| The review of multiple sclerosis in modern medicineMultiple sclerosis(MS)is an autoimmune diseases which is characterized by demyelination in white matter lesions of central nervous system (CNS) and occurrence in the role of the genetic susceptible in-dividual and environmental factors, and the exact pathogenesis is still not fully identified yet. Most researchers thought that the cause of the MS was the increased Th1 lymphocyte which was caused by the imbalance of Th1/Th2. The CD8+T lymphocyte also played the pathogenic role in the MS. CD4+T lymphocyte, Th1, CD8+T lymphocyte play the promoter action to disease, Th2, CD4+CD25+T lymphocyte play the suppressive action to disease.MS is divided into five types:relapsing-remitting(RR), secondly-progressive (SP), primary progressive(PP), progress relapsing(PR) and the benignity. RR-MS is the most common type. According to the phase of the disease, MS was divided into the acute period or the aggravating period,the chronic progressive period,the relapsing remitting period and the clinical stabilization period.The treatment should block the way of the pathological immune response of T lymphocyte, adjust the balance of Th1 and Th2, in order to control the acute attack, prevents the recrudescence and progress. The later period adopts just right for the illness and the support therapy, relieving patients'pain. The main current trentments are glucocorticoid, Immunoglobulin and immunosuppressive agents in acute phase, and the effect is well. and interferon is used in the ease period, whose further effect is uncertain. But the side effect of glucocorticoid and immuno-suppressive agents are many, and some medicines are expensive, which all limit its clinical use.The review of multiple sclerosis in Chinese medicine There isn't the name of "multiple sclerosis" in Chinese medicine. Combining the clinical practice, the disease occured in the "brain and marrow", Atrophy syndrome has more objective evidence.So far, the recogination of TCM to the etiology and pathogensis of MS is limited to individual thought. In a word, it can can be summerized as theory of exogenous pathogenic and internal injury, sthenia in extrinsic and asthenia in intrinsic.mutual consumption of yin and yang, as well as theory of heat rentention causing by phlegmatic hygrosis.This disease has not yet been promulgated uniform standard of syndrome, clinical reported that there are generally syndrome of asthenia of both the blood and QI, asthenia of both the spleen and kidney, wind and wet stasis in collaterals, sputum stasis in meridians and collaterals, immersing by heat and wet, paralysis by stasis of wind and sputum, blood stasis obstructing the collaterals, QI asthenia causing blood stasis, asthenia of both the liver and kidney, asthenia of the kidney-YANG, hyperactivity of YANG due to YIN deficiency, full of sputum and wet, asthenia of both YIN of the liver and kidney with internal heat and sputum stasis, QI asthenia causing blood stasis, QI asthenia causing obstruction in the collaterals. In which, asthenia of both the spleen and stomach and asthenia of both YIN of the liver and kidney were the most common syndrome.According to the diversification of syndrome, the treatment is also various. It was said that the treatment of MS in the Chinese medicine or in the Cooperation of Chinese and Western medicine can improve the symptoms, extend the remission period, and reduce the side effects of west medicines. And had significant superiority than the groups of no treatment or pure western medicine treatment. But the evaluation standard of the most clinical effect report was not objective and not unified; the cases are few; the viewing time is short, which is insufficient regarding the observation of Chinese medicine's further effect; randomization, the comparison and the blind method was few reported. These all reduce the confidence level about the effect of Chinese medicine or the Cooperation of Chinese and Western medicine.BackgrondMultiple sclerosis is an autoimmune diseases which is characterized by demyelination in white matter lesions of central nervous system. RR-MS is the most common type. After many time's recrudescence, the neural dysfunction get worse and worse, Reducting the patients'life quality. RR-MS can change into SP-MS,25 years later since first attack,80% of the patients will change into this type, the condition will aggravate gradually and no longer alleviate. Therefore reduce the recrudescence is the key point and the difficuly of the current's treatment.It was said that the treatment of MS in the Chinese medicine or in the Cooperation of Chinese and Western medicine can improve the symptoms, reduce the recrudescence, and relieve the side effects of west medicine.This topic use the Yiqi jieyu Formula which is my teacher, chief physician Li Tao's experience