Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS) and Related Disorders

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Multiple Sclerosis is an autoimmune disease that affects the brain and spinal cord, eventually causing scarring and sclerosis to the nerve axons and degenerating the myelin sheaths that promote nerve conduction. Sclerosis is defined as an induration, or hardening, caused by overgrowth of fibrous tissue and other changes mainly attributed to dysfunctional inflammatory processes. The presentation and course of this disease is extremely variable, and the fear of the next devastating episode of severe and debilitating symptoms is perhaps the worst part of the disease for many patients. Complementary and Integrative Medicine and the various treatment protocols of Traditional Chinese Medicine (CIM/TCM) present an array of now proven therapeutic tools to improve outcomes and quality of life, and can be utilized with short courses of acupuncture and and individualized prescription of herbal and nutrient medicines. For patients experiencing more severe symptoms, the physiotherapies of TCM (Tui na) present useful protocols to maintain healthy physical function and comfort.
Amyotrophic Lateral Sclerosis, commonly referred to as ALS or Lou Gehrig's Disease, is a neurodegenerative disease that mainly affects peripheral motor neurons, but is also rooted in degeneration of the upper motor neurons in the brain and spinal cord. While for many the prognosis with ALS is not good, the quality of life and functional capacity can be maintained with the right course of integrated therapies.

Both of these central sclerosing pathologies involve progressive neurodegenerative changes to the brain. ALS usually progresses fast, though, with most patients not surviving 10 years. ALS is poorly understood, even today, but current evidence suggests that excess free radical reactive oxygen species (oxidants, or ROS) are responsible for the early programmed cell death, or apoptosis, of upper motor neurons. Glutamate toxicity, deficient levels of glutathione detoxification, and other neurodegenerative mechanisms may be involved in the slow, or rapid, progression of both of these diseases. Only about 10 percent of ALS is linked to potentially inherited traits, which is also similar to MS. Most, if not all, patients will benefit from restoration of homeostatic neuroprotective mechanisms. Obviously, given the lack of true understanding of these two neural sclerosing pathologies, the actual pathophysiology is complex, and utilizing a more holistic approach to management and treatment, integrating Complementary Medicine, is very important. Continuing to seek a specific allopathic treatment alone to manage symptoms, while ignoring the complex underlying health problems that form a multifactorial root of the disease, is a ticket for failure to cure, or even manage the disease, and many patients now recognize the importance of pursuing a holistic treatment regimen. While the chance of a cure in the early stages is slim, utilizing every treatment option available to decrease the periods of symptomatic exacerbation and prolong the times of asymptomatic remission is a realistic goal. The science of Traditional Chinese Medicine offers an array of therapies, centuries of study and clinical response, and an amazing amount of modern research and application of therapeutics to help treat these diseases.

Utilization of Integrative and Complementary Medicine (CIM/TCM) to treat and prevent relapse in MS and ALS is increasing dramatically around the world. Studies in China, Europe and South America found that with increased support for this medical specialty, utilization has increased to over 50 percent of patients. Studies have demonstrated that an array of therapies, especially utilizing herbal and nutrient medicine, physiotherapies and acupuncture, improves quality of life, relieves symptoms of pain, spasticity, paresthesia, insomnia, depression and fatigue, and counters the harsh side effects of medications. Increasingly, we see evidence that Complementary and Integrative Medicine (CIM/TCM) may provide significant benefits in reduction of relapse of MS as well. A 2015 meta-review of published studies by the City University of New York and the New York University School of Medicine found that use of acupuncture to treat MS is now fairly common, with anecdotal evidence of success, but that the published literature was still limited to 12 peer-reviewed studies of low quality, although most of these found that acupuncture was successful in improving symptoms such as spasticity, fatigue and pain, and improved quality of life (PMID: 25045394). The website of the National Multiple Sclerosis Society of the United States now endorses acupuncture as adjunct care in the treatment of MS. Of course, actual clinical treatment with CIM/TCM involves an array of therapeutic protocols that have been studied and proven, all combined into an individualized course of therapy. To see some of the studies that confirm efficacy of this array of therapies, refer to links below in Additional Information.

As the search for underlying causes of neurodegeneration and inflammatory scarring in Multiple Sclerosis continues, the explanations have become more complex, not more specific. For example, an Italian vascular surgeon, Dr. Paolo Zamboni, promoted the idea that poor venous flow from the brain contributes to iron overload toxicity that promotes the degeneration of the myelin sheaths (see the article on this website entitled Iron Overload Toxicity and Chronic Disease). His study in 2009 of 65 patients found that all of these patients had chronic cerebrospinal venous insufficiency (CCSVI). Follow-up study at the School of Medicine and Biomedical Sciences Buffalo Neuroimaging Analysis Center, in Buffalo, New York, in 2011, though, found that about 23 percent of healthy subjects met the criteria for CCSVI, while 56 percent of MS patients met the criteria, and 42.3 percent of patients with other neurological diseases. These findings present many doubts and questions about the causative aspect of chronic cerebrospinal venous insufficiency for MS patients, yet the use of venous stents, surgically implanted, has grown into a large and lucrative treatment protocol, mainly driven by the large percentage of patients that are not being helped by the array of pharmaceutical treatments. Since the use of venous stents are not proven to help the MS patient, these procedures are not covered by standard insurance policies, and cost around 11 thousand dollars.

Many experts believe that the venous insufficiency noted in over half of the MS patients was probably due to the common symptom of poor muscular control and contracture of muscles in the neck that many MS patients experience. Dr. Zamboni noted that venous pressure was identical in the MS patients with CCSVI and control subjects, and follow-up studies in Israel, the Netherlands and Germany found no abnormal blood flow in MS patients. An article in the New York Time Sunday Magazine of October 28, 2012, quoted one of the German researchers, Dr. Florian Doepp, a neurologist at Charite Hospital in Berlin, as stating: “I conclude there is no evidence for CCSVI in multiple sclerosis and no evidence to support (the surgical treatment for it)". A number of sound studies, performed before Dr. Zamboni's study, and after, have identified dysfunction in the iron metabolism that is associated with Multiple Sclerosis, though, and which may be associated with abnormal expression of iron transport proteins and their receptors, which is linked to chronic inflammatory dysfunction and oxidative stress. Obviously, there are a number of factors that contribute to the pathology, all of which should be addressed in a holistic integrative protocol. There are sensible and safe treatment options to reduce potential iron overload toxicity and restore iron homeostasis, as well as to aid the body with specific antioxidants. Combined with therapy to improve muscular function and reduce muscular, or myofascial contracture at the upper back and neck that may impinge venous circulation, as well as arterial nutrition, these types of approaches, found in Complementary and Integrative Medicine (CIM/TCM), may have a significant impact on the disease. An array of treatment protocols addressing this array of underlying factors that drive the sclerosing disease are available with CIM/TCM, with increasing proof of effectiveness.

The now large array of treatment options and hypotheses concerning the multi-factorial nature of Multiple Sclerosis points to the need for a more holistic treatment protocol. Addressing a number of these health issues safely, without side effects, is the goal for more and more MS patients that have researched their disease. Integrating courses of therapy from the TCM physician, utilizing not only acupuncture, but physiotherapy, herbal and nutrient medicine, provides an array of treatment benefits that may address a number of important health issues. Regarding the issue of iron overload toxicity, herbal and nutrient chelators may be important, and myofascial release of chronically contracted muscles in the neck may aid vascular flow and relieve symptoms. At the same time, acupuncture stimulation, antioxidant therapy, restoration of the glutathione metabolism, clearing of glutamate toxicity, and support of healthy regeneration of glial support cells and myelin sheaths may be included in the same course of therapy. Addressing neurohormonal health and balance may also be vital to a comprehensive treatment strategy, and utilization of a competent and knowledgeable Complementary Medicine physician, integrated with standard care, provides patients with a safe, effective, individualized, and comprehensive protocol of therapies. Each patient may choose to integrate a little or a lot of these therapies into their overall treatment plan. A proactive approach is essential.

Correct Diagnosis of Motor Neuron Disease is Very Important to Finding an Effective Therapeutic Protocol, and Diagnosis is Usually Very Difficult

Motor Neuron Diseases (MNDs) are a a sizable group of progressive neurological disorders that involve slowly degenerating nerve cells, or neurons, their myelin sheaths, and the supportive glial cells. Neurons are large cells that are unique in the body, evolved to carry electrochemical, or ionic, signals, often across relatively long distances, with signals carried out from the brain and spinal cord termed motor, or efferent, and signals returning to the spinal cord and brain termed sensory, or afferent. Of course, these divisions do not describe the system entirely, as many efferent nerve pathways are simply the connective synapse from one neuron to another. Generalized, though, the important efferent, or exiting, nerve pathways, are termed motor, as they provide signals to control movements and activities. This aspect of the efferent nervous system is divided into upper motor neurons (UMN) and lower motor neurons (LMN), distinguishing nerve cells and their axons that extend from the brain and brain stem through the spinal cord, or upper, from nerve cells and their axons that connect to this system outside of the spinal cord and carry electrochemical, or ionic, signals to the the organs and extremities. The somatosensory nerve cells, or the main afferent nerves, have a different setup, though, with the sensory neuron bodies located in spinal ganglions and their axons actually extending from the peripheral, or lower, system, into the spinal cord, brain stem and/or brain, with the sensory neuron bodies situated to the side of the long axon, directing the signals. These axons are bundled into complex groups of fibers and pathways, though, often called a plexus or ganglion, and the division of signals is not as distinct as we would like, but rather more of a quantum field of biochemical electrical signals. If this seems confusing, it is, and hence a firm diagnosis of neurological diseases is often confusing as well.

In Motor Neuron Diseases we often see the degeneration of the myelin sheaths that surround the long axons of the neurons, in a nodal pattern, with the periodic unsheathed parts of the axons actually conducting the electrochemical signals, and the amount of myelin affecting mainly the speed and strength of this signal. Of course, the myelin surrounds both the motor and sensory nerve axons, and diseases of myelin degeneration will have both motor and sensory function loss. What basically distinguishes these diseases, then, is the type and degree of degeneration of the neurons, affecting some systems more than others, but even this does not fully explain the different manifestations of the diseases. Hence, many uncertainties still exist, both in understanding the pathologies, the causes of these diseases, and of course, the exact diagnosis. Research in the last decade has found a number of areas of degeneration, though, not only in the myelin sheaths, but in the mitochondria of neurons, the glial support cells, and the neurohormonal mechanisms that control cell apoptosis, or programmed cell life and death. The genetic and epigenetic causes are multifocal, involving an array of genes and epigenes, and are seen in only a small percentage of these patients, such as 5-10 percent of ALS patients. An array of environmental causes, coupled with an array of propensities to disease mechanisms, explains these Motor Neuron Diseases, and thus an array of treatment protocols may be needed to affect the course of the disease, and a holistic approach to counter the whole cycle of dysfunction is sensible. For instance, a 2010 study of environmental causes of ALS, by experts at the University degli Studi di Modena e Reggio Emilia, in Modena, Italy, found that exposure to pesticides increased the risk of ALS by 3.6 fold, and a follow-up larger study at the University of Michigan, headed by Dr. Eva L. Feldman, published in 2016 in JAMA Neurology, studied 156 ALS patients matched with 128 control subjects, and determined that exposure to pesticides at any time in life was associated with a 5-fold increased risk for the disease. When integrating and designing holistic therapy to address the array of potential causes and contributors to Motor Neuron diseases, the most correct diagnosis helps to design the most individualized and effective treatment protocol.

The Motor Neuron Diseases (MNDs) include ALS, PLS (Primary Lateral Sclerosis), Progressive Bulbar Palsy (brain stem neurons), Pseudobulbar Palsy (upper motor neurons that affect the brain stem neurons), Progressive Muscular Atrophy (lower motor neurons), and SMA (Spinal Muscular Atrophy), with 5 types distinguished, mainly affecting the lower motor neurons. Multifocal Motor Neuropathy (MNN) is still considered a neuropathy, or nerve disease, that mimics Motor Neuron Diseases (MNDs), and is distinguished from Motor Neuron Diseases (MNDs) by the findings of a focal nerve conduction block. Determining in diagnosis the progression of these MNDs in the Upper Motor Neurons and then the Lower Motor Neurons, and Bulbar neurons (mainly controlling the face and neck), is important in both determining the prognosis and in the expansion of treatment protocols. While it is typical to describe these various Motor Neuron Diseases as distinct, with ALS distinguished from PLS by stating that PLS is confined to the upper motor neurons, this has been proven to be untrue, and the various sclerosing and degenerative diseases in the category Motor Neuron Diseases are in fact heterogeneous (diverse in presentation) and vary in treatment needs. To see proof of this, click here: Of course, with diseases that are poorly understood and diagnosed largely by signs and symptoms, and progression of these signs and symptoms, patients with early stages of these slowly progressive diseases are often not diagnosed correctly. It is very important to find a specialist that is knowledgeable to achieve a correct diagnosis. Currently, when the diagnosis is clarified, which is rarely seen at an early stage, there is much potential for improved outcomes with integration of intelligent Complementary and Integrative Medicine (CIM/TCM) protocols, which should be started at an early stage of the disease for greatest effects. Obviously, patients with these diseases have to take a stronger proactive approach to achieve this effective integration of complementary protocols and achieve a correct and revealing diagnosis at an early stage of the disease. Studies in Europe and China in the last decade do show that a majority of patients with ALS and other MNDs do integrate Complementary Medicine, and are pleased with the results, but lack of insurance coverage and support in standard medicine sorely hampers this vital resource for patients.

