Multiple sclerosis (MS) is an autoimmune disease characterized by demyelinating lesions in the white matter of the central nervous system (CNS) and occurs in genetically susceptible individuals with environmental factors. The pathological changes are multiple demyelinating plaques in the white matter of the CNS, accompanied by gliosis. It is characterized by the spatial multiplicity of signs and symptoms and the temporal multiplicity of the disease course.
Wu Jitao, Department of Encephalopathy, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
Multiple sclerosis is widely distributed in the world, especially in some countries in Europe and the United States the prevalence rate is quite high, there is no comprehensive and detailed epidemiological statistics in China, but in recent decades there are more and more clinical reports of multiple sclerosis patients in China, showing an increasing trend.
I. Overview of multiple sclerosis
1.Pathological characteristics
The pathological characteristics of MS are focal, mostly located in scattered demyelinated plaques around the ventricles, with reactive gliosis, but also axonal injury, the lesions can involve the white matter of the brain, spinal cord, brainstem, cerebellum and optic nerve.
Coronal views of the brain and spinal cord reveal more pinkish-gray scattered plaques of varying morphology, ranging in size from 1 to 20 mm in diameter, with the center of the hemianopia and the periventricular area, especially the anterior horn of the lateral ventricle, being the most common. The early demyelination lacks inflammatory cellular response, and the lesions are pale in color with unclear borders, called shadow plaque. Acute cases in China are mostly seen as softened necrotic foci with spongy cavities, which are different from the typical sclerotic spots in Europe and America.
2.Etiology
(1) Viral infection
Epidemiological data suggest that the development of MS is related to viral infections, and there was a high suspicion of neuroviruses such as measles virus and human T-lymphotropic virus type I (HTLV-T), but the virus has never been confirmed or isolated from the brain tissue of MS patients.
(2) Genetic factors
There is a clear familial predisposition to MS, with first-degree family members of patients having a 12-15-fold greater risk of the disease than the general population. MS genetic susceptibility may have a majority of weakly acting genes interacting to determine the risk of MS development. The MHC-II region of the human major tissue-soluble leukocyte antigen, located on chromosome 6, is currently thought to play a role in susceptibility, and different ethnic groups are associated with certain HLA.
(3) Environmental factors
The incidence of MS tends to increase with latitude. the geographical distribution characteristics of MS indicate that environmental factors such as temperature, diet, sunlight, and toxins also play a role in the development of MS. among the environmental factors affecting the population, diet and temperature are particularly important, and temperature can affect the endocrine process of human development, the mechanism of which is not yet clear.
3. Incidence and regional characteristics of MS
The incidence of MS increases with latitude, and the farther away from the equator, the higher the incidence. high-risk areas for MS include the northern United States, Canada, Iceland, the United Kingdom, Northern Europe, Tasmania, Australia, and South New Zealand, with a prevalence of 40/100,000 or more. The prevalence rate in equatorial countries is less than 1/100,000, and the prevalence rate in Asia and Africa is lower, about 5/100,000. There is no epidemiological data on MS in China yet, but the number of reported MS cases has been increasing for more than 40 years, and experts tend to think that MS is not rare in China, but China is still a low incidence area.
MS occurs in young people, and the age of onset is 10-50 years old, with 20-40 years old being the most common age, and under 10 years old and over 50 years old being less common. The peak age of onset of the disease is 22-23 years for women and 25 years for men, with more women than men. The incidence in children is less common.
Clinical diagnosis
1. Symptomatic features
MS can have acute, subacute or chronic onset, and its clinical manifestations are complex.
The first symptoms may include localized weakness and numbness in one or more limbs, tingling sensation or instability in one limb, sudden loss of vision or blurred vision in one eye, diplopia, balance disorder, bladder dysfunction, etc. The clinical manifestations vary depending on the distribution and size of the lesion.
