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Brief Summary: On May 25, 2007, the patient Mrs. M from Indonesia, who suffered from ALS, was hospitalized in our hospital. After about 70-day TCM treatment, she achieved significant improvement, especially the gripping power of her hands increased a lot. Before she left our hospital, her left hand could hold objects of 21.6 kg, and her right hand could hold objects of 30.0 kg. It is considerably ideal.

 

Record of Hospitalization

Name: Mrs. M                                                                                                            Sex: Female

Age: 42                                                                                                                       Profession: Housewife

Nationality: Indonesia                                                                                                 Marital Status: Married

Onset Season: Summer                                                                                              Date of Admission: May 25, 2007  

Complainer: The patient himself                                                                                    Reliability: Reliable

Major Complaint: The patient has suffered from weakness of the four limbs for 8 months, and the condition has been aggravated for 2 months.

Present Illness: In September 2006, the patient began to feel pains of the right waist. At that time, the patient applied ¡°Dampness Damage Plaster¡± for external use. Her pains got some improvement. Three days later, the right lower limb started to be suffered from weakness and sense of heaviness. She did no other treatment about it. A month later, the upper limbs were suffered from weakness, and there appeared involuntary beating in the limbs muscles. Therefore, she went to a local hospital for EMG examination, and she was diagnosed with ¡°Motor Neuron Disease¡± (MND). She was told that it is incurable, and then she got no treatment. In Jan. 2007, the patient¡¯s hands were not able to hold any heavy objects. From March to May 22, 2007, she ordered Chinese medicine from a hospital in Hebei province. In recent two months, the weakness of the lower limbs was aggravated, and she had difficulty in raising her upper limbs, with frequent involuntary beating in the muscles of the limbs. She came to our hospital for further treatment at 19:30 p.m. on May 25, 2007. Since she got the disease, her spirit and appetite have been both normal with slightly poor sleep. Her 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 operation or trauma history. No history of preventive vaccination provided.

Personal History: She was born in Indonesia, living in a dry environment. No contact history of schistosomiasis. No addiction to smoking, alcohol or special food. She was even-tempered and open-minded.

Marital History: She got married at 20. She has given birth to three sons and three daughters. Her husband and children have been healthy all the time.

Menstrual History: Her menstrual onset was at the age of 15. Generally, her menstrual period was six days every 28 or 29 days. Her last menstruation was on May 3, 2007.

Family History: Her mother has suffered from ALS for 9 years. Her father is healthy. No family history of other special diseases.

Physical Examination:

T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

She grew normally with common nourishment. Her mind was clear. She had an expression of chronic illness and languidness. Her body was in a positive posture and she was cooperative in examination. Her skin was moist. No jaundice in the sclera. No superficial lymph-node enlargement. Bilateral pupils were round, equal in size, and sensitive to light. No thoracic deformity. Sound of breath was bilaterally normal on auscultation. No respiratory rales or pleural friction rubs. Heart border was normal. Heart beat was 80 times/minute. 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 pressing pains in renal region. Bowel sound was normal. No spinal and pelvic deformity or tenderness. The upper limbs were not able to hold any heavy objects and had difficulty in uplifting. There was involuntarily frequent beating in the muscles of the limbs. When she stooped down, there was involuntary beating in the back¡¯s muscles. There was obvious weakness of the limbs. Her muscles strength was Grade ¢ó with normal muscle tension. The brinell levy was (+). Other physiological reflex has not been elicited. Her tongue was slightly red with white and thin tongue coating. Her pulse was thready and weak.

Diagnostic examination: Not provided.

First diagnosis: 

TCM diagnosis: Wilting syndrome

Symptom identification: Deficiency of the liver and kidneys, the liver wind entering the network channels.

Western medicine diagnosis: 1. Motor Neuron Disease (MND)

                       2. Amyotrophic Lateral Sclerosis (ALS)

 

First Medical Record

May 25, 2007

Mrs. M, a 42-year-old female, has suffered from weakness of the four limbs for 8 months, and the condition has been aggravated for 2 months. She was picked up by our staff in Zhijiang Airport, and arrived in Huaihua Red Cross Hospital for further treatment at 19: 30 p.m. on May 25, 2007.

Essentials for Diagnosis:

1. The patient has suffered from weakness of the four limbs for 8 months, and the condition has been aggravated for 2 months.

2. In September 2006, the patient began to feel pains of the right back. At that time, the patient applied ¡°Dampness Damage Plaster¡± for external use. Her pains got some improvement. Three days later, the right lower limb started to feel weakness and sense of heaviness. She did no other treatment about it. A month later, the upper limbs started to feel weakness, and there appeared involuntary beating in the muscles of the limbs. Therefore, she went to a local hospital for EMG examination, and she was diagnosed with ¡°Motor Neuron Disease¡± (MND). She was told that it is incurable, and then she got no treatment. In Jan. 2007, the patient¡¯s hands were not able to hold any heavy objects. From March to May 22, 2007, she ordered Chinese medicine from a hospital in Hebei province. In recent two months, the weakness of the lower limbs was aggravated, and she had difficulty in raising her upper limbs, with frequent involuntary beating in the muscles of the limbs. She came to our hospital for further treatment at 19:30 p.m. on May 25, 2007. Since she got the disease, her spirit and appetite have been both normal with slightly poor sleep. Her bowel movement and urination were both normal.

