中醫 施今墨對藥 中醫基礎 中西醫結合

Traditional Chinese Medicine SHI JIN MO DUI YAO 5 TCM Principles Integrated Traditional & 2 Multiple Sclerosis (MS) - A 5 Art of Combining Western Medicine Chinese Medicine Perspective Medicinals According to 7 Getting Results in Multiple Master Shi Jin Mo Sclerosis Management 研究 質量 安全 Research, Quality, safty and Efficacy

CONTENTS 10 Sun Ten Ginseng-Premium six Years Old Ginseng

中醫 Traditional Chinese Medicine Multiple Sclerosis (MS) – A Chinese Medicine Perspective

Signs and Symptoms nourish kidney and liver yin, transform • Weakness and loss of muscle phlegm and move blood. • co-ordination Over time, kidney yin vacuity is likely to • Tingling, numbness, dizziness change into a vacuity of both yin and yang. • Blurred vision Thus, herbs are added that supplement • Pain yang. Also, more stasis moving herbs may • Heat sensitivity be needed, including herbs that move liver • Loss of bladder control qi. As stasis may transform into heat, heat • Memory loss, problem-solving clearing herbs may also be added. difficulties • Mood disturbances Theory behind the symptoms The liver stores blood and opens at the eyes; hence there is a strong connection Multiple sclerosis (MS) is an unpredictable Western Drug Therapies between the state of the liver and the state disease of the nervous system in which Your patient may already take the following of the eyes. Liver yin/blood vacuity may communication between the brain and Western Medication: impair vision. other parts of the body is disrupted. Its • Steroids with anti-inflammatory effects can range from relatively mild properties (e.g. prednisone) to reduce Blood and yin deficiency may give rise to devastating. The symptoms may severity of attacks. to internal wind, manifesting as spasms. mysteriously occur and then disappear. In • Beta interferon to decrease myelin The spleen governs the movement and the worst cases, a person with MS may be destruction, reduce frequency transformation of food and water, and is unable to write, speak, or walk. and severity of attacks, and slow progression of disease. the source of qi and blood formation. It also governs the flesh and limbs. Hence, During an MS attack, inflammation occurs • Immunotherapy, antigen-targeting, the nourishment of the body’s flesh relies in areas of the white matter (pale-coloured cytokines, and remyelination are on the correct function of the spleen, and nerve tissue) of the central nervous system experimental therapies that may alter if spleen function is disturbed this may in random patches called plaques. This is the course of the disease. lead to lack of strength, impaired use and followed by destruction of myelin, the fatty even atrophy of the muscles. covering that protects nerve cell fibers in TCM Pattern Differentiations the brain and spinal cord. Myelin allows Overview The kidney is the root of earlier heaven; it for the smooth, high-speed transmission During the acute period, a common governs the bones and engenders marrow. of electrochemical messages between pattern presentation is kidney and liver The brain is considered the “sea of the brain, the spinal cord and the rest yin vacuity with concurrent phlegm and marrow”, and the kidney not engendering of the body. When myelin is damaged, blood stasis. In addition, treatment with marrow may cause “emptiness of the sea neurological transmission of messages steroids tends to give rise to pathogenic of marrow”, manifesting as slow thinking, may be slowed or blocked completely, fire which exacerbates the already present 1 forgetfulness and dizziness. Also, the resulting in diminished or lost function. yin vacuity . Treatment includes herbs that