(1) Spinal cord conduction tract and motor damage
More than half of the patients have sensory impairment, including profound sensory impairment and Romberg’s sign. Romberg’s sign manifests as progressive hemifacial atrophy and is rarely seen clinically. Damage to the posterior cervical tract of the spinal cord produces Lhermitte’s sign, which is characterized by abnormal pins and needles pain during excessive forward flexion of the neck, spreading from the neck to the thighs or feet along the spine. Ninety percent of patients may have dyskinesia, commonly asymmetric spastic light paraplegia, with weakness or heaviness in the lower extremities. Some patients may have painful tonic seizures or other seizure symptoms such as dysarthria, diplopia, ataxia, vision loss, vertigo, trigeminal neuralgia, sensory abnormalities, etc.
②Brain dysfunction
Patients may have psychiatric symptoms, such as pathological emotional exaltation such as euphoria and excitement, and in most cases depression, irritability, indifference and drowsiness, strong crying and laughing, unresponsiveness, repetitive language, suspicion and persecution delusion, etc. 80% of patients have fatigue. There may also be aphasia, hemianopia, headache, nausea, vomiting, vertigo, and dysarthria. Very few patients may have seizures.
(iii) Brainstem and visual symptoms
Visual impairment is seen in about half of the patients, starting from one side and invading the other side at intervals, or both eyes are affected successively for a short period of time. The onset is acute, often with remission-relapse, and recovery may begin after several weeks. The lesion invades the medial longitudinal tract and causes inter-nuclear ophthalmoplegia, and invades the median reticular formation of the paramedian bridge, leading to a half syndrome; other brain nerve involvement is rare, such as central or peripheral facial palsy, deafness, tinnitus, vertigo, dysarthria, and dysphagia.
④Cerebellar dysfunction
Cerebellar ataxia is seen in about half of the patients, but Charcot’s three main signs (nystagmus, intentional tremor, and gibberish-like speech) are only seen in some patients with advanced MS.
2. Diagnostic imaging
CT scan of the brain
The main changes are multifocal hypodense spots in the white matter of the brain, mostly around the lateral ventricles, followed by the centrum semiovale, cerebellum, midbrain and pons.
Magnetic resonance imaging (MRI)
MRI scans are more sensitive than CT scans in detecting asymptomatic demyelinating plaques and lesions of the brainstem, optic nerve, and spinal cord. The T1 low-signal and T2 high-signal plaques of different sizes can be seen around the anterior and posterior corners of the lateral ventricles, the center of the hemianopia and the corpus callosum, or fused plaques, mostly located in the body of the lateral ventricles; irregular T1 low-signal and T2 high-signal plaques can be seen in the brainstem, cerebellum and spinal cord; most patients with long duration of disease can be accompanied by brain white matter atrophy such as dilatation of the ventricular system and widening of the cerebral sulcus.
3.Laboratory diagnosis
Blood test
In the acute phase or active phase of the disease, the number of CD8+ T lymphocytes in peripheral blood decreases, the number of CD4+ T lymphocytes increases, and the CD4+/CD8+ ratio increases; the content of myelin basic protein in serum and cerebrospinal fluid increases, which parallels the degree of the disease; during the active phase of the disease, the inflammatory cytokines TNF-a, IFN In the active phase of the disease, the expression of inflammatory cytokines TNF-a, IFN-1,2,6 and IL-1,2,6 was increased in the serum and cerebrospinal fluid, myelin basic protein (MBP) was increased in the serum, and adhesion molecules (vascular cell adhesion VCAM-1 ), intercellular adhesion molecule VCAM-1), intercellular adhesion molecule ICAM-1 and its receptor, very late antigen VLA-4, lymphocyte function The expression of lymphocyte function associated antigen (LFA-1) was increased.
Cerebrospinal fluid examination
(1) Mildly increased or normal cerebrospinal fluid (CSF) single nucleated cells (MNC), usually within 15×106/L; about 1/3 of cases with acute onset or progression may have mild to moderate increase, usually not exceeding 50×106/L. Above this value, other diseases should be considered instead of MS. About 40% of MS cases have mildly increased CSF protein.