The primary focus in explaining the pathology of MS and ALS is centered on the autoimmune reactivity, but here too there is some uncertainty regarding the specific classification of disease. In 2015, experts at the Medical University of Vienna, in Austria tried to distinguish the immune features in a number of similar diseases, including MS, autoimmune encephalitis, acute demyelinating polyradiculoneuritis, and acute disseminated encephalomyelitis. Archival autopsy data of a patient who died of autoimmune enchephalitis showed that he met all of the diagnostic criteria for MS, and demyelination and brain tissue degeneration was associated with IgM antibody levels at active sites with activation of the immune complement system causing excess inflammatory reaction, which included a domination by B-cells, profound infiltration of CD8+ T cells and a nearly complete absence of CD4+ T cells (PMID: 26637427). These same researchers examined laboratory animals in 2014 with MS and induced autoimmune encephalitis to determine the extent of oxidative cause, finding that a variety of both causes of oxidative stress and manifestations in these study models exist. Studies of chronic human MS tissues show that oxidative stress is integral to the disease damage, and may be attributed to a variety of factors, including iron accumulation and iron release from brain lesions. The amplification of this oxidative injury can be attributed to autoimmune imbalance as well as iron toxicity, and the immune causes in the autoimmune reaction are varied as well (PMID: 24622774). Studies have also found that both viral immune responses and autoimmune reactivity may explain this confusing scenario, explaining why standard immune-suppressing drugs fail to promote long-term remission in most MS patients (PMID: 24083230). Recent studies have shown that both CD4+ and CD8+ immune complements are involved in MS, and the targeting of just CD4+ driven disease mechanisms with new biologic drugs would be prolematic (PMID: 26635816). These multifactorial diseases obviously need a more holistic approach to treatment.

Multifocal Motor Neuropathy (MNN) and Small Fiber Neuropathy

A correct diagnosis and understanding of the disease is very important to finding the best overall treatment protocol, especially in difficult chronic diseases that are still poorly understood. Multifocal Motor Neuropathy (MMN) is another progressive condition that shares many signs and symptoms with ALS and MS and is thought to have an autoimmune component, but only involves the lower motor neurons, or nerve cells outside of the spinal cord, brain stem and brain. Multifocal Motor Neuropathy was not defined as a disease until the late 1980s, and most patients with MNN have received a mistaken diagnosis of ALS. MNN, like ALS, usually begins in one or both hands, and like ALS, is characterized by weakness, atrophy, and muscle cramps. Muscle twitching, or fasciculations, lack of sensory nerve involvement, and exacerbation of symptoms with exposure to either cold or heat are mainly what distinguishes MNN from ALS. The diagnostic hallmark of MNN is an EMG finding of a focal conduction block in only the motor nerves, with no findings of sensory abnormalities, and usually symptoms predominant on one side of the body, but this disease hallmark is difficult to detect, and hence, most patients continue to be misdiagnosed and treated with the wrong drug therapy. Use of a nerve ultrasound is now found useful to clarify the diagnosis, with multifocal nerve enlargements found in testing (PMID: 25620065). MNN usually begins in the dominant hand with periods of marked weakness and muscle atrophy, with the ulnar and median nerve pathways most often affected. Progression of the disease usually involves the lower extremity on the same side of the body, with common peroneal and tibial nerves affected at their distal segments.

Most cases of MNN are now treated with either intravenous immunoglobulin (IVIG) or immunosuppressant therapy, usually with cyclophosphamide or Rituximab, a monoclonal antibody against a protein expressed on B cells. In the past, corticosteroid therapy, with Prednisone, was used, but finally found to be ineffective, with greater risk than benefit. Newer immune altering or suppressing drug therapy provides greater benefits for managing symptoms, but also a high incidence of future adverse effects. A sensible approach to these problems is to try to integrate Complementary Medicine to reduce or eliminate these adverse effects of therapy, as well as to do more than just manage symptoms, and actually resolve some of the underlying health problems driving the disease, as well as improve quality of life with aging and progression of the disease. Medications such as Rituximab commonly create both T-cell and B-cell suppression syndromes, such as Cytokine Release Syndrome, where monoclonal antibodies bind to T-cell receptors and activate a systemic inflammatory response. This is not an immediate side effect of the medication, but often happens over time, and usually is diagnosed as a severe infection, with many patients even unaware that this occurred as a side effect of medication. Experts agree that treatment with intravenous immunoglobulin or immunosuppressant therapy is effective in the short term, but long-term therapy does not prevent the progression of the disease, and slowly progressing axonal degeneration. Complementary and Integrative Medicine (CIM/TCM) could greatly enhance the long-term outcomes, and may even provide potential for actual prevention of the progression of the disease, providing means to decrease neuronal loss. Short courses of frequent acupuncture and electroacupuncture stimulation combined with more persistent courses of individualized herbal and nutrient medicine provide many benefits to the overall treatment plan with relatively small cost and effort.

Small Fiber Neuropathy is a condition characterized by pain and dysesthesia that typically begins in the hands or feet, but often spreads up the limbs. Patients typically have an increased sensitivity to pain and experience pain that is inexplicable, and often cannot feel pain in a concentrated small area of the body, and show reduced ability to differentiate between hot and cold stimuli, but in some cases experience painful episodes triggered by hot or cold. This is a form of peripheral neuropathy that is still poorly understood and seldom diagnosed. Obviously, many cases of Small Fiber Neuropathy could be mistaken for Multifocal Motor Neuropathy and Motor Neuron Diseases at early stages, where EMG testing is not performed or unclear, and mild motor weakness is often hard to assess. Distinguishing these disease mechanisms at an early stage is very important if a holistic and sensible protocol is to be designed, though.

In 2015, study of Multifocal Motor Neuropathy (MMN) and Progressive Muscular Atrophy (PMA) at the University of Utrecht School of Medicine and the Brain Center Rudolf Magnus, in Utrecht, The Netherlands, tested 25 patients with MNN, 55 patients with PMA and 25 patients with ALS, along with 50 healthy control subjects. Looking for markers of disease, mainly associated with B-cells, 16 tested immune cytokines and chemokines were not significantly increased in MNN or PMA, even when the presence IgM monoclonal gammoglobulins or IgM anti-GM1 antibodies were found. Thus, MNN and PMA appeared to not be associated with a systemic B-cell mediated immune response (PMID: 26298317). It appears that the standard treatment protocol of Rituximab may not be correct. Also in 2015, these researchers at the University of Utrecht School of Medicine tested 445 patients diagnosed with ALS, 158 patients with PMA, 60 patients with PLS and 88 patients with MNN, all with suspicion of monoclonal gammopathy (abnormal M protein produced by white blood cells) in blood serum, and compared to 430 matched control subjects. This test may help distinguish these motor neuron diseases. The experts found that neither ALS or PLS was associated with monoclonal gammopathy, and IgM monoclonal gammopathy was found in only 7 percent of MNN patients, and 8 percent of PMA patients. MMN and PMA are associated with IgM monoclonal gammopathy and anti-GM1 antibodies, but not ALS and PLS (PMID: 25549972). Some of these subsets of patients appeared to share traits with subsets of patients with the other diseases. Diagnosis may not be clear. While it is tempting to simplify the approach to treatment and prescribe standard allopathic medicines that fit a one-size-fits-all protocol, it is clear that these disorders are still poorly understood, varied and complex in their pathological considerations, and could benefit from a more holistic approach to treatment.

Understanding Multiple Sclerosis, or MS

MS affects many more women than men, commonly manifesting between the ages of 20 to 40, and characterized by long periods of exacerbation and remission. Common symptoms include weakness, tremor, poor coordination, spasms, and functional difficulties in the skeletal muscles. Urinary and bowel dysfunction, visual problems, dysesthesia (sensations of tingling, crawling or burning) in the arms and legs, cognitive dysfunction, depression, hearing loss, and trouble chewing and swallowing, are also seen. Fatigue is the most common and bothersome symptom as the disease progresses, and is often worse in the late afternoon. As there is no clear diagnostic test for MS, diagnosis is one of exclusion, ruling out other neurological disorders that have similar symptom presentation. Since the sclerosing of the myelin sheaths may occur in various parts of the brain and spinal cord, symptoms presentation may vary considerably.

Often, the initial manifestation of symptoms is mild enough to be overlooked in diagnosis, and a long period of remission of symptoms occurs, leading to the actual diagnosis only after more extensive disease progression occurs in the brain with a strong symptomatic exacerbation. The neurologist typically diagnoses Multiple Sclerosis when dysfunction is noted in at least 2 different parts of the central nervous system, such as abnormal reflex responses in different areas, motor weakness, decreased or abnormal sensations, abnormal pupil responses, or rapid eye movements triggered by eye movement (nystagmus). Examination of cerebrospinal fluid with spinal tap (lumbar puncture), brain MRI, and nerve function studies (evoked potential), are commonly used to confirm the diagnosis. Autoreactive myelin antigen-specific T cells are seen in the peripheral blood circulation, but blood tests are considered inconclusive. The use of optical coherence tomography (OCT) and 3 Tesla sodium MRI (3TMRI) present less expensive and perhaps more accurate means to gauge the progression of the disease, as the optic nerve is almost always affected, and as demyelination occurs the nerve axons create more sodium channels to maintain conduction, which is revealed by this test. Such biomarkers of the disease hold a promise for improved individualized treatment in the future, especially treatment that integrates Complementary Medicine with pharmacological treatment options.

In recent years, with improved methods of neuroimaging, scientists are finally discovering the specifics of the disease, and gaining a better understanding for the overall treatment protocol needed to restore the damage. A 2013 study at Norfolk and Norwich University Hospital, in England, found that degeneration of both the grey matter (nerve cell bodies and unmyelinated axons) and white matter (myelinated axons) occurs in MS, and that the damage to the grey matter is largely independent of the white matter lesions (see study link cited below in additional information). Grey matter volume loss, or neurodegeneration, in specific focal areas of the brain, namely the pre/postcentral regions, such as the left pre/post central gyrus, correlated with the level of functional disability. Such research demonstrates the need to incorporate a more complex array of treatment strategies into the overall treatment protocol, or a more holistic approach. It is important to help the body to restore myelination of nerve axons, but also to restore the health of the unmyelinated grey matter, and slow the progression of accelerated nerve cell death, or apoptosis. During periods of exacerbation of the disease symptoms, more focus should be placed upon restoration of the grey matter, and during periods of remission, white matter. The left pre/post central gyrus (ridge) is an area of the cerebrum located under the apex of the skull, extending towards the ear. Treatment with TCM in China has focused upon this area with reflexive scalp acupuncture in the treatment of MS for decades, primarily on the left scalp, as an important part of the overall treatment protocol. This primary motor cortex of grey matter is composed largely of Betz cells, which are perhaps the largest cells in the central nervous system, sometimes reaching 100 micrometers in diameter. These large Betz motor neuron cells not only have large axons that connect with the corticospinal tract and spinal cord, but an array of connecting dendrites that project into all layers of the cortex. Stimulation of these specific areas of the brain with electroacupuncture, combined with an array of herbal and nutrient aids to the health of the nerve cells and myelinated axons, as well as improved circulation of these nutrients into and out of the brain, provides the patient with a sensible comprehensive treatment strategy. Each part of this strategy should be looked at as synergistic with the other parts, working together to achieve the goals.

Currently, the U.S. National Library of Medicine, and the National Institutes of Health, confirm that there is no known cure of Multiple Sclerosis, and that standard medicine focuses on slowing the disease progression and controlling symptoms only. Various immune suppressing and immune mimicking drugs are used, as well as steroids. Benzodiazepines, antidepressants, anti-cholinergic medications, and amantadine are used to control symptoms.

The list of medications taken for prolonged periods may become large, causing a wide array of side effects, but there is little sound evidence to support these combination drug therapies. On the other hand, patients may depend on just one or two strong immunosuppressant drugs during periods of remission, but invariably, the next period of symptoms exacerbation will still arrive. Strong immunosuppressant drugs come with many serious potential adverse effects with chronic use. Many patients today are looking to Complementary Medicine to at least reduce the need for so many problematic drugs, as well as provide some of the standard support therapies, such as physiotherapy, targeted stretch and exercise instruction, stress reduction, nutritional advice, and help with improved body mechanics and postural corrections. Integrating a knowledgeable Licensed Acupuncturist with these various skills and therapies can greatly improve the overall success of the comprehensive treatment protocol. In addition, the effects of acupuncture stimulation, herbal and nutrient medicines, and even mind-body medicine, may provide dramatic aid to both symptom relief, and get at the underlying health problems in a holistic fashion.

In 2014, the second phase of human clinical trials of an integrative combination therapy to treat Multiple Sclerosis with glatiramer acetate (Copaxone), an immunomodulating drug that has now gone generic, composed of a combination of four basic amino acids, glutamic acid, lysine, alanine, and tyrosine, with the estrogen type 3, estriol, for which there is a proven bioidentical phytoestrogen derived from a plant, was completed at the University of California in Los Angeles (UCLA). While a 2004 Cochrane meta-review of studies of glatiramer acetate did not show proof of beneficial effects on the main outcome measures in treating MS, it did show proof that the risk of relapse was substantially effected. This human clinical trial for women with multiple relapses of MS symptoms demonstrated that this combination of treatments, Copaxone combined with Estriol, significantly reduced relapse rates in the first year of study, and demonstrated measurable benefits in cognitive function. No other human clinical trial of a combined drug therapy has demonstrated significant benefits. While the long-term efficacy of this therapy needs to be explored, what we see from this stage of clinical trials is that an integrated drug therapy that largely mimics therapy presented in herbal/nutrient Complementary Medicine, shows very positive effects in reducing relapse in the short term, and more importantly, does so with almost no risk of adverse effects. While we may not see this as a final cure for MS, we do see proof that the integration of Complementary Medicine could reap large benefits, and provide a relatively inexpensive treatment protocol. Research such as this provides the Complementary Medicine physician, especially the Licensed Acupuncturist and herbalist, to devise better holistic protocols in the future, based on scientific study, that offers an individualized and integrative complex treatment protocol to improve the lives of MS patients.

