Brief Summary:
An ALS patient, Thanasis,
from
Greece,
who suffered from difficulties in speaking and swallowing and the
weakness of his left fingers, was hospitalized in our hospital.
He has achieved significant improvement after more than two-month TCM
treatment in our hospital, especially his improvement in swallowing and
speaking.
¡¡
Record of
Hospitalization
Name:
Thanasis Sex: Male
Age:
57 Profession: Office
Clerk
Nationality:
Greece Marital Status: Married
Onset Season:
Summer Date of Admission: July 21, 2007
Complainer:
The patient
himself Reliability: Reliable
Major Complaint:
The
patient has suffered from difficulties in speaking and swallowing for two years,
accompanied with weakness of his left fingers for nine months.
Present Illness:
In July 2005, the patient began to feel unclearness and disfluency of his
speaking with some difficulty in swallowing without any obvious causes. He
coughed when he drank water. But at that time, the patient paid no attention to
it, and did no treatment about it. Therefore, the disease was developing
progressively. In Oct. 2006, the patient began to feel weakness of his left
fingers, and then went to a local hospital for a diagnosis. After the EMG
examination, the patient was diagnosed with
amyotrophic lateral sclerosis
(ALS).
The patient was told that his disease was incurable, and then he got no
treatment. In Feb. 2007,
the patient went to
another local hospital for a further diagnosis, and he was prescribed by some
western medicine for oral taking until now. He was picked up by our staff in
Zhijiang Airport and arrived in Huaihua Red Cross Hospital for further treatment
at 19: 00 p.m. on July 21, 2007. Since he got the disease, his sleep and
appetite were both poor. His spirit was good. His bowel movement and urination
were both normal.
Disease History:
No history of typhoid, tuberculosis, hepatitis, malaria or other infectious
diseases. No allergic history of medicine or food. No trauma history. No history
of preventive vaccination provided. In 1997, he got an operation for his hernia.
But now, it is cured. In 1997, he suffered from diabetes. Since then, he has
taken the medicine for it until now.
Personal History:
He was born in Greece. No contact history of schistosomiasis. No addiction to
smoking, alcohol or special food. He was mild-tempered and open-minded.
Marital History:
He got
married at the age of 29. He has one son. His wife and child have been healthy
all the time.
Family History:
His
parents were both healthy. No family history of special disease.
Physical Examination:
T 36.5¡æ£¬P
80 beats/minute, R 18 times/minute, BP 130/85 mmHg, W 98 kg.
He grew normally with common
nourishment. His mind was clear. He had an expression of chronic illness and
languidness. His body was in a positive posture and he was cooperative in
examination. His skin was moist. No jaundice in the sclera. No superficial
lymph-node enlargement. Bilateral pupils were round and equal in size and
sensitive to light. No thoracic deformity. Sound of breath was bilaterally
normal on auscultation. No respiratory rales or pleural friction rubs. Heart
border was normal. Heart beat was 80 times/minute. Cardiac rhythm was regular.
No pathological murmurs on auscultation.
Abdomen touched flat and soft without tenderness or rebounding tenderness. The
liver and spleen were not palpable. No percussion pains in renal region. Bowel
sound was normal. No spinal and pelvic deformity or tenderness. He suffered from
unclearness and disfluency of speech, accompanied by difficulty in swallowing,
poor movement of his tongue and coughing as drinking. His tongue was
rugged with atrophic tongue
muscles.
His fingers
were suffered from weakness so that he had difficulty in holding any objects.
The muscles of his hands were
atrophic.
The experiment on his
hands was (+). There was uncontrollable and frequent muscles¡¯ trembling on his
upper limbs, chest and back. The
muscle strength of his
upper limbs was Grade
¢ó
with low muscle hypertonicity. His lower limbs were weak in free movement
without any tenderness or deformity. The examinations of the anus and pudendum
were both normal. Other physiological reflex has not been elicited. His tongue
was red with white and slightly heavy-greasy tongue coating. His pulse was
slippery, thready and weak.
Diagnostic
examination: Not provided.
First Diagnosis:
TCM diagnosis:
Wilting syndrome
Symptom
identification: Spleen-kidneys lungs vacuity.
