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TRADITIONAL CHINESE MEDICINE AND MULTIPLE SCLEROSIS
A patient guide by Edythe Vickers, N.D., L.Ac., and Subhuti Dharmananda, Ph.D.
BACKGROUND: EASTERN AND WESTERN PERSPECTIVES
Traditional Chinese medicine (TCM) has evolved over the past two and a half millennia to become the second largest health-care system in the world, after modern Western medicine. Because of its reliance on ancient doctrine and experience, TCM holds that the causes of most diseases as stemming from spiritual, emotional, behavioral, dietary, and climatic factors, in contrast to the biological and biochemical basis seen by practitioners of modern Western medicine. Chinese medical treatment is aimed at adjusting the environmental and human influences through lifestyle adjustments, the use of medicinal herbs, and physical therapies. Since modern Western medicine—with its reliance on the latest research findings and technologies—depicts the causes of most diseases as stemming from genetic, structural, pathogenic (infective or toxic), nutritional, and behavioral factors, treatments are bioengineering, surgery, chemotherapy, dietary restriction, nutritional supplements, and behavior modification. Given that TCM and modern Western medicine have some overlap—in that they both recognize the roles that diet and behavior play in disease etiology—a detailed exploration is warranted.
With regard to diet, Chinese medical doctrine holds that all ingested substances, whether classified as food, herb, or drug, have an influence on physiological function. The influence of an ordinary apple, for example, is said to be cooling and astringent, benefiting the digestive system and lungs. On the other hand, mutton is warming and moisturizing, benefiting the digestive and endocrine systems. By cooking foods through different methods, or adding seasonings during cooking, the nature of the food can be altered. Depending upon the selection of foods and their specific method of preparation, a person may maintain the balance that exists, restore balance, or, with the incorrect choices, become unbalanced. The role of the traditional-style medical doctor is to direct the individual to eat foods and consume herbs that will restore and maintain the balance that has been lost. A well-known saying in the Orient is: “Medicine and herbs have a common source; herbs and food have common uses.” This means that foods, herbs, and medicines must be considered as one subject when it comes to health.
Western medical theory holds that foods are comprised of chemicals, that the body reduces the complex foods to a mixture of these basic chemical components through the digestive process, and that the body takes only those components it needs and eliminates the rest. The dietary chemical components that are currently deemed essential to health have been determined to be important mainly by the process of individually eliminating them from the diet of test animals and observing whether or not an abnormality arises, then restoring the substance to see if the abnormality is corrected. Based on these observations and analysis of human dietary intakes, a list of recommended daily amounts of nutrients has been developed, and individuals are asked to be sure that all these recommendations are met, regardless of their source. However, because recent experience has shown that high-fat diets can increase risks of cancer and heart disease, an upper limit is placed on the ingestion of total fats, and of the subgroup saturated fats. In a similar manner, an upper limit is recommended for total intake of cholesterol, salt, simple sugar, and total calories to help minimize the occurrence, and severity of certain diseases, such as atherosclerosis, hypertension, and diabetes.
TCM practitioners recommend the use of foods on the basis of the inherent qualities of the whole, prepared, food, while modern Western-medicine practitioners recommend the use of foods based on the quantities of certain constituents, source and method of preparation notwithstanding. Since in the Orient, herbs are regarded as having a similar use as foods and similar origin as drugs, they are likewise used according to their inherent qualities to help achieve bodily balance. In the West, herbs are not deemed essential (they are generally low in nutrients and their need in human health has not been firmly established), so they are simply not recommended. Further, because of lack of experience using herbs instead of poisonous plants serving as the source of powerful drugs (e.g., foxglove as the source of digitalis), fear of adverse reactions or of unforeseen future risks from using herbs frequently outweighs the attraction of any possible health benefits.
