Comparison Integration of Western and Eastern Medicine Jing
- Slides: 157
Comparison & Integration of Western and Eastern Medicine Jing Liu, Ph. D, Lic. Ac 2011
l A copy right is reserved for the materials in the following presentation
Integrated Medicine l Western Medicine + TCM + Natural Medicine ( Nutrition, diet, herbs, natural therapies in the world) 11/10/10 Jing Liu 3
Content l Fatigue - Hormone Balance l Inflammation l Pain l Comments on acupuncture clinical trails: l Placebo, Specificity of acupoints
Cause of Fatigue l Insomnia Heart - kidney disharmony l Hormone dysfunction Kidney deficiency l Gut inflammatory status Spleen: Dampness / phlegm
Yin & Yang Insomnia treatment l WM ¡ Sedative-Hypnotics or antipsychotics ¡ Adverse reactions: drowsiness, weakness, pseudodepression in the morning l EM ¡ Encouraging Yang energy in the morning and nourishing Ying in evening ¡ Yang encouraging : Yin nourishing: 11/10/10 Jing Liu
Yin & Yang Theory and Sleep l A general principle in traditional Chinese Medicine (TCM) practice l Morning Yang Time: adrenal, thyroid hormone awake and rise to peak - energetic, active l Evening and Night Yin time: melatonin and serotonin dominant –calm and sound sleep l Higher Yang in the morning, Deeper Yin control in evening and night, better quality of sleep 11/10/10 Jing Liu 8
Sleep and Hormone Balance
Insomnia - Cortisol Dysfunction Syndrome l l l l Fatigue Depression Insomnia Irritability/. Anxiety Sweets craving Poor concentration Headache Allergy Elevated sympathetic nerve tone and decreased cortisol l = Heart Kidney Disharmony 心肾不交 ?
Insomnia Treatment Basic Formula (1) Kidney strengthening Mai Wei Di Huang Tang 麦味地黄 ¡Add: Ginseng人参, Royal jelly蜂王浆, Adrenal hormone promoting: Shan Zhu Yu山茱萸, Shu Di Huang熟地黄 Estrogenic phytohormone: Shan Yao山药(tocopherol, Coenzyme Q 9, Cyloartenol, 1 - feruloyl glycerol, hydro-Q 9, chromene)
Insomnia Treatment Basic Formula (2) 酸枣仁汤 l 酸枣仁 l 川芎 Anti-inflammatory l 茯苓 Reduce edema l 知母 Anti-sympathetic, Anti-inflammatory l 甘草 Anti-inflammatory, Detox l Add: hehuanhua合欢花, lianzixin莲子芯,baishao 白芍
Causes of Fatigue l Heart: Insomnia l Kidney: Hormone Dysfunction ( HPTA Axis) l Spleen: Gastrointestinal Dysfunction
Fatigue and Hormone HPA Axis l The current evidence supports the following factors of HPTA axis dysfunction in patients related with chronic fatigue syndrome (CFS): l l Mild hypocortisolism l Attenuated diurnal variation of cortisol l Blunted HPTA axis responsiveness to body need. l hypothyroid function l Imbalanced sexual hormones
Adrenal Hormone Synthesis l
Adrenal Hormone Synthesis
Estrogen Family
Adrenal Dysfunction / Fatigue l Adrenal glands are unable to keep pace with the demands of perpetual stress. l Stress signals > cortex > limbic system > sympathetic nerve > adrenal gland > cortisol release/thyroid hormone l The gland can't produce quite enough of the hormones our mind-body need. l Existing blood tests, aren't sensitive enough to detect the decline in adrenal function: cortisol panel test
The Symptoms of Adrenal Fatigue l Qi & Yin Deficiency l l l l l Fatigue, mostly Midday Fatigue Unexplained Weight loss Reduced tolerance for stress Insomnia Anxiety Craving for sweets and salty foods Body hair loss Body aches Depression l Low Cortisone Syndrome l Above symptoms plus: Increased susceptibility to infections Allergies to things you were never allergic to before Chemical sensitivities (Hyper Chemical Sensitivity)
Herbs for Adrenal Dysfunction l l l l l Panax Ginseng 人参 Elwutherococcus 西伯利亚人参 Rhodiola 红景天 Yin Yang Huo 淫羊藿 Shan zhu yu 山茱萸 Ocimum sanctum ( holy basil) 圣罗勒 Withania 睡茄 Glycyrrhiza 甘草 (Hypotension) Other herbs for Kidney Yin/Yang deficiency
Treatment of Adrenal Fatigue l l l Progesterone cream Iodine / tyrosine Phosphorylated serine / He Shou Wu 何首乌 Pregnenolone / Cortisol Melatonin at bed time
Hypothyroidism (1) Qi & Yang Deficiency l Fatigue l Shortness of breath with a shallow and slow respiratory pattern l Low basal body temperature, Cold intolerance l Thyroid-Related Depression l slow heart rate l Sluggish reflexes l Constipation l Poor muscle tone (muscle hypotonia) l Slow speech and a hoarse, breaking voice Depression Kidney deficiency l Decreased libido l Hair loss l Lower renal function with decreased glomerular filtration rate l Impaired memory l Abnormal menstrual cycles l Thin, brittle fingernails Female infertility
Hypothyroidism (2) Spleen deficiency l l l Weight gain and water retention Enlarged tongue Yellowing of skin due to impaired conversion of beta-carotene to vitamin A Impaired Puffy face, hands and feet (Non-specific Edema? ) Impaired cognitive function (brain fog) Yin & Blood deficiency l Dry, itchy skin l Decreased sweating l Others l Elevated serum cholesterol l Muscle cramps and joint pain l Hyperprolactinemia and galactorrhea