2 Sun Ten Newsletter Winter 2008 function of the bladder to store and medicinals. Medicinals often used are [Ligustrum], Lu Jiao Jiao [Deer Horn discharge urine relies on the kidney. Rou Cong Rong [Cistanche], Suo Yang Glue], Gui Jia Jiao [Tortoise Plastron Phlegm is engendered when the spleen [Cynomorium dongariorum], Nu Zhen Glue], Chun Niu Xi [Achyranthes], function of movement and transformation Zi [Ligustrum], Tu Si Zi [Cuscuta], and Dang Gui [Angelica Sinensis], and of fluids is impaired, and may manifest Xian Ling Pi [Epimedium] to supplement Gan Cao [Licorice], 10 to 12 g per day in symptoms such as clouded spirit, kidney essence and strengthen kidney each herb, except licorice which is numbness or heaviness of the limbs, or qi. Liu Wei Di Huang Wan [Rehmannia Six 5 g per day. dizziness. Blood stasis may be caused by Formula] with He Shou Wu [Ho Shou Wu] 2. Spleen-stomach deficiency: Liu Jun several factors, e.g. an impaired spleen supplements liver and kidney, nourishes Zi Tang Jia Wei [Six Major Herbs causing qi vacuity and hence qi lacking the blood, increases essence and astringes Combination Modified] with Huang adequate force to move the blood. Other jing qi. Qi [Astragalus] and Dan Shen [Salvia] causes are blood deficiency, qi stagnation, added, 8 to 15 g per day each herb, blood cold or blood heat. The primary To transform dampness, warming and except Da Zao [Jujube] 12 pieces and symptom of blood stasis is pain in a fixed transforming medicinals are used such Gan Cao [Licorice] 4 g. location. as Ban Xia [Pinellia] and Shi Chang Pu 3. Qi and blood stasis: Combination of [Acorus]. To address blood stasis and Xiao Chai Hu Tang [Minor Bupleurum Pattern Differentiation phlegm, medicinals are used that move Combination] with blood moving According to Flaws and Sionneau2, “the blood and transform stasis, and warm yang herbs: Dan Shen [Salvia], Bai Shao single most commonly seen pattern of MS and free the network vessels. Examples are [White Peony], Chi Shao [Red Peony], in real-life Western patients is qi and yin Ji Xue Teng [Milettia], Dan Shen [Salvia], and Chuan Xiong [Cnidium], plus dual vacuity,3 meaning spleen qi and liver Chuan Xiong [Cnidium], Yi Mu Cao Huang Qi [Astragalus], Sheng Di kidney-yin vacuity.” However, Flaws and [Leonorus], E Zhu [Zedoaria], Hong Hua Huang [Rehmannia, raw], and Dang Sionneau further expound that “it is the [Carthamus], Niu Xi [Achyranthes]. These Gui [Angelica Sinensis], minus, rule rather than the exception that there are used along with Gui Zhi [Cinnamon Sheng Jiang [raw Ginger] and Da Zao will be five or more concomitant patterns Twigs], Mu Gua [Chaenomeles ] and Yi Zhi [Jujube]. 9 to 15 g per day each herb, in cases of MS”.4 They advise “whenever Ren [Alpinia]. except Gan Cao [Licorice] 4 g. there are such complicated patterns, one 4. Damp-heat: Qing Hao [Artemisia should first identify all patterns present When qi flows correctly, blood flows Annua], Hua Shi [Talc], Bai Shao in order of predominance; two, state the naturally and phlegm is eliminated. Thus, [Peony], Huang Qin [Scute], Chai requisite treatment principles for each in addition to above blood moving and Hu [Bupleurum], Zhu Ru [Bamboo], of those patterns in the same order; and phlegm transforming medicinals, one Mu Tong [Akebia], Fu Ling [Hoelen], thirdly, compose on an ad hoc basis a should add supportive medicinals that Zhi Shi [Citrus Sinensis], Ban Xia treatment plan that addresses all those strengthen the spleen, rectify qi, or free [Pinellia], Da Huang [Rhubarb], Da patterns in the same proportions and with the network vessels (as enduring diseases Zao [Jujube]. 8 to 12 g each herb, the same priorities.”5 enter the network vessels). Examples are except Da Zao [Jujube] 12 pieces. Bai Zhu [Atractylodes, white], Shan Yao Treatment Strategies and Medicinals [Dioscorea], Sha Ren [Cardamon], Dang Modifications according to accompanying Treatment strategies centre on supplementing Shen [Codonopsis] to strengthen the symptoms included: liver and kidney, transforming phlegm and spleen, adding medicinals like Chen Pi • Urinary incontinence: add Tu Si Zi quicken blood stasis, and strengthening the [Citrus] to rectify qi. [Cuscuta], Yi Zhi Ren [Alpinia]. spleen. • Constipation: add He Shou Wu [Ho- Clinical Studies shou-wu], Tao Ren [Persica], Rou Care has to be taken in kidney In a study by Lu Xi and Wang Yaohuo Cong Rong [Cistanche] and Da Huang supplementation so that the often times at the Departments of Neurology and [Rhubarb]. cloying nature of kidney supplements Traditional Chinese Medicine in Fujian6,7, • Mental fogginess: add Wu Wei Zi does not cause obstruction. This can be patients were divided into four pattern- [Schizandra]. prevented by adding warming and freeing groups, each of which received treatment • Abdominal distention: add Hou Po according to their pattern. All quantities [Magnolia Bark] and Zhi Shi [Citrus refer to raw herbs. sinensis]. 1. Liver and kidney yin deficiency: Zuo • Muscular atrophy: add Dang Gui Gui Wan Jia Wei [Left Restoring [Angelica Sinensis], Xu Duan Pill Modified], with the addition of [Dipsacus] and E Jiao [Gelatin]. Zhi Mu [Anemarrhena], Nu Zhen Zi [Ligustrum], Dan Shen [Salvia], Dang Anti-inflammatory Western drugs Gui [Angelica Sinensis], and Bai Shao (dexamethasone or prednisone) were [White Peony]. The exact ingredients given during acute active periods. Of 32 are: Sheng Di Huang [Rehmannia, cases, two cases experienced complete raw], Shu Di Huang [Cooked relief from all symptoms after taking 45 Rehmannia] Gou Qi Zi [Lycium Fruit], and 68 doses; 15 were markedly improved Zhi Mu [Anemarrhena], Dan Shen and 15 somewhat improved. Generally [Salvia], Bai Shao [White Peony], it took 20 to 40 doses to achieve these Shan Zhu Yu [Cornus], Nu Zhen Zi results.

