Brief Summary: The Saudi Arabian patient, Mr. Abdullah, suffers from Parkinson’s disease. He has body trembling accompanied by a progressive weakness for one year. His movement is difficult and slow. After the comprehensive treatment here, he has achieved obvious improvement.

Name: Abdullah                                                             Sex: Male

Age: 55                                                                          Nationality: Saudi Arabia                

Marital status: Married                                                    Onset Season: Summer                    

Date of Admission: Feb. 26, 2007                                   Date of Recoding: Feb. 26, 2007

Complainer of history: The patient himself                         Reliability: Reliable

Major complaint: The patient was suffering from body trembling accompanied by an aggressive weakness for one year.

Present illness: Eleven years ago, without any obvious cause, the patient began to have dizziness, dreaminess, slow response and a little bit body trembling. At that time, he hadn’t done anything about his illness due to ignorance, it progressively grew worse. In February, 2006, the patient’s whole body trembling aggravated. He got starting difficult, slow movement and response. Tonus on his four limbs increased and he felt asthenia from the head to foot. He checked in a local hospital (not in detail) and the diagnosis for him is Parkinson’s disease. The doctors in the hospital gave him L-dopa (3 times a day and each time 250mg) which belongs to dopamine drugs and amantadine (twice a day and each time 150mg) for orally taken until now. Because he had no obvious improvement on his disease condition, he came to hospitalize in our Traditional Chinese Medicine (TCM) Department. Since he has the disease, his spirit was a little worse; his appetite was good, but the quality of his sleep was bad; his bowel movement and urination were normal.

Past history: He was quite health before. No history of typhoid, tuberculosis, diarrhea and hepatitis. No history of medicine or food allergy. No history of traumatism or operation. No history of preventive vaccination provided.

Personal history: He was born in Saudi Arabia. No contact history of schistosomiasis. He had regular diet and sleep. No addiction to alcohol or smoking.

Marital history: He married at 23 and has a daughter and a son. His wife and children are all healthy.

Family history: No family history of the similar or other special disease.

Disease statement: From the patient himself. Consider it was reliable.

Physical examination

T: 36.5℃，P: 78bpm, R: 20bpm, BP: 115/75mmHg

He is mid-nourished and normally developed. His mind is clear. He is in a positive position and cooperative in examination. His skin and sclera have no jaundice. His head, facial features are normal. Bilateral pupils are round and symmetrical in size and sensitive to light. No purulence from the external auditory canal. No flaring of alaenasi. No cyanopathy in his lips and no reddish in the pharynx. No swelling of the tonsil. Soft neck and middle placed trachea. No swelling of the thyroid gland. No thoracic deformity. His respiratory movement is smoothly. Bilateral of his vocal fremitus are normal. Percuss sounds clear. Sound of breath is bilaterally normal on auscultation. No respiratory rales or pleural friction rubs. Heart border is normal. Heart beat 78bpm. Cardiac rhythm is regular. No pathological murmurs of heart on auscultation. Abdomen is flat and soft without tenderness or rebound tenderness. Liver and spleen are not palpable. No percussion pain on renal region. Bowel sound is normal. The anus and pudendum have not been checked. No Spinal deformity. He can move freely. He has obviously whole body trembling, starting difficult, slow movement and response. Tonus on his four limbs increased and he feels asthenia from the head to foot. He has dizziness and dreamful sleep. The pathological signs are not elicited out. Light red tongue, white and thin tongue fur, fine and deep pulse.

Accessory examination: It is vacant at the moment.

First diagnosis: TCM diagnosis: Trembling and numbness.

Symptom diagnosis: Enrich the liver and kidney, extinguish wind and quicken the network vessels.

WM diagnosis: Parkinson’s disease.

Dr. Yan Zaoming/ Dr. DaiLei

                        First Medical Record

Abdullah, a 55-year-old male, has been suffering from whole body trembling for about 11 years accompanied by an aggravated acratia for one year. He was received by our staff in Zhijiang Airport and arrived at our Huaihua Red Cross Hospital on February 26, 2007.  

Case characteristics:  

1. He has suffered from whole body trembling about 11 years accompanied by an aggravated acratia for one year.

2. Eleven years ago, without any obvious cause， the patient began to have dizziness, dreamful sleep, slow response and a little bit whole body trembling. At that time, because he hadn’t done any examination and treatment about his illness due to ignorance, it progressively grew worse. In February, 2006, the patient’s whole body trembling aggravated. He got starting difficult, slow movement and response. Tonus on his four limbs increased and he felt asthenia from head to foot. He checked in a local hospital (not in detail) and the diagnosis for his disease was Parkinson’s disease. The doctor in the hospital gave him L-dopa (3 times a day and each time 250mg) which belongs to dopamine drugs and amantadine (two times a day and each time 150mg) for orally taken until now. Because he had no obvious improvement on his disease condition, he came to hospitalize in our Traditional Chinese Medicine (TCM) Department. Since he has the disease, his spirit is a little worse; his appetite is good, but the quality of his sleep is bad; his bowel movement and urination are normal.

