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Bruce's BLOG

Monday, June 23, 2008

12:47PM - June 23, 2008

Just finished a much needed refresh of the website at http://aplasticcentral.com. Cleaned out a bunch of junk that had accumulated, fixed broken links and updated the entry pages. If anyone actually reads this, please leave me a comment. I really wonder if anyone uses the website anymore. The forum also seems to have much less activity than it did in the past.

Tuesday, May 20, 2008

9:36PM - Update

I just keep hanging around. Not feeling great but not feeling all that bad. I anticipate that I will be back on the transfusion band wagon again. Had one in March and am already feeling drained at times - have a doctor appointment in July so will see how it goes.

Friday, July 20, 2007

7:19PM - TCM Update

As mentioned on the Toast Forum at http://apasticcentral.com, it has been four full months since my last blood transfusion so I remain cautiously optimstic that whatever I am doing is working to some extent. So for the record, here is what I am doing:

Daily sauna and "treatment" as outlined oft before - see
http://aplasticcentral.com/aplastic_healing.htm and
http://aplasticcentral.com/Holistic_Medicine/coffee_enema.htm .

I have backed off a bit on the number of supplemental vitamins etc. and am trying to get my nutrition the natural way.

I have added a daily dose of customized herbal treatment (10 different herbs especially blended to tonfigy the blood, liver etc.) and do daily accupressure on four points

1) Hand at the point where thumb and forefinger come together (there is like a bone spur there that you can feel)
2) Inside arm at a point 2 fingers below the elbow
3) Inside calf a palm's lenght below the bottom of the knee
4) Foot where big toe and first tow join on the top

I put a finger tip pressure on each area on both sides of the body for 1 1/2 - 2 minutes each.

Most days I have tremendous energy and am getting back to where I was several years ago.

CAUTION - If you are taking any prespecription drugs, consult with your doctor before experimenting with herbs as there is a danger of contra indicators. My Hematologist is aware of what I am doing and agrees that whatever I am doing appears to be working. Unfortunately not all doctors are as open minded so please check with your doctor before trying any of this stuff or at least be off conventional meds that may negatively interact with this strategy.

Humbly yours,

The Original and still trying AA/MDS Guinea Pig

Monday, May 28, 2007

10:28PM - Biochemistry, Molecular Bilogy and Genetics

Understanding the interrelationship between Biochmeistry, Molecular Biology and Genetics will go a long way in helping me better understand Aplastic and MDS. See link below and wiki the three subject areas.

http://en.wikipedia.org/wiki/Image:Schematic_relationship_between_biochemistry%2C_genetics_and_molecular_biology.svg

Tuesday, April 10, 2007

11:41AM - Bruce and TCM

Thanks to Grace, Michelle's college roommate and her friend Brian I will be entering the world of TCM. I have now had two acupuncture treatments, will have 2-3 more and then will be provided herbal treatments and advice on how to stimulate my nerve pathways. I am really looking forward to this and will report on progress.

Tuesday, March 20, 2007

5:11PM - Progress Report

I am officially "predictable" according to my new doctor. Every 2 months, my counts will have crashed and I will need PRBC's. I push myself to be able to do what I want but never truly have the energy any more. Oh well. Things could be worse. My hemoglobin was at an all time low post original admission 8.2 and platelets are at 18. Not very encouraging given all the vitamins and minerals etc I am taking. I will also be getting one of my favorite procedures next appointmen - Bone Marrow Biopsy - Whoopee! Dr. Brodkin wants to have his own benchmmark which makes sense to me.

Wednesday, January 3, 2007

9:54AM - Cancer Research

Cancer research not affiliated with Pharma companies - found this link at the MDS forum

http://cancerfocus.net/

Friday, December 29, 2006

7:54AM - Early Life Events and Consequences

Feature Article
Early life events and their consequences for later disease: A life history and evolutionary perspective
Peter D. Gluckman 1 2 *, Mark A. Hanson 2, Alan S. Beedle 1
1Liggins Institute, University of Auckland, and National Research Centre for Growth and Development, Private Bag 92019, Auckland, New Zealand
2Centre for Developmental Origins of Health and Disease, University of Southampton, Southampton SO16 5YA, United Kingdom

email: Peter D. Gluckman (pd.gluckman@auckland.ac.nz)

*Correspondence to Peter D. Gluckman, Liggins Institute, University of Auckland, Private Bag 92019, Auckland, New Zealand

Funded by:
British Heart Foundation

Abstract
Biomedical science has little considered the relevance of life history theory and evolutionary and ecological developmental biology to clinical medicine. However, the observations that early life influences can alter later disease risk - the developmental origins of health and disease (DOHaD) paradigm - have led to a recognition that these perspectives can inform our understanding of human biology. We propose that the DOHaD phenomenon can be considered as a subset of the broader processes of developmental plasticity by which organisms adapt to their environment during their life course. Such adaptive processes allow genotypic variation to be preserved through transient environmental changes. Cues for plasticity operate particularly during early development; they may affect a single organ or system, but generally they induce integrated adjustments in the mature phenotype, a process underpinned by epigenetic mechanisms and influenced by prediction of the mature environment. In mammals, an adverse intrauterine environment results in an integrated suite of responses, suggesting the involvement of a few key regulatory genes, that resets the developmental trajectory in expectation of poor postnatal conditions. Mismatch between the anticipated and the actual mature environment exposes the organism to risk of adverse consequences - the greater the mismatch, the greater the risk. For humans, prediction is inaccurate for many individuals because of changes in the postnatal environment toward energy-dense nutrition and low energy expenditure, contributing to the epidemic of chronic noncommunicable disease. This view of human disease from the perspectives of life history biology and evolutionary theory offers new approaches to prevention, diagnosis and intervention. Am. J. Hum. Biol. 19:1-19, 2007. © 2006 Wiley-Liss, Inc. © 2006 Wiley-Liss, Inc.



--------------------------------------------------------------------------------
Received: 1 June 2006; Revised: 17 August 2006; Accepted: 29 August 2006
Digital Object Identifier (DOI)

Wednesday, December 27, 2006

12:51PM - 2006 Holiday Update

Well, I'm still here and it's coming up on the 5th anniversay of my diagnosis. When I first started the website and dealing with AA, you would have thought I was the first person ever to deal with a life threatening diagnosis. As time goes by, I realize that my situation is nothing compared to many others who fight much more difficult situations. I am trying to move on and only deal with my illness as an inconvenience that requires me to stop in for a little blood once in awhile.

I still must be extremely dilligent about avoiding stress, over-extending, physical exertion, exposure to colds, flu, etc, but otherwise lead a pretty normal semi-retired existence.

I've spent some time updating the website and am trying to learn more about RSS to allow automatic news feeds. It has also been suggested that I revive the data collection effot so plan to do that in the next couple of weeks. Previous attempts always got hacked into and created lots of extra work. Maybe I'll discuss the issue with my host company. It will probably require some kind of registration process and I'll actually post on the forum and see how many people respond. That will be my clue.

So for now, I am back to needing transfusions about every 2 months but may see if I can extend a bit. Most days I feel pretty strong but every once in a while I get knocked on by kiester as a reminder that all is not normal. At times like that, I try to lay really low and avoid anything that may cause a serious relapse.

Merry Christmas and Happy New Year to anyone who still reads this.

Monday, November 20, 2006

9:16AM - Platelets Up, Ferratin Down, Transfusion on 11/16

Positive news for a change. Platelets are at 26! Go pineapple! Sue is feeding me 1/4 of a pineapple every day based on readings from Dr. Raza. I have not seen that level in about 2 years. Hemoglobin was down to 8.3 so I had to have blood but I seem to remember that last time I became transfusion independent, platelets were the first to increase. Will be checking into that later. Right now I am on the way to Watertown (snowing up here - what is wrong with this picuture? I thought I moved to Carolina to get away from this stuff!)

Exjade report - after the rash I stopped but according to Martha, a very nice PA at Dr. Brodkin/s office, my ferratin level dropped from 1300 to 800 - she thinks that is quite remarkable. I took 1/2 dose yesterday and had a very minor reaction so will try taking it every other day at 1/2 dose.

Feeling very strong with my new blood - I was pretty weak prior to the latest transfusion. Had trouble even making it up a flight of stairs again. But Sunday, I carried a 4x8 sheet of plywood up the stairs and worked all day framing in the attic and still had energy to burn.

Friday, October 27, 2006

8:02PM - Back on the Wagon

I am officially back on my protocol and have been since Dr. Brodkin delivered my counts on October 20th. Hemoglobin down to 9.1, WBC count consistenly below 2 and Platelets still in the 13 range. I don't track them as closely as I used to but will have to start paying attention again and am hoping that getting back with the program will reverse the downward slide.

I am taking more supplements than I can keep track of, on a modified rotational diet with lots of grains, greens, beans, roots, fruits, weeds and seeds. Loading on carrots, carrot juic, bananas, pineapple, brown rice, organic lettuce (now have to be concerned about e-coli?) and all the good stuff I can think of. No popcorn, dairy, chocolate, alcohol, processed foods, Bojangles or McD's for me! Based on past experience the first week is the toughest. I made it through that with Sue's help so here's hoping I can make it work.

I'm light headed from low RBC's but otherwise able to function pretty well. Am unable to do anything strenuous but otherwise life is good.

