Brief Summary:
An ALS patient, Thanasis,
from
Greece,
who suffered from difficulties in speaking and swallowing and
the weakness of his left fingers, was hospitalized in our
hospital.
He has achieved significant improvement after more than
two-month TCM treatment in our hospital, especially his
improvement in swallowing and speaking.
Record of Hospitalization
Name:
Thanasis Sex: Male
Age:
57
Profession: Office
Clerk
Nationality:
Greece Marital Status:
Married
Onset
Season:
Summer Date of Admission: July
21, 2007
Complainer:
The
patient himself Reliability: Reliable
Major
Complaint:
The
patient has suffered from difficulties in speaking and
swallowing for two years, accompanied with weakness of his left
fingers for nine months.
Present Illness:
In July 2005, the patient began to feel unclearness and
disfluency of his speaking with some difficulty in swallowing
without any obvious causes. He coughed when he drank water. But
at that time, the patient paid no attention to it, and did no
treatment about it. Therefore, the disease was developing
progressively. In Oct. 2006, the patient began to feel weakness
of his left fingers, and then went to a local hospital for a
diagnosis. After the EMG examination, the patient was diagnosed
with
amyotrophic lateral sclerosis
(ALS).
The patient was told that his disease was incurable, and then he
got no treatment. In Feb. 2007,
the
patient went to another local hospital for a further diagnosis,
and he was prescribed by some western medicine for oral taking
until now. He was picked up by our staff in Zhijiang Airport and
arrived in Huaihua Red Cross Hospital for further treatment at
19: 00 p.m. on July 21, 2007. Since he got the disease, his
sleep and appetite were both poor. His spirit was good. His
bowel movement and urination were both normal.
Disease History:
No history of typhoid, tuberculosis, hepatitis, malaria or other
infectious diseases. No allergic history of medicine or food. No
trauma history. No history of preventive vaccination provided.
In 1997, he got an operation for his hernia. But now, it is
cured. In 1997, he suffered from diabetes. Since then, he has
taken the medicine for it until now.
Personal
History: He was born in Greece. No contact history of
schistosomiasis. No addiction to smoking, alcohol or special
food. He was mild-tempered and open-minded.
Marital History:
He
got married at the age of 29. He has one son. His wife and child
have been healthy all the time.
Family History:
His
parents were both healthy. No family history of special disease.
Physical Examination:
T 36.5¡æ£¬P
80 beats/minute, R 18 times/minute, BP 130/85 mmHg, W 98 kg.
He grew normally
with common nourishment. His mind was clear. He had an
expression of chronic illness and languidness. His body was in a
positive posture and he was cooperative in examination. His skin
was moist. No jaundice in the sclera. No superficial lymph-node
enlargement. Bilateral pupils were round and equal in size and
sensitive to light. No thoracic deformity. Sound of breath was
bilaterally normal on auscultation. No respiratory rales or
pleural friction rubs. Heart border was normal. Heart beat was
80 times/minute. Cardiac rhythm was regular. No pathological
murmurs on auscultation.
Abdomen touched flat and soft without tenderness or rebounding
tenderness. The liver and spleen were not palpable. No
percussion pains in renal region. Bowel sound was normal. No
spinal and pelvic deformity or tenderness. He suffered from
unclearness and disfluency of speech, accompanied by difficulty
in swallowing, poor movement of his tongue and coughing as
drinking. His tongue was
rugged with atrophic
tongue muscles.
His fingers were suffered from weakness so that he had
difficulty in holding any objects.
The muscles of his hands were
atrophic.
The
experiment on his hands was (+). There was uncontrollable and
frequent muscles¡¯ trembling on his upper limbs, chest and back.
The muscle
strength of his
upper limbs was Grade
¢ó
with low muscle hypertonicity. His lower limbs were weak in free
movement without any tenderness or deformity. The examinations
of the anus and pudendum were both normal. Other physiological
reflex has not been elicited. His tongue was red with white and
slightly heavy-greasy tongue coating. His pulse was slippery,
thready and weak.
Diagnostic examination: Not provided.
First
Diagnosis:
TCM
diagnosis: Wilting syndrome
Symptom identification: Spleen-kidneys lungs vacuity.
