Alzheimer S Disease: the Pathogenesis and Treatment by Chinese Medicine
Alzheimer’s disease: The Pathogenesis and Treatment by Chinese Medicine
Rong Zhu CMD
Abstract:Alzheimer’s disease(AD) isa progressive and irreversible brain disorder that is associated with comprehensive diffuse atrophyof cerebral cortex, therefore causes the dysfunction of centre nervous system. At present,the cause of the disease remains unknown and there is no effective treatment available. This article explains the pathogenesis of AD based on the theory of Chinese medicine, the knowledge of modern medicine, and combination of clinical observation and literature review. The author believes that AD is caused by the essential depletion and vacuity of kidney, spleen-stomach and Qi-Blood; by the tangle of phlegm-stasis thereby obstructs the path of brain and clouds the mental activity. The treatment of AD should be focused onfilling in the essence of the body, invigorating the kidney, fortifying the spleen and heart to cultivatethe root, dispelling phlegm and relieving congestion, removingthestasis in the blood vessel to governthe sign. The cure of AD would be possible if this fundamental and incidental guideline is followed.
Keywords: Alzheimer’s disease, Chinese medicine, pathogenesis,treatment
Alzheimer's disease is a progressive, irreversible neurodegenerativedisease of central nervous system with no known cause or cure. The disease usually begins after age 60, and its incidence increases as age advances. Although younger people also may get AD, it is much less common. About 5 percent of men and women ages 65 to 74 have AD, and nearly half of those age 85 and older may have the disease.The disease progresses gradually, although sometimes symptoms seem to plateau for a while. The main manifestations are irreversible progressive degeneration of the intelligence, the memory, the ability of orientation, the judgment and the language ability.It becomes one kind of disease which harms the senior citizensphysically and mentally. The mortality is high. So far there is no effective treatmentor prevention of worsen development of AD in the field of Western medicine.And the thoroughly permanently cure is out of the question. Therefore discussing its pathogenesis and therapy methods from the angle of Chinese medicine appears especially important. Based on the theory of Chinese medicine and addition of clinical observation and the literature review, the author summarizes the pathogenesis and treatment measure of AD as follows:
A. The Pathogenesis of Alzheimer’s Disease from Chinese Medicine Point of View
In Chinese Medicine Alzheimer's diseasepertains to the categories ofDementia, Idiocy, Depressive Psychosis,and Melancholia. Ithad already been recognized as early as in Canon of medicine.The cause of thedisease had been correlated to the dysfunction of the five internal organs in addition to the brain vacuity. Zhangjingyue, a famous medical journalist in the Ming dynasty compiled a monograph of The Jingyue Complete Compendium,which had diagnosed the disease as "mania-depressive psychosis and dementia”. In his Dialectical Record, Chen Shiduo,a famous doctor in Qing Dynasty, hada special discussion of "dementia". Wang Qingren,another famous doctor of Qing Dynasty,compiled Correction of the Errors in Medical Worldin which he elaborated that the dementia pathogenesis has a lot to do with the dysfunctionof the brain that has been blocked by Qi-stagnation andblood-stasis. The brain is then gradually atrophied. The following is the outline showing the AD pathogenesis in the view of Chinese medicine.
