to make herb plaster, applying the herb plaster onto the affected regions, once a day.

Effect Observation: After 5 days of the above treatment, the strong itch disappeared, the swelling of legs was relieved greatly, the erosion inside the 3 big blisters was healed already. But many large pieces of red maculae on the skin of neck, chest, back, waist and groins were not disappeared yet. It showed there was retention of stagnant heat evil in the interior organs yet. So that it's necessary to remove the stasis by purgation and strength clearing away damp-heat.

Recipe:

ShengDiHuang,Dried Rehmannia Root 30g

ZiCao,Arnebia Root 25g

MaChiJian,Portulaca Herb 30g

ShengDaHuang,Raw Rhubarb 10g (to be decocted later)

MuDanPi,Tree Peony Bark 20g

HuangQin,Scutellaria Root 12g

BaiXianPi,Dittany Bark 30g

JinYinHua, Honeysuckle Flower 15g

HuangBai,Phellodendron Bark 15g

ShanZhi,Capejasmine Fruit 15g

CheQianCao,Asiatic Plantain Herb 20g

TuFuLing, Smilax Glabra Rhizome 20g

DiFuZi,Broom Cypress Fruit 20g

LongDanCao,Gentian Root 15g

GanCao,Liquorice Root 10g

All the above drugs were to be decocted in water for oral taking. 5 doses were prescribed.

After taking the decoction, the affected skin became dry and rough, and then desquamated slowly, therefore the patient was healed. After 3 months of follow-up, the illness didn't recur. Then it's ending.