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Brief Summary: On May 22, 2008, Said, who suffered from weakness of the double lower limbs and disabilities of speaking and swallowing, was hospitalized in our hospital. After about three-month TCM treatment here, he got much improvement, especially significant on the stiffness of his upper limbs.

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Record of Hospitalization

Name: Said                                                                                                               Sex: Male

Age: 47                                                                                                                     Profession:  Office clerk of the government

Nationality: Moslem                                                                                                 Birthplace: Afghanistan

Marital Status: Married                                                                                            Onset Season: Spring                

Complainer: The patient¡¯s son                                                                                   Date of Admission: May 22, 2008       

 

First Medical Record

Date: May 22, 2008             Time: 19:20 p.m.

Felix, a 47-year-old male, has suffered from weakness of the double lower limbs for 3 years, and his condition has been aggravated by disabilities of speaking and walking for 1 year. He was hospitalized in our hospital at 19:00 p.m. on May 22, 2008.

Essentials for Diagnosis:

1. The patient has suffered from weakness of the double lower limbs for 3 years, and his condition has been progressively aggravated by disabilities of speaking and walking for 1 year.

2. 3 years ago, the patient began to suffer from weakness of the left limbs, accompanied by atrophic, stiff and beating muscles without any obvious reasons. His condition was gradually aggravated and then it affected the right limbs. In 2006, he was diagnosed with ALS after an examination of MRI in Germany. And then he was prescribed by rilutek for the treatment. But there was no improvement. A year ago, he began to have the difficulties in speaking and walking. His lower limbs were stiff and spastic. Besides the muscles of the lower limbs beat obviously. His spirit and appetite were both poor. The food intake was normal. His bowel movement and urination were both normal.

3. T 36.2¡æ£¬P 80 beats/minute, R 20 times/minute, BP 120/80 mmHg.

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

5. No thoracic deformity. Chest percussion noted resonance. Sound of breath is bilaterally clear on auscultation. No sound of pleural friction. Heart border was normal. Heart beat was 80 times/minute. Cardiac rhythm was regular. No pathological murmurs on auscultation.

6. His double hands lost the functions. Besides, it is easy for him to get tired. The muscles of the upper limbs were slightly atrophic. The muscular strength of his upper limbs was Grade ¢ò. The gripping power of the left hand was 0 kg, and that of the right hand was 4.9 kg. His lower limbs were unable to do any activities. The muscular strength of his lower limbs was Grade¢ñ. His lower limbs were stiff in scissor gait. What¡¯s more, the muscles beat obviously. He was unable to speak with difficulty in swallowing. His tongue was red with white tongue coating. His pulse was thready and weak. 

7. Diagnostic examination: The MRI shows ALS.

Diagnostic Basis:

TCM: The patient has suffered from weakness of all the double lower limbs for 3 years, and his condition has been progressively aggravated by disabilities of speaking and swallowing for 1 year. Besides, he had difficulty in swallowing with much phlegm-drool. His double hands were unable to do any activities, especially obvious in the left hand. His lower limbs were completely unable to walk completely. What¡¯s more, his lower limbs were stiff and spastic, and the muscles beat obviously. His tongue was red with white tongue coating. According to the symptoms of his tongue and pulse, it is shown that due to vacuity of the spleen and qi, liver wind stirring internally and fluid depletion, his body couldn¡¯t nourish the muscles of his limbs. Then it gradually leads to the atrophy of his limbs. He is mainly characterized by weak limbs and emaciated muscles, which even cause his limbs to lose functions. So it is believed as wilting.

Western Medicine: The patient has suffered from weakness of the double lower limbs for 3 years, and his condition has been progressively aggravated by disabilities of speaking and walking for 1 year. His double hands lost the functions. Besides, it is easy for him to get tired. The muscles of the upper limbs were slightly atrophic. The muscular strength of the upper limbs was Grade ¢ò. The gripping power of the left hands was 0 kg, and that of right hand was 4.9 kg. His lower limbs were completely unable to do any activities. The muscular strength of the lower limbs was Grade ¢ñ. His lower limbs were stiff in scissor gait. The muscles beat obviously. What¡¯s more, he was unable to speak with difficulty in swallowing. The MRI examination showed ALS.

