TCM China:  

Record of Herbal Treatment Of Felix  from America Improvement Of ALS
 

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Brief Summary: On July 18, 2007, Felix, who suffered from weakness of all the limbs, as well as difficulties in speaking and swallowing, was hospitalized in our hospital. After about three-month TCM treatment here, all his symptoms have been improved significantly.

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Record of Hospitalization

Name: Felix                                                                                                               Sex: Male

Age: 27                                                                                                                      Profession:  Office Clerk

Nationality: China                                                                                                    Birthplace: The United States

Marital Status: Unmarried                                                                                       Onset Season: Summer                 

Complainer: The patient himself                                                                              Date of Admission: Oct.14, 2007       

Major Complaint: The patient has suffered from weakness of all the limbs for one and a half years, and his condition has been progressively aggravated by difficulties in speaking and swallowing for 10 months.

Present Illness: In Apr. 2006, the patient fell down to the ground carelessly when walking. At that time, the patient didn¡¯t feel any discomfort. A week later, the patient had stiffness of his left ankle joints, but he paid no attention to it. Several days later, the patient fell down to the ground again when he tried to pick up some objects. After that, he had stiffness of both ankle joints, accompanied with discomfort of his left hip and weakness of his arms. He did no examination or treatment about it. Therefore, the condition was aggravated progressively. In Dec. 2006, the patient had difficulties in speaking and swallowing along with choking when drinking water. He still took no examination or treatment. In May 2007, the patient went to a local hospital for a diagnosis. After the EMG examination, the patient was diagnosed with amyotrophic lateral sclerosis (ALS). The doctor told the patient it was incurable and prescribed him rilutek Capsule for one-month oral taking. He got no obvious improvement. In Aug. 2007, the patient again went to a local hospital for another examination, and he was diagnosed with amyotrophic lateral sclerosis (ALS). To seek for a comprehensive treatment, he arrived in our hospital on Oct.14, 2007. Since he got the disease, his spirit and appetite were both slightly poor, especially poor in sleep. His bowel movement and urination were both normal. 

Disease History: No history of typhoid, tuberculosis, hepatitis, malaria or other infectious diseases. No allergic history of medicine or food. No trauma history. No history of blood transfusion. History of preventive vaccination not provided.

Personal History: He was born in the United States. No contact history of schistosomiasis. No addiction to smoking, alcohol or special food. He was mild-tempered and open-minded.

Marital History: Unmarried.

Family History: His parents are both healthy. No family history of special diseases.

Physical Examination:

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

He grew normally with common nourishment. 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. His skin was moist. No jaundice in the sclera. No superficial lymph-node enlargement. Bilateral pupils were round and equal in size and sensitive to light. No deformity of skull and the five sense organs. No swollen tonsil. With soft neck and trachea placed in the middle. No enlargement of the thyroid gland. No congestion of the jugular vein. No thoracic deformity. Sound of breath was bilaterally normal on auscultation. No respiratory rales or pleural friction rubs. Heart border was normal. Heart beat 80/min. Cardiac rhythm was regular. No pathological murmurs on auscultation. Abdomen touched flat and soft without tenderness or rebounding tenderness. The liver and spleen were not palpable. No percussion pains in renal region. Bowel sound was normal. No spinal and pelvic deformity or tenderness. He suffered from weakness of the upper limbs with declining gripping power of both hands. In the examination, the gripping power of his left hand was 12.5 kg, and that of the right hand was 11.4 kg. The extorsion of double forearms was limited. His upper limbs were Grade ¢ó with normal muscle hypertonicity. Both of his lower limbs were weak with mild stiffness of double ankle joints. His movement was inflexible. His lower limbs were Grade ¢ó with normal muscle hypertonicity. His speaking was neither clear nor fluent, accompanied by difficulty in swallowing and choking while drinking. Other physiological reflex exists. The pathological symptoms have not been elicited. His tongue was slightly red with white and thin tongue coating. His pulse was weak.

Diagnostic examination: Not provided.

First Diagnosis: 

TCM diagnosis: flaccidity syndrome

Symptom identification: Lung-spleen qi vacuity, accompanied with deficiency of the liver and kidneys.

