MULTIPLE SCLEROSIS-revisited
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 couldn’t 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:
Vertigo
Muscular weakness
Numbness
Burning pains
Pins and needles
Co-ordination problems
Vision disturbance including blurring and double vision (Tortora and Grabowski,1993, p.439)
Unilateral optic neuritis
Pain
Incontinence (sphincter impairment)
And less commonly:
Facial palsy
Epilepsy
Mental symptoms of MS are usually summarized as:
Aphasia
Euphoria
Dementia (Hope, R et al p.454)
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 becauseits 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 Skegg’s 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).
Skegg’s 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 Skegg’s patients exhibited clinical features such as:
Depression
Depression with conversion symptoms
Hysterical personality
Hysterical conversion
Obsessive compulsive personality
Anxiety
Personality changes
Sleeplessness
Suicidal
Delusions
Disorientated
Fear of the dark
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 heaven’s 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 children’s 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 people’s 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 ½ 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:
- “onset heat” – similar to an exterior wind heat
- “seeing the form” – ie appearance of red colored dots and papules. Its important here to note that there is a sequence to spots; going from the face, neck, chest, abdomen, limbs to finish on the palms and soles.
- “disappearing” period – the red papules emerge together to form darker red patches and then they disappear ( Deng, 1999, p.369).
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:
- Xuan Du Fa Biao Tang (Dissipate Toxin and Release the Exterior Decoction)
- Qing Jie Tou Biao Tang (Clear, Release, Penetrate the Exterior Decoction) which contains: Xi He Liu, Chan Tui, Gen Gen, Sheng Ma, Zi Cao, Ge Gen, Sang Ye, Ju Hua, Gan Cao, Niu Bang Zi, Jin Yin Hua, Lian Qiao
- Sha Shen Mai Dong Tang (Glehnia and Ophiopogonis Decoction)
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:
Maciocia’s choice of words is significant in his discussion of differentiation and treatment of MS in that he says “there are only 2 basic patterns”:
- Spleen xu, with damp- phlegm
- Liver and Kidney xu. (Macioca,1994, p.702)
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).