Wilson's Temperature Syndrome l Temperature lower than 98. 60 F l Hypothyroidism symptoms with normal T 3, T 4 l Typically brought on by stress l often exist with chronic fatigue syndrome, fibromyalgia’ l Improved by treatment of T 3 or herbs / supplements; not respond to T 4 treatment
Causes of Hypothyroid Syndrome l Iodine deficiency l Stress l Hushimoto disease ( chronic lymphocytic thyroiditis), 25% l lithium-based mood stabilizers, usually used to treat bipolar disorder (previously known as manic depression) l Congenital hypothyroidism is very rare accounting for approximately 0. 2‰
Thyroid Hormone l 90% T 3 (effects fast, short term) l 10% T 4 (effects slow, long term) l T 3 is only form of thyroid hormone to supply energy to heart from breaking down fat l Over dose of T 3 cause cardiac overloading
Conversion of T 3 or RT 3
Conversion of T 4 to T 3 Promoters (1) l l l l Kelp (iodine, Iron), selenium Zinc, potassium, cupper High protein diet Vitamin A, E, C, B 2, B 3, B 6, B 12 Growth Hormone Testosterone Ashwaganda (India herb)
Inability to convert T 4 to T 3 l Excessive alcohol l Low protein/fat diet l Too much cruciferous vegetables l Walnuts
Low T 3 / High reverse T 3 Promoters l l l l Stress - epinephrine / NE, cortisol Free radicals Aging Fasting Diabetes Toxic metal exposure Inflammation-elevated inflammatory factors: IL-6, TNFalpha, IFN-2
Iodine Deficiency l 88% America women are in iodine deficiency. l Low iodine cause hyperestrogenic state and higher free estrogen level up to 80 to 90%, normal is 40 to 60%. l When Iodine is enriched, the estrogen receptor activity in the breast is reduced. l Iodine promote apoptosis and disrupt proliferation l Low iodine cause fibrocystic breast; Effective therapy (82%) in treating fibrocystic breast disease and prevent breast cancer l TCM: Hai Zao, Kun Bu 海藻,昆布
Iodine Deficiency
Causes of Iodine Deficiency l Diet in shortage of iodine l Iodine Taken Up: Thyroid: 6 mg; breasts: 5 mg /day; other tissues: 2 mg/day l Japanese women: 13. 8 mg daily, lowest in breast cancer l Diet high in pasta/bread containing bromide (bind to iodine receptor) l Fluoride use (inhibiting iodine binding l Vegan and vegetarian diet
Drugs for T 3/T 4 replacement l T 3: Liothyronine, Triiodothyronine l T 4: Levothyroxine (Synthroid) Transfom to be T 3, but take up to 8 weeks to reach the required level of T 3. l Armour® a naturally derived from porcine thyroid glands. (T 3 liothyronine is 4 x as potent as T 4 levothyroxine; so 38 mcg T 4 and 9 mcg T 3 per grain of thyroid.
Thyroid Hormone Replacement Failure l After increase dosage still feel fatigue: l Magnesium deficiency l Adrenal deficiency l Overdose l Poor absorption from unhealthy gut
Side Effects of T 3 Therapy l l l l Fluid pretension Achiness Jitteriness Irritability Dull headache Increased heart rate Can not be used for severe Adrenal or cardiac deficiency
Herbs for Thyroid Function l Huang Qi黄芪 l Huang Qi Wu Wu Tang黄芪五物汤 l Or add: Xiao Chai Hu Tang小柴胡汤, in case of autoimmune l Prolonged hypothyroidism cause adrenal fatigue l Adrenal: Ying Yang Huo 淫羊藿, Shan Zhu Yu山茱萸 l When the herbs not effective enough, add T 3, to reduce the dose of T 3 and reduce the side effect of T 3
Natural Supplements for Thyroid Function l Guggul (Commiphora mukul) increase iodine intake and thyroid hormone production, enhance thyroid perocidase enzymes l Seaweed (algae) : Kelp (kun Bu) bladder wrack fucus vesiculosus (best antioxidant among seaweeds) l Seaweed contain diiodothyoinine (DIT), which may promote thyroid function l Zinc, Selenium l Blue Flag - potent detoxifier of thyroid l Improvement usually occurs within 3 to 4 weeks
Hushimoto’s Disease l Reduce autoimmune response and inflammation l l Xiao Chai Hu Tang 小柴胡汤 Curcumin Boswellia Lycopus virginicus(lycopus lucidus 泽兰) l inhibit iodine metabolism, inhibits release of thyroxine from thyroid, binds with TSH, decrease pulse and BP l 95% improvement rate, officially recognized in Germany as prescription l Rosemary extract (迷 迭香 100: 1), reduce antibody
Hormone: Progesterone l Produced mainly in ovary, little in adrenal gland; Increase 100 x during pregnancy l Enhance: thyroid function, apoptosis, estrogen sensitivity, brain cell growth in fetus l Decrease: breast cell growth, breast cancer, atherosclerosis, l Decrease Brain degeneration, neuro-blastoma, MS; antidepression l Burn fat for energy; hair growth; l Progestins are NOT equal to progesterone
Herbs for Progesterone l Juglans regia (England Walnut 核桃), progesterone detected l Progesterone-like steroids in Dioscorea mexicana of yam family native to Mexico, containing steroid diosgenin converting into progesterone. l Diosgenin and progesterone found in other Dioscorea species. l Dioscorea pseudojaponica from Taiwan, containing saponins —converted to diosgenin -> progesterone. l Other Dioscorea species: Dioscorea villosa and. Dioscorea polygonoides. l Dioscorea villosa contains 3. 5% diosgenin. l Dioscorea polygonoides contain 2. 64% l Dioscorea family: Shan Yao山药, Bi Xie, Chuan Shan Long穿山龙, Shan Ci Gu山慈姑 I l Sheng Ma 升麻 l Maca l Fu Pen Zi 覆盆子
