When we stand in front of Leonardo da Vinci’s Mona Lisa in The Louvre museum, the optical image will be translated into electric pulses in the retina cells in the our eye. Those electric signals will move along the optic nerves, relay neurons, thalamus, to the visual cortex in the occipital lobe that is located at the back of the brain. There we can feel the image in front of us. The electric signals are further sent to millions of other cortex neurons to be analyzed (what, where, when) and integrated (recognition, identification, categorization and comparing with previous stored signals) so that we know that the pretty women with mysterious smile is Mona Lisa. We may feel excited. Then the cortex neurons may send out electric pulses along with relay neurons, memory and language center where the words are processed and selected, motor control area, cranial nerves to the larynx, tongue, mouth, face, and eyes. Then we say “wow, fantastic!” with the eyes opening widely (Fig. 1, [[i],[ii],[iii],[iv],[v]]). This simple reflection after seeing the Mona Lisa for the first time involves the activities of thousands of nerve cells. Any damages of these cells and connections will cause a weak or dysfunction of the feeling, speech and facial expression in front of Mona Lisa.
Multiple sclerosis (MS) is such chronic and progressive autoimmune disease that may affect the nerve cells of our whole body, especially those in the brain and spinal cord [[vi],[vii]]. MS damages the myelin sheath, the material that surrounds and protects the axons of nerve cells. This damage slows down or blocks signal transmission between neurons and target cells (Fig. 2 [[viii]]), leading to the MS symptoms of visual and motor disturbances, muscle weakness, trouble with coordination and balance, sensation problems such as numbness, prickling, or “pins and needles”, thinking and memory problems, etc. (Fig. 3, [6,[ix]]). In 2009, there were estimated to be 23,700 Australians with MS (0.1% of the population) and of these, 11,400 (48%) had a profound or severe core-activity limitation [[x]].
The cause of MS is unclear. The possible mechanism is thought to be either destruction by the immune system (by both inflammation and axonal degeneration [[xi]]) or failure of the myelin-producing cells, which might include genetics and environmental factors such as infections. The rarity of MS among Samis, Turkmen, Uzbeks, Kazakhs, Kyrgyzis, native Siberians, North and South Amerindians, Chinese, Japanese, African blacks and New Zealand Maoris, as well as the high risk among Sardinians, Parsis and Palestinians, clearly indicate that the environment and diet culture are important determinants of the uneven geographic distribution of MS [[xii]]. MS is usually diagnosed based on the presenting signs and symptoms and the results of supporting medical tests (MRI and analysis of cerebrospinal fluid). The clinical courses of MS are progressive with or without relapsing and remitting. Currently, there is no known cure for MS, but medicines (such as interferon-β, glatiramer acetate, mitoxantrone, natalizumab and immunosuppressors) may slow it down and help control symptoms [6]. Alternative treatments, including physical and occupational therapies, dietary supplementation and regimens may also help since many facts indicate that MS may relate to life styles [[xiii]]. Hypovitaminosis D, adverse health behaviors (smoke, alcohol, obesity, less physical activity, etc.), increase the risk of MS [[xiv],[xv]], while diet modification (linoleate other than oleate vegetable oil [[xvi]], higher intake of linolenic acid [[xvii]]), and vitamins D [[xviii]] showed benefits to MS.
There is no such name of the disease “multiple sclerosis” in traditional Chinese Medicine (TCM) in literature. Many doctors treat MS as some syndrome patterns according to the patient’s clinical manifestations. If there is clinical extremity weakness, difficult to move or even paralysis and muscle atrophy, it is generally attributed to the category of “Wei Zhen” (痿证, flaccidity syndrome), which may be the most cases [[xix]]; If the clinical manifestations are clumsy hand and foot movements, walking instability, trouble with coordination and balance, it belongs to the category of “Gu Yao” (骨繇, bone tremor); The lower back and limb pain with activity limitation, numbness and cold feeling, identified as “Bi Zheng” (痹证, arthralgia-syndrome); The paralysis of limbs, classified as “Feng Fei” (风痱, hemiplegia) and so on. The TCM pathogenesis of MS includes asthenic vital Qi with pathogen lingering, Yang deficiency of kidney, Yin deficiency of liver and kidney, Qi and blood deficiency of spleen and stomach, stagnation of phlegm-dampness, Qi deficiency and blood stasis, etc. However, from the analysis of clinical experiences and reports, kidney and blood stasis are the main pathogenesis of this disease. The illness sites are in the brain and spine but they relate to kidney, liver and spleen, especially close to the kidney. The kidney deficiency is the main pathological basis of multiple sclerosis. Kidney deficiency leads to blood stasis and kidney deficiency occurs with blood stasis mostly. The kidney deficiency is the basis (the primary) and blood stasis is the sign (the secondary) [[xx]]. Therefore, the herbal treatments may include Huang Qi (黄芪), Dang Sheng (党参), Bai Zhu (白术) for tonifying the spleen and replenishing Qi; Xiang Ling Pi (仙灵脾), Ba Ji Tian (巴戟天) for warming and recuperating kidney Yang; Tu Si Zi (菟丝子), Sha Yuan Zi (沙苑子) for recuperating kidney Yang and nourishing kidney Yin; Bai Hua She She Cao (白花蛇舌草), Pu Gong Ying (蒲公英) for dissipating heat and detoxifying; Chi Shao (赤芍), Chuan Qiong (川芎), Hong Hua (红花) for activating blood circulation to remove stasis; Ban Xia (半夏), Dan Nan Xing (胆南星), Ze Xie (泽泻) for dissipating phlegm and dehygrosis; Quan Chong (全虫), Jiang Can (僵蚕), Shui Zhi (水蛭), Gou Teng (勾藤) for expelling Wind evil, dredging Channel and relieving pain [20]. In a study of 43 MS patients treated with Bu Shen Gu Sui tablet (补肾固髓片, BSGS), the total effective rate was 88.37%. High dose BSGS in the guinea pig models could obviously reduce the incidence of experimental allergic encephalomyelitis, inhibit inflammatory reaction of the brain and spinal cord as well as demyelination, and simultaneously inhibit the activity of serum IL-2, IL-6, TNF and MBP (P < 0.01) [[xxi]].
In addition to the herbal medicine, other complementary and alternative medicine methods are also helpful on MS. In a survey of 3140 MS patients, more than half of them (57.1%) had used at least one complementary and alternative medicine modality, among which were ingested herbs (26.6%), chiropractic manipulation (25.5%), massage (23.3%) and acupuncture (19.9%) [[xxii]]. Compared with conventional therapies, complementary and alternative medicine rarely showed unwanted side effects [[xxiii]]. Although MS is a progressive disease and has no cure currently, the average life expectancy is 30 years from onset. Almost 40% of people with MS reach the seventh decade of life [6]. Therefore, the quality of life acquired from the complementary and alternative medicine appears more important. Everyone with MS would still like to feel the excitement from the masterpieces like Mona Lisa.
