Case 1

Name: Yang.

Sex: Female.

Age: 9,7 years.

0ccupation: A worker.

Chief Complaint: Pain of right lower abdomen for 1 day.

History of Present Illness: One day ago, the patient got a pain in the right lower abdomen without any obvious causes. It's a paroxysmal dull pain and occurred sometimes mildly and sometimes severely. It wasn't accompanied with nausea, vomiting, fever, diarrhea and so on, bull there were dizziness, fatigue and lassitude. Then she went to the department of internal medicine in a hospital for treatment on May 29,1998. The physician doubtfully diagnosed it as "Acute Appendi-citis" and treated it with intravenous dripping " Gentamycin" and "Levofloxacin," but there wasn't curative effect on her at all, the abdominal pain remained occurring intermittently. Then she was send to the department of surgery and she was going to be treated by an operation. At that time I happened to be there too and then knew about the state of her illness. Through careful asking the history of her illness, it was known that her last menstruation just occurred on May 20,1998 and ended on May 25,1998, furthermore, the patient usually got lassitude, fatigue, bad sleeping and poor appetite, and she was always in sarrow and melancholy whatever happened. After having a discussion together, the surgeon agreed to my suggestion and sent the patient to me for getting treatment of using Chinese herbs. After the illness came on, the patient kept her urination and defecation well all along. There was not other complaint.

Menstrual and Obstetrical Histories: 14[(5-6)¡Â28]¡Á(1998-5-20); 0-0-0-0.

Physical Examination: The patient was weak with a pale lusterless complexion. The pulse was thready and soggy, the tongue was pale with a thin layer of white fur. The heart and lungs were all normal. The abdomen was soft and flat, there was tenderness in the right lower abdomen, there weren't rebound tenderness and muscular tension. Result of gynecological exami-nation were all normal.

Diagnosis : Dysmenorrhea.

Differentiation: This disease, in TCM, belongs to the category of "TongJing"(dysmenorrhea). It's postmenstrual dysmenorrheal of deficiency type. Usually there are 3 types of dysmenorrhea, they are premenstrual type, intermenstrual type and postmen-strual type. The premenstrual type is mainly due to stagnation of qi and its therapeutic principle is soothing liver to activating qi; the intermenstrual type is mainly due to blood stasis and its therapeutic principle is activating blood to resolve stasis; the postmenstrual type is mainly due to deficiency of blood usually and its therapeutic principle is nourishing Yin and blood. This case just belongs to dysmenorrhea of postmenstral type. It's caused by asthenia of heart and spleen, the deficiency of heart-qi could directly cause the flowing of blood became slow and unsmooth, the deficiency of spleen qi could cause there appeared a failure of spleen to control the blood. So that the asthenia of heart and spleen caused the internal organs couldn't be nourished well as normal and then there appeared an abdominal pain. Usually such pain is a dull pain and occurring inter-mittently, it should be distinguished from the abdominal pain resulting from " intestinal carbuncle" ( acute appendicitis ) in clinical work. The abdominal pain resulting from intestinal carbuncle is a sharp prickling pain, usually accompanied with fever, nausea and so on. If a doctor couldn't think about it carefully and conscientiously, even his (or her) tiniest negligence will lead to a greatest error, the patient would get suffering from being cut and sliced very unfortunately.

Therapeutic Principle: Relieving the secondary symptom in the acute stage: stopping the abdominal pain quickly with accupuncture; curing the primary symptom in the chronic stage: after the pain was relieved, using some qi-invigorating drugs, heart and spleen nourishing drugs and blood nourishing drugs in order to cure the disease completely.

Recipe: Modified Decoction for Invigorating Spleen and Nourishing the Heart.

