¡¡Brief Summary:
On Apr. 7, 2009,
Ms. Rahma from Yemen suffering from rheumatoid arthritis and osteoporosis and
not able to walk for seven years due to weak and stiff knees. After 15 days TCM
treatment in our hospital, she could walk now herself with the stick. This is
the miracle made by TCM and our hospital. Click here
to watch the video interview.
Record of
Hospitalization
Name:
Rahma Birthplace:
Yemen
Sex:
Female
Profession:
Housewife
Age:
46
Nationality:
Arab
Marital
Status:
Married Onset
Season:
Vernal equinox
Date of
Admission:
Apr. 7, 2009
Date of
Record:
Apr. 7, 2009
Complainer:
The patient herself
First Medical
Record
Date: Apr. 7, 2009 Time: 19: 00 p. m.
Rahma, a 46-year-old female,
has suffered
from rheumatoid arthritis, accompanied
with the symptoms of joint pains of the four limbs for 9 years and inability to
walk for 7 years. Her condition became more serious, so she was hospitalized in
our hospital for treatment at 19: 00 p. m. on Apr. 7, 2009.
Essentials for Diagnosis:
1. The patient has suffered from the symptoms of joint pains of the four limbs
for 9 years and inability to walk for 7 years.
2.
In 2000, the
patient felt joint pains of her left elbow and could not flex the left elbow.
Then the joint pains gradually spread to the knees without obvious reasons, so
she went to a local hospital for X-ray examination and was diagnosed with
rheumatoid arthritis and
osteoporosis. Then she was given various kinds of western medicines for
treatment, but her condition broke out repeatedly and gradually became serious.
She could not walk and was confined to a wheelchair since 2003. She hadn¡¯t taken
any treatment except western medicine, so she came to our hospital for further
treatment on Apr. 7, 2009.
3.
T 37.2¡æ,
R 20 times/minute, P 80 times/minute, BP 140/88mmHg.
4. She grew
normally with common nutrition. Her mind was clear. She had an expression of
chronic illness and tiredness. She was cooperative with clear 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 joint pains all over the body, especially in the morning and evening. Her
condition became more serious when the weather was cold. Her lower limbs could
not walk and she was confined to a wheelchair. There were the symptoms of
stiffness, deformity and difficulty in activities of the joints of her fingers,
left elbow and knees.
7. Accessory
examination: None
Diagnostic
Basis:
TCM:
The patient has suffered from the symptoms of
joint pains of the four limbs for 9 years and inability to walk for 7 years.
Wind-cold-damp evil rested on the channels and network vessels and obstructed qi
and blood, which resulted in joint pains. Wind was swift and changeable and due
to the prevalence of wind evil, the patient could feel the joint pains. The
obstruction of the movement of qi and blood as well as the fluids caused the
formation of phlegm-stasis, which stagnated the joints, so there
were the symptoms of swelling joints even rigidity, deformity and difficulty in
extension.
Western Medicine: The patient has suffered from the symptoms of joint pains of
the four limbs for 9 years and inability to walk for 7 years.
She felt joint
pains all over the body, especially in the morning and evening. Her condition
became more serious when the weather was cold. Her lower limbs could not walk
and she was confined to a wheelchair. There were the symptoms of stiffness,
deformity and difficulty in activities of the joints of her fingers, left elbow
and knees.
Diagnostic
Differentiation:
TCM: The
patient¡¯s impediment pattern should be differentiated from wilting pattern,
which 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: Rheumatoid arthritis should
be differentiated from gout, which usually occurs in male. It usually affects
the joint of the big toe. Meanwhile, it can also affect the joints of the ankle,
knee, elbow, wrist and fingers. The onset is
numerously abrupt, accompanied by the symptoms
of inflammation, swelling and heat pains. The affected part could not be touched
when the pains are severe. So they are not difficult to be distinguished.
First
Diagnosis:
TCM (Traditional Chinese Medicine) diagnosis: Impediment pattern
Symptom identification: Depletion of liver-kidney, obstruction of channels and
network vessels due to cold-damp.
Western Medicine diagnosis: Rheumatoid arthritis
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. Common diet.
5. TCM treatment strategy: supplement the liver,
boost the kidney, dissipate cold, dispel dampness, quicken the blood and free
the channels and network vessels.
6. Herbal
tea: one dosage a day and drink twice.
7. Acupuncture and massage: once a day.
8. Have
more medical examination if necessary.
Date: Apr. 8, 2009 Date: 10: 00 a. m.
The patient has suffered from the symptoms of joint pains of the four limbs for
9 years and inability to walk for 7 years.
In 2000, the
patient felt joint pains of her left elbow and could not flex the left elbow.