Formula coming from years of treatment for MS, Observeing it's effect to the recurrence and immune status of MS patients.Objects and methodsThere are 41 patients who came from ward and outpatient of neurological department in Xiyuan Hospital. The diagnostic criteria was according for the McDonald criteria revised in 2005. The select criteria: (1) Age from 18 to 72, both men and women;(2) with multiple sclerosis diagnosis. The exclusion criteria:(1)Other demyelination diseases except MS;(2)Have received immunosuppressant therapy within six weeks;(3)Severe psychiatric disorder, so as to cannot cooperate with investigation;(4)Participanting in other researchs at the same time. The syndrome differentiation criterion referred to the Diagnostics in TCM. In order to observe the immunity change under the influence of Yiqi jieyu Formula, we divided MS into acute period in which accepted the glucocorticoid therapy less than a month; under-glucocorticoid period which between more than a month's glucocorticoid therapy and less than a month after the therapy's suspending; and the clinical stabilization period in which suspended the therapy more than a month.After asking the patients some questions, we filled in the questionnaire. The questionnaire consists of neural dysfunction, accompanied symptoms, tongue and pulse condition, etc. And tested the leval of T lymphocyte subsets at the right time. The data was managed and analyzed with SPSS 17.0 sofeware.Treatment:In acute period we adopt glucocorticoid therapy with Chinese medicine, and pure chinese medicine in clinical stabilization period. The composing of Yiqi jieyu Formula:Radix Astragali Hedysari 30g, Rhizoma Atractylodis Macrocephalae 15g, Radix saposhnikoviae 10g, Radix Bupleuri 12g, Fructus Aurantii 12g, Radix Paeoniae Alba 15g, Radix Glycyrrhizae 6g. And add or subtract some Chinese medicine according patients'symptoms. One dose a day, and take it twice a day. When the patients get better, we can reduce the dose properly.Results1 Generally contentsSex ratio:there were 8 males and 33 females, and the ratio of male to female is 1:4.Age structure:the initial onset age of the patients was from 20 to 72 years old, and the average age is 38.8 years old. There are 17 cases from 41 to 50 year-old,14 cases from 20 to 40 year-old,7 cases from 31 to 40 year-old,5 cases from 50 to 60 year-old, and 2 cases more than 60 year-old. The course of disease and the situation of visiting the doctor:The course of disease in this group was from 2 months to 24 years, and the average course was 6.0958±4.52413 years. There were 24 cases in good compliance and 17 cases in poor compliance.2 Symptoms of MSAccording to the investigation, the most common symptom of neural dysfunction is numbness of the limbs, accounting for 71.8%; paresthesia accounts for 64.1%;while asthenia of limbs, zonesthesia and visual deterioration are also common symptoms, accounting for 46.2%,35.9%,51.3%respectively.It's relatively less common to see blurred vision and pain of eyes in neural dysfunction, which respectively account for only 10.3%,0%. There are 3 symptoms with their frequency above 50%, which are lassitude, weakness at waist and knees and dreaminess;and 4 are between 40-50%, which are disturbed, scared of cold, laziness to speak and forgetfulness;7 are between 30-40%, which are respectively early to awake, depressed, light color of lips and nails, slight sleep, trembling, dryness of mouth and thoat, as well as chest distress. High occurrence of the signs of tongue are light in color (56.4%), thin white coated (74.4%), mediate in size accouting for the majority (53.9%), and fat tongue body with indentation are also have a high frequency. in total there are 11 kinds of pluse, with wiry pulse and deep thin pulse are the most common to see.3 The distribution of symptom type of MSWe divided 39 cases of MS patients according to their symptom differentiation, among which 15 cases are depression of liver and deficiency of spleen,9 cases yang hyperactivity and yin deficiency, 6cases qi deficiency,7cases deficiency of both qi and yin, as well as 2 cases are deficiency of kidney essence.4 The relation among stages of MS, syndromes and T lymphocyte subsets 1) Make Chi-square test to the syndromes distribution in different stages of MS, the syndrome distribution of liver depression and spleen deficiency was different in different stages of MS, P<0.05, and was most in the clinical stabilization period. The other syndromes distribution had no significant differences among groups, P>0.05.2) Make ANOVA test to T lymphocyte subsets in different stages of MS, CD3+T lymphocyte was different in different stages of MS (P< 0.05), and the value was highest in acute period; The other T lymphocyte subsets had no difference among groups (P>0.05).3) Make ANOVA test to T lymphocyte subsets in different