Brief Summary:
On
July 9, 2007, an ALS patient
from
Indonesia,
Qamar, who
has
suffered from spasms and weakness of his limbs and
fibrillation and
atrophy of
his muscles,
was hospitalized in our hospital.
He has achieved significant improvement after more than
two-month TCM treatment in our hospital.
Record of Hospitalization
Name:
Qamar Sex:
Male
Age:
60 Profession: Engineer
Nationality:
Pakistan Marital Status:
Married
Onset
Season:
Summer Date of Admission:
July 9, 2007
Complainer:
The
patient himself Reliability: Reliable
Major
Complaint:
The
patient has suffered from spasms and weakness of his limbs for
seven years, and the condition has been aggravated by
fibrillation and
atrophy of
his muscles
for eight months.
Present Illness:
In Oct. 2000, the patient began to feel spasms and weakness of
his limbs accompanied with some difficulties in movement without
any obvious causes. Then the patient went to a local hospital
for a diagnosis, and was diagnosed with motor neuron disease.
The detailed treatment was unknown. In Mar. 2006, after the EMG
examination, he was diagnosed with multifocal motor neuropathy,
accompanied by the transferring stagnation of left Ulna, left
central artery and right Ulna. In the following 4 to 6 weeks, he
continuously took immunoglobulin three times. Each time he took
the medicine for five days, and 250 ml each day. After taking
the immunoglobulin, he felt his spasms were well controlled. In
Sep. 2006, he took a further EMG examination, the symptoms of
transferring stagnation disappeared, and he was diagnosed with
motor neuron disease. Over the past 6 weeks, he has taken
riluzole, 50 ml each day.
To
seek for a further comprehensive treatment, he arrived in our
hospital at 19: 00 p.m. on July 9, 2007. Since he got
the disease, his spirit and sleep were both poor. His appetite
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.
Personal History:
He was born in Pakistan. 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 30. He has no child.
Family History:
No
family history of special disease.
Physical Examination:
T 36.2¡æ£¬P
80 beats/minute, R 18 times/minute, BP 140/80 mmHg.
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
spasms and weakness, accompanied by muscular atrophy of his arm.
The
muscle strength of his
upper limbs was Grade
¢ó.
The strength of his left hand was 6 kg, and that of the right
hand was 10 kg. Since his
fingers were suffered from weakness so that he could neither
hold any fine objects nor write with any pens. The
experiment on his hands was (+). There was no obvious atrophy on
his lower limbs. His anklebones were stiff. He felt his legs
weak as walking. His lower limbs could raise 40 degrees, with
inflexible movement. The reflection of his knee jumping was
normal. The brinell levy was (-), the
barthel levy was (-), and the babinski levy also was (-).
There were muscles trembling all over his body. He felt weak and
tired, accompanied by the limp wilting lumbus and knees,
purple eyes-orbit, and pale face.
His tongue coating was very little with red and purple tongue
body. There were teeth marks on the edge of his tongue. His
pulse was deep, thready and weak.
Diagnostic examination: Not provided.
First
Diagnosis:
TCM
diagnosis: Wilting syndrome
Symptom identification: Wind-stasis blocks the sinews and
vessels, accompanied by deficiency of the liver and kidneys, and
malnutrition of the sinews and vessels.
Western medicine diagnosis:
Motor Neuron Disease
First
Medical Record
July
9, 2007
Qamar, a 60-year-old male, has suffered from spasms and weakness
of his limbs for seven years, and the condition has been
aggravated by
fibrillation and
atrophy of
his muscles
for eight months. He was picked up by our staff in Zhijiang
Airport and arrived in Huaihua Red Cross Hospital for further
treatment at 19: 30 p.m. on July 9, 2007.
Essentials for Diagnosis:
1.
The patient has suffered from spasms and weakness of his limbs
for seven years, and the condition has been aggravated by
fibrillation and
atrophy of
his muscles
for eight months.
2.