1. Kidney-Essence Deficiency and Brain-Marrow Atrophy
The kidney stores the essence of life. Itcontrols the bone and the bone marrow by connecting them to the brain through Qi. The brain is the original place of human mental activity. It governs human state of mind. Li Shizhen,a famous Doctor of Ming Dynasty, pointed out that "brain is the house of mental activity". The function of brain directlyaffects human’s intelligence and memory. The brain marrow is nourished by the Qi from the strong essential kidney. It had been recorded that "The kidney engenders the marrow" in The Natural Phenomena of Yin-Yang. InLing-ShuTreatise of Sea the author mentioned that "The brain is the sea of marrows”. Brain and marrow are different in name, but they come from the same source. Bothof themare formed from the kidney-essence. In his Summery ofChinese and WesternMedicine Tang Rongchuan,a famous Doctor in Qing Dynastypointed out that "the kidney is in charge of the bone. The Qi of kidney passes through the spinal cord. When the kidney essence is sufficient, it then enters the spine, forms the marrow andgoes upinto the brain.This builds up the brain marrow. It means that the marrow is the reservoir of the essence". In his The Comprehension of Medicine, Cheng Guopeng, a famous doctor in Qing Dynasty, said "Kidney hosts wisdom.If kidney is insufficient, the wisdomwoulddecline, and the memory of the past would be lost easily".In his Corrections of the Errors in Medical World Wang Qingren further pointed out that, "The inspiration and memory are not stored in heart, but in the brain." "Old people lost memory are because the brains are gradually getting empty." So the brain essence isthe material base and the fountain house of the functional activity. If the kidney essence is sufficient, the brainwould be active. On the other hand, if the kidney essence is insufficient, the brainwould beidle; the mental activitywould be weaken andbecomes apraxia. It has also been confirmed in modern medicine that the cerebrum of AD appears moderate or heavieratrophy.There is an increase in ditch and width of the brain, and expansion of the brain ventricles. Obviously the kidney deficiency can cause the atrophy of brain. The clinical data also demonstrated that the kidney-deficient patientsshowed some kind of decline of brain function. If kidney canbe strengthened, the brain would be nourished. It can be said that the kidney essence is the root of brain function. Thus kidney deficiency addition to brain marrow atrophyis the main reason of Alzheimer’s disease.
2. Heart-SpleenVacuity and Qi-Blood Depletion
The heart is the monarch of all the organs and taking charge of mental activity. The brain is the house of mental activity. Obviously the heart and the brain are inseparable. As The Functions of Viscera and Bowels, a chapter of the medical classic Plain Questions indicates, “The heart is the monarch. It governs all the vital functions of the whole body including mental activities.” In The Essence of Sphygmology, a chapter of the Plain Questions said, “The head is the house of mental activities.” Obviously the mental activity is taking the brain as the carrier, but managed by the heart. If Qi-Blood of the heart is sufficient, then the brain is nourished and mental activity is clear and bright. Otherwise, the mental activity will lose its management and its nourishment, and becomes clouded and unclear.
Spleen and stomach are providing the material supplies for the acquired constitution and are the source of producing the Qi and Blood. The book Miraculous Pivot says in the chapter of The Normal Individual Fasting: "Mental activity is from the essence of the foods." If the weakness of the spleen and the stomach sustains, the transportation of foods to the heart would be reduced and the heart would lose its source of nourishment; then the spiritual activitydecreases and wisdom getting weaker.This meansthat the kidney would receive fewer nutrients as well. The consequences of it are the kidney would lose the ability to regenerate its essence,the encephala atrophy would take place and nervous system wouldbe weaker.This would then injure the spiritual activity. Apparently the spleen is providing the basic materials for the acquired constitution, while thekidney is the foundation of the congenital constitution. The essence of life stored in the kidney can only be plentiful when provided continuously with the nutrition transformed by the spleen. In his The Medical Records, Chen xingxuansays: "The kidney regulates water metabolism, andstores the essence of the five Zang-organs and six Fu-organs in it.It means that the essence is stored in the kidney, but does not generate in the kidney. For example,the money and grain store in the warehouse, however they are not producedby warehouse.So we must constantly refill the spleen-stomachreservoir."
Moreover, the spleen is the main place where phlegm is produced. Insufficiency of the spleen-Qi and dysfunction of the spleen transportation will lead to the retention of fluid. Too much fluid will cause dampness andwill ferment phlegm.Latter then moves along with the Qi to the whole body, “accumulates in the chest, occupiesthe place outside the heart, and clouds the spirit activity and causes dementia." (Chen Shiduo).
