Case 1

Name: Zhu.

Sex: Female.

Age: 27 years.

0ccupation: An accountant.

Chief Complaint: Pain of fingers and toes for 2 years after parturition.

History of present Illness: Two years ago, the patient had a normal parturition, 1 week later, she got a pain in her fingers and toes. It's a continuous prickling-like pain and could be easily aggravated by cold or overcast weather. Furthermore, there was morning-rigidity of hands, which persisted more than 1 hour each day and caused her hands couldn' t spread out and crook back. In the past 2 years, she had been to some hospitals in Nanjing, it was confirmed as "Rheumatoid Arthritis" through some relative medical examination, then she was separately treated by oral taking chinese herbs, anti-immune drugs of Western medicine and external fuming and washing of chinese herbs and so on. Under the treatment, the pain was relieved quickly, but it would come back again as soon as the treatment stopped. In the recent half a year, it got worse and worse, furthermore, her waist and knees were all involved, and it' s very easy to be aggravated by weather changing. Usually the aggravated pain couldn't be relieved even by external applying "ZhuiFengGao. " Then she came to our hospital for treatment on December 28, 1996. After the illness came on, the patient kept her appetite, sleep, urination and defecation normal all along. There was not other complaint.

Physical Examination: The patient was conscious with a normal general condition. The pulse was thready and uneven, the tongue was pale with a thin layer of white fur. The fingers and toes weren't deformed. Activities of the fingers and the toes were all normal. There was not other abnormal sign.

Diagnosis: Rheumatoid Arthritis.

Differentiation: It's deficiency of qi and blood after parturi-tion. The exogenous wind-cold and dampness evils took advantage of this opportunity and attacked the body, lurked into the merdians and bones. Because the evils lurked in bones and meridians very deeply, it's difficult to exterminate them completely.

Therapeutic Principle: Treating this illness should be slowly and permanently in order to exterminate the evils completely. Some insect herbs which are all good at getting into tiniest meridian and searching lurked evils should be used in order to eliminate the evils which lurked in the meridian and the bone; some liana herbs should be used in order to relax the tendons and dredge the meridian passage, in addition, it' s necessary to nourish kidney and benefit qi and blood. Because it' s a chronic disease of many years, it's necessary to take medicinal liquor slowly in order to cure the disease completely.

Recipe: Medicinal Liquor of Insects, Snake and Three Lianas.

JinQianBaiHuaShe,Multibanded krait 8 ones

QiShe,Long-noded Pit Viper 15g

WuShaoShe, Black-tail Snake 15g

ChuanShanJia,Pangolin Scale 15g

DiBieChong,Ground Beetle 20g

0uanXie, Scorpion 15g

WuGong, Centipede 15g

0iangLang,Dung Beetle 15g

RenDongTeng, Honeysuckle Stem 30g

DaXueTeng, Sargentgloryvine 50g

JiXueTeng,Spatholobus Stem 60g

GuSuiBu,Drynaria Rrhizome 30g

GouQiZi,Wolfberry Fruit 30g

QiangHuo,Notopterygium Root 25g

DuHuo,Pubescent Angelica Root 25g

ShuDiHuang,Prepared Rehmannia Root 60g

ZhiHuangQi,Moxa-prepared Milkvetch Root 60g

DangGui,Chinese Angelica Root 25g

All the above drugs were to be soaked into 3kg of spirit distilled from sorghum. The wine jug was sealed hermetically. 2 months later, it's time to begin drinking the medicinal liquor, 0nly 1 little cup of the liquor each time, 3 times a day. During the treatment, she was told to take the Pills of Six Mild Drugs in order to protect the stomach. There wasn't other taboo.

Effect Observation: After 1 month's treatment, the pain in the fingers and toes was relieved greatly. The pain in the waist and the knees disppeared. It's unnecessary for her to apply "ZhuiFengGao" onto the affected region even during the days of weather changing. Then she was told to continue taking the medicinal liquor. After 1 years' follow-up, the illness was cured and didn' t recur.

In addition, the patient's father also had an aching-pain in the waist and the legs for many years, he drinked the medicinal liquor with his daughter together, his illness was cured too.

Case 2

Name: Xue.

Sex: Female.

Age: 51 years.

0ccupation: A peasant.

Chief Complaint: Malformed fingers and pain for 2 years.

History of Present Illness: Two years ago, the patient got a pain in her fingers of both hands without obvious causes. It' s a constant prinkling like pain, accompanied with morning rigidity. After treatment of taking chinese herbs and Western medicine in the local hospital, there was no curative effect on her. Furthermore, the interphalangeal articulations of hands became red and swollen, and then got malformed. At last, they became spindle-like malformation, the fingers of both hands couldn't crook back. In the past 2 years, she got an insufferable pain so that she couldn't sleep well. Then she came our hospital for treatment on January 23, 1996. After the illness came on, she kept her spirit normal. In addition her stool was loose and formless, her urine was white and abundant. There wasn't other complaint.

