用中医治疗艾滋病

Fundamental Therapeutic Principles in the Treatment of AIDS Using Chinese MedicineJohn F.MooreSIOM Second Year Presentation2007用 中 医 治疗艾滋病Objective To introduce the etiology and pathophysiology of AIDS from a biomedical and Chinese Medical perspective using portions of the Classics and modern clinical discussion,To discuss the most frequently seen clinical presentations of AIDS,To introduce clinically relevant herbal treatment methods for these presentations.PandemicAIDS is a chronic,incurable,viral disease which destroys the bodys adaptive(acquired)immune system,leaving it vulnerable to myriad opportunistic infections.HIV(Human Immunodeficiency Virus),the virus that causes AIDS,is transmitted via body fluids(blood,semen,vaginal fluid,pre-ejaculate,breast milk)from one infected person to another.Modes of transmission:unprotected sexual intercourse,IV needle stick,MTCT(mother to child transmission via birth&breastfeeding).Some Sobering AIDS StatisticsGlobally,between 33.4 and 46 million people currently live with HIV.UNAIDS and the WHO estimate that AIDS has killed more than 25 million people since it was first recognized in 1981,making it one of the most destructive epidemics in recorded history.More than 64%of all people living with HIV are in sub-Saharan Africa,as are more than three quarters(76%)of all women living with HIV.In North America,an estimated 1.4 million people are infected.*The U.S.had 1.2 million people living with HIV last year.The U.S.therefore ranks among the top 10 countries in terms of infected people.*:/en.wikipedia.org/wiki/Image:HIV_Epidem.pngPrevalence of Adult HIV Infection Worldwide,2005(Joint United Nations Program on HIV/AIDS)What exactly is Immunity?Strict definition:“Nonsusceptibility to the invasive or pathogenic effects of foreign microorganisms,or to the toxic effect of antigenic substances.1“A condition of being able to resist a particular disease,especially through preventing development of a pathogenic microorganism,or by counteracting the effects of its products.2HIV/AIDS&ImmunityIn order to understand the pathomechanism of HIV/AIDS,we need to understand the basics of the immune system.Structure of the Immune SystemIMMUNE SYSTEMINNATE IMMUNITYGeneric Immunity common to all animal and plant life.Immediate defense against infection.Short-term protection.ACQUIRED(ADAPTIVE)IMMUNITYImmunity with memory that provides long-lasting protection for the host against future pathogens.NATURALLY ARTIFICIALLYMATERNAL(PASSIVE)INFECTION(ACTIVE)ANTIBODY TRANSFER(PASSIVE)IMMUNIZATION(ACTIVE)Acquired ImmunityCell-Mediated Immunity:the aspect of the immune system that involves the activation of macrophages,natural killer(NK)cells,specific cell-destroying T-lymphocytes,and the release of various secretions in the defense of the host against a pathogen.Immunity with“memory.In order to function properly,the cell-mediated immune system relies upon the chemical direction of the T-Helper(CD4)cells to hunt down and destroy infectious organisms.Immune System Agents:InterferonInterferon:natural proteins produced by the cells of the immune system of most vertebrates in response to challenges by foreign agents such as viruses,bacteria,parasites,and tumor cells.Interferon assists the immune response by inhibiting viral replication within other cells of the body.It can also stimulate the activity of lymphocytes.Immune System Agents:T-CellsT-Cells:White blood cells known as lymphocytes that play a crucial role in cell-mediated immunity.T-Helper Cells,Natural Killer Cells,T-Memory Cells,etc.The foundation of the acquired/adaptive immune system.T-Helper(CD4)cells are responsible for governing the activity of other lymphocytes and as such are a crucial part of the immune system.Immune System Agents:PhagocytesPhagocyte:acellthatingestsanddestroysforeignmattersuchasmicroorganismsordebrisviaaprocessknownasphagocytosis.Theycanalsoinduceapoptosisofnormalandtumorcellsandproduceotherimmunestimulating/modulatingsubstances.The“frontlineofthebodysdefensesagainstimmuneinfection.HIV&T-Helper(CD4)CellsHIV,the