Wednesday, 11 February 2015

(First edited)) Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Fibromyalgia


Weight Loss the Easy Ways 
Andrea Albright Featured on Health and Fitness Jan. 2015
will Personally Coach You How to Get There The Easy Way

If You Are Looking For a SoulMate
Celebrity Patti Stanger Will Coach You To Get Him/Her
and Keep Him/Her for Good,The Simple Way

By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                       Fibromyalgia
 
Fibromyalgia, according to the American College of Rheumatology 1990 criteria for the Classification of Fibromyalgia fibromyalgia are
(1) Widespread pain in combination with
(2) Tenderness at 11 or more of the 18 specific tender point sites(a) as a result in responding to pressure.

I. Symptoms
Symptoms of Fibromyalgia may be depending to the patients' gender
According to College of Medicine at Peoria, University of Illinois, women experienced significantly more common
1. Fatigue,
2. Morning fatigue,
3. Hurt all over, total number of symptoms, and
4. irritable bowel syndrome. Women had significantly
5. More tender points pain
6. Tension headache
7. Migraine
8. Temporomandibular disorder
But significantly different between the sexes, for the below symptoms
 6. Pain severity,
7. Physical functioning
8. psychologic factors, such as anxiety, stress, and depression(1)(2).

Other symptoms may include widespread musculoskeletal pain, multiple “tender points”, sleep disturbance, stiffness,  headache, dizziness, trouble with concentration, urinary urgency(3).

According to the American College of Rheumatolog disordered sleep is a prominent symptom in fibromyalgia, others included symptoms such as waking unrefreshed, fatigue, tiredness, and insomnia(4).
II. Causes and Risk factors
A. Causes

1. Oxidative stress
Stronger evidences demonstrated that oxidative stress is associated to clinical symptoms in FM fibromyalgia(5).

2. Chronic stress
The relationship between stress, depression and functionality seems to be part of a complex mechanism,  affecting the quality of life of patients with FM(6).

3. Alpha1-Antitrypsin (AAT) 
There is a a possible relationship between AAT deficiency (AAT-D) and fibromyalgia (FM)(7).

4. Inflammatory rheumatic disorders
Demonstrated evidences suggested that fibromyalgia occurs much more frequently than expected in individuals with inflammatory rheumatic disorders(8).

5. Sleep disturbance
There is a reciprocal relationship exists between pain and sleep. Treatment targeted insomnia may improve pain(9).

6. Etc.
B. Risk factors
1. Gender 
If you are women, you are at higher risk than men to develop Fibromyalgia(10).

2. Family history
According to the study whether Fibromyalgia (FM) patients differ from their first-degree relatives with and without FM regarding the four personality traits, based on Cloninger’s TPQ questionnaire, there are factors in this personality trait that are hereditary and that may contribute to the development of FM(11).

3. Environmental susceptibility may be the possible causes of Fibromyalgia(12).

4. Other illness
Certain illness are associated to the increased risk of Fibromyalgia, such as diseases of infection.
5. Etc.

III. Complications
1. Negative impact in relationships

According to survey a large community sample of adults with fibromyalgia about the impact on the spouse/partner, children and close friends,  beside well documents of physical impairments, the disease can result in a substantial negative impact on important relationships with family and close friends(13).

2. Psychological problem
According to the study by Monash University and Monash Medical Centre, patients with FM are experiences complications of  pain, perceived stress, fatigue, confusion, and mood disturbance(14).

3. Pain disability, depression, and pressure sensitivity differences in genders
According to the study of differences complications of men and women with fibromyalgia syndrome (FMS), there is a the differences in pain, disability, depression, and pressure sensitivity between men and women with fibromyalgia syndrome (FMS)(15).

4. Impaired functionality, and impact on the quality of life
 FM group, has a positive correlation observed between the depressive symptoms and perceived stress , pain, impaired functionality, and impact on the quality of life(16).

5. Fall risk
There were significant relationships between fall risk and pain score (NRS scores, the Numeric Rating Scale) and Fibromyalgia Impact Questionnaire(FIQ) fatigue sub-scores in the fibromyalgia patients according to the study by Pamukkale University Medical School(17).

6. Postural control deficits
According to study, middle-aged FM patients have consistent objective sensory deficits on dynamic posturography, despite having a normal clinical neurological examination and suggested that the development of interventions to improve balance and reduce falls in FM patients may need to combine balance training with exercise and cognitive training(18).

7.  Infections, neoplastic and cardiovascular disease and mortality
 Fibromyalgia (FM) patients are more susceptible with an increase in comorbidity (infections, neoplastic and cardiovascular disease) as well as with an increase in mortality.
The association between FM and HIV and hepatitis C virus infections suggests a possible relationship between FM and chronic viral infection. Patients with FM may have an increased risk of developing cancer, accidental death and death from cancer(19).
8. Etc.
IV. Diagnosis 
  In the narrative review of the literature, consensus documents by the American College of Rheumatology (ACR), in primary care include:
1. Complete medical history including medication, complete medical examination, basic laboratory tests to screen for inflammatory or endocrinology diseases, referral to specialists only in case of suspected somatic diseases, assessment of limitations of daily functioning, and other functional somatic symptoms and mental disorders(20).

2. Other study suggested of 4 phased diagnosis.
a. In phase one, physicians undertook a self-assessment of their practice.
b. Phase two of the study involved diagnosis and treatment of a virtual case vignette.
3. The third phase consisted of analysis of the data from phase two and providing feedback from an expert rheumatologist, and
4. The fourth phase was to complete patient report forms for five patients in their practice(21).

Here, we quote the text from the study of The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgiaand Measurement of Symptom Severity by FREDERICK WOLFE,1 DANIEL J. CLAUW,2 MARY-ANN FITZCHARLES,3 DON L. GOLDENBERG,4
ROBERT S. KATZ,5 PHILIP MEASE,6 ANTHONY S. RUSSELL,7 I. JON RUSSELL,8 JOHN B. WINFIELD,9 AND MUHAMMAD B. YUNUS10
Objective. To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms.
Methods. We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale.
Results. Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI >7 AND SS >5) OR (WPI 3–6 AND SS >9).
Conclusion. This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.
Please note:
This criteria set has been approved by the American College of Rheumatology (ACR) Board of Directors as Provisional.This signifies that the criteria set has been quantitatively validated using patient data, but it has not undergone validationbased on an external data set. All ACR-approved criteria sets are expected to undergo intermittent updates.As disclosed in the manuscript, these criteria were developed with support from the study sponsor, Lilly Research Laboratories.The study sponsor placed no restrictions, offered no input or guidance on the conduct of the study, did not participatein the design of the study, see the results of the study, or review the manuscript or submitted abstracts prior to thesubmission of the paper. The recipient of the grant was Arthritis Research Center Foundation, Inc. The authors receivedno compensation. The ACR found the criteria to be methodologically rigorous and clinically meaningful.ACR is an independent professional, medical and scientific society which does not guarantee, warrant or endorse anycommercial product or service. The ACR received no compensation for its approval of these criteria(22).
V. Prevention
1. Vitamin D 
Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. Vitamin D deficiency is common in fibromyalgia and occurs more frequently in patients with anxiety and depression(23).

2. Omega 3 fatty acid
Regular intake of high oral doses of omega 3 fish oil (varying from 2400-7200 mg/day of EPA-DHA), showed a clinically significant in pain reduction, improved function up to 19 months after treatment initiation with no serious adverse effects(24).

3. Caffeine
According to forty-three of fifty-eight (74.1%) female patients with fibromyalgia completed an eight-week treatment period, the combination of carisoprodol and paracetamol (acetaminophen) and caffeine are effective in the treatment of fibromyalgia(25).

4. Coenzyme Q10 
CoQ10 treatment not only restored mitochondrial dysfunction and the mtDNA copy number, but also decreased oxidative stress, and increased mitochondrial biogenesis(26).
VI. Treatments
A. In conventional medicine perspective

FMS usually involves females, often appearance during menopause and diagnosed both in young as well as elderly individuals. In children with FMS, management is focus mostly on education, behavioral and cognitive change (with a strong emphasis on physical exercise), and less in medication, including muscle relaxants, analgesics and tricyclic agents(27).
A.1. Non medication
1. Psychological control
According to the study by Monash University and Monash Medical Centre, levels and type of psychological control buffer mood, stress, fatigue, and pain in FM appeared to be important “up-stream” process in FM mechanisms and amenable to intervention(28).

2.  Operant behavioural (OBT) and cognitive behavioural (CBT) therapy
OBT or CBT showed a significant reduction in pain intensity post-treatment. In addition, the CBT group reported statistically significant improvements in cognitive and affective variables and the OBT group demonstrated statistically significant improvements in physical functioning and behavioural variables, after 12 months of treatments, according to University of Heidelberg(29).

3. Exercise
Exercise therapy showed a strong dysfunctional response of patients with chronic pain and aberrations in central pain modulation(30).