Western medicine diagnosis:
Amyotrophic Lateral Sclerosis
(ALS)
First
Medical Record
July
18, 2007
Thanasis, a 57-year-old male, has suffered from difficulties in
speaking and swallowing for two years, accompanied with weakness
of his left fingers for nine months. He was picked up by our
staff in Zhijiang Airport and arrived in Huaihua Red Cross
Hospital for further treatment at 19: 00 p.m. on July 21,
2007.
Essentials for Diagnosis:
1.
The patient has suffered from difficulties in speaking and
swallowing for two years, accompanied with weakness of his left
fingers for nine months.
2. In
July 2005, the patient began to feel unclearness and disfluency
of his speech with some difficulties in swallowing without any
obvious causes. He coughed when he drank water. But at that
time, the patient paid no attention to it, and did no treatment
about it. Therefore, the disease was developing progressively.
In Oct. 2006, the patient began to feel weakness of his left
fingers, and then went to a local hospital for a diagnosis.
After the EMG examination, the patient was diagnosed with
amyotrophic lateral sclerosis
(ALS).
The patient was told that his disease was incurable, and then he
got no treatment. In Feb. 2007,
the
patient went to another local hospital for a further diagnosis,
and he was prescribed by some western medicine for oral taking
until now. He was picked up by our staff in Zhijiang Airport and
arrived in Huaihua Red Cross Hospital for further treatment at
19: 00 p.m. on July 21, 2007. Since he got the
disease, his sleep and appetite were both poor. His spirit was
good. His bowel movement and urination were both normal.
3. T 36.5¡æ£¬P
80 beats/minute, R 18 times/minute, BP 130/85 mmHg, W 98 kg.
4. He
grew normally with common nourishment. His mind was clear. He
had an expression of chronic illness and languidness. His body
was in a positive posture and he was cooperative in examination.
5.
He suffered from unclearness and disfluency of speech,
accompanied by difficulty in swallowing, poor movement of his
tongue and coughing as drinking. His tongue was
rugged with atrophic
tongue muscles.
His fingers were suffered from weakness so that he had
difficulty in holding any object.
The muscles of his hands were
atrophic.
The
experiment on his hands was (+). There was uncontrollable and
frequent muscles¡¯ trembling on his upper limbs, chest and back.
The muscle
strength of his
upper limbs was Grade
¢ó
with low muscle hypertonicity. His lower limbs were weak in free
movement without any tenderness or deformity. The examinations
of the anus and pudendum were both normal. Other physiological
reflex has not been elicited. His tongue was red with white and
slightly heavy-greasy tongue coating. His pulse was slippery,
thready and weak.
6. No
thoracic deformity. Chest percussion noted resonance. Sound of
breath is bilaterally clear on auscultation. No sound of pleural
friction.
7.
Diagnostic examination: Not provided
Diagnostic Basis:
TCM:
The patient has suffered from difficulties in speaking and
swallowing for two years, accompanied with weakness of his left
fingers for nine months. The muscles of his upper limbs were
atrophic and weak, accompanied with languid spirit and pale
faces. His speech was neither clear nor frequent, with
difficulty in swallowing,
poor movement of his tongue and coughing as drinking. His tongue
was rugged
with atrophic tongue muscles.
His tongue
was red with white and slightly heavy-greasy tongue coating. His
pulse was slippery, thready and weak. Because of the
insufficiency of the liquids, abnormality of the qi and blood,
and the lungs heat scoring the lobes, his limbs lose the
nutrition. Due to the deficiency of
the spleen and stomach, the essence-blood could not nourish his
sinews and vessels. Then it leads to the malnutrition of the
muscles, and gradually it resulted in flaccidity.
Western Medicine: The patient has suffered from difficulties in
speaking and swallowing for two years, accompanied with weakness
of his left fingers for nine months.
He suffered from unclearness and disfluency of speech,
accompanied by difficulty in swallowing, poor movement of his
tongue and coughing as drinking. His tongue was
rugged with the
atrophic tongue muscles.
His fingers were suffered from weakness so that he had
difficulty in holding any object.
The muscles of his hands were
atrophic.
The
experiment on his hands was (+). There was uncontrollable and
frequent muscles¡¯ trembling on his upper limbs, chest and back.
The muscle
strength of his
upper limbs was Grade
¢ó
with low muscle hypertonicity. In Oct. 2006, after the EMG
examination, he was diagnosed with
amyotrophic lateral sclerosis
(ALS).
