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CHINESEHERBALTREATMENTFORMULTIPLESCLEROSIS

ANDOTHERFLACCIDITYSYNDROMES,INCLUDINGMYASTHENIAGRAVISAND
AMYOTROPHICLATERALSCLEROSIS.
bySubhutiDharmananda,Ph.D.,Director,InstituteforTraditionalMedicine,Portland,Oregon

ANEWDISEASE
Multiplesclerosis(MS)isamoderndisease.Itmayhaveoccurredinearliercenturies,buttheoreticaland
diagnostic limitations made it impossible to clearly define this disease. The earliest recorded medical
discussionsofMSareattheendofthelastcentury,anditisdifficulttotracepotentialcasesofthedisorder
morethanafewdecadesbeforethat.
The use of sclerosis in the disease name is in reference to the scarring of the nerves (formation of
plaques,wheremyelinnolongerforms)ofthecentralnervoussystem(CNS)thatresultsfrominflammation
and subsequent destruction of their myelin sheaths. The detection of demyelination in living persons
requires the most modern of medical techniques.Until the development of magnetic resonance imaging
(MRI)intheearly1980s,confirmationthatapersonsufferedfromMShadtoawaitautopsy,thoughthe
disease could be guessed with some reliability by a comprehensive description of its course and
manifestations. One test, the hot bath diagnostic procedure, was used for about fifty years (until MRI
becameprevalent):personswithMSwouldusuallydisplaymoreseveresymptomsafterexposuretoahot
bath.
Theonsetofthediseaseisinsidiousanditscourseishighlyvariableovertime.Insomecases,minor
neurologicaldisturbancesprecedethemorecharacteristicflareups(calledexacerbations)byseveralyears.
Symptomsmaybequitedifferentamongindividuals.Weakeningofthelegs,bladder,andcolonmuscles
inthelowerbodyarecommon,butsoarementalfogginessandopticneuritisindicatingbraindamage.
Thetermmultipleisusedbecausemanynervesareaffected,butthediseasemightshowevidentimpact
ononlyasinglemusclegroupduringthefirstyearsofdevelopment.Evenwithmoderntechnology,afirm
diagnosisofMSisnoteasilyestablishedbyphysiciansuntilithasreachedasomewhatadvancedstage
sometimesadecadeormoreaftertheonsetoftroublesomesymptoms.TheaverageageatdiagnosisofMS
intheU.S.isabout31.
IMMUNOLOGICALNATUREOFTHEDISEASE
An extensive review of the immunological disturbance in MS was presented by Byron Waksman of the
NewYorkchapteroftheMultipleSclerosisSocietyin1986(1).Thechronicnatureofthediseaseappears
tobelinkedtothepresenceofaspecificgenebelongingtothemajorhistocompatibilitycomplex(MHC)
that results in susceptibility to the disease.Individuals without this genetic background may suffer from
acute demyelinating diseases (such as GuillainBarre syndrome) without experiencing relapse and
progressive deterioration, as occurs with MS. Other autoimmune diseases, such as insulindependent
diabetes,myastheniagravis,thyroiditis,andchroniculcerativecolitis,oftenoccurinthesameindividuals
who experience MS, or in their parents, siblings, or children, as a result of the genetic background that
predisposestheindividualtoautoimmunedisease.ThechildofaparentthathasMShasabouta40times
higherriskofdevelopingMSthanothers(2).
MSisararediseaseinChina,Japan,andotherpartsofAsia.Similarly,thediseaseisnotfoundamong
Africanblacks(butisfoundamongasmallproportionofAmericanblackswhohaveCaucasianancestors),
Eskimos, and several other population groups. It occurs with fairly high frequency in the Caucasian
population,withabout75%ofcasesbeingfemale(inChina,itappearsthatonlyabout50%ofcasesare

female). In the U.S., the incidence rate for MS is estimated to be about 0.080.12% of the population
(about250,000350,000casesatpresent),butitisabout0.30.4%ofCaucasianwomenovertheageof
30.There are clear genetic influences not only on the incidence of the disease among races and within
families,butalsoonthetendencytosuffercertainsymptomsofthedisease.DifferencesbetweenJapanese
andAmericanpatientsinthemainsiteofattackagainstthecentralnervoussystemhavebeennoted:50%of
Japanese cases of MS involve the optic nerve and spinal cord only, and another 33% of the cases
additionally involve the cerebrum among Americans, the comparable figures are 13% and 66%,
respectively.
Itisapparentthatvirusesplayaroleinboththedevelopmentofthediseaseanditsflareups.It has
beenproposedthatduringanimmuneattackagainstoneormoreofthecommonviralinfections,aTcell
lineisestablishedthat,whenactivated,attacksmyelin,withmyelinbasicprotein(BP)asoneofthekey
sitesofattack.Thismayoccurevenifthevirusdoesnotenterthenervoussystem(theprimedTcellsfrom
theperipheralbloodcanattackmyelinsolongastheTcellsurfacereceptorhasacloseenoughmatchto
myelinBP).Apossibleriskfactorfordevelopingthediseaseislateexperienceclosetotimeofpuberty
ofcommonchildhoodinfections,suchasrubella,measles,andmumps.Measles,inparticular,appearsto
beaninitiatingvirus.
It is possible, but not demonstrated, that immunization against these childhood viral diseases may
preventthemfromactingasinitiatorsofMSitistoosoonaftertheintroductionofmassimmunizationsto
telltheeffects(thoughweshouldknowsoon).Evenso,othervirusesmayreplacethosementionedabove
intheroleofMSinitiation.Forexample,HHV6,aherpesvirusthatcausesthechildhooddisordercalled
roseola, and which may exist undetected in a large portion of the population, appears to be involved in
severalotherdiseasesandhasbeensuggestedtobeoneofthepotentialculpritsinMS,sincethevirusis
foundintheoligodendrocytesofMSpatients(30).ThevirusisfoundintheregionoftheMSplaquesbut
not the unaffected parts. While HHV6 is found in persons without MS, it is not found in the
oligodendrocytesinotherwisehealthypeople.HHV6infectsboththeTcells,alteringtheiractivity,and
thecentralnervoussystem.CNSinfectionswiththevirusareassociatedwithmultifocaldemyelinationand
canproduceadiseasethatappearsidenticaltoMS(31).InterestinHHV6hasbeenstimulatedbyfindings
that it can coinfect cells that are infected by human immunodeficiency virus (HIV) and can activate
replicationofthatvirus(itisthuscalledatransactivator).ItispossiblethatHHV6playsaroleinMSin
conjunctionwithotherviruses.
Interestingly,theincidenceofMSishigher(withintheCaucasianpopulation)inthefarnorthernandfar
southernlatitudestowardstheearthspoles.Fromthisobservation,ithasbeensuggestedthatwhereone
livesaroundthetimeofpubertymaybethekeyfactorindiseaseinitiation,asopposedtowhereonelives
when the disease manifests obvious symptoms. The risk at puberty might be related to growth of the
centralnervoussystemandchangesinimmuneresponsesundertheinfluenceofhormonesduringthatstage
ofdevelopment.TheunevendistributionofMScasesaroundtheworldhasbeensuggestedtoberelatedto
exposuretovirusesorbacteriafromanimals,suchasdairycowsordogs(3).Inoneinstance,islandsinthe
NorthAtlanticthatwerefreeofMSshowedahighincidenceofMScasesafewyearsafterarmygarrisons
hadbeenontheislandforawhile,implicatinganinfectiousagentcarriedbythearmymembersortheir
accompanyingdogsorotherlivestock.
It has also been suggested that deficiencies in certain nutrients (such as calcium, vitamin D, vitamin
B12 ,selenium,andessentialfattyacids)duringthedevelopmentofthenervoustissuesmayenhancerisk
forsufferingfromMS(4).ThemetabolismofvitaminDandcalciumareinfluencedbysunexposure,and
there can be dietary factors influencing availability of all these nutrients that may vary by location and
culture.
Duringthe1980s,someobserversrevivedtheearlierproposalthatMSwastheresultofaspirochetal

