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CHINESE HERBAL TREATMENT FOR MULTIPLE SCLEROSIS

AND OTHER FLACCIDITY SYNDROMES, INCLUDING MYASTHENIA GRAVIS AND AMYOTROPHIC LATERAL SCLEROSIS.
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

A NEW DISEASE Multiple sclerosis (MS) is a modern disease. It may have occurred in earlier centuries, but theoretical and dia nostic limitations made it impossible to clearly de!ine this disease. "he earliest recorded medical discussions o! MS are at the end o! the last century, and it is di!!icult to trace potential cases o! the disorder more than a !e# decades be!ore that. "he use o! $sclerosis% in the disease name is in re!erence to the scarrin o! the nerves (!ormation o! pla&ues, #here myelin no lon er !orms) o! the central nervous system ('NS) that results !rom in!lammation and subse&uent destruction o! their myelin sheaths. "he detection o! demyelination in livin persons re&uires the most modern o! medical techni&ues. (ntil the development o! ma netic resonance ima in (M)I) in the early *+,-.s, con!irmation that a person su!!ered !rom MS had to a#ait autopsy, thou h the disease could be uessed #ith some reliability by a comprehensive description o! its course and mani!estations. /ne test, the hot bath dia nostic procedure, #as used !or about !i!ty years (until M)I became prevalent)0 persons #ith MS #ould usually display more severe symptoms a!ter e1posure to a hot bath. "he onset o! the disease is insidious and its course is hi hly variable over time. In some cases, minor neurolo ical disturbances precede the more characteristic !lare2ups (called e1acerbations) by several years. Symptoms may be &uite di!!erent amon individuals. Wea3enin o! the le s, bladder, and colon4muscles in the lo#er body4 are common, but so are mental !o iness and optic neuritis4indicatin brain dama e. "he term 5multiple. is used because many nerves are a!!ected, but the disease mi ht sho# evident impact on only a sin le muscle roup durin the !irst years o! development. Even #ith modern technolo y, a !irm dia nosis o! MS is not easily established by physicians until it has reached a some#hat advanced sta e4 sometimes a decade or more a!ter the onset o! troublesome symptoms. "he avera e a e at dia nosis o! MS in the (.S. is about 6*. IMM(N/7/8I'A7 NA"()E /9 ":E DISEASE

An e1tensive revie# o! the immunolo ical disturbance in MS #as presented by ;yron Wa3sman o! the Ne# <or3 chapter o! the Multiple Sclerosis Society in *+,= (*). "he chronic nature o! the disease appears to be lin3ed to the presence o! a speci!ic ene belon in to the ma>or histocompatibility comple1 (M:') that results in susceptibility to the disease. Individuals #ithout this enetic bac3 round may su!!er !rom acute demyelinatin diseases (such as 8uillain2;arre syndrome) #ithout e1periencin relapse and pro ressive deterioration, as occurs #ith MS. /ther autoimmune diseases, such as insulin2dependent diabetes, myasthenia ravis, thyroiditis, and chronic ulcerative colitis, o!ten occur in the same individuals #ho e1perience MS, or in their parents, siblin s, or children, as a result o! the enetic bac3 round that predisposes the individual to autoimmune disease. "he child o! a parent that has MS has about a ?- times hi her ris3 o! developin MS than others (@). MS is a rare disease in 'hina, Aapan, and other parts o! Asia. Similarly, the disease is not !ound amon A!rican blac3s (but is !ound amon a small proportion o! American blac3s #ho have 'aucasian ancestors), Es3imos, and several other population roups. It occurs #ith !airly hi h !re&uency in the 'aucasian population, #ith about BCD o! cases bein !emale (in 'hina, it appears that only about C-D o! cases are !emale). In the (.S., the incidence rate !or MS is estimated to be about -.-,E-.*@D o! the population (about @C-,---E6C-,--- cases at present), but it is about -.6E-.?D o! 'aucasian #omen over the a e o! 6-. "here are clear enetic in!luences not only on the incidence o! the disease amon races and #ithin !amilies, but also on the tendency to su!!er certain symptoms o! the disease. Di!!erences bet#een Aapanese and American patients in the main site o! attac3 a ainst the central nervous system have been noted0 C-D o! Aapanese cases o! MS involve the optic nerve and spinal cord only, and another 66D o! the cases additionally involve the cerebrumF amon Americans, the comparable !i ures are *6D and ==D, respectively. It is apparent that viruses play a role in both the development o! the disease and its !lare2ups. It has been proposed that durin an immune attac3 a ainst one or more o! the common viral in!ections, a "2cell line is established that, #hen activated, attac3s myelin, #ith myelin basic protein (;G) as one o! the 3ey sites o! attac3. "his may occur even i! the virus does not enter the nervous system (the primed "2cells !rom the peripheral blood can attac3 myelin so lon as the "2cell sur!ace receptor has a close enou h match to myelin ;G). A possible ris3 !actor !or developin the disease is late e1perience4close to time o! puberty4o! common childhood in!ections, such as rubella, measles, and mumps. Measles, in particular, appears to be an initiatin virus. It is possible, but not demonstrated, that immuniHation a ainst these childhood viral diseases may prevent them !rom actin as initiators o! MSF it is too soon a!ter the introduction o! mass immuniHations to tell the e!!ects (thou h #e should 3no# soon). Even so, other viruses may replace those mentioned above in the role o! MS

initiation. 9or e1ample, ::I2=, a herpes virus that causes the childhood disorder called roseola, and #hich may e1ist undetected in a lar e portion o! the population, appears to be involved in several other diseases and has been su ested to be one o! the potential culprits in MS, since the virus is !ound in the oli odendrocytes o! MS patients (6-). "he virus is !ound in the re ion o! the MS pla&ues but not the una!!ected parts. While ::I2= is !ound in persons #ithout MS, it is not !ound in the oli odendrocytes in other#ise healthy people. ::I2= in!ects both the "2cells, alterin their activity, and the central nervous system. 'NS in!ections #ith the virus are associated #ith multi!ocal demyelination and can produce a disease that appears identical to MS (6*). Interest in ::I2= has been stimulated by !indin s that it can co2 in!ect cells that are in!ected by human immunode!iciency virus (:II) and can activate replication o! that virus (it is thus called a transactivator). It is possible that ::I2= plays a role in MS in con>unction #ith other viruses. Interestin ly, the incidence o! MS is hi her (#ithin the 'aucasian population) in the !ar northern and !ar southern latitudes to#ards the earth.s poles. 9rom this observation, it has been su ested that #here one lives around the time o! puberty may be the 3ey !actor in disease initiation, as opposed to #here one lives #hen the disease mani!ests obvious symptoms. "he ris3 at puberty mi ht be related to ro#th o! the central nervous system and chan es in immune responses under the in!luence o! hormones durin that sta e o! development. "he uneven distribution o! MS cases around the #orld has been su ested to be related to e1posure to viruses or bacteria !rom animals, such as dairy co#s or do s (6). In one instance, islands in the North Atlantic that #ere !ree o! MS sho#ed a hi h incidence o! MS cases a !e# years a!ter army arrisons had been on the island !or a #hile, implicatin an in!ectious a ent carried by the army members or their accompanyin do s or other livestoc3. It has also been su ested that de!iciencies in certain nutrients (such as calcium, vitamin D, vitamin ;*@, selenium, and essential !atty acids) durin the development o! the nervous tissues may enhance ris3 !or su!!erin !rom MS (?). "he metabolism o! vitamin D and calcium are in!luenced by sun e1posure, and there can be dietary !actors in!luencin availability o! all these nutrients that may vary by location and culture. Durin the *+,-.s, some observers revived the earlier proposal that MS #as the result o! a spirochetal (bacterial) in!ection o! the 'NS. In part, this #as because o! the ne#ly identi!ied 7yme Disease, caused by a tic32borne spirochete, and it has a re ional occurrence (!avorin northern deciduous !orests) and autoimmune2li3e character (C). "he earlier hypothesis, proposed in *+-+ and considered a possibility throu h the *+C-.s, #as that MS mi ht have been due to another spirochete, the one that causes neurosyphilis, or one li3e it. "hus !ar, a bacterial in!ection has not been sho#n to be the immediate cause o! MS, but the several decades lon history o!

proposals that MS is initiated by an in!ection sho#s a consistent understandin that the disease is not solely based on enetics, climate, emotions, or other non2in!ection etiolo ies. ;y contrast, the neuromuscular 'harot2Marie2"ooth disease, #hich also causes #ea3enin and #astin o! the le muscles and, later in its development, other peripheral muscles, appears to be based primarily on enetic bac3 round. /nce "2cells aimed at myelin sheath sur!ace proteins have developed, later in!ections, not necessarily the same as the initiatin virus, can tri er a subse&uent !lare2up o! the autoimmune disease. Many patients observe a close connection bet#een e1perience o! in!luenHa or common cold and symptoms o! the disease, and this connection is documented (6@). It has been proposed that !lare2ups that do not appear to !ollo# an in!ection actually !ollo# either an in!ection that did not mani!est overt symptoms or activation o! a latent virus (such as one o! those in the herpes !amily) #ithout evident symptoms. A success!ul immune response to the in!ectious a ent may have prevented the symptoms !rom developin , but then continued on to attac3 the myelin. Not only viruses, but other types o! in!ections, such as bacteria or parasites, mi ht induce MS e1acerbations (=). Several viral and bacterial peptides have been sho#n to activate "2cells that #ere primed to attac3 myelin ;G. 'hronic sinusitis has been stron ly associated #ith MS, #ith the possibility that the sinus in!ection (#hich can be viral or bacterial) induces an immune response that eventually promotes the attac3 a ainst myelin. It has recently been su ested that the cyto3ine called tumor necrosis !actor ("N9) is associated #ith production o! multiple sclerosis symptoms (B). "his cyto3ine is !ound in the myelin lesions and cerebral spinal !luid o! MS patients. "N9, and other cyto3ines (e. ., interleu3ins *,?, and *-, and inter!eron amma) that mi ht act concurrently, are induced in several in!ectious and parasitic diseases. ::I2= is a po#er!ul inducer o! "N9 in peripheral blood mononuclear cells (?6). Inter!eron amma and "N9 slo# the suppression o! immune attac3. As a result, an immune attac3 a ainst a minor in!ection may be prolon ed until myelin is also attac3ed, and the action o! the cyto3ines may then prolon the MS e1acerbation. "he antidepressant dru rolipram is a "N9 inhibitor that has been su ested as a use!ul therapy !or MS (,)F several other dru s have been revealed to have anti2"N9 activity in recent years, includin 0 3etoti!en (used !or treatin asthma), thalidomide (a sedative), and pento1iphyllene (used !or treatin blood clottin in peripheral vessels)F some o! these could also be o! bene!it !or persons #ith MS (the selection o! dru s allo#s choice amon the primary indications !or their use). Inter!eron beta (provided as the dru betaseron), inhibits inter!eron amma and "N9 and aids the !unction o! suppressor "2 cells.

