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Brief Summary: On June 18, 2008, George, from Tanzania, who suffered from poor activities of the lower limbs and weakness all over the body, was hospitalized in our hospital. He  has achieved much improvement after 60-day TCM treatment here. When he was here, it si hard for him to walk upward a step on the stairs. During treatment, he could walk upward at least 20 steps on the stairs.

 Record of Hospitalization

Name: George                                                                                                            Sex: Male

Age: 13                                                                                                                      Profession:  Student

Nationality: Tanzania                                                                                                 Marital Status: Unmarried

Onset Season: Grain rain                                                                                           Date of Admission: June 18, 2008  

Complainer: The patient¡¯s father                                                                                 Reliability: Reliable

 

First Medical Record

Date: June 18, 2008                     Time: 19.00 p.m.

George, a 13-year-old male, has suffered from poor activities of the lower limbs for 8 years, and his condition has been aggravated by the weakness all over the body for 3 years. He was hospitalized in our hospital for further treatment at 19: 30 p.m.on  June 18, 2008.

Essentials for Diagnosis:

1. The patient has suffered from poor activities of the lower limbs for 8 years, and his condition has been aggravated by the weakness all over the body for 3 years.

2. 8 years ago, the patient began to suffer from the weakness of the right limb without any obvious causes, which caused his inconvience in activities and walking. With the time going by, his condition was aggravated. Then he was diagnosed with DMD after the EMG examination in a local hospital. Now, the patient can¡¯t walk steadily with staggering and waddling gait. It is easy for him to fall down. He suffered from weakness all over the body and had difficulty in raising his upper limbs. Sometimes he had the symptoms of putting out his tongue and running at the mouth. His food intake was poor with much sleep. He felt that there were some slight aching pains in the joints all over the body. His bowel movement urination was normal,but his urinationwas incontinent.

3. T 36.2¡æ£¬P 80 beats/minute, R 20 times/minute, BP 110/60 mmHg, K 70 kg.

4. He grew normally with obese shape. His mind was clear. He had an expression of chronic illness and languidness. His body was in a passive posture and he was cooperative with clear mind.

5. His gait was staggering in wadding gait. The appearance of the gastrocnemius, deltoid, infraspinatus and gluteus were enlarged. His pulse was thready and weak. The body of his tongue was enlarged with white tongue coating. The gripping power of his left hand was 4.9 kg, and that of the right hand was 8.2 kg.

6. Diagnostic examination: The EMG shows ¡°DMD¡±.

Diagnostic Basis:

TCM (Traditional Chinese Medicine): The patient has suffered from poor activities of the lower limbs for 8 years, and his condition has been aggravated by the weakness all over the body for 3 years. The patient can¡¯t walk steadily with staggering and waddling gait. It is easy for him to fall down. He suffered from weakness all over the body and had difficulty in raising his upper limbs. Sometimes he had the symptoms of putting out his tongue and running at the mouth. His food intake was poor with much sleep. He felt that there were some slight aching pains in the joints all over the body. His bowel movement was normal,but his urinationwas inwntinent. His pulse was thready and weak. The body of his tongue was enlarged with white tongue coating. According to the symptoms of his tongue and pulse, it is shown that due to vacuity of the spleen and kidneys, deficiency of the qi and blood, the patient¡¯s limbs were weak. He is mainly characterized by weak limbs and dysfunction of the limbs. So it is believed as wilting.

Western Medicine: The patient has suffered from poor activities of the lower limbs for 8 years, and his condition has been aggravated by the weakness all over the body for 3 years. The gripping power of his left hand was 4.9 kg, and that of the right hand was 8.2 kg. His gait was staggering in wadding gait. The appearance of the gastrocnemius, deltoid, infraspinatus and were enlarged is obese. The EMG shows ¡°DMD¡±.

Diagnostic Differentiation:

TCM (Traditional Chinese Medicine): The patient¡¯s wilting syndrome should be differentiated from impediment syndrome. Wilting syndrome is characterized by limp, weak, and emaciated limbs with muscular atrophy. A patient suffered from Wilting syndrome seriously may even become unable to hold an object or to stand without any support. Besides, the patient usually has no joint pains. On the contrary, impediment syndrome is generally characterized by aching pains, fixed heaviness and inflexibility of sinews and bones, muscles and joints, with occasional numbness or swelling, though, no paralytic manifestations exist. They are not difficult to be distinguished in clinics.

Western Medicine: Wilting syndrome should be differentiated from Myasthenia Gravis (MG), which is an acquired autoimmune disease with the transferring obstacles owing to the reduced acetylcholine receptor in the site of neuromuscular junction. It can occur at any age. The most obvious characteristic of MG in clinics is rapid fatigability during the movement of the skeletal muscles, which will be improved by rest or cholinesterase. They are not difficult to be distinguished in clinics.

First Diagnosis: 

TCM (Traditional Chinese Medicine) diagnosis: Wilting syndrome

Symptom identification: Vacuity of the spleen and kidneys.

Western Medicine diagnosis: DMD

Plans for treatment strategy and nursing:

1. Routine care of traditional Chinese internal medicine.

2. Grade II care.

3. Under the care of a companion.

4. Low-fat and high-protein diet.

5. Herbal tea (to boost qi, fortify the spleen and supplement the kidneys): one dosage a day and drink twice.

Main herbs used in the herbal tea: baisheng (white ginseng), baishu (ovate atractylodes root), fuling (poria), etc.

