¡¡Brief Summary:
On May 2, 2008, Abdel, from Indonesia, who suffered from
difficulty in speaking and swallowing, as well as
weakness of all the limbs, was hospitalized in our
hospital. He himself thinks that he has achieved 20%
improvement after more than 40-day TCM treatment here.
¡¡
Record of Hospitalization
Name: Abdel
Sex: Male
Age:
64 Profession: Medical
Professor
Nationality: Sudan
Marital Status: Married
Onset Season:
Pure brightness
Date of Admission: May 2, 2008
Complainer: The patient
himself Reliability: Reliable
First Medical Record
May 2,
2008
Abdel,
a 64-year-old male, has suffered from difficulty in speaking and swallowing, as
well as weakness of all the limbs for 16 years, and his condition has been
aggravated by atrophy of all the limbs and disability in movement for half a
year. He was hospitalized in Huaihua Red Cross Hospital for further treatment at
1: 30 a.m. May 2, 2008.
Essentials for Diagnosis:
1. The
patient has suffered from difficulty in speaking and swallowing, as well as
weakness of all the limbs for 16 years, and his condition has been aggravated by
atrophy of all the limbs and disability in movement for half a year.
2. In
1992, the patient began to have difficulty in speaking and poor coordinative
ability of left hand without any obvious causes, and his condition was
aggravated gradually. In 1993, he suffered from troubles of chewing and
swallowing. In 1994, he was diagnosed with
amyotrophic
lateral sclerosis (ALS)
after MRI examination. And then, his condition was aggravated progressively. In
the recent half a year, he couldn¡¯t take care of himself. He has ever been
prescribed by Rilutek, vitamin and vitamine-E for oral taking, but he got no
obvious improvement. To seek for a further comprehensive treatment, he was
hospitalized in our hospital on May 2, 2008. His present symptoms are
as follows: difficulty in speaking and swallowing, sometimes with rapid
breathing, disability of
prostration and disability of raising his arms, and drooping of double hands. He
is able to walk with the support but the left leg is unable to move. The patient
used the wheelchair at present. His tongue was not able to do any movement, and
the muscles all over the limbs twitched frequently. His spirit was poor, with
sound sleep and poor food intake. His urination was normal, but the
bowel movement was of constipation,
once every 2 to 3 days.
3. T
36.3¡æ£¬P
89 beats/minute, R 22 times/minute, BP 110/80 mmHg.
4. He
grew normally with common nutrition. His mind was clear. He had an expression of
chronic illness and languidness. His body was in a positive posture and he was
cooperative in examination.
5.
His double arms were not able to lift up,
and he got tired easily. The
muscles of thenar and
hypothenar, muscle of hukou, deltoid, and musculi triceps brachii of the double
hands were atrophic. His
upper limbs were Grade
¢òwith
muscle hyperthyroidism.
The gripping power of his left hand was 4.5 kg, and that of the right hand was
5.2 kg. His lower limbs were not able to walk. His lower limbs were also Grade
¢ò.
The muscles of his limbs beat and twitched obviously. Besides, he had difficulty
in speaking and swallowing. His tongue body was pale with slimy tongue coating.
His pulse was weak.
6. No
thoracic deformity. Sound of
breath was bilaterally normal on auscultation.
No sound of pleural friction.
Heart border was normal. Heart beat was 89 times/min. Cardiac rhythm was
regular. No pathological murmurs on
auscultation.
7.
Diagnostic examination: The MRI shows ¡°ALS¡±.
Diagnostic Basis:
TCM
(Traditional Chinese Medicine): The patient has suffered from difficulty in
speaking and swallowing, as well as weakness of all the limbs for 16 years, and
his condition has been aggravated by atrophy of all the limbs and disability in
movement for half a year. His symptoms were as follows: difficulty in speaking
and swallowing, too much phlegm-drool, sometimes with rapid breathing,
disability of prostration
and disability of raising his arms with double hands drooping. His left leg
could not move, and his tongue was not able to do any movement, and muscles all
over the limbs twitched frequently. His spirit was poor, with sound sleep and
poor food intake. His urination was normal, but the
bowel movement was of constipation,
once every 2 to 3 days. His tongue body was pale with slimy tongue coating. The
pulse was weak. According to the symptoms of his tongue and pulse, it is shown
that due to deficiency of qi and blood, insufficiency of the liquids, the
patient could not nourish the muscles of his limbs. Then it gradually leads to
the atrophy of his limbs. He is mainly characterized by weak limbs, emaciated
muscles, which even cause his limbs to lose functions. So it is believed as
wilting.
Western Medicine: The patient has suffered from difficulty in speaking and
swallowing, as well as weakness of all the limbs for 16 years, and his condition
has been aggravated by atrophy of all the limbs and disability in movement for
half a year. His double arms were not able
to lift up, and he got tired easily. The
muscles of thenar and
hypothenar, muscle of hukou, deltoid, and musculi triceps brachii of the double
hands were atrophic. His
upper limbs were Grade
¢òwith
muscle hyperthyroidism.