Hormons: Estradiol(E 2) l Neuro-protective l Breast cancer promoting l Cell proliferation with alveoli formation (hyperplasia) and even cyst formation
Effects of Estrogen Therapy l Prevent osteoporosis l Decrease LDL and increase HDL l l l Increase blood pressure, triglyceride Gallstone Elevated liver enzyme Increase carbohydrate craving Decrease thyroid function by increasing binding thyroid binding globulin
Estrogen Balance l l l In the 1960 s and 70 s Dr. Henry Lemon concluded: Estrogen Quotient EQ=E 3/E 1+E 2 EQ<1: high risk for breast cancer EQ>1. 5: low risk for breast cancer
Hormone: Estriol l Anti-inflammation l Promote shift from T helper (Th) 1 to Th 2 l Reduce autoimmune disease l Prevent osteoporosis l Breast caner protection l Menopause improvement 92 l Don't seem to increase risk of breast cancer Estriol binds to estrogen receptors with much weaker activity, competing stronger estradiol binding to receptors - protective against breast cancer
Estrogen Dominance Fatigue Hypothyroidism by decrease conversion of T 4 to T 3 l Decreased sex drive l Depression / anxiety / Migraines / Insomnia l Memory loss or foggy thinking l Mood swings / Memory loss or foggy thinking l Weight gain secondary to insulin resistance / Fat gain l PMS / Menstrual disturbances--irregular and heavy bleeding. • Bone loss / Hair Loss l Breast cancer / Fibrocystic breasts / Uterine cancer / fibroids l Water retention, bloating. l Tendency of autoimmune disorder Correction: Progesterone therapy
Estrogen Dominance After menopause, Progesterone decreases by over 99% from its original youthful baseline levels; while estrogen production only decreases by about 40%. l New research show that almost all the uncomfortable symptoms of PMS and of Menopause are actually caused by low progesterone levels in the body.
Breast Cancer prevention l Bio-identical Estrogen therapy l E 3: E 2 = 4: 1 l l DIP D Vitamin D deficiency Iodine deficiency P Progesterone deficiency
Hormone: Testosterone l l l Testosterone Improve insulin resistance, belly fat Improve: sleep, vitality, libido/orgasm/arousal Not necessary cause prostate cancer Herbs:Yin Yang Huo淫羊藿, Rou Cong Rong肉苁蓉, Lu Rong鹿茸, Ren Shen人参
Hormone: DHEA the first anti-aging hormone l l l l Improve motivation, well being, memory, libido/orgasm Anti-atherosclerosis Antidiabetic Anti-inflammatory Antiosteoporotic Anti-senility Reduce fat Protect thymus and immune function l 50 mg daily anti-age without significant side effects
Fatigue ¡Fatigue and GI dysfunctiion / Candida
Symptoms of Candia (1) l l l l fatigue concentration/focus memory problems painful joints, muscle aches unrefreshing sleep white coated tongue chronic sinusitis Diarrhea or chronic constipation headaches including migraines visual blurring, sensitivity to light, eye pain Depression, irritability, anxiety sensitivity to heat/cold alcohol intolerance gluten intolerance
Symptoms of Candia (2) l l l l Irritable bowel numbness/tingling in the face or extremities dryness of mouth and eyes menstrual problems (PMS/endometriosis) recurrent yeast infections skin rashes, dry/flaking skin Eczema, dermatitis, acne jock and rectal itching chronic athlete's foot, toenail and fingernail fungus ringing in the ears (tinnitus) allergies sensitivity to noise/sounds, foods, chemicals feeling in a fog muscle weakness jerky-leg syndrome low sex drive
Anti-Candida Herbs l Cinammon l Grapefruit seed extract l Olive leaf extract l Garlic extract l Berbering, Goldenseal l Oregano leaf extract l Pau d’arco l Zinc l Coconut oil l Candex (cellulase enzymes)
Introduction: Inflammation l Normal inflammation is a necessary protective response to harmful stimuli to the body. l Prolonged or excessive inflammation is related pathological status including infection, autoimmune disorders, atherosclerosis, Alzheimer's, autism, arthritis and even cancer
Inflammation Process Eicosanoid Cyclooxygenase Pathway Pathogen IL-1, TNF-a, PDGF, IFNs, Tyrosine Kinase chemokines inflammation Adhesion proliferation penetration hypoxia, superoxide, NO, free radical cancer AA COX 2 PGE 2 inflammation
Eicosanoid Synthesis Prostaglandin/Inflammation Formation Pathway
Eicosanoid Synthesis Prostaglandins and related compounds are collectively known as eicosanoids. Most are produced from arachidonic acid (AA) l Step one: Release of AA from membrane phospholipids by phospholipase A 2(PLA 2). l Step Two: AA is metabolized by COX enzymes to be prostaglandin E 2 (PGE 2), or Thromboxin (TXA 2) or prostacyclin (PGI 2), l AA also metabolized by lipoxygenase or cytochrome P 450 to be l leukotrienes Ecosanoid considered "local hormones. " participating in intercellular signaling,
Role of Ecosanoid inflammation fever regulation of blood pressure blood clotting immune system modulation control of reproductive processes & tissue growth regulation of sleep/wake cycle.