4. Other therapies
According to the  University of Munich
a. Physiotherapy may reduce overloading of the muscle system, improve postural fatigue and positioning, and condition weak muscles, localized as well as generalized pain in short term.
b. Trigger point injection may reduce pain originating from concomitant trigger points in selected FM patient.
c. Massage may reduce muscle tension and may be prescribed as a adjunct with other therapeutic interventions.
d. Acupuncture may reduce pain and increase pain threshold.
d. Biofeedback may positively influence subjective and objective disease measures.
f. TENS may reduce localized musculoskeletal pain in fibromyalgia(31).

5. Ozone therapy
 Ozone therapy significantly improves both depression scores and the Physical Summary Score, after  24 sessions of ozone therapy during a 12-week period, with most frequently side-effec of transient meteorism after ozone therapy sessions(32).

A.2. Medications
The aim of medicine is to relieve the symptoms of the disease
According to meta-analyses and systematic reviews published since 2005, stepped care approach based upon existing evidence includes(33)
(1) Simple analgesics (acetaminophen or nonsteroidal anti-inflammatory drugs);
(2) Tricyclic antidepressants (if neuropathic, back or fibromyalgia pain) or tramadol;
(3) Gabapentin, duloxetine or pregabalin if neuropathic pain;
(4) Cyclobenzaprine, pregabalin, duloxetine, or milnacipran for fibromyalgia;
(5) Topical analgesics (capsaicin, lidocaine, salicylates) if localized neuropathic or arthritic pain; 
(6) Opioids

C. Alternative treatments
Regarding alternative treatments,
1. Acupuncture and several types of meditative practice show the most promise for in scientific investigation.
2. Magnesium, l-carnitine, and S-adenosylmethionine are nonpharmacological supplements with the most potential for further research.
3.  Individualized treatment plans that involve several pharmacological agents and natural remedies appear promising as well.(34).
Other study insisted
4. Some herbal and nutritional supplements (magnesium, S- adenosylmethionine) and massage therapy have the best evidence for effectiveness with FM. Other CAM therapies such as  
5. Chlorella, biofeedback, relaxation have either been evaluated in only one randomised controlled trials (RCT) with mixed results(34a).

D. In Herbal medicine perspective
According to St. Joseph's Healthcare Hamilton
1. Glucosamine, echinacea, and garlic were the most frequently used products.
2. Women reported NHP use more frequently than men (11.5% vs. 7.1%).
3. As compared to young adults, NHP use was about 50% higher in middle-aged and older Canadians. with fibromyalgia achieves a prevalence of 23.3%(35).

1. Ginkgo biloba
 Coenzyme Q10 combined with a Ginkgo biloba extract showed a progressive improvement in the quality-of-life scores, compared to those at the start with mild adverse effects(36).

2. Harpagophytum procumbens (Devil’s claw), Salix alba (White willow bark), and Capsicum frutescens (Cayenne)
 Harpagophytum procumbens (Devil’s claw), showed significantly in reduced pain but additional trials testing these herbal medicines against standard treatments will clarify their equivalence in terms of efficacy(37).
C. In traditional Chinese medicine perspective
1. Acupuncture

Acupuncture significantly improved symptoms of fibromyalgia, not restricted to pain relief but most significant for fatigue and anxiety, according to Mayo Clinic College of Medicine(39).
2. Combination of acupuncture and cupping therapy
A combination of acupuncture and cupping therapy was better than conventional medications for reducing pain,  improving depression scores with related to FM with no adverse effects, according to the study by The Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine(40).

2. Chinese herbal formulas
According to the differentiation of Two TCM practitioners conducted baseline TCM diagnostic examinations on 56 women with FM,
There are three primary TCM diagnoses of FM were found in the population:  
2.1. Qi and Blood Deficiency
2.2. Qi and Blood Stagnation 
2.3. Liver Qi Stagnation .
Other study showed that FM are also associated to
2.4. Yin and blood deficiency of the liver 

2.5. Yang-weakness of the spleen and kidney
2.6. Yin-weakness of the kidney(41).

Dr. Shen in the article of Chinese Herbs & Chinese Medicine for Fibromyalgia, suggested the below formula to relieve pain
Bai shao – 20%, qin jiao – 10%, du huo – 10%, yan hu sou – 10%, yu jin – 10%, tao ren – 10%, hong hua – 10%, mu dan pi – 10%, da zao – 5%, gan cao – 5%,
Basic Pain Formula; Take 3-4 grams (scoops), 3 times a day mixed with liquid or food.
Preferably on an empty stomach. (Should not be taken by pregnant women)(42).

Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer 
 
References
(a) http://www.ncbi.nlm.nih.gov/pubmed/2306288
(1) http://www.ncbi.nlm.nih.gov/pubmed/11286669
(2) http://www.ncbi.nlm.nih.gov/pubmed/11974674
(3) http://www.ncbi.nlm.nih.gov/pubmed/15074033
(3a) http://www.ncbi.nlm.nih.gov/pubmed/19333104
(3b) http://www.ncbi.nlm.nih.gov/pubmed/24870121
(4) http://www.ncbi.nlm.nih.gov/pubmed/21594765
(5) http://www.ncbi.nlm.nih.gov/pubmed/22532869
(6) http://www.ncbi.nlm.nih.gov/pubmed/22641587
(7) http://www.ncbi.nlm.nih.gov/pubmed/15694694 
(8) http://www.ncbi.nlm.nih.gov/pubmed/19078011
(9) http://www.ncbi.nlm.nih.gov/pubmed/20047347
(10) http://www.ncbi.nlm.nih.gov/pubmed/15074033
(11) http://www.ncbi.nlm.nih.gov/pubmed/21122266
(12) http://www.ncbi.nlm.nih.gov/pubmed/21594765
(13) http://www.ncbi.nlm.nih.gov/pubmed/23172797 
(14) http://www.ncbi.nlm.nih.gov/pubmed/23152697
(15) http://www.ncbi.nlm.nih.gov/pubmed/23171037
(16) http://www.ncbi.nlm.nih.gov/pubmed/22641587
(17) http://www.ncbi.nlm.nih.gov/pubmed/23179001
(18) http://www.ncbi.nlm.nih.gov/pubmed/21810264
(19) http://www.ncbi.nlm.nih.gov/pubmed/21794265
(21) http://www.ncbi.nlm.nih.gov/pubmed/23118542
(22) http://www.rheumatology.org/practice/clinical/
classification/fibromyalgia/2010_Preliminary_Diagnostic_Criteria.pdf
(23) http://www.ncbi.nlm.nih.gov/pubmed/16850115
(24) http://www.ncbi.nlm.nih.gov/pubmed/20090445
(25) http://www.ncbi.nlm.nih.gov/pubmed/2667860
(26) http://www.ncbi.nlm.nih.gov/pubmed/22898267
(27) http://www.ncbi.nlm.nih.gov/pubmed/23024967
(28) http://www.ncbi.nlm.nih.gov/pubmed/23152697
(29) http://www.ncbi.nlm.nih.gov/pubmed/16859516
(30) http://www.ncbi.nlm.nih.gov/pubmed/22786458
(31) .http://www.ncbi.nlm.nih.gov/pubmed/11028838
(32) http://www.ncbi.nlm.nih.gov/pubmed/23046293
(33) http://www.ncbi.nlm.nih.gov/pubmed/19410099 
(34) http://www.ncbi.nlm.nih.gov/pubmed/20192908
(34a) http://www.ncbi.nlm.nih.gov/pubmed/16454724
(35) http://www.ncbi.nlm.nih.gov/pubmed/16921199
(36) http://www.ncbi.nlm.nih.gov/pubmed/12025528
(37)  http://www.ncbi.nlm.nih.gov/pubmed/17202897 .
(39) http://www.ncbi.nlm.nih.gov/pubmed/16770975
(40) http://www.ncbi.nlm.nih.gov/pubmed/20423209 
(41) http://www.ncbi.nlm.nih.gov/pubmed/22026964
(42) http://www.drshen.com/herbsforfibromyalgia.htm

Quick and Easy Healthy Kid Loved Lunch Box Recipe: Hummus and veggie wrap



By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.
Recipes contributed by The Lunch Box, Packed with fun, healthy meals that keep them smiling, by Kate McMillan and Sarah Putman Clegg, published by Weldonowen.


Rockin' wrap: Fun and flavor-packed handfuls that will be the star of lunch table


Spread a flour tortilla or 2 corn tortillas with thin layer of hummus, homemade a purchased. mash a couple of ripe avocado slices on top. Add baby spinach and red bell pepper strips horizontal line across the center. Roll up the tortilla into tight cylinder, either hand-roll style or burrito style.
 

 

 

Tuesday, 10 February 2015

(4th edited )Most common diseases of 50 plus - Diseases of Central Nervous system(CNS): TCM treatments of Dementia Caused by Heart Qi Deficiency

Weight Loss the Easy Ways
Andrea Albright Featured on Health and Fitness Jan. 2015
will Personally Coach You How to Get There The Easy Way

If You Are Looking For a SoulMate
Celebrity Patti Stanger Will Coach You To Get Him/Her
and Keep Him/Her for Good,The Simple Way

By Kyle J. Norton Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                     Diseases of Central Nervous system

                             Dementia

About 5-8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. Dementia is the loss of mental ability, severe enough to interfere with people's every life and Alzheimer's disease is the most common type of dementia in aging people.