Thursday, October 12, 2006

12:35PM - Exjade

With a great deal of reluctance (I really don't like drugs!), I started on exjade yesterday after having baseline for vision and hearing - I can't see or hear already but I guess it could get worse. I'll be watching for side effects and post here if anything out of the ordinary happens.

Wednesday, October 4, 2006

8:09PM - Settled in North Carolina

OK, so I am settled in North Carolina and wondering how important getting away from the Northeast will be in my healing process. I have long believed that the constant nasal congestion is in a large part due to the climate so we'll see. So far, I seem to be much less congested and I will not miss the cold and grey days. I have received 2 transfusions in the last 4 months so no demonstrable progress on that front. I am finally settling into some kind of a routine in the new house after multiple moving trips so will be anxious to see if this transfusion holds me or not. I am taking the full compliment of Dr. Rogers recommnedaitons - about 30 different things in total - A real pain but will give it until they run out to see if anything chanes.

Wednesday, May 31, 2006

10:27PM - Leaky Gut Syndrome

Leaky gut syndrome
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Intestinal permeability or leaky gut syndrome is the term used to describe a situation where the lining of the gut has become damaged, allowing things which would normally be contained within the gut to leak into the bloodstream. Leaky gut syndrome can be caused by candidiasis, where the yeast Candida albicans burrows through the gut wall, causing increased permeability. The food which leaks into the bloodstream is then attacked by the immune system, which becomes overloaded.

Nutritionists claim that leaky gut syndrome can cause food intolerances and an overload on the liver. It is sometimes treated with the amino acid glutamine, but the candida overgrowth must be brought under control first.

It has become commonplace for people to mistakenly self-diagnose themselves with 'Leaky gut syndrome' in place of a simply treated acid indigestion problem, because of strong food odors that permeate from their bodies.

A useful approach may also be found in the thinking of other doctors. They break down such cases into a cycle of allergic reaction (usually dietary), malnutrition, bacterial disequilibrium, then the resultant strain on liver function and expression of relevant symptoms.

Based on patient lab tests, a physician can ascertain the likely systemic cause of the situation, then goes about an appropriate course of treatment; generally meaning a person first avoids their allergens, then rids themselves of internal problem microgrowth (sometimes with antibiotics), then builds back their immunity, with a basic rotation diet of natural unprocessed food supplemented with vitamins, minerals, amino acids, probiotics, and herbs.



http://osiris.sunderland.ac.uk/autism/gut.htm

The purpose of the gastro-intestinal tract, or gut, is multi-fold. Basically, it:

i) Digests foods,
ii) Absorbs small food particles to be converted into energy.
iii) Carries nutrients like vitamins and minerals attached to carrier proteins across the gut lining into the bloodstream.
iv) Contains a major part of the chemical detoxification system of the body, and
v) Contains immunoglobulins or antibodies that act as the first line of defence against infection.



The leaky gut (or LGS) is a poorly recognised but extremely common problem. It is rarely tested for. Essentially, it represents a hyperpermeable intestinal lining. In other words, large spaces develop between the cells of the gut wall, and bacteria, toxins and food leak in.

The official definition is an increase in permeability of the intestinal mucosa to luminal macromolecules, antigens and toxins associated with inflammatory degenerative and/or atrophic mucosal damage.

If the gut is not healthy, neither is the rest of the body. It is the point of fuel and nutrient entry. If healing is at a standstill look at the gut to see if this is the block. Chemical sensitivity, fibromyalgia and escalating food allergies are among the many problems caused by the leaky gut.
If gas, bloating, abdominal pain, indigestion, alternating constipation and diarrhoea are symptoms, irritable bowel syndrome may not be all that's going on.


The Mucosal Barrier
The barrier posed by the intestinal mucosa is, even in normal subjects, an incomplete one. Small quantities of molecules of different sizes and characteristics cross the intact epithelium by both active and passive mechanisms. The route by which such transfer occurs is, at least in part, dependent on molecular size. Molecules up to about 5000 Daltons in size cross the epithelial membrane of the microvilli. Larger molecules may utilise an intercellular pathway or depend on being taken up by endocytosis entering the cell at the base of the microvilli.


How Does The Gut Become Leaky?
Once the gut lining becomes inflamed or damaged, this disrupts the functioning of the system. The spaces open up and allow large food antigens, for example, to be absorbed into the body. Normally the body sees only tiny food antigens. When it sees these new, larger ones, they are foreign to the body's defence system. So the attack results in the production of antibodies against once harmless, innocuous foods.


Isn't Leakier Better?
It might sound good that the gut can become leaky, because it would seem that the body would be better able to absorb more amino acids, essential fatty acids, minerals and vitamins. For the body to absorb a mineral it does not just slowly diffuse across the gut membrane it must be attached to a carrier protein. This protein hooks onto the mineral and actually carries it across the gut wall into the bloodstream. However, when the intestinal lining is damaged through inflammation these carrier proteins get damaged as well, so now the victim is vulnerable to developing mineral and vitamin deficiencies.


The 7 stages of the 'inflamed’ gut.
1 . When the gut is inflamed, it does not absorb nutrients and foods properly and so fatigue and bloating can occur.
2. As mentioned previously, when large food particles are absorbed there is the creation of food allergies and new symptoms with target organs, such as arthritis or fibromyalgia.
3. When the gut is inflamed the carrier proteins are damaged so nutrient deficiencies occur which can also cause any symptom, like magnesium deficiency induced muscle spasm or copper deficiency induced high cholesterol.
4. Likewise when the detox pathways that line the gut are compromised, chemical sensitivity can arise. Furthermore the leakage of toxins overburdens the liver so that the body is less able to handle everyday chemicals.
5. When the gut lining is inflamed the protective coating of lgA (immunoglobulin A) is adversely affected and the body is not able to ward off protozoa, bacteria, viruses and yeast’s like candida.
6. When the intestinal lining is inflamed, bacteria and yeast’s are able to translocate. This means that they are able to pass from the gut lumen or cavity, into the bloodstream and set up infection anywhere else in the body.
7. The worst symptom is the formation of antibodies. Sometimes these leak across and look similar to antigens on our own tissues. Consequently, when an antibody is made to attack it, it also attacks our tissue. This is probably how autoimmune disease s tart. Rheumatoid arthritis, lupus, multiple sclerosis, thyroiditis and many others are members of this ever-growing category of ‘incurable’ diseases.

http://www.mdheal.org/leakygut.htm

Sunday, May 21, 2006

1:12AM - In Search of Knowledge

http://en.wikipedia.org/wiki/List_of_laws_in_science

Occam's razor states that the explanation of any phenomenon should make as few assumptions as possible, eliminating those that make no difference in the observable predictions of the explanatory hypothesis or theory

The razor's strict form, which prohibits irrelevant assumptions in a given theory, is justified by the fact that all assumptions introduce possibilities for error. If an assumption does not improve the accuracy of a theory, its only effect is to make the theory more error-prone, and since error is undesirable in any theory, unnecessary assumptions should be avoided.

The common form of the razor, used to distinguish between equally explanatory theories, can be supported by appeals to the practical value of simplicity. Theories exist to give accurate explanations of phenomena, and simplicity is a valuable aspect of an explanation because it makes the explanation easier to understand and work with. Thus, if two theories are equally accurate and neither appears more probable than the other, the simple one is to be preferred over the complicated one, because simplicity is valuable.

Occam's razor has become a basic tool for those who follow the scientific method. The primary activity of science — formulating theories and selecting the most promising ones — is impossible without a way of choosing from among the theories which fit the evidence equally well, the number of which can be arbitrarily large (see underdetermination).

"Theories should be as simple as possible, but no simpler." Einstein

the popular rephrasing of the razor - that "The simplest explanation is the best one" - can lead to a gross oversimplification when the word simple is taken at face value

http://www.loveoftruth.org/ Ian Wolstenholme

...the Western mind is extremely sophisticated. It needs to be given information. So the first piece of information that I communicate to people is that we have all been conditioned to believe that we are one person, but we are actually made up of many parts...many behaviors and emotional states, each one with a script that gets played out when the part is triggered. And then there is the part I call the "Seer." This is the part that Buddha talked about to his disciples, the place of the Present or nonduality. The Seer is a space that everybody has experienced. It is only when we go into one of our conditioned selves that we become "dual." And in order to locate ourselves as the Seer of our experience, all we have to do is make the distinction between that and the many other parts of the self.

when not in the Seer part — the part that is in the Present — one must be in a part of oneself that comes from the past, andd that part will do everything it can to get other people to play their parts in that script....resentment, blame, excuses, etc. Step back from the script and view everything from the point of view of the Seer - this is the beginning of understanding. A Seer will see things for what they are, not what we want them to be.

Saturday, May 20, 2006

9:20AM - Yeast & Fungal Infection

Breaking this whole concept out as a seaparte research thread. This theory says that my yeast overgrowth causes leaky gut or some similar malady that mannifests itself in a normal person with fatigue, discomfort, fibromyalgia and all those other wierd sounding illnesses. In my case, the bacteria or yeast or fungus or whatever has leaked out of my gut, into my bloodstream and on into my bone marrow where it is causing my stem cells to be improperly formed. So...is there a causal link between fungal, bacterial or viral afflictions and BMD?

Following this because of the findings in the ION panel about d-arabitol (arabinitol)and d-lactate.