3. T: 36.5℃，P: 78bpm, R: 20bpm, BP: 115/75mmHg

4. He is mid-nourished and normally developed. His mind is clear, chronic face mirroring difficult condition, languor expression. He is in a positive position and cooperative in examination.

5. He has obviously whole body trembling, starting difficult, slow movement and response. Tonus on his four limbs increased and he feel asthenia from head to foot. He has dizziness and dreamful sleep.

6. Bilateral of his vocal fremitus are normal. Percuss sounds clear. Sound of breath is bilaterally normal on auscultation. No respiratory rales or pleural friction rubs.

7. Accessory examination: It is vacant at the moment.

Diagnosis

TCM: He has been suffering from whole body trembling for about 11 years accompanied by an aggravated acratia for one year. The disease is onset slowly after the middle or old aged people. He has obvious whole body trembling, starting difficult, slow movement and response. Tonus on his four limbs increased and he feels asthenia from head to foot. He has dizziness and dreamful sleep. The pathogenesis of this disease is liver-kidney yin depletion.  

Western medicine: He has suffered from whole body trembling about 11 years accompanied by an aggravated acratia for one year. The disease is onset slowly. He has obvious whole body trembling, starting difficult, slow movement and response. Tonus on his four limbs increased and he feels asthenia from head to foot. He has dizziness and dreamful sleep. The diagnosis for the patient was Parkinson’s disease in his country.

Diagnostic differentiation:

Differentiated with Qizong (tugging and slackening): Qizong is also called clonic spasm. Usually, it was seen in acute fever or some chronic diseases acute attack. Mostly the patients twitched continually, sometimes it accompanied by a short-term interval. Hands and feet bending and stretching are in turn of tracing and slacking. Some of the patients could have fever, two eyes looking upward or clouded spirit symptoms. Trembling syndrome is a kind of chronic disease procedure. The main symptoms present on the head, neck or four limbs autonomously tremble or sharking. The trembling of the hands and feet has a small extent, but a quick frequent. There are no limbs twitching traction, fever or clouded spirit symptoms, etc. After combined analyst with his disease history, it was not hard to distinguish them from each other.   

Western medicine differential diagnosis should be differentiated from progressive supranuclear paralysis. Progressive supranuclear paralysis is also often onset during the middle or odd aged people. The clinical symptoms have extrapyramidal symptoms, such as myotonia, tremble, etc. But this disease has a prominent obstacle on eyeballs staring. Myotonia is mainly on the trunk of the body. Because the limb muscles are less troubled, it keeps a good flexibility of the limb movement. The tension of neck extensor muscle increased lead to neck hyperextension and this is different from neck stretching of Parkinson’s disease. It should be differentiated in clinical examination.      

First diagnosis: TCM diagnosis: Trembling and numbness.

Symptom diagnosis: Insufficiency of the liver and kidney; liver wind enters the network vessels.

WM diagnosis: Parkinson’s disease.

Treatment strategy and daily care

1. On routine care of traditional Chinese internal medicine

2. On grade II care

3. Regular diet

4. Herbal tea: enrich the liver and kidney, extinguish wind and quicken the network vessels. The prescription is to enrich yin and extinguish wind decoction. Such as Shoudi (cooked rehmannia), Guiban (tortoise plastron), Tianma (gastrodia root).     One dosage a day and drink by twice, five days.  

5. Massage: once a day

6. Acupuncture: once a day

7. Have more medical examinations if necessary

8. Have a positive and optimistic attitude towards the disease

Dr. Yan Zaoming/ Dr. Dai Lei

Date: 26^th of February 2007                            Time: 9:00 a.m.

This morning is Deputy Chief Physician Yan Zaoming’s ward-round. The patient complained that he has obviously whole body trembling and feels asthenia from head to foot. He gets starting difficult, slow movement and response. He has dizziness and dreamful sleep. Physical examination: T: 36.5℃，P: 78bpm, R: 20bpm, BP: 115/75mmHg, heart and lung (—), Abdomen is flat and soft (—).

