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1、,Fundamental Therapeutic Principles in the Treatment of AIDS Using Chinese Medicine,John F. Moore SIOM Second Year Presentation 2007,用 中 医 治 疗 艾 滋 病,http:/ introduce the etiology and pathophysiology of AIDS from a biomedical and Chinese Medical perspective using portions of the Classics and modern c
2、linical discussion, To discuss the most frequently seen clinical presentations of AIDS, To introduce clinically relevant herbal treatment methods for these presentations.,Pandemic,AIDS is a chronic, incurable, viral disease which destroys the bodys adaptive (acquired) immune system, leaving it vulne
3、rable to myriad opportunistic infections. HIV (Human Immunodeficiency Virus), the virus that causes AIDS, is transmitted via body fluids (blood, semen, vaginal fluid, pre-ejaculate, breast milk) from one infected person to another. Modes of transmission: unprotected sexual intercourse, IV needle sti
4、ck, MTCT (mother to child transmission via birth & breastfeeding).,Some Sobering AIDS Statistics,Globally, between 33.4 and 46 million people currently live with HIV. UNAIDS and the WHO estimate that AIDS has killed more than 25 million people since it was first recognized in 1981, making it one of
5、the most destructive epidemics in recorded history. More than 64% of all people living with HIV are in sub-Saharan Africa, as are more than three quarters (76%) of all women living with HIV. In North America, an estimated 1.4 million people are infected.* The U.S. had 1.2 million people living with
6、HIV last year. The U.S. therefore ranks among the top 10 countries in terms of infected people.*,*http:/ of Adult HIV Infection Worldwide, 2005 (Joint United Nations Program on HIV/AIDS),What exactly is Immunity?,Strict definition: “Nonsusceptibility to the invasive or pathogenic effects of foreign
7、microorganisms, or to the toxic effect of antigenic substances.” 1 “A condition of being able to resist a particular disease, especially through preventing development of a pathogenic microorganism, or by counteracting the effects of its products.”2 1 http:/www.online-medical-dictionary.org/omd.asp?
8、q=immunity 2 - http:/www.nlm.nih.gov/medlineplus/mplusdictionary.html,HIV/AIDS & Immunity,In order to understand the pathomechanism of HIV/AIDS, we need to understand the basics of the immune system.,Structure of the Immune System,IMMUNE SYSTEM,INNATE IMMUNITY Generic Immunity common to all animal a
9、nd plant life. Immediate defense against infection. Short-term protection.,ACQUIRED (ADAPTIVE) IMMUNITY Immunity with memory that provides long-lasting protection for the host against future pathogens.,NATURALLY,ARTIFICIALLY,MATERNAL (PASSIVE),INFECTION (ACTIVE),ANTIBODY TRANSFER (PASSIVE),IMMUNIZAT
10、ION (ACTIVE),Acquired Immunity,Cell-Mediated Immunity: the aspect of the immune system that involves the activation of macrophages, natural killer (NK) cells, specific cell-destroying T-lymphocytes, and the release of various secretions in the defense of the host against a pathogen. Immunity with “m
11、emory.” In order to function properly, the cell-mediated immune system relies upon the chemical direction of the T-Helper (CD4) cells to hunt down and destroy infectious organisms.,Immune System Agents: Interferon,Interferon: natural proteins produced by the cells of the immune system of most verteb
12、rates in response to challenges by foreign agents such as viruses, bacteria, parasites, and tumor cells. Interferon assists the immune response by inhibiting viral replication within other cells of the body. It can also stimulate the activity of lymphocytes.,Immune System Agents: T-Cells,T-Cells: Wh
13、ite blood cells known as lymphocytes that play a crucial role in cell-mediated immunity. T-Helper Cells, Natural Killer Cells, T-Memory Cells, etc. The foundation of the acquired/adaptive immune system. T-Helper (CD4) cells are responsible for governing the activity of other lymphocytes and as such
14、are a crucial part of the immune system.,Immune System Agents: Phagocytes,Phagocyte: a cell that ingests and destroys foreign matter such as microorganisms or debris via a process known as phagocytosis. They can also induce apoptosis of normal and tumor cells and produce other immune stimulating/mod
15、ulating substances. The “frontline” of the bodys defenses against immune infection.,HIV & T-Helper (CD4) Cells,HIV, the virus that causes AIDS, replicates itself by invading a host T-Helper Cell, exploiting its genetic material, reproducing viral replicates of itself, and killing the host cell in th
