| 1 Summary of Literature ReviewMultiple sclerosis (MS) is an autoimmune disease which is characterized by demyelination in white matter lesions of central nervous system (CNS) and occurrence in the role of the genetic susceptible individual and environmental factors. The Clinical process of MS is varied, relapsing and remitting is the symptoms of most patients who suffering from MS, there are somebody has rapidly progressive, the disease eventually will lead to nervous system disability, then bring a heavy financial and spiritual burden to society, families and individuals, so it makes a great concern.Since the 19th century, Ollivier and Cruveilhier descripted this disease's features of clinical and pathological firstly, the researchers had done a lot of researches about MS. However, the exact pathogenesis is still not fully identified yet. The present study supports in the occurrence of the disease is under the joint action of various factors, lead to the destruction of blood-brain barrier, inflammatory infiltration and axonal damage and other auto-immune attack, which eventually brought about the demyelination. Most researchers thought that the cause of the MS was the increased Thl lymphocyte. The CD8+T and CD4+T lymphocyte also play an important role in the MS.Based on different pathogenesis theory, the treatments of multiple sclerosis of western medicine are varied, for example:hormones, immunosuppressive agents, stem cell transplantation, plasma exchange, but no specific treatment.There isn't the name of "multiple sclerosis" in Chinese medicine. This disease, according to the clinical manifestations, can be divided into an "hemiplegia after apoplexy ","Atrophy syndrome", "hemiplegia", "Vertigo", "bone forced labor", "gradual loss of vision without apparent cause ", " Bringing the faint vague vision" diseases, such as the scope.Based on the lack of blood and qi, organ dysfunction, this disease occurred by the internal and exogenous factors, excessive or insufficient. 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.According to reports, traditional Chinese medicine showed a certain effect in improves symptoms and signs of the disease.2 BackgroundThe Asian MS patients are more easily damaged with spinal cord and optic nerve, which leading to disability and visual impairment are more than western. The re laps ing-remit ting (RR) MS is more than 85%of the total number, and there is no fundamental solution, so how to prolong the remission time has become an important problem needed to resolve in nowadays.This topic is my teacher, the chief physician Li Tao's experience coming from years of treatment for MS, observing the traditional Chinese medicine (TCM) effect to the relapse and immune status of MS patients.3 Objects and methodsThere are 64 patients came from the hospital wards and outpatient neurology clinic of Xiyuan Hospital and Tongren hospital. The diagnostic criteria for multiple sclerosis in 2010 under the revised McDonald criteria, RR-MS. Inclusion criteria:1) Age 18-75 years old, both men and women; 2) with multiple sclerosis; 3)with RR-MS. Exclusion criteria:1) In addition to optic neuritis of multiple sclerosis and other demyelinating disease; 2) within six weeks used immunosuppressant therapy; 3) a serious mental illness who do not meet the clinical investigation; 4) At the same time, other researchers. The syndrome differentiation criterion referred to the Diagnostics in TCM.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 level of T lymphocyte subsets at the right time. The data was managed and analyzed with SPSS 17.0 software.The TCM group has 33 patients, who followed the doctor's orders to take TCM; control group of 31 who have never used TCM for the 13 patients, and 18 patients in the course of the disease using the TCM occasionally, the time of they used the TCM is less than their own average recurrence interval of 1/4.In acute period we adopt hormone therapy or gamma globulin therapy, in clinical stabilization period the TCM group used pure TCM, the control group without medication or treatment with immunosuppressive agents. The composing of Formula:Rhizoma Atractylodis Macrocephalae 15g, Radix Bupleuri 12g, Radix Paeoniae Alba 15g, Radix Paeoniae Rubra 15g, Radix Angelica 15g, Smilax Glabra 15g, Radix Glycyrrhizae 6g, Fructus Aurantii 12g. And add or subtract some TCM according patients'symptoms. One doses a day, and takes it twice a day.4 Results4.1 In general33 cases of TCM group, male 7 cases, female 26 cases, male to female ratio is about 1:3.71; the control group 31 cases,5 cases of men, female 26 cases, male to female ratio is about 1:5.2.The initial onset age of the patients was from 22 to 72 years old, and the average age is 40.47 years old. TCM group:there are 9 cases from 30 to 39 year-old,9 cases from 40 to 49 year-old,5 cases from 50 to 59 year-old, average 41.91 years old. The control group:there are 9 cases from 30 to 39 year-old,13 cases from 40 to 49 year-old,2 cases