In Oct. 2000, the patient began to feel spasms and weakness of his limbs
accompanied with some difficulties in movement without any
obvious causes. Then the patient went to a local hospital for a
diagnosis, and was diagnosed with motor neuron disease. The
detailed treatment was unknown. In Mar. 2006, after the EMG
examination, he was diagnosed with multifocal motor neuropathy,
accompanied by the transferring stagnation of left Ulna, left
central artery and right Ulna. In the following 4 to 6 weeks, he
continuously took immunoglobulin three times. Each time he took
the medicine for five days, and 250 ml each day. After taking
the immunoglobulin, he felt his spasms were well controlled. In
Sep. 2006, he took a further EMG examination, the symptoms of
transferring stagnation disappeared, and he was diagnosed with
motor neuron disease. Over the past 6 weeks, he has taken
riluzole, 50 ml each day.
To
seek for a further comprehensive treatment, he arrived in our
hospital at 19: 00 p.m. on July 9, 2007. Since he got
the disease, his spirit and sleep were both poor. His appetite
was good. His bowel movement and urination were both normal.
3. T 36.2¡æ£¬P
80 beats/minute, R 18 times/minute, BP 140/80 mmHg.
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 spasms and weakness, accompanied by muscular
atrophy of his arm.
The
muscle strength of
his upper
limbs was Grade
¢ó.
The strength of his left hand was 6 kg, and that of the right
hand was 10 kg. Since his
fingers were suffered from weakness so that he could neither
hold any fine objects nor write with any pens. The
experiment on his hands was (+). There was no obvious atrophy on
his lower limbs. His anklebones were stiff. He felt that his
legs were weak as walking. His lower limbs could raise 40
degrees, with inflexible movement. The reflection of his knee
jumping was normal. The brinell levy
was (-), the barthel levy was (-), and the babinski levy also
was (-).
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 spasms and weakness of his limbs
for seven years, and the condition has been aggravated by
fibrillation and
atrophy of
his muscles
for eight months.
Because of the
deficiency of the liver and kidneys,
so 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. The lumbar is the house for the
kidneys, and the kidneys are in the charge of the bones. Since
the insufficiency of the essence, his lumbus and knees are limp
and weak, with the muscle wasting. And since deficiency of the
liver and kidneys, the wind stasis blocks the sinews and
vessels.
Western Medicine: The patient has suffered from spasms and
weakness of his limbs for seven years, and the condition has
been aggravated by
fibrillation and
atrophy of
his muscles
for eight months.
He suffered from spasms and weakness, accompanied by muscular
atrophy of his arm.
The
muscle strength of
his upper
limbs was Grade
¢ó.
The strength of his left hand was 6 kg, and that of the right
hand was 10 kg. Since his
fingers were suffered from weakness so that he could neither
hold any fine objects nor write with any pens. The
experiment on his hands was (+). There was no obvious atrophy on
his lower limbs. His anklebones were stiff. He felt his legs
weak as walking. His lower limbs could raise 40 degrees, with
inflexible movement. The reflection of his knee jumping was
normal. The brinell levy was (-), the
barthel levy was (-), and the babinski levy also was (-).
In Sep. 2006, he was diagnosed with
Motor
Neuron Disease in a local hospital.
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 the 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 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: Wind-stasis blocks the sinews and
vessels, accompanied by deficiency of the liver and kidneys, and
malnutrition of the sinews and vessels.
Western medicine diagnosis:
Motor Neuron Disease
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, quicken the blood, free the network
channels, soften the liver, supplement the kidneys and
extinguish the wind): Taking four dosages of the herbal tea. One
dosage a day and drink twice.
Prescription: Varied the formula of the Major Wind-Stabilization
Pill.
Main
herbs used in the herbal tea: shudi (cooked rehmannia root),
huangqi (Astragalus root), dansheng (salvia root), etc.
6.
Acupuncture and massage: once a day.
7.
Have more medical examinations if necessary.
Date:
July 10, 2007 Time: 11:00 a.m.
