Peripheral nerve damage-Guillain-Barre Syndrome (G.B.S)-Wei Syndrome

[Michael]

SETCION 1: GENERAL INFORMATION
Sex: Female
DOB: 1974
Occupation: Accountant
Date of First Visit: 12th Feb 2003

SECTION 2: DATA COLLECTED FRM FOUR DIAGNOSTIC TECHNIUES
2.1 INQUIRIES:
2.1.1 Chief Complaint: Numbness of the limbs, and unstable walking for 2 months.

2.1.2 Present case history: Since two months ago, the patient suddenly had numbness in the limbs, weakness of two legs, trembling hands, and difficulty in walking without any reasons. There were no headache, no vomiting, no unconsciousness, and no fever. Normal bowel and urination, normal appetite.
2.1.3 Previous history: The patient went to western hospital for specialist examination on cerebral disease. He had Electric Myography, and the result shown reduced wave amplitude of right tibia nerve, which implied that the nerve impulse conduction speed was reduced. He had no histories of hepatitis, no trauma, and no allergic.
2.1.4 Personal history: No drinking, no smoking.
2.1.5 Family history: N/A.

2.2 INSPECTION/OBSERVATION:
2.2.1 Spirit: Consciousness: spirit – normal
2.2.2 Complexion: No skin condition, no bleeding.
2.2.3 Appearance: Facial crease normal.
Normal development
Pupil with normal reaction to the light
Facial crease normal
Jugular vein not expending, nor visible
No deformation
Straight line walking - difficult
Tongue in the middle not deviated.
No oedema on both legs.

2.2.4: Body stature: Walk to the room by himself
Tendon reflex – delay
Skin sensation – normal
2.2.5: Tongue: thin coating
2.2.6: Other parts of the body:
Pupil – symmetric, reaction normal.
Eye balls moves freely without tumbling.
Throat –reflex normal.
Neck – soft
Trachea – in the middle
Thyroid – normal
Thorax – symmetric
2.2.7 Excretion and Secretion: Bowel and urination were normal

2.3 AUSCULTATION & OLFACTION
2.3.1 Auscultation:
Respiration sound – normal, no rale sound, heart rate 80 beat/min – regular.
No pathogenic murmur sound
Tendon reflex normal (++)

2.4 Palpitation:
2.4.1 Pulse: thready pulse
2.4.2 Palpating different parts of the body:
Can not palpate lymph nodes.
Ataxia – normal
Abdominal palpation – soft, no palpable tenderness.
Liver and Spleen were not palpable
Murphy sign – negative

[Michael]

SECTION 3: WESTERN MEDICAL RECORDS
3.1 Physical examination: (Positive signs)
T(37.0oC), P(80 beat/min), R(20 breaths/min)), B(130/80 mmgH)

3.2 Laboratory tests results
Electric myography
Thyroid function normal
Anti-haemolysin close to the upper border.

SECTION 4: DIAGNOSIS SUMMARY:
4.1 Chinese Medicine Diagnosis
Wei Syndrome due to stagnation of meridians and collaterals.
4.2 Western Medicine Diagnosis
Peripheral nerve damage. Guillain-Barre Syndrome (G.B.S)

Guillain-Barrè (ghee-yan bah-ray) syndrome is a disorder in which the body's immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances the weakness and abnormal sensations spread to the arms and upper body. These symptoms can increase in intensity until certain muscles cannot be used at all and, when severe, the patient is almost totally paralyzed. In these cases the disorder is life threatening – potentially interfering with breathing and, at times, with blood pressure or heart rate – and is considered a medical emergency. Such a patient is often put on a respirator to assist with breathing and is watched closely for problems such as an abnormal heart beat, infections, blood clots, and high or low blood pressure. Most patients, however, recover from even the most severe cases of Guillain-Barrè syndrome, although some continue to have a certain degree of weakness.

Guillain-Barrè syndrome can affect anybody. It can strike at any age and both sexes are equally prone to the disorder. The syndrome is rare, however, afflicting only about one person in 100,000. Usually Guillain-Barrè occurs a few days or weeks after the patient has had symptoms of a respiratory or gastrointestinal viral infection. Occasionally surgery or vaccinations will trigger the syndrome. The disorder can develop over the course of hours or days, or it may take up to 3 to 4 weeks. Most people reach the stage of greatest weakness within the first 2 weeks after symptoms appear, and by the third week of the illness 90 percent of all patients are at their weakest.

[Michael]

SECTION 5: DIFFERENTIATION AND ANALYSIS
5.1 List all the evidence of the differential diagnosis:
Numbness of the limbs - stagnation of meridians and collaterals.
Weakness of two legs - stagnation of meridian and collaterals.
Difficulty in walking. - stagnation of the meridians and collaterals.

5.2 Analysis of the Aetiology and pathogenesis
Due to emotional stress from work, and working conditions, the patient had stagnation of Qi circulation and developed in stagnation of meridians and collateral.

5.3 Principles of treatment:
Invigorate Qi and Blood, warm and activate the meridians.

5.4 Prescriptions and Administration
HuangQi15, BaiZhu10, ChuanXiong15, JiXueTeng15, ChiShao15, SangZhi30, SangJiSheng15, DangGui15, ChuanWu5, CaoWu5, XiQianCao15 DiLong10 ChuanNiuXi10 HuaiNiuXi10 MuGua10