Case 1

Name: Min.

Sex: Female.

Age: 6 years.

0ccupation: A pupil.

Chief Complaint: High fever and swelling-pain of cheeks for 10 days.

History of Present Illness: Ten days ago, the patient had a high fever, rhinorrhea and swelling-pain in her cheeks due to having a cold. Then she was led to the local clinic for treatment, after physical examination, it was diagnosed as a common cold and she was treated with intramuscular injecting "Benzylpenicillin, Ribavirin "and oral taking "Aspirin. "After 10 days' treatment, her high fever was not relieved yet, the swelling-pain in her cheeks became more and more severe, so it's difficulty for her in chewing and swallowing as normal. Then her mother led her to our hospital for treatment on October 7,1996. After the illness came on, her stool was costive and dry, her urine was scanty and yellow. Her appetite got poor because of the severe swelling pain. Her sleeping was normal all along. There was not other complaint.

Physical Examination: The temperature was 39.7¡æ. The patient was conscious with a fresh red complexion. The pulse was bounding and rapid. The tongue was red with a thin layer of white fur. Both parotid glands were severe swelling. If touched upon, there was severe tenderness. The chest and abdomen were all normal. There was not other abnormal sign.

Lab Test: The result of blood routine test was as follow: Hb ll0g/L, WBC 4.6¡Á10(9)/L, N 0.47, L 0.53.

Diagnosis: Epidemic Parotitis.

Differentiation: It's stagnation of qi and blood stasis in the both parotid glands, which was caused by wind-heat attacking from the exterior. Because the wind heats were not expelled timely, they then got into the interior from the superficies and caused the internal heat in Zang and Fu organs. When the internal heat couldn't be removed in time, it then caused the permanent high fever; the stagnation of qi and blood stasis in both parotid glands could directly caused the swelling-pain in cheeks. This disease, in TCM, is named as "ZhaSai(mumps). "

Therapeutic Principle: clearing away heat to cool blood, softening and resolving the hardness to induce subsidence of swelling, dredging intestines to dispel heat, it's necessary to use external treatment in the same period. The therapeutic principle of external treatment should be cooling the blood and clearing away the heat evil, striking the blood stasis and softening the hardness.

Recipe:

ShengShiGao,Gypsum 30g (to be decocted earlier)

ShengDiHuang,Dried Rehmannia Root 15g

HuangLian,Coptis Root 6g

HuangQin,Scutellaria Root 8g

LongDanCao,Gentian Root 10g

CangZhu,Atractylodes Rhizome 15g

YiYiRen, Coix Seed 15g

JieGeng,Platyeodon Root 10g

XiaKuCao,Prunella Spike 12g

JiangHuang,Turmeric Rhizome 10g

BaiJiangCan,Batrytieated Silkworm 10g

ShengDaHuang,Raw Rhubarb 12g (to be decocted later)

CheQianCao,Asiatie Plantain Herb 15g

SheGan,Belamcanda Rhizome 10g

ChanYi,Cieada Slough 10g

GanCao,Liquorice Root 6g

All the above drugs were to be decocted in water for oral taking. 3 doses were prescribed. Hot and greasy food was forbidden during the treatment. In the same period, she was told to apply the external drugs onto both sides of parotid glands.

Recipe :

ShengDaHuang, Raw Rhubarb

SheXiang, Musk

HuangLian, Coptis Root

ChanSu, Toad Venom

BingPian, Borneol

XiongHuang, Realgar

(Each herb was taken just the proper amount)

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 1 day's treatment, the patient got a normal temperature at once. After 2 days' treatment, the swelling-pain in both parotid glands disappeared, then she was to1d to take the 3rd dose to climate the remnaut of the heat evil in the body. After 3 days' treatment, the patient was cured completely. After 1 month' s follow up, the illness didn' t recur. Then it's ending.

Case 2

Name: Lu.

Sex: Female.

Age: 6 years.

Occupation : A pupil.

Chief Complaint: High fever and swelling-pain of cheeks for 1 week.

History of Present Illness: One week ago, the patient had a high fever due to a cold, the temperature was waving between 39¡æ and 40.1¡æ ,it was followed by a severe swelling-pain in her parotid regions. The pain was too severe for her to chew and swallow food. Then she was led to local policlinic for treatment. After physical examination, it was diagnosed as "Epidemic Parotitis" and she was treated with intramuscular injecting "Benzylpenicillin" and " Ribarizin," oral taking " isatis root granule," but there was no curative effect on her. Then she was treated by intravenous dripping "Benzylpenicillin" and "Ribarizin"for 1 week, and applying the affected regions with plaster of opuntia dillenii, but there was no effect on her either. The swelling-pain got worse and worse, the high fever remained unchanged. Then her father led her to our hospital for treatment on October 27, 1996. After the illness came on, her sleeping, urination and defecation were all normal, but she got a poor appetite due to the suffering from the illness. There was not other complaint.

Physical Examination: The temperature was 39.9¡æ. The patient was somnolent with an acute complexion. The pulse was bounding and rapid, the tongue was red with a thick layer of white fur. Both sides of parotid glands became walnut-like swelling. If touched upon, there was severe tenderness. The chest and abdomen were all normal. There was not other abnormal sign.

Diagnosis: Epidemic Parotitis.

