Brief Summary:
On Aug. 20, 2008,
Noraldoha, from Libya,
who has suffered from
generalized white patches for 3 years, was hospitalized in our hospital.
She has achieved much improvement after about 30-day TCM treatment here.
¡¡
Record of Hospitalization
Name: Noraldoha
Sex: Female
Age:
13 Profession: Student
Nationality:
Libya Marital Status: Unmarried
Onset Season: Winter
Date of Admission:
Aug. 20, 2008
Complainer: The patient
herself Reliability: Reliable
First Medical Record
Date:
Aug. 20, 2008 Time: 19:00 p.m.
Noraldoha, a 13-year-old female, has suffered from generalized white patches for
3 years. She was hospitalized in our hospital for further treatment at 19: 00
p.m. on Aug. 20, 2008.
Essentials for Diagnosis:
1. The
patient has suffered from generalized white patches for 3 years.
2.
Three years ago, the patient began to feel that the skin on the left anklebone
turned white gradually and finally it developed to be white patches. It
progressively spread to all over the body. She had ever been treated in many
countries, but there was no obvious improvement. Her present condition was as
follows: There were obvious white patches on the both anklebones, knees, elbow
joints and the left eyepit. There were no feelings of itching or ardor. The skin
on the area of the lesions was slightly dry. There were no joint pains. She kept
a sound sleep with normal food intake. Her bowel movement and urination
were both normal.
3. T
36.3¡æ£¬P
80 beats/minute, R 20 times/minute, BP 110/75 mmHg.
4. She
grew normally with a thin shape. Her mind was clear. She had an expression of
chronic illness and languidness. Her body was in a positive posture and she 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.
There could see generalized white patches all over the body in different size.
The hairs on the area of the lesions turned white. The white patches were
especially obvious on the skin of the left anklebone, about the size of 12 cm ¡Á
10 cm. Her tongue was red with thin and white tongue coating. Her pulse was
thready and rapid.
7.
Diagnostic examination: Not provided.
Diagnostic Basis:
TCM
(Traditional Chinese Medicine): The patient has suffered from generalized white
patches for 3 years. There were obvious white patches on the both anklebones,
knees, elbow joints and left eyepit. There were no feelings of itching or ardor.
The skin on the area of the lesions was slightly dry. There were no joint pains.
She kept a sound sleep with normal food intake. Her bowel movement and urination
were both normal.
Her tongue
was red with thin and white tongue coating. Her pulse was thready and rapid.
According to the symptoms of
her tongue and pulse, it is shown that due to yin vacuity of the liver and
kidneys, disharmony of the qi and blood, the patient¡¯s skin lost the nutrition
and then caused the color of the skin turned pale. It has slowly developed to be
the white patches for a long time. So it is believed as vitligo.
Western Medicine: The patient has suffered from generalized white patches for 3
years. There could see generalized white
patches all over the body in different size. The skin around was in deep color.
There were no feelings of pains or itching. The hairs on the area of the lesions
turned white. The white patches were especially obvious on the skin of the left
anklebone, about the size of 12 cm ¡Á 10 cm. So it is not difficult to
diagnose it with vitligo.
Diagnostic Differentiation:
TCM
(Traditional Chinese Medicine): The patient¡¯s vitligo
should be differentiated from sweat stain (lentigo aestiva). Vitligo is characterized by pure white
patches with white hairs in the middle, while the skin around was in deep color.
There were no feelings of pains or itching. On the contrary, sweat stain is
common seen that the lesions were in purple patches or white patches. It is
especially obvious in summer after sweating. It is infectious, and often affects
young people who always sweat. So they are not difficult to be distinguished in
clinics.
Western Medicine: Vitligo
should be differentiated from achromic nevus, which is a limited light patches.
It is usually in size of a palm. Besides, it appears when someone was born or
not long before someone¡¯s birth and it will be kept for a whole life. On the
contrary, vitligo was a common acquired skin disease of pigment-loss. They are not difficult to be
distinguished in clinics.
First Diagnosis:
TCM
(Traditional Chinese Medicine) diagnosis: Vitligo
Symptom identification: Yin vacuity of the liver and kidneys, disharmony of the
qi and blood, and blood vacuity engendering wind.
Western Medicine diagnosis:
Vitligo
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 diet.
5.
Herbal tea (to nourish the blood and dispel wind): one dosage a day and drink
twice.
Main
herbs used in the herbal tea: shudi (cooked rehmannia
root), danshen (salvia root), honghua (carthamus
flower), etc.
6.
Acupuncture and massage: once a day.
7.
Spot-Removing Dispersion, for spreading the suffering parts, three times a day.
8.
Have more medical examinations if necessary.
Date:
Aug. 21, 2008 Time: 9:00 a.m.
Three
years ago, the patient began to suffer from the white patches on the left
anklebone. Several months later, they expanded progressively and spread to the
right anklebone and the knees, even to the elbow joints, the chest and the
loins. The white patches on the left anklebone were especially obvious about the
size of 20 cm ¡Á 18 cm, while the others were in different size. The smallest one
was about the size of 1 cm ¡Á 1.5 cm. There were no obvious feelings of itching
or pains. The patient became thin with pale face and clouding eyepit. Her tongue
was red with thin and white tongue coating. Her pulse was thready and rapid. She
has had no menstruation so far. She has ever had the history of diabetes for 2
years and has been taking insulin for the treatment. The TCM treatment diagnosed
it with vitligo because of vacuity of yin and the blood, disharmony of the qi
and blood. The TCM treatment strategy is to nourish the blood and dispel wind,
enrich yin and supplement the kidneys, disharmony the qi and blood. The
prescription was as follows: shudi (cooked rehmannia
root), danshen (salvia root), honghua (carthamus
flower), etc. 4 dosages in total. Besides, the patient would use
Spot-Removing Dispersion to spread the suffering parts, three times a day.
Date:
Aug. 22, 2008 Time: 9:00 a.m.
The
patient's examinations of the blood, the functions of the liver and kidneys, E4A
were all normal. Her blood sugar was also normal, but the urinalysis and urine
sugar (+3) were abnormal. The doctor told the patient that she should eat less
sweet food. What's more, due to the equation of time, her sleep was poor. There
was no other discomfort.
Date:
Aug. 24, 2008 Time: 9:00 a.m.
The
patient's condition kept the same as before, so her prescription was changed a
little. 5 dosages in total.
Date:
Aug. 29, 2008 Time: 9:00 a.m.
The skin on the elbow joints and
the anklebone was in deep color. Her other condition kept normal. She felt the
palms sweating. Her prescription was changed as follow: shouwu (flowery
knotweed), chuanqiong (ligusticum
root), zicao (puccoon),
etc. 3 dosages in total.
Date:
Sept. 1, 2008 Time: 9:00 a.m.
The color of the skin with the
white patches became deep, so she kept the same prescription. 5 dosages in
total.
Date:
Sept. 5, 2008 Time: 9:00 a.m.
The skin with the white patches has
got much improvement. Her feeling of coldness on the limbs has disappeared. Her
family and she herself were happy with the improvement. She kept a pleasant
mood. Her prescription was changed a little again. 5 dosages in total.
Date:
Sept. 11, 2008 Time: 9:00 a.m.
The patient's palms sweat again, so
the doctor changed the former prescription again. 5 dosages in total.
Date:
Sept. 15, 2008 Time: 9:00 a.m.
The
patient's condition kept steady. She would leave the hospital today.¡¡