43) I am high in D Lactate (1.1)D lactate - Clostridial Species is a bacteria (anerobic spore formin rods found in soil and the gut) General intestinal microbial overgrowth leads to a wide variety of sypmtoms due to reactions produced by bacteria, parasite or fungi. - Should I be taking the Probiotics from Metalife (John) If you fail to digest protein Exception to the use of Probiotics
D-lactate is neurotoxic (poisonous or destructive to nerve tissue) at elevated concentrations - induced by carbohydrate malabsorption. - Do I have this issue? If high, it causes intestinal bacterial overgrowth of If multiple

45) High d-arabinitol is uniquely produced by intestinal yeast and the degree of elevation is a useful marker of its growth. These results indicate that I am high in candida yeast resulting in "Invasive Candidiasis" which is a serious condition that affects thousands of patients. Candida is a yeast that normally inhabits a healthy colon in small numbers. However, in many cases, the yeast becomes so prolific that it escapes the confines of the intestinal tract and causes havoc throughout the rest of the body creating a condition termed invasive Candidiasis. These microorganisms produce gas and toxins that irritate and can damage tissues, glands, or organs and severely compromise the immune system. Various autoimmune conditions are linked to Candidiasis, where cross reactivity (molecular mimicry) with human tissue and Candida organisms has occurred. Anti Fungals - Yeast is another class of microbes that can chronically grow in the intestinal tract through the release of toxic metabolytes. Yeast overgrowth can be caused by excessive sugar, alcohol, antibiotics, and breads. So, do I have yeast overgrowth and should I be taking anti fungal agents? (See next item) I need to read about yeast overgrowth.

http://www.doctorfungus.org/


Viral, bacterial, fungal or some combination of many? My pre cursors to BMD = Chronic sinusitis, sore throats, allergies, menengitis, shingles.

Diseases and Infestations Produced by the Fungi Diseases and Infestations Produced by the Fungi

Mycology is the branch of biology that deals with the study of fungi. In this section of the site we provide discussions of the ways that fungi can cause disease or infestations of humans, animals, plants, and inanimate environmental surfaces.

Site Development Status: At present, the web pages are only developed for the diseases of people, and those pages are best developed for candidiasis. But, we are actively developing content in the other areas!

http://www.doctorfungus.org/mycoses/human/human_index.htm

NOTE - It appears that fungal overgrowth is a RESULT of neutropenia rather than a CAUSE of BMD. - This may be chasing the wrong theory altogether - need to hear what Dr. Rogers has to say.

Sunday, May 7, 2006

11:19AM - Similar Illnesses & Foundations

http://www.clfoundation.org/

http://www.ncrr.nih.gov/clinical/rdcrn_studylist.asp#RochesterNY

http://rarediseasesnetwork.epi.usf.edu/bmfdc/index.htm

http://www.itppeople.com/index.html

http://www.aamds.org/aplastic/

http://www.mds-foundation.org/

http://www.mds-foundation.org/cgi-bin/ultimatebb.cgi?ubb=forum;f=1;hardset=0;start_point=0;DaysPrune=0

http://aafa-ner.org/aa-mds/

http://www.leukemia-lymphoma.org/hm_lls

http://www.lymphoma.org/site/pp.asp?c=bfIKIVMIG&b=36832

Saturday, May 6, 2006

12:10AM - Transplant & Stem Cell Information

Survival Rates as of 2001 http://www.marrow.org/NMDP/SLIDESET/sld036.htm

http://www.upstate.edu/microb/about.php -SUNY Upstate Microbiology & Immunology

http://ora.ra.cwru.edu/stemcellcenter/whoweare/whoweare.htm - Stem Cell Center in Ohio

http://stemcells.alphamedpress.org/cgi/content/full/21/1/21 - Stem Cell Center and interesting article

http://www.applesforhealth.com/OrganDonation/ambbt5.html - Study at U of R about bone cells aiding the production of blood cells?

Advance May Boost Bone Marrow Transplants

While visiting today be sure to visit the other healthy sections on applesforhealth.com.
Click Here

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Two independent studies suggest a way to boost production of blood progenitor cells in adults, an advance scientists say could open the life-saving potential of bone marrow transplants to perhaps many more cancer patients.

The rodent research has uncovered a reciprocal relationship between two versatile cell types -- hematopoietic stem cells and osteoblasts -- which give birth to, respectively, blood and bone. It turns out the two groups not only reside in next-door locales in the cushy filling of bone, but they also appear to follow one another's population trends, scientists found.

The studies point to the importance of the surrounding tissue, or "niche," in the fate of stem cells, the harbingers of all the cells that make up an organism. In the embryo, stem cells emerge in the first days of development, endowed with the potential to morph into each of the body's 200 types of tissue. In the adult, such jack-of-all-trades cells occupy specialized areas, including bone marrow, skin and the pancreas, where they not only reproduce themselves but also give rise to new cells of the tissue type they inhabit.

The far-reaching reconstructive properties of stem cells make them attractive targets for research aimed at developing ways to repair or replace damaged or destroyed tissue and organs. To date, an estimated 5-million patients, with disorders ranging from immune deficiency and infertility to menopause and malignancy, have undergone stem-cell transplantations worldwide.

"The microenvironment, or niche, in which stem cells reside controls their renewal and maturation," molecular biologists Ihor Lemischka and Kateri Moore of Princeton University in New Jersey note in an analysis of the findings. "The niche that regulates blood-forming stem cells in adult animals has eluded researchers -- until now."

The teams demonstrated for the first time the crucial role osteoblasts play in the regulation of the hematopoietic stem cells, which replenish at least 10 blood-cell lineages in mammals. Simply put, they found increasing the number of the bone-forming cells results in a parallel spike in the nearby HSC population.

Tapping into this neighborly connection could lead to long-sought medical benefits, the investigators surmise.

"There are many clinical challenges facing our patients that could be met if we could expand stem cell populations," said Dr. David Scadden, director of the Center for Regenerative Medicine and Technology at Massachusetts General Hospital in Boston and senior author of one of the studies published in the Oct. 23 issue of the British journal Nature.

"The ability to enhance the number of stem cells an individual produces could have an immediate impact on patient care," added Scadden, who also serves as associate professor of medicine at the Harvard Medical School.

The news should be of particular interest to transplant patients, for whom an inadequate stem-cell supply often means facing increased risks from or having to forego altogether a potentially life-saving procedure, said Dr. Jane Liesveld, clinical director of the leukemia, blood and marrow transplant program at the James P. Wilmot Cancer Center at the University of Rochester Medical Center in New York.

The researchers succeeded in doubling production of the self-renewing HSCs -- which can develop into any kind of blood cell -- in mice that are genetically designed to serve as models for human disease. They also identified a potential treatment strategy that might duplicate this effect in patients, an approach they are preparing to test.

"It's especially exciting because the compound we used is already known to work safely in people, so we can start looking quickly to see whether this strategy will work in people, too," said first study author Dr. Laura Calvi, an endocrinologist at Rochester.

In parallel findings that end a 25-year quest, other investigators determined the location in mice where the multi-purpose HSCs reside. They also identified the mechanisms involved in controlling the size of the niche and the number of the adult blood-bearing cells the body produces.

Such understanding marks an important step toward putting the stem cells to expanded therapeutic use, said Linheng Li, assistant investigator at the Stowers Institute for Medical Research in Kansas City, Mo., and lead author of the second Nature report.

"Bone marrow stem cell transplantation has been used to treat leukemia and other cancers for more than 40 years; however, successful transplantation requires a large number of healthy adult stem cells," Li, who also is assistant professor of pathology at the University of Kansas School of Medicine in Kansas City, Kan., told United Press International.

"The number of bone marrow stem cells available in the body is extremely limited, and it has not been possible to grow and expand adult stem cells ... outside of the body," Li said. The new discoveries may enable scientists take a limited number of bone marrow stem cells, grow them to a number sufficient for therapeutic purposes, then transplant them back into the body to perform their curative work, he added.

In contrast to many groups that have sought ways to expand stem cell populations by adding growth factors to bone marrow samples, Scadden, Calvi and company instead focused on the adult blood cells' home environment in the marrow cavity inside long bones. They found by prodding the neighboring bone cells to action, they could boost the blood cell populations as well.

"For the most part, hematopoietic stem cells researchers haven't thought that much about osteoblasts, though they're in the bone marrow right next to the blood cells that are developing," said study co-author Dr. Laurie Milner, associate professor of pediatrics and medical oncology at Rochester's Aab Institute of Biomedical Sciences.

The team had set out to determine whether osteoblasts -- which generate new tissue to spruce up age-withered bone -- also might have a reviving effect on stem cells. The investigators found mice with an over-active osteoblast trigger showed excessive numbers of both bone- and blood-producing cells in the bone marrow.

In further tests, they discovered the fortified protein, a receptor for the bone-building parathyroid hormone, could be acting through a pathway known to spur stem cell proliferation. Next, they investigated whether injections of PTH -- a treatment approved for the bone-thinning condition called osteoporosis -- might beef up stem cell production.

"The magnitude of change we saw with activating the osteoblastic cells was two-fold over a four-week interval," Scadden told UPI.

All of the recipients of PTH-treated bone marrow survived for at least 28 days following the transplant, compared to only 27 percent of the control mice that had received normal tissue, the researchers found.

