Wednesday, 15 February 2017

The holistic Prevention, Management and Treatment of Dementia due to Spleen Qi deficiency - TCM Herbal Chain Hu (Bupleurum)

Kyle J. Norton (Scholar) 
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Dementia is defined as neuro degeneration syndrome among elder, affecting memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement over 47 millions
of worldwide population, mostly in the West. The evaluation of the syndrome by holistic medicine has been lacking, especially through conventional medicine research and studies.

   TCM Treatment of Dementia Induced by Spleen Qi deficiency - TCM Herbal Chain Hu (Bupleurum)

Based on Chinese ancient medical records, causes of dementia are the results of (*)
B.1. Deficiency of Qi, mainly due to
B.3.3. Spleen Qi deficiency
Spleen is a vital organ, according to traditional Chinese medicine, with function in absoring nutrients and transporting them to body's organs and cells. Spleen Qi deficiency is a condition of the inability of the spleen in maximized transportation of nutrients to body organs, including the brain. Prolong period of malnutrition of brain cells may induce abnormal functions in information transmitting or death of neurons, causing cognitive impairment(844), including learning and memory deficits(842) and changes in brain tissues and behavior patterns(843)(842).

2. Chai Hu (Bupleurum)
Chai Hu, the bitter, slightly cold herb is also known as bupleurum root, used in TCM as antitrypanosomal, antimicrobial and antiviral, such as cold and influenza, alternated chill and fever, malaria(1047), cytotoxic(1045) and anti-cancer agents(1046) and to treat irregular menses, prolapse of uterus and rectum(1048), etc., as it regulates and clears heat, improves liver function, raises Yang(1048) and resolves depression and stagnation, etc. by enhancing the functions of liver, gall bladder, pericardium, triple burner channels.

1. β-terpinene
2. imonene
3. β-fenchene
4. ulegone
5. Isoborneol
6. β-terpineol
7. α-copaene
8. Humulene
9. A-farnesene10. Aromadendrene
11. Cis-caryophyllene
12. β-elemene,13. Gamma-muurolene
14. Patchoulane
15. Pootkatone
16. Ledol
17. Etc.

Herbal chai hu used in the treatment and prevention of dementia(1049)(1050) in traditional Chinese medicine, may be due to its effectiveness of phytochemicals in exertion of its neuroprotective effects(1051) through its cytoprotection of neuron, and neuroprotective mechanisms(1052), against apoptosis of neurons(1051) due to Aβ oligomer-induced neuronal damage(1060) in concentration of corticosterone on hippocampal neurons(1059) in a dose-dependent manner.
Yokukansan, a popular herbal combination in Japan and China, containing chai hu, may be the next potential herbal formula used for treatment of Alzheimer's disease, Lewy body disease, Parkinson's disease, especially for the behavioral and psychiatric symptoms of dementia BPSD)(1064)(1065)(1066).

2.1. In dementia symptoms
In dementia, Yokukansan, also known as TJ-54, composed of sev Angelica acutiloba, Atractylodes lancea, Bupleurum falcatum, Poria cocos, Glycyrrhiza uralensis, Cnidium officinale and Uncaria rhynchophylla,(1052)showed to ameliorate the memory disturbance, anxiety-like behavior, aggressive behaviors, decrease in social behaviors, learning deficits and non-cognitive defects(1055) through improvement of neuronal and astroglial cells, via inhibit glutamate-mediated excitotoxicity(1053)(1054). According to 1KeimeiMemorial Hospital in Japan, the formula also showed to improve behavioral and psychological symptoms of dementia (BPSD) together with donepezil in patients with Alzheimer's disease (AD)(1056).

2.2. In Alzheimer's disease and dementia with Lewy bodies
In Alzheimer's disease, Yokukansan improved psychological symptoms of dementia (BPSD)(1058), such as hallucinations, agitation, anxiety, irritability or abnormal behavior(1057) in elderly patients1056). In patients with dementia with Lewy bodies, Kampo medicine, yokukansan (YKS), including chai hu, also improved behavioural and psychological symptoms of dementia (BPSD), through neuropsychiatric Inventory scores(1061).