V. Treatments
C. In traditional Chinese Medicine Perspective(*)
Based on Chinese ancient medical records. causes of dementia are the results of (*)
C.2. Deficiency of Qi, mainly due to 
C.2.2. Heart (Yang) Qi deficiency
Heart  Qi deficiency is a condition of the inability of the heart in transportation of nutrients to body organs, including the brain through blood circulation. Prolong period of malnutrition of brain cells may induce abnormal function of brain's cells in information transmitting  or death of neurons, causing cognitive impairment(844), including learning and memory deficits(842) and changes in brain tissue and behavior patterns(843)(842).
Herbal medicine for Heart Qi deficiency 

1. Dan shen
Dan Shen is also known as Red Sage Root with taste of   the bitter and slightly cold in nature, used in TCM as antithrombotic(845), antihypertonic (lowering blood pressure)(846), antimicrobial(847), anti-inflammatory(848)(849), agent and to treat coronary and cerebrovascular disease, dysmenorrhea, amenorrhea, hepatitis, hepatocirrhosis, restlessness, insomnia, irritability,(850) etc., by enhancing the functions of heart and liver channels.

Phytochemicals
1. Cryptotanshinone
2. Hydroxytanshinone,
3. Methyltanshinonate
4. Methylene tanshiquinone
5. Przewatanshinquinone A
6. Przewatanshinquinone B
7. Miltirone
8. Dihydrotanshinone I
9. Tanshinol A
10. Tanshinol B
11. Tanshinol C,
12. Nortanshinone
13. 1, 2, 15, 16-tetrahydrotanshiquinone
14. Danshensuan A, B, C
15. Protocatechuic acid,
16. Protocatechuic aldehyde
17. Etc.


1.1. Dementia 
According to Mashhad University of Medical Sciences, dan shen in the pharmacological effects on the central nervous system, showed to exert its neuroprotective activity through and antiparkinsonian,l relaxant, analgesic, memory enhancing(850). In PC12 cells, combination application of salvianolic acid B (Sal B) and Ginkgo biloba extract EGb 761, effectively inhibited the formation of amyloid fibrils, protected PC12 cells(855) from beta-AP25-35-induced cytotoxicity and ROS accumulation(854).

1.2. Alzheimer's disease (AD)
Simple simple and poly hydroxycinnamic acids and diterpenoid quinone, showed to improved cognitive deficits in mice model, through protection of neuronal cells, prevention of amyloid fibril formation and preformed amyloid fibril disaggregation related to Alzheimer's disease(851). Salvianolic acid B (Sal B)isolated fronm dan shen, in animal model, not only prevented Abeta-induced cytotoxicity(857) but also improved cognitive deficits and protection of neuronal cells(852), through its effects on suppressing the production of ROS, calcium flux, and apoptosis(853) and promoted amyloid precursor protein (APP) metabolism toward the non-amyloidogenic products pathway in cortical neuronal cell(856) and multifunctional machenisms(857). Compound Danshen Tablets (CDST), in rat model, exhibted spatial cognition and decreased beta-APP expression in the cortex and hippocampus, detected via immunohistochemistry(859).

1.3.  In learning and memory impairment
In diabetic rats model, dan shen injection improved the learning and memory decline, through upregulation of expression of MKP-1 in reduced inflammation(861) under hyperglycemia(860). HX106N, a Chimese herbal formula, containing dan shen, in Aβ25-35 peptide mice, enhanced on memory impairment and oxidative stress through increased levels of heme oxygenase-1 (HO-1)(862). In a joint study of renowned institutions, in mouse model, myelophil, a combination of extracts taken from Astragali Radix and Salviae Miltiorrhizae Radix, significantly exhibited its anti-amnesic properties in  memory impairment, through the modulation of cholinergic activity(863). Tanshinones, a group of diterpenoids found in dan shen, improved learning and memory impairments, through its inhibitory effect on acetylcholinesterase(864)

1.4. In neuroprotective effects
Tanshinone IIA (Tan IIA), one of the major active constituents of dan shen exerted its by neuroprotective effects, by inhibiting transcription and translation of genes involved AD development(858). In neurotoxicity of β-amyloid protein (Aβ) contributed Alzheimer's disease (AD), dan shen extract suppressed the increased intracellular reactive oxygen species levels, through deduction of decreased the protein expression involved in the development of neurodegenerative disease, including Ads(865). According to Eur J Pharmacol and University of Sydney, salvianolic acid B (SalB), in mouse model, exhibited neuroprotective effects in an amyloid β (Aβ) peptide-induced Alzheimer's disease, through its anti-inflammatory and anti-oxidative effects(866) and ameliorated cholinergic dysfunction- or Aβ(25-35)-induced memory impairment(867), respectively.


2. Ren shen (Ginseng)
Ren Shen is a smells aromatic, tastes sweet and slightly warm herbs, also known as Gingshen, used in TCM as improved immune system(868)(869), Anti Cancer(870)(871), Anti aging(872)(873), Anti stress(874)(875), anti Erectile dysfunction(876)(877), etc. agent and to generates fluids and reduce thirst and symptoms of diabetes(878)(879), for xinqixu (heart qi deficient) related coronary heart disease (CHD)(880)(881), anxiety(882)(883), insomnia(884)(885), depression(886)(887), neurodegenertive disorders(888)(889)(890), bleeding in the vagina not during period(891), seizures(892)(893), chronic fatigue(894)(895), etc. as it strongly tonifies Original Qi, the Spleen and the Lungs, promotes generation of Body Fluids, calms thirst and the Mind,(896) etc. by enhancing the functions of spleen and lung channels(897).

Phytochemicals
1. Saponins
2. Panaxynol
3. Ginsenyne
4. Alpha pansinsene
5. Beta pansinsene
6. Beta farnesene
7. Bicyclogermacrene
8. Beta elemene
9. Gama elemene
10. Alpha neodovene
11. Beta neodovene
12. Alpha humulene
13. Beta humulene
14. Ccaryophyllene
15. Beta gurjunene
16. Alpha gurjunene
17. Alpha selinene
18. Beta selinene
19. Gama selinene
20. Selin-4, alpha guaiene
21. Gama cubebene
22. Beta patchoulene
23. Hepatadecanol-1
24. Etc.

Herbal ren shen used in the treatment and prevention of dementia(898) in traditional Chinese medicine, may be due to its effectiveness of phytochemicals in ameliorated amyloid pathology(899)(900) and related cognitive deficits(901). In aging related dementia, based on the history of use, and pharmacological investigation, ren shen showed a strong evidence in cognitive improvement, through cholinesterase inhibitory activity and cholinergic function(902). According to Beijing University of Chinese Medicine, combination extract of Renshen (Panax Ginseng), Yinyanghuo (Herba Epimedii Brevicornus), Yuanzhi (Radix Palygalae) and Jianghuang (Rhizoma Curcumae Longae) (GEPT) exhibited neuroprotecting mechanism in preventing and treating of AD(903).

2.1. In Alzheimer's disease
Alzheimer's disease is a brain disorder named after German physician Alois Alzheimer. The disease destroys brain cells involved inflammation, mitochondrial dysfunction or oxidative stress(904), causing problems with memory, thinking and behavior severe(904) enough to affect language communication(905), memory(906), lifelong hobbies or social life(907).
Ginseng extracts, in Alzheimer's disease (AD) patients showed significantly in attenuated amyloid plaque deposition as well as short- and long-term memory impairment. through its phytochemical gintonin effect via the mediation in promotion of non-amyloidogenic processing(908). In amyloid β peptide induced AD cell model, ginsenoside Rg1, the main chemical constituent of ginseng, improved the memory impairment associated with Alzheimer's disease (AD), through suppressing the signaling transduction pathways and decreasing the inflammation factors(909)(910); increasing cell viability, reducing oxidative damage (including apoptosis), restoring mitochondrial membrane potential(911). According to the join 17-month old male APP/PS1 mice study by University of Michigan and Yunnan University of Traditional Chinese Medicine, total saponin in leaves of Panax notoginseng (LPNS) attenuated reactive oxygen species (ROS) accumulation and cell death in brain cells through activation of Nrf2 (nuclear translocation) and upregulation of downstream antioxidant systems(912).
 Unfortunately, according to the review over 20 databases from their inception to January 2009 and included all randomized clinical trials (RCTs) from Korea Institute of Oriental Medicine, the use of ginseng for treatments of Alzheimer's disease is scarce and inconclusive(913).

2.2. In Parkinson's and Hungtinton's diseases
Parkinson's disease is a progressive disorder of the nervous system, affecting movement of muscles(917)(918), speech(919), poster, balance, auto functioning(920), etc. The disease's symptoms worsen over time. According to a multicenter study, phosphorylated forms, pS129 is associated to the severity and progression of  Parkinson diseases(914). NFE2L2 gene, an important regulator of the cellular protection against oxidative stress, if defects can also contribute to the pathogenesis of the disease(915)(916). In the pathogenesis of Parkinson's disease (PD), Ginsenoside Rb, effectively inhibit or reverse the aggregation process may thus represent a viable therapeutic strategy against PD and related disorders, through anti-amyloidogenic and antineurotoxical effects(921). Its water extract in induced cytotoxicity in SH-SY5Y human neuroblastoma cells, also  exhibited significant protective effects possibly through the suppression of ROS generation(922). According to Russian Academy of Medical Sciences, use of ginseng and other herbs, such as eleutherococcus, Rhodiola rosea, etc.,  in a complex therapy for Parkinson's disease, may be due to theirs normalized immune, antioxidant, and hormonal parameters(923).
In Huntington's disease, Ginsenosides, the main chemical constituents of ginseng, showed to exert its neuroprotective effect against neurons from glutamate-induced apoptosisin in vitro(924).


