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Giovanni Maciocia 'The Practice of Chinese Medicine'. ISBN 0-443-043051
United Kingdom 1994.
http://www.giovanni-maciocia.com/
Multiple sclerosis is the most common neurological disease in the Northern hemisphere. Its pathology consists in the partial destruction of the myelin sheaths around the spinal cord, brain and optic nerves. The lesions are disseminated at intervals and the many varied symptoms depend on the location of the lesions. Because the lesions can partially heal, this disease goes
through characteristic phases of remission and relapse. In young people the first presenting symptom is often retrobulbar neuritis causing blurred vision, whilst in old people it is weakness of a leg. As mentioned above, this disease is characterized by many different symptoms according to the location of the lesions in the myelin sheath. These include: blurred vision, weakness and heaviness of one or both legs, jerking of the legs, double vision, vertigo, vomiting, incoordination, a feeling in arms and legs like suffering an electric shock, numbness or tingling of limbs, urgency or hesitancy of urination, impotence. With the progressive degeneration of the myelin sheath there is an increasing incoordination and weakness of the legs and arms. In the late stages there is complete paralysis usually of the spastic type together with urinary incontinence and gross cerebellar disturbance with ataxic gait.
In Chinese medicine, multiple sclerosis is a type of Atrophy Syndrome.
Aetiology and Pathology.
Invasion of external Dampness is an important cause of disease in the beginning stages. External Dampness invades the channels of the legs first and creeps upwards. This is contracted by living in damp places, sitting on damp grass, failing to dry oneself after swimming, being exposed to damp weather when wearing insufficient clothes, or being exposed to foggy weather. Women are particularly prone to invasion of Dampness during their menstrual cycle and after childbirth. Dampness obstructs the channels and causes a feeling of heaviness in the legs, numbness and tingling.
Diet:
Excessive consumption of greasy-fried or cold foods impairs the Spleen and leads to the formation of Dampness. Dairy foods such as milk, cheese, butter and cream are one of the most common causes of Dampness in Western countries.
Excessive Sexual Activity.
Excessive sexual activity weakens the Kidneys and Liver and is particularly responsible for the manifestations in the middle to late stages of multiple sclerosis, i.e. dizziness, blurred vision, urgency or hesitancy of urination and extreme weakness of the legs.
Shock.
Shock causes a sudden depletion of Heart- and Spleen-Qi. The Spleen influences the muscles, so this depletion deprives the muscles of nourishment, and the Heart controls the circulation of Blood, so it leads to poor circulation of both Qi and Blood to the limbs. Both these factors may cause weakness of the legs, dizziness and vertigo. In most cases the symptoms in the early stages reflect an invasion of Dampness: they are a feeling of heaviness, numbness and tingling of the limbs. In the middle stages of the disease there is a progressive deficiency of Liver and Kidneys with such symptoms as dizziness, vertigo, blurred vision, progressive weakness of the legs, and urinary hesitancy or urgency. If Liver-Yang develops, there is stiffness of the legs, more severe vertigo and vomiting. In the late stages, with the development of Liver-Wind, there is tremor and severe spasms of the legs.
Acupuncture and Herbal Treatment.
Acupuncture is the treatment of choice for multiple sclerosis. There are only two basic patterns:
Damp-Phlegm with Spleen Deficiency.
Liver and Kidney Deficiency.
Damp-Phlegm With Spleen Deficiency.
Clinical Manifestations:
Numbness, feeling of heaviness of the legs, tingling, dizziness, tiredness.
Tongue: Swollen with teeth-marks and a sticky coating.
Pulse: Weak and Slippery.
Treatment Principle:
Resolve Dampness, tonify the Spleen and invigorate the Connecting channels.
Herbal Treatment:
Si Miao San Variation (Four Wonderful Powder):
Cang Zhu Rhizoma Atractylodis lanceae 6 g
Huang Bo Cortex Phellodendri 9 g
Niu Xi Radix Achyranthis bidentatae seu Cyathulae 6 g
Yi Yi Ren Semen Coicis lachryma jobi 9 g
Bi Xie Rhizoma Dioscoreae hypoglaucae 6 g
Bai Zhu Rhizoma Atractylodis macrocephalae 6 g
Du Huo Radix Angelicae pubescentis 6 g
Explanation:
– Si Miao San (first four herbs) resolves Damp-Heat from the Lower Burner and legs.
– Bi Xie resolves Dampness from the legs.
– Bai Zhu tonifies Spleen-Qi and dries Dampness.
– Du Huo expels Wind-Dampness from the Lower Burner and invigorates the Connecting channels.