Sun Ten Newsletter Winter 2008 3 Case study by Professor Liu You Case Study by Dr Qin Liangfu9 she was stable and did not experience Zhang, recorded by Dr Zhou Jun 45-year old female, has been experiencing a relapse as in previous years. She still Liang8 lack of strength in the lower limbs and has had difficulty walking, though, and felt 35-year old female. One year ago she started been unable to walk without support for 10 numbness and weakness in the calves, to experience numbness and weakness in years. She experiences frequent dizziness, especially the left one. The extremities the extremities, blurred vision and a stiff impaired eyesight, numb fingers, cold felt stiff, she passed stool every three neck. She was diagnosed with MS and lower arms and legs, constipation and days, the sides of the tongue were red underwent Western medical treatment, incontinence. When the symptoms with little coating, and the pulse was which improved her situation slightly. started she was diagnosed with MS, string-like. Upon her return to China, the Two months ago, her condition worsened. which has relapsed nine times since the previous prescription was modified to the She again experienced numbness in diagnosis. The symptoms are exacerbated following: Gou Qi Zi [Lycium Fruit] 25 g, her extremities, and she didn’t have the during winter and spring. At her first Huang Qi [Astragalus] 30 g, Huang Jing strength to lift or even hold objects. She Chinese Medicine consultation, additional [Polygonatum Root] 15 g, Chuan Xiong also experienced difficulties walking and observations were: Thin body, dark red [Cnidium] 9 g, Bai Zhi [Angelica] 9 g, Qiang had no appetite. Pale red tongue, white tongue body, thin coating, fine and string- Huo [Notopterygium] 9 g, He Shou Wu coating, weak pulse. like pulse. [Ho Shou Wu] 30 g, Dang Gui [Angelica Sinensis] 9 g, Ju Hua [Chrysanthemum] Pattern Differentiation: Spleen stomach Pattern Differentiation: Liver kidney yin 9 g, Shu Di Huang [Rehmannia, cooked] vacuity, leading to lack of nourishment of vacuity, ascendant liver yang. 15 g, Bai Shao [White Peony] 9 g, Hong sinews and muscles. Treatment: Decoction (all quantities Hua [Carthamus] 9 g, Niu Xi [Achyranthes] Treatment: Supplement the middle and in raw herbs): Gou Qi Zi [Lycium Fruit] 15 g, Duan Mu Li [Oyster Shell] 30 g, benefit qi with Bu Zhong Yi Qi Tang Ji 25 g, Huang Qi [Astragalus 30 g, Huang Zhe Bei Mu [Fritillaria] 15 g, Xuan Shen Jian [Ginseng & Astragalus Combination Jing [Polygonatum Root] 15 g, Dan Shen [Scrophularia] 15 g, Zhi Gan Cao [Radix Modified]. All quantities in raw herbs: [Salvia] 9 g, Chuan Xiong [Cnidium] Glycyrrhizae Uralensis Preparata] 6 g, Tai Huang Qi [Astragalus] 30 g, Tai Zi Shen 9 g, Bai Zhi [Angelica] 9 g, Qiang Huo Zi Shen [Radix Pseudostellariae] 30 g, [Pseudostellaria] 30 g, Gan Cao [Licorice] [Notopterygium] 9 g, Du Huo [Tu Huo] 9 g, Shi Jue Ming [Concha Haliotidis] 30 g, 10 g, Bai Zhu [Atractylodes, white] 15 g, He Shou Wu [Ho Shou Wu] 30 g, Dang Tian Ma [Gastrodia Root] 15 g, Fan Xie Ye Wu Gua Long [Herba Tetrastigmae Gui [Angelica Sinensis] 6 g, Shu Di Huang [Senna Leaf] 3 g, Sheng Da Huang [Hou Hypoglauci] 30 g, Chen Pi [Citrus] 5 g, Niu [Rehmannia, cooked] 15 g, Bai Shao Xia] 3 g. Da Li [Radix Millettiae Speciosae] 30 g, [White Peony] 