2.3. In cognitive impairment
Klotho Gene Deficiency has been found to associated to oxidative stress related cognitive impairment(925). In aging mice model, ginseng exhibited anti oxidative stress in ameliorated lipid peroxidation and restores antioxidant capacity(926), and reduced accumulation of intercellular messenger, nitric oxide (NO)(927) may be a potential treatment herbal medicine for cognitive impairment(927). Ginsenoside Rb1, a major chemical constituent found in ginseng, showed to inhibit cognitive impairment caused by diabetes, through GSK3β, a negative regulator in the hormonal control of glucose homeostasis)-mediated endoplasmic reticulum(ER) stress due to physiological and pathological insults in high glucose-treated hippocampal neurons(928).

2.4. In neuroprotective effects
In high glucose-induced neurotoxicity in primary cultured rat hippocampal neurons, Ginsenoside Rb1 also, exerted a wide variety of neuroprotective effects by inhibiting CHOP signaling pathway involved in apoptosis signal in ER stress- and CHOP-mediated apoptosis(940), oxidative stress(926) and mitochondrial dysfunction(929)(941) and neuroinflammation(941). According to University Complutense of Madrid, Ginseng and its major constituents as potential neuroprotective agents against progression of Parkinson's disease(943),due ti its effectiveness in inhibition of oxidative stress(926) and neuroinflammation(941), decrease in toxins-induced apoptosis(944) and regulation of channels and receptors and channel activity(945)(942).

3. Xi yang shen(946), Yin in nature, The Sweet, slightly bitter, cool herb has been used in TCM to treat fatigue(947)(948), diabetes(949), cardiovascular diseases(950)(951) and atopic diseases(952), promote saliva, quench thirst(949)(950), due to yang deficiency of lungs, by promoting the lung and spleen qi, through increasing the digestive system in absorbing vital energy and reducing the heat causes of qi stagnation through Heart, Lung, Kidney channels.

Phytochemiclas
1. Resin
2. Pinene, Dipentene
3. α Phellandrene
4. β Phellandrene
5. α-amyrone,
6. α-amyrinone
7. α-amyrin
8. β-amyrin
8. Viridiflorol
9. Insensole
10. Insensole oxide
11. Ginseng Saponins: ginsenoside -R0, -Rb1, -Rb2, -Rb3, -Rc, -Rd, -Re, -Rf, -Rg1, -Rg2, -Rg3, -Rh1, -RA0, quinquenoside R1, gypenoside X1, F3, F11.
12. Etc.

Herbal Xi yang shen used in the treatment and prevention of dementia(953) in traditional Chinese medicine, may be due to its effectiveness of phytochemicals in ameliorated amyloid pathology(953) causes of neuro cells apoptosis(954) and related cognitive deficits(955).

3.1. In Alzheimer's disease
In Alzheimer's disease cell model, induced by Abeta25-35, water extracts of American Ginseng (WEAG), exerted a significant neuroprotective effects of  SH-SY5, a human derived cell line against cells apoptosi(954. Pseudoginsenoside-F11 (PF11), a main component of found in American ginseng, in Alzheimer's disease (AD) mice model, induced by scopolamine, morphine and methamphetamine, significantly mitigated learning and memory impairment in 15 days, through inhibited the expressions of β-amyloid precursor protein (APP) and Aβ1-40 in the cortex and hippocampus, restored the activities of antioxidants in decreased the production of malondialdehyde (MDA), a indicators of lipid peroxidation (953).

3.2.  In Huntington’s disease, Parkinson’s disease
In neurodegeneration-like Huntington's disease and Parkinson's disease rat model, induced by 3-nitropropionic acid (3-NP). preparation of American ginseng leaves and stems significant reduced brain degeneration through its active phytochemicals, ginsenosides, Rb1, Rb3 and Rd(958), according to Baylor College of Medicine and Austin State University(957). Ginseng saponins, an active ingredients also found in ginseng species, including American ginseng also showed to exert beneficial effects on aging, central nervous system (CNS) disorders, and neurodegenerative disease through mediated protective mechanisms, including attenuated free radicals(959)(960).

3.3. In Neuroprotective effects
Pseudoginsenoside-F11 (PF11), a phytochemical of Panax quinquefolism (American ginseng) showed to exhibit its neuroprotective effect on methamphetamine (MA)-induced behavioral and neurochemical toxicities in mice(964) and  on Parkinson's disease (PD), in rat mode, in improvement of locomotor(962) by evoked neuronal excitability was mediated by increased release of glutamate(962); motor balance, coordination, and apomorphine-induced rotation, through its through inhibiting free radical formation and stimulating endogenous antioxidant release(961). According to the State Key Laboratory of Chinese Medicine and Molecular Pharmacology, water extracts of American Ginseng (WEAG) also exerted its neuroprotective effect on on SH-SY5Y cells apoptosis induced by Abeta25-35, in Alzheimer's Disease cellular model(963).

3.4. In  Cognitive impairment 
Amyloid β (Aβ) accumulation and elevated oxidative stress, and apoptosis of the neurons has shown to induce the progression of Alzheimer's disease (AD), Pseudoginsenoside-F11 (PF11) found abundantly in American ginsen, exhibited recognition improvement effect in mouse model, through its antioxidant status in inhibition ofamyloidogenesis and oxidative stress and enhancement of neuronal functions(965) as well as ameliorated cognitive impairment, neuroinflammation, and biochemical alterations caused by accumulation of intercellular messenger, nitric oxide (NO)(966).


Back to General health http://kylejnorton.blogspot.ca/p/general-health.html

Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca

Reprinted from Norton Journal, Volume I, Most Common Diseases of Ages of 50 Plus - Chapter of Diseases of Central Nervous system(CNS): Dementia - Treatments in Traditional Chinese Herbal Medicine by Kyle J. Norton  


4. Sang shen
 Sang shen also known as Mulberry or Morus Fruit, the sweet, sour and cold herb has been used in TCM as antioxidant(968)(969), antiinflammatory(969), anti ageing(991) and neuroprotective(968)(970) agent and to treat vertigo, tinnitus, insomnia, atherosclerosis(971)(973), vascular smooth muscle cells(972), lipid accumulation(974), weak digestion, premature white hair, thirst(967), diabetes(967), diarrhea, etc., as it nourishes Yin, and Blood, promotes generation of Body Fluid, moistens the Intestines, etc. by enhancing the functions of heart, liver and kidney channels(975).

Phytochemicals
1. Resveratrol
2. Anthocyanosides
3. Carotene
4. Thiamine
5. Ribflavin
6. Vtamin C
7. Vannin
8. Linoleic acid
9. Stearic acid
10. Etc.

Herbal sang shen used in the treatment and prevention of dementia(977) in traditional Chinese medicine, may be due to its effectiveness of phytochemicals in exertion of its neuroprotective effects(968)(970) through anti oxidative stress(968)(969), anti inflammatory(969) and anti excitotoxic (involved Alzheimer's disease) mechanisms(978) against cell membrane damage and mitochondrial function induced by oxygen-glucose deprivation (OGD) and glutamate-induced cell death(977).

4.1. In aging Alzheimer's disease(ADs)
Decreased the levels of serum aspartate aminotransferase caused by oxidative stress(979), alanine aminotransferase(980), triglyceride(981) and total cholesterol(982) due to ageing have shown to involve in the development of Alzheimer's disease. In ageing animals, mulberry extracts (ME), rich in phenolics and anthocyanins, significantly demonstrated  less amyloid beta protein and improved learning and memory ability through its antioxidant enzymes and reduction of oxidative damage(983).
Cyanidin-3-glucoside (C3G) fraction extracted from sang shen effectively protected primary cortical neurons in 7 days, against glutamate-induced cell death cause of dementia, including Alzheimer's disease(ADs(978) in rat model(984).

4.2. In Parkinson's disease
Parkinson's disease (PD), is one of the most common neurodegenerative disorders with result of dopaminergic deafferentation of the basal ganglia)(985) and involvement of oxidative stress(986)(987).
According to Kyung Hee University, 70 % ethanol extract of mulberry fruit (ME), in dose-dependent manner, in vitro and in vivo PD models showed to prevent 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced dopaminergic neuronal damage(999), through its antioxidant and anti-apoptotic effects, regulating reactive oxygen species and NO generation(988).
 
4.3. Neuroprotective effects
Cyanidin-3-O-beta-d-glucopyranoside (C3G) found abundantly in the mulberry fruits exerted significantly its cytoprotective effect on PC12 cells(derived from a pheochromocytoma of the rat adrenal medulla) under oxidative stress induced neuro-degenerative diseases(983)(989). In neurological disorders, including Alzheimer's and Parkinson's diseases, caused by cerebral ischemia, mulberry leaves (ML) exhibited neuroprotective actions in reduced the cytotoxicity in the PC12 cells against oxygen glucose deprivation with enhanced accumulation of gamma-aminobutyric acid (GABA)(990).