Of course there is no single amino acid, vitamin, or herb that cures MS, and lack of a miracle cure has spurred standard medicine to strongly discourage and discount Complementary and Integrative Medicine, but a high percentage of patients utilize this specialty, achieving realistic goals of therapy. When integrating Complementary Medicine, the patient should be aware of the array of treatment goals, and form realistic step-by-step assessments of benefit. Of course, immediate relief of symptoms is always a goal, but improvement in quality of life, function, mental and emotional well being, and eventually, improvement in the pathological dysfunctions that underlie the disease, are also important. Prevention of relapse is perhaps the greatest goal, and proof of efficacy of any treatment, standard or Complementary, is elusive, and hard to objectively measure. Nevertheless, research is very encouraging, and with some knowledge of this research, the patient may be reassured that realistic goals of homeostatic maintenance and prevention of neurodegeneration may be achieved. Some of these goals in treatment are more immediate, and some are, of course, achieved with long-term and comprehensive strategies. Awareness of these diverse goals helps to keep a proper focus on realistic goals of therapy, and helps establish a workable individualized treatment plan that is both persistent, but not overwhelming.

As we gain better understanding of these sclerosing pathologies of the central nervous system, we see the importance of early detection and diagnosis, and treatment at the early stages. Complementary Medicine offers much promise in preventive measures and reversal of neurodegeneration at an early stage. If the pathology has progressed, Complementary Medicine appears to show considerable promise in the area of neuroregeneration as well, and works as an excellent adjunct therapy to standard medicine in preventing progression of the disease. As patients gain a better understanding of these pathologies, it is obvious to many that integration of safe and effective treatment strategies in Complementary Medicine may make the difference in quality of life and prevention of profound disability.

Understanding the complex pathology of Multiple Sclerosis

Understanding Multiple Sclerosis helps both the patient and physician in devising a comprehensive treatment strategy to achieve individualized goals. Today, MS is also known as encephalomyelitis disseminata (disseminated sclerosis of the brain and spinal cord), and is at its root an inflammatory disorder. Almost any neurological symptom may appear with this disease, and may vary considerably from one patient to the next, and change in presentation from one period of exacerbation to another. The result of this inflammatory dysfunction is the degeneration of the fatty myelin sheaths around neural axons, the often very long projections from nerve cells, or neurons. The fatty myelin sheath is composed of a large number of fatty pods surrounding Schwann cells that are separated by nodes of Ranvier. These separations, or nodes, allow a fast conduction of electrical impulses (saltation). Saltatory conduction of the nerve signal increases the conduction velocity of electrochemical signals greatly, and loss of myelin slows the nerve conduction. In addition, the myelin sheaths inhibit charge leakage from the axon, and the gaps in the myelin sheathing allow for quick leaps of charge from one gap, or node, to the next. Loss of the myelin sheath leads to both slow conduction and loss of the electrochemical potential of the axon itself. Some axons (a portion of a single nerve cell) may extend to greater than a meter in length, while others, predominantly inhibitory, may be a short as a millimeter. The longest axons in the body are believed to be in the sciatic nerve, and extend from the base of the spine to the toe. Why the body attacks only the axons in the brain and spinal cord, and not the peripheral nerve axons, is still unknown. The damage in MS is primarily to the oligodendrocytes, or the support (glial) cells that manufacture and maintain the fatty tissue called myelin in the brain. The most important part of this disease process is the body's ability to maintain and manufacture myelin, which changes in the course of the disease, accounting for the periods of remission and exacerbation. Both accelerating regeneration of myelin and oligodendrocytes, and inhibiting the immune dysfunction, is the primary goal of therapy.

The mechanisms of injury to the nerve axons with demyelination has been poorly understood for decades. More recent research at Yale University School of Medicine by Dr. Stephen G. Waxman has shown that a cascade of events leads to the destruction of axons in the CNS white matter. ATP depletion can lead to failure of the sodium/potassium ion ATPase, which results in depolarization and dysfunction of the cell membrane function, with excess sodium ions further contributing to the loss of membrane sodium ion gradient. When demyelination occurs, the brain responds by creating more sodium channels to increase conduction. The increase in intracellular sodium, together with depolarization, triggers reverse sodium-calcium exchange, and increased calcium ions in the cell eventually leads to degeneration and cell death (neurodegeneration). While pharmaceutical research focuses on ways to alter the sodium channel subtypes to control progression of disease, the holistic approach in Complementary Medicine seeks to aid healthy metabolism by replenishing ATP, regenerating myelin, improving axonal membrane health and function, and helping to clear excess calcium ions from inside these cells, supporting the glutathione metabolism, and other detoxifying and antioxidant pathways. Some novel methods of clearing intracellular calcium, such as supplementation with magnesium and potassium are also being explored. The key mechanism of protection and detoxification in our cells is the glutathione metabolism, which may be inhibited by both glutamate toxicity and increased oxidative stress. An article on this website entitled Glutathione Regulation and the Importance of Maintaining Balance will help you to understand this important system of cellular repair and regeneration.

Not only damage to the myelinated axons, or white matter (myelin is white), but damage to the unmyelinated nerve cells, or neurons, themselves, is an important aspect of the pathology in Mutliple Sclerosis and ALS. As cited above, researchers have discovered with enhanced imaging techniques of the brain that this neurodegeneration of the grey matter, or nerve cells themselves, is highly correlated with functional disability, independent of the damage to the myelinated white matter. Treatment should focus on restoration of both the myelinated axons and the cell bodies themselves. Dysfunction of the mechanism of apoptosis, or normal programmed cell death, of these motor neurons, may play an important role in the progression of the disease. Researchers in 2013 at Norfolk and Norwich University, in England (study cited below), showed that volume loss in this grey matter, specifically in the pre/post central gyrus on the left, within the motor cortex of the cerebrum, just under the scalp at the apex of the brain extending toward the ear, was highly correlated with the degree of functional instability of the patients. Apoptosis is the process of normal programmed cell death, where all cells live out a programmed life span, and then are replaced with new cells. Only in recent years was the accepted doctrine in modern medicine that neurons did not die and regrow like the other cells in the body dispelled, as the study of neuroplasticity was achieved with enhanced neuroimaging and advanced testing of biochemical changes. An array of biochemical processes coordinate to achieve this homeostatic apoptosis in a healthy, or unhealthy, manner, including loss of cell membrane assymetry, blebbing (cell membrane bulging), cell shrinkage, nuclear DNA fragmentation, and chromatin condensation. Premature cell death is caused by factors external to the nerve cell, such as chronic low-grade infection, toxins, or trauma, while normal apoptosis is primarily caused by mechanisms within the cell.

Research has uncovered a variety of potential contributors to MS pathology. In 1989, researchers at the University of Western Ontario, in London, Canada, explored the theory that problems with iron metabolism, and iron overload toxicity, contributed to the pathological mechanisms. Prior autopsy studies had detected high iron concentrations in the brains of MS patients. This study found that mean serum ferritin (the protein that stores and releases iron) was high in MS patients, especially those in more severe stages of the disease. Red blood cell ferritin and transferrin was not high compared to control subjects. These patients were tested to see if the marker for an iron overload toxicity disease, hemochromatosis, was present. None of the MS patients had this marker of disease, HLA-A3 histocompatibility antigen (see study link below in additional information). Study at Cairo University, in Cairo, Egypt, in 2008, found that iron overload toxicity and upregulation of iron-handling proteins, such as Transferrin receptor, could contribute to the pathology of MS in conjunction with oxidative stress and a proinflammatory environment (e.g. a Th1/Th2 imbalance in autoimmune disease) (Abo-Krysha N, Rashed L; Mult Scler 2008 Jun;14(5):602-8). In 2009, an Italian vascular surgeon, Dr. Paolo Zambrini, published a study of a small number of MS patients compared to controls that also showed evidence of iron overload toxicity related to the disease. Iron overload toxicity is also associated with Parkinson's disease and other rheumatoid diseases, and is highly associated with chronic inflammatory disease, oxidative stress, viral diseases, and chronic low-grade bacterial infection.

MS is not considered a hereditary disease, but a number of genetic and epigenetic variants are believed to increase the risk of developing this disease. For instance, in identical twins the occurrence in both persons is about 35 percent, and the occurrence in siblings is lower than 5 percent. The part of the genetic code called the major histocompatibility complex (HLA), which mediates interactions between leukocytes (white blood cells) and between leukocytes and other inflammatory mediators, is linked to MS. For most patients, genetic expression has little to do with the disease, and this is good news for these patients, as correction of the inflammatory dysfunctions that have led to this autoimmune neurodegeneration may have a significant effect on the course of the disease. By addressing the specific inflammatory dysfunctions research is revealing integral to the disease, and at the same time supplying the body with the ability to better grow and maintain myelin, the patient has a great chance in extending periods of remission, and ultimately limiting the symptomatic aspects of this disease. Complementary and Integrative Medicine (CIM/TCM) supplies the nutrient chemicals for myelin regeneration and maintenance, the herbal chemicals to counter specific inflammatory dysfunctions, and the stimulation of the brain cells with acupuncture to insure optimum function. In addition, TCM supplies valuable physiotherapies to maintain muscle strength, decreases the various stressors that contribute to worsening of symptoms, and improves the quality of life.

We see that there are a variety of treatment protocols with CIM/TCM that could improve the outcomes of standard medicine in the treatment of Multiple Sclerosis, individualized and applied to the the 3 stages of the MS disease cycle. As research progresses, each year we find more and more therapies that complement the new pharmaceutical strategies, and now we just have to find the impetus to integrate them into care, preferably at an early stage of the disease.

Treatment Strategies in Complementary Medicine for Multiple Sclerosis

There is no known cure for Multiple Sclerosis, a chronic autoimmune demyelinating disease of the central nervous system with a multifactorial set of causes. This disease is so complex that we still do not have an effective treatment strategy. In 2016, experts at The University of Chicago School of Medicine reported that despite widespread prescription of at least 12 immunomodulatory drugs, the standard treatment of MS has "only modest effects on disease progression", and a new focus on enhancement of remyelination and CNS repair is now seen. A third treatment strategy proposed involves "enhancing the integrated stress response" (PMID: 26873788). These strategies have been the focus of Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) as an adjunct protocol for MS treatment for decades, with very little support from the standard medical community, despite a wealth of research confirming effects and safety. While much money is spent on advertising today to convince patients that current pharmaceuticals will effectively treat exacerbations and prevent or delay future debilitating states, this is obviously inadequate in reality. These new realms of focus on drug therapies for MS involve the innate metabolism and integrated systems of the immune, hormonal and neurological aspects of our physiology, and obviously need a restorative holistic approach to treatment, not just allopathic drugs that target one part of this complex metabolism. The integrated stress response involves mitochondrial health, amino acid deficiencies, responses to low-grade chronic viral infection, deficiency of hemoglobin and altered iron homeostasis, and stress on the membrane endoplasmic reticulum (ER), which causes a stress response called Elf2-alpha phosphorylation of protein messengers, and leads to cellular dysfunction (unfolded proteins) and cell death (apoptosis). These complex aspects of the disease show that there is a need to integrate a wide variety of treatment protocols to address this whole cycle of dysfunction.

While the array of treatments available in Complementary Medicine present many options and opportunities to the patient with Multiple Sclerosis, perhaps the most important times to pursue this course of treatment is early in the course of the disease, and during times of increased stress. The disease course has been divided into 3 phases, preclinical, relapsing phase, and progressive phase. During the preclinical phase, there are few signs of the disease, but MRI studies show that a significant number of inflammatory periods in the brain do occur. The relapsing phase usually starts with a significant period of symptoms, and repeats these episodic debilitating phases, with periods of remission between. The average length of time until difficulty with walking occurs is 8 years, with needing a cane or walker, 15 years, and with need for a wheelchair, 30 years. There is still no way to predict the highly variable course, though. Periods of relapse often occur after delivering a child, or after the stress of an illness, or following an emotionally stressful time. Decreasing stress and treating with Complementary and Integrative Medicine (CIM/TCM) during these times of increased stress may help with coping and decrease the negative health burden of stress. Treatment and preventive strategies in Complementary Medicine are different for these phases of disease, periods of symptom flare or remission, and times of increased stress. The disease course in MS is thought to begin in childhood, and probably involves the combination of susceptibility, viral, fungal or bacterial infection, and low hormone Vitamin D level. Measurement of hormone Vitamin D level and effective restoration of this metabolism is thought to be very important in the early and middle stages of the disease. Health of the gastrointestinal tract and its immune protection is also important during this early phase. The search for pre-clinical signs has revealed that optic nerve degeneration is an early sign in all cases in the animal model, and the blood-brain barrier marker aquaporin-4 is being investigated as a potential marker of pre-clinical disease. If such markers of early disease potential were utilized, preventive measures with Complementary and Integrative Medicine may be made much more effective.

Preventive measures in the early stages of Multiple Sclerosis are particularly important. In 2012, a meta-review of all scientific literature at Griffith University in Queensland, Australia found that 3 environmental concerns were particularly linked to MS, deficiency of the hormone we call Vitamin D, exposure to and chronic infection by the Epstein-Barr virus (EBV), and cigarette smoking. Vitamin D hormonal deficiency is much more complex than we have led to believe, as this hormonal system operates in a feedback manner and is highly regulated (see the article on this website entitled Vitamin D, the true story). The Epstein-Barr herpes virus is now linked to many chronic diseases, including mononucleosis, Hodgkin's lymphoma and other cancers, central nervous system lymphomas associated with HIV, and various autoimmune diseases. Studies in the United States have found that about half of all children show evidence of prior exposure by age 5 and up to 95 percent of adults have evidence of prior infection. The World Health Organization now states that there is evidence that over 90 percent of the adult population in the world harbors a latent EBV viral infection. The adaptive immune system creates protection from EBV after the maternal antibody protection, with interaction between the B-cell and T-cell complements creating a memory of EBV immunity. It is believed that EBV causes only mild symptoms in children, usually eliciting no alarm, but that about 35 percent of exposures in the teenage and early adult years results in mononucleosis. Healthy immune function of the mother, breastfeeding and immunity passed via colostrum, and healthy function of the adaptive immune responses in early life may be the key to protection.

