Name: Hrabina Vladimir                                                                                 Nationality: Czech Republic

Sex: Male                                                                                                       Occupation: Engineer

Age: 48                                                                                                           Married status: Married

Date of admission: March 9^th, 2007                                                              Date of record: March 9^th, 2007

Complainer of history: Patient himself                                                            Chief Complaint: Difficulty in vocalizing and shrink in his tongue for 2 years.

Present illness:

Two years ago, without any reason, his tongue started atrophy, combined with inflexibility of its movements and difficulty in vocalizing. In the local hospital, he, after the MRI examination, was diagnosed as MND-ALS. He did not take any treatment except in-taking Vitamin B12. Later, he lost much weight and felt numb in the limbs, shortness in breathing and had handicaps in swallowing. His condition was worse and worse. From May of 2006, he started taking our herbal tea shipped by this hospital, gradually, he felt better and better. He gained weight from 59kg to 61.5kg. The difficulty in swallowing was released a lot. He had taken our treatment in this hospital for one month from August 15^th, 2006 to September 14^th, 2006. He got visible improvement last time. After that, he took 2 months¡¯ herbal medication back home to stabilize his condition. When he finished that, he felt worse again, so he decided to come back to our hospital for the second time.  His tongue coating is yellowish and greasy, pulse is deep and thin.

Past Illness:

Normal general health status; no history of operation; no allergic history; no tuberculosis or hepatitis history.

Personal history: he was born in Czech, living condition is damp, and he doesn¡¯t have the habit of 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 wife are healthy.

Physical Examination

Vital signs: T 36.5¡æ, P 81/min, R 21/min, BP 106/76 mmHg

The patient is well developed; well nourished. He has a clear mind, tired complexion of chronic disease, cooperative examination. There are no swellings of lymph nodes, normal skin; lips are red, alveolar ridges normal. Normal contour and normal breast. No abnormal breath sound. No pathologic heart murmur. His heartbeat is 80 and rhythm is normal.

Specialized Examination: His tongue body is visibly shortened, not flat, and uneven at the edge of the tongue. The tongue body is not soft but hard, tongue coating is yellowish and greasy, pulse deep and thin, there is a clear visible muscle twitch in his upper limbs, but the shaking in his right lower limbs is much clearer. There is a clear atrophy in his right supraspinous muscle.

Auxiliary examination:

MRI results certify MND-ALS

Tentative diagnosis:

TCM: flaccidity syndrome

Western Medicine: MND-ALS

Symptomatology diagnosis:

Impairment of the liver and kidney£»Weakness of the spleen and stomach.

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, nourishing the liver and the kidney. The prescription is No.2 for ALS.

6. Acupuncture and massage once a day.

7.     Increase nourishment; keep a diet of enough protein and be optimistic.

The medical record of doctors¡¯ round

March 10^th, 2007 9:00 am

Today the professor Yan, the patient¡¯s attending doctor checked the patient. The patient¡¯s tongue is visibly shortened; the edge of the tongue is not flat, it is uneven. The tongue body is not soft but hard, tongue coating is yellowish and greasy, pulse deep and thin. There is a clear muscle twitch in his upper limbs, but the shaking in his right lower limbs is clearer than that of left one. Therefore, the attending doctor decided to use the No.2 prescription for ALS.

March 11^th, 2007 9:00 am

The return receipts of his Three-routine examination, electrocardiogram and kidney-function examination show that no abnormity exists. ALT: 51U/T (+); AST: 53U/T (+); TBIL: 71.1umol/L (+); DBIL: 13umol/L (+).

March 12^th, 2007 9:00 am

Today he does not feel any discomfort, fever, headache, dizziness, or nausea. His spirit is good, and he slept well last night. His bowel movement and urination are normal. His tongue body is still visibly shortened; the edge of the tongue is uneven as before. Clear visible muscle twitch in his upper limbs. There is also a clear shrink in his right supraspinous muscle. The tongue is reddish; tongue-coating is yellowish and greasy, deep and thin pulse.

