Summary: On January 08, 2011, David, from the
United States, who had suffered from wilting pattern or muscle atrophy in
traditional Chinese medicine (TCM) or amyotrophic lateral sclerosis (ALS) in the
concept of western medicine for 6 months, accompanied by unclear speech for 11
months and weakness and muscles atrophy of the right upper limb, was
hospitalized in our hospital. He had achieved significant improvement after 70
days TCM treatment.
Record of Hospitalization
David T. Anderson Sex: Male
Marital Status: Married
Date of Admission: Jan. 8, 2011
First Medical Record
Jan. 8, 2011 Time: 14:00 pm
45-year-old man had suffer from unclear speech for 11 months and muscle atrophy
of the right upper limb for 6 months, accompanied by weakness and muscle
jumpings all over the body. The patient was hospitalized in our hospital for TCM
treatment at 14 pm on January 8, 2011.
Essential for Diagnosis:
patient had suffered from unclear speech for 11 months and muscle atrophy of the
right upper limb for 6 months.
patient had complained of speech problem, weak wriggling of the facial and
tongue muscles and weak chewing without any obvious cause of disease in March,
2010. Then, he went to local hospital to take MRI examination and EMG check. The
report showed that Mr. David indeed had ALS. He took the medicine of Rilutek and
vitamins for the treatment of ALS, but the therapeutic effects were not great.
In August of the same year, there was evident muscular atrophy of the right
upper limb, especially of the thumb web muscles and the muscles of the thenar
and hypothenar. He lost weight for 20 pounds, accompanied by weakness and muscle
jumpings over the whole body. In November, 2011, he began to take the herbal
medicines delivered from our hospital for treatment, and his above-mentioned
conditions were reduced somewhat.
3. When the
patient hospitalized in our hospital, he had speech difficulty and swallowing
problem and sometimes he suffered from coughs. The right upper limb was weak,
accompanied by muscle atrophy. He was very easy to be tired and was feeling weak
all over the body. Besides, he had muscle jumpings over the general body and
occasionally had short breath and chest tightness. The patient felt dry in the
mouth and liked hot drinking. Sometimes, he coughed with white and sticky
sputum. He felt cold limbs. His spirit was ok. Anyway, He had good appetite and
sleep. There was bowel movement one time a day. Urine was of yellow color. The
tongue was slightly red with thin and yellow tongue-coating. In the middle of
the tongue, there were cracks, and along the tongue edge, there were tooth
marks. The surface of the tongue was a little uneven with weak wriggling of the
tongue. The pulse was slippery.
36.3¡ãC R: 20 times/minute P: 60 times/minute BP: 104/70mmHg
5. He grows
normally. The patient¡¯s daily food was of medium nutrition. He had conscious
mind and natural facial expression, but the expression was exhausted. He could
walk by himself. He cooperated with doctors when did the physical examination.
formation and size of the thorax were normal. The breathing sounds of the lungs
were clear, with no pathological murmurs. The heart rate was regular and it was
60 times per minute.
Examinations of MRI and EMG in March, 2010 in America showed the patient had
been attacked by ALS.
The patient complained of speech problem for 11 months, accompanied by weakness
of the right upper limb and muscle atrophy for 6 months. Due to the long time of
disease, the qi and blood of the patient had been damaged and it also caused the
deficiency of intestines, spleen and qi, and therefore, speech problem, chewing
difficulty and weakness over the whole body occurred. Nutrition could not be
better digested due to the deficiency of intestines and spleen. And because of
that, he suffered from muscle atrophy. Muscle jumpings over the general body
were due to insufficiency of the liver and kidney. From the principle of TCM,
deficiency of intestines, spleen and qi and liver-kidney yin deficiency were the
characters of atrophy disease.
Medicine: According to the reports of
electromyography and MRI and the symptoms of speech problem and muscle spasms
over the general body, he should have suffered from ALS.
