Internal Medicine
Considering that Chinese medicine has been involved with promoting health and treating disease for over 2000 years, it is not surprising that it has accumulated a large body of knowledge on the use of herbs to promote health and reduce the impacts of aging, commonly known as deficiency (Xu) patterns.
In this regard, it is important to note that the discipline of Internal Medicine provides two contributions–
1) suggestions for personalized food intakes and nutrition, and
2) on the use of specific herbal preparations with medicinal functions for an individual.
Research and related articles on Chinese herbs in internal medicine
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Metabolism ‒ Networked Perspectives
Network theory, a subset of Graph theory, uses vertices (nodes) and edges (connectors) to depict interactions between the members of an interacting system. It is a powerful tool which allows us to visualize relationships (connections) between entities (structures, nodes) in complex and dynamic systems. With a network diagram, we are able to depict as many interactions as we want, between as many entities as we want, without having to write a single equation. In complex networks, we see both highly connected entities (nodes) and less connected ones. It is reasonable to assume that the nodes with the most connections have greater influences on the operational stability of the system, the complete network. Similarly, it is also reasonable to say that a system that has only a few nodes with the most connections is inherently more unstable than one with a larger number of highly connected nodes.
Networks can be simplified by collapsing fragments of complex systems into higher order structures (“super nodes”), as long as none of the connections in the network are changed. In this manner, we can visualize metabolic processes as layered networks, ascending in complexity from macromolecules, like enzymes, to subcellular organelles, like mitochondria, to organ/networks, like the Liver, the Kidney, or the Heart (TCM). Within this framework, using networks, which has broad applications ‒ ranging from physics to physiology ‒ we have an elegant yet non-quantitative model to conceptualize interactions between organ systems and target enzymes ‒ e.g. biomarkers of clinical significance ‒ which are affected in the course of illnesses which affect that organ. Biomarkers are what are being tracked in clinical lab work.
Using the network formalism, the authors have linked three large interconnected networks ‒ the Cardiovascular, the Urogenital and the Nutritional & Metabolic systems ‒ to present a large number of disease signs and symptoms, using the reductionistic paradigm favored in Western medicine. Examples from the diagram include the associations between cytochrome P450 gene polymorphisms (CYP2C9, CYP24A1) and coronary artery diseases (CAD), the associations between obesity and endocrine alterations or alterations in the butyrylcholinesterase (BChE) gene, and the roles of variations in NOX4, a member of the NOX family of NADPH oxidases, in initiating renal tubule injuries. The reductionistic approach often leads clinicians to treat each individual condition with a separate drug. Current clinical-epidemiological evidence suggests that this scattershot approach to treating complex and chronic diseases is not working. A principal mechanism leading to the failure of this strategy is adverse drug-drug interactions, i.e., alterations of metabolic processes that derail normal physiology, sometimes irrevocably, leading to dependence on the drug(s) for survival.
For example, we may use large numbers of drugs to treat the constellation of symptoms of a chronic and resistant disease pattern like Metabolic Syndrome ‒ a combination of obesity, hypertension, hyperlipidemia syndromes, and hyperglycemia. This clinical strategy appears to be both damaging and relatively ineffective, because very few people actually get cured and stop taking the medications.
However, as the network model suggests, it may be easier to treat this confounding diversity of system level malfunctions (illnesses), if we understand the key factors (smaller networks) responsible for driving the larger and more complex networks, e.g., organ systems, into a state of chronic disharmony.
To be successful, we must determine the relevant metabolic networks that are deranged in the course of an illness. If we can do that, the solution may be straightforward, and will also be less expensive in the long term, compared to a lifetime with multiple drug therapies. As an example, we know that regular/proper nutrition and hydration, modest levels of stretching/exercise, and social support networks leading to increased mindfulness, avoidance of habits like smoking, and stress reduction can work wonders on controlling Metabolic Syndrome, if started early. The work of Dean Ornish (MD) demonstrates this strategy quite well, with regard to reversing of the atherogenic impacts of cardiovascular diseases.
We need to start thinking about the forest, i.e., the whole person, rather than the cluster of trees ‒ the individual illnesses they present.
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Chinese Herbs and Osteoporosis
There is increasing interest in the use of natural ( i.e., herbal) products to increase bone density and to reduce fractures, especially among the elderly. Herbal products are safer and can be used as part of a long-term strategy, having fewer adverse side effects, if used properly.
