Brief
Summary:
On Mar. 2, 2009, Michel from Brazil, who has suffered from ALS,
accompanied with the symptoms of the weakness of his right
fingers for 10 months and hoarse voice for 4 months, was
hospitalized in our hospital. He has achieved significant
improvement after 30 days TCM treatment here.
Record of Hospitalization
Name:
Michel Birthplace:
Brazil
Sex:
Male Profession: Retired
Age:
70 Nationality: Brazil
Marital Status:
Married Onset Season: The Summer
Solstice
Date of Admission:
Mar. 2, 2009 Date of Record: Mar. 2, 2009
Complainer:
The patient himself
First Medical Record
Date: Mar. 2, 2009 Time:
2: 00 a. m.
Michel, a 70-year-old male, has suffered from the symptoms of
the weakness of his right fingers for 10 months and hoarse voice
for 4 months. His condition became more serious, so he was
hospitalized in our hospital for treatment on Mar. 2, 2009.
Essentials for Diagnosis:
1. The patient has suffered from the symptoms of the weakness of
the right fingers for 10 months and hoarse voice for 4 months.
His condition became more serious.
2. Last May, the patient felt the weakness of his right fingers
without obvious reasons. At that moment, he didn¡¯t pay much
attention to this and had not taken any examination and
treatment. Later his condition gradually became worse. So last
October he went to local hospital for EMG examination and was
diagnosed with ALS, then the doctor prescribed Rilutek capsules
for treatment, twice a day. Now he felt the weakness of the
hands, especially the right hand. The flexibility of his right
fingers declined. There were slight spasms and jumping of the
muscles all over the body. In recent four months, the patient
felt his condition obviously became more serious. He had hoarse
voice when he was speaking. There was no obvious improvement
after the treatment, so he came to our hospital for further
treatment. He had pale tender-red tongue. There were teeth marks
on the edges of the tongue and cracks in the middle of the
tongue. He had wiry pulse. His spirit, appetite, urine and bowel
movement were normal.
3. T 36.5¡æ,
P 80 times/minute, R 20 times/minute, BP 190/90mmHg.
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 felt the weakness of the hands, especially the
right hand. The flexibility of his right fingers declined. There
were slight spasms and jumping of the muscles all over the body.
He had hoarse voice when he was speaking. His blood pressure was
a little high. The gripping power of his left hand was 15.6 kg,
and that of his right hand was 6.8 kg. He had pale tender-red
tongue. There were teeth marks on the edges of the tongue and
cracks in the middle of the tongue. He had wiry pulse.
7. Accessory examination: EMG showed that he had ALS.
Diagnostic Basis:
TCM: The patient has suffered from the weakness of the right
fingers for 10 months and hoarse voice for 4 months. These
conditions became more serious. He felt the weakness of the
hands, especially the right hand. The flexibility of his right
fingers declined. There were slight spasms and jumping of the
muscles all over the body. He had hoarse voice when he was
speaking. The patient was mainly characterized by disabled
wilted limbs, so it was not difficult to be diagnosed as wilting
pattern.
Western Medicine: The patient has suffered from the weakness of
the right fingers for 10 months and hoarse voice for 4 months.
These conditions became more serious. He felt the weakness of
the hands, especially the right hand. The flexibility of his
right fingers was good as before. There were slight spasms and
jumping of the muscles all over the body. He had hoarse voice
when he was speaking. The gripping power of his left hand was
15.6 kg, and that of his right hand was 6.8 kg. So last October
he was given EMG examination which showed that he had 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 (Traditional Chinese Medicine) diagnosis: Wilting pattern
Symptom identification: Depletion of liver-kidney, obstruction
of qi and blood.
Western Medicine diagnosis: 1. ALS
2. Hypertension
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.
Low-fat and high-protein diet.
5.
TCM treatment strategy: supplement the liver, boost the kidneys,
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 examinations if necessary.
Date: Mar. 3, 2009 Date:
10: 30 a. m.