The Epstein-Barr virus may remain latent as part of the cell gene throughout one's life, but when the latent viral DNA in B cells and vascular epithelium is reactivated, productive infection may occur. Maintaining healthy immune function is important to prevent this reactivation, and Complementary and Integrative Medicine and TCM may help maintain immune homeostasis. Chinese herbal medicine also provides some herbal chemicals proven to counter EBV. In 2002, experts at Howard University in Washington DC reviewed the scientific literature regarding herbal remedies for EBV and found that Curcumin (Turmeric), a chemical found in a number of Chinese herbs (Curcuma zedoaria, or E zhu and Curcuma longa or aromatica, Yu jin), at a significant concentration, exhibited the most potent anti-EBV activity, with passionflower extract the next most potent, but possessing only one-tenth the strength of Curcumin. At higher concentrations, a number of the herbal remedies were found to possess significant anti-EBV activity, though (see the study link below in additional information). Research in 2015, at the Kyungpook University School of Medicine, in Daegu, South Korea, also showed that another much researched chemical in Chinese herbs, Quercetin, prevents EBV infection and expression from a latent state by inducing apoptosis in snU719 cells in the CNS, and reducing EBV latency (PMID: 26059439). Such study of Chinese herbal medicine are thus being proposed for new drug treatment approaches. Quercetin is found in medicinal licorce root (Gan cao), Apocynum venetum (Luo bu ma), Loranthus parasiticus (Sang ji sheng), Euonymus alatus (Wei mao or Gui jian yu), Psidium guajava (Fan shi liu), Hypericum japonicum (Di er cao, or St. John's Wort), and Aster ageratoides (Hong tuan yao), and is now standardized and combined with other synergistic herbal chemicals, such as Resveratrol. This same medical school in South Korea found in 2014 that the immune enhancing Chinese herb Cordyceps (Dong chong xia cao) was a potent suppressor of EBV viral replication. A treatmen protocol of Cordyceps, Resveratrol plus Quercetin, and Curcumin could thus be very valuable as an adjunct treatment for MS patients, and we see that a wide array of Chinese Herbal Formulas contain these beneficial herbal chemicals.

The neurodegenerative component of MS has been the focus of much research in the last decade, and newer drugs, such as Dimethyl Fumarate (Tecfidera) are biologic derivatives of the ester of fumaric acid that target the Nrf2 pathway of antioxidant activity, long recognized in herbal medicine and dietary medicine as a treatment for psoriasis and eye disease. Extracts from the herb Fumaria officianalis in Europe have been used successfully for centuries to treat psoriasis and conjuctivitis, both topically and internally, although some toxicity is present. In China, Sarcanda globra, or Zhong jie feng, has been standardized and used to treat various cancers, and contains significant fumaric acid. Fumaric acid is thought to act as both an antioxidant and immunomodulator. This Nrf2 antioxidant pathway is activated by such herbal medicines as Silymarin marianum, or Milk Thistle, Scutellaria baicalensis (Huang qin), Paeonia lactifllora (Bai shao), and Trypterygium wilfordii (Lei gong teng), showing that Chinese Herbal formulas are helpful in decreasing MS relapse. Integration of Chinese Herbal formulas may be useful as an adjunct to decrease dosage or duration of biologic drugs when adverse health effects are a problem, or to enhance the effects of these drugs with no adverse effects. A number of treatment protocols in CIM/TCM can act holistically to enhance the overall treatment outcomes. This research and discovery of a biologic drug that helps delay relapse in MS by creating a strong fumarate stimulation of the Nrf2 pathway, which is strongest in the liver metabolism, only confirms the traditional strategy in Chinese Herbal Medicine, that makes use of herbal formulas that are anti-inflammatory and antioxidant and largely target this liver metabolism.

There is sound evidence that a combined treatment protocol in Complementary and Integrative Medicine (CIM/TCM) could be utilized during the remission phase early in the course of Multiple Sclerosis that would significantly reduce the risk of relapse, and be integrated into the overall treatment strategy. Such a course of integrative therapy would pose virtually no adverse health risks, and present very little expense. Utilization of liquid 5000 IU dosages of the hormone Vitamin D3, or cholecalciferol, with bioidentical estriol cream topically, combined in a guided manner appropriately during phases of the menstrual cycle with biodentical progesterone stimulating cream used topically, and a combination of L-glutamate, P5P (active Vitamin B6), inositol hexacotinate (active Vitamin B3), L-tyrosine, L-lysine and alanine, liquid methylcobalamin (B12), and CoQ10-H2, could provide a platform of holistic therapy that could benefit MS patients greatly, and could be combined with short courses of acupuncture, herbal medicine, and dietary changes. Simple testing with saliva and blood stick could be utilized to monitor the need for D3, estriol and progesterone. Combining such protocol in an individualized and step-by-step manner, with the help of a knowledgeable Complementary Medicine physician, such as a competent Licensed Acupuncturist and herbalist, present healthy options for the MS patient that may be integrated with standard medicine and perhaps both decrease relapses, benefit cognitive function and overall health, and reduce the need for problematic pharmaceutical therapy that often comes with alarming long-term adverse effects.

We know from scientific study that a number of strategies could prove useful in altering the degenerative course of Multiple Sclerosis. Rebuilding myelin sheaths is a primary goal in the MS treatment protocol, although excess inflammatory dysfunction may need to be tempered to make significant progress. Research has revealed that increasing cholinergic stimulation to oligodendrocytes may significantly promote remyelination. Inhibition of acetylcholinesterase, the enzyme controlling rate of breakdown of acetylcholine (ACh), a key neurotransmitter, may also be very helpful. A number of researched herbal chemicals are proven effective as reversible, or noncompetitive, acetylcholinesterase inhibitors. These include huperzine A, physostigmine, piperine, piperamine, coumarins, galanthamine, and lycorine, in order of potency. Huperzine A is widely used in China, and proven successful in a number of human clinical trials for various neurodegenerative diseases. The herbal formula Vinpurazine from Health Concerns contains Huperzine A, vinpurazine and rosemary extract, providing a valuable combination of herbal chemicals to increase acetylcholine and improve circulation. Coumarins are found in over 100 plant families, but furanocoumarins are a type that have been used medicinally to protect against tissue damage, clear toxins and fungi, and are found in Myrrhis, Xanthoxylum, Psoralea (Bu gu zhi), Artemesia (Qing hao), Angelica dahurica (Bai zhi), Ammi visnaga, Cnidium monnieri (Shi chuang zi), and the medicinal citrus peels (Chen pi / Qing pi / Zhi shi). This is an example of just part of a holistic protocol. Piperine and piperamine is found in the Chinese herb Piper nigrum (Hu jiao), a species of pepper.

Not only inhibiting breakdown of acetylcholine, but promoting production of this stimulatory neurotransmitter may be helpful to restoring oligodendryte function and myelin repair. The Chinese herb Polyogalae tenufolia (Yuan zhi) is shown to be cholinergic and used in a number of neurological diseases. Herbs that contain acetylcholine include European mistletoe (Viscum album), Nettle, Piper nigrum (Hu jiao), hawthorn (Shan zha), and kudzu (Ge gen). Supplementation with choline and inositol may also be helpful, and since the neural cells need ATP to synthesize acetylcholine, aids to ATP synthesis (Vitamins B2 riboflavin and B3 inositol hexacotinate), may also be helpful in this regard. Phosphatidlycholine is a nutritional medicine utilized to aid neural health, and the combination of phosphatidylcholine and phosphatidylserine is used to restore neural cell membrane functions. Calcium AEP is another aid to nerve conduction and neural health, used for over 30 years to improve neurotransmission, nerve impulse generation, and muscular contractions. Alpha glyceryl phosphoryl choline (Alpha GPC) is another medicinal choline used in neurological treatment, and may be helpful (CogniSpark by Health Concerns). While no single herbal or nutritional medicine will cure Multiple Sclerosis, research has, and is, revealing a wealth of helpful tools in the holistic scheme.

Researchers at the University of California San Francisco (UCSF) have identified a correlation between higher levels of glutamate toxicity and disease burden in MS, as well as ALS. Glutamate excitotoxicity was first observed in 1957 with monosodium glutamate, a food additive used to enhance desire for the food, and since then hundreds of glutamate additives have been created to increase sales of produced foods. A combination of factors was found responsible for neurodegeneration in MS at UCSF, including glutamate toxicity, mitochondrial dysfunction, reactive oxygen species burden (oxidant stress), and changes in calcium ion channels. The phytosterols stigmasterol, beta-sitosterol, and lupeol, methylselenocysteine, Gotu kola, Withania, and Siberian Ginseng all may be helpful to reverse this cascade of problems associated with glutamate excitotoxicity. A number of herbal and nutrient medicines have been researched to aid myelin repair or decrease myelin degeneration. These include Vitamins B12 methylcobalamin and B1 thiamine (benfotiamine), the amino acid histidine, and omega 3 essential fatty acids. Studies at Emory University have shown that progesterone may be a remarkable aid to myelin repair as well. Researchers Donald Stein and David Wright administered progesterone immediately after brain trauma and observed significant benefit on myelin repair. Bioidentical progesterone creams may be useful in specific cases, administered with professional guidance, to aid the process of myelin repair, in both women and men.

The wide array of adjunct therapies now proven to aid in the expanded protocol to address the complex multifactorial disease syndrome of Multiple Sclerosis can be used in simple individualized protocols. All of these herbal and nutrient medicines do not have to be taken together and constantly in chronic use to work. Such an approach is used with allopathic medicine, creating single chemicals that act on a single part of the biological cycle, and thus need to be taken continuously. In holistic medicine, the goals involve using these medicines to restore innate metabolism and help the integrated stress response work better, achieving the homeostatic balance that naturally protects an individual with the disease from relapse and severity of the disease. While there is no known cure for MS, there is obviously a wide range of responses, and obviously a large number of individuals with the causative factors, such as latent EBV infection, that do not have MS. Utilizing CIM/TCM with short courses of acupuncture and a step-by-step approach with these resaerched herbal and nutrient medicines could be the key to much better outcomes. Relying on standard pharmaceutical approaches alone, when experts around that world acknowledge the fact that these approaches are currently only producing modest benefits is just not sensible.

There is now proof that degenerated myelin neural sheaths and neurons themselves in the CNS may be regenerated

Research in recent years at the esteemed Cleveland Clinic Lerner Research Institute has found that damaged neurons themselves may be regrown. Bruce Trapp, chair of neurosciences at this institute, has stated in a Cleveland Clinic news release: “Our study suggests that demyelinated tissues produce signals that can enhance the generation of new neurons in damaged areas of the brain. Based on our findings, there is enough evidence to support the idea that new neurons can be re-grown in Multiple Sclerosis lesions." Providing stimulation and support for re-growth of neurons in the brain, as well as regrowth of myelin sheaths, could potentially restore some of the damage seen in progressive cases of Multiple Sclerosis. Much research in recent years has shown that specific acupuncture and electroacupuncture stimulation affects specific areas of the brain, and such stimulation may be very important in the acceleration of neural regrowth. Current pharmacological strategies using recombinant interferon and amino acid polypeptides to encourage this neuroregeneration result in only a 30 percent decrease in the rate of relapse. Complementary Medicine could increase this outcome considerably if integrated into the treatment protocol. The research at the Cleveland Clinic shows with long-term MRI studies that periods of inflammatory activity are more frequent than periods of symptom relapse during the 10-15 year phase of relapse and remission that follows an asymptomatic pre-clinical phase, and usually occurs between the ages of 20-40. Early intervention in clearing suspected chronic low-grade infections and supporting healthier immune function with CIM/TCM is thus important as well.

Understanding of the inflammatory processes in MS has been elusive, but as research uncovers an array of inflammatory processes, effective therapies are found to address these aspects of the disease progression. There is little hope that a specific allopathic medicine will be found to stop this elaborate cascade of inflammatory effects and immune dysfunction, but holistic medicine holds the promise of addressing many of the known dysfunctions of the immune complement system that have gone awry. We do know that T cell receptors are activated with an autoimmune myelin antigen-specific response, and that this autoreactive response is largely confined to the brain, despite myelin being a part of the peripheral nervous system. In animal models of this autoimmune encephalomyelitis, the myelin autoantigen is presented to the peripheral body, activating CD4+ T cells in the peripheral lymphoid tissues, and then these activated T cells cross the blood brain barrier in mass, whereas T cells not activated do not cross. Study has also shown that a significant percentage of MS patients have damage driven by a CD8+ cascade, though, and a one-size-fits-all approach with biologic drugs is problematic. A cascade of immune events then occurs, with certain immune mediators, or cytokines, overexpressed, as well as certain chemical messengers or chemokines. The common autoimmune cytokines and chemokines, such as TNF-alpha and nitric oxide, are overexpressed, leading to the cascade of neurodegeneration of myelin and formation of fibrous lesions. This strong inflammatory cascade is regulated by the body even in the absence of drug therapy, but a wide variety of stressors allow a recurrence of this inflammatory cascade, and progressive damage to the myelin sheaths, that the particular body does not have the ability to clear and regenerate with healthy myelin. These areas of damage grow to also destroy neurons. As the research from the Cleveland Clinic above reveals, though, the damaged areas do respond with accelerated regrowth. The area of neuroregeneration is thus very important to the overall treatment protocol.