Since bone, is formally linked to the Kidney (Ki) organ-network, many Chinese herbal formulations include Ki tonifying herbs. Blood tonics and heat clearing , e.g., yin nourishing, herbs may also be used in these formulations.
The bisphosphonates, a common class of western drugs used to treat osteoporosis, are known to have adverse effects– on the GI system, causing conditions like erosion of the esophagus, gastritis, and inflammation, and on the skeletal system, causing conditions like osteonecrosis of the jaw.
Since there is increasing concern about herb-drug interactions, herbal preparations may be sidelined since few herbal-medical practitioners, including those in China, have the ability to combine both herbal and synthetic drug combinations in a safe and efficacious manner.
However, herbal preparations can be used in the early phases of a bone protective therapeutic regimen in combination with specially designed exercises and can be expected to be both effective and safer, with few adverse side effects.
Here are a few recent reports on this subject.
Medicinal Herbs in the Prevention and Treatment of Osteoporosis
Chenrui Li, Qiang Li, Ruijun Liu, Yinbo Niu, Yalei Pan, Yuankun Zhai, Qibing Mei
The American Journal of Chinese Medicine, Vol. 42, No. 1, 1–22 (2014).
Chinese Herbal Medicine for Osteoporosis: A Systematic Review
of Randomized Controlled Trails
Zhi-qian Wang, Jin-long Li, Yue-li Sun, Min Yao, Jie Gao, Zhu Yang, Qi Shi, Xue-jun Cui, and Yong-jun Wang
Evidence-Based Complementary and Alternative Medicine (2013).
Click here for access.
An innovative herbal product for the prevention of osteoporosis.
P. C. Leung, K. F. Cheng, and Y. H. Chan
Chinese Journal of Integrative Medicine, vol. 17, no. 10, pp. 744–749 (2011).
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Chinese Herbs and Chronic Kidney Disease (CKD)
It is nice to see that MEDSCAPE is reviewing mainstream journal articles for the application of Chinese herbs to treat widespread life threatening conditions like CKD.
Therapeutic Use of Traditional Chinese Herbal Medications for Chronic Kidney Diseases
Kidney Int. 2013;84(6):1108-1118. OPEN ACCESS
Traditional Chinese herbal medications (TCHMs) are frequently used in conjunction with western pharmacotherapy for treatment of chronic kidney diseases (CKD) in China and many other Asian countries. The practice of traditional Chinese medicine is guided by cumulative empiric experience. Recent in vitro and animal studies have confirmed the biological activity and therapeutic effects of several TCHMs in CKD.
OPEN ACCESS (MEDSCAPE)
The therapeutic principles of TCM for CKD include ‘replenishing vital energy and nourishing blood,’ ‘clearing heat and eliminating dampness,’ and ‘coordinating Yin and Yang in the body.’ Hundreds of herbs used in prescriptions of a single herb, decoctions of multiple herbs, or patent medicines have been used to treat patients with CKD. These prescriptions have effects including promotion of diuresis, reduction of proteinuria, and improvement of renal function.
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Chinese Herbs & Diabetes
Chinese Herbs Reduce Progression to Diabetes by a Third
excerpt
A combination of 10 Chinese medicinal herbs in a capsule, known as Tianqi, reduced progression to type 2 diabetes in people with impaired glucose tolerance (IGT) in a randomized controlled trial in China.
This is the first study to show that a Chinese herbal medicine can “reduce the progression of prediabetes to diabetes,” says study author Chun-Su Yuan, MD, PhD, from the Tang Center for Herbal Medicine Research at the University of Chicago, Illinois. Tianqi “could provide a new option for diabetes management, using herbal medicine alone or as an adjuvant to currently used therapies,” he noted.
Most significantly, the researchers found that taking Tianqi reduced the risk for diabetes by almost a third (32.1%) compared with placebo, after adjustment for age and gender. The proportion of participants who had normal glucose tolerance after 12 months of receiving either Tianqi or placebo was 63.1% (n=125) and 46.6% (n=89), respectively ( P = .001). A total of 36 participants in the Tianqi group (18.18%) and 56 in the placebo group (29.32%) developed diabetes ( P = .01).