Diagnostic Differentiation:
TCM:
The patient¡¯s
wilting
syndrome should be differentiated from impediment syndrome.
Wilting syndrome is characterized by the limp, weak, and
emaciated limbs with muscular atrophy. A patient suffered from
wilting
syndrome may even become unable to hold any objects or to stand
without any support. Besides, the patient¡¯s lower limbs are more
often affected, though he or she usually has no joint pains. On
the contrary, impediment syndrome is generally characterized by
aching pains, fixed heaviness and inflexibility of sinews and
bones, muscles and joints, with occasional numbness or swelling,
though, no paralytic manifestations. They are not difficult to
be distinguished in clinics.
Western Medicine: Wilting syndrome should be
differentiated from grave myasthenia gravis, which is an
acquired autoimmune disease with the transferring obstacles of
nerve-muscles, and is caused by the autoimmune reaction
resulting from the acetylcholine receptor (AchR) of the striated
muscle. It can occur at any age and there are about 60 percent
people stricken before 30 years old. Women are more often
affected than men are. The most obvious characteristic of MG is
rapid fatigability of the skeletal muscles affected, improved
with rest or medicines that inhibits the activity of
cholinesterase. It can involve the cardiac muscle and smooth
muscle. MG patients of different ages often have different
clinical manifestations and courses, which are different from
those of wilting syndrome patients.
First
Diagnosis:
TCM
diagnosis: Wilting syndrome
Symptom identification: Spleen-kidneys lungs vacuity
Western medicine diagnosis:
Amyotrophic Lateral Sclerosis
(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.
High-protein diet.
5.
Herbal tea (to boost qi and fortify the spleen, supplement the
kidneys and boost the lungs): Taking five dosages of the herbal
tea. One dosage a day and drink twice.
Prescription: Varied Decoction of the Fortifying-Spleen and
Supplementing-Kidneys.
Main
herbs used in the herbal tea: baisheng (white ginseng), huangqi
(astragalus root), baishu (ovate atractylodes root), etc.
6.
Acupuncture and massage: Once a day.
7.
Take more exercise on the tongue and the suffering parts.
8.
Have more medical examinations if necessary.
Date:
July 22, 2007 Time:
10:00 a.m.
The
patient has suffered from difficulties in speaking and
swallowing for two years, accompanied with weakness of his left
fingers for nine months. The patient began to suffer from
unclearness speech, accompanied with difficulty in swallowing,
coughing as drinking two years ago, and his condition was
getting worse day by day. Nine months ago, he began to feel the
weakness of his left fingers with difficulty in holding any
objects. His finger and arms were both suffered from muscular
atrophy, and muscular trembling of the upper body.
His food intake was poor. Sometimes he felt there was some
phlegm on his throat. His lower limbs were weak.
His
tongue coating was slightly heavy-greasy with rugged
lingual surface. The
muscles of his tongue were atrophic and trembling. There were
tooth-marks at the edges of the tongue. The movement of his
tongue was poor. His pulse was slippery, thready and weak.
TCM
diagnosis: Wilting syndrome
Symptom identification: Spleen-kidneys lungs vacuity.
Western medicine diagnosis:
Amyotrophic Lateral Sclerosis
(ALS)
Principle of TCM treatment: Boosting qi and fortifying the
spleen, supplementing the kidneys and boosting the lungs.
Doctor¡¯s requirement is to take four dosages of the herbal tea
of the same prescription.
Date:
July 25, 2007 Time:
10:00 a.m.
The
patient felt that his difficulty in swallowing got some
improvement.
Doctor¡¯s requirement is that he
would continue to take five dosages of the herbal tea of the
former prescription.
Date:
July 30, 2007 Time:
9:00 a.m.
His
swallowing and movement of his tongue was getting better. His
sleep was bad with nightmare. The doctor advised him to add
poria, spiny jujube kernel and polygala root decocted into the
former prescription.
Date:
July 31, 2007 Time:
9:00 a.m.
Today
the patient complained that his swallowing, the movement of his
tongue and the muscular
fibrillation all
over his body all achieved some improvement. His sleep was still
poor, while his diet was normal. The TCM strategy was to boost
qi and fortify the spleen, supplement the kidneys and boost the
lungs, soften the liver and extinguish the wind. He would
continue to take four dosages of the herbal tea of the former
prescription.
