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 This article was submitted early in 2003. We would like to thank Mazen for this wonderful article.

 

Dear Sir

My father is ill -AMYOTROPHIC LATERAL SCLEROSIS or MND.

we believe that shoud be some alternative or herbal traditional chinese medicine can go better. I found an article in internet about chinese medicine can do

better.(formula- Hu Qian Wan) , and (Jin Suo Gu Jing Wan), Yisui Tang, Please inform me - how i can find (formula- Hu Qian Wan).did you have this formula? i sent to you the article. best regards mazen hassan I give you the web site that you found the articles of chinese medicine?

http://www.itmonline.org/arts/msalsmg.htm

http://www.itmonline.org/arts/als.htm

http://www.alscenter.org/clinical_trials/

http://www.lef.org/protocols/prtcl-008.shtml

http://www.mndassociation.org/full-site/home.shtml

http://www.goulburn.net.au/~shack/therapies.htm

 

BASIC HERBAL THERAPY FOR FLACCIDITY SYNDROME

 

The recommended traditional herb formula for treatment of the liver/kidney deficiency type wei syndrome is Hu Qian Wan. The Chinese name may be roughly translated as Pill of Tiger's Walk; it refers to the well-controlled movements a tiger makes from a place of hiding while stalking a prey. The tiger also represents the yin: a tiger in hiding has great potential for expressing its power, and that hidden potential is yin. The herb formula has the therapeutic action of nourishing yin (Hu Qian Wan is sometimes described as the Pill of Hidden Tiger). As with other traditional treatments, the formula may be modified somewhat according to clinical presentation, especially at the initiation of therapy. For long-term applications, it is considered a well-balanced prescription.

 

Hu Qian Wan (25) is a formula devised by Zhu Danxi (1280-1358 A.D.) that was recorded in his book Dan Xi Xin Fa (Dan Xi's Theories). Zhu Danxi was originally known as Zhu Zhenheng, and he lived in Danxi (Zhejiang Province). He became known as the renowned physician of Danxi, and was thus given the name Zhu Danxi thereafter. Zhu is known as leader of one of the four schools of Chinese medical disease etiology and treatment that evolved during the period of 1150-1350 A.D.; Zhu's was the last of these schools

(26) and one of the most influential in subsequent centuries. The four schools of thought were labeled according to the type of therapy that was predominantly advocated: cooling, purgation, spleen/stomach tonification, and yin nourishing. In modern practice, the latter two tonification-based schools remain dominant forces, joined by the late 19th century "school" of vitalizing blood circulation.

 

Zhu believed that the yin was always at risk for becoming deficient. Thus, in most chronic diseases, the aim of therapy should be to protect and nourish the yin. He devised several new formulations, many of them containing herbs that nourish the yin and cleanse deficiency fire (which is a type of yang agitation that can arise from yin deficiency and can cause worsening of yin deficiency). Zhu lived in southern China, where it was more likely that persons would suffer from the effects of heat and depletion of yin. He felt, however, that the main cause of yin deficiency was over-indulgence, including sexual excess, which could drain the kidney essence. He also pointed out that certain herbs could be damaging, especially for stroke, paralysis, nervous, and mental diseases: those containing what we now call heavy metals, and those which have properties of being spicy, fragrant, dry, hot, and stimulating (which could further weaken the cooling, moistening yin).

 

Hu Qian Wan is an expanded version of another of Danxi's formulas, Da Bu Yin Wan (Great Yin Nourishing Pill), made with rehmannia and tortoise shell to nourish the yin, and phellodendron and anemarrhena to clear deficiency fire. To make Hu Qian Wan, one adds certain to this basic formula several ingredients to treat the specific manifestation for which the formula was

intended: weakness of the lower back and knees, flaccidity of muscles and bones, and difficulty walking. The key additions are tiger's bone (now replaced by other bones) and cynomorium. Tiger's bone is said to treat weak and soft sinews and bones, and weakness of the knees and legs caused by deficiency of liver and kidney. Cynomorium has the same uses, and is also indicated for exhaustion of body fluids. These two herbs transform the basic treatment for yin deficiency into a treatment for flaccidity affecting the lower back and legs. One of the aims of the formula is to alleviate weakness of the tendons, which is deemed the main reason that there is difficulty in walking. Peony is added to the prescription to enhance the action of rehmannia in nourishing the liver, so as to benefit the liver's associated tissues-the tendons. Citrus and dry ginger are added to aid the stomach in digesting the combination of rehmannia and cynomorium, which are quite rich and heavy in nature.