2.3. In Parkinson's disease
In neuropsychiatric symptoms in patients with Parkinson's disease, yokukansan, containing Chai hu, using the Unified PD Rating Scale part III (UPDRS-III) and Hoehn and Yahr scale, showed effectively in ameliorated symptoms of delusions, agitation, depression, euphoria, disinhibition with aberrant motor activity but irritability(1062). In behavioral and psychological symptoms, the herbal formula, also exhibited improvements of these symptoms, without worsening cognitive function, ability to perform activities of daily living, or parkinsonism, after 4 weeks(1063). Yokukansankachimpihange, another formula containing chai hu, showed to exhibit anti hallucinate effects, through its major phytochemical atractylenolide III and β-eudesmol, via its antagonistic activity against serotonin receptors induced non-motor symptom of Parkinson's disease and various forms of dementias(1067).

According to traditional Chinese medicine, the effectiveness of a herbal formula, is not results of single ingredient or single herb itself, but the combination of all ingredients of all herbs in the formula, even some herbs in the formula may show significant efficacies in Western studies and clinical trials.

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(842) Folate deficiency in rat pups during weaning causes learning and memory deficits. by Berrocal-Zaragoza MI1, Sequeira JM1, Murphy MM2, Fernandez-Ballart JD2, Abdel Baki SG3, Bergold PJ3, Quadros EV1.(PubMed)
(843) Changes in brain tissue and behavior patterns induced by single short-term fasting in mice. by Hisatomi Y1, Asakura K, Kugino K, Kurokawa M, Asakura T, Nakata K.(PubMed)
(844) Combined low calcium and lack magnesium is a risk factor for motor deficit in mice. by Taniguchi R1, Nakagawasai O, Tan-no K, Yamadera F, Nemoto W, Sato S, Yaoita F, Tadano T.(PubMed)
(1045) Anti-infective and cytotoxic properties of Bupleurum marginatum by Ashour ML, El-Readi MZ, Hamoud R, Eid SY, El Ahmady SH, Nibret E, Herrmann F, Youns M, Tahrani A, Kaufmann D, Wink M1.(PubMed)
(1046) Reactive oxygen species-mediated apoptosis contributes to chemosensitization effect of saikosaponins on cisplatin-induced cytotoxicity in cancer cells by Wang Q1, Zheng XL, Yang L, Shi F, Gao LB, Zhong YJ, Sun H, He F, Lin Y, Wang X.(PubMed)
(1047) Ethnoveterinary plant remedies used by Nu people in NW Yunnan of China by Shen S1, Qian J, Ren J.(PubMed)
(1048) Chai Hu(Complementary and Alternative Healing University)
(1049) Use of Yokukansan (TJ-54) in the treatment of neurological disorders: a review by de Caires S1, Steenkamp V.(PubMed)
(1050) Effects of yokukansan, a traditional Japanese medicine, on memory disturbance and behavioral and psychological symptoms of dementia in thiamine-deficient rats by Ikarashi Y1, Iizuka S, Imamura S, Yamaguchi T, Sekiguchi K, Kanno H, Kawakami Z, Yuzurihara M, Kase Y, Takeda S.(PubMed)
(1051) Neuroprotective effects of total saikosaponins of Bupleurum yinchowense on corticosterone-induced apoptosis in PC12 cells by Li ZY1, Guo Z, Liu YM, Liu XM, Chang Q, Liao YH, Pan RL.(PubMed)
(1052) Ethanol extract of Bupleurum falcatum Linne and saikosaponins inhibit neuroinflammation via inhibition of NF-κB by Park WH1, Kang S1, Piao Y1, Pak CJ1, Oh MS2, Kim J3, Kang MS1, Pak YK4.(PubMed)
(1054) Neuroprotective effects of yokukansan, a traditional Japanese medicine, on glutamate-mediated excitotoxicity in cultured cells by Kawakami Z1, Kanno H, Ueki T, Terawaki K, Tabuchi M, Ikarashi Y, Kase Y.(PubMed)