(2) IgG intrathecal synthesis assay: Increased cerebrospinal fluid IgG (CSF-IgG) in MS is mainly synthesized within the central nervous system and is an important routine test for cerebrospinal fluid immunology. The CSF-IgG index is a quantitative index of intrathecal IgG synthesis, expressed as [CSF IgG/serum IgG]/[CSF albumin/serum albumin]{[CSF-IgG/S-IgG]/[CSF-Alb/S-Alb]}. An IgG index greater than 0.7 indicates intrathecal synthesis and is seen in more than about 70% of MS patients. ② Cerebrospinal fluid IgG oligoclonal band (CSF-IgG OB): It is a qualitative index of intrathecal IgG synthesis, and the positive rate of oligoclonal band can reach more than 95% by using agarose isoelectric focusing and immunoblotting techniques with double antibody peroxidase labeling and affinity-biotin amplification system. Both cerebrospinal fluid and serum should be tested, and only the presence of oligoclonal bands in cerebrospinal fluid and serum deficiency support the diagnosis of MS; however, cerebrospinal fluid oligoclonal bands are not MS-specific indicators.
Third, the understanding of MS in Chinese medicine
There is no disease name of “multiple sclerosis” in the literature of traditional Chinese medicine, therefore, most of the physicians treat the disease according to its clinical manifestations and assign it to a certain disease. Clinical weakness of the limbs, inconvenience, paralysis, or even muscle atrophy, generally attributed to the “impotence” category, such as the “Suwen Xuanji Original Disease Style – Five Movement Main Disease” said “impotence, that is, hand and foot impotence, weakness to run.” There are more clinical reports of this kind. Clinical manifestations of clumsy hand and foot movements, unstable walking, and ataxia on physical examination are classified as “bone carelessness”. It is believed that “carefree” is “shaking”, which depicts the ataxia of the team. If the pain in the back and back cannot be stretched, the limbs are painful, and the feeling of numbness is cold, it is identified as “paralysis”; if there is visual impairment, and the vision is unclear, it is identified as “faint vision”; if there is sudden blindness, it is classified as “green blindness If there is a sudden loss of vision, it is classified as “green blindness”; if there is a speech disorder, it is classified as “mute syncope”; if the limbs are paralyzed, it is classified as “wind prickly heat”, as stated in the Treatise on the Origin of Diseases: “The symptoms of wind prickly heat are no pain in the body, the limbs are not collected, and the mind is No confusion ……”. If the speech disorder is accompanied by limb weakness or paralysis, it is equivalent to “mute prickly heat” in Chinese medicine; it is also believed that during the exacerbation of multiple sclerosis, there are typical symptoms of external wind “in the meridians” and “in the internal organs”. “The clinical manifestations of multiple sclerosis are very similar to those of acute cerebrovascular diseases such as “stroke”, whether in the acute attack or in remission. In Chinese medicine, it is called “stroke”, so it is classified as “stroke”, “wind Yi” and “wind rash” in Chinese medicine. However, if it is called “stroke”, it is easily confused with cerebrovascular diseases such as cerebral infarction and cerebral hemorrhage, which is not conducive to differentiation.
There is no unified understanding of the etiology and pathogenesis of multiple sclerosis in Chinese medicine, but the following are commonly reported clinically: 1.
1. Spleen and kidney Yang deficiency
The kidney is the origin of the congenital, the main bone and marrow, the brain is the sea of marrow, the “Ling Shu Hai Lun” said: “the sea of marrow has a surplus of light energy and strength, from its degree; the sea of marrow is not enough, the brain turns tinnitus, shin acid, vertigo, eyes do not see, slack and rest”; congenital endowment or deficiency, room strain injury to the kidney or long-term disease damage to the kidney Yang, kidney Yang deficiency, can not produce bone If there is a deficiency of kidney yang, the kidney cannot produce bone and marrow, the marrow is empty, the brain is deprived of nourishment and the disease develops, the brain turns to tinnitus, dizziness, or the waist and knees are sore and weak, the limbs are cold and fearful of cold. If the spleen is the source of Qi and blood biochemistry, a weak spleen and lack of Qi and blood biochemistry will lead to dizziness, dizziness in vision, lack of energy and weakness.