virus that causes AIDS,replicates itself by invading a host T-Helper Cell,exploiting its genetic material,reproducing viral replicates of itself,and killing the host cell in the process.Without adequate numbers of T-Helper Cells,the bodys cell-mediated immune system fails and opportunistic infections proliferate.As the virus continues to reproduce,more T-Cells are destroyed,ultimately leading to their complete annihilation and the functional destruction of the entire immune system.HIV TransmissionMechanismT-Helper(CD4)Cell HIV ParticleHIV Viral Load vs.CD4+T Lymphocyte Count Over the Untreated Course of Disease:/en.wikipedia.org/wiki/Image:Hiv-timecourse.png_ CD4+T Lymphocyte count(cells/mm)_HIV RNA copies per mL of plasmaThe Stages of AIDSIn 1990,the World Health Organization(WHO)grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1.Most of these conditions are opportunistic infections that are easily treatable in healthy people.Stage I:HIV disease is asymptomatic and not categorized as AIDS Stage II:includes recurrent upper respiratory tract infections Stage III:includes unexplained chronic diarrhea for longer than a month,severe bacterial infections and pulmonary tuberculosis Stage IV:includes toxoplasmosis of the brain,candidiasis of the esophagus,trachea,bronchi or lungs and Kaposis sarcoma;these diseases are indicators of AIDS.AIDS cannot be cured,only managed via a complex cocktail of pharmaceutical drugs which inhibits the activity of HIV,preventing it from penetrating the T-Helper host cell and replicating.This therapy is called Highly Active Anti-Retroviral Therapy,or HAART.To date,this is most widely-used therapy in treating AIDS.New drugs are constantly under development by pharmaceutical companies.Prescription Drug Therapy “The CocktailWhat is HAART?The drug cocktail in HAART includes Protease Inhibitors,Reverse Transcriptase Inhibitors(NRTIs such as AZT),Non-Nucleoside Reverse Transcriptase Inhibitors(NNRTIs),and Entry&Fusion Inhibitors.In concert these drugs are effective at stabilizing T-Cell counts(CD4 count)and reducing the replication of HIV(viral load).However,they are very expensive and can have many side effects.They must be taken together in order to work.Prescription Drug TherapySide-effects of HAART include fatigue,gastrointestinal distress,CNS disorders,peripheral polyneuropathy,renal problems,hepatotoxicity,changes in blood count,allergies,lactic acidosis,pancreatitis,avascular necrosis,osteopenia,osteoporosis,etc.Prescription Drug TherapyHAART is also expensive.A months supply of the drugs which comprise HAART can cost between$1,000-$1,400 USD.One year of drug therapy alone(not counting doctors calls or office visits)can cost up to$16,800.用 中医治疗艾滋病HIV/AIDS&Chinese Medicine用 中 医 治疗艾滋病“People with strong zheng qi do not succumb to epidemic infections.(Huang Di Nei Jing)Defining AIDS in TCMAIDS,(Acquired Immune Deficiency Syndrome),is referred to phonetically as 艾 滋 病(ai zi bing)in Chinese.1AIDS can be defined in several different ways according to TCM pattern identification.Because AIDS is a“new disease,having only been identified in 1981,there is no specific research on the disease from the past or in the Classics.TCM does possess a large body of information about infectious diseases and epidemics,and ways to describe the symptoms of those suffering from AIDS.Terminology AIDS can be compared to other conditions which have been copiously researched and documented in the Chinese Medical Tradition.Chinese Medicine uses the term“infectious epidemic diseases,疫 病(yi bing)to describe epidemic diseases such as AIDS,which are caused by invading evils(viruses).The Chinese term for“virus is bing du 病 毒,literally“toxic/poison disease.AIDS can also be thought of as a“pestilence,or“plague.The Chinese term for this is 温疫(wen yi).Such a disease was thought to have a long latency,sudden onset,and severe symptoms.Wen