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Brief Summary:
On Aug. 27,
2009, Michael from
Philippines, who has suffered
from the muscular atrophy and lack of power for one year, accompanied by the
useless right hand and difficult walking for half a year. After 29-day
treatment here, the stiffness of the both arms disappeared and he could bend and
stretch them freely. The gripping power of his both hands was obviously
increased. He could raise the both arms freely. The muscular stiffness
disappeared. The pains of the right wrist, elbow and
shoulder was stopped. The power of the both lower limbs was increased. He
walks very freely. He felt pretty good. His appetite was good. The sleeping
was normal.
Record of Hospitalization
Name: Michael
Birthplace:
Philippines
Sex: Male
Profession: Worker
Age: 40
Date of Admission: Aug. 27, 2009
Religion:
Philippines
Date of Record: Aug. 27, 2009
Marital
Status: Married
Onset Season: Autumnal equinox
Complainer:
The patient himself
First Medical
Record
Date: Aug. 27,
2009 Time: 19: 00 p. m.
Michael, a
40-year-old male, has suffered from the muscular atrophy and lack of power for
one year, accompanied by the useless right hand and difficult walking for half a
year. He was hospitalized in our hospital at 19: 00 p. m. on Aug 27, 2009.
Essentials for
Diagnosis:
1. The
patient has suffered from the muscular atrophy and lack of power for one year,
accompanied by the useless right hand difficult walking for half a year.
2. In
September, 2008, the patient began to feel the muscular atrophy and lack of
power without obvious reasons, but he didn¡¯t pay much attention to it at that
time and hadn¡¯t taken any examination or treatment. The situation is getting
worse day by day, so he was given MRI examination in the local hospital and was
diagnosed with ALS. The doctor told him there was no treating strategy, so he
didn¡¯t receive any treatment. During the recent half a year, the patient¡¯s
condition was getting worse, his right hand is useless and feel difficult in
walking (he could just walk for 500 meters). In June of 2009, he was given
acupuncture and massage in a Chinese clinic locally, and the condition was
better. In July of 2009, the patient began to take the herbal tea sent from our
hospital, and he felt the condition was improving. So he came to our hospital on
Aug. 27, 2009 for further treatment. At that time, his energy and appetite was a
litter bad, the sleeping was ok, both the urine and stool were ok.
3. T
36.4¡æ, R 20 times/minute, P 80 times/minute, BP 110/85mmHg.
4. He
grew normally with medium nutrition. His mind was clear. He had an expression of
chronic illness and tiredness. His body was cooperative with his mind.
5.
No thoracic
deformity. Sound of breath was bilaterally normal on auscultation. No dry and
moist damp rales. Heart border was normal. Heart beat was 80 times/minute.
Cardiac rhythm was regular. No pathological murmurs on auscultation.
6. The
patient felt weakness of the both upper extremities, and
supraspinous muscle was a little atrophied. His both upper extremities couldn't
do outward rotation and feel difficult to hold up. He was not able to hold
things in both hands. Both the thenar muscles and hypothenar muscles are
atrophied. The interphalangeal joints were so stiff that he couldn't extend
them.
The gripping power of the left hand was
4.0 kg (+)
and that of the right hand was
2.2 kg (+).
The muscular tension of the both upper extremities was weak. The myodynamia was
of grade
¢ò.
The both lower limbs of was so weak that he felt difficult in walking. He could
just walk for 500 meters. The gastrocnemius of the both lower limbs was
atrophied, especially in the right side. The myodynamia was of grade
¢ó.
The muscular tension was a little weak.
7. Accessory
examination:
Absent.
Diagnostic Basis:
TCM: The
patient has suffered from the muscular atrophy and lack of power for one year,
accompanied by the useless right hand and difficult walking for half a year.
The patient was mainly characterized by muscular
looseness and weakness resulting in the muscular atrophy and the patient
couldn¡¯t freely move as the time going. His
tongue was dark. His tongue coating was yellow and slimy. His pulse was wiry,
thready and slippery. According to the symptoms of the tongue and pulse,
he was diagnosed with wilting pattern.
Western Medicine: The patient has suffered from the muscular atrophy and lack of
power for one year, accompanied by the useless right hand and difficult walking
for half a year. The patient's both upper extremities were weak, and the
supraspinous muscle was a little atrophied. His both upper extremities couldn't
do outward rotation and feel difficult to hold up. He was not able to hold
things in both hands. Both the thenar muscles and hypothenar muscles are
atrophied. The interphalangeal joints were so stiff that he couldn't extend
them.
The gripping power of the left hand was
4.0 kg (+)
and that of the right hand was
2.2 kg (+).
The muscular tension of the both upper extremities was weak. The myodynamia was
of grade
¢ò.
The both lower limbs were so weak that he felt difficult in walking. He could
just walk for 500 meters. The gastrocnemius of the both lower limbs was
atrophied, especially in the right side. The myodynamia was of grade
¢ó.
