by Heiko Lade
The purpose of this paper is to present the reader with an overview of multiple sclerosis (MS) from a TCM perspective as well as reviewing some of the modern medical theories attributed to its causative factors. Much research has been done and continues to attract scientists, statisticians, academics and the full spectrum of orthodox medical practitioners ranging from psychiatrists and neurologists in their quest for a cure. In New Zealand at the time of writing, the most favorable option in terms of biomedical treatment are weekly injections of interferon beta-1a.At a cost of $400 NZ per week, for the duration of the disease, coupled with side effects and then only to slow down the progression of the illness leaves huge scope for TCM research. Dr Martin Pollock, a neurologist of Dunedin Hospital did warn me that once becoming involved in a study of this subject, that it would consume me because of the vast number of theories and material available. This definitely applies to the orthodox view of MS but from a TCM view, literary sources (in English) were limited and basically consistent with the concept of MS being due to Liver/Kidney and /or Spleen xu. Initially in practice I adhered to this concept but have now changed my view and present this paper so that other practitioners may consider a different approach with their treatment. This different approach to treatment of MS has come to me as a result of combining modern medical research with classical Chinese knowledge coupled with a bit of lateral thinking. Some Chinese medicine purists may disagree with the concept of trying to fit a traditional viewpoint within an orthodox structure but Chinese medicine is evolving and the fusion of western medical concepts is inevitable and possibly even beneficial. Eight hundred years ago Li Dong-yuan said "Ancient and modern times differ; Ancient formulas are helpless for modern diseases"(1993, p.viii.). I couldnt agree more when it comes to treating multiple sclerosis.
Jon Martin Sharcot, a Parisian physician who had a particular habit of performing autopsies on all of his deceased patients was the first person to coin the term sclerosis(Pollock, 2000).In fact multiple sclerosis is a new disease. Though being regarded as a twentieth century disease it probably existed earlier. Medical discussions beyond 1900 are few (Dharmananda, p.1).Dr Pollock suggests that there would of been fewer people with MS in earlier centuries because people did not live as long as today (Pollock, 2000). Patients with MS generally worsen as they age and it is not easily diagnosed in say the early adolescent years. Confirmation of diagnosis used to be only verified at an autopsy though other clear physical signs were diagnostic enough. Even with all the modern diagnostic procedures available in the sixties and seventies a common medical test to confirm MS was the hot bath test as hot weather and hot baths aggravate MS. Nowadays however, magnetic resonance imaging (MRI) is the main diagnostic procedure to confirm diagnosis and progression of the disease. The MRI scan is also used in modern China to determine the results of TCM treatment on MS. However, as the MRI scan is so expensive in China, MRI is used more as a diagnosis and when there is improvement they do not redo the scan (Dong, 2000). Physical Symptoms of MS can be summarized as follows:
And less commonly:
Mental symptoms of MS are usually summarized as:
Essentially Multiple Sclerosis is an auto-immune disease where the immune system attacks itself, in the case of MS, an inflammatory response around the myelin sheath causes the damage (Strand p.1). The myelin sheath is like an insulation around the nerve and this breakdown is called demyelination. As a result, the patient experiences muscular weakening and numbness (Dharmananda, p.4).
Eventually there is a formation of many small plaques throughout the CNS. Interestingly, the peripheral nerves are unaffected.
The rate at which demylination occurs, and hence increasing plaques is dependent upon the number of intermittent attacks. These relapsing-remitting attacks can vary ranging from weeks to years. During the stable period, damaged nerves can recover if the attack was not severe. Generally speaking, though, scarring occurs and leaves the patient worse off with each attack.
Unfortunately, there is also a progressive type of MS that causes a continual digression until death (Dharmananda, p.4).
Mental symptoms are rarely mentioned in any TCM literature sources which is intriguing because its as if they are insignificant. My first observations of the emotional state of patients with MS seemed to suggest a type of "lily disease" which was later confirmed by Flaws on his Chinese medical psychiatry website. Patients with MS often do have serious emotional and mental problems preceding physical symptoms.
Karen Skeggs, from the Department of Psychological Medicine, University of Otago Medical School, Dunedin, has written papers discussing MS and its psychiatric manifestations. It must be pointed out that Skeggs work is significant in that her research is based upon Dunedin people. Dunedin is geographically in a latitude that increases disposition to MS. In fact, the incidence of MS is 3 times higher in Dunedin (New Zealand) than say for example Hamilton in the North Island (Pollock, 2000).
Skeggs research found that some patients had clear mental symptoms and the absence of specific neurological features, prior to the diagnosis of MS. In fact, demyelination may occur in the brain and cause depression and hence some patients had been misdiagnosed, from a psychiatric point of view (Skegg, K et al 1988, pp733-736). In her study group, 16% of patients diagnosed with MS had been referred to psychiatrists prior to the official diagnosis of MS.
This can indicate that the mental symptoms of an MS patient and their possible TCM causes should be considered with greater importance and this will be discussed later.
Some of Skeggs patients exhibited clinical features such as:
The slow progression of MS in the early stages can be quite confusing to the mentally suffering patient as they feel something is wrong and they, and no-one else knows what it is. Many patients actually are relieved when the official diagnosis of MS has been confirmed. Physicians have experienced that their patients even became euphoric when told that they have MS (Morris, 2000). "At last they believed me that something was wrong" as quoted from one of the authors patients.
The late Dr. Christopher Stubbs, a former lecturer at the Dunedin School of Medicine sums it up for us quite well "MS patients had been given rose tinted glasses as a compensatory mechanism by nature to cope with all the weird mental symptoms but unfortunately at the conclusion of diagnosis it was too late to jump off a cliff like they wanted to, because they were now wheel chair bound" (Isbister, 2000).
This then brings us to the possible biomedical causes of MS. It will be demonstrated that there is no known cause but only numerous hypothesizes. In essence, any hypothesis should be regarded as a co-existent factor with the disease and not really a cause. Dharmananda (pp1-4) has already given us an up to date overview of biomedical co-factors thought to contribute to the disease and this paper will use his work as a reference point.
Perhaps the most intriguing factor is the predisposition to having the disease because of geographical factors. It seems that the closer one is born and lives in their youth to the north or south poles can be a contributing causative factor. For example, in England it is 40/100,000 but in Orkney and Shetland it is 120/100,000 (Hope,R et al p.454). Even though MS is rarer in Asian people compared to Caucasians, MS does have a higher incidence (1.9 1) for those in the most northern reaches of China (Dong, 2000). Yet Eskimos who live even further north, remain free from the illness, as do African Negroes. Perhaps the geographical factor is of relevance to the TCM practitioner if one were to consider energetic disturbances from a feng shui perspective. The closer you go to poles, the more you would find the magnetic extreme ( ie yin or yang). The northern pole is suspected of being more yang because as that is where the heavens energy enters (Atherton, 2000). Some research comparing the symptoms of MS from people in the southern hemisphere with the northern hemisphere may provide insight here.
Pollock feels that the latitude idea is the perhaps the most significant causative factor in the disease along with the Scottish genetic factor. He pointed out that in Dunedin there are more people with MS whose surname starts with "Mc" than with any other. Dunedin also has a large number of Scottish immigrants dating from the 19th century (Pollock, 2000).
Research into genetics has revealed that genes play a role in the predisposition to MS. The MS gene belongs to the major histocompatibility complex (MHC) (Dharmananda, p.1). Statistically, the offspring of MS parents increases the likely hood of their childrens susceptibility to the disease.
Nutritional treatment and vitamin/mineral deficiencies has long been the focus of treatment by naturopaths and dieticians. Certainly, a higher standard of nutrition will benefit anyone with any chronic disease such as MS because vitamin and mineral supplements are concentrations of gu qi and supplement the Spleen qi to nourish the jing .
