Anti-inflammatory approaches in Chinese Medicine

What alternatives are there for reducing inflammation? By looking at some of the more recent discoveries on sepsis, we may be able to find out a little more. People with sepsis or septicemia are more prone to a secondary infection. It is postulated that the immune system is already compromised, and studies do show that people with sepsis are more heavily colonized by Epstein-Barr or Herpes Simplex viruses.

Sepsis occurs when inflammation, a normal immune reaction goes out of control. Bacterial infections are most often the cause, but it is the wayward inflammation, combined with low blood pressure during sepsis, that may cause permanent brain damage.

In fact, as Iwashyna et al (2013) discovered, many continue to suffer severe brain (e.g. dementia) and body problems (e.g. problems walking) for years after sepsis, and these problems are of a magnitude that place a real burden on the caregivers.

Researchers have discovered HMGB1 to be a late mediator of lethal sepsis, but found traditional anti-inflammatories like dexamethasone, cortisone, aspirin, ibuprofen, etc to be ineffective in influencing endotoxin-induced HMGB1 release, even at superpharmacological concentrations!

That said, the same researchers found traditional Chinese herb Salvia Miltiorrhiza to contain three active ingredients (tanshinone I, tanshinone IIA, and cryptotanshinone) that dose-dependently attenuated endotoxin-induced HMGB1 release. The tanshinone IIA extract TSNIIA-SS, widely used to treat cardiovascular disorders, selectively abrogated endotoxin-induced HMGB1 cytoplasmic release in a glucocorticoid receptor-independent manner.

The use of steroids to treat inflammation has been controversial, and antibiotics, while able to stem sepsis-induced infection, are not targeting the inflammation proper. Further research is also being carried out the Feinstein Institute for Medical Research in the USA, this have discovered that the humble and simple mung bean used in traditional Chinese medicine can help with infection and sepsis. In technical terms it reduces the release of HMGB1 which in theory can increase survival rates.

Luis Ulloa et al (2014) traced a pathway that starts from a branch in the sciatic nerve and ended in the adrenals that were tasked to produce dopamine. This pathway had gone from the sciatic nerve to the spinal cord and the brain, and then back down the vagus nerve to the adrenals. The research was thorough and included taking out independent sections of the nerve pathway and even the adrenals, any of which would take away the anti-inflammatory effects of the acupuncture.

These results show potential benefits for treating not just sepsis, but also other inflammatory diseases such as rheumatoid arthritis, osteoarthritis and Crohn’s disease, and can be most useful in situations where the adrenal glands are still functioning well.

Ulloa has chosen to test the use of an acupuncture point ST36, traditionally used to fortify the immune and digestive systems, and asserted that he would continue to research on the use of other acupoints, because “all acupoints but one—360 of 361 described in humans—are located in the proximity of a major nerve.”

Further research has also been done on the frequency-dependent effects of acupuncture on the same acupuncture point ST36. In 2 papers by Kim et al in (2007 & 2008), the researchers suggested that suppressive effects of low-frequency acupuncture on ST36 are mediated by sympathetic post-ganglionic neurons, while the suppressive effects of high-frequency acupuncture are mediated by the sympatho-adrenal medullary axis.

There are alternatives to using corticosteroids to relieve inflammatory processes that harm our body. Some of the ideas presented here include the use of food/herbs that act on HMBG1, or by affecting the production of neurotransmitter dopamine, which is very much related to the expectation of an occurrence of pleasurable activity. Which then bring about the postulate that by conducting mind-body exercises through imaging and visualization, we might to some extent be able to quell inflammation and bring about healing.

References:

  1. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010 Oct 27;304(16):1787-94.
  2. Wei et al. A Cardiovascular Drug Rescues Mice from Lethal Sepsis by Selectively Attenuating a Late-Acting Proinflammatory Mediator, High Mobility Group Box 1. J Immunol. 2007 March 15; 178(6): 3856–3864.
  3. Shu Zhu, Wei Li, Jianhua Li, Arvin Jundoria, Andrew E. Sama, and Haichao Wang. It Is Not Just Folklore: The Aqueous Extract of Mung Bean Coat Is Protective against Sepsis. Evidence-Based Complementary and Alternative Medicine Volume 2012, Article ID 498467.
  4. Luis Ulloa et al. Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nature Medicine 20, 291–295 (2014).
  5. Wang H, Ward MF, Sama AE. Targeting HMGB1 in the treatment of sepsis. Expert Opin Ther Targets. 2014 Mar;18(3):257-68.
  6. Kim HW, Uh DK, Yoon SY, Roh DH, Kwon YB, Han HJ, Lee HJ, Beitz AJ, Lee JH. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull. 2008 Mar 28;75(5):698-705.
  7. Kim HW, Uh DK, Yoon SY, Roh DH, Kwon YB, Han HJ, Lee HJ, Beitz AJ, Lee JH. Low-frequency electroacupuncture suppresses zymosan-induced peripheral inflammation via activation of sympathetic post-ganglionic neurons. Brain Res. 2007 May 7;1148:69-75.