Variations:
– If the condition is very long-standing and Dampness is pronounced add Huo Xiang Herba Agastachis and Pei Lan Herba Eupatorii fortunei.
– If there is a lot of numbness and tingling add Sha Ren Fructus seu Semen Amomi and Wei Ling Xian Radix Clematidis chinensis.
Case History 29.1
Multiple Sclerosis: Dampness in the Spleen-Male, Age 45.
A 45-year-old man had been diagnosed as suffering from multiple sclerosis (MS) only a few months earlier. The first symptoms of his condition were numbness of the left arm, tingling of the limbs and around the mouth, dizziness and a feeling of heaviness of the head and legs. He also felt very tired. His pulse was Slippery but also Weak and his tongue was Swollen with a sticky-yellow coating inside a Stomach-crack.
Diagnosis:
This condition was clearly due to Dampness and Phlegm obstructing the channels and also the head. There was also an underlying deficiency of Spleen and Stomach as evidenced by the tiredness, Weak pulse and Stomach-crack on the tongue.
Treatment principle:
The principle of treatment applied was to tonify the Spleen and resolve Dampness, as well as remove obstruction from the channels and invigorate the Connecting channels.
Herbal treatment:
The herbal formula used was a variation of Si Miao San Four Wonderful Powder:
Huang Bo Cortex Phellodendri 6 g
Cang Zhu Rhizoma Atractylodis lanceae 6 g
Yi Yi Ren Semen Coicis lachryma jobi 9 g
Niu Xi Radix Achyranthis bidentatae seu Cyathulae 6 g
Bai Zhu Rhizoma Atractylodis macrocephalae 6 g
Wei Ling Xian Radix Clematidis chinensis 4.5 g
Sha Ren Fructus seu Semen Amomi 4 g
Explanation:
The first four herbs resolve Dampness in the Lower Burner.
Bai Zhu tonifies the Spleen and drains Dampness.
Wei Ling Xian and Sha Ren eliminate obstructions from the channels, resolve Dampness and invigorate the Connecting channels.
Case History 29.2
Multiple Sclerosis: Dampness in the Spleen-Female, Age 36.
A 36-year-old woman had been suffering from MS for 3 years. Her main symptoms were a feeling of heaviness of her legs, lack of balance, weakness of the legs, difficulty in walking and urinary incontinence. She had a 2-year-old child and her symptoms improved during the pregnancy. Her tongue was slightly Pale but with a Red tip. It was Swollen and had a Heart-crack. The coating was sticky. Her pulse was Weak and Fine and the Heart position was particularly Weak.
Diagnosis: The main manifestations are clearly those of Dampness invading the Lower Burner and the leg channels. However, the cause of the disease had its roots not only in the Spleen but also the Heart. The Weak Heart pulse and Heart crack on the tongue point to shock injuring both Spleen and Heart. She confirmed that she had suffered a severe shock a year before the onset of her symptoms.
Treatment principle:
The treatment principle adopted was to resolve Dampness from the Lower Burner, tonify the Spleen and strengthen the Heart. She was treated primarily with acupuncture.
This patient is still being treated; her condition has shown an improvement of some 60% and is now quite stable.
Clinical Manifestations of Liver and Kidney Deficiency:
Progressive weakness of the legs, weak back and knees, dizziness, poor memory, blurred vision, hesitancy or urgency of urination.
Treatment Principle:
Tonify Kidneys and Liver and strengthen bones and tendons.
Herbal Treatment:
Liu Wei Di Huang Wan Variation (Six-Ingredient Rehmannia Pill):
Shu Di Huang Radix Rehmanniae glutinosae praeparata 24 g
Shan Zhu Yu Fructus Corni officinalis 12 g
Shan Yao Radix Dioscoreae oppositae 12 g
Ze Xie Rhizoma Alismatis orientalis 9 g
Mu Dan Pi Cortex Moutan radicis 9 g
Fu Ling Sclerotium Poriae cocos 9 g
Du Huo Radix Angelicae pubescentis 4 g
Sang Ji Sheng Ramus Loranthi 6 g
Ji Xue Teng Caulis Millettiae seu Caulis Spatholobi 6 g
Wu Jia Pi Cortex Acanthopanacis radicis 6 g
Du Zhong Cortex Eucommiae ulmoidis 4.5 g
Explanation:
– The formula Liu Wei Di Huang Wan (first six herbs) nourishes Kidney- and Liver-Yin.
– Du Huo expels Wind-Damp from the channels of the Lower Burner and invigorates the Connecting channels.
– Sang Ji Sheng nourishes Liver-Blood and the tendons.