Atrophy diseases are usually differentiated with Bi syndrome or impediment
pattern. Atrophy diseases have such characteristics as atrophy of the limbs¡¯
muscles, the weakness of the limbs and the uselessness of the thin feet. The
muscular atrophy and muscle jumpings are the main symptoms of atrophy diseases.
The impediment patterns are reflected by the pains or tense pains on the body
joints. So it is easy to differentiate them.
diagnosis: ALS should be differentiated with
myasthenia gravis. Myasthenia gravis would be aggravated after exercises and it
would be reduced after some rest. Almost no muscle atrophy and muscle jumpings.
But ALS is caused by lesions of the central nervous system, accompanied by
muscular atrophy and muscle jumpings. Therefore, there is no difficulty to
identification: liver-spleen qi vacuity and liver-kidney yin
medicine diagnosis: ALS
Treatment strategy and nursing:
care of traditional Chinese internal medicine.
Pathogenesis: dampness and heat staying in the channels and joint points, qi
vacuity and blood stasis, and deficiency of the livers and lungs.
strategy: fortifying spleen, nourishing intestines and
nourishing liver and spleen.
tea: one dosage a day and drink twice
Acupuncture and massage: once a day
more medical examination if necessary.
9, 2011 Time: 10:00 am
Zhang, associate chief physician, paid a visit to the patient. The patient
complained of disfluency in speech, occasional coughing, swallowing problem, and
weakness over the whole body and muscle jumpings. There was evident muscle
atrophy on the right upper limb, especially on the thenar and hypothenar
eminences and tucks muscles. He was easy to be fatigue after doing some
exercise. Occasionally, the patient suffered from short breath and choking
sensation in the chest. He felt dry in the mouth and liked warm drinking. He
expectorated with white and viscous sputum. The patient always felt cold in the
four limbs. He had normal spirit and good appetite and sleep. One time of bowel
movement everyday. The tongue was light red with thin and yellow tongue coating.
There were cracks in the middle of the tongue, teeth prints on the edge of the
tongue and slightly rough and uneven tongue surface. The pulse was slippery. He
had the medical history of asthma. Professor Zhang thought from the TCM
principle that the patient¡¯s conditions were due to the deficiency of
intestines, spleen and qi and the deficiency of liver, spleen and yin. He
suffered from atrophy diseases. The TCM formula should have the functions of
invigorating intestines, fortifying spleen and nourishing liver-kidney.
10, 2011 Time: 10:00 am
said there was slightly reduce in the dry taste in the mouth. No change on other
12, 2011 Time: 10:15 am
complained of bad sleep those days and no evident change on the muscle jumpings
of the upper limbs and muscles behind the legs of lower limbs. Yesterday, the
stool was watery but he did not sugger from diarrhea. Urine was good. Thirst in
the mouth was reduced and the saliva was much. The tongue was slightly red with
thin and yellow tongue coating. There were cracks in the middle of the tongue,
teeth prints on the edge of the tongue and slightly rough and uneyen tongue
surface. No obvious change on the creeping motion of the tongue body. The pulse
16, 2011 Time: 10:30 am
said muscle jumpings of the muscles behind the legs were reduced, even though no
evident change on the muscles of the two upper limbs and back. There was some
improvement in speech problem, dry taste and the quantity of saliva in the
mouth. There was some increase of the tucks muscles. The tongue was slightly red
with thin tongue coating. The pulse was slippery and weak. His spirit, appetite
and sleep were good.
20, 2011 Time: 10:00 am
complained of bad sleep due to the noise of the air conditioner in recent two
days. He felt obvious muscle jumpings during the night. The power of the two
hands was increasing. The patient felt slightly dry in the mouth. The quantity
of saliva was basically normal. The tongue was slightly red with thin and yellow
tongue coating. The pulse was slippery but a little bit powerful.
