Brief Summary: On February 9, 2010, Saeed, who has suffered from rheumatoid arthritis, accompanied with the symptoms of joint pains and joint tumidness for 10 years, was hospitalized in our hospital. He has achieved obvious improvement after 16 days TCM treatment here.

 

Record of Hospitalization

Name: Saeed                                                                                                      Birthplace: Iran

Sex: Male                                                                                                           Profession: Physician

Age: 39                                                                                                               Date of Admission: February 10, 2010

Nationality: Muslim                                                                                           Date of Record: February 10, 2010

Marital Status: Married                                                                                    Onset Season: Vernal equinox

Complainer: The patient himself

 

First Medical Record

Date: February 10, 2010                                      Time: 4: 00 a. m.

Saeed, a 39-year-old male, has suffered from rheumatoid arthritis, accompanied with the symptoms of the joint pains and swelling for 10 years. He was hospitalized in our hospital for treatment at 4: 00 a. m. on February 10, 2010.

Essentials for Diagnosis:

1. The patient had had joint pains and swelling for 10 years.

2. Ten years ago, the patient began to have joint pains and swelling without obvious reason. Then he came to a local hospital and he was diagnosed as rheumatoid arthritis. He got the treatment in the local hospital. However, his condition did not become better. To pursue the comprehensive treatment, he came to our hospital on February 10, 2010.    

3. T 36.4≧, R 20 times/minute, P 80 times/minute, BP 120/70mmHg.

4. He grew normally with common nutrition. His mind was clear. He had an expression of chronic illness and tiredness. His body was in a positive posture and he 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 had joint pains and swelling. Besides, he had difficulty in walking.

7. Accessory examination: None.

Diagnostic Basis:

TCM: The patient had had the joint pains and swelling for 10 years. Besides, he had difficulty in walking. His sleeping was bad. When he got up in the morning, he always felt thirsty and tired. He was easy to wake up. Wind-cold-damp evil rested on the channels and network vessels and obstructed qi and blood, which resulted in joint pains. From the aspect of TCM, it was impediment pattern.

Western Medicine: The patient had had the joint pains and swelling for 10 years. Besides, he had difficulty in walking. He was diagnosed as rheumatoid arthritis by his local hospital.

Diagnostic Differentiation:

TCM: The patient's impediment pattern should be differentiated from wilting pattern. Wilting pattern is mainly characterized by limp, emaciated sinews and bones, with weakness of the muscles. However, impediment pattern is generally characterized by joint pains. So they are not difficult to be distinguished.

Western Medicine: The patient¨s rheumatoid arthritis should be differentiated from hyperplastic osteoarthritis.

First Diagnosis:

TCM (Traditional Chinese Medicine) diagnosis: Impediment pattern

Symptom identification: Depletion of liver-kidney, obstruction of channels and network vessels due to damp-heat.

Western Medicine: Rheumatoid arthritis

Plans for treatment strategy and nursing:

1. Routine care of traditional Chinese internal medicine.

2. Grade II care.

3. Common diet.

4. TCM treatment strategy: supplement the liver and kidneys, clear heat, dispel dampness, quicken the blood circulation and free the channels and network vessels.

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

6. Acupuncture and massage: once a day.

7. Have more medical examination if necessary.

 

Date: February 11, 2010                                     Time: 10: 00 a. m.

Ten years ago, the patient began to have joint pains and swelling without obvious reason. Then he came to a local hospital and he was diagnosed as rheumatoid arthritis. He got the treatment in the local hospital. However, his condition did not become better. Besides, he had difficulty in walking. His sleeping was bad. When he got up in the morning, he always felt thirsty and tired. He was easy to wake up. Wind-cold-damp evil rested on the channels and network vessels and obstructed qi and blood, which resulted in joint pains. Then according to the patient¨s condition, our expert team prescribed a special formula for him.

The prescription was as follows: chen pi (tangerine peel) 10g, dan shen (salvia root) 15g, bai shao (white peony root ) 15g, etc.

 

Date: February 12, 2010                                       Time: 14: 00 p. m.

According to the feedback, there was no abnormity of the examination of urine R. Besides, his functions of the liver and kidneys were all in normal condition. His RF and ESR were a little higher than normal level. 

 

Date: February 17, 2010                                      Time: 10: 00 a. m.

The patient said that his condition had improved a lot especially his walking and joint pains. Then based on his original formula, we changed a little to let him get further progress.   

 

Date: February 22, 2010                                       Time: 10: 00 a. m.

The patient said that his condition continued to become better. His sleeping was good. And he did not feel tired when he got up. So we changed his formula a little. 

 

Date: February 24, 2010                                       Time: 10: 00 a. m.

After the 16 days of comprehensive treatment here including herbal tea, massage and acupuncture, the symptoms improved a lot. He decided to leave our hospital tomorrow.

 

Please click here to download Wechat and scan the following QR code to add Dr. XiXi.

More Rheumatoid Arthritis cases that we helped well:

Case-1  Case-2  Case-3  Case-4  Case-5