Alzheimer’s disease is currently thought to contribute to about 75% of all cases of senile dementia that occur in the U.S. The disorder is marked by reduced levels of acetylcholine, development of amyloid plaques, and degeneration of brain tissue. It produces cognitive and coordinative dysfunctions with notable loss of memory. From the modern medical viewpoint, the cause of Alzheimer’s disease is not yet established. There is a genetic component, since the frequency of the disease is higher in an identical twin or a child of a person with Alzheimer’s disease, and the disease occurs with higher frequency in persons with the genetic disorder producing Down’s Syndrome. But other factors, as yet unidentified, seem to be at least as important as genetics, based on the distribution of the disease. No infectious agent that might cause the disease has been identified, and there is no current evidence suggesting that an infection is involved.

Except for one of the rare genetic forms of the disease that causes early dementia, Alzheimer’s usually does not occur in clinically obvious form before age 60. The incidence of the disorder increases with age, such that up to 30% of those over age 80 are believed to suffer from some degree of Alzheimer’s disease. A recent study has suggested that early subtle signs-such as limited linguistic complexity-reveal the tendency to develop Alzheimer’s disease. Such indicators may be detected before age 30. This would support the idea that the disorder has a genetic basis which yields an evident mental disease under the influence of the aging processes. It is possible, though not proven, that chemical pollutants, high fat diet, and sedentary life style may lead to the severe form of the disease.

Current orthodox medical treatment involves use of hydergine, dexedrine, and a variety of antidepressant drugs, all of which can produce modest improvements, especially in early stages of the disease. There are several experimental drugs in various stages of clinical trials that may improve the outcomes. Because of the advanced age of most sufferers, it is unlikely that even the most effective treatments would be able to produce complete remission.

In Europe, one of the main therapies for Alzheimer’s disease is Ginkgo biloba leaf extract, which is a widely-used plant drug sold in pharmacies. This flavonoid-rich extract promotes blood circulation to the brain as well as to other parts of the body. Because a large investment in research dollars has been made in testing ginkgo extract, many people do not realize that the same or similar effects may be attained by using other herbs that are a source of circulation-promoting flavonoids.

Currently, there are two ways to support Alzheimer’s patients disease in China: use of complex herbal formulas based on the traditional methods of Chinese medicine, or administration of an alkaloid drug, called huperzine A, derived from the herb huperzia. This drug inhibits the breakdown of
the neurotransmitter acetylcholine, allowing more of it available for brain functions, including memory. Huperzine A has passed Phase I trials in the U.S. and it may become available as a prescription drug at the end of this decade.

It is not possible to get sufficient quantities of huperzine A by simply consuming the whole herb from which it is derived, nor its crude extract in reasonable dosage. There are, however, numerous Chinese herbal formulas that may significantly increase levels of acetylcholine.

In analyzing the Chinese medical therapies for Alzheimer’s, it is important to recognize the difficulty in distinguishing this condition from other cases of senile dementia, mainly atherosclerotic dementia. A firm diagnosis of Alzheimer’s is made by extensive procedures that might include a CT
scan, MRI, and EEG. In most cases, such procedures are not routinely done in China; therefore, the symptom pattern is used as the diagnostic criteria. Some reversible diseases produce dementia and even severe depression may produce dementia, so the treatments that are reported to be successful for dementia might not succeed in actual cases of Alzheimer’s disease.

According to the fundamental ideas of Chinese medicine, the brain is an outgrowth of and is nourished by the kidney. Therefore, brain
defects and deterioration of the brain may be prevented, limited, or halted by the ingestion of kidney tonics. Rich nourishing agents such as placenta, rehmannia, and cistanche; kidney essence astringents, such as rose fruit and schizandra; and qi and blood tonics that ultimately help nourish the essence, such as astragalus, polygonatum, and tang-kuei, are frequently recommended to benefit the brain. The cognitive functions of the brain are said to be regulated by the heart: the kidney provides the substance, the heart the regulation of
activity. Memory, cognition, and wisdom are believed to become disordered if the heart is agitated or if the influence of the orifices that connect the heart and brain are blocked by phlegm obstruction of the channels. The herbs zizyphus, biota, polygala, and acorus are considered important for treating heart disorders affecting memory and cognition. To benefit the function of the heart, qi tonic herbs are also used, as they enhance the energy or qi of the heart.
Formulas based on the combination of heart-regulating herbs coupled with kidney and qi tonic herbs are sold in China as Bu Nao Wan (Brain Tonic Pills) or Jian Nao Wan (Healthy Brain Pills).