Western medicine diagnosis: Amyotrophic Lateral Sclerosis (ALS)

 

First Medical Record

Oct.14, 2007 

Felix, a 27-year-old male, has suffered from weakness of all the limbs for one and a half years, and his condition has been progressively aggravated by difficulties in speaking and swallowing for 10 months. He was picked up by our staff in Huaihua railway station and arrived in Huaihua Red Cross Hospital for further treatment at 9: 00 a.m. on Oct.14, 2007. 

Essentials for Diagnosis:

1. The patient has suffered from weakness of all the limbs for one and a half years, and his condition has been progressively aggravated by difficulties in speaking and swallowing for 10 months.

2. In Apr. 2006, the patient fell down to the ground carelessly when walking. At that time, the patient didn¡¯t feel any discomfort. A week later, the patient suffered from stiffness of his left ankle joints, but he paid no attention to it. Several days later, the patient fell down to the ground again when he tried to pick up some objects. After that, he had stiffness of both ankle joints, accompanied with discomfort of his left hip and weakness of his arms. He did no examination or treatment about it. Therefore, the condition was aggravating progressively. In Dec. 2006, the patient had difficulties in speaking and swallowing along with choking when drinking water. He still took no examination or treatment. In May 2007, the patient went to a local hospital for a diagnosis. After the EMG examination, the patient was diagnosed with amyotrophic lateral sclerosis (ALS). The doctor told the patient it was incurable and prescribed him rilutek Capsule for one-month oral taking. He got no obvious improvement. In Aug. 2007, the patient again went to a local hospital for another examination, and he was diagnosed with amyotrophic lateral sclerosis (ALS). To seek for a comprehensive treatment, he arrived in our hospital on Oct.14, 2007. Since he got the disease, his spirit and appetite were both slightly poor, especially poor in sleep. His bowel movement and urination were both normal. 

3. T 36.4¡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 positive posture and he was cooperative in examination.

5. He suffered from weakness of all the limbs with declining gripping power of both hands. In the examination, the gripping power of his left hand was 12.5 kg, and that of the right hand was 11.4 kg. The extorsion of double forearms was limited. His upper limbs were Grade ¢ó with normal muscle hypertonicity. His double ankle joints were in mild stiffness with slow movement. His lower limbs were Grade ¢ó with normal muscle hypertonicity. His speaking was neither clear nor fluent, accompanied by difficulty in swallowing and choking while drinking water. His tongue was slightly red with white and thin tongue coating. His pulse was weak.

6. No thoracic deformity. Chest percussion noted resonance. Sound of breath is bilaterally clear on auscultation. No sound of pleural friction.

7. Diagnostic examination: Not provided.

Diagnostic Basis:

TCM: The patient has suffered from weakness of all the limbs for one and a half years, and his condition has been progressively aggravated by difficulties in speaking and swallowing for 10 months. All his limbs were weak, accompanied with languid expression on his face. His speaking was neither clear nor frequent, accompanied with difficulty in swallowing and choking while drinking water. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Because of the insufficiency of the liquids, abnormality of the qi and blood, and lung heat scoring the lobes, his body loses the nourishment. What¡¯s more, due to the deficiency of spleen and stomach, along with the disability of the transportation and transformation, and shortage of the source of qi-blood, all lead to the malnutrition of the muscles, and gradually it results in flaccidity.

Western Medicine: The patient has suffered from weakness of all the limbs for one and a half years, and his condition has been progressively aggravated by difficulties in speaking and swallowing for 10 months. He suffered from weakness of all the limbs with declining gripping power of both hands. In the examination, the gripping power of his left hand was 12.5 kg, and that of the right hand was 11.4 kg. The extorsion of double forearms was limited. His upper limbs were Grade ¢ó with normal muscle hypertonicity. His double ankle joints were in mild stiffness with slow movement. His lower limbs were Grade ¢ó with normal muscle hypertonicity. His speaking was neither clear nor fluent, accompanied by difficulty in swallowing and choking while drinking water. In May 2007, he was diagnosed with amyotrophic lateral sclerosis (ALS) in a local hospital.

Diagnostic Differentiation:

TCM: The patient¡¯s flaccidity syndrome should be differentiated from impediment syndrome. Flaccidity syndrome is characterized by limp, weak, and emaciated limbs with muscular atrophy. A patient suffered from flaccidity 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: Flaccidity 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: Lung-spleen qi vacuity, accompanied with deficiency of the liver and kidneys.