Finding the key T cell types in the cascade of inflammatory dysfunction has been the focus of research, and some concrete information has been uncovered. In 2008, Thomas Korn of the University of Munchen, Germany, working with the Harvard Medical School Center for Neurological Diseases, reviewed current research and noted that, while evidence is still elusive, studies point to Epstein-Barr virus (EBV) as an instigating pathogen in post-mortem studies of patients with MS lesions, that multiple factors appeared to be needed to activate myelin antigen-specific T cell receptors, that activated T cell receptors appeared to create a Th1/Th2 imbalance common to autoimmune diseases, the interferon gamma (dysregulated Th1 response) appeared to be overexpressed during MS exacerbations, and that a subset of T helper cells, Th17, appeared to be the key immune cell in the disease cascade. Th17 cells produce IL-17, are particularly prone to stimulation by chronic fungal and Klebsiella infections, and are particularly adept at infiltrating tissues and cause more severe inflammatory responses. Th17 appears to promote not just IL-17, but other cytokines and chemokines that need to be further investigated. Th17 cells also appear to need a predominant Th1 imbalance, and overexpression of interferon-gamma to overexpress. Thus the array of targets in restoring homeostatic functions include Th1/Th2 balance, clearing of deep chronic low-grade infections involving Epstein-Barr virus, fungi such as Candida, and Klebsiella, and inhibition of IL-17. This theory also explains the partial success with interferon beta therapy, as a balance of interferon signaling molecules is needed.

In summary, MS should be prevented or treated early in the course of the disease, which is rarely diagnosed at present due to the lack of recognizable symptoms in the early stages. Except for periods of acute onset and remission, anti-inflammatory therapy has a limited benefit, and support for remyelination and neuroregeneration is the primary focus. There are many therapeutic options for patients, and the variance between one patient's disease and another, and between phases of the disease for a single patient, are considerable. Therapeutic options include regulation of inflammatory processes, support therapies to slow progression of disability, symptoms relief, improved quality of life, and neuroregeneration. Complementary Medicine has much to offer the patient.

An array of benefits from TCM (Traditional Chinese Medicine) are applicable to the integrative or adjunct therapeutic protocol for MS

While there is no cure for Multiple Sclerosis (MS), there are a number of ways to prevent or delay relapse, to relieve symptoms, to reverse neurodegenerative changes, and to correct the immune imbalances and autoimmune dysfunction seen in the disease. While herbal and nutrient medicine are obvious choices in therapy, and physiotherapies will help maintain physical function, acupuncture itself presents and array of benefits. Merely stating that acupuncture cannot cure Multiple Sclerosis does not negate its benefits, especially since all experts agree that there is no cure for MS. We must look to and array of specific benefits that could combine to form a holistic treatment protocol in acupuncture. Physiotherapies have been proven to benefit MS patients, and may be combined with acupuncture in the same treatment session if the physician has studied Tui na physiotherapy. A 2015 meta-review of physiotherapy in the treatment of MS, by the University of Glasgow School of Medicine and Glasgow Caledonian University, in Glasgow, Scotland, showed that 13 high quality RTCs have shown that this is an effective adjunct treatment protocol (PMID: 26281954). Recent studies have led to a few countries approving cannabinoids, especially CBD (cannabidiol) to reduce the spasticity and stretch reflex that is problematic in MS and ALS, and a combination of physiotherapy and CBD shows promise. Obvious benefits of a comprehensive holistic protocol with CIM/TCM, such as relieving stress, promoting more restful sleep, and improving overall vitality and quality of life with short courses of acupuncture combined with herbal and nutrient medicines, have been emphasized in recent years, but if we look at the actual physiological goals with the disease, we see that an array of scientific studies support acupuncture stimulation to achieve many of the goals of correcting the underlying pathophysiological dysfunctions as well, especially when combined with proven herbal and nutrient medicines.

Scientific studies now confirm that neuronal damage and dysfunction, linked to mitochondrial dysfunction, are highly associated with relapse in Multiple Sclerosis, and numerous studies now show that specific acupuncture and electroacupuncture stimulations improve mitochondrial health and the energy metabolism in mitochondria in the brain. Key herbal chemicals in Chinese herbal medicine, such as Resveratrol, are now proven to significantly benefit neuronal health and mitochondrial function by activation of sirtuin-1, a micro-RNA protein expressed as a key regulator of cellular energy, and found to be inactivated in neurodegenerative diseases. Study links below in Additional Information provide just some of this important research that is leading to the conclusion that we need a broader treatment protocol to effectively treat Multiple Sclerosis, a changing and variable multifactorial disease. In recent years, randomized controlled human clinical studies of Cannabidiol in the treatment of spasticity in MS and ALS patients have also shown proof of effectiveness, and no evidence of adverse effects. To see one such study, conducted in 2016 by experts at the University of Genoa and Sapienza University of Rome, Italy, just click here: . An array of complementary therapies can be successfully utilized to improve quality of life in MS and ALS and easily integrated with standard care, and a synergistic array of individualized treatments will provide the best overall outcomes. Holistic medicine depends on combining various complements with relatively mild effects and low dosage to achieve the best effects wtih the least risk of adverse effects, and each individual needs to determine what array of treatments is most effective for them, and most practical.

Immune dysfunction lies at the heart of these diseases, with autoimmune components and dysfunctions related to superantigen responses, as well as neurohormonal immune dysfunctions. The studied immune modulating effects of acupuncture and electroacupuncture are well documented. For instance, the main pharmacological approach to MS at present is the use of synthesized recombinant interferon-beta. Interferons are protein cytokines released by host immune cells in response to pathogens, particularly viruses and parasites, which control the complex complement immune responses, and activate immune cells to produce NK cells and macrophages, as well as increase the ability of T-cells to recognize the pathogens that need to be eliminated. One of the chief functions of interferons is to increase the ability of host cells to resist new infection by viruses. There are about 10 types of interferon known to us, divided into 3 distinct types. Interferon-beta and -alpha are in the Type 1 class, and both Interferon-alpha and -beta are approved to treat MS. In 1998, at the Showa University School of Medicine, in Tokyo, Japan, researchers showed that electroacupuncture stimulation at a single point, ST36 stimulated increased Interferon-beta and Interferon-alpha in laboratory animals (PMID: 9817445). Studies in 2014, at the State University of Medicine in Berlin (Universitatsmedizin Berlin), in Germany, also found that electroacupuncture at a single point, ST-30, augmented Interferon-gamma expression (PMID: 24732949). Viral proteins from the Epstein-Barr virus have been shown to potentially interfere with interferon signaling, possibly contributing to the disease. The combination of electroacupuncture at ST36 and ST30, with herbal medicine that is shown to counter Epstein-Barr infection, presents a novel approach to the adjunct treatment of MS with TCM therapies.

Overexpression of Interleukin-17 has been linked to MS pathology. A 2014 study at Peking University, in China, found that acupuncture at the points ST40 and P6 was able to lower the expression of IL-17 in laboratory animals (PMID: 24778705). We also know that MS is an autoimmune disorder driven by the imbalance of T-helper types 1 and 2 (Th1/Th2). Research in 2009 at the University of Prince Edward Island, and Charlottetown, Canada, found in a randomized, controlled human clinical trial that electroacupuncture restored the balance between Th1 and Th2 systems and affected key cytokine expressions (PMID: 19724980). Such scientific study points to the significant beneficial effects that short course of acupuncture and electroacupuncture have on the disease course. While the immediate effects may or may not be dramatically evident to the patient, the combination of these studied acupuncture stimulations, combined with other individualized acupuncture stimulations, herbal and nutrient medicine that achieves real goals to alter the disease course, and even physiotherapies in TCM, provides an array of benefits incorporated into a single treatment.

Amyotrophic Lateral Sclerosis, or ALS, and Primary Lateral Sclerosis, or PLS

ALS is a devastating disease, with a life expectancy of 3-5 years after symptom onset, although the survival extends to decades for some patients. There is only one medication that has shown modest efficacy to extend the survival time (Riluzole). The underlying cause is still unknown, yet a number of disease mechanisms have been clearly associated with the disease. These include mitochondrial dysfunction, protein aggregation, excess free radical production or poor clearance, glutamate excitotoxicity, inflammatory dysfunction, and poor regulated or dysregulated programmed cell death (apoptosis). Although much research has demonstrated the efficacy of Complementary and Integrative Medicine (CIM) to affect these various disease mechanisms, Complementary Medicine is still not integrated into standard treatment. A 2005 study at the University of Wisconsin at Madison School of Pharmacy found that "almost half of (ALS) patients surveyed utilized herbal supplements, and two-thirds of ALS study subjects took vitamins" (PMID: 16520295). A 2008 study by experts at the University of California Fresno School of Medicine, and the University of Alabama School of Nutritional Science, found that there is evidence supporting the use of Vitamin B12 methycobalamin high dosage (5000 IU liquid or intramuscular injection), Vitamin B6 as P5P, folic acid as 5MTHF, Vitamin E as mixed tocopherols, CoQ10-H2, zinc monomethinonine, N-acetyl cysteine, and melatonin (PMC: 2631353). This study and studies of herbal medicines may be found in Additional Information. Choosing a knowledgeable Licensed Acupuncturist and herbalist, or a Naturopathic Doctor to provide this adjunct therapy is essential, though, as self-prescribing with herbal and nutrient medicines of questionable quality in an unregulated commercial arena is likely to provide very limited benefits.

ALS was first described in 1869 by the famous neurologist Jean-Martin Charcot, and was called Charcot's Disease. Research now shows that ALS shares common biological mechanisms with other neurodegenerative diseases, such as Alzheimer's disease, Parkinsonism, and Multiple Sclerosis. The classic form of ALS affects motor neurons at 2 or more levels that supply multiple regions of the body, both upper motor and lower motor neurons, and may affect the spinal cord, brainstem, precentral gyrus, and prefrontal motor neurons. The loss of lower motor neurons leads to weakness, while the loss of upper motor neurons leads to stiffness, spasticity, and abnormal reflexes, as well as cognitive impairment and maladaptive social behavior. The presentation may vary considerably, and the diagnosis is primarily based on clinical signs and symptoms, although electrodiagnostic testing is used to contribute to accuracy. While patients with this progressive presentaton of motor dysfunction are often diagnosed with either ALS or PLS, and told that PLS only affects the upper motor neurons, this has been proven to be untrue in studies for decades, as the patient presentations vary considerably, and the measurable effects as well. A more holistic and thorough approach to treatment will provide much better outcomes for most patients. A 2007 study at the University of Western Ontario School of Medicine found that there was no clear way to distinguish ALS and PLS, and that "our findings suggest that a patient presenting with spasticity who does no develop wasting within 3 years most likely has PLS" (PMID: 17296839).

A 2015 meta-review of published studies of herbal and nutrient medicine in the treatment of ALS (amyotrophic lateral sclerosis), by experts at the University of Pavia School of Medicine, in Pavia, Italy, found that with the very limited efficacy of standard pharmaceuticals to treat this disease, and harsh adverse side effects, much more research has been conducted to test herbal and nutrient combinations, and that "overall scientific reports indicate that natural products have beneficial effects on patients with ALS, low side effects and multiple targets." There is no reason to avoid integration of these professionally prescribed herbal and nutrient medicines. To see this study summary, click here: . Short courses of acupuncture with prolonged professional individualized prescription of various herbal and nutrient medicines could significantly improve quality of life and relieve symptoms, as well as aid in restoration of the nervous system. A 2015 multicenter review of CIM/TCM as part of the protocol to treat ALS by physicians at medical schools of Duke University, the University of North Carolina, the University of California at Davis, and Harvard Medical School noted that most patients in 2015 were integrating Complementary Medicine due to the "lack of disease-modifying agents" in standard pharmacy, and that acupuncture, nutritional medicine, chelation, dietary protocols and 'energy healing' were most popularly used, and recommended that patient autonomy and shared decision making in this difficult and often severe disease was very important (PMID: 26515629).

Research in the last few years has demonstrated that electroacupuncture significantly improves mitochondrial health and function in brain cells (see study links below), and chemicals in Chinese herbs, such as Resveratrol are now well-studied as aids to mitochondrial health as well. Numerous research studies have found that a number of Chinese herbs clear excess free radicals, improve mitochondrial function, and clear excess intracellular calcium. A number of herbs show efficacy to clear glutamate excitotoxicity and aid repair of neurons. The number of scientific studies that have demonstrated efficacy of nutrient medicines to improve mitochondrial health, clear free radical reactive oxygen species (oxidants), clear protein aggregation in the brain, aid the immune system in inflammatory regulation, and prevent dysregulation of cell apoptosis is now very large. To continue to pretend that it is 50 years ago and this research has not been conducted is absurd. There is much that the physicians and patients can do to improve the health of ALS patients. Discouraging this type of therapy seems cruel. A number of articles on this website offer information on the glutathione metabolism, brain health, and neurodegenerative diseases, with links to many scientific studies. As of 2014, more than 18 drugs were tested in phase 2 or 3 RCTs for the treatment of ALS and only Riluzole was shown mildly effective to slow the disease progression. Lithium produced positive results, but the form and dosage of this mineral showed more adverse health effects than benefits. Lithium orotate in a low dose is a traditional and very safe medicine that was shown to have benefit in the overall treatment protocol for ALS, and the only side effect with higher dosage was inositol depletion. Inositol hexacotinate could be taken with the lthium orotate, and produced healthy results.