"Treatment with PTH had a remarkable effect on these animals' recovery from bone marrow transplantation," Scadden said. "This work opens a new angle from which we can attack the challenges of stem cell transplantation, focusing on the environment to achieve a stem cell effect."

Lemischka concluded the investigators "demonstrate that osteoblasts have a crucial role in HSC regulation."

The research could speed stem cell studies significantly, producing results in weeks or months, compared to years with traditional gene-knockout technology, Li noted. The findings also might be particularly relevant to patients with such cancers as leukemia and lymphoma, which originate from gene mutations in stem cells, he said.

"(The studies) may contribute to elucidating the (tumor-causing) process in some cancers and determining what environmental factors, including currently used medicines, may influence these changes," Li explained.

The research might help produce more effective bone marrow transplantation and gene therapy that employs stem cells, he speculated.

Scadden and colleagues are starting clinical trials of patients with blood cancers to analyze the effect of PTH treatment on stem cell donors and recipients. They also will investigate whether the hormone can help expand stem cell populations outside the body, such as the tiny amounts found in banked samples of umbilical cord blood.

"It is still very early to know," Scadden said, "but these studies do suggest that there may be an alternative means of improving stem cell harvests or stem cell engraftment that are particularly relevant for cancers of the blood and immune system."

Currently, some 25 percent of patients who need an autologous stem cell transplant -- in which they are both donor and recipient -- come up short, precluding the procedure. And, about one-third of candidates for allogeneic, or conventional, transplant fail to find a suitably matched donor even though government-funded umbilical cord blood banks have a rich array of blood samples that could match most patients, Scadden pointed out.

The problem in both cases is too few stem cells in the patient's harvest or a cord blood sample for a safe adult transplant. However, if it works in humans as it appears to in mice, the PTH approach could provide an answer for both circumstances, stimulating stem cell production in the donor in anticipation of a transplant or enabling a small amount of cord blood cells to proliferate on their own after the procedure, Scadden predicted.
--
Copyright 2004 by United Press International.
All rights reserved.

12:07AM - Traditional Chinese Medicine & Herbals

http://www.getwellnatural.com/product_detail.php?id=3 - Blood Well recommended on ITP Forum

http://integrativemedicine.arizona.edu/fellowship/fellows.html

http://www.medicalacupuncture.org/aama_marf/journal/vol15_1/vol_15_num_1_case_2.html

http://www.tcmtreatment.com/forum/default.asp

http://www.tcmtreatment.com/

Hi, Wanted to share the Chinese medicine slant on this remission/cure discussion. Rob is intensely studying Chinese medicine as well as seeing the Chinese do regularly, and he shares what he's learned every evening at dinner.

TCM sees in AA not one disease, but many. The symptom of nonfunctional bone marrow is just one clue. The TCM doc also looks at other factors (um, not sure what these are) to determine how to treat your disease. They use language that is totally foreign to Westerners--eg. TCM docs are admonished by the literature to determine if the kidneys are "too watery or too fiery." The answer to this question would determine how the kidneys are "tonified."

Sounds voodoo, I know. Thing is, it's been shown to work about as well as ATG/cyclo, so there must be something to it.

Anyhow, this would fit in the the observation that every individual responds a little differently to standard treatments. Everybody's AA is a slightly different animal, depending on how we metabolize, the cause, and God knows what else. So, what they call "durable" remission is probably possible for some, not for others, or maybe for everyone, but with different modalities.

Andrea

The TCM rates of recovery matching other methods make me think once again that maybe no matter what we do, we either recover or don't, although maybe a push in the right direction helps some recover more quickly?

Lexi

What's interesting about Chinese Medicine is that they do have lots of data, case studies and trials. As Andrea said, it's highly individualized. So many things are assessed...twelve main meridians are checked via your pulse, your symptoms, life style, history, likes, dislikes, etc. all make up a diagnosis. They can and do replecate outcomes all the time. But as we have seen, nothing works all time.

Marlene

http://www.itmonline.org/arts/itp.htm

TREATMENT OF ITP WITH CHINESE MEDICINE

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Idiopathic Thrombocytopenic Purpura (ITP) is a somewhat archaic term for a condition of low platelets (thrombocytes). Idiopathic means that the cause is unknown; with advances in modern technology, a substantial amount has been learned about the causes. While one may not be able to definitively point to all the causative factors and agents involved in any one patient, as is the case with many diseases, now it is often possible to describe much of the etiology and pathology of ITP quite accurately. Purpura refers to the splotches seen on the skin where capillaries have leaked blood to yield a bruise or many red or purple petechia (flat, pin-head sized spots). However, with careful monitoring of the platelet counts and appropriate treatment when the platelets approach a low level, people with this disease may rarely show any such symptom. Nonetheless the moniker ITP has stuck in the medical literature and will, as a result, continue to be used here.

The deficiency of platelets has two basic origins: autoimmune attack against platelets (primary ITP) and bone marrow disorder (usually: secondary ITP). In primary ITP, the bone marrow produces platelets as fast as usual (at least in the early stages of the disease), but even before they have a chance to mature, they are taken out of circulation. An antibody of the G series (the type involved in several autoimmune diseases), IgG, attaches to the platelets and marks them to be removed from circulation. It is likely that individuals who suffer this disease have a genetic propensity to get it, and that a viral disease triggers it. Many autoimmune disorders have this characteristic. In such cases, treatment is often aimed at inhibiting the immune system with corticosteroids (e.g., prednisone). If necessary, the spleen is removed (splenectomy) in order to both reduce the production of anti-platelet antibodies and to slow the clearance of the platelets from the system (the spleen filters out the platelet-immune complex). A suitable name for this disease is autoimmune thrombocytopenia.

Autoimmune thrombocytopenia occurs mostly in children and young adults (typically before age 30), though it can rarely occur later in life. Many times, it manifests as an acute disease, lasting a few weeks and then clearing up completely. It might recur again later after another viral infection or with reactivation of a chronic virus, but eventually it ceases to be a problem in the majority of children who experience it. The acute manifestation can usually be controlled by a course of therapy using steroids to inhibit the immune response for a period of several weeks. Chronic autoimmune thrombocytopenia develops in a small percentage of patients. In that case, steroid therapy eventually fails (due to the side effects from prolonged administration). Until recently, the main therapy for chronic autoimmune thrombocytopenia has been splenectomy, which is sometimes curative, but at least reduces the disease severity. More recently, intravenous (IV) infusion of normal IgG (hence the treatment initials: IVIG) to replace the body’s anti-platelet IgG has been tried with some success and may replace splenectomy for some patients. IVIG has also been proposed as an alternative to the initial therapy with prednisone. Other therapies are also being developed. Medical opinion appears to be leaning towards finding an alternative to splenectomy.

A defect in the production of platelets by the bone marrow, resulting in ITP, can occur as part of a general bone marrow dysfunction, in which both red and white blood cells are also produced insufficiently. Or, it can occur secondary to leukemia, in which the stem cells that yield white blood cells proliferate and crowd out the stem cells that produce platelets and red blood cells (yielding high white cell count and low RBC and platelet counts). Low platelets can also occur as the result of certain medical treatments, such as chemotherapy for cancer. Some chronic diseases that affect the immune system, such as HIV, hepatitis C, and systemic lupus, may yield a combination of inhibited platelet production and shortened time that platelets persist in the blood, with resulting ITP. For these situations, the platelet deficiency is called secondary ITP, because there is something else going on first or at the same time that yields the clinical result. The platelet disorder that may be resolved if the other disease process or medical treatment is removed.

CHINESE HERB THERAPY

In China, both primary and secondary ITP are noted in the medical literature, though primary ITP is the main subject of the reports and is the object of the current article. Treatment, other than Western medical therapies, is based on using Chinese herbs: reports of acupuncture therapy are rare or non-existent. The Chinese herbal therapies vary markedly from one physician to the next and sometimes among different patients, depending on the differential diagnosis.

The general theory of treating primary ITP, at least as it occurs in children and young adults, is that there is a heat syndrome causing the blood to escape the vessels. Therefore, clearing heat is the primary concern. Also, since bleeding is the symptom, treatment with hemostatic herbs, especially those which are also cooling, is standard procedure. There are two major causes of the blood heat, one being an excess heat syndrome that might be associated with a viral infection and the other is a yin deficiency syndrome, which may arise from nutritional deficits, prior diseases, or inherent factors. In the case of the yin deficiency syndrome, nourishing yin (tonification) is deemed the most important aspect of therapy.

Except in the cases of dominant excess syndrome, there are usually some herbs included in the ITP treatment to tonify the spleen, owing to the concept that the spleen restrains the blood within the vessels and the spleen helps produce new blood and replenishes the yin. In patients who show an evident spleen qi deficiency syndrome, the qi tonics may become a major part of the therapy, with less emphasis on clearing heat or nourishing yin. In cases where there is prolonged disease, the deficiency of qi often extends to a deficiency of the kidney and additional tonic therapies may be added. For most cases of secondary ITP, the theory is that the bone marrow is inadequate to produce the cells and this is addressed by tonifying the kidney (to invigorate marrow), nourish the liver (to increase the blood storage), and tonify the qi to help produce blood and essence.

Within the theoretical framework, a number of different herbs are selected. Among the most commonly used herbs for primary ITP are the ones listed in Table 1.

Table 1: Herbs Commonly Used in the Treatment of Primary ITP in Four Categories.