Date:
Aug. 2, 2007 Time: 9:00
a.m.
His
fingers of both hands were weak with difficulty in flexible
movement of joints. The doctor advised him to take four dosages
of the herbal tea to soak his hands. The main herbs in the
herbal tea for external use are cinnamon twig, ground pine,
millettia root and stem, etc.
Date:
Aug. 4, 2007 Time: 9:00
a.m.
Today
the patient complained that his swallowing, the movement of his
tongue and the muscular
fibrillation all
over his body all achieved some improvement. His sleep was
better than before. Sometimes he felt some pains on his arms.
Doctor¡¯s requirement is to take five dosages of the herbal tea
of the same formula.
Date:
Aug. 9, 2007 Time: 9:00
a.m.
The
muscular
fibrillation all over his body was lessened. He spoke very
slowly with dry month and inflexible movement of his tongue. His
lingual surface was tugged with its muscular atrophy. His tongue
coating was white with less liquid. The TCM strategy was to
boost qi and fortify the spleen, supplement the kidneys and
boost the lungs, and extinguish the wind. He would continue to
take five dosages of the herbal tea of the former prescription.
Date:
Aug. 11, 2007 Time:
9:00 a.m.
His fingers of the
hands were with muscular atrophy and poor movement of the
fingers. The oral taking herbal tea should combine with five
dosages of the herbal tea for the external use.
The main herbs in the herbal tea for
external use are cinnamon twig, ground pine, millettia root and
stem, etc.
Date:
Aug. 14, 2007 Time:
9:30 a.m.
The
patient¡¯s difficulty in swallowing and the muscular
fibrillation all
over his body both achieved obvious improvement. His difficulty
in speaking was also getting better. The strength of the limbs
increased. He could raise his thumb to praise something good. He
also complained that he felt dumbness of his fingers and dryness
of his mouth at night, sometimes accompanied with a drumming in
the ears.
Doctor¡¯s requirement is to take five dosages of the herbal tea
of the same prescription.
Date:
Aug. 19, 2007 Time:
9:00 a.m.
The
patient¡¯s diet was poor, but his dry month was getting better.
His tongue coating was slightly greasy. He would continue to
take five dosages of the herbal tea of the same prescription,
adding tangerine peel into it.
Date:
Aug. 24, 2007 Time:
9:00 a.m.
The
patient complained that his difficulties in speaking and
swallowing achieved significant improvement. The upper limbs
were painful, and his diet was poor. Doctor¡¯s requirement is to
take four dosages of the herbal tea of the same prescription.
Date:
Aug. 28, 2007 Time: 9:00 a.m.
The patient felt
that the strength of his left fingers increased. The muscular
trembling was lessened. He had a little amount of
phlegm.
Doctor¡¯s requirement is to take three dosages of the herbal tea
of the same prescription.
Date:
Aug. 31, 2007 Time:
9:00 a.m.
These
days the patient has suffered from diarrhea with water-like
bowel movement. He had no bellyache or any swelling of stomach.
He had poor absorption and coughing. Doctor¡¯s requirement is to
take five dosages of the herbal tea of the same prescription.
Date:
Sep. 1, 2007 Time: 9:00
a.m.
The
patient suffered from diarrhea with water-like bowel movement 3
to 4 times a day. He felt poor spirit with tired body during
taking the self-prepared medicine for his diarrhea. He was given
the injection 1000ml with 10% of potassium chloride 10ml and
caloric agent. He took herbal tea orally to boost qi and fortify
the spleen and help to digest. The doctor advised him not to eat
the cold food or oily food.
Date:
Sep. 4, 2007 Time: 9:00
a.m.
The
patient still suffered from diarrhea, 2 to 3 times a day. After
using the
agastache qi-righting Pills, his
diarrhea was getting better. This morning, had only once bowel
movement and his bowel movement returned to normal. The doctor
still advised him to take the herbal tea.
Date:
Sep. 5, 2007 Time: 9:00
a.m.
The
patient suffered from diarrhea several days ago with poor intake
and weakness body. He had history of diabetes, so could not give
injection with some medicine containing any sugar or amino acid.
