Brief Summary: On Jan. 23, 2009, Osama, from Bahrain, who has suffered from ALS, accompanied with the symptoms of the stiffness and weakness of the four limbs for 6 months, was hospitalized in our hospital. He has achieved significant improvement after 28 days TCM treatment here.

Record of Hospitalization

Name: Osama                                               Birthplace: Bahrain

Sex: Male                                                      Profession: Doctor

Age: 50                                                         Nationality: Bahrain

Marital Status: Married                               Date of Admission: Jan. 23, 2009

Onset Season: Grain in Ear                          Date of Record: Jan. 23, 2009

Complainer: The patient himself                    Degree of Reliability: Reliable

First Medical Record

Date: Jan. 23, 2009                                        Time: 2: 00 a. m.

Osama, a 50-year-old male, has suffered from the stiffness and weakness of the four limbs for 6 months. It became more serious for two months. He was hospitalized in our hospital for treatment on Jan. 23, 2009.

Essentials for Diagnosis:

1. T 36.4℃, P 80 times/minute, R 20 times/minute, BP 140/100 mmHg.

2. His present symptoms were as follows: the stiffness of the joints of the four limbs; atrophy and weakness of the muscles all over the body; spasms; obvious jumping of the muscles of the upper arms and occasional muscle jumping of the other parts of the body. He could walk about 20 meters with the help of mobility aids. He could go on simple movements such as eating, tooth brushing, etc. with using the upper limbs but could not dressing and lifting articles with the hands. The functions of speaking, swallowing and breathing were normal. He had no symptoms of headache; tinnitus; spontaneous sweating; night sweating; cough and rales in the lungs. His vision was normal. Occasionally, he had the symptom of nasal congestion. He was easy to have a cold. He was fond of drinking water. His appetite was good. He didn’t feel mouth dry and bitter. There was tidal fever of. his chest, palms and soles. His urine and bowel movement were normal.

3. His spirit was good. He had an expression of chronic illness. He grew normally. He seemed to be skinny. His body was in a negative posture. He was confined to a wheelchair. He had pale red tongue, thin and yellow tongue coating, floating and deep pulse. The heart and lungs were normal. There were no tapping pains in the area of the kidneys. His abdomen was soft. There were no pressing pains and rebound tenderness. The liver and spleen can not be felt by pressing. The muscular strength of his four limbs declined. Moreover, he had muscular hypertonia. There was different degree of muscular atrophy all over the body. His joints were stiff, but there were no symptoms of inflammation and pains. Besides, there was no edema of the lower limbs, but he had varicosity. Physiologic reflex exists, but no pathologic reflex.  

4. Diagnostic examination: MRI and EMG showed he had ALS.

Diagnostic Basis:

TCM: The patient’s wilting pattern is due to insufficiency of qi and yin, malnutrition of the sinews and vessels. His physical condition is originally weak, so kidney vacuity can not control the fire, and this condition results in effulgent fire tormenting metal and the loss of the lung function. Accordingly, the fluids can not reach the five viscera and then this condition causes the malnutrition of the body which eventually brings about crippling wilt.

Western Medicine: The patient has typical symptoms including peripheral paralysis of the upper limbs, central paralysis of the lower limbs, motor neuron mixed lesion of the four limbs, etc. Accessory examinations of MRI and EMG show that he has 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, sometimes with the numbness and emaciation of the muscles. 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.

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. Low-fat and high-protein diet.

5. Acupuncture and massage: once a day.

6. Strengthen the functional exercise of the four limbs: once a day.

7. Herbal tea: one dosage a day and drink twice.

Main herbs used in the herbal tea: gouqi (lycium berry), baizhu (ovate atractylodes root), chuanxiong (ligusticum root), etc.

Date: Jan. 26, 2009                                       Time: 10: 00 a. m.

The patient said his diet was normal. His sleep was better than before. Yesterday he slept seven hours. The jumping of the muscles all over the body had lessened 50%. The pains of his shoulder joints improved a lot. The movement of the four limbs greatly lightened. The patient felt the healing effect was obvious. Continue to take the same prescription.

Date: Jan. 29, 2009                                       Time: 10: 00 a. m.