Note that some of the herbs are classified differently than the standard Materia Medica categories.

Heat Clearing
Hemostatic
Qi Tonifying
Liver Nourishing

rehmannia, raw
agrimony
astragalus
tang-kuei

gardenia
imperata
licorice
gelatin

moutan
eclipta
codonopsis
tortoise shell

red peony
rubia
hoelen
ho-shou-wu

salvia
san-chi
atractylodes
lycium

lithospermum
biota tops
jujube
millettia

isatis leaf
sanguisorba
dioscorea
cuscuta


Within these four groups are herbs that vitalize blood circulation (red peony, moutan, salvia, san-chi, tang-kuei, millettia), which is another method of therapy that has been proposed, to be described later in this article.

According to the Chinese medical reports, administration of decoctions made with the above-mentioned herbs in appropriate combinations will raise the platelet levels in patients with persistent ITP, often to an acceptable level, though only rarely will they return to the normal range. Normal platelet levels are usually defined as 150 or above (billions of platelets per liter of blood). According to the clinical reports, the use of herbs will often raise the platelets from the unacceptable level (below 50, at which bleeding that is difficult to stop may occur) to an average of about 75–85. Some patients described in the literature had their platelet levels reach over 100 and very few attained a completely normal level.

Primary ITP spontaneously resolves at a rate that is better with younger age; overall only about 20% of cases are persistent and refractory to standard treatments. If the Chinese herb therapy can raise the platelets to an acceptable level, the condition may stabilize for most individuals within a few days or weeks; if there is a relapse, then the same kind of treatment might be applied again.

For persisting ITP, which is a greater concern because of the difficulty of finding suitable modern medical therapy, Chinese herbal treatment will usually be administered for several weeks or months. In the Chinese clinical evaluations, the success of the therapy for the chronic disease is often monitored in terms of the relapse rate after the herbs have been stopped. Herbal therapy is reported to be of some benefit to nearly all patients, though the degree of improvement varies markedly and the relapse rate (within a year, if monitored that long) is often high.

Virtually all studies of ITP treatment include a control group that receives steroids, usually at high doses (about 45 mg/day). The Chinese herbal therapies are claimed to be superior in their results and lacking in the characteristic side effects of the drugs. Because the randomization and matching of patients in the herb treatment and control groups is usually not clear in the Chinese reports, the value of the comparisons can be questioned. Further, it is unclear in the reports to what extent the corticosteroid dosage is manipulated according to methods commonly recommended in modern clinical practice. Therefore, in the summaries of the medical journal articles presented here, the results for the control group are usually not indicated. The main purpose of conveying the information presented in the Chinese journal articles is to illustrate the selection of herbs, the dosage (described in a separate section of this article), duration of therapy, time to obtain changes in platelets, and the claimed results of therapy.

Much of the work done on ITP in China has been carried out at the Shanghai College of Traditional Chinese Medicine. This very large college has a number of affiliated hospitals where studies can be carried out. There are also other medical universities in Shanghai that cooperate with the TCM College in conducting some of the studies.

CLINICAL REPORTS INVOLVING DIFFERENTIAL DIAGNOSIS

The majority of the recent Chinese clinical reports describe trials involving a single herb formula that may be modified slightly according to presenting conditions. However, outside of the trial setting, differential diagnosis is the rule, so this aspect is presented first.

A study of patients with ITP according to their traditional Chinese diagnostic category was carried out by the Shanghai College of Traditional Chinese Medicine and published in 1991 (1). It involved 103 patients (75 female) with an age range of 12–58 years. The differentiation went this way:

Table 2: Division of 103 Patients with ITP into Four Diagnostic Categories

with Group Characteristics: Age, Disease Duration (years), IgG Levels, and Platelet Counts.

Differentiation Group
Number of Patients
Mean Age
(Mean Duration of Disease)
IgG
(Control: 18)
Platelets
(Control: 122)

Qi Deficiency
20
24 (3)
115
29

Blood heat
22
26 (4)
63
44

Yin deficiency
43
36 (7)
80
39

Yang deficiency
18
40 (12)
112
34


The qi-deficiency group was described as a spleen-deficiency type; the blood-heat type was described as an excess syndrome, the yin-deficiency type was described as a syndrome secondary to chronic spleen deficiency; and the yang-deficiency type was said to be a deficiency of spleen and kidney. The control group of non-ITP patients involved 20 individuals with a similar ratio of the two sexes, mean age of 30, and similar range of ages as the differentiation group. The control group was included for obtaining relative blood values.

Looking at the mean values for patient age and disease duration only, it can be seen that the disease generally started before age 30 and falls in the category of chronic ITP. According to the analysis, the most common type of the disease is a yin-deficiency syndrome. Both the blood-heat and yin-deficiency syndromes can be described as being of the general heat-type of ITP, accounting for 2/3 of the cases. The deficiency of qi and of yang correlated with the most dramatic elevation of IgG. In the report, there were also slight elevations noted in IgA and IgM for all the ITP patients, but not sufficient to explain the disease manifestation. The platelet numbers did not vary much from one group to the next (the control group level is quite low to begin with, suggesting that these numbers are not directly comparable to those from other laboratories). The report also presented information on T-cell subsets, but there were no significant differences in their numbers or ratios among the different groups, including the controls.

In 1991, a research team at the Shanghai College of TCM presented a formula for ITP (2) with the following ingredients: astragalus, codonopsis, tang-kuei, moutan, agrimony, isatis leaf, perilla stem, licorice, raw rehmannia, cooked rehmannia, and eclipta. The trial group of 36 patients receiving this formula ranged in age from 13–60 years. Treatment time was at least three months (average 110 days) and it was reported that all but 3 of the patients had improvement of symptoms. The average increase of platelets was from 38 to 79, and the average decrease in IgG was from 74 to 32. The formula included herbs for tonifying qi (astragalus, codonopsis, licorice), nourishing yin (rehmannia and eclipta), clearing heat (moutan, isatis leaf, raw rehmannia), and inhibiting bleeding (agrimony and eclipta). The use of perilla stem (zisugeng) is unique; it is not found in other formulations for ITP (see key herbs section, below).

This basic formula was later adopted by another group at the same college using differential diagnosis and treatment (3). According to their report, there were four categories of disorder and treatments, but the data for all the patients were then pooled for analysis rather than divided by group. The above-mentioned formula was adopted for the yin-deficiency group and modifications of it were used for the other groups as shown in Table 3.

Table 3: Differential Therapy for ITP at the Shanghai College of Traditional Chinese Medicine.

Differentiation Group
(Number of Patients)
Herb Formula

Qi Deficiency
(30)
astragalus, codonopsis, tang-kuei, moutan, agrimony, isatis leaf, perilla stem, licorice, etc.

Blood heat
(24)
buffalo horn, raw rehmannia, red peony, moutan, eclipta, trachycarpus, rubia, isatis leaf, perilla stem, licorice, etc.

Yin deficiency
(76)
astragalus, codonopsis, tang-kuei, moutan, agrimony, perilla stem, licorice, raw rehmannia, cooked rehmannia, eclipta, etc.

Yang deficiency
(24)
astragalus, codonopsis, tang-kuei, moutan, agrimony, perilla stem, licorice, raw rehmannia, cooked rehmannia, eclipta, epimedium, cuscuta seed, etc.


As in the previous report on differentiation of the syndrome, the most common form was the yin deficiency type and the combined heat syndromes (yin deficiency and excess heat as blood heat) comprised 2/3 of the cases. All of the formulas included moutan, perilla stem, and licorice, and all but the qi-deficiency formula included raw rehmannia, while all but the blood-heat formula included astragalus, codonopsis, tang-kuei, and agrimony. For the kidney-deficiency cases, the formulas included cooked rehmannia and eclipta. The herb formulas were prepared as a liquid syrup and consumed three times per day. A control group was given prednisone; treatment time was at least three months. Side effects of the herb therapy were limited to a few cases of loss of appetite and thin stools. The prednisone group presented side effects in half the patients including the typical increase of body weight and upset stomach. Mean values for platelets in the herb group rose from 38 before treatment to 68 after treatment. The control group had nearly identical mean values. Some patients were treated for six months to a year, and the platelet values continued to rise slowly in the herb treatment group, reaching 75 at six months and 88 at one year. The IgG values in the herb treatment group declined from 99 at the beginning of treament to 41 at the end of treatment (three months); the values for the control group were similar. The authors claimed that the best therapeutic responses were among the patients suffering from qi deficiency and yin-deficiency syndromes.

In a more recent study (4) conducted Shenyang (rather than Shanghai), patients were simply divided into two groups, one being the common yin-deficiency type with heat symptoms (30 patients), and a spleen-kidney deficiency group, involving spleen qi deficiency and kidney/liver yin deficiency (31 patients) with pallor signs The treatments were:

· Yin deficiency type: codonopsis, cuttlebone, rehmannia, moutan, artemisia, gelatin

· Kidney/Spleen deficiency type: ho-shou-wu, lycium, ginseng, astragalus, tang-kuei, san-chi.

The herbs for the yin deficiency type were made as a decoction with 10–15 grams of each herb (except cuttlebone at 25 grams). The herbs for the kidney/spleen type were made into tablets, given 4–6 each time, three times daily, with 380 mg/tablet. A control group was treated with prednisone. At the end of four weeks, 35 of the herb treated patients had some level of improvement; after one year, 56 of the 61 herb treated patients had some degree of improvement.