In the cerebral spinal !luid o! MS patients, it has been !ound that there is a si ni!icantly hi her level o! aldehydes, includin !ormaldehyde (66). "hese aldehydes can cause protein cross2lin3in (thereby ma3in the proteins physiolo ically inactive) and bloc3 nerve impulses. "heir action is more evident at hi her temperatures, #hich may partly e1plain the hot2bath phenomenon in persons #ith MS. "he hi h levels o! aldehydes may be associated #ith the observed phenomena o! reduced antio1idant activity in persons #ith MS, su estin a role !or o1idative stress in the susceptibility to or e1pression o! e1acerbations (6?). It has been proposed that #ea3enin o! the blood2brain barrier may permit easier access o! lo# density lipoproteins (7D7) and other substances to the cerebral2spinal !luid that ma3e the myelin more susceptible to o1idative dama e and immune system attac3 (6C). 7D7 tends to be hi h in persons #ho are physically in active and in those #ho consume lar e amounts o! saturated !ats. Accordin to this line o! thou ht, a ents that promote reater inte rity o! this barrier could slo# the pro ression o! MS by limitin inappropriate access to the nerves. Administration o! antio1idants, includin vitamin ', vitamin E, and lutathione have been sho#n to improve the antio1idant activity (6=), but have not yet been tested lon enou h to demonstrate an impact on the !re&uency, severity, or duration o! e1acerbations. In most cases, an in!ection (or other inducin a ent) initiates an autoimmune attac3 or enhances an on oin attac3 that produces notable symptoms. "hese symptoms may last !or a !e# days to a !e# #ee3s in the remittin type o! MS. Within a !e# days o! the immune activation, the natural re ulation o! the immune system4 #hich may be inhibited due to host !actors or the in!luence o! chronic viral in!ection 4produces a #ithdra#al o! the attac3, and there can then be recovery o! the dama ed nerves (#hich is &uic3er, as #ith other in>uries, #ith youth and ood nutritional status). With each e1acerbation (autoimmune attac3), there is local vascular in!lammation (in the area o! the 'NS), usually #ith severe local edema, !ollo#ed by demyelination o! the a!!ected nerves, resultin in scarrin i! the attac3 is su!!iciently severe (remyelination o! the nerves can occur i! there is limited dama e). Steroids administered at the onset o! an e1acerbation may reduce demyelination, but lon 2term administration o!!ers little bene!it. In persons #ho respond poorly to steroids, it is possible that processes other than immune attac3 and in!lammation, such as aldehyde !ormation and o1idative stress, continue to en!orce the nerve dama e. "he process o! demyelination is one o! the causes o! muscular #ea3enin or numbness0 nerve transmission via the a!!ected nerves is disrupted. Even so, areas o! pla&ues as seen by M)I, #hich represent essentially irreversible dama e, do not necessarily cause persistent inter!erence #ith nerve transmission. Some individuals sho# little or no symptoms even #ith e1tensive pla&ue !ormation, #hile others sho# si ni!icant impairment #ith little evidence o! pla&ues. "his is probably because there

are other mechanisms o! nerve inhibition and because the nervous system is sometimes able to develop alternative routes o! transmittin the essential in!ormation. :o#ever, once the dama e !rom repeated attac3s has reached a certain level o! severity, the disease mani!estation (e. ., muscular #ea3enin ) in most individuals becomes continuous rather than intermittent. 9urther, #hen a person is debilitated !or an e1tended period o! time, they may cease the attempt at movement and thus deprive the nervous system o! the stimulus needed to reroute si nals. "here are at least t#o types o! MS disease described by the course o! development. "he intermittent type (or relapsin 2remittin ) is one in #hich there are !lare2ups o! the attac3 a ainst myelin !ollo#ed by a period o! recovery, o!ten #ith several #ee3s, months, and sometimes years, be!ore the ne1t attac3. "he avera e rate o! e1acerbations durin the !irst years a!ter dia nosis is about *.@CJyear. In a !e# cases, the cycle o! attac3s appears to end spontaneously and there may be !e#, i! any, residual symptomsF the MS does not pro ress to a more serious or paralytic condition. "he pro ressive type usually !ollo#s a course o! steadily #orsenin debility, #here there may be only a !e# days o! relative relie!, !ollo#ed by continued pro ression o! the disease. "his type leads to severely impaired immobility and eventually to deathF !ortunately, it is the less common !orm. With current therapies that can bene!it persons #ith MS (#hen applied in a timely manner), the main lon 2 term problem may be deterioration o! health due to lac3 o! e1ercise, #ith accumulation o! secondary diseases. In sum, persons #ho e1perience MS usually have a enetic bac3 round that ma3es this particular disease more li3ely. "hey then e1perience an in!ection (or combination o! in!ections) that establishes the possibility o! autoimmune attac3s a ainst myelin. A combination o! other !actors then conver e to enable the disease process0 these may include nutritional de!iciencies, dama e to the blood2brain barrier, lo# antio1idant potential, and chronic 'NS in!ection. 9inally, the disease mani!ests in a series o! e1acerbations, usually induced by acute in!ections, turnin into a pro ressive, non2 remittin disease #hen and i! the immune system loses its ability to #ithdra# the antimyelin attac3 or #hen other processes (such as accumulation o! o1idiHed !ats) continue to dama e myelin. While this scenario may need to be updated some#hat as additional in!ormation is ac&uired, it is su!!icient to su est several methods o! therapy, some o! #hich have already provided help to persons #ith MS. ;e!ore turnin to the 'hinese medical analysis o! the disease, it is #orth mentionin some other diseases that have related characteristics. Since MS is not a !re&uent disease in 'hina, e1perience treatin several other disorders that have muscular #ea3enin and autoimmune processes in common, may help to add to our 3no#led e o! success!ul approaches. Myasthenia ravis (M8) produces symptoms o! muscular #ea3nessF li3e MS, it is insidious, variable, and potentially !atal (in the

pro ressive !orm o! the disease). M8 appears to be initiated by a virus, but the site o! attac3 by the activated "2cells is di!!erent than #ith MS4the acetylcholine receptors o! the nerves are a!!ected. "he motor neuron de enerative diseases also share some similarities #ith MS. In one, amyotrophic lateral sclerosis (A7S), the muscular #ea3ness usually be ins in the hands and spreads to the !orearms and le s. "his is accompanied by (and o!ten preceded by) spasms and increased tendon re!le1es. "he site o! autoimmune attac3 appears to be mainly the anterior horns o! the motor neuronsF the brain !unctions are not a!!ected. (nli3e MS and M8, it does not o!ten display e1tended periods o! remission, rather, it tends to pro ress rapidly, o!ten leadin to death #ithin CE= years. A more beni n !orm o! this disease is pro ressive spinal muscular atrophy, #hich causes muscle #astin and #ea3ness, but does not cause si ni!icant shortenin o! li!espan. ':INESE MEDI'A7 ":E/)IES In the most ancient 'hinese medical te1ts, and in many subse&uent #or3s, there are some re!erences to diseases #ith symptoms o! muscular #ea3enin . "hese are calledweizheng0 !laccidity syndromes. "here are !our basic causes o!, or contributors to, the development o! these syndromes0 *. A !everish disease (no# understood to be caused by an in!ection in most cases) dama es the nutritive essences that supply the muscles and tendons Knote0 in 'hinese traditional anatomy, the terms o!ten re!er to !unctions more than to isolated tissues. "he tendons $aid in controllin movements.%L @. /r an dys!unctions result in poor nutrition or in inhibited circulation, thus denyin nutrition to the destination tissues. 6. Spiritual e1haustion reduces the communication bet#een the mind and body, a!!ectin sensation, movement, and mental clarity. ?. Adverse dietary !actors can lead to #ea3ness o! muscles and la1ness o! tendons, and they can e1acerbate de!iciency o! essence. In the Huangdi Neijing Suwen, (+) the problem o! muscular !laccidity receives an entire chapter. "he basic ideas, lar ely retained since ancient times, have been elaborated recently in the Advanced Text !!" !# T$ad%t%!na& C'%ne(e Med%c%ne and P'a$)ac!&!*+ (*-). "he eneral problem is described as bein due to a disorder a!!ectin one o! the !ive internal or an systems ( zang). "hus, there are !ive types o! wei (!laccidity) syndromes. "hree o! these mi ht be o! interest in re ard to diseases such as M8, MS, and A7S.