(1055) Ameliorative effects of yokukansan, a traditional Japanese medicine, on learning and non-cognitive disturbances in the Tg2576 mouse model of Alzheimer's disease by Tabuchi M1, Yamaguchi T, Iizuka S, Imamura S, Ikarashi Y, Kase Y.(PubMed)
(1056) Effects of Yokukansan on behavioral and psychological symptoms of dementia in regular treatment for Alzheimer's disease by Okahara K1, Ishida Y, Hayashi Y, Inoue T, Tsuruta K, Takeuchi K, Yoshimuta H, Kiue K, Ninomiya Y, Kawano J, Yoshida K, Noda S, Tomita S, Fujimoto M,Hosomi J, Mitsuyama Y.(PubMed)
(1057) Treatment of behavioral and psychological symptoms of Alzheimer-type dementia with Yokukansan in clinical practice. by Hayashi Y1, Ishida Y, Inoue T, Udagawa M, Takeuchi K, Yoshimuta H, Kiue K, Ninomiya Y, Kawano J, Sameshima T, Kawahara T, Goto I, Shudo K, Kurayama S, Nakamura J, Okahara K, Mitsuyama Y.(PubMed)
(1058) Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer's disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine by Rodda J1, Morgan S, Walker Z.(PubMed)
(1059) Neuroprotective effect of yokukansan against cytotoxicity induced by corticosterone on mouse hippocampal neurons. by Nakatani Y1, Tsuji M2, Amano T3, Miyagawa K4, Miyagishi H4, Saito A4, Imai T4, Takeda K4, Ishii D4, Takeda H2.(PubMed)
(1060) Glycyrrhiza and Uncaria Hook contribute to protective effect of traditional Japanese medicine yokukansan against amyloid β oligomer-induced neuronal death. by Kanno H1, Kawakami Z, Iizuka S, Tabuchi M, Mizoguchi K, Ikarashi Y, Kase Y.(PubMed)
(1061) Improvement in delusions and hallucinations in patients with dementia with Lewy bodies upon administration of yokukansan, a traditional Japanese medicine.
Iwasaki K1, Kosaka K, Mori H, Okitsu R, Furukawa K, Manabe Y, Yoshita M, Kanamori A, Ito N by Wada K, Kitayama M, Horiguchi J, Yamaguchi S, Takayama S,Fukuhara R, Ouma S, Nakano S, Hashimoto M, Kinoshita T.(PubMed)
(1062) An exploratory study of the efficacy and safety of yokukansan for neuropsychiatric symptoms in patients with Parkinson's disease. by Hatano T1, Hattori N, Kawanabe T, Terayama Y, Suzuki N, Iwasaki Y, Fujioka T; Yokukansan Parkinson’s Disease Study Group.(PubMed)
(1063) Successful treatment with Yokukansan for behavioral and psychological symptoms of Parkinsonian dementia by Kawanabe T1, Yoritaka A, Shimura H, Oizumi H, Tanaka S, Hattori N.(PubMed)
(1064) New possibility of traditional Chinese and Japanese medicine as treatment for behavioral and psychiatric symptoms in dementia by Kung FC1, Ishii R, Liu HC, Takeda M.(PubMed)
(1065) A randomized cross-over study of a traditional Japanese medicine (kampo), yokukansan, in the treatment of the behavioural and psychological symptoms of dementia by Mizukami K1, Asada T, Kinoshita T, Tanaka K, Sonohara K, Nakai R, Yamaguchi K, Hanyu H, Kanaya K, Takao T, Okada M, Kudo S, Kotoku H, Iwakiri M, Kurita H, Miyamura T, Kawasaki Y, Omori K, Shiozaki K, Odawara T, Suzuki T, Yamada S, Nakamura Y, Toba K.(PubMed)
(1066) Yokukan-san: a review of the evidence for use of this Kampo herbal formula in dementia and psychiatric conditions. by Okamoto H1, Iyo M2, Ueda K3, Han C3, Hirasaki Y3, Namiki T3.(PubMed)
(1067) Pharmacological effects of "jutsu" (Atractylodis rhizome and Atractylodis lanceae rhizome) on 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI)-induced head twitch response in mice (I).

Murayama C1, Wang CC2, Michihara S3, Norimoto H4.(PubMed)

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