(bacterial)infectionoftheCNS.Inpart,thiswasbecauseofthenewlyidentifiedLymeDisease,causedby
a tickborne spirochete, and it has a regional occurrence (favoring northern deciduous forests) and
autoimmunelike character (5). The earlier hypothesis, proposed in 1909 and considered a possibility
through the 1950s, was that MS might have been due to another spirochete, the one that causes
neurosyphilis,oronelikeit.Thusfar,abacterialinfectionhasnotbeenshowntobetheimmediatecause
of MS, but the several decades long history of proposals that MS is initiated by an infection shows a
consistentunderstandingthatthediseaseisnotsolelybasedongenetics,climate,emotions,orothernon
infection etiologies. By contrast, the neuromuscular CharotMarieTooth disease, which also causes
weakeningandwastingofthelegmusclesand,laterinitsdevelopment,otherperipheralmuscles,appears
tobebasedprimarilyongeneticbackground.
OnceTcellsaimedatmyelinsheathsurfaceproteinshavedeveloped,laterinfections,notnecessarily
thesameastheinitiatingvirus,cantriggerasubsequentflareupoftheautoimmunedisease.Manypatients
observeacloseconnectionbetweenexperienceofinfluenzaorcommoncoldandsymptomsofthedisease,
andthisconnectionisdocumented(32).Ithasbeenproposedthatflareupsthatdonotappeartofollowan
infectionactuallyfolloweitheraninfectionthatdidnotmanifestovertsymptomsoractivationofalatent
virus(suchasoneofthoseintheherpesfamily)withoutevidentsymptoms.Asuccessfulimmuneresponse
totheinfectiousagentmayhavepreventedthesymptomsfromdeveloping,butthencontinuedontoattack
themyelin.
Not only viruses, but other types of infections, such as bacteria or parasites, might induce MS
exacerbations (6). Several viral and bacterial peptides have been shown to activate Tcells that were
primedtoattackmyelinBP.ChronicsinusitishasbeenstronglyassociatedwithMS,withthepossibility
that the sinus infection (which can be viral or bacterial) induces an immune response that eventually
promotestheattackagainstmyelin.
Ithasrecentlybeensuggestedthatthecytokinecalledtumornecrosisfactor(TNF)isassociatedwith
productionofmultiplesclerosissymptoms(7).Thiscytokineisfoundinthemyelinlesionsandcerebral
spinal fluid of MS patients. TNF, and other cytokines (e.g., interleukins 1,4, and 10, and interferon
gamma)thatmightactconcurrently,areinducedinseveralinfectiousandparasiticdiseases.HHV6isa
powerfulinducerofTNFinperipheralbloodmononuclearcells(43).InterferongammaandTNFslowthe
suppressionofimmuneattack.Asaresult,animmuneattackagainstaminorinfectionmaybeprolonged
untilmyelinisalsoattacked,andtheactionofthecytokinesmaythenprolongtheMSexacerbation.The
antidepressant drug rolipram is a TNF inhibitor that has been suggested as a useful therapy for MS (8)
severalotherdrugshavebeenrevealedtohaveantiTNFactivityinrecentyears,including:ketotifen(used
for treating asthma), thalidomide (a sedative), and pentoxiphyllene (used for treating blood clotting in
peripheral vessels) some of these could also be of benefit for persons with MS (the selection of drugs
allows choice among the primary indications for their use). Interferon beta (provided as the drug
betaseron),inhibitsinterferongammaandTNFandaidsthefunctionofsuppressorTcells.
InthecerebralspinalfluidofMSpatients,ithasbeenfoundthatthereisasignificantlyhigherlevelof
aldehydes,includingformaldehyde(33).Thesealdehydescancauseproteincrosslinking(therebymaking
the proteins physiologically inactive) and block nerve impulses. Their action is more evident at higher
temperatures,whichmaypartlyexplainthehotbathphenomenoninpersonswithMS.Thehighlevelsof
aldehydesmaybeassociatedwiththeobservedphenomenaofreducedantioxidantactivityinpersonswith
MS,suggestingaroleforoxidativestressinthesusceptibilitytoorexpressionofexacerbations(34).
Ithasbeenproposedthatweakeningofthebloodbrainbarriermaypermiteasieraccessoflowdensity
lipoproteins(LDL)andothersubstancestothecerebralspinalfluidthatmakethemyelinmoresusceptible
tooxidativedamageandimmunesystemattack(35).LDLtendstobehighinpersonswhoarephysically
in active and in those who consume large amounts of saturated fats. According to this line of thought,

agents that promote greater integrity of this barrier could slow the progression of MS by limiting
inappropriate access to the nerves. Administration of antioxidants, including vitamin C, vitamin E, and
glutathione have been shown to improve the antioxidant activity (36), but have not yet been tested long
enoughtodemonstrateanimpactonthefrequency,severity,ordurationofexacerbations.
In most cases, an infection (or other inducing agent) initiates an autoimmune attack or enhances an
ongoingattackthatproducesnotablesymptoms.Thesesymptomsmaylastforafewdaystoafewweeks
in the remitting type of MS. Within a few days of the immune activation, the natural regulation of the
immunesystemwhichmaybeinhibitedduetohostfactorsortheinfluenceofchronicviralinfection
produces a withdrawal of the attack, and there can then be recovery of the damaged nerves (which is
quicker, as with other injuries, with youth and good nutritional status). With each exacerbation
(autoimmuneattack),thereislocalvascularinflammation(intheareaoftheCNS),usuallywithseverelocal
edema,followedbydemyelinationoftheaffectednerves,resultinginscarringiftheattackissufficiently
severe(remyelinationofthenervescanoccurifthereislimiteddamage).Steroidsadministeredattheonset
ofanexacerbationmayreducedemyelination,butlongtermadministrationofferslittlebenefit.Inpersons
who respond poorly to steroids, it is possible that processes other than immune attack and inflammation,
suchasaldehydeformationandoxidativestress,continuetoenforcethenervedamage.
The process of demyelination is one of the causes of muscular weakening or numbness: nerve
transmission via the affected nerves is disrupted. Even so, areas of plaques as seen by MRI, which
represent essentially irreversible damage, do not necessarily cause persistent interference with nerve
transmission.Someindividualsshowlittleornosymptomsevenwithextensiveplaqueformation,while
othersshowsignificantimpairmentwithlittleevidenceofplaques.Thisisprobablybecausethereareother
mechanismsofnerveinhibitionandbecausethenervoussystemissometimesabletodevelopalternative
routes of transmitting the essential information. However, once the damage from repeated attacks has
reachedacertainlevelofseverity,thediseasemanifestation(e.g.,muscularweakening)inmostindividuals
becomescontinuousratherthanintermittent.Further,whenapersonisdebilitatedforanextendedperiod
of time, they may cease the attempt at movement and thus deprive the nervous system of the stimulus
neededtoreroutesignals.
ThereareatleasttwotypesofMSdiseasedescribedbythecourseofdevelopment.The intermittent
type(orrelapsingremitting)isoneinwhichthereareflareupsoftheattackagainstmyelinfollowedbya
periodofrecovery,oftenwithseveralweeks,months,andsometimesyears,beforethenextattack. The
averagerateofexacerbationsduringthefirstyearsafterdiagnosisisabout1.25/year.Inafewcases,the
cycle of attacks appears to end spontaneously and there may be few, if any, residual symptoms the MS
doesnotprogresstoamoreseriousorparalyticcondition.Theprogressivetypeusuallyfollowsacourseof
steadilyworseningdebility,wheretheremaybeonlyafewdaysofrelativerelief,followedbycontinued
progression of the disease. This type leads to severely impaired immobility and eventually to death
fortunately, it is the less common form.With current therapies that can benefit persons with MS (when
applied in a timely manner), the main longterm problem may be deterioration of health due to lack of
exercise,withaccumulationofsecondarydiseases.
In sum, persons who experience MS usually have a genetic background that makes this particular
diseasemorelikely.Theythenexperienceaninfection(orcombinationofinfections)thatestablishesthe
possibilityofautoimmuneattacksagainstmyelin.Acombinationofotherfactorsthenconvergetoenable
the disease process: these may include nutritional deficiencies, damage to the bloodbrain barrier, low
antioxidantpotential,andchronicCNSinfection.Finally,thediseasemanifestsinaseriesofexacerbations,
usually induced by acute infections, turning into a progressive, nonremitting disease when and if the
immune system loses its ability to withdraw the antimyelin attack or when other processes (such as
accumulationofoxidizedfats)continuetodamagemyelin.While this scenario may need to be updated
somewhatasadditionalinformationisacquired,itissufficienttosuggestseveralmethodsoftherapy,some