Chinese Herbal Medicine Tianqi Reduces Progression From Impaired Glucose Tolerance to Diabetes: A Double-Blind, Randomized, Placebo-Controlled, Multicenter Trial
The Journal of Clinical Endocrinology & Metabolism, Volume 99, pp648–655. DOI: http://dx.doi.org/10.1210/jc.2013-3276
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Chinese Herbs and Cancer
Over the last few years, clinicians around the world have been continuing formal validation of the benefits of herbal medicines for the treatment of cancer, both in primary and adjunctive roles.
Therapeutic Applications of Herbal Medicines for Cancer Patients
Shu-Yi Yin, Wen-Chi Wei, Feng-Yin Jian, and Ning-Sun Yang
Evidence-Based Complementary and Alternative Medicine
Volume 2013, Article ID 302426, 15 pages
http://dx.doi.org/10.1155/2013/302426 OPEN ACCESS
The Main Anticancer Bullets of the Chinese Medicinal Herb,Thunder God Vine
Zi Liu, Liang Ma and Guang-Biao Zhou
Molecules 2011, 16, 5283-5297 OPEN ACCESS
excerpted from the abstract
The thunder god vine or Tripterygium wilfordii Hook. F. is a representative Chinese medicinal herb which has been used widely and successfully for centuries in treating inflammatory diseases. More than 100 components have been isolated from this plant, and most of them have potent therapeutic efficacy for a variety of autoimmune and inflammatory diseases. In the past four decades, the anticancer activities of the extracts from this medicinal herb have attracted intensive attention by researchers worldwide. The diterpenoid epoxide triptolide and the quinone triterpene celastrol are two important bioactive ingredients that show a divergent therapeutic profile and can perturb multiple signal pathways.
As an adjunctive modality, Yin protecting and nourishing herbs have long been used for protecting the GI tract from the ravages of chemo- and radiation treatments. Among these formulae, PHY 906 is the most famous for its continuing advancement in US clinical trials.
Preclinical studies of the Chinese Herbal Medicine formulation PHY906 (KD018) as a potential adjunct to radiation therapy.
Int J Radiat Biol. 2013 Jan;89(1):16-25. OPEN ACCESS
doi: 10.3109/09553002.2012.717733
CONCLUSION: In this mouse model, PHY906 (KD018) decreased the toxicity of abdominal irradiation without protecting tumors and thereby increased the therapeutic ratio.
The four-herb Chinese medicine PHY906 reduces chemotherapy-induced gastrointestinal toxicity.
Sci Transl Med. 2010 Aug 18;2(45):45ra59. doi: 10.1126/scitranslmed.3001270.
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Hu tao ren (Walnut, Semen Juglandis) is well known in Chinese medicine as a Yang tonic that replenishes Jing (essence) and benefits the Lung (wheezing, asthma), Large Intestine (constipation), and Kidney (yang, jing deficiencies) organ networks with its sweet and warm nature.
It is getting increased attention in Western nutrition and medicine for its benefits as a source of alpha-linolenic acid, an omega-3 fatty acid that reduces inflammation.
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Dang Gui Buxue Tang is well known to Chinese medicine physicians as a classic treatment for acute blood loss. Here is a Fall 2012 study on its application for Women’s Health, from the journal Menopause.
A randomized, double-blind, multiple-dose escalation study of a Chinese herbal medicine preparation (Dang Gui Buxue Tang) for moderate to severe menopausal symptoms and quality of life in postmenopausal women
Published ahead of Print, 17 September 2012 doi: 10.1097/gme.0b013e318267f64e
Wang, Chi Chiu MD, PhD; Cheng, King Fai MD; Lo, Wing Man RN; Law, Cindy BNurs; Li, Lu MD, PhD; Leung, Ping Chung MD; Chung, Tony Kwok Hung MD; Haines, Christopher John MD
This phase II clinical trial investigated the dose-response relationship of a Chinese herbal medicine preparation, Dang Gui Buxue Tang (DBT), on the quality of life in postmenopausal women.
The authors conclude that DBT preparations at 6.0 g/day significantly improve physical and psychological scores. No serious adverse events were noted during the 12-week intervention period and DBT apparently does not affect hormones or lipid profiles.
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Huang Qin Tang, an 1,800 year old Traditional Chinese Medicine (TCM) formula more recently known as PHY906, has undergone significant testing for use as supportive therapy for patients whose gastrointestinal system and health has been adversely affected by cancer therapies. It is now becoming part of the TCM toolkit in Integrative Oncology. The four herbs in the formula are Huang Qin, Bai Shao, Da Zao, and Gan Cao.
Here are some recent articles.
