Acute Purulent Appendicitis

Case 1
Name: Zhao.
Sex: Female.
Age: 22 years.
Occupation: A worker.
Chief Complaint: Pain of right lower abdomen for 1 week.
History of Present Illness: One week ago, the patient got a pain
in her right lower abdomen without obvious causes. It' s a
sharp prickling pain, accompanied with fever and chill at the
beginning. Then she went to the local hospital for treatment.
Alter some relative medical examination, it was diagnosed as
Acute Appendicitis" and she was treated with intravenous
dripping some antibiotic drugs such as "Penicillin G,
Gentamycin" and so on. After 6 days' treatment, the fever and
the chill disappeared while the pain in the right lower abdomen
couldn't be relieved yet.S0 that she was sent to the surgery of
other hospital. The surgeon suggested that the illness should
be treated by an operation. But the patient herself didn't accept
the operation. Then she came to our hospital for treatment on
August 30,1999. Alter the illness came on, her appetite got
poor and she defecated once every 3 days, the stool was dry
and hard in texture, the urine was normal. There was not other
complaint.
Physical Examination: The temperature was 37.8. The
patient was weak with a painful complexion. The pulse was
thready and soggy. The tongue was pale, tender and teethprinted with whitish fur. The lungs and the heart were all
normal. The abdomen was flat and soft. There were fixed
tenderness and rebound tenderness at the right McBurney
point, there was muscular tension at the part of the right lower
abdomen. There was not other abnormal sign.
Lab Test: WBC 16.810(9)/L, N 0.70, L 0.30.
Roentgenogram of Abdomen: Normal.
Diagnosis: Acute Purulent Appendicitis.
Differentiation: This disease, in TCM, belongs to the category of
"ChangYong" ( intestinal carbuncle ). As usual, intestinal
carbuncle is caused by accumulation of heat evil and fire-toxin
in the intestine and its therapeutic principle is clearing away
heat and expelling the toxic material. As for this case, it's
different from the common cases. Why? Because this patient
had been treated with numerous antibiotics. And the pulse, the
tongue showed there was accumulation of pathogenic water
and dampness in the interior organs. It was caused by
numerous antibiotics and a lot of fluid, which were poured into
the blood circulation quickly and directly. Not only the
momentum of the sickness was immediately defeated but
also the functional activities of Yang-qi were restrained. This is
the characteristic phenomenon in dime practise named as "A
sudden cooling therapy always hurts Yang qi." So that the
restrained Yang-qi eouldn't transport the fluid and water
effectively as normal it was reflected by the patient's pulse and
tongue, which were all different from the common cases. It was
just like what a set phrases said: More haste, less speed; a
thing negates itself when developed to the extreme. Now the
constant prickling pain in the fight lower abdomen showed the

heat evil and the fire-toxin which accumulated in the intestine

were merely hemmed in, but weren't be annihilated yet.
Therapeutic Principle: It's necessary to use warming therapy
and heat-clearing therapy together in order to cope with the
pathogenic water and dampness and heat evil at the same
time. Warming the middle Jiao and eliminating the phlegm evil
in order to clear away the pathogenic water and dampness;
clearing away heat to remove toxin in order to annihilate the
heat evil and fire-toxin accumulated in the intestine.
Recipe:
ShengDiHuang,Dried Rehmannia Root 18g
MuDanPi,Tree Peony Bark 10g
BaiJiangCan, Batryticated Silkworm 15g
QiYeYiZhiHua, Windpipe Trachea 25g
OanJiang,Dried Ginger 8g
ZhiFuZi,Prepared Aconite Root 8g
DanNanXing,Arisaema with Bile 8g
BaiHuaSheSheCao, Oldenlandia 30g
BanBianLian,Radical Lobelia 15g
BanZhiLian,Barbat Skullcap 15g
PuGongYing,Dandelion Herb 25g
DiLong, Earthworm 15g
BaiJiangCao, Patrinia 25g
ChiXiaoDou,Red Beam 25g
ZhiShi,Immature Bitter Orange 15g
All the above drugs were to be decocted in water for oral
taking. 5 doses were prescribed. Cold and cool food was
forbidden. She was told to stop the original treatment.
Effect Observation: After taking the decoction, the abdominal
pain disappeared. But the patient got cough, rhinorrhea and
fever because the weather was becoming cooler in the recent
days, furthermore, the stool was dry and hard yet.
Physical examination showed her temperature was 38.9, the
pulse was floating and rapid, the tongue was light red with a
thin layer of white fur. All these signs showed the pathogenic
water-dampness and heat evil accumulated in the intestine had
been removed mostly while the lungs were attacked by the
exogenous pathogenic wind-heat. Because the lungs are in
close relationship with the large intestine, expelling heat and
toxic material by purgation should be more suitable for the
illness than expelling pathogenic wind and cold and relieving
superficies-syndrome, for expelling heat and toxic material by
purgation could not only expel the wind-heat to relieve cough
and fever but also expel the remnant of evil in the intestine to
relieve obstipation. This therapy is called as "treating the lower
to cure the upper disease" in TCM.
Recipe :
ShengShiGao,Gypsum 30g (to be decocted earlier)
LuGen,Reed Rhizome 25g
ZhiMu,Windweed Rhizome 12g
ZhiKe,Fruit of Citron 10g
ShengDaHuang,Raw Rhubarb 9g (to be decocted later)
BanBianLian,Radical Lobelia 12g
BanZhiLian, Barbat Skullcap 12g
GanJiang,Dried Ginger 9g
ZhiFuZi,Prepared Aconite Root 5g

