Multiple Sclerosis (MS) is a disease involving demyelination of the nerves of the central nervous system. No clear causal explanation has been found. It may be related to an immune response that disrupts the neurological system and produces degeneration and demyelination in the brain, spinal cord and optical nerves. It can cause a variety of symptoms including weakness and tingling, paralysis of the limbs, diplopia, ataxis etc.
There is a high incidence of MS amongst Caucasian people in Europe. Incidence in the UK is between 40 and 120 per 100,000[1] and has recently been increasing. MS has been rare in Asia in the past, although its incidence has recently been increasing in China.[2], [3] Conventional treatment of MS involves administration of intravenous steroid infusions, which can provide temporary relief for those in the acute progressive stage of the disease. The disease usually quickly recurs after such treatment, however, and such treatment with steroids has unpleasant side-effects. After patients have been diagnosed with MS in the UK they are given a certificate of disability to allow them to receive social benefits, nursing and treatment for their symptoms.
The author of this paper reports here on her recent successful treatment of 20 patients with MS using a comprehensive treatment method of acupuncture and herbal medicine. Many of the patients experienced satisfactory control of their symptoms.[4]
Report of typical cases
Case one: a sudden recurrence of MS which was completely controlled during the acute stage
A 43 year old shopkeeper, Ms B, presented in clinic complaining that her MS had suddenly returned one month ago. She had been diagnosed with MS six years previously through CT scan after reporting weakness of her left arm, leg and eyelid, as well as other mild symptoms that all disappeared in a short time. Since then she had been living a peaceful life without disability. One month prior to presenting in clinic her health had suddenly deteriorated, with paralysis of the limbs on the right side of her body, weakness of her right eyelid (which would not open) and numbness on the right side of her face. She was admitted to hospital for three days to receive mythylprednisolone infusions. After she was discharged her symptoms became even worse. The weakness of the right eyelid spread to the left eyelid, and the diplopia now affected both eyes. She reported feeling stressed and depressed, and suffered from insomnia and constipation. She came for treatment at the clinic of the author after having previously received effective herbal treatment for her psoriasis.
Diagnostic information: paralysis of the right eye lid, diplopia of both eyes, hemianopsia of the left eye, muscular tension of the right arm and leg, Babinski reflex on the right side positive, knee reflex negative; ataxia confirmed by difficulty performing finger to finger and finger to nose tests. Tongue: dark red with little coating. Pulse: wiry and fine.
Differentiation of syndromes: Liver and Kidney yin deficiency causing interior Liver wind.
Treatment:
- Scalp acupuncture: central line, top and middle regions of the left motor area, foot motor-sensory area and chorea-trembling control area.
- Body acupuncture: Quchi L.I.-11, Shousanli L.I.-10, Hegu L.I.-4, Taichong LIV-3 with reducing method; Zusanli ST-36 with reinforcing method; Tongziliao GB-1 with even method. All points retained for 30 minutes.
- Herbal prescription: Sheng Di Huang (Rehmanniae Radix) 15g, Huang Qi (Astragali Radix) 30g, Dang Gui (Angelicae sinensis Radix) 10g, Du Zhong (Eucommiae Cortex) 15g, Chuan Niu Xi (Cyathulae Radix) 15g, Bai Shao (Paeoniae Radix alba) 30g, Gou Teng (Uncariae Ramulus cum Uncis) 10g, Shi Jue Ming (Haliotidis Concha) 10g, Ye Jiao Teng (Polygoni Multiflori Caulis) 10g , Mai Men Dong (Ophiopogonis Radix) 10g and Zhi Gan Cao (Glycyrrhizae Radix preparata) 5g. These herbs were given as a decoction, to be boiled and drunk twice daily for five doses in a week.
At her second visit one week later her right arm and leg felt significantly better, with less numbness and weakness. She no longer experienced diplopia when looking to the right, although it was still present when looking to the left. Her hot flashes, anxiety and insomnia had also improved. For her second treatment the same acupuncture points were repeated. Her herbal prescription was also repeated with the addition of Chuan Lian Zi (Toosendan Fructus) 10g and Bai Ju Hua (Chrysanthemi Flos) 10g, and prescribed for another five doses for that week.
By the time of her third and fourth visits her eyelids were gradually regaining the ability to open, the tension of her limbs had disappeared and she was able to walk and hold objects in her hand. She still experienced mild ataxia.
After maintaining weekly treatment for another month, her vision was completely clear, she could walk unaided and her ataxia had disappeared. She was again able to go about her life as normal.
This case belongs to the first class of recovery (see below for recovery standards criteria).
