Name: Bian.

Sex: Female.

Age: 52 years.

Occupation: A peasant.

Chief Complaint: Chest pain for half a year.

History of Present Illness: Half a year ago, the patient got an oppression pain in the left lower chest wall due to a cold, it was not accompanied by palpitation, shortness of breath, hemoptysis and purulent sputum, sometimes there were dry cough and whitish sticky sputum. The pain was often aggravated by her expiration. She herself took some drugs for treating common cold and "Piminodine" for relieving it, but there was no curative effect on her. Then she went to a hospital for treatment. Through examination of chest roentgenogram, it was diagnosed as "Sinister Pleurisy,"and she was sent to a hospital in Nanjing for treatment. In the hospital, the illness was diagnosed as "Tuberculous Pleurisy," she was treated with "Rifampicin, Isoniazid" and some routine antibiotic drugs, but the treatment couldn't be effective against her chest pain. Then she came to our hospital for treatment on October 24, 1995. After the sickness came on, her appetite became poor and her sleeping became bad. She often got a sensation of hectic fever, which usually occurred in afternoon or evening. Additionally, the patient had gotten "Pulmonary Tuberculosis" before 25 years and it had been calcific for many years. There was not other complaint.

Physical Examination: The patient was weak with a sallow complexion. The pulse was thready and rapid, the tongue was red with a thick layer of yellow fur, the edge of the tongue was teeth-printed. The respiratory sounds were lowered in the lower region of left lung. Some dry rales could be heard occasionally. The heart was normal. The abdomen was normal too. There was not other abnormal sign. Lab Test: ESR was 108mrn/h. The result of liver function was in normal limit. The result of blood routine examination and routine uronoscopy were all normal. Examination of Chest Roentgenogram: The chest roentgenogram which was taken on October 20, 1995 showed there were some spot-like and high densityed shadows in the region above the hilus of dextral lung; the sinister costophrenic angle was obtuse. The diaphaneity of the lateral region of the sinister lung field was lower than normal. There was not other abnormal sign.

Diagnosis: Tuberculous Pleurisy.

Differentiation: This disease, in TCM, belongs to the category of "XieTong" ( chest pain), "FeiLao" ( pulmonary tuberculosis) or "FeiWei" (atrophy of lung lobe). It was deficiency of Yin and hyperactivity of pathogenic fire due to persistent dampness-heat syndrome. The hyperfunctional asthenic-fire burnt the lung and caused the clear fluid in lung became dried-up, then the lobes of lung couldn't be moistened as normal, therefore, the lobes of lung couldn't unfold normally; furthermore, the persistent dampness-heat evil in lung certainly resulted in stagnation of qi

and blood stasis in lung, which could directly obstructed the pulmonary collaterals, then the lobes of lung could not be nourished effectively and then became withered. It was indicated by the obtuse costophrenic angle of the chest roentgenogram.

Therapeutic Principle: Nourishing Yin and restoring Yang, nourishing liver and kidney, clearing away heat evil and cooling the bood, activating blood to resolve stasis, dredging the obstructed collateral.

Recipe:

GuiBan,Tortoise Plastron 25g to be decocted earlier)

BieJia,Fresh-water Turtle Shell 25g (to be decocted earlier)

XiaKuCao,Prunella Spike 20g

ChuanShanJia,Pangolin Scale 10g (to be decocted earlier)

DanShen,Red Sage Root 15g

ChiShao,Red Peony Root 15g

ShuiZhi, Leech 5g

TaoRen,Peach Seed 15g

DiLong, Earthworm 10g

DiBieChong,Ground Beetle 5g

XiXin,Asarum Herb 5g

MaHuang, Ephedra 6g

DanNanXing,Arisaema with Bile 10g

TanXiang, Sandalwood 10g

ganCao,Liquorice Root 10g

All the above drugs were to be decocted in water for oral taking,3 doses were prescribed. During the same period, acupoint injection was used. The selected points were Shenshu(BL23, both sides) and Zusanli (ST36)(both sides), each side of the selected points were alternatively used in every other day. 2ml of placenta injection was injected into the used side, 1ml a point. Totally she was injected for 5 days.

Effect Observation: After taking the decoction, result of reexamination of ESR was 52mm/h. Reexaminatioh of chest roentgenogram showed the diaphaneity of the lateral region of the sinister lung field became as clear as normal. The sinister

costophrenic angle unfolded already, but the sinister low region of the chest roentgenogram was indistinct for some reasons, so I couldn't draw a conclusion according to it. Meanwhile, the patient told me the chest pain disappeared, she could sleep well throughout night, her appetite got good too. The pulse was soggy and thready, the tongue was red with a thin layer watery fur. Then it's necessary to continue the original treatment.

Recipe:

guiBan,Tortoise Plastron 25g (to be decocted earlier)

BieJia,Fresh-water Turtle Shell 25g (to be decocted earlier)

XiaKuCao,Prunella Spike 20g

ChuanShanJia,Pangolin Scale 10g (to be decocted earlier)

DanShen,Red Sage Root 15g

TanXiang, Sandalwood 20g

XiXin,Asarum Herb 5g

MaHuang, Ephedra 8g

DanNanXing,Arisaema with Bile 10g

TaoRen,Peach Seed 20g

ZhuLing, Umbellate Pore Lungus 15g

DangShen,Pilose Asiabell Root 30g

ShuDiHuang,Prepared Rehmannia Root 25g

GanCao,Liquorice Root 10g

All the above drugs were to be decocted in water for oral taking,3 doses were prescribed.

After taking the decoction, reexamination of chest reoentgenogram showed the sinister costophrenic angle unfolded completely, it was sharp as if crescent. Additionally, the patient got good appetite and sleeping already, chest pain disappeared, 0nly dry cough and hectic fever occasionally occurred. Then it' s necessary to reinforce the curative effect.

Recipe:

ShaShen, Ladybell 20g

GouQiZi,Wolfberry Fruit 20g

ShuDiHuang,Prepared Rehmannia Root 20g

GuiBan,Tortoise Plastron 15g (to be decocted earlier)

FuLing, Tuckahoe 15g

ChuanBeiMu,Sichuan Fritillary Bulb 15g

HongHua, Safflower 10g

TaoRen,Peach Seed 15g

DanShen,Red Sage Root 10g

TanXiang, Sandalwood 15g

XiaKuCao, Prunella Spike 15g

BaiBu,Stemona Root 10g

XiXin,Asarum Herb 5g

MaHuang, Ephedra 6g

GanCao,Liquorice Root 10g

E'Jiao, Donkey-hide Gelatin 15g

All the above drugs, except E'Jiao, Donkey-hide Gelatin, were to be decocted in water for oral taking, 3 doses were prescribed. E'Jiao, Donkey-hide Gelatin was to be melted in the finished decoction.

After taking the 3 doses, there was not discomfort any more. The result of ESR became normal too. After 2 years' follow-up, there was not recurrence of the illness all along, then it¡¯s ending.