Maiwei (vessel !laccidity, associated #ith the heart system) is described as muscular atrophy and debility o! the lo#er limbs caused by patholo ic heat o! the heart, $empty% blood vessels, and malnutrition o! the muscles o! the lo#er limbs. Rouwei (muscle !laccidity, associated #ith the spleen) has symptoms includin sensory disturbance o! the s3in, and atrophy, !laccidity, and debility o! the muscles. "he syndrome is due to patho enic heat and dampness invadin the spleen #ith impairment o! stomach yin. uwei (bone !laccidity, associated #ith the 3idney) is caused by severe e1haustion o! 3idney yin and essence #ith accompanyin de!iciency !ire that causes atrophy and !laccidity o! the muscles o! the lo#er limbs and #ea3ness o! the spine that ma3es it impossible !or people to support themselves in an upri ht position. "he modern te1ts ma3e some sli ht rearran ements o! the cate ories, !or e1ample0 liverJ3idney #ea3ness is presented as a sin le cate ory, rather than t#o cate ories. A combination o! the liverJ3idney and spleen types is probably closest to depictin MS and other neuromuscular disorders that a!!ect the lo#er limbs !irst. "he wei syndromes #ere described as bein initiated by patho enic heat (or damp2 heat, the combination o! t#o adverse in!luences) and display their symptoms o! muscular #ea3enin as a result o! !luid and nutrient de!iciency (e. ., lun !luid dryness, empty blood, stomach or 3idney yin de!iciency). "he t#o other wei syndromes, a!!ectin the tendons (liverF causin contracted li aments) or the s3inJhair (lun F causin crac3ed and brittle s3in, paralysis o! e1tremities), are also thou ht to be initiated by heat !ollo#ed by impairment o! !luids. "heNeijing emphasiHes that lac3 o! nourishment in the channels (meridians) and in the muscles is the principal cause o! the !laccidity. "he 'hinese concept o! nourishment is broader than that identi!ied in modern terminolo y as essential !ood components, because it includes several o! the metabolic products o! the !ood components (!or e1ample, hormones enerated !rom precursors) and their entry into destination tissues (promoted by local microcirculation). "o remedy the problem usin acupuncture (the main therapy mentioned in the Neijing), one toni!ies the de!iciency by usin the sprin points ( rong) on the meridians and promotes the !lo# o! nutrients and ener y throu h the meridians by treatin the stream points ( shu)0 $"his !orti!ies the de!icient, and restores order to #hat is rebellious.% "he traditional means o! treatin !luid impairment is to nourish blood and essence. "here are several herbs classi!ied as blood and essence tonics. In addition, &i tonics #ill help enerate the essential !luids !rom !oods. 'onnectin to the Western conception o! the disease, the initiatin in!ections !or MS and !or its e1acerbations may involve a !ebrile syndromeF the imbalance that results mi ht be destruction o!

!luids (the myelin sheath bein a !luid !atty membraneF its &uality is similar to that o! essenceF the brain and spinal cord are understood, by the concepts o! traditional 'hinese medicine, to be an e1tension o! the 3idney system, the storehouse o! the essence). An alternative traditional description o! !laccidity syndrome4#ith similar conclusions4in presented in an article about treatin one patient #ith MS (**). "he doctors, Mhou and 7u, pointed out that ancient scholars believed the loss o! sensations, one o! the common MS symptoms, is related to the !o (primitive instinctF one o! the $souls% described in 'hinese medicine). "he !o is overned by the spirit (shen) #hich subsists on the essence ("ing). Nuotin !rom the Huangdi Neijing Lingshu0 $"he !o enters and e1ists #ith the essence...spiritual e1haustion scatters the soul and the !o.% Gursuin this line, the authors state0 "he 3idney houses the essenceF the brain is the mansion o! the ori inal spirit. Disorders o! the spirit are usually related to a de!iciency and dama e o! 3idney essence #hich results in malnourishin o! the brain. An insu!!iciency o! ori inal spirit in turn a!!ects the !unction o! the !o. "he mani!estations o! pain and soreness o! the bac3, atrophic #ea3ness o! the le s, looseness o! the lo#er passes (colon and bladder), and a sin3in , thready, #ea3 pulse con!irm the dia nosis o! 3idney de!iciency #ith dama e to the essence. Goor memory and insomnia sho# an insu!!iciency o! the sea o! marro# (brain). "he 3idney essence is the most re!ined o! the body !luids reco niHed by traditional doctors. It is a substance that is, in part, present at birth (perhaps correspondin to the enetic material) and is, in part, replenished by re!inement o! nutritious !ood. E1posure to cold, e1cessive e1perience o! !ear, overindul ence in se1ual activity, !rustration !rom not bein able to !ul!ill one.s #ishes, over2tiredness !rom travelin in conditions o! severe heat, consumption o! too much salt, and physical in>ury to the internal or ans are causes o! 3idney #ea3ness cited in traditional literature. /ther causes may include traumatic in>ury to the internal or ans, e!!ects o! invasive sur ery, chemical dama e to the endocrine system, and chronic in!ections. Dietary causes o! !laccidity are usually described in terms o! e1cessive inta3e. Aside !rom e1cessive consumption o! salt dama in the 3idney system, too much sour !ood is said to cause muscular la1ity, and too much s#eet !ood #ea3ens the !unctions o! the spleen, the or an system that is most essential to the nourishment o! the muscles. "oo much spicy !ood #ill cause !urther dama e to depleted yin and essence. "here!ore, diet is important to avoidin development o! !laccidity syndromes or to counteract a disease #hich produces !laccidity.

;ASI' :E);A7 ":E)AG< 9/) 97A''IDI"< S<ND)/ME "he recommended traditional herb !ormula !or treatment o! the liverJ3idney de!iciency typewei syndrome is #u $ian %an. "he 'hinese name may be rou hly translated as Gill o! "i er.s Wal3F it re!ers to the #ell2controlled movements a ti er ma3es !rom a place o! hidin #hile stal3in a prey. "he ti er also represents the yin0 a ti er in hidin has reat potential !or e1pressin its po#er, and that hidden potential is yin. "he herb !ormula has the therapeutic action o! nourishin yin ( #u $ian %an is sometimes described as the Gill o! :idden "i er). As #ith other traditional treatments, the !ormula may be modi!ied some#hat accordin to clinical presentation, especially at the initiation o! therapy. 9or lon 2term applications, it is considered a #ell2balanced prescription. #u $ian %an (@C) is a !ormula devised by Mhu Dan1i (*@,-E*6C, A.D.) that #as recorded in his boo3 Dan Xi Xin Fa (Dan Oi.s "heories). Mhu Dan1i #as ori inally 3no#n as Mhu Mhenhen , and he lived in Dan1i (Mhe>ian Grovince). :e became 3no#n as the reno#ned physician o! Dan1i, and #as thus iven the name Mhu Dan1i therea!ter. Mhu is 3no#n as leader o! one o! the !our schools o! 'hinese medical disease etiolo y and treatment that evolved durin the period o! **C-E*6C- A.D.F Mhu.s #as the last o! these schools (@=) and one o! the most in!luential in subse&uent centuries. "he !our schools o! thou ht #ere labeled accordin to the type o! therapy that #as predominantly advocated0 coolin , pur ation, spleenJstomach toni!ication, and yin nourishin . In modern practice, the latter t#o toni!ication2based schools remain dominant !orces, >oined by the late *+th century $school% o! vitaliHin blood circulation. Mhu believed that the yin #as al#ays at ris3 !or becomin de!icient. "hus, in most chronic diseases, the aim o! therapy should be to protect and nourish the yin. :e devised several ne# !ormulations, many o! them containin herbs that nourish the yin and cleanse de!iciency !ire (#hich is a type o! yan a itation that can arise !rom yin de!iciency and can cause #orsenin o! yin de!iciency). Mhu lived in southern 'hina, #here it #as more li3ely that persons #ould su!!er !rom the e!!ects o! heat and depletion o! yin. :e !elt, ho#ever, that the main cause o! yin de!iciency #as over2 indul ence, includin se1ual e1cess, #hich could drain the 3idney essence. :e also pointed out that certain herbs could be dama in , especially !or stro3e, paralysis, nervous, and mental diseases0 those containin #hat #e no# call heavy metals, and those #hich have properties o! bein spicy, !ra rant, dry, hot, and stimulatin (#hich could !urther #ea3en the coolin , moistenin yin). #u $ian %an is an e1panded version o! another o! Dan1i.s !ormulas, Da &u 'in %an(8reat <in Nourishin Gill), made #ith rehmannia and tortoise shell to nourish