Case two: A chronic case of gradually deteriorating MS which stabilised following TCM treatment.
Ms K, 62 years old, had been diagnosed with MS 20 years ago. Over the last three years, however, her symptoms had gradually worsened. Previously she had experienced only mild symptoms and had been able to maintain a relatively normal life. She was now experiencing weakness of her arms and legs on both sides of her body (worse on right side), poor vision in her right eye and ataxia which made it difficult to stand and walk so that she needed to use a walking stick. She had recently developed an involuntary tremor of the affected limbs and head. She was also experiencing palpitations and a sensation of trembling in her chest. Her symptoms had become too uncomfortable to bear, which was why she came for TCM treatment.
Diagnostic information: the neurological reflexes of her legs were over-active; Babinski reflex was positive; finger to finger test of ataxia was strongly positive.
Tongue: deep-red. Pulse: wiry-fine.
Differentiation of syndromes: Liver, Spleen and Kidney qi and yin deficiency with empty heat causing interior wind.
Treatment:
- Scalp acupuncture: central line, top and middle regions of motor area, chorea-trembling control area.
- Body acupuncture: Yinlingquan SP-9, Sanyinjiao SP-6 and Zusanli ST-36 with reinforcing method; Taichong LIV-3 with reducing method.
- Herbal prescription: Sheng Di Huang (Rehmanniae Radix) 15g, Huang Qi (Astragali Radix) 30g, Dang Gui (Angelicae sinensis Radix) 10g, Xuan Shen (Scrophulariae Radix) 15g, Chuan Niu Xi (Cyathulae Radix) 15g, Gou Qi Zi (Lycii Fructus) 10g, Gou Ji (Cibotii Rhizoma) 10g, Yi Yi Ren (Coicis Semen) 30g, Huang Bai (Phellodendri Cortex) 10g and Zhi Gan Cao (Glycyrrhizae Radix preparata) 5g. These herbs were given as a concentrated powder of which six grams was taken twice daily.
At her second visit the palpitations and sensation of trembling in the chest were better. The tremor of her head still happened every day, however. For her second treatment the same acupuncture points were used, but electro-stimulation was added in order to provide stronger treatment.
The herbal prescription was modified as follows: Sheng Di Huang (Rehmanniae Radix) 15g, Gou Teng (Uncariae Ramulus cum Uncis) 10g, Shi Jue Ming (Haliotidis Concha) 30g, Qiang Huo (Notopterygii Rhizoma seu Radix) 10g, Rou Cong Rong (Herba Cistanches)15g, Huang Qi (Astragali Radix) 30g, Tian Ma (Gastrodiae Rhizoma) 10g, Gui Ban (Plastrum Testudinis) 10g, Lu Jiao Shuang (Cornu Cervi Gelatinum) 10g, Ye Jiao Teng (Polygoni Multiflori Caulis) 15g and Zhi Gan Cao (Glycyrrhizae Radix preparata) 5g. This prescription was then varied according to her symptoms over the next three months, with acupuncture given once a week. The result was that the tremors of her head and limbs were now controlled, her bowel movements were regular and although she still experienced weakness in her legs, she was able to manage everything in her daily life.
This case belongs to the second class of recovery (see below).
Case three: Chronic progressive MS with an acute deterioration of symptoms that stabilised with TCM treatment.
Ms H, 52 years old, had been diagnosed with MS six years previously during which time the condition had become progressively worse. She experienced weakness in her legs, ataxia, constipation and dribbling of urine with frequent incontinence. She also suffered from depression, anxiety and insomnia.
Diagnostic information: weakness of lower part of legs with grade III myodynamia, decreased knee reflex, positive Babinski reflex, finger to finger test of ataxia positive. Tongue: pale and plump with little white coating. Pulse: deep and fine.
Differentiation of syndromes: Spleen and Kidney qi and yin deficiency causing accumulation of turbid dampness.
Treatment:
- Special acupuncture technique: needle the special Jiaji points[5] in line with Pishu BL-21, Ganshu BL-18 and Shenshu BL-23.
- Scalp acupuncture: central line, top and middle regions of motor area on both sides.
- Body acupuncture: Qihai Ren-6, Zhongji Ren-3, Sanyinjiao SP-6, Zusanli ST-36 with reinforcing method; Taichong LIV-3 with reducing method.