From a newborn baby to an adult, all systems are developing, not only in size or weight, but their function also matures and modifies at different life stages, until the end of adolescence. This ongoing development of organs and systems is reflected in the amount of common diseases that children get, especially for the immune system, leading many diseases with microorganism infections [[1]].
Common cold and influenza (flu)
The cold is most likely what a child will have to deal with at some point, especially for infants and preschool children because they haven’t yet developed resistance to most of the viruses that cause a cold [[2]]. Both common cold and flu are caused by virus infections. Since these viruses are best proliferated in 33–35 °C, and the virus defense capacity of our immune system becomes weaker at a lower body temperature [[3],[4]], these virus will proliferate once they get into the upper respiratory tract and we will get “cold” symptoms including sneezing, runny nose, coughs, headaches, fever and muscle aches (Fig. 1, [[5]]). There is currently no cure for the common cold and flu. Fortunately, our body’s immune system can fight off the virus most of the time [[6],[7]]. Treatments in western medicine are bed rest and fluids to let the immune system fight off the cold virus while easing the discomforts it causes. Over the counter medications may also help combat some symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen and ibuprofen are used to alleviate the fever an well as acting as an analgesic, while guaifenesin and dextromethorphan are used for their expectorant and antitussive properties. Eventually, the cold will run its course and the child will get better on their own [5]. This sharply contrasts the traditional Chinese medicine (TCM) approach, which mainly splits colds into two categories: wind cold and wind heat. Wind cold is when one develops a cold from chilly wind, while wind heat is caused by the opposite. The two different types present with slightly different symptoms and require different approaches in treatment. Wind cold normally presents with fever, chills, and inability to get warm, a productive cough with clear mucus, stiff neck and shoulders, occipital headache, and bradycardia. Treatment involves sweating therapy because it warms while simultaneously detoxifying the body. This is accompanied with warm miso soup made with the white part of the spring onion and ginger. However, if wind cold is allowed to persist without treatment for a few days, then it may present with the inability to sweat, which will render the first line treatment ineffective. If this is the case, then treatment involves an ephedra decoction, which is concentrated ephedra (Ma Huang Tang (麻黄汤); Ma Huang is currently not scheduled in Australia and hence, it’s illegal to use it. See below for its substitutes)combined with licorice. The ephedrine will open the airways while stimulating the body to sweat, while the licorice modulates the ephedrine and has anti-inflammatory and antitussive properties. When the pernicious influence of the wind combines with heat, the fever is worse than the chills. The primary symptom is a sore throat with swollen, headache, irritability, fever and tachycardia. The cough is usually dry or nonproductive, with occasional expectoration of yellow mucus. Treatment normally involves Yin Qiao San (银翘散), but if the fever is severe, then Zhong Gan Ling (重感灵) is preferred. If sore throat severe, then Chuan Xin Lian (穿心莲) Antiphlogistic Tablets can be added to the treatment [[8]]).
Chickenpox
Chickenpox is a disease primarily associated with children, particularly among those under age 12 [[9]]. When most people think of chickenpox, they picture a child with those characteristic red bumps scratching himself to death. Although there exists a vaccine for chickenpox, choosing not to get it could cause the disease to be contracted fairly easily. The chickenpox virus is an offset of the herpes virus that may not show symptoms for years after initial contraction [7]. The distinguishing symptom of chickenpox is a rash consisting of red bumps (Fig.2, [[10]]) that spreads across the entire body over the course of several days. These bumps will eventually turn into blisters and produce itchiness. If the child scratches too much, these blisters may break, opening the body to more foreign invaders. Treatment includes hydrocortisone or oatmeal baths to soothe the itching, as well as NSAIDs if the fever rises above 38°C (or 101°F). The child should also be quarantined to ensure that the highly contagious disease does not spread, especially to adults where it could develop into shingles. In TCM, for the chickenpox with mild symptoms (sparse and light rashes, thin blisters as bright dews with less redness), the wind-heat evil is mild. The treatment for that will be the formulas with wind-scattering, heat-clearing and detoxifying functions. For the chickenpox with severe symptoms (large area of red pox, thick blisters with cloudy fluid inside), the toxic heat is flourishing, deep to nutrient Qi and defensive Qi. Then the treatment of heat-clearing, nutrient Qi-cooling and detoxifying formulas will be used [[11]]. TCM treatment could get similar or better effectiveness as intravenous aspirin on controling fever and drying up blisters [[12]]. According to the TCM theory, a great formula to help children overcoming Chickenpox quicker is Chai Hu Gui Zhi Gan Jiang Tang (柴胡桂枝干姜汤) or a simple Xiao Chai Hu Tang (小柴胡汤). If the blisters mature, perhaps a modified version of one of those formulas to address the rash is helpful [[13],[14]].
Asthma/respiratory tract infection
Asthma is a chronic condition in which inflammation of the bronchi causes trouble breathing, and occasionally, complete closure of the airways (Fig.3. [[15]]. Currently the cause of asthma is unclear, although environmental and genetic factors may be at play. Many environmental factors have been associated with the asthma’s development and exacerbation including allergens, bacterial and virus infections in the respiratory tract [[16]]. The onset of child asthma is seen mostly at 1-6 years old and 95% induction is due to the respiratory tract infection [[17]]. Symptoms include shortness of breath, wheezing, coughing, and tightness in the chest. For immediate relief in the event of an asthma attack, Short-acting beta2-adrenoceptor agonists (SABAs) such as Salbutamol remain first line treatment. It is delivered into the respiratory tract via inhalation. For long term management, corticosteroids, Long-acting beta-adrenoceptor agonists (LABAs), leukotriene antagonists, and mast cell stabilizers are used. These medications all reduce the inflammation in the airways, leading to less restricted airflow [14]. In the TCM theory of asthma, the attack of the disease is caused by both internal and external reasons. The internal responsibility is the internal retention of phlegm and fluid, related to the organs of lung, spleen and kidney. The external factor is mainly outside evil (exogenous pathogens) invasion. Child lung is delicate, his spleen and kidney are insufficient at functions. The deficient lung causes the failure of defense against outside evil. Pathogens injure the pulmonary collaterals, leading body fluid condensed into the phlegm. Dysfunction of the spleen in transport produces dampness and phlegm, leading the phlegm storage up in the lung. The kidney weakness can’t transform water into clear fluid, leading the phlegm formation up in the lung [15]. Therefore, the treatment is to warm the lung and cold, eliminate phlegm and relieve asthma for the cold type asthma. Ventilate the lung, eliminate evil heat, eliminate phlegm and relieve asthma for the hot type asthma. Invigorate Qi (vital energy) and consolidate the exterior, strengthen the spleen and replenish Qi, tonify kidney, strengthen spleen and consolidate the constitution for deficiency type of asthma [[18]]. In a study, Ding Chuan Tang (定喘汤, DCT), a formula long used for the opening of the airways, was tested on children with asthma in a randomized, double-blind clinical trial. Children were given 6 grams of DCT or placebo daily for 12 weeks. At the end of the study, airway hyper-responsiveness was significantly improved for the treatment group. This suggested that DCT resulted in more stable airways with less side effects [[19]]. Ding Chuan Tang contains Ma Huang (麻黄) and Kuan Dong Hua (款冬花) which are both not legally available in Australia. To substitute Ma Huang, you could use Zi Su Ye (紫苏叶) and to replace Kuan Dong Hua, either the cough herbs can be given at a higher dosage or based on the presentation, Pi Pa Ye (枇杷叶), Ting Li Zi (葶苈子) or Zi Su Zi (紫苏子) can be added [[20],[21],[22]].