4.4. In memory improvement
In mice model, mulberry fruits extract, significantly increased pre- and post-synapse formation(992), acetylcholine synthesisation(993), neuronal cell differentiation(994), neurite outgrowth(995) and neuronal cell proliferation(996) in the hippocampus, against loss of memory through its antioxidant in protecting or enhancing neuronal functions mediated by neurotrophic factors, such as nerve growth factor (NGF)(991). According to National Chung Hsing University, in memory deterioration in ageing animals, phenolics and anthocyanins, from mulberry fruits, inhibited amyloid beta protein(998) and improved learning and memory ability through induced  higher antioxidant enzyme activity and less lipid oxidation in both the brain and liver(997).

Reprinted from Norton Journal, Volume I, Most Common Diseases of Ages of 50 Plus - Chapter of Diseases of Central Nervous system(CNS): Dementia - Treatments in Traditional Chinese Herbal Medicine by Kyle J. Norton  

Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
References
(*) http://www.hindawi.com/journals/ecam/2012/692621/ 
(842) http://www.ncbi.nlm.nih.gov/pubmed/25313575
(843) http://www.ncbi.nlm.nih.gov/pubmed/24224039
(844) http://www.ncbi.nlm.nih.gov/pubmed/23391905
(845) http://www.ncbi.nlm.nih.gov/pubmed/20451955
(846) http://www.ncbi.nlm.nih.gov/pubmed/21855622
(847) http://www.ncbi.nlm.nih.gov/pubmed/25272827
(848) http://www.ncbi.nlm.nih.gov/pubmed/23469598
(849) http://www.ncbi.nlm.nih.gov/pubmed/25525444
(850) http://www.ncbi.nlm.nih.gov/pubmed/16619340
(851) http://www.ncbi.nlm.nih.gov/pubmed/24393583
(852) http://www.ncbi.nlm.nih.gov/pubmed/17964692
(853) http://www.ncbi.nlm.nih.gov/pubmed/16890202
(854) http://www.ncbi.nlm.nih.gov/pubmed/17039773
(855) http://www.ncbi.nlm.nih.gov/pubmed/22314911
(856) http://www.ncbi.nlm.nih.gov/pubmed/19154776
(857) http://www.ncbi.nlm.nih.gov/pubmed/23703159
(858) http://www.ncbi.nlm.nih.gov/pubmed/24859152
(859) http://www.ncbi.nlm.nih.gov/pubmed/22594104
(860) http://www.ncbi.nlm.nih.gov/pubmed/25187809
(861) http://www.ncbi.nlm.nih.gov/pubmed/22320295
(862) http://www.ncbi.nlm.nih.gov/pubmed/24694662
(863) http://www.ncbi.nlm.nih.gov/pubmed/24690775
(864) http://www.ncbi.nlm.nih.gov/pubmed/17714702
(865) http://www.ncbi.nlm.nih.gov/pubmed/24932696
(866) http://www.ncbi.nlm.nih.gov/pubmed/23461850
(867) http://www.ncbi.nlm.nih.gov/pubmed/21903108 
(868) http://www.ncbi.nlm.nih.gov/pubmed/15035888
(869) http://www.ncbi.nlm.nih.gov/pubmed/18635912
(870) http://www.ncbi.nlm.nih.gov/pubmed/25625815
(871) http://www.ncbi.nlm.nih.gov/pubmed/19277659
(872) http://www.ncbi.nlm.nih.gov/pubmed/24979747
(873) http://www.ncbi.nlm.nih.gov/pubmed/23548988
(874) http://www.ncbi.nlm.nih.gov/pubmed/14737017
(875) http://www.ncbi.nlm.nih.gov/pubmed/15215639
(876) http://www.ncbi.nlm.nih.gov/pubmed/25442300
(877) http://www.ncbi.nlm.nih.gov/pubmed/24824453
(878) http://www.ncbi.nlm.nih.gov/pubmed/23147499
(879) http://www.ncbi.nlm.nih.gov/pubmed/19277974
(880) http://www.ncbi.nlm.nih.gov/pubmed/19960983
(881) http://www.ncbi.nlm.nih.gov/pubmed/18198636
(882) http://www.ncbi.nlm.nih.gov/pubmed/12435210
(883) http://www.ncbi.nlm.nih.gov/pubmed/17089329
(884) http://www.ncbi.nlm.nih.gov/pubmed/25063041
(885) http://www.ncbi.nlm.nih.gov/pubmed/20804838
(886) http://www.ncbi.nlm.nih.gov/pubmed/21273053
(887) http://www.ncbi.nlm.nih.gov/pubmed/19632285
(888) http://www.ncbi.nlm.nih.gov/pubmed/25349145
(889) http://www.ncbi.nlm.nih.gov/pubmed/24316034
(890) http://www.ncbi.nlm.nih.gov/pubmed/23717136
(891) http://www.ncbi.nlm.nih.gov/pubmed/6834589
(892) http://www.ncbi.nlm.nih.gov/pubmed/15660764
(893) http://www.ncbi.nlm.nih.gov/pubmed/16782310
(894) http://www.ncbi.nlm.nih.gov/pubmed/23301896
(895) http://www.ncbi.nlm.nih.gov/pubmed/25032018
(896) http://www.tcmassistant.com/herbs/ren-shen.html
(897) http://alternativehealing.org/ren_shen.htm
(898) http://www.ncbi.nlm.nih.gov/pubmed/18083315
(899) http://www.ncbi.nlm.nih.gov/pubmed/24854439
(900) http://www.ncbi.nlm.nih.gov/pubmed/16511867
(901) http://www.ncbi.nlm.nih.gov/pubmed/24503167
(902) http://www.ncbi.nlm.nih.gov/pubmed/23717087
(903) http://www.ncbi.nlm.nih.gov/pubmed/23789219
(904) http://www.ncbi.nlm.nih.gov/pubmed/19519302
(905) http://www.ncbi.nlm.nih.gov/pubmed/8485510
(906) http://www.ncbi.nlm.nih.gov/pubmed/25632113
(907) http://www.ncbi.nlm.nih.gov/pubmed/25568286
(908) http://www.ncbi.nlm.nih.gov/pubmed/22543851
(909) http://www.ncbi.nlm.nih.gov/pubmed/25340298
(910) http://www.ncbi.nlm.nih.gov/pubmed/22214447
(911) http://www.ncbi.nlm.nih.gov/pubmed/24975829
(912) http://www.ncbi.nlm.nih.gov/pubmed/24916704
(913) http://www.ncbi.nlm.nih.gov/pubmed/19584437 
(914) http://www.ncbi.nlm.nih.gov/pubmed/25637461
(915) http://www.ncbi.nlm.nih.gov/pubmed/25496089
(916) http://www.ncbi.nlm.nih.gov/pubmed/20196834
(917) http://www.ncbi.nlm.nih.gov/pubmed/25467144
(918) http://www.ncbi.nlm.nih.gov/pubmed/24933489
(919) http://www.ncbi.nlm.nih.gov/pubmed/25627959
(920) http://www.ncbi.nlm.nih.gov/pubmed/25573070
(921) http://www.ncbi.nlm.nih.gov/pubmed/25449909 
(922) http://www.ncbi.nlm.nih.gov/pubmed/21349320
(923) http://www.ncbi.nlm.nih.gov/pubmed/21165417
(924) http://www.ncbi.nlm.nih.gov/pubmed/19185022 
(925) http://www.ncbi.nlm.nih.gov/pubmed/23084645
(926) http://www.ncbi.nlm.nih.gov/pubmed/25550330
(927) http://www.ncbi.nlm.nih.gov/pubmed/24132508
(928) http://www.ncbi.nlm.nih.gov/pubmed/24535619
(929) http://www.ncbi.nlm.nih.gov/pubmed/24223941
(940) http://www.ncbi.nlm.nih.gov/pubmed/24535619
(941) http://www.ncbi.nlm.nih.gov/pubmed/24132508
(942) http://www.ncbi.nlm.nih.gov/pubmed/25349145
(943) http://www.ncbi.nlm.nih.gov/pubmed/24316034
(944) http://www.ncbi.nlm.nih.gov/pubmed/14637121
(945) http://www.ncbi.nlm.nih.gov/pubmed/24678300 
(946) http://alternativehealing.org/american_ginseng.htm 
(947) http://www.ncbi.nlm.nih.gov/pubmed/19415341
(948) http://www.ncbi.nlm.nih.gov/pubmed/21803872 
(949) http://www.ncbi.nlm.nih.gov/pubmed/24891873 
(950) http://www.ncbi.nlm.nih.gov/pubmed/21985167
(951) http://www.ncbi.nlm.nih.gov/pubmed/15998708
(952) http://www.ncbi.nlm.nih.gov/pubmed/22038929
(953) http://www.ncbi.nlm.nih.gov/pubmed/23541491
(954) http://www.ncbi.nlm.nih.gov/pubmed/19180962
(955) http://www.ncbi.nlm.nih.gov/pubmed/22213250
(956) http://www.ncbi.nlm.nih.gov/pubmed/24132508
(957) https://nwpf.org/stay-informed/news/2005/06/ginseng-compounds-may-fight-huntington%E2%80%99s-disease,-parkinson%E2%80%99s-disease/
(958) http://www.biospace.com/News/ginseng-substances-fight-brain-disease-in-rats/20252020
(959) Plants and phytochemicals for Huntington's disease
(960) http://www.ncbi.nlm.nih.gov/pubmed/16518078
(961) http://www.ncbi.nlm.nih.gov/pubmed/24386001 
(962) http://www.ncbi.nlm.nih.gov/pubmed/21864652 
(963) http://www.ncbi.nlm.nih.gov/pubmed/19180962 
(964) http://www.ncbi.nlm.nih.gov/pubmed/13679222 
(965) http://www.ncbi.nlm.nih.gov/pubmed/23541491 
(966) http://www.ncbi.nlm.nih.gov/pubmed/24132508 
(967) http://www.ncbi.nlm.nih.gov/pubmed/23936259
(968) http://www.ncbi.nlm.nih.gov/pubmed/25580148
(969) http://www.ncbi.nlm.nih.gov/pubmed/23957352
(970) http://www.ncbi.nlm.nih.gov/pubmed/23424869
(971) http://www.ncbi.nlm.nih.gov/pubmed/24833292
(972) http://www.ncbi.nlm.nih.gov/pubmed/25614977
(973) http://www.ncbi.nlm.nih.gov/pubmed/21619919
(974) http://www.ncbi.nlm.nih.gov/pubmed/24143244
(975) http://alternativehealing.org/sang_shen.htm
(976) http://www.ncbi.nlm.nih.gov/pubmed/22952555
(977) http://www.ncbi.nlm.nih.gov/pubmed/22359473
(978) http://www.ncbi.nlm.nih.gov/pubmed/23481689
(979) http://www.ncbi.nlm.nih.gov/pubmed/18416873
(980) http://www.researchgate.net/publication/13595646_Increased_aspartate_aminotransferase_activity_in_cerebrospinal_fluid_and_Alzheimer%27s
_disease
(981) http://www.ncbi.nlm.nih.gov/pubmed/25076901
(982) http://www.ncbi.nlm.nih.gov/pubmed/12742802
(983) http://www.ncbi.nlm.nih.gov/pubmed/?term=Morus+Fruit+aging+dementia
(984) http://www.ncbi.nlm.nih.gov/pubmed/22359473
(985) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181806/
(986) http://www.ncbi.nlm.nih.gov/pubmed/24252804
(987) http://www.ncbi.nlm.nih.gov/pubmed/12666096
(988) http://www.ncbi.nlm.nih.gov/pubmed/20187987
(989) http://www.ncbi.nlm.nih.gov/pubmed/16181734
(990) http://www.ncbi.nlm.nih.gov/pubmed/16462030
(991) http://www.ncbi.nlm.nih.gov/pubmed/23182412
(992) http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=9&ved=0CFIQFjAI&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0896627304001825&ei=_zLWVK3lKM6GyASJuoGoDQ&usg=AFQjCNEyc3lFHKLgR23BgeVDvLJlA88EPw&sig2=X0709mxdzLje7Wm8hEa0Cg&bvm=bv.85464276,d.aWw
(993) http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCQQFjAA&url=http%3A%2F%2Fnewsroom.ucla.edu%2Freleases%2Flost-memories-might-be-able-to-be-restored-new-ucla-study-indicates&ei=UTPWVL2RB4r5yATevoCYDg&usg=AFQjCNGgIpa9vkpNArifuMS8d5CLtiNfaA&sig2=Afv4YqTenwLVNXkc0Cr6Cw&bvm=bv.85464276,d.aWw
(994) http://www.ncbi.nlm.nih.gov/pubmed/17978032
(995) http://www.ncbi.nlm.nih.gov/pubmed/15010693
(996) http://www.ncbi.nlm.nih.gov/pubmed/22403568
(997) http://www.ncbi.nlm.nih.gov/pubmed/19443193
(998) http://www.ncbi.nlm.nih.gov/pubmed/23451158
(999) http://www.ncbi.nlm.nih.gov/pubmed/22403568 