Ecosanoid Inhibitors Corticosteroids are anti-inflammatory from preventing PL A 2 expression, reducing AA release. Stress – adrenal fatigue – cortisol exhaustion - inflammation COX-2 is stimulated by growth factors, cytokines, and endotoxins. Attempts have been made to develop drugs that inhibit: Phospholipase A 2 / AA / COX for treating inflammatory diseases
Inflammation exist in many diseases: cancer, autoimmune disorders, infections, et al. l WM ¡ COX-2 inhibitor (Vioxx, Celebrex) ¡ Adverse reactions: PGI 2 inhibition – inner membrane of blood vessel damage leading stomach ulcer, kidney failure, cardiac attack l EM ¡ Natural COX 2 inhibitor: Curcumin, turmeric姜黄, coptis黄连, berberine, Paeonia Latiflora芍药, Boswellia乳香 ¡ No obvious PG I 2 inhibition; Only benefit to heart 11/10/10 Jing Liu
COX-2 w COX-2 levels increase in inflammatory diseases such as arthritis. COX-2 expression is increased in some cancer cells. Angiogenesis, essential to tumor growth, requires COX -2. Over expression of COX-2 leads to expression of VEGF (vascular endothelial growth factor). Regular use of NSAIDs has been shown to decrease the risk of developing colorectal cancer.
Anti-inflammatory Therapy Side effects & Limitations of Chemical Drugs l Naproxen, trade name Alevea, a nonsteroidal anti-inflammatory drugs (NSAID) l ibprofen, indomethacin and ketoprofen. l Common side effects l Constipation; diarrhea; dizziness; drowsiness; gas; headache; heartburn; nausea; stomach upset; stuffy nose. l Severe side effects l rash; hives; itching; swelling of the mouth, face, lips, or tongue; wheezing); bloody stools; change in the amount of urine produced; chest tightness or pain; confusion; dark urine; depression; fainting; fast or irregular heartbeat; fever, chills, or persistent sore throat; loss of appetite; mental or mood changes; numbness of arm or leg; onesided weakness; pale stools; red, swollen, blistered, or peeling skin; ringing in ears; seizures; severe headache or dizziness; stomach pain, nausea, vomiting or bleeding; shortness of breath; weight gain; swelling of the hands, legs, or feet; bruising or bleeding; joint or muscle pain; tiredness or weakness; vision or speech changes; grounds; yellowing skin or eyes. l This is not a complete list of all side effects that may occur.
COX Inhibitors l Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and derivatives of ibuprofen: a. Inhibit COX to form prostaglandins involved inflammation, pain. b. Inhibit blood clotting by blocking TXA 2 c. block AA enters COX active site. Most NSAIDs inhibit both COX I & COX II. Selective COX-2 inhibitors have been developed, e. g. , Celebrex and Vioxx. w COX-2 inhibitors are less likely to cause gastric toxicity compared with NSAIDs that block COX-1. l
Inflammation and Endothelial Dysfunction to Microvascular Dysfunction l Endothelial dysfunction is integral to the pathogenesis of many disorders: l l l Atherosclerosis Autoimmune disorders Inflammation Infection Trauma
Arterial Wall Anatomy
Endothelium of Blood Vessels
Vascular Endothelial Mediators
Thromboxane A 2 - TXA 2 Stimulates blood platelet aggregation, essential to role of platelets in blood clotting. w Aspirin inhibit TXA 2 formation in blood platelets. w This effect of aspirin is long-lived, 7 days, because platelets lack a nucleus and do not make new enzyme.
Leukotrienes produce inflammation in: Blood vessel walls as part of the pathology of atherosclerosis. Bronchioles causing asthmatic constriction and asthma. Anti-asthma medications include: w Zyflo (zileuton): inhibitors of 5 -Lipoxygenase w Singulair (montelukast) & Accolate (zafirlukast): block leukotriene-receptor interactions.
Natural COX-2 Inhibitors l Huangqin黄芩 was found to have COX-2 inhibitory properties in China, Spain, Korea, Canada and United States l Ginger姜 is a strong anti-inflammatory herb. Studies indicate that ginger is a safe COX- 2 and COX-1 modulator l Scientists in the USA, Sweden, Taiwan and Germany have confirmed that green tea is a high active COX-2 inhibitor. l The chemical ingredients, salicylic acid and polyphenols, including EGCG, in green tea are effective cancer antagonists.
Turmeric or curcuma longa l The anti-COX-2 effect of turmeric was discovered by Vanderbilt University researchers. Cornell University in New York and the University of Leicester in England. l The active anti-inflammation component curcumin is about 50% as effective as cortisone. l The purified form of 95% curcuminoids per dose is the best anti-inflammatory effects. l A number of publications have shown the anti-cancer effects of turmeric in in vitro and in vivo.