According to the report, the time from starting herb therapy until the platelet counts started to rise was, on average, 24 days (compared to 8 days for the prednisone group), and it took three months for the herb treated group to reach its maximum level of platelets, compared to 22 days for the prednisone group. After one year of therapy, the herbs were stopped. The relapse rate for the patients who did best in the herb treatment group (in terms of platelet improvements and corresponding improvements in symptoms), of which there were 24, was examined. There were 11 patients that remained stable (no relapse), while 13 patients had a relapse (between 3.5 and 11 months after stopping the herbs).

A similar pair of differential groups was described in an earlier study (1987) with the following formulas (5):

· Yin-deficiency type: tortoise shell, oyster shell, phellodendron, imperata, biota tops, sanguisorba, lycium, eucommia, scute, lycium bark, gardenia, san-chi.

· Kidney/Spleen-deficiency type: astragalus, imperata, schizandra, codonopsis, hoelen, tang-kuei, atractylodes, lycium gelatin, san-chi.

These formulas were ground into powder, made into pills and taken in the amount of 5 grams of herb powder twice per day. The patients had been treated with Western medicine without success. The results from the two groups were pooled, and it was claimed that all patients showed some improvement.

These studies that involve differential diagnosis do not clearly demonstrate that such differentiation is essential to the outcomes. All of the formulas include herbs that clear heat, inhibit bleeding, and nourish yin. While kidney deficiency is mentioned in the reports, there is very little reliance on kidney-yang tonic herbs in the prescriptions. Even when kidney-tonic herbs are included (such as the yin-nourishing rehmannia and eclipta or the yang tonics eucommia, cuscuta, and epimedium), the ones selected are also traditionally classified as nourishing the liver, so that a liver-nourishing principle would describe the basis of treatment equally well.

CHINESE CLINICAL REPORTS WITH BASE FORMULAS THAT MAY BE MODIFIED

There are a substantial number of reports in the Chinese medical literature published during the 1980’s and early 1990’s describing treatments for ITP. They usually present a basic formula that can be modified slightly for individual presentation of symptoms; the modifications may not be directly relevant to the experience of ITP. Due to concerns about the quality of clinical testing and reporting, and due to the fact that most of these reports are available only in summary or abstract form, only the most basic information is presented here in table format to illustrate the nature of the prescriptions used.

Table 4: Clinical Reports on Herbal Therapy for ITP.

The majority of these reports were summarized in The Treatment of Difficult and Recalcitrant Diseases with Chinese Herbs (5), translated from Compendium of Secret Chinese TCM Formulas, a three-volume book of medical report summaries first published in 1989. In a few cases, the study reported here was available only as an abstract in Abstracts of Chinese Medicine (a quarterly journal) or other source. A total of 600 patients were involved in the herbal treatments; most studies also had a control group of about 20 patients using steroids.

Author (Citation)
[No. Of Patients]
Formula Ingredients; Modifications
Comments

Sha Bingyi (5)
[22]
agrimony, jujube, oyster shell, licorice, forsythia, salvia
Symptom improvement reported after 5 days, substantial platelet increase after 10 days.

Yang Jin (5)
[50]
agrimony, sanguisorba, codonopsis, atractylodes, cornus, salvia, astragalus, shou-wu, rehmannia, scrophularia, licorice, phytolacca (this herb is boiled a long time to reduce toxicity); for yin deficiency, remove codonopsis and atractylodes, add phellodendron, anemarrhena, moutan, tortoise shell; for qi deficiency, add hoelen, jujube
All but 2 patients improved; after treament was concluded there was no relapse during a six month follow-up.

Su Eryun (5)
[33]
millettia, agrimony, licorice, tang-kuei, ixeris, biota tops, astragalus, raw rehmannia; for yin deficiency, increase rehmannia, decrease astragalus; for blood stasis, double the millettia dose
Improvements claimed for 25 of the 33 patients.

Zhang Yisheng (5)
[80]
gardenia, raw rehmannia, red peony, moutan, tang-kuei, astragalus; for heavy bleeding, add lithospermum, rubia, agrimony; for anemia, add gelatin, millettia, ho-shou-wu; for yin deficiency add yu-chu, glehnia, ophiopogon, imperata; for qi deficiency, add codonopsis, atractylodes, hoelen, dioscorea
Bleeding brought under control in all cases.

Deng Youan, et al. (5) [31]
cnidium, salvia, tang-kuei, carthamus, millettia, red peony, leonurus; for qi deficiency add codonopsis, astragalus, dioscorea; for weak digestion, add atractylodes, hoelen, crataegus, malt, citrus, magnolia bark; for kidney yang deficiency, add morinda, cuscuta; for kidney yin deficiency add ligustrum, lycium
For treatment of chronic platelet deficiency but not for use when the platelets are very low, causing purpura. Average treatment time was one month. IgG was greatly decreased after treatment. A few patients had no relapse for at least 6 months.

Liu Shaoxiang (5)
[62]
agrimony, rumex, millettia; for qi deficiency add astragalus and codonopsis; for blood deficiency add tang-kuei and gelatin; for weak digestion, add atractylodes
Secondary ITP was mainly treated, with chemotherapy and radiation the cause. Reported platelet restoring effect took place in 5 days on average.

Han Weigang and Qi Rongfang (6)
[27]
buffalo horn, raw rehmannia, moutan, red peony, isatis leaf, paris, agrimony, lithospermum; for blood heat, add fresh lotus node; for qi deficiency, add astragalus; for yin deficiency, add ho-shou-wu
24 of 27 patients reported to respond well with 12 days treatment.

Gao Xiang, et al. (7)
[35]
astragalus, codonopsis, hoelen, atractylodes, rehmannia, tang-kuei, psoralea, drynaria, cuscuta; for nose bleed add agrimony; for purple petechia, add salvia; for poor appetite, add red atractylodes and citrus
30 day treatment course (could be extended), 31 of 35 patients showed some improvement. Platelet counts increased from average of 52 to 79.

Cui Shuzhen, et al. (8) [100]
cnidium, salvia, red peony, millettia, leonurus; digestive disturbance, add crataegus, malt, citrus, atractylodes, malt; serious bleeding, add raw rehmannia, moutan, and cirsium
See Dong Youan study above, with nearly identical in treatment. This study involved children 6 months to 13 years with persistent ITP. One month treatment course; platelet increased from 26 to 109. All patients “improved.”

Peng Xiang, et al. (9)
[24]
astragalus, codonopsis, atractylodes, licorice, rumex, scute, coptis, frankincense, myrrh, tribulus
Improvements noted in 20 of 24 patients.

He Guoxing and Wang Xiuhua (10)
[52]
rehmannia, deer antler gelatin, tortoise shell gelatin, ho-shou-wu, codonopsis, tang-kuei, astragalus, epimedium, salvia, rubia, ligustrum, licorice
Improvements noted in 50 of 52 patients.

Zhang Gaochen and Mao Yuwen (11)
[55]
tang-kuei, agrimony, moutan, gardenia, san-chi, biota tops
Treatment time was 9–36 days, and mean platelet count rose from 58 to 78; 2/3 of patients improved.

Li Zhiyuan (12)
[23]
astragalus, codonopsis, tang-kuei, nutmeg, rehmannia, cinnamon bark, aconite, dioscorea, agrimony, gelatin
20 of 23 patients improved. No relapse during 3–6 month follow-up.

Duan Yu, et al. (13)
[10]
bupleurum, codonopsis, scute, licorice, jujube, equisetum, pyrrosia, verbena, rehmannia
Average treatment time was 4 weeks; an IV drip of hemostatic drugs and vitamins was given for an average of 3 day. Mean platelets increased from 19 to 121.

Xiang Renpu (14)
[26]
raw rehmannia, agrimony, ho-shou-wu, lycium, psoralea, cistanche, salvia, red peony, rubia, tang-kuei, moutan, cornus
All but 1 patient has some improvement, but relapse was common. Platelet count increased by an average of 32.


BLOOD STASIS HYPOTHESIS FOR CHRONIC AUTOIMMUNE THROMBOCYTOPENIA

It has been proposed by some authors that the symptomatic manifestation of purpura signifies a blood stasis syndrome and that the chronic disease, in particular, should be treated mainly by vitalizing blood circulation. One of the first descriptions of this approach was from the Heilongjiang College of Traditional Chinese Medicine, published in 1981 and then republished in English in 1983 (15). The authors reported that in a group of 200 ITP patients, there were 46 who had chronic cases and, of these, 30 had “varying degrees of blood stasis.” The remaining 16 chronic cases had varying degrees of spleen qi deficiency with inability to restrain the blood and yin deficiency with glowing fire.

The symptoms of blood stasis were: bruising and petechia; dry, lusterless hair; dark facial color; purplish congestion in the eye vessels; lower eyelid shows purplish dark case; pulse was thready and/or astringent. Two or more of these signs were needed to place an ITP patient in the diagnostic category of blood stasis. Since the purpura signs are to be expected in chronic cases of ITP in those seeking treatment, only one other sign would be necessary to yield the diagnosis. The proposed formula was: millettia, red peony, san-chi flowers, rubia, tang-kuei, salvia, codonopsis, jujube, eclipta, rehmannia. If there was a high level of bleeding, the formula could be modified by temporarily removing red peony and salvia and adding agrimony, lotus node, charred hair, and trachycarpus. Additional anti-hemorrhage herbs might be added according to their reputation for treating a specific site of bleeding. The authors claimed that improvements occurred in all but 3 of the 30 cases of blood stasis that were so treated. The average duration of therapy was 85 days (about three months) and the platelet levels increased from 41 before treatment to 85 after treatment.