The muscular tension was a little weak.
He was given MRI examination in the local hospital and was diagnosed with ALS in
May, 2009.
Diagnostic
Differentiation:
TCM: The
patient's wilting pattern should be differentiated from the 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. So 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 no the following symptoms:
cranial nerve palsy, trembling of the eyeballs, speech difficulties and
ataxia.
The disease can be diagnosed clearly by the examination of CT or MRI.
First Diagnosis:
TCM diagnosis:
Wilting pattern
Symptom
identification: the liver-kidneys yin vacuity and the improper nourishment of
the sinews.
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. Normal
food.
5. TCM
treatment strategy: enrich the liver and the kidneys, emolliate the sinews and
free the channels.
6. Herbal
tea: one dosage a day and drink twice.
7. Acupuncture
and massage: once a day.
8. Have
more medical examinations if necessary.
Date: Aug. 28,
2009 Time: 11: 00 a. m.
The patient was
hospitalized for the muscular atrophy and lack of power for one year,
accompanied by the useless right hand and difficult walking for half a year.
After the examination, both the thenar
muscles and hypothenar muscles are atrophied. The gripping power
of the left hand was 4.0 kg (+)
and that of the right hand was 2.2 kg
(+). He was not
able to hold things in both hands. The interphalangeal joints were so stiff that
he couldn't extend them. The bilateral supraspinous muscle was atrophic. His
both upper extremities couldn't do outward rotation and feel difficult to hold
up. The gastrocnemius of the both lower limbs was atrophied, especially in the
right side. He felt difficult in walking accompanied by the stiff muscles of the
both arms. The joints of the elbow and the wrist of right shoulder were painful.
His tongue was dark. His tongue coating was thin. His pulse was
thready. His problem is due to Professor Yang believed that the patient had
suffered from wilting pattern due to the liver-kidneys yin vacuity and the
improper nourishment of the sinews. So the treatment strategy for him was to
enrich the liver and the kidneys, emolliate the sinews and free the channels.
Date: Sep. 1, 2009 Time: 10: 00 a. m.
The patient's fingers of the both hands were more active than before. The
difficulties in holding up the both arms were better. The stiffness of the
muscles of the both arms released. The joints of the right neck, elbow, and the
wrist were not painful. The other symptoms were the same as before. The former
prescription was changed a little. 5 dosages in total.
Date: Sep. 6, 2009 Time: 10: 00 a. m.
After 9-day
treatment of enriching the liver and the kidneys, emolliating the sinews and
freeing the channels, the fingers of the both hands
were more active than before. The gripping power of the left hand was increased.
The stiffness of the both arms was better. The pains of joints of the right
neck, elbows, and the wrists were obviously released. The both lower limbs were
more powerful than before. His tongue was dark. His tongue coating was
thin. His pulse was thready. The former prescription was changed a little. 5
dosages in total.
Date: Sep. 11, 2009 Time: 10: 00 a. m.
The stiffness of
the joints of the hands was mostly released. He could bend and stretch them
freely. The gripping power was increased. He could hold a glass and bowl, drink
water and have meals by himself. The joints of the both wrists, elbows and the
shoulders acted freely. His both arms could raise up, so did his hands.
The stiffness of the both arms was released. The
pains of the right wrists, elbows and shoulders were stopped. The power of the
both lower limbs was increased. The patient himself said that it is ok to walk
as long as he wanted. His tongue was dark. His tongue coating was thin.
His pulse was thready. The prescription was the same
as before. 6 dosages in total.
Date: Sep. 16, 2009 Time: 10: 00 a. m.
After the
treatment of enriching the liver and the kidneys, emolliating the sinews and
free the channels, softening hardness and dissipating binds, many symptoms of
the patients were better now. The stiffness of the both arms disappeared. His
tongue was a little dark. The tongue coating was thin. His pulse was thready.
The pulse was weak when being pressed heavily. So the
prescription was changed and the doctor added some herbs to fortify the spleen
and boost qi, supplement the liver and the stomach. 5 dosages in total.
Date: Sep. 21, 2009 Time: 10: 00 a. m.
The patient was given the test of the gripping power. The gripping power of the
left hand was 7 kg, which was increased 3 kg compared with that of the
admission. The right one was 3.4 kg, which was increased 1.2 kg compared with
that of the admission. The patient felt good without any
discomfort.
The prescription was the same as before. 3 dosages in total.
Date: Sep. 24, 2009 Time: 10: 00 a. m.
After
29-day treatment of enriching the liver and the kidneys, emolliating the sinews
and freeing the channels, softening hardness and dissipating binds, and
adjusting the treatment according to his symptoms, together with acupuncture and
massage, many symptoms of the patient released. The
patient decided to leave the hospital today.¡¡
Letters to Friends, To
Dr. Ming; Personal Observations and Comments From an American
Point of View
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