3. Restrained LiverQi and Tangled Phlegm-Stasis
Liver playsa vital role in the dementia. It can restrain the free movement of Qi.The accumulation of stress from the family,the society and other fields in life will emotionally affect aged people, causingdepression.The body loses its balance. The liver is then unable to flow its Qi easily in and out. Gradually, this stagnation ofQi will cause the retention of dampness and form phlegm; will block the blood circulation and induce blood stasis. The consequences of this stasis of Qi, blood and phlegm are heartache, headache, spiritual disorientation andmental dysfunction. The modern medicine also demonstrated that patients with Alzheimer's disease have a remarkable pathological change in their cerebral and glial tissues. There is a deposition of an abnormal protein (amyloid beta) outside nerve cells to form an amyloid. These diffuse plaques are called senile or neuritic plaques. In addition, an accumulation of abnormal protein filaments inside nerve cells is formed from the aggregation of tau-protein. This is the evidence proved from a different angle that the phlegm-stasis is one of the characters of this disease. Chen Shiduo, a famous doctor of Qi dynasty said in his book The Dialectical Record “The dementia begins from the stagnation of the Qi in liver and ends up with an exhaustion of the Qi in spleen-stomach.In the situation of liver-Qi stagnation, the wood is overcoming soil as to unable to remove the phlegm; while in the situation of stomach exhaustion, the soil can not control the water as to unable to digest the phlegm. In hisCorrections on the Errors of Medical World, Wang Qingren emphasized that the ecchymosis is the important pathogenic factor. He thought that the blood stasis blocked the meridian and disconnecting the Qi flow among brain and the internal organ. So the Qi and blood can not go up to the head and nourish the brain as for damaging the spirit.
B. Treatment of Alzheimer’s Disease with Chinese Medicine
The fundamental root of Alzheimer’s disease is inside-deficient and outside-sufficient. In clinical,most cases manifest complicated syndromes interweaving deficiency and excess. The treatment should measure the actual situation of the deficiency-sufficiency and the incidental-fundamental. Reinforcing the body deficiency and strengthening the body resistance. Dispelling the excessive syndrome and eliminating the pathogenic factors; or strengthening the body's natural resistance and eliminating the pathogenic factors at the same time. This is the only way to have a better effect.
1. Tonifying the Kidney and Replenishing Essence, Supplementing the Bone Marrow and Nourishing the Brain
The kidney essence deficiency and brain marrow atrophy are the main origin of Alzheimer's disease. Therefore, invigorating the kidney and replenishing the essence should be considered. The treatment should be given according to the syndrome of deficiency if it’s in kidney,in Yin or in yang.In the situation of kidney deficiency, replenishing the kidney essence is needed. Therefore the following Chinese herbal drugs should be given. Most of these items are friendly in taste and in feelings. The are Prepared Rehmannia Root, Wolfberry Fruit, Pilose Antler, Frost Pilose Antler, Dogwood Fruit, Tortoise-Plastron etc. A fact should be pointed out that the Qiis from the same originas essence.So the smart way of replenishing essence should be companied with replenishing Qi. Therefore these items are ought to be given as well. They are Ginseng, Astragalus Root, Polygonatun Root etc.In the situation of Qi deficiency, boosting the vital-Qi to restore the energy is needed. The drugs with sweat flavor and worm nature should be used. Again boosting vital-Qi should be companied with drugs for essence as well. These drugs are Ginseng, Astragalus Root, Plygonatun Root, Ginnamon Bark, Liquorice etc.In the situation of Yin deficiency, enrich the yin is needed. Therefore these drugs should be used, such as ripe Rehmannia Root, raw Rehmannia Root, Dogwood Fruit, Wolfberry Fruit, Chinese Yam, Ophiopogon Root etc.They are belong to sweet, soft, rich tasting in nature drugs to replenish the true yin. But Yang and Yin are interdependence. So often combining Antler, Dodder Seed, Eucommia Bark etc. to warm and tonifying nature. So the Yin obtains the Yang’s sublimation, its origin will not be dry out.In the situation of yang deficiency,invigorating the Yang is needs. The drugs with the nature of pungent-hot and sweet-warm are preferred since they can support the Yang and preserve the Origin-Qi. They are including Prepared Lateral Root of Aconite, Cinnamon Bark, Ginseng, Desertliving Cistanche, Dodder Seed, Eucommia Bark etc. At the same time, some drugs that can enrich the Yin should also be used, such as Prepared Rehmannia Root, Wolfberry Fruit, and Dogwood Fruit and so on. In this case, the Yang obtains the help from Yin; its function will be more abundant.Modern famous doctor Zhang Xichun already advocated invigorating the kidney to replenish the essence and nourish the brain. He createda recipe to enriching the kidney to nourish the brain includingWalnut, the Antler and so on. The evidence from pharmacological research proved that Ginseng, Wolfberry Fruit, Siberian Solomonseal Rhizome etc. has the effect of anti-agingand improving brain function. Apparently, invigorating the kidney to fill in the essence andstrengthening the root to support the primordium is one of the basic methods of treating the Alzheimer’s disease.