ofwhichhavealreadyprovidedhelptopersonswithMS.
Before turning to the Chinese medical analysis of the disease, it is worth mentioning some other
diseasesthathaverelatedcharacteristics.SinceMSisnotafrequentdiseaseinChina,experiencetreating
severalotherdisordersthathavemuscularweakeningandautoimmuneprocessesincommon,mayhelpto
addtoourknowledgeofsuccessfulapproaches.Myastheniagravis(MG)producessymptomsofmuscular
weaknesslikeMS,itisinsidious,variable,andpotentiallyfatal(intheprogressiveformofthedisease).
MGappearstobeinitiatedbyavirus,butthesiteofattackbytheactivatedTcellsisdifferentthanwith
MStheacetylcholinereceptorsofthenervesareaffected.Themotorneurondegenerativediseasesalso
share some similarities with MS. In one, amyotrophic lateral sclerosis (ALS), the muscular weakness
usually begins in the hands and spreads to the forearms and legs. This is accompanied by (and often
precededby)spasmsandincreasedtendonreflexes.Thesiteofautoimmuneattackappearstobemainly
theanteriorhornsofthemotorneuronsthebrainfunctionsarenotaffected.UnlikeMSandMG,itdoes
notoftendisplayextendedperiodsofremission,rather,ittendstoprogressrapidly,oftenleadingtodeath
within56years.Amorebenignformofthisdiseaseisprogressivespinalmuscularatrophy,whichcauses
musclewastingandweakness,butdoesnotcausesignificantshorteningoflifespan.
CHINESEMEDICALTHEORIES
In the most ancient Chinese medical texts, and in many subsequent works, there are some references to
diseaseswithsymptomsofmuscularweakening.Thesearecalledweizheng:flacciditysyndromes.There
arefourbasiccausesof,orcontributorsto,thedevelopmentofthesesyndromes:
1. Afeverishdisease(nowunderstoodtobecausedbyaninfectioninmostcases)damagesthenutritive
essences that supply the muscles and tendons [note: in Chinese traditional anatomy, the terms often
refertofunctionsmorethantoisolatedtissues.Thetendonsaidincontrollingmovements.]
2. Organ dysfunctions result in poor nutrition or in inhibited circulation, thus denying nutrition to the
destinationtissues.
3. Spiritual exhaustion reduces the communication between the mind and body, affecting sensation,
movement,andmentalclarity.
4. Adverse dietary factors can lead to weakness of muscles and laxness of tendons, and they can
exacerbatedeficiencyofessence.
IntheHuangdiNeijingSuwen,(9)theproblemofmuscularflaccidityreceivesanentirechapter.The
basicideas,largelyretainedsinceancienttimes,havebeenelaboratedrecentlyintheAdvancedTextbook
ofTraditionalChineseMedicineandPharmacology(10).Thegeneralproblemisdescribedasbeing
duetoadisorderaffectingoneofthefiveinternalorgansystems(zang).Thus,therearefivetypesofwei
(flaccidity) syndromes. Three of these might be of interest in regard to diseases such as MG, MS, and
ALS.
Maiwei(vesselflaccidity,associatedwiththeheartsystem)isdescribedasmuscularatrophyanddebilityof
the lower limbs caused by pathologic heat of the heart, empty blood vessels, and malnutrition of the
musclesofthelowerlimbs.
Rouwei(muscleflaccidity,associatedwiththespleen)hassymptomsincludingsensorydisturbanceofthe
skin, and atrophy, flaccidity, and debility of the muscles. The syndrome is due to pathogenic heat and
dampnessinvadingthespleenwithimpairmentofstomachyin.
Guwei (bone flaccidity, associated with the kidney) is caused by severe exhaustion of kidney yin and
essencewithaccompanyingdeficiencyfirethatcausesatrophyandflaccidityofthemusclesofthelower
limbs and weakness of the spine that makes it impossible for people to support themselves in an upright
position.

The modern texts make some slight rearrangements of the categories, for example: liver/kidney
weaknessispresentedasasinglecategory,ratherthantwocategories.Acombinationoftheliver/kidney
and spleen types is probably closest to depicting MS and other neuromuscular disorders that affect the
lowerlimbsfirst.
The wei syndromes were described as being initiated by pathogenic heat (or dampheat, the
combinationoftwoadverseinfluences)anddisplaytheirsymptomsofmuscularweakeningasaresultof
fluidandnutrientdeficiency(e.g.,lungfluiddryness,emptyblood,stomachorkidneyyindeficiency).The
twootherweisyndromes,affectingthetendons(livercausingcontractedligaments)ortheskin/hair(lung
causingcrackedandbrittleskin,paralysisofextremities),arealsothoughttobeinitiatedbyheatfollowed
byimpairmentoffluids.TheNeijingemphasizesthatlackofnourishmentinthechannels(meridians)and
inthemusclesistheprincipalcauseoftheflaccidity.TheChineseconceptofnourishmentisbroaderthan
that identified in modern terminology as essential food components, because it includes several of the
metabolicproductsofthefoodcomponents(forexample,hormonesgeneratedfromprecursors)andtheir
entry into destination tissues (promoted by local microcirculation). To remedy the problem using
acupuncture(themaintherapymentionedintheNeijing), one tonifies the deficiency by using the spring
points (rong) on the meridians and promotes the flow of nutrients and energy through the meridians by
treatingthestreampoints(shu):Thisfortifiesthedeficient,andrestoresordertowhatisrebellious.
Thetraditionalmeansoftreatingfluidimpairmentistonourishbloodandessence.Thereareseveral
herbsclassifiedasbloodandessencetonics.In addition, qi tonics will help generate the essential fluids
fromfoods.ConnectingtotheWesternconceptionofthedisease,theinitiatinginfectionsforMSandfor
itsexacerbationsmayinvolveafebrilesyndrometheimbalancethatresultsmightbedestructionoffluids
(themyelinsheathbeingafluidfattymembraneitsqualityissimilartothatofessencethebrainandspinal
cord are understood, by the concepts of traditional Chinese medicine, to be an extension of the kidney
system,thestorehouseoftheessence).
Analternativetraditionaldescriptionofflacciditysyndromewithsimilarconclusionsinpresentedin
an article about treating one patient with MS (11). The doctors, Zhou and Lu, pointed out that ancient
scholarsbelievedthelossofsensations,oneofthecommonMSsymptoms,isrelatedtothepo (primitive
instinctoneofthesoulsdescribedinChinesemedicine).Thepoisgovernedbythespirit(shen)which
subsistsontheessence(jing).QuotingfromtheHuangdiNeijingLingshu:Thepoentersandexistswith
theessence...spiritualexhaustionscattersthesoulandthepo.Pursuingthisline,theauthorsstate:
Thekidneyhousestheessencethebrainisthemansionoftheoriginalspirit.Disordersofthe
spirit are usually related to a deficiency and damage of kidney essence which results in
malnourishingofthebrain.Aninsufficiencyoforiginalspiritinturnaffectsthefunctionofthe
po. The manifestations of pain and soreness of the back, atrophic weakness of the legs,
loosenessofthelowerpasses(colonandbladder),andasinking,thready,weakpulseconfirm
thediagnosisofkidneydeficiencywithdamagetotheessence.Poor memory and insomnia
showaninsufficiencyoftheseaofmarrow(brain).
The kidney essence is the most refined of the body fluids recognized by traditional doctors. It is a
substance that is, in part, present at birth (perhaps corresponding to the genetic material) and is, in part,
replenished by refinement of nutritious food. Exposure to cold, excessive experience of fear,
overindulgenceinsexualactivity,frustrationfromnotbeingabletofulfilloneswishes,overtirednessfrom
traveling in conditions of severe heat, consumption of too much salt, and physical injury to the internal
organs are causes of kidney weakness cited in traditional literature.Other causes may include traumatic
injury to the internal organs, effects of invasive surgery, chemical damage to the endocrine system, and
chronicinfections.
Dietary causes of flaccidity are usually described in terms of excessive intake. Aside from excessive

consumptionofsaltdamagingthekidneysystem,toomuchsourfoodissaidtocausemuscularlaxity,and
too much sweet food weakens the functions of the spleen, the organ system that is most essential to the
nourishmentofthemuscles.Toomuchspicyfoodwillcausefurtherdamagetodepletedyinandessence.
Therefore, diet is important to avoiding development of flaccidity syndromes or to counteract a disease
whichproducesflaccidity.

