Denmark ALS patient.
Brief Summary: Mr. Joern, from Denmark, suffered from ALS with the symptoms of weakness and amyotrophy of the left lower limbs with lame walking. After the comprehensive treatment here, his symptoms get much improvement.
Records of Hospitalization
Name: Joern Sex: Male
Age: 60 years Profession: Travel Director
Nationality: Denmark Marital status: Married
Onset Season: Summer Date of Admission: Jan. 6th, 2006
Complainer: The patient himself Reliability: Reliable
Major complaint: The patient has suffered from weakness and amyotrophy of the left lower limbs for 2 years with six-month walking lamely condition.
Present illness: In January of 2006, the patient began to have weakness of the left lower limbs without any obvious cause. At that time, the patient didn’t pay enough attention to nor do anything about it. In June of 2006, he began to have muscular spasm and atrophy in his left lower limbs, walking lamely; however, he had no treatment for those symptoms. In Sep. 2006, he was diagnosed as ALS by EMG and affection of Borelin by LP in the local hospital, where he got three-month oral medication called Runterk which was to be proved effectless. And in Dec. 2006 he took twenty-day herbal tea posted to him from our hospital, after which he felt certain symptomatic improved. So he came to our hospital for further treatment. Since he had the disease, his spirit, appetite and sleep had been good, and his urination and defecation normal.
Past history: No history of typhoid, tuberculosis, malaria and hepatitis. No allergic history of medicine or food. No operation history. No history of preventive vaccination provided. In May of 2005 he had plastic operation meniscus.
Personal history: He was born in Denmark. No contact history of schistosomiasis. No addiction to smoking, alcohol or special food. And he was even-tempered and optimistic.
Marital history: He was married at 25 and had given birth to a son and a daughter. His wife and children have been healthy all the time.
Family history: Her parents were both healthy. No history of special disease.
Physical examination
T 36.5℃，P 78 bpm, R 20bpm, BP 130/80mmHg, W 86kg
He is mid-nourished and normally developed. His mind is clear. He has an expression of chronic illness and languidness. He is in a positive position and cooperative in examination. His skin is moist. No jaundice in the sclera. No superficial lymph-node enlargement. Bilateral pupils are round and equal in size and sensitive to light. No chest deformity. Sound of breath is bilaterally normal on auscultation. No respiratory rales or pleural friction rubs. Heart border is normal. Heart beat 78/min. Cardiac rhythm is regular. No pathological murmurs on auscultation. Abdomen touches flat and soft without tenderness or rebound tenderness. Liver and spleen are not palpable. No percussion pain in renal region. Bowel sound is normal. No spinal and pelvic deformity or tenderness. No deformity or inflexibility of the right lower extremity or upper ones. The condition of the left lower extremity will be discussed in the next paragraph. The development of his anus or pudendum is normal. His tongue body is dull red with thin and white coating, and his pulse deep, thread-like and loose.
Left lower limbs: weakness and mild amyotrophy. The circumference of the right thigh measured 12cm above the knee joint is 42cm, while that of the left one is 44cm. Measured around 14cm below the knee joint, the circumference of the left leg is 34cm, while that of the right one is 36cm. Muscular strength is normal but muscular tension is weakerl. There are obvious muscular jumps in his left thigh and right leg.
Diagnostic examination: In Sep. 2006, he was diagnosed as ALS by EMG in a local hospital.
First diagnosis:
TCM diagnosis: Wei-syndrome (flaccidity syndrome)
Symptom diagnosis: liver and kidney deficiency; spleen and stomach qi-asthenia.
WM diagnosis: ALS
First Medical Record
Jan. 6th 2007
Joern, a 60-year male, the patient has suffered from weakness and amyotrophy of left lower extremity for 2 years with six-month condition of walking lamely. He came to the TCM Dep. of Huaihua Red Cross Hospital on Jan. 6th 2007.
Essentials for diagnosis:
1. Weakness and amyotrophy of the left lower extremity for two years; walking lamely for half a year.
2. In Jan. 2006, the patient began to have weakness of left lower extremity without any obvious cause. At that time, the patient didn’t pay enough attention to nor do anything about it. In Jun. 2006, he began to have muscular spasm and atrophy in his left lower limb, walking lamely; however, he had no treatment for those symptoms. In Sep. 2006, he was diagnosed as ALS by EMG and affection of Borelin by LP in a local hospital, where he got three-month oral medication called Runterk which was of no effect. And in Dec. 2006 he took twenty-day herbal tea posted by our hospital, after which he felt certain symptomatic improvement. So he came to our hospital for TCM treatment. Since he had the disease, his spirit, appetite and sleep were good, and his urination and defecation were normal.