Other sources suggest the bodies ability to assimilate the trace mineral gold, should be considered to be a key factor in MS treatment (Gurudas,1983, p.145).
Dr. Ray Strand believes it is due to oxidative stress and advocates an aggressive nutritional regime to control it (Strand, p.1).
Bacterial and parasitic infection has also been suggested to aggravate MS. It is not known whether the bacteria themselves are the cause, or the fact that as a result of an infection taking place an auto-immune response is triggered. It seems that a number different infections can do this and MS people are susceptible to a variety of triggers. Sinus infection, for example can also be responsible for a relapse (Dharmananda, p.3).
Viruses certainly take precedence to researchers as being a probable cause of the MS or at least being involved as some kind of synergistic co-factor that may trigger the genetic disposition.
The situation of being infected with one virus becomes more difficult to treat when the patient becomes infected with more than one virus. This is not new as its known that statistically patients with HIV and HBV concurrently have a poorer prognosis than just having HIV. One can only assume that being overloaded with viruses when susceptible to MS can only increase this risk of relapse.
Which viruses have been correlated with MS involvement? As more research is done, new viruses are being found to co-exist with MS. A recent German study undertaken by Dr. Klaus-Peter Wandinger of the University of Lubeck School of Medicine found that 100% of MS patients had the antibodies against Epstein-Barr virus, a herpes virus. The researchers concluded that the Epstein-Barr virus "is a prerequisite" for the disease. Further work revealed that the herpes drug acyclovir when prescribed to MS patients lead to less relapses (Wandinger, 2000).
Another herpes virus known as HHV-6 is found in the oligodendrocytes of MS patients but not in others peoples oligodendrocytes. As was discussed previously, when more than one virus is present in the body they help each other out, and in many cases, to the detriment of the patient. For example, HHV-6 and HIV use each other, where HHV-6 is the transactivator (Dharmananda, p.2).
What other virus may contribute to the MS picture? The Measles virus, which is the main focus of this paper. Measles is caused by the rubeola virus and is a common childhood disease manifesting in a rash of flat red or brown blotches lasting from 4-7 days. The rash starts at the forehead, goes down over the face, neck and body. According to the National Disease Surveillance Centre (NDSC pp1-3) complications can include diarrhea, conjunctivitis, ear infections, pneumonia/bronchitis (1 in 25) [Medinfo says (1 in 100)], convulsions (1 in 200) and meningitis/encephalitis (1 in 1000). Apparently, according to Medinfo, immunization is eradicating the disease. However, I have seen children who have contracted the measles at age around 10 and 12 even though having been vaccinated. This is of major concern, as the closer to puberty one contracts the measles, the higher the risk factor of being susceptible to MS (Dharmananda, p.2). I have also seen a young child of 3 _ years that had been immunized for measles at 15 months old then having got the measles 6 months later. After a trip overseas another six months later, she came down with itchy red spots on the groin and bottom that never went away with creams and steroids prescribed by medical physicians. A TCM treatment of using measles expelling herbs such as Fu Ping and Jing Jie, caused the skin spots to break out all over the body in an initial reaction to then cure the condition. This simple case demonstrates that its possible that the measles virus can lie dormant and be expelled using acrid measles expelling herbs.
Whilst on the subject of measles its appropriate to quickly reiterate and refresh the readers knowledge of TCM and measles. Measles is also called "sand" in TCM as the spots can feel like sesame seeds when pushed. There are three stages:
In children the spirit qi is weak and their channels and vessels are not exuberant so its why they can become easily sick and for diseases to change for better and for worse quickly (Deng, 1999, p.365). If there is weak proper [zheng] qi, the rash can sink back into the body and this is regarded as a dangerous sign (Ward, 2000).
Black (2000) suggests 3 formulas to treat the different stages:
Herbs that expel measles are summarized below:
Jing Jie initial stages of measles
Bo He early stages of measles
Sheng Ma early stages of measles
Niu Bang Zi incomplete expression of measles
Chan Tui incomplete expression of measles
Fu Ping accelerate full expression of measles
Ge Gen encourage rash of measles to surface
Zi Cao encourage complete expression of measles rash
Before discussing the diagnosis and causes of MS according to TCM, a question is first submitted to the reader. If the zheng qi and jing is weak and the measles infection is strong and virulent, hence sinking into the interior, where does it go and what happens to the toxin?
TCM and Multiple Sclerosis:
Maciocias choice of words is significant in his discussion of differentiation and treatment of MS in that he says "there are only 2 basic patterns":
These are patterns and not causes. To clarify the difference between patterns and causes would need a simple example. In the treatment of migraines for example, the cause is often Liver and Kidney xu causing yang rising often due to overwork or excess sex depleting water (Kidney) and Chinese medicine then says to treat the root. Using Kidney tonics combined with herbs to bring down rebellious liver yang in a case like this is clearly justified and usually achieves good clinical results, giving a cure. However, in MS, its as if something attacks the Kidneys or Spleen qi itself causing it to rapidly become xu. Patients in fact often say "something is attacking me."
The symptoms of multiple sclerosis fall in the TCM category of wei zheng, that is atrophy syndrome (flaccidity syndrome).
Spleen governs the flesh, that is to say the muscles, so in simplified terms, tonics for the Spleen will improve the muscle weakness often experienced in MS. Furthermore, Spleen xu impairs normal transformation and transportation allowing phlegm to accumulate from damp (Clavey, 1995, p.193). Symptoms arise such as lethargy, difficult concentration, nausea with digestive problems, so a base formula like Liu Jun Zi Tang (Six Gentleman Decoction) can be useful. Wu Jun-Yu & Bai Yong-Bo suggest if the phlegm is more predominant, with clear phlegm signs and symptoms such as sticky phlegm, slimy feeling inside the mouth, dry mouth with no desire to drink to use Wen Dan Tang (Warm the Gall Bladder Decoction) or Dao Tan Tang (Abduct Phlegm Decoction) (Wu, J & Bai, Y, 1993, p.5).
Phlegm accumulating and then combining with stagnant blood will result in the collaterals becoming obstructed. Symptoms such as numbness and paralysis result, more commonly known as painful obstruction syndrome (Clavey,1995,p.206). Various stages of MS often manifest in numbness and paralysis and so the formulae Da Huo Luo Dan (Major Invigorate the Collateral Pills) and Xiao Huo Luo Dan (Minor Invigorate the Collateral Pill) are worth considering. In particular three of the ingredients of Xiao Huo Luo Dan, Mo Yo (myrrha), Ru Xiang (gummi olibanum) and Di Long (lumbricus) the author finds most useful clinically to open up the collaterals.
If dampness predominates as a result of Spleen xu, Maciocas herbal treatment of choice is Si Miao San (Four Marvel Pill), plus the addition Bi Xie (Rhizoma Dioscoreae Hypoglaucae )and Du Huo (Radix Angelicae Pubenscentis) to target the lower limbs and Bai Zhu to improve Spleen function (Maciocia, 1994 , p.703).
Blood stasis is clearly becoming a more and more predominant problem in modern civilization. Modern day TCM practitioners such as Yan De Xin make use of Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction) particularly in qi and blood disorders contributing to aging (Luger, 2000, pp33-34 ).
The MS patient has enough dilemma dealing with infections and life traumas and this is further stressed by aging and declining zheng qi. Coupled with blood stasis as well, can mean the use of Xue Fu Zhu Yu Tang (Drive Out Stasis in the Blood Mansion) quite justifiable and is the formula suggested by Wu and Bai (Wu, J & Bai, Y, 1993, p.4). Even though blood stasis is regarded as a pattern discrimination for MS, I personally find blood stasis is usually a concurrent existing factor with other zang-fu patterns. Even without clear blood stasis signs like purple tongue and choppy pulse, herbs like Hong Hua and Ji Xue Teng can be considered to be added as part of a MS treatment strategy.
