Qiang Su,Zhuo-Feng Liu,Teng Zheng,Yun Lu,Ru Wang,Yuan-Wei Gan,Jiang Liang,Zheng-Shi Wu,3

1Guizhou University of Traditional Chinese Medicine,Guiyang 550002,China.2Department of Rheumatology and Hematology,the First Affiliated Hospitai of Guizhou University of Traditional Chinese Medicine,Guiyang 550002,China.3The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550002,China.4Guiyang Maternal and Child Care Hospital,Guiyang 550002,China.

Abstract This paper introduced and summarized the experience of the national-level old Chinese medicine expert Wu Zhengshi on syndrome differentiation and treatment of anaphylactoid purpura.Wu Zhengshi believes that blood-heat is the main cause of anaphylactoid purpura.When Qi is weak,the human body is attacked by external heat,resulting in the damage of the blood system,which lead to the anaphylactoid purpura.The blood is thermalized poison,which enters the vessel quickly and forces the blood to overflow the vessel,which develops for the purpura.According to the ancient book of Chinese medicine Jie Wei Yuan Sou (1550 C.E.),Wu Zhengshi put forward the treatment of relieving blood detoxification,heat and cooling blood,which achieved significant curative effects.

Keywords:Anaphylactoid purpura,Blood-heat,Experience of famous doctors,Wu Zhengshi

Background

Wu Zhengshi (1940–),male,chief physician and professor,was approved by the Ministry of Personnel,the Ministry of Health and the State Administration of Chinese Medicine in 1996 as the second batch of teachers to inherit the academic experience of old Chinese medicine experts in the country and enjoy special subsidies from the State Council.Wu Zhengshi was born into a family of traditional Chinese medicine(TCM) doctors,which had incorporated ideas from epidemic febrile disease school and a leprosy monographJie Wei Yuan Sou.He has been a family student since childhood,and has graduated from the Shanghai Second Medical College and the Guiyang College of TCM in the postgraduate class of TCM.He has been personally passed on by teachers such as Yuan Jiaji and has been engaged in TCM clinical work for more than 50 years,and has gained considerable experience in TCM internal medicine,pediatrics,gynecology,especially difficult and complicated diseases such as rheumatism and skin diseases.The clinical treatment of anaphylactoid purpura is based on the method of“cooling blood to stop bleeding,clearing heat and detoxifying”,and advocates pure Chinese medicine for the treatment of anaphylactoid purpura.It has unique insights and significant clinical efficacy.

Anaphylactoid purpura is an allergic vasculitis that invades the capillaries and small blood vessels of the skin or other organs.It is characterized by skin purpura,joint pain (74%–84%),abdominal pain (61%–76%),and kidney disease (44%–47%).The disease can be seen at any age,but a total of 75% of patients are children under 7 years old,with a male to female ratio of 1.5:1.Western medicine treatment is mainly based on antihistamines and glucocorticoids.There are disadvantages that cannot prevent neopurpura,nor can it treat and prevent kidney disease and improve prognosis [1,2].The disease belongs to the “blood syndrome” and “purpura” in Chinese medicine.There are also many aliases such as “grape-like pestilence”,“purple cloud wind” and “blood wind”.As described in the ancient book of Chinese medicineWaike Zhengzong(1617 C.E.):“grape-like pestilence,was coused by pathogenic factors,blocked in the skin,and form grapes-color purple spots,visible in the whole body skin” [3].By summarizing the experience of Wu Zhengshi treating anaphylactoid purpura,the author analyzes the experience as follows.

Dialectical understanding of anaphylactoid purpura of Wu Zhengshi

External evils is the main cause of anaphylactoid purpura

The dialectical understanding of allergic purpura of Wu Zhengshi was originated from the ancient book of Chinese medicineJie Wei Yuan Sou.The symptoms of“purple wind” and “blood wind” in the book are very similar to anaphylactoid purpura.It believes that the disease is “injured by seven emotions,damaged by original Qi,feeling unclean poison,accumulated within a long time of five insects,wine-colored fortune,sullen and angry,wind,cold,summer heat and dampness”.Wu also agreed in the clinical evidence that the mainly cause of the disease is external evils,and heat evils,including wind heat,damp heat,and heat toxin.Exogenous and seasonal evils,Qi are easily fire formation,hidden between the fur and muscles,or exposed to the poison of heat,trigger off the lurking heat.Wind-heat,damp-heat,heat-toxin fight with Qi and blood,heat injury to the blood network,forced blood to act deliberately,spill out of the vein,penetrate the skin,and develop purpura.