 

Hu Qian Wan is sometimes extended with tang-kuei, achyranthes, and mutton (a recommendation from a 17th century text), usually for cases of severe blood deficiency; other variations are prepared by adding yang tonics (in which case anemarrhena and phellodendron may be removed) or qi tonics. The usual preparation method is to combine the herbs ground up to powder and honey to make 9 gram pills (about 6 grams of the herbs per pill). It is taken one pill each time, 2-3 times daily (12-18 grams of the herbs per day).

 

The prescription that was initially given to the patient described by Zhou and Lu was a modification of another traditional formula used for

flaccidity: Dihuang Yin Zi (Rehmannia Formula for Paralysis), a decoction containing rehmannia, cornus, schizandra, polygala, acorus, morinda, cistanche, aconite, cinnamon bark, hoelen, ophiopogon, and dendrobium. It nourishes the yin, but also revitalizes the yang. The modified formula was taken daily by the MS patient for more than three months. As a follow-up, Hu Qian Wan was administered in conjunction with the Dihuang Yin Zi decoction for one year. According to the doctors, The patient was eventually cured, thus confirming the benefit of kidney-nourishing decoctions and pills for MS.

 

Zhang Jianguo presented a case study (12) of treatment for chronic progressive spinal lateral sclerosis. As with the above analysis, the patient was diagnosed as suffering from deficiency of kidney and liver, insufficiency of blood and essence, and malnourishment of ligaments and bones. The treatment was a modification of the "Decoction of Flying Feet" (derived from Hu Qian Wan and Deer Antler Gelatin Pills) which includes the

tonics: tortoise shell, rehmannia, tiger bone, eucommia, dipsacus, cuscuta, atractylodes, and licorice; later the prescription was modified by adding astragalus. The formula tonifies qi, yin, and yang. Treatment time was two months and gradual normalization of limb movements ensued.

 

A formula for treating wei syndrome was developed by Hukui Futei in Japan, based on Hu Qian Wan (27). It is called Wei Zheng Fang (Flaccidity Syndrome

Formula) and is made with rehmannia, anemarrhena, phellodendron, peony, tang-kuei, achyranthes, atractylodes, astragalus, and eucommia. It has been used in Japan for treating disorders such as multiple myelitis, polio, and paralysis due to beriberi. Dr. Domei Yakazu reported good results in treating an MS patient using this formula for two and a half years.

 

In a review of traditional concepts of paralysis, Dr. Hong-yen Hsu (13) describes the syndrome of atrophy of the muscles. There are two

sub-categories: weak and strong confirmation (constitution).

 

The weak confirmation is caused by yin weakness which impairs the flow of bodily fluids thereby preventing nutrients from reaching the muscles and bones...the strong confirmation may occur when the flow of the sunlight yang meridian becomes imbalanced by an attack of wet fever [damp-heat]. This will then impair the circulation to the limbs and cause the muscles to atrophy. A strong confirmation may also be induced by lung fever, wet sputum, or stagnant blood.

 

This explanation is based on the Neijing description.

