Brief Summary: On Apr. 10, 2009, Hassan from Nigeria, who has suffered from white patches all over the body for one year, was hospitalized in our hospital. He has achieved much improvement after 15 days TCM treatment here.

 

Record of Hospitalization

Name: Hassan                                                                                                          Sex: Male          

Age: 46                                                                                                                    Profession: Businessman

Marital Status: Married                                                                                          Date of Admission: Apr. 10, 2009

Onset Season: Vernal equinox                                                                                 Date of Record: Apr. 10, 2009

Complainer: The patient himself

 

First Medical Record

Date: Apr. 10, 2009                                      Time: 19: 00 p. m.

Hassan, a 46-year-old male, has suffered from white patches all over the body for one year. He was hospitalized in our hospital for treatment at 19: 00 p. m. on Apr. 10, 2009.

Essentials for Diagnosis:

1. The patient has suffered from white patches all over the body for one year.

2. Last January, the patient began to feel that the skin of the armpits turned white and it developed to white patches. So he went to a local hospital for examination and was diagnosed with vitiligo. Then he took some medicine for treatment, but there was no obvious improvement. Besides, he went to Dubai for treatment in January, but there was still no improvement and the condition gradually became worse. So he came to our hospital for treatment. Since he suffered from the disease, his spirit and appetite were generally good, but his sleep was not good. His bowel movement was normal, but he had frequent urination with 4-5 times of night urination every night.

3. T 36.5≧, P 80 times/minute, R 20 times/minute, BP 120/70mmHg.

4. He grew normally with common nutrition. His mind was clear. He had an expression of chronic illness and tiredness. His body was in a positive posture and he was cooperative with clear mind.

5. There were generalized white patches all over the body in big size which formed masses. The hairs on the area of the lesions turned white. His skin was dry.

6. 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.

7. Accessory examination: None.

Diagnostic Basis:

TCM: The patient has suffered from white patches all over the body for one year. There were generalized white patches all over the body in big size which formed masses. The hairs on the area of the lesions turned white. His skin was dry. There was no sense of itching and scorching hot. He could feel the mouth dry and bitter. He had much drinking and was fond of cold drink. His sleep was not good. His bowel movement was normal, but he had frequent urination with 4-5 times of night urination every night. His tongue was pale dark with the cracks in the middle of the tongue. His tongue coating was thin and white. His pulse was thready and rapid. According to the symptoms of the tongue and pulse, the patient was diagnosed with white patches due to dual vacuity of qi and yin, effulgent yin vacuity fire, disharmony of qi and blood. These conditions resulted in improper nourishment of the skin, and then the color of the skin turned white and finally formed the white patches.

Western Medicine: The patient has suffered from white patches all over the body for one year. There were generalized white patches all over the body in big size which formed masses. The hairs on the area of the lesions turned white. His skin was dry. There was no sense of itching and scorching hot. So it was not difficult to be diagnosed as vitiligo.

Diagnostic Differentiation:

TCM: The patient¨s vitiligo should be differentiated from sweat stain (lentigo aestiva). Vitiligo is characterized by pure white patches with white hairs in the middle, while the skin around was in deep color. There are no feelings of pains or itching. Regarding sweat stain, the area of the lesions is 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: Vitiligo 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 is born or not long before someone¨s birth and it will be kept for a whole life. So they are not difficult to be distinguished in clinics.

First Diagnosis:

TCM (Traditional Chinese Medicine) diagnosis: White patches

Symptom identification: dual vacuity of qi and yin, effulgent yin vacuity fire.

Western Medicine diagnosis: Vitiligo

Plans for treatment strategy and nursing:

1. Routine care of traditional Chinese internal medicine.

2. Grade II care.

3. Common diet.

4. TCM treatment strategy: boost qi, enrich yin, downbear fire, nourish the blood, free the channels and network vessels and restore the skin.

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

Main herbs used in the herbal tea: baishao (white peony root), chuanxiong (ligusticum root), danpi (moutan root bark), etc.

6. Acupuncture and massage: once a day.

7. Have more medical examination if necessary.

 

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

The patient has suffered from white patches all over the body for one year. Last January, the patient began to feel that the skin of the armpits turned white and it developed to white patches. He was given the medicine for treatment in the local hospital, but there was no obvious improvement. Besides, he went to Dubai for treatment in January, but there was still no improvement and the condition gradually became worse. So he came to our hospital for treatment. At present, there were generalized white patches all over the body in big size which formed masses. The hairs on the area of the lesions turned white. His skin was dry. There was no sense of itching and scorching hot. He could feel the mouth dry and bitter. He had much drinking and was fond of cold drink. His sleep was not good and was easy to wake up. He could sleep for 4-5 hours every night. He had the symptom of headache and dizziness. He was easy to be angry and tired. Sometimes, he could feel aching pains of the shoulders and back as well as the stomach pains. Besides, he had constipation. He felt scorching pains when urinating. He had frequent urination with 4-5 times of night urination every night. His tongue was pale and dark with the cracks in the middle of the tongue. His tongue coating was thin and white. His pulse was thready and rapid. According to the symptoms of the tongue and pulse, Professor Yang believed that the patient had suffered from white patches due to dual vacuity of qi and yin, effulgent yin vacuity fire. So the treatment strategy was to boost qi, enrich yin, downbear fire, nourish the blood, free the channels and network vessels and restore the skin. The prescription was as follows: baishao (white peony root), chuanxiong (ligusticum root), danpi (moutan root bark), etc. 4 dosages in total.

 

Date: Apr. 12, 2009                                     Time: 15: 00 p. m.

According to the feedback, the routine examinations of the bowel movement, urine and blood were normal. The function of the liver and kidneys were normal.

 

Date: Apr. 14, 2009                                      Time: 15: 00 p. m.

The patient said his sleep was better than before, but there was no change of the skin. Continue to take the same prescription. Meanwhile, the doctor prescribed some herbs for external use. 4 dosages in total.

 

Date: Apr. 18, 2009                                      Time: 15: 00 p. m.

His sleep was good, but there was slight abdominal distention. The dryness of the skin was improved, but there was no change of the area of the white patches. The former prescription was changed a little. 4 dosages in total.

 

Date: Apr. 22, 2009                                      Time: 15: 00 p. m.

His spirit and sleep were good. His urine and bowel movement were normal. There were no abdominal distention and dryness of the skin. The area of the white patches slightly turned dark. Continue to take the same prescription. 4 dosages in total.

 

Date: Apr. 25, 2009                                      Time: 10: 00 a. m.

The patient decided to leave the hospital tomorrow.