Gastroenteritis
Gastroenteritis is an inflammation of the gastrointestinal tract, usually resulting in vomiting, diarrhea, and abdominal pain, which usually begin 12–72 hours after contracting the infectious agent. In children, most cases are caused by the virus (70% of cases, mostly under age 2 [[23]]) and bacteria (15% of cases), although parasitic and non-infectious causes are possible. Risk of infection is higher in children due to their lack of immunity and relatively poor hygiene. Gastroenteritis is usually an acute and self-limiting disease that does not require medication—normally treated with rehydration and rest. However, in severe cases, antiemetics such as ondansetron or antibiotics may be used [[24]]. In TCM, gastroenteritis is caused by gastrointestinal dampness and heat; retention of food in the stomach and intestine; and deficiency of the spleen and stomach. Therefore, the treatments are clearing heat and removing dampness, regulating Qi to stop diarrhea; remove retention and pacify the stomach, regulating the stomach descending adverse Qi; strengthening spleen and subduing the advice of Qi, pacify the stomach and stop diarrhea [[25]]. Berberine is a traditional Chinese medicine used for a long time in china. It is one of the most important alkaloids that contains in the TCM herbs of Huang Lian (黄连) and Huang Bai (黄柏). It shows a significant inhibitory effect of bacteria, including dysentery bacillus, Mycobacterium tuberculosis, pneumococcus, typhoid and diphtheria bacilli. It is widely used to treat bacterial gastroenteritis, diarrhea and other gastrointestinal diseases [[26]]. According to the TCM theory, depending on the presentation formulas such as Xie Xin Tang (泻心汤), Ban Xia Xie Xin Tang (半夏泻心汤), Sheng Jiang Xie Xin Tang (生姜泻心汤) are very capable formulas to help bring about a quick recovery [[27],[28],[29]].
Urinary tract infection
A urinary tract infection (UTI) occurs when the kidneys (pyelonephritis), ureters (ureteritis), bladder (cystitis), or urethra (urethritis) become infected. By age 5, about 8% of girls and 1%-2% of boys have had at least one UTI. It is usually caused by E coli, but can also be viral or fungal. Its clinical symptoms are mainly frequent/urgent/painful urination, fever, lower abdominal or lower back pain or discomfort. Some kids experience UTIs again and again — these are called recurrent UTIs. If left untreated, recurrent UTIs can cause kidney damage, especially in kids younger than 6. Because most urinary tract infections are bacterial, normal course of treatment involves antibiotics [[30],[31]]. TCM believes that UTI (belongs to the category of stranguria in TCM) is mainly due to the heat and dampness in the lower Jiao and heat accumulation in the bladder. It mostly begins from the dampness and heat in the bladder—its disease is in the bladder. The dampness and heat will damage Yin when the disease last for a long time and lead Yin deficiency—its disease is in the kidney. In addition, stranguria is related to blood stasis. The treatment of TCM is removing damp-heat, treating stranguria and diuretic, promoting blood circulation and removing blood stasis [[32]]. Some formula examples are: Ba Zheng San (八正散), Wu Ling San (五苓散), Gua Lou Qu Mai Wan (栝楼瞿麦丸) or Tao He Cheng Qi Tang (桃核承气汤) which all can be helpful depending on the severity of the symptoms and the dominance of heat or dampness [[33],[34],[35],[36]].
In addition to the weakness of child immune defense to the microorganisms during the development, the whole body is facing the challenges in the interactions of material metabolism to the outside world.
Allergies
The medical term of allergy is defined as the Type I hypersensitivity disorder of the immune system [[i]]. The rapid inflammatory response of the Type I hypersensitivity involves a type of antibody called Immunoglobulin E (IgE) and certain white blood cells called mast cells and basophils. It can cause many diseases, such as asthma, allergic rhinitis, allergic otitis media, etc. [[ii],[iii]] The lay term “Allergy” may include any discomfort or illness caused by the reactions of our immune system to foreign materials, which includes other types of hypersensitivity, such as rheumatoid arthritis (Type III), contact dermatitis (Type IV), etc. [[iv]]. The risk factors for allergy are from both sides of host (our body) and environment. Host factors include heredity, gender, race, and age. The environmental factors include microorganisms, environmental pollution and foods [1] (Fig. 1, [[v]]). Allergies in infants and children are common. Food allergies affect about 6% to 8% of children under age 5 [[vi]]. By age 6, 42% children have symptoms of upper respiratory allergies [[vii]]. If both parents have allergies, their (biological) child has a 75% chance of having allergies [[viii]]. The symptoms and signs of allergy include runny nose, nasal stuffiness, sneezing, nose rubbing, sniffling, Itchy, runny eyes, skin rashes, swollen, hives, fever, eczema, asthma, stomach pain, diarrhea, vomiting, headache, etc. [[ix], [x], [xi]] The treatment of allergy includes finding/avoiding the allergens and releasing the symptoms by medications such as antihistamines, glucocorticoids, and anti-leukotrienes. In addition to avoiding the environmental factors, TCM pays more attention to the adjustment of the host. According to TCM theory, the appearance of an allergic reaction is the sign—the pathological change resulted from the inside and outside pathogenic factors; while the system disability is the origin—the disorder of the internal environment stability and adaptability [[xii]]. An allergy is associated with the specific physical constitution. There are two allergic constitutions: heat and cold. The heat constitution is prone to an allergic reaction to increased temperature. TCM believes that “Heat can drive wind”. A “wind” is a kind of an allergic reaction, such as itchy skin when in heat. On the contrary, the person with cold constitution is easy to allergic to cold temperature. The outside cold is considered as a “cold evil”. When the cold evil invades the respiratory tract, the body’s Yang will expel the evil out. Sneezing and runny nose are the process of expelling the cold evil out. As long as the chill is out, the allergic reaction will stop [[xiii]]. Therefore, the TCM treatment strategy is scattering wind, clearing heat (for heat constitution) or expelling cold (for cold constitution), and drying wet. Here is an example of a formula for an allergy from the well-known doctor Chen Yu Zhu (祝谌予): Fang Feng (防风)、Chai Hu (柴胡)、Hu Mei (乌梅)、Wu Wei Zi (五味子)，for allergy treatment with modifications. For the one with wind cold, add Gui Zhi (桂枝)、Ma Huang (麻黄)、Sheng Ma (升麻) and Jing Jie (荆芥)；For the one with wind heat, add Ju Hua (菊花)、Chan Yi (蝉衣)、Yi Hua (银花) and Be He (薄荷)；For the one with blood heat, add Dan Pi (丹皮)、Zi Cao (紫草)、Bai Mao Gen (白茅根)；For the one with heat evil in the interior, add Lian Qiao (连翘)、Yin Hua (银花)、Gan Cao (甘草)、Pu Gong Ying (蒲公英)、Zi Hua Di Ding (紫花地丁) and Ban Lan Geng (板蓝根) [[xiv]]. In allergy treatment, it’s important to treat the Taiyin (Lung, Spleen) realm as the effective function of these two organs (according to TCM theory), the problem will be treated at the at the root. This means, that during the active stage of the allergic reaction the formula can focus on the “wind-evil” (the branch) where as during the latent stage, Taiyin should be supported. There are many formuls to consider, some examples are: Yu Ping Feng San (玉屏风散), Gui Zhi Tang (桂枝汤), Li Zhong Wan (理中丸), Si Ni Tang (四逆汤).