 

To rectify the problem in individuals suffering from deficiency of liver and kidney, recommended formulas are Ginseng and Tang-kuei Ten Combination (Shichuan Dabu Tang) and Tiger's Shinbone and Cynomorium Combination (Hu Qian Wan) for kidney and liver deficiency. For the strong confirmation, recommended formulas are San Miao Wan Modified (phellodendron, atractylodes, achyranthes, tang-kuei, stephania, tokoro, tortoise shell) for damp heat; Dao Tan Tang (with chih-shih, arisaema, pinellia, hoelen, citrus, ginger, and licorice) for sputum obstruction; and Tang-kuei Four Combination Modified (tang-kuei, cnidium, peony, rehmannia, persica, carthamus,

zedoaria) for blood stagnation. According to traditional theory, a chronic disease that is caused primarily by deficiency syndrome tends to be insidious, while those caused by excess syndrome tend to show rapid progression. In the book The Treatment of Knotty Diseases with Chinese Acupuncture and Chinese Herbal Medicine (15) Shao Nianfang divides MG treatments into two basic categories: deficiency of spleen/kidney (weak category) and damp-heat (strong category). The deficiency type, especially with qi and yang deficiency, is said to be the most commonly-observed, clinically. Recommendations for treating deficient patients include use of a large dosage of astragalus and inclusion of chih-shih (which will clear phlegm-damp obstruction). For yang deficiency patients, the use of aconite is helpful and the amount should be large (30-60 grams, boiled for two hours).

 

In general, according to Shao, for MG of the deficiency syndrome type, one can use patent medicines such as Buzhong Yiqi Wan (Ginseng and Astragalus Combination), Fuzi Lizhong Wan (Aconite, Ginseng, and Ginger Combination), Hu Qian Wan, Jin Suo Gu Jing Wan (Lotus Stamen Formula), and Renshen Jianpi Wan (Ginseng Stomachic Pills), or a decoction made with ginseng, atractylodes, astragalus, platycodon, lycium fruit, aconite, cimicifuga, bupleurum, pueraria, tang-kuei, ma-huang, and licorice (Ginseng and Astragalus Combination modified). The dosage of the herbs is from 6 grams

(licorice) to 60 grams (astragalus) each, with a total of about 200 grams for a one day dose. For yang deficiency patients, one can add cinnamon bark and deer antler; for yin deficiency patients, one can add Hu Qian Wan to the treatment.

 

For the damp-heat type, it is suggested to use the patent medicines, such as Longdan Xiegan Wan (Gentiana Combination) or Yangyin Qingfei Wan, or the decoction of atractylodes, phellodendron, scute, dioscorea, stephania, coix, peony, chaenomeles, glehnia, silkworm excrement (San Miao San modified). The dosage of herbs is from 10 grams (phellodendron, scute) to 30 grams

(coix) with a total daily dose of about 150 grams.

 

Citing a case study of early onset of MG, Shao describes a young man with four limbs so flaccid and weak that he could not hold something in his hands, nor could he walk. He was diagnosed as suffering from deficiency of central qi following an acute illness with fever. He was given a decoction of atractylodes, pueraria, licorice, chih-shih, and tang-kuei. After fourteen days there was some improvement, and the formula was modified by adding lycium fruit, ho-shou-wu, aconite, and achyranthes. Treatment with this modified formula was followed for thirty days, after which there was significant reduction of symptoms. Finally, the patient was given Ginseng Stomachic Pills and Rehmannia Eight Formula daily. A follow-up two years later showed that recovery was complete.

 

Li Genghe (16) recommended that the treatment of MG follow the principle of tonifying the spleen and kidney. For spleen deficiency, the Ginseng and Astragalus Combination was used with optional additions of polygonatum, dioscorea, dolichos, and placenta. For spleen deficiency complicated by kidney yin deficiency, the Decoction of Left Restoration plus astragalus, atractylodes, and codonopsis was used (optional additions were ho-shou-wu, ophiopogon, peony, gelatin, and placenta). For spleen deficiency complicated by kidney yang deficiency, the Decoction of Right Restoration with eucommia replaced by deer antler, and with the addition of astragalus, codonopsis, and tang-kuei was used (optional additions were cynomorium, morinda, psoralea, eucommia, loranthus, and placenta). Li noted that common cold and bronchial infection (e.g., pneumonia) were predisposing factors for exacerbations. While steroids could be effective at that time, use of Chinese herbs was helpful in supporting the energy of the body and strengthening resistance; he recommended using ginseng, gecko, rehmannia, aquilaria, placenta, oyster shell, and licorice.