Damp and heat can invade the spleen causing muscle flaccidity and atrophied muscles. This is known as rouwei (Dharmananda, p.5) and Wu & Bai advocate the formula Er Miao Wan (Two Wonders Pill) and Bie Xie Fen Qing Yin (Dioscorea Hypoglanca Decoction to separate the clear ) (Wu,J & Bai,Y, 1993, p.4). Heat can also directly damage the fluid of Liver and Kidneys causing a dual yin deficient condition. Classic symptoms including five hearts hot, night sweats, tinnitus, low back ache, dizziness, poor memory, blurred vision and of course lack of strength in lower limbs, muscle wasting and progressive weakness (Wu & Bai,1993, p.3 & Maciocia,1994, p.704). A water/wood xu condition can also lead to yang rising and internal stirring wind causing stiffness of legs and vertigo.
A number of formula can address the yin xu of Liver and Kidneys including:
These formulas all contain rehmannia, which can be cloying. My experience with rehmannia is that many westerners seem to not be able to digest it well, even if well indicated. A testing script of 3-4 packets is advised and if bloating and/or loose stools result youll be left with two alternatives. One, omit it all together or try adding digestive herbs such as Chen Pi and Sha Ren.
This is why the formula Er Zhi Wan (Two Ultimate Pill) is my formula of choice, as it is less cloying than the rehmannia based formulae. In addition to that the formula is more specific to treat weakness and atrophy of the lower limbs and blurring vision which are two key notes symptoms of MS.
Clinically I have found that MS patients falling into a Liver/ Kidney yin xu pattern can clearly present with for example a yin xu type tongue but do not always have symptoms such as five hearts hot, night sweats, low back ache or tinnitus for which Liu Wei Di Huang Wan is more appropriate.
In more complicated cases of MS there are concurrent Spleen and Kidney yang xu or Spleen and Kidney qi and yin xu. Here the TCM practitioner must discern as to which organ is more xu and adjust his formulation accordingly. For example, using a combination Shen Ling Bai Zhu San (Ginseng, Poria & Atractylodes Macrocephala Powder) for Spleen xu plus Zuo Gui Wan (Return the Left Pill) for Kidney xu as suggested by Wu & Bai (1993, p.3) may prove to be a too cloying formula because of the rehmannia.
TCM literature on MS rarely puts much discussion emphasis on the jing. Vickers and Dharmananda however discuss jing in relation to MS. In fact their writings compares the demyelination process of the fat loss around the nerves to the loss of vital fluid essence (Vickers & Dharmananda, p3).
As there is a clear genetic factor in MS I feel the jing needs to be addressed in any MS treatment strategy. The MS conditions worsens with the aging process, that is, it worsens with the natural decline of Kidney qi and jing. As the essence weakens, so does the resistance to exterior pathogenic factors. Pathogenic factors, that is colds and flu can be the precursor to an MS attack. Should the preventative treatment for MS involve something like using Yu Ping San (Jade screen powder), commonly used to protect wei qi against perverse attack? Or would herbs to address the jing be more appropriate and treat the deep constitutional weakness?
Herbs such as He Shou Wu well known for its action of benefiting the essence, could be quite useful. If it because too cloying, try adding Bai Zhi (Radix Angelicae) or Zi Su Ye (Folium Perillae Fructuscentis) as suggested by Heiner Fruhauf which could make it more user friendly (Fruhauf, 1998b). I also like the herb Lian Xu (Stamen Nelumbinis Nuciferae) as its an astringent and helps incontinence and urinary problems and in addition, according to Li Shi Zhen, treats gray hair implying some jing strengthening qualities. Bensky and Gamble do confirm that it retains the essence.
Another herb Huang Jing is also to be considered. One of my patients with MS, had Huang Jing as one of the herbs in her prescription and she told me that she felt a great urge to eat the "black thing" as it seemed really nourishing! Fruhauf also informs us that Taoists regarded it as the Essence of the Earth and used it for longevity (Fruhauf, H, 1998a,p.14). Huang Jing does "Tonify the essence after a chronic wasting disease" (Bensky, D and Gamble, A ,1986, p.467) and clinically I find it much easier to work with than rehmannia. Care still needs to taken with Huang Jing as its contraindicated with Spleen xu and damp, often concurrent with the MS pathology. Interesting that these Taoist longevity medicinals such as He Shou Wu and Huang Jing always require perfect stomach and spleen harmony to assimilate the ingredients!
Either we have jing tonic herbs being cloying on a weak spleen or they are too hot like Lu Rong (Cornu Cervi Parvum). Another medicine which I feel is potentially capable of increasing jing, or at least replenishing it is Feng Yu (Royal Jelly), again needing to be careful because of its hot nature.
The jing as we know is commonly called the "essence". Maciocia has divided it up in that there is pre-heaven essence, post heaven essence and the Kidney essence (Maciocia, 1989, pp38-41 ). The general consensus is that jing can not be increased, or as qi gong master Richard Mooney says "what you get, is what youve got." (Mooney, 1997).
Kidney essence is circulated all over the body especially in the 8 extra ordinary channels and there will be a later discussion of the 8 extraordinary channels in particular the chong mai, in relation to MS and jing. However, now the jing of the 20th and 21st century will be looked at.
Maciocia in his translation of the "simple questions" discusses the 7 and 8 year cycles of female and male development (Maciocia, 1998, p.39 ).
In the female "The kidney energy of a girl becomes abundant at the age of 7, her baby teeth are replaced by permanent ones and the hair grows. At age 15 the dew of Heaven arrives (menstruation), the Directing Vessel begins to flow, the Penetrating Vessel is flourishing, the periods come regularly and she can conceive".
It was already observed in the 1970s that since the early 1900s, girls were menstruating 6 months earlier with each decade. Gorman informs us that U.S pediatricians now say puberty is appearing commonly in 6 and 7 year olds. In fact 7% of white girls and 27% of African-American girls start developing breasts and pubic hair at age 7 (Gorman, 62, Time August 21, 2000a).
There have been many theories as to why this is happening such as excess pesticides in food causing a hormone like effect. It could also be hormone supplementation to beef, pork and chicken.
Pediatric endocrinologists put it down to the massive increase in childhood obesity in the last twenty years. Leptin, a protein that triggers puberty is produced by fat cells. I would of course ask, what is triggering the increased obesity, is it the intake of less nutritious based foods, or less exercise or something else? Some Homoeopaths believe immunizations, result in a suppression of the life force contributing the susceptibility to host of chronic problems (Sanders, 2000, pp 17-19) such as ulcerative colitis, asthma and multiple sclerosis. Perhaps obesity can be added to list? Peter Tomminello, senior lecturer and former principle of the Sydney College of Homoeopathic Medicine says that "In homoeopathy the main antidote to vaccination is Thuja. This is an outstanding antisycotic medicine. The sycotic miasm is the one that has the greatest tendency to overgrowth and hence obesity. This is how they understand the relationship of vaccination and obesity. It is a generally accepted principal amongst the majority of homoeopaths. It is also associated with excesses in appetite (Tomminello, 2000)."
Others have suggested that the advent of the electric light and people thereby staying awake longer, altering hormones such as melatonin to be responsible for the change in puberty. Also something that is known as time-life-scale units may also be a contributing factor to people growing up faster. There is more pressure on the 2000 child to be competitive in sports, studies and social activities, thereby cramming more into a life and forcing maturation.