The evil of wind-heat.The wind and heat are all Yang evils,being apt to attack Yang portion of body,so the rash of anaphylactoid purpura is bright red,and it occurs on the muscle surface,head and face,and limbs.The wind with heat evils are mobile and changeable.Therefore,the rash often appears in batches,and sometimes it stops,and migratory joint pain occurs.The fire heat evil easily damage to liquid and stirs the blood,accelerates blood flow,burns the veins,and forces blood to act as purpura,so symptoms such as dry mouth,spontaneous bleeding of the gum,and bloody stool can occur.

The evil of damp-heat.Although the evil of damp-heat begins to suffer externally,it is easy to commit spleen and stomach in the middle energizer,so abdominal pain,abdominal distention,and gastric stuffiness may occur.The damp heat evil injects into the lower energizer joints,so the joints of the lower limbs became swollen and painful.Dampness is sticky and stagnant,fighting the evil of heat,such as oily flour,stagnate and harden after invading the body,and is difficult to dispel.Damp-heat evil can not be relieved after inducing sweating like cold pathogen,and can not be relieved by clearing heat.Therefore,the course of the patients who feel damp-heat evil is intractable,and it is easy to relapse later.

The evil of heat toxin.Anaphylactoid purpura in the acute stage is often caused by heat toxin.At this time,heat toxin stagnates Qi and blood,and the stasis of toxin and stasis can be attacked and channeled with the flow of meridians,tissue and organ such as interstices and pores,sinew and bone,internal organs can be damaged.Heat toxin evil goes out interstices of the flesh,resulting to skin maculopapular eruption.Joint swelling and pain can appear due to the heat toxin evil spreading sinew and bone.Internal attack of internal organs can cause abdominal pain.Heat also can cause testicle swelling and pain.In addition,the purpura caused by blood poisoning of heat toxin,maculopapular eruption is concentrated,dense macula,dark red or purple,soon the local skin color of the maculopapular eruption turned black.

The heat of medicinal toxicity.Most patients with anaphylactoid purpura have often received glucocorticoid therapy repeatedly,although glucocorticoids are immunosuppressive,anti-inflammatory,and promote hematopoietic function,side effects are also very common.Sudden withdrawal is easy to repeat.Some scholars have analyzed the TCM flavor of glucocorticoids.They think that it is similar to warm medicine and belongs to the acrid-dry and sweet-mild product of TCM,which belongs to the kidney,spleen and lung channel[4].Wu was deeply inspired and believed that repeated and irregular hormone interventions are more likely to help the fire and damage to Yin,and complicate the mechanism of disease.Those who are not worried about life can actually be completely cured by simply clearing heat,cooling blood and stopping bleeding with TCM.

Deficiency of healthy Qi is the internal cause

If constitutional insufficiency,or prolonged illness,it consuming Qi and injuring Yin,can lead to Qi deficiency and Yin injury,and the disease conversion of excess into deficiency,or deficiency-excess in complexity.

Qi deficiency.Wu believes that the deficiency of lung and spleen Qi is an important internal cause of anaphylactoid purpura.Lung governs the skin,the Qi deficiency of lung results to the failure of resisting external evil,and easy to be attacked by external evils,which failure to disperse,and lead to purpura attack.Spleen governs limbs and muscles,the spleen Qi deficiency cannot raise,the function of transportation and transformation water-dampness decline,the blood is not controlled,and the blood overflows,causes purpura with symptoms of anorexia,weak and easily fatigued extremities,and even joint swelling.

Yin deficiency.Children are pure-Yang constitution,sickness can easily transform into heat and fire,and heat evil scorches body fluids and damage to Yin;or improper treatment at the beginning of the early disease,and a large number of glucocorticoids are used.For example,Zheng Xin,a modern Chinese medicine master,believes that glucocorticoids are “pure Yang products” [5,6],Yang evil damage Yin,which results in liver-kidney Yin deficiency,Yin deficiency improper nourishment,internal blazing of vacuity heat transforms into fire,blood chaotic movement of hot,eventually leads to purpura.