Regarding the influence of behavior on health, Chinese medical doctrine suggests that certain behavioral patterns associated with emotional experiences may lead to disease. Probably the most important causative factor identified in this medical system is the failure to resolve emotional distress by appropriate familial and societal interactions. It is understood that unrelieved emotional stresses cause alterations in the functions of the internal organs, ultimately leading to their malfunction and the initiation of disease processes. For example, a large portion of the cases of cancer, autoimmune diseases, and gynecological disorders are thought, by the Chinese physicians, to be induced by or promoted by anger, depression, and anxiety. Appropriate resolution in the Orient may include discussing the situation and the emotional problem with respected elder family members to obtain wise advice towards resolution; attaining agreement with one’s spouse over areas of controversy; and simply obeying the rules laid down by Confucius or other great thinkers regarding one’s place in the family and within the greater society. This concern is basically for spiritual health, in the sense that one can, and should, strive to resolve spiritual emptiness—a potential basis for disease and failure to handle emotional situations—by communication with spiritual leaders in the community and by following the teachings of revered historical figures. It should be noted that, during the past few decades in the People’s Republic of China, this aspect of health care has been demoted in emphasis due to the government’s negative position on religion and spirituality; a failed policy that is now slowly turning around.
Western medical theory expresses the idea that various human behaviors entail certain risks associated with disease or debility. Cigarette smoking, excessive drinking of alcohol, over-eating, illicit drug use, and participation in activities that have a high accident rate (e.g., automobile racing, skiing) are examples of high-risk behaviors. Continuation of these behaviors may lead to diseases, injury, or death. To alter the behaviors, education is offered to clarify the nature of the risk, and interested individuals may participate in programs to assist behavior changes (e.g., AA meetings). While it has been recognized recently that emotional stress and depression can have an adverse impact on immune function, there is rarely any further elucidation of the link between emotion, high-risk behavior, and the onset of disease. In fact, recent research findings suggesting that there are genetic factors behind the undertaking of high-risk behaviors has focused attention on the biological side of the problem, rather than the emotional. Nonetheless, there is increasing discussion of the value of “support groups” in reducing disease symptoms and enhancing survival in cases of serious illnesses. Participation in such support groups has been shown to alleviate depression and double the life span of patients with terminal breast cancer. In China, the extended family and members of the local community are supposed to be in place at all times as a support group, but this is often not the case in America where high divorce rates and relocation of family members have been dominant features of the social landscape for generations.
It can be seen that, even in these two areas (diet and behavior) of overlapping ideas about disease etiology, there are considerable differences between the TCM and modern Western viewpoints. As a result, the diseases are described in different terms and treated by different means. In those areas where there is even less overlap in ideas about cause of disease, there are greater differences in the therapeutic approaches taken, and it becomes quite a complex task to describe the Chinese theory in terms that would be comprehensible to someone trained in the modern Western medical way of thinking.
MULTIPLE SCLEROSIS
As relates to MS, the Chinese believe that the disease process most likely originates with a combination of spiritual and emotional factors, and that the “trigger” for the disease may be an experience of a feverish illness, usually an infectious disease. The weakening of and loss of control over the musculature may come about because the critical energizing and regulating functions of the internal organs have become disturbed due to the loss of spiritual focus, perhaps because of a frightful experience which has “scattered one’s soul from its resting place.” The triggering disease consumes vital fluid essences that are essential to nourishing the body and providing a relaxing medium for the spirit. Without spiritual relaxation, there is ongoing agitation, and destruction of bodily harmony.
Western medicine is still pursuing the precise description of MS, but currently it is believed that a combination of genetic predisposing factors and an episode of a common viral disease initiates an autoimmune process which leads to the symptoms of the disorder (inhibition of nerve transmission to the muscles), exacerbated by subsequent infections or other stimulants to the autoreactive immune system. In other words, the disease has nothing to do with either personal experiences (other than having an infection) or general bodily balance, but rather is attributed to an inherited coil of DNA and another slice of DNA provided by the virus. Therefore, TCM diverges from Western medicine by placing human experience above inheritance and biology as a cause. TCM practitioners would not deny that the specific disease manifestation—multiple sclerosis, rather than another chronic disease causing similar symptoms—might be based on heredity, but they would focus on other experiences to explain why the disease arises and persists.
Therefore, the Oriental and Western views can be partially reconciled by saying that a genetic propensity for the disease needs to be present in order for one to experience MS, but that life experiences other than the viral infection might also be necessary cofactors to initiate and maintain the full disease process. MS is a relatively rare disease in China, and this is believed by modern researchers to reflect a genetic difference between the Oriental population and the others—mainly Caucasian—that have a higher incidence of the disease. Further, MS is more common in individuals who grew up in northern areas rather than southern areas, suggesting either exposure to a pathogen or food product that is more common in the cold climates.