6. Acupuncture and massage: once a day.

7. Do functional exercise for all the limbs.

8. Have more medical examinations if necessary.

 

Date: June 19, 2008                               Time: 15:00 p.m.

The patient¡¯s father said that his son had suffered weakness of all the limbs with difficulty in walking for 8 years. Besides, he was sleepy and somnolent with obese shape. He had difficulty in walking. What¡¯s more, his gait was staggering in wadding gait. After his crouch, he had difficulty in standing up. He had a large amount of food-intake. His urination was incontinent, but his bowel movement was normal. The body of his tongue was slight red and enlarged with white and slimy thick tongue coating. His pulse was deep, thready and weak. The TCM diagnosed it as wilting syndrome, while western medicine diagnosed it with progressive DMD. Due to vacuity of the spleen and kidneys, the TCM treatment strategy is to boost qi, fortify the spleen and supplement the kidneys. The prescription was as follows: baisheng (white ginseng), baishu (ovate atractylodes root), fuling (poria), etc. 4 dosages in total.

 

Date: June 22, 2008                               Time: 9:00 a.m.

The patient¡¯s urination was incontinent, so he had once bed-wetting last night. He was still somnolent with poor spirit. He slept for 12 to 14 hours a day. He felt heaviness and fatigue all over the body. What¡¯s more, there were slight aching pains in the joints all over the body. The prescription was kept the same. 5 dosages in total.

 

Date: June 27, 2008                               Time: 9:00 a.m.

The patient himself felt that the weakness of all his limbs got some improvement. Besides, his father found that all the activities of his son were much more flexible than before. His somnolence, fatigue, and difficulties in walking and activities all got obvious improvement, so was the incontinent urination. In recent days, he hasn¡¯t had any phenomenon of bed-wetting. Now, the amount of his activities was increasing. He kept a good spirit. But he still felt weakness of the loins, the double lower limbs and the joints. He still had difficulty in standing up after a crouch. The TCM treatment strategy kept boosting qi, fortifying the spleen and supplementing the kidneys. The former prescription was changed a little. 5 dosages in total.

 

Date: July 2, 2008                               Time: 9:00 a.m.

Since the patient felt weakness of all the limbs with over-weight shape, he had difficulty in walking. The doctor advised him to decrease the diet, especially gradually to avoid some fatty food. He should do more exercise and sleep less. His incontinent urination has almost disappeared. The doctor added bushy knotweed root into his last prescription. 5 dosages in total.

 

Date: July 7, 2008                               Time: 9:00 a.m.

His difficulties in walking and activities got further improvement, so did his somnolence and fatigue. His sleep also decreased to 10 hours a day. The amount of his activities was increased a lot. He seldom had symptoms of bed-wetting. He still felt weakness of the loins. His bowel movement was normal. His pulse was deep, thready and weak. The prescription was changed as follows: dansheng (salvia root), gancao( licorice root), zaopi( cornus fruit), etc. 5 dosages in total.

 

Date: July 12, 2008                               Time: 9:00 a.m.

In the past, it was easy for the patient to fall down when he walked. These days, there was no phenomenon of falling down when he tried to walk. His other condition kept steady. The formula was kept the same 3 dosages in total.

 

Date: July 17, 2008                               Time: 9:00 a.m.

The patient seldom had symptoms of bed-wetting. His father said that the strength of his son¡¯s loins had been increased a lot. He could get up and stand up by himself. The doctor again changed his prescription a little. 5 dosages in total.

 

Date: July 22, 2008                               Time: 9:00 a.m.

The patient¡¯s condition kept steady. His weight was decreased by 2 kg after one-month hospitalization. His father had asked him not to lose weight too quickly, and it isn¡¯t helpful for him to recover. His prescription was again changed a little. 5 dosages in total.

 

Date: July 27, 2008                               Time: 9:00 a.m.

The difficulties in walking and activities were further improved. Under the company of his father, he was able to go up the stairs and go down the stairs twice a day. He kept a pleasant mood. No falling down when he tried to walk. No bed-wetting. His diet and sleep were both normal. He kept the same prescription. 5 dosages in total.

 

Date: Aug 1, 2008                               Time: 9:00 a.m.

The patient¡¯s condition kept normal. His walking and activities were much easier and more flexible than before. He has never fallen down in these days. His incontinent urination has disappeared. He didn¡¯t felt obvious fatigue. He kept the same formula. 5 dosages in total.

 

Date: Aug 5, 2008                               Time: 9:00 a.m.

The strength of his double lower limbs and the loins was increased a lot. He was able to go up from the third floor to the fifth floor. These days, he had no symptoms of bed-wetting. He sometimes would fall down. He still felt weakness of the joints, so he couldn¡¯t crouch. He could raise his upper limbs easily. The formula would be kept the same. 5 dosages in total.

 

Date: Aug 11, 2008                               Time: 9:00 a.m.

His condition kept normal. He would kept the same formula. 7 dosages in total.

 

Date: Aug 16, 2008                               Time: 9:00 a.m.

The patient¡¯s condition kept steady. Since his visa was expired, he would leave the hospital tomorrow.

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