3. T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

4. She grew normally with common nourishment. Her mind was clear. She had an expression of chronic illness and languidness. Her body was in a positive posture and she was cooperative in examination.

5. She suffered from weakness of limbs. Both of her hands were not able to hold any heavy objects, with difficulty in raising her upper limbs. Her muscle strength was Grade ¢ó with normal muscle tension. The brinell levy was (+).

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

7. Diagnostic examination: Not provided.

Diagnostic Basis:

TCM: The patient has suffered from weakness of the four limbs for 8 months, and the condition has been aggravated for 2 months. Due to deficiency of the liver and kidneys, the essence-blood could not nourish the muscles and vessel. Gradually it resulted in wilting syndrome. The loins are the residence of the kidneys, and the kidneys are in charge of the bone. The insufficiency of the essence-marrow makes limbs wilting and makes the lumbus and knees weak. Her tongue was red and the pulse was thready and weak. These are also the reflections of deficiency of yin and blood, which belongs to the scope of wilting syndrome.

Western medicine: The patient has suffered from weakness of the four limbs for 8 months, and the condition has been aggravated for 2 months. Both of her hands were not able to hold any objects, and had difficulty in uplifting. There was involuntarily frequent beating in the muscles of the limbs. When she stooped down, there was involuntary beating in the back¡¯s muscles. There was obvious weakness of the limbs. Her muscle strength was Grade ¢ó with normal muscle tension. The brinell levy was (+). The patient was diagnosed with ¡°Motor Neuron Disease¡± (MND) by EMG examination in a hospital in her own country.

Diagnostic Differentiation:

Western medicine: Wilting syndrome should be differentiated from myasthenia gravis, which is a kind of acquired autoimmune disease that there appear transmitting obstacles in the sites of the neuromuscular junctions owing to the reduced acetylcholine receptor. Myasthenia gravis 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 and weakness of the part of the body¡¯s striated muscles. It will be improved with rest or medicines that inhibit the activity of choline esterase. It can also involve cardiac muscles and smooth muscles.

First Diagnosis: 

TCM diagnosis: Wilting syndrome

Symptom identification: Deficiency of the liver and kidneys, the liver wind entering the network channels.

Western medicine diagnosis: 1. Motor Neuron Disease (MND)

                       2. 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 liver and to boost the kidneys, to track down wind and to free the network channels): Take three dosages of the herbal tea, one dosage a day and drink twice.

Prescription: Varied Decoction of the Kidneys-Supplementing Liver-Boosting.

Main herbs used in the herbal tea: shudi (cooked rehmannia root), zaopi (cornus fruit), gouqi (lycium), etc.

6. Acupuncture and massage: once a day.

7. Have more medical examinations if necessary.

 

Date: May 26, 2007                               Time: 9:00 a.m.

Today the patient complained to Dr. Yang that there was obvious weakness of the limbs, with some difficulty in raising her upper limbs. The regular examination of the urination was normal.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat.

Dr. Yang¡¯s analysis:

1.      The patient has suffered from weakness of the four limbs for 8 months, and the condition has been aggravated for 2 months.

2.      She suffered from weakness of limbs. Both of her hands were not able to hold any heavy objects, with difficulty in raising her upper limbs. There was involuntarily frequent beating in the muscles of the limbs. When she stooped down, there was involuntary beating in the muscles of the back. Her muscle strength was Grade ¢ó with normal muscle tension.

3. The patient was diagnosed with ¡°Motor Neuron Disease¡± (MND) by EMG examination in a national hospital. According to the above information, TCM diagnosed as wilting syndrome, which is characterized as retardation of the limbs¡¯ muscles and vessel, weakness of the limbs, difficulty in movement, accompanied by muscular atrophy. In clinical practice, this kind of disease affects lower limbs more common, which is also called ¡°crippling wilt¡±. The patients who suffer from it feel weakness of the spleen and stomach, lack of sources of the qi and blood, which could not nourish the muscles and vessels, and so it forms wilting limbs. The kidneys are in charge of the bone. The insufficiency of the essence-marrow makes the limbs wilting and makes the lumbus and knees weak. 

Doctor¡¯s diagnosis: Deficiency of the liver and kidneys, the liver wind entering the network channels.

Doctor¡¯s strategy: Supplementing the liver and boosting the kidneys, tracking down wind and freeing the network channels.

Prescription: Varied Decoction for Kidney-Supplementing Liver-Boosting.

Doctor¡¯s requirement is to take three dosages of the herbal tea of the same formula. One dosage a day and drink twice. Acupuncture and massage for once a day. The patient should have more medical examinations if necessary.

 

Date: May 27, 2007                                   Time: 9:00 a.m.

The patient did not complain about any other special discomfort and still felt her limbs weak with difficulty in raising the upper limbs. There was involuntarily frequent beating in the muscles of the limbs. The examinations of the blood and the function of her liver and kidneys were all normal. ECG examination was also normal. After the B-ultrasonic examination, her liver, gallbladder, spleen and lungs were all normal.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat. Her tongue was slightly red with white and thin tongue coating. Her pulse was thready and weak. Doctor¡¯s requirement is that the herbal tea should follow the original formula.

 

Date: May 28, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort and still felt her limbs weak with difficulty in raising the upper limbs. Both of her hands were not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat. No aversion to coldness or fever. No feeling of headache or dizziness. No nausea or vomit. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is that the herbal tea should follow the original formula.

 

Date: June 1, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort and still felt her limbs weak with difficulty in raising the upper limbs. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat. No aversion to coldness or heat. No feelings of headache or dizziness. No nausea or vomit. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is to take five dosages of the herbal tea of the same prescription.

 

Date: June 6, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort and still felt her limbs weak with difficulty in raising the upper limbs. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is that the herbal tea should follow the original formula.

 

Date: June 11, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort and still felt her limbs weak with difficulty in raising the upper limbs. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is to take five dosages of the herbal tea of the same prescription.

 

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

The patient did not complain about any other special discomfort. The weakness of her limbs was improving, and her upper limbs were getting better to uplift than before. Her hands could rise by about 2cm. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg. Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is that the herbal tea should follow the original formula.

 

Date: June 21, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort. The weakness of her limbs was improving, and her upper limbs were getting better to uplift than before. She could raise her hands to about 2cm. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is to take five dosages of the herbal tea of the same prescription.

 

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

The patient did not complain about any other special discomfort. The weakness of her limbs was improving, and her upper limbs were getting better to uplift than before. She could raise her hands to about 2cm. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is that the herbal tea should follow the original formula.

 

Date: June 29, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort. The weakness of her limbs was improving, and her upper limbs were getting better to uplift than before. She could raise her hands to about 2cm. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg. Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is to take five dosages of the herbal tea of the same prescription.

 

Date: July 3, 2007                                Time: 9:00 a.m.

The patient did not complain about any other special discomfort. The weakness of her limbs was improving, and her upper limbs were getting better to uplift than before. She could raise her hands to about 2cm. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is that the herbal tea should follow the original formula.

 

Date: July 7, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort. The weakness of her limbs was improving, and her upper limbs were getting better to uplift than before. She could raise her hands to about 2 cm. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg. Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is to take five dosages of the herbal tea of the same prescription.

 

Date: July 11, 2007                                  Time: 9:30 a.m.

The patient did not complain about any other special discomfort. The weakness of her limbs was improving, and her upper limbs were getting better to uplift than before. She could raise her hands to about 4cm. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is that the herbal tea should follow the original formula.

 

Date: July 15, 2007                                  Time: 9:30 a.m.

The patient did not complain about any other special discomfort. The weakness of her limbs was getting better, and her upper limbs achieved obvious improvement to uplift. She could raise her hands to about 4cm. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is that the herbal tea should follow the original formula.

 

Date: July 19, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort. The weakness of her limbs and her upper limbs both achieved obvious improvement. She could raise her hands to about 4cm. Both of her hands were still not able to hold any heavy objects.

Examination: T 36.3¡æ£¬P 80 beats/minute, R 20 times/minute, BP 100/70 mmHg.

Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is to take five dosages of the herbal tea of the same prescription.

 

Date: July 23, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort. The weakness of her limbs was getting much better, and her upper limbs achieved obvious improvement to uplift. She could raise her hands to about 4cm. Both of her hands were still not able to hold any heavy objects. Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is that the herbal tea should follow the original formula.

 

Date: July 28, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort. The weakness of her limbs was getting much better, and her upper limbs achieved obvious improvement to uplift. She could raise her hands to about 4cm. Both of her hands were still not able to hold any heavy objects, but she could write slowly. Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is that the herbal tea should follow the original formula.

 

Date: August 2, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort. The weakness of her limbs was improved significantly, and her upper limbs achieved obvious improvement to uplift. She could raise her hands to about 4cm. Both of her hands were still not able to hold any heavy objects, but she could write slowly. Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. Doctor¡¯s requirement is that the herbal tea should follow the original formula.

 

Date: August 4, 2007                                  Time: 9:00 a.m.

The patient did not complain about any other special discomfort. The weakness of her limbs was improved significantly, and her upper limbs achieved obvious improvement to uplift. She could raise her hands to about 4cm. the ripping power of her hands increased markedly. The left hand could hold objects of 21.6 kg, and the right hand could hold objects of 30.0 kg. The movements of her fingers were poor, but she could write slowly. Her heart and lungs were normal, and her abdomen was soft and flat. Her spirit and appetite were both normal, and her sleep was good. Her bowel movement and urination were both normal. Her tongue was slightly red with white and thin tongue coating. Her pulse was deep and thready. The patient would leave the hospital tomorrow.

 

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