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MULTIPLE SCLEROSIS: Western Science and Traditional Chinese Medicine Jeff Kingham

Table of Contents

Abstract Introduction Western Medicine and Multiple Sclerosis What is Multiple Sclerosis? Etiology Signs and Symptoms Diagnosis Prognosis and Western Medicine Treatments History of Multiple Sclerosis Medicine Significant American Multiple Sclerosis Organizations History of Traditional Chinese Medicine and Multiple Sclerosis Use of Traditional Chinese Medicine in the Multiple Sclerosis Community Traditional Chinese Medicine and Multiple Sclerosis Syndromes of Multiple Sclerosis in Traditional Chinese Medicine Treatment of Multiple Sclerosis Syndromes in Traditional Chinese Medicine Special Issues Regarding Treatment of Multiple Sclerosis in Traditional Chinese Medicine Other Issues and Research Outside the Mainstream

x. ABSTRACT x. INTRODUCTION x. WHAT IS MULTIPLE SCLEROSIS?

Multiple Sclerosis (MS) is an illness characterized by more than one site of inflammationscarring (sclerosis) of the myelin tissue surrounding the brain and spinal cord. Myelin is a whitematter protective tissue covering and insulating nerve fibers and enhancing the conductive capabilities of the nerve cells. When scarring of the myelin occurs, nerve signal communication is impaired. The scarring creates a pattern of what is called demyelination. The loss of healthy nerve myelination reduces the speed and accuracy with which sensory and motor impulses can be sent, received, and interpreted by the brain and body. Demyelination is the primary factor contributing to the common symptoms that people with MS suffer. Although sclerotic tissue may undergo instances of re-myelination, after several episodes of a scarring-healing cycle the nerve axon itself often becomes irreparably damaged, especially in long nerve tracts. This can create extreme exacerbations of symptoms. Interesting data about who suffers from MS continues to provoke debate about the disease. Conservative estimates place the number of MS sufferers in the world at more than 2,500,000, with more than 500,000 Americans affected, making the United States disproportionately represented. Significantly more women than men are diagnosed MS, with only 2 men contracting the disease for every 3 women. The occurrence of the disease increases in countries that are further from the equator. In the temperate climates of North America and Europe-Scandinavia MS occurs in about 1:2000 in the population whereas in tropical countries it is about 1:10,000. According to the data it seems that development of the disease is linked to where an individual spent the first 15 years of life, meaning that a person who grew up in the tropics and moved to a temperate zone after the age of 15 or so retains the incidence rate of those who live in the tropics. Caucasians are the more likely suffers of MS, with lower incidences of the disease appearing among Latinos, Asians, and African-Americans. Nearly all diagnoses of MS (90%) are made in individuals between the ages of 16 and 60. x. ETIOLOGY MS is classified as an autoimmune disease, in which, for uncertain reasons, the bodys immune system begins to attack seemingly healthy body tissuemyelin, in the case of MS. While there has been no consensus in the medical community as to a specific cause of this autoimmune dysfunction, several theories are widely supported. The most popular theory current today holds that the disease occurs in individuals with a preexisting genetic susceptibility who suffer exposure to some environmental attack (perhaps a virus or a toxin) that disturbs the blood-brain barrier. This attack results in an inflammation that could then serve to set off an autoimmune attack on nerve tissue. This, however, represents a crude description of the theory, with most researchers believing that numerous disease and disharmony patterns converge in MS patients, who probably suffer from the manifestation of not just a single disorder, but a degenerative cascade initiated by numerous external assaults that eventually set off a preexisting genetic trigger. Despite the genetic theories about the causes of MS, this disease is not, strictly considered, a hereditary disease. Rather, as researchers describe it, there are hereditary factors that can make a person more likely to contract the disorder. Because of this, MS is classed a familial disease instead of a genetic one, with the first generation blood relatives of an MS-sufferer being 30-50 times more likely to manifest the disorder than people in the general population.