2. Liver and kidney Yin deficiency
Liver and kidney are of the same origin. Liver collects blood, which is the main tendon, while kidney collects essence, which is the main bone and marrow. Liver blood depends on the production of kidney essence, and kidney essence depends on the moistening of liver blood. Insufficient liver blood and liver yin will draw down kidney yin over time, so that the kidney essence is depleted, the essence does not produce marrow, the bone is not nourished, and the brain is not filled; or congenital kidney essence deficiency, essence does not produce blood, then liver blood is insufficient, liver and kidney yin deficiency, the veins are not nourished, water does not contain wood, the wind is moving inside, the essence is empty, the brain marrow is not filled and the disease develops, and in the late stage of the disease, there is mostly liver and kidney deficiency, which can be seen as limb weakness, unsteady gait, numbness of hands and feet, dizziness; liver blood deficiency, the eyes are not nourished The eyes are not nourished by insufficient liver blood, so the vision is blurred and even blind.
3. Qi deficiency and blood stasis
Qi is the handsome of blood, and blood is the mother of qi. Long-term deficiency of Qi and Blood, weakness of Qi to move Blood, poor blood flow, stagnation of Blood, and stasis of veins and channels. The symptoms include dizziness, yellowish complexion, shortness of breath and weakness, unstable walking, numbness of limbs and a feeling of banding.
4. Weakness of spleen and stomach, deficiency of qi and blood
The spleen and stomach are the main receivers and transporters of water and grains, and the “Spiritual Pivot – five retention of fluids” says: “The fluids of the grains and grains are combined and made into paste, which penetrates into the bone void and replenishes the brain marrow.” The symptoms include weakness of the limbs, poor diet, poor speech, dizziness, etc.
5. Dampness and heat infiltration
Inadequate diet or strain on the spleen, the spleen loses its health and is unable to transport water and dampness, and the dampness becomes phlegm, which blocks the meridians and develops. Or even phlegm and dampness may become heat for a long time, with internal disturbance of phlegm and heat, blocking the clear orifices, so that clear yang does not ascend and turbid yin does not descend and the disease develops. The limbs are weak and impotent, especially the lower limbs, and the hands and feet are numb and slightly swollen, the chest and epigastrium are stuffy, nausea and vomiting, and dizziness and dullness.
6. Blood stasis blocking the ligaments
“Long-term disease enters the ligament”, “long-term disease more silt”, the disease is prolonged blood flow is not smooth, or even blood stagnation, stagnation of veins and channels and the onset of disease. The symptoms are impotence and weakness of the limbs, numbness of the hands and feet, and painful twitching of the limbs.
In summary, the cause of this disease is related to the feeling of external evil, emotional and mental discomfort, poor diet, excessive labor and fatigue, and congenital kidney essence deficiency. The pathogenesis mainly includes deficiency of Yang, Yin deficiency of liver and kidney, weakness of Qi and blood in the spleen and stomach, phlegm and dampness, and blood stasis in Qi deficiency. However, from clinical experience and the summary analysis of clinical literature reports, kidney deficiency and blood stasis are the main pathogenesis of the disease, and the location of the disease in the brain marrow is related to the kidney, liver and spleen, especially close to the kidney. According to the discussion of “Nei Jing”, “the kidney is the master of water and receives the essence of the five viscera and six bowels and hides it”, “the kidney produces bone marrow”, “the kidney is the master of the bone marrow of the body”, ” The brain is the sea of marrow”, “all marrow belongs to the brain”, “if the kidney does not produce, the marrow cannot be full”, “if there is a surplus of the sea of marrow, it is light and strong, and it is over its degree; if there is a deficiency of the sea of marrow, the brain turns to tinnitus, shins are sore, vertigo cold, the eyes do not see, slack and rest”; Zhang Jiebin cloud: “emotions hidden in the kidney, kidney pass in the brain …… so the essence into and after the brain marrow is born.” Zhang Xichen said, “The kidney is the sea of marrow is the place where the marrow is gathered, not the place where the marrow is born, look into its origin, it is really the real yin and real yang in the kidney brewed and combined …… edge of the governor vein up and infused in the brain.” From the above literature, we can see that the kidney, bone, marrow and brain have a very close physiopathological connection, the kidney is full of energy, the marrow is nourished, the brain function is sound, the kidney is deficient, the marrow is not born, the marrow is not enough, the brain is not nourished, so the kidney deficiency is the main pathological basis of multiple sclerosis.