Among those with the necessary genetic and environmental factors, the reason why some are afflicted with MS and others are not, or why the disease follows such different courses in different individuals, remains an open question for which TCM theory may provide some insights.
Although the Chinese see anxiety, depression, fright, and fear as contributors to the disease process (helping to initiate and aggravate the condition), Western doctors observe these emotional patterns in patients diagnosed with the disease and attribute the emotional conditions largely to a reaction to the diagnosis. That is, once a person is informed that they have a disease which may be progressive and debilitating, they become anxious, depressed, and fearful.
Western doctors observe demyelination of the nerve fibers and its eventual scarring (sclerosis) as the characteristic pattern of MS. Demyelination—a loss of fatty substance surrounding the nerve fibers—roughly corresponds to a description, by Chinese doctors, of the loss of a vital fluid essence (jing). The autoimmune process, with stimulated production of antibodies that attack the body instead of attacking a pathological organism, corresponds roughly to the Oriental description of dysfunction and disharmony of the internal organs. Where the Western physician imagines the microscopic changes revealed from isolated tissues, the Chinese physician imagines broad processes that correspond to things experienced in daily life.
TREATMENT STRATEGIES
To resolve MS, a current Western medical approach is to find a protein that will block the autoimmune attack, thereby stopping any further demyelination, and thus preventing further development of MS. Another is to apply a peptide (cytokine, a small protein, such as interferon) that regulates immune responses and controls initiating viruses, thus reducing the number of MS attacks. There are numerous other methods being investigated, in which something is introduced into the body to interfere with the autoimmune process. The Chinese medical approach is also to introduce something into the body, with the aim of replenishing body essence and to rehabilitate internal organ functions, through diet and herbs, rather than products of advanced technology. Acupuncture is applied in an effort to rectify the circulatory disturbances that arise from the disharmony of organ functions; the improved circulation helps the organs and tissues return to a normal, healthy condition. Further, steps to resolve underlying spiritual and emotional distresses are undertaken on the basis of discussions and recommendations.
The herb combinations prescribed by doctors of Chinese medicine are selected on the basis of past experience with treating “flaccidity syndromes” (mostly diseases other than MS that cause muscular weakening) and on the basis of the current health status of the individual. The latter is to be established by asking questions and conducting some traditional diagnostic procedures, such as analyzing the appearance of the tongue and feeling of the pulse at the wrist. Not only do the symptoms of MS vary from individual to individual, but also the health histories (such as coexisting diseases or syndromes) are different, and these factors must be accounted for in determining suitable prescriptions. Acupuncture treatments are likewise selected on the basis of previous experience with other patients, such as those who experience paralysis due to stroke, and on the basis of unique characteristics of the individual currently under treatment. Thus, there is not a single remedy for MS that can be offered through the traditional Chinese medical approach, but rather a composite treatment based on individual needs.
According to a published clinical trial and a small number of individual case reports from China, MS symptoms can be effectively controlled in many patients by consistent use of Chinese herb formulas. To attain a successful outcome, the correct herb prescription for the individual’s unique needs must be selected, the dosage must be adequate, and the duration of treatment must be long enough so that beneficial results persist once the therapy has been completed.
The duration of therapy for MS patients reported in Chinese studies ranges from two months to over two years; herbs used to prevent exacerbations might be taken for several more years. If the herbs are discontinued after the initial treatment period, some patients may remain free of symptoms for many years. In some cases, there can be a relapse, but prompt resumption of herb use will help the individual regain freedom from disease symptoms for a period of time. Despite the long duration of therapy necessary in some cases, it is not uncommon in China for improvements to be noted within the first two months.
Improvements to be expected include an enhancement in one’s overall sense of well-being, a reduction in the severity of persisting symptoms, a reduction in the use of drugs that control symptoms, including antidepressant drugs, and a reduction in the incidence of bouts of weakness. In some cases (perhaps 20%), the individual will apparently be cured.