Eczema in Children
Eczema often refers to as atopic dermatitis. It also refers to as allergic skin disease in lay term. The eczema in Children most commonly presents before the age of 5. About 60% of patients will experience symptoms of atopic dermatitis by age 1 (Fig. 2, [[xv]], and another 30% will experience symptoms by age 5. It is a non-contagious inflammatory skin condition [[xvi]]. The cause of eczema is unknown but is presumed to be a combination of genetic and environmental factors [[xvii]]. Children born into families that have a history of allergic diseases such as asthma or hay fever are at an increased risk for eczema developing [16]. The main environmental factors to cause the eczema in children are the intake foods (especially cow’s milk, egg, wheat, fish, soy and peanuts), inhalation (especially house dust, mite and grass pollen), and direct contact (such as soap, bubble bath, sweat, saliva, clothes, metals and pets). Initially the children suffering from skin redness, rash, then rough skin and scaling. The child’s skin feels like touching on sandpaper. The hot and wet environments or situations can make the eczema performance significantly [15,[xviii],[xix],[xx]]. The treatment of allergy includes removing the environmental factors, the use of ointments, lotions, steroid creams, oral antihistamines, steroids and antibiotics if involving infections. In TCM, the infant and toddler eczema refers to “milk tinea”. It is caused by endogenous damp toxin, exogenous wind evil and loss of spleen functions. Therefore, the appearance of an eczema often reflects the child’s dyspepsia [[xxi]]. In clinic, the infant and toddler eczema can be divided into two categories: (1) Damp-heat flourishing in the interior: flushing skin, red papules and vesicles, the outflow mucus on the broken blister and scabs after the dryness, red eye, red tongue, a tongue with thin yellow greasy coating, and slippery and rapid pulse. (2) Blood dryness and wind prevailing: dry and rough skin, itching, scratching white dander, dry stool, often accompanied by a thirsty throat, restless sleep, thin coating of tongue with less fluid, and thready and rapid pulse. The treatment for the first situation (damp-heat): clear away heat and promote diuresis, dispel wind and arrest itching by Xiao Feng San (消风散) with modifications. The treatment for the second situation (blood dryness): nourishing blood and Ying, dispelling wind and moistening dryness by Si Wu Tang (四物汤) and San Miao Wan (三妙丸) with modifications [[xxii]]. In addition, it was very effective for the eczema in children to scrub gently the affected area with the water boiling juice from Qing Li Cao (清沥草), 3 times a day for a few days. One of the main topical treatments for an active stage of eczema is Qing Dai Gao (青黛膏), Dian Dao San (颠倒散) or San Huang Xi Ji (三黄洗剂), depending on the exact presentation of the condition.
ADHD
Attention deficit hyperactive disorder, or ADHD, is a mental disorder that has been affecting more and more people throughout the world. It is diagnosed with inattentiveness, hyperactivity, and impulsiveness that go beyond what would be considered for a normal child (Fig. 3, [[xxiii]]). These symptoms must emerge before 12 years of age for a diagnosis to be made. Children diagnosed with ADHD have trouble focusing and sitting still for long periods of time, as well as acting impulsively upon their first thought without thinking things through. This will impact the child’s home, social, and, especially so, school life, as children with ADHD usually do poorly in school. Currently, the causes of ADHD remain an area of controversy – risks factors involve genetics, executive function, environment, diet and social. The pathophysiology of the ADHD brain may or may not be changed. Treatment, which is controversial, involves stimulant (Adderall) and non-stimulant (atomoxetine) medications, as well as psychotherapy ([xxiv], [xxv]). TCM believes that the imbalance of Yin and Yang is one of the basic pathological abnormal consciousness of ADHD. Its specific performance reflects in the disorders of visceral function, involving the four viscera of heart, liver, spleen and kidney. In clinic, ADHD is divided into three types: (1) Kidney-Yin deficiency and liver-Yang hyperactivity: Dysphoria with feverish sensation in the chest, palms and sole, or burning cheeks; less shiny on nails and hair; dry mouth and throat; night sweats; preferring cold diet; red tongue with less or no coating; thready and rapid pulse. (2) Qi deficiency of heart and spleen: Unwholesome complexion, thin body shape; dreaminess, a light sleeper; poor food intake, pale tongue with scalloped edges, thin and white coating; thready and weak pulse. (3) Accumulation of damp-heat inside, phlegm-fire disturbing heart: Restless, chest tightness and epigastric fullness and pain; bitter taste in mouth and anorexia; thirsty and desiring for drinking; abundant phlegm, yellow urine, dry stool; red tongue with yellow greasy coating; slippery and rapid pulse. The treatment strategies are (1) Nourishing the liver and kidney, nourishing Yin and Yang, calming the mind and promoting mentality; (2) nourishing Qi and invigorating the spleen, nourishing the heart and tranquilizing the mind; (3) clearing heat and purging fire, removing dampness and resolving phlegm [[xxvi]]. Some studies showed that the total effective rate on ADHD by TCM treatment reached 86%-94% for children’s IQ tests or academic records, although there is no significant difference between the herbs and western medicine (Ritalin), the TCM group had less side effects than the western medicine group [[xxvii],[xxviii]]. As many factors are to consider for ADHD, it’s vital to see a qualified Chinese medicine practitioner to determine an effective treatment approach for your child.
The Wu Xing or 5 elements are an ancient mnemonic device. It was and is used to describe interactions and relationships between phenomena.