Quick and Easy Healthy Kid Loved Lunch Box Recipe: Apple cheddar and peanut butter

Weight Loss the Easy Ways 
Andrea Albright Featured on Health and Fitness Jan. 2015
will Personally Coach You How to Get There The Easy Way

If You Are Looking For a SoulMate
Celebrity Patti Stanger Will Coach You To Get Him/Her
and Keep Him/Her for Good,The Simple Way


By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.
Recipes contributed by The Lunch Box, Packed with fun, healthy meals that keep them smiling, by Kate McMillan and Sarah Putman Clegg, published by Weldonowen.


Split a focaccia square in half in crosswise. Spread the cut side of 1 half with peanut butter. Top with layer of cheddar cheese slices and then a later of thin apple slices. Cover with the other half, cut side down and press gently.

Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer

Monday, 9 February 2015

(First edited)) Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) -Chronic Lower Back Pain

Weight Loss the Easy Ways 
Andrea Albright Featured on Health and Fitness Jan. 2015
will Personally Coach You How to Get There The Easy Way

If You Are Looking For a SoulMate
Celebrity Patti Stanger Will Coach You To Get Him/Her
and Keep Him/Her for Good,The Simple Way

By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Chronic Lower Back Pain

Low back pain is a Musculoskeletal disorders (MSDs) of degenerative disc disease, with pain persisted for longer than 3 months, affecting over 80% of the population in US alone some points in their life. Chronic LBP prevalence in older adults was significantly higher than the 21-to-44-year age group and inflicted more disabled, longer symptom duration, etc.(2). The unique impact of CLBP is unknown(3).

I. Signs and symptoms
1. Movement-evoked discomfort(4)
2. Hypersensitivity to cold stimuli(4)
3. Morning stiffness, as a result of inflammation due to aging causes of degenerated discs(5)
4. Sleep interruptions due to pain
5. Higher compressive axial and tensile radial strains(6)
6. Depression, anxiety disorders and adjustment disorders
In the study of 127 patients suffering from chronic back pain in multimodal inpatient pain therapy who were assessed by a psychologist, showed that there was a high prevalence of depression, anxiety disorders and adjustment disorders in patients with chronic back pain(7).
7. Pain interfered with daily living, depressive, and quality of life(8).
8. Diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain
due to chronic osteoarthritis (OA) pain and chronic low back pain (LBP)(9).
9. Metabolic syndrome
The prevalence of metabolic syndrome among chronic lower back pain patients was 36.2% (30.2% male, 38.6% female), according to Seoul Medical Center(9a)
10. Etc.

II. Causes of chronic back pain
1. Trochanteric bursitis 

Trochanteric bursitisis a clinical condition simulated major hip diseases and low back pain, it may also be mimic nerve root pressure syndrome(10).

2. Spinal stenosis
Aging population with spinal stenosis are at the higher risk of developing low back pain(11).

3. Chronic compression of the dorsal root ganglion (CCD) is associated with  Chronic Low back pain(12).

4. Cauda equina syndrome (CES)
Although each type of CES has different typical signs and symptoms, low back pain may be the most significant one, accompanied by sciatica, lower extremities weakness, saddle or perianal hypoesthesia, sexual impotence, and sphincter dysfunction(13).

5.  “Wear and tear” and “disc space loss” are associated with the development of Chronic Low back pain as a result of a progressive loss of structural integrity(14).

6. Osteoarthritis (OA), low back pain (LBP), and fibromyalgia (FM)
Although Osteoarthritis (OA), low back pain (LBP), and fibromyalgia (FM) are only poorly correlated with clinical pain, they all demonstrate abnormalities of muscles, ligaments, or joints(15).

7. Spondylitis
Spondylitis is associated with low back pain(16).

8. Extracellular matrix protein SPARC (Secreted Protein, Acidic, Rich in Cysteine) 
SPARC-null mice display behavioral signs consistent with chronic low back and radicular pain that attribute to intervertebral disc degeneration(16b). According to McGill University,  human subjects with back pain exhibit signs of disc degeneration and increased methylation of the SPARC promoter, in transient transfection assays(16a).

8. Etc.
III. Risk factors 
1. Aging
Elder is at higher risk  of chronic back pain due to discs degeneration(17a).

2. Repetitive bending and lifting can usually lead to severe back pain and sciatica over a period of 30 years as a result of ‘Annulus-driven’ disc degeneration involved a radial fissure and/or a disc prolapse(17).

3. An increased risk for incident chronic LBP if exposed twice to awkward postures(18).

4. Sex, race and Lumbar symptoms
a. Back and spine impairments were more common in women than in men, and
b. Chronic LBP  is more common among white people  than black people (38·7).
c. Lumbar symptoms were 2·86 times more likely than thoracic symptoms to become chronic(19).

5. Smoking
The prevalence of chronic LBP was 23.3% in daily smokers and only 15.7% in non-smokers. Back pain treatment programs may benefit from integrating smoking habit modification(20).

6. Psychiatric disorders are associated to the increased risk of transition to chronicity in men with first onset low back pain(21).

