53歲女性患者，有自發性氣胸病史，2012年6月罹患細菌性骨髓炎，經抗生素治療後眼下和下肢卻出現紅痛紫斑，予類固醇治療後皮膚病灶較穩定出院，總計8週，但不過一個多月，又被臺北榮總免疫科診斷出結節性紅斑，予抗生素治療住院11天，結節腫漸消、褪成瘀青狀而出院，關節卻開始痠痛緊，手麻僵。同年11月前脛再出現紅熱、硬、壓痛結節，併發癢熱紅疹蔓延下肢，故於11月19日至本院中醫部就診。初診時見下肢腫脹痛不能站，踝、膝關節和足跟沒不可見，有紅熱硬、壓痛結節斑塊和瘀斑，伴低燒，關節痠痛緊，手麻僵彎曲不利；舌質淡紅暗，胖大，邊有齒痕，苔薄膩邊少，津少，舌下絡脈怒張，脈弦細澀數無力。由病程變化推論因細菌性骨髓炎經抗生素、類固醇治療後，失於攝養致三焦氣虛，邪熱入少陽，三焦決瀆失司，膽火內鬱，火熱鬱於三焦引發結節性紅斑。證屬濕熱蘊結，血熱內盛，氣虛血瘀。主方用小柴胡湯疏調氣機，暢三焦、開鬱結、達腠理透邪濁，合滋陰、涼血活血、扶正補氣的治則中，隨病情變化，在血熱內盛時酌加清熱解毒、涼血消斑藥：白花蛇舌草、半枝蓮、青黛、紫草根，觀察皮膚病灶漸穩定，大範圍的紅、腫、硬、癢痛結節和紅疹在3天內消退，並減少發作的嚴重度和復原時間。

We report a 53-year-old woman with history of spontaneous pneumothorax, treated with 8 weeks of antibiotics due to osteomyelitis in June, 2012, but after that, erythematous, painful purpura appeared in her armpit and lower limbs, and relieved after steroid therapy. However, only I month later, with a diagnosis of erythema nodosum, she accepted 11 days of antibiotics in the hospital. Nodules gradually faded into a bruise-like appearance, but following arthralgia, numb and stiff fingers. In November, 2012, she suffered from tender, erythematous, subcutaneous nodules in the front of tibia again, and itching, warm, erythematous papules in lower extremities. Due to these recurrences, she came to our hospital for Chinese medicine treatment On November 19th. Bloating , painful legs, and knee, ankle joints, heel edema limited her action, with tender, erythematous, subcutaneous nodules papules, and purpura appearing in the lower extremities, low-grade fever, arthralgia, numb and stiff fingers, a little purple-colored, swollen and indented tongue with greasy fur, and also string-like, fine, sluggish, rapid but weak pulsation. This process of disease intends a mechanism of heat retention in triple burner due to Qi defiency after long-term use of antibiotics and steroid therapy, and "Retained dampness-heat toxin pattern, blood heat pattern and Qi deficiency with blood stasis pattern." Therefore,we choose Xiao-Chai-Hu-Tang following a therapeutic principle of "regulating qi of triple burner to outthrust turbidity through the interstices, with "cooling and activating the blood, reinforcing the healthy qi, tonifying qi, and enriching yin." Besides, with the patient's condition changing, "clearing heat and resolving toxin herbs
", like Hedyotis diffusa, Scutellaria barbata D. Don, Baphicacanthus cusia, and Arnebia euchroma (Royle) Johnst was given in the "blood heat stage". We observed the foci healed well, and wide-area erythematous, subcutaneous nodules and papules disappeared in 3 days, and reduced the severity of foci and recovery time.