Western medicine
diagnosis:
Amyotrophic Lateral
Sclerosis
(ALS)
First Medical Record
July 18,
2007
Thanasis, a
57-year-old male, has suffered from difficulties in speaking and swallowing for
two years, accompanied with weakness of his left fingers for nine months. He was
picked up by our staff in Zhijiang Airport and arrived in Huaihua Red Cross
Hospital for further treatment at 19: 00 p.m. on July 21, 2007.
Essentials for
Diagnosis:
1. The patient has
suffered from difficulties in speaking and swallowing for two years, accompanied
with weakness of his left fingers for nine months.
2. In July 2005, the
patient began to feel unclearness and disfluency of his speech with some
difficulties in swallowing without any obvious causes. He coughed when he drank
water. But at that time, the patient paid no attention to it, and did no
treatment about it. Therefore, the disease was developing progressively. In Oct.
2006, the patient began to feel weakness of his left fingers, and then went to a
local hospital for a diagnosis. After the EMG examination, the patient was
diagnosed with
amyotrophic lateral
sclerosis
(ALS).
The patient was told that his disease was incurable, and then he got no
treatment. In Feb. 2007,
the patient went to
another local hospital for a further diagnosis, and he was prescribed by some
western medicine for oral taking until now. He was picked up by our staff in
Zhijiang Airport and arrived in Huaihua Red Cross Hospital for further treatment
at 19: 00 p.m. on July 21, 2007. Since he got the disease, his sleep
and appetite were both poor. His spirit was good. His bowel movement and
urination were both normal.
3. T 36.5¡æ£¬P
80 beats/minute, R 18 times/minute, BP 130/85 mmHg, W 98 kg.
4. He grew normally
with common nourishment. His mind was clear. He had an expression of chronic
illness and languidness. His body was in a positive posture and he was
cooperative in examination.
5.
He suffered
from unclearness and disfluency of speech, accompanied by difficulty in
swallowing, poor movement of his tongue and coughing as drinking. His tongue was
rugged with atrophic tongue
muscles.
His fingers
were suffered from weakness so that he had difficulty in holding any object.
The muscles of his hands were
atrophic.
The experiment on his
hands was (+). There was uncontrollable and frequent muscles¡¯ trembling on his
upper limbs, chest and back. The
muscle strength of his
upper limbs was Grade
¢ó
with low muscle hypertonicity. His lower limbs were weak in free movement
without any tenderness or deformity. The examinations of the anus and pudendum
were both normal. Other physiological reflex has not been elicited. His tongue
was red with white and slightly heavy-greasy tongue coating. His pulse was
slippery, thready and weak.
6. No thoracic
deformity. Chest percussion noted resonance. Sound of breath is bilaterally
clear on auscultation. No sound of pleural friction.
7. Diagnostic
examination: Not provided
Diagnostic Basis:
TCM: The patient has
suffered from difficulties in speaking and swallowing for two years, accompanied
with weakness of his left fingers for nine months. The muscles of his upper
limbs were atrophic and weak, accompanied with languid spirit and pale faces.
His speech was neither clear nor frequent, with difficulty in swallowing,
poor
movement of his tongue and coughing as drinking. His tongue was
rugged with atrophic tongue muscles.
His tongue was red with
white and slightly heavy-greasy tongue coating. His pulse was slippery, thready
and weak. Because of the insufficiency of the liquids, abnormality of the qi and
blood, and the lungs heat scoring the lobes, his limbs lose the nutrition.
Due to the deficiency of the spleen and stomach, the
essence-blood could not nourish his sinews and vessels. Then it leads to the
malnutrition of the muscles, and gradually it resulted in flaccidity.
Western Medicine: The
patient has suffered from difficulties in speaking and swallowing for two years,
accompanied with weakness of his left fingers for nine months.
He suffered
from unclearness and disfluency of speech, accompanied by difficulty in
swallowing, poor movement of his tongue and coughing as drinking. His tongue was
rugged with the atrophic
tongue muscles.
His fingers
were suffered from weakness so that he had difficulty in holding any object.
The muscles of his hands were
atrophic.
The experiment on his
hands was (+). There was uncontrollable and frequent muscles¡¯ trembling on his
upper limbs, chest and back. The
muscle strength of his
upper limbs was Grade
¢ó
with low muscle hypertonicity. In Oct. 2006, after the EMG examination,
he was diagnosed with
amyotrophic lateral
sclerosis
(ALS).