According to Wu Xing theory, the structure of the cosmos mirrors the five phases. Any action, any incident, any occurrence or any event can be related to one of these phases.
This is rather interesting; the system bases on the 5 cardinal points which relate to the directions of North, South, East and West and most likely as a 5th point, the center (or the middle)!
In Traditional Chinese medicine, we apply the theory of Wu Xing for both, assessment of an individual or a condition. We also use it as a diagnostic tool.
We differentiate between the following five phases:
Wood (Chinese: 木, pinyin: mù)
Fire (Chinese: 火, pinyin: huǒ)
Earth (Chinese: 土, pinyin: tǔ)
Metal (Chinese: 金, pinyin: jīn)
Water (Chinese: 水, pinyin: shuǐ)
Phase
Wood
Fire
Earth
Metal
Water
Colour
Green
Red
Yellow
White
Black
Emotion
Anger
Happiness
Worry
Sadness
Fear
Yin organs
Liver
Heart / Pericardium
Spleen
Lung
Kidney
Yang organs
Gallbladder
Small Intestine, Triple Burner
Stomach
Large Intestine
Urinary bladder
Sensory organ
Eyes
Tongue
Mouth
Nose
Ears
Sense
Sight
Speech
Taste
Smell
Hearing
Body part
Tendons
Blood vessels
Muscles
Skin
Bones
Body fluids
Tears
Sweat
Saliva
Mucous
Urine
Taste
Sour
Bitter
Sweet
Pungent
Salty
Having now established the basis of the Wu Xing, allow me to use several descriptive samples for your perception & understanding.
The colours are linked to the colour of the facial colour for instance. Black shadows under the eyes will be a sign for kidney deficiency. A yellowish-green complexion can show a disharmony between the spleen and liver and at the red tip of the tongue relates to heat in the heart which would stop people from sleeping restfully.
Emotions display the state of health, either conveying a sense of dis-eases or good health. Someone being overly angry is an unmistakable sign of a liver pattern. Sadness drains the Lung energy and hence allows external disease factors to enter our internal system or can result in Skin conditions.
The Yin and the Yang organs pair and become a unit. If one of them is out of balance, it will affect the partner’s organ or Acupuncture channel as well. So, we have pairs of Liver/Gallbladder, Heart/Small Intestine, Spleen/Stomach, Lung/Large Intestine, Kidney/Urinary bladder and Triple burner/Pericardium. As a system of transport the Triple burner and the Pericardium pair and in the Wu Xing, they also belong to the Fire element.
Any condition of sensory organs and associated senses, relate directly to the element. Eye problems all have something to do with the liver and particularly the liver blood nourishing the eyes or ear problems such as tinnitus (ringing in the ears) will have to be treated via the kidney organ. The nose is related to the Lungs (the Yin organ closest to the exits) and manifests with head colds, then penetrating a deeper level and hence affecting the Lung organ (bronchitis, pneumonia, etc.). The sensory organs are the openings/entry-exits of the organs.
How do body parts relate to the Wu Xing? It’s the quality of an element or phase that represents each part. An example are muscles, if nourished properly with appropriate food, they will flourish, look pink and firm and feel strong. Nourishment in Chinese medicine is provided by a strong partnership: the stomach and the spleen.
The body fluids categorise the same way: each element governs a certain fluid. If we consider urine (that is related to the Water element) we can assess the state of the kidney and urinary bladder. Too much urine, too little urine, burning or frequent urination will allow us to treat the respective organ.
The tastes are not only related to a certain phase, but also play an imperative role in treatment with herbs. The herb actions in Chinese medicine are classified by their flavours and not by their chemical constituents!
We look at individual elements but also look at their interaction. In healthy phenomena, remember that’s what the Wu Xing represents and we use the human body as an example, the cycle goes from Wood, Fire, Earth, Metal, Water and back to Water. And this cycle is the nourishing cycle.
Wood brings about Fire, Fire brings about Earth, Earth brings about Metals (or the nutrients that grow in it) and Metal brings about Water where Water nourishes Wood.
If any of the phases become weak, for instance because someone has endured a long time of sadness, the control cycle kicks in. Wood controls Earth, Fire controls Metal, Earth controls Water, Water controls Fire, etc. one disharmony or weakness will usually cause more disharmonies over time. This is also how we can connect emotions and emotional states to individual organs and treat them via the organs.
As you can see, it’s an intrinsic system that is based on observation of nature and cycles in our universe. That’s how we treat the individual and not the ailment.
Dysmenorrhea (Greek term, meaning “painful menstruation”, is a medical condition of excessive menstrual pain during menstruation that interferes with daily activities (Fig. 1, [[1]]). It does not include the common situation of mild discomfort or pain during normal menstruation. The menstrual pain of dysmenorrhea is often described as menstrual cramps, also including sharp, throbbing, dull, burning, or shooting pain in the lower abdomen [[2]]. Dysmenorrhea often co-occur with other symptoms including breast tenderness, nausea, vomiting, diarrhea, constipation, headache, dizziness, disorientation, hypersensitivity to sound, light, smell and touch, fainting, and fatigue [2,[3]].
Clinically, dysmenorrhea can be classified as primary or secondary. If a detailed gynecological clinical examination failed to find the significant abnormalities on pelvic organs, it is diagnosed as a primary dysmenorrhea, also known as functional dysmenorrhea. Secondary dysmenorrhea refers obvious genital diseases, such as endometriosis, pelvic inflammation, cancer and so on [[4]].
Primary dysmenorrhea is more common in women 20-30 years of age. Then the incidence gradually decreases with age, while secondary dysmenorrhea gradually increased. The incidence of dysmenorrhea worldwide can be as wide as 16.8-81%. The different definitions and different survey methods make it difficult to obtain the true incidence of dysmenorrhea. Unless the symptoms affect the quality of life, women may not see a doctor on those discomforts [[5]]. In an investigation of 388 female Australian students in Grades 11 and 12, 53% of those girls with dysmenorrhea reported that it limited their activities [[6]].
Dysmenorrhea can be caused by many factors. The following are the common ones [[7]]:
Stenosis of uterine cervix is the mainly obstructions that are preventing outflow of menstruation, leading dysmenorrhea.
Uterine hypoplasia may have uterine ischemia and hypoxia, leading dysmenorrhea.
The abnormal position of the uterus (extreme tilted forwards or backwards, Fig. 2 [[8]]) can affect blood outflow, leading dysmenorrhea.
Mental and neurological factors: Some women are over-sensitive to pain. Girl’s menarche, psychological stress may cause dysmenorrhea.
Genetic factors: There is a certain relationship between mother and daughter on dysmenorrhea.
Endocrine factors: Dysmenorrhea may be related to the elevated progesterone.
The increased endometrial and menstrual blood prostaglandin plays a role in the contraction of the uterine muscle fibers and may cause dysmenorrhea.