ShengDiHuang,Dried Rehmannia Root 15g

MuDanPi,Tree Peony Bark 12g
FanXieYe,Senna Leaf 18g (to be decocted later)
All the above drugs were to be decocted in water for oral
taking. 2 doses were prescribed.
After taking the 1st dose, the patient could move her stool
smoothly and then her temperature got normal. After taking
the 2nd dose, all the uncomfortable sensation disappeared,
there were not tenderness and rebound tenderness at the right
McBurney point. The result of blood routine examination was as
below: WBC 7.2 10(9)/L, N 0.68, L 0. 32. All the signs
indicated the illness was cured completely.
After 2 months' follow-up, the illness didn't recur, then it's
ending.
Case 2
Name: Zhang.
Sex: Male.
Age: 32 years.
0ccupation: A brick-layer.
Chief Complaint: Metastatic pain of right lower abdomen for 2
days.
History of Present Illness: Two days ago, the patient got a pain
in the upper abdomen due to immediate working after his
lunch. At the beginning it was a dull pain and occurred
sometimes mildly and sometimes severely. Then he thought it
might be a stomachache, and he had a rest and took some pills
for relieving stomachache by himself. But the pain couldn't be
relieved and slowly transferred to the regions around his navel.
Moreover it became a constant distending pain and occurred
obviously severelier than before, accompanied with nausea and
chill. 1 day ago, the pain then transferred to the right lower
abdomen and became a sharp prinkling-like pain which got
worse and worse quickly and caused he couldn' t stand or sit at
ease.
Furthermore he got high fever, chill, nausea and vomiting. Then
he went to the surgery of a hospital on June 7, 2000. After
physical examination, it was diagnosed as "Acute Appendicitis
and he was suggested that the illness should be treated by an
operation. But the patient was poor and he couldn't afford the
operation. Then he came to me for non-operational treatment.
After the illness came on, he lost his appetite and didn' t have a
meal in the past 2 days. Furthermore he got bad sleeping due
to the severe abdominal pain. His defecation and urination were
all normal. There was not other complaint.
Physical Examination: The temperature was 38. 2. The
patient was conscious with an acute painful complexion. He
groaned and moaned constantly. The pulse was thready and
floating, the tongue was light red with a thin layer of white
map-like fur. HR was 92beats/rain, the cardiac rhythm was
regular. There weren't systolic murmur and diastolic murmur.
The respiratory sounds were clear, no rales could be heard in
lungs. The abdomen was soft and flat, the liver and the spleen
couldn't be palpated in the inferocostal region. There was
muscular tension in the right lower abdomen, there were fixed

tenderness and rebound tenderness at the right McBurney

point. There was not other abnormal sign.
Lab Test: WBC 9.810(9)/I., N 0.88. L 0.12.
Diagnosis: Acute Appendicitis.
Differentiation: This disease, in TCM, belongs to the category of
"ChangYong" (intestinal carbuncle). It was caused by the
accumulated heat-toxic in the intestine, which attacked the
intestinal wall and caused the intestinal carbuncle, then the
patient got the abdominal pain. As for why the abdominal pain
was a metastatic pain, it was caused by the different
pathogenesis in the different stage. At the beginning of this
illness, the accumulated heat toxic in the intestine disturbed
the normal functional activities of intestine-qi, then there
appeared the intermittent dull pain in the upper abdomen.
With the illness was going along, the accumulated heat-toxic
continuously disturbed the functional activities of intestine-qi
and there slowly appeared stagnation of intestine-qi, then the
intermittent dull pain slowly became the constant distendingpain, finally blood stasis was formed in the affected part of
intestine, then there appeared the fixed prinkling-like pain and
tenderness at the affected part. In addition, the accumulated
heat toxic continuously fumigated and evaporated the intestinal
fluid, then there was deficiency of Yin, it was reflected by the
map like fur; the toxic fire flamed upward and disturbed the
functional activities of stomach-qi, then the stomach-qi traveled
upward reversely, it was reflected by the poor appetite, nausea
and vomiting; when the heat-toxic diffused into the blood
circulation, there appeared the high fever and chill
Therapeutic Principle: Clearing away heat and removing toxic
from the intestine; nourishing Yin and cooling blood; activating
blood to eliminate stagnation; invigorating spleen qi.
Recipe:
ShengDiHuang,Dried Rehmannia Root 18g
MuDanPi,Tree Peony Bark 12g
PuGongYing,Dandelion Herb 15g
BaiHuaSheSheCao, Oldenlandia 25g
DangShen,Pilose Asiabell Root 25g
BaiZhu,Bighead Atractylodes Rhizome 15g
BanBianLian, Radical Lobelia 15g
BanZhiLian,Barbat Skullcap 15g
DanShen,Red Sage Root 18g
TaoRen,Peach Seed 15g
BaiJiangCan, Batryticated Silkworm 15g
MaChiJian,Portulaca Herb 30g
ShuiZhi, Leech 5g
ZhiKe,Fruit of Citron 20g
8hengDaHuang,Raw Rhubarb 10g (to be decocted later)
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. He should take the decoction in
morning, afternoon and evening separately.
Effect Observation: After taking the 1st dose, the patient
excreted a lot of foul and black stool immediately, the
abdominal pain was relieved greatly and his temperature
lowered to 37.8. After 3 days' treatment, the abdominal pain
disappeared at all, there wasn't uncomfortable sensation any

more, the nausea and vomiting disappeared too, he got good

appetite. Then he was told to continue taking the 2 doses in
order to eliminate the remnant of the evils. After taking the 2
doses, he got well completely. After 1 month's follow-up, the
patient was in good health all along. Then it' s ending.