Whatever the official cause may be, one can conclude that the jing of the 1600s is acting differently in the year 2000. Is the jing under too much stress from pesticides, drugs, immunizations, chemicals and the stress of life imposed upon the modern day child? If the jing has changed, has the original yuan qi changed and the true qi (zhen qi) changed? Are we becoming more susceptible to pathogens because the wei qi is not as good as what it used to be? The incidence of early maturity is higher in girls than with boys. Is it because the more female orientated extraordinary vessels, the ren and chong mai are being effected.
Pathogens, in particular external pathogens have been known to cause illness since the first Chinese medical books were written. As Chinese medicine evolved, it brought us different theoretical and practical treatment methods. Its is known that pathogens can attack at any level of the 6 divisions such as the tai yang or a warm pathogen can go to any of the 4 levels, wei, ying etc. In the Nan Jing [translated by Pirog] it states that "When the [extraordinary vessels] receive pathogenic qi which stagnates in them, swellings and heat will result." (Pirog,1996, p.156). In Li Shi Zhens general introduction of the Qi Jing Ba Bai Kao it states
"The 8 extra meridians do not have an internal external relationship. That is why they are called extra channels. The 12 channels are like rivers and the 8 extraordinary like canals. When the Qi of the 12 channels is full, it goes into the 8 extraordinary meridians. Chan You Ren said that when it rains and the rivers get full, then the canals also fill up." (Trans. Deng & Lade). One could interpret this as extraordinary channels only receive the "good" surplus from 12 channels, for example if the patient was dosing himself up with tonics.
Many practitioners however, use the 8 extraordinary channels to treat at a deeper constitutional level, drawing upon the reserves of jing. This is unlike the Nan Jing, which outlined the use of the extraordinary channels to drain the shi pathogen in them. Thus the 8 extraordinary vessels and their clinical use has always intrigued me because of its seemingly contradictory nature. On one hand we can access them for their reserves of original qi and jing to treat constitutionally. If we draw on that jing, from the 8 extraordinary vessels which are also the storage house for pathogens do we also pull all these unwanted pathogens into the system? This may partly explain why sometimes 8 extraordinary vessel treatments seem to aggravate the condition of the patient initially which has been my experience in clinic.
In cases of shock, again the energy of the extraordinary channels is transferred to the main vessels (Macciocia, 1989, p.355). So when a stressful life event happens, the body pulls out some jing and qi to deal with it. Does it also pull out the stored pathogen at the same time to cause havoc? Perhaps afterward the pathogen resettles into the extraordinary channels again. Or does the pathogen pulled out from shock, cause more problems? Alternatively, has 20th century living with its abundance of pathogens saturated our 8 extraordinary vessels, to the point that it forces the reserves of jing to prematurely leak out, causing degenerative type diseases.
Having stated all this now lets think back this to that measles pathogen as it was counter flowing and sinking inward. Could it have gone into the channel system of the 8 extraordinary vessels?
Historically, Chinese medicine obviously thought it is was important to treat measles properly and had specific formulae to expel the various type of counter flowing measles. Wiseman & Feng Ye (1998) informs us that the measles toxin can sink to a variety of locations. "Measles toxin entering construction" (ma du ru ying) is where it enters the construction-blood and sometimes the pericardium (1998, p.388). It can also fall into the lung (ma du xian fei) (p.388) or there is a classification of "unfavorable measles pattern (ma zhen ni zheng) (p.637) and measles block pattern (ma zhen bi zheng) (p.387).All these complications of the measles needed treatment with specific formulae. However no TCM literature sources speak of any problems caused by latent measles toxins. Yet one acupuncturist that I interviewed experienced for example, that when he was treating a patient for a chronic cough with acupuncture, he had caused a small pox vaccination of thirty years ago to erupt and throw out pus. Reactions like that gave this practitioner (and myself) the view that it is a valid concept that pathogens can stay lingering in the body (Black, 2000). If a pathogen can stay lingering from small pox, surely then the measles pathogen could linger as well.
Could a pathogen that had proceeded to the blood (xue) level then go the chong mai as it is the sea of blood? Communication with Will Maclean suggests that this hypothesis has validity. Maclean also felt that some formula seem to deal with that problem specifically, such as Tao Ren Cheng Qi Tang for acute heat and blood stagnation in the uterus stemming from an original externally contracted pathogenic attack (Maclean,2000).
Modern medical research has possibly confirmed that the measles can lay dormant inside the body and the measles has been thought to have caused more than one problem. It was believed to be the culprit of encephalitis lethargica (sleeping sickness), but there was never conclusive evidence (Pollock,2000). Encephalitis lethargica appeared in the winter of 1916-1917 in Vienna to spread out over the world affecting 5,000,000 people. It disappeared as mysteriously as it came in 1927 (Sacks,1973, p.9). There had been other similar type epidemics, spanning over 2000 years including the London Sleeping Sickness of 1672-1673. There is another disease, Subacute Sclerosing Panencephalitis (SSPE) that is caused by the measles virus or measles immunization. Its a very rare disease (1 in a million according some sources and 1 in 100,000 according to the NZ Department of Health) affecting mainly males with its symptoms being generalized convulsions, dementia, coma and death. There is no treatment but Dr. K. Peuschel of Switzerland suggests MS treatments as the disease is comparable (Peuschel,1996, p.1).
The list goes on, and more diseases attributed to the measles are subacute measles encephalitis (SME), measles inclusion body encephalitis (MIBE) and acute measles encephalitis (AME). Doctors Poon, Techertkoff and Win have also found that through fine needle aspiration biopsy (FNAB) and election microscopy that children with HIV who also have central nervous system damage was due to the measles virus! They contribute it to defective cellular immunity from either congenital or acquired causes. Whats of interest here again is the fact that in their study, they found that the child had been immunized for the measles, yet it was the measles that caused the problem!
Where does one test for these high antibody titers of the measles? In the serum and cerebrospinal fluid. So the question poised is: Which channels, or more specifically which extraordinary channels concourse the cerebrospinal fluid?
Drs Domingo et al inform that individual viruses are changing! This is known as viral quasispecies which are closely related viruses but actually are non identical. The last 2 decades has documented genetic variations in viruses, especially RNA viruses of which the measles is one. Genetic variation allows mutation of viruses to occur. Its already been shown that the measles virus has hypermutated to cause SSAP (Domingo et al,1998, pp1-9) a disease that manifests in very similar ways to MS.
Viruses can also persist by remaining secluded in a special area of the body such as the CNS. Could these special areas where they lie dormant be in the 8 extraordinary channels or possibly even the Gaohuang for those really clever viruses! Other viruses lie dormant for decades to come out in different ways. For example, the chicken pox virus (a herpes virus) can manifest itself again decades later as shingles. So why couldnt the measles virus manifest itself again later on?
There are mutant distributions of viral quasispecies out there. There is evidence to support that viruses such as poliovirus, which is now believed not to exist, actually does exist (Domingo et all 1-9).
The rate of SSPE has declined since the introduction of the measles vaccination in the USA in 1966. This is in the eyes of modern medicine provides evidence that the virus caused the problem, therefore believe its appropriate to immunize against measles. However, comparing the risk of getting the disease from the measles virus or from the vaccination still carries a 12% risk (MMWR p.3).
Could the measles virus be the initiating factor for MS? Inconclusive evidence suggests such is the case. Severe neurological diseases, auto-immune diseases and even cancer may be due to the effects of "slow, inapparent and recurrent viruses" as already reported in a 1974 Scientific American.