In a Chinese study [1] with 35 patients, four different herb formulas were developed. People were treated according to the diagnosis that would place each into one of the four broad diagnostic categories that matched the herb therapeutics. The complex herb formulas were prepared as decoctions (tea made by boiling the herbs for about 45 minutes) using 8 to 15 grams of each ingredient (a total of about 150 grams per day), consumed as a cooling drink (rather than hot, as many MS patients have an aversion to heat). Anti-inflammatory Western drugs were given during acute active periods of the disease. Except for three patients that discontinued treatment within the first ten days, some improvement was found in all who tried this method. Two cases were deemed basically cured after taking just 45 and 68 doses; 15 were markedly improved, and another 15 somewhat improved—most of them taking 20 to 40 doses. Eleven of the patients had tried corticosteroids unsuccessfully before switching to the traditional herb combinations; of these, 7 were markedly improved, 3 improved, and only 1 failed to respond.
The same researchers then conducted a study [2] of prevention of exacerbations. 30 MS patients (15 male and 15 female) were given an herbal formula, called Ping Fu Tang, comprised of 17 herbs. Each herb was used in a dosage of 8–15 grams (except two auxiliary herbs used in low dosage), with a total daily dosage of about 150–180 grams of herbs in decoction. The herbs were taken in two to three divided doses each day. The patients took these herbs for a period of 3 to 13 years (average of 6 years) and during this period, only two mild exacerbations occurred in the group. By contrast, a control group of 15 MS patients had an exacerbation rate of 1–4 times per year.
Two case studies of MS treatments were reported [3] from the work of Dr. Domei Yakazu in Japan. Good therapeutic results were described from the regular ingestion of an herb formula over a period of two and a half years in a man aged 48, and marked improvement was noted in a woman, aged 34, who consumed two traditional formulas for a period of approximately two months. According to a translated report from China [4], a female patient, aged 38, was treated with herb decoctions for about 15 weeks and was then given herb pills to take regularly for one year. The clinicians reported that she was cured as a result of the treatment. A general survey of Chinese journals shows that there are a small number of other similar reports, each article describing one or two patients treated with obvious benefit.
The dosages of herbs used in Chinese clinical studies that have demonstrated successful resolution of MS, and other chronic diseases, tend to be quite high. Longer-term therapy with lower dosage, as used in Japan, has been reported to produce good results, but no claims of cures, as yet. Because Americans are not used to relying on herb remedies, the dosage applied in China may seem exceptionally high when compared with ingestion of drugs, vitamins, or even herb remedies that are administered for less serious disorders. Chinese herbs may be provided in bulk form to make a strong decoction, or by spoonfuls of powdered herb or extracts. If the herbs are taken in pill or tablet form, the number of them to be ingested might be quite high (e.g., 24 large tablets per day).
While the herb compounds used in treating MS are nontoxic, it is possible to experience some reactions. The most likely adverse response is a gastro-intestinal reaction that might include indigestion, loss of appetite, nausea, vomiting, diarrhea, flatulence and bloating. Such reactions can usually, but not always, be eliminated by changing the time of taking the herbs in relation to meals, by providing a digestion-promoting formula (or a simple ginger tea) to be taken at the same time, or by using a different prescription. In a very small number of cases, an allergy-like reaction may arise, and this usually manifests early in the treatment with a rash which will be alleviated when the use of those particular herbs ceases, but will quickly reappear if the same herbs are taken again.
If herb therapy is the primary method of treatment and if there are no special difficulties encountered (e.g., no need for frequent changes in prescription), an office visit every two to three months may be adequate once a treatment program has been established. If acupuncture is pursued as an additional therapy, treatments might be undertaken at the rate of three to four times per month (more frequently following an exacerbation of MS). An acupuncture procedure known as scalp acupuncture appears to provide the best results. A specialist in this type of acupuncture, Mingqing Zhu, works at the Chinese Scalp Acupuncture Center in San Francisco. He has written a book about his techniques [5], which is available from the Center, and has personally trained many American acupuncturists in its use (practitioners can also learn many of the techniques from his book).
In addition to the traditional Chinese techniques, nutritional interventions may be suggested; these are based on Western research, but have been adopted as part of natural medicine in modern China. For example, studies have shown that some individuals with MS have low blood levels of vitamin B12, a nutrient which is essential to myelin sheath repair (it may be necessary to give this nutrient by injection, since poor intestinal absorption may be the reason for low blood levels). Calcium supplements can be especially important to women suffering from MS, since any reduced mobility from the disorder can lead to increased risk of osteoporosis. Magnesium supplements could be helpful in reducing spasms, which are a problem for some persons with MS. Dietary modifications, to remove allergens and to adjust the fat content (to very low levels), have been reported as helpful in some patients.
