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Traditional Chinese medicine (TCM) has thousands years history. It has unique basic theories and diagnostic methods. It is a very effective therapy in treating many chronic diseases and some acute diseases. If you are interested in TCM, welcome to pop in to this TCM forum, let's discuss on any topic about Chinese herbal medicine and acupuncture. If you have any health problem, you are welcome to visit my clinic Knowhow Acupuncture at No.1 Harley street, London. If you are far away from London, you can pop in my online clinic to get some help. If you like this blog please share it to your friends.

Friday, 3 November 2017

A natural herb for the treatment of diabetes

Tiejun Tang

Diabetes is a very common disease. According to the WHO Global Report on Diabetes in 2014, there are 422 million adults suffering from diabetes. Most patients have to rely on chemical hypoglycaemic agents or even insulin injection for their whole life. Chemical drugs often cause many side effects after long term use, and the blood sugar levels are still not properly controlled in some cases. Good news for diabetes patient is that a Chinese herb has good effect on reducing blood sugar. It is a natural way to fight diabetes.

Corn silk (CS) is a commonly used Chinese herbal medicine. In Chinese it is called Yumixu. It was used to treat Xiao Ke (diabetes) for thousands of years in China. It may be used alone or in combination with other herbs according to syndrome differentiation diagnosis. It also can be used as daily food therapy for diabetes patients. The hypoglycaemic mechanisms of CS have been investigated by many researchers around world.

The peroxisome proliferator-activated receptors play a pivotal role in metazoan lipid and glucose homeostasis. Synthetic activators of PPAR alpha (fibrates) and PPAR gamma (glitazones) are therefore widely used for treatment of dislipidemia and diabetes. Rau O (2006) reported CS showed a significant effect of PPAR gamma activator [1]Non-enzymatic glycation and the accumulation of advanced glycation end products (AGEs) are associated with diabetes. Farsi DA (2008) reported that secondary metabolites from several plant species are known to inhibit non-enzymatic glycation and the formation of AGEs, including flavonoids found in CS. The results identify modern resistant and high phenolic maize inbreds as promising candidates for the development of natural AGE inhibitors for the prevention and treatment of diabetic complications[2]. Guo J (2009) reported CS extract markedly reduced hyperglycaemia in alloxan-induced diabetic mice. The action of CS extract on glycaemic metabolism is through increasing insulin level as well as recovering the injured beta-cells. Their research results suggest that CS extract may be used as a hypoglycaemic food or medicine for hyperglycaemic people[3]. Zhao W (2012) reported polysaccharides of CS have significant anti-diabetic effect on streptozotocin (STZ)-induced diabetic rats. The results demonstrated that daily treatment with 100-500 mg/kg body weight of CS extraction the diabetic rats could not only lead to a significant decrease on the animal's blood glucose level, but also reduce the serum lipid level including total cholesterol and total triglyceride [4]. Wen X (2015) reported Corn Silk Polysaccharide (CSP) D3 can inhibit the expression level of TGF-β1 of diabetic rat’s kidney and restrain macrophages in order to protect the kidneys of diabetic rats[5]. Zhang Y (2015) reported flavonoids extracted from CS can significantly reduce the body weight loss, water consumption, and especially the blood glucose of diabetic mice. It can increase serum total superoxide dismutase (SOD) and high density lipoprotein cholesterol level (HDL-C), decrease total cholesterol, triacylglycerol, low density lipoprotein cholesterol (LDL-C) [6]. Sabiu S (2016) reported in vitro analysis of CS extract that the result showed it exhibited potent and moderate inhibitory potential against α-amylase and α-glucosidase, respectively[7]. Cha JH (2016) reported CS extract improves levels of adipocytokine secretion and glucose homeostasis. It is also effective in decreasing the regulatory pool of hepatic cholesterol, in line with decreased blood and hepatic levels of cholesterol through modulation of mRNA expression levels of HMG-CoA reductase, acyltransferase (ACAT), and farnesoid X receptor (FXR)[8]. Chang CC (2016) report, the ethyl acetate fraction of CS exhibits dual antioxidant and anti-glycation activities and protects insulin-secreting cells from glucotoxicity[9]. Wang B (2017) reported CS has multiple beneficial effects, including hypotensive, anti-diabetic, and hypolipidemic properties. This suggests that CS could be used to treat or prevent metabolic syndrome[10]Pan Y (2017) aimed to investigate the physicochemical properties and antidiabetic effects of a polysaccharide obtained from corn silk (PCS2). The results showed that PCS2 was a heteropolysaccharide with the average molecular weight of 45.5kDa. PCS2 treatment significantly reduced the body weight loss, decreased blood glucose and serum insulin levels, and improved glucose intolerance. The levels of serum lipid profile were regulated and the levels of glycated serum protein, non-esterified fatty acid were decreased significantly. The activities of superoxide dismutase, glutathione peroxidase and catalase were notably improved. PCS2 also exerted cytoprotective action from histopathological observation. These results suggested that PCS2 could be a good candidate for functional food or medicine for diabetes treatment[11].