Considering the genetic angle of this theory, some recent research has been argued to show that all autoimmune diseases can be traced back to a shared genetic error. A 2001 study suggested that T-cell immune factors active in type 1 diabetes target the same self-attacking-antigens as in MS. Advanced diagnostic tests utilizing what are known as microarray technologies now make it possible to scan hundreds of genes and pinpoint the ones that are more likely to give rise to MS. Viruses are considered a primary suspect in setting off the autoimmune attack that results in MS. This view is based on several epidemiological rationales. The geographical distribution of the disease primarily in the temperate zones is argued to suggest a viral agent. In addition, several historical MS-clusters have been argued to evidence the likelihood of viral causation. Four different clusters of MS outbreaks arose on the Faroe Islands between 1943 and 1989. During this time various groups of British soldiers were garrisoned on the island. This has led researchers to consider that a disease-agent brought to the Islands by the troops and possibly thereafter spread through sexual activity led to the outbreaks. Another indication of possible viral causation has been suggested by what some researchers argue is the biological similarity between some viruses and myelin. According to this theory, there are viruses that bear a strong resemblance to the myelin protein and may confuse the immune system, resulting in a bodys T- cells attacking its own myelin in addition to the viral antigen that initiated the attack. Interestingly, some research has linked both these diseases with cow milk protein. Another major suspect in the etiology of MS is the toxic load that burdens the body of an MS patient. This views holds that repeated exposures to an assortment of environmental toxins over many years overloads or damages the bodys immune system eventually triggering antibody reactions in the MS sufferer. Some of the implicated toxins include: carbon monoxide; diesel fumes; solvents; aerosol sprays; outgassing from furniture, carpets, plastics, etc. Interestingly, MS patients have been found to have seven times the normal amount of mercury in their cerebral spinal fluid. A link with emotional health has also been noted. With many patients the initial episodes of manifested MS symptoms occurred following events of great stress or emotional trauma, which served perhaps to destabilize the immune system to such a point that the already lurking MS disharmony pattern was able to fully manifest. x. SIGNS AND SYMPTOMS Not all the common symptoms affect all MS patients. No two people with the disease have exactly the same experience. Symptoms and severity both vary widely. Some or most of the symptoms may be unremitting or may cease at times. Most patients have episodes of attacks and remissions throughout their life with the disease. Occasionally symptoms may disappear completely, leaving little permanent damage. Depending on where the lesions, the scleroses, occur in the nervous system, the MS patient tends to have different experiences with the disease. When the cerebrum and cerebellum are affected, the MS sufferer tends to predominantly suffer balance problems, speech problems, coordination, and tremors. When it is the motor nerve tracts that bear the brunt of the assault people are likely to suffer muscle weakness, spasticity, paralysis, vision problems, bladder, and bowel problems. An MS patients whose sensory nerve tract is scarred often experiences incorrect interpretations of sensory stimuli, numbness, prickling, burning sensation.

In order of prevalence among MS affected individuals the most commonly acknowledged symptoms are: fatigue; numbness, tingling, burning sensations; tremors; balance/coordination problems; depression; spasticity; bladder and bowel control difficulties; vision loss; etc.. Martin Charcot, the French neurologist who first described MS in 1868 as a distinct disease, noted three symptoms of the disease, which are known as Charcots triad and are still important in diagnosing the disease: nystagmus; intention tremors; and, scanning speech. x. DIAGNOSIS As of yet there are no tests in particular that can be said to prove a person has MS or is likely to have it in the future, though the microarray technologies discussed above can pinpoint if some suspected genetic triggers are present in a persons genetic makeup. A definitive diagnosis of MS must be made using both clinical (history, general intake questioning, low-tech neurological testing) and paraclinical (high-tech analysis and tissue testing) evidence. Important in the intake and history are inquiries about family neurological disorders including MS, past surgeries, illnesses, allergies, geographic locations where the patient has lived, whether heat adversely affects the symptomology, etc. Doctors further develop the diagnosis with the use of neurological examinations, including Babinskis test, clonus test, eye-tracking, and balance tests. Most crucially for an accurate diagnosis, evidence must be found of neurological lesions in at least two distinct areas of myelin in the central nervous system. For a proper diagnosis, the different lesions must be determined to have occurred at different times. Lastly, any possible causes for the present lesions other than MS must be ruled out to make the final diagnosis. There are three main paraclinical diagnostic tools used. The first is an MRI of the brain and spinal cord. MRIs can show areas of sclerosis. The second form of paraclinical testing are evoked potentials tests (EPTs). Like the MRI, these are painless, noninvasive procedures. With EPTs, electrodes are placed on different parts of the body to determine if and where delays in normal nerve transmission occur. The three main systems of nervous communication looked at by EPTs in the MS patient are visual, auditory, and motor-sensory connections to the extremities (i.e., feet and hands). A third primary diagnostic tool used is analysis of the cerebral spinal fluid (CFS). This is done by means of a lumbar puncture (spinal tap). The spinal fluid of MS patients has some dissimilarities with the general population including elevated mercury levels, as well as higher levels of gamma globulin, lymphocytes, and protein. x. PROGNOSIS AND WESTERN MEDICINE TREATMENTS In the beginning phases of MS, diagnostic tests, such as MRIs, may be negative but the patient may feel subjective sensory symptoms. These initial symptoms often include numbness, tingling, or fatigue. In the early stages of the disease these symptoms often cannot be corroborated by diagnostic tests. For these reasons and many more, a confirmed clinical diagnosis of MS in many cases takes years. Researchers have learned that the way MS manifests and develops during the first 5 years or so in the newly diagnosed patient provides significant clues as to how the disease will likely progress in subsequent decades. Those patients whose symptoms and degeneration can be slowed and moderated in the early course of the disease will be more likely to retain greater neurological health later on. Recent studies show that 90% of MS-sufferers with minimized symptomology 5 years after onset were still ambulatory 15 years into the disease. Generally, about 75% of those with MS never need to make use of a wheelchair, and 70% remain amulatory