BASICHERBALTHERAPYFORFLACCIDITYSYNDROME
Therecommendedtraditionalherbformulafortreatmentoftheliver/kidneydeficiencytypeweisyndrome
isHuQianWan.TheChinesenamemayberoughlytranslatedasPillofTigersWalkitreferstothewell
controlledmovementsatigermakesfromaplaceofhidingwhilestalkingaprey.Thetigeralsorepresents
theyin:atigerinhidinghasgreatpotentialforexpressingitspower,andthathiddenpotentialisyin.The
herbformulahasthetherapeuticactionofnourishingyin(HuQianWanissometimesdescribedasthePill
ofHiddenTiger).Aswithothertraditionaltreatments,theformulamaybemodifiedsomewhataccording
toclinicalpresentation,especiallyattheinitiationoftherapy.Forlongtermapplications,itisconsidereda
wellbalancedprescription.
HuQianWan(25)isaformuladevisedbyZhuDanxi(12801358A.D.)thatwasrecordedinhisbook
DanXiXinFa(DanXisTheories).ZhuDanxiwasoriginallyknownasZhuZhenheng,andhelivedin
Danxi(ZhejiangProvince).HebecameknownastherenownedphysicianofDanxi,andwasthusgiven
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 11501350 A.D. Zhus 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 tonificationbased
schoolsremaindominantforces,joinedbythelate19thcenturyschoolofvitalizingbloodcirculation.
Zhubelievedthattheyinwasalwaysatriskforbecomingdeficient.Thus,inmostchronicdiseases,the
aimoftherapyshouldbetoprotectandnourishtheyin.He devised several new formulations, many of
themcontainingherbsthatnourishtheyinandcleansedeficiencyfire(whichisatypeofyangagitationthat
canarisefromyindeficiencyandcancauseworseningofyindeficiency).ZhulivedinsouthernChina,
whereitwasmorelikelythatpersonswouldsufferfromtheeffectsofheatanddepletionofyin.He felt,
however,thatthemaincauseofyindeficiencywasoverindulgence,includingsexualexcess,whichcould
drainthekidneyessence.Healsopointedoutthatcertainherbscouldbedamaging,especiallyforstroke,
paralysis,nervous,andmentaldiseases:thosecontainingwhatwenowcallheavymetals,andthosewhich
havepropertiesofbeingspicy,fragrant,dry,hot,andstimulating(whichcouldfurtherweakenthecooling,
moisteningyin).
Hu Qian Wan is an expanded version of another of Danxis formulas, Da Bu Yin Wan (Great Yin
Nourishing Pill), made with rehmannia and tortoise shell to nourish the yin, and phellodendron and
anemarrhenatocleardeficiencyfire.TomakeHuQianWan,oneaddscertaintothisbasicformulaseveral
ingredientstotreatthespecificmanifestationforwhichtheformulawasintended:weaknessofthelower
backandknees,flaccidityofmusclesandbones,anddifficultywalking.Thekeyadditionsaretigersbone
(nowreplacedbyotherbones)andcynomorium.Tigersboneissaidtotreatweakandsoftsinewsand
bones,andweaknessofthekneesandlegscausedbydeficiencyofliverandkidney.Cynomoriumhasthe
same uses, and is also indicated for exhaustion of body fluids. These two herbs transform the basic
treatmentforyindeficiencyintoatreatmentforflaccidityaffectingthelowerbackandlegs.One of the
aimsoftheformulaistoalleviateweaknessofthetendons,whichisdeemedthemainreasonthatthereis
difficultyinwalking.Peonyisaddedtotheprescriptiontoenhancetheactionofrehmanniainnourishing
theliver,soastobenefittheliversassociatedtissuesthetendons.Citrusanddrygingerareaddedtoaid
thestomachindigestingthecombinationofrehmanniaandcynomorium,whicharequiterichandheavyin
nature.
HuQianWanissometimesextendedwithtangkuei,achyranthes,andmutton(arecommendationfrom
a17thcenturytext),usuallyforcasesofsevereblooddeficiencyothervariationsarepreparedbyadding
yang tonics (in which case anemarrhena and phellodendron may be removed) or qi tonics. The usual
preparationmethodistocombinetheherbsgrounduptopowderandhoneytomake9grampills(about6

gramsoftheherbsperpill).Itistakenonepilleachtime,23timesdaily(1218gramsoftheherbsper
day).
TheprescriptionthatwasinitiallygiventothepatientdescribedbyZhouandLuwasamodificationof
another traditional formula used for flaccidity: Dihuang Yin Zi (Rehmannia Formula for Paralysis), a
decoction containing rehmannia, cornus, schizandra, polygala, acorus, morinda, cistanche, aconite,
cinnamonbark,hoelen,ophiopogon,anddendrobium.Itnourishestheyin,butalsorevitalizestheyang.
ThemodifiedformulawastakendailybytheMSpatientformorethanthreemonths.Asafollowup,Hu
QianWanwasadministeredinconjunctionwiththeDihuangYinZidecoctionforoneyear.According
to the doctors, The patient was eventually cured, thus confirming the benefit of kidneynourishing
decoctionsandpillsforMS.
ZhangJianguopresentedacasestudy(12)oftreatmentforchronicprogressivespinallateralsclerosis.
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
modificationoftheDecoctionofFlyingFeet(derivedfromHuQianWanandDeerAntlerGelatinPills)
whichincludesthetonics:tortoiseshell,rehmannia,tigerbone,eucommia,dipsacus,cuscuta,atractylodes,
andlicoricelatertheprescriptionwasmodifiedbyaddingastragalus.The formula tonifies qi, yin, and
yang.Treatmenttimewastwomonthsandgradualnormalizationoflimbmovementsensued.
AformulafortreatingweisyndromewasdevelopedbyHukuiFuteiinJapan,basedonHuQianWan
(27). It is called Wei Zheng Fang (Flaccidity Syndrome Formula) and is made with rehmannia,
anemarrhena,phellodendron,peony,tangkuei,achyranthes,atractylodes,astragalus,andeucommia.Ithas
beenusedinJapanfortreatingdisorderssuchasmultiplemyelitis,polio,andparalysisduetoberiberi.Dr.
DomeiYakazureportedgoodresultsintreatinganMSpatientusingthisformulafortwoandahalfyears.
In a review of traditional concepts of paralysis, Dr. Hongyen Hsu (13) describes the syndrome of
atrophyofthemuscles.Therearetwosubcategories:weakandstrongconfirmation(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
mayoccurwhentheflowofthesunlightyangmeridianbecomesimbalancedbyanattackof
wetfever[dampheat].Thiswillthenimpairthecirculationtothelimbsandcausethemuscles
toatrophy.Astrongconfirmationmayalsobeinducedbylungfever,wetsputum,orstagnant
blood.
ThisexplanationisbasedontheNeijingdescription.
To rectify the problem in individuals suffering from deficiency of liver and kidney, recommended
formulasareGinsengandTangkueiTenCombination(ShichuanDabuTang)andTigersShinboneand
CynomoriumCombination(HuQianWan)forkidneyandliverdeficiency.For the strong confirmation,
recommendedformulasareSanMiaoWanModified(phellodendron,atractylodes,achyranthes,tangkuei,
stephania,tokoro,tortoiseshell)fordampheatDaoTanTang(withchihshih,arisaema,pinellia,hoelen,
citrus,ginger,andlicorice)forsputumobstructionandTangkueiFourCombinationModified(tangkuei,
cnidium, peony, rehmannia, persica, carthamus, zedoaria) for blood stagnation. According to traditional
theory,achronicdiseasethatiscausedprimarilybydeficiencysyndrometendstobeinsidious,whilethose
causedbyexcesssyndrometendtoshowrapidprogression.
TREATINGAUTOIMMUNITY
ZhengWentaoandMengrouundertookageneralanalysisofautoimmunedisorders(14),withadetailed
description of three autoimmune diseases: systemic lupus erythematosus, myasthenia gravis, and