 

CLINICAL TRIALS IN CHINA

 

1. Multiple Sclerosis

 

The largest study (17) of Chinese medical treatment for MS was carried out by Lu Xi and Wang Yaohuo at the Departments of Neurology and Traditional Chinese Medicine in Fujian. Patients were first divided into four groups for differential treatment, two groups with deficiency-type syndrome and two groups with excess-type syndrome. The categories and treatments were:

 

1. Liver/kidney yin deficiency: raw and cooked rehmannia, lycium fruit,

anemarrhena, salvia, peony, cornus, ligustrum, deer horn glue, tortoise plastron glue, achyranthes (chuanniuxi), tang-kuei, and licorice. This is a modification of the traditional Left Restoring Pill (Zuo Gui Wan) with the addition of anemarrhena, ligustrum, salvia, tang-kuei, and peony; it is somewhat similar to Hu Qian Wan. Each herb is used in a dosage of 10-12 grams per day, except licorice (5 grams).

 

2. Spleen-stomach weakness: astragalus, salvia, codonopsis,

atractylodes, hoelen, pinellia, citrus, jujube, and licorice. This is a modification of the traditional Major Six Herbs Combination (Liu Junzi Tang) with astragalus and salvia added. Each herb is used in a dosage of 8-15 grams per day, except jujube (12 pieces) and licorice (4 grams).

 

3. Qi and blood stasis syndrome: astragalus, codonopsis, salvia,

rehmannia (raw), peony (red and white), bupleurum, tang-kuei, scute, cnidium, pinellia, and licorice. This formula combines Minor Bupleurum Combination (Xiao Chaihu Tang) with three herbs for promoting blood circulation-salvia, peony (red and white), and cnidium-plus astragalus. Each herb is present in the amount of 9-15 grams per day, except licorice (4 grams).

 

4. Damp-heat syndrome: ching-hao, talc, peony, scute, bupleurum, bamboo,

akebia, hoelen, chih-shih, pinellia, rhubarb, jujube. This formula is similar to treatments for febrile diseases described in previous centuries, such as the Ching-hao and Scute Combination (Hao Jin Qingtan Tang). Each herb is present in the amount of 8-12 grams, except jujube (12 pieces).

 

The formulas would be modified for certain presenting symptoms. For example, for urinary incontinence, add cuscuta, alpinia, and rose fruit; for constipation, add ho-shou-wu, persica, cistanche, and rhubarb; for mental fogginess, add schizandra; for abdominal distention, add magnolia bark and chih-shih; for muscular atrophy, add tang-kuei, gelatin, and dipsacus.

 

The decoctions were consumed as a cooling drink (rather than hot; because many MS patients have an aversion to heat), once per day. Anti-inflammatory Western drugs (dexamethasone or prednisone) were given during acute active periods. Thirty-five patients were treated and except for three that discontinued treatment within the first ten days, some improvement was found. Two cases were deemed basically cured after taking 45 and 68 doses; 15 were markedly improved and another 15 somewhat improved, most of them taking 20-40 doses. Eleven of the patients had tried corticosteroids unsuccessfully before switching to the traditional herb combinations; of these, seven were markedly improved, three improved, and only one failed to respond.