Clearing heat and sufficient sleep are important in the acute phase of anaphylactoid purpura

Wu syndrome differentiation and treated acute anaphylactoid purpura,and advocated “clearing heat”.The aim is to clear heat and remove toxin,cool blood and stop bleeding,as well as take care of alleviating pain,imrove the functions of spleen and stomach,and pay special attention to the sleep.

Clearing heat and removing toxin

That is,using the herbs of acrid,disperses,cool and discharge properties to clear the heat and toxin.This method is applicable to the evidence that the evil of wind-heat has attacked the lung-defense since the beginning of purpura.Symptoms include fever,mild aversion to wind and cold,slight thirst,red-tipped tongue,thin white coating,and floating and rapid pulse.The main herbs in the prescription of Yinqiao powder,namely Lianqiao(Forsythiae Fructus),Jinyinhua(Flos Lonicerae),etc.are often used;or the clear heat with bitter cold and purging fire and detoxifying products to clear the interior heat,purging fire and removing toxin.This method is applicable to the evidence that the poison of evil heat is inside,and the poison of fire is turned into depression.Symptoms include high fever,severe thirst,irritability,abdominal pain,yellow and reddish urine,black and dry bound stool,red tongue,yellow tongue fur and rapid pulse.Classic ancient prescription Huanglian Jiedu decoction is often used.

Cooling blood and stopping bleeding

Combining the herbs of dispeling the evil heat and cooling blood could dispel the heat from Qi and blood.This method is applicable to the evil heat entering body and blood aspect.Symptoms are fever aggravated at night,irritability and restlessness,epistaxis,bloody urine,bloody stool,purple and crimson tongue,and often use cooling blood and stopping bleeding products such as Shengdihuang (Radix Rehmanniae Recens),Cansha (Bombycis Excrcmentum),Cebaitan(Biotae Folium Carbonisatum),and Dajitan (Cirsii Herba Carbonisata);when accompanied with abdominal pain,lower limb pain and other symptoms,rugs such as Yanhusuo (Rhizoma Corydalis),Baishao(Radix Paeoniae Alba),Rendongteng (Caulis Lonicerae),and Shenjincao (Herba Lycopodii) could be chosen.

Sufficient sleep

Wu attached great importance to the impact of sleep on the disease in the clinical.Ancient doctors recognized the impact of reasonable schedules on human health.The ancient book of Chinese medicineSu Wen · Shanggu Tianzhen Lun(221 B.C.E.–220 C.E.)said:“They ate a balanced diet at regular times,arose and retired at regular hours,avoided over-stressing their bodies and minds,and refrained from overindulgence of all kinds;they maintained well-being of body and mind,thus can keep a long health life.” Ge Hong pointed out in another ancient book of Chinese medicineBaopuzi·Jiyan(the Eastern Jin Dynasty):“Failure to rest on time can cause physical injury”;the ancient book of Chinese medicineShi Wen(168 B.C.E) unearthed from Changsha Mawangdui said:“Sleeping on time is not just a matter for humans,all animals including the human being need to eat to survive,and to sleep on time to keep healthy.” It can be seen that the ancients realized the existence of the biological clock,the disruption of the living rules,and the imbalance of living,the mental disorders,the visceral functions were damaged,and all tissues and organs of the body could produce diseases.Therefore,a reasonable schedule protects the brain,regulates immunity,and promotes development.Modern physicians have also confirmed the huge impact of the biological clock on the human body.The 2017 Nobel Prize winners in physiology or medicine,Jeffrey C.Hall,Michael Rosbash,and Michael W.Young,in recognition of their discovery of the molecular mechanism of biological rhythms,confirming that the disorder of the biological clock,especially the huge damage caused by staying up late,can even cause the occurrence of malignant tumors[7].Wu found that lack of sleep is one of the causes of anaphylactoid purpura in his clinical experience for many years,so he particularly emphasized the importance of sleep for rehabilitation,combined with China's national conditions and modern research[8,9],requiring children under 2 years of age should sleep before19:00;children aged 2–4 should fall asleep before 19:30;children aged 4–7 should fall asleep before 20:00;teenagers aged 7–15 should fall asleep before 20:30;teenagers aged 15–20 should fall asleep before 21:00;adults should fall asleep before 22:00;seniors go to bed before 21:30.