scleroderma. The basic approach might reflect on ways to evaluate the immunological aspect of MS.
Citingtraditionalliterature,theauthorsstate:
Withthestationingofgenuineqiintheinteriorwatchingoverthespirit,sicknessisunableto
intrude...the righteous qi is generated, transformed, and supplied by the essence of fluid and
grain.Whenthespleenisflourishing,theexternalevilisunabletoenterthebody.Thespleen
isthematerialsourceofthebodysdefensemechanism.Thustheflourishingordegeneration
ofthespleenfunctionwillreflectthestrengthorweaknessofthebodysimmunesystem.
Thezhengqi(translatedasgenuineorrighteousqi)istheguardianofthebodyshealthandtheregulator
of the immune system. Since qi tonic herbs are the basis of prescriptions for promoting zhengqi, these
commentsspeakinsupportoftheuseofqitonictherapiesforautoimmunedisorders.However,theauthors
continue:Kidneyyinandyangarethekeyfactorsintheregulationandbalancingofyin,yang,qi,blood,
and all the bodys immune mechanism. The visceral organs through their mutual dependence and
restriction follow the rule: extreme damages balance stabilizes stabilization allows generation. Proper
regulationofthenormalimmuneresponseisthusachieved[throughbalance].Suchstatementsarguefor
theuseofkidney(essence)nourishingherbsandfollowingabalancedlifestyle,intreatingautoimmunity.
Qiinexcessmayinhibitoroverride,asstatedintheFiveElementTheory.Theendresultisthecreation
ofanimbalanceoftheimmuneregulation,thusgeneratingautoimmunediseases.Accordingtotheauthors
observation,theremayappearinthecourseofanautoimmunediseasesymptomsofdeficiency,excess,ora
combinationofdeficiencyandexcess.Thus,whiledeficiencyofqiandessencemayformthebasisof
autoimmunity, at certain times in the development of autoimmune diseases, treatment of excess
(accumulation)maybeofimportance.
MYASTHENIAGRAVIS
ZhangandMengstatethat:AccordingtoTCM,thespleengovernsthemuscles,thefourextremities,and
the upper and lower eyelids. Therefore, the causative mechanism for MG is injury to the spleen and
stomachanddeficiencyanddegenerationofthecentralqi.Theyrecommendedtheuseoflargedosesof
Ginseng and Astragalus Combination, with doses of astragalus in the range of 3090 grams. Further,
systemic MG is due to deficiency and injury of the spleen and stomach involving both the liver and
kidney.Thiscausesstasisofqiandblood,lackoftransformationoffluid,obstructionofthemeridiansand
luovessels[meridians,jing,aregenerallydistributedverticallyandrunthroughthedeeptissuesconnecting
branches,luo,aredistributedhorizontallyandsuperficially],andadecreasedabilitytomovetheligaments
andbones.Theauthorsstatethatfavorableresultshavebeenobtainedusinglargedosagesofherbs.In
additiontoGinsengandAstragalusCombination,theyrecommendCinnamonandAconiteCombination,
PillofRightRestoration,andFortifiedPillofBuddhasWarriorAttendanttheselatterformulasallcontain
kidney tonic herbs and have a warming action that helps to overcome stagnation. For another case,
characterizedbymaximumdepletionofthespleenandkidney,andindissolublephlegmandturbidity,the
recommended treatments were large dosages of Saussurea and Cardamon Combination to invigorate the
spleenandclearawaythedampness,andthekidneytonifyingRehmanniaEightFormula,inadditionto
thepreviouslymentionedprescriptions.A speciallymodified formula made with astragalus, codonopsis,
atractylodes,aconite,cinnamonbark,rehmannia(raw),dioscorea,cornus,hoelen,lyciumfruit,deerantler
gelatin, and morinda was said to have produced dramatic effects after fifteen days of treatment (this is
followingtreatmentwiththeotherprescriptions).
InthebookThe 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 dampheat (strong category). The deficiency type, especially with qi
andyangdeficiency,issaidtobethemostcommonlyobserved,clinically.Recommendationsfortreating
deficientpatientsincludeuseofalargedosageofastragalusandinclusionofchihshih(whichwillclear

phlegmdamp obstruction). For yang deficiency patients, the use of aconite is helpful and the amount
shouldbelarge(3060grams,boiledfortwohours).
Ingeneral,accordingtoShao,forMGofthedeficiencysyndrometype,onecanusepatentmedicines
suchasBuzhongYiqiWan(GinsengandAstragalusCombination),FuziLizhongWan(Aconite,Ginseng,
and Ginger Combination), HuQianWan, 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, tangkuei, mahuang, and licorice
(GinsengandAstragalusCombinationmodified).Thedosageoftheherbsisfrom6grams(licorice)to60
grams(astragalus)each,withatotalofabout200gramsforaonedaydose.Foryangdeficiencypatients,
onecanaddcinnamonbarkanddeerantlerforyindeficiencypatients,onecanaddHuQianWantothe
treatment.
For the dampheat type, it is suggested to use the patent medicines, such as Longdan Xiegan Wan
(GentianaCombination)orYangyinQingfeiWan, or the decoction of atractylodes, phellodendron, scute,
dioscorea, stephania, coix, peony, chaenomeles, glehnia, silkworm excrement (SanMiaoSan modified).
Thedosageofherbsisfrom10grams(phellodendron,scute)to30grams(coix)withatotaldailydoseof
about150grams.
CitingacasestudyofearlyonsetofMG,Shaodescribesayoungmanwithfourlimbssoflaccidand
weakthathecouldnotholdsomethinginhishands,norcouldhewalk.Hewasdiagnosedassuffering
from deficiency of central qi following an acute illness with fever. He was given a decoction of
atractylodes,pueraria,licorice,chihshih,andtangkuei.Afterfourteendaystherewassomeimprovement,
andtheformulawasmodifiedbyaddinglyciumfruit,hoshouwu,aconite,andachyranthes. Treatment
with this modified formula was followed for thirty days, after which there was significant reduction of
symptoms.Finally,thepatientwasgivenGinsengStomachicPillsandRehmanniaEightFormuladaily.A
followuptwoyearslatershowedthatrecoverywascomplete.
LiGenghe(16)recommendedthatthetreatmentofMGfollowtheprincipleoftonifyingthespleenand
kidney.Forspleendeficiency,theGinsengandAstragalusCombinationwasusedwithoptionaladditions
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 hoshouwu, 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 tangkuei was used (optional additions
werecynomorium,morinda,psoralea,eucommia,loranthus,andplacenta).Linotedthatcommoncoldand
bronchialinfection(e.g.,pneumonia)werepredisposingfactorsforexacerbations.Whilesteroidscouldbe
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,andlicorice.
CLINICALTRIALSINCHINA
1.MultipleSclerosis
Thelargeststudy(17)ofChinesemedicaltreatmentforMSwascarriedoutbyLuXiandWangYaohuoat
theDepartmentsofNeurologyandTraditionalChineseMedicineinFujian.Patientswerefirstdividedinto
four groups for differential treatment, two groups with deficiencytype syndrome and two groups with
excesstypesyndrome.Thecategoriesandtreatmentswere:
1. Liver/kidney yin deficiency: raw and cooked rehmannia, lycium fruit, anemarrhena, salvia, peony,
cornus, ligustrum, deer horn glue, tortoise plastron glue, achyranthes (chuanniuxi), tangkuei, and

