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Multiple Sclerosis : Treatment
   
Western Medicine Chinese Medicine

Most difficult for multiple sclerosis patients is the uncertainty. What will their clinical course be? How will their illness affect their family? Will they be able to work? Are the current treatments helpful? Anytime they do not feel well, is it the multiple sclerosis or something else? Obviously, the mainstay of treatment is addressing these issues with support and education. This is often accomplished with the greatest success by multiple sclerosis centers, which affords "one-stop shopping" with the opportunity for patients to relate to peers, psychologists, psychiatrists, social workers, physical therapists, nurses, neurologists, and when necessary, other medical specialists and attorneys expert in the problems of those with chronic illness.

The treatment of acute relapse
Since spontaneous recovery after follows a relapse, treatment is not required for every exacerbation. Corticosteroids shorten the duration of relapse and have few complications, even when multiple courses have been administered.

The treatment of symptoms
The most common problems associated with multiple sclerosis are psychiatric. By being multidisciplinary and involving a peer group, multiple sclerosis centers can serve a major role in the management of these problems. Anxiolytic and/or antidepressant medications are occasionally required.

Spasms are the other common and troubling sequelae of this disease. Spasms, more frequent at night, often respond to a benzodiazepine at bedtime. Weakness and spasticity contribute differentially to immobility in-patients with multiple sclerosis. The relief of spasticity can aggravate weakness and paradoxically reduce mobility, since patients may depend on increased muscle tone in order to stand. Spasticity is often treated with baclofen. Maintenance physical therapy programs may help in the treatment of both.

Bladder dysfunction can be characterized as failure to store or failure to empty. Failure to store is treated with anticholinergic agents (oxybutynin or propantheline) Failure to empty is treated by intermittent self-catheterization, which is easily adopted by motivated patients with adequate vision and arm function, and ensures complete bladder emptying. Symptomatic bacterial infection requires specific antimicrobial treatment.

Influencing the course of multiple sclerosis
Interferon beta is the only treatment demonstrated to alter the natural history of multiple sclerosis. Drawbacks are every-other-day injections and substantial side effects, rather like flu, resolving over weeks. Ambulatory patients with exacerbating remitting disease have the burden of their disease decreased by one-third after five years of treatment.
 

TCM's experience with multiple sclerosis (MS) indicate that therapeutic strategies for individuals undergoing a MS relapse or those who are newly diagnosed, should focus on releasing the body surface, expelling wind, clearing heat, resolving phlegm, activating blood and unblocking the meridians. In the late stages or the remission period, strategies should focus on fortifying the kidney, replenishing essence, soothing the liver, nourishing the blood, supplement qi (vital energy) and reinforcing spleen. Nevertheless, it is recommended that treatment be based on syndrome differentiation.

Meridian obstructions by phlegm and heat
Therapeutic aim: Clear heat, resolve phlegm, smooth and unblock meridians
Sample prescription:Cleansing Phlegm Decoction (Di Tan Tang)

In the prescription, pinella and arisaema are the main ingredients for cleansing the phlegm. The others work together to clear heat, replenish qi and enhance spleen, so that meridian flows are smoothed, and orifices in the head region can be unblocked. Symptoms like dizziness, speaking difficulty, numbness and weakness in the limbs can be relieved.

Damp-heat dissemination
Therapeutic aim: Clear heat, resolve dampness and strengthen joints
Sample prescription:Modified Two Wonders Powder (Jia Wei Er Miao San)

In the prescription, coix seeds, atractylodes rhizome and Corktree bark are the main ingredients for clearing damp-heat. The others activate blood flow, strengthen tendons and bones. As a result, problems in the limbs can be relieved.

Blood stasis accumulated in meridians
Therapeutic aim: Replenish qi and blood, and activate circulation.
Sample prescription: Sacred Healing Decoction (Sheng Yu Tang)

All the above ingredients are used for enriching the qi and blood as well as promoting their circulations. As a result, signs such as weakness or abnormal feelings caused by stagnated condition can be resolved.

Deficiencies in the lung and spleen
Therapeutic aim: Consolidate qi, invigorate the spleen and stomach.
Sample prescription:Power of Gingeng, Poria and Atractylodes (Seng Ling Bai Shu San)

In the prescription, ginseng, atractylodes and poria are the main ingredients for invigorating the spleen and replenishing qi. Hyacinth bean, lotus seeds, coix seeds and yam can expel the accumulated dampness effectively; together with cardamom seeds, balloonflower and liquorice, the qi flow can be consolidated. As a result, both of the spleen and lung are fortified.