As stated previously, ALS and PLS are not associated wtih IgM monoclonal gammopathy (abnormal M protein produced by white blood cells), and the pharmaceutical drug Rituximab now prescribed to treat these diseases thus may not be effective. Immunoglobulin M (IgM) is a basic antibody produced by B cells. Another prescribed medication, the NMDA receptor antagonist riluzole (Rilutek), is now the only FDA approved drug for ALS, but has limited effects for only a subset of patients, targeting excitotoxicity in the brain at the glutamate receptors, but with considerable adverse health effects. To truly treat ALS and PLS, restoration of homeostatic balance in both the immune system and neurohormonal system, and restoration of damaged or degenerated tissues needs to be accomplished. Up to 95 percent of ALS are not associated with an inherited set of genes, but activaton of various gene alleles associated wth human endogenous retrovirus (HERV) DNA has been linked to the disease, and expression of HERV-K RNA is associated with severity of the dsease. Standard medicine has jumped to the assumption that we should then try to prescribe the various antiretroviral drugs used to treat HIV, although there is no proof that this would have any beneficial effect for ALS, but abundant proof that these drugs come with devastating adverse health effects, and in fact have to be switched regularly when treating the HIV retroviruses, as they don't work on all types of HIV, and HIV types show adaptation. This is common today in standard care, rushing to overprescribe harsh unproven drug therapies, and at the same time stating that we should avoid benign treatments in Complementary and Integrative Medicine because they are not 100 percent proven! As is shown above, there are more and more experts at University Medical Schools coming to the conclusion that this is a mistake.

Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) does offer an array of safe and gentle effective treatments that address these same targets in care of ALS and PLS, countering excitotoxicity, glutamate receptor imbalance, epigenetic regulation of HERV expression, mitochondrial dysfunction, oxidative stress, and neurohormonal balance. Unfortunately, so far, we are still using only a very limited scope of treatment with CIM/TCM for these difficult Motor Neuron Diseases. The attitude persists that since not enough study has been financed to prove that this large array of treatments is definitively proven to work in the RCT testing and safety system set up to determine whether new pharmaceuticals are safe, that we should just stick to the most simplistic and benign treatments with CIM/TCM. This perspective is not sensible, though, as the RCT system cannot adequately assess the efficacy of a holistic protocol, by nature focusing on just one biochemical action at a time, not a synergistic array, and the safety of the treatments in CIM/TCM are not in question. They are proven to be very safe, and many years, decades, and even centuries of clinical use support their safety, especially within a holistic protocol that combines low dosage of a variety of synergistic chemicals. Until we take a more realistic perspective and fully embrace a more complex holistic protocol, supported by scientific study and clinical efficacy, we may not see the results we would like from this holistic treatment protocol in difficult diseases such as MS and ALS.

Glutamate NMDA toxicity is a central mechanism linked to be both MS and ALS, leading to excitotoxicity. As stated, the phytosterols stigmasterol, beta-sitosterol, and lupeol, methylselenocysteine, Gotu kola, Withania, and Siberian Ginseng all may be helpful to reverse this cascade of problems associated with glutamate excitotoxicity. Beneficial nutrients for brain health, such as L-phenylalanine and the L-tryptophan metabolite kynurenic acid, act as antagonists to the glycine binding site to help modulate NMDA receptor excitotoxicity. The side effects of these herbs and nutrients is better overall brain health. L-arginine, an essential amino acid, produces agmatine, a direct antagonist to the glutamate NMDA receptor, and a producer of nitric oxide, also an NMDA receptor antagonist, all without side effects. Magnesium potassium supplement could also benefit as a channel blocker to inhibit glutamate toxicity. Use of the herbal acetylcholinesterase inhibitor Huperzine A, and the active chemical Bis(12)-hupyridone, has also been shown to protect against glutamate-induced neurotoxicity. Are these simple nutrient supplements miracle cures? NO. This is not the point, as a more holistic and comprehensive protocol can provide significant benefit, and so far, modern medicine has not produced this miracle cure, or even a successful treatment. Research that shows specific benefits regarding pathophysiology for Chinese herbs and formulas is difficult, but as the biological mechanisms are elucidated, research is being applied to an array of herbal chemicals that achieve various goals in therapy. The advent of the Big Data approach to research is expected to produce much more evidence-based proof. Studies have shown that acupuncture stimulation acts on the CNS via glutamate NMDA receptors as well. While our present system of RCTs is not set up to evaluate a larger holistic synergistic therapeutic protocol, such integrative therapy could be greatly benefiting patients today.

A new perspective of stress in modern medicine: Psychoneuroimmunology

It is well recognized that Multiple Sclerosis and ALS occur in relatively young men and women during times of high stress, and relapse of the disease also occurs during times of stress. The defining of stress allows the patient and physician to better determine the best therapeutic protocol to treat or prevent these diseases and relapses of symptoms. For twenty years, the subject of psychoemotional stress has been heavily researched in modern medicine, especially in the realm of psychoneuroimmunology, a holistic perspective of health that explores the relationship between psychological factors, neurophysiological mechanisms, immune responses, and the hormonal, or endocrine functions. The subject of the placebo responses, cognitive effects on treatment, stress biomarkers, and the health consequences of beliefs, knowledge and expectancies on treatment outcomes has been a realm of medical research that has been exceedingly interesting to the University researchers, but generally put down by the clinical medical doctors and pharmaceutical researchers. This are of medicine has, in recent years, become a subject of interest to clinical nursing specialists, and is finally gaining some momentum in standard medicine. The term Mind-Body approach is now becoming common in standard practice, although a few years ago this would have been ridiculed by most M.D.s. Nevertheless, despite the bias against holistic medicine in standard practice, the sound research of decades makes this subject hard to reject. Of course, this same holistic connection between the Psyche, the Nervous System, and the whole physiology of the human organism, was a central facet of Traditional Chinese Medicine, and was well documented in texts dated to at least 400 BC. The challenge for humanity today is to advance their modern understanding of stress and apply it holistically and objectively to medical treatment and improved health.

Objective Signs of Metabolic Stress and their meaning

Laboratory analysis may now give the patient and physician some interesting biomarkers of stress. The two chief biomarkers relate to adrenal and metabolic strain from physiological and/or emotional/mental stress. These two biomarkers are diurnal cortisol and alpha-amylase, which are both measurable with inexpensive salivary samples. Understanding these two key biomarkers of stress helps us understand the complete picture of what we need to accomplish to better cope with stress and resolve pathologies related to chronic stress. Glucocorticoids such as cortisol have been found to inhibit the expression of sirtuin-1, a key factor associated with relapse in Multiple Sclerosis. Cortisol is highly regulated in a diurnal pattern in the Adrenal-Hypothalamus axis.

Alpha-amylase is an enzyme that is created to yield increased glucose and maltose from the breakdown of large carbohydrates such as starch and glycogen (the chief form of carbohydrate energy storage in our bodies). Glycogen is the form of starch that is stored in animal tissues, commonly called 'animal starch' to distinguish it from plant starches in our food. We store most of our energy fuel as fats (triglycerides mainly), but our bodies do keep a significant amount of animal starch, or glycogen, in all of our cells, and this fuel is utilized mainly when a sudden increase in energy is needed in the organ cells or muscles. Such a sudden need of cellular energy is usually generated by stress, or strain above what our bodies can normally handle. The glycogen storage in our bodies that is accessible to our organs is primarily stored in the liver cells. Red blood cells and muscle cells store various amounts of glycogen to handle mechanical, or musculoskeletal, strain. Our brains store glycogen and starch that can be converted within the brain when needed, to glucose energy, by a localized process called glycogenesis. Our daily habits, and training, both physical training and mental, determine the amount of stored glycogen in our cells. When there is a daily strain from stress that we are not trained to handle, or are physically and mentally incapable of handling, there is too much alpha-amylase secreted that is not utilized, and will show up on the saliva tests.

Cortisol is a steroid hormone produced by the adrenal gland, or top of the kidneys, and is well known to be released in the body in acute response to stress, but is also useful in the body to increase blood sugar, stimulate gluconeogenesis in the brain, suppress immune inflammatory responses that are in excess, and aid in fat, protein and carbohydrate metabolism. Because of the wide array of immediate effects of cortisol, there are a number of pharmaceutical analogs used extensively in medicine. The levels of cortisol in the body are tightly regulated, with the hypothalamus-pituitary-adrenal axis controlling the levels, which normally follow a diurnal pattern, with less cortisol during sleep and more during the active portion of the day. When cortisol levels do not change quickly enough to provide a good response to stress, we generally say that the patient has a adrenal deficiency syndrome. Slow cortisol response that is chronic will create a feeling of daytime fatique and insomnia, and have quite a depressing affect on the thyroid function. To adequately assess cortisol levels, first a waking cortisol level is measured, usually with active metabolites in the saliva. If this is off, a diurnal cortisol panel is taken, with 4 samples space throughout the day and night. Other related adrenal hormones, steroid hormones, thyroid hormones, and cortisol binding globulin, are usually measured as well to produce a thorough analysis and diagnosis. The production of cortisol in the adrenal gland involves a series of precursors, cholesterol, pregnenelone, and progesterone, and deficiencies of these may decrease adrenal cortisol responses, as well as a problem with hydroxylase enzymes, or the aldosterone metabolism and feedback. Using a pharmaceutical cortisol analoque may also damage the natural cortisol response in the body, and hypothyroid conditions will, of course, affect the metabolic rate of cortisol production.

Many studied factors are well known to stimulate increased cortisol responses, including stimulants like caffeine, sleep deprivation, intense exercise, high mental stress, anxiety, anorexia, and long commuting. Oral contraceptives increase cortisol levels even in young women that excercise regularly. Patients with excess body fat may generate excess cortisol in these fatty tissues. Postmenopausal estrogen deficiency is highly linked to increased cortisol, or unhealthy changes in diurnal cortisol response. Many therapeutic measures have been studied and are shown to decrease excess cortisol levels, including acupuncture, massage therapy, stress reduction therapies, omega-3 fatty acids, magnesium, etc. The best long-term benefit, though, will come from a balancing of the endocrine system, with a holistic and comprehensive restoration of physiologically normal steroid hormone levels, thyroid and hypothalamic function, and adrenal function. A knowledgeable Licensed Acupuncturist can prescribe inexpensive lab tests and analysis, and use a complete protocol to restore this homeostasis in a step-by-step process.

IgA (immunoglobulin A) and lysozyme have also been identified as biomarkers of stress. These metabolites are measurable in simple inexpensive salivary metabolite tests as well. While these biomarkers are not as clearly associated with stress disorders, they also provide additional information that the physicians of the future can assess and help guide therapy. Not all patients with high stress will test positive, and some patients may have other reasons in their health history for the high levels seen on tests. These facts do not rule out the usefulness of such biomarkers. Instead, a complete profile should be performed with individualized assessment. In standard medicine, there is much resistance to this strategy, as standard medical doctors have been convinced that they must use tests that are universally applicable in order to utilize drug therapies that are universally applicable. The difference in basic approach is becoming very clear to the patient population in recent years, and patients who respect the logic of the individualized comprehensive assessment and holistic integrated approaches in medicine are increasingly choosing to utilize Complementary and Integrative Medicine.

Other biomarkers now utilized in the analysis of stress related pathologies include reserved B lymphcytes, the C3 subunit of the complement system, various cytokines of the complement system, and the imbalance of helper T-cell responses. Of course, each individual patient may present a different array of these various biomarkers, and the baseline values of each individual may be somewhat different. This lack of universality of stress biomarkers has led to an easy skepticism over the years, as standard biomedical research is looking for factors that can be applied universally to make a universally applied pharmaceutical realstic. The truth is that various biomarkers of disease must be analyzed on an individual basis, and the sum total of a variety of objective values in laboratory analysis must be applied to the signs and symptom patterns of the individual patient. With this approach, a clear set of treatment protocols may be individually tailored to each patient, vastly improving the potential treatment outcomes. A number of modern laboratories are now offering such an approach.

To objectively assess that imbalances associated with chronic metabolic stress, simple saliva and veinous bloodstick testing is now readily available and highly accurate. Years of research and testing have resulted in the laboratory experts refining these tests and proving accuracy. Laboratories such as ZRT (Zava Research Technology) in Portland, Oregon, now provide much information to both patients and physicians to insure trust in these laboratory assessments, the science involved, and the professional assessments that are individualized to the patient. These tools now enable the Complementary Medicine physician to utilize modern objective laboratory values and biomarkers to enhance and individualize the treatment of stress related disease and disorder. These tests also help the patient and physician understand what can be done to prevent an unwanted acceleration of the aging process, and to prevent diseases related to aging.