In a typical acute virus infection, the infected cell dies after 1-2 days. But some virus infections do not lead to the cells death because they do stop the synthesis of RNA and protein in those cells. The method to do this is by altering the protein layer in the outer membrane of the cell, allowing them to multiply. These new cells are attacked as "foreign" objects by their own immune system. Rustigen of the Tufts University School of Medicine was able to persistently keep cells infected with the measles virus alive and these cells were then able to reproduce passing on an "incomplete" virus each time.
The mechanism of determining normal recovery from a simple measles infection as opposed to developing SSPE is not known. Inclusion bodies of the measles variety have been found in the brain of MS patients and J. Holland concludes "If measles virus is a cause of MS, the virus must be replicating in an even more defective way that what it does in SSPE" (S. Holland, 35).
People can also have viruses without getting any symptoms. For example, many people have genital herpes without ever having had any symptoms. 15-30% of people tested prior to the nationwide measles vaccinations in the U.S. had evidence of measles antibody without ever having had a history of measles.
Maciocia, whose view I agree with, suggests that immunizations cause the pathogen to by pass by the exterior and penetrate the interior (Maciocia,1994, p.634).Such as the measles immunization, to penetrate the interior from there to (what I believe) the chong mai, and brew and then cause havoc later. This is why I cant agree with Dharmanandas view of advising measles immunization to children of the parents with MS. He says (page 2) "immunization against these childhood viral diseases may prevent them from acting as initiators of MS, it is too soon after the introduction of mass immunizations to tell the effects (though we, should know soon)".
My view is that the measles virus from the immunization is a latent heat toxin just brewing there in the interior. So when could these latent toxins cause havoc? Could it be when the jing has declined such as when the 7 and 8 year cycles reach the age 35 in females and 40 in males and the Kidney is weakened. Ironically, that would be very soon, the year 2001 in fact, as the measles immunization program started in the United States in 1966. Perhaps there will an increase in diseases such as MS (or something worse) starting then.
Some discussion of the chong mai is now necessary to understand the importance of this extra ordinary channel in the treatment of MS.
One of my patients with MS said to me "I always remembers my first attack of MS. For no reason I suddenly felt the power and energy draining out of my spire from the inside and then numbness started in my fingers with raised watery blisters here [pointing to PC-6 and HT-7 area]"
MS patients also comment about the "plug being pulled" or "the tap being turned on and all life drained out" pointing to their spine. Other patients who have had a history of either falling onto their coccyx or getting a whip lash have remarked thats what they feel caused the MS. Could the trauma to the spine have disrupted the chong and ren mai and stirred up any pathogens resident there? I suspect the qi is leaving the spine taking with it the essence and the pathogen. Anatomically, its known there are 2 extra vessels in the spine, itself, the ren mai and chong mai and the Kidney and du mai also transverse the lower lumbar spine, so hence all are connected. Yes, some could argue that its the ren mais qi leaving the spine but I hope to convince the reader otherwise.
Li Shi Zhen informs us that "There is surplus qi in the woman and not enough blood and when the period comes, blood is lost and this damages the ren and chong mai." (Deng & Lade) Pregnancy leads to changes in the chong mai, particularly in the first 3 months of the childs growth where the qi in the chong mai can rebel upwards (Maciocia, 1996 p.444).
One symptom well documented in modern medicine is that women with a diagnosis of MS often remain healthy and stable during pregnancy. Is this because during pregnancy, they are not losing blood and therefore the chong mai is not being damaged? Perhaps, any pathogens in the chong mai are not being distributed at the wei level anymore as most of the blood is now targeted to the uterus and child. As the chong mai irrigates the jing, and there is more jing accumulating during the pregnancy, as its not being lost, may explain improved health during pregnancy. In Acupuncture Imaging, in a discussion under stress, Mark Seem states that according to Schatz, embryologically its possible that the first channel developed in utero is the chong mai (Seem, 1990, p.48). Fundamentally, this makes sense and provides fuel in the concept that the chong mai can be considered in the treatment in chronic inherited auto immune disorders such as multiple sclerosis.
Flaws sights an example of treating an MS patient before, during and after pregnancy and explains how "yin fire" can counter flow and go up the chong mai. His view is that as the child in utero grows, so does the growth of yang qi and believes that is the mechanism for MS remissions during pregnancy (MacPherson & Kaptchuk, 1997, pp110 111).
I believe the chong mai certainly is involved in the remission of MS during pregnancy, but it is because the jing, qi and pathogens are going directly to the growing child.
Running Piglet Disorder is associated with the chong mai. Ben Tun as it is known in Chinese medicine is regarded as one of the stagnations due to Kidney disorders (Sang, 1981, p.569). Running piglet disorder can also be due to stuck qi turning to heat or accumulation of cold in the lower jiao caused by Kidney yang xu. As Deadman and Al-Khafaji (1998, p.153) put it, "Qi is discharged and rushes up the penetrating channel [chong mai] causing great agitation and anxiety" and "rushes up to the throat with such ferocity that the patient feels he is close to death. It attacks and then remits". Running piglet disorder clinically can manifest in different ways, including severe anxiety and rushing sensations usually going upwards. Some of the mental symptoms of MS may fit into this picture. Matsumoto and Birch give us some mental symptoms of chong mai imbalance such as emotional over excitement and being easily shocked and surprised (Matsumoto & Birch, 1986, pp90-91) as they often get panic attacks, anxiety attacks and a feeling of choking causing weird mental symptoms. Could the MS patients chong mai imbalance be contributing to symptoms like this?
An interesting symptom that I have some across in my MS patients is that they often had cold feet and a hot/warm face often appearing with red checks. Is this yin xu fire with Spleen/Kidney yang xu, or it is a symptom of chong mai imbalance? That is, the qi of the chong mai rebels upwards and the cold feet below are also due to a chong mai problem as the vessel descends to the feet via the Kidney vessel.
Maciocia suggests the relevance of using the extraordinary channels in the treatment of MS notably the du mai to benefit the spine as well as the dai mai, and yin and yang qiao and wei mai channels ( Maciocia, 1994, p.706). As these latter channels have their origin in the chong mai, anyway, surely then treating the chong mai can be justified for MS patients.
Are there any other signs that may provide evidence to the fact that the chong mai plays a role in the MS picture? Many female patients that I have seen with MS, after observation and questioning revealed one interesting symptom. They dont have much body hair. Remember Maciocia tells us that when the chong mais "blood is abundant, it moistens the skin and promotes the growth of body hair" (Maciocia, 1996, p.18). Obviously there will be exceptions and it may be just be total co-incidence that my female patients had less body hair, but never the less its fuel for thought and I ask the readers to observe their MS patients in this aspect.
This then brings us to the discussion of Man Jing Zi and why I suggest it for MS treatment. A more comprehensive discussion of Man Jing Zi can be found in the journal of ACMERC (November 2000,Vol 5:5, pp 4-8) by the author. In summary however, Li Shi Zhen noted that Man Jing Zi can grow and blacken hair and the Yao Xing Lun (refer to the Zhong Yao Da Ci Dian p.5309) states that it makes the beard grow. Personal experience has shown that it can increase the growth of the beard. Clinically I have used it to improve the vertical wrinkle lines above the top lip in women, commonly seen in post menopausal woman when the blood dries up and chong mai empties. Though Li Shi Zhen never said it, I feel it benefits the chong mai and possibly acts as carrier herb to the channel.
Some may still doubt that Man Jing Zi has little more use than treating wind heat in the head but consider the use of its cousin, the agnus-castus species. Peter Borten, US TCM practitioner and member of the Chinese Herb Academy has provided an over view of this herb. It is used for menstrual disorders including menopausal symptoms, it regulates estrogen, affects lutenizing hormone production, treats fibroids and has a corpus luteum hormone effect (Borten, 2000).Do any TCM practitioners use the chong mai to influence any of the above symptoms? I have started using Man Jing Zi in gynecological disorders, in particular post menopausal symptoms due to jing and chong mai deficiency. Coupled with the fact that Man Jing Zi has an auxiliary use of treating numbness, stiffness and cramping from wind and dampness as well as having benefits to the eye in the case of blurred vision can make this medicinal worth considering for the MS patient.