- Herbal prescription: Cang Zhu (Atractylodis Rhizoma) 10g, Huang Bai (Phellodendri Cortex) 10g, Zhi Mu (Anemarrhenae Radix) 10g, Du Zhong (Eucommiae Cortex) 15g, Chuan Niu Xi (Cyathulae Radix) 15g, Yi Yi Ren (Coicis Semen) 30g, Gou Ji (Cibotii Rhizoma) 10g, Hua Shi (Talcum) 15g, Chuan Xiong (Chuanxiong Rhizoma)10g, Du Huo (Angelicae pubescentis Radix) 10g and Zhi Gan Cao (Glycyrrhizae Radix preparata) 5g. These herbs were given as a decoction for one month until the ataxia and white tongue coating disappeared, bowel movements were regular and normal urination was resumed.
During subsequent visits, the above prescription was prescribed in concentrated powder form in order to continue to strengthen the Spleen and Kidney. If she experienced deterioration of her symptoms during treatment (i.e. more weakness and ataxia), decoctions were resumed for a short time and the frequency of acupuncture treatments was increased. In general, however, she remained stable and able to manage everything in her life; she did, however, still experience weakness in her legs (which have never completely improved despite regular acupuncture and herbal medicine for over two years).
This case belongs to the second class of recovery (see below).
Case four: A severe case of MS with upper motor neuron damage, where the severe attacks of spasms and limb tension were improved with TCM treatment
Miss B, 32 years old, had been diagnosed with MS 15 years previously and had experienced gradual deterioration of her condition over the last year. Her condition was severe; she was unable to live independently and was permanently confined to her bed or wheelchair. When she first presented in clinic she was in a wheelchair and suffering from severe attacks of muscle spasm, with extreme tightness and hyper-sensitivity of the muscles of all of her limbs. She also experienced intense shaking of her head and limbs whenever she was touched (even gently) or if she became emotionally agitated. Her head was constantly shaking and she also experienced urinary incontinence. During her recent stay in hospital she had received special support from care workers, but no more medical treatment. Because she was unable to move from her wheelchair it was necessary to examine and treat her in a seated position. Her tongue was red with a white coating and her pulse was deep and wiry.
Differentiation of syndromes: Liver wind agitating within.
Treatment
- Initially it was impossible to treat with acupuncture because even the slightest touch (for example during pulse diagnosis) would set her hand trembling. She was therefore initially given herbal medicine only.
- Herbal prescription: Gui Ban (Plastrum Testudinis)10g, Huang Qi (Astragali Radix) 30g, Sheng Di Huang (Rehmanniae Radix) 30g, Wu Gong (Scolopendra) 10g, Bai Shao (Paeoniae Radix alba) 30g, Mai Men Dong (Ophiopogonis Radix) 10g, Bie Jia (Tryonycis Carapax) 10g, Jiang Can (Bombyx batryticatus) 10g, Dang Gui (Angelicae sinensis Radix) 10g and Shui Niu Jiao (Bubali Cornu) 10g. These herbs were given as a decoction.
After two weeks of treatment she became calmer, with less shaking of the head and less tremor and hypersensitivity of the muscles in her limbs. Scalp acupuncture was then included using the following points: central line, top and middle regions of the motor area and chorea-trembling control area.
After a couple of months of the above treatment some body acupuncture points were added as follows: Zusanli ST-36 with reinforcing method and Taichong LIV-3 and Neiguan P-6 with reducing method. Acupuncture was given weekly and she took her herbal medicine (as a decoction) every day.
After four months of treatment she was much calmer, such that she was now able to sit and read for a while without attacks of spasm and trembling.
This case belongs to the third class of recovery (see below).
Overall analysis
General information
All of the 20 cases here were Caucasian; eight were male and 12 were female. The youngest was 24 years old and the oldest 62. The shortest duration of disease was six months, and the longest 20 years. All of them had received their diagnosis in hospital from a neurologist, which was confirmed by the positive pathological reflexes shown during tests at the author’s clinic.
Clinical evaluation standards and results
In order to evaluate the effects of TCM treatment, the following criteria were used:
- First class recovery: MS was completely controlled and all symptoms disappeared. There were five cases in this group (25 per cent).
- Second class recovery: main and recent symptoms were controlled and there was improvement in the deteriorating state of the patient. There were eight cases in this group (40 per cent[6]).
- Third class recovery: severe symptoms were reduced and patients were able to maintain a stable condition, although they were still significantly affected by the disease. There were five cases in this group (25 per cent).
- No change: there was no change to either acute or chronic symptoms. There were two cases in this group (10 per cent).
Based on these criteria the rate of excellent results using TCM treatment in this study is 25 per cent, with an overall rate of effectiveness of 90 per cent.
Patient sample
There are broadly two types of patients who seek TCM treatment for MS.
