Brief
Summary:
On Apr. 7, 2009, Ms. Rahma from Yemen suffering from rheumatoid
arthritis and osteoporosis and not able to walk for seven years
due to weak and stiff knees. After 15 days TCM treatment in our
hospital, she could walk now herself with the stick. This is the
miracle made by TCM and our hospital.
Please check the video on youtube
Record of Hospitalization
Name:
Rahma Birthplace:
Yemen
Sex:
Female
Profession:
Housewife
Age:
46
Nationality:
Arab
Marital Status:
Married Onset Season:
Vernal equinox
Date of Admission:
Apr. 7, 2009
Date of Record:
Apr. 7, 2009
Complainer:
The patient herself
First Medical Record
Date: Apr. 7, 2009 Time:
19: 00 p. m.
Rahma, a 46-year-old female,
has suffered from
rheumatoid arthritis, accompanied with the symptoms of joint
pains of the four limbs for 9 years and inability to walk for 7
years. Her condition became more serious, so she was
hospitalized in our hospital for treatment at 19: 00 p. m. on
Apr. 7, 2009.
Essentials for Diagnosis:
1. The patient has suffered from the symptoms of joint pains of
the four limbs for 9 years and inability to walk for 7 years.
2.
In 2000, the patient felt joint pains of her left elbow and
could not flex the left elbow. Then the joint pains gradually
spread to the knees without obvious reasons, so she went to a
local hospital for X-ray examination and was diagnosed with
rheumatoid arthritis
and osteoporosis. Then she was given various
kinds of western medicines for treatment, but her condition
broke out repeatedly and gradually became serious. She could not
walk and was confined to a wheelchair since 2003. She hadn¡¯t
taken any treatment except western medicine, so she came to our
hospital for further treatment on Apr. 7, 2009.
3. T 37.2¡æ,
R 20 times/minute, P 80 times/minute, BP 140/88mmHg.
4. She grew normally with common nutrition. Her mind was clear.
She had an expression of chronic illness and tiredness. She was
cooperative with clear mind.
5. No thoracic deformity. Sound of breath was bilaterally normal
on auscultation. No sound of pleural friction. Heart border was
normal. Heart beat was 80 times/minute. Cardiac rhythm was
regular. No pathological murmurs on auscultation.
6. The patient felt joint pains all over the body, especially in
the morning and evening. Her condition became more serious when
the weather was cold. Her lower limbs could not walk and she was
confined to a wheelchair. There were the symptoms of stiffness,
deformity and difficulty in activities of the joints of her
fingers, left elbow and knees.
7. Accessory examination: None
Diagnostic Basis:
TCM: The patient has
suffered from the symptoms of joint pains of the four limbs for
9 years and inability to walk for 7 years. Wind-cold-damp evil
rested on the channels and network vessels and obstructed qi and
blood, which resulted in joint pains. Wind was swift and
changeable and due to the prevalence of wind evil, the patient
could feel the joint pains. The obstruction of the movement of
qi and blood as well as the fluids caused the formation of phlegm-stasis, which stagnated the joints, so there
were the symptoms of swelling joints even rigidity, deformity
and difficulty in extension.
Western Medicine: The patient has suffered from the symptoms of
joint pains of the four limbs for 9 years and inability to walk
for 7 years.
She felt joint pains all over the body, especially in the
morning and evening. Her condition became more serious when the
weather was cold. Her lower limbs could not walk and she was
confined to a wheelchair. There were the symptoms of stiffness,
deformity and difficulty in activities of the joints of her
fingers, left elbow and knees.
Diagnostic Differentiation:
TCM: The patient¡¯s impediment pattern should be differentiated
from wilting pattern, which is characterized by limp, weak, and
emaciated limbs with the numbness of the muscles. But the
patient usually has no joint pains. On the contrary, impediment
pattern is generally characterized by joint pains. So they are
not difficult to be distinguished.
Western Medicine:
Rheumatoid arthritis should be differentiated from gout, which
usually occurs in male. It usually affects the joint of the big
toe. Meanwhile, it can also affect the joints of the ankle,
knee, elbow, wrist and fingers. The onset is
numerously abrupt, accompanied
by the symptoms of inflammation, swelling and heat pains. The
affected part could not be touched when the pains are severe. So
they are not difficult to be distinguished.
First Diagnosis:
TCM (Traditional Chinese Medicine) diagnosis: Impediment pattern
Symptom identification: Depletion of liver-kidney, obstruction
of channels and network vessels due to cold-damp.
Western Medicine diagnosis: Rheumatoid arthritis
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. Common diet.
5. TCM treatment strategy:
supplement the liver, boost the kidney, dissipate cold, dispel
dampness, quicken the blood and free the channels and network
vessels.
6. Herbal
tea: one dosage a day and drink twice.
7. Acupuncture and massage: once a
day.
8. Have
more medical examination if necessary.
Date: Apr. 8, 2009 Date:
10: 00 a. m.
