1 Western medical aetiology and pathology

The real cause of MS is unknown. However, in recent years scientists have begun to posit that a viral infection may be the underlying cause. The hypotheses are:

1. The autoimmune mechanism of MS is activated through molecular mimicry. This idea has been supported by studies that have found homologous proteins in antigenic regions of Epstein–Barr virus (EBV) and myelin basic protein.

2. Infection by a virus during adolescence could establish a latent infection in the CNS. Scientists propose that reactivation of this latent virus could lead to ‘cytopathic and/or immunological damage to oligodendrocytes’.

3. Viral infection may cause exacerbations of MS that already exists, leading to the further development of lesions. This influence on exacerbation rate may be through the activation of immune host response, leading to upregulation of the immune system or alteration of the permeability of the blood–brain barrier.

Regardless of the cause, the immune system plays an important role in the destruction of myelin, which results in MS. During the disease process, leukocytes are drawn to regions of the white matter of the brain where they initiate inflammatory response reactions. During the inflammation, the myelin gets stripped from the axons in a process called demyelination. Additionally, the inflammation can also damage the underlying axonal membrane. This membrane is a sophisticated structure that enables the action potential, or nerve transmission, to travel along the nerve. The inflammation also kills the glial cells, particularly the myelin-producing oligodendrocytes, which are lost in great numbers. Almost no oligodendrocytes persist in the middle of chronic MS lesions.

During the secondary phase of this progressive disease, inflammation decreases but the axons still continue to die. The lost myelin can be replaced with scar tissue (sclerosis), which can block the formation of new myelin. Once axons have become scarred they do not fully regain their former function. All of these processes of inflammation – demyelination, oligodendrocyte death, membrane damage and axonal death – produce the symptoms of MS. Therefore, the result of MS is primarily axonal loss and neurodegeneration. The disease process begins with brain and spinal cord atrophy, and advances relentlessly throughout the course of the disease.

2 Diagnosis by Western medicine

The brain and spinal cord are damaged in the earlier stage of the development of MS, even before symptoms occur. The diagnosis of MS is usually made from clinical symptoms and a neurological examination.

• Some patients have increased γ-globulin levels, called oligoclonal bands in their cerebrospinal fluid.

• Evoked response tests may indicate short-circuiting in the CNS.

• Magnetic resonance imaging (MRI) allows the brain to be seen without surgery. MRI is particularly sensitive to MS, and has therefore become an important aid to diagnosis.

3 Chinese medical aetiology and pathology

Some of the symptoms of MS are difficulty walking, paraesthesias such as numbness or ‘pins and needles’ on the skin, loss of vision, tremors, poor coordination, slurred speech, paralysis and a decline in cognitive function. These symptoms can be characterized in Chinese medicine as Wei Zheng , flaccidity syndrome, Ji Bi , rheumatism with muscle involvement, Bi Zheng , arthralgia syndrome, Shi Yin , aphonia, Xuan Yun , vertigo, Zhen Chan , tremors and Niao Shi Jin , urinary incontinence.

According to Chinese medicine theory, the causes of MS are invasion of external pathogens and/or the presence of internal pathogens such as Heat and Dampness that block the channels. Or the external invasions and internal pathogens damage the Yin, causing deficiency syndromes. Yin deficiency is a prerequisite that allows pathogens to remain in the body and induce more Heat syndromes. These Heat syndromes singe the Blood and cause Blood stasis, and aggravate diseases.

Invasion of external Wind, Cold and Dampness are important causes of the disease in the beginning stages when the body has insufficient vital Qi to prevent it from happening. The external pathogens invade muscles, limbs and joints, and obstruct the channels, leading to pain and numbness in the impaired area. Chinese medicine says: ‘Wind, Cold and Dampness are three pathogens that invade the body and cause Bi (pain) syndrome’. The predisposing factor is that a person has had some history of living in damp or foggy weather, or has worn wet clothes or sat on the cold, wet ground. Or women may have been invaded by pathogens particularly during menstrual flow and after childbirth. This latter additional predisposing factor may be why MS appears more frequently in women than in men.

When the body cannot eliminate external pathogens that obstruct the channels for a long period of time, Qi and Blood cannot flow through them to nourish organs and the pathogens sink deeper into the organs and destroy them, leading to chronic illness. The clinical symptoms and signs can be very complicated, manifesting as both excess and deficiency. The pathogens stagnate in the body, turning into Fire. In addition, as these patients usually have a constitutional Yin deficiency, deficient Fire causes the condition to damage Yin further. The Fire, whether excess or deficient, singes the Blood, thus causing Blood stasis. Finally, the body, joints and limbs become difficult to move and the illness results in deformities in the body.

4 General treatment principle

Eliminate pathogenic Wind, Cold and Dampness in the channels, remove Blood stasis and prevent Yin damage.

Differentiation and Treatment

1 Invasion by Wind, Cold and Dampness

2 Damp Heat

Clinical Manifestations

Flaccid legs, pain and tingling in the limbs with slightly swollen legs, and a slight hot sensation when the skin is touched. The tongue has a yellow sticky coating. The pulse is soft and rapid.

Treatment Principle

Clean the pathogenic Heat and drain Dampness.

Acupuncture

LI-11 Quchi, ST-36 Zusanli, ST-40 Fenglong and SP-9 Yinlingquan.

Supplementary Treatment

If the patient has tingling or sharp pain and it is fixed in location, add Hong Hua Carthami Flos and Tao Ren Persicae Semen, and needle BL-17 Geshu and SP-10 Xuehai; if the upper limbs are involved, add Qiang Huo Notopterygii Rhizoma seu Radix and needle LI-15 Jianyu, LI-11 Quchi, LI-4 Hegu and TB-5 Waiguan; if the lower limbs are involved, add Du Huo Angelicae pubescentis Radix and Wei Ling Xian Clematidis Radix, and needle ST-31 Biguan, GB-30 Huantiao, GB-34 Yanglingquan, ST-41 Jiexi and GB-39 Xuanzhong.

3 Deficiency of Liver and Kidney Yin

Clinical Manifestations

Weakness and flaccidity of the muscles, thirst with no desire to drink, sore and numb limbs, dizziness and blurred vision. The tongue is red with less coating. The pulse is thready and rapid.

Treatment Principle

Nourish Liver and Kidney Yin.

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Musculoskeletal Key

Fastest Musculoskeletal Insight Engine

Multiple sclerosis

1 Western medical aetiology and pathology

2 Diagnosis by Western medicine

3 Chinese medical aetiology and pathology

4 General treatment principle

Differentiation and Treatment

1 Invasion by Wind, Cold and Dampness

Clinical Manifestations

Treatment Principle

Herbal Treatment

Acupuncture

Supplementary Treatment

2 Damp Heat

Clinical Manifestations

Treatment Principle

Herbal Treatment

Acupuncture

Supplementary Treatment

3 Deficiency of Liver and Kidney Yin

Clinical Manifestations

Treatment Principle

Herbal Treatment

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