Diagnostic
Differentiation:
TCM: The patient¡¯s
wilting
syndrome
should be differentiated from impediment syndrome. Wilting syndrome is
characterized by the limp, weak, and emaciated limbs with muscular atrophy. A
patient suffered from wilting
syndrome may
even become unable to hold any objects or to stand without any support. Besides,
the patient¡¯s lower limbs are more often affected, though he or she usually has
no joint pains. On the contrary, impediment syndrome is generally characterized
by aching pains, fixed heaviness and inflexibility of sinews and bones, muscles
and joints, with occasional numbness or swelling, though, no paralytic
manifestations. They are not difficult to be distinguished in clinics.
Western
Medicine: Wilting syndrome should be differentiated from grave myasthenia
gravis, which is an acquired autoimmune disease with the transferring obstacles
of nerve-muscles, and is caused by the autoimmune reaction resulting from the
acetylcholine receptor (AchR) of the striated muscle. It can occur at any age
and there are about 60 percent people stricken before 30 years old. Women are
more often affected than men are. The most obvious characteristic of MG is rapid
fatigability of the skeletal muscles affected, improved with rest or medicines
that inhibits the activity of cholinesterase. It can involve the cardiac muscle
and smooth muscle. MG patients of different ages often have different clinical
manifestations and courses, which are different from those of wilting syndrome
patients.
First Diagnosis:
TCM diagnosis:
Wilting syndrome
Symptom
identification: Spleen-kidneys lungs vacuity
Western medicine
diagnosis:
Amyotrophic Lateral
Sclerosis
(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. High-protein diet.
5. Herbal tea (to
boost qi and fortify the spleen, supplement the kidneys and boost the lungs):
Taking five dosages of the herbal tea. One dosage a day and drink twice.
Prescription: Varied
Decoction of the Fortifying-Spleen and Supplementing-Kidneys.
Main herbs used in
the herbal tea: baisheng (white ginseng), huangqi (astragalus root), baishu
(ovate atractylodes root), etc.
6. Acupuncture and
massage: Once a day.
7. Take more exercise
on the tongue and the suffering parts.
8. Have more medical
examinations if necessary.
Date: July 22,
2007 Time: 10:00 a.m.
The patient has
suffered from difficulties in speaking and swallowing for two years, accompanied
with weakness of his left fingers for nine months. The patient began to suffer
from unclearness speech, accompanied with difficulty in swallowing, coughing as
drinking two years ago, and his condition was getting worse day by day. Nine
months ago, he began to feel the weakness of his left fingers with difficulty in
holding any objects. His finger and arms were both suffered from muscular
atrophy, and muscular trembling of the upper body.
His food intake was poor. Sometimes he felt there was some phlegm on his throat.
His lower limbs were weak.
His tongue coating
was slightly heavy-greasy with rugged
lingual surface. The muscles of his
tongue were atrophic and trembling. There were tooth-marks at the edges of the
tongue. The movement of his tongue was poor. His pulse was slippery, thready and
weak.
TCM diagnosis:
Wilting syndrome
Symptom
identification: Spleen-kidneys lungs vacuity.
Western medicine
diagnosis:
Amyotrophic Lateral
Sclerosis
(ALS)
Principle of TCM
treatment: Boosting qi and fortifying the spleen, supplementing the kidneys and
boosting the lungs.
Doctor¡¯s requirement
is to take four dosages of the herbal tea of the same prescription.
Date: July 25,
2007 Time: 10:00 a.m.
The patient felt that
his difficulty in swallowing got some improvement.
Doctor¡¯s requirement is that he
would continue to take five dosages of the herbal tea of the former
prescription.
Date: July 30,
2007 Time: 9:00 a.m.
His swallowing and
movement of his tongue was getting better. His sleep was bad with nightmare. The
doctor advised him to add poria, spiny jujube kernel and polygala root decocted
into the former prescription.
Date: July 31,
2007 Time: 9:00 a.m.
Today the patient
complained that his swallowing, the movement of his tongue and the muscular
fibrillation all over his
body all achieved some improvement. His sleep was still poor, while his diet was
normal. The TCM strategy was to boost qi and fortify the spleen, supplement the
kidneys and boost the lungs, soften the liver and extinguish the wind. He would
continue to take four dosages of the herbal tea of the former prescription.