9 g, Hong Hua [Carthamus] Qian Jin Ba [Flemingia philippinensis root] 9 g, Niu Xi [Achyranthes] 15 g, Sang Zhi The foot bath and acupuncture was 30 g, Chai Hu [Bupleurum] 10 g, Sheng [Mulberry Twig] 15 g, Jin Ying Zi [Rosehips] performed as before. After one month, Ma [Cimicifuga] 10 g, Dang Gui [Angelica 30 g, Sang Piao Xiao [Ootheca Mantidis] her walking ability and dizziness had Sinensis] 10 g. 30 g, Ye Jiao Teng [Polygonum Stem 30 g, steadily improved. The patient was able to After seven doses, the numbness was He Huang Pi [Albizzia] 30 g, Huo Ma Ren gradually reduce her doses of interferon reduced and she felt a little more strength, [Hemp Seeds] 30 g, Tai Zi Shen [Radix and her other Western Medication. She no other change was noted. Ji Nei Jin Pseudostellariae] 30 g, Ling Yang Jiao Fen continues her Chinese Medicine at home [Endothelium Corneum Gigieriae Galli] [Pulvis Cornu Antelopis] 0.6 g, Shi Jue with stabilising results. 10 g (raw herb) was added to her original Ming [Concha Haliotidis] 30 g, Tian Ma prescription, and the patient took another [Gastrodia Root] 25 g. Taken daily. Formulas increasing the seven doses of the altered prescription. effectiveness of steroid drugs There was further improvement concerning Ren Shen Yang Rong Tang [Ginseng Nutritive her numbness and weakness, but the Combination]. In Japan, this formula blurry vision and stiff neck remained is used to increase the effectiveness of unchanged. prednisolone, a steroid drug that may be Ji Xue Teng [Milettia] 20 g and Nu Zhen used in cases of MS to reduce symptoms Zi [Ligustrum] 15 g were added to her during relapses.10 original prescription (all quantities in raw herbs). After taking this adjusted Traditional Indication: Qi and blood vacuity prescription for 14 days, all above Acupuncture: Bai Hui [GV 20], Yin Tang with vacuity cold, heart blood vacuity and symptoms improved considerably. The [Extra], Shuai Gu [GB 8], Feng Chi [GB 20], lung qi vacuity. Addressing symptoms thus improved prescription was used as a Tou Lin Qi [GB 15], Jian Yu [LI 15], Qu Chi [LI such as forgetfulness, sweating, base prescription for long-term treatment, 11], Wai Guan [SJ 5], Feng Shi [GB 31], Zu feverishness, shortness of breath, cough, with modifications according to the San Li [ST 36], San Yin Jiao [SP 6], Tai Chong sputum, cold extremities, no vigour, tires symptoms at a particular point in time. [LV 3]. Every second day for 20 minutes. After easily, pale complexion, dizziness, blurred extracting the needles, the patient received vision, muscle spasms. Professor Liu You Zhang advises his Huo Guo therapy on the back. patients that in MS relapses and The patient also received a herbal foot Sheng Mai San [Ophiopogon Combination] recuperation tend to alternate. Hence, bath to soak her feet daily for 20 minutes. relieves respiratory distress in cases of MS even if all symptoms seem cured one After one month of treatment, the patient and increases the effectiveness of most of should not become careless and continue went back home to Europe and continued the steroid drugs used to treat MS.11 long-term treatment for at least one to two with the herbal prescription and Huo Guo years. therapy for almost one year. That winter References available on request.

4 Sun Ten Newsletter Winter 2008