Natural COX-2 Inhibitors l Curcumin and capsaicin significantly lowered lysosomal enzymes from macrophages in animals l Macrophages from rats secreted less PG E 2, leukotrienes B 4 and C 4 and AA. l Curcumin and capsaicin lowered eicosanoids and AA in macrophage lipids. l Curcumin and capsaicin can lower secretary functions of macrophages in a beneficial manner.
Natural Anti-inflammation/COX-2 Agents Drynaria fortunei l Extracts of Drynaria fortunei (Gu Sui Bu): significant inhibition of carrageenan-induced paw oedema and granuloma formation in rats, almost comparable to that caused by indomethacin. Df significantly attenuated formalin-induced pain and acetic acid-induced writhing episodes in mice. l Clinical trial: significant effects for arthritis pain, joint function and osteoporosis without significant side effects l CONCLUSION: potent anti-inflammatory agent for alleviating painful inflammatory conditions of osteoarthritis. l The herbal formula for arthritis: Gu Sui Bu, Fang Feng, Cuan Duan, Zhi Mu, Jing Jie + Huang Qi Wu Wu Tang
Herbs with COX-2 Inhibitory Effects l green tea, ginger, grape seed, Holy basil, oregano, rosemary and willow bark l Giardina C褐茸藻, Stylopine from chelidonium majus白屈菜, Berbarine/Huanglian黄连, ginger, ginsenoside人参皂甙 Rh 1, grape seed葡萄, Salvia miltiorrhiza 丹参, fevervew, scutellaria黄 芩, phellodendron amurense黄柏, carthamus tinctorius红花, nettle leaf荨麻,willow bark柳树 皮
Anti COX Agents - Antioxidants l The oxygen burst in the inflammatory status generate excessive amount of reactive oxygen species (ROS). l Reactive neutrophil activity in the process is a principle source of ROS. l Inflammatory responses can be suppressed by the application of ROS scavenger, superoxide dismutase (SOD) and antioxidants. l Many antioxidants possess COX-2 inhibiting effects: Polyphenol and catechin in green tea Flavonoid and ursolic acid in many herbs linoleic acid, melatonin, IFN-βin our bodies physiologically inhibitory COX-2 effect
Omega-3: Role in Anti-inflammation l ω-3, mainly DHA and EPA, can effectively inhibit COX mediated AA metabolism and PGE 2 -inflammation/cancer l Plant ω-3 shows inhibitory effect on inflammation and cancer
Acupuncture Mechanism: Pain / Inflammation / immune Pain Inflammatory Immune Cholinergic suppression: Sensory nerves Parasympathetic nerve endings release acetylcholine (ACh), Hypothalamus suppress release Anti-inflammatory output via CNS TNF-a, IL-1β in brain Neuroimmunology modulation
Inflammation Role of Arachidonic Acid l High arachidonic acid consumption (Omega-6) is not advised for individuals with a history of inflammatory disease, it may counter the anti-inflammatory effects of omega-3 fatty acid supplementation.
Inflammation Omega-3 : Omega 6
Inflammation Omega-3 : Omega 6 l Patients with autism had significantly higher Omega 6 in RBC membranes compared to higher Omega 3 in healthy people l Significantly reduced levels of ARA /EPA ratio in RBC polar lipids, when supplemented with EPA-rich fish oils l By taken EPA supplements, significantly reduced PLA 2 concentrations
Natural Anti-inflammation/COX-2 Agents Curcuma longa L l Positive effect on neurogenesis in hippocampus by increasing brain-derived neurotrophic factor(BDNF) Improving stress, depression, a selective monoamine oxidase inhibitor (MAOI) Clinical trials: Alzheimer's disease.
Anti-inflammatary Supplements l Feverfew (菊蒿) l Holy basil (圣罗勒) l Nettle Leaf(荨麻) l Oregano l Rosemay(迷迭香) l Boswellia
Natural Anti-inflammation Agents: Antioxidants l The oxygen burst in the inflammatory status generate excessive amount of reactive oxygen species (ROS). Reactive neutrophil activity in the process is a principle source of ROS. l Inflammatory responses can be suppressed by the application of ROS scavenger, superoxide dismutase (SOD) and antioxidants.
Natural Anti-inflammation Agents: Antioxidants l Many antioxidants possess COX-2 inhibiting effects. l Phenol and flavonoid compounds in many herbs: polyphenol and catechin in green tea, ginkgo biloba, soy, etc. l Some important antioxidants/anti-inflammation chemicals produced in the body: Glutathione, , melatonin, pyruvate, IFN-b, and SOD.
Natural Anti-inflammation Agents from diet: Berries l Berries Blueberries, raspberries, strawberries: antiinflammatory Blackberries and blueberries are especially great.
Natural Anti-inflammation Agents from diet: Omega-3 l -3, mainly DHA and EPA, can effectively inhibit COX mediated AA metabolism and PGE-2 inducible inflammation/cancer. l High -6 low -3 diet favor inflammation l flax seed oil, walnut, pumpkin seed are rich in 3 but in shortage of DHA. l Botanical -3 may anti-inflammation by inhibiting -6 through competing delta desaturase 6.
Root of Inflammation l Broad-spectrum antibiotics kill good bacteria in gut, leading to leaky gut syndrome - large molecules get through. l l London’s Royal Free Hospital studied 60 autistic children: many more intestinal lesions than nonautistic children l In fact, over 90% of autistic children had chronically inflamed guts.
