Brief Summary:
On May 2, 2008, Abdel, from Indonesia, who suffered from
difficulty in speaking and swallowing, as well as weakness of
all the limbs, was hospitalized in our hospital. He himself
thinks that he has achieved 20% improvement after more than
40-day TCM treatment here.¡¡
Record of
Hospitalization
Name:
Abdel Sex: Male
Age:
64
Profession: Medical
Professor
Nationality:
Sudan Marital Status:
Married
Onset Season:
Pure brightness Date of Admission: May 2,
2008
Complainer:
The patient
himself Reliability: Reliable
First Medical
Record
May 2, 2008
Abdel, a
64-year-old male, has suffered from difficulty in speaking and
swallowing, as well as weakness of all the limbs for 16 years,
and his condition has been aggravated by atrophy of all the
limbs and disability in movement for half a year. He was
hospitalized in Huaihua Red Cross Hospital for further treatment
at 1: 30 a.m. May 2, 2008.
Essentials for
Diagnosis:
1. The patient has
suffered from difficulty in speaking and swallowing, as well as
weakness of all the limbs for 16 years, and his condition has
been aggravated by atrophy of all the limbs and disability in
movement for half a year.
2. In 1992, the
patient began to have difficulty in speaking and poor
coordinative ability of left hand without any obvious causes,
and his condition was aggravated gradually. In 1993, he suffered
from troubles of chewing and swallowing. In 1994, he was
diagnosed with
amyotrophic lateral sclerosis
(ALS) after MRI
examination. And then, his condition was aggravated
progressively. In the recent half a year, he couldn¡¯t take care
of himself. He has ever been prescribed by Rilutek, vitamin and
vitamine-E for oral taking, but he got no obvious improvement.
To seek for a further comprehensive treatment, he was
hospitalized in our hospital on May 2, 2008. His
present symptoms are as follows: difficulty in speaking and
swallowing, sometimes with rapid breathing, disability of
prostration and disability of raising his arms, and drooping of
double hands. He is able to walk with the support but the left
leg is unable to move. The patient used the wheelchair at
present. His tongue was not able to do any movement, and the
muscles all over the limbs twitched frequently. His spirit was
poor, with sound sleep and poor food intake. His urination was
normal, but the bowel movement was of constipation, once every 2
to 3 days.
3. T 36.3¡æ£¬P
89 beats/minute, R 22 times/minute, BP 110/80 mmHg.
4. He grew normally
with common nutrition. 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.
His double arms were not
able to lift up, and he got tired easily. The
muscles of thenar and
hypothenar, muscle of hukou, deltoid, and musculi triceps
brachii of the double hands were atrophic.
His upper limbs
were Grade
¢òwith
muscle hyperthyroidism.
The gripping power of his left hand was 4.5 kg, and that of the
right hand was 5.2 kg. His lower limbs were not able to walk.
His lower limbs were also Grade
¢ò.
The muscles of his limbs beat and twitched obviously. Besides,
he had difficulty in speaking and swallowing. His tongue body
was pale with slimy tongue coating. His pulse was weak.
6. No thoracic
deformity. Sound of breath was bilaterally normal on
auscultation. No sound of pleural friction. Heart border was
normal. Heart beat was 89 times/min. Cardiac rhythm was regular.
No pathological murmurs on
auscultation.
7. Diagnostic
examination: The MRI shows ¡°ALS¡±.
Diagnostic Basis:
TCM (Traditional
Chinese Medicine): The patient has suffered from difficulty in
speaking and swallowing, as well as weakness of all the limbs
for 16 years, and his condition has been aggravated by atrophy
of all the limbs and disability in movement for half a year. His
symptoms were as follows: difficulty in speaking and swallowing,
too much phlegm-drool, sometimes with rapid breathing,
disability of prostration and disability of raising his arms
with double hands drooping. His left leg could not move, and his
tongue was not able to do any movement, and muscles all over the
limbs twitched frequently. His spirit was poor, with sound sleep
and poor food intake. His urination was normal, but the bowel
movement was of constipation, once every 2 to 3 days. His tongue
body was pale with slimy tongue coating. The pulse was weak.
According to the symptoms of his tongue and pulse, it is shown
that due to deficiency of qi and blood, insufficiency of the
liquids, the patient could not nourish the muscles of his limbs.
Then it gradually leads to the atrophy of his limbs. He is
mainly characterized by weak limbs, emaciated muscles, which
even cause his limbs to lose functions. So it is believed as
wilting.
Western Medicine:
The patient has suffered from difficulty in speaking and
swallowing, as well as weakness of all the limbs for 16 years,
and his condition has been aggravated by atrophy of all the
limbs and disability in movement for half a year.
His double arms were not
able to lift up, and he got tired easily. The
muscles of thenar and
hypothenar, muscle of hukou, deltoid, and musculi triceps
brachii of the double hands were atrophic.
His upper limbs
were Grade
¢òwith
muscle hyperthyroidism.
The gripping power of his left hand was 4.5 kg, and that of the
right hand was 5.2 kg. His lower limbs were not able to walk.
His lower limbs were also Grade
¢òwith
muscle
hyperthyroidism.
The muscles of his limbs beat and twitched obviously. The MRI
shows ¡°ALS¡±.
Diagnostic
Differentiation:
TCM (Traditional
Chinese Medicine): The patient¡¯s wilting syndrome should be
differentiated from impediment syndrome. Wilting syndrome is
characterized by limp, weak, and emaciated limbs with muscular
atrophy. A patient suffered from Wilting syndrome seriously may
even become unable to hold an object or to stand without any
support. Besides, the patient usually has no joint pain. On the
contrary, impediment syndrome is generally characterized by
aching pain, fixed heaviness and inflexibility of sinews and
bones, muscles and joints, with occasional numbness or swelling,
though, no paralytic manifestations exist. They are not
difficult to be distinguished in clinics.
