¡¡Brief Summary:
On May 18, 2009,
Anmad from Jordan, who has suffered from ALS, accompanied with the symptoms of
the weakness and difficulty in activity of the four limbs for 8 months and the
difficulties in swallowing and speaking for 4 months, was hospitalized in our
hospital. He has achieved much improvement after 35 days TCM treatment here. He
could walk much longer distances. Two hands become stronger.
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Record of
Hospitalization
Name:
Anmad
Birthplace: Jordan
Sex:
Male
Profession: Carpenter
Age:
60
Date of Admission: May 18, 2009
Nationality:
Jordan
Date of Record: May 18, 2009
Marital Status:
Married Onset Season: Autumn
begins
Complainer:
The
patient himself
First Medical Record
Date: May 18,
2009 Time: 1: 00 a. m.
Anmad, a
60-year-old male, has suffered from ALS, accompanied with the symptoms of the
weakness and difficulty in activity of the four limbs for 8 months and the
difficulties in swallowing and speaking for 4 months. He was hospitalized in our
hospital at 1: 00 a. m. on May 18, 2009.
Essentials for
Diagnosis:
1. The
patient has suffered from the symptoms of the weakness and difficulty in
activity of the four limbs for 8 months and the difficulties in swallowing and
speaking for 4 months.
2. Last
October, the patient began to feel the weakness and difficulty in activity of
the four limbs without obvious reasons, so he went to a local hospital for EMG
and MRI examinations and was diagnosed with ALS. The local doctors told him
there was no treatment except for Rilutek capsules (once a day). He didn¡¯t take
any other treatment, and then his condition gradually became serious. He had the
difficulties in swallowing and speaking since this January, so he came to our
hospital for further treatment on May 18, 2009.
3. T
36.2¡æ,
R 20 times/minute, P 80 times/minute, BP 130/90mmHg.
4. He
grew normally with common nutrition. His mind was clear. He had an expression of
chronic illness and tiredness. His body was cooperative with his mind.
5. No
thoracic deformity. Sound of breath was bilaterally normal on auscultation.
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 limbs and the difficulty in walking. He had
poor balance. Besides, he had the difficulty in raising due to the weakness of
the upper limbs. His hands were delicate and the ability to act was declining.
There was obvious muscular jumping all over the body. He had the difficulty in
swallowing, so he could just take liquid diet
with a small amount. His speaking was not clear and fluent, so it was difficult
for others to understand.
7. Accessory
examination: None.
Diagnostic
Basis:
TCM: The patient
has suffered from the symptoms of the weakness and difficulty in activity of the
four limbs for 8 months and the difficulties in swallowing and speaking for 4
months. He felt the weakness of the limbs and the difficulty in walking. He had
poor balance. Besides, he had the difficulty in raising due to the weakness of
the upper limbs. His hands were delicate and the ability to act was declining.
There was obvious muscular jumping all over the body. He had the difficulty in
swallowing, so he could just take liquid diet
with a small amount. His speaking was not clear and fluent, so it was difficult
for others to understand. His tongue was pale. His tongue coating was putrid and
slimy. His pulse was thready and weak. According to the symptoms of the tongue
and pulse, the patient was characterized by the weakness of the limbs and the
difficulties in walking, swallowing and speaking, so he was diagnosed with
wilting pattern.
Western
Medicine: The patient felt the weakness of the limbs and the difficulty in
walking. He had poor balance. Besides, he had the difficulty in raising due to
the weakness of the upper limbs. His hands were delicate and the ability to act
was declining. There was obvious muscular jumping all over the body. He had the
difficulty in swallowing, so he could just take
liquid diet with a small amount. His speaking was not clear and fluent,
so it was difficult for others to understand. Last October, he was given EMG and
MRI examinations in the local hospital and was diagnosed with ALS.
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 tumor of spinal cord, which is
characterized by nerve root pains of the upper limbs, but without extensive
trembling of the muscle bundles. Besides, there is disturbance of sensation and
obstruction of the subarachnoid cavity. The disease can be diagnosed clearly by
the examination of CT or MRI.
First Diagnosis:
TCM diagnosis:
Wilting pattern
Symptom
identification: insufficiency of center qi, phlegm-damp obstructing the channels
and network vessels.
Western Medicine
diagnosis: 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. Common
diet.
5. TCM
treatment strategy: fortify the spleen, boost qi, transform phlegm 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 examinations if necessary.
Date: May 20, 2009 Time: 10: 00 a. m.