syndromes of MS, there were no significant differences in different syndromes of MS (P>0.05).5 The effect of herbal medicine to T lymphocyte subsetsMake paired t-test to T lymphocyte subsets between cases of no treatment and the very cases after they acceptted herbal medicine treatment, the value of Th1 declined after herbal treatment and there were significantly difference compared with no treatment (P<0.05); The other T lymphocyte subsets showed no statistical differences.6 The change of recrudescence6.1 There were 11 cases in good compliance whose course of taking herbal medicine surpassed the past average interval of recurrence. Make paired t-test to the interval of recurrence between 11 cases of no treatment and the very cases after they acceptted herbal medicine treatment, the relapsing time decreased after treatment of herbal medicine and there were significant differences compared with no treatment(P<0.05).6.2 The other 13 cases in good compliance had not relapsed since receiving the treatment of herbal medicine, but the course of taking herbal medicine is shorter than the average interval time, and these cases are being observed. 6.3 There are 17 cases in poor compliance, and these cases will not be studied for the effect of herbal medicine treatment.Discussions1 The distribution of symptom type of MSIn this investigation, the proportion of liver depression and spleen deficiency syndrome was most. But literature search reported that asthenia of both the spleen and stomach and asthenia of both YIN of the liver and kidney were the most common syndrome. The difference may come from the different appreciation to the syndrome.2 The relation among stages of MS, syndromes and T lymphocyte subsets1) The syndrome distribution of liver depression and spleen deficiency was different in different stages of MS, P<0.05, and was most in the clinical stabilization period. This result was consistent with the character of MS, the disease recrudesce once by once, the neural dysfunction get worse and worse, The patients was anxious and depressed because of a long time's disease.2) In this investigation, we can conclude:CD3+T lymphocyte had some relative with the stages of MS, and the value was highest in acute period; But literature search reported that the pathogeny of MS is due to imbalance of Thl/Th2, and the Thl value was highest in acute period. In this investigation, the value of Thl in acute period was higher than the value in the clinical stabilization period, but there were no significantly difference between two groups. The cause of the difference may due to:1. the cases were few, especially in acute period; 2. the value of T lymphocyte subsets was interfered by glucocorticoid. Therefore we should confirm the results in future in the condition of more patients and test the T lymphocyte subsets in the proper time.3) There were no significant differences among T lymphocyte subsets in different syndromes of MS. 3 The effect of herbal medicine to T lymphocyte subsetsThe value of Thl declined after herbal medicine treatment and there were significantly difference compared with no treatment (P<0.05). we can conclude:Yiqi jieyu Formula coule reduce the value of Th1, while the decline of Thl is the sign of recovery. In view of neural dysfunction can hardly get better, Thl could be adopt as an sign to observe the efficiency of herbal medicine treatment.4 The effect of herbal medicine to recrudescenceThere are 11 cases in good compliance whose course of taking herbal medicine surpass the past average interval of recurrence. the relapsing time decrease after treatment of herbal medicine and there are significant differences compared with no treatment(P<0.05). we can conclude:Yiqi jieyu Formula has the possibility of reducing the relapsing time, and this result is very excited.Yiqi jieyu Formula coule reduce the value of Thl and adjust the abnormal immunity. It may be the very cause to reducing the relapsing time.In a word, reducing the relapsing time is the most important in the treatment of multiple sclerosis. We can conclude in this investigation that Yiqi jieyu Formula coule reduce the value of Thl and reduce the relapsing time, and accordingly decrease the disability and neural dysfunction, improve the life quality of MS patients. The herbal medicine have less side effects, lower price and can be used widely, it will be a new and exciting method to treat MS. However, due to the limited time and the relatively low incidence of the multiple sclerosis, the cases were few; And because of the long period of treatment and poor compliance, there were great difficulties in the study of this subject. Due to few cases in this subject, and that we adopted self-control study, the results need to be confirmed by further accumulation of cases. |
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