Acupuncture and Stress Reduction: Scientific proof

While Traditional Chinese Medicine (TCM) and its array of treatments offer the patient with Multiple Sclerosis or ALS many effective benefits, and cannot be explained in simple terms, the TCM treatment of trigger point needle stimulation, or acupuncture, does offer the patient the most basic of needs in managing the disease, stress reduction, and ample proof is provided for the effectiveness. While there is no single treatment option, isolated in human clinical trial, that cures the disease, this does not mean that the many researched treatments in TCM and Complementary Medicine do not benefit the patient and provide valuable help to achieve slowing of the progression of the disease and maintenance of the remission state, as well as relief of symptoms. As far as researched proof of benefit goes, though, the use of acupuncture stimulation itself to help reduce stress is a proven and valuable tool in the overall treatment protocol. This may be utilized alone in short courses of therapy, or combined with a more complex holistic treatment protocol, with herbal and nutrient medicine, physiotherapies (Tui na), and instruction in better dietary and maintenance regimens. An array of integrated therapies, including targeted exercise regimens and cognitive behavioral interventions, are being studied and proven to be of benefit. Integrating these therapies successfully is the task of the individual patient, with considerations of time and money, as well as medical benefits, to be considered. Short courses of acupuncture, physiotherapy, and herbal nutrient medicine provide a relatively inexpensive treatment