7. Alcohol dependency
Alcohol consumption appears to be associated with complex and chronic LBP only and in people with alcohol consumption dependence(22).

8. Others
Occupational factors, including presence of multiple functional symptoms, disease-related factors, onorganic disease, pain in the legs, significant disability at onset, a protracted initial episode, multiple recurrences,   a history of low back pain, spinal condition, etc. are all associated with higher risk to develop chronic back pain(23).

9. Etc.

IV. Diagnosis
1. Health and family history and physical exam

If you are experience low back pain, a decrease in sensation, and weakness of the extremities, the diagnosis may include a complete family history including the prior and current illnesses and injuries and a physical exam include pressure on (palpate) the spine, which may cause tenderness over the affected area. The pain may radiate along the course of a rib to the anterior chest or abdomen. Gait and posture can be affected by disc herniation that causes spinal cord compression and are usually evaluated during the physical exam(24).

2. Other tests may include 
a. X ray
b. CT scan
c. MRI
d. Radiography of the spine
e. Etc.
Clinicians should refrain from routine, immediate lumbar imaging as it does not improve clinical outcomes, in primary care patients with nonspecific, acute or subacute LBP and no indications of underlying serious conditions, experts suggested (25)(26)(27).

V. Complications
1. Mental health
 Adults aged 65 years and above with chronic impairing LBP had higher mental health scores, according to the study of a crosssectional, telephone survey of 5,357 households(28).

2. Sleep disturbance, and interleukin-6
Inflammatory processes may play a significant role in the cycles of pain and sleep disturbance. In adults with CLBP, poorer sleep quality was associated with higher pro inflammatory cytokine(IL-6) levels(29). The sleep of the patients with CLBP was significantly altered compared with that of the healthy population(30).

3. Maladaptive movement and motor control impairments
 Chronic low back pain (CLBP) disorders are more likely present with mal-adaptive primary physical and secondary cognitive compensations(31).

4. Somatic dysfunction (by the presence of any of 4 TART criteria: tissue texture abnormality, asymmetry, restriction of motion, or tenderness)
Somatic dysfunction in lumbar and sacrum/pelvis regions, is common in patients with chronic LBP, according to study(32).

5. Etc.

VI. Prevention
1. Weight loss Weight loss is associated chronic low back pain and cardiovascular risk factors, according to the study by Natural Wellness and Pain Relief Centers of Michigan(33).

2. Tai Chi
Ancient health art of Tai Chi may contribute to chronic pain management in 3 major areas: adaptive exercise, mind-body interaction, and meditation. Tai Chi seems to be an effective intervention in osteoarthritis, low back pain, and fibromyalgia(34).

3. Moderate alcohol consumption and quit smoking
Alcohol dependency and smoking are the risk factors of chronic low back pain.

4. Moderate exercise
Moderate exercise are associated to reduced risk of chronic low back pain as it increases oxygenation and blood circulation in the body(35).

5. Avoid recurrent Low back injure
Recurrent Low back injure and injure which has been not treated well may come back to haunt you when you get older, according to traditional Chinese medicine.

6. Yoga 
According to a randomized control single blind active study in an residential Holistic Health Centre in Bangalore, India, assigned 80 patients (37 female, 43 male) with CLBP, seven days intensive residential Yoga program showed to reduce pain, anxiety, and depression, and improved spinal mobility(36).

7. Healthy diet including calcium and vitamin D can prevent osteoporosis causes of chronic low back pain.

8. Etc.

VII. Treatments
A. In conventional medicine perspective

A.1. Non surgical treatment
1. Exercise therapy
Exercise therapy is the most widely used type of conservative treatment for low back pain as it improved post-treatment pain intensity and disability, and long-term function(38). The therapy is effective for chronic but not for acute low back pain, some study suggested(37). Impairment-based manual therapy and exercise directed at the hip joints, showed effectively in improvements in pain, function, and disability in patients with CLBP(39).

2. Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a beneficial treatment for chronic nonspecific back pain, as its improvements in a wide range of relevant cognitive, behavioral and physical variables, according to the study by Uni Health, Uni Research, Bergen, Norway(40).

3.   Medication
The range of regularly prescribed pharmacological agents to treat Chronic Low back pain extends from nonopioids (paracetamol, NSAIDs, and COX-2 inhibitors) to opioids, antidepressants and anticonvulsants(42).


3.1. Non-steroidal anti-inflammatory drugs (NSAIDs)
Transdermal fentanyl significantly improved visual analog scale scores and Oswestry Disability Index scores in 73% of patients, especially those with specific low back pain awaiting surgery(43).
Side effects include  nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, drowsiness, etc.

3.2. Opioids 
Tapentadol’s μ-opioid agonism shows a greater contribution to analgesia in acute pain with fewer adverse events. Noradrenaline reuptake inhibition shows a greater contribution in chronic neuropathic pain models, according to the study by Johns Hopkins University School of Medicine(44)
Side effects include Nausea, dizziness, constipation, CNS sedation, etc.

3.3. Antidepressants
Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are a class of medication used as antidepressants in the treatment of depression, anxiety disorders, and some other disorders. According to study, visual analog scale scores were similar in patients taking versus those not taking SSRIs/SNRIs throughout the study(45).
Side effects include  nausea/vomiting, drowsiness, headache, bruxism, tinnitus, extremely vivid or strange dreams, dizziness, fatigue, etc.

3.4. Anticonvulsants 
Anticonvulsants benzodiazepines, the medication used in the treatment of epileptic seizures has been used as adjunctive medications for acute low back pain, with high incidence of sedation(46).
Side effects are not limited to dependency, rebound anxiety, memory impairment, discontinuation syndrome, muscle weakness, dizziness, mental confusion, depression, etc.

3.5. Antispasmodic drug
Eperisone had an analgesic and muscle relaxant effect in patients with LBP.  The drug may represents a valuable alternative to traditional analgesics and muscle relaxants for the treatment of LBP, according to the study by Service of Rehabilitation and Functional Reeducation, S. Orsola-Malpighi Hospital, Bologna(47).
Side effects are not limited to redness, itching, urticaria, edema, rash, pruritus, sleepiness, insomnia, headache, nausea and vomiting, anorexia, abdominal pain, etc.

4. Injection
In the comparison of the clinical effectiveness of FJ injections (FJI) and  denervation in patients with chronic low back pain, found that the FJ injections (FJI) is usually the first choice should be for treatment of Chronic LBP patients. If pain reoccurs after a period of time or injection is not effective, FJ radiofrequency (FJRF) procedure should be used for replaced treatment(47a).

5. Others
According to Avalon Health Solutions, beside conventional medicine, use of alternative treatments included: chiropractor, OA 11%, CLBP 34%; physical therapy, 20% in both groups; transcutaneous electrical nerve stimulations (TENS), OA 14%, CLBP 22%; acupuncture, hydrotherapy, massage therapy, and biofeedback, <3%(48).
Multidisciplinary rehabilitation program and oral drug treatment and oral drug treatment alone, improve most domains of quality of life in chronic low back pain patients in the 6-month period(49).
Biopsychosocial rehabilitation and intensive individual therapist-assisted back muscle strengthening exercises, showed  a long-term improvements in pain and disability scores(50).

A.2.  Surgical treatments
Most patients with back pain will not be beneficiary from surgery as it is only performed when conservative treatment is not effective in reducing pain or  if anatomic abnormalities consistent with the distribution of pain are identified. The most common types of low back surgery include
1. Microdiscectomy
Many patients may be symptomatic following LMD, significant disability and dissatisfaction are uncommon. Female sex, young age, lack of exercise, and chronic preoperative LBP may predict a worse outcome. Disc collapse is a universal finding, particularly at L4-L5. Neither DSC nor Modic changes seem to affect patient outcome, according to the retrospective cohort study of patients who underwent LMD in 2004-2005(51).

2. Discectomy(SD)
Recurrent or persistent low back pain (LBP) after surgical discectomy (SD) for intervertebral disc herniation has been well documented(52).

3. Laminectomy is a most minimally invasive surgical procedure removed a portion of the vertebral bone called the lamina, through a small skin incisions(53).

4. Spinal fusion is a surgical procedure to join two or more vertebrae,  either from the patient (autograft) or a donor (allograft), for stimulation of natural bone growth.
According to study, no subset of patients with chronic LBP could be identified for whom spinal fusion with a predictable and effective treatment(54). The surgical procedure showed a strong evidence in support the treatment of back pain caused by fractures, infections, progressive deformity, or instability with spondylolisthesis(57). Spinal fusion may be effective than standard rehabilitation for improving pain in people with chronic non-radicular low back pain, but it is no better than intensive rehabilitation with a cognitive behavioural component(56) but associated with a 16% pooled rate of early complication(55)

5. Etc.

B. In herbal medicine perspective
 Moderate evidences suggested the use of  Salix alba (White willow bark) for short-term improvements in pain acomparable to medication for daily doses standardized to 120 mg or 240 mg salicin with an additional trial demonstrating relative equivalence to 12.5 mg per day of rofecoxib(58).