Excessive or abnormal contractions of the uterus lead to uterine ischemia and uterine muscle spasms, resulting in pain in menstruation.
Gynecological diseases, such as endometriosis, pelvic inflammation, adenomyosis, hysteromyoma and intrauterine device can easily cause dysmenorrhea.
Sedentary lifestyle, eating cold food, strenuous exercise during menstruation, invasion by the wind, cold and damp, stimulations by some industrial or chemical odor (gasoline, perfume), etc., may cause dysmenorrhea.
If the symptoms of primary dysmenorrhea are strong enough to disrupt the normal life and activities significantly, palliative medical therapy may be applied, including non-steroidal anti-inflammatory drugs, COX-2 inhibitor, hormonal contraceptives, estrogen and progesterone [2,7]. For the secondary dysmenorrhea, it is very important to cure the original diseases that cause the pain, rather than just the pain management temporarily.
In Traditional Chinese Medicine (TCM), dysmenorrhea are mainly divided into four types with different treatments each type [7,[9],[10]]:
1. Qi stagnation and blood stasis: Distending pain and tenderness in the lower abdomen one or two days prior to or during menstruation accompanied with fullness sensation in the chest, hypochondrium and breast, deep-purple blood with clots, relief of pain after discharge of clots, ecchymoses on the tongue edges, string-like pulse. Treatment by soothing the liver and regulating Qi, removing blood stasis and relieving pain with Ge Xia Zhu Yu Tang (膈下逐瘀汤) with addition: Dang Gui (当归), Chi Shao (赤芍), Liu Ji Nu (刘寄奴), Niu Qi (牛膝) 15g each，Chuan Qiong (川芎), Tao Ren (桃仁), Hong Hua (红花), Yan HuSuo (延胡索), Wu LingZhi (五灵脂), Wu Yao (乌药), Xiang Fu (香附) 12g each，Zhi Qiao (枳壳), Dan Pi (丹皮) 9g each，Gang Cao (甘草) 6g and Dan Sen (丹参)30g。
2. Stagnancy of Cold and Dampness: Distending pain in the lower abdomen several days prior to or during menstruation, which can be relieved by warmth, menstrual flow scanty in amount, dark in color and with clots, pale tongue with white and greasy fur, deep and tense pulse. Treatment by warming the channels and removing blood stasis, dispersing cold and eliminating wet with Shao Fu Zhu Yu Tang (少腹逐瘀汤) with addition: Xiao Hui Xiang (小茴香), Gang Jiang (干姜), Rou Gui (肉桂) 6g each，Yan Hu Suo (延胡索), Chuan Qiong (川芎), Cang Zhu (苍术) 9g each，Mo Yao (没药), Chi Shao (赤芍), Pu Huong (蒲黄), Wu Ling Zhi (五灵脂), Wu Yao (乌药), Wu Zhu Yu (吴茱萸) 12g each，Dang Gui (当归), Fu Ling (茯苓) 15g each。
3. Deficiency of Both Qi and Blood: Vague pain in the lower abdomen during or 1-2 days after menstruation which can be relieved by pressing, scanty menstruation with reddish and thin blood, accompanied with lack of vitality and asthenia, pale tongue with white and thin fur, thready and weak pulse. Treatment by replenishing Qi, nourishing blood and relieving pain with Shen Yu Tang (圣愈汤) with addition or subtraction: Ren Sen (人参), Dang Gui (当归), Shu Di (熟地), Ji Xue Ten (鸡血藤) 15g each，Huang Qi (黄芪) 30g，Chuan Qiong (川芎), Xiang Fu (香附), Yan HuSuo (延胡索), Zhi Gang Cao (炙甘草) 9g each，Bai Shao (白芍) 18g and Hong Hua (红花) 12g。
4. Liver and Kidney Deficiency: Pain in the lower abdomen during or 1-2 days after menstruation, sour and pain in lower back, thin menstrual flow, scanty in amount, dark in color, dizziness, tinnitus, hot flush, thready and weak pulse, thin and white or yellow tongue coating. Treatment by nurturing kidney, nourishing liver and relieving pain with Tiao Gan Tang (调肝汤) with addition: Dang Gui (当归), Shan Zhu Yu (山茱萸), E Jiao (阿胶), Shan Yao (山药), Xiang Fu (香附) 12g each，Bai Shao (白芍), Ba Ji Tian (巴戟天), Shu Di (熟地) 15g each，Gang Cao (甘草) 6g，Gou Qi Zi (枸杞子) 30g and Dan Pi (丹皮) 9g。
In addition, acupuncture, nutrient supplements (vitamin B3, vitamin C, rutin [1], fish oil, magnesium [2]), diet modifications (higher fiber, protein, less sweets and avoiding caffeine), keeping warm (including topical heat on the lower abdomen), proper exercise before menstruation and stress relief will help to release the pain of the primary dysmenorrhea [7].
[5] Latthe P et al: WHO systematic review of prevalence of chronic pelvic pain: neglected reproductive health morbidity ：BMC Public Health ，2006 ：6: 177
[6] Hillen TI et al: Primary dysmenorrhea in young Western Australian women: prevalence, impact, and knowledge of treatment. J Adolesc Health. 1999 Jul;25(1):40-5.
Infertility is fundamentally the inability to conceive a baby, including the inability of a male to provide normal sperms and the state of a female who is unable to carry a pregnancy to full term [[1]]. The causes of infertility include specific male causes, specific female causes, combined and unexplained infertility (Fig. 2, [1]). On the male side, low semen count and quality due to endocrine problems, drugs, radiation, infection, hormone imbalance, and blockage of the man’s duct system are the common causes. On the female side, egg released not at the optimum time for fertilization, problems of releasing eggs, structural problems in the Fallopian tube, endometriosis, pelvic inflammatory disease, age-related factors, imbalanced hormones and uterine problems are the common causes of infertility. Genetic factors, DNA damages, diabetes mellitus, thyroid disorders, adrenal disease, hypothalamic-pituitary factors, environmental factors (such as toxins, physical and chemical agents and smoking) can cause infertility on either sex. In addition, approximately one in five couples will experience unexplained infertility despite completing a full infertility work-up. One in six couples in Australia and New Zealand suffers infertility [[2]]. Worldwide, 3-7% of all couples have an unresolved problem of infertility and 12-28% of all couples experience this problem for at least one year [1]. The infertility is highly related to the age. The older the age, the more problems on the fertility (Fig. 3, [[3]]).
Depending on the causes, infertility can be treated with psychological adjustment [[4]], medicine (Clomid, Pergonal, Follistim, Metformin, Parlodel, etc.) [[5]], surgery (Fallopian tube sterilization reversal, hydrosalpinx removal, testicular sperm aspiration, vasectomy reversal, etc.) [[6]], artificial insemination, or assisted reproductive technology (conception cap, semen collectors, intracervical and intrauterine inseminations, In-vitro fertilization and donor insemination, etc.) [1]. Many times these treatments are combined. One thing is very important for the infertility treatment: when starting the treatment to adjust the molecular metabolisms and functions, the organic diseases of infertility must be excluded.