The patient has suffered from the symptoms of joint pains of the
four limbs for 9 years and inability to walk for 7 years.
In 2000, the patient felt joint pains of her left elbow and
could not flex the left elbow. Then the joint pains spread to
the knees without obvious reasons, so she went to a local
hospital for X-ray examination and was diagnosed with
rheumatoid arthritis and
osteoporosis. Then she was given various kinds
of western medicines for treatment, but her condition broke out
repeatedly and gradually became serious. She could not walk and
was confined to a wheelchair since 2003. At present, she felt
joint pains all over the body, especially in the morning and
evening. Her condition became more serious when the weather was
cold. She could not walk. There were the symptoms of stiffness
and deformity of the joints of her fingers, left elbow, knees
and right ankle. The quality of her sleep was not good and she
could sleep for about 4-6 hours every night. She was over
thinking. There were no symptoms of dry and bitter mouth as well
as headache and dizziness. She had frequent urination and
constipation once in 2-3 days. Her tongue was pale white and
slightly enlarged. There were teeth marks on the edges of the
tongue. Her tongue coating was white. Her pulse was deep,
thready and slippery. There was similar health problem in her
family members. According to the symptoms of the tongue and
pulse, Professor Yang believed that she had suffered from
impediment pattern due to depletion of liver-kidney,
obstruction of channels and
network vessels due to cold-damp, so the treatment strategy was
to supplement the liver, boost the kidney, dissipate cold,
dispel dampness, quicken the blood and free the channels and
network vessels. The prescription was as follows: baishao (white
peony root), chuanxiong (ligusticum
root), chuanlianzi (toosendan fruit), etc. 3 dosages in total.
Date: Apr. 9, 2009 Time:
11: 00 a. m.
The result of the examinations was as follows: anti ¡°O¡± and RF
were normal. ESR (35mm/h) was a little high. The function of the
liver and kidneys were normal. The routine examinations of urine
and bowel movement were normal. The routine examination of the
blood showed that WBC (18.1¡Á109/L) was a
little high.
Date: Apr. 10, 2009 Time:
9: 30 a. m.
The patient said she slept well last night and had two times of
urination. She had a rest for 8 hours, but there were still
pains all over the body. The prescription was as follows: duhuo
(duhuo
angelica root), duzhong (eucommia bark), danggui (tangkuei),
etc. 4 dosages in total.
Date: Apr. 14, 2009 Time:
10: 00 a. m.
The patient said the joint pains further lessened. Her sleep and
spirit were good. Last night she had one time of urination. The
flexibility of her joints was better. Her tongue was pale white
and slightly enlarged. There were teeth marks on the edges of
the tongue. Her tongue coating was white. Continue to take the
same prescription. 4 dosages in total.
Date: Apr. 18, 2009 Time:
10: 00 a. m.
She said the pains all over the body basically disappeared. She
felt slight joint pains of her knees when she walked outside.
Her sleep, urine and bowel movement were normal. 4 dosages in
total.
Date: Apr. 22, 2009 Time:
10: 00 a. m.
There were no pains all over the body in the recent two days.
Compared with before, the flexibility of the joints were better.
Continue to take the former prescription. 4 dosages in total.
Date: Apr. 25, 2009 Time:
10: 00 a. m.
Compared with before, she could walk further in recent two days
with the aid of a stick. But sometimes there were medium joint
pains of the left leg in the morning and evening. The former
prescription was changed a little. 4 dosages in total.
The patient is continuing with treatment here when this medical
report is listed. (April 29, 2009)
------------------
To whom it may concern,
Mrs. Rahma Said Aweis, 46 years, a Somali refugee in Yemen
complains of ¡°Rheumatoid Arthritis¡± for 9 years. It is
aggressive and lead to destruction of both knees, left elbow,
and cervical spine. There are fixed flexion deformities of both
knees and elbow and unstable cervical spine. In addition, she
suffered severe chronic pain because of the active disease.
PLAN OF TREATMENT:
Control disease process, inflammation, pain, and chronic
depression using Steroids, antidepressants, analgesics, and
DMARDs.
Rehabilitation:
1.
Toilet chair.
2.
Training for ADLs.
3.
Mild ROM and strengthening exercises.
Surgery:
1.
Consider bilateral knee transplant.
The problem is in the rarity and very high expenses to access
and good quality rehabilitation and surgical services locally in
Yemen.
The clinic is supporting them for now in the treatment because
of their very limited financial resources.
Best regards,
Dr. Youssef Fahim Guirguis
M.Sc. Rheumatology and Rehabilitation
Medical Director, Ras Morbat clinics, Ade, Yemen
Check
the original handwriting here
¡¡
Please click here to download Wechat and scan the following QR code to add
Dr. XiXi.
More
Rheumatoid Arthritis cases that we helped well:
Case-1
Case-2
Case-3
Case-4
Case-5
¡¡
