Name: Eugene                                                                                                     Sex: Male

Age: 63                                                                                                               Profession: Scientist

Nationality: USA                                                                                               Marital Status: Married

Major complaint: He has had weakness of the four limbs and difficulties in walking for 3 years.

Disease history: 3 years ago, the patient felt weakness of the two hands without obvious reasons. Gradually the condition got worse. He felt weakness of the lower limbs and difficulties in walking. Then he was diagnosed with ALS at a local hospital by MRI.

Personal history: He was born in USA and his living environment was good. He smokes. He was moderate in temper.

Family history: The families do not suffer from the similar disease.

Date: April 14, 2010                 Time: 13:00 p.m.

Eugene, a 63-year-old male, has suffered from ALS accompanied by weakness of the four limbs and difficulties in walking for 3 years. He was hospitalized in our hospital for treatment at 13:00 p.m. on April 14, 2010.

Essentials for Diagnosis:

1. The patient has suffered from weakness of the four limbs and difficulties in walking for 3 years.

3. T 36.4¡æ£¬P 82 beats/minute, R 20 times/minute, BP 120/80 mmHg.

4. He grew normally with medium nutrition. His mind was clear. He had an expression of chronic illness and his body was skinny. His body was in a positive position and he was cooperative with clear mind.

5. No thoracic deformity. Sound of breath was bilaterally normal on auscultation. No sound of pleural friction. Heart border was normal. No pathological murmurs on auscultation. Normal size of the thorax, voiceless on auscultation, clear breath sounds in the lungs, no dry and damp rales, no widen heart border, P: 82 times/minute, no pathological murmurs.

6. The muscular atrophy in the whole body was obvious. There were slight muscular jumpings in the forearms. The gripping strength of the left hand was 14.3 kg. The right hand was 17.1 kg in the strength. The tongue body was slight reddish with cracks. The pulse was like a thin thread.

7. Assistant examination: MRI showed ALS.

Diagnostic Basis:

TCM: The patient has suffered from weakness of the four limbs and difficulties in walking for 3 years. And he had the difficulties in walking and need to use the walker for help. There was stiffness of the lower limbs and poor balance. There were muscular jumpings in the four limbs sometimes. The hands were weak; especially the right hand could not hold things. He had diplopia. He had problem in speaking. The speech was slurred. The main symptom was futility of the body. So he was diagnosed with Wilting Pattern.

Western medicine: 1. Weakness f the four limbs and difficulties in walking for 3 years. 2. Obvious muscular atrophy in the whole body, slight muscular jumpings in the forearms. 3. The gripping strength of the left hand was 14.3 kg. The right hand was 17.1 kg in the strength. 4. MRI showed ALS.

Diagnostic Differentiation:

TCM: It should be differentiated from impediment syndrome. The characteristic of wilting syndrome are powerless sinews and bones, futility of the body, there are no pains in the joints generally. But the impediment syndrome mainly has pains in the joints of the body. So they are not difficult to be differentiated from each other.

Western Medicine: The patient¡¯s ALS should be differentiated from all myasthenia gravis. Myasthenia gravis usually is worse when the patient does the exercise and better after having a rest; there is no muscular atrophy. Neither does pseudo-hypertrophy. So they are not difficult to be distinguished.

First Diagnosis: 

TCM diagnosis: wilting syndrome

Pathogenesis: vacuity of qi and yin, obstruction of the network vessels and channels.

Rules of treatment: boost qi and nourish yin, quicken the blood circulation and free the network vessels and channels.

Western medicine diagnosis: 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. Rules of treatment: boost qi and nourish yin, quicken the blood circulation and free the network vessels and channels.

6. Herbal tea: Take four dosages of the herbal tea, one dosage a day and drink twice.

7. Acupuncture and massage: once a day.

8. Have more medical examinations if necessary.

Date: April 15, 2010                                 Time: 8:40 a.m.

The patient had had weakness of the four limbs and difficulties in walking for 3 years. 3 years ago, the patient felt the weakness of the two hands without obvious reasons. Gradually the condition got worse. He felt the weakness of the lower limbs and difficulties in walking. Then he was diagnosed with ALS at a local hospital by MRI. And now he had the difficulties in walking and need to use the walker for help. There was stiffness of the lower limbs and poor balance. There were muscular jumpings in the four limbs sometimes. The hands were weak; especially the right hand could not hold things. He had diplopia. He had problem in speaking. The speech was slurred. The main symptom was futility of the body. The muscular atrophy in the whole body was obvious. There were slight muscular jumpings in the forearms. The gripping strength of the left hand was 14.3 kg. The right hand was 17.1 kg in the strength. The tongue body was slight reddish with cracks. The pulse was thin and weak.

