Traditional Chinese Medicine Offers New Option for IBS Patients

Tiejun Tang

Today, April 19th, is the World IBS Day. Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder that causes chronic abdominal pain, bloating, diarrhea, and constipation. According to a pooled prevalence analysis of 53 studies that used Rome III criteria from 38 countries and involved 395,385 participants, the prevalence of IBS was 9.2%, with a higher prevalence in women than in men (12.0% vs. 8.6%) ^[1].

In 2017, I wrote an article titled "How to Treat IBS with Chinese Herbal Medicine and Acupuncture?" (click to read the full text). Since then, more research progress has been made on this topic. This paper is an update discussing of the the recent advancements in the treatment of IBS with traditional Chinese medicine.

Although Western medicine has made progress in treating IBS for the past years, there are still some challenges. The National Institute for Health and Care Excellence (NICE) recommends dietary changes, symptomatic treatment, tricyclic antidepressants (TCAs), and psychotherapy for IBS treatment. However, TCAs are associated with reported side effects of up to 15 symptoms, including severe symptoms such as headache, epilepsy, sexual dysfunction, and weight gain. As a result, many IBS patients may have to deal with persistent symptoms or suffer from the side effects of TCAs. ^[2]

According to the basic theory of traditional Chinese medicine, IBS is mainly caused by the imbalance of liver and spleen. Liver qi stagnation and spleen deficiency are the primary pathologies of IBS. This dissonance can lead to digestive dysfunction, which leads to the symptoms of IBS ^[3]. TCM offers a holistic approach to treating IBS by addressing underlying imbalances in the body. Common Chinese treatments for IBS include herbs, acupuncture, and moxibustion can ease the conditions.

Tongxie Yaofang, a traditional formula that originated in the Ming Dynasty of China, is a common formula for treating IBS. A research report showed it can effectively improve intestinal permeability and enhance intestinal mucosal barrier function, which may be related to the inhibition of the inflammatory cascade and the NF-κB and Notch signaling pathways^[4]

Wenshen Jianpi Wan is a patent herbal pill which is based on the traditional formula Si Shen Wan. A laboratory research study showed it can reduce visceral hypersensitivity in IBS-D model rats, possibly by down-regulating TNF-α, p-MEK1/2, p-ERK1 in colon tissue and p-ERK2 expression, it also down-regulated the expressions of p-MEK1/2, p-ERK1, and p-ERK2 in the hippocampus^[5].

Acupuncture is also widely used in the treatment of IBS. A multicenter randomized controlled trial study conducted in 7 hospitals in China showed that acupuncture was more effective than western medicine in treating IBS, and the treatment effect could last up to 12 weeks^[6].

A literature study has analyzed the relevant pathophysiological mechanisms and curative effects of acupuncture in the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D). It was found that acupuncture can regulate brain-gut peptides in IBS-D patients, change brain connections and activities, promote neuroendocrine function and mental state, and reduce inflammation and intestinal allergies^[7].

In conclusion, clinical and experimental research reports showed that both Chinese herbal medicine and acupuncture can improve IBS symptoms through different mechanisms, and the combination of herbs and acupuncture may bring better results. TCM therapy can completely avoid the side effects caused by western medicine and bring significant benefits to IBS patients.

Reference:

1.  Oka P. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020; 5(10):908-917
2. Pierre M Bet . Side effects of antidepressants during long-term use in a naturalistic setting. Eur Neuropsychopharmacol. 2013; 23(11):1443-51
3.  Cheng-Jiao Yao,. Traditional Chinese medicine for irritable bowel syndrome. Medicine (Baltimore). 2020; 99(48): e23394.
4. Qiuke Hou. Tong-Xie-Yao-Fang improves intestinal permeability in diarrhoea-predominant irritable bowel syndrome rats by inhibiting the NF-κB and notch signalling pathways. BMC Complement Altern Med. 2019; 19: 337
5. Tianyuan Jiang.  Wenshen-Jianpi prescription, a Chinese herbal medicine, improves visceral hypersensitivity in a rat model of IBS-D by regulating the MEK/ERK signal pathway. Front Pharmacol. 2022; 13: 955421
6.  Lixia Pei. Effect of Acupuncture in Patients With Irritable Bowel Syndrome: A Randomized Controlled Trial. Mayo Clin Proc. 2020; 95(8):1671-1683.
7. Gezhi Zhang. Effects and Mechanisms of Acupuncture on Diarrhea-Predominant Irritable Bowel Syndrome: A Systematic Review. Front Neurosci. 2022;16:918701.