3. T 36.5℃，P 78bpm, R 20bpm, BP 130/80mmHg, W 86kg
4. He is mid-nourished and normally developed. His mind is clear. He has an expression of chronic illness and languidness. He is in a positive position and cooperative in examination.
5. He has weakness and mild amyotrophy in left lower extremity. The circumference of the right thigh measured 12cm above the knee joint is 42cm, while that of the left one was 44cm. Measured around 14cm below the knee joint, the circumference of the left leg is 34cm, while that of the right one is 36cm. Muscular strength is normal but muscular tension weaker than normal. And there are obvious muscular jumps in his left thigh and right leg. His hands are normal.
6. No thoracic deformity. Chest percussion noted resonance. Sound of breath is bilaterally clear on auscultation. No sound of pleural friction.
7. Diagnostic examination: In Sep. 2006, he was diagnosed as ALS by EMG in a local hospital.
Diagnostic basis
TCM: He has weakness and mild amyotrophy of left lower extremity for two years with six-month condition of walking lamely. There exists flaccidity of sinews and vessels in his left lower extremity. And there are obvious muscular jumps in his left thigh and right leg.
Western medicine: He has weakness and mild amyotrophy in left lower extremity. The circumference of the right thigh measured 12cm above the knee joint is 42cm, while that of the left one was 44cm. Measured around 14cm below the knee joint, the circumference of the left leg is 34cm, while that of the right one is 36cm. Muscular strength is normal but muscular tension weaker than normal. And there are obvious muscular jumps in his left thigh and right leg.
Diagnostic differentiation
TCM: The patient’s Wei-syndrome should be differentiated from Bi-syndrome. Although they both fall into the category of limb disease, they are different in pathogeny, pathogenesis and clinical manifestations. Wei-syndrome is characterized as limp, weak and emaciated limbs with shriveled muscles. A patient suffering from Wei-syndrome may even become unable to hold an object or to stand without support. Besides, the patient’s lower limbs are more often affected, though he or she usually has no joint pain. On the contrary, Bi-syndrome is generally characterized as aching pain, fixed heaviness and inflexibility of sinews and bones, muscles and joints, with occasional numbness or swelling, though, no paralytic manifestations. The pathogenesis of Wei-syndrome is that the essence and blood in five-fu organs is insufficient to travel through the whole body leading to malnourish of the meridians and collaterals; while that of Bi-syndrome is that the obstruction of meridians and collaterals by pathogenic qi blocks the circulation of qi and blood. They are not difficult to be distinguished in clinics.
WM: Wei-syndrome should be differentiated from myasthenia gravis which can occur at any age and strikes typically between ages 10 and 35. Women are more often affected than men. The most obvious characteristic of MG is rapid fatigability of the skeletal muscles affected, improved with rest in various degrees. The patient’s condition fluctuates, relatively better in the morning and worse at dusk. The onset is all of a sudden, often begun with a group of muscles, and as time goes on, the disease progressively affects other groups. It is most common that the cranial innervate muscles are often the first group of muscles to be affected evidenced by the fact that about 90 percent of persons with MG have such initial symptoms as drooping eyelids (ptosis) and double vision (diplopia). And the bulbar muscles and girdle muscles are often the second group of muscles to be affected. MG patients of different ages often have different clinical manifestations and courses which are different from those of Wei-syndrome paients.
First diagnosis:
TCM diagnosis: Weizheng (flaccidity syndrome)
Symptom diagnosis: liver and kidney deficiency; spleen and stomach qi-asthenia.
WM diagnosis: ALS
Plan of treatment strategy and nursing
1. On routine care of traditional Chinese internal medicine
2. On grade II care
3. Under care of a companion
4. High-protein diet
5. Herbal tea (to nourish liver and kidney and to invigorate spleen and replenish qi): one dosage a day and drink by twice
Main herbs used in the herbal tea: Shudi (Cooked Rehmannia), Baishen (White Ginseng), Tubie (Wingless cockroach), Zaopi (Cornus), Niuxi (Achyranthes), Ruxiang (Frankincense), Moyao (Myrrh), Suoyang (Cynomorium), Yimi (Coix), Zhimu (Anemarrhena), Jixueteng (Millettia), Baizhu (Ovate Atractylodes).
6. Acupuncture and massage: once a day
7. Have more medical examinations if necessary
Date: 7th of Jan. 2007 Time: 9:00 a.m.
In today’s doctor’s rounds, the patient told Dr. Yang that he has weakness of left lower extremity and difficulty in walking.
Examinations: T 36.5℃，P 78bpm, R 20bpm, BP 130/80mmHg, W 86kg.