24, 2011 Time: 10:00 am
felt better those days. He did not suffer from asthma since being hospitalized
in our hospital. Swallowing was good. He sometimes got coughing when drank water
too fast. Strength over the whole body was increasing. The power of gripping:
right hand, 13.1kg, left hand, 27.4kg. Muscle jumpings were reduced. The patient
did not feel too dry in the mouth any more. And the quantity of saliva was
basically normal. The tongue was slightly red with thin and yellow tongue
coating. The pulse was slippery.
28, 2011 Time: 9:00 am
had nasal obstruction, dry feeling in the throat and mouth and weak sensation
over the general body due to catching a cold recently. He did not cough. Sleep
was not so good. Speech was better. There was no evident change on muscle
31, 2011 Time: 9:00 am
said he had recovered from cold.
5, 2011 Time: 10:00 am
felt less muscle jumpings these days, especially during the night. Other
conditions were stable. The tongue was a little bit red with white and thick
tongue coating. The pulse was slippery.
9, 2011 Time: 11:00 am
jumpings were reduced, but there were still some jumpings on the muscles of the
upper limbs, shoulders and back. He did not feel dry in the mouth and throat any
more. Swallowing was good. The strength of the four limbs was increasing and the
motion of the two hands was better than before. The tongue was a little bit red
with white and thick tongue coating. The pulse was slippery.
12, 2011 Time: 11:10 am
patient¡¯s conditions were stable recently. The mouth was a little dry. Appetite
and sleep were good.
16, 2011 Time: 9:30 am
said the strength over the whole body was increasing. It was easy for him to do
some exercise. The muscle jumpings over the general body were reduced to around
60%. There was a sense of sore pains on the region of the right cheek bone, but
it was much better than 3 days ago. Speech was better. Swallowing was good. He
felt dry in the mouth during the night. When he lied on his side, he liked to
breathe with his mouth open. The motion of the tongue was more flexible than
before. There was some improvement in the uneven tongue surface. The tongue was
red with white and slightly yellow tongue coating. The pulse was slippery.
21, 2011 Time: 9:00 am
of the patient were keeping better. Appetite and sleep were good. He felt weak
when spoke with slow tempo.
25, 2011 Time: 9:00 am
said his conditions were better. Appetite, sleep and swallowing were good. He
did not feel dry in the mouth any more. Muscle jumpings on the right upper limb
were a little obvious. The weak sense of the speaking was turning better. The
tongue was red with thin tongue coating. The pulse was thin and slippery.
28, 2011 Time: 10:00 am
complained of no special change on his conditions in recent 3 days. He felt dry
in the mouth. Sleep was not so good. The tongue was red with thin and yellow
4, 2011 Time: 10:00 am
said his conditions were turning better. The strength over the whole body was
increasing. Dry taste in the mouth dispelled. He could sleep around 7 hours.
Except that muscle jumpings on the right upper limb were still evident, muscle
jumpings on other parts were reduced. The phlegm in the throat was gone.
8s, 2011 Time: 10:00 am
complained that the weak sense of speaking sometimes was good but sometimes was
bad. The tempo of speech was slow. Other conditions were turning better and
12, 2011 Time: 10:00 am
conditions of the patient were stable those days.
18, 2011 Time: 9:30 am
said his conditions were better. And he asked to leave the hospital tomorrow.
19, 2011 Time: 10:00 am
than 2 months TCM treatment, the patient requested to leave hospital today.
After treatment in our hospital, the patient¡¯s conditions were much better than
before. He did not suffer from choking, swallowing problem, the peristaltic
facial muscles, dryness in the mouth, short breathing, chest tightness and cold
limbs any more. There were some evident improvements on speech problem, chewing
weakness, weak sense of the general body and muscle jumpings. Since he was
hospitalized in our hospital, his asthma had been controlled without any
advice after leaving hospital:
2. Take 30
days herbal medicine back for continuing treatment.
wind-cold and be careful with the cold.
4. Keep doing functional
exercise of the limbs and the muscles of the tongue.
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