Diagnostic Differentiation:

TCM: 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 may even become unable to hold an object or to stand without any support. Besides, the patient¡¯s lower limbs are more often affected, though he or she 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. 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 and there are about 60 percent people stricken before 30 years old. Women are more often affected than men are. The most obvious characteristic of MG is rapid fatigability of the skeletal muscles affected, improved with rest or medicines that inhibits the activity of cholinesterase. It can involve cardiac muscle and smooth muscle. MG patients of different ages often have different clinical manifestations and courses, which are different from those of flaccidity syndrome patients.

First Diagnosis: 

TCM diagnosis: Wilting syndrome

Symptom identification: Liver wind stirring internally and vacuity of the spleen and qi.

Western medicine diagnosis: Amyotrophic Lateral Sclerosis (ALS)

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 settle the liver and extinguish wind, soften the liver and check tetany, fortify the spleen and boost qi): one dosage a day and drink twice.

Main herbs used in the herbal tea: huangqi (astragalus root), zaopi (cornus fruit), baishao (white peony), etc.

6. Acupuncture and massage: once a day.

7. Have more medical examinations if necessary.

 

Date: May 24, 2008                             Time: 8:30 a.m.

The patient has suffered from weakness of the double lower limbs for 3 years, and his condition has been progressively aggravated by disabilities of speaking and walking for 1 year. Before the hospitalization here, he had been hospitalized in Germany, India, France and Iran for treatment, but there was no improvement. His symptoms were gradually aggravated. At present, the patient¡¯s lower limbs were unable to do any activities, even in rigid paralysis. He walked in scissors gait. His legs even couldn¡¯t bend or stretch. His spirit-mind was feeble-mindedness. Sometimes he enjoyed giggle. The body of his tongue was stiff and inflexible. He was unable to speak and had difficulty in swallowing. His upper limbs were stiff, too, but the muscles of the upper limbs had no obvious symptoms of atrophy. The western medicine diagnosed it with motor neuron damage. The TCM treatment diagnosed it with wilting. The symptoms belong to liver wind stirring internally, vacuity of the liver and kidneys, qi-vacuity of the spleen and lungs. The TCM strategy is to settle the liver and extinguish wind, dispel phlegm, soften the liver and check tetany. The prescription was kept the same. 7 dosages in total.

 

Date: May 25, 2008                       Time: 9:00 a.m.

The patient was in feeble-mindedness accompanied with giggle. The doctor doubted whether there were lesions in his skull. The doctor advised him to go to No. Two People¡¯s Hospital for the MRI examination on his head tomorrow.

 

Date: May 26, 2008                        Time: 14:00 p.m.

After the MRI examination on the head, there found nothing abnormal. His son said that he had the same symptoms at home. He sometimes cried and sometimes giggled. The native doctor had ever given him anti-depression for oral taking. But there was no obvious improvement.

 

Date: June 1, 2008                        Time: 8:30 a.m.

Today his son said that the movement of his father¡¯s hands had been improved since he was hospitalized here. His hands were more flexible than before. His pulse was deep. He kept the same prescription. 5 dosages in total.

 

Date: June 6, 2008                        Time: 8:30 a.m.

His son said that his father had stopped taking the medicines of anti-depression. His sleep was good. He still kept the same prescription. 5 dosages in total.

 

Date: June 7, 2008                        Time: 8:00 a.m.

Last night, the patient didn¡¯t sleep well, so he took 5 mg diazepam tablet before sleep.

 

Date: June 10, 2008                        Time: 9:00 a.m.

These two nights, he didn¡¯t sleep well. Besides, his other condition didn¡¯t get obvious improvement. His pulse was deep and thready, his tongue was yellow. He kept the same prescription. 5 dosages in total.

 

Date: June 15, 2008                        Time: 9:00 a.m.

His son said that the movement of his upper limbs got some improvement since he was hospitalized here. He still kept the same prescription. 5 dosages in total.