Root of Diseases - Inflammation Root of Inflammation - GI microflara l l l Alzheimer, Autism Chronic lung/bronchus infection Arthrosclerosis Sinus infection/allergy Chronic Fatigue syndrome Fibromyagia l l l Autoimmune disorders: MS Lupus Colitis Arthritis
Acupuncture Pain 11/10/10 Jing Liu 90
Acupuncture for pain Indication l A wide range of pain conditions, such as postoperative pain, carpal tunnel syndrome, fibromyalgia, headache, low-back pain, menstrual cramps, myofascial pain, osteoarthritis, and tennis elbow. l Doctors from three medical schools published on New England Journal of Medicine l Conclusion: acupuncture is an effective means for treating lower back pain, based partly on a recent study of 6, 359 patients published 11/10/10 Jing Liu 91
Acupuncture Clinical Trail Osteoarthritis l 20 millions people with osteoarthritis l No satisfied pharmaceutical drugs l COX-2 inhibitor may cause heart, kidney stomach damage l Phase III radomized controlled clinical trail at Maryland School of Medicine in 2006 l 570 participants with moderate and severe pain l Results: significantly improve knee pain and function
Acupuncture for pain Significant, Mechanism New branch of therapy in clinical medicine: Trans-cutaneous Intervention therapy l A lot of augments on the meridian theory At least, most parts of acupuncture theory and practice can be explained by the modern neurology or neurochemistry. ¡ CNS endorphin, serotonin, dopamine modulation, opioid receptor stimulation ¡ Neural segmental analgesia (spinal cord) ¡ Local anti-inflammatory cytokine, microcirculation promotion 11/10/10 Jing Liu 93
Specificity of Acupuncture points l Brain: Overlapped, relatively less specificity l Spinal cord: neural segmentation distribution, relatively specificity, with connection l Local: chemicals, neuro-muscle-tendon effects, specific
Acupuncture Evidences in neurochemistry l In the mid 1970 s, Mayer and his colleagues revealed that acupuncture led to a significant increase in the endogenous endorphin production and the effect of acupuncture can be blocked by the opioid receptor antagonist naloxone 11/10/10 Jing Liu 95
Acupuncture Evidences in neurochemistry l A large body of evidence indicates that acupuncture significantly affects the production and release of neurotransmitters including epinephrine, norepinephrine, dopamine, and 5 -hydroxytryptamine l Stress-induced increases in norepinephrine, dopamine, and corticosterone were inhibited after EA, l EA effects on the release of neurotransmitters are likely to be mediated through endogenous opioids. l EA at different frequencies (2, 10, or 100 Hz) elicited the analgesic effects and such effects could be at least partially blocked by a serotonin receptor antagonist 11/10/10 Jing Liu 96
Acupuncture Neural segmental analgesia 11/10/10 97
Acupuncture Pain management and muscle relaxation l Acute pain l Muscle spasm l Chronic pain l Muscle spasm - shortening - fibrosis -hardening
Trigger Point – neural-muscle cycle l Pain signals from the muscles and joints cause changes in the central nervous system (CNS) that in turn causes changes in the nerves affecting muscles and joints inducing perception of perpetuating pain. By needling into specific sites, such as hypersensitive skin or tight bands of muscle, this cycle is broken
Trigger Point – Muscle spasm l Chronic inflammation and pain results in muscle spasms and lead to changes in the muscle structure. Long lasting muscle spasm causes accumulation of fibrotic tissue inside the muscle (can be palpated as taut band) with subsequent muscle shortening.
Trigger points - Location l Taut bands of muscle and are especially tender to palpate. l The muscle tendon junction and tendon attachment to bone provides a complete needling location for the tight muscle and mechanical distraction of fibrotic tissue, resulting in relaxation. l The treatment will increases circulation to the area and decreases pressure on joints.
Acupuncture for Pain Neuro-muscular mechanism ¡Needling by blocking the excessive release of acetylcholine from the peripheral nerve terminal at the neuromuscular junction (where the nerve transmits signals to the muscle); or muscle-tendon conjunction, where golgi receptor located, inducing muscle contraction inhibition, resulting in muscle relaxation and pain releasing.
Negative feedback regulation of muscle tension by Golgi tendon organs
Golgi Tendon Organ
“Golgi Points ? ” l ST 36 l GB 34, 37, Sp 6 l LI 3, 10 l BL 25 l Si 5
Acupuncture Back Pain- Piriformis Syndrome
Role of natural anti-inflammatory Agents in Cancer Treatment l WM ¡ Chemo or Radiation: limited effectiveness ¡ Side effects from cytotoxicity: immune, bone marrow, digestion, wellbeing l EM ¡ Supportive therapy: immune, bone marrow, digestion, gut bacteria, detoxification (free radicals) ¡ Enhance and reduce resistance of chemo: anti-inflammation ¡ Cause of cancer treatment: inflammation/detox 11/10/10 Jing Liu, MD, Ph. D 108
Cancer and COX-2 l A number of clinical investigations showed that high COX-2 activity was found in patients with a variety of cancers: Colorectal, gastric, breast, non-small cell lung, ovarian, hepatocellular, pancreatic, bladder, skin, and particularly, 80 -90% colon cancer
COX-2 Inhibitors for Chemo-resistance l Chemotherapeutic drug resistance is an unresolved challenge in clinical cancer treatment, particularly for the metastasis carcinoma status. l The inflammation and pro-inflammatory cytokines are strong intrinsic factors for promoting multiple drug resistance (MDR). l Chemotherapy may induce the activities of COX-2 and inflammation. l COX-2 stimulates the P-Glycoprotein of the MDR, which rejects the drug out of the cancer cells. COX-2 inhibitors, celecoxib, aspirin, ibuprofen, and indomethacin may enhance chemotherapy
Synergistic Effect of Herbs with Chemo? l Multiple target model of cancer cell for Natural COX-2 Inhibitors l Multiple Signal Transduction systems (modulate the DNA/RNA and cell activities/growth, developed from evolution, primary cell to human being ) Growth factors Tyrosine Kinase EGFR/HER 2 IGFR
Pathway of Chemotherapy Resistance Breast Cancer
Natural Anti-inflammatory Agents Enhance Effects of Chemotherapy l Morphologic changes Fig 1. of MCF-7 cells treated with COPE and TAX
Are Antioxidants counteract with Chemotherapy? l Meith I. Block analyzed the results of antioxidants applications, including glutathione, melatonin, vitamin A, vitamin C, N-acetylcysteine, vitamin E, ellagic acid antioxidant mixture, from randomized and controlled clinical trials in 845 articles. l Conclusion: None of the trials reported evidence of significant decreases in efficacy from taking antioxidant supplements during chemotherapy.