Special traditional medicine treatment for anaphylactoid purpura

Wu has been engaged in clinical work for more than 50 years.On the basis of knowing the cause and mechanismand the most common clinical symptoms of damp-heat brewing internally and Qi-blood damage,he summarized the commonly used self-made anti-purity experienced Wushi Xiaodian prescription:Lianqiao(Forsythiae Fructus),Jinyinhua (Flos Lonicerae),Zhuling (Polyporus),Mudanpi(Cortex Moutan Radicis),Cebaitan (Biotae Folium Carbonisatum),Dajitan (Cirsii Herba Carbonisata),Diyutan(SanguisorbaeRadixCarbonisata),Oujietan(Nelumbinis Rhizomatis Nodus Carbonisatus),Difuzi(Fructus Kochiae),Baixianpi (Cortex Dictamni),Kuxingren (Semen Armeniacau Amarum),Jiegeng(Radix Platycodonis),Sigualuo (Retinervus Luffae Fructus),Cansha(BombycisExcrementum),Shengdihuang (Radix Rehmanniae Recens).The above formula variation in accordance with signs.Details are as follows.Clearing heat and removing toxin:Lianqiao(Forsythiae Fructus),Jinyinhua (Flos Lonicerae),Huanglian (Rhizoma Coptidis),Huangbo (Cortex Phellodendri),Mudanpi (Cortex Moutan Radicis);Cooling blood:Difuzi (Fructus Kochiae),Baixianpi(Cortex Dictamni),Zhuling (Polyporus),Sigualuo(Retinervus Luffae Fructus),Cansha (Bombycis Excrementum),Shengdihuang (Radix Rehmanniae Recens);Stops bleeding:Cebaitan (Biotae Folium Carbonisatum),Dajitan (Cirsii Herba Carbonisata),Diyutan (Sanguisorbae Radix Carbonisata),Oujietan(Nelumbinis Rhizomatis Nodus Carbonisatus),Baimaogen(Rhizoma Imperatae).

In addition,herbs are adjusted on the basis of the above experienced Wushi Xiaodian prescription according to the following symptoms.Tongue:using Fangfeng (Radix Saposhnikoviae) when with tongue fur;using Cangzhu (Atractylodes Rhizoma) when with thick tongue fur;using Beishashen (Radix Glehniae),Taizishen (Radix Pseudostellariae) when with sparse coating tongue;using Shanzhizi (Gardeniae Fructus)when with prickly tongue.Concurrent symptoms:using Yanhusuo (Rhizoma Corydalis),Qingpi(Pericarpium Citri Reticulatae Viride),Baishao (Radix Paeoniae Alba) in patients with abdominal pain;Sangzhi (Ramulus Mori),Rendongteng (Caulis Lonicerae),and Shenjincao (Herba Lycopodii) are used in patients with melosalgia;if with serious melosalgia,Huangbo (CortexPhellodendri),Sangjisheng (Herba Taxilli),Weilingxian (Radix Clematidis),Xuchangqing(Radix Cynanchi Paniculati)could be added;Qinjiao (Radix Gentianae Macrophyllae) and Qianghuo (Rhizoma et Radix Notopterygii)are used in patients with upper limb pain.Chaosuanzaoren (Semen Ziziphi Spinosae),Fushen(Sclerotium poriae Circum Radicem Pini),Longgu (Os Draconis),Yuanzhi(Radix Polygalae)should be added in patients with insomnia;Lugen(Rhizoma Phragmitis)and Shihu (Herba Dendrobii) are used in patients with dry mouth;Zhuru (Caulis Bambusae in Taeniam),Xuanfuhua (Flos Inulae),Shanyao (Rhizoma Dioscoreae) and Chaobaibiandou (Semen Lablab Album) are used in patients with hiccough;Houpu(Cortex Magnoliae Officinalis) and Huomaren (Semen Cannabis) are used in patients with dry bound stool;Fuling (Poria) and Fulingpi (Poriae Cortex) are used in patients with thin sloppy stool;Jingjietan(Schizonepetae Herba et Flos Carbonisatae) and Huaihua (Flos Sophorae) are used in patients with bloody stool;in patients with bloody urine and proteinuria,the amount of Baimaogen (Rhizoma Imperatae) can be increased;Qingdai (Indigo Naturalis),Shengshigao (Gypsum Crudum),Chantui(Periostracum Cicadae) and Gouteng (Ramulus Uncariae cum Uncis) are used in patients with fever;Chantui (Periostracum Cicadae) and Gouteng(Ramulus Uncariae cum Uncis)can be used in patients with crying and scream.