March 16^th, 2007 9:00 am

Today he did not complain about any discomfort, fever, headache, dizziness, or nausea. His spirit is good, and he slept well last night. His bowel movement and urination are normal. His tongue body is still visibly shortened, not flat and uneven at the edge of the tongue. There is visible muscle twitch in his upper limbs. The atrophy in his right supraspinous muscle is slightly reduced. The tongue is reddish; tongue-coating is yellowish and greasy, deep and fine pulse.

March 20^th, 2007 9:00 am

Today he does not feel any discomfort, fever, headache, dizziness, or nausea. His spirit is good, and he slept well last night. His bowel movement and urination are normal. His tongue body is 1or 2cm longer than before. His speaking is slightly clearer. It is uneven at the edge of the tongue. Clear visible muscle twitch in his upper limbs. There is also a clear shrink in his right supraspinous muscle. The tongue is reddish; tongue-coating is yellowish and greasy, deep and fine pulse.

March 24^th, 2007 9:00 am

Today he does not feel any discomfort, fever, headache, dizziness, or nausea. His tongue can put out longer, his speaking is clearer than before. His spirit is good, his appetite is good, and he slept well last night. His bowel movement and urination are normal. The tongue is reddish; tongue-coating is white and thin, deep and fine pulse. No change in his prescription.

March 28^th, 2007 9:00 am

Today he does not feel any discomfort, fever, headache, dizziness, or nausea. His tongue can put out longer; his speaking is clearer and more fluent than before. His spirit is good, his appetite is good, and he sleeps well. His bowel movement and urination are normal. The tongue is reddish; tongue-coating is white and thin, deep and fine pulse. No change in his prescription. We ask him to enhance the exercise about his tongue- function.

April 1^st, 2007 9:00 am

He says he have gained further improvements. The extent of the movements in his tongue is enlarged; he can speak more clearly, the uneven edge of his tongue is better than before. His appetite and sleeping are as good as before. He has normal urination and bowel movements. The tongue fur is white and fine. Deep and fine pulse.

April 5^th, 2007 9:00 am

Today he doesn¡¯t complain about any discomfort. His tongue can put out a bit longer; his speaking is clearer and more fluent than before. His spirit is good, his appetite is good, and he slept well last night. He has normal bowel movement and urination. The tongue is reddish; tongue-coating is white and thin, deep and fine pulse. The same prescription as before.

April 9^th, 2007 9:00 am

Today he doesn¡¯t feel any discomfort. His tongue can put out a little longer; his speaking is clearer and more fluent than before. His spirit is good, his appetite is good, and he slept well last night. His bowel movement and urination are normal. The tongue is reddish; tongue-coating is white and thin, deep and fine pulse.

April 13^th, 2007 9:00am

Today he doesn¡¯t complain about any discomfort. His tongue can put out a little longer; his speaking is clearer and more fluent. His spirit is good, his appetite is good, and he slept well last night. He has normal bowel movement and urination. The tongue is reddish; tongue-coating is white and thin, deep and fine pulse. The doctor asked him to do more exercise about tongue function.

April 17^th, 2007 9:00am

Today he doesn¡¯t complain about any discomfort, His tongue can put out a bit longer; his speaking is clearer and more fluent than before. His spirit is good, slept well, appetite is good. His bowel movement and urination are normal. The tongue is reddish; tongue-coating is white and thin, deep and fine pulse.

April 21^st, 2007 9:00am

Today he does not complain about any discomfort, fever, headache, dizziness, or nausea. He slept well last night. The tongue is reddish; tongue-coating is white and thin, deep and fine pulse.

April 25^th, 2007 9:00am

Today he doesn¡¯t complain about any discomfort, he can put out his tongue about 2cm longer. His speaking is clearer and more fluent. The tongue is reddish; tongue-coating is white and thin, deep and fine pulse.

April 29^th, 2007 9:00am

Today he doesn¡¯t complain about any discomfort, he can put out his tongue about 2cm longer. He can speak clearer and more fluently. His upper-limbs are stronger, the muscle-twitch on his body almost disappear. The atrophy in his both supraspinous muscles is generally recovered. The tongue is reddish; tongue-coating is white and thin, deep and fine pulse. The same prescription as before, the doctor asks him to enhance the exercise about his tongue-function.

May 3^rd, 2007 9:00am