The hypoglycaemic mechanism of CS is a multi-target approach. It not only reduces blood sugar but also balances the blood lipid, preventing and reducing complications of diabetes. This multi-target approach is different from western medicine treatment. The hypoglycaemic effect of CS is not as fast and strong as metformin, but it’s effects are more stable and much safer.  

Except CS many other Chinese herbs also have a good effect to reduce blood sugar. In my clinical practice I usually select few herbs to compose a formula for different individual patients.  For the early stages of Type 2 diabetes the use of herbal medicine can get the sugar level under control. For severe cases, when patients have to use western medicine, CS can be elected to enhance the effect of western medicine and reduce their side effect.

Reference:
  1. Rau O, et al. Screening of herbal extracts for activation of the human peroxisome proliferator-activated receptor. Pharmazie. 2006; 61(11):952-6.
  2. Farsi DA, et al. Inhibition of non-enzymatic glycation by silk extracts from a Mexican land race and modern inbred lines of maize (Zea mays).  Phytother Res. 2008; 22(1):108-12.
  3. Guo J, et al. The effects of corn silk on glycaemic metabolism. Nutr Metab (Lond). 2009; 23(6):47.
  4. Zhao W, et al. Comparison of anti-diabetic effects of polysaccharides from corn silk on normal and hyperglycemia rats.Int J Biol Macromol. 2012; 50(4):1133-7.
  5. Wen X, et al. The Influence of Corn Silk Polysaccharide on Signal Pathway of TGF-β1 in Type 2 Diabetic Mellitus Rat. Open Biomed Eng J. 2015; 9: 204-8 
  6. Zhang Y, et al. Anti-Diabetic, Anti-Oxidant and Anti-Hyperlipidemic Activities of Flavonoids from Corn Silk on STZ-Induced Diabetic Mice. Molecules. 2015; 21(1):E7.
  7. Sabiu S, et al. Kinetics of α-amylase and α-glucosidase inhibitory potential of Zea mays Linnaeus (Poaceae), Stigma maydis aqueous extract: An in vitro assessment. J Ethnopharmacol. 2016; 183:1-8.
  8. Cha JH, et al. Corn silk extract improves cholesterol metabolism in C57BL/6J mouse fed high-fat diets.Nutr Res Pract. 2016; 10(5): 501-506.
  9. Chang CC, et al. The ethyl acetate fraction of corn silk exhibits dual antioxidant and anti-glycation activities and protects insulin-secreting cells from glucotoxicity. BMC Complement Altern Med. 2016; 16(1):432.
  10. Wang B, et al. Beneficial Effects of Corn Silk on Metabolic Syndrome. Curr Pharm Des. 2017 Sep 26. doi: 10.2174/1381612823666170926152425. [Epub ahead of print] 
  11. Pan Y,et al. Physicochemical properties and antidiabetic effects of a polysaccharide from corn silk in high-fat diet and streptozotocin-induced diabetic mice. Carbohydr Polym. 2017; 164: 370-378. 


Sunday, 13 August 2017

How to prevent and treat coronary in-stent restenosis with Chinese medicine?

Tiejun Tang


Coronary in-stent is the most common treatment in coronary heart disease (CHD).  It can improve myocardial ischemiaand release angina immediately. About 800,000 Americans receive stents each year. Although coronary artery stent is very effective on CHD, but the ischaemic heart disease still is the world’s biggest killer according to WHO’s report (2012). Statistical data showed 73,000 people died from CHD every year in the UK. (200 died per day). The biggest problem in the treatment of CHD is restenosis or re-narrowing of the coronary artery. 

Restenosis usually occurs 6-9 months after stent placement, as a result of neointimal hyperplasia due to the proliferation and migration of vascular smooth muscle cells. A recent research report showed that from 2006 to 2014, 65,443 patients underwent percutaneous coronary intervention (PCI) and 6,872 patients (10.5%) with 8,921 lesions were treated for in-stent restenosis (ISR). The proportion of patients undergoing revascularization for restenosis increased 0.28% per year[1].

The small scaffold stent props open the diseased artery to prevent heart attacks, but because
the body treats stents as foreign, the risk of blood clots is ever present. That is why its short term effects are good, but long term effects are not satisfactory.  Dr Aseem Malhotra said to Daily Mail: ‘There is no evidence that coronary angioplasty reduces risk of heart attack or death in patients with uncomplicated stable angina’

In traditional Chinese medicine (TCM) angina is known as Xin Tong or Xiong Bi. The common pathological mechanisms of this disease were due to heart blood stagnation, heart yang deficiency, cold stagnation or phlegm obstruction. Chinese medicine usually selects different herb formula to treat different individual cases. Some formulas have been used for thousands of years. Every prescription was modified according to the symptoms of the individual patients.