Date: Aug. 2,
2007 Time: 9:00 a.m.
His fingers of both
hands were weak with difficulty in flexible movement of joints. The doctor
advised him to take four dosages of the herbal tea to soak his hands. The main
herbs in the herbal tea for external use are cinnamon twig, ground pine,
millettia root and stem, etc.
Date: Aug. 4,
2007 Time: 9:00 a.m.
Today the patient
complained that his swallowing, the movement of his tongue and the muscular
fibrillation all over his
body all achieved some improvement. His sleep was better than before. Sometimes
he felt some pains on his arms.
Doctor¡¯s requirement
is to take five dosages of the herbal tea of the same formula.
Date: Aug. 9,
2007 Time: 9:00 a.m.
The muscular
fibrillation all over his body was
lessened. He spoke very slowly with dry month and inflexible movement of his
tongue. His lingual surface was tugged with its muscular atrophy. His tongue
coating was white with less liquid. The TCM strategy was to boost qi and fortify
the spleen, supplement the kidneys and boost the lungs, and extinguish the wind.
He would continue to take five dosages of the herbal tea of the former
prescription.
Date: Aug. 11,
2007 Time: 9:00 a.m.
His
fingers of the hands were with muscular atrophy and poor movement of the
fingers. The oral taking herbal tea should combine with five dosages of the
herbal tea for the external use. The main herbs in the
herbal tea for external use are cinnamon twig, ground pine, millettia root and
stem, etc.
Date: Aug. 14,
2007 Time: 9:30 a.m.
The patient¡¯s
difficulty in swallowing and the muscular
fibrillation all over his body both
achieved obvious improvement. His difficulty in speaking was also getting
better. The strength of the limbs increased. He could raise his thumb to praise
something good. He also complained that he felt dumbness of his fingers and
dryness of his mouth at night, sometimes accompanied with a drumming in the
ears. Doctor¡¯s
requirement is to take five dosages of the herbal tea of the same prescription.
Date: Aug. 19,
2007 Time: 9:00 a.m.
The patient¡¯s diet
was poor, but his dry month was getting better. His tongue coating was slightly
greasy. He would continue to take five dosages of the herbal tea of the same
prescription, adding tangerine peel into it.
Date: Aug. 24,
2007 Time: 9:00 a.m.
The patient
complained that his difficulties in speaking and swallowing achieved significant
improvement. The upper limbs were painful, and his diet was poor. Doctor¡¯s
requirement is to take four dosages of the herbal tea of the same prescription.
Date: Aug. 28,
2007 Time: 9:00 a.m.
The
patient felt that the strength of his left fingers increased. The muscular
trembling was lessened. He had a little amount of
phlegm.
Doctor¡¯s requirement
is to take three dosages of the herbal tea of the same prescription.
Date: Aug. 31,
2007 Time: 9:00 a.m.
These days the
patient has suffered from diarrhea with water-like bowel movement. He had no
bellyache or any swelling of stomach. He had poor absorption and coughing.
Doctor¡¯s requirement is to take five dosages of the herbal tea of the same
prescription.
Date: Sep. 1,
2007 Time: 9:00 a.m.
The patient suffered
from diarrhea with water-like bowel movement 3 to 4 times a day. He felt poor
spirit with tired body during taking the self-prepared medicine for his
diarrhea. He was given the injection 1000ml with 10% of potassium chloride 10ml
and caloric
agent. He took herbal tea orally to boost qi and fortify the spleen and help to
digest. The doctor advised him not to eat the cold food or oily food.
Date: Sep. 4,
2007 Time: 9:00 a.m.
The patient still
suffered from diarrhea, 2 to 3 times a day. After using the
agastache
qi-righting Pills, his
diarrhea was getting
better. This morning, had only once bowel movement and his bowel movement
returned to normal. The doctor still advised him to take the herbal tea.