One group constitutes those who are suffering with acute symptoms; these patients tend to have a short course of treatment (one to four months) in order to improve the recent symptoms and then stop. Sixteen out of the 20 cases reported here fit into this category (80 per cent). The other group of patients comes for ongoing (though sometimes intermittent) treatment to manage their symptoms and maintain a stable condition. Four of the 20 cases reported here fit into this category (20 per cent).
Discussion
Although the data gathered in this study is not sufficient to definitively prove the efficacy of the TCM treatment of MS, it suggests that if the correct method of treatment is used TCM treatment is effective at controlling the acute, recurring symptoms of MS and also stopping any further deterioration of the disease.
Acupuncture methods
The key to the successful treatment of MS with acupuncture is choosing the appropriate method and strength of treatment for a particular case. Table one shows the best acupuncture methods to treat particular symptoms, based on the clinical experience of the author.
| Symptoms | Scalp acupuncture | Body acupuncture | Electro-acupuncture |
| Spasm | ++ | +- | +- |
| Convulsion | ++ | — | +- |
| Tremor | ++ | +- | +- |
| Tension | ++ | +- | +- |
| Atrophy | + | ++ | ++ |
| Weakness | + | ++ | ++ |
| Dystaxia | ++ | + | + |
| Optical Disorder | + | ++ | — |
++ Application essential
+ Application useful
+- Application appropriate depending on the particular condition of the
patient
— Application contraindicated[7]
Table one: Acupuncture methods for the treatment of specific symptoms of MS
Acupuncture treatment is much more effective when the appropriate method and dosage is applied. In the experience of the author acupuncture is much more effective than physiotherapy or massage in the treatment of MS. In general the patient tends to feel much better for at least a couple of days after a session. It is therefore advisable to treat at least once or twice per week. In terms of dosage, the author has found that gentle treatment and gradual change is desirable. Because of the hyper-sensitive muscles of patients who are experiencing spasm, convulsions and tension, electro-stimulation should be applied cautiously (at the risk of aggravating the symptoms). In addition to this, due to the generally sensitive reactions of patients with neurological problems, the strength of treatment should also be carefully increased when treating atrophy and weakness.
Herbal medicine
The herbal formulae for the treatment of specific patterns are as follows:
。 Liver and Kidney yin deficiency: Yi Guan Jian (Linking Decoction)
- Spleen and Kidney qi and yin deficiency: Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
- Accumulation of dampness: San Miao Wan (Three-Marvel Pill)
- Liver wind agitating within: Zhen Gan Xi Feng Tang (Sedate the Liver and Extinguish Wind Decoction)
The above formulae alone are not powerful enough to treat MS effectively. It is also necessary to strengthen the brain, fill the bone marrow and benefit the spinal chord. Thus the above formulae are often modified by adding Shu Di Huang (Rehmanniae Radix preparata) or Sheng Di Huang (Rehmanniae Radix), Chuan Niu Xi (Cyathulae Radix), Du Zhong (Eucommiae Cortex), Di Long (Pheretima), Lu Jiao Shuang (Cornu Cervi Gelatinum) [or Lu Jiao Jiao (Colla Cornu Cervi)] and Rou Cong Rong (Herba Cistanches). In order to regulate the immune system it is often necessary to tonify qi and blood with herbs such as Huang Qi (Astragali Radix) and Dang Gui (Angelicae sinensis Radix). To treat convulsions, internal wind can be extinguished using Jiang Can (Bombyx batryticatus), Di Long (Pheretima) and Quan Xie (Scorpio). By integrating the correct TCM patterns with clear diagnostic findings of Western medicine, TCM practitioners should be able provide treatment that is focused and potent enough to effect a beneficial change in the condition of most patients with MS.[DM1]
In terms of administration of herbs, in general the herbs should be given as a decoction (five to seven doses per week) during an acute episode or if the symptoms are severe. During the chronic or stable phases the herbs can be given as concentrated powders. Some patent herbal formulas can also be effective such as Jian Bu Zhuang Gu Wan (Vigorous Walk, Strengthen Bone Pill) – previously called Jian Bu Hu Qian Wan – or Da Huo Luo Dan (Great Invigorating the Connecting Channels Pill).
Combination of herbs with medical drugs
The acute symptoms of MS are usually treated with oral or intravenous steroids. This treatment is not always effective, however – as case one above illustrates – where despite steroid infusions the patient continued to deteriorate (and then improved quickly with TCM treatment). It may be possible that in some cases patients actually respond to Western treatment better after TCM treatment – in the experience of the author if there is qi stagnation the ability of the body to respond to the drug is also obstructed; in such cases acupuncture treatment to reestablish the free movement of qi will produce a better response to the drug. Therefore the most effective way to treat a severe acute episode of MS may be a combination of steroids and TCM treatment, administered as early as possible. For the chronic or stable stage of MS, it is also advisable to employ comprehensive TCM treatment.