The
patient has suffered from spasms and weakness of his limbs for
seven years, and the condition has been aggravated by
fibrillation and
atrophy of
his muscles
for eight months. The patient suffered from weakness of fingers
and had difficulty in holding
chopsticks.
His upper limbs and fingers were all with obviously muscular
atrophy. His les and ankle joints were stiff, so he had
difficulty in walking. There was muscular trembling all over his
body, accompanied with
limp wilting lumbus
and knees, purple eyes-orbit, and pale
face. His tongue coating was very little with red and
purple tongue body. There were teeth marks on the edge of his
tongue. His pulse was deep, thready and weak.
TCM
diagnosis: Wilting syndrome
Symptom identification: Wind-stasis blocks the sinews and
vessels, accompanied by deficiency of the liver and kidneys, and
malnutrition of the sinews and vessels.
Western medicine diagnosis:
Motor Neuron Disease
Principle of TCM treatment: Boosting qi, quickening the blood,
freeing the network channels, softening the liver, supplementing
the kidneys and extinguishing the wind
Doctor's requirement is to take four dosages of the herbal tea
of the same prescription.
Date:
July 13, 2007 Time:
10:00 a.m.
Today
the patient had the functions of his liver and kidneys emanated.
After the ECG and
B-ultrasonic
examination, it shows that his
Uric acid ammonia
was higher to 10.1. He would continue to take the examination if
necessary. In the B-ultrasonic examination, he had enlargement
of prostate. There was no other abnormity. After the treatment
of herbal tea, accompanied by acupuncture and massage, he felt
the stiffness of his lower limbs was lessened.
Doctor's requirement is that he
would continue to take five dosages of the herbal tea of the
former prescription, and add cornus fruit 15g.
Date:
July 18, 2007 Time:
9:00 a.m.
The
patient's condition kept stable. There were no special changes,
and the doctor advised him to add peach kernel and carthamus
flower into the former herbal tea, and do more exercise,
especially for the suffering parts.
Date:
July 23, 2007 Time:
9:00 a.m.
Today
the patient complained that trembling of his muscles was
lessened, and the stiff lower limbs were getting better.
However, there were no obvious improvement on the weakness of
his fingers and the difficulty in holding any objects. The
treatment strategy is to boost qi, quicken the blood, soften the
stiffness, supplement the kidneys and extinguish the wind.
Doctor's requirement is to take five dosages of the herbal tea
of the same formula.
Date:
July 28, 2007 Time:
9:00 a.m.
Today
the patient complained that his condition was getting worse. His
improvement was not significant enough. The doctor advised him
to do more functional exercise, and change the herbal tea as
following: the main herbs in five dosages of the herbal tea:
taoren (peach kernel), baisheng (white ginseng), honghua
(carthamus), etc.
Date:
July 30, 2007 Time:
9:00 a.m.
Today
the patient complained that his fingers were weak and had
difficulty in movement, especially worse on his left hand. The
doctor advised him to use the external medicine for soaking his
hands. The main herbs in the three dosages of the external
herbal tea as follow: ground pine, sargentodoxa stem, cinnamon
twig, etc.
Date:
Aug. 2, 2007 Time: 9:00
a.m.
The
muscular trembling all over his body was lessened. His lower
limbs was stiff, especially his right leg. He felt his back was
stiff, and he had difficulty in raising his legs and walking.
The doctor advised him to do more exercise and take more
nutrition food. The herbal tea is mainly to quicken the blood
and soften the stiffness.
Date:
Aug. 6, 2007 Time: 9:00
a.m.
Today
the patient complained that the muscular trembling all over his
body was lessened significantly, his
hip joints
pains caused by
trauma were improved obviously. The doctor advised him to add
spiny jujube kernel in the herbal tea for oral taking, combined
five dosages of the herbal tea for external use for soaking his
hands.
Date:
Aug. 7, 2007 Time: 9:00
a.m.
Today
the patient complained that the muscular trembling all over his
body was lessened, and that his lower limbs were still stiff and
spastic.