Deficiencies in the kidneys and liver
Therapeutic aim: Invigorate liver and kidney, nourish yin to clear heat.
Sample prescription:Modified Zuogui Drink

In the prescription, the cornus fruits, dodder seeds, achyranthes and tortoise shell tonify and nourish liver and kidney; the deerhorn replenishes essence and promotes marrow production; the anemarrhena rhizome and corktree bark nourish yin and clear virtual heat.

Depletion in kidney yang
Therapeutic aim: Warm and invigorate the kidneys, replenish essence and marrow.
Sample prescription:Modified Erxian Decoction plus Yougui Drink

In the prescription, the epimedium, eye-grass rhizome, morinda and monkshood can warm kidney and replenish essence; the rehmannia rhizome, cornus fruits and eucommia bark nourish yin and tonify the kidneys which will benefit kidney yang; Chinese angelica nourishes blood; deerhorn glue replenishes essence and marrow.

Acupuncture therapies for multiple sclerosis

During the remission period, the recovery process in MS individuals may take months or even years. Acupuncture not only eases the suffering of patients, it can also stimulate the overall modulation system and speed up the healing process.

Physicians usually focus on the head region during treatment, such as bai-hui, qu-bin, shuai-gu, feng-chi and yu-zhen. They choose one side for stimulation and then carry out the procedure on the opposite side. Needles should be retained for 30 minutes each time, and the procedure should be carried out once a day. After 10 days, there should be a 3-day rest period and then another cycle should take place. Below are the selected acupoints for relief of symptoms:

Acupoints in the head

Paralysis in the upper limbs: jian-yu, qu-chi, wai-guan, he-gu, shou-san-li;
Paralysis in the lower limbs: huan-tiao, bi-guan, feng-shi, zu-san-li, yang-ling-quan, san-yin-jiao, xuan-zhong, kun-lun, mai-bu;
Speaking difficulties: lian-quan, he-gu, tong-li, ya-men;
Dysphagia: tian-tu, lian-quan, fu-tu, feng-chi, he-gu;
Urinary retention or incontinence: guan-yuan, qi-hai, zhong-ji, shen-shu;
Constipation: zu-san-li, yang-ling-quan, tian-shu, da-chang-shu, zhong-wan;
Blurred vision: jing-ming, tai-yang, guang-ming;
Facial distortion: yi-feng, xia-guan, di-cang joined jia-ju.

Acupoint injection

Herbal infusions can be injected at selected points so as to exert stimulating and pharmaceutical effects. Selection of these points are based on the particular manifestations of MS; however the acupoints are usually in the lower limbs, such as fu-tu, bi-guan, zu-san-li, cheng-shan, yang-ling-quan and yin-ling-quan. Some of the herbal injections include Chinese angelica, red sage root and safflower flower. Every two days, 0.5-1.0 ml of diluted herbal infusion should be injected at 2-3 selected points, 5-7 injections for one cycle.

Chinese safflower

Physical therapies

Individuals will remain unsteady and clumsy in their movements or suffer from paralysis to a certain extent when they enter the remission period, therefore, proper physical exercise helps to improve muscular strength, prevent atrophy and stiffness or relieve the muscle spasm. It would be beneficial to choose some traditional self-practice exercises. TCM massage is another alternative, which has some set procedures, for example:

Upper limb weakness: grasp the tendons in the shoulder region, twist and knead the lateral side of the arm, and then strike on acupoints like jian-yu, he-gu and qu-chi.

Lower limb weakness: grasp the medial aspect of the upper thigh, calf of the lower leg and heel tendon, twist and kneed around the upper tight, and then strike on acupoints like yang-guan, huan-tiao, jie-xi and du-bi.

Hydrotherapy

Hydrotherapy is the use of water to treat disease, alleviate pain, induce relaxation, and maintain general good health. For therapeutic purposes, the water may be warm or cold, or in the form of ice or steam. This method is used to relax muscles and joints, soothe anxiety, relieve stress, and enhance mobility. It can be achieved through swimming, underwater exercise, or warm baths in a darkened room that helps individuals to focus on breathing exercises and other pain-control methods. Herbal washing or bathing are combined in some centers.