Bing 温病 DifferentiationAccording to Chinese Medicine,AIDS is caused by external viral evils invading inward and taking advantage of some pre-existing deficiency.The evil hides in the xue luo 血络(blood connecting vessels)and the ying fen 营分(nutritive level)like other wen re bing 温热病(warm heat diseases).This disease can also be referred to as a fu qi wen bing 伏气温病(hidden qi warm disease).This disease is accompanied by symptoms of xu lao 虚劳(deficiency taxation).Symptoms of fu qi wen bing伏气温病 Weakness of yuan qiDamage to jing;qi insufficiencyProgressive emaciationFatigueNight sweatsPoor appetiteDiarrheaClassic Text:Jin Gui Yao Lue 金柜药锊方论Han Dynasty c.206-220 BC JinGuiYaoLue(“EssentialsfromtheGoldenCabinet)chapter:“TheTheoryofVacuityTaxation(xulao虚劳):“Emptypulse,facecolorpale,facecolorwhite,palpitations,emaciation,inabilitytowalkduetosoreandthinskin,blurredvision,witheredhair,subaxillarylymphadenopthy,nightsweats,loosestools,diarrhea,crampingordistensioninthelowerabdomenorevendiarrheawithundigestedfoodinthestools,nocturnalemissions(etc).:/Zhang Zhong-jing150-219 A.D.Classic Text:温 疫 论 Wen Yi Lun (“Treatise on Warm Epidemic Diseases)by Wu Yao-ke,Ming Dynasty c.1642 AD“Warm epidemics are not caused by wind,cold,summerheat,or dampness but by a strange sort of qi affecting the space between heaven and earth.emphasis added-referring to a pestilential qi and not a climactic or other external causative factor,etc.Classic Text:温 疫 论 Wen Yi Lun (“Treatise on Warm Epidemic Diseases)by Wu Yao-ke,Ming Dynasty c.1642 ADWu You-ke considered epidemic qi in the body as a pestilential toxin he called li qi 疬气.(Infectious)Pathogen can be transmitted from one person to another,unlike wind,cold,or dampness.(Communicable)Does not manifest symptoms soon after the exposure to the pathogen.(Latent)Epidemic qi invades,resides,and lurks in the membrane source mo yuan 膜原.(Chronic)One Concept of Immunity in Chinese Medicine“Fu Zheng Yu Qu Xie 扶 正 与 去 邪 Support the righteous and eliminate the evil(pathogen)Fu zheng:support the righteous qi,strengthen the bodys resistance,and improve immune functionQu Xie:eliminate,inhibit,and expel the disease causing factors(bing yin 病因),such as the AIDS virusRoot Treatment of AIDS Fu Zheng Pei Ben 扶扶 正正 培培 本本(Supporting the Righteous&Cultivating the Root)“Emptiness should be supplemented and fullness should be drained.(Ling Shu The Spiritual Pivot).Supporting/assisting the righteous&cultivating the root is indicated in the case of emptiness damage to the righteous qi.Treatment:balance and supplement the lungs,spleen,&kidneys,improve deficiency of qi and blood,yin and yang.The Concept of Immunity in TCMSupporting the righteous enables the body to eliminate the evil;Eliminating the evil simultaneously preserves the righteous while getting rid of the pathogen.Both methods should be used in the treatment of AIDS.扶正与去邪Commonly Used Treatment MethodsFu Zheng Pei Ben(Supporting the Righteous&Cultivating the Root)-Bu Pi(Supplementing the Spleen)-Bu Shen(Supplementing the Kidneys)Qing Re Jie Du(Clearing Heat&Resolving Toxins)Huo Xue Hua Yu(Activating the Blood&Transforming Stasis)扶正培本清热解毒活血化瘀Bu Pi Supplementing the SpleenInjury to the Spleen&Stomach is the most common cause of deficient righteous qi.Spleen qi is easily damaged by external evils,including viruses.Herbs that strengthen the Spleen also improve immunity.补脾Bu Shen Supplementing the KidneysKidney jing deficiency can lead to weakness in all other areas of the body and vice versa.AIDS patients generally present with kidney yin or yang deficiency,or with both.In Kidney deficient patients,metabolism,cellular immunity,and humoral immunity are all lower than in normal patients.Kidney yin enrichment can improve the bodys immunity while prolonging the survival of antibodies.Kidney yang enrichment can excite the nerves and humoral reaction,strengthen body resistance,and promote the formation of new antibodies.