Thus I present a new treatment strategy for MS. The measles toxin, or remnants of it have sunk into the interior probably because of constitutional jing and qi insufficiency to lodge in the chong mai. As the body ages and weakens with declining Kidney qi, the latent measles toxin, probably mutated in some way starts to cause havoc to the channels, resulting in often a Liver/Kidney and or Spleen/damp disharmony. Treatment then, according to principles of Chinese medicine is treat the root whilst attending to the manifestation. The root now being latent measles toxin and the manifestation being the xu condition, or shi as it will be in some cases.
Logic has it, that in expelling the pathogen it would have to come out somewhere but how would it came out? Obviously it would expel itself through the skin just as when treating children with the measles when their rash is not expressing itself properly. The case history will clearly show that spots (that sometimes look like the measles), rashes, lumps and other types of type sores will come out and express themselves during the course of treatment.
My own suspicion that the measles virus may contribute to other auto immune diseases was also on the mind of another US TCM Practitioner, Jeff Gould who pondered the question: "I know there are a lot of auto immune disorders out there, many of them manifesting in women primarily. I know from a western perspective they have different causes, (maybe) but Im beginning to wonder, energetically and from a Chinese Bian Zheng differentiation, whether or not they have a similar cause, but manifest differently based on body constitution problems. For example, one patient gets rheumatoid arthritis and the other gets lupus, the third gets Hashimotos disease. Does anyone have any thoughts on this?" (Gould,2000). Since then it prompted me to apply this treatment principle (of using measles expelling herbs) in a number of auto immune diseases. (Case histories using measles expelling herbs for rheumatoid arthritis and SLE will be presented at a later date)
Other TCM practitioners may wish to further investigate my treatment strategy in their quest in the treatment of auto immune diseases. There must be more than the half dozen measles expelling herbs outlined in Bensky and Gamble that could prove to be useful. For example, Todd Luger director of the Chinese Herb Academy has written about of a substitute species of Sheng Ma, rhizoma serrulata which is used in southern China, specifically for the measles (Luger,2000).
In Culpepers Complete Herbal of the 16th century (p.52), one particular herb bistort, (polygonum bistorta), has the recorded use to "expelleth the venom of the plague, the small-pox, the measles .driving it out by sweating" similar to the acrid dispersing herbs of TCM. (This herb, incidentally is listed in the Zhong Yao Da Ci Dian as Quan Shen (Polygonum Bistorta L) but has no recorded use for measles.
Needless to say, many people might say its quite speculative on my part to start using measles expelling herbs in the treatment of MS. After all, there is only some antidotal evidence to show the connection between the measles and MS. Some any even ask "What about the geographical factor? How does that tie in with the measles?" So for those, I give a hypothesis to ponder upon. Sunlight, which contains ultra violet light, and that which is further broken up into UV A, B and C. The atmospheric density and ozone layer deflect most of the UV-C, but, not all of it! UV-C when beamed upon bacteria and viruses cause them to get a deadly sunburn. I suspect that there is more UV-C coming to the higher and lower latitudes. In addition to this, these areas such as north Scotland and southern New Zealand get increased hours of daylight in the warmer seasons.
Imagine the young child with measles who is almost better and then wants to go to play in the yard. The measles has not fully expressed itself yet so the UV-C rays can penetrate through the skin and either force the pathogen to retreat or damage and mutate the pathogen to also sink back to the interior. This may explain why African Negroes do not get MS, as UV light does not penetrate as far through dark skin as it does through white skin! Is the measles virus reactive to ultra violet light? I suspect so, as the measles vaccine should not be exposed to light. MS is lower in the Asian populations, perhaps because the yellow skin is not quite as protective as the Negro skin but better than the Caucasian skin. When a child is sick with the measles it shuns bright light is this a protective mechanism? Then perhaps this quasiespecies of measles acts like a transactivator for many other viruses, such HHV-6 and the epstein-barr virus or its presence affects the DNA and genetic disposition in some way. The mechanism for that is beyond me and I am only concerned with expelling the pathogen.
Could getting these childhood diseases be actually good for you? After all, the measles has been around for centuries, documented in Persia in the 9th century and as Clavey (2000) informed me, even earlier in the east when during the song dynasty Pang An-Shi first made the distinction between measles and small pox. Possibly the measles activates the jing in some way to strengthen us against diseases.
Even some doctors are now concluding its good to get sick! "More infectious disease early in life might afford a lifetime protection". Statements like this one are as a result of a 1000 child study at the University of Arizona. They found that young children who had been exposed to day care centers had caught more colds and infections but then had less asthma later on in life compared to children who stayed at home in their sterile environment away from all the bugs (Gorman, 2000b, p.62).
The whole concept of treating auto-immune diseases with Chinese herbs could now take a new direction. Dharmananda at the ITM clinic in the USA has developed a specialized formula for auto-immune disorders called Lithospermum 15. Consisting of various herbs but interestingly the king herb in the formula is Zi Cao, a herb that expels measles! Im sure the herb was put in for its heat clearing properties, but perhaps this formula works well as the other jing tonic herbs, such Nu Zhen Zi, Gou Qi Zi in the formula coupled with blood movers Dan Shen and Dang Gui are helping to discharge the measles.
The detailed case history presented below will provide some strategies in applying measles expelling herbs in conjunction with the traditional tonics. Maciocia does conclude that "Chinese medicine cannot completely cure this condition" and "If the patient is still walking, one expect some results." (Maciocia,1994, pp706-707). Bob Flaws also portrays a very optimistic result with his case history presented in Acupuncture In Practice. This patient was in the early stages of the disease, and relatively young, aged 28. Chinese research on MS does indicate success with applying the zang/fu approach. The average rate of relapse of patients on TCM treatment according to Lu Xi et al was 0.01 times per year compared to 3 relapses per year in the control group (Lu Xi et al,1995, p.1). The reality is that TCM works for MS and clearly the results should be compared to new drugs such as avonex which only slows down the progression of the illness in two out of three people.
But consider the TCM treatment as revealed by Lu Xi et al (p.1), 1000 packets of herbs over 6 years! Is that really treating the root? Alternatively why not consider the approach of using measles expelling herbs in conjunction with accurately prescribed tonics.
MS Case history
Female aged 40, was diagnosed with MS 5 years ago but felt she had the first symptoms 15 years ago, 9 months after the birth of her twins. She also has a twin sister who was diagnosed with MS one year ago and her brother is possibly experiencing some MS symptoms as well. As a child she had the usual childhood diseases including mumps, chicken pox and measles as well as a history of nose bleeds. There was also a history of tonsillitis which she used to get up to 10 times per year and at age 30, the tonsils were removed. She also has had immunity injections for polio and small pox. At age 15 she had chest infections and viral pneumonia.
Psychological background included having a domineering father who was over protective. When she was a child there was also a fear of dogs. Other treatment prior to coming to me included psychotherapy where the treatment was based around "learning to accept that she has MS."
Generally she is a worrier, particularly she worries about her children, feels nervous, has low self esteem and wants to please people. Wind frightens her, especially at night as it sends chills down her spine. In addition to psychotherapy she has had western herbs such as burdock and St. Johns Wort, homeopathy from a classically trained homeopath, other natural therapies and some acupuncture. Meditation also plays a role in her life which she tries to do on a regular daily basis, for 5-10 minutes per day and 2 times per week she tries to meditate for 1 hour.