from 50 to 59 year-old, average 39.03 years old.The disease time:In TCM group, who less than 5 years, accounting for 66.7%. In the control group, who less than 5 years, accounting for 61.3%.According to the investigation, the most common symptom of neural dysfunction is numbness of the limbs, accounting for 62.50%; second is limb weakness or sensory dysfunction, respectively accounting for 51.56%; it's relatively less common to pain of eyes, accounting for only 7.81%.There are three symptoms with their frequency above 50%, which are depression (67.19%), lassitude (59.38%), weakness at waist and knees (51.56%).4.2 Recurrence intervalMake Chi-square test to the recurrence time of patients between the TCM group and the control group, there is significant difference, P<0.05. Make Independent-sample t-test between the interval of recurrence of two groups show significantly different (P<0.05).There were 16 cases in the TCM group, whose course of taking herbal medicine surpassed the past average interval of recurrence. Make paired t-test to the interval of recurrence between 16 cases of no treatment and the very cases after they accepted herbal medicine treatment, the relapsing time decreased after treatment of herbal medicine and there were significant differences compared with no treatment (P<0.05). The other 17 cases 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.4.3 Stage and drugMake ANOVA test to T lymphocyte subsets in different stages of MS, there is no significant difference, P>0.05.To observe the effect of TCM, TCM group were selected according to the following criteria:1) blooding before hormone treatment; 2) review intervals less than 3 months; 3) in clinical stabi lization period without immunosuppressive agents, hormones. We select 20 patients about 52 cases to be analyzed.Make paired t-test to T lymphocyte subsets between cases of no treatment and the very cases after they accepted herbal medicine treatment, the value of Thl 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.Through the classification of the frequency statistics about the TCM, found the medicine we often used are white peony root (89.27%), licorice (89.27%), Atractylodes (86.44%), Citrus Aurantium (78.53%), Bupleurum (74.58%), Smilax Glabra (71.19%), red peony root (64.97%), the system monkshood (62.15%), etc. From that, we also found there are three prescriptions we used to cure the MS, they are Xiaoyaosan for syndrome of depression of liver and deficiency of spleen, Bazhentang for syndrome of asthenia of both the blood and qi, Sinisan and Zuoguiwan for syndrome of yang hyperactivity and yin deficiency.There is a special drug, Radi x Aconiti Lateral isPreparata. It appears in all types, even someone who did not have the symptom the drug adapted. Therefore, make paired t-test to theThl declined between cases of no treatment and the very cases after they used this drug, the result show there is statistical differences, P>0.05.The three most commonly used drugs for addition according to different neurological deficits:limb weakness mainly used Radix Aconiti Lateralis Preparata (64.55%), Radix Clematidis mainly for a sense of belted (62.20%), Radix Sileris mainly for limb numbness (60.81%).5 DiscussionsThree syndromes, from more to less, respectively:syndrome of depression of liver and deficiency of spleen, syndrome of asthenia of both the blood and qi, syndrome of yang hyperactivity and yin deficiency.Vertical control and parallel control are indicative of TCM can prolong remission period of multiple sclerosis. Make Chi-square test and found that the frequency of recurrence in the two groups have significant difference (P< 0.05). This phenomenon shows that TCM can reduce relapses.Differential Treatment can make Thl down. Combined with modern pharmacological studies, Radix Aconiti Lateralis Preparata, Radix Clematidis, Radix Si leris have different effects on neurological deficit.Make paired t-test found TCM can decline Thl, to improve T cell immunity, thereby prolonging remission period of MS. TCM can improve symptoms, but quantitative discussion is difficult, therefore only select the more specific to analysis. The study found Radix Aconiti Lateralis Preparata can improve T cell immunity.In summary, this subject shows the TCM and Radix Aconiti Lateralis Preparata can prolong the remission period of MS, but there are still many issues:1) limited to a lower incidence of the disease, especially in China, the number of cases collected less than normal, the number of years observed also shorter, although TCM can prolong remission period, if it can reduce the relapse frequency, need further study; 2) the specific role of TCM in the treatment is not clear, and whether any other drug also can affect the T cell? 3) in the cours, which Radix Aconiti Lateralis Preparata make Thl decline, whether other drug involved? If we used Radix Aconiti Lateralis Preparata alone, can achieve this effect?... |
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