Then the joint pains spread to the knees without obvious reasons, so she went to
a local hospital for X-ray examination and was diagnosed with
rheumatoid arthritis and
osteoporosis. Then she was given various kinds of western medicines for
treatment, but her condition broke out repeatedly and gradually became serious.
She could not walk and was confined to a wheelchair since 2003. At present, she
felt joint pains all over the body, especially in the morning and evening. Her
condition became more serious when the weather was cold. She could not walk.
There were the symptoms of stiffness and deformity of the joints of her fingers,
left elbow, knees and right ankle. The quality of her sleep was not good and she
could sleep for about 4-6 hours every night. She was over thinking. There were
no symptoms of dry and bitter mouth as well as headache and dizziness. She had
frequent urination and constipation once in 2-3 days. Her tongue was pale white
and slightly enlarged. There were teeth marks on the edges of the tongue. Her
tongue coating was white. Her pulse was deep, thready and slippery. There was
similar health problem in her family members. According to the symptoms of the
tongue and pulse, Professor Yang believed that she had suffered from impediment
pattern due to depletion of liver-kidney,
obstruction of channels and network vessels
due to cold-damp, so the treatment strategy was to supplement the liver, boost
the kidney, dissipate cold, dispel dampness, quicken the blood and free the
channels and network vessels. The prescription was as follows: baishao (white
peony root), chuanxiong (ligusticum
root), chuanlianzi (toosendan fruit), etc. 3 dosages in total.
Date: Apr. 9, 2009 Time: 11: 00 a. m.
The result of the examinations was as follows: anti ¡°O¡± and RF were normal. ESR
(35mm/h) was a little high. The function of the liver and kidneys were normal.
The routine examinations of urine and bowel movement were normal. The routine
examination of the blood showed that WBC (18.1¡Á109/L) was
a little high.
Date: Apr. 10, 2009 Time: 9: 30 a. m.
The patient said she slept well last night and had two times of urination. She
had a rest for 8 hours, but there were still pains all over the body. The
prescription was as follows: duhuo (duhuo
angelica root), duzhong (eucommia bark), danggui (tangkuei), etc. 4 dosages in
total.
Date: Apr. 14, 2009 Time: 10: 00 a. m.
The patient said the joint pains further lessened. Her sleep and spirit were
good. Last night she had one time of urination. The flexibility of her joints
was better. Her tongue was pale white and slightly enlarged. There were teeth
marks on the edges of the tongue. Her tongue coating was white. Continue to take
the same prescription. 4 dosages in total.
Date: Apr. 18, 2009 Time: 10: 00 a. m.
She said the pains all over the body basically disappeared. She felt slight
joint pains of her knees when she walked outside. Her sleep, urine and bowel
movement were normal. 4 dosages in total.
Date: Apr. 22, 2009 Time: 10: 00 a. m.
There were no pains all over the body in the recent two days. Compared with
before, the flexibility of the joints were better. Continue to take the former
prescription. 4 dosages in total.
Date: Apr. 25, 2009 Time: 10: 00 a. m.
Compared with before, she could walk further in recent two days with the aid of
a stick. But sometimes there were medium joint pains of the left leg in the
morning and evening. The former prescription was changed a little. 4 dosages in
total.
The patient is continuing with treatment here when this medical report is
listed. (April 29, 2009)
------------------
To
whom it may concern,
Mrs.
Rahma Said Aweis, 46 years, a Somali refugee in Yemen complains of ¡°Rheumatoid
Arthritis¡± for 9 years. It is aggressive and lead to destruction of both knees,
left elbow, and cervical spine. There are fixed flexion deformities of both
knees and elbow and unstable cervical spine. In addition, she suffered severe
chronic pain because of the active disease.
PLAN
OF TREATMENT:
Control disease process, inflammation, pain, and chronic depression using
Steroids, antidepressants, analgesics, and DMARDs.
Rehabilitation:
1.
Toilet chair.
2.
Training for ADLs.
3.
Mild
ROM and strengthening exercises.
Surgery:
1.
Consider bilateral knee transplant.
The
problem is in the rarity and very high expenses to access and good quality
rehabilitation and surgical services locally in Yemen.
The
clinic is supporting them for now in the treatment because of their very limited
financial resources.
Best
regards,
Dr.
Youssef Fahim Guirguis
M.Sc.
Rheumatology and Rehabilitation
Medical Director, Ras Morbat clinics, Ade, Yemen
Check the original handwriting here
¡¡
More Rheumatoid
Arthritis cases that we helped well:
Case-1
Case-2 Case-3
Case-4 Case-5
¡¡