Date: April 16, 2010                                 Time: 8:30 a.m.

The test results: Blood R, functions of the liver and kidneys: (£­), Urine R, RBC 1¡ª3/HP, BLD blood:1+, acetone body: 1+

Date: April 17, 2010                                 Time: 8:30 a.m.

The patient said that the condition of the muscular jumpings improved a lot. But the walking situation was still the same. So the treating strategy was the same as before. 5 dosages in total.

Date: April 20, 2010                                 Time: 8:40 a.m.

The patient felt the weakness of the lower limbs. The walking posture was still the same. The muscular jumpings disappeared. So the treating strategy was changed a little. 5 dosages in total.

Date: April 25, 2010                                 Time: 8:40 a.m.

The patient felt that his health was stable. The walking situation improved continuously. Good sleep at night. Appetite was good. Urination and bowel movement were normal. So the treating strategy was the same as before. 5 dosages in total.

Date: April 30, 2010                                 Time: 8:40 a.m.

The patient told us that today he could walk about 300 meters long by himself without help or assistance. The balance was better, so was the speaking. There was no muscular jumping. The tongue body was slight red with cracks. The tongue coating was thin and the pulse was weak and like string. The treatment strategy was not changed. 5 dosages in total.

Date: May 5, 2010                                   Time: 8:40 a.m.

The patient said that the strength in the lower limbs was increased. But after long time walking, he felt the heavy sense in the legs. The walking balance was not so good, compared with before there was of improvement. The other condition was stable. The tongue body was slight red with cracks. The tongue coating was thin and the pulse was weak and string like. The treatment strategy was the same. 5 dosages in total.

Date: May 10, 2010                                   Time: 8:40 a.m.

The patient said that the walking balance still get further improvement. There was no other complaint. The tongue body was slight red with cracks. The tongue coating was thin and the pulse was weak and string like. We still followed the same strategy. 5 dosages in total.

Date: May 15, 2010                                   Time: 8:40 a.m.

The patient continued to exercises everyday. The walking balance got obvious improvement. He did not complain other discomforts. The tongue body was slight red with crack. The tongue coating was thin and the pulse was weak. There was no need to change the treatment strategy. 5 dosages in total.

Date: May 20, 2010                                   Time: 9:00 a.m.

The patient¡¯s condition was stable. The walking was better continuously. Good sleep at night. The appetite was good. The urination and bowel movement were normal. The tongue body was slight red with cracks. The tongue coating was thin and the pulse was weak and taut. The herbal formula was the same as last one. 5 dosages in total.

Date: May 25, 2010                                   Time: 9:00 a.m.

The patient¡¯s condition was fine. No special complaints. But he thought that the improvement was subtle these days and asked for stronger and powerful treatment. The herbal formula changed. The other 6 dosages in total.

Date: May 31, 2010                                   Time: 9:00 a.m.

The patient did not have discomforts. The balance was good when he was walking. But the lower limbs were still weak. The tongue body was slight red with cracks. The tongue coating was thin and the pulse was weak and taut. The herbal formula was the same as last one. 5 dosages in total.

Date: June 5, 2010                                      Time: 9:00 a.m.

The patient fell down unexpectedly during the morning exercises. There was a little hurt in the back of the head. He was advised to be careful and just do some mild exercises. The formula changed a little. 5 dosages in total.

Date: June 10, 2010                                      Time: 9:00 a.m.

The patient told that his sleep and appetite were good. The urination and bowel movement were normal. His balance was not bad but still with weakness of the lower limbs. The treatment strategy was the latest one. 5 dosages in total.

 Date: June 15, 2010                                      Time: 9:00 a.m.

There was no abnormality with the sleep, appetite, urination and bowel movement. But the lower limbs were still lack of strength. The tongue body was slight red with cracks. The tongue coating was thin and the pulse was thin and weak. We prescribed a new formula. 7 dosages in total.

Date: June 22, 2010                                      Time: 9:00 a.m.

The patient said that the condition was of gradual improvement. The tongue body was slight red with crack. The tongue coating was thin and the pulse was weak and taut. The formula changed again. 4 dosages in total.

Date: June 26, 2010                                      Time: 9:00 a.m.

The patient¡¯s condition was stable. He was advised to have more nourishing food. There was a new herb added into last formula. 4 dosages in total.

Date: June 30, 2010                                      Time: 9:00 a.m.

The patient said that there was ulcer in the mouth with pains. We suggested him to avoid spicy and pungent food, but have more vegetables and fruits. At the same time, we gave him Vitamin B2 and other chewing supplements. The formula was the same as used on 22 June but changed a little. 6 dosages in total.

Date: July 6, 2010                    Time: 10:00 a.m.