studies involving patients with spinobulbar muscular atrophy ( sbma ) , which is often referred to as kennedy s disease , similar to those involving patients with progressive muscular disease ( pmd ) , are rare .
this paper reports a case study involving the use of korean medicine to treat a patient with sbma .
we treated a patient with sbma with unique symptoms by using various kinds of pharmacopuncture and herbal medicines for about two and a half years .
after the treatment had ended , we evaluated the patient s conditions and the side effects of the treatment .
after treatment , the patient s symptoms were stabilized , and the patient suffered no abnormalities or side effects .
no special changes in condition were noted during treatment period , and the patient was very satisfied with his response to treatment .
existing treatments have some considerable after effects and are difficult to apply in domestic clinics . in this regard , our findings should open possibilities for new clinical guidelines .
nevertheless , the limitations associated with this case study should be resolved , and more studies need to be conducted .
x - linked spinobulbar muscular atrophy , also known as kennedy s disease , is a neurodegenerative disease caused by an expansion of a polymorphic cag tandem - repeat in the androgen receptor gene .
it presents as weakness and wasting of bulbar , facial , and proximal limb muscles owing to loss of anterior horn cells in the brain and the spinal cord .
it follows a slowly progressive course , and the patient has normal or minimally- reduced life span .
although several therapeutic strategies have been proposed , currently no effective therapy exists to arrest or delay disease progression .
two case reports on the treatment of progressive muscular disease ( pmd ) by using korean traditional medicine can be found in the literature [ 3 , 4 ] . according to these papers ,
significant improvements in muscle function were achieved by using korean traditional medicine to treat patients with pmd .
however , studies involving patients with kennedy s disease , similar to those involving patients with pmd , are , to the best of the authors knowledge , nonexistent .
for that reason , we present the case of a patient with x - linked spinobulbar muscular atrophy who was treated using korean traditional medicine .
the patient was a 42-year - old male , whose chief complaints were proximal muscle weakness since the summer of 2010 and dysarthria since december 2012 . when he visited our clinic , he stated the he had been weaker and less flexible than others .
his past medical history was non - specific , and his family s medical history showed that his mother suffered from head tremors and his father suffered from gastric cancer .
his current medications were tanamin ( 80 mg , one tablet once a day ) and gliatilin ( 400 mg , one tablet twice a day ) .
the patient had been a heavy drinker since his 20 s , and since that time his hands had been trembling .
he drank two bottles of soju five days a week for two and a half years when he was in his 30 s. after that , he drank two bottles of soju about twice a week . at that time
later , he lost weight ( 70 kg ) , but his breasts were still large . from the summer of 2010 , he has had difficulty running , climbing stairs , and walking for a long time , and he has had increasing weakness in his arms and legs .
in addition , he has had difficulty holding up his hands while washing his hair because of arm weakness .
he exercised two hours a day , four to five times a week , but he felt that he was losing strength .
he had easily climbed three flights of stairs until 2012 , but now climbing above the first floor was difficult . from december 2012 , he has experienced hoarseness , and he has felt an intermittent pulling sensation in his left fascial muscle . he has had mildly slurred speech and a nasal voice because of facial and tongue palsy . a few years ago , his finger started to shake unconsciously .
, his weight has been relatively stable , but the muscles of both limbs have started to sag .
3 ) , hypospermia , and erectile dysfunction . deoxyribonucleic acid ( dna ) testing for kennedy s disease confirmed the diagnosis and revealed an expansion of 47 cag repeats ( normal being < 33 ) . a neurologic examination , and the results were normal , his mental status was alert . he had tongue fasciculation , but other cranial nerve functions were normal .
the results from examinations of his upper and lower extremities are shown in ( tables 1,2 ) , respectively .
the results for the deep tendon reflex ( dtr , deep tendon reflex ) are shown in table 3 .
the patient s squatting , hopping , toe gait and heel gait were intact , as was his sensory touch , pinprick test .
finger to nose movement , rapid alternating movement , and heel to shin movement , which are cerebellar functions , were all intact , his tandem gait was without sway .
