TCM Principles - Modern Research in the Treatment of Dementia with TCM


 

TCM Principles

 

Modern Research in the Treatment of Dementia with TCM

 

By Dagmar Riley

  


Definition

According to DSM-IV, dementia is characterised by multiple cognitive deficits that are severe enough to cause significant impairment in social or occupational functioning. These deficits must show evidence of decline from previous levels of functioning, include memory impairment and at least one other cognitive disturbance (aphasia, apraxia, agnosia, or a disturbance in executive functioning). The rate of occurrence is higher in later life; the highest prevalence is above age 85. Dementia is classified as being progressive, static, or remitting. The subtypes of dementia are listed below:

  • Dementia of the Alzheimer's type - deterioration of higher cortical function (the most common form).

  • Vascular dementia - one form is multi-infarct dementia, which may be secondary to atherosclerosis.

  • Dementia due to other general medical conditions, including infection with the human immunodeficiency virus (HIV), traumatic brain injury, Parkinson's disease, Huntington's disease, Pick's disease, Creutzfeldt-Jakob disease, normal-pressure hydrocephalus, hypothyroidism, brain tumor, and vitamin B deficiencies.

  • Substance induced persisting dementia due to drug or alcohol abuse, medication, or toxin exposure.

Dementia and Chinese Medicine

In Traditional Chinese Medicine, there is no distinction between Alzheimer's Disease and Vascular Dementia. The symptoms of dementia fall under the category of lao nian xing chi dai and are often linked with kidney vacuity and marrow emptiness, spleen vacuity leading to internal phlegm-damp generation, ascendant liver yang, blood and/or phlegm stagnation, and toxicity.

 

The Kidney Engenders Marrow

The brain is nourished by the kidney, and insufficiency of the kidney may lead to emptiness of the sea of marrow, manifesting in brain deterioration. Hence, treatment with kidney tonics may slow down such a process.

 

Recommended herbs include Shu Di Huang [Cooked Rehmannia] to nourish kidney yin, Rou Cong Rong [Cistanche] to strengthen kidney yang; Wu Wei Zi to astringe kidney.

 

Recommended formulas include Liu Wei Di Huang Wan [Rehmannia Six Formula] or Ba Wei Di Huang Wan [Rehmannia Eight Formula]. The original contains Fu Zi [Aconite], which due to present Australian regulations cannot be used in a formula. This can be substituted with other yang supplementing herbs or inner warming herbs, such as Rou Gui [Cinnamon Bark]: Add Rou Gui [Cinnamon] to Liu Wei Di Huang Wan [Rehmannia Six Formula]. The heart stores the spirit. The heart is the seat of consciousness and mental function. Herbs that can be used in heart disharmonies disturbing mental function include Bai Zi Ren [Biota], Suan Zao Ren [Zizyphus], and Yuan Zhi [Polygala].

 

In addition to the above, special attention needs to be paid to blood stagnation and phlegm. Recommended formulas or singles include: Blood stasis: Dan Shen [Salvia], Chuan Xiong [Cnidium].

 

Phlegm: Digestives such as Liu Jun Zi Tang [Six Major Herbs Combination].

 

Blood Stasis and Ageing

In his article "Salvia and the History of Microcirculation Research in China" Subhuti Dharmananda states: A relatively new area of concern for blood stasis is in relation to ageing. In the theoretical framework of ancient Chinese medicine, ageing was understood to be related to a degradation of the essence (jing) that is stored in the kidney and which helps nourish the liver yin and blood and also helps stimulate the nutritive functions associated with the spleen. Decline in essence results in drying of the blood, contraction of the ligaments, withering of the flesh, and overall reduction in vitality, mental function, and health. During the 20th Century, possibly due to changes in the environment, diet, and lifestyle (as well as progress in medical research into ageing), it was generally agreed that disorders associated with ageing additionally involve blood stasis. Dr A. Koo, from the Department of Physiology at the Chinese University of Hong Kong, described widely used Chinese herbs that had good potential for treating microcirculation disorders by their vasodilation activity: salvia, ilex (maodongqing), and capillaries (yinchenhao).