the yin, and phellodendron and anemarrhena to clear de!iciency !ire. "o ma3e #u $ian %an, one adds certain to this basic !ormula several in redients to treat the speci!ic mani!estation !or #hich the !ormula #as intended0 #ea3ness o! the lo#er bac3 and 3nees, !laccidity o! muscles and bones, and di!!iculty #al3in . "he 3ey additions are ti er.s bone (no# replaced by other bones) and cynomorium. "i er.s bone is said to treat #ea3 and so!t sine#s and bones, and #ea3ness o! the 3nees and le s caused by de!iciency o! liver and 3idney. 'ynomorium has the same uses, and is also indicated !or e1haustion o! body !luids. "hese t#o herbs trans!orm the basic treatment !or yin de!iciency into a treatment !or !laccidity a!!ectin the lo#er bac3 and le s. /ne o! the aims o! the !ormula is to alleviate #ea3ness o! the tendons, #hich is deemed the main reason that there is di!!iculty in #al3in . Geony is added to the prescription to enhance the action o! rehmannia in nourishin the liver, so as to bene!it the liver.s associated tissues4the tendons. 'itrus and dry in er are added to aid the stomach in di estin the combination o! rehmannia and cynomorium, #hich are &uite rich and heavy in nature. #u $ian %an is sometimes e1tended #ith tan 23uei, achyranthes, and mutton (a recommendation !rom a *Bth century te1t), usually !or cases o! severe blood de!iciencyF other variations are prepared by addin yan tonics (in #hich case anemarrhena and phellodendron may be removed) or &i tonics. "he usual preparation method is to combine the herbs round up to po#der and honey to ma3e + ram pills (about = rams o! the herbs per pill). It is ta3en one pill each time, @E6 times daily (*@E*, rams o! the herbs per day). "he prescription that #as initially iven to the patient described by Mhou and 7u #as a modi!ication o! another traditional !ormula used !or !laccidity0 Dihuang 'in (i()ehmannia 9ormula !or Garalysis), a decoction containin rehmannia, cornus, schiHandra, poly ala, acorus, morinda, cistanche, aconite, cinnamon bar3, hoelen, ophiopo on, and dendrobium. It nourishes the yin, but also revitaliHes the yan . "he modi!ied !ormula #as ta3en daily by the MS patient !or more than three months. As a !ollo#2up, #u $ian %an #as administered in con>unction #ith the Dihuan <in Mi decoction !or one year. Accordin to the doctors, "he patient #as eventually cured, thus con!irmin the bene!it o! 3idney2nourishin decoctions and pills !or MS. Mhan Aian uo presented a case study (*@) o! treatment !or chronic pro ressive spinal lateral sclerosis. As #ith the above analysis, the patient #as dia nosed as su!!erin !rom de!iciency o! 3idney and liver, insu!!iciency o! blood and essence, and malnourishment o! li aments and bones. "he treatment #as a modi!ication o! the $Decoction o! 9lyin 9eet% (derived !rom #u $ian %an and Deer Antler 8elatin Gills) #hich includes the tonics0 tortoise shell, rehmannia, ti er bone, eucommia, dipsacus, cuscuta, atractylodes, and licoriceF later the prescription #as modi!ied by

addin astra alus. "he !ormula toni!ies &i, yin, and yan . "reatment time #as t#o months and radual normaliHation o! limb movements ensued. A !ormula !or treatin wei syndrome #as developed by :u3ui 9utei in Aapan, based on#u $ian %an (@B). It is called %ei (heng )ang (9laccidity Syndrome 9ormula) and is made #ith rehmannia, anemarrhena, phellodendron, peony, tan 23uei, achyranthes, atractylodes, astra alus, and eucommia. It has been used in Aapan !or treatin disorders such as multiple myelitis, polio, and paralysis due to beriberi. Dr. Domei <a3aHu reported ood results in treatin an MS patient usin this !ormula !or t#o and a hal! years. In a revie# o! traditional concepts o! paralysis, Dr. :on 2yen :su (*6) describes the syndrome o! atrophy o! the muscles. "here are t#o sub2cate ories0 #ea3 and stron con!irmation (constitution). "he #ea3 con!irmation is caused by yin #ea3ness #hich impairs the !lo# o! bodily !luids thereby preventin nutrients !rom reachin the muscles and bones...the stron con!irmation may occur #hen the !lo# o! the sunli ht yan meridian becomes imbalanced by an attac3 o! #et !ever Kdamp2 heatL. "his #ill then impair the circulation to the limbs and cause the muscles to atrophy. A stron con!irmation may also be induced by lun !ever, #et sputum, or sta nant blood. "his e1planation is based on the Neijingdescription. "o recti!y the problem in individuals su!!erin !rom de!iciency o! liver and 3idney, recommended !ormulas are 8insen and "an 23uei "en 'ombination ( Shichuan Dabu Tang) and "i er.s Shinbone and 'ynomorium 'ombination ( #u $ian %an) !or 3idney and liver de!iciency. 9or the stron con!irmation, recommended !ormulas are San Miao %anModi!ied (phellodendron, atractylodes, achyranthes, tan 23uei, stephania, to3oro, tortoise shell) !or damp heatF Dao Tan Tang(#ith chih2shih, arisaema, pinellia, hoelen, citrus, in er, and licorice) !or sputum obstructionF and "an 23uei 9our 'ombination Modi!ied (tan 23uei, cnidium, peony, rehmannia, persica, carthamus, Hedoaria) !or blood sta nation. Accordin to traditional theory, a chronic disease that is caused primarily by de!iciency syndrome tends to be insidious, #hile those caused by e1cess syndrome tend to sho# rapid pro ression. ")EA"IN8 A("/IMM(NI"< Mhen Wentao and Men rou undertoo3 a eneral analysis o! autoimmune disorders (*?), #ith a detailed description o! three autoimmune diseases0 systemic lupus erythematosus, myasthenia ravis, and scleroderma. "he basic approach mi ht re!lect

on #ays to evaluate the immunolo ical aspect o! MS. 'itin traditional literature, the authors state0 With the stationin o! enuine &i in the interior #atchin over the spirit, sic3ness is unable to intrude...the ri hteous &i is enerated, trans!ormed, and supplied by the essence o! !luid and rain. When the spleen is !lourishin , the e1ternal evil is unable to enter the body. "he spleen is the material source o! the body.s de!ense mechanism. "hus the !lourishin or de eneration o! the spleen !unction #ill re!lect the stren th or #ea3ness o! the body.s immune system. "he zheng*i (translated as enuine or ri hteous &i) is the uardian o! the body.s health and the re ulator o! the immune system. Since &i tonic herbs are the basis o! prescriptions !or promotin zheng*i, these comments spea3 in support o! the use o! &i tonic therapies !or autoimmune disorders. :o#ever, the authors continue0 $Pidney yin and yan are the 3ey !actors in the re ulation and balancin o! yin, yan , &i, blood, and all the body.s immune mechanism. "he visceral or ans throu h their mutual dependence and restriction !ollo# the rule0 e1treme dama esF balance stabiliHesF stabiliHation allo#s eneration. Groper re ulation o! the normal immune response is thus achieved Kthrou h balanceL.% Such statements ar ue !or the use o! 3idney (essence) nourishin herbs and !ollo#in a balanced li!e style, in treatin autoimmunity. $Ni in e1cess may inhibit or override, as stated in the 9ive Element "heory. "he end result is the creation o! an imbalance o! the immune re ulation, thus eneratin autoimmune diseases. Accordin to the author.s observation, there may appear in the course o! an autoimmune disease symptoms o! de!iciency, e1cess, or a combination o! de!iciency and e1cess.% "hus, #hile de!iciency o! &i and essence may !orm the basis o! autoimmunity, at certain times in the development o! autoimmune diseases, treatment o! e1cess (accumulation) may be o! importance. M<AS":ENIA 8)AIIS Mhan and Men state that0 $Accordin to "'M, the spleen overns the muscles, the !our e1tremities, and the upper and lo#er eyelids. "here!ore, the causative mechanism !or M8 is in>ury to the spleen and stomach and de!iciency and de eneration o! the central &i.% "hey recommended the use o! lar e doses o! 8insen and Astra alus 'ombination, #ith doses o! astra alus in the ran e o! 6-E+- rams. 9urther, $systemic M8 is due to de!iciency and in>ury o! the spleen and stomach involvin both the liver and 3idney. "his causes stasis o! &i and blood, lac3 o! trans!ormation o! !luid, obstruction o! the meridians and luo vessels Kmeridians, "ing, are enerally distributed vertically and run throu h the deep tissuesF connectin branches, luo, are distributed horiHontally and super!iciallyL, and a decreased ability to move the li aments and bones.% "he authors state that !avorable results have been obtained

usin lar e dosa es o! herbs. In addition to 8insen and Astra alus 'ombination, they recommend 'innamon and Aconite 'ombination, Gill o! )i ht )estoration, and 9orti!ied Gill o! ;uddha.s Warrior AttendantF these latter !ormulas all contain 3idney tonic herbs and have a #armin action that helps to overcome sta nation. 9or another case, characteriHed by $ma1imum depletion o! the spleen and 3idney, and indissoluble phle m and turbidity, the recommended treatments #ere lar e dosa es o! Saussurea and 'ardamon 'ombination to invi orate the spleen and clear a#ay the dampness, and the 3idney toni!yin )ehmannia Ei ht 9ormula, in addition to the previously mentioned prescriptions. A specially2modi!ied !ormula made #ith astra alus, codonopsis, atractylodes, aconite, cinnamon bar3, rehmannia (ra#), dioscorea, cornus, hoelen, lycium !ruit, deer antler elatin, and morinda #as said to have produced dramatic e!!ects a!ter !i!teen days o! treatment (this is !ollo#in treatment #ith the other prescriptions). In the boo3 T'e T$eat)ent !# ,n!tt+ D%(ea(e( -%t' C'%ne(e Ac./.nct.$e and C'%ne(e He$ a& Med%c%ne (*C) Shao Nian!an divides M8 treatments into t#o basic cate ories0 de!iciency o! spleenJ3idney (#ea3 cate ory) and damp2heat (stron cate ory). "he de!iciency type, especially #ith &i and yan de!iciency, is said to be the most commonly2observed, clinically. )ecommendations !or treatin de!icient patients include use o! a lar e dosa e o! astra alus and inclusion o! chih2shih (#hich #ill clear phle m2damp obstruction). 9or yan de!iciency patients, the use o! aconite is help!ul and the amount should be lar e (6-E=- rams, boiled !or t#o hours). In eneral, accordin to Shao, !or M8 o! the de!iciency syndrome type, one can use patent medicines such as &uzhong 'i*i %an(8insen and Astra alus 'ombination), )uzi +izhong %an (Aconite, 8insen , and 8in er 'ombination), #u $ian %an, ,in Suo u ,ing %an (7otus Stamen 9ormula), and Renshen ,ian!i %an (8insen Stomachic Gills), or a decoction made #ith insen , atractylodes, astra alus, platycodon, lycium !ruit, aconite, cimici!u a, bupleurum, pueraria, tan 2 3uei, ma2huan , and licorice (8insen and Astra alus 'ombination modi!ied). "he dosa e o! the herbs is !rom = rams (licorice) to =- rams (astra alus) each, #ith a total o! about @-- rams !or a one day dose. 9or yan de!iciency patients, one can add cinnamon bar3 and deer antlerF !or yin de!iciency patients, one can add #u $ian %an to the treatment. 9or the damp2heat type, it is su ested to use the patent medicines, such as +ongdan -iegan %an (8entiana 'ombination) or'angyin $ingfei %an, or the decoction o! atractylodes, phellodendron, scute, dioscorea, stephania, coi1, peony, chaenomeles, lehnia, sil3#orm e1crement ( San Miao Sanmodi!ied). "he dosa e o! herbs is !rom *- rams (phellodendron, scute) to 6- rams (coi1) #ith a total daily dose o! about *C- rams.