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. Regular diet.

5. Herbal tea (to supplement the center and boost qi, 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), shanyao (dioscorea), etc.

6. Acupuncture and massage: once a day.

7. Have more medical examinations if necessary.

 

Date: Oct. 15, 2007                               Time: 10:00 a.m.

Today the patient complained to Dr. Yang that all his limbs felt weak, accompanied with stiffness of his double ankle joints and inflexible movement. His speaking was neither clear nor fluent, along with difficulty in swallowing and choking while drinking water. The results of the three major routine examinations are all normal. The examination to the six items of hepatitis B is normal, and the examinations to the function of his liver and kidneys are both normal. The result of Electrolyte turned out to be normal and the examination to sternum is normal, too. The ECG examination is also normal.

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

His heart and lung were normal, and his abdomen was soft and flat.

Dr. Yang¡¯s analysis:

1. The patient has suffered from weakness of the limbs and his condition has been progressively aggravated for one and a half years, accompanied with difficulties in speaking and swallowing for 10 months.

2. He suffered from weakness of all the limbs with declining gripping power of both hands. In the examination, the gripping power of his left hand was 12.5 kg, and that of the right hand was 11.4 kg. The extorsion of double forearms was limited. His double ankle joints were in mild stiffness with inflexible movement. His speaking was neither clear nor fluent, accompanied by difficulty in swallowing and choking while drinking water. His tongue was slightly red with white and thin tongue coating. His pulse was weak.

3. National examination: In May 2007, he was diagnosed with amyotrophic lateral sclerosis (ALS) in a local hospital.

According to the above information, TCM considered it as flaccidity syndrome. Because of the insufficiency of the liquids, abnormality of the qi and blood, and lung heat scoring the lobes, his body loses the nourishment. What¡¯s more, due to the deficiency of spleen and stomach, along with the disability of the transportation and transformation, and shortage of the source of qi-blood, all lead to the malnutrition of the muscles, and gradually it results in flaccidity. Dr. Yang¡¯s analyzed it was Lung-spleen qi vacuity, accompanied with deficiency of the liver and kidneys.

Principle of TCM treatment: Supplementing the center and boosting qi, enriching and nourishing the liver and kidneys

Herbal tea prescribed for four days including baisheng (white ginseng), baishu (ovate atractylodes root), shanyao (dioscorea), etc. One dosage a day and drink twice.

Doctor¡¯s requirement is to take four dosages of the herbal tea of the above prescription. Acupuncture and massage for once a day. The patient will have more medical examinations if necessary.

 

Date: Oct. 16, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He still said that all his limbs felt weak, accompanied with stiffness of his double ankle joints and inflexible movement. The extorsion of double forearms was limited. Besides, his speaking was neither clear nor fluent, along with difficulty in swallowing and choking while drinking water.

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

His heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite got better, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Oct. 20, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved a lot. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite got better, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Oct. 25, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite got better, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Oct. 30, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite got better, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Nov. 5, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously.  In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite got better, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Nov. 10, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite got better, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take five dosages of the herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Nov. 16, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Nov. 20, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Nov. 25, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Nov. 30, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Dec. 5, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Dec. 10, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Dec. 10, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

      

Date: Dec. 16, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Dec. 20, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Dec. 25, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Dec. 30, 2007                               Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms were getting better. He also felt the stiffness of his double ankle joints and inflexible movement got some improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved obviously. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

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

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms got much better. He also felt the stiffness of his double ankle joints and inflexible movement got much improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water was improved significantly. In the examination, his heart and lung were normal, and his abdomen was soft and flat. His spirit and appetite were both normal, and his sleep was sound. Both of his bowel movement and urination were normal. His tongue was slightly red with white and thin tongue coating. His pulse was weak. Doctor¡¯s requirement is to take herbal tea of the same prescription. One dosage a day and drink twice.

 

Date: Jan. 8, 2008                             Time: 9:00 a.m.

The patient did not complain about any other special discomfort. He said that the weakness of all his limbs and the limited extorsion of double forearms got much better. He also felt the stiffness of his double ankle joints and inflexible movement got much improvement. Besides, he still had difficulty in speaking with unclear and influent words, but the symptom of difficulty in choking while drinking water has been improved significantly. The patient demanded to leave the hospital today.

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