Old formula, new Rx: The journey of PHY906 as cancer adjuvant therapy. Shwu-Huey Liu, Yung-Chi Cheng. Journal of Ethnopharmacology 140 (2012) 614– 623. Click here to access the article.
Interaction of a traditional Chinese Medicine (PHY906) and CPT-11 on the inflammatory process in the tumor microenvironment. Ena Wang, Scott Bussom, Jinguo Chen, Courtney Quinn, Davide Bedognetti, Wing Lam, Fulan Guan, Zaoli Jiang, Yichao Mark, Yingdong Zhao, David F Stroncek, Jeffrey White, Francesco M Marincola and Yung-Chi Cheng. BMC Medical Genomics 2011, 4:38.
http://www.biomedcentral.com/1755-8794/4/38
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A series of articles were recently published in the journal Nature (22 December 2011. Vol. 480 No. 7378_supp pp. S81-S121. ) on the value of Traditional Chinese Medicine (TCM). The collection can be found at
http://www.nature.com/nature/outlook/asian_medicine/index.html
Of specific interest to TCM physicians are two articles that I found particularly interesting. The first one is on how the molecular constituents of Chinese herbal medicine are transformed by gut flora, known as the human microbiome— “Microbiome: That healthy gut feeling”, by James Mitchell Crow (Nature 480, S88–S89; doi:10.1038/480S88a).
2 excerpts from the article
“Our microscopic passengers have long been suspected of being active participants in a mutually beneficial partnership. Integral to this picture is the interplay between gut bacteria and health. The global rise of chronic health conditions, ranging from obesity and diabetes to bowel disease and cancer, is increasingly being linked with perturbations in gut flora. And while modern medicine is struggling to tackle such multi-component diseases, the ancient medical philosophies and practices of Asia — particularly those of traditional Chinese medicine (TCM) — could offer an alternative approach. TCM’s reliance on complex mixtures of compounds, and its philosophy of treating the human body as a whole, complete system that needs to be balanced, matches up well with the synergistic properties of the gut microbiome.”
“That at least some of the ingredients in herbal medicine exert their biological effects through interactions with our gut microbiota is not a new revelation. As long ago as the 1950s, Wei Xi, a microbiologist in the Dalian Medical University, China, proposed that the key to understanding the action of herbal medicines in the body was to consider their interaction with the microbes in our gut.”
The second one— “Convergence: Where West meets East”, by Peng Tian (Nature 480, S84–S86; doi:10.1038/480S84a.) is about the potential for a fusion of Western and Eastern medicine in the future. This nascent field of healthcare is based on prevention and lifestyle modifications (i.e., the educated patient), more than a primary or strict reliance on pharmaceutical interventions. By using this approach we aim to reduce both the adverse effects of Western medicines and the associated healthcare costs. It is sometimes referred to as Integrative Medicine.
excerpted from the article
East meets West
The absence of scientific development processes and controlled clinical trials has held back the integration of traditional Asian medicine and modern medicine for centuries. Some of its concepts appear more magical than practical, and, without a physical basis, have resisted measurement and observation. But slowly these differences are resolving.
Much of the drive for integration will come from China and its neighbours. “We should build our own methodology to evaluate the unique features and efficacy of TCM,” says Zhimin Wang. “There are so many possible ways of integration between TCM and modern medicine. We should keep our minds open.”
The days of competition between these two systems could well be gone. “The two systems cannot replace each other,” says Boli Zhang. “But instead they will fill each other out.”
This is a great set of articles covering a range of healthcare issues and is suitable for both the public and for clinicians trained in Western medicine.
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Nanoparticles prepared from the water extract of Gusuibu (Drynaria fortunei J. Sm.) protects osteoblasts against insults and promotes cell maturation
Hsu C-K, Liao M-H, Tai Y-T, Liu S-H, Ou K-L, Fang H-W, Lee I-J, Chen R-M
International Journal of Nanomedicine
Published Date July 2011 Volume 2011:6 Pages 1405 – 1413
DOI: http://dx.doi.org/10.2147/IJN.S20473
Comments
Interesting in vitro study on the variability of the protective action of Gu Sui Bu (Drynaria fotunei) on murine osteoblasts as a function of concentration (1-1000 ug/ml) and duration of exposure (24 to 72 hours). Traditional Chinese medicine (TCM) physicians recognize the herb as a Yang tonic with the ability to strengthen bone.