C. In traditional Chinese medicine perspective 
1. Acupuncture
 Acupuncture needling showed effectively in treatment for patients of chronic low back pain, according to the study of a total of 640 participants (160 in each of four arms) between the ages of 18 and 70 years of age who have low back pain lasting at least 3 months recruited from integrated health care delivery systems in Seattle and Oakland(59). Patients with chronic low back pain with severe baseline dysfunction had mau be also beneficary in most short-term benefit from acupuncture, according to the study of Characteristics of patients with chronic back pain who benefit from acupuncture(60).

2. Herbs
2.1. Traditional Chinese medicine interprets chronic lower back pain as of results of
(1) “Qi and/or Blood StagnationÈ with symptoms of piercing pain; activity limited by feeling of local heaviness, lumbar and flank stiffness with bending limitation and purple tongue, etc.;

(2) “Cold/Damp,” with symptoms of Cold/Damp pain, pallid face and greasy coating, etc.

(3) Kidney Deficiency,” with symptoms of dull pain and recurrent vague pain.

(4) “Warmth/Heat,” with symptoms of purple tongue, yellow tongue coating, and burning pain(61).

2.2. Herbal formulas (Please consult with your traditional Chinese medicine practitioner before applying)
a. Shen Tong Zhu Yu Wan (Shen Tong Zhu Yu Pian), a Chinese herbal formula, used to treat shoulder pain, pain in the arm, lumbago, pain in the leg or pain in the entire body due to obstruction of the flow of Qi and blood in channels. promotes blood circulation and Qi, removes blood stasis and obstruction in the channels, alleviates blood-arthralgia and pain.
b. Ingredients
 Radix Gentianae Macrophyllae (Qin Jiao), Rhizoma Chuanxiong (Chuan Xiong), Semen Persicae (Tao Ren), Flos Carthami (Hong Hua), Radix Glycyrrhizae (Gan Cao), Rhizoma Et Radix Notopterygii (Qiang Huo), Resina Commiphorae (Mei Yao), Radix Angelica Sinensis (Dang Gui), Rhizoma Cyperi (Xiang Fu), Radix Achyranthis Bidentatae (Niu Xi), Phertima (Di Long), Rhizoma Wenyujin Concisa (Jiang Huang), Rhizoma Corydalis (Yan Hu Suo)(61a).

2. Liu Wei Di Huang Wan (Kidney Yin deficiency)
a. Liu Wei Di Huang Wan can replenish Yin due to the Yin insufficiency of the kidney, the innate foundation of all organs with respect to the Yin-Yang principles, Qi essence etc.
b. Ingredients
Radix Rehmanniae Preparata (Shu Di Huang), Fructus Corni Officinalis (Shan Zhu Yu), Cortex Moutan Radicis (Mu Dan Pi), Rhizoma Dioscoreae Oppositae (Shan Yao), Sclerotium Poriae Cocos (Fu Ling), Rhizoma Alismatis Orientalis (Ze Xie)(61b).

3. Jin Kui Shen Qi Wan (Kidney Yang deficiency)
a. Jin Kui Shen Qi Wan can replenish Yang due to the Yang insufficiency of the kidney, the innate foundation of all organs with respect to the Yin-Yang principles, Qi essence etc.
b. Ingredients
Radix Rehmanniae Preparata (Shu Di Huang), Fructus Corni officinalis (Shan Zhu Yu), Rhizoma Dioscoreae Oppositae ((Shan Yao), Cortex Moutan Radicis (Mu Dan Pi), Sclerotium Poriae Cocos (Fu Ling), Rhizoma Alismatis Orientalis (Ze Xie), Cortex Cinnamomi Cassiae (Rou Gui), Radix Aconiti Lateralis Preparata (Zhi Fu Zi), Radix Achyranthis Bidentatae (Niu Xi), Radix Polygoni Multiflori (He Shou Wu), Fructus Lycii Chinensis (Gou Qi Zi),  Fructus Schisandrae Chinensis (Wu Wei Zi(61c).

D. TCM and conventional medicine baclofen 
Acupuncture and acupuncture + baclofen which is used as a muscle relaxer ufor treatment tof muscle symptoms , showed a significantly higher reduction and improvement in a Visual Analogue Scale (VAS) and Roland Disability Questionnaire (medical questionnaire, RDQ) score in patient with chronic lower back pain, according to a randomised controlled clinical trial(62)


Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer

References
(a) http://en.wikipedia.org/wiki/Low_back_pain 
(1) https://www.mja.com.au/journal/2004/180/2/management-chronic-low-back-pain
(2) http://jah.sagepub.com/content/22/8/1213.refs
(3) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2065872/
(4) http://www.ncbi.nlm.nih.gov/pubmed/20714283
(5) http://www.ncbi.nlm.nih.gov/pubmed/17543240
(6) http://www.ncbi.nlm.nih.gov/pubmed/21337394
(7) http://www.ncbi.nlm.nih.gov/pubmed/23149491
(8) http://www.ncbi.nlm.nih.gov/pubmed/11845338
(9) http://www.ncbi.nlm.nih.gov/pubmed/22716295
(10) http://www.ncbi.nlm.nih.gov/pubmed/15587030
(11) http://www.ncbi.nlm.nih.gov/pubmed/22828693
(12) http://www.ncbi.nlm.nih.gov/pubmed/23054639
(13) http://www.ncbi.nlm.nih.gov/pubmed/19493474
(14) http://www.ncbi.nlm.nih.gov/pubmed/20838269
(15) http://www.ncbi.nlm.nih.gov/pubmed/21833699
(16) http://www.ncbi.nlm.nih.gov/pubmed/21952186
(16a) http://www.ncbi.nlm.nih.gov/pubmed/21867537
(16b) http://www.ncbi.nlm.nih.gov/pubmed/20714283
(17) http://www.ncbi.nlm.nih.gov/pubmed/22881295 
(17a) http://www.ncbi.nlm.nih.gov/pubmed/22892966
(18) http://www.ncbi.nlm.nih.gov/pubmed/21897339
(19) http://www.societyns.org/runn/2008/andersson_pain.pdf
(20) http://www.ncbi.nlm.nih.gov/pubmed/19796577
(21) http://www.ncbi.nlm.nih.gov/pubmed/20735749 
(22) http://www.ncbi.nlm.nih.gov/pubmed/23146385
(23) http://www.ncbi.nlm.nih.gov/pubmed/9090769
(24) http://www.mdguidelines.com/degeneration-thoracic-or-thoracolumbar-intervertebral-disc
(25) http://www.ncbi.nlm.nih.gov/pubmed/21214357.
(26)  http://www.ncbi.nlm.nih.gov/pubmed/11701101
(27) http://www.ncbi.nlm.nih.gov/pubmed/19200918
(28) http://jah.sagepub.com/content/22/8/1213.full.pdf+html
(29) http://www.ncbi.nlm.nih.gov/pubmed/21188850.
(30) http://www.ncbi.nlm.nih.gov/pubmed/18389288
(31) http://www.ncbi.nlm.nih.gov/pubmed/16154380
(32) http://www.ncbi.nlm.nih.gov/pubmed/22802542
(33) http://www.ncbi.nlm.nih.gov/pubmed/22654693
(34) http://www.ncbi.nlm.nih.gov/pubmed/22609642 
(35) http://www.ncbi.nlm.nih.gov/pubmed/23131528
(36) http://www.ncbi.nlm.nih.gov/pubmed/22500659
(37) http://www.ncbi.nlm.nih.gov/pubmed/20227641
(38) http://www.ncbi.nlm.nih.gov/pubmed/15867410
(39) http://www.ncbi.nlm.nih.gov/pubmed/22547920 
(40) http://www.ncbi.nlm.nih.gov/pubmed/23091394
(42) http://www.ncbi.nlm.nih.gov/pubmed/21887117
(43) http://www.ncbi.nlm.nih.gov/pubmed/22665347
(44) http://www.ncbi.nlm.nih.gov/pubmed/21887117
(45) http://www.ncbi.nlm.nih.gov/pubmed/22437221
(46) http://www.ncbi.nlm.nih.gov/pubmed/20205483
(47) http://www.ncbi.nlm.nih.gov/pubmed/18836866
(47a) http://www.ncbi.nlm.nih.gov/pubmed/22437295
(48) http://www.ncbi.nlm.nih.gov/pubmed/22304678
(49) http://www.ncbi.nlm.nih.gov/pubmed/21642845 
(50) http://www.ncbi.nlm.nih.gov/pubmed/20147878
(51) http://www.ncbi.nlm.nih.gov/pubmed/21515503
(52) http://www.ncbi.nlm.nih.gov/pubmed/18164474
(58) http://www.ncbi.nlm.nih.gov/pubmed/17202897
(59) http://www.ncbi.nlm.nih.gov/pubmed/18307808
(60) http://www.ncbi.nlm.nih.gov/pubmed/19772583
(61) http://www.ncbi.nlm.nih.gov/pubmed/21204636
(61a) http://www.yinyanghouse.com/store/catalog/herbal-supplements/shen-tong-zhu-yu-wan-shoulder-leg-back-pain-herbal-formula
(61b) http://www.activeherb.com/yinvive/
(61c) http://www.activeherb.com/yanvive/
(62) http://www.cmjournal.org/content/5/1/15