Her first major attack of MS gave her the symptoms of numbness on the left side. Three years ago she was wheel chair bound for 9 months and this attack was precipitated by a severe cervical neck pain and spasm which the specialist believed to be unrelated to the MS. Treatment consisted of pregnizone and when I saw her she could walk and was on Aropax medication for her emotional state. The specialist had advised her to start on Avonex, interferon beta 1-a.
The presenting symptoms were:
- sometimes clots
- bleeding last 7 days
Pulse: thin, fine, Kidney yin xu
Tongue: no coat, pale red, paler edge, Spleen yin xu cracks.
As can be seen with the presenting symptoms, many fall into a Spleen xu pattern and John McDonald & Penners "Zang Fu Syndromes" outlines some of the major symptoms for us such as sallow complexion, fatigue and abdominal distention (1999, p.39). The symptom of bladder urgency is probably due to Spleen xu, as opposed to Kidney xu. This is so because of the loss of the Spleens ascending action, remembering that that the function of the Spleen is to raise the yang and therefore hold the urine up. As the Spleen qi weakens, so does its ability to control the flesh, that is the spincter muscles of the urethra causing urinary in continence (Maclean & Lyttleton, 1998, p.438).
The nocturia however, falls into a Kidney xu pattern as do the dry eyes, slight deafness and previous history of double vision.
Constipation in her case, is a bit harder to clearly ascertain as to which pattern it falls into. A formula like Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), more commonly thought of to treat loose stools can in fact treat Spleen qi xu constipation, as suggested by Becker and could be tempting to use here ( Becker, 2000, p.23 ). Bensky and Barolet also advise that modification of the formula by adding honey and sesame oil can treat constipation (1990, p.243 ). However as the bowels are sometimes dry I suspect it falls into a Kidney xu pattern, with the resultant heat drying the stool.
So this MS case classically falls into a dual Spleen and Kidney/Liver xu pattern. In the past I would of just had an aggressive policy of dosing my patient the appropriate tonics. My experience has been, that doing so one of two things results. Initially they respond, and then later its as if the tonics stop working, and the attacks come on with a greater force than what the tonics can deal with. Or the treatment seems to slow down the overall process and thus still helps the patient. Patients at this stage, often drop out of treatment, usually because of the cost or change practitioners hoping for a stronger treatment. I have seen the patients on the rebound as well, coming in to see me with their pages and pages of tonic scripts from other practitioners. In the United States though, there are practitioners such as Zev Rosenberg who would have been more daring and prescribed herbs to treat MS along the methods outlined by Dr Li to resolve yin fire (Rosenberg). I can strongly recommend to read his piece on auto immune disorders for a totally different approach to what I advocate.
First treatment: Zusanli ST-36, warm needle
Si Jun Zi Tang (Four-Gentleman Decoction) is used to replenish Spleen qi with Mu Xiang to prevent stagnation of the tonics. Sha Shen and Dang Gui for yin and blood respectively and Sang Ye and Hei Zi Ma (Sang Ma Wan, Mulberry Leaf & Sesame seed pill) to improve vision and address the dry stools.
Fu Ping and Chan Tui to expel latent measles toxin.
2nd treatment: (10 days later)
The energy has picked up and she is sleeping less, she is less hungry and has less cravings for sweets. There is no major change to the tongue.
repeat the above formula with the addition of:
3rd treatment: (1 week later)
Overall more energy, sleeping less but emotionally low and flat. The tongue is less pale on the edge, and the bladder has improved. There is however lots of wind and the abdomen is sore and swollen with much gurgling.
Treatment: Zusanli ST-36, warm needle
I suspected the He Shou Wu was causing the wind and gurgling in the stomach but wanted to keep the He Shou Wu in the formula and thought by adding Zhe Ke some of the cloying symptoms may be regulated by moving Liver qi. Huang Bai was added to clear any heat from the tonics.
4th treatment:(1 week later)
Some nasal dripping at the front, mild sore throat, tight chest, feels some general aching at night and is breathless when walking up stairs. Bowels have been blocked for 3 days with cold hands and feet. She is sleeping 8 hours per day. Slight pins and needles around the head.
Tongue: no major change
Pulse: Kidney yin xu, ( NB not floating)
Treatment: Sanyinjiao SP-6 ( which gave a very strong de qi sensation),Taixi KID-3.
With this combination I changed strategy slightly. Supplementing Spleen qi with Gan Cao, Fu Ling, Bai Zhu and regulating and warming the middle with Gan Jiang. To benefit the essence I continued to use to Huang Jing and He Shou Wu. Du Huo, Jie Geng and Wu Wei Zi were added to address the upper respiratory symptoms. I didnt pick up any external attack on the pulse and therefore contribute it to a Kidney xu condition. Sang Ji Shen further nourishes Kidney yin. Two measles expelling herbs make up the remaining herbs.
5th treatment: (1 week later)
She didn't want to drink the herbs because she has had nausea all week, not from the herbs, as the nausea had started the week before but didnt tell me. In a previous relapse (MS attack) she also had nausea that she described like a morning sickness. This is important to note as some of my other MS patients also have had an attack of nausea "like morning sickness" preceding their MS attacks. I believe this is contributed to rebellion in the chong mai. During the week she also had a dream where she was speeding on water and a huge building made of glass next to the lakes shore shattered. Her interpretation of this dream was signified as a shattering break through. She had one fall during the week and there was some tingling and today she had a frontal headache.
The tongue's colour had improved, because there was more colour at the edge. The pulse reflected a deepness and roughness in the heart.
Treatment: Zusanli ST-36, Sanyinjiao SP- 6, Hegu LI- 4
Dan Shen Yin (Salvia Decoction) in the combination addresses the heart and blood stagnation where as Jie Xue Teng and Wu Jia Pi symptomatically treat the tingling (via blood and damp). The Ren Shen is to tonify original qi.
6th treatment: 1 week later
There is no nausea, no tingling, no breathless and less cold hands and feet. She is sleeping 8 hours per day. I suspect the Ren Shen was the main reason for the improvement as I have seen this happen before. However the answer is not to keep dosing the patient with Ren Shen as my experience is that the effectiveness seems to wear off with time, as if the body rejects it in some way. In milder cases of MS though I suspect that it is more successful. [At the time of completing this paper, I came across a discussion of Ren Shen translated by Paul Unschuld. Interestingly, it said Ren Shen is contraindicated in cases where poison causing an illness with sand (-like skin eruptions [measles]) pox etc it will block the way for toxin release and cause greatest misery(p.286). Since then, I no longer use Ren Shen with my MS patients.]
Treatment: right Neiguan P- 6, Sanyinjiao SP- 6
Here Gui Pi Tang (Restore the Spleen Decoction) was chosen to treat more the mental state of deliberation and worry, as I suspected dwelling on the idea that an attack may come again was weakening her Spleen qi and heart blood. The important herbs were still the measles expelling herbs.
7th treatment:1 week later
Feeling well, sleeping 9 hours and doing a bit of exercise. She "wants to stretch as if something is unfolding". With walking there is still tiredness and the tongue is still showing improvement at this stage. Another comment that she made was that she was drinking less hot drinks. Admittedly, this was something I should of checked on the initial consultation but now she had cut back from 8 to 5 hot drinks per day. A further indication that the Spleen qi had improved.
Treatment: Zusanli ST- 36, warm needle
The strategy here is still to supplement the Spleen qi with tonics and some symptomatic herbs to addresses numbness etc but I added a relatively large dose of Ge Gen, to increase the measles expelling action. Ce Bai Ye was added with the intention to act as a blood mover for the measles pathogen.