Are Antioxidants counteract with Chemotherapy? l Instead, many of the studies suggested increased survival times, increased tumor responses, and less toxixity responses from taking antioxidants than controls[1] l [1] Block KI, etc. Impact of antioxidant supplementation on chemotherapeutic toxicity: a systematic review of the evidence from randomized controlled trials. l Int J Cancer. 2008
Are Antioxidants counteract with Chemotherapy? l The natural supplements may be taken after the chemotherapeutic agents are eliminated from plasma, which could be from a few hours to a few days. l The supplements should be stopped at least one day before the next chemotherapy session. l The information about the pharmacological dynamics of the chemotherapeutic agents should be researched before the natural supplements is administered.
11/10/10 Jing Liu, MD, Ph. D 118
l End
Inflammation and Endothelial Dysfunction to Microvascular Dysfunction l Endothelial dysfunction is integral to the pathogenesis of many disorders: l l l Atherosclerosis Autoimmune disorders Inflammation Infection Trauma
Vascular Endothelial Mediators
Nitric Oxide/L-Arginine-Herbs l Nitric Oxide (NO) l anti-inflammatory and anti-proliferative effects l Endothelial function protection l Atherosclerosis protection
Nitric Oxide/L-Arginine-Herbs l L-arginine l Control blood pressure and improve heart function l Reducing cholesterol and plaque formation l Promote anti-aging growth hormone l Enhancing immune function and stop some cancer cell growth l Improving memory l Improve erectile dysfunction
Nitric Oxide/L-Arginine-Herbs l Herb l Dang Gui l Bai Shao l Bai Jili
The signal molecule ·NO (nitric oxide) may initiate prostaglandin synthesis by reacting with superoxide anion (O 2·-) to produce peroxynitrite, which oxidizes the heme iron enabling electron transfer from the active site tyrosine. Prostaglandin synthesis in response to some inflammatory stimuli is diminished by inhibitors of Nitric Oxide Synthase.
Autoimmune disorders l WM ¡ Prednisone, immune suppressor, T-cell inhibitor ¡ Adverse reaction: mal-metabolism cortisone withdrawal syndrome, immune dysfunction l EM ¡ Immune enhancing and Immune suppression together: astraglus vs. scutellaria, Bupleurum ¡ Stimulating adrenal –cortisone function for cortisone withdrawal syndrome (NIH fund supported project) ¡ Gentle but effective T-cell or TNF inhibitor: Olivenol, Rapamycin, Dichroa febrifuga黄常山, Principle: TNF is a dual side blade sword 11/10/10 132
Infection l WM ¡ Limitations of antibiotics in Chronic infection: immune function, beneficial bacteria damage, drug resistance ¡ Co-existing inflammation, congested microcirculation l EM ¡ Detox - anti-pathogen ¡ De-congestion of circulation- open the microcirculation: antibiotic availability, flushing out toxins ¡ Promoting Qi – enhancing immune function ¡ Strengthen “spleen system” – protect digestion and prebiotic 11/10/10 Jing Liu 133
Natural therapy for autoimmune disorder David Fernandez (2010) discover: rapamycin can be an effective treatment in human lupus, SLE. regulates interferon-α and T cell and promote Th 2 versus Th 1 immune responses suggest that the colitis, including crohn’s disease and ulcerative colitis, can be well controlled by natural therapy in many cases, and can be well integrated with cortisone or immune suppressor Probiotic + Enzymes + Herbs + Diet
Gastroesophageal reflux (GERD) l WM ¡ ¡ H 2 blocker – Zantac Proton pump inhibitor – Prilosec Mucosal protectors – sucralfate Motility drugs - empty stomach, Reglan. l EM ¡ Mucosal protection: Gastric acid pseudo-overproduction, Deglycyrrhizinated licorice (DGL) Calming acid reflux and peptic ulcers by: ü Anti-inflammation and the pathogens ü Protect mucosal membrane by increasing the thick mucous production ü Free of the ingredients of increase fluid retention ¡ Anti-inflammation: Chamomile, slippery elm, coptis ¡ Motility promoting: Auklandia lappa Codonopsis 11/10/10¡ Digestive function promotion: Jing Liu, MD, Ph. D
针刺特异性的f. MRI 证据 1 l l (A) Both manual (MA) and electro-acupuncture (EA) but not tactile control stimulation at ST-36 induce f. MRI signal decrease in the amygdala as evidence by f. MRI signal time-courses during stimulation blocks (gray). l (B) The CTS patients demonstrated less hyperactivation and more focused SI finger representation to innocuous stimulation of the 3 rd finger. l (C) CTS patients demonstrated less separation of somatotopic representations. After acupuncture treatment, the 2 nd and 3 rd finger representations were more separated, approximating normal somatotopy in HC
- Bai 111
- What happened after rome fell
- Western and eastern hemisphere
- Differences between eastern and western absolutism
- How did chandragupta maurya begin building his empire?
