Case one: Liver Cancer with Repeated Fever
Mar 9, 2015 09:50 AM  

Patient: Cao, female, born in January, 1938.

She made her first visit on February 10th, 2014.

Chief Complaint: Repeated fever for over 1 month.

One month ago, she started suffering a fever with unknown cause. Though she received antisepsis and anti-inflammation treatment in the hospital, yet the fever still occurred repeatedly with her body temperature varying from 37.5℃ to 38.5℃. On January 24th, 2014, she took physical examination in a university affiliated hospital. Color ultrasound discovered in the liver several hypoechoic masses in bull's-eye appearance, with maximum size of 3.4*72.5px, and well-defined boundary. It indicated the possibility of liver cancer metastasis. Abdominal CT discovered nodules in the liver, which indicated possibility of cancer metastasis. Heart color ultrasound discovered that left atrium increased in size and left ventricular had decreasing diastolic function. Chest CT discovered that pulmonary field was not clear with its coarse and disorderly texture, which indicated the possibility of chronic bronchitis. There were uneven low-density images in the liver, which indicated the possibility of space occupying lesions. she had taken 3 doses of the prescription: perilla leaf (ZiSuYe) 8g, apricot kernel (XingRen) 9g,  schizonepeta (JingJie) 9g, radix bupleuri scorzoneraefolii (NanChaiHu) 6g, scutellaria (HuangQin)8g, stemona(BaiBu) 8g, ginger-processed officinal magnolia bark (JiangHouPo) 9g, American ginseng (XiYangShen) (boiled separately for 120 minutes). 6g loquat leaf (PiBaYe) 9g, kadsura pepper stem (HaiFengTeng) 12g, mix-fried licorice (ZhiGanCao)9g, ginger-processed pinellia (JiangBanXia)(smashed)8g, ophiopogon (MaiMenDong) 9g. Because of the spring festival, she stopped taking antisepsis and anti-inflammation treatment. Now she still suffers from the fever. After the noon her temperature starts to rise and reaches its climax (37.4-37.8℃) between 8 and 10 o'clock at night. The maximum temperature became a little lower than before. Irritating cough got its remission with loud breathing, yet no phlegm and no sore throat. She has had diabetes and coronary heart disease for 10 years.

Pulse Diagnosis:slightly rapid(shuo), rough(se), and empty under heavy pressure with cubit (chi) pulse  slightly sunken(chen);  slightly vacuous(xu) for inch(cun) and bar(guan) pulse on the right hand with inch pulse slightly floating(fu) and slightly string-like(xian) under light pressure; slightly floating(fu) and slightly string-like(xian) for bar pulse on the left hand.

Tongue Diagnosis:crimson tongue with fur in the middle slightly thick and yellow, and fur in the root thicker and slightly slimy.

TCM Diagnosis: fever, liver fixity, wasting-thirst

Differentiation: dual disease of Taiyin meradians withexterior and interior cold wind and stagnated heat; dual disease of Shaoyang meradianswith wind-dampness and stagnated heat as well as small-scale fluid invasion; extremely weak for qi of spleen and lung.

Prescriptionmulberry leaf(Sangye)9g, apricot kernel(XingRen)(smashed)9g  Sichuan1 fritillaria (ChuanBeiMu)9g, American ginseng(XiYangShen)3g, (boiled separately for 120 minutes.

Stir-fried gardenia(ChaoZhiZi)6g, pear peel(LiPi)(self-provided)15g, tangerine pip (Juhe)(smashed)10g, peach kernel(TaoRen)8g, large gentian(QinJiao)12g, white paeony(BaiShao)10g, licorice(GanCao)10g, moutan bark(MuDanPi)8g, cardamomBaiDouKou)9g (added after the other herbs are boiled for 15 minutes). Four doses, and one dose was boiled for 30 minutes and taken twice one day after meals in the morning and evening.

Nursing Requirements and Prohibitions:keep a cheerful mood and forbid raw and cold food.

Observation: Is cough relieved? Is fever reduced?

On February 14th,2014, she made a subsequent visit.

After taking the medicine, her cough was relieved and her fever reduced with her temperature occasionally 37.2℃.

Prescriptionmulberry leaf (Sangye) 9g, apricot kernel (XingRen) (smashed) 9g,   Sichuanfritillaria (ChuanBeiMu) 9g, American ginseng (XiYangShen) (boiled separately for 120 minutes) 4g stir-fried gardenia (ChaoZhiZi) 6g, pear peel (LiPi) (self-provided) 15g, tangerine pip (Juhe) (smashed) 10g, peach kernel (TaoRen) 8g, large gentian (QinJiao) 12g, licorice (GanCao) 10g, moutan bark (MuDanPi) 8g, ophiopogon (MaiMenDong) 9g,scorch-fried crataegus (JiaoShanZha) 12g.Four doses, one dose was boiled for 30 minutes and taken twice one day after meals in the morning and evening.  

Then she paid visits for another 15 times.

On June 26th,2014, abdominal B ultrasound discovered nothing abnormal in the sound images of liver, gall bladder, pancreas, spleen, and two kidneys.

Abdominal CT discovered nothing abnormal.

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