The patient had the symptoms of the weakness of the four limbs and muscular
atrophy for 8 months and the difficulties in swallowing and speaking for 4
months, so he came to our hospital for further treatment. His present physical
condition was as follows: obvious muscular atrophy of the
thenars of his
left hand, hukou, forearm, left biceps brachii, etc. The gripping power of his
left hand was just 2.8 kg. There was obvious muscular atrophy of musculi
quadriceps femoris. He could not crouch down and stand up. He had the symptoms
of the stiffness and function disorder of the ankle joints. His tongue was
obviously atrophic and rough. The flexibility of the tongue was not good and his
tongue could not reach out of the mouth. His tongue coating was putrid and
slimy. He had much phlegm-drool. His pulse was weak. These symptoms were due to
lung-spleen qi vacuity, phlegm obstructing the channels and network vessels. So
the treatment strategy was to supplement the spleen, boost qi, transform phlegm
and free the channels and network vessels. The prescription was four gentlemen
decoction in combination with phlegm-abduction decoction. 3 dosages in total.
Date: May 23,
2009 Time: 10: 00 a. m.
The patient felt
the phlegm-drool in the mouth slightly lessened. There was some improvement of
the swallowing. The other condition was the same. Continue to take the former
prescription in combination with
oral taking flesh-engendering powder. 5 dosages in
total.
Date: May 28,
2009 Time: 10: 00 a. m.
The function of
his swallowing was better and he could take the food easily. There was some
improvement of his pronunciation. The flexibility of
the tongue was better than before and he could constrainedly reach his tongue
out of the mouth. The gripping power of the right hand increased, but there was
no improvement of the left hand. He felt the strength of the lower limbs
slightly increased when walking, but there was still the stiffness of the ankle
joints. His tongue was pale. His tongue coating was thin and slimy. His pulse
was stronger than before. So the treatment strategy was to quicken the blood
circulation and move stasis. The former prescription was made a little
adjustment. 4 dosages in total.
Date: Jun. 1, 2009 Time: 10: 00 a. m.
The function of his swallowing was obviously improved and he could take the
common food. There was some improvement of his pronunciation and he could
communicate with others by simple words. But his pronunciation was not so clear.
The flexibility of the tongue was better than before and his tongue could reach
out of the mouth for about 1 cm. There was some improvement of the function of
the four limbs. He could stretch his fourth finger and fifth finger by himself.
The gripping power of the left hand slightly increased. His tongue was dark. His
tongue coating was yellow. His pulse was stronger than before. Continue to take
the same prescription. 5 dosages in total.
Date: Jun. 6, 2009 Time: 10: 00 a. m.
Yesterday he suddenly felt the blocking sense of the throat and had the symptom
of hasty breathing. He felt there was something in the throat. After
observation, Professor Yang found his throat was slightly red and his bilateral
tonsils
were swollen (left side: III¡ã, right side: II¡ã). The
other condition was the same. These symptoms were due to lung-spleen qi vacuity,
phlegm-damp obstruction and wind toxin staying in the throat. So the treatment
strategy was to supplement the spleen, boost the lungs, rectify qi, transform
phlegm, resolve toxin and disinhibit the throat. 3 dosages in total.
Date: Jun. 9,
2009 Time: 10: 00 a. m.
The blocking
sense of the throat disappeared. The swelling of his bilateral tonsils were
better. There was obvious improvement of the function of the swallowing.
His pronunciation was clear than before. The gripping
power of the left hand was increasing. The tongue was flexible than before. His
tongue was dark. His tongue coating was thin. His pulse was moderate. Continue
to take the same prescription. 5 dosages in total.
Date: Jun. 12, 2009 Time: 11: 00 a. m.
His common condition was comparatively good. His diet and sleep were normal. The
tongue and fingers were flexible. His walking was better. But he had much phlegm
and there were the symptoms of the inflammation and
congestion of
the bilateral tonsils. The
former prescription was changed. 8 dosages in total.
Date: Jue. 16, 2009 Time: 10: 00 a. m.
His left
tonsil was
swollen (III¡ã), which was connected with
uvula. He felt the local pains. The other condition was normal. He took some
medicine for two days to improve tonsillitis.
Date: Jun. 21, 2009 Time: 10: 00 a. m.
After 35 days comprehensive treatment here, his swallowing was obviously
improved. Meanwhile, there was some improvement of his
pronunciation. The flexibility of the tongue and the function of the four limbs
became better. He decided to leave the hospital with taking 45 days herbal tea
back to home due to family affairs.
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