He got an examination of his blood sugar, which showed 6.1. The
doctor advised him to stop antidiabetic medicines, and he should
take them again after he returned his function of diet and
digestion of
intestinal tract. The herbal tea is to fortify the spleen,
transform the food, soften the liver and extinguish the wind.
Date:
Sep. 6th 2007 Time:
11:40 a.m.
The
patient complained that he had suffered diarrhea again with 4 to
5 times bowel movement last night. He felt weak with low spirit,
poor appetite and poor sleep. The herbal tea Poria and Ovate
Atractylodes Powder was to prescribe for his diarrhea. The
doctor gave him three dosages of the herbal tea, and One dosage
a day and drink twice. The western medicine was the injection
with 10% glucose 500ml + vitamin C 2.0 + 10% potassium chloride
10ml + amino acid 250 ml to supplement enough energy. Since the
patient had the history of diabetes, he was give 8 ml insulin
instead of 500 ml glucose, so as to prevent the patient¡¯ s blood
sugar increasing. The patient was given the careful treatment
and would continue to take the examination when necessary.
Date:
Sep. 12th 2007 Time:
9:00 a.m.
The
patient had 3 times bowel movement yesterday morning since he
had eaten eggs. After examination, the patient was considered to
be with poor digestion. The doctor advised him not to take any
eggs or oily food at this time. The patient¡¯s former herbal tea
should add blast-fried ginger 7 g, aconite accessory tuber 12g,
and mume fruit 20 g.
Date:
Sep. 13th 2007 Time:
9:00 a.m.
The
patient¡¯s diarrhea recovered by taking the medicine to warm and
supplement the spleen, and he had only once bowel movement
today. His appetite increased and his spirit was getting better.
The herbal tea prescription is the same as the former.
Date:
Sep. 16th 2007 Time:
9:00 a.m.
The
patient¡¯s bowel movement was normal, his appetite increased, and
his spirit was getting better. His muscular trembling was
lessened. His tongue was still numb, and he had difficulty in
swallowing. His month was slightly dry. The herbal tea
prescription is the same as the former.
Date:
Sep. 19th 2007 Time:
9:00 a.m.
The
patient¡¯s bowel movement was normal, his appetite increased
obviously and he could swallow food. His muscular trembling was
lessened day by day. He was still weak and tired since he had
suffered from diarrhea before. He had no dry month. Doctor¡¯s
requirement is to take four dosages of the herbal tea of the
same prescription as Sep. 16th.
Date:
Sep. 23rd 2007 Time:
9:00 a.m.
The
patient¡¯s condition was normal. There were some slight pains on
his lower limbs. Doctor¡¯s requirement is to take five dosages of
the herbal tea of the same prescription.
Date:
Sep. 25th 2007 Time:
10:00 a.m.
After
hospitalization in our hospital and the treatment of our herbal
tea accompanied by acupuncture and massage and some exercise,
the ALS patient¡¯s difficulties in swallowing and speaking, and
his muscular trembling all achieved significant improvement.
Today, he demanded to leave the hospital with 3-month herbal tea
for home taking.
The
main herbs such as white ginseng, astragalus root, salvia root,
etc are contained in the 90-day herbal tea.
The
main herbs such as white ginseng, astragalus root, ovate
atractylodes root, etc are contained in the 5-day honey pills.
Date:
Sep. 28th 2007 Time:
9:00 a.m.
The
patient had diarrhea last night again with twice
loose
bowel movement. He also felt some bellyache. The doctor prescribed
him the
herbal tea decocted with agastache,
aconite accessory tuber, and mume fruit. This morning he still
had diarrhea with some bellyache. His other condition was good
without dry month. Doctor¡¯s requirement is to take two dosages
of the herbal tea of the same prescription.
Date:
Sep. 30th 2007 Time:
9:00 a.m.
After hospitalization in our hospital and the treatment of our
herbal tea accompanied by acupuncture and massage and some
exercise, the ALS patient¡¯s difficulties in swallowing and
speaking, and his muscular trembling all achieved significant
improvement. His poor intake, weak and tired body also was
improved obviously. Now he has no diarrhea, and the strength of
his limbs increased a lot. He kept a good mood. He demanded to
leave the hospital with three-month herbal tea and 5-day honey
pills for home taking.¡¡