Information Resources / Additional Information and Links to Scientific Studies

  1. As more and more information about Multiple Sclerosis is uncovered, this still poorly understood disease that is now one of the most common causes of disability in young and middle-aged adults is finally being treated with a more varied and holistic approach. This synopsis of current knowledge and standard treatment protocols, by the renowned Cleveland Clinic, shows that the progressive pathology changes over the course of the disease, and thus requires changing approaches to therapy, with multiple approaches and an interdisciplinary approach. An array of comorbid diseases and symptoms also has to be addressed to maintain quality of life, and Complementary and Integrative Medicine is starting to play a valuable role for many with this devastating disease:
  2. A 2013 study at Norfolk and Norwich University, in the United Kingdom, found that damage to the grey matter (neurons, dendrites, and both myelinated and unmyelinated axons, and glial support cells) in Multiple Sclerosis occurs largely independent of white matter lesions (the bulk of myelinated long axons), and that grey matter degeneration occurs in specific regions of the brain, rather than globally. Such findings are transforming our knowledge of MS and leading to the call for a broader therapeutic treatment approach. Functional disability in MS is specifically associated with atrophy of the pre/post central cyrus, and regions of grey matter degeneration in relapsing-remission MS involved the bilateral thalamus, basal ganglia, and cingulate gyrus as well. Treatment that is neuroprotective and restorative to these specific areas of the brain could be invaluable, and much acupuncture research has demonstrated how specific acupuncture and electroacupuncture stimulations benefit these specific regions of the brain:
  3. A new medication approved in 2015, dimethyl fumarate, was shown to target the detox and antioxidant pathway called the Nrf2 genetic response. An explanation of this pathway, here from a 2007 research paper by experts at the University of Connecticut, in the U.S., shows that this Nrf2 response is involved in many areas of the body to protect against excess reactive oxidant stress (ROS) and works with the glutathione metabolism. Here, the experts look at the application to prevention of liver and gastrointestinal disease, but later it was discovered that this Nrf2 pathway is important in preventing the degeneration of the myelin sheaths and mitochondria in support cells of the brain:
  4. This 2008 review of studies of the pathophysiology of Multiple Sclerosis, by experts at the University of Munich, in Germany, shows that we still do not really understand the cause of MS, but that both genetic and environmental causes are evident, and that recent gene mapping has shown that many genetic alleles (half of the DNA) may be involved in the disease, besides the suspect HLA (human leukocyte antibody) of the MHC (major histocompatability complex), which is a focus of research of the genetic component of autoimmune disease. We now understand that CD4+ T cells may play an important role in the pathogenesis, activated by various antigens, and perhaps a superantigen response. The response of these activated T cells involves an imbalance of T-helper cell types (Th1 and Th2), as in all autoimmune diseases, and the Th17 cells appear to be central to this mechanism:
  5. A 2014 assessment of the causes of Multiple Sclerosis, by experts at Martin-Luther University Hall-Wittenburg, in Germany, shows that we still do not know the array of causes of MS, but that the superantigen response is a viable explanation, related to human endogenous retroviruses (HERV) that may be sensitive to either T-cell or B-cell superantigen responses:
  6. A 2015 study at Kyung Hee University, in Seoul, South Korea, found that the still experimental practice of bee-venom acupuncture was shown to reduce the CD4+ expression, and inhibit excess Th1 and Th17 responses in the laboratory animals. This practice, where diluted bee venom is prepared and administered to the acupuncture point for stimulation, was used on just the ST36 point in these experiments, an inexpensive and harmless practice. The results show that such therapy, growing in popularity in Asia, may provide significant benefits for MS patients early in the course of the disease:
  7. An overview of the practice of bee venom acupuncture, from doctors at the Seoul College of Korean Medicine, in Seoul, South Korea, shows that this practice is simple and safe, with much evidence of benefit:
  8. A 2013 study at Harbin Medical University, in Harbin, China, found that electroacupuncture could exert significant effects in restoring balance between the Th1 and Th2 responses via Beta-endorphin production at the spinal cord. This study was performed on laboratory animals with induced autoimmune encephalomyelitis, but the results could obviously affect patients with MS or ALS. The treatment was performed daily, though, for 21 days, and the common practice of infrequent acupuncture treatments could be responsible for the less than desirable results in the treatment of early stage MS seen clinically at present:
  9. A 2014 study at the Beijing University of Chinese Medicine found that acupuncture at P6 and ST40 significantly decreased the expression of the cytokine IL-17 in laboratory animals:
  10. A 2010 randomized controlled study at the Korea Institute of Oriental Medicine, in Daejeon, South Korea, showed that electroacupuncture at the point ST36 could significantly benefit immune modulation of inflammatory responses in ALS, and reverse degeneration of the motor neurons:
  11. A 2014 meta-review of scientific studies of acupuncture for the treatment of MS, by Hunter College, the City College of New York, New York University School of Medicine, and the Langone Medical Center in New York, New York, U.S.A. showed that there were only 15 small studies published to study the large amount of clinical anecdotal evidence supporting acupuncture as adjunct care in MS. These experts state that it would be a mistake to deny care based on the lack of study, and instead recommended its use and suggested that we finally conduct large human clinical studies to measure benefits:
  12. A 2015 study of the herbal chemical Arctigenin, from the Chinese herb Arctium lappa, or Niu Bang Zi (Great Burdock fruit), by the Tianjin Medical University, in Tianjin, China, showed that this herbal medicine could reduce chronic inflammation and demyelination in laboratory animals with MS, and that Th17 and and Th1 cells were inhibited in vivo, as well as Th1 cytokines linked to the disease. The array of anti-inflammatory, immunomodulating and antioxidant effects noted in laboratory study shows that this herb could be a very useful part of herbal therapy integrated into care for the MS patient, as well as other autoimmune diseases:
  13. A 2014 meta-review of scientific studies of acupuncture in the integrated treatment for Multiple Sclerosis, at the New York University School of Medicine, concluded that many studies showed success with acupuncture in the treatment of MS, but that these studies were poorly funded and not detailed enough, or lacked quality study design. The recommendation was to proceed with higher quality human clinical trials and studies to gain a more accurate proof of specific benefits:
  14. A 2015 meta-review of quality randomized controlled human clinical trials of physiotherapy in the treatment of MS, but experts at the University of Glasgow School of Medicine, in Glasgow, Scotland, found that ample proof of benefit exists for the integration of physiotherapy and acupuncture into treatment. Acupuncture and physiotherapy can be combined in the same treatment session by Licensed Acupuncturists trained in Tui na physiotherapy:
  15. A 2015 review by experts at the University of Vall d'Hebron School of Medicine in Spain of standard treatment of spasticity in advanced MS shows that there is greater understanding of the causes but still failure in treatment with physiotherapy and drugs, and thus undertreatment is the standard. More and more studies show that there is promise in the integration of acupuncture, physiotherapy and herbal and nutrient medicine to finally achieve better outcomes with MS spasticity:
  16. A 2012 meta-review of studies of Chinese Herbal Medicine to treat Multiple Sclerosis, by the Beijing University of Chinese Medicine, in Beijing, China, found that 16 quality randomized controlled clinical trials with 913 patients included were found published. The evidence supports Chinese Herbal Medicine to improve neurological signs and immune indexes, and to reduce recurrence in remission-recurrence types of the disease, and the reported adverse events were even less than in the control groups:
  17. A 2015 meta-review of published studies of herbal and nutrient medicine in the treatment of ALS (amyotrophic lateral sclerosis), by experts at the University of Pavia School of Medicine, in Pavia, Italy, found that with the very limited efficacy of standard pharmaceuticals to treat this disease, much more research has been conducted to test herbal and nutrient combinations, and that "overall scientific reports indicate that natural products have beneficial effects on patients with ALS, low side effects and multiple targets." There is no reason to avoid integration of these professionally prescribed herbal and nutrient medicines:
  18. A 1989 study at the University of Western Ontario, in London, Ontario, Canada, found that even in 1989, it was well known that high iron concentrations and iron overload toxicity were associated with many cases of Multiple Sclerosis, but the mechanisms of cause or exacerbation were poorly understood. This study showed that levels of mean ferritin, transferrin saturation, and red blood cell ferritin were associated with the severity of the disease as well. No association between the immune marker HLA-A3 histocompatibility antigen (MHC) and serum ferritin was found, though. Since 1989, the study of MS has found that the disease mechanisms, even in the small percentage with genetic associations (5-10 percent only) go way beyond these HLA/MHC genetic abnormalities, though, that were used to dismiss iron overload toxicity as one of the causal or exacerbating factors in MS:
  19. A 2012 assessment of scientific studies at the University of Kansas Medical Center Department of Molecular and Integrative Physiology, in Kansas City, Kansas, U.S.A. found that iron overload toxicity, or accumulation, does occur in the brain, brain stem and spinal cord of patients with Multiple Sclerosis, often associated with areas of focal inflammation in white matter and associated with veins. Iron overload toxicity could cause inflammatory dysfunction, mitochondrial dysfunction, and could increase oxidant stress, which are all hallmarks of the disease:
  20. A 2012 randomized controlled study at Fujian University of TCM, in Fuzhou, China, found that electroacupuncture at DU20, DU14, UB23 and K3 daily for 10 days significantly increased the activity of the hippocampal mitochondrial respiratory chain enzyme complex and ATP concentration, and improved mitochondrial function. Many such studies now show in laboratory animals that specific acupuncture stimulations improve CNS mitochondrial function, demonstrating how such therapy could be useful in a number of difficult diseases, including MS, ALS and Alheimer's disease:
  21. A 2013 assessment of glutamate excitotoxicity in the brain as one of the causes of Multiple Sclerosis was provided by experts at the University of Nis, in Nis, Serbia. Here, we see that the glutamate metabolism in the CNS, one of the most important excitatory neurotransmitter systems, linked to GABA and inclusive of NMDA, the focus of the only drug that presently controls ALS and affects the course of MS, involves glutamate receptor alterations, glutamate transporter alterations, and metabolizing enzymes. We also know that many food chemicals created to increase desire or addiction to processed foods involve glutamates, and glutamate toxicity is a poorly addressed environmental problem. Restoration of glutamate metabolism with integration of Complementary Medicine is a viable protocol that could improve outcomes in MS, ALS and related MNDs:
  22. A U.S. FDA description of the only approved drug to treat ALS, riluxole, or Rilutek, shows that this drug targets hypotheses regarding the unknown etiology and pathogenesis of the disease, namely motor neurons injured by environmental factors and glutamate toxicity, with reactive oxygen stress (ROS) related to SOD (superoxide dismutase). We also see the potential for serious adverse health effects with chronic use, potentially lessened by integrating Complementary Medicine:
  23. A 2003 review of all published studies of Riluzole, or Rilutek, for ALS by the California Pacific Medical Center in San Francisco, California, U.S.A. found that this, the only approved standard drug for ALS, maybe extends survival time for ALS patients by just 2 months on average, and very small benefits in function, with no aid to muscle strength. Clearly, more is needed: 2014 rev
  24. 2014 review of treatment options for ALS but the Columbia University Medical Center, in New York, U.S.A. showed that more than 18 drugs have gone to phase 2 or 3 randomized controlled human clinical trials and all but Riluzole failed, except for lithium, although the form and dosage of lithium that was adopted in standard medicine long ago was problematic as well. The traditional form of the mineral lithium, low dose lithium orotate, could be a safe and effective adjunct in the holistic protocol:
  25. A 2004 explanation of the pathophysiology of glutamate NMDA toxicity, by experts at the University of California San Diego, The Salk Institute, The Scripps Institute, and The Burnham Institute, provide helpful details that both explain how NMDA receptor antagonists in pharmacology, but also integrated holistic therapies, such as aids to mitochondrial health, antioxidants, and other researched treatments could create greater overall benefits to protect patients with Motor Neuron Diseases related to glutamate toxicity:
  26. A 2015 study of the use of Cannabidiol to treat spasticity in MS and ALS, at the Vita-Salute University San Raffaele School of Medicine, in Milan, Italy, found that the Cannabidiol medicine Sativex is proven to reduce spasticity:
  27. A 2010 randomized controlled human clinical trial of Cannabidiol in the treatment of MS, by the Royal Berkshire and Battle Hospitals of the National Health Service (NHS) Trust in the United Kingdom, confirmed that Cannabidiol, here in the form of Sativex, a standardized blend of THC and Cannabidiol, significantly reduced spasticity in advanced MS patients. There is absolutely no evidence that such adjunct care could harm the patient and thus no reason to integrate this into the holistic treatment protocol:
  28. A 2015 randomized controlled study at Huashan Hospital, in China, found that electroacupuncture stimulation to 2 points, DU20 and DU14, upregulated the expression of GLT-1, or glutamate transporter protein, and inhibited the excessive release of glutamate in study animals with induced CNS damage from ischemia:
  29. A 2015 study at China Pharmaceutical University in Nanjing, China, found that curcumin, an active chemical in a number of Chinese herbs, and now standardized and enhanced in extract supplements, significantly attenuates glutamate toxicity in the brain via anti-inflammatory pathways, protecting mitochondrial function, neurons and glial cells:
  30. A 2015 study at the Mashad University of Medical Sciences, in Iran, found that the herb St. Johns' Wort, or Hypericum perforatum, beneficially increases T reg cells and improves myelination, reduces lymphocyte infiltration, and reduces severity of Multiple Sclerosis, or autommune encephalomyelitis. This simple herbal extract could be part of an effective adjunct treatment:
  31. A 2014 study at China Pharmaceutical University in Nanjing, China, found that quercetin and luteolin, found in various Chinese herbs, and EGCG (epigallocatechin gallate), a green tea extract, also exert significant anti-inflammatory and neuroprotective effects, much like curcumin. Quercetin is a flavone found in Sang ji shen, Luo bu ma, Yu xing cao, Zi wan, Man shan hong (Rhododendron dahurica) and other herbs, and luteolin is found in Jin yin hua, Jin gu cao, Lu cao, He zi (Terminalia chebula), Salvia tomentosa, and in small amounts in foods with yellow pigment, such as bell peppers, celery, broccoli, thyme, rosemary, oregano and olive oil:
  32. A 2014 study at the Shanghai University of Traditional Chinese Medicine, in Shanghai, China, found that due to the limited success of current pharmaceutical therapy, that many studies have recently investigated the use of Complementary and Integrative Medicine to treat this motor neuron disease, with evidence supporting herbal medicine. Therapeutic effects to decrease oxidant stress, excitotoxicity, neuroinflammation, and calcium channel toxicity have been noted:
  33. A 2015 study at the University of Maryland School of Medicine, in Baltimore, Maryland, U.S.A. found that a standardized extract from the Chinese herb Trypterygium wilfordii (Lei gong teng), and the Chinese herb Celastrus aescultis, long used and much studied to treat autoimmune disorders, called Celastrol, inhibited Th17 expression and modulated T-regulatory cell responses in a manner that suppressed autoimmune Rheumatoid Arthritis and relieved inflamed joints. The application for Lei gong teng to treat MS and many autoimmune disorders is obvious:
  34. A 2015 study at China Medical University, in Shenyang, China, found that the active chemical in the Chinese herb Trypterygium wilfordii, or Lei gong teng, could also enhance the Nrf2 pathway and glutathione metabolism to protect cells and tissues in the brain, as well as modulating inflammatory responses. Here the study was applied to stroke patients and recovery, but this also could be applied to MS and uses the same strategies as newer biologics approved to treat MS, such as dimethyl fumarate:
  35. A 2011 assessment of the diagnosis, understanding and treatment of ALS (amyotrophic lateral sclerosis) was presented by an expert from the Federation of Maladies of the Nervous System, and the Petie-Salpetriere Hospital, in Paris, France, showing that we still know very little about this disease of how to treat it. We do know that the cause is multifactorial, that only one medication has shown efficacy in 2011, Riluzole, an NMDA receptor antagonist that is similar to Ketamine and Memantine, and that diagnosis is based on history and exam, or signs and symptoms, and is distinguished from other diseases by interpretation of the EMG (electromyogram), a nonspecific nerve conduction test. The known aspects of the disease include mitochondrial dysfunction, protein aggregation, oxidant stress, excitotoxicity, inflammation, and dysfunction of cellular apoptosis (programmed cell death or lifespan). These aspects of the disease can be treated effectively with Complementary and Integrative Medicine, expanding the treatment protocol and management of the disease. Since the prognosis in ALS is very poor, but extremely varied, with most patients dying within 5 years, but 5 percent of patients living for decades, and the quality of life dependent on multidisciplinary care, integration of intelligent protocols in Complementary Medicine seems very sensible, yet is still discouraged in standard medicine:
  36. A 2013 follow-up to the above assessment of ALS, by Dr. Paul Gordon M.D., the Associate Director of the ALS Research Center at Columbia University, in New York, New York, U.S.A., since 2003, with a fellowship from The Cleveland Clinic Foundation, and currently a researcher at the Petie-Saltpetriere Hospital in Paris, shows that we found only 5-10 percent of patients with multifocal genetic inheritance, and environmental factors associated include aging, tobacco use, and athleticism, giving us very little to work with. We now know that the disease affects both the motor neurons and the surrounding glial cells in the brain, though, further clarifying the potential for integration of support therapies in Complementary Medicine. In 2013, we still have only Riluzole as proven to have some effect to slow the progression of the disease, with all other clinical trials of new drugs failing. Research is focused on more robust neuroprotective agents, as well as non-pharmaceutical therapies to improve quality of life and relieve symptoms. Obviously, there is much that can be gained from Complementary and Integrative Medicine in the overall treatment protocol:
  37. A 2009 assessment of diagnostic clarification in Motor Neuron Diseases (MNDs), by Dr. Paul Gordon and colleagues at Columbia University, in New York, New York, U.S.A. shows that early signs in this problematic diagnostic differential include focal motor weakness, bulbar onset (e.g. dysphagia, or trouble swallowing, dysarthria, or joint pain in the face and mouth, and tongue fasciculations), and later weight loss, reduced force vital capacity, and limb weakness that could distinguish a purely Upper Motor Neuron disease from an eventual Lower Motor Neuron Disease, which would show these signs:
  38. A 2007 review of diagnostic differentiation of ALS and PLS by experts at the London Health Sciences Centre, UK, and the University of Western Ontario, in Canada, showed from an assessment of 700 patients that there were no definitive objective diagnostic tests to distinguish these 2 types of Motor Neuron Disease, and that we can only assume that patients who do not develop wasting of the muscles within 3 years of onset likely have a diagnosis of PLS. This is important for patients seeking a more comprehensive treatment strategy, as standard medicine tries to simplify the focus of treatment by stating that PLS is a disease the only affects the upper motor neurons (spinal cord, brainstem and brain):
  39. A 2001 assessment of integration of Complementary Medicine into the treatment protocol for ALS, by experts at Ludwig Maximillians University, in Munich, Germany, found that at that time, surveys in Europe showed that 54 percent integrated CIM into care, using acupuncture, homeopathy, naturopathy, and other treatments, with almost all of this care initiated by the patients and with costs of care coming out of pocket, not reimbursed by insurance or government healthcare spending:
  40. A 2008 study at the University of California Fresno School of Medicine, and the University of Alabama Department of Nutritional Sciences, explains the then current scientific evidence and rationale for the use of Vitamins B12, B6, E, CoQ10, zinc monomethionine, Acetyl L-carnitine, melatonin and active folate in the treatment of ALS:
  41. A 2013 study at The Hong Kong Polytechnic University, in China, showed that the standardized Chinese herbal medicine Huperzine A can effectively protect CNS neurons against glutamate toxicity and decrease neuronal excitotoxicity, providing potential benefits similar to, or enhancing, current drug therapy for ALS:
  42. A multicenter study in China, centered at the Shanghai University of Traditional Chinese Medicine and Fudan University, in Shanghai, China, found that integration of TCM and Naturopathic medicine was now widely practice to treat ALS in China in a survey of 12 hospitals in Shanghai, with 99 percent of patients now supporting this Complementary and Integrative Medicine (CIM/TCM) in their treatment of ALS:
  43. A 2012 study of the integration of electroacupuncture in the treatment of Relapsing-Remitting Multiple Sclerosis, at the University of Campinas, Brazil, showed that this treatment could improve the quality of life significantly, and reduce pain and depression. The use of CIM in Brazil is now shown to improve quality of care and reduce healthcare costs:
  44. A 2011 description of Multifocal Motor Neuropathy, from the University Medical Center Utrecht, in Utrecth, the Netherlands, shows that differentiation between MNN and ALS is difficult, and that current treatment strategies with immune modulating drugs is problematic and does not slow the progression of the disease, and that efficacy with Rituximab is still not established at this time. Clearly, the need for Complementary and Integrative Medicine to help with disease treatment, quality of life, comorbid conditions, and even hope of reversing progression of the disease is evident:
  45. A 2002 study of the long-term effects of intravenous immunoglobulin therapy (IVIg) for Multifocal Motor Neuropathy (MNN), by experts at the University Medical Center Utrecht, in Utrecht, The Netherlands, showed that this therapy did resolve motor nerve conduction block in some nerves, yet not in others, and remyelination occurred in some nerves, but not in others, which worsened. The treatment showed some improvement in muscle strength in the short term, but long-term effects did not prevent progression of the disease, and that axon loss cannot be prevented with this therapy alone. Much study has shown the potential for Complementary and Integrative Medicine to stimulate nerve growth and supply nutrients for peripheral nerve regeneration:
  46. A current guideline for treatment of neuropathy and neuropathic pain, by Kaiser Permanente, in the U.S.A. shows that this large hospital group recommends acupuncture for the treatment of neuropathic pain:
  47. A current set of guidelines for the treatment of motor neuron diseases such as MS, ALS and MNN, at the Royal Free and Unversity College Medical School, in London, United Kingdom, shows that Complementary and Integrative Medicine are now part of the overall treatment protocol for these difficult diseases, and that many patients are now utilizing acupuncture, physiotherapies, antioxidants, nutrient therapies such as creatine, and other CIM therapies:
  48. A 2014 rondomized controlled study in China found that deep electroacupuncture stimulation at the point GB30, near the sciatic path in the piriformis muscle, significantly improved axonal growth and upregulated Nerve Growth Factor (NGF) and downregulated the Fos proteins associated with inflammatory damage to the nerve, in laboratory animals with induced nerve damage:
  49. A 2010 study at the Korea Institute of Orental Medicine, in Daejeon, South Korea, showed that electroacupuncture stimulation at the point ST36 in laboratory animals with ALS significantly improved motor function and decreased pro-inflammatory TNF-alpha in the cells of the brain and spinal cord, and improved antioxidant status:
  50. A second randomized controlled study at the Korea Institute of Oriental Medicine, in Daejeon, South Korea, showed that addition of bee venom to the acupuncture stimulation at ST36 produced more intense anti-inflammatory effects in the brainstem and brain. These studies of laboratory animals were useful to measure cellular and mitochondrial effects, and were very specific in assessing benefts. Bee venom is a safe and harmless tincture that should become more available soon, and is easy to use in acupuncture therapy:
  51. A 2014 study at the Federal University of Santa Maria, in Sao Paolo, Brazil, showed that standardized anthocyanins and anthoprocyanidins, a group of pigmented flavonoid antioxidants in foods and herbs, is proven to reverse some of the neurodegenerative damage seen in demyelinating diseases - the most widely used medicinal is pycnogenol, extracts from the pine and spruce trees, but anthocyanins are found in most berries and highly pigmented foods as well in small amounts, and standardized supplements such as bilberry:
  52. Glutathione capacity, our main cellular detox mechanism, is very important for brain health, and is proven to be helpful if not essential for neurodegenerative CNS disorders such as Multiple Sclerosis. Here, the research is supported by experts at Vrjie University Medical Center in The Netherlands:
  53. A 2014 study of Resveratrol as a novel adjunct treatment for MS, at McGill University and the Montreal Neurological Institute, found that in MS patients, that B-cell depletion was associated with reduction of relapses in relapse-remission types of Multiple Sclerosis, but that this was due to an aberrant mechanism in these complement immune responses, where B cells overexpress the inflammatory cytokines TNF-alpha and lymphotoxin, leading to increased expression of miR-132, a micro-RNA protein that suppresses sirtuin-1, an epigenetic protein that aids insulin metabolism and mitochondrial health in the brain. In studies of laboratory animals, inhibition of sirtuin-1 resulted in the exaggerated expression of TNF-alpha and lymphotoxin, and Resveratrol, a well-studied active chemical derived from the Chinese herb Polygonum cuspidatum (Hu zhang), and found in grape and berry skins, normalized and activated the sirtuin-1. This disease mechanism may be associated with superantigen responses, and B-cell activation of T-cells:
  54. A 2010 study of Resveratrol as an adjunct treatment in a holistic protocol to treat Multiple Sclerosis, at the University of Pennsylvania, in Philadelphia, Pennsylvania, U.S.A. found that Resveratrol attenuates neuronal damage and dysfunction by sirtuin-1 activation, and that current MS therapies have limited the ability to prevent neuronal damage. The integration of Resveratol and acupuncture could be invaluable to the holistic protocol needed to treat MS effectively. Here, a pharmaceutical analog to the herbal chemical Resveratrol is studied, showing that these chemicals hold much promise in future treatment, and are a part of heavy research in Biologics:
  55. A 2013 review of scientific study of the hormone Vitamin D deficiency and its relationship to both early immune imbalances causing Multiple Sclerosis in children, and the potential link to adult relapse rate, is presented by experts at the esteemed Pierre and Marie Curie University Medical School, in Paris, France. It is pointed out that the process of finding specifically whether adult supplementation with Vitamin D will provide significant benefits will take years, but that it is advisable that all adult MS patients with a hormone Vitamin D deficiency supplement in the meantime:
  56. A 2015 study at the University Hospital of Lausanne, in Switzerland, found that the most robust data identifying environmental causes of Multiple Sclerosis at present were childhood hormone Vitamin D deficiency and Epstein-Barr viral infection late in childhood. The associations between these factors and the gut-brain axis, or relationship between the symbiotic gut Biome and inflammatory dysfunction affecting the brain, studied now in Neurohormonal Immunology, are becoming increasingly important in the understanding of MS pathology. These experts note that adult supplementation with the hormone Vitamin D may not have an appreciable effect, though, and that the focus should be on correcting the causes of childhood biotic depletion and Vitamin D deficiency as a preventive measure. These experts also note, though, that the importance of "add-on" treatment measures, or a more holistic integration of Complementary Medicine, is becoming apparent in standard medicine with the treatment of MS and related disorders:
  57. A 2015 multicenter study of the relationship of the gut biota and the hormone Vitamin D deficiency noted in early childhood onset of the slowly progressing Multiple Sclerosis pathology, by experts at the Baylor Institute for Immunological Research, the University of Maryland School of Medicine, and UCSF in San Francisco, California, as well as the esteemed Johns Hopkins University School of Medicine, in Baltimore, Maryland, U.S.A. found that there are distinct differences in the gut Biome between MS patients and healthy control subjects, and that Vitamin D supplementation improved some of these biotic problems, suggesting that this was one mechanism by which Vitamin D supplement benefited MS patients, and explained the findings of early childhood onset of MS associated with deficient hormone Vitamin D. Further study is needed to determine if overuse of childhood antibiotics and other causes of alteration and destruction of the symbiotic gut biome in children is perhaps associated with later onset of the MS: