Brief Summary: On June 20, 2009, Emre from Turkey, a 23-year-old student, was hospitalized in our hospital for suffering from metachromatic leukodystrophy (MLD). There was numbness in the both of his lower limbs. The walking condition was poor and inconvenient in the recent 6 years. After 76 days treatment in our hospital, the patient got obvious improvement. The walking condition became much better. There were no sense of numbness and tight feeling on the lower limbs. The edema on the lower limbs was disappeared. The trembling on the right hand has improved. The patient himself could walk about 200 to 300 meters. Before came here, he has to walk supported by two people.

 

Records of Hospitalization

Name: Emre                                                                                                       Birthplace: Turkey

Sex: Male                                                                                                            Profession: Student 

Age: 23                                                                                                               Date of Admission: June. 20, 2009

Nationality: Turkey                                                                                             Date of Record: June. 20, 2009

Marital Status: Unmarried                                                                                  Onset Season: Moderate Heat

Complainer: The patient herself. The case was recorded by TCM group.

 

First Medical Record

Date: June. 20, 2009                                                     Time: 01: 00 a. m.

Emre, a 23-year-old male, has suffered from MLD, accompanied with the numbness of the lower limbs for 6 years. The walking condition was inconvenient in the latest 6 years. He has to walk supported by two people. He was hospitalized in our hospital for treatment at 01:00 am on June. 21, 2009.

Essentials for Diagnosis:

1. The patient has suffered from the numbness of the lower limbs. The walking condition was inconvenient in the recent 6 years.

2. The patient suffered numbness of lower limbs without obvious reason in June, 2003. The walking condition became inconvenient. At that time, he paid no attention to it and did not take any examination or treatment. Then the condition became worse gradually. In 2007, he was examined by MRI at the local hospital (name unknown) and diagnosed as MLD. In the recent years, the condition became worse. The walking became very difficult for him. There were numbness and stiffness of the lower limbs. There were stiffness and deformity of the two ankles. There was slight edema on the legs. To pursue improvement, he came to our hospital for the treatment on June. 20, 2009.

3. T 36.6≧, P 80 times/minute, R 20 times/minute, BP 120/85mmHg.

4. He grew normally with medium nutrition. His mind is conscious. He looked tired with a feeling of chronic illness.

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's lower limbs were numb and stiff. The walking was inconvenient for him in the latest 6 years. The right leg was worse than the left one. There were stiffness and deformity of the two ankles. There was slight edema on the lower limbs. The knee joints were limited to bend or stretch. He could only raise the lower limbs at about 30 degrees. The muscle tensions of the lower limbs were weak. The strength of the lower limbs was of Grade  = 3 \* ROMAN III. The tongue body was thin and slight reddish. His tongue coating was yellowish and thin. His pulse was slippery. According to the symptoms of the tongue and pulse, he was diagnosed with wilting pattern.

7. Accessory examination: none.

Diagnostic Basis:

TCM: The patient's lower limbs were numb and stiff. The walking was inconvenient for him in the latest 6 years. The right leg was worse than the left one. There were stiffness and deformity of the two ankles. There was slight edema on the lower limbs. The knee joints were limited to bend or stretch. He could only raise the lower limbs at about 30 degrees. The muscle tensions of the lower limbs were weak. The strength of the lower limbs was of Grade  = 3 \* ROMAN III. The tongue body was thin and slightly reddish. His tongue coating was yellowish and thin. His pulse was slippery. According to the symptoms of the tongue and pulse, he was diagnosed as wilting pattern.

Western Medicine: The patient's lower limbs were numb and stiff. The walking was inconvenient for him in the latest 6 years. The right leg was worse than the left one. There were stiffness and deformity of the two ankles. There was slight edema on the lower limbs. The knee joints were limited to bend or stretch. He could only raise the lower limbs at about 30 degrees. In 2007, he was diagnosed with MLD by MRI examination.  

Diagnostic Differentiation:

TCM: The patient's wilting pattern should be differentiated from impediment pattern. Wilting pattern is mainly characterized by limp, emaciated sinews and bones, with weakness of the muscles. However, impediment pattern is generally characterized by joint pains. So they are not difficult to be distinguished.

Western Medicine: MLD should be differentiated from Alexander disease. Alexander disease appears at an earlier time, usually when the patient is a baby. The patient has a big head. The intelligence regresses gradually. There are spasms and epilepsy with the patient. Some cases could be seen on the children or adults. There are white substances in a diffuse and lower density in the forehead with the help of CT examination. So they are not difficult to be distinguished.

First Diagnosis:

TCM (Traditional Chinese Medicine) diagnosis: Wilting pattern

Symptom identification: vacuity of the liver and kidneys, disharmony of the qi and blood.

Western Medicine: Metachromatic Leukodystrophy (MLD)

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 and boost the liver and kidneys, free the vessels and network channels, quicken the blood circulation.

6. Herbal tea: one dosage a day and drink twice.

7. Acupuncture and massage: once a day.

8. Have more medical examinations if necessary.

　

Date: June 20, 2009                                                     Time: 10: 00 a. m.

The patient's lower limbs were numb and stiff. The walking was inconvenient for him in the latest 6 years. In 2007, he was diagnosed with MLD by MRI examination. There were stiffness and deformity of the two ankles. There was slight edema on the lower limbs. The knee joints were limited to bend or stretch. He could only raise the lower limbs at about 30 degrees. The tongue body was thin and slightly reddish. His tongue coating was yellowish and thin. His pulse was slippery. According to the symptoms of the tongue and pulse, he was diagnosed with wilting pattern. Symptom identification: vacuity of the liver and kidneys, disharmony of the qi and blood. TCM treatment strategy: supplement and boost the liver and kidneys, free the vessels and network channels, quicken the blood circulation.

　

Date: June 21, 2009                                 Time: 10:00 a. m.

The patient's condition has got obvious improvement. He could use his hands to eat food. There was no trembling in the hands. He could cross his legs, when he lies down on the bed. He could not do this movement at all before. His walking also has got obvious improvement. Before coming to our hospital, he could only walk with the help of two people. Now he could walk about 8 meters long by himself. The sleeping was normal. Continue to take the same prescription. 4 dosages per day.

 

Date: June 23, 2009                                 Time: 10:00 a. m.

The patient and his family surprisingly found that the patient himself could walk without help from others about 20 minutes long in the morning, and another 20 minutes in the afternoon. The activity of the ankle joints increased. His diet and sleeping were good. Continue to take the same prescription. 6 dosages per day.

　

Date: June 30, 2009                                 Time: 10:00 a. m.

The patient's condition was normal. The walking condition has got improvement day by day. His diet and sleeping were good. The urination and bowel movement were normal. The stiffness of the lower limbs has got obvious improvement. Continue to take the same prescription. 5 dosages per day.

　

Date: July 5, 2009                                 Time: 10:00 a. m.

The patient's condition has got obvious improvement gradually. Now he could walk about 100 meters long freely. Continue to take the same prescription. 5 dosages per day.

 

Date: July 10, 2009                                 Time: 10:00 a. m.

The patient's condition has got continuous improvement. He could walk about 100 meters long without uncomfortable feeling. He was told to increase the activity of the lower limbs. Continue to take the same prescription. 5 dosages per day.

　

Date: July 15, 2009                                 Time: 10:00 a. m.

The patient's condition has become better. He could squat, stoop and walk much conveniently than before. He wanted to lose some weight in the next treatment. The prescription was changed a little. 5 dosages per day.

　

Date: July 20, 2009                                 Time: 10:00 a. m.

The patient's walking and movement conditions have got continuous improvement. There was obvious trembling on the right hand, when he held some large or warm objects. The prescription was changed a little. 5 dosages per day.

　

Date: July 25, 2009                                 Time: 10:00 a. m.

The walking condition has got continuous improvement. The trembling on the right hand has not got obvious improvement. Considering the damage of the nerve, it need a certain time for nerve to recover. Continue to take the same prescription. 6 dosages per day.

　

Date: July 31, 2009                                 Time: 10:00 a. m.

The patient's body movements have got further improvement. His diet and sleeping were good. The urination and bowel movement were normal. There were no muscle trembling and stiffness in the lower limbs. The trembling in the right hand has got slight improvement. Continue to take the same prescription. 5 dosages per day.

 

Date: Aug. 5, 2009                                 Time: 10:00 a. m.

The patient's condition has got continuous improvement. The trembling in the right hand had no obvious improvement. The prescription was changed a little. 5 dosages per day.

 

Date: Aug. 10, 2009                                 Time: 10:00 a. m.

Yesterday the patient had done about 2 hours exercise. The trembling in the right hand had no obvious improvement. The prescription was adjusted a little. 5 dosages per day.

 

Date: Aug. 15, 2009                                 Time: 10:00 a. m.

The patient's health condition was normal and stable. Continue to take the same prescription. 5 dosages per day.

 

Date: Aug. 20, 2009                                 Time: 10:00 a. m.

The patient said that he had a good feeling of his condition. When held on objects, the trembling in the right hand has got improvement. Continue to take the same prescription. 5 dosages per day.

 

Date: Aug. 25, 2009                                 Time: 10:00 a. m.

The patient said that the trembling in the right hand has got obvious improvement than before. Continue to take the same prescription. 5 dosages per day.

 

Date: Aug. 31, 2009                                 Time: 10:00 a. m.

There was no obvious improvement with the right hand. Continue to take the same prescription. 3 dosages per day.

 

Date: Sep. 3, 2009                                 Time: 10:00 a. m.

He decided to leave the hospital with taking 2 months herbal tea back to home for continuous treatment.