Date: Sep. 5,
2007 Time: 9:00 a.m.
The patient suffered
from diarrhea several days ago with poor intake and weakness body. He had
history of diabetes, so could not give injection with some medicine containing
any sugar or amino acid. He got an examination of his blood sugar, which showed
6.1. The doctor advised him to stop antidiabetic medicines, and he should take
them again after he returned his function of diet and digestion of
intestinal tract. The herbal tea is
to fortify the spleen, transform the food, soften the liver and extinguish the
wind.
Date: Sep. 6th
2007 Time: 11:40 a.m.
The patient
complained that he had suffered diarrhea again with 4 to 5 times bowel movement
last night. He felt weak with low spirit, poor appetite and poor sleep. The
herbal tea Poria and Ovate Atractylodes Powder was to prescribe for his
diarrhea. The doctor gave him three dosages of the herbal tea, and One dosage a
day and drink twice. The western medicine was the injection with 10% glucose
500ml + vitamin C 2.0 + 10% potassium chloride 10ml + amino acid 250 ml to
supplement enough energy. Since the patient had the history of diabetes, he was
give 8 ml insulin instead of 500 ml glucose, so as to prevent the patient¡¯ s
blood sugar increasing. The patient was given the careful treatment and would
continue to take the examination when necessary.
Date: Sep. 12th
2007 Time: 9:00 a.m.
The patient had 3
times bowel movement yesterday morning since he had eaten eggs. After
examination, the patient was considered to be with poor digestion. The doctor
advised him not to take any eggs or oily food at this time. The patient¡¯s former
herbal tea should add blast-fried ginger 7 g, aconite accessory tuber 12g, and
mume fruit 20 g.
Date: Sep. 13th
2007 Time: 9:00 a.m.
The patient¡¯s
diarrhea recovered by taking the medicine to warm and supplement the spleen, and
he had only once bowel movement today. His appetite increased and his spirit was
getting better. The herbal tea prescription is the same as the former.
Date: Sep. 16th
2007 Time: 9:00 a.m.
The patient¡¯s bowel
movement was normal, his appetite increased, and his spirit was getting better.
His muscular trembling was lessened. His tongue was still numb, and he had
difficulty in swallowing. His month was slightly dry. The herbal tea
prescription is the same as the former.
Date: Sep. 19th
2007 Time: 9:00 a.m.
The patient¡¯s bowel
movement was normal, his appetite increased obviously and he could swallow food.
His muscular trembling was lessened day by day. He was still weak and tired
since he had suffered from diarrhea before. He had no dry month. Doctor¡¯s
requirement is to take four dosages of the herbal tea of the same prescription
as Sep. 16th.
Date: Sep. 23rd
2007 Time: 9:00 a.m.
The patient¡¯s
condition was normal. There were some slight pains on his lower limbs. Doctor¡¯s
requirement is to take five dosages of the herbal tea of the same prescription.
Date: Sep. 25th
2007 Time: 10:00 a.m.
After hospitalization
in our hospital and the treatment of our herbal tea accompanied by acupuncture
and massage and some exercise, the ALS patient¡¯s difficulties in swallowing and
speaking, and his muscular trembling all achieved significant improvement.
Today, he demanded to leave the hospital with 3-month herbal tea for home
taking.
The main herbs such
as white ginseng, astragalus root, salvia root, etc are contained in the 90-day
herbal tea.
The main herbs such
as white ginseng, astragalus root, ovate atractylodes root, etc are contained in
the 5-day honey pills.
Date: Sep. 28th
2007 Time: 9:00 a.m.
The patient had
diarrhea last night again with twice
loose bowel movement. He
also felt some bellyache. The doctor prescribed
him the herbal tea decocted
with agastache,
aconite accessory
tuber, and mume fruit. This morning he still had diarrhea with some bellyache.
His other condition was good without dry month. Doctor¡¯s requirement is to take
two dosages of the herbal tea of the same prescription.
Date: Sep. 30th
2007 Time: 9:00 a.m.
After hospitalization in our hospital and the treatment of our herbal tea
accompanied by acupuncture and massage and some exercise, the ALS patient¡¯s
difficulties in swallowing and speaking, and his muscular trembling all achieved
significant improvement. His poor intake, weak and tired body also was improved
obviously. Now he has no diarrhea, and the strength of his limbs increased a
lot. He kept a good mood. He demanded to leave the hospital with three-month
herbal tea and 5-day honey pills for home taking.