The authors of this report quoted earlier physicians as stating that one should not just attempt to stop bleeding, but should move or circulate the blood. This should be done whether the blood is fresh or black, and whether the condition is associated with cold or heat. The authors then relayed their own experience:

In the beginning stage [of treatment] if we use the principle of following the etiology (e.g., kidney yin deficiency with uprising and flaming of deficiency fire; spleen deficiency with loss of control and blood not returning to the vessels), we will have some patients respond poorly to this treatment. These patients will present the signs of blood stasis....Chinese researchers using animal experiments found that the treament method of vitalizing blood and dissolving blood stasis inhibit the formation of IgG and regulates the T-cell balance....The treatment of vitalizing blood and dissolving blood stasis lowers capillary fragility and decreases the permeability of vessels and, in this way, resistance to bleeding is increased.

In two of the studies cited in Table 4, the base formula that is applied is: cnidium, salvia, tang-kuei, carthamus, millettia, red peony, leonurus. The ingredients in common here are salvia, red peony, millettia, and tang-kuei.

The principle of using a blood-vitalizing therapy for ITP, incorporating many of the same herbs, was mentioned recently in a reported clinical trial 16). The herb therapy was comprised of astragalus, atractylodes, polygonatum, tang-kuei, millettia, red peony, moutan, carthamus. According to the authors, 2/3 of the patients showed improvements, and the average platelet count for the whole group increased from 34 to 57, while the IgG level decreased from 195 to 122. In addition, the researchers measured hepatoglobin, a substance produced by the liver that is elevated in patients with ITP; this substance declined by 1/3 following the herb treatment. The authors expressed the view that ITP had the characteristic of a dysfunctional immune system which could be corrected by tonifying the qi (with astragalus, polygonatum, and atractylodes; this method of therapy promotes the correct qi and reduces the pathological qi) and invigorating blood circulation (which inhibits autoimmune attacks).

A disorder similar in symptoms to primary ITP, idiopathic multifocal bleeding and platelet aggregation defect (IMBPAC), was addressed with a blood-vitalizing therapy by physicians working at the Tongji Medical University in Wuhan (17). They used Xiaoyu Zhixue Pian (Reduce Stagnation, Regulate Blood Tablets) made with astragalus, codonopsis, licorice, peony, tang-kuei, and persica. The herbal material, corresponding to 1.2 grams crude herb per tablet, was administered 5–8 tablets each time, 2–3 times daily. They reported a hemostatic effect in most patients in 5–7 days (total treatment time was four months). Instead of relying on hemostatic herbs, the formula boosts the qi and vitalizes blood circulation

NORMALIZING PLATELET FUNCTIONS

There is considerable concern raised in modern medical practice about altering platelet functions. During the 20th century, the primary cause of premature death in the Western world was a blood clot that either caused a heart attack or stroke. As a result, the stickiness of platelets, which contributes to forming the blood clot, has been deemed one of the most serious pathological problems. Patients who experienced a non-fatal blood clot event would often be placed on life-long therapy to inhibit platelet sticking, so as to avoid a second event.

The ease with which a clot could form in the population (especially those past 45 years of age) appears to be due to several factors, including excess blood sugars and lipids, high oxidation status (lipid peroxidation products in the membranes), and the influence of smoking, excessive alcohol consumption, use of exogenous estrogens (menopause treatment), and the effects of sedentary lifestyle. These factors help explain why there was such a dramatic increase in fatality due to blood clots during the 20th century compared to the 19th century, and also why there were declines in incidence of these problems in the latter part of the 20th century after recommendations were made for adjusting life style and using drugs to inhibit clotting.

However, one effect of the high incidence of clotting and the corresponding medical attention to the clotting problem is to generate an image of platelets as being inherently harmful and to view substances that alter bleeding and clotting to be something that must be strictly controlled medically. In relation to herbal medicine, this has meant serious concerns about using herbs that influence clotting (many of them do if the dosage is high enough), and especially using these herbs along with medical therapies that influence clotting.

Chinese physicians have emphasized the use of blood-vitalizing herbs ever since Wang Qingren, in the first half of the 19th century, proposed that blood stasis was a major factor in several serious diseases. His blood-vitalizing formulas had dramatic effects in many cases, and were widely adopted for use during the 20th century when the cardiovascular diseases became prominent.

One of the issues that was raised was whether or not blood-vitalizing herbs might worsen, or even induce, bleeding; the other was whether or not hemostatic herbs might worsen or induce undesired blood clotting. A traditional theory, that some bleeding disorders are due to blood stasis, meant that Chinese doctors would sometimes treat bleeding with herbs that had a reputation for getting rid of clotted blood (e.g., bruising as occurs with injuries). Those herbs were shown in some pharmacology experiments to reduce platelet aggregation, which, one would think, would worsen rather than aid bleeding. An explanation for the apparent contradiction between clinical observations and the laboratory experiments is that at low dosage the herbs can regulate platelet function and stop bleeding when the function is deficient, while at very high doses (as used in laboratory experiments and some decoctions), the herbs specifically reduce platelet sticking.

One of the apparent paradoxes of modern Chinese herbal medicine is the use of san-chi (Panax notoginseng) to treat bleeding and also to help resolve blood clots and vitalize blood circulation. Other herbs that might have this effect are agrimony, rubia, and leonurus. While this diversity of actions may appear contradictory, it is not inherently so. For example, if the dietary and other lifestyle factors yield platelets which function abnormally, then lifestyle changes and herbs that help normalize their functions can have several beneficial effects. Normal-acting platelets will not be likely to spontaneously clot in the blood vessels, but they will clot promptly when there is a damaged vessel causing leakage of blood. Herbs that regulate blood circulation might normalize platelet functions and, at the same time, influence blood vessel dilation, vessel wall integrity, and other factors. The idea that the Chinese herbs will have a normalizing function, rather than causing an adverse effect, is one which is difficult to prove, leaving some question in the minds of concerned practitioners and patients. Chinese physicians, for the most part, have adopted the view that the use of the herbs to regulate blood conditions is safe.

KEY HERBS FOR REGULATING BLOOD

Table 5 presents hemostatic herbs that are included in several of the formulas for treating ITP. There are a wide range of botanical sources represented here (each herb being from a different plant family) and wide range of active constituents that might ultimately contribute to hemostatic action, including essential oils, flavonoids, saponins, and alkaloids. Other herbs that are used to treat bleeding, such as fried schizonepeta, typha, and the thistles (breea and cirsium), are not commonly used for ITP, suggesting that the physicians have focused on a small group of herbs that may be more suited to treating this particular disorder.

The possible mechanisms of action of the hemostatic herbs include:

· increasing the production of platelets

· promoting the ability of platelets to aggregate when there is blood leakage

· decreasing capillary permeability

· contracting peripheral blood vessels

· inhibiting autoimmune attack against platelets

These effects should be expected to be observed within a few days of administering the herbs. In most of the Chinese medical reports, improvement in symptoms (such as spontaneous bleeding and petechia) were observed within about 10 days. Changes in bone-marrow functions and autoimmune processes may require somewhat longer therapy, at least several weeks (typically one to three months treatment time), with increasing effect in responsive patients. The reported changes include higher platelet counts and lower IgG levels. Three groups of active constituents are known to have some hemostatic effects and may influence autoimmune processes:

· anthraquinones, found in rubia and rumex and also an ingredient of rhubarb root (which has hemostatic effects, but is not included in the ITP formulas)

· flavonoids, found in eclipta and agrimony, and also in scute (used to inhibit bleeding but rarely in the ITP formulas)

· alkaloids, found in lotus (all plant parts), eclipta, and san-chi

The role of essential oils (which usually dilate vessels; some might increase bleeding), triterpenes, and saponins found in several of the herbs remains unknown. One of the most frequently-used herbs in the formulas, raw rehmannia, contains iridoid glycosides that have hemostatic effects (see: Rehmannia). The same active constituents are found in gardenia, which is mentioned in a few of the ITP treatments, as well as in scrophularia and cornus (only rarely mentioned in the ITP formulas).

Table 5: Hemostatic Herbs Used for ITP.

All of the herbs listed here are reported to shorten bleeding time in laboratory testing.

Common Name
Pinyin
Botanical Name
Active Constituents
Comments

Agrimony xianhecao
Agrimonia pilosa;

agrimonin (essential oil); agriminolide (flavonoid)
Agrimonin has been developed into a hemostatic drug in China, but pharmacology studies give conflicting results. The clinical effectiveness is not confirmed.

Biota tops
ceboye
Biota orientalis

essential oils: juniperic acid, thujone
Biota leaves are frequently used (applied topically and taken internally) to treat alopecia, which is thought to involve an autoimmune disorder.

Eclipta hanliancao
Eclipta prostrata

(ecliptine, wedelolactone)
Though classified as a yin tonic, it is often used to control bleeding. The flavonoids may reduce capillary permeability.