Conclusion
Although MS is a severe, refractory disease TCM treatment can be effective, whether used during the acute or chronic progressive stages of the disease. TCM can play a positive role in stopping the development of the disease and and deterioration of the patient.
The advantages of TCM are that it can effectively ameliorate the symptoms of MS, regulate the immune system, improve motor function, promote nerve regeneration and correct local circulation, especially if used over a long period of time. In addition TCM has no toxicity or side-effects if used correctly, even when used over the long-term.
The limitations of TCM are that in the short term it tends only to be effective at stabilising the patient’s condition at a particular stage of the disease (whether acute or chronic). That is, if the damaged nerve is engaged in an inflammatory procedure and there has not been complete demyelination, TCM treatment will control the inflammation and prevent further demyelination. TCM treatment is unfortunately not potent enough to treat disability where degeneration of the nerve has already occurred. It is of course difficult to heal such demyelination. Whilst it is not possible to cover the subject here, however, clinical experience from China suggests that TCM treatment over a sufficiently long period of time can potentially support the regeneration of the nervous system.[8] [DM2]
Treatment of MS with TCM can take a long time. In Western countries, TCM is classed as a complementary or alternative treatment and is thus usually provided by private clinics. Patients have to pay for such treatment themselves (or sometimes via private insurance). Therefore an important factor governing the success of TCM treatment is whether a patient can afford treatment over a sufficiently long period. Because TCM treatment for MS patients is currently not available in hospital, it makes it difficult to conduct the necessary clinical research to investigate its efficacy. It is the author’s hope that this small study will be followed with larger and more rigorous clinical trials. In the experience of the author TCM has much to offer patients across the world who suffer from MS.
Ms Dan Jiang MMedsci (China), FATCM, MBAcC graduated from Beijing University of Chinese Medicine in 1978, where she gained her Master’s medical degree in 1987 and remained as a lecturer and student supervisor (in the university’s affiliated hospital) until 1991. Since then she has practiced and taught TCM in the UK for almost 20 years, with clinics in Sheffield and London. She has published more than 20 papers including a Chinese language book Principles and practice of TCM in the West. Her website is at www.jiangacu-herbconsultant.com
References
[1] Edwards, C.R.W. Ed. (1995). Principles and Practice of Medicine. 18th Ed. Edinburgh: Churchill Livingstone
[2] Sun, Y. (1997). “Strengthening Research on Prevention and treatment of MS. China”. Journal of Integrated Traditional and Western Medicines 17(2), 113
[3] Sun, Y. (1992). “Clinical Observation of Identification and Treatment of 22 Cases of MS”. Chinese Medicine: 33(10), 31
[4] To say ‘cure’ in the case of MS would necessarily require follow-up monitoring for a longer period of time.
[5] The special Jiaji points are located one cun from the posterior midline in line with the intervertebral spaces. This is different from the Huatuojiaji (M-BW-35), which are located 0.5 cun from the posterior midline. The reason for using these points is that the Huatuojiaji (M-BW-35) points are too near the parts of the spine which may be damaged from MS and thus may be over sensitive and painful when needled.
[6] One case involved a man with severe MS experiencing paralysis of the legs and fecal and urinary incontinence. After three months of treatment he was able to control his defecation and urination, and the mobility of his legs was improved. Because of his improved state, he travelled abroad for a holiday, but unfortunately died of respiratory failure caused by pneumonia whilst abroad.
[7] Some patients experiencing convulsions and hyper-sensitive muscles, may be unable to bear the stimulation of body acupuncture. Electro-stimulation is contra-indicated for the points around of eyes.
[8] For example, the author conducted research on the massage treatment of disabled children with Cerebral Palsy in China, finding that some children were able to walk remarkably better after treatment. The researchers found that healing (nerve regeneration) occurred in the affected areas of the brain, as confirmed by CT scan and evoked response testing. (D Jiang etc, The Clinical and Testing Research for 100 Cases of Cerebral Paralysis in Children Cured by Massage, Journal of Chinese Medicine and Pharmacology, Issue 1, 1990)
[DM1]I have rewritten this – is it OK? OK
[DM2]I have rewritten and added an endnote – I presume your research was published in a Chinese language paper? Is this ok?