Discuss Parkinson’s Disease in World Parkinson’s Day

 Tiejun Tang  

Today is the World Parkinson's Day. 11^th April is the birthday of Dr. James Parkinson. He is the first physician to recognize Parkinson’s as a medical condition. He was born and practiced in London as a surgeon. In the UK this week is the Parkinson’s disease awareness week. It is observed annually in the UK to raise awareness about the disease and support those affected by it. Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects movement, causing tremors, stiffness, and difficulty with balance and coordination.   

Over the past generation, the number of individuals with PD globally has more than doubled to over 6 million. In all the neurological disorders included in Global Burden of Disease (GBD) 2015, PD was the fastest growing^[1,2].

Modern medicine offers several treatments for PD, including medication, surgery, and deep brain stimulation. The currently available treatment methods are all symptomatic ones and caused some side effects. No treatment has been proven to slow the progression of PD^[3].

Traditional Chinese medicine believes that PD is mainly caused by deficiency of liver and kidney yin in the early stage; in the middle stage, it is mainly caused by wind phlegm and blood stasis; in the later stage, deficiency of both yin and yang and deficiency of both qi and blood are the main pathology change. In terms of treatment, Chinese medicine applied nourishing yin, detoxifying. Nourishing the qi & blood, and tonified yin & yang^[4].

Clinical studies have demonstrated that acupuncture may be beneficial for PD treatment, particularly in terms of ameliorating PD symptoms when combined with anti-PD medication, reducing the required dose of medication and associated side effects. During early stages of PD, acupuncture may even be used to replace medication. It has also been found that acupuncture can protect dopaminergic neurons from degeneration via antioxidative stress, anti-inflammatory, and antiapoptotic pathways as well as modulating the neurotransmitter balance in the basal ganglia circuit^[5]. A meta-analysis of 2314 patients showed: Compared with dopamine replacement therapy alone, the addition of acupuncture was significantly beneficial in improving the Unified Parkinson’s Disease Rating Scale score (UPDRS) in PD patients^[6]. The other research showed electroacupuncture on the points of GB34 and LV3 can improve the level of dopamine in the brain of PD animal models ^[7].

Chinese herbs and herbal extracts show potential clinical benefit in slowing the progression of PD in humans. Such as ginseng and ginsenosides, ginkgo biloba and EGb 761, Polygonum multiflorum, and triptolide in Tripterygium wilfordii can alleviate the symptoms caused by the degeneration of dopamine neurons. Herbs or herbal extracts can promote neuronal survival and neurite out rowth, promote functional recovery after brain injury, regulate cell survival genes and signals, anti-apoptotic activity, and improve cerebral blood circulation^[8].

Liuwei Dihuang Wan is a very popular herbal remedy. An network pharmacology research found that: Since they contain several active components, target multiple ligands, and activate various pathways. The hub components possibly include quercetin, stigmasterol, kaempferol, and beta-sitosterol and act through pairing with hub targets, such as AKT1, VEGFA, and IL6, to regulate neuronal death, G protein-coupled amine receptor activity, reactive oxygen species metabolic process, membrane raft, MAPK signaling pathway, and cellular senescence for the treatment of PD^[9].

