Asian herbal medicine involves therapy using herbal preparations that are often complex mixtures of many different herbs. Asian herbal medicine frequently is used in combination with acupuncture, but it also may be used on its own. Asian herbal medicine may be administered in several different ways, including as tablets, pills, powders, capsules, or tinctures. Raw herbs or extracts of herbs also may be used.
When considering the use of Asian herbal medicine, it is essential to know which specific herbs are being used and to recognize that the full range of effectiveness and toxicity has not been fully established for any of these herbal preparations. These issues and other important factors related to herbal medicine in general are discussed in more detail in the section on herbs. In addition, the section on herbs has information on some Asian herbs, including Asian ginseng, astragalus, dong-quai, ephedra (ma huang), Ginkgo biloba, and licorice (see "Herbs").
Limited information is available on Asian herbal medicine in the treatment of MS. One study evaluated the effects of Ping Fu Tang, a mixture of 17 different herbs (8). In this study, 45 people with MS were monitored for nearly 3 years. Two groups were followed: a treatment group that received the herbal therapy, and a control group that was treated with conventional Western medicine or a combination of Western and Chinese medicine. The group that received the herbal therapy had a significant decrease in attack rate compared to the control group. Unfortunately, the results of this study are difficult to interpret because of limited reporting about the characteristics of the people in the study, the way in which the study was conducted, and the type of monitoring that was performed.
Several other studies of the use of Asian herbal medicine in MS have been reported. These studies are difficult to interpret because most of them have been published in Chinese and only summaries are readily available in English (9). In 1990, one Chinese study reported beneficial effects with herbal treatment in 35 people with MS. In 1995, another study reported by the same research group found that Ping Fu Tang, a mixture of 17 different herbs, decreased the rate of MS attacks. Several other MS studies of Chinese herbal medicine (as well as Japanese herbal medicine) have been conducted. Paradoxically, in one of these studies, an herb that appears to stimulate the immune system, Ganoderma lucidum, was reported to slow the disease course in five people with MS. Overall, because these studies are not available in English, it is impossible to rigorously evaluate them or to make any clear conclusions about the research results.
Several specific Chinese herbs have anti-inflammatory effects or suppress the activity of the immune system and therefore could be therapeutic for MS. These herbs include Ginkgo biloba (see "Herbs" chapter), Re Du Qing, Berberis, Stephania tetrandra, and Tripterygium wilfordii.
A compound from Stephania tetrandra, tetrandrine, has produced promising results in scientific studies. This chemical suppresses the immune system through mechanisms that are different from several conventional medications. In addition, tetrandrine appears to produce additional immune-suppressing effects when it is given in combination with conventional medications. One study showed that tetrandrine decreased the severity of experimental allergic encephalomyelitis (EAE), the animal model of MS. Further studies are needed to study the effects of this compound.
One of the more extensively studied immune-suppressing Chinese herbs is Tripterygium wilfordii, also known as Thunder God Vine, threew-ingnut, or lei-gong-teng. Scientific studies indicate that this herb decreases the activity of T cells and other specific components of the immune system. In addition, it lessens the severity of EAE. One study conducted in China following ten people with MS found that T. wilfordii produced "significant" improvement in eight people and mild improvement in two people.
T. wilfordii has been studied primarily in autoimmune disorders other than MS. Beneficial effects have been noted in animals with an experimental form of lupus. Some clinical improvement has been noted in people with rheumatoid arthritis and lupus.
At this time, studies are too limited for this therapy to be recommended specifically for MS or other autoimmune conditions. In addition, use of this herb has been associated with serious side effects (see below).
If considering Asian herbal medicine, people with MS should be aware of individual herbs or herbal mixtures that may stimulate the immune system (Table 4.2). The immune-stimulating effects of these herbs have been shown in scientific tests or in laboratory animals. Their effects on humans in general or on people with MS have not been specifically investigated. Thus, the immune-stimulating activity of the herbs represents a theoretical risk for people with MS.
Fu-zheng therapy, a type of Chinese herbal medicine, is believed to improve the ability of the body to defend itself. Two herbs used in Fu-zheng therapy, astragalus and Ligustrum lucidum, have been shown to activate immune cells. Licorice and Asian ginseng, which are present in many different types of Chinese herbal medicine, have diverse effects on the immune system, including stimulating effects. Green tea contains potent antioxidant compounds, which also may produce immune-stimulating activity; this is discussed elsewhere in this book (see "Coffee and Other Caffeine-Containing Herbs").
Some types of Japanese herbal medicine have immune-stimulating properties (see Table 4.2). Some of these mixtures also are used in Chinese
TABLE 4.2. Asian Herbal Medicine That May Stimulate the Immune System
Chinese: Asian ginseng (Panax ginseng) Japanese: Kakkan-to
Acanthopanax obovatus Kanzo-bushi-to
Angelica sinensis (dong quai) Shosaiko-to
Artemisis myriantha Artemisis annua
Astragalus (Astragalus membranaceus) Coix
Ge-gen-tang Green tea Licorice
Reishi mushroom (Ganoderma lucidum) Salvia miltiorrhiza
Shiitake mushroom (Lentinus edodes) Sophora flavescens Xiao-chai-hu-tang medicine; for example, the Japanese herbs kakkan-to and shosaiko-to are the same as the Chinese herbs ge-gen-tang and xiao-chai-hu-tang, respectively.
Toxic effects have been associated with the use of some types of Asian herbal medicine (Table 4.3); these effects are not specific to MS. These herbs should be used with caution. Serious toxic effects on multiple body organs have been associated with some of these herbs. T. wilfordii has caused stomach upset, infertility, and, on one occasion, death. Less significant toxicity has been observed with the regular use of licorice, which may produce high blood pressure and low blood levels of potassium. The use of ma huang (ephedra) has been associated with increased blood pressure, other dangerous cardiac and neurologic side effects, and, rarely, death. Due to safety concerns, the FDA banned the sale of ephedra products in the United States on December 30, 2003.
TABLE 4.3. Potentially Toxic Asian Herbs
Aristolochia fangchi Guiji
Baijiaolia Jin bu yuan
Caowu Ma huang (ephedra)
Datura preparations Tripterygium wilfordii
Fuzi Yangjinhua Guangfangji
Chinese herbal medicine should be obtained from a trained herbalist. Monthly costs are approximately $20 to $60.
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