licorice.ThisisamodificationofthetraditionalLeftRestoringPill(ZuoGuiWan)withtheadditionof
anemarrhena, ligustrum, salvia, tangkuei, and peony it is somewhat similar to Hu Qian Wan. Each
herbisusedinadosageof1012gramsperday,exceptlicorice(5grams).
2. Spleenstomachweakness:astragalus,salvia,codonopsis,atractylodes,hoelen,pinellia,citrus,jujube,
andlicorice.ThisisamodificationofthetraditionalMajorSixHerbsCombination(LiuJunziTang)
withastragalusandsalviaadded.Eachherbisusedinadosageof815gramsperday,exceptjujube
(12pieces)andlicorice(4grams).
3.Qiandbloodstasissyndrome:astragalus,codonopsis,salvia,rehmannia(raw),peony(redandwhite),
bupleurum,tangkuei,scute,cnidium,pinellia,andlicorice.ThisformulacombinesMinorBupleurum
Combination(XiaoChaihuTang)withthreeherbsforpromotingbloodcirculationsalvia,peony(red
andwhite),andcnidiumplusastragalus.Eachherbispresentintheamountof915gramsperday,
exceptlicorice(4grams).
4. Dampheat syndrome: chinghao, talc, peony, scute, bupleurum, bamboo, akebia, hoelen, chihshih,
pinellia,rhubarb,jujube.Thisformulaissimilartotreatmentsforfebrilediseasesdescribedinprevious
centuries,suchastheChinghaoandScuteCombination(HaoJinQingtanTang).Eachherbispresent
intheamountof812grams,exceptjujube(12pieces).
The formulas would be modified for certain presenting symptoms. For example, for urinary
incontinence,addcuscuta,alpinia,androsefruitforconstipation,addhoshouwu,persica,cistanche,and
rhubarbformentalfogginess,addschizandraforabdominaldistention,addmagnoliabarkandchihshih
formuscularatrophy,addtangkuei,gelatin,anddipsacus.
Thedecoctionswereconsumedasacoolingdrink(ratherthanhotbecausemanyMSpatientshavean
aversion to heat), once per day.Antiinflammatory Western drugs (dexamethasone or prednisone) were
givenduringacuteactiveperiods.Thirtyfivepatientsweretreatedandexceptforthreethatdiscontinued
treatmentwithinthefirsttendays,someimprovementwasfound.Twocasesweredeemedbasicallycured
after taking 45 and 68 doses 15 were markedly improved and another 15 somewhat improved, most of
themtaking2040doses.Elevenofthepatientshadtriedcorticosteroidsunsuccessfullybeforeswitching
to the traditional herb combinations of these, seven were markedly improved, three improved, and only
onefailedtorespond.
These researchers followed up their work with an attempt to prevent exacerbations (18). They
prescribedPingFuTang(PacifyRelapseDecoction)to30patientsoveraperiodof313years(averageof
6 years). The formula contained astragalus, codonopsis, hoelen, atractylodes, pinellia, licorice, jujube,
bupleurum, scute, tortoise shell, ligustrum, tangkuei, 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
previousarticlefortreatmentofmultiplesclerosis,basedondeficienciesofliver,kidney,andspleen(italso
has some herbs of Minor Bupleurum Combination, as mentioned below). The preventive therapy was
basicallyatonicformula.Itwasprescribedintheformofadecoction,takenin23dailydoses,using815
gramsofeachherb(exceptsmalleramountsoflicoriceandjujube).Accordingtotheresearchers,relapses
were prevented except for two patients who each experienced only one minor exacerbation, each event
followingaviralinfection(commoncold).AcontrolgroupofMSpatientsnottreatedbythisremedywas
monitoredforthreeyears:theysufferedfromexacerbationsattherateof14timesperyear.
Ping Fu Tang included rehmannia, tortoise shell, peony, and anemarrhena, ingredients of Hu Qian
Wan,whichhavethefunctionsofnourishingyinandbloodandcleansingdeficiencyfire.Inaddition,they
addedligustrum,lyciumfruit,andophiopogontonourishyin.Astrategyfornourishingbloodandessence
is to tonify the qi so that more nutrients are obtained from the food. The formula included astragalus,
codonopsis,hoelen,atractylodes,licorice,andjujubetowardsthisend(theseherbsalsoenhanceimmune

functionstoaidresistancetoinfectionsthatinduceexacerbations).Sincethepointofthetreatmentwasnot
to rectify flaccidity, but rather to prevent flaccidity by preventing exacerbations, the herbs for treating
flaccidityinthelegs,suchastigerboneandcynomoriumfoundinHuQianWanwerenotincluded.Also,
asthepatientsarebeingtreatedcontinuouslywiththeyinnourishingtonics,itisnotnecessarytostrongly
inhibit deficiency fire, so phellodendron is not essential to the prescription (anemarrhena, unlike
phellodendron,hasthesecondarypropertyofbeingayintonic).Thus, the treatment largely reflects the
principles of Zhu Danxi in relation to understanding the cause of a flaccidity syndrome. The doctors
explainedthatpartoftheirthinkingindevelopingtheformulawasbasedonthecurrentunderstandingof
autoimmunity, which explains the presence of so many qi tonics and the herbs of Minor Bupleurum
Combination(XiaoChaihuTang),suchaspinellia,bupleurum,andscute,whichisbelievedtobehelpful
inchronicinflammatorydiseases.
If a Tcell 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
preventingdamageduetotheusualsequenceofeventsinanexacerbation.Protectionfromtransmissible
viral infections, such as staying away from those who are currently suffering from the infection, is one
methodofprevention.Enhancingtheimmunesystemfunctionswithtonicherbsisanothermethod.Many
Westerners are led to believe, by poorly written articles on immune disorders, that enhancing immune
systemvigilancewouldworsenanyautoimmunediseasehowever,thiswouldonlybeapotentialproblem
during an exacerbation even then, other components of the immune system that help to shutdown the
autoimmuneattackmaybecoaxedintoactivitywithproperimmuneregulatingherbaltreatmentstrategies.
2.AmyotrophicLateralSclerosisandProgressiveSpinalMuscularAtrophy
CasestudiesofALSwerereportedbyLinTongguo(19).Inonecase,theprimaryformulacombinedtonic
herbs:astragalus,tangkuei,peony,rehmannia,aconite,cinnamonbark,andlyciumfruit,withseveralherbs
usedtopromotecirculationofbloodandrelievespasms(thespasmsbeingasignificantprobleminmany
casesofALS):centipede,scorpion,persica,carthamus,morustwig,andclematis.Theseherbsweremade
as a decoction taken in divided doses three times daily for several days.In addition, a small amount of
powdermadefromstrychnosandmusk(0.25gramsofeach,threetimesdaily)wasgiven.Asfollowup,
the decoction formula was modified (cnidium, platycodon, chihko, tiger bone, deer antler, and zaocys
wereaddedmorustwigandclematisweredeleted)andmadeintopillsinsteadofdecoction,tobetaken18
gramsperdaythemuskandstrychnospowderswereincludedinthepills.Thepillsweretakenfortwo
yearsuntilthediseasewasresolved.Afollowupafterthreeyearswithnofurthermedicationshowedthat
thediseasehadremitted.Asimilarapproachwasusedwithasecondpatientwhoconsumedadecoction
madewithastragalus,atractylodes,cinnamontwig,tangkuei,persica,carthamus,centipede,eupolyphaga,
fenugreek,aconite(chuanwu), licorice, and zaocys. After using this decoction for several days, the pill
describedabovewasusedforlongtermmedicationandaclinicalcurewasobtained,withafollowupafter
fiveyearsconfirmingthesatisfactoryresult.
Thethirdcaseemphasizedtreatmentofyindeficiencyfire,usingadecoctionwithphellodendron,raw
rehmannia, moutan, alisma, anemarrhena, hoelen, stephania, coix, chinchiu, dipsacus, achyranthes,
centipede,andscorpion.Thisdecoctionwasgivenformorethantwomonthsandthenmodified,taking
outstephania,coix,andchinchiu,andaddingdipsacus,deerantler,epimedium,tangkuei,cnidium,and
carthamus.Thisformulawasthenusedformorethanthreemonths.Finally,theabovementionedpillwas
againusedforlongtermtherapy,andacurewasobtained,withnorelapsebytheendoftwoyearswithout
themedication.
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
BenefitingMarrow). One such prescription contained tangkuei, lycium fruit, atractylodes, ophiopogon,