 

Plant Name

Active Ingredient

Traditional Use

AD Drug Target

Panax notoginseng

[San Qi/Tian Qi]

Ginsenoside Rg1

Ginsenoside

TCM: Improve learning and memory function

Secretase activity

Neprilysin

Ginkgo biloba

[Yin Xing]

Fresh plant extract

TCM: for respiratory disorders, improve memory loss

DemTec cognition score

Dipsacus asper Wall

[Xu Duan]

Akebia saponin D

TCM: enhancing kidney function

Aß toxicity

Paeonia suffruticosa

[Mu Dan Pi]

1,2,3,4,6-penta-O-

galloyleta-d-

glucopyranose

TCM: to treat inflammatory and pyretic disorders

Aß fibril formation, stabilization; in vivo long-term

Polygala tenuifolia Willd

[Yuan Zhi]

Tenuifolin (extract)

TCM: to improve memory loss

Secretase activity: morphological plasticity

Radix saivia miltiorrhizae

[Dan Shen]

Triterpenoids; Tanshinone

TCM: to treat head conditions and stroke

AChE activity; Aß toxicity in vivo and in vitro; NOS

Dang Gui & Peony Combination

[Dang Gui Shao Yao San]

Extract

TCM, TJM: enhancement of women’s health

Apoptosis in vitro

Fungi Monascuc pupureus

[Hong Qu Jun]

Monascus fermented red rice

TCM: enhancement of blood flow

Ach E activity, antioxidant; secretase activity

Uncaria rhynchophylla

[Diao Gou Teng]

Triterpene esters and uncarinic acids

TCM: oriental medicine; improvement of cardiovascular and nervous system

Aß aggregation and fibril stabilisation

Fungus Ganodernla lucidum

[Ling Zhij

Ganoderic acid (Triterpen glycoside)

TCM: as anti-tumor, immunomodulatory and immunotherapeutic agent

Preserving synaptic density; preserving Aß-induced apoptosis

Lycium barbarum

[Ningxia gouqij

Plysaccharides

TCM: used as anti-tumor, immunomodulatory, anti-hypertension agent

Reverses Aß and homocyteine induced apoptosis

Yukukansan, chin. Yi Gan San

[Bupleurum Formula]

Composition of crude drug herbs

TCM, Kampo: to treat restless leg syndrome and agitation in children

Aß toxicity in vivo: decrease in anxiety, increase in locomotor activity in Tg2576 AD mice

 

Summary of Research and Studies - Alzheimer’s Disease (AD)

Alzheimer's disease (AD) is the most common cause of dementia in the elderly, accounting for approximately 60% of cases of dementia. AD is defined as memory loss with at least one other area of cognitive impairment (e.g. language, attention, orientation, self-monitoring, judgment, motor skill, inability to perform daily activities).

 

Table One is an excerpt from the article, Traditional used plants against cognitive decline and Alzheimer disease, by Gunter Peter Eckert. The original table contains all traditionally used plants tested recently, however only the Chinese Medicine plants are summarised.

 

Most Frequently Used Herbs in TCM Classics

A study examined 27 ancient TCM books and established a database identifying 236 formulae for improving cognitive function, from which 10 TCM herbs were prioritised due to the highest frequency, The herbs were: Fu Ling [Hoelen], Ren Shen [Ginseng], Yuan Zhi [Polygala], Gan Cao [Licorice], Dang Gui [Angelica Sinensis], Shi Chang Pu [Acorus], Suan Zao Ren [Zizyphus], Shu Di Huang [Cooked Rehmannia], Mai Dong [Ophiopogon], Sheng Jiang [Fresh Ginger].

 

*Reproduced with kind permission from Health World Limited - Australia and New Zealand

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