Blood stasis is also an important pathological factor in this disease. Patients with multiple sclerosis often have numbness of the limbs, a feeling of banding, a dark tongue or petechiae, and other manifestations of blood stasis. Moreover, kidney deficiency, yin deficiency, fluid deficiency, and empty veins, modern medicine confirms that the blood volume in the veins decreases while the blood viscosity increases, and the blood flow rate slows down while the blood stagnates in the veins. The blood flow rate is not only related to the blood volume in the veins, if the kidney deficiency Yang is insufficient, the power of warming and promoting blood flow is weakened and the blood flow slows down, stagnating the veins and collaterals; if the true Yang in the kidney fails, the Yang deficiency produces internal cold, and the cold causes the blood to coagulate, which will also lead to stagnation of the veins and collaterals. It can be seen that kidney deficiency is prone to stasis, and kidney deficiency is more prone to stasis. Therefore, this disease is based on kidney deficiency, and blood stasis is the standard.
IV. Treatment of multiple sclerosis
(i) Western medicine treatment
The treatment of multiple sclerosis in the past and at present is mainly the application of adrenocorticotropic hormone, and clinical practice has also proved that the development of the disease can be quickly controlled in patients with acute attacks. However, after the drug is reduced or stopped, the disease is prone to recurrence, prompting the long-term use of drugs and side effects will also increase and aggravate; hormone therapy does not affect the whole course of the disease, and has no effect on the recovery of neurological function. Other immunosuppressants to control the relapse of multiple sclerosis have to be taken for a long time (more than three years), and the side effects are great, so that most patients cannot adhere to the medication.
1. Acute phase
(1) Adrenocorticotropic hormone therapy: It is generally believed that the mechanism of action of this therapy on MS is mainly: (1) non-specific immunosuppressive effect; (2) alteration of immune function through immune-mediated mechanism; (3) direct neurophysiological effect; (4) reduction of lipid peroxide content in the damaged spinal cord. It has anti-inflammatory and immunomodulatory effects, and is the main therapeutic drug for acute attacks and relapses in MS. Long-term application cannot prevent relapse, and the longer it is discontinued, the more difficult it is, and it is easy to relapse when the dose is reduced, and it is easy to cause serious side effects such as osteoporosis and femoral head necrosis. ①Methylprednisolone high dose short course therapy: 500-1000mg/d, intravenous drip for 3-4 days, the course of 3-5 days, later to prednisone oral, 1mg/(kg.d), oral drug for 11 days, and then gradually reduce the dose until discontinued (about 1 month); ②Prednisone 80-90mg/d, 6-10d, and then gradually reduce the dose to 60mg/d for 5d; 40mg daily for 5d, and then reduce by 10mg every 5d for 4-6 weeks as a course.
(2) Immunosuppressants: ① Azathioprine: reported to reduce recurrence rate, but with bone marrow suppression, leukopenia, and hepatic toxic side effects. Its usage: 2-3mg/(kg.d); ②Cyclophosphamide: reported to reduce the relapse rate, but its efficacy is not yet very certain, and has serious side effects: alopecia, leukopenia, hematuria, leukemia, etc. Dosage: 700mg/O, once every 2 months.
(3) Immunoglobulin: Immunoglobulin can enhance the body’s resistance, and its mechanism of action is to regulate the immune system and promote the regeneration of myelin. It is effective for some patients with MS in the acute stage and can improve their symptoms. Dosage 0.4g/(kg.d) for 3-6 months.
(4) β-interferon (IFN-β)
IFN-β has immunomodulatory effect and can suppress cellular immunity. It can reduce the deterioration rate of MS, but it is expensive and has side effects such as causing redness and pain at the injection site, liver function damage, and anemia. Dosage: IFN-β/α is used to treat first-episode MS with 22ug or 44ug, subcutaneously, 1-2 times/week. For confirmed R-RMS, 22ug, 2-3 times/week. 250ug for IFN-β/b, subcutaneous injection every other day.
(5) Stem cell transplantation
The efficacy is uncertain and expensive, so it has not been widely used in clinical practice.
2. Remission period
The drugs used in remission are basically the same as those used in the acute phase: β-interferon, immunoglobulin, azathioprine, cyclophosphamide, etc. The clinical efficacy is not definite, and it is not effective against recurrence.