Imperata
maogen
Imperata cylindrica

triterpenes: simiarenol, fernenol
The triterpenes reduce inflammation; there may be flavonoids in the flower that reduce capillary permeability.

Lotus node
oujie
Nelumbo nucifera

alkaloids: nuciferine, liriodenine
The alkaloids shorten bleeding time.

Rubia
qiancaogen
Rubia cordifolia

alizarin, purpurin

anthraquinones
The herb extract dilates vessels and shortens bleeding time.

Rumex
(yangdi; suanmo)
Rumex spp.

anthraquinones: emodin
Although not frequently mentioned in the Chinese literature, the rumex plants are recommended for bleeding in association with blood stasis.

San-chi
sanqi
Panax notoginseng

dencichine
This is the key ingredient in the popular hemostatic remedy Yunnan Baiyao.

Sanguisorba
diyu
Sanguisorba officinalis

saponins: sanguisorbin
Sanguisorba is especially used in cases of rectal bleeding.


In development of herbal formulas for ITP, there may be some influence of what has been called the “doctrine of signatures” in selecting some of the herbs. The hallmark of the disease, as seen from the traditional viewpoint without laboratory tests, is the petechia with a red to purple color. Several of the herbs recommended for the treatments also have a red to purple color. Examples are the purple-colored (zi) lithospermum (zicao) and perilla stem (zisugeng), the cinnabar-colored (dan) salvia (danshen) and moutan (mudanpi), and the red-colored (chi or hong) herbs red peony (chishao) and carthamus (honghua). The herb jujube used in the treatments may have been the red one (hongzao), rather than the more common black one (dazao), though the variety was not clearly specified in the literature. Similarly, there is the blood-colored millettia (jixueteng; xue = blood), and the reddish herbs which are noted for their color in their botanical names (Sanguisorba; sangui = blood; Rubia; rubi = red). Isatis leaf, used in some formulas, is the source of the purple dye indigo. The yin-tonic lycium fruit, which is used in some formulas, is a bright-red colored fruit, while the astringent cornus fruit has a purplish color. It is not clear to what extent the red to purple color of the herbs has influenced their selection for treatment of ITP by modern practitioners, but the color of herbs is known to have been a factor in the early development of the Chinese herbal medical system.

DOSAGE

Information about herb dosage was not available for all the studies, but in many cases doses of herbs used in decoction were given. The description for most of the treatments is use of “heavy dosage” of the individual herbs, with amounts of 9–15 grams per day of each ingredient, sometimes more. Typically, the herbal formulas (or at least, the portion described) would contain 8–10 ingredients, with possible additions (for particular symptoms or disease manifestation) of 1–3 other ingredients. As a result, the decoctions would be made from a minimum of about 100 grams to a maximum of about 150 grams, with 125 grams being typical. In the West, it is common to use dried extracts in place of decoctions; these dosages correspond to about 18–27 grams per day. In most of the reports, the decoctions were divided into two doses per day. It is understood that children receive lower doses, based on their age. In the Pharmacopoeia of China, a dosage schedule relating children’s dosage to adult dosage is presented as follows:

Age
Dosage Range

1–2 years
1/5–/14 of the dose for adult

2–4 years
1/4–1/3 of the dose for adult

4–6 years
1/3–2/5 of the dose for adult

6–9 years
2/5–1/2 of the dose for adult

9–14 years
1/2–2/3 of the dose for adult

14–18 years
2/3 to full dose for adult


A good example of dosing for adults and for children is offered by examining two studies published in 1991, one (7) aimed at treating adults (ages 18–53) and the other (8) aimed at treating children (ages 6 months to 13 years). Both studies involved decoctions that had a basic formula which could be modified for the individual cases. The adult formula was based on tonifying the spleen and kidney yang and was comprised of 12 grams each of psoralea, drynaria, cuscuta, atractylodes, and hoelen; 15 grams of tang-kuei; and 20 grams each of astragalus, codonopsis, and rehmannia. The total dosage of the base formula was 135 grams. Modifications to the formula involved adding from 10–30 grams of one or two herbs, such as agrimony or salvia. For the children’s study, the formula was based on vitalizing blood circulation and the formula was: 15 grams of leonurus; 10 grams each of salvia, red peony, and millettia; and 5 grams of cnidium. The base formula dosage was 50 grams. Modifications involved adding from 1 to 6 herbs, with dosages of 5–15 grams each. In this case, the dosage was about one-third the adult dosage, which corresponds to the Pharmacopoeia dosing for ages 2–6 years of age. These two formulas also illustrate a difference in therapeutic approach; the young children generally suffer from the early stage of an acute ITP which is treated here by the principle of invigorating blood circulation while the older patients, many of whom suffered the disease chronically and therefore suffer the effects of the persistent disease and the medical treatments (including steroids used before) were treated with herbs that tonify the liver, kidney, and spleen.

In one study (5) of acute ITP (treatment time 10 days), a very large dose of agrimony root (whole herb is more commonly used) is given. The dosing of this ingredient in decoction form is described as follows: 100 grams for adults, 50 grams for 7–12 years, 30 grams for 5–6 years, 20 grams for 2–4 years, 10 grams for infants.

In two of the ITP reports (and the one report on IMBPAD), pills and tablets were used rather than decoctions. The pills for ITP were made from powdered herbs, consumed in the amount of 5 grams each time, twice daily; the tablets for ITP were poorly described; they contained 380 mg per tablet, with a dosage of 12–18 tablets per day, for a daily intake of about 5–7 grams per day. It is common practice to use about 5–10 times as much herb to make a decoction as to make a pill when treating the same disorder, so these dosages fit the usual pattern. For IMBPAD, the dosages reported for the tablets corresponded to 12–29 grams per day of crude herbs, but the processing to yield the tableted material was not specified. The limited reporting of using non-decoction forms such as these makes it difficult to know if they are as effective as the high dosage decoctions.

REFERENCES

1. Huang Zhengqiao, et al., Study on the relationship between TCM differentiation of primary thrombocytopenic purpura and immunology, Journal of Traditional Chinese Medicine 1991; 32(10): 607–609.

2. Zhou Yongming, et al., Clinical observation on the principle of strengthening spleen, tonifying kidney, and purging fire for primary thrombocytopenic purpura, Shanghai Journal of Traditional Chinese Medicine 1991; (3): 1–3.

3. Huang Zhengziao, et al., Clinical study on initial thrombocytopenic purpura, China Journal of Traditional Chinese Medicine and Pharmacy, 1993; 8(2): 11–14.

4. Zeng Fanchang, et al., Clinical study of Zhinu-1 and Zhinu-2 in treating 61 patients with ITP, Chinese Journal of Integrated Chinese and Western Medicine 1996; 16(4): 207–209.

5. Fruehauf H, The Treatment of Difficult and Recalcitrant Diseases with Chinese Herbs, 1997 ITM, Portland, OR.

6. Han Weigang and Qi Rongfang, 27 cases of primary thrombocytopenic purpura treated by traditional Chinese medicine, Gansu Journal of Traditional Chinese Medicine 1995; 8(4): 11–12.

7. Gao Xiang, et al., Treatment of chronic primary thrombocytopenic purpura with Chinese herbs, Journal of Traditional Chinese Medicine 1991; 32(3): 24.

8. Cui Shuzhen, et al., Treatment of infant persistent thrombocytopenic purpura with Chinese herbs, Jilin Journal of Traditional Chinese Medicine 1991; (3): 25.

9. Peng Xiang, et al., Treatment of 24 cases of primary thrombocytopenic purpura with Shenqi Sanhuang Tang, Journal of Norman Bethune University of Medical Sciences 1989; 15(5): 538–539.

10. He Guoxing and Wang Xiuhua, Treatment of 52 patients with thrombocytopenic purpura with Bushen Shenxue Tang, Shanxi Journal of Traditional Chinese Medicine 1991; 7(6): 23–24.

11. Zhang Gaochen and Mao Yuwen, Treatment of thrombocytopenia with Weixueling Gao, Jiangsu Journal of Traditional Chinese Medicine 1985; 6(7): 312–313, 315.

12. Li Zhiyuan, Treatment of 23 cases of primary thrombocytopenic purpura mainly by warming and tonifying the spleen and kidney, Hubei Journal of Traditional Chinese Medicine 1987; (3): 24–25.

13. Duan Yu, et al., Treatment of primary thrombocytopenic purpura by modified Minor Decoction of Bupleurum, Journal of Traditional Chinese Medicine 1995; 13(2): 96–98.

14. Xiang Renpu, Treatment of 26 cases of primary thrombopenic purpura by tonifying the kidney and activating the blood, Zhejiang Journal of Traditional Chinese Medicine 1988; 23(2): 79.

15. San Weisheng and Ren Qifang, Chronic idiopathic thrombocytopenic purpura: 46 cases with differentiation of symptom-sign complex, Journal of the American College of Traditional Chinese Medicine 1983; (2): 25–29.

16. Yang Jingming, et al., Invigorating qi and promoting blood circulation in the treatment of chronic idiopathic thrompocytopenic purpura, Chinese Journal of Integrated Traditional and Western Medicine 1996; 2(1): 12–14.

17. Shen Di, et al., Clinical observation on effect of Xiaoyu Zhixue Tablet on 104 patients with idiopathic multifocal bleeding and platelet aggregation defect, Chinese Journal of Integrated Traditional and Western