tortoiseshell,achyranthes,phellodendron,alisma,chaenomeles,andlicoriceforayindeficiencycaseand
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. Longterm followup showed persisting benefits of the treatment, with normal nerve
conductionandphysicalactivities.
Inastudy(21)of15patientswithprogressiveALS,asignificantlyexpandedversionofHuQianWan
wasemployed.Thiscontainedastragalus,epimedium,deerantler,syngnathus,seahorse,ginseng,tortoise
shell glue, tangkuei, peony, rehmannia, lycium fruit, eucommia, dipsacus, cuscuta, cynamorium,
atractylodes, coix, citrus, achyranthes, chaenomeles, chinchiu, agkistrodon, tiger bone, psoralea,
anemarrhena,phellodendron,cinnamontwig,chianghuo,tuhuo,andsiler.Theformulawasbasedonthe
traditionalprescriptionJianBuHuQianWan(StepReinforcingTigersWalkPill).Thepillsweretakenin
adosageof39gramsatatime,23timesperdaydependingonthepersonsconstitutionandseverityof
thedisease,butwerenottobeusedbypatientsshowingyindeficiencyfiresyndrome.Twoofthepatients
weresaidtobecuredandfiveimproved.The pills were to be used on a regular basis over a period of
severalyears.
Strychnos is sometimes mentioned as part of ALS treatments. A muscleinvigorating combination
knownasMobilizingPowdermayproducetemporaryalleviationofflaccidity.Thecombinationincludes
strychnos,musk,andcentipede.Strychnosinsmalldosestonesthemusclesandinlargedosesparalyzes
them.It is used in the treatment of other autoimmune disorders, including MG and rheumatoid arthritis.
Unfortunately,thisherbcannotenterintoWesterntreatmentsforautoimmunediseasesbecauseofconcerns
overthetoxicityofstrychnine,oneofthemainactivecomponents.
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,tortoiseshell,deerantlergelatin(eachherb915gramsindecoction),with5grams
each phellodendron, and anemarrhena. This formula is a substantial modification of Hu Qian Wan,
utilizingseveralyangtonicherbstoreplacethetigersboneoftheancientprescription.Accordingtothe
report,59caseswereconsideredcured(symptomsalleviated,musclesregenerated,andmuscularfunction
restored),18markedlyimproved,25improved,and8showednoimprovement.
3.MyastheniaGravis
Yakazureported(23)thatformulascontainingmahuang,suchasPuerariaCombination(GegenTang)and
MinorBlueDragonCombination(XiaoQinglongTang),wererepeatedlyfoundtoimprovesymptoms,at
least for shortterm treatment, in patients with MG. He attributes this effect to the active component
ephedrine,whichwaspreviouslyreportedtobeeffectiveformyastheniabyDr.NabiRyokeninhisbook
The Revised Practical Medical Service. Mahuang is traditionally used in the treatment of muscular
aching and ephedrine is known to promote circulation through the striated muscles. Yakazu also
recommended the use of peony and licorice, stating that this combination adjusts the tenseness of the
muscles. Licorice also has cortisonelike action. These two herbs are frequently used to relieve muscle
spasms, perhaps with better effect in patients suffering from deficiency syndromes. In like manner, he
thoughtthatpueraria,traditionallyusedtorelaxtensemusclesintheneckandshoulders,mighthelptotreat
flaccidityofthesesamemuscleswhengiventopatientswithMG.InthecasestudyofearlyMGpresented
byShaoNianfang,puerariawasincluded.
In a study (24) of treatments for MG reported by Qiu Chengling, eight patients received capsules
containingstrychnos(0.2gramspercapsule),graduallyincreasingthedailydosagetoreachsevencapsules

each time, three times daily. In addition, the patients were treated with decoctions according to the
classification of underlying syndrome. For those with spleen deficiency, Ginseng and Astragalus
Combination (Buzhong Yiqi Tang) plus epimedium was given. For spleen and kidney deficiency, a
decoctionofastragalus,epimedium,tangkuei,atractylodes,codonopsis,rehmannia,dioscorea,curculigo,
anemarrhena,andmorindawasgivenincasesofmoresevereyangdeficiencyandcold,cinnamontwig,
aconite,anddeerantlergluewereadded.Asaresultofthesetherapies,5ofthe8patientsnotedsignificant
improvements.
LiGenghe(16)reportedonthecumulativeresultsoftreating250patientsoveraperiodoffiveyears.
Heclaimedthatlongtermingestionofherbsthattonifythespleenandkidneycouldleadtoaclinicalcure
in nearly half the patients. The duration of therapy necessary was 35 months for the eyemuscle type
(whichwaseasiertocure)and68monthsforthegeneraltype.Domei Yakazu believedthatthosenot
curedbytonificationtherapiesmightbenefitfromthemahuangformulas.
SUMMARYOFCLINICALTRIALS
Formalclinicaltrialsinvolvingseveralpatientsratherthanindividualcasestudiesbeganin1975andhave
includedonlyfewhundredpatients.SincetheWesternmedicalknowledgeofthediseaseswaslimitedand
advancedequipmentoftennotavailable,theearlyresearchwasbasedalmostentirelyontraditionalanalysis
of treating flaccidity syndrome and guesses as to the treatment of autoimmunity. The claimed positive
results,rangingfromahighproportionofpersonswithmarkedimprovementstoasubstantialnumberof
cases declared cured, were often a consequence of treating patients with different formulas according to
diagnostic categories and with changes in prescription during the first few weeks or months of therapy.
Tonificationofspleen,kidney,andliveraretheprominentmethodsoftherapy.Itwascommontocombine
decoctionsandpills,andtousepillsaslongtermtherapy,whichsometimeslastedfortwoyears.Insome
cases,acupuncture,Westernmedicine,andothertherapiesweresaidtobeused:undoubtedly,inmosttrials
the patients received the therapeutic interventions that the physicians felt were necessary within the
limitationsofwhatcouldbeoffered.
AMERICANPATIENTSWITHMS
AccordingtocliniciansworkingattheITMclinic,diagnosisofAmericanpatientssufferingfrommultiple
sclerosis reveals the presence of yin deficiency, but relatively little experience of the yin deficiency fire.
Rather,theseindividualshaveagreatertendencytodisplaysignsofweaknessofthestomachfunctionsand
some deficiency of kidney yang. This apparent difference between these findings compared to the
explanation of leg flaccidity by Zhu Danxi may be related to several factors.For example, MS is more
common in the colder northern regions, where yang deficiency is more prevalent, while Zhu observed
patients in southern regions where yang deficiency is less common. The cause of the disease, though
complex,appearstobeinfectiousagentsandautoimmuneprocess,ratherthandebilitatinglifestyle(though
lifestylefactorscouldcontributetodiseaseinitiationandprogression),whichwasthedominantconcernin
Zhus time. The Western diet may help to limit deficiency fire syndrome, but might worsen stomach
problems.MalabsorptioninMSpatientshasbeennotedforfats,vitaminB12 ,anddxylose,andlowHCl
levels may be responsible for limited digestion of meats (28). In China, low HCl levels were noted in
patientswithMG(29),andthelowestlevelswerecloselyassociatedwithrefractorinesstotreatment.
DIETARYANDNUTRITIONALCONSIDERATIONS:EASTANDWEST
Providingadequatenutritionisconsideredcriticalinthetraditionaldescriptionofflacciditysyndrome.To
treatessencedeficiency,Chinesedoctorsrecommendthatcertainfoodsbeeaten,includingduck,abalone,
pigkidney,liver,lotusseeds,rosehips,andwalnuts(29).