20 years after their diagnosis. A lucky 40% of the MS community experiences few disruptions to most normal activities. The golden rule in the successful management of MS is early treatment makes the difference. It is becoming clear that if the disabling ravages of the disease can be held off in the first few years then permanent disability can often be avoided. A number of drug therapies are Western Medicines (WM) primary strategy for combating the effects and progression of MS. While many experimental drug therapies are being studied, there are four main classes of drugs employed in accepted standard treatment today. Beta-interferons are used to stop the inflammation of myelin lesions through various biological mechanisms including affecting the blood brain barrier. This can serve to decrease relapse rates, increase time between exacerbations, decrease the intensity of exacerbations, and slow the development of sclerotic tissue. Glatiramer acetate chemically looks like myelin and suppresses the autoimmune attack on the bodys own myelin. Mitoxantrone is used in chemotherapy. In the MS patient it suppresses the immune activity of the T cells and B cells which attack the myelin. Steroidal drug therapies are used for brief times during acute flare-ups of the disease. Steroids can shorten the duration of acute exacerbation by reducing the swelling and inflammation in the myelin lesions. x. HISTORY OF MULTIPLE SCLEROSIS MEDICINE x. AMERICAN MULTIPLE SCLEROSIS ORGANIZATIONS x. HISTORY OF TRADITIONAL CHINESE MEDICINE AND MULTIPLE SCLEROSIS x. USE OF TRADITIONAL CHINESE MEDICINE IN THE MULTIPLE SCLEROSIS COMMUNITY Two large surveys have suggested that acupuncture use among the community of MS suffers is higher than among the general population. A Canadian study and one conducted in the United States both found that around one-fifth to one-quarter of their survey respondents acknowledged receiving acupuncture in the treatment of MS-related symptoms since their diagnosis. This surpasses the use of acupuncture by general population by approximately 10%. Most of those who received acupuncture reported that the symptoms that were most improved as a result were pain, spasticity, and parasthenia. x. SYNDROMES OF MULTIPLE SCLEROSIS IN TRADITIONAL CHINESE MEDICINE In traditional Chinese medicine (TCM) MS is considered among a category of disease called wei zhong, atrophy disorder. It would seem that TCM is better able to fully acknowledge the distinct common patterns of manifestation and progression, recognizing the several unique presentations of MS, treating each in unique and different ways based on their unique and different characterizations. Among the patterns of disharmony associated with MS are: Phlegmheat depleting the yin; Damp-heat damaging the sinews; Blood deficiency with stirring of

internal wind; Deficiency of liver blood and kidney yin; Qi and yin deficiency; Kidney yang deficiency. x. TREATMENT OF MULTIPLE SCLEROSIS IN TRADITIONAL CHINESE MEDICINE The treatment of MS according to TCM principles varies widely based on which of the above patterns is elicited by the patient. But, in general, the treatment strategies for wei syndromes emphasize the strengthening of yang-ming channels and organs. The yang-ming is the source of qi, blood, and jing. Ultimately the yang-ming also provide the nourishment for the spleen, liver, and kidney, all of which are to some extent out of healthy balance in the wei zhong patient. x.SPECIAL ISSUES REGARDING TREATMENT OF MULTIPLE SCLEROSIS IN TRADITIONAL CHINESE MEDICINE Like acupuncture, TCM herbal medicine treatment will differ widely depending on which disharmony pattern presents in the patient. Regardless, it is important for the TCM practitioner to refrain from stimulating the immune system in the MS patient. Because of the autoimmune nature of the disease, a stimulated immune function could possibly lead to exacerbations in the progression of the disease. Some of TCMs commonly-used immune-stimulating herbs include: American ginseng(Panax ginseng), dong quai (Angelica sinensis), astragalus (Astragalus membranaceus), coix, Epimedium sagittatum, reishi mushroom (Ganoderma lucidum), shiitake mushroom (Lentinus edodes), Acanthopanax obovatus, Artemisia myriantha, Artemisia annua, Salvia Miltiorrhiza, Sophora flavescens, green tea, and licorice. x. OTHER ISSUES AND RESEARCH OUTSIDE THE MAINSTREAM References: Essentials of Chinese Medicine: Internal Medicine, by Anshen Shi. (Bridge Publishing Group, 2003). National Multiple Sclerosis Society Research Highlights, special issue 2002. Published by NMSS Research Programs Department Treatment of Modern Western Medical Diseases with Chinese Medicine, by Bob Flaws and Philippe Sionneau. (Blue Poppy Press, 2001). Gary Nulls Natural Living website (www.garynull.org <http://www.garynull.org/>). February/March 2005. Multiple Sclerosis Foundation website (www.msfacts.org <http://www.msfacts.org/>) March 2005. Multiple Sclerosis International Federation website (www.msif.org <http://www.msif.org/>) March 2005. University of Maryland Medical Center website (www.unm.edu <http://www.unm.edu/>) March 2005.

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