DangShen,Pilose Asiabell Root 30g

BaiZhu,Bighead Atractylodes Rhizome 15g

FuShen,Poria with Hostwood 15g

SuanZaoRen,Wild Jujuba Seed 15g

YuanZhi,Polygala Root 12g

ShiChangPu,Grassleaved Sweetflag Rhizome 12g

BaiShao,White Peony Root 12g

LongYanRou,Longan Aril 18g

ZhiHuangQi,Moxa-prepared Milkvetch Root 25g

DangGui,Chinese Angelica Root 9g

ShuDiHuang,Prepared Rehmannia Root 25g

MuXiang, Aucklandia Root 15g

WuMei,Black Plum 12g

YiYiRen,Coix Seed 25g

ZhiGanCao,Prepared Liquorice Root 15g

All the above drugs were to be decocted in water for oral taking. 5 doses were prescribed. Cool and cold food was forbidden during the treatment. In addition, I used acupuncture immediately in order to stop the pain quickly.

Acupuncture Method: I pricked the right point of Zhongdu (LR6) with a 1.5cun needle, manipulating the needle with heat producing skill. The abdominal pain was relieved immediately by such skillful acupuncture. Then she returned home and began 0ral taking the Chinese herbs.

Effect Observation: After taking the decoction, she came back and told me the abdominal pain had disappeared already. She felt she was energetic very much. Then she was told to take the pills for invigorating spleen and nourishing the heart in order to reinforce the curative effect. After 1 year's follow-up, the illness didn't recur. Then it' s ending.

Case 2

Name: Shi.

Sex: Female.

Age: 29 years.

Occupation: A college student.

Chief Complaint: Abdominal pain for 3 days.

History of Present Illness: Three days ago, the patient menstruated again. At that time she ate a piece of ice cream. Immediately she got a severe pain in the lower abdomen, which ranged from both sides of groin, whole lower abdomen to lumbosacral portion. It' s a severe aching pain and caused she was drenched in sweat and could neither sit nor sleep at ease. Then she went to local clinic for treatment and was treated with intramuscular injecting "Anisodamine, Atropine" and oral taking "Belladonna pills," "the pills for relieving dysmenorrhea. "After 2 days' treatment, the pain couldn' t be relieved yet, the insufferable pain made her groan and moan all a day. Then she came to our hospital for treatment on April 30,1996. Through careful asking the history of her illness, it was known that the present menstruation was less in amount, dark red in colour and occurring in drops. After the illness came on, she couldn't sleep well throughout night because of the severe pain, while her urination, defecation and appetite were all normal. There wasn't other complaint.

Menstrual and Obstetrical Histories : 13¡Á(6¡Â28)¡Á(1996--4-27);1-0-0-1.

Physical Examination: The patient was conscious with an acute painful complexion. The pulse was thready and uneven, the tongue was pale with a thin layer of white fur. The chest and the abdomen were all normal. There was not other abnormal sign.

Diagnosis : Dysmenorrhea.

Differentiation: This disease, in TCM, belongs to the category of intermenstrual dysmenorrhea. It was caused by cold evil which accumulated in the uterus and caused there appeared stagnation of qi and blood stasis in the uterus. So that the menstruation couldn't flow out smoothly and normally. Where there is obstruction, there is a pain this is a basic principle in TCM. So that the patient got the pain in the lower abdomen.

Therapeutic Principle: Warming the uterus in order to eliminate the pathogenic cold; activating blood to resolve stasis.

DiBieChong,Ground Beetle 20g

LuJiaoShuang,Deglued Antle Powder 20g

All the above drugs were to be ground into powder, the 2 kinds of powder should be mixed together, filling the mixed powder into the large-sized capsules, taking 2 pieces of the capsule each time, 3 times a day, in morning, afternoon and evening separately.

Effect Observation: After taking 2 pieces, the abdominal pain was relieved immediately, the aching pain in the lumbosaeral portion disappeared at all. After taking 4 pieces, the abdominal pain disappeared at all. After 2 days' treatment, the menstrual tion's flowing became smooth as normal. Then she was told to stop taking the capsule. After 15 days' follow-up, the pain didn't recur. Then it' s ending.