 

These researchers followed up their work with an attempt to prevent exacerbations (18). They prescribed Ping Fu Tang (Pacify Relapse Decoction) to 30 patients over a period of 3-13 years (average of 6 years). The formula contained astragalus, codonopsis, hoelen, atractylodes, pinellia, licorice, jujube, bupleurum, scute, tortoise shell, ligustrum, tang-kuei, peony, ophiopogon, rehmannia, lycium, and anemarrhena. The prescription basically has the effect of tonifying qi, yin, and blood, and clearing deficiency heat. It can be seen that this prescription is derived from the first two formulas listed in the previous article for treatment of multiple sclerosis, based on deficiencies of liver, kidney, and spleen (it also has some herbs of Minor Bupleurum Combination, as mentioned below). The preventive therapy was basically a tonic formula. It was prescribed in the form of a decoction, taken in 2-3 daily doses, using 8-15 grams of each herb (except smaller amounts of licorice and jujube). According to the researchers, relapses were prevented except for two patients who each experienced only one minor exacerbation, each event following a viral infection (common cold). A control group of MS patients not treated by this remedy was monitored for three years: they suffered from exacerbations at the rate of 1-4 times per year.

 

Ping Fu Tang included rehmannia, tortoise shell, peony, and anemarrhena, ingredients of Hu Qian Wan, which have the functions of nourishing yin and blood and cleansing deficiency fire. In addition, they added ligustrum, lycium fruit, and ophiopogon to nourish yin. A strategy for nourishing blood and essence is to tonify the qi so that more nutrients are obtained from the food. The formula included astragalus, codonopsis, hoelen, atractylodes, licorice, and jujube towards this end (these herbs also enhance immune functions to aid resistance to infections that induce exacerbations). Since the point of the treatment was not to rectify flaccidity, but rather to prevent flaccidity by preventing exacerbations, the herbs for treating flaccidity in the legs, such as tiger bone and cynomorium found in Hu Qian Wan were not included. Also, as the patients are being treated continuously with the yin-nourishing tonics, it is not necessary to strongly inhibit deficiency fire, so phellodendron is not essential to the prescription (anemarrhena, unlike phellodendron, has the secondary property of being a yin tonic). Thus, the treatment largely reflects the principles of Zhu Danxi in relation to understanding the cause of a flaccidity syndrome. The doctors explained that part of their thinking in developing the formula was based on the current understanding of autoimmunity, which explains the presence of so many qi tonics and the herbs of Minor Bupleurum Combination (Xiao Chaihu Tang), such as pinellia, bupleurum, and scute, which is believed to be helpful in chronic inflammatory diseases.

 

If a T-cell attack against myelin sheaths is initiated by influenza, common cold, sinusitis, or other infections, ability to prevent such infections or halt their progress would be one obvious key step in preventing damage due to the usual sequence of events in an exacerbation. Protection from transmissible viral infections, such as staying away from those who are currently suffering from the infection, is one method of prevention. Enhancing the immune system functions with tonic herbs is another method. Many Westerners are led to believe, by poorly written articles on immune disorders, that enhancing immune system vigilance would worsen any autoimmune disease; however, this would only be a potential problem during an exacerbation; even then, other components of the immune system that help to shut-down the autoimmune attack may be coaxed into activity with proper immune-regulating herbal treatment strategies.

 

2. Amyotrophic Lateral Sclerosis and Progressive Spinal Muscular Atrophy

 

Case studies of ALS were reported by Lin Tongguo (19). In one case, the primary formula combined tonic herbs: astragalus, tang-kuei, peony, rehmannia, aconite, cinnamon bark, and lycium fruit, with several herbs used to promote circulation of blood and relieve spasms (the spasms being a significant problem in many cases of ALS): centipede, scorpion, persica, carthamus, morus twig, and clematis. These herbs were made as a decoction taken in divided doses three times daily for several days. In addition, a small amount of powder made from strychnos and musk (0.25 grams of each, three times daily) was given. As follow-up, the decoction formula was modified (cnidium, platycodon, chih-ko, tiger bone, deer antler, and zaocys were added; morus twig and clematis were deleted) and made into pills instead of decoction, to be taken 18 grams per day-the musk and strychnos powders were included in the pills. The pills were taken for two years until the disease was resolved. A follow-up after three years with no further medication showed that the disease had remitted. A similar approach was used with a second patient who consumed a decoction made with astragalus, atractylodes, cinnamon twig, tang-kuei, persica, carthamus, centipede, eupolyphaga, fenugreek, aconite (chuanwu), licorice, and zaocys. After using this decoction for several days, the pill described above was used for long-term medication and a clinical cure was obtained, with a follow-up after five years confirming the satisfactory result.

