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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.

 

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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