Sex: Male                                                                                                           Profession: Engineer

Age: 47                                                                                                               Married status: Married

Date of hospitalization: August 15^th, 2006                                                            Date of record: August 15^th, 2006

Chief Complaint: The patient has suffered difficult in vocalizing and shrinking of his tongue for 2 years.

Present illness:

Two years ago, without any reasons, his tongue started to be atrophic, combined with inflexibility of its movement and difficulty in vocalizing. In the local hospital, he, after the MRI examination, was diagnosed with ALS, which was difficult to be cured. He did not take any treatment except take Vitamin B12. Later, he became thinner and felt numb in the limbs, shortness in breathing and had difficulty in swallowing. His condition was worse and worse. Three months ago, he tried our herbal tea prescribed by our hospital, gradually, he felt better and thus he came to our hospital for better comprehensive treatment. The difficulty in swallowing was reduced a lot. His tongue coating is yellowish and greasy. The pulse is deep and fine.

Past Illness:

Generally normal health status; no history of operation; no allergic history to any medicine; no infectious disease history of tuberculosis or hepatitis.

Personal history: he was born in Czech. The living environment is damp. The patient has no addiction to smoking or drinking and has a peaceful personality.

Marriage history: he got married at 22 years old; he has one son. Both of his son and his wife are healthy.

Physical Examination

Vital signs: T 37≧, P 80/min, R 21/min, BP 130/92 mmHg, weight 59kg.

Normal growth of his body and good nutrition level. Clear mind and tired complexion. Cooperative for examination. There are no swellings of lymph nodes. Normal skin. The lips are red, alveolar ridges normal. Breast is normal. No abnormal breath sound. No pathologic heart murmur. Heart rate is 80 times per minute and the rhythm is normal.

Specialized Examination: His tongue body is obviously shortened and uneven at the both edges of the tongue. The tongue body is not soft but hard, tongue coating is yellowish and greasy. The pulse is deep and fine. There is obvious muscular shaking of his upper limbs, but the shaking of the right lower limbs is clearer than that of left one. There is also obvious atrophy in his right supraspinous muscle.

Diagnosis:

TCM: flaccidity Syndrome (Impairment of the liver and kidney, deficiency of spleen and stomach.)

Western Medicine: ALS

Differential Diagnosis:

At the last period of arthralgia-syndrome, the limbs got the symptom of atrophy, because the limbs can't move flexible and the joints are painful a lot. But there is no pain of the joints in the symptoms of flaccidity syndrome, and the pain of the joints is a characteristic of arthralgia-syndrome. The patient does not feel painful in the joints; he just has the symptoms as shortened tongue-body, unclear voice and difficulty in speaking, uneven tongue edge, irregular tongue-body, spasms of the muscle of his four limbs.

Treatment strategy:

1. TCM medical department routine nursing.

2. Second level nursing.

3. Accompany nursing.

4. Half liquid diet.

5. Herbal tea for supplementing qi and nourishing yin, tonifying the liver and the kidney, and Zi Gan Yang Rong Decoction is prescribed for him, twice a day, 200 milliliters each time.

6. Acupuncture and massage once a day.

7. Increase nutrition; take a diet with enough protein and try to keep optimistic.

Physical conditions after our treatments:

After 28 days' treatments here, his tongue gets a clear improvement. It can move more flexibly like twisting or curving in the mouth, he can speak more clearly, the right edge of his tongue-body is obviously flatter than before, and the left edge gets a slight improvement. The muscular spasms all over the whole body fundamentally disappear. His tongue coating is white and thin; pulse is deep and fine.

The daily record is as follows:

August 21^st, 2006 9:30 am

He has a common mood and feels energetic. Normal appetite. There is obvious shaking in his lower limbs and frequent shaking in the back. He can sleep well. The urination and bowel movement are normal. The tongue coating is yellowish and greasy. The pulse is deep and fine.

August 22^nd, 2006 9:00 am

He has a better mood today. The feeling of his tongue is better and its movement is slightly better. There is still obvious shaking of his four limbs. The atrophy of his right supraspinous muscle is slightly better. His sleeping is good. The tongue coating is yellowish and greasy, and the pulse is deep and fine.

August 25^th, 2006 10:00 am

Today the patient feels better of his tongue, it can move more flexibly, and he can feel the improvement when speaking. The shaking in his back is reduced more, but there is still obvious shaking in his lower limbs. He feels energetic all over the body. His appetite and sleeping are good. The bowel movement and urination are normal. We tell him to do the tongue exercise three times for 30 minutes a day, relatively at morning, noon, and afternoon. When doing the exercise, we ask him to swallow the saliva.

August 28^th, 2006 9:00 am

He feels good about the tongue, it can move more, and he can speak clearer and stronger. The shaking in his back continued to be reduced. But the shaking in his lower limbs is slightly reduced; the atrophy in his right supraspinous muscle is fundamentally recovered. His mood and appetite are good, sleep well. The tongue coating is yellowish and greasy, and pulse is deep and fine.

August 31^st, 2006 9:00 am

He feels that has been better than before. His tongue can move a little bit more. He can also speak much clearer. The atrophy in his right supraspinous muscle is recovered. His mood and appetite are good, sleep well. The tongue coating is yellowish and greasy, and the pulse is deep and fine.

September 3^rd, 2006 9:00 am

The patient tell us that he gets much improvements, he can move his tongue more freely, even roll his tongue in his mouth, his voice is clearer. The hollowed surface at the right edge of his tongue is better, and the shakings in his back, shoulder and lower limbs are slight. He can do sports longer and stronger without tiredness. His appetite and sleeping are as good as before.

September 6^th, 2006 9:00 am

He feels more improvements, he can move his tongue more flexibly, even roll more his tongue in his mouth, his voice is much clearer. The hollowed surface at the right edge of his tongue is flatter, and the spasms in his back, shoulder and lower limbs have disappeared. His emotional condition is quite good. He can do exercise longer and stronger without tiredness. His appetite and sleeping are as good as before. He has normal urination and bowel movement. The tongue fur is yellowish and fine. Keep on with the same prescription of herbal tea. We ask him to do more exercise about his tongue functions.

September 9^th, 2006 9:00 am

He tells us that he has gained further improvements. The extent of the movements at his tongue is increased; he can roll and stretch more his tongue in his mouth, he can speak more clearly, the edge of his tongue is flat without atrophic surface, and only a little atrophic at the left edge. The muscular shaking all over his body disappears. His appetite and sleeping are as good as before. He has normal urination and bowel movement. The tongue coating is yellowish and thin.

September 12, 2006 9:00 am

He says he gains further improvements. The extent of the movements in his tongue is increased; he can roll and stretch more his tongue in his mouth, his voice is clearer, the edge of his tongue is flat without atrophic surface and only a little atrophy at the left edge. There is no obvious  muscular shaking all over his body. His appetite and sleeping are as good as before, and he feels energetic all the time. He has normal urination and bowel movements. The tongue coating is whitish and thin. The pulse is deep and fine. The weight rises up to 61.5 kg from 59 kg now.

September 14^th, 2006 8:00 am

Today is his last time treatment. In the early morning we give him an earlier routine treatment because he has to catch the flight. He says the treatment we have offered him is very successful; he has gained much improvement here. There is no obvious muscular shaking all over his body. The edge of his tongue is flat without atrophic surface and only a little atrophy at the left edge of the tongue. He can roll and stretch more his tongue in his mouth, his voice is clearer. The tongue coating is whitish and thin. The pulse is deep and fine.