To further improve the treatment of PD, it is important to integrate the strengths of both Western medicine and TCM. While Western medicine is effective in managing acute symptoms of PD, TCM has shown potential in slowing the progression of the disease and improving the overall quality of life of patients. Therefore, a combination of Western medicine and TCM may provide a more holistic and personalized approach to treating PD, tailored to the individual needs of each patient.

Overall, on this World Parkinson's Day, it is important to raise awareness about PD and support those affected by it. By integrating the strengths of Western medicine and TCM, we may be able to provide better care and improve the quality of life for PD patients.

Reference:

1.  Jacob Stovner. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2018; 17 (11):954-976.
2.  Dorsey ER. The Parkinson pandemic—a call to action. JAMA Neurol. 2018;75(1):9-10.
3. Salawu F. Current management of Parkinson's disease. Ann Afr Med. 2010; 9(2):55-61.
4.  Yuqing Hu. Traditional Chinese medicine syndrome differentiation and treatment by stages of Parkinson’s disease: study protocol for a multicentre, randomized, double-blind, placebo-controlled clinical trial. BMC Chinese Medicine 2022; volume17, Article number: 68.
5. Yadan Zhao. Acupuncture for Parkinson's Disease: Efficacy Evaluation and Mechanisms in the Dopaminergic Neural Circuit. Neural Plast 2021. 15;2021:9926445.
6. Guoxin Zhang. Effectiveness of Traditional Chinese Medicine as an Adjunct Therapy for Parkinson’s Disease: A Systematic Review and Meta-Analysis. PLOS. ONE. March 10, 2015.
7.  Jaung-Geng Lin. Electroacupuncture Promotes Recovery of Motor Function and Reduces Dopaminergic Neuron Degeneration in Rodent Models of Parkinson’s Disease. Int J Mol Sci. 2017; 18(9): 1846.
8. Liang-Wei Chen. Chinese herbs and herbal extracts for neuroprotection of dopaminergic neurons and potential therapeutic treatment of Parkinson's disease. CNS Neurol Disord Drug Targets 2007;6(4):273-81.
9.  Dongtao Lin. Study on the Mechanism of Liuwei Dihuang Pills in Treating Parkinson's Disease Based on Network Pharmacology. Biomed Res Int. .2021 . 28;2021:4490081.

How to treat fatty liver?

 Tiejun Tang       

Fatty liver also known as hepatic steatosis, is a growing health concern worldwide. It is estimated that 25% of the global population has fatty liver disease, with prevalence rates as high as 60% in some countries ^[1].

Many people ignore the dangers of fatty liver and leave it untreated, in fact excess fat in the liver can lead to liver damage and negatively affect your health.

The main hazards of fatty liver are as follows:

1) Inflammation: As the liver becomes fatty, it becomes inflamed, which can lead to liver damage and scarring.

2) Liver dysfunction: When the liver becomes inflamed and damaged, it impairs its ability to function properly. This can cause problems with the liver's ability to detoxify blood, produce important proteins, and regulate hormones.

3) Increased risk of type 2 diabetes: Fatty liver disease is associated with insulin resistance, which increases the risk of type 2 diabetes.

4) Cardiovascular disease: Fatty liver disease is also associated with an increased risk of cardiovascular disease, including heart attack and stroke.

5) Liver cancer: In severe cases, fatty liver can develop into liver cancer.

There is no specific medication or treatment specifically approved for fatty liver in Western medicine. Treatment is typically focused on managing any underlying conditions and making lifestyle changes to improve liver health

In Traditional Chinese Medicine (TCM) the liver is regarded as one of the most important organs in the body, responsible for storing blood and regulating the flow of Qi (vital energy) throughout the body. The liver is also associated with the emotion of anger. According to TCM theory, liver Qi stagnation and blood stasis are the main pathological mechanisms of fatty liver disease. This stagnation and stasis can result from various factors, such as overeating, alcohol consumption, and emotional stress, leading to a buildup of fat in the liver ^[2].