Dr. Yan’s analysis:

1. The patient has suffered from whole body trembling about 11 years accompanied by an aggravated acratia for one year.

2. Physical examination seen the upward recordings.

3. The patient got the definite diagnosis in a local hospital (not in detail) was Parkinson’s disease.

Based on the upward materials, we considered it is “Tremor& paralysis” in TCM diagnosis. “Tremor& paralysis” is also called “Parkinson’s disease”. This kind of disease usually onset the middle aged or elder aged men. The characters which show in clinical practice are trembling, tonus and reducing movement. Liver-kidney yin depletion is the main pathogenesis of this disease. The old people mostly have blood vacuity and essence depletion, and plus they do not absorb enough nutrition, or damaged by disease, lead to liver-kidney yin depletion, and sinew and vessels deprived of nourishment. Because it can not control liver yang, and liver wind stirring internally, it lead to tremble or hypertonicity rigidity. The differentiation of symptoms and signs is: insufficiency of the liver and kidney, liver wind enter vessel. The principle of treatment: Enrich the liver and kidney, extinguish wind and quicken the network vessels. The prescription is to enrich yin and extinguish wind decoction. Such as Shoudi (cooked rehmannia), Guiban (tortoise plastron), Tianma (gastrodia root). One dosage a day and drink by twice, five days.

Massage and Acupuncture: once a day. Have more medical examinations if necessary

Dr. Yan Zaoming/ Dr. Dai Lei

Date: 27^th of February 2007                            Time: 9:00 a.m.

Today the patient still complained that he has obviously whole body trembling and feels asthenia from head to foot. He gets starting difficult, slow movement and response. He has dizziness and dreamful sleep. Physical examination: Heart and lung (—), Abdomen is flat and soft (—). He has no other special discomfort. He presented with a bad spirit. His appetite is good. His bowel movement and urination are normal. Red tongue, white and thin tongue fur, deep and fine pulse. The doctor asked him to do active movement often, to take more vegetables and fruits, and to avoid irritation food. Observe the patient’s condition. Continue using the same prescription.

Dr. Yan Zaoming/ Dr. Dai Lei

Date: 28^th of February 2007                            Time: 9:00 a.m.

Today the patient said he feels less asthenia from head to foot and whole body trembling. He still gets starting difficult and still slowing in movement and response. There is no dizziness on him and he had a good sleep. Physical examination: Heart and lung (—), Abdomen is flat and soft (—). He presented with a good spirit. His appetite is good. His bowel movement and urination are normal. Light red tongue, white and thin tongue fur, deep and fine pulse. The doctor asked him to build up his confident and continue to do exercise. Observe the changes of the patient’s condition. Continue using the same prescription.

Dr. Yan Zaoming/ Dr. Dai Lei

Date: 4^th of March 2007                            Time: 9:00 a.m.

Today the patient said he feels much less asthenia from head to foot and whole body trembling. He gets less starting difficult. He is a little less in slow movement and response. Dizziness and dreamful sleep are nearly disappeared. Physical examination: Heart and lung (—), Abdomen is flat and soft (—). He presented with a good spirit. His appetite is good. His bowel movement and urination are normal. Light red tongue, white and thin tongue fur, deep and fine pulse. The doctor asked him to cooperate with the treatment in order to get a much better therapeutic effectiveness. Continue using the same prescription. Such as Shoudi (cooked rehmannia), Guiban (tortoise plastron), Tianma (gastrodia root). One dosage a day and drink by twice, five days.

Dr. Yan Zaoming/ Dr. Dai Lei

Date: 8^th of March 2007                            Time: 9:00 a.m.

Today the patient said he feels obvious less asthenia from head to foot and whole body trembling. He gets obvious less starting difficult and less in slow movement and response. No aversion to cold, fever, headache, dizziness, nausea, or vomit. He presents with a good spirit. His sleep is good. His bowel movement and urination are normal. Physical examination: Heart and lung (—), Abdomen is flat and soft (—). Light red tongue, white and thin tongue fur, deep and fine pulse. Continue using the same prescription. Observe the changes of the patient’s condition.  

Dr. Yan Zaoming/ Dr. Dai Lei

Date: 12^th of March 2007                            Time: 9:00 a.m.

Today the patient said he feels obvious less asthenia from head to foot and whole body trembling. He gets obvious less starting difficult and less in slow movement and response. Physical examination: Heart and lung (—), Abdomen is flat and soft (—). He presents with a good spirit. His sleep is good. His bowel movement and urination are normal. Continue using the same prescription. Such as Shoudi (cooked rehmannia), Guiban (tortoise plastron), Tianma (gastrodia root). One dosage a day and drink by twice, four days.

Light red tongue, white and thin tongue fur, deep and fine pulse.

Dr. Yan Zaoming/ Dr. Dai Lei

Date: 16^th of March 2007                            Time: 9:00 a.m.

Today the patient said he feels obvious less asthenia from head to foot and whole body trembling. He gets obvious less starting difficult and less in slow movement and response. No aversion to cold, fever, headache, dizziness, nausea, or vomit. He presents with a good spirit. His sleep is good. His bowel movement and urination are normal. Physical examination: Heart and lung (—), Abdomen is flat and soft (—). Light red tongue, white and thin tongue fur, deep and fine pulse. The patient is going to leave the hospital today.

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