补肾ResearchNumerous clinical studies,most from China,report that CD4 cell count increases while viral load decreases after patients receive Chinese Medical treatments.Most serious AIDS research involving Chinese Medicine is conducted by Chinese researchers.Tanzania StudyA widely-cited study conducted by Chinese researchers in Tanzania using Chinese herbal therapy showed promising results.The study,which began in 1989 and ended in 1991,measured the effectiveness of TCM herbal formulas in 158 infected people.Tanzania Study Results3 cases reporting excellent results,36 cases reporting good results,24 cases reporting partial effect.95 cases reported no change,with 13 deaths at the end of the study.7 cases at the end of the study tested negative for the virus on ELISA and Western blot tests,with only one case reverting back to positive within one year.The results,while not overwhelmingly positive,suggest that herbal therapy has immune-modulating and antiviral effects,and that further study is warranted.Traditional Chinese Medicine Tumor Hospital,ShenzhenOBJECTIVE:To study the therapeutic effect of Chinese medicinal herbs on HIV patients.METHODS:We adopted the combined Chinese medicinal herbs for treatment,the chief components of which is to enhance human immunity while lightening the clinical symptoms.The clinical aspects,the CD4,CD8 lymphocyte numbers and the plasma viral load of the patients were compared before and after the treatment.RESULTS:Of 28 patients examined,all experienced increased body weight,average increase 5.4 kg after treatment.Symptoms abated completely in 7 cases having long-time fever,4 cases of diarrhea,2 cases of large scale skin ulcer and 1 case of skin rash after one month treatment.After 5 months of treatment,3 cases with lymphadenopathy had symptoms completely abate;in 7 additional cases the symptoms diminished or decreased in number.CD4 lymphocytes increased in 42.9%and 50.0%patients and viral load decreased in 71.4%and 80.0%patients after two months and five months treatment with Chinese medicinal herbs respectively.Taking clinical symptoms and laboratory indices into consideration,the total effective rate of Chinese medicinal herbs reached 94.0%.CONCLUSION:The Chinese medicinal herbs used in this study can obviously improve clinical symptoms,increase CD4 lymphocytes and decrease serum viral load of HIV patients.Source:Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi.1999 Sep 30;13(3):291-4.Beijing University of Technology,BeijingOBJECTIVE:To evaluate the therapeutic effect of Qu Du Zeng Ning Capsule on AIDS.METHODS:Qu Du Zeng Ning Capsule is a capsule containing extracts from 4 Chinese medicinal herbs.Totally 1,000 AIDS patients were treated,among them 60 patients were clinically observed weekly.Blood routine tests,liver,heart and kidney function,X-ray,CD4,CD8 cells were examined before and after treatment at 1,3,6 month.The patients were treated with 4 capsules t.i.d for 6 months.RESULTS:The symptoms were improved in most of the patients,the CD4 cells increased from 115.0 to 295.2/ul and the viral load(RNA copies/ml)in most patients reduced markedly or maintained at the same level.CONCLUSION:These data indicated that Qu Du Zeng Ning Capsule was effective for treatment of AIDS patientsSource:Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi.2004 Dec;18(4):305-7.Chinese Herbal Therapy and HIV/AIDS中医药治疗与艾滋病Kidney Yin&Blood Tonics:Improve Immunity and Prolong Antibody SurvivalShu di,He shou wu,Nu zhen zi,Gou qi zi,Gui ban,Bie jia,Tian men dong,Sang ji sheng,etc.Kidney Yang Tonics:Strengthen body resistance,and promote the formation of new antibodies.Yin yang huo,Ba ji tian,Xian mao,Rou cong rong,Dong chong xia cao,Bu gu zhi,Suo yang,Du zhong,etc.Qing Re Jie Du Clearing Heat&Resolving ToxinsAIDS is a pestilential infectious disease caused by externally invading evils that can generate stagnation and the accumulation of hot toxins.Heat toxins usually manifest on the surface,i.e.in the form of skin eruptions(Kaposis sarcoma,boils,macules,etc.)Most AIDS patients suffer from debilitating fevers,sweating,and dehydration.Treatment:clear heat,resolve toxins to support the righteous and eliminate evil.Herbs which clear heat and resolve toxins are also anti-inflammatory,antiviral,and antibacterial.