There is a long recorded history of Traditional Chinese Medicine (TCM) being used in the treatment of infertility. In fact, records indicating herbal treatment of infertility and miscarriage date back to 200 A.D., including mention of formulas that are still used for those same purposes today [[7]]. Since the most situations of infertility are due to the imbalances of the molecular metabolisms and functions, while TCM has advantages at the regulations of functional balances individually, TCM shows many benefits in the treatment of infertility. TCM believes that women infertility is due to the lack of innate endowment, excessive intercourse, deficiency of kidney essence, deficiency of Chong and Ren channels; or deficiency of kidney yin, deficiency and cold of the uterus; or body weak, deficiency of Yin and blood, lack of nourishing womb and pulse; or sluggish emotion, stagnation of liver Qi, dissonance of Qi and blood; or obesity, excessive eating and rich fatty diet, Yang deficiency of spleen and kidney, the development of phlegm dampness, block of Qi, block of Chong and Ren channels; or blood stasis and condensation, accumulation of diseases in womb [[8]]. The followings are the common types of infertility and treatment for women in the clinics [8]:
Kidney Yang deficiency: Infertility for a long time, delayed menstruation, low volume of menstrual flow with light color, or oligomenorrhea, amenorrhea; dark and gloomy complexion, lumbar soreness and leg weakness, sexual apathy, clear urine in large amounts, watery stool, pale tongue with white coating, deep and slow pulse. Treatment: Warming kidney and nourishing liver; Regulating and reinforcing Chong and Ren channels. Recipe: Yu Lin Zhu (毓麟珠, from “Jingyue Encyclopedia”《景岳全书》) plus Zi He Che (紫河车), Dan shen (丹参) and Xiang Fu (香附).
Liver depression: Infertility for years, irregular menstrual cycle, abdominal pain during the period with clogged flow, less volume, dark color, and small blood clots, premenstrual breast distending pain, depression, irritability. Normal or dark red tongue with thin and white coating, stringy-taut pulse. Treatment: Soothing the liver and alleviating the depression; Nourishing blood and strengthening spleen. Recipe: Kai Yu Zhong Yu Tang (开郁种玉汤, from Fu Qingzhu’s Obstetrics and Gynecology, 《傅青主女科》).
Phlegm dampness: Inability to conceive a baby for a long time, fat body shape, delayed period or even amenorrhea, increased and thick leucorrhea, pale complexion, dizziness, palpitations, chest distress, nausea. White and greasy tongue coating, slippery pulse. Treatment: Drying damp and eliminating phlegm; Regulating Qi and menstruation. Recipe: Qi Gong Wan (启宫丸, experienced formula) plus Shi Chang Pu (石菖蒲).
Blood stasis: Infertility for a long time, delayed and hypo menorrhea, black and purple blood with clots, or dysmenorrhea, recurrent pain refused to press in the outer part of the lower abdomen. Dark purple tongue or purple dots on the side of the tongue, thready and stringy pulse string. Treatment: promoting blood circulation and removing blood stasis, regulating the menstruation. Recipe: Shao Fu Zhu Yu Tang (少腹逐瘀汤, from “Correction on the Errors of Medical Works” 《医林改错》).
Kidney Yin deficiency: Infertility for a long time, preceded and hypo menorrhea, red without clot, or normal menstruation but with extreme weight loss, soreness and weakness of waist and legs, dizziness, palpitation and insomnia, temperament, dry mouth, burning sensation of five centers, afternoon low-grade fever. Reddish tongue with less coating, thready and rapid pulse. Treatment: Nourishing yin and enriching blood; Regulating Chong channel and replenishing vital essence. Recipe: Yang Jing Zhong Yu Tang (养精种玉汤, from Fu Qingzhu’s Obstetrics and Gynecology,《傅青主女科》) plus Nu Zhen Zi (女贞子), Han Lian Cao (旱莲草).
For male infertility, TCM believes that kidney stores essence and control reproduction; It is the material basis of human growth, development and reproduction. The imbalance of kidney Yin and Yang, especially the kidney deficiency, is one of the main pathological mechanisms of sterility. The other mechanisms include deficiency of Qi and blood, Qi stagnation and blood stasis, damp heat of essence room, liver depression and blood stasis, and so on. The followings are the common types of infertility and treatment for women in the clinics [[9]]:
Kidney deficiency of Yang: Infertility after marriage, low sexual desire, impotence with erectile dysfunction, or a weak erection, chilly seminal fluid, low sperm count with low motility; usually accompanied by lower back pain and knee weakness, psychological fatigue, limb chills, clear urine in large amounts, pale tongue, thin white fur, deep and thready pulse. Treatment can be chosen with Jin Kui Shen Qi Wan (可选用金匮肾气丸), Qiang Shen Pian (强肾片), Ginseng and deer velvet pill (人参鹿茸丸).
Kidney deficiency of Yin: Infertility after marriage, spermatorrhea, premature ejaculation, scarce semen; often associated with lower backache and leg weakness, dizziness, tinnitus, feverishness in palms and soles, dry mouth, insomnia, forgetfulness, red tongue with less coating, thready and rapid pulse. Treatment can be chosen with Wu Zi Yan Zong Wan (五子衍宗丸), and Liu Wei Di Huang Wan (六味地黄丸).
Deficiency of both QI and blood: Infertility after marriage, low sexual desire, thin semen, low sperm count with a low survival rate, pale or sallow complexion, body weakness, lack of Qi and no desire to speak, dizziness, pale tongue with thin and white coating, thin and weak pulse. Treatment can be chosen with Shi Quan Da Bu Wan (十全大补丸), Ren Shen Gui Pi Wan (人参归脾丸).
Damp-heat and blood-stasis obstruction: hypochondriac pain and bitter taste in the mouth, agitated, irritable, moist and hyperhidrosis at scrotum, pruritus vulvae, urethral secretion, decreased libido, impotence, premature ejaculation, excessive dead sperm or non-liquefaction, scanty and brownish urine, red tongue, yellow greasy moss, stringy and rapid pulse. Treatment should be done by clearing heat and removing dampness, with Cheng’s Bi Xie Fen Qing Decoction with addition or subtraction.
Stagnation of Qi and blood stasis: abdominal and perineal pain, seminal vesicle thickening, dragging and distending discomfort on testicle, dark purple tongue, thready and unsmooth pulse. The treatment choice can be promoting blood circulation to dispel blood stasis; dredging the meridians and producing essence by Xue Fu Zhu Yu containing Tao Hong Si Wu Tang (血府逐瘀含桃红四物汤) with addition or subtraction.