His diet, sleep and drinking were normal. The jumping of the muscles all over the body and the pains of the shoulder joints disappeared. He could flex his right fingers. His gripping power obviously increased. The ability to raise his hands also improved a lot. The height of raising the hands was nearly parallel to the ground. His mood was comparatively stable. So the doctor suggested him to take only half of the western medicines which were used to treat depression and relieve muscular spasms. There was no obvious stiffness of the muscles all over the body. His pulse was floating and slippery. His tongue coating was slightly slippery.

Date: Feb. 1, 2009                                       Time: 10: 00 a. m.

His diet and sleep were normal. There were no symptoms of the jumping of the muscles and joint pains. He could feel slight stiffness of the muscles of the lower limbs. Based on the ground, he could raise his hands more than 90 degree. In recent two days, his blood pressure had reduced from 140/100mmHg to 130/90mmHg. The gripping power of his hands improved. That of his right hand was from 6.8 kilos to 10.8 kilos, and that of his left hand from 4.2 kilos to 7.2 kilos. He would begin the functional exercise of the four limbs tomorrow. Once a day. The prescription was as follows: baizhu (ovate atractylodes root), danggui (tangkuei), chuanxiong (ligusticum root), etc. 3 dosages in total.

Date: Feb. 4, 2009                                       Time: 10: 00 a. m.

The patient could get up from a seat in the recent days. Yesterday he walked about 50 meters with the help of mobility aids, while he could walk just about 20 meters when he came here. His diet and sleep were normal. The prescription was changed a little. 3 dosages in total.

Date: Feb. 7, 2009                                       Time: 11: 00 a. m.

Today he could walk about 70 meters with the help of mobility aids. The joint pains of his left shoulder lessened. There was no jumping of the muscles. His diet also improved. So he was required to stop taking the western medicine which was used to relieve muscle spasms. The prescription was as follows: gouqi (lycium berry), maidong (ophiopogon tuber), shanzhuyu (cornus fruit), etc. 3 dosages in total.

Date: Feb. 10, 2009                                      Time: 11: 00 a. m.

His diet and sleep were normal. There was still slight stiffness of his lower limbs. The former prescription was changed a little.

Date: Feb. 13, 2009                                      Time: 11: 00 a. m.

His condition was stable. Furthermore, his health condition was improving day by day. However, there was slight stiffness of the lower limbs as well as the left fingers. The other condition was normal. So the prescription was changed as follows: guizhi (cinnamom twig), danggui (tangkuei), etc. 4 dosages in total.

Date: Feb. 17, 2009                                      Time: 11: 00 a. m.

His condition was comparatively stable. The stiffness of his lower limbs further improved. He kept in good mood and spirit. He decided to leave for Beijing on Feb. 20 in order to negotiate with embassy of Bahrain to persuade his government to provide another 2 months treatment cost in our hospital. Then he would come back to our hospital for further treatment to consolidate the effect.

A Letter Written By Dr. Ming:

This is Dr. Zhu Ming from Huaihua Red Cross Hospital, China. I am the Chinese medicine doctor to help your countryman Dr. Osama Al Dallal who suffered from ALS. This condition is within the category of the top six difficult health problems.
　

When he arrived here twenty days ago, his symptoms are 1. Muscle jumping all day long over the body. 2. weak hands gripping power 4 kilos and 7 kilos.3. Joint pains over the body. 4. Stiffness of the two legs. 5 high blood  pressure. 5 could only walk for 20 meters with the aid of the walker.
　

We offered Chinese medicine herbal tea, massage and acupuncture for Dr. Osama. After twenty days treatment here, we are very happy to see very good improvement for his symptoms. 1. Muscles jumping over the body disappear totally. 2. The gripping power of his right hand increased 4 kilos, and that of his left hand increased 3 kilos. 3. Joint pains 90% gone.4. Two legs are much softer. 5. Blood pressure comes to normal range without taking western medicine for blood pressure control. 6. Could walk 70 meters with the aid of the walker now.
　

So it is strongly suggested that Dr. Osama to stay here for the continuous another two months treatment instead of only staying here for one month. Very hopefully, he will be able to walk back without using walker after general three months treatment here. So please be kind to offer support and concern for this patient. Letting him stay here for general three months please. Thank you very much.
　

Best regards!
　

Dr. Ming

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