As mentioned earlier, avoiding certain foods is also a consideration of traditional Chinese thinking.
Blackpepperistobeavoidedincasesofmuscularweakness.Recentlyitwasshownthatacomponentof
pepperinhibitsconvulsionsanditmayhaveamildinhibitoryactiononmuscularcontraction.Cinnamon,
with its key component cinnamaldehyde, should be avoided in persons with MS, as the aldehydes may
alreadyinhibitnervetransmission.Thesetwoherbsarewarmandspicyinnature,andwouldbelimitedby
the prevailing Chinese theory that spicy herbs can worsen yin deficiency. Cinnamon is used in some
treatments of flaccidity, but might be more suitably replaced by other herbs that accomplish the same
therapeuticgoal,suchascynomorium,morinda,ordryginger.
Ingestion of essential fatty acids and EPA from fish oil appears to be of some aid in treating
autoimmunityingeneral(4).Fattyacidsandfishoilsupplementationmaycorrespondtotonifyingtheyin,
basedonChinesedietaryrecommendations.Avoidanceofzincoruseofzincchelatingagentsalsoreduces
some autoimmune responses (1), though zinc deficiency can lead to easier experience of viral infections
thatactivateMSattacks.
Tortoiseshell(richingelatin)anddeerantlergelatinareincludedinseveralprescriptionsfortreatment
offlaccidityofthelegs.Glycineisamajorcomponentofgelatin,whichisclassifiedbyChinesedoctorsas
a blood and yin tonic. The amino acid glycine has been recommended for persons with MS since it
counteracts aldehyde accumulation and has antispasmodic properties (daily dosage is about 3 grams per
day).
Since1950,ithasbeenproposedthatadietlowinsaturatedfatsmaybenefitsomeMSpatients,anda
clinicatOregonHealthSciencesUniversity,formerlyrunbyDr.RoySwank,professorofneurology,has
specializedinthisareaoftreatmentforseveralyears.Herecommendsnomorethan10gramsofsaturated
fatperday,whichbasicallyyieldsavegetariandietsupplementedbyfish(threeormoretimesperweek
thefishoilsareconsideredbeneficialasarepolyunsaturatedoils).Manypersonsfindthisdiettostricttobe
practical.Highlevelsofpolyunsaturatedoilsmayincreaseoxidativestress,andsoshouldbecounteredby
takingantioxidants.
Vitamin B12 is found primarily in animal foods and is also present in walnuts. This vitamin may
contributesomeoftheessencetonifyingpropertiesoffoodsrecommendedbyChinesedoctors.Anumber
ofreportsofvitaminB12 deficiencyinsomeMSpatientshasledtotheuseofthisvitaminintreatmentof
those who are found to have low B12 either in the serum or the cerebrospinal fluid. Low vitamin B12
levels were found to be associated with earlier onset of disease symptoms and were reduced by
corticosteroidadministration(38).However,itmaybetheunsaturatedB12 bindingcapacitythatismore
oftenlow,eveniftotalB12 levelsarenormal(39).WhenpatientswithchronicprogressiveMSweregiven
6 mg of oral B12 every day for six months, there were improvements in visual and brainstem auditory
evokedpotentials.SinceMSpatientsarelikelytohavepoorB12 uptake,B12 isoftengivenbyinjection,
withdosesupto1mgeachtime.
STEPSTOTAKEINTREATMENT
To follow Chinese medical theories and experience in treating MS, MG, ALS, and other flaccidity
syndromes,onewouldundertakethefollowing:
1.Eatadietthatisnourishingtothespleen,kidney,andliver,especiallywithessencetonifyingfoods(this
wouldincludevariousbeansandseeds,meats,seafoods,andmildlyastringentfruits).Avoidexcessive
amounts of sour, spicy, and salty foods. Consider use of nutritional supplements with selenium,
calcium, vitamin B12 , antioxidants, and essential fatty acids. Also consume gelatin or a glycine
supplement(3gramsperday),especiallyincaseswheremusclespasmsoccur.

2. Consumeherbformulasthatmatchtheparticularmanifestationofsymptomsandsignsrecognizedby
traditionalmedicaltheory.Deficiencyistobenourishedobstruction,overcomeandexcess,drained.
Incasesofdeficiencysyndrome(whichappeartobethemostcommon),considertheuseofsubstantial
doses of tonic herbs, and give special attention to the need for yin or yang tonic agents. Anti
inflammatorydrugsmayhelplimitthedamagetomyeliniftheiruseisinitiatedearlyinanattack,but
theymayhavelittlebenefittherestofthetime.Immuneregulatingdrugs,suchasbetaseron,canbe
triediftheherbtherapiesfailtoproduceadequateregulation.
3. Avoid viral infections (and other infections) by minimizing exposure to infected persons and to
potentiallyharmfulenvironmentalconditions(e.g.,chill).Takeanantiviralherbcombinationwhenan
acuteviralattackissuspected.Treatallinfectionspromptly,whetherusingherbsordrugs.
4.Utilizepracticesthatevokespiritualrejuvenation.TraditionalChineseexercises,suchasQiGongand
Tai Ji Quan may be helpful in strengthening the normal qi, benefiting the kidney, and calming the
spirit.Theyalsoimprovemusclecontrolandbalance.
5. Useacupuncturetoinvigoratecirculationofqiandbloodinthelimbsandtorestorenervoussystem
connections.Scalpacupuncturehasprovenhelpfulintreatingdisordersofthecentralnervoussystem,
including MS (40). Dr. Chen Zelin and Chen Meifang in the book A Comprehensive Guide To
Chinese Herb Medicine (41), recommend the following body points for flaccidity syndrome (34
pointsshouldbeselectedforeachdailyoreveryotherdaytreatmentfor10days):
Flaccidityofthearms:GV4,12LI11,15SI4,9TB5,BL11.
Flaccidityofthelegs:GV2,3BL57,60GB30,31,34,39SP6,9ST36
6.NewWesternmedicalapproachesshouldalsobeconsidered.Recentresearchsuggeststhatitmaybe
possible to selectively inhibit the autoimmune attack against myelin using a Tcell receptor (TCR)
peptidedrugthatdoesnotdefeattheentireimmunesystembutratherblockstheattackbymatchingthe
basic protein on myelin that binds the Tcells. Initial tests in animals with experimental allergic
encephalymyelitis,amodelforMS,showedgoodresults,andclinicaltestsinasmallnumberofpatients
haveyieldedpromisingoutcomes(42).Ifsuccessful,thesamebasicmethod,usingadifferentpeptide,
might be useful for other autoimmune disorders, such as MG. The drastic inhibition of immune
functions, which is possible with currentlyavailable drugs, such as high dose corticosteroids or
cyclosporin, should only be considered as an emergency measure. Chinese herb drugs that inhibit
acetylcholinesterase, such as huperzine A and fordine, have been used with some success in treating
myastheniagravisinChina.
7.ParentswhohaveMSshouldtakespecialcaretomakesurethattheirchildrengetadequatenutrition,
havevaccinationsagainstcommonpreventablediseases,andtakestepstoavoidexcessiveexposureto
infectiousandparasiticagents.Theirchildrenhaveanincreasedriskofdiseaseduetogeneticfactors,
sothatextracaremaybeneededtoavoiddevelopmentofthedisease.
ACKNOWLEDGMENTS
SeveralChineselanguagearticlesweretranslatedbyFuKezhiinHarbinDengZhongjia,throughliterature
research,providedanarticleonPingFuTang,aportionofthatarticlewastranslatedbyHeinerFruehauf,
Ph.D.,L.Ac.inPortlandDr.FruehaufalsoprovidedtranslationsofarticlesonALSandprogressivespinal
muscularatrophy.BarryLevine,L.Ac.inNorwood,Massachusetts,providedseveralabstractsandarticles
ontheWesternmedicalanalysisofMSanditstreatment.TheMSFoundationinFortLauderdale,Florida
providedfundingfortreatmentsofMSpatientsattheITMclinic.
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