At ITM’s An Hao Natural Health Care Clinic in Portland, Oregon, about 45 MS patients have undertaken treatment with Chinese herbs, nutritional supplements, and acupuncture during the past eight years, most of them carefully monitored during 1994–1996 as part of a study partially funded by gifts from the MS Foundation of Fort Lauderdale, Florida. Using the protocols at the An Hao Clinic, including scalp acupuncture, as long as the treatments are pursued regularly, there is relief of many symptoms (including urinary disorders and constipation), less use of certain drugs (notably antidepressants), and reduction or elimination of attacks of muscular weakening and incoordination. Adverse reactions to the standard herb formulas have not been a problem with this relatively small group, but a number of patients were unwilling to take the large amounts of herbs recommended.
We do not know, at this time, to what extent it is possible to reverse neurological damage that leads to a person being wheelchair bound. At our clinic, several persons with MS who use walking aids (such as canes or walkers) have been able to eliminate the need for these devices as the result of acupuncture treatments, especially the scalp acupuncture that has previously been used by Dr. Zhu to successfully treat paralysis due to stroke. One person with MS who was wheelchair bound was able to begin standing and walking with the assistance of a walker, but still uses the wheelchair much of the time. The outcome depends on the nature and extent of the nerve damage that has occurred, and on the willingness and ability of the person to attempt the physical therapies to restore mobility. If there remains some limited ability to walk when acupuncture and herb therapy are initiated, then it is very likely that the individual can be coaxed into a greater mobility.
Irregularity in using Chinese medical therapies (infrequent acupuncture, missing daily doses of herbs) appears to be the main reason for poor results among those with the relapsing/recovering type of MS. With MS, as with many other chronic diseases, some individuals who try the Chinese medical approach stop using it before it can have a marked effect. This drop-out from treatment may be due to inconvenient access to the clinical site, unwillingness to take the herbs and supplements regularly, or disappointment if there is not prompt, dramatic, and sustained benefit. Few participants, regardless of their enthusiasm for the method, were able to come to the clinic for twice-per-week acupuncture, during the first 2–3 months of treatment, as would be preferred from the practitioner’s point of view.
Since sclerosing is a cumulative process, effective control of the disease over an extended period of time can also prevent the worsening of symptoms that occurs when large areas of nerve fibers are damaged. For many chronic diseases, Western medicine offers a control of symptoms through life-long administration of a synthetic drug. Substituting a life-long application of Chinese herb formulas may produce comparable results, while avoiding some of the side-effects typically associated with the chemical isolates that comprise pharmaceutical products. More importantly, the Chinese medical therapies aimed at relieving the MS can help treat other health problems at the same time.
ACCESS
For persons in the Portland area, it is possible to be enrolled in the ongoing MS study program at ITM’s clinic (write to ITM for a packet of information; 2017 S.E. Hawthorne, Portland, OR 97214). For persons elsewhere in the U.S., ITM has a Practitioner Reference Guide listing about 400 practitioners who have direct access to ITM’s information about treatment protocols. Additional resources for treatment, both orthodox and alternative, are available from the Multiple Sclerosis Foundation (MSF, 6350 N. Andrews Ave., Fort Lauderdale, FL 33309).
ADDENDUM
In the book Insights of a Senior Acupuncturist, Miriam Lee describes her concept of MS and its treatment [6]. Lee practiced acupuncture in China and Singapore for more than twenty years before coming to the United States, where she continued her practice for twenty more years before writing her book. The following are excerpts from her analysis of one patient, a forty year old woman, who had received a medical diagnosis of presumptive MS of recent origin. Whether or not the case was actually MS or some other nerve disorder that produced similar symptoms is not relevant to the significant factors of the Chinese medical analysis.
For the previous two years, the patient had experienced a period of intense depression, anger, and sadness, following the ending of a relationship...excessive emotions, especially those associated with a broken heart, sadness, anger, depression, worry, constant replay of mental dialogues—”he said...I said...”—were the deeper root of her problem. These mental dialogues were destructive, never-ending loops that can bind up a person’s qi [or “chi”, circulating vital energy] with a chain as strong as iron and consume it with nothing to show but suffering. When this internal dialogue takes over, the patient cannot concentrate, cannot sleep, may eat a lot and gain no weight or may eat little and add pounds, all indications of internal secretion imbalance. Eventually, muscle control is lost and coordination is impaired.