Physical Examination: The patient was conscious with a normal general condition. The pulse was thready and uneven, the tongue was pale and teeth-printed with a thick layer of watery fur. The interphalangeal articulations of both hands were all malformed, they looked spindle-like, but they weren't red and swollen, there was tenderness in them which caused they could not be palpated. There was not other abnormal sign.

Diagnosis: Rheumatoid Arthritis.

Differentiation: This disease, in TCM, belongs to the category of "WangBi" (severe osteoarthritis). It's caused by wind-cold and dampness evils, which got into the finger bones and stayed there permanently. As a result of it, the finger joints became spindle-like and malformed. In addition, the pulse and the tongue reflected there were deficiency of spleen-qi and retention of phlegm-dampness evils. As for the sharp pain in the finger joints, it was caused by the accumulation of cold-dampness evils.

Therapeutic Principle: Strengthening spleen to percolate dampness, strike blood stasis and eliminating phlegm, dredging the obstructed meridinan, invigorating qi and nourishing blood, activating blood to resolve stasis.

Recipe :

YiYiRen,Coix Seed 80g

BaiJieZi,White Mustard Seed 20g

ZhiChuanWu, Prepared Sichuan Aconite Root 12g (to be decoted earlier)

ZhiHuangQi, Moxa-prepared Milkvetch Root 30g

DangGui,Chinese Angelica Root 15g

ChuanXiong,Chuanxiong Rhizome 20g

ShuDiHuang,Prepared Rehmannia Root 30g

ZhiCaoWu, Prepared Wild Aconite Root 12g (to be decocted earlier)

ChuanShanJia, Pangolin Scale 15g (to be decocted earlier)

WuShaoShe, Black-tail Snake 15g

QiangLang, Dung Beetle 15g

WeiLingXian,Clematis Root 20g

GuiZhi,Cinnamon Twig 25g

QiangHuo,Notopterygium Root 20g

GanCao,Liquorice Root 12g

All the above drugs were to be decocted in water for oral taking. 5 doses were prescribed, cold food was forbidden during the treatment.

Effect Observation: After 5 days' treatment, the pain in the finger joints was relieved greatly, the fingers of both hands could crook back. Then she was told to continue taking 5 doses of the above prescription. After taking the decoction, the pain disappeared, the movement of her fingers became freely. After half a year' s follow-up, the illness didn' t recur again. Then it' s ending.

Case 3

Name: Jiang.

Sex: Female.

Age: 31 years.

0ccupation: A doctor.

Chief Complaint: Pain and rigidity of fingers for 3 months.

History of present Illness: Three months ago, the patient got a pain and rigidity of finger joints without any obvious causes. The pain was a sharp prinkling-like pain and located at each finger joint. Especially in every morning, when she just woke up, the pain became more severe and there was morning rigidty, which caused her finger joints couldn't spread out and crook back. 0nly by her rubbing on the finger joints, could they spread out and crook back with great difficulty. Sometimes her morning rigidity was so severe that the finger joints couldn't spread out and crook back all a day. After treatment in the local hospital, the above symptom couldn't be relieved. Through some lab tests, the illness was diagnosed as "Rheumatoid Arthritis. "Then she came to me for treatment on April 8,1999 through somebody. After the illness came on, her urine and stool were normal all along.

Her appetite and sleeping were normal too. There wasn't other complaint.

Physical Examination: The patient was conscious with a normal general condition. The chest and the abdomen were all normal. The finger-joints of both hands were swollen, they looked spindle-like and couldn't spread out and crook back normally. There was tenderness in them. The pulse was thready and uneven, the tongue was rich red with a thin layer of white fur. There wasn't other abnormal sign.

Lab Test: The results of ESR and ASO were all in normal limits. RF was positive.

Diagnosis: Rheumatoid Arthritis.

Differentiation: This disease, in TCM, belongs to "Bi-Syndrome." It's syndrome of simultaneous occurrence of cold and heat evils, which was caused by cold-dampness soaking into the bones and wind heat's getting into the channels.

Therapeutic Pinciple: expelling dampness and cold evils; clearing away heat evil from the channels, activating blood to eliminate stagnation.

Recipe:

ZhiHuangQi,Moxa-prepared Milkvetch Root 30g

DangGui,Chinese Angelica Root 10g

JiangHuang, Turmeric Rhizome 15g

GuiZhi,Cinnamon Twig 6g

SangZhi, Mulberry Twig 15g

RenDongTeng, Honeysuckle Stem 25g

DiLong, Earthworm 15g

BaiJiangCan,Batryticated Silkworm 12g

LuoShiTeng,Chinese Stariasmine 25g

QiangHuo,Notopterygium Root 12g

WeiLingXian,Clematis Root 15g

RuXiang, Frankincense 10g

MoYao, Myrrha 10g

DanShen,Red Sage Root 25g

GanCao,Liquorice Root 6g

All the above drugs were to be decocted in water for oral taking. 10 doses were prescribed. Hot and greasy food was forbidden. In the same period, she was told to take the capsule of scorpion and centipede. Recipe:

QuanXie, Scorpion

WuGong, Centipede

(Each herb was taken just the proper amount. )

All the above drugs were to be ground into powder, she should mix the 2 kinds of powder together and fill the capsules with the powder, taking 0.8g of the capsules each time, 3 times a day, she should avoid wind and cold in order to warm her hands.