 

In China, Chinese herbal medicines are widely used for preventing restenosis after stent placement. A Meta-analysis on 52 trials (4905 patients),  the result showed at the end of at least 3 months' follow up, Chinese herb medicine could significantly reduce restenosis rate, cardiac mortality, recurrence rate of angina, acute myocardial infarction, numbers of repeat PCI, and numbers of coronary artery bypass graft[2]. Chinese herb treatment includes extracts from mixtures of herbs, single herbs, or a compound of herb decoction.  The most commonly used single herb is Dan Shen (Salvia miltiorrhiza). More than 230 randomized controlled trials (RCTs) of Danshen dripping pillin treating angina pectoris. Among the included 109 RCTs with 11,973 participants, the efficacy of Danshen was better than isosorbide dinitrate in treating angina pectoris[3]. Dan Shen also showed a good effect on preventing restenosis after coronary stent[4].  Xiong Shao capsule is an herbal remedy which was composed by ChuanxiongLigusticum chuanxiongand Chishao (red paeony root). Clinical study showed it can effectively prevent restenosis after PCI in combination with conventional western medical treatment.[5]

If you have time to read all of reference below this article, you will understand coronary stent and by-pass operation are not only option in CHD treatment. TCM as an alternative option is the right choice, because it can reduce the mortality rate and save lives. 

Reference:
1. Waldo SW. Incidence, procedural management, and clinical outcomes of coronary in-stent restenosis: Insights from the National VA CART Program.Catheter Cardiovasc Interv. 2017 Jun 28. doi: 10.1002/ccd.27161. 
2. Zheng GH.Systematic Review of Chinese Herbal Medicines for Preventing in-Stent Coronary Restenosis after Percutaneous Coronary Intervention. Evid Based Complement Alternat Med. 2012;2012:253409.
3. Jia Y. How Efficacious is Danshen (Salvia miltiorrhiza) Dripping Pill in Treating Angina Pectoris? Evidence Assessment for Meta-Analysis of Randomized Controlled Trials. J Altern Complement Med. 2017 Jun 26. doi: 10.1089/acm.2017.0069
4. Fu GS. Clinical observation of compound Danshen drop pill preventing restenosis of patients with coronary heart disease after stenting operation (Part 1) China Medical Herald2009; 6:68–69.
5. Lu XY. Clinical study on effect of Xiong Shao capsule on restenosis after percutaneous coronary intervention. Chinese Journal of Integrated Traditional and Western Medicine. 2006;26(1):13–17.

Wednesday, 24 May 2017

How to treat IBS with Chinese herbal medicine and acupuncture?

Tiejun Tang 


Irritable bowel syndrome (IBS) is a common, chronic disease. IBS occurs in 10-20% of the population in the UK, but prevalence is thought to be higher than this as many people with the disorder do not seek medical advice.[1] If you often have unexplained diarrhoea and /or constipation accompanied by abdominal pain and stressed mood,  you may suffer from IBS, and should contact your GP. IBS diagnosis can be confirmed by exclusion using stools test, blood test and colonoscopy results.


Western medicine usually focuses on the symptoms for IBS patients. Antispasmodics can relieve abdominal pain and cramping and antimotility agents can relieve diarrhoea. Laxatives can relieve constipation and anti-depressants can relieve stressed moods. All of these medicines only can release symptoms temporarily. It is difficult to cure the IBS from the root. Many patients have to live with IBS for many years.

According to the philosophy of traditional Chinese medicine depression and stressed mood was due to liver qi stagnation, and diarrhoea and constipation were due to spleen deficiency. If the diarrhoea were triggered by emotional stimulation, the Chinese medicine diagnosis should be “liver restrict spleen” or “disharmonious between liver and spleen”. The treatment principle for this condition must be dispersing the depressed liver and benefiting the spleen. The basic classic formula is Sini San, a prescription which has more than 1700 years history for diarrhoea treatment. Alternatively we also can use modified Senling Baizhu San and Tongxie YaoFang according to patient’s symptoms for individual cases.