Acupuncture can restore some amount of control once it has been lost, but requires many sessions over a long period of time. If the syndrome is recognized and dealt with early, the worst effects can be averted and the body’s fuller utilization of its qi can be restored in a course of treatment two times a week for several weeks.
Though treatment can help to break the blockages of the energy, the patient herself must decide to step out of the circle of thoughts and memories, hurt, anger, guilt, and resentment. Acupuncture treatment can increase the qi available to make these changes in dealing with life’s problems and thus change the vicious downward circle into a beneficial upward one.
I advised this woman to sing. Not sad songs but hymns of praise. To sing them out loud, not just hum, paying attention to the words. The issue in this woman’s case was, in part, a spiritual one. Besides the fact that singing does wonders for the lungs and circulation, the words serve as a reminder of the wonders of creation that are all too easily forgotten in the face of hurt and disappointment...Nothing is really worth the slow dying that results from hanging on to old hopes and negative feelings, but human beings unfortunately seem to do so.”
This description was accompanied by mention of some appropriate acupuncture points used in the treatment sessions and certain dietary modifications, but the main focus was the mental—and spiritual—aspects of the process, which influence the circulation of qi, and eventually cause the disease to manifest in the form of MS. The genetic background, viral influence, immune disorder, or myelin sheath destruction are not part of the description: those are merely the scientifically isolated features of what happens to the body as the mind goes through its crisis. As to the chances of success with this method for treating persons with MS, Dr. Lee states: “It takes many treatments and a strong commitment to changing lifestyle, diet, and emotional habits.”
REFERENCES
1. Lu Xi and Wang Yaohua, Thirty-five cases of multiple sclerosis treated by traditional Chinese medicine principles according to differential diagnosis, Chinese Journal of Integrated Traditional and Western Medicine 1990, 10(3).
2. Lu Xi, Wang Huayen, Wang Yaohua, Research on the prevention of MS reoccurrence with traditional Chinese medicine, Journal of Traditional Chinese Medicine 1995; 36(7).
3. Hsu Hong-yen, Neuromuscular disorders and diseases, Bulletin of the Oriental Healing Arts Institute 1978, 4 (4).
4. Xie Hai Zhou and Li Xiao Lu, The clinical application of tonifying and benefiting the kidney essence for multiple sclerosis, Journal of the American College of Traditional Chinese Medicine, 1985, 4.
5. Zhu Mingqing, Zhu’s Scalp Acupuncture, 1992 Eight Dragons Publishing, Hong Kong.
6. Lee, Miriam, Insights of a Senior Acupuncturist, 1992 Blue Poppy Press, Boulder, CO.
For additional information, consult the book Chinese Herbal Therapies for Immune Disorders by S. Dharmananda, 1988, revised 1993, ITM, 2017 SE Hawthorne, Portland, Oregon 97214.
APPENDIX: Typical Treatment Protocol Used at ITM’s Clinic
Acupuncture: provided at least three to four times per month initially, and twice per month later, with a focus on scalp points. Treatment time is about 20 to 30 minutes. There may be certain needles left in place for a longer period, to be removed after returning home.
Herb tablets: a general formula for autoimmune disorders plus a general formula for “kidney/spleen deficiency syndrome” is taken daily. An anti-viral formula is kept on hand to be used in place of the other herbs in the event of initiation (apparent or evident) of a viral infection; this is to avert an exacerbation induced by the viral infection.
Nutritional supplements: a multivitamin/mineral tablet is used daily to provide calcium, magnesium, and B-vitamins (two tablets each time, twice daily, provides 500 mg calcium and 400 mg magnesium plus numerous other nutrients), and B12 injections are given weekly (some persons learn to self-administer the injection).
Actual treatments are adjusted according to diagnosis and specific symptoms. A health professional trained in TCM can determine what adjustments might be necessary. If no obvious benefit is noted within three months of regular therapy, a different approach should be tried.
July 1996
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Post time: 2009-04-27 17:08:24
Post time: 2009-04-27 17:08:52