The weakness of his fingers was improved.
Doctor's requirement is to take the herbal tea of the same
formula.
Summary Stage
Date:
Aug. 9, 2007 Time:
10:00 a.m.
Qamar, a 60-year-old male, has suffered from spasms and weakness
of his limbs for seven years, and the condition has been
aggravated by
fibrillation and
atrophy of
his muscles
for eight months. He was picked up by our staff in Zhijiang
Airport and arrived in Huaihua Red Cross Hospital for further
treatment at 19: 30 p.m. on July 9, 2007. He has been
hospitalized for 30 days here.
Admission Situation:
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.
Examination: T 36.2¡æ£¬P
80 beats/minute, R 18 times/minute, BP 140/80 mmHg.
His
heart and lungs were normal. His abdomen was soft and flat.
He suffered from spasms and
weakness, accompanied by muscular atrophy of his arm. The
muscle
strength of his
upper limbs was Grade
¢ó.
The gripping power of his left hand was 6 kg, and that of the
right hand was 10 kg. Since
his fingers were suffered from weakness so that he could neither
hold any fine objects nor write with any pens. The
experiment on his hands was (+). There was no obvious atrophy on
his lower limbs. His anklebones were stiff. He felt his legs
weak as walking. His lower limbs could raise 40 degrees, with
inflexible movement. The reflection of his knee jumping was
normal. The brinell levy was (-), the
barthel levy was (-), and the babinski levy also was (-).
Admission Diagnosis:
TCM
diagnosis: Wilting syndrome
Symptom identification: Wind-stasis blocks the sinews and
vessels, accompanied by deficiency of the liver and kidneys, and
malnutrition of the sinews and vessels.
Western medicine diagnosis:
Motor Neuron Disease
The Process of the
Diagnosis:
After the patient
was hospitalized in our hospital, he was prescribed with herbal
tea to boost qi, quicken the blood,
free the network channels, soften the liver, supplement the
kidneys and extinguish the wind. The prescription varied in
Atractylodes and Avate Atractylodes Decoction, and Major
Wind-Stabilization Pills. One
dosage a day and drink twice. Acupuncture and massage: once a
day. The patient's condition was improved.
Current Condition:
The
muscular trembling all over his body was lessened, and the
weakness of his fingers was improved. The experiment on his
hands, the gripping power of his left hand is 14.3 kg, and that
of his right hand is 18.7 kg. The muscular atrophy of his hands
got no marked changes.
The
muscle strength of
his upper
limbs was Grade
¢ó,
and the
muscle strength of his
lower limbs was Grade
¢ó.
The movement of his ankle joints got better than before. His
tongue coating was very little with red and purple tongue body.
There were teeth marks on the edge of his tongue. His pulse was
deep, thready and weak.
Current Diagnosis:
TCM
diagnosis: Wilting syndrome
Symptom identification: Wind-stasis blocks the sinews and
vessels, accompanied by deficiency of the liver and kidneys, and
malnutrition of the sinews and vessels.
Western medicine diagnosis:
Motor Neuron Disease
Plans
for treatment strategy and nursing:
1.
Continue to take the herbal tea.
2.
Acupuncture and massage: once a day.
3.
The functional exercise on the lower limbs.
4.
Keep a pleasant mood and be open-minded.
His fingers were
suffered from 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. 11, 2007 Time:
9:30 a.m.
The
weakness of his lower limbs and the muscular trembling all over
his body both were lessened. But sometimes his condition
repeated. The doctor advised him to continue five dosages of the
herbal tea of the former prescription.
Date:
Aug. 16, 2007 Time:
9:30 a.m.
There
were no special changes on the patient's condition. The doctor
advised him to get the injection of tangkuei as acupoint
injection, one bottle a day. The herbal tea should follow the
former prescription adding dioscorea root 20 g into it.
Date:
Aug. 18, 2007 Time:
9:00 a.m.