- Secneer
- Western vs eastern values
- Comparison convergence test
- Three dimensions of corporate strategy
- Forward backward integration
- What is simultaneous integration
- Zi jing chinese
- Jing video download
- Main function of operating system
- Jenny jing
- Wang jing & co
- Goh jing rong
- Jingshan primary
- Sang jing
- Jing shan primary school uniform
- Drew maywar
- Jing xu uc merced
- Southern and eastern asia map
- Brain wrinkles southern and eastern asia
- 5 heroines of order of the eastern star
- Southern and eastern asia physical features answer key
- Southern and eastern asia physical features map
- Brain wrinkles southern and eastern asia
- Brain wrinkles southern and eastern asia
- Of vietnam
- Mischief rule
- Lesson 1 physical geography of the russian core
- Fantasticcomparative and superlative
- Disadvantage of golden rule
- Creative tourism eastern macedonia and thrace
- Sustainable tourism eastern macedonia and thrace
- Southern and eastern asia physical features map answer key
- Physical features of southern and eastern asia
- Ww1 map eastern front
- Freemasonry
- Mbulelo cabuko
- Eastern woodlands landforms
- The fugates
- Pompey's eastern settlement
- Eastern woodlands homes
- Middle eastern double reed instrument
- Italian cdm
- Far eastern art
- Igcse history chapter 6
- What is considered eastern europe
- Chapter 16 eastern mediterranean answers
- Flights to honoré de balzac tram stop
- Sabey eastern washington
- Moody tiger
- Eastern philosophy
- Eastern kentucky flights
- Eastern european cuisine
- Oceans in the eastern hemisphere
- Roman catholic vs eastern orthodox
- Blue skinned people of kentucky
- Stalingrad war
- No limits eastern shore
- University of eastern colorado firewatch
- Eastern europe landforms
- Eastern woodland location
- Physical features of india
- Beringia
- Shatter belt definition ap human geography
- High school grading scale
- East pacific oscillation
- Federal republic
- The beginnings of our global age europe africa and asia
- Eastern sierra observatory
- Eastern beliefs • buddhism hinduism confucianism *
- Offshoring eastern europe
- Metu ocw
- Latitude fatitude
- Eastern woodlands long house
- Eastern woodland painting
- Eastern woodland indians homes
- Blackwater national wildlife refuge hunting
- Eastern home shopping & leisure co., ltd.
- Eastern ct eweb
- People of the eastern woodlands
- Eastern half of the roman empire
- Yong mok hin
- Nba sos
- Eastern partnership
- Eastern hemisphere
- Eastern africa farmers federation
- Eastern front ww1 map
- Industrialized regions
- Eastern half of roman empire
- Eastern ghats
- How did its rivers affect eastern europe
- The gray eyed morn smiles on the frowning night
- Middle east map
- Fertile crescent ap human geography definition
- Eastern woodlands tribes
- What did the timucua tribe eat
- Christian meditation vs eastern meditation
- Eastern federal corporation
- Eastern partnership
- Eastern football netball league
- Community care plan of eastern carolina
- European footholds in the eastern hemisphere
- Eastern south america
- Western mountains plateaus and basins
- Western mountains plateaus and basins
- Daimler co ltd v continental tyre case summary
- Lesson 1 slavery and western expansion
- Roman contributions to western civilization
- Western blot tips and tricks
- Chapter 16 a diverse heritage
- Rome and the roots of western civilization
- West side story romeo and juliet worksheet
- Compare contrast definition
- Iso/osi vs. tcp/ip
- Comparison and critique of osi and tcp/ip model
- Universitatea de medicina si farmacie victor babes
- Bachelor of public health monash
- Native colour wheel
- Mrbs scholarship
- Victor babeş university of medicine and pharmacy
- Victor babes university of medicine and pharmacy
- Internal medicine jeopardy questions and answers
- Ficks second law
- Apollo iconography
- Pharmacotritae
- National center for disaster medicine and public health
- Internal medicine society of australia and new zealand
- Alternative system of medicine ppt
- Chapter 11 complementary and alternative medicine
- M&m stamps
- Chairback brace indication
- Duke family medicine and community health
- Oral disease
- American academy of physical medicine and rehabilitation
- Scpmpaware
- Pubh4401
- Why did a stale- mate develop on the western front?
- Why did a stale- mate develop on the western front?
- Western film characteristics
- Western interior paleontological society
- Western subgenres
- Erpno
- Western federation of professional surveyors
- Western uplands europe
- Who was the leader of the franks
- Language
- Sample buffer 역할
- Western alamance lacrosse
- Sda unions in kenya
- Vegetation of canada
- Western dredging association
- In the u.s., the most heavily abused drug(s) is/are:
- Twh fht
- Branding identity western sydney