清热解 毒Herbs for Clearing Heat&Resolving ToxinsBecause most heat-clearing,toxin-resolving herbs are both bitter and cold,they are traditionally contraindicated in xu lao disorders.(Reminder-Xu lao:Empty pulse,face color pale,face color white,palpitations,emaciation,inability to walk due to sore and thin skin,blurred vision,withered hair,subaxillary lymphadenopthy,night sweats,loose stools,diarrhea,cramping or distension in the lower abdomen or even diarrhea with undigested food in the stools,nocturnal emissions).Bitter&cold herbs must be combined with sweet,warm herbs to support the righteous while eliminating the evil:simultaneous treatment of the deficiency and excess.Herbs for Clearing Heat&Resolving ToxinsClear Heat&Toxicity:Jin yin hua,Lian qiao,Da qing ye,Ban lan gen,Pu gong ying,Xia Ku Cao,Huang qin,Huang lian,Huang bai,etc.Herbs for Clearing Heat&Resolving ToxinsYeast-Fungal inhibiting function:Ku shen,Bai xian pi,Da huang,She gan,Bai tou weng,Jie geng,Yu xing cao,Ding xiang,Shi liu pi,Huang bai,Huang qin,etc.Herbs for Clearing Heat&Resolving ToxinsTumor inhibiting function:Quan shen,Fen wei cao,Ban zhi lian,Bai hua she she cao,She mei,Zi cao,etc.Huo Xue Hua Yu Activating the Blood&Transforming Stasis“If qi and blood are not harmonious,then 100 diseases change and arise.(Huang Di Nei Jing 黄帝内经).If qi moves,blood moves.If qi stagnates,blood becomes static.Because qi and blood are both deficient in AIDS patients,the body lacks the strength to move blood and fluids.Fluid stagnation can lead to abdominal masses,tumors,ascites,lymphedema,etc.Herbs that move the blood can reduce capillary permeability,are anti-inflammatory,activate the absorption of inflammation,and regulate the immune system.Treatment:Invigorate the blood,transform stasis.活血化瘀Herbs for Invigorating the Blood and Dispelling StasisThese herbs should not be used carelessly or unnecessarily in AIDS patients.Herbs to supplement the qi(dang shen,huang qi,etc.)should accompany these herbs to activate the blood by activating the flow of qi.Use both draining and supplementing simultaneously.Chuan xiong,Chi shao,Tao ren,Hong hua,Dan shen,Yu jin,San qi,Yan hu suo,etc.Revivo:Chinese Patent Herbal Medicine for AIDSRevivo is an blend of Chinese herbs which has recently grown in popularity for the treatment of AIDS-related opportunistic diseases.Some limited clinical research has cited its immunoprotective effects.There is also considerable anecdotal evidence,yet large-scale clinical tests have yet to be undertaken.It is administered as an herbal powder added to hot water and contains:Niu bang zi 牛蒡子(burdock seed)Yi yi ren 意苡仁(Jobs tears)Ku gua 苦瓜(bitter melon)Hypericum chinensisLian zi 濂子(Lotus)Xia ku cao 夏枯草(prunella)Da zao 大枣(jujube date)Gan cao 甘草(licorice root)CBA:Revivo vs.HAARTCost of Revivo per month:$130.42Average Cost of HAART per month:$1,200.00Revivo viral load reductionSource:/ HIV HospitalRevivo CD4 count increaseSource:/ HIV HospitalHerbs that Boost the Zheng Qi-Interferon(Partial List of Herbs that can Increase Production of Interferon)huo ma ren jin yin huaju hua lian qiao long yan rou ma huang mai men dong man tuo luomu dan pimu tongqing feng tengren shen rou gui sang ye shan yao shan zhasheng di huang sheng mashu di huang suan zao ren tian ma tian men dong wu meiwu zhu yu xia ku caoxiang fuxin yi hua xuan shenyi yi renai yebai he bai shao bai zhi bai zhu ban xia bo he chai hu chen pi chuan bei mu da huang dang gui dong gua zigan cao ge gengua digua lou gui zhi han fang jihong huahuai mihuang bai huang lian huang qi huang qinChinese Herbs&Interferon ProductionHerbs that Boost the Zheng Qi T-Cells(Partial List of Herbs that can Increase Production of T-Cells)ling zhi lu genpu gong ying ren shen sang ji shengsang ye s