8th treatment: 1 week later
Lately there had been more urination and some weight loss, restless legs and jerks which she has had before and a desire to stretch her legs. There were less bruises, less bloated stomach and overall improvement and "more enthusiasm."
But, she has noticed a strange itchy feeling in L.I-1 to L.I- 4 area and in the area around SP-2 to SP-4. A rash had also broken out around the chin area and in the morning prior to seeing me her face had a reddish rash but it had gone way.
This is what I had been trying to achieve. Was it a co-incidence the skin erupted after the addition of Ge Gen?
(Acupuncture not noted on file)
This formula was prescribed in the form of freeze dried granules .
9th treatment:1 week later
She had caught a cold during the week. I thought it may be possible that the measles expelling herbs had damaged the wei qi, but it was the first day of winter in Dunedin (Southern New Zealand). The cold was gone but she had had an attack of nausea and dizziness for 1 day. The attack had even made her hair "go limp", that is "lost all its life force". The appetite was reduced.
Treatment: Right Houxi SI-3, Left BL- 62 (with strong electric feeling)
There was still a mild residual dry cough left after the cold, hence the yin tonics.
Huang Jing and Bai He to treat her mental state as she was feeling like a relapse was going to happen and she had a "fear that she would die". Fruhauf has explained that Bai He can treat "lily disease" and I thought it could help her mental state (1998,p.14).
10th treatment: 3 weeks later
She had had a bad flu which led to a chest infection resulting in loose phlegm, cough, running nose and a decrease in energy. The herbs had not been taken, (because of the cold) and had taken antibiotics which caused thrush. Her balance had gone off a bit and there was numbness at the sides of ribs and front of shins.
Treatment: Right SP-4, Left P- 6
Herbs: to finish the previous prescription
11th treatment: 1 week later
Feeling better and the energy is returning, but there are still problems with the balance.
Treatment: Shangjuxu ST-37
This formula clearly contains an abundance of measles expelling herbs plus the addition of Man Jing Zi to what I believe is to access the chong mai. I was of two minds in my choice of using Huang Qi, I wanted to protect the wei qi but at the same time wanted to expel the pathogen and thought Huang Qi might hold it in.
12th treatment: (2 weeks later)
She had caught another cold giving her a sore throat, chest infection, clear phlegm and running nose. Her legs were "funny" and cant walk well and "doesnt feel a connection from waist down". There was pain under the left rib (near SP-16). She has had this sharp stabbing pain before, which sometimes lasts for 10 seconds, and is on and off for a few days. Sometimes she also had as a stinging cold sensation in the sacrum. Including all this she had panic attacks, for which she took Aropax. Whats interesting here, is her description of the mental state. It comes from the stomach with nausea with a tingling cold feeling. She feels that she wants to run away and can almost feel like "close to death". The cold tingling feeling is like a "rushing sensation going up and down the spine". To me that sounds like running piglet syndrome and chong mai imbalance. Appearance wise, she was pale with flushed red checks and had cold feet.
But, of most significance was the fact that she broke out in "lumps and bumps" on her body! There was one on the lung channel near LU-3, one on her nose, one above the breast like a bright red one inch circle. It felt like a lump developing before it went red and then developed a head.
Treatment: Right Zulingqi GB-41, Left Weiguan SJ- 5. [Fuai SP-16 (Laser)]
Basically the formula consists of spleen tonics, blood tonics, and measles expelling herbs.
13th treatment: 2 weeks later
She had picked up mentally after last treatment, though had caught a cold with a sore throat but it went away "surprisingly quickly". There had been a bit of left foot drop and she was sleeping 10 hours per day. One significant improvement though was with her finger nails, which were now growing. As she commented "they never used to " indicated a positive change in her blood and liver. Overall she commented that so far she had responded better to this kind of treatment than anything so far. However, she was under a new kind of stress. The New Zealand government has chosen her and 179 others to be subsidized to receive weekly injections of Avonex and is under pressure from the her doctor and specialist to start immediately and take advantage of this lucky situation. I didnt want to concurrently treat her with herbs and have her taking the interferon beta- 1a as it being in my opinion a shao yang pathogen would only complicate the treatment. It was decided then, to continue herbal treatment for a bit longer before going on to interferon beta-1a treatment.
There had been more blotches on the face, red patches and lumps that came up into a white head. The tongue was clearly showing definite improvement.
Treatment: Shangjuxu ST-37, Qixue KID-13, Guanyuan REN-4
Again, here the formula has measles expelling herbs and Spleen tonics with some additions.
14th treatment: 2 weeks later
Her legs gave out one time and had one particularly exhausting day and slept 12 hours. Again, she describes her attack as a plug being pulled, the nails went soft and the hair went limp. When she tries to sit straight up her body sort of falls forward. In addition there is a "strange [unexplainable] feeling" like a dizziness with sudden loss of appetite and nausea that lasts for 5 minutes. Irritability and impatience are also present. On a positive note her menstrual cycle only lasted 4 days instead of ten days and 3 days after starting the herbs red blotchy lumps came up on her face.
In her experience, though, she feels that a relapse is lurking and she is getting exhausted in trying to fight it off.
Yet the tongue still showed improvement so I continued with measles expelling herbs.
Treatment: Zusanli ST-36
Some herbs such as Chen Pi have been added to symptomatically treat the nausea.
15th treatment: 2 weeks later
The energy is "not too had", the legs have improved, and the hair has improved again, that is the "life force" had returned. She feels itchy all over and 2 lumps came up on the forehead that were itchy, lifted off and left a small temporary crater. There was also a large red boil with a white head that didnt discharge anything.
Treatment: Gongsun SP-4, Neiguan P-6, laser Baihui DU-20
16th treatment: 2 weeks later
She has been off Aropax now for 3 weeks and has experienced what she feels are strange withdrawal symptoms. There are noises in the head, a peculiar rushing in the ears with a rushing sensation around in the head and the sound of a train going over tracks and a feeling that the head would explode.
Other positive changes were that co-ordination with her typing has improved. She is also more alert and more grounded.
Treatment: Gongsun SP-4, Shangjuxu ST-37
17th treatment: 2 weeks later
She is tired but has been doing a lot more than usually and there seems to be only small symptoms as opposed to being under a major attack. Overall she is feeling better. Her skin continues to have lumps and bumps with spots breaking out. The tongue continues to show steady improvement. At his point she decided to start the interferon beta-1a therapy so no herbs were prescribed. Ironically, she had a craving for a banana and ate some without any adverse reaction. Perhaps this was symbolic of the fact that the treatment had restored her qi to a healthier level.
One will also notice that there was not really a lot of treatment, in fact only 2 packets of herbs per week containing on average 12-14 herbs per prescription. Acupuncture was provided as a supportive measure initially weekly and then fortnightly. Results were obtained and I believe the treatment is preventing a worsening of the condition.
This case further more demonstrates that the use of measles expelling herbs can discharge through the skin some kind of latent heat toxin in MS patients. I expect that if the treatment can expel all of the latent toxin the attacks of MS will cease permanently. How long this would take I couldnt say but I expect at least six months to one year of treatment to have a gradual release of the toxin. Then TCM treatment can be used to restore the patient back to original health. Whether or not the permanent damage to the nerves when patients are already crippled could be restored, remains to be seen. Further experience with other cases has revealed that using a large amount of Ge Gen (up to 30g) and an average dose of Zi Cao (6-9g) with a low dose of Man Jing Zi (3g) may prove to be more effective than using a larger number of measles expelling herbs.
I hope this paper gives some new insight in the treatment of MS.
Comments welcome firstname.lastname@example.org
Thanks to Warren Cochran of University of Technology, Sydney and John McDonald of Australian College of Natural Medicine, Brisbane for proof reading prior to publication.
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