施今墨对药

2SunTenNewsletterWinter2008MultipleSclerosis(MS)–AChineseMedicinePerspectiveCONTENTSTradiTiONalChiNESEMEdiCiNEintegratedTraditional&WesternMedicine7GettingResultsinMultipleSclerosisManagementTraditionalChineseMedicine2MultipleSclerosis(MS)-AChineseMedicinePerspective10SunTenGinseng-PremiumsixYearsOldGinsengresearch,Quality,saftyandEfficacy中西醫結合中醫基礎中醫研究質量安全中醫Multiplesclerosis(MS)isanunpredictablediseaseofthenervoussysteminwhichcommunicationbetweenthebrainandotherpartsofthebodyisdisrupted.Itseffectscanrangefromrelativelymildtodevastating.Thesymptomsmaymysteriouslyoccurandthendisappear.Intheworstcases,apersonwithMSmaybeunabletowrite,speak,orwalk.DuringanMSattack,inflammationoccursinareasofthewhitematter(pale-colourednervetissue)ofthecentralnervoussysteminrandompatchescalledplaques.Thisisfollowedbydestructionofmyelin,thefattycoveringthatprotectsnervecellfibersinthebrainandspinalcord.Myelinallowsforthesmooth,high-speedtransmissionofelectrochemicalmessagesbetweenthebrain,thespinalcordandtherestofthebody.Whenmyelinisdamaged,neurologicaltransmissionofmessagesmaybeslowedorblockedcompletely,resultingindiminishedorlostfunction.SignsandSymptomsWeaknessandlossofmuscle• co-ordination• Tingling,numbness,dizziness• Blurredvision• Pain• Heatsensitivity• Lossofbladdercontrol• Memoryloss,problem-solving• difficultiesMooddisturbances• WesternDrugTherapiesYourpatientmayalreadytakethefollowingWesternMedication:Steroidswithanti-inflammatory• properties(e.g.prednisone)toreduceseverityofattacks.Betainterferontodecreasemyelin• destruction,reducefrequencyandseverityofattacks,andslowprogressionofdisease.Immunotherapy,antigen-targeting,• cytokines,andremyelinationareexperimentaltherapiesthatmayalterthecourseofthedisease.TCMPatternDifferentiationsOverviewDuringtheacuteperiod,acommonpatternpresentationiskidneyandliveryinvacuitywithconcurrentphlegmandbloodstasis.Inaddition,treatmentwithsteroidstendstogiverisetopathogenicfirewhichexacerbatesthealreadypresentyinvacuity1.Treatmentincludesherbsthatnourishkidneyandliveryin,transformphlegmandmoveblood.Overtime,kidneyyinvacuityislikelytochangeintoavacuityofbothyinandyang.Thus,herbsareaddedthatsupplementyang.Also,morestasismovingherbsmaybeneeded,includingherbsthatmoveliverqi.Asstasismaytransformintoheat,heatclearingherbsmayalsobeadded.TheorybehindthesymptomsTheliverstoresbloodandopensattheeyes;hencethereisastrongconnectionbetweenthestateoftheliverandthestateoftheeyes.Liveryin/bloodvacuitymayimpairvision.Bloodandyindeficiencymaygiverisetointernalwind,manifestingasspasms.Thespleengovernsthemovementandtransformationoffoodandwater,andisthesourceofqiandbloodformation.Italsogovernsthefleshandlimbs.Hence,thenourishmentofthebody’sfleshreliesonthecorrectfunctionofthespleen,andifspleenfunctionisdisturbedthismayleadtolackofstrength,impaireduseandevenatrophyofthemuscles.Thekidneyistherootofearlierheaven;itgovernsthebonesandengendersmarrow.Thebrainisconsideredthe“seaofmarrow”,andthekidneynotengenderingmarrowmaycause“emptinessoftheseaofmarrow”,manifestingasslowthinking,forgetfulnessanddizziness.Also,theShiJiNMOdUiYaO5ArtofCombiningMedicinalsAccordingtoMasterShiJinMo施今墨對藥5TCMPrinciplesSunTenNewsletterWinter20083functionofthebladdertostoreanddischargeurinereliesonthekidney.Phlegmisengenderedwhenthespleenfunctionofmovementandtransformationoffluidsisimpaired,andmaymanifestinsymptomssuchascloudedspirit,numbnessorheavinessofthelimbs,ordizziness.Bloodstasismaybecausedbyseveralfactors,e.g.animpairedspleencausingqivacuityandhenceqilackingadequateforcetomovetheblood.Othercausesareblooddeficiency,qistagnation,bloodcoldorbloodheat.Theprimarysymptomofbloodstasisispaininafixedlocation.PatternDifferentiationAccordingtoFlawsandSionneau2,“thesinglemostcommonlyseenpatternofMSinreal-lifeWesternpatientsisqiandyindualvacuity,3meaningspleenqiandliverkidney-yinvacuity.”However,FlawsandSionneaufurtherexpoundthat“itistheruleratherthantheexceptionthattherewillbefiveormoreconcomitantpatternsincasesofMS”.4Theyadvise“whenevertherearesuchcomplicatedpatterns,oneshouldfirstidentifyallpatternspresentinorderofpredominance;two,statetherequisitetreatmentprinciplesforeachofthosepatternsinthesameorder;andthirdly,composeonanadhocbasisatreatmentplanthataddressesallthosepatternsinthesameproportionsandwiththesamepriorities.”5TreatmentStrategiesandMedicinalsTreatmentstrategiescentreonsupplementingliverandkidney,transformingphlegmandquickenbloodstasis,andstrengtheningthespleen.Carehastobetakeninkidneysupplementationsothattheoftentimescloyingnatureofkidneysupplementsdoesnotcauseobstruction.Thiscanbepreventedbyaddingwarmingandfreeingmedicinals.MedicinalsoftenusedareRouCongRong[Cistanche],SuoYang[Cynomoriumdongariorum],NuZhenZi[Ligustrum],TuSiZi[Cuscuta],andXianLingPi[Epimedium]tosupplementkidneyessenceandstrengthenkidneyqi.LiuWeiDiHuangWan[RehmanniaSixFormula]withHeShouWu[HoShouWu]supplementsliverandkidney,nourishestheblood,increasesessenceandastringesjingqi.Totransformdampness,warmingandtransformingmedicinalsareusedsuchasBanXia[Pinellia]andShiChangPu[Aco