Effect Observation: After 10 days' treatment, the patient came back for reexamination. She told me the finger pain had been relieved greatly; rigidity of the finger joints got better than before, it usually persisted from morning to noon while the finger joints could spread out and crook back freely in the afternoon. In addition, the tongue was pale with a thin layer of white fur, the pulse was deep and uneven. All these signs showed the heat evil in the channels had been cleared away while the cold-dampness evil in the bones was there yet. So that the next therapeutic principle should be strengthening the effect of expelling pathogenic wind and expelling damp pathogen, activating blood and expelling pathogenic cold. Recipe :

ZhiHuangQi,Moxa-prepared Milkvetch Root 30g

DangGui,Chinese Angelica Root 12g

JiXueTeng,Spatholobus Stem 25g

DiBieChong, Ground Beetle 15g

GuiZhi, Cinnamon Twig 12g

ChuanXiong,Chuanxiong Rhizome 15g

ZhiChuanWu, Prepared Sichuan Aconite Root 10g (to be decocted earlier)

ZhiCaoWu, Prepared Wild Aconite Root 10g (to be decocted earlier)

XiXin,Asarum Herb 8g

DanShen,Red Sage Root 25g

WuShaoShe,Black-tail Snake 18g

WeiLingXian,Clematis Root 20g

0iangHuo, Notopterygium Root 15g

SangZhi,Mulberry Twig 15g

GanCao,Liquorice Root 6g

All the above drugs were to be decocted in water for oral taking. 10 doses were prescribed. In the same period, she should take the capsule of scorpion and centipede as before. Dietetic restraint was idem.

After taking the decoctions, the patient came back on April 28, 1999 for reexamination. She told me the finger pain had disappeared at all, most finger joints could stretch out and crook back freely, only the 3rd finger joints of right hand and the middle finger joints of left hand couldn' t do the motion freely. The tongue was red with a thin layer of white fur, the pulse was thready and floating. All these signs showed the cold-dampness in the bone had been removed mostly while there was asthenic-heat in the internal organs and the channels. So that it's necessary to omit 10g of ZhiChuanWu(Prepared Sichuan Aconite Root),10g of ZhiCaoWu(Prepared Wild Aconite Root), 15g of ChuanXiong ( Chuanxiong Rhizome ), 15g of QiangHuo (N0topterygium Root) and 8g of ZhiGanCao(Prepared liquorice Root), add 15g of Dilong (Earthworm), 15g of BaiJiangCan (Batryticated Silkworm), 20g of RenDongTeng (Honeysuckle Stem), 10g of HuangLian (Coptis Root) and 60g of YiYiRen (Coix Seed) in the original recipe. She was told to take 10 doses ofthis changed prescription for oral administration, taking the capsule of scorpion and centipede as before. Dietetic restraint was idem.

After taking the decoction, she came back and told me the rigidity of every finger joint disappeared at all, there was only a dull pain in the ring finger joint of right hand and the middle finger joint of left hand. Reexamination of lab test showed that RF was negative. All these signs showed the illness had been cured. The treatment should be stopped and it's necessary to make pills for oral administration in order to consolidate the curative effect.

Recipe:

ZhiHuangQi,Moxa-prepared Milkvetch Root 60g

DangGui,Chinese Angelica Root 30g

JiXueTeng,Spatholobus Stem 15g

DiBieChong,Ground Beetle 25g

SangZhi, Mulberry Twig 30g

guiZhi,Cinnamon Twig 18g

ChuanShanJia, Pangolin Scale 15g

JinoianBaiHuaShe,Multibanded Krait 5 ones

QuanXie, Scorpion 30g

WuGong, Centipede 20g

WeiLingXian,Clematis Root 30g

WuShaoShe,Black-tail Snake 40g

UanShen,Red Sage Root 50g

HuangLian,Coptis Root 20g

HuangQin,Scutellaria Root 20g

RenDongTeng, Honeysuckle Stem 60g

ChuanXiong,Chuanxiong Rhizome 24g

GanCao,Liquorice Root 15g

All the above drugs were to be ground into powder, she was to1d to fill the capsules with the powder, taking 5g or 6g of the capsules each time,3 times a day.

After 1 month of the above treatment, the patient came to me on June 15,1999 for reexamination. She told me there was no uncomfortable sensation on her, the dull pain in the fingers had already disappeared, her hands could stretch out and crook back freely, originally spindle-like finger joints had became normal in shape. Examination of liver function and RF were all normal. All these signs indicated this illness had been cured completely. After half a year's follow-up, the illness didn't recur. Then it's ending.