The patient has suffered from the weakness of the right fingers
for 10 months and hoarse voice for 4 months. These conditions
became more serious. Last May, he felt the weakness of the right
fingers without obvious reasons, so he was given EMG examination
in October which showed that he had ALS. Then he began to take
Rilutek for treatment since Nov. 5, 2008. At present, he felt
the weakness of the hands, especially the right hand. The
flexibility of his right fingers declined. There were slight
spasms and jumping of the muscles all over the body. He had
hoarse voice when he was speaking. His blood pressure was a
little high. His breath was normal. There were no symptoms of
stomach pains and distension. His urine and bowel movement were
normal. He didn¡¯t feel mouth dry and was fond of cold drink. His
sleep was good, but he was easy to wake up and feel tired. He
had pale tender-red tongue. There were teeth marks on the edges
of the tongue and cracks in the middle of the tongue. He had
wiry pulse. According to the symptoms of the tongue and pulse,
Professor Yang believed that he had suffered from wilting
pattern due to depletion of liver-kidney, obstruction of qi and
blood, so the treatment strategy was to supplement the liver,
boost the kidneys, quicken the blood and free the channels and
network vessels. The prescription was as follows: baishao (white
peony root), shanyao (dioscorea root), huangqi (astragalus
root), etc. 3 dosages in total.
Date: Mar. 4, 2009 Time:
14: 30 p. m.
According to the feedback, the routine examinations of the blood
and urine were normal. The function of the liver and kidneys
were also normal except total bilirubin (20 umol/L) which was a
little high compared with normal figure 5.1 umol/L-19 umol/L.
Date: Mar. 5, 2009 Time:
9: 00 a. m.
His spirit and sleep were good. His urine and bowel movement
both were normal. There were no obvious changes about the
weakness and flexibility declining of the right fingers. Because
the treatment period was comparatively short, the doctor
suggested him take the same herbal tea. 4 dosages in total.
Date: Mar. 9, 2009 Time:
10: 00 a. m.
His spirit and sleep were good. His urine and bowel movement
both were normal. The patient complained that there was obvious
trembling of the muscles of his upper arms. He felt the weakness
of the hands, especially the right hand. The other condition was
normal. So the doctor added some herbs to extinguish wind and
check tetany. 4 dosages in total.
Date: Mar. 9, 2009 Time:
12: 00 p. m.
The patient fell down due to incaution at 11 o'clock in the
morning. He felt obvious pains of his left ankle joint, so the
former prescription was changed a little. 4 dosages in total.
Meanwhile, he was given X-ray examination of his left ankle
joint.
Date: Mar. 10, 2009 Time:
11: 00 a. m.
He felt pains of his left ankle joint, so he was given CT and
X-ray examination which showed that he had fracture of the left
fibula¡¯s far end. Then he was given the plaster to fix the end
of the fracture, and the doctor suggested him lie down to have a
good rest.
Date: Mar. 13, 2009 Time:
8: 40 a. m.
His condition was stable. He didn¡¯t complain about the pains of
his left ankle joint, but there was slight swelling of his left
foot. Compared with before, the trembling of the muscles of his
upper limbs had lessened. The condition of his right limb was
better than the left limb. The prescription was as follows:
jixueteng (millettia root and stem),
danggui (tangkuei), honghua (carthamus flower), etc. 4 dosages
in total.
Date: Mar. 17, 2009 Time:
10: 00 a. m.
His condition and sleep were good. His urine and bowel movement
both were normal. The patient didn¡¯t complain about the pains of
his left ankle joint and there was no swelling of his left foot.
He said the jumping of the muscles of his pectoralis major, etc.
obviously lessened. To some extent, the jumping of the muscles
of his upper limbs also lessened. Continue the same
prescription. 4 dosages in total.
Date: Mar. 21, 2009 Time:
10: 00 a. m.
His condition was stable. There were no obvious discomforts. His
sleep was good. His urine and bowel movement were normal.
Continue the same prescription. 5 dosages in total.
Date: Mar. 26, 2009 Time:
9: 30 a. m.
He didn¡¯t complain any discomforts. The jumping of the muscles
obviously lessened. There was no swelling of his left foot. His
sleep was good. His urine and bowel movement were normal. He
said he had black stool in recent two days, but there was no
abnormality when he passed the stool. Today he was given the
routine examination of the stool. The former prescription was
changed a little. 5 dosages in total.
Date: Mar. 31, 2009 Time:
10: 00 a. m.
The patient decided to leave the hospital tomorrow and he took
six months herbal tea for continuous treatment.
30/03/09
After a month of treatment, I feel confident
and hopeful, like I never felt before, because I see now signs
of improvement, little signs but visible ones. Tomorrow I will
be going back to my country, Brazil, carrying with me enough
herbs for six months, where I will continue the treatment. I
hope signs of improvement will show magic and stronger, and I
will recover somehow. My wife and I, wish to thank you all,
doctors, nurses, translators and staff for your help and
kindness.
Michel
Sallouti
Check the
original handwriting here
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