In the clinical TCM has been used to treat fatty liver disease for centuries, and clinical studies have shown promising results. For example, a randomized controlled trial involving 80 patients with non-alcoholic fatty liver disease (NAFLD) found that a combination of acupuncture and Chinese herbal medicine resulted in significant improvements in liver function and a reduction in liver fat content compared to the control group ^[3]. Another study involving 60 patients with NAFLD found that treatment with a TCM formula for 12 weeks led to significant reductions in liver fat content and improved liver function ^[4].

The mechanisms of Chinese herbal medicine were investigated through modern pharmacology research. Laboratory research has shown that certain TCM formulas and extracts can reduce fat accumulation in liver cells and improve liver function. For example, a study found that a TCM formula containing rhubarb, baicalin, and choline bitartrate was able to reduce liver fat content and improve liver function in rats with NAFLD ^[5]. Another study found that curcumin, a compound found in turmeric and commonly used in TCM, was able to reduce liver fat accumulation and improve liver function in mice with NAFLD ^[6].

Molecular mechanism research has shown that TCM and its extracts can affect various signaling pathways involved in the development and progression of fatty liver disease. For example, one study found that berberine, a compound found in various TCM herbs, was able to improve liver function and reduce liver fat accumulation by regulating the AMPK/mTOR signaling pathway ^[7].

Overall, the use of TCM for the treatment of fatty liver disease has shown promising results in both clinical practice and scientific research. Further studies are needed to fully understand the mechanisms by which TCM treats fatty liver disease and to optimize its clinical use.

References:

1.   Younossi, Z. M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016; 64(1), 73-84.

2.    Xiong, J. Traditional Chinese medicine for the treatment of nonalcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials. Journal of Traditional Chinese Medicine. 2019; 39(5), 677-689.

3.    Wu, J., Clinical observation of acupuncture combined with Chinese medicine for the treatment of non-alcoholic fatty liver disease. Chinese Journal of Integrative Medicine, 2016; 22(5), 341-346.

4.   Li, Q. Clinical observation of traditional Chinese medicine formula for the treatment of nonalcoholic fatty liver disease: A prospective, multicenter, observational study. Medicine, 2019; 98(23), e15906.

5.   Wang, Y. Protective effect of rhubarb, baicalin, and choline bitartrate on nonalcoholic fatty liver in rats. Journal of Cellular Biochemistry. 2019; 120(11), 18219-18226.

6.   Wu, L. Curcumin suppresses expression of adipogenic genes in 3T3-L1 adipocytes and high-fat diet-induced obese mice. Phytotherapy Research. 2018; 32(8), 1533-1542.

7. Li, T. Mechanisms of action of berberine and its derivatives: A review of research progress in the past decade. Pharmacological Reports. 2018; 70(5), 925-937.

Acupuncture and moxibustion improve leukopenia caused by chemo and radiotherapy

 Tiejun Tang

Leukopenia is one of the most common side effects of chemo and radiotherapy in cancer treatment. When the level of white blood cell (WBC) count is too low, chemo or radiotherapy has to be terminated to avoid fatal uncontrollable infection. If the chemo or radiotherapy plan is not completed, the remaining tumor cells will recur, leading to treatment failure. This is a difficult situation that western medicine doctors have to face in tumor treatment.

Can Chinese medicine help in this situation? The following research reports give a positive answer:

A randomized controlled trial (RCT), published in the journal Supportive Care in Cancer in 2014^[1], found that acupuncture combined with moxibustion was more effective than medication in increasing WBCs counts in breast cancer patients undergoing chemotherapy. Another study, published in the Journal of Traditional Chinese Medicine in 2012 ^[2], found that moxibustion was effective in preventing leukopenia in lung cancer patients undergoing chemotherapy.

A Meta-analysis research which Leukopenia is one of the most common side effects of chemo and radiotherapy in cancer treatment. When the level of white blood cell (WBC) count is too low, chemo or radiotherapy has to be terminated to avoid fatal uncontrollable infection. If the chemo or radiotherapy plan is not completed, the remaining tumor cells will recur, leading to treatment failure. This is a difficult situation that western medicine doctors have to face in tumor treatment.