 

Date: June 20, 2008                        Time: 9:00 a.m.

His condition was the same as before. His prescription was changed as follows: danggui (tangkuei), danshen (salvia root), shanyao (dioscorea), etc. 5 dosages in total.

 

Date: June 26, 2008                         Time: 9:00 a.m.

The patient still had difficulty in swallowing with chocking when he drank water. He was unable to speak. His limbs were all stiff, especially serious on the lower limbs. The muscles all over the body beat uncontrollable. His sleep was normal with much sweat. His tongue was red, but he had difficulty in the movement of the tongue. The pulse was thready and weak. The prescription was changed as follows: baisheng (white ginseng), danshen (salvia root), honghua (carthamus flower), etc, 5 dosages in total.

 

Date: June 30, 2008                       Time: 9:00 a.m.

The patient sweated too much. His other condition kept the same. His tongue was thready and rapid. The prescription was changed as follows: zaopi (cornus fruit), baishen (white ginseng), danggui (tangkuei), etc. 3 dosages in total.

 

Date: July 3, 2008                          Time: 10:00 a.m.

His sweat was decreased, but it was still more than the normal people. His prescription was changed a little. 3 dosages in total.

 

Date: July 8, 2008                         Time: 10:00 a.m.

His sweat was improved. The other condition kept the same. His tongue was pale. The pulse was thready and rapid. The prescription was kept the same. 5 dosages in total.

 

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

The patient was unable to speak with difficulty in swallowing. The muscles of the limbs were stiff. He couldn't walk or do any activities. Besides, he had difficulty in the movement of the tongue. There were teeth-marks at the edge of his tongue with white and slimy tongue coating. His bowel movement was dry, once every two days. His pulse was thready and weak. These days, his appetite was decreased a lot. The TCM treatment strategy was to boost qi, fortify the spleen and quicken the blood. The prescription was changed as follows: chenpi (tangerine peel), huangqi (astragalus root), baishen (white ginseng), etc. 5 dosages in total.

 

Date: July 20, 2008                         Time: 9:00 a.m.

These days, the patient¡¯s phlegm drool was decreased, and he increased his diet. The stiffness of the upper limbs got some improvement. He kept a steady and pleasant mood. His bowel movement and urination were both normal. But there was no improvement on the stiffness of the lower limbs. He kept the same prescription. 5 dosages in total.

 

Date: July 25, 2008                        Time: 9:00 a.m.

The difficulty in swallowing was improved. The chocking in drinking water was also lessened. His diet was normal. His bowel movement was also normal, once a day. His phlegm drool was decreased. His tongue was red with yellow and slimy tongue coating. His pulse was thready and weak. The stiffness of the upper limbs got significant improvement, but there was still no improvement on the stiffness of the lower limbs. His prescription was changed as follows: zaopi (cornus fruit), taoren (peach kernel), gouqi (lycium), etc. 5 dosages in total.

 

Date: July 31, 2008                        Time: 9:00 a.m.

His son said that the strength of his father¡¯s upper limbs and lower limbs was increased a lot. He could do some simple activities. His upper limbs got the most obvious improvement. The difficulty in swallowing was also improved a lot. His prescription was changed a little, 5 dosages in total.

 

Date: Aug. 4, 2008                        Time: 9:00 a.m.

The patient¡¯s phlegm drool was decreased, but there was still phlegm. The movement of his tongue was poor. His tongue was red with yellow and thick tongue coating. The pulse was thready and weak. His prescription was changed a little again. 5 dosages in total.

 

 Date: Aug. 9, 2008                         Time: 10:00 a.m.

These days, his appetite and difficulty in swallowing have got further improvement. The stiffness of the upper limbs has got significant improvement. But there was no obvious improvement on the stiffness of the lower limbs. He still couldn¡¯t speak. His sleep was poor, but he kept a pleasant mood. Due to the problem of his visa, he had to go home. The prescription was kept the same. 3 dosages in total.

 

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

The patient would leave the hospital tomorrow.

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