Note: Chapter 21 of the Jin Gui Yao Lue (Essential prescriptions of the Golden Cabinet – 金 匱要略) is dedicated to Women’s Miscellaneous Disease and one particular formula Wen Jing Tang (温经汤)stands out: Line 22.9: … [this formula] also governs women’s lesser abdominal cold and chronic failure to conceive; it also helps to eliminate blood from flooding or excessive menstrual bleeding or failure of the menses to arrive [at their proper] time.
Fertility is a complicated procedure of sperms and ova reactions, including spermatogenesis and oogenesis, transportation of gametes, fertilization and fetal development in the precisely regulated molecular environments through the whole procedure. Any imbalance of these molecules may lead to the infertility [[10], [11]]. The recent medical sciences demonstrate that TCM formulas regulate the body molecular balances and lead to the recovery of diseases [[12], [13]]. One study showed that the management of female infertility with Chinese Herbal Medicine can improve pregnancy rates 2-fold within a 4 month period compared with Western Medical fertility drug therapy or IVF [[14]]. In addition to the treatments of infertility with western medicine, TCM plays a very important role in helping many many couples to realize their dreams to have a baby.
[4] Alice Domar et al: Understanding the perceptions of and emotional barriers to infertility treatment: a survey in four European countries. Hum. Reprod., Apr 2012; 27: 1073 – 1079.
[10] B Dousset et al: Seminal cytokine concentrations (IL-1beta, IL-2, IL-6, sR IL-2, sR IL- 6), semen parameters and blood hormonal status in male infertility. Hum. Reprod., Jul 1997; 12: 1476 – 1479.
[11] Antonio Cianci et al: Relationship between tumour necrosis factor and sex steroid concentrations in the follicular fluid of women with immunological infertility. Hum. Reprod., Feb 1996; 11: 265 – 268.
[12] Fritz Wieser et al: Evolution of medical treatment for endometriosis: back to the roots? Hum. Reprod. Update, Sep 2007; 13: 487 – 499.
[13] Zhenzhen Zhang et al: Therapeutic Potential of Wenshen Xiaozheng Tang, a Traditional Chinese Medicine Prescription, for Treating Endometriosis. Reproductive Sciences, Oct 2013; 20: 1215 – 1223.
[14] Ried K, Stuart K.: Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic review. Complement Ther Med. 2011 Dec;19(6):319-31. doi: 10.1016/j.ctim.2011.09.003. Epub 2011 Oct 5.
The cause of MS is unclear. The possible mechanism is thought to be either destruction by the immune system (by both inflammation and axonal degeneration [[xi]]) or failure of the myelin-producing cells, which might include genetics and environmental factors such as infections. The rarity of MS among Samis, Turkmen, Uzbeks, Kazakhs, Kyrgyzis, native Siberians, North and South Amerindians, Chinese, Japanese, African blacks and New Zealand Maoris, as well as the high risk among Sardinians, Parsis and Palestinians, clearly indicate that the environment and diet culture are important determinants of the uneven geographic distribution of MS [[xii]]. MS is usually diagnosed based on the presenting signs and symptoms and the results of supporting medical tests (MRI and analysis of cerebrospinal fluid). The clinical courses of MS are progressive with or without relapsing and remitting. Currently, there is no known cure for MS, but medicines (such as interferon-β, glatiramer acetate, mitoxantrone, natalizumab and immunosuppressors) may slow it down and help control symptoms [6]. Alternative treatments, including physical and occupational therapies, dietary supplementation and regimens may also help since many facts indicate that MS may relate to life styles [[xiii]]. Hypovitaminosis D, adverse health behaviors (smoke, alcohol, obesity, less physical activity, etc.), increase the risk of MS [[xiv],[xv]], while diet modification (linoleate other than oleate vegetable oil [[xvi]], higher intake of linolenic acid [[xvii]]), and vitamins D [[xviii]] showed benefits to MS.
There is no such name of the disease “multiple sclerosis” in traditional Chinese Medicine (TCM) in literature. Many doctors treat MS as some syndrome patterns according to the patient’s clinical manifestations. If there is clinical extremity weakness, difficult to move or even paralysis and muscle atrophy, it is generally attributed to the category of “Wei Zhen” (痿证, flaccidity syndrome), which may be the most cases [[xix]]; If the clinical manifestations are clumsy hand and foot movements, walking instability, trouble with coordination and balance, it belongs to the category of “Gu Yao” (骨繇, bone tremor); The lower back and limb pain with activity limitation, numbness and cold feeling, identified as “Bi Zheng” (痹证, arthralgia-syndrome); The paralysis of limbs, classified as “Feng Fei” (风痱, hemiplegia) and so on. The TCM pathogenesis of MS includes asthenic vital Qi with pathogen lingering, Yang deficiency of kidney, Yin deficiency of liver and kidney, Qi and blood deficiency of spleen and stomach, stagnation of phlegm-dampness, Qi deficiency and blood stasis, etc. However, from the analysis of clinical experiences and reports, kidney and blood stasis are the main pathogenesis of this disease. The illness sites are in the brain and spine but they relate to kidney, liver and spleen, especially close to the kidney. The kidney deficiency is the main pathological basis of multiple sclerosis. Kidney deficiency leads to blood stasis and kidney deficiency occurs with blood stasis mostly. The kidney deficiency is the basis (the primary) and blood stasis is the sign (the secondary) [[xx]]. Therefore, the herbal treatments may include Huang Qi (黄芪), Dang Sheng (党参), Bai Zhu (白术) for tonifying the spleen and replenishing Qi; Xiang Ling Pi (仙灵脾), Ba Ji Tian (巴戟天) for warming and recuperating kidney Yang; Tu Si Zi (菟丝子), Sha Yuan Zi (沙苑子) for recuperating kidney Yang and nourishing kidney Yin; Bai Hua She She Cao (白花蛇舌草), Pu Gong Ying (蒲公英) for dissipating heat and detoxifying; Chi Shao (赤芍), Chuan Qiong (川芎), Hong Hua (红花) for activating blood circulation to remove stasis; Ban Xia (半夏), Dan Nan Xing (胆南星), Ze Xie (泽泻) for dissipating phlegm and dehygrosis; Quan Chong (全虫), Jiang Can (僵蚕), Shui Zhi (水蛭), Gou Teng (勾藤) for expelling Wind evil, dredging Channel and relieving pain [20]. In a study of 43 MS patients treated with Bu Shen Gu Sui tablet (补肾固髓片, BSGS), the total effective rate was 88.37%. High dose BSGS in the guinea pig models could obviously reduce the incidence of experimental allergic encephalomyelitis, inhibit inflammatory reaction of the brain and spinal cord as well as demyelination, and simultaneously inhibit the activity of serum IL-2, IL-6, TNF and MBP (P < 0.01) [[xxi]].