his hands had atrophied , and he had gynecomastia . the nerve conduction study ( both limbs ) showed low sensory nerve action potentials ( snaps ) over the f - w and the w - e segments on the left median and ulnar nerves , as well as low snaps on the bilateral sural and superficial peroneal nerves .
f - waves were demonstrated on neither the bilateral median and left ulnar nerve nor the right ulnar nerve .
electromyography ( emg , left limb , thoracic vertebrae part ) revealed moderate to severe denervation potential with reduced interference pattern in the left abductor pollicis brevis muscle , moderate denervation potential with reduced interference pattern in the left extensor digiti communis muscle , and mild denervation in the right t10 paraspinal muscle .
the emg findings for the left tibialis anterior muscle and the left t10 paraspinal muscle were normal .
from october 29 , 2013 , to april 25 , 2016 , the patient was treated with 0.2 cc of scolopendrid pharmacopuncture ( korean pharmacopuncture institutem , korea ) injected at each of the following acupoints : joksamni ( st36 ) , susamni ( li10 ) , hapgok ( li4 ) , pungbu ( gv16 ) , and pungji ( gb20 ) . from october 29 to november 9 , 2013 , he was prescribed a concoction of exsiccata lacca sinica 10 g , semen strychni 2 g , rhizoma smilacis 10 g , flos lonicerae 10 g , herba protulacae 10 g , herba oldenlandiae diffusae 10 g , radix polygalae 2 g , and galla rhois 10 g administered 30 minutes after eating meal ( 3 times a day ) . from october 29 to november 29 , 2013 ,  aconibal tab , and 
lactic acid bacteria were administered three times a day . after more than a year of outpatient treatment , the conditions and the symptoms of the patient remained unchanged .
x - linked spinobulbar muscular atrophy ( kennedy s disease ) affects muscles and motor neurons , manifesting as weakness and wasting of bulbar , facial , and proximal limb muscles due to loss of anterior horn cells in the brain and spinal cord . as in this case , patients typically present in middle age with muscle cramps , bulbar weakness or leg weakness . muscle weakness , wasting , and fasciculations are generally slowly progressive , with some patients becoming wheelchair - dependent 20 to 30 years into the course of the disease .
interestingly , in one large series of patients , nearly 100% of the patients showed abnormalities in their sensory responses on nerve conduction studies .
unfortunately , no effective therapy for this condition is available ; a recently concluded trial of dutasteride was unable to demonstrate any statistically significant effect on the patient s muscle strength versus those receiving a placebo .
our patient received outpatient treatment , total of 44 times , from october 29 , 2013 , to april 25 , 2016 .
no progression of the disease and no special change in condition were noted during treatment period .
the limitations of this study include small sample size ( one patient ) , uncontrolled design , and a dubitable before and after comparison .
because existing treatments would cause several considerable side effects and are difficult to apply in domestic clinics , we expect our findings , despite the limitations of the study , to lead possibly to new clinical guidelines .
 objectives : studies involving patients with spinobulbar muscular atrophy ( sbma ) , which is often referred to as kennedy s disease , similar to those involving patients with progressive muscular disease ( pmd ) , are rare . 
 this paper reports a case study involving the use of korean medicine to treat a patient with sbma.methods:we treated a patient with sbma with unique symptoms by using various kinds of pharmacopuncture and herbal medicines for about two and a half years . 
 after the treatment had ended , we evaluated the patient s conditions and the side effects of the treatment.results:after treatment , the patient s symptoms were stabilized , and the patient suffered no abnormalities or side effects . 
 no special changes in condition were noted during treatment period , and the patient was very satisfied with his response to treatment.conclusion:existing treatments have some considerable after effects and are difficult to apply in domestic clinics . in this regard , our findings should open possibilities for new clinical guidelines . 
 nevertheless , the limitations associated with this case study should be resolved , and more studies need to be conducted . 
Objectives:
Methods:
Results:
Conclusion:
1. Introduction
2. Case study
3. Discussion