Western Medicine:
Wilting syndrome should be differentiated from Myasthenia Gravis
(MG), which is an acquired autoimmune disease with the
transferring obstacles owing to
the reduced
acetylcholine receptor
in the site of
neuromuscular junction. It can occur at any age. The most
obvious characteristic of MG in clinics is rapid fatigability
during the movement of the skeletal muscles, which will be
improved by rest or cholinesterase. They are not difficult to be
distinguished in clinics.
First
Diagnosis:
TCM (Traditional
Chinese Medicine) diagnosis: Wilting syndrome
Symptom diagnosis:
Lungs-spleen qi vacuity, accompanied with vacuity of the liver
and kidneys, phlegm-damp obstructing the channels.
Western Medicine
diagnosis:
Amyotrophic Lateral Sclerosis
(ALS)
Plans for treatment
strategy and nursing:
1. On routine care
of traditional Chinese internal medicine.
2. On grade II
care.
3. Under the care
of a companion.
4. Regular diet.
5. Herbal tea (to
supplement the spleen and boost the lungs, to enrich and nourish
the liver and kidneys): one dosage a day and drink twice.
Main herbs used in
the herbal tea: baisheng (white
ginseng), baishu (ovate
atractylodes root), fuling (poria),
etc.
6. Acupuncture and
massage: once a day.
7. Do functional
exercise for all the limbs.
8. Have more
medical examinations if necessary.
Date: May 3,
2008 Time: 16:00 a.m.
The patient¡¯s
routine examinations are as follows: the examinations of blood,
urine, blood sugar, the function of the liver and kidneys were
all normal. The patient has suffered from difficulty in speaking
and swallowing, as well as weakness of all the limbs for 16
years, and his condition has been aggravated by atrophy of all
the limbs and disability in movement for half a year. He kept a
clear mind with mouth phlegm drooling. The movement of his
tongue was limited due to atrophy, and even his tongue was not
able to do any flexible movement. His tongue body was pale with
slimy tongue coating. The pulse was weak. These symptoms belong
to lungs-spleen qi vacuity, liver-kidneys depletion and
phlegm-damp obstructing the channels. The TCM treatment strategy
is to supplement the spleen and boost the lungs, enrich and
supplement liver and kidneys, transform the phlegm and free the
channels.
Date: May 6,
2008 Time: 10:00 a.m.
The phlegm-drool in
his mouth decreased. Besides, his spirit got better, while other
symptoms were the same as before. His tongue was pale with slimy
tongue coating. The pulse was weak. He would continue to take
another 5 dosages of the herbal tea.
Date: May 11,
2008 Time: 10:00 a.m.
His spirit got
better. His swallowing also got improvement. Besides, the
phlegm-drool in his mouth decreased obviously, but he still
could not speak. His tongue was not able to do any movement. His
deltoid was atrophic obviously, so he could neither raise his
shoulder nor take a deep breath. He had difficulty in flexible
movement of all the limbs. His tongue was pale with thin tongue
coating. The pulse was weak. The TCM treatment strategy is still
to supplement the spleen and boost the lungs, enrich and nourish
the liver and kidneys, transform the phlegm and free the
channels. The doctor advised his family numbers to help him to
do some functional movement for his limbs.
Date: May 16,
2008 Time: 10:00 a.m.
After the patient
has been hospitalized for half a month, there was still no
obvious improvement on the
dysfunction of the limbs. The psoas and muscle adductor of the
double legs were spastic with stiff double ankles. He was not
able to stand or walk. Due to the long-term disease, his
condition belongs to a chronic disease. TCM treatment strategy
is still to supplement the spleen and boost the lungs, enrich
and nourish the liver and kidneys, transform the phlegm and free
the channels.
Date: May 23,
2008 Time: 8:30 a.m.
The patient said
that there was no obvious improvement as to his symptoms, while
he felt great pains on his waist. There was no abnormality on
the outlook of his waist, but with obvious pains when pressed.
The patient was advised to do a CT examination in another
hospital.
Date: May 27,
2008 Time: 8:30 a.m.
After the CT
examination on the lumbar vetebrae, the disci intervertebrales L3/
4 and L4/ 5 bulged slightly. His condition was
reported to Doc. Ming. The TCM treatment would continue as
before.
Date: May 30,
2008 Time: 9:00 a.m.
His symptoms were
as before. After Dr. Huang feibo¡¯s diagnosis, he considered the
patient¡¯s lumbar to be another treatment. Doc. Ming agreed to
the treatment. At the same time, his TCM treatment would
continue as before.
Date: June 1,
2008 Time: 9:00 a.m.
Dr. Huang feibo, as
well as the patient and his family all agreed to another
treatment. Then the patient was prescribed some western
medicines. At the same time, he was advised to reflect his
feeling about his stomach, so as to take measures to protect his
stomach.
Date: June 5,
2008 Time: 9:00 a.m.
After taking the
medicine, the patient neither feel any discomfort on his stomach
nor feel his appetite decreased. His pulse was fine, and his
tongue was white. He would continue to take another 5 dosages of
herbal tea of the same prescription.
Date: June 10,
2008 Time: 9:00 a.m.
There was no other
discomfort except the painful lumbar. His pulse was fine and
weak, and his tongue coating was white. His herbal tea was
adjusted as follows: huangqi (astragalus
root), baisheng (white ginseng),
zaopi (cornus fruit), etc.
Date: June 15,
2008 Time: 9:00 a.m.
The patient demanded to leave the hospital today, and he was
approved to leave the hospital this afternoon.
¡¡