'itin a case study o! early onset o! M8, Shao describes a youn man #ith !our limbs so !laccid and #ea3 that he could not hold somethin in his hands, nor could he #al3. :e #as dia nosed as su!!erin !rom de!iciency o! central &i !ollo#in an acute illness #ith !ever. :e #as iven a decoction o! atractylodes, pueraria, licorice, chih2 shih, and tan 23uei. A!ter !ourteen days there #as some improvement, and the !ormula #as modi!ied by addin lycium !ruit, ho2shou2#u, aconite, and achyranthes. "reatment #ith this modi!ied !ormula #as !ollo#ed !or thirty days, a!ter #hich there #as si ni!icant reduction o! symptoms. 9inally, the patient #as iven 8insen Stomachic Gills and )ehmannia Ei ht 9ormula daily. A !ollo#2up t#o years later sho#ed that recovery #as complete. 7i 8en he (*=) recommended that the treatment o! M8 !ollo# the principle o! toni!yin the spleen and 3idney. 9or spleen de!iciency, the 8insen and Astra alus 'ombination #as used #ith optional additions o! poly onatum, dioscorea, dolichos, and placenta. 9or spleen de!iciency complicated by 3idney yin de!iciency, the Decoction o! 7e!t )estoration plus astra alus, atractylodes, and codonopsis #as used (optional additions #ere ho2shou2#u, ophiopo on, peony, elatin, and placenta). 9or spleen de!iciency complicated by 3idney yan de!iciency, the Decoction o! )i ht )estoration #ith eucommia replaced by deer antler, and #ith the addition o! astra alus, codonopsis, and tan 23uei #as used (optional additions #ere cynomorium, morinda, psoralea, eucommia, loranthus, and placenta). 7i noted that common cold and bronchial in!ection (e. ., pneumonia) #ere predisposin !actors !or e1acerbations. While steroids could be e!!ective at that time, use o! 'hinese herbs #as help!ul in supportin the ener y o! the body and stren thenin resistanceF he recommended usin insen , ec3o, rehmannia, a&uilaria, placenta, oyster shell, and licorice. '7INI'A7 ")IA7S IN ':INA *. Multiple Sclerosis "he lar est study (*B) o! 'hinese medical treatment !or MS #as carried out by 7u Oi and Wan <aohuo at the Departments o! Neurolo y and "raditional 'hinese Medicine in 9u>ian. Gatients #ere !irst divided into !our roups !or di!!erential treatment, t#o roups #ith de!iciency2type syndrome and t#o roups #ith e1cess2 type syndrome. "he cate ories and treatments #ere0 *. 7iverJ3idney yin de!iciency0 ra# and coo3ed rehmannia, lycium !ruit, anemarrhena, salvia, peony, cornus, li ustrum, deer horn lue, tortoise plastron lue, achyranthes (chuanniu.i), tan 23uei, and licorice. "his is a modi!ication o! the traditional 7e!t )estorin Gill ( (uo ui %an) #ith the addition o! anemarrhena, li ustrum, salvia, tan 23uei, and peonyF it is some#hat similar to #u

$ian %an. Each herb is used in a dosa e o! *-E*@ rams per day, e1cept licorice (C rams). @. Spleen2stomach #ea3ness0 astra alus, salvia, codonopsis, atractylodes, hoelen, pinellia, citrus, >u>ube, and licorice. "his is a modi!ication o! the traditional Ma>or Si1 :erbs 'ombination (+iu ,unzi Tang) #ith astra alus and salvia added. Each herb is used in a dosa e o! ,E*C rams per day, e1cept >u>ube (*@ pieces) and licorice (? rams). 6. Ni and blood stasis syndrome0 astra alus, codonopsis, salvia, rehmannia (ra#), peony (red and #hite), bupleurum, tan 23uei, scute, cnidium, pinellia, and licorice. "his !ormula combines Minor ;upleurum 'ombination ( -iao /haihu Tang) #ith three herbs !or promotin blood circulation4salvia, peony (red and #hite), and cnidium4plus astra alus. Each herb is present in the amount o! +E*C rams per day, e1cept licorice (? rams). ?. Damp2heat syndrome0 chin 2hao, talc, peony, scute, bupleurum, bamboo, a3ebia, hoelen, chih2shih, pinellia, rhubarb, >u>ube. "his !ormula is similar to treatments !or !ebrile diseases described in previous centuries, such as the 'hin 2hao and Scute 'ombination (#ao ,in $ingtan Tang). Each herb is present in the amount o! ,E*@ rams, e1cept >u>ube (*@ pieces). "he !ormulas #ould be modi!ied !or certain presentin symptoms. 9or e1ample, !or urinary incontinence, add cuscuta, alpinia, and rose !ruitF !or constipation, add ho2 shou2#u, persica, cistanche, and rhubarbF !or mental !o iness, add schiHandraF !or abdominal distention, add ma nolia bar3 and chih2shihF !or muscular atrophy, add tan 23uei, elatin, and dipsacus. "he decoctions #ere consumed as a coolin drin3 (rather than hotF because many MS patients have an aversion to heat), once per day. Anti2in!lammatory Western dru s (de1amethasone or prednisone) #ere iven durin acute active periods. "hirty2 !ive patients #ere treated and e1cept !or three that discontinued treatment #ithin the !irst ten days, some improvement #as !ound. "#o cases #ere deemed basically cured a!ter ta3in ?C and =, dosesF *C #ere mar3edly improved and another *C some#hat improved, most o! them ta3in @-E?- doses. Eleven o! the patients had tried corticosteroids unsuccess!ully be!ore s#itchin to the traditional herb combinationsF o! these, seven #ere mar3edly improved, three improved, and only one !ailed to respond. "hese researchers !ollo#ed up their #or3 #ith an attempt to prevent e1acerbations (*,). "hey prescribed Ping )u Tang (Gaci!y )elapse Decoction) to 6- patients over a period o! 6E*6 years (avera e o! = years). "he !ormula contained astra alus, codonopsis, hoelen, atractylodes, pinellia, licorice, >u>ube, bupleurum, scute, tortoise

shell, li ustrum, tan 23uei, peony, ophiopo on, rehmannia, lycium, and anemarrhena. "he prescription basically has the e!!ect o! toni!yin &i, yin, and blood, and clearin de!iciency heat. It can be seen that this prescription is derived !rom the !irst t#o !ormulas listed in the previous article !or treatment o! multiple sclerosis, based on de!iciencies o! liver, 3idney, and spleen (it also has some herbs o! Minor ;upleurum 'ombination, as mentioned belo#). "he preventive therapy #as basically a tonic !ormula. It #as prescribed in the !orm o! a decoction, ta3en in @E6 daily doses, usin ,E*C rams o! each herb (e1cept smaller amounts o! licorice and >u>ube). Accordin to the researchers, relapses #ere prevented e1cept !or t#o patients #ho each e1perienced only one minor e1acerbation, each event !ollo#in a viral in!ection (common cold). A control roup o! MS patients not treated by this remedy #as monitored !or three years0 they su!!ered !rom e1acerbations at the rate o! *E? times per year. Ping )u Tang included rehmannia, tortoise shell, peony, and anemarrhena, in redients o!#u $ian %an, #hich have the !unctions o! nourishin yin and blood and cleansin de!iciency !ire. In addition, they added li ustrum, lycium !ruit, and ophiopo on to nourish yin. A strate y !or nourishin blood and essence is to toni!y the &i so that more nutrients are obtained !rom the !ood. "he !ormula included astra alus, codonopsis, hoelen, atractylodes, licorice, and >u>ube to#ards this end (these herbs also enhance immune !unctions to aid resistance to in!ections that induce e1acerbations). Since the point o! the treatment #as not to recti!y !laccidity, but rather to prevent !laccidity by preventin e1acerbations, the herbs !or treatin !laccidity in the le s, such as ti er bone and cynomorium !ound in #u $ian %an #ere not included. Also, as the patients are bein treated continuously #ith the yin2 nourishin tonics, it is not necessary to stron ly inhibit de!iciency !ire, so phellodendron is not essential to the prescription (anemarrhena, unli3e phellodendron, has the secondary property o! bein a yin tonic). "hus, the treatment lar ely re!lects the principles o! Mhu Dan1i in relation to understandin the cause o! a !laccidity syndrome. "he doctors e1plained that part o! their thin3in in developin the !ormula #as based on the current understandin o! autoimmunity, #hich e1plains the presence o! so many &i tonics and the herbs o! Minor ;upleurum 'ombination ( -iao /haihu Tang), such as pinellia, bupleurum, and scute, #hich is believed to be help!ul in chronic in!lammatory diseases. I! a "2cell attac3 a ainst myelin sheaths is initiated by in!luenHa, common cold, sinusitis, or other in!ections, ability to prevent such in!ections or halt their pro ress #ould be one obvious 3ey step in preventin dama e due to the usual se&uence o! events in an e1acerbation. Grotection !rom transmissible viral in!ections, such as stayin a#ay !rom those #ho are currently su!!erin !rom the in!ection, is one method o! prevention. Enhancin the immune system !unctions #ith tonic herbs is another method. Many Westerners are led to believe, by poorly #ritten articles on immune