Can Chinese medicine help in this situation? The following research reports give a positive answer:

A randomized co include 15 RCTs 1130 patients, the results showed that acupuncture can increase WBC count after chemotherapy (P <0 .00001), reduce the incidence of myelosuppression (P = 0.0002), and improve the clinical treatment effectiveness (P = 0.05). The differences were statistically significant^{. [3]}

A RCT involving 650 breast cancer patients were eligible for inclusion. Analysis by the random-effects model showed a significant effect by acupuncture of ameliorating leucopoenia during chemotherapy. Levels of WBCs were increased (P < 0.001) neutrophil counts (P < 0.001) were significantly enhanced. Moreover, regardless of the manner through which acupuncture was applied, overall values of WBCs increased. ^[4]

A Six RCTs with a total of 681 patients with various types of cancer receiving ongoing chemotherapy or after chemotherapy. The results of two RCTs suggested the effectiveness of moxibustion combined with chemotherapy vs. chemotherapy alone. Six RCTs showed that moxibustion was more effective than various types of control interventions in increasing WBC counts. ^[5]

The exact mechanisms by which acupuncture and moxibustion work to alleviate leukopenia are not yet fully understood. However, it is believed that they may help stimulate the immune system and increase the production of WBCs. They may also help reduce inflammation and oxidative stress, both of which can contribute to leukopenia.

Except acupuncture Chinese herbal medicines also can prevent and treat the bone marrow suppression caused by chemo and radiotherapy, and increase the WBCs count. I used wrote an article on this topic in 2010. ( Click the link to read more). In a recent, meta-analysis research which included of 14 RCT involving 1,053 patients the results showed that Chinese herbal medicine + chemotherapy had greater beneficial effects on WBC, neutrophil , hemoglobin and platelet counts. Compared with chemotherapy alone or western medicine + chemotherapy, Chinese herbal medicine combined with chemotherapy can effectively improve the clinical symptoms of chemotherapy-induced leukopenia^{. [6]}

It is important to note that acupuncture and moxibustion should not be used as a substitute for conventional cancer treatment, but they can be used as a complementary therapy to help alleviate side effects of chemo and radiotherapy.

In conclusion, acupuncture and moxibustion have shown promise in the treatment of leukopenia caused by chemo and radiotherapy. The combination of acupuncture and herbal medicine will lead a double effect in the clinical. The intervention of this complementary medicine therapy can often affect the prognosis of cancer treatment

References:       

1.  Lu, W.Acupuncture and moxibustion for chemotherapy-induced leukopenia: a randomized controlled trial. Supportive Care in Cancer. 2014; 22(6), 1733-1738.
2. Chen, X.Clinical observation of moxibustion in preventing chemotherapy-induced leukopenia in lung cancer patients. Journal of Traditional Chinese Medicine.2012; 32(3), 343-346.
3.  Jiayun Nian. Efficacy and safety of acupuncture for chemotherapy-induced leukopenia: A systematic review and meta-analysis. Medicine (Baltimore). 2022; 21;101(42):e30995.
4.  Ya Wen Shih. Effectiveness of Acupuncture in Relieving Chemotherapy-induced Leukopenia in Patients With Breast Cancer: A Systematic Review With A Meta-Analysis and Trial Sequential Analysis. Integr Cancer Ther. 2021 Jan-Dec;20:15347354211063884.
5. Tae-Young Choi. Moxibustion for the treatment of chemotherapy-induced leukopenia: a systematic review of randomized clinical trials. Support Care Cancer. 2015 Jun;23(6):1819-26
6.  Qing Wang. Chinese Herbal Medicine for Chemotherapy-Induced Leukopenia: A Systematic Review and Meta-Analysis of High-Quality Randomized Controlled Trials. Front Pharmacol. 2021 May 4;12:573500.