The patient has weakness in left lower extremity and difficulty in walking. The circumference of his right thigh measured 12cm above the knee joint is 42cm, while that of the left one was 44cm. Measured around 14cm below the knee joint, the circumference of the left leg is 34cm, while that of the right one is 36cm. Muscular strength is normal but muscular tension weaker than normal. And there are obvious muscular jumps in his left thigh and right leg. His tongue is dull red with thin and white coating, and his pulse deep, threadlike and loose. In Sep. 2006, he was diagnosed as ALS by EMG in a local hospital.
Dr. Yang’s analysis:
1. According to those manifestations, the patient’s disease falls into the category of Wei-syndrome (flaccidity syndrome) which refers to the flaccidity and weakness of extremities leading to inability to move freely. In clinics, amyotrophy and weakness of lower extremities are eminent. The cause of the disease can be external or internal. The external cause is the long-term infiltration of splenic and gastric fluid by exogenous pathologic factors such as warmth, heat, toxin, and damp heat. While the internal causes are always impaired function of the zang-fu organs due to factors such as irregular diet, chronic illness, or overstrain, etc., leading to the asthenia of spleen and stomach and consumption of liver and kidney. The condition of chronic wei-syndrome patients will become critical if the splenic and renal essence and qi are severely exhausted.
2. Symptom diagnosis: liver and kidney deficiency; spleen and stomach qi-asthenia.
3. Principle of TCM treatment: to nourish liver and kidney and to invigorate spleen and replenish qi. Main herbs used in the herbal tea for six days: Shudi (Cooked Rehmannia), Baishen (White Ginseng), Tubie (Wingless cockroach), Zaopi (Cornus), Niuxi (Achyranthes), Ruxiang (Frankincense), Moyao (Myrrh), Suoyang (Cynomorium), Yimi (Coix), Zhimu (Anemarrhena), Jixueteng (Millettia), Baizhu (Ovate Atractylodes). A daily dosage should be decocted twice.
4. Other treatments or examinations: daily acupuncture and massage; have more medical examinations if necessary.
Date: 8th of Jan. 2007 Time: 9:00 a.m.
Today the patient has no discomforts such as headache, dizziness, nausea, vomit, fever or aversion to cold, except weakness in left lower extremity and difficulty in walking. He has no problem with spirit and appetite, and he has had a good sleep. His bowel movement and urination are normal. His heart and lungs are normal. His abdomen is flat and soft. The condition of his left lower limb remains the same. His tongue is dull red with thin and white coating. His pulse is deep, threadlike and loose. Doctor’s request: the herbal tea should follow the original formulation.
Date: 9th of Jan. 2007 Time: 9:00 a.m.
Today the patient has no discomforts such as headache, dizziness, nausea, vomit, fever or aversion to cold, except weakness in left lower extremity and difficulty in walking manifested as walking lamely. He has no problem in spirit and appetite, and he has had a good sleep. His bowel movement and urination are normal. He has had routine blood, urine and stool test, liver function test, hepatitis-B test, kidney function tests, blood sugar test, blood fat test, of which the results are all normal. He also has had ECG and X-ray of hip joints of which the results are both normal. And he has had ultrasonic examination of his spleen, kidney and gall bladder, of which the results are all normal. However, he has liver enlargement. His tongue is dull red with thin and white coating. His pulse is deep, threadlike and loose. Doctor’s request: the herbal tea should follow the original formulation.
Date: 12th of Jan. 2007 Time: 9:00 a.m.
Today the patient has no discomforts such as headache, dizziness, nausea, vomit, fever or aversion to cold, except weakness in left lower extremity and difficulty in walking. He has no problem with spirit and appetite, and he has had a good sleep. His bowel movement and urination are normal. His heart and lungs are normal. His abdomen is flat and soft. Unlike before, his right toes are able to flex and extend again. His tongue is dull red with thin and white coating. His pulse is deep, threadlike and loose. Doctor’s request: the patient should have confidence in fight against the disease and be cooperate in the treatment.
Date: 16th of Jan. 2007 Time: 9:00 a.m.
Today the patient has no discomforts such as headache, dizziness, nausea, vomit, fever or aversion to cold, except weakness in left lower extremity and difficulty in walking manifested as walking lamely. He has no problem in spirit and appetite, and he has had a good sleep. His bowel movement and urination are normal. His heart and lungs are normal. His abdomen is flat. His tongue is dull red with thin and white coating. His pulse is deep, threadlike and loose. Doctor’s request: the herbal tea should follow the original formulation.
Date: 19th of Jan. 2007 Time: 9:00 a.m.
Today the patient has no discomforts such as headache, dizziness, nausea, vomit, fever or aversion to cold, except weakness in left lower extremity and difficulty in walking manifested as walking lamely. He has no problem in spirit and appetite, and he has had a good sleep. His bowel movement and urination are normal. His heart and lungs are normal. His abdomen is flat. His tongue is dull red with thin and white coating. His pulse is deep, thread-like and loose. Doctor’s advice: the herbal tea should follow the original formulation.