In a pharmacological research to investigate the effects of Sini San and fluoxetine on the levels of central and peripheral 5-HT in a rat model of depression, the result showed that after eight weeks Sini San treatment  appeared at least as effective as fluoxetine. It suggested Sini San can replace fluoxetine in the later stages of depression treatment to minimize side effects of this anti-depressant[2].  In another  report from my ex colleague’s research team, it showed Shenling Baizhu San suppresses colitis associated colorectal cancer through inhibition of epithelial-mesenchymal transition and myeloid-derived suppressor infiltration[3]. Baishaoyao (Paeonia lactiflora Pall) is a common ingredient of these three formulas. In in-vitro and in-vivo studies showed it has a beneficial effect of Anti-inflammatory and immunomodulation[4]. With regard to the pathophysiology of IBS a recent report indicated that low-grade mucosal inflammation and immune activation were involved.[5] Based on thousand years clinical experience of Chinese medicine and modern scientific research, we have enough reasons to try Chinese medicine in IBS treatment.

Acupuncture and moxibustion also have good effect on IBS if a good protocol is selected. Although there is much evidence indicating that acupuncture works well on IBS,[6] unfortunately NICE did not recommend acupuncture in their clinical guidance. Maybe their decision based on different treatment protocols.

The advantage of TCM is to combine herbs and needles. The treatment effect of herbs and acupuncture can enhance each other. Chinese medicines tend to cure the disease from the root and not just control the symptoms.

References:
1.   Guidelines on the Irritable Bowel Syndrome: Mechanisms and Practical Management; British Society of Gastroenterology (May 2007)
2. Li Y. Effects of Sini San used alone and in combination with fluoxetine on central and peripheral 5-HT levels in a rat model of depression. J Tradit Chin Med. 2013 Oct;33(5):674-81.
3. Lin X. Shenling Baizhu San supresses colitis associated colorectal cancer through inhibition of epithelial-mesenchymal transition and myeloid-derived suppressor infiltration.BMC Complement Altern Med. 2015 Apr 22;15:126.
4. He DY. Anti-inflammatory and immunomodulatory effects of paeonia lactiflora pall, a traditional Chinese herbal medicine. Front Pharmacol. 2011 Feb 25;2:10
5.  Holtmann GJ . Pathophysiology of irritable bowel syndrome.Lancet Gastroenterol Hepatol. 2016 Oct;1(2):133-146.
6.  Xiao-Peng Ma. Acupuncture-moxibustion in treating irritable bowel syndrome: How does it work? World J Gastroenterol. 2014 May 28; 20(20): 6044–6054.

Monday, 13 March 2017

A new acupuncture technique for dance injuries

Tiejun Tang

Dance injuries are very common in professional dancers. A recent systematic review study showed the period prevalence of musculoskeletal injuries in ballet dancers is 280%. The most prevalent musculoskeletal disorders included: hamstring strain (51%), ankle tendinopathy (19%) and general lower back pain (14%)[1].Typical treatments for dance injuries are usually physiotherapy, massage and pain killers, with some dancers trying traditional acupuncture. Although these therapies can temporarily release pain to varying degrees,the effect comes slowly and tends to be of limited duration.  Dance injuries have a considerable impact upon the lives and careers of the dancers impairing their training and performance and potentially resulting in long term chronic pain or even disablement.


As an acupuncturist I used to work in the pain clinic at Whittington hospital for many years, where we used acupuncture to help a lot of patients who suffer from a broad range of pain types. Many of the patients had been taking pain killers for a long time with limited effect.We applied acupuncture in every patient, plus cupping in some severe cases. Most of patients saw note worthy improvement after 5-10 sessions. In some cases, very significant improvement was noted.


Dance injuries may not have been common in ancient China, but injuries arising from martial arts and acrobatics training were. The ancient doctors believing that life energy (Qi) stagnation and blood stasis were the main pathological changes arising from trauma injuries, this caused pain and that acupuncture stimulated the energy flow and consequently relieved the pain. The treatment outcomes remain valid today, but we now have a new technique called Fu's SubcutaneousNeedle (FSN)[2] which has an almost magical effect without the need to fully penetrate the skin. It is my experience that this relatively new acupuncture technique can obtain immediate pain release effects. This treatment differs from traditional acupuncture in that it applies a special patent needle to the sub-cutaneous layer, the innermost layer of skin, where there are no nerves and therefore minimal sensation of pinprick for the patient. After about 30-40 minutes about 80% of patients feel the pain much better or totally disappeared right after the treatment finish.


As well as releasing the local pain of dance injury, acupuncture also can relieve anxiety, benefit sleep and boost energy levels in dancers. A good health condition is a guarantee of good dance. Acupuncture can help you to become a great dancer!

Reference
  1. Smith TO. Prevalence and profile of musculoskeletal injuries in ballet dancers: A systematic review and meta-analysis.Phys Ther Sport. 2016;19:50-6.
  2. Tiejun Tang. FSN – A Magical Acupuncture for Pain Release. http://chinesemedicinesalon.blogspot.co.uk/2016/09/fsn-magical-acupuncture-for-pain-release.html