The theoretical basis for the prescription are as follows.Lianqiao (Forsythiae Fructus) is combine with Jinyinhua (Flos Lonicerae),which means Wu Jutong Yinqiao San.Jinyinhua (Flos Lonicerae) tastes slightly bitter and acrid,the drug property is cold,is good at clearing heat and removing toxin,and dispersing wind-heat;Lianqiao (Forsythiae Fructus)tastes bitter and slightly acrid,the drug property is cold,is good at clearing heat and removing toxin,dispersing abscesses and nodules,dispersing wind-heat,and can draws out toxicity.Both medicines are upper energizer essential medicines,which can not only disperse wind-heat,clear heat and remove toxin,but also repel foulness filth and eliminate turbid [10].Huanglian(Rhizoma Coptidis)is adept in clearing heat and drying dampness,purging fire and removing toxin,and good at treating middle-energizer dampness-heat syndrome.Huangbo(Cortex Phellodendri)leaves lower energizer,good treatment of heat toxin of lower energizer,used for purpura lower limb rashes,and even testicle swelling and pain.Shengdihuang (Radix Rehmanniae Recens) is combine with Mudanpi (Cortex Moutan Radicis),Shengdihuang (Radix Rehmanniae Recens)tastes sweet,the drug property is cold,is good at clearing heat and cooling blood,enriching yin and engendering liquid;Mudanpi (Cortex Moutan Radicis)tastes bitter and acrid,the drug property is slightly cold,is expert in clear heat and cool blood,activate blood and disperses stasis,and clear vacuity heat.Two medicines are used together to engender liquid with cold and sweetness and clear heat,and take the“drains downward”effect of Mudanpi(Cortex Moutan Radicis)to prevent Shengdihuang (Radix Rehmanniae Recens)from getting too slimy,especially suitable for syndrome of Yin deficiency and blood heat[11].

Wu often treats skin diseases with basic couplet medicines,which are compatible with Difuzi (Fructus Kochiae)and Baixianpi(Cortex Dictamni),it can clear heat and dry dampness,dispel wind and resolve toxin.Cansha (Bombycis Excrementum) is compatible with Sigualuo (Retinervus Luffae Fructus),which could dispel wind and dredge collaterals,resolve toxin,clear heat and transform dampness,and has a good effect on anaphylactoid purpura.Zhuling (Polyporus) can remove joint swelling due to its heat-clearing and damp-draining effects,and modern research has anti-allergic effects,and is especially suitable for anaphylactoid purpura.Cebaitan (Biotae Folium Carbonisatum),Dajitan (Cirsii Herba Carbonisata),Diyutan (Sanguisorbae Radix Carbonisata),Oujietan(Nelumbinis Rhizomatis Nodus Carbonisatus),Baimaogen(Rhizoma Imperatae)are used as the group medicines,cooling blood to stop bleeding,astricting to stop bleeding;Baimaogen (Rhizoma Imperatae) can also cure bloody urine and proteinuria.Yanhusuo(Rhizoma Corydalis),Qingpi (Pericarpium Citri Reticulatae Viride),Baishao (Radix Paeoniae Alba)nourishing blood and moving Qi to relieve pain,used for abdominal pain of purpura.Sangzhi (Ramulus Mori),Rendongteng (Caulis Lonicerae),and Shenjincao (Herba Lycopodii) could disinhibite the joints and clear heat,and has good treatment of heat impediment,especially for lower limb pain with joint swelling.

Case Presentation

Case history and symptoms

Tan XX,a 7-year old girl,first diagnosed on May 8,2019.Main complaint:repeated lower extremity purpura for 1 month(on behalf of children and parents).Current medical history:one month ago,the child developed purpura in the lower extremities,joint swelling and pain,abdominal pain,no gross hematuria,and melena due to external sensation.She was diagnosed as “anaphylactoid purpura” in the Department of Pediatrics of Guizhou Provincial People's Hospital (No relevant test results were provided).And she was treated with vitamin C,hormones and antihistamines,the abdominal pain,arthralgia and spot rash improved after treatment,but the purpura was repeated twice.She was also given methylprednisolone 5 mg orally,once a day,a week ago.Her methylprednisolone have been stopped.There were no proteinuria and occult blood in the routine urine examination during the treatment.Sometimes abdominal pain,no lower limb pain.