 

The third case emphasized treatment of yin deficiency fire, using a decoction with phellodendron, raw rehmannia, moutan, alisma, anemarrhena, hoelen, stephania, coix, chin-chiu, dipsacus, achyranthes, centipede, and scorpion. This decoction was given for more than two months and then modified, taking out stephania, coix, and chin-chiu, and adding dipsacus, deer antler, epimedium, tang-kuei, cnidium, and carthamus. This formula was then used for more than three months. Finally, the above-mentioned pill was again used for long-term therapy, and a cure was obtained, with no relapse by the end of two years without the medication.

 

In a report by Kang Yanghuo of two cases of progressive spinal myoatrophy

(20) the main prescriptions given were variations of Shengji Yisui Tang (Decoction for Generating Muscles and Benefiting Marrow). One such prescription contained tang-kuei, lycium fruit, atractylodes, ophiopogon, tortoise shell, achyranthes, phellodendron, alisma, chaenomeles, and licorice for a yin deficiency case and deer antler, eucommia, atractylodes, astragalus, psoralea, malt, crataegus, pinellia, codonopsis, sinapis, hoelen, alisma, chaenomeles, achyranthes, and cinnamon twig for a yang deficiency case with weak digestion and phlegm accumulation. Treatment time was six months and included acupuncture and massage therapy. Long-term follow-up showed persisting benefits of the treatment, with normal nerve conduction and physical activities.

 

In a study (21) of 15 patients with progressive ALS, a significantly expanded version of Hu Qian Wan was employed. This contained astragalus, epimedium, deer antler, syngnathus, sea horse, ginseng, tortoise shell glue, tang-kuei, peony, rehmannia, lycium fruit, eucommia, dipsacus, cuscuta, cynamorium, atractylodes, coix, citrus, achyranthes, chaenomeles, chin-chiu, agkistrodon, tiger bone, psoralea, anemarrhena, phellodendron, cinnamon twig, chiang-huo, tu-huo, and siler. The formula was based on the traditional prescription Jian Bu Hu Qian Wan (Step Reinforcing Tiger's Walk Pill). The pills were taken in a dosage of 3-9 grams at a time, 2-3 times per day depending on the person's constitution and severity of the disease, but were not to be used by patients showing yin deficiency fire syndrome. Two of the patients were said to be cured and five improved. The pills were to be used on a regular basis over a period of several years.

 

Strychnos is sometimes mentioned as part of ALS treatments. A muscle-invigorating combination known as Mobilizing Powder may produce temporary alleviation of flaccidity. The combination includes strychnos, musk, and centipede. Strychnos in small doses tones the muscles and in large doses paralyzes them. It is used in the treatment of other autoimmune disorders, including MG and rheumatoid arthritis. Unfortunately, this herb cannot enter into Western treatments for autoimmune diseases because of concerns over the toxicity of strychnine, one of the main active components.

 

A large scale study of progressive spinal muscular atrophy (80 cases) and ALS (30 cases) was described by Huo Yintang (22). The primary formula used for treatment was Yisui Tang, made with codonopsis, atractylodes, astragalus, rehmannia, psoralea, dipsacus, cuscuta, achyranthes, cibotium, tang-kuei, peony, millettia, tortoise shell, deer antler gelatin (each herb 9-15 grams in decoction), with 5 grams each phellodendron, and anemarrhena. This formula is a substantial modification of Hu Qian Wan, utilizing several yang tonic herbs to replace the tiger's bone of the ancient prescription. According to the report, 59 cases were considered cured (symptoms alleviated, muscles regenerated, and muscular function restored), 18 markedly improved, 25 improved, and 8 showed no improvement.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

tcm.health-info.org 2002