(ii) Combined Chinese and Western medicine treatment
1. Acute phase: hormone therapy and TCM treatment of both the symptoms and the root cause. Short course impact treatment with high dose of adrenocorticotropic hormone, the preferred drug is methylprednisolone. Usage: 1000mg/d, slow (at least 3 hours) intravenous drip, after 3-5 days of improvement and stabilization, reduce to 500mg/d for 5 days, 200mg/d for 5 days, then change to oral dexamethasone 80mg/d, reduce 20mg every 10-15 days until discontinuation. In addition to hormone therapy, Chinese herbal medicine is also used. According to Chinese medicine, multiple sclerosis is based on the deficiency of both spleen and kidney, and is accompanied by heat toxicity, blood stasis, phlegm and dampness, and internal wind paralysis. Multiple sclerosis usually starts with external dampness and heat, which leads to poor flow of qi and blood, and then to brain marrow, resulting in brain dysfunction and limb impotence. Dampness and heat accumulation, the three jiao gasification unfavorable, resulting in liver loss of drainage, spleen loss of health, kidney loss of opening and closing, so that water does not turn into fluid, gradually gathered into phlegm. The phlegm rises with the qi and flows through the meridians, which leads to stagnation of the qi and blood and numbness of the limbs. Over time, phlegm and stagnation of each other, blocking the meridians, so that the qi and blood can not moisten the meridians, appearing impotence of the hands and feet and other symptoms. Therefore, the medicine is based on Astragalus, Radix Codonopsis, Atractylodes, etc. to tonify the spleen and benefit the qi; Xian Ling Spleen, Baji Tian, etc. to warm the kidney yang; Semen Cuscutae, Sha Yuan Zi, etc. to tonify the kidney yang and nourish the kidney yin; Bai Hua Shi Tong Cao, Dandelion, etc. to clear heat and detoxify; Red Peony, Chuan Xiong, Red Flower, etc. to invigorate the blood and remove blood stasis; Han Xia, Bile Nan Xing, Ze Di, etc. to remove phlegm and dispel dampness; Quan Worm, Stiff Silkworm, Leech, Gou Teng, etc. to dispel wind and relieve pain. It is proved that treatment with Chinese herbal medicine can reduce the side effects of hormones and prevent recurrence by taking it for a long time.
2. Recovery period (treatment period): Chinese herbal medicine is mainly used to improve the symptoms and the quality of survival, and to treat the disease at its root. It is mainly to nourish the spleen and kidney, activate blood circulation and remove blood stasis. Astragalus, Radix Codonopsis, Atractylodes, Xian Ling Spleen, Bacopa monniera and Cornu Cervi Pantotrichum are used to tonify the spleen and kidneys; Angelica sinensis, Chuanxiong, Radix Paeoniae and Salviae Miltiorrhizae are used to invigorate the blood and remove blood stasis. For dizziness and tinnitus, magnet, raw dragon mushroom, etc. are used to revive the submerged yang; for blurred vision, cassia seeds, grain essence grass, mimosa, etc. are used to clear the liver and brighten the eyes; for soreness of the waist and knees, weakness of the lower limbs and paralysis, niu knee is used to strengthen the tendons and bones and warm the kidneys. For convulsions of the limbs, use whole worm, cicada, leech, etc. to dispel wind and open the channels; for chills in the limbs, use cinnamon stick, dry ginger, etc. to warm and open the meridians; for poor food and dullness, use sandy kernel, chicken internal gold to regulate qi and awaken the spleen; for constipation, use fire hemp, Yu Li Ren, Da Yun, etc. to laxative; for urinary incontinence, use puzzle kernel, mulberry cuttlebone to fix the kidney and reduce urination. In addition to the overall adjustment with Chinese medicine, multiple vitamins and neuroprotective drugs: VB1, VC, VB12, cerebroprotein hydrolysate, cytidylcholine, etc. should be used to nourish and protect nerve cells, improve the symptoms and reduce the patient’s pain. At the same time, active rehabilitation treatment should be carried out during this period, such as acupuncture, tui-na, medical sports therapy, etc. Rehabilitation therapy can improve local blood circulation and nutritional function, increase metabolism, improve motor function, relieve symptoms and reduce patient’s pain.