disorders, that enhancin immune system vi ilance #ould #orsen any autoimmune diseaseF ho#ever, this #ould only be a potential problem durin an e1acerbationF even then, other components o! the immune system that help to shut2do#n the autoimmune attac3 may be coa1ed into activity #ith proper immune2re ulatin herbal treatment strate ies. @. Amyotrophic 7ateral Sclerosis and Gro ressive Spinal Muscular Atrophy 'ase studies o! A7S #ere reported by 7in "on uo (*+). In one case, the primary !ormula combined tonic herbs0 astra alus, tan 23uei, peony, rehmannia, aconite, cinnamon bar3, and lycium !ruit, #ith several herbs used to promote circulation o! blood and relieve spasms (the spasms bein a si ni!icant problem in many cases o! A7S)0 centipede, scorpion, persica, carthamus, morus t#i , and clematis. "hese herbs #ere made as a decoction ta3en in divided doses three times daily !or several days. In addition, a small amount o! po#der made !rom strychnos and mus3 (-.@C rams o! each, three times daily) #as iven. As !ollo#2up, the decoction !ormula #as modi!ied (cnidium, platycodon, chih23o, ti er bone, deer antler, and Haocys #ere addedF morus t#i and clematis #ere deleted) and made into pills instead o! decoction, to be ta3en *, rams per day4the mus3 and strychnos po#ders #ere included in the pills. "he pills #ere ta3en !or t#o years until the disease #as resolved. A !ollo#2up a!ter three years #ith no !urther medication sho#ed that the disease had remitted. A similar approach #as used #ith a second patient #ho consumed a decoction made #ith astra alus, atractylodes, cinnamon t#i , tan 23uei, persica, carthamus, centipede, eupolypha a, !enu ree3, aconite (chuanwu), licorice, and Haocys. A!ter usin this decoction !or several days, the pill described above #as used !or lon 2term medication and a clinical cure #as obtained, #ith a !ollo#2up a!ter !ive years con!irmin the satis!actory result. "he third case emphasiHed treatment o! yin de!iciency !ire, usin a decoction #ith phellodendron, ra# rehmannia, moutan, alisma, anemarrhena, hoelen, stephania, coi1, chin2chiu, dipsacus, achyranthes, centipede, and scorpion. "his decoction #as iven !or more than t#o months and then modi!ied, ta3in out stephania, coi1, and chin2 chiu, and addin dipsacus, deer antler, epimedium, tan 23uei, cnidium, and carthamus. "his !ormula #as then used !or more than three months. 9inally, the above2mentioned pill #as a ain used !or lon 2term therapy, and a cure #as obtained, #ith no relapse by the end o! t#o years #ithout the medication. In a report by Pan <an huo o! t#o cases o! pro ressive spinal myoatrophy (@-) the main prescriptions iven #ere variations o! Sheng"i 'isui Tang (Decoction !or 8eneratin Muscles and ;ene!itin Marro#). /ne such prescription contained tan 2 3uei, lycium !ruit, atractylodes, ophiopo on, tortoise shell, achyranthes, phellodendron, alisma, chaenomeles, and licorice !or a yin de!iciency case and deer

antler, eucommia, atractylodes, astra alus, psoralea, malt, cratae us, pinellia, codonopsis, sinapis, hoelen, alisma, chaenomeles, achyranthes, and cinnamon t#i !or a yan de!iciency case #ith #ea3 di estion and phle m accumulation. "reatment time #as si1 months and included acupuncture and massa e therapy. 7on 2term !ollo#2up sho#ed persistin bene!its o! the treatment, #ith normal nerve conduction and physical activities. In a study (@*) o! *C patients #ith pro ressive A7S, a si ni!icantly e1panded version o! #u $ian %an #as employed. "his contained astra alus, epimedium, deer antler, syn nathus, sea horse, insen , tortoise shell lue, tan 23uei, peony, rehmannia, lycium !ruit, eucommia, dipsacus, cuscuta, cynamorium, atractylodes, coi1, citrus, achyranthes, chaenomeles, chin2chiu, a 3istrodon, ti er bone, psoralea, anemarrhena, phellodendron, cinnamon t#i , chian 2huo, tu2huo, and siler. "he !ormula #as based on the traditional prescription ,ian &u #u $ian %an (Step )ein!orcin "i er.s Wal3 Gill). "he pills #ere ta3en in a dosa e o! 6E+ rams at a time, @E6 times per day dependin on the person.s constitution and severity o! the disease, but #ere not to be used by patients sho#in yin de!iciency !ire syndrome. "#o o! the patients #ere said to be cured and !ive improved. "he pills #ere to be used on a re ular basis over a period o! several years. Strychnos is sometimes mentioned as part o! A7S treatments. A muscle2 invi oratin combination 3no#n as MobiliHin Go#der may produce temporary alleviation o! !laccidity. "he combination includes strychnos, mus3, and centipede. Strychnos in small doses tones the muscles and in lar e doses paralyHes them. It is used in the treatment o! other autoimmune disorders, includin M8 and rheumatoid arthritis. (n!ortunately, this herb cannot enter into Western treatments !or autoimmune diseases because o! concerns over the to1icity o! strychnine, one o! the main active components. A lar e scale study o! pro ressive spinal muscular atrophy (,- cases) and A7S (6cases) #as described by :uo <intan (@@). "he primary !ormula used !or treatment #as'isui Tang, made #ith codonopsis, atractylodes, astra alus, rehmannia, psoralea, dipsacus, cuscuta, achyranthes, cibotium, tan 23uei, peony, millettia, tortoise shell, deer antler elatin (each herb +E*C rams in decoction), #ith C rams each phellodendron, and anemarrhena. "his !ormula is a substantial modi!ication o! #u $ian %an, utiliHin several yan tonic herbs to replace the ti er.s bone o! the ancient prescription. Accordin to the report, C+ cases #ere considered cured (symptoms alleviated, muscles re enerated, and muscular !unction restored), *, mar3edly improved, @C improved, and , sho#ed no improvement. 6. Myasthenia 8ravis

<a3aHu reported (@6) that !ormulas containin ma2huan , such as Gueraria 'ombination ( egen Tang) and Minor ;lue Dra on 'ombination ( -iao $inglong Tang), #ere repeatedly !ound to improve symptoms, at least !or short2term treatment, in patients #ith M8. :e attributes this e!!ect to the active component ephedrine, #hich #as previously reported to be e!!ective !or myasthenia by Dr. Nabi )yo3en in his boo3 T'e Rev%(ed P$act%ca& Med%ca& Se$v%ce . Ma2huan is traditionally used in the treatment o! muscular achin and ephedrine is 3no#n to promote circulation throu h the striated muscles. <a3aHu also recommended the use o! peony and licorice, statin that this combination $ad>usts the tenseness% o! the muscles. 7icorice also has cortisone2li3e action. "hese t#o herbs are !re&uently used to relieve muscle spasms, perhaps #ith better e!!ect in patients su!!erin !rom de!iciency syndromes. In li3e manner, he thou ht that pueraria, traditionally used to rela1 tense muscles in the nec3 and shoulders, mi ht help to treat !laccidity o! these same muscles #hen iven to patients #ith M8. In the case study o! early M8 presented by Shao Nian!an , pueraria #as included. In a study (@?) o! treatments !or M8 reported by Niu 'hen lin , ei ht patients received capsules containin strychnos (-.@ rams per capsule), radually increasin the daily dosa e to reach seven capsules each time, three times daily. In addition, the patients #ere treated #ith decoctions accordin to the classi!ication o! underlyin syndrome. 9or those #ith spleen de!iciency, 8insen and Astra alus 'ombination (&uzhong 'i*i Tang) plus epimedium #as iven. 9or spleen and 3idney de!iciency, a decoction o! astra alus, epimedium, tan 23uei, atractylodes, codonopsis, rehmannia, dioscorea, curculi o, anemarrhena, and morinda #as ivenF in cases o! more severe yan de!iciency and cold, cinnamon t#i , aconite, and deer antler lue #ere added. As a result o! these therapies, C o! the , patients noted si ni!icant improvements. 7i 8en he (*=) reported on the cumulative results o! treatin @C- patients over a period o! !ive years. :e claimed that lon 2term in estion o! herbs that toni!y the spleen and 3idney could lead to a clinical cure in nearly hal! the patients. "he duration o! therapy necessary #as 6EC months !or the eye2muscle type (#hich #as easier to cure) and =E, months !or the eneral type. Domei <a3aHu believed that those not cured by toni!ication therapies mi ht bene!it !rom the ma2huan !ormulas. S(MMA)< /9 '7INI'A7 ")IA7S 9ormal clinical trials involvin several patients rather than individual case studies be an in *+BC and have included only !e# hundred patients. Since the Western medical 3no#led e o! the diseases #as limited and advanced e&uipment o!ten not available, the early research #as based almost entirely on traditional analysis o! treatin !laccidity syndrome and uesses as to the treatment o! autoimmunity. "he