The gripping power of his left hand was 4.5 kg, and that of the right hand was
5.2 kg. His lower limbs were not able to walk. His lower limbs were also Grade
¢òwith
muscle hyperthyroidism.
The muscles of his limbs beat and twitched obviously. The MRI shows ¡°ALS¡±.
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 pain. On the contrary, impediment
syndrome is generally characterized by aching pain, 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 diagnosis: Lungs-spleen qi vacuity, accompanied with vacuity of the
liver and kidneys, phlegm-damp obstructing the channels.
Western Medicine diagnosis:
Amyotrophic
Lateral Sclerosis (ALS)
Plans
for treatment strategy and nursing:
1. On
routine care of traditional Chinese internal medicine.
2. On
grade II care.
3.
Under the care of a companion.
4.
Regular diet.
5.
Herbal tea (to supplement the spleen and boost the lungs, to enrich and nourish
the liver and 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:
May 3, 2008 Time: 16:00 a.m.
The
patient¡¯s routine examinations are as follows: the examinations of blood, urine,
blood sugar, the function of the liver and kidneys were all normal. The patient
has suffered from difficulty in speaking and swallowing, as well as weakness of
all the limbs for 16 years, and his condition has been aggravated by atrophy of
all the limbs and disability in movement for half a year. He kept a clear mind
with mouth phlegm drooling. The movement of his tongue was limited due to
atrophy, and even his tongue was not able to do any flexible movement. His
tongue body was pale with slimy tongue coating. The pulse was weak. These
symptoms belong to lungs-spleen qi vacuity, liver-kidneys depletion and
phlegm-damp obstructing the channels. The TCM treatment strategy is to
supplement the spleen and boost the lungs, enrich and supplement liver and
kidneys, transform the phlegm and free the channels.
Date:
May 6, 2008 Time: 10:00 a.m.
The
phlegm-drool in his mouth decreased. Besides, his spirit got better, while other
symptoms were the same as before. His tongue was pale with slimy tongue coating.
The pulse was weak. He would continue to take another 5 dosages of the herbal
tea.
Date:
May 11, 2008 Time: 10:00 a.m.
His
spirit got better. His swallowing also got improvement. Besides, the
phlegm-drool in his mouth decreased obviously, but he still could not speak. His
tongue was not able to do any movement. His deltoid was atrophic obviously, so
he could neither raise his shoulder nor take a deep breath. He had difficulty in
flexible movement of all the limbs. His tongue was pale with thin tongue
coating. The pulse was weak. The TCM treatment strategy is still to supplement
the spleen and boost the lungs, enrich and nourish the liver and kidneys,
transform the phlegm and free the channels. The doctor advised his family
numbers to help him to do some functional movement for his limbs.
Date:
May 16, 2008 Time: 10:00 a.m.
After the patient has been
hospitalized for half a month, there was still no obvious improvement on the
dysfunction of the limbs. The psoas and muscle
adductor of the double legs were spastic with stiff double ankles. He was not
able to stand or walk. Due to the long-term disease, his condition belongs to a
chronic disease. TCM treatment strategy is still to supplement the spleen and
boost the lungs, enrich and nourish the liver and kidneys, transform the phlegm
and free the channels.
Date:
May 23, 2008 Time: 8:30 a.m.
The
patient said that there was no obvious improvement as to his symptoms, while he
felt great pains on his waist. There was no abnormality on the outlook of his
waist, but with obvious pains when pressed. The patient was advised to do a CT
examination in another hospital.
Date:
May 27, 2008 Time: 8:30 a.m.
After
the CT examination on the lumbar vetebrae,
the disci intervertebrales L3/ 4 and L4/ 5 bulged
slightly. His condition was reported to Doc. Ming. The TCM treatment would
continue as before.
Date:
May 30, 2008 Time: 9:00 a.m.
His
symptoms were as before.
After Dr. Huang feibo¡¯s diagnosis, he considered the patient¡¯s lumbar to be
another
treatment. Doc. Ming agreed to the treatment. At the same time, his TCM
treatment would continue as before.
Date:
June 1, 2008 Time: 9:00 a.m.
Dr.
Huang feibo, as well as the patient and his family all agreed to another
treatment. Then the patient was prescribed some western medicines. At the same
time, he was advised to reflect his feeling about his stomach, so as to take
measures to protect his stomach.
Date:
June 5, 2008 Time: 9:00 a.m.
After
taking the medicine, the patient neither feel any discomfort on his stomach nor
feel his appetite decreased. His pulse was fine, and his tongue was white. He
would continue to take another 5 dosages of herbal tea of the same prescription.
Date:
June 10, 2008 Time: 9:00 a.m.
There
was no other discomfort except the painful lumbar. His pulse was fine and weak,
and his tongue coating was white. His herbal tea was adjusted as follows:
huangqi (astragalus root), baisheng (white
ginseng), zaopi (cornus fruit), etc.
Date:
June 15, 2008 Time: 9:00 a.m.
The
patient demanded to leave the hospital today, and he was approved to leave the
hospital this afternoon. ¡¡