3. Remission period: anti-relapse herbal treatment. Multiple sclerosis often remits and relapses repeatedly, and the purpose of treatment in remission is to prevent relapses. Therefore, in this period, the treatment emphasizes on supporting the righteousness and eliminating the evil, adjusting the balance of yin and yang of the body, and fundamentally solving the intrinsic factors of its occurrence and development. The pathogenesis involves many internal organs, especially the liver, spleen and kidney. According to the principle of “if there is deficiency, it should be tonified, and if there is damage, it should be benefited”, the disease is based on the deficiency of both spleen and kidney, so the treatment is based on tonifying the spleen and kidney, often using Baji Tian and Epimedium to warm the kidney yang; Cistanches, Sha Yuan Zi, Zhen Zhen Zi and Cuscuta, etc. to seek yin in yang and yang in yin, to fill the role of kidney essence and support kidney qi. Adding Radix et Rhizoma Ginseng and Rhizoma Atractylodis Macrocephalae to strengthen the spleen and regulate Qi, and adding Radix et Rhizoma Polygonati and Rhizoma Polygonati to strengthen the function of benefiting Qi, nourishing Yin and generating Blood. Astragalus, Curcuma longa, Gaijin, Bacopa monniera, Cornu Cervi Pantotrichum, Eucommia and many other herbs have immune regulating effects, and can be taken for a long time instead of western medicine immune preparations because of their small side effects. Clinical studies have found that prolonged use of Chinese medicine can regulate the body’s immunity and prevent recurrence, and the efficacy of Chinese medicine against recurrence is remarkable. A considerable number of patients who insist on taking Chinese medicine for more than 3 years have not relapsed after follow-up. Some patients have been taking herbal medicine for 3 years and have not relapsed for 10 years after stopping the medicine.
V. Conclusion
The shortest duration of the disease was 2 months, and the longest was 20 years.
①Symptom distribution: visual impairment: 169 cases; motor impairment: 177 cases; sensory impairment: 154 cases; cerebellar symptoms: 59 cases; psychiatric symptoms: 54 cases; chest and abdominal girdling sensation: 68 cases; Lhermitte’s sign: 46 cases.
②Regional distribution: northeast region: 80 cases; northwest region: 36 cases; southwest region: 16 cases; southeast coast: 13 cases; central plain: 45 cases.
③Age distribution: age: 2-78 years old, average 32.4 years old. 5 cases under 10 years old; 9 cases from 10-20 years old; 157 cases from 20-50 years old; 19 cases over 50 years old.
④Cold and cold caused 136 cases; caused by exertion 25 cases; caused by emotion 10 cases; no causative factors 19 cases. There were 136 cases of recovery from multiple attacks. There were 54 cases of recurrence after recovery from the first attack.
2. Patients recovered at least partially after an acute attack, but the time of recurrence could not be predicted. Factors with good prognosis include female, onset before 40 years of age, clinical manifestations of visual or somatosensory impairment, etc. The presence of cone system or cerebellar dysfunction suggests a poor prognosis.
Patients with multiple sclerosis should avoid physical fatigue, improve their living environment, pay attention to the routine of life, prevent colds and keep warm. Patients should have a happy spirit, be confident and actively cooperate with the doctor’s treatment.
3. The treatment principle of Chinese medicine is holistic concept and evidence-based treatment. The cause of multiple sclerosis is still unclear, and Chinese medicine can adjust the overall state of the patient, reduce the patient’s symptoms, reduce the sequelae and improve the patient’s quality of life through evidence-based treatment. Chinese medicine can reduce the relapse rate of multiple sclerosis in remission and slow down the development of lesions. In particular, Chinese medicines that activate blood circulation, remove blood stasis and tonify the kidney mostly have immune regulating effects, so taking Chinese medicines for a longer period of time can prevent relapse of multiple sclerosis. The side effects of Chinese medicine are small and can be taken for a long time, and it can reduce the side effects of hormones, reduce the dosage of hormones, and even replace hormones. The cost of Chinese medicine treatment is much lower than that of Western medicine, which is more suitable for Chinese national conditions. Therefore, the prospect of Chinese herbal medicine for MS is promising.