claimed positive results, ran in !rom a hi h proportion o! persons #ith mar3ed improvements to a substantial number o! cases declared cured, #ere o!ten a conse&uence o! treatin patients #ith di!!erent !ormulas accordin to dia nostic cate ories and #ith chan es in prescription durin the !irst !e# #ee3s or months o! therapy. "oni!ication o! spleen, 3idney, and liver are the prominent methods o! therapy. It #as common to combine decoctions and pills, and to use pills as lon 2term therapy, #hich sometimes lasted !or t#o years. In some cases, acupuncture, Western medicine, and other therapies #ere said to be used0 undoubtedly, in most trials the patients received the therapeutic interventions that the physicians !elt #ere necessary #ithin the limitations o! #hat could be o!!ered. AME)I'AN GA"IEN"S WI": MS Accordin to clinicians #or3in at the I"M clinic, dia nosis o! American patients su!!erin !rom multiple sclerosis reveals the presence o! yin de!iciency, but relatively little e1perience o! the yin de!iciency !ire. )ather, these individuals have a reater tendency to display si ns o! #ea3ness o! the stomach !unctions and some de!iciency o! 3idney yan . "his apparent di!!erence bet#een these !indin s compared to the e1planation o! le !laccidity by Mhu Dan1i may be related to several !actors. 9or e1ample, MS is more common in the colder northern re ions, #here yan de!iciency is more prevalent, #hile Mhu observed patients in southern re ions #here yan de!iciency is less common. "he cause o! the disease, thou h comple1, appears to be in!ectious a ents and autoimmune process, rather than debilitatin li!e style (thou h li!e style !actors could contribute to disease initiation and pro ression), #hich #as the dominant concern in Mhu.s time. "he Western diet may help to limit de!iciency !ire syndrome, but mi ht #orsen stomach problems. Malabsorption in MS patients has been noted !or !ats, vitamin ; *@, and d21ylose, and lo# :'l levels may be responsible !or limited di estion o! meats (@,). In 'hina, lo# :'l levels #ere noted in patients #ith M8 (@+), and the lo#est levels #ere closely associated #ith re!ractoriness to treatment. DIE"A)< AND N(")I"I/NA7 '/NSIDE)A"I/NS0 EAS" AND WES" Grovidin ade&uate nutrition is considered critical in the traditional description o! !laccidity syndrome. "o treat essence de!iciency, 'hinese doctors recommend that certain !oods be eaten, includin duc3, abalone, pi 3idney, liver, lotus seeds, rose hips, and #alnuts (@+). As mentioned earlier, avoidin certain !oods is also a consideration o! traditional 'hinese thin3in . ;lac3 pepper is to be avoided in cases o! muscular #ea3ness. )ecently it #as sho#n that a component o! pepper inhibits convulsions and it may have a mild inhibitory action on muscular contraction. 'innamon, #ith its 3ey

component cinnamaldehyde, should be avoided in persons #ith MS, as the aldehydes may already inhibit nerve transmission. "hese t#o herbs are #arm and spicy in nature, and #ould be limited by the prevailin 'hinese theory that spicy herbs can #orsen yin de!iciency. 'innamon is used in some treatments o! !laccidity, but mi ht be more suitably replaced by other herbs that accomplish the same therapeutic oal, such as cynomorium, morinda, or dry in er. In estion o! essential !atty acids and EGA !rom !ish oil appears to be o! some aid in treatin autoimmunity in eneral (?). 9atty acids and !ish oil supplementation may correspond to toni!yin the yin, based on 'hinese dietary recommendations. Avoidance o! Hinc or use o! Hinc2chelatin a ents also reduces some autoimmune responses (*), thou h Hinc de!iciency can lead to easier e1perience o! viral in!ections that activate MS attac3s. "ortoise shell (rich in elatin) and deer antler elatin are included in several prescriptions !or treatment o! !laccidity o! the le s. 8lycine is a ma>or component o! elatin, #hich is classi!ied by 'hinese doctors as a blood and yin tonic. "he amino acid lycine has been recommended !or persons #ith MS since it counteracts aldehyde accumulation and has antispasmodic properties (daily dosa e is about 6 rams per day). Since *+C-, it has been proposed that a diet lo# in saturated !ats may bene!it some MS patients, and a clinic at /re on :ealth Sciences (niversity, !ormerly run by Dr. )oy S#an3, pro!essor o! neurolo y, has specialiHed in this area o! treatment !or several years. :e recommends no more than *- rams o! saturated !at per day, #hich basically yields a ve etarian diet supplemented by !ish (three or more times per #ee3F the !ish oils are considered bene!icial as are polyunsaturated oils). Many persons !ind this diet to strict to be practical. :i h levels o! polyunsaturated oils may increase o1idative stress, and so should be countered by ta3in antio1idants. Iitamin ;*@ is !ound primarily in animal !oods and is also present in #alnuts. "his vitamin may contribute some o! the essence2toni!yin properties o! !oods recommended by 'hinese doctors. A number o! reports o! vitamin ; *@ de!iciency in some MS patients has led to the use o! this vitamin in treatment o! those #ho are !ound to have lo# ;*@ either in the serum or the cerebrospinal !luid. 7o# vitamin ;*@ levels #ere !ound to be associated #ith earlier onset o! disease symptoms and #ere reduced by corticosteroid administration (6,). :o#ever, it may be the unsaturated ;*@bindin capacity that is more o!ten lo#, even i! total ; *@ levels are normal (6+). When patients #ith chronic pro ressive MS #ere iven = m o! oral ;*@ every day !or si1 months, there #ere improvements in visual and brainstem auditory evo3ed potentials. Since MS patients are li3ely to have poor ; *@upta3e, ;*@ is o!ten iven by in>ection, #ith doses up to * m each time.

S"EGS "/ "APE IN ")EA"MEN" "o !ollo# 'hinese medical theories and e1perience in treatin MS, M8, A7S, and other !laccidity syndromes, one #ould underta3e the !ollo#in 0 *. Eat a diet that is nourishin to the spleen, 3idney, and liver, especially #ith essence2toni!yin !oods (this #ould include various beans and seeds, meats, sea!oods, and mildly astrin ent !ruits). Avoid e1cessive amounts o! sour, spicy, and salty !oods. 'onsider use o! nutritional supplements #ith selenium, calcium, vitamin ;*@, antio1idants, and essential !atty acids. Also consume elatin or a lycine supplement (6 rams per day), especially in cases #here muscle spasms occur. @. 'onsume herb !ormulas that match the particular mani!estation o! symptoms and si ns reco niHed by traditional medical theory. De!iciency is to be nourishedF obstruction, overcomeF and e1cess, drained. In cases o! de!iciency syndrome (#hich appear to be the most common), consider the use o! substantial doses o! tonic herbs, and ive special attention to the need !or yin or yan tonic a ents. Anti2in!lammatory dru s may help limit the dama e to myelin i! their use is initiated early in an attac3, but they may have little bene!it the rest o! the time. Immune2re ulatin dru s, such as betaseron, can be tried i! the herb therapies !ail to produce ade&uate re ulation. 6. Avoid viral in!ections (and other in!ections) by minimiHin e1posure to in!ected persons and to potentially harm!ul environmental conditions (e. ., chill). "a3e an antiviral herb combination #hen an acute viral attac3 is suspected. "reat all in!ections promptly, #hether usin herbs or dru s. ?. (tiliHe practices that evo3e spiritual re>uvenation. "raditional 'hinese e1ercises, such as $i ong and Tai ,i $uan may be help!ul in stren thenin the normal &i, bene!itin the 3idney, and calmin the spirit. "hey also improve muscle control and balance. C. (se acupuncture to invi orate circulation o! &i and blood in the limbs and to restore nervous system connections. Scalp acupuncture has proven help!ul in treatin disorders o! the central nervous system, includin MS (?-). Dr. 'hen Melin and 'hen Mei!an in the boo3 A C!)/$e'en(%ve G.%de T! C'%ne(e He$ Med%c%ne (?*), recommend the !ollo#in body points !or !laccidity syndrome (6E ? points should be selected !or each daily or every other day treatment !or *days)0 9laccidity o! the arms0 8I ?, *@F 7I **, *CF SI ?, +F "; C, ;7 **. 9laccidity o! the le s0 8I @, 6F ;7 CB, =-F 8; 6-, 6*, 6?, 6+F SG =, +F S" 6=

=. Ne# Western medical approaches should also be considered. )ecent research su ests that it may be possible to selectively inhibit the autoimmune attac3 a ainst myelin usin a "2cell receptor ("')) peptide dru that does not de!eat the entire immune system but rather bloc3s the attac3 by matchin the basic protein on myelin that binds the "2cells. Initial tests in animals #ith e1perimental aller ic encephalymyelitis, a model !or MS, sho#ed ood results, and clinical tests in a small number o! patients have yielded promisin outcomes (?@). I! success!ul, the same basic method, usin a di!!erent peptide, mi ht be use!ul !or other autoimmune disorders, such as M8. "he drastic inhibition o! immune !unctions, #hich is possible #ith currently2available dru s, such as hi h dose corticosteroids or cyclosporin, should only be considered as an emer ency measure. 'hinese herb dru s that inhibit acetylcholinesterase, such as huperHine A and !ordine, have been used #ith some success in treatin myasthenia ravis in 'hina. B. Garents #ho have MS should ta3e special care to ma3e sure that their children et ade&uate nutrition, have vaccinations a ainst common preventable diseases, and ta3e steps to avoid e1cessive e1posure to in!ectious and parasitic a ents. "heir children have an increased ris3 o! disease due to enetic !actors, so that e1tra care may be needed to avoid development o! the disease. A'PN/W7ED8MEN"S Several 'hinese lan ua e articles #ere translated by 9u PeHhi in :arbinF Den Mhon >ia, throu h literature research, provided an article on Ping )u Tang, a portion o! that article #as translated by :einer 9ruehau!, Gh.D., 7.Ac. in GortlandF Dr. 9ruehau! also provided translations o! articles on A7S and pro ressive spinal muscular atrophy. ;arry 7evine, 7.Ac. in Nor#ood, Massachusetts, provided several abstracts and articles on the Western medical analysis o! MS and its treatment. "he MS 9oundation in 9ort 7auderdale, 9lorida provided !undin !or treatments o! MS patients at the I"M clinic. )E9E)EN'ES *. Wa3sman ;, Multi!le Sclerosis, inPe$(/ect%ve( !n A.t!%)).n%t+ ('ohen I, Editor), ')' Gress *+,,, ;oca )aton, 97. @. )ose A, et al., enetic susce!tibility to familial multi!le sclerosis not lin0ed to the myelin basic !rotein gene, 7ancet *++6F 6?*(,,C?)0 **B+E**,*. 6. Marshall I, Multi!le sclerosis is a chronic central ner1ous system infection by a s!irochetal agent, Medical :ypotheses *+,,F @C0 ,+E+@. ?. Werbach M, N.t$%t%!na& In#&.ence( !n I&&ne((, "hird 7ine Gress *++6, "arHana, 'A.