In the book Jingyue Quanshu (Collected Works of
Zhang Jingyue
; 1637 A.D.), a chapter on dementia (chidai) describes
the problem as a combination of collapse of original qi (yuanqi) and the
presence of impure qi in the meridians and heart orifices. Tonification therapy
is the proposed solution, as the restoration of normal qi will help to dispel
the pathological qi. A formula developed by Zhang for dementia is Qi Fu
, comprised of ginseng, cooked rehmannia, tang-kuei, atractylodes,
zizyphus, baked licorice, and polygala. The latter herb helps to clear the
phlegm obstruction of the orifices.

In the book Bianzheng Lu (Manual of Medical
; 1690), Chen Shiduo proposed that the first step in
development of dementia is depression of liver qi, which is usually caused by
emotional problems. This liver qi disorder might eventually lead to exhaustion
of the stomach qi because the pathological qi from the liver is easily
transmitted to the stomach, where it disrupts normal digestive functions. The
resulting undigested food in the stomach can produce obstructive phlegm. He said
that “treating phlegm is treating dementia.” To accomplish the goal, he
suggested that one would tonify the spleen and stomach, resolve phlegm, and
clear the orifices of the heart. A formula that Chen developed is Su Xin
, comprised of ginseng, hoelen, pinellia, bupleurum, coptis, evodia,
gardenia, aconite, tang-kuei, peony, and zizyphus. Bupleurum invigorates the
flow of liver qi; coptis and gardenia purge the pathologic qi of the liver,
while evodia disperses the liver qi that is damaging the stomach functions;
pinellia and hoelen resolve phlegm. Chen devised some alternative formulas for
dementia, including ingredients such as shen-chu to enhance the stomach’s
digestive activity, arisaema to cleanse the accumulated phlegm, and acorus to
open the clogged orifices.

At the end of the 19th century, Wang Qingren, who is famous for
developing the use of blood-vitalizing therapies, proposed that dementia was
caused by an emptying of the material substance making up the marrow and brain,
and by stagnant blood clogging the orifices. A formula he developed for this
purpose is Tong Qiao Huo Xue Tang, comprised of red peony, cnidium,
persica, carthamus, onion, musk, jujube; rice wine is added to the water when
preparing the decoction. Onion and musk help to clear out the clogged orifices.
The wine helps activate the blood-vitalizing properties of the formula.

The modern (post-1950) Chinese approach to Alzheimer’s follows
closely the ideas of Wang Qingren. Degenerative changes in tissues are usually
treated by herbs that promote blood circulation-often relying on salvia in place
of persica and carthamus used in Wang’s time-plus tonics to treat the deficient
organ. The brain is nourished with kidney tonics and qi tonics, such as
rehmannia and ginseng. Many physicians still pursue the method of differential
diagnosis, and the treatments may vary rather than follow a set pattern based on
the disease description.

The treatment of Alzheimer’s should begin at its earliest signs,
since any brain cells that have been destroyed cannot be regenerated and the
fibrous and mineralized plaques that form in the brain are unlikely to be
removed as a result of the ingestion of herbs. Chinese herbs can still prove
useful in later stages, by preventing further degeneration or optimizing the
function of the intact brain cells, but attempts to more fully resolve the
disease could only meet with success in the early phases. During this earlier
period, a definitive diagnosis of Alzheimer’s is not always possible, but one
can safely administer the Chinese tonic herbs and blood circulation agents.
Despite the fact that brain disorders can be described
generally by the theoretical framework of traditional Chinese medicine, many
physicians working in China continue to rely on differentiating cases. The
particular disorder, Alzheimer’s disease, may occur either from a variety of
different causes or from a basic cause in a variety of constitutional
situations. The primary differential categories used by Chinese doctors to
describe senile dementia are:

  1. Spleen qi deficiency, with phlegm and stagnating blood obstructing the
    orifices to the brain.
  2. Liver qi stagnation, with entanglement of qi, accumulation of phlegm, and
    stagnating blood.
  3. Hot phlegm clogging the orifices.
  4. Spleen and kidney yang deficiency, with phlegm and stagnating blood
    obstructing the orifices to the brain.
  5. Deficiency of liver and kidney yin, with phlegm and stagnating blood
    obstructing the orifices and with generation of internal wind.
  6. Qi and blood stagnation, obstructing the orifices to the brain.