2. Invigorating the Spleen and Replenishing the Qi, Tonifying the Blood and Nourishing the Heart
The spleen provides the material basis for the acquired constitution and is the source of the Qi and bloodproduction. While as the heart is the house of the spiritual activity. Human spiritual activity and consciousness depend on the nourishment of the Qi and blood.Fortifying the spleen would enable the transformation of Qi-bloodfrom the origin; tonifying the blood would enable the maintenance of the heart to control the mental activity being clearly and brightly. In the case of weakened spleen, restoring vital energy and fortifying the spleen is needed.The drugs often used are: Ginseng, Dangshen, Astragalus Root, Siberian Solomonseal Rhizome, Acanthopanax Root, and Poria, etc. The prescriptions usually used are: Decoction of Six Noble Drugs, Decoction for Reinforcing Middle-warmer and Replenishing Qi and so on.In the case of weakened heart, boosting the Qi and relieving the mental stress is needed. The drugs often used are: Ginseng, Prepared Rehmannnia Root, Chinese Angelica Root, Schisandra Fruit, Fleece-Flowe Root,Poria, Longan Aril, Polygala Root, Arborvitae Seed, Red Sage Root, Winter-worm Summer-herb etc. The recipes often used are: Decoction for Invigorating the Spleen and Nourishing the Heart, Ginseng Nutrition Decoction, etc.
3. Soothing the Liver and Regulating the Circulation of Qi, Removing the Blood Stasis and Resolving the Phlegm
Zhang Jingyue pointed out that the onset of the dementia was mostly because of the stagnation of liver-Qi, dissatisfaction, over thinking and preoccupation or because of fear and frightening. The Qi is then backflow to the heart or liver-gallbladder to become dirty Qi. So in the case of liver Qi stagnation,smoothing the liver and rectifying the Qi is needed. The drugs often used are: Bupleurum Root, Curcuma Root, Chuanxiong Rhizome, White Peony Root, Tangerine Peel etc. The recipe is Bupleurum Powder for Reliving Liver-Qi. However liver is the unyielding viscus. When Qi is stagnated for a period of time, there is a chance that it can transform into fire. Therefore some drugs like Moutan Bark, Capejasmine Fruit, Scutellaria Root and Coptis Root should be used. The recipes often used are Decoction of Gentian for Purging Liver-fire; Liver-Transforming Brew;Decoction of Silk Tree for Depression-Resolving(Silk Tree Flower, Curcuma Root, Red Sage Root, Chinese Angelica Root, White Peony root, Arborvitae Seed, Poria Root, Aquilaria , Candied Tangterine, Bupleurum Root, Peppermint, Capejasmine Fruit, Jujube). AsProf. Ding Guangdisaid, “The drugs for liver disease should be used carefully. For regulating the flow of vital energy, it must prevent consumingtoo much vital Qi to scorch the essence yin;for clearing the fire and heat it must prevent injuring stomach and wounding spleen. If the stagnation of liver Qi lasts for a long time, it will produce the phlegm-stasis. The latter will then obstruct the life-light receiving entrance and cloud the spirit. In this situation, dissolving phlegm and rectifying Qi is needed. In hisSecretRecord at Stone Chamber, Chen Shiduo, the doctor of the Qing Dynasty said "There is nomiracle method treating the dementia, only one way is feasible, to treat the phlegm.The more phlegm is produced, the severe dementia would be. It can not be cured by only using the common recipe Two Old Drugs Decoction." The medicationsoften used are Pinellia Tuber, Tangerine Peel, White Mustard Seed, Poria, Grassleaved Sweetfkag Rhizome, Polygala Root, Curcuma Root and Arisaema Root etc. The prescriptions are Phlegm-Abducting Decoction, No-Forgetting Powder(Grassleaved Sweetfkag Rhizome, Poria, Poria Root, Ginseng, Polygala Root) and Elixir of Cure Dementia(Ginseng, White Mustard Seed, Cuscuta Seed, White Atractylodes Rhizome, Poria Root, Pinellia Tuber, Prepared Lateral Root of Aconite, Cynanchum Root and Cinnabar).