16、e process. Without adequate numbers of T-Helper Cells, the bodys cell-mediated immune system fails and opportunistic infections proliferate. As the virus continues to reproduce, more T-Cells are destroyed, ultimately leading to their complete annihilation and the functional destruction of the entire
17、 immune system.,http:/www.wellesley.edu/Chemistry/Chem101/hiv/tcells-hiv.jpg,HIV Transmission Mechanism,T-Helper (CD4) Cell,HIV Particle,HIV Viral Load vs. CD4+T Lymphocyte Count Over the Untreated Course of Disease,http:/en.wikipedia.org/wiki/Image:Hiv-timecourse.png,_ CD4+ T Lymphocyte count (cell
18、s/mm) _HIV RNA copies per mL of plasma,The Stages of AIDS,In 1990, the World Health Organization (WHO) grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1. Most of these conditions are opportunistic infections that are easily treatable in
19、 healthy people. Stage I: HIV disease is asymptomatic and not categorized as AIDS Stage II: includes recurrent upper respiratory tract infections Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis Stage IV: includes toxopl
20、asmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposis sarcoma; these diseases are indicators of AIDS.,AIDS cannot be cured, only managed via a complex cocktail of pharmaceutical drugs which inhibits the activity of HIV, preventing it from penetrating the T-Helper
21、host cell and replicating. This therapy is called Highly Active Anti-Retroviral Therapy, or HAART. To date, this is most widely-used therapy in treating AIDS. New drugs are constantly under development by pharmaceutical companies.,Prescription Drug Therapy “The Cocktail”,What is HAART?,The drug cock
22、tail in HAART includes Protease Inhibitors, Reverse Transcriptase Inhibitors (NRTIs such as AZT), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), and Entry & Fusion Inhibitors. In concert these drugs are effective at stabilizing T-Cell counts (CD4 count) and reducing the replication of HIV
23、 (viral load). However, they are very expensive and can have many side effects. They must be taken together in order to work.,Prescription Drug Therapy,Side-effects of HAART include fatigue, gastrointestinal distress, CNS disorders, peripheral polyneuropathy, renal problems, hepatotoxicity, changes
24、in blood count, allergies, lactic acidosis, pancreatitis, avascular necrosis, osteopenia, osteoporosis, etc.,http:/ Drug Therapy,HAART is also expensive. A months supply of the drugs which comprise HAART can cost between $1,000-$1,400 USD. One year of drug therapy alone (not counting doctors calls o
25、r office visits) can cost up to $16,800.,用 中医治疗艾滋病,HIV/AIDS & Chinese Medicine,用 中 医 治 疗艾 滋 病,“People with strong zheng qi do not succumb to epidemic infections.” (Huang Di Nei Jing),Defining AIDS in TCM,AIDS, (Acquired Immune Deficiency Syndrome), is referred to phonetically as 艾 滋 病 (ai zi bing) i
26、n Chinese.1 AIDS can be defined in several different ways according to TCM pattern identification. Because AIDS is a “new” disease, having only been identified in 1981, there is no specific research on the disease from the past or in the Classics. TCM does possess a large body of information about i
27、nfectious diseases and epidemics, and ways to describe the symptoms of those suffering from AIDS.,http:/web.mit.edu/tidor/www/research/aids_virus_dh.jpg,Terminology,AIDS can be compared to other conditions which have been copiously researched and documented in the Chinese Medical Tradition. Chinese
28、Medicine uses the term “infectious epidemic diseases,” 疫 病 (yi bing) to describe epidemic diseases such as AIDS, which are caused by invading evils (viruses). The Chinese term for “virus” is bing du 病 毒, literally “toxic/poison disease.” AIDS can also be thought of as a “pestilence,” or “plague.” Th
29、e Chinese term for this is 温疫 (wen yi). Such a disease was thought to have a long latency, sudden onset, and severe symptoms.,Wen Bing 温病 Differentiation,According to Chinese Medicine, AIDS is caused by external viral evils invading inward and taking advantage of some pre-existing deficiency. The ev
30、il hides in the xue luo 血络(blood connecting vessels) and the ying fen 营分(nutritive level) like other wen re bing 温热病(warm heat diseases). This disease can also be referred to as a fu qi wen bing 伏气温病 (hidden qi warm disease). This disease is accompanied by symptoms of xu lao 虚劳(deficiency taxation).