– Ji Xue Teng and Wu Jia Pi invigorate the Connecting channels, move Blood and strengthen tendons and bones.
– Du Zhong may be added in a small dose, even though it is a Yang tonic, to tonify the lower back and legs and strengthen the spine. The emphasis of the formula as a whole is to nourish Yin, so it is good to include a Yang tonic as Yang corresponds to movement.
Variations:
– If there is stasis of Blood evidenced by pain in the limbs add Hong Hua Flos Carthami tinctorii, Tao Ren Semen Persicae and Niu Xi Radix Achyranthis bidentatae seu Cyathulae.
– If there are spasms, add Jiang Can Bombyx batryticatus and Di Long Pheretima aspergillum.
– If, in a very chronic case, there is a deficiency of both Yin and Yang of the Kidneys (deficiency of Yang appearing later while the tongue is still Red), add Lu Jiao Cornu Cervi to tonify Kidney-Yang and strengthen the spine.
Patent Remedies:
Du Huo Ji Sheng Wan (Angelica Pubescens-Loranthus Pill):
Du Huo Radix Angelicae pubescentis
Xi Xin Herba Asari cum radice
Fang Feng Radix Ledebouriellae sesloidis
Qin Jiao Radix Gentianae macrophyllae
Sang Ji Sheng Ramus Loranthi
Du Zhong Radix Eucommiae ulmoidis
Niu Xi Radix Achyranthis bidentatae seu Cyathulae
Dang Gui Radix Angelicae sinensis
Chuan Xiong Radix Ligustici wallichii
Sheng Di Huang Radix Rehmanniae glutinosae
Bai Shao Radix Paeoniae albae
Ren Shen Radix Ginseng
Fu Ling Sclerotium Poriae cocos
Rou Gui Cortex Cinnamomi cassiae
Gan Cao Radix Glycyrrhizae uralensis
Explanation:
This remedy tonifies Liver and Kidneys and expels Wind-Dampness from the back and legs. It is suitable only if there is a deficiency of Kidney-Yang. The tongue presentation appropriate to this remedy, therefore, is a Pale body.
Du Zhong Bu Tian Su (Eucommia Benefiting Heaven Pill):
Du Zhong Cortex Eucommiae ulmoidis
Gou Qi Zi Fructus Lycii chinensis
Huang Qi Radix Astragali membranacei
Dang Shen Radix Codonopsis pilosulae
Dang Gui Radix Angelicae sinensis
Sheng Di Huang Radix Rehmanniae glutinosae
Ba Ji Tian Radix Morindae officinalis
Shan Zhu Yu Fructus Corni officinalis
Rou Cong Rong Herba Cistanchis
Lian Zi Semen Nelumbinis nuciferae
Bai Zi Ren Semen Biotae orientalis
Explanation:
This remedy tonifies both Kidney-Yang and Kidney-Yin, nourishes the Liver, and benefits sinews and bones. It is suitable for multiple sclerosis from deficiency of Liver- and Kidney-Yin:
the Kidney-Yang tonics within the formula will help the movement of the limbs.
The tongue presentation appropriate to this remedy is a slightly Red body colour with a rootless coating. If the body-colour is very Red and the tongue is completely without coating, this pill is not suitable.
Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill):
Shu Di Huang Radix Rehmanniae glutinosae praeparata
Shan Yao Radix Dioscoreae oppositae
Shan Zhu Yu Fructus Corni officinalis
Ze Xie Rhizoma Alismatis orientalis
Fu Ling Sclerotium Poriae cocos
Mu Dan Pi Cortex Moutan radicis
Explanation:
This pill nourishes Liver- and Kidney-Yin: it will not have any direct effect on the channels and sinews, but it can be used to nourish Kidney-Yin in conjunction with acupuncture. The tongue presentation appropriate to this remedy is a Red body with a rootless coating or without coating.
Prognosis:
Whilst Chinese medicine cannot completely cure this condition, it can offer considerable help in alleviating its symptoms and slowing down its progress. Acupuncture helps considerably in eliminating the feeling of heaviness and tingling of the limbs and in facilitating walking. The earlier the treatment is started the better the results. If the patient is still walking one can expect some results, but if he or she is permanently in a wheelchair then results will be very poor or non-existent. If treatment is started at the very early stages, the symptoms can be eliminated completely and the progression of the disease halted indefinitely. This is all the more likely to happen if the patient cooperates in changing life style by taking more rest, adjusting the diet, and reducing sexual activity. Initially, treatment should be carried out 2-3 times a week. After a few weeks it can be spaced
out to once a week and then once a fortnight. If a good improvement is obtained, the patient should be seen about once a month thereafter.