Differentiation: It's stagnation of qi and blood stasis in both parotid regions, which was caused by wind-heat attacking from the exterior. The wind-heat got into the interior from the superficies and tangled with internal dampness-evil, so there was entanglement of dampness-heat evil in the body. Because the dampness-heat evil was too heavy, sticky to be eliminated easily, the permanent fever couldn't be relieved easily. As for the stagnation of qi and blood stasis in both parotid regions, it could directly cause the swelling pain in both cheeks.

Therapeutic Principle: Clearing away heat and cooling blood, dispelling wind and expelling dampness, removing stasis by purgation, softening and resolving the hardness to induce subsidence of the swelling.

Recipe:

ShengShiGao,Gypsum 30g (to be decocted earlier)

ShengDiHuang,Dried Rehmannia Root 20g

HuangLian,Coptis Root 10g

HuangQin,Seutellaria Root 10g

LongDanCao, Gentian Root 15g

ChanYi,Cieada Slough 12g

BaiJiangCan,Batryticated Silkworm 15g

ShengDaHuang,Raw Rhubarb 12g (to be decocted later)

JieGeng,Platycodon Root 15g

SheGan,Belamcanda Rhizome 15g

ShanZhi,Capejasmine Fruit 15g

ShengGanCao,Raw IAquorice Root 10g

All the above drugs were to be decocted in water for oral taking. 3 doses were prescribed. Greasy and hot 'food was forbidden during the treatment. In the same peroid, her father was told to apply external drugs onto the affected part in order to soften and resolve the hardness.

Recipe:

ShengDaHuang,Raw Rhubarb

SheXiang, Musk

Huanggian, Coptis Root

ChanSu, Toad Venom

BingPian, Borneol

XiongHuang, Realgar

(Each herb was taken just the proper amount)

All the above drugs were to be ground into powder, her father was told to mix the above powder together and mix them with some vinegar and honey to make herb plaster, applying the plaster onto both sides of parotid glands, once a day.

Effect Observation: After 1 day's treatment, the patient excreted some stool which was dark in colour and foul in smell, then she got a normal temperature at once. After 2 days' treatment, there wasn't the swelling pain in both sides of parotid glands. The patient could play with her little friend freely. After 3 days' treatment, the patient was cured completely. After half a year's follow-up, the patient was in good health all along. Then it's ending.

Case 3

Name: Ding.

Sex: Male.

Age: 15 years.

Occupation: A middle school student.

Chief Complaint: Swelling-pain of both cheeks for 2 days.

History of Present Illness: Two days ago, the patient got a swelling pain in his both cheeks, accompanied with general lassitude and fatigue, but there weren't chill and fever. The pain could be aggravated by his chewing or swallowing. 1 week ago, one of his classmate got "Epidemic Parotitis. "Then his father led him to our hospital for treatment on May 20, 1997. After the illness came on, his appetite, urination, defecation and sleeping were all normal. There was not other complaint.

Physical Examination: The temperature was 37¡æ. The patient was conscious with a normal general condition. The pulse was floating and tense. The tongue was light red with a thin layer of white fur. Both parotid glands were severe swelling. If touched upon, there was severe tenderness. The chest and abdomen were all normal. There was not other abnormal sign.

Diagnosis: Epidemic Parotitis.

Differentiation: It's caused by exogenous wind warm, which attacked the body from the exterior and lurked in the portial interstices and the muscle. Because the wind-warm had not gotten into the meridian deeply, there were not chill, high revere and so on. All these symptoms showed it is the beginning of the supurficies-syndrome of wind-warm type. The channels and internal organs were not involved yet.

Therapeutic Principle: Dispelling wind and relieving super ficies-syndrome, clearing away heat to remove toxin, softening and resolving the hardness and inducing subsidence of swelling. Because the evils only involved the superficies, some purgent-flavored and warm-propertied herbs should be used in order to expel pathogenic wind and relieve superficies syndrome more quickly. In addition, the external drugs should be applied to remove the pathogenic heat and toxic substance, soften and resolve hardness to induce subsidence of swelling.

Recipe:

MaHuang, Ephedra 5g

GuiZhi,Cinnamon Twig 8g

LianQiao,Forsythia Fruit 12g

YeJuHua,Wild Chrysanthemum Flower 15g

JieGeng,Platycodon Root 15g

SheGan,Belamcanda Rhizome 12g

NiuBangZi,Arctium Fruit 12g

ShanDouGen,Subprostrate Sophoia Root 12g

ShengGanCao,Raw Liquorice Root 6g

ChanYi,Cicada Slough 10g

BaiJiangCan,Batryticated Silkworm 10g

JinYinHua, Honeysuckle Flower 15g

All the above drugs were to be decocted in water for oral taking. 3 doses were prescribed. Hot and greasy food was forbidden during the treatment. In the same period, the patient's father was told to apply the external drugs onto the affected regions.

Recipe :

ShengDaHuang, Raw Rhubarb

SheXiang, Musk

HuangLian, Coptis Root

ChanSu, Toad Venom

BingPian, Borneol

XiongHuang, Realgar

(Each herb was taken just the proper amount)

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

Effect Observation: After 1 day's treatment, the swelling pain disappeared. The swelling parotid regions got normal already. After 3 days' treatment, patient got well completely. Then it's ending.