31、,http:/www.cbc.ca/news/sars/gfx/epidemic1.jpg,Symptoms of fu qi wen bing 伏气温病,Weakness of yuan qi Damage to jing; qi insufficiency Progressive emaciation Fatigue Night sweats Poor appetite Diarrhea,http:/kanji.sapp.org/img/05/0595.gif,Classic Text: Jin Gui Yao Lue 金柜药锊方论 Han Dynasty c. 206-220 BC,Ji
32、n Gui Yao Lue (“Essentials from the Golden Cabinet”) chapter: “The Theory of Vacuity Taxation” (xu lao 虚劳): “Empty pulse, face color pale, face color white, palpitations, emaciation, inability to walk due to sore and thin skin, blurred vision, withered hair, subaxillary lymphadenopthy, night sweats,
33、 loose stools, diarrhea, cramping or distension in the lower abdomen or even diarrhea with undigested food in the stools, nocturnal emissions” (etc).,http:/library.thinkquest.org/03oct/02088/images/zhangzhong.jpg,Zhang Zhong-jing 150-219 A.D.,Classic Text: 温 疫 论 Wen Yi Lun (“Treatise on Warm Epidemi
34、c Diseases”) by Wu Yao-ke, Ming Dynasty c. 1642 AD,“Warm epidemics are not caused by wind, cold, summerheat, or dampness but by a strange sort of qi affecting the space between heaven and earth.” emphasis added-referring to a pestilential qi and not a climactic or other external causative factor, et
35、c.,http:/ Text: 温 疫 论 Wen Yi Lun (“Treatise on Warm Epidemic Diseases”) by Wu Yao-ke, Ming Dynasty c. 1642 AD,Wu You-ke considered epidemic qi in the body as a pestilential toxin he called li qi 疬气. (Infectious) Pathogen can be transmitted from one person to another, unlike wind, cold, or dampness.
36、(Communicable) Does not manifest symptoms soon after the exposure to the pathogen. (Latent) Epidemic qi invades, resides, and lurks in the membrane source mo yuan 膜原. (Chronic),One Concept of Immunity in Chinese Medicine,http:/ Zheng Yu Qu Xie” 扶 正 与 去 邪 Support the righteous and eliminate the evil
37、(pathogen) Fu zheng: support the righteous qi, strengthen the bodys resistance, and improve immune function Qu Xie: eliminate, inhibit, and expel the disease causing factors (bing yin 病因), such as the AIDS virus,Root Treatment of AIDS,Fu Zheng Pei Ben 扶 正 培 本 (Supporting the Righteous & Cultivating
38、the Root) “Emptiness should be supplemented and fullness should be drained.” (Ling Shu The Spiritual Pivot). Supporting/assisting the righteous & cultivating the root is indicated in the case of emptiness damage to the righteous qi. Treatment: balance and supplement the lungs, spleen, & kidneys, imp
39、rove deficiency of qi and blood, yin and yang.,The Concept of Immunity in TCM,Supporting the righteous enables the body to eliminate the evil; Eliminating the evil simultaneously preserves the righteous while getting rid of the pathogen. Both methods should be used in the treatment of AIDS.,扶正与去邪,Co
40、mmonly Used Treatment Methods,Fu Zheng Pei Ben (Supporting the Righteous & Cultivating the Root) -Bu Pi (Supplementing the Spleen) -Bu Shen (Supplementing the Kidneys) Qing Re Jie Du (Clearing Heat & Resolving Toxins) Huo Xue Hua Yu (Activating the Blood & Transforming Stasis),扶 正 培 本,清 热 解 毒,活 血 化
41、瘀,Bu Pi Supplementing the Spleen,Injury to the Spleen & Stomach is the most common cause of deficient righteous qi. Spleen qi is easily damaged by external evils, including viruses. Herbs that strengthen the Spleen also improve immunity.,补脾,Bu Shen Supplementing the Kidneys,Kidney jing deficiency ca
42、n lead to weakness in all other areas of the body and vice versa. AIDS patients generally present with kidney yin or yang deficiency, or with both. In Kidney deficient patients, metabolism, cellular immunity, and humoral immunity are all lower than in normal patients. Kidney yin enrichment can impro
43、ve the bodys immunity while prolonging the survival of antibodies. Kidney yang enrichment can excite the nerves and humoral reaction, strengthen body resistance, and promote the formation of new antibodies.,补肾,Research,Numerous clinical studies, most from China, report that CD4 cell count increases
44、while viral load decreases after patients receive Chinese Medical treatments. Most serious AIDS research involving Chinese Medicine is conducted by Chinese researchers.,Tanzania Study,A widely-cited study conducted by Chinese researchers in Tanzania using Chinese herbal therapy showed promising resu
45、lts. The study, which began in 1989 and ended in 1991, measured the effectiveness of TCM herbal formulas in 158 infected people.,Tanzania Study Results,3 cases reporting excellent results, 36 cases reporting good results, 24 cases reporting partial effect. 95 cases reported no change, with 13 deaths
46、 at the end of the study. 7 cases at the end of the study tested negative for the virus on ELISA and Western blot tests, with only one case reverting back to positive within one year. The results, while not overwhelmingly positive, suggest that herbal therapy has immune-modulating and antiviral effe
47、cts, and that further study is warranted.,Traditional Chinese Medicine Tumor Hospital, Shenzhen,OBJECTIVE: To study the therapeutic effect of Chinese medicinal herbs on HIV patients. METHODS: We adopted the combined Chinese medicinal herbs for treatment, the chief components of which is to enhance human immunity while lightening the clinical symptoms. The clinical aspects, the CD4, CD8 lymphocyte numbers and the plasma viral load of the patients were compared before and after the treatment. RESULTS: Of 28 patients examined, all exper
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