C. 8ay D and Dic3 8, Is multi!le sclerosis caused by an oral s!irochete2 , "he 7ancet *+,=F @ (,?+,)0 BCEBB. =. 8ianani ) and Sarvetnic3 N, 3iruses, cyto0ines, antigens, and autoimmunity , Groceedin s National Academy o! Sciences (SA *++=F +60 @@CBE@@C+. B. )aine 'S, Multi!le sclerosis4 T5) re1isited, with !romise , Nature Medicine *++C *(6)0 @**E@*?. ,. Sommer N, et al., The antide!ressant roli!ram su!!resses cyto0ine !roduction and !re1ents autoimmune ence!halomyelitis , Nature Medicine *++CF *(6)0 @??E @?,. +. Ni Maoshin , T'e Ye&&!- E)/e$!$0( C&a((%c !# Med%c%ne , Shambala *++C, ;oston, MA. *-. Wan Shoushen , Advanced Text !!" !n T$ad%t%!na& C'%ne(e Med%c%ne and P'a$)ac!&!*+, V!&.)e III, Ne# World Gress *++=, ;ei>in . **. Mhou Oiehai and 7u 7i1iao, The clinical a!!lication of tonifying and benefiting the 0idney essence in multi!le sclerosis , Aournal o! the American 'olle e o! "raditional 'hinese Medicine *+,CF ?0 =CE==. *@. Mhan Aian uo, /hronic !rogressi1e s!inal lateral sclerosis , Aournal o! the American 'olle e o! "raditional 'hinese Medicine *+,CF ?0 ==E=B. *6. :su :<, Paralysis, neuralgia, rheumatism, gout, and their /hinese herb treatment, ;ulletin o! the /riental :ealin Arts Institute *+B+F ?0 ?EC. *?. Mhan Wentao and Men )ou,6utoimmune diseases as treated by traditional /hinese medicine, Aournal o! the American 'olle e o! "raditional 'hinese Medicine *+,@F *0 6+EC-. *C. Shao Nian!an , T'e T$eat)ent !# ,n!tt+ D%(ea(e( -%t' C'%ne(e Ac./.nct.$e and C'%ne(e He$ a& Med%c%ne, Shandon Science and "echnolo y Gress *++-, Ainan. *=. 7i 8en ho, Discussion about myasthenia gra1is and the s!leen70idney theory , Aournal o! "raditional 'hinese Medicine, *+,=F =(*)0 ?,EC*. *B. 7u Oi and Wan <aohua, Thirty7fi1e cases of multi!le sclerosis treated by traditional /hinese medical !rinci!les using differential diagnosis , 'hinese Aournal o! Inte rated "raditional and Western Medicine *++-F *-(6)0 *B?E*BC. *,. 7u Oi, 7i Mhi#en, and Wan :u, Research on the !re1ention of multi!le sclerosis rela!se with traditional /hinese medicine , Aournal o! "raditional 'hinese Medicine *++CF 6=(B). *+. 7in "on uo, Treatment of amyotro!hic lateral sclerosis with a series of !ro1ed formulas, 8uan 1i Aournal o! "raditional 'hinese Medicine *+,6F =(@)0 @@E@6.

@-. Pan <an huo, /ase re!orts of flaccid com!le.es4 successful treatment of two cases of !rogressi1e s!inal myoatro!hy , American 'olle e o! "raditional 'hinese Medicine *+,CF ?0 C+E=6. @*. Oie Wen Hhen , Treatment of !rogressi1e amyotro!hic lateral sclerosis with modified ,ian &u )u (ian %an, Shan hai Aournal o! "raditional 'hinese Medicine *+,CF **0 6@. @@. :uo <intan , Treatment of myodystro!hy with /hinese herbs , "ian>in Aournal o! "raditional 'hinese Medicine *+,CF =. @6. <a3aHu Domei, Myasthenia gra1is, ;ulletin o! the /riental :ealin Arts Institute *+,CF*- (=)0 @C@E@CB. @?. Niu 'henlin , Strychnos used in treating myasthenia gra1is , Mhe>ian Aournal o! "raditional 'hinese Medicine *+,=F @* (*). @C. :uan ;in shan and Wan <u1ia, T'!.(and F!$).&a( and T'!.(and He$ ( !# T$ad%t%!na& C'%ne(e Med%c%ne, V!&.)e 1 , :eilon >ian Education Gress *++6, :arbin, 'hina. @=. <a3aHu Domei, The descendent schools4 the medical !hiloso!hy of +i and (hu in the $in and 'uan Dynasties, ;ulletin o! the /riental :ealin Arts Institute *+,C, *-(?)0 *?*E*?=. @B. :su :< and :su 'S, C!))!n&+ U(ed C'%ne(e He$ F!$).&a( -%t' I&&.(t$at%!n(, /riental :ealin Arts Institute *+,-, 7on ;each, 'A. @,. Murray M and GiHHorno A, Enc+c&!/ed%a !# Nat.$a& Med%c%ne, Grima Gublishin *++-, )oc3lin, 'A. @+. "u 7aihei, et al., Pathogenesis of s!leen deficiency in myasthenia gra1is , inInte$nat%!na& C!n#e$ence !n T$ad%t%!na& C'%ne(e Med%c%ne and P'a$)ac!&!*+ 2345, 'hina Academic Gublishers, Shan hai. 6-. 'halloner, G;, et al., Pla*ue7associated e.!ression of ##378 in multi!le sclerosis, Groceedin s o! the National Academy o! Sciences (SA *++CF +@0 B??-. 6*. 'arri an D), :arrin ton D, and Pno1 PP, Subacute leu0oence!halitis caused by /5S infection with ##378 manifesting as acute multi!le sclerosis , Neurolo y *++=F ?B(*-)0 *?CE*?,. 6@. Arnason ;8W, Interferon beta in multi!le sclerosis , Neurolo y *++6F ?60 =?*E =?6. 66. Pho3hlov AG, et al., Disorders of formaldehyde metabolism and its metabolic !recursors in !atients with multi!le sclerosis , Mhurnal Nevropatolo ii I Gsi3hiatrii *+,+F ,+ (@)0 ?CE?,. 6?. 'alabreses I, et al., /hanges in cerebros!inal fluid le1els of malondialdehyde and glutathione reductase acti1ity in multi!le sclerosis , International Aournal o! 'linical Gharmacolo y )esearch *++?F *?(?)0 **+E*@6.

6C. Ne#combe A, 7i :, and 'uHner M7, +ow density li!o!rotein u!ta0e by macro!hages in multi!le sclerosis !la*ues4 im!lications for !athogenesis , Neuropatholo y and Applied Neurobiolo y *++?F @-(@)0 *C@E*=@. 6=. Mai A, Sorensen GS, :ansen A', #igh dose antio.idant su!!lementation to MS !atients. 9ffects on glutathione !ero.idase, clinical safety, and absor!tion of selenium, ;iolo ical "race Element )esearch *++-F @?(@)0 *-+E**B. 6B. Mhan En&in (editor in 'hie!), C'%ne(e Med%cated D%et, Gublishin :ouse o! Shan hai 'olle e o! "raditional 'hinese Medicine *+,,, Shan hai. 6,. 9re&uin S", et al., Decreased 1itamin &:; and folate le1els in cerebros!inal fluid and serum of multi!le sclerosis !atients after high7dose intra1enous methyl!rednisolone, Aournal o! Neurolo y *++6F @?-(C)0 6-CE6-,. 6+. Pira A, "obimatsu S, and 8oto I, 3itamin&:; metabolism and massi1e7dose methyl 1itamin &:; thera!y in ,a!anese !atients with multi!le sclerosis , Internal Medicine *++?F 66(@)0 ,@E,@. ?-. Dharmananda S and Iic3ers E, Syno!sis of scal! acu!uncture, S"A)" 8roup Manuscripts, *++=. ?*. 'hen M7 and 'hen M9, A C!)/$e'en(%ve G.%de t! C'%ne(e He$ a& Med%c%ne , /riental :ealin Arts Institute *++@, 7on ;each, 'A. ?@. Iandenbar3 AA, et al., Treatment of multi!le sclerosis with T7cell rece!tor !e!tides4 results of a double7blind !ilot trial , Nature Medicine *++=, @(*-)0 **-+E ***C. ?6. 9lammand 7, et al., ##378 induces I+7:& and T5)7al!ha, but not I+78 in !eri!heral blood mononuclear cell cultures , Aournal o! Iirolo y *++*F =C0C*-CE C**-. 5o1ember :<<8