According to the category that seems most appropriate, one
may tonify qi, yin, and/or yang, disperse qi and blood, and resolve phlegm
accumulation. The tonic herbs to be used are the same as those commonly found in
traditional formulas to treat problems of aging: ginseng, astragalus,
atractylodes, dioscorea, rehmannia, lycium fruit, cistanche, and morinda. For
unclogging the orifices, acorus, polygala, arisaema, typhonium, and alum are
used in various combinations. Acorus and polygala are said to restore proper
communication between the kidney and heart;. Alum (an aluminum sulfate compound)
and arisaema are considered remedies for “mental phlegm.” Sedative herbs are
sometimes included in prescriptions for dementia, including zizyphus, fu-shen,
biota, dragon bone, and oyster shell.

According to traditional Chinese medicine, the depletion of
kidney-which is the dominant cause of symptoms associated with aging-can be
largely overcome by regular ingestion of either Rehmannia Six Formula (Liu
Wei Di Huang Wan
) or Rehmannia Eight Formula (Ba Wei Di Huang Wan).
Stagnation of blood can be limited by daily ingestion of salvia wine, or some
other salvia-based herbal preparation. The obstruction by phlegm can be largely
overcome by reducing fat in the diet (a health-promoting strategy that is
recommended by all physicians today) and by using herbal formulas that aid the
digestive process, such as Six Major Herbs Combination (Liu Jun Zi Tang)
or a formula that contains herbs such as crataegus and shen-chu. Saponins from
ginseng (and from several traditional anti-aging tonic formulas) have been shown
to improve memory function. Sleep disorders-which may respond to the use of herb
therapies-are commonly reported among the elderly and may contribute to
worsening mental function.

A report in the Shanghai Journal of Traditional Chinese Medicine
(1991) describes a study with 60 patients divided into a Chinese herb group and
a control group (both used Western medications as needed). Six different herb
formulas were used for the study, given according to the diagnosis of the
patients’ underlying conditions. Eighteen symptoms other than memory functions
were monitored, including headache, dizziness, tinnitus, and head fullness; poor
appetite and constipation; fatigue and leg weariness; fever and sweating; and so
on. The Chinese medical treatment group showed improvements in all of the
symptoms except tinnitus. There were also changes in the tongue (less redness)
and tongue fur (less greasiness). When the symptom changes related to mental
condition were compiled, 7 of 30 in the Chinese medical group showed marked
improvement and 16 more showed some improvement. Thus, about 77% showed some
degree of improvement, but there was no notable difference between these results
for mental capabilities and those of the Western medical control group. The
patients in this study were treated with herbs in capsules or tablets, in order
to obtain good compliance, not higher-dosage decoctions as would have been
preferred by the physicians. The dosage used began low and was increased
gradually. Treatment time was six months, and the treatment then needed to be
continued to maintain the benefits.

Based on a review of the literature on Alzheimer’s disease and
senile dementia, a general formula would be acorus, polygala, platycodon,
ginseng, atractylodes, licorice, astragalus, citrus, pinellia, crataegus,
shen-chu, curcuma, gastrodia, salvia, cnidium, red peony, zizyphus, rehmannia,
lycium fruit, tang-kuei, cistanche, morinda, aconite, dioscorea, and hoelen (or
fu-shen). Certain herbs could be deleted or added to focus the formulation on specific symptoms.

Doctor Qiqing Li will choose Rehmannia Six Formula (Liu
Wei Di Huang Wan
) , Rehmannia Eight Formula (Ba Wei Di Huang Wan) or any other accordingly to the symptoms and conditions of the patient.



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