Brief Summary: On October 21, 2009, Pervez from India, who has suffered from ALS was hospitalized in our hospital. She had the symptom of the weakness of the body for 1 year. Her condition worsened with the difficulty of the speaking and swallowing. She could not walk for 4 months. She has achieved obvious improvement after 26 days TCM treatment here. Compared with before, her speaking and swallowing have got obvious improvement. The function of the upper limb in the right side body has become normal. The power of her lower limbs increased. The symptom of muscular jumping improved a lot.

Name: Pervez                                                                                                       Birthplace: India

Sex: Female                                                                                                          Profession: Professor

Age: 52                                                                                                                 Date of Admission: October 21, 2009

Nationality: Indian                                                                                                Date of Record: October 21, 2009

Marital Status: Married                                                                                       Onset Season: Autumnal Equinox

Complainer: The patient's daughter. The case was recorded by TCM group.

First Medical Record

Date: October 21, 2009                                       Time: 1: 00 a. m.

Pervez from India, who has suffered from ALS was hospitalized in our hospital. She had the symptom of the weakness of the body for 1 year. Her condition worsened with the difficulty of the speaking and swallowing. She could not walk for 4 months.

Essentials for Diagnosis:

1. The patient has suffered from the symptom of the weakness of the body for 1 year. Her condition worsened with the difficulty of the speaking and swallowing. She could not walk for 4 months.

2. In October, 2008, the patient began to feel the weakness of the body without obvious reasons, but she didn’t pay much attention to this and hadn’t taken any examination and treatment. Then the condition gradually became worse. During the latest 4 months, her condition further worsened with the difficulty of the speaking and swallowing. At the same time, she could not walk well. Then she was given MRI examination in the local hospital and was diagnosed with ALS. The doctor told her there was no treatment for ALS except for Rilutek capsules. Besides, she didn’t take any treatment. There were symptoms of the weakness of the whole body, especially the right side. Her right hand could not hold on the object. Her right arm could not raise upward. The lower limbs were swollen and limited to walk. The knee in the right foot could not stretch or bend. Her speaking was not fluent and clear. There was difficulty to swallow, so she could only take liquid food. The chewing ability was weak, too. Her tongue body was dark red. Her tongue coating was thin and white. Her pulse was wiry and weak. So she came to our hospital on October 21, 2009 for better treatment.

3. T 36.2℃, R 20 times/minute, P 80 times/minute, BP 100/60mmHg.

4. She grew normally with medium nutrition. Her mind was clear. She had an expression of chronic illness and tiredness. Her body was cooperative with her mind.

5. No thoracic deformity. Sound of breath was bilaterally normal on auscultation. No sound of pleural friction. Heart border was normal. Heart beat was 80 times/minute. Cardiac rhythm was regular. No pathological murmurs on auscultation.

6. The patient felt the weakness of the whole body, especially the right side. Her right hand could not hold on the object. Her right arm could not raise upward. There was obvious muscular atrophy on the biceps and triceps of the right upper arm. The thenar and hypothenar muscles were also amyotrophic. The muscular tension on the left upper arm was of grade  = 3 \* ROMAN III. Her right hand was weak. The muscular tension on the right upper arm was of grade  = 2 \* ROMAN II. The lower limbs were swollen and limited to walk. The knee in the right foot could not stretch or bend. There was obvious muscular atrophy on the gastrocnemius and soleus muscles of the right foot. The muscular tension on the right foot was of grade  = 2 \* ROMAN II. And the muscular tension on the left foot was of grade  = 3 \* ROMAN III. There were obvious muscular jumpings of the body. Her speaking was not fluent and clear. There was difficulty to swallow, so she could only take liquid food. The chewing ability was weak, too.

7. Accessory examination: None.

Diagnostic Basis:

TCM: The patient has suffered from the weakness of the body for 1 year. Her condition worsened with the difficulty of the speaking and swallowing. She could not walk for 4 months. It is due to qi vacuity of the spleen and lungs, insufficiency of the qi and blood. Qi and blood could not supplement the body, sinews and the network vessels, so there was weakness of the body. Her speaking was not clear; it is due to obstruction of phlegm damp in the network vessels and channels. Her body was of atony and weakness. It is due to qi stagnation and blood stasis, there is downward dampness in the lower limbs. Her tongue body was dark red. Her tongue coating was thin and white. Her pulse was wiry and weak. According to the symptoms of the tongue and pulse, he was diagnosed with wilting pattern.

Western Medicine: The patient has suffered from the symptom of the weakness of the body for 1 year. Her condition worsened with the difficulty of the speaking and swallowing. She could not walk for 4 months. The patient felt the weakness of the whole body, especially the right side. Her right hand could not hold on the object. Her right arm could not raise upward. There was obvious muscular atrophy on the biceps and triceps of the right upper arm. The thenar and hypothenar muscles were also amyotrophic. The muscular tension on the left upper arm was of grade  = 3 \* ROMAN III. Her right hand was weak. The muscular tension on the right upper arm was of grade  = 2 \* ROMAN II. The lower limbs were swollen and limited to walk. The knee in the right foot could not stretch or bend. There was obvious muscular atrophy on the gastrocnemius and soleus muscles of the right foot. The muscular tension on the right foot was of grade  = 2 \* ROMAN II. And the muscular tension on the left foot was of grade  = 3 \* ROMAN III. There were obvious muscular jumpings of the body. There was difficulty to swallow, so she could only take liquid food. The chewing ability was weak, too. She was given MRI examination in the local hospital and was diagnosed with ALS in June 2009.

Diagnostic Differentiation:

TCM: The patient's wilting pattern should be differentiated from impediment pattern. Wilting pattern is characterized by limp, weak, and emaciated limbs with the numbness of the muscles. But the patient usually has no joint pains. On the contrary, impediment pattern is generally characterized by joint pains. So they are not difficult to be distinguished.

Western Medicine: ALS should be differentiated from progressive muscular dystrophy, which is characterized by obvious muscular dystrophy in the legs. But there is no muscular trembling in the fascicle. The disease can be diagnosed clearly by the examination of MRI.

First Diagnosis:

TCM diagnosis: Wilting pattern

Symptom identification: qi vacuity of the lungs and spleen, obstruction of phlegm-damp on the network vessels.

Western Medicine diagnosis: ALS (amyotrophic lateral sclerosis)

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. Liquid food.

5. TCM treatment strategy: supplement the spleen and boost the lungs, transform the phlegm and free the network vessels.

6. Herbal tea: one dosage a day and drink twice.

7. Acupuncture and massage: once a day.

8. Have more medical examinations if necessary.

Date: October 21, 2009                                       Time: 10: 00 a. m.

The patient has suffered from the symptom of the weakness of the body for 1 year. Her condition worsened with the difficulty of the speaking and swallowing. She could not walk for 4 months. The patient felt the weakness of the whole body, especially the right side. Her right hand could not hold on the object. Her right arm could not raise upward. The lower limbs were swollen and limited to walk. The knee in the right foot could not stretch or bend. Her throat was dry with congestion. Her voice was hoarse and weak. The patient felt fatigue and lack of sleeping. She could only sleep for 4 to 5 hours every night. Her tongue body was dark red. Her tongue coating was thin and white. Her pulse was wiry and weak. Her condition is due to qi vacuity of the lungs and spleen, obstruction of phlegm-damp on the network vessels. So our treatment strategy is to supplement the spleen and boost the lungs, transform the phlegm and free the network vessels. The prescription was as follows: bai shen (White Genseng), dang gui (Tangkuei), etc. 3 dosages in total.

Date: October 24, 2009                                       Time: 10: 00 a. m.

The feedback of the herbal formula was as follows: the edema on the lower limbs were reduced, her voice and swallowing improved a little. The knee on the right foot could stretch and bed now. So there was some improvement towards her treatment. The prescription has changed a little. We will focus on transforming the phlegm, dispelling the dampness and freeing the network vessels. 5 dosages in total.

Date: October 29, 2009                                       Time: 10: 00 a. m.

The patient just got cold herself. There were pains in the throat. Her swallowing was not good as before, accompanied the symptoms of weakness and fatigue. Her tong body was dark red. Her tongue coating was thin and white. Her pulse was weak. Her current condition was due to qi vacuity of the lungs and spleen, stagnation of wind evil on the throat. The treatment strategy was to course the wind, resolve evil and free the throat, accompanied by supplementing the spleen and boosting the lungs, transforming the phlegm and freeing the network vessels. She should pay attention to her health to avoid getting cold again. The former prescription was changed a little. 5 dosages in total.

Date: November 1, 2009                                       Time: 10: 00 a. m.

The pains on the throat stopped. Her speaking and swallowing became better. Her spirit condition was good. She could hold on the object with her right hand. At the same time, she could raise her right arm freely. The walking became easier and more convenient for her than before, as the lower limbs improved a lot. The tongue body was dark. The tongue coating was white. The pulse was more powerful than before. The treatment strategy was to supplement the spleen and boost the lungs, strengthen the liver and kidneys, soothe the sinews and free the network vessels. The prescription was made a little change. 5 dosages in total.

Date: November 6, 2009                                       Time: 10: 00 a. m.

Her spirit condition became much better. Her speaking and swallowing improved day by day. She could hold on the object with her right hand. At the same time, she could raise her right arm freely. The lower limbs were more powerful. She could walk easier with holding on the wall. The tongue body was slightly red. The tongue coating was thin and white. The pulse was steady. So the prescription was the same. 5 dosages in total.

Date: November 11, 2009                                      Time: 10: 00 a. m.

The general condition was good. Her diet and sleeping were normal. The urination and bowel movement were good. The function of the upper limb in the right side body became normal. The patient felt weak in the lower limbs. The tongue body was pale. The tongue coating was thin and white. The pulse was steady. The prescription was the same. 5 dosages in total.

Date: November 15, 2009                                       Time: 10: 00 a. m.