Physical examination and auxiliary examination

At the consultation,we saw spot-shaped soy-sized purpura on both lower limbs,and that in the left lower limb was serious,dark,red,dense,without itching,and did not fade after press(Figure 1A),eat and sleep were acceptable,the urine is yellow,the amount of urine is normal,the stool is dry and difficult to solve,it has not been solved for 3 days.Red tongue,thin and yellow tongue fur,rapid and gentle floating pulse.Blood routine:WBC 10.5 × 109/L,PLT 288 × 109/L,L %:30.7%,N %:59,8%.No abnormalities in blood coagulation function and urine routine were found.

Diagnosis and therapeutic methods

western medicine diagnosis:anaphylactoid purpura;TCM diagnosis:purpuric disease,syndrome of bleeding due to blood heat and wind-heat.

Cooling blood and stopping bleeding,clearing heat and removing toxin,and relieving pain,were the principle of treatment.The self-made prescription is as follows:Cebaitan (Biotae Folium Carbonisatum)20 g,Dajitan (Cirsii Herba Carbonisata) 20 g,Diyutan(Sanguisorbae Radix Carbonisata) 20 g,Oujietan(Nelumbinis Rhizomatis Nodus Carbonisatus) 20 g,Baimaogen (Rhizoma Imperatae) 15 g,Mudanpi(Cortex Moutan Radicis) 12 g,Lianqiao (Forsythiae Fructus) 12 g,Jinyinhua (Flos Lonicerae) 30 g,Kuxingren(Semen Armeniacau Amarum)10 g,Jiegeng(Radix Platycodonis) 10 g,Huangbo (Cortex Phellodendri) 10 g,Zihuadiding (Herba Violae) 15 g,Kushen (Radix Sophorae Flavescentis) 12 g,Huhuanglian (Rhizoma Picrorhizae)10 g,Cuyanhusuo(Rhizoma Corydalis) 15 g,Huanglian (Rhizoma Coptidis) 10 g,Zhuling (Polyporus) 15 g,Difuzi(Fructus Kochiae) 15 g,Baixianpi (Cortex Dictamni)15 g,Sigualuo (Retinervus Luffae Fructus) 15 g,Cansha(Bombycis Excrementum) 12 g,Houpu(Cortex Magnoliae Officinalis) 12 g,Chaohuomaren (Semen Cannabis) 5 g.The method of taking TCM is intelligent no-cooking granules,one dose a day for half an hour after three meals a day for 6 days.Children are instructed not to take hormones and any other drugs,go to bed before 20:30,avoid drinks,sugars,starchy foods,coarse grains,porridge,fruits and spicy and fatty foods to prevent the spleen and stomach from being disturbed.

Follow-up visits

After 6 doses,the purpura subsided obviously.After add or subtract some herbs according to the symbols for 3 weeks,the rash completely subsided(Figure 1B),and abdominal pain,joint pain and other symptoms were also disappeared.During the follow-up six months,no new cases of purpura were found in the child,and there were no abdominal pain or joint pain during the period.There were no abnormalities in the two routine urine tests.

Comments

Cebaitan (Biotae Folium Carbonisatum),Dajitan(Cirsii Herba Carbonisata),Diyutan (Sanguisorbae Radix Carbonisata),Oujietan (Nelumbinis Rhizomatis Nodus Carbonisatus),Baimaogen(Rhizoma Imperatae)performs function of stop bleeding.Zhuling(Polyporus),Sigualuo (Retinervus Luffae Fructus),Cansha (Bombycis Excrementum) are used for cooling blood.Mudanpi (Cortex Moutan Radicis) could clear heat and cools blood;Lianqiao (Forsythiae Fructus),Jinyinhua (Flos Lonicerae),and Huanglian (Rhizoma Coptidis) take upper energizer to disperse wind and clear and detoxify.Huangbo (Cortex Phellodendri),Zihuadiding (Herba Violae) could clear heat toxin of lower energizer.Cuyanhusuo (Rhizoma Corydalis) is used to move Qi to relieve pain.Kuxingren (Semen ArmeniacauAmarum) and Jiegeng (Radix Platycodonis) could facilitate the Qi dynamic,skin disease and lung treatment.Difuzi (Fructus Kochiae)and Baixianpi (Cortex Dictamni) could dispel wind and resolve toxin.Houpu(Cortex Magnoliae Officinalis) and Chaohuomaren (Semen Cannabis) are used to promote movement of the Qi and relax the bowels.