Focus on Chinese Herbal Medicine Therapy for Multiple Sclerosis by Dialectical Treatment
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) that primarily affects individuals in middle age. It leads to significant social and economic burdens due to its debilitating nature. While modern Western medicine has made strides in treating MS, it is often accompanied by severe side effects, such as progressive multifocal leukoencephalopathy and serious infections, which arise from universal immunosuppression. To mitigate these adverse effects, complementary and alternative medicines (CAMs), particularly Chinese herbal medicine (CHM), have gained attention as a viable therapeutic option. This article explores the application of CHM in MS treatment, focusing on its dialectical approach, which offers a new perspective in managing this complex disease.
The Pathogenesis of MS in Traditional Chinese Medicine (TCM)
In TCM, MS is believed to originate from a deficiency in the brain medulla, which is closely linked to the kidney. The kidney is considered the foundation of congenital constitution, and its insufficiency can lead to symptoms such as dizziness and depression. According to the ancient TCM text “Miraculous Pivot,” a healthy individual has a sufficient brain medulla, while its deficiency results in vertigo, tinnitus, fatigue, and weakness. Modern TCM practitioners further emphasize that congenital deficiency syndrome is a critical factor in MS, often characterized by an empty governor channel and damage to kidney yang and brain marrow.
The spleen and stomach, which support the acquired constitution, play a vital role in nourishing the blood and vital energy. Poor vision, for instance, is attributed to spleen and stomach deficiency, while muscular atrophy results from spleen vital energy deficiency. The liver, responsible for body liquid drainage, can cause depression, dysphoria, and dementia when its vital energy is stuck or hyperactive. Additionally, the liver stores blood and controls vessels, and its dysfunction can lead to arthralgia and impaired vision.
The lung, as the upper source of water, is susceptible to heat, which can scorch its function. The spleen controls the skin and fur, and their inability to be nourished by body fluids can result in abnormal sensations and itching. The heart, which stores the spirit and controls the mind, can lead to mental fatigue when its yang is devitalized. Heart disorders are also associated with itching, pain, and dysarthria, as the heart opens at the tongue and relies on heart blood for nourishment.
The Role of Exogenous Diseases and Pathological Products in MS
Exogenous diseases, such as damp heat, cold qi, and wind pathogens, can invade the human body and disrupt the function of the five viscera (heart, liver, spleen, lung, and kidney). Damp heat damages the spleen, leading to vital energy and blood loss, which affects the nourishment of limbs, eyes, muscles, fur, and tongue. Cold qi injures yang qi, causing whole-body stagnation, while wind pathogens result in vertigo, tremor, and ataxia, symptoms consistent with MS.
Pathological products like phlegm and fluid retention also play a significant role in MS. Phlegm retention causes stagnation of channels and vital energy, leading to abnormal sensations, numbness of limbs, and hemiplegia. It can also deceive and disturb the mind, causing lassitude, delirium, or madness. Gore, a pathological product of blood stasis, affects the movement of vital energy and blood, leading to choroid stasis and loss of nourishment.
Chinese Herbal Medicine Prescriptions for MS
Several CHM prescriptions have been studied for their efficacy in treating MS and experimental autoimmune encephalomyelitis (EAE), an animal model of MS. Among these, Buyang Huanwu (BYHW) decoction, Bushen Yisui (BSYS) decoction, and Liuwei Dihuang (LWDH) pills have shown promising results.
Buyang Huanwu (BYHW) Decoction
BYHW decoction consists of seven ingredients, with Astragalus mongholicus as the sovereign drug. It promotes vital energy to activate blood circulation, supported by Radix Paeoniae, which cools and activates the blood. Ligusticum wallichii, Peach seed, Red flower, Angelica sinensis diels, and Pberetima serve as adjunctive drugs, collectively promoting blood circulation and removing blood stasis. Studies on EAE mice have shown that BYHW can reduce neurological function scores and play a role in anti-inflammation and immunomodulation by inhibiting the Rho-associated coiled-coil forming kinase II/Toll-like receptor 4/nuclear factor-kB inflammatory pathway and regulatory T cells.
Bushen Yisui (BSYS) Decoction
Formerly known as Erhuang Fang, BSYS decoction comprises ten ingredients, with Radix rehmanniae recens and prepared rehmannia root as monarch drugs. These nourish kidney yin and brain marrow, supported by Fritillaria thunbergiimiq, Gastrodiaelata, leenurus, heterophyllus, leech, and Scorpio, which dissipate phlegm, soothe wind, and remove blood stasis. BSYS has shown neuroprotective effects in EAE mice, reducing nerve function scores, inflammatory cell infiltration, demyelination, and axonal injury. It also alleviates clinical symptoms in the acute phase of MS and significantly reduces recurrence during remission.
Liuwei Dihuang (LWDH) Pills
LWDH pills consist of six ingredients that nourish yin, support the kidneys, and feed the marrow. In EAE mice, LWDH reduces neurological scores and inflammatory infiltrates, while also decreasing tumor necrosis factor alpha (TNF-a) protein and mRNA expression. This suggests that LWDH regulates the balance between Th1 and Treg cells, offering neuroprotective and immunoregulatory benefits.
Other Notable CHM Prescriptions
Hyungbangpaedok San (HBPDS), a classic TCM formula, has shown efficacy in treating EAE mice by reducing demyelination and infiltration, as well as inhibiting pro-inflammatory cytokines and chemokines. Yiguan Jian (YGJ), which treats yin-deficiency in the liver and kidney, has demonstrated effects on inflammatory plaque and serum cytokines in EAE rats, delaying onset and alleviating symptoms. Wendan decoction, used for phlegm and heat syndrome, and Huangqi Guizhi Wuwu (HQGZWW) decoction, for arthromyodynia, have also shown potential in modulating immune responses and reducing MS severity.
Conclusion
The etiology and pathogenesis of MS in TCM are complex, reflecting the integration of Chinese traditional philosophy and medicine. Dialectical treatment in TCM offers a unique approach to managing MS, improving symptoms, prolonging remission, and controlling recurrence. While modern Western medicine provides effective treatments, its side effects necessitate the exploration of alternative therapies like CHM. Further research is needed to establish unified dialectical standards, evaluation criteria, and treatment plans for MS. This review highlights the clinical characteristics of TCM in MS treatment, providing a foundation for future studies and applications of CHM in managing this challenging disease.
doi.org/10.1097/CM9.0000000000001110
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