Mona Lisa to MSWhen 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]].

 

Myelin SheethsThe 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.

 

Symptoms of MSThere 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.

 

References:

[i] Visual system: http://en.wikipedia.org/wiki/Visual_system

[ii] Language process: http://en.wikipedia.org/wiki/Language_processing_in_the_brain

[iii] Image of neurons: http://www.raykarush.com/2013/04/14/the-invisible-cloak-of-time-gutting-awful/

[iv] Image of brain function area: http://knowingallah.com/index.php/en/articles/article/1411

[v] Image of expression: http://xtsportfolio.yolasite.com/introduction-to-the-study-of-language.php

[vi] MS: http://en.wikipedia.org/wiki/Multiple_sclerosis

[vii] Misawa S et al: Peripheral nerve demyelination in multiple sclerosis. Clin Neurophysiol. 2008 Aug;119(8):1829-33. doi: 10.1016/j.clinph.2008.04.010. Epub 2008 May 20.

[viii] Fig. 2: http://www.livingarchive.org.uk/includes/external/mywebpage/graemechurch.html

[ix] MS symptoms: http://www.nlm.nih.gov/medlineplus/multiplesclerosis.html

[x] Australian: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4429.0Main+Features100182009

[xi] Lloyd H. Kasper and Jennifer Shoemaker: Multiple sclerosis immunology: The healthy immune system vs the MS immune system. Neurology, Jan 2010; 74: S2 – S8.

[xii] Rosati G et al: The prevalence of multiple sclerosis in the world: an update. Neurol Sci. 2001 Apr;22(2):117-39.

[xiii] C Skegg: tiple sclerosis: nature or nurture? BMJ, Feb 1991; 302: 247 – 248.

[xiv] Charles Pierrot-Deseilligny and Jean-Claude Souberbielle: Is hypovitaminosis D one of the environmental risk factors for multiple sclerosis? Brain, Jul 2010; 133: 1869 – 1888.

[xv] RA Marrie et al: High frequency of adverse health behaviors in multiple sclerosis. Multiple Sclerosis Journal, Jan 2009; 15: 105 – 113.

[xvi] J. H. D. Millar et al: Double-blind Trial of Linoleate Supplementation of the Diet in Multiple Sclerosis. Br Med J, Mar 1973; 1: 765 – 768.

[xvii] Shumin M. Zhang et al: Dietary Fat in Relation to Risk of Multiple Sclerosis among Two Large Cohorts of Women. Am. J. Epidemiol., Dec 2000; 152: 1056 – 1064.

[xviii] Nicole Marie Summerday et al: Vitamin D and Multiple Sclerosis: Review of a Possible Association. Journal of Pharmacy Practice, Feb 2012; 25: 75 – 84.

[xix] Wei Zheng: http://journal.9med.net/html/qikan/zgyx/szgygy/2007101810/xstt/20080831064158693_314593.html

[xx] TCM of MS: http://wenku.baidu.com/view/46bc831eb7360b4c2e3f644f.html

[xxi] Liu XY, Sun Y: [Clinical and experimental study on multiple sclerosis with bushen gusui tablet]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2001 Jan;21(1):10-4.

[xxii] Sangeetha Nayak et al: Use of unconventional therapies by individuals with multiple sclerosis. Clinical Rehabilitation, Feb 2003; 17: 181 – 191.

[xxiii] S Schwarz et al: Complementary and alternative medicine for multiple sclerosis. Multiple Sclerosis Journal, Sep 2008; 14: 1113 – 1119.