The
muscular trembling all over his body both was lessened. He was
still suffering form the weakness of his fingers, especially his
left hand. The lower limbs were stiff, accompanied by some
pains. The doctor advised him to take the former herbal tea
adding corydalis tuber and aconite main tuber into it, combined
with 6 dosages of the herbal tea for soaking his hands.
Date:
Aug. 21, 2007 Time:
9:00 a.m.
The patient
suffered form the weakness if his lower limbs, accompanied by
stiffness of his legs with some slight pains.
Doctor's requirement is to take three dosages of the herbal tea
of the same prescription for oral taking.
Date:
Aug. 24, 2007 Time:
9:00 a.m.
The patient
complained that his right foot was
terminal varus and had difficulty in walking. There was no
significant improvement on his weakness and atrophy fingers. The
trembling of the muscles and the stiffness of the legs was
improved a lot. 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 himself
felt the strength of the lower limbs increased. The muscular
trembling all over his body also was lessened.
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.
The patient's ankle
joints of the right foot were stiff and
varus.
Doctor's requirement is to take five dosages of the herbal tea
of the same prescription adding peach kernel, combined with
three dosages of the herbal tea for soaking his hands.
Date:
Sep. 3, 2007 Time: 9:00
a.m.
The
patient suffered from pains of neck and shoulders. It got worse
in movement. The doctor advised him to take an X examination to
make sure whether there were any lesions on his
cervical spine. The
muscular trembling on his arms was light on the day and worse at
night. His other condition was normal.
Date:
Sep. 5, 2007 Time: 9:00
a.m.
Today
the patient got the examination of the
cervical lateral films. His
cervical physiological curvature changes straight to 3 to 7.
There were bone spurs around his
centrum. It was
considered to be cervical degenerative lesions. The stiffness
and varus
of his right
ankle joints
were improved. He continued to soak his hands with the herbal
tea for external use and the herbal tea for oral taking.
Date:
Sep. 10, 2007 Time:
9:00 a.m.
The
patient was preparing to travel and demanded to take 5-day honey
pills for oral taking. The main herbs in honey pills: angelica
root, astragalus root, peach kernel, etc.
Date:
Sep. 14, 2007 Time:
9:00 a.m.
Today
the patient went to Xi¡¯an for traveling and took 5-day honey
pills for oral taking. He would continue to take herbal tea
after coming back to the hospital.
Date:
Sep. 19, 2007 Time:
09:00 a.m.
During the travel, the patient's condition was normal. The
muscular all over his body worsened. He felt some discomfort of
his neck since he fell to the ground during travel. He continued
to take the same prescription as that of Sep. 5th,
adding notoginseng root into it.
Date:
Sep. 22, 2007 Time:
9:00 a.m.
The
patient himself complained that his lower limbs walked very
well. The muscular trembling sometimes repeated, and it got
better after massage. Since the northern travel is very dry, the
patient felt his nose was very dry. The doctor advised him to
take 6 dosages of the herbal tea the same as Sep. 19th.
Date:
Sep. 25, 2007 Time:
9:00 a.m.
After
the treatment of the herbal tea, acupuncture and massage, the
spasms and weakness of the patient¡¯s limbs, accompanied with
muscular atrophy, muscular trembling all over his body, and
stiffness of his legs ankle joints all achieved significant
improvement. He demanded to leave the hospital and take 3month
herbal tea for home taking.
The
main herbs in 60 dosages of the herbal tea for home taking:
white peony, astragalus root, peach kernel, etc.
The
main herbs in 10-day honey pills: white peony, carthamus flower,
notoginseng root, etc. And another 30-day herbal tea will
prescribe to him according his improvement and will send it to
him by air shipping.
Date:
Sep. 28, 2007 Time:
9:00 a.m.
The patient's condition was good. Today the patient took 2-month
herbal tea and left the hospital. The doctor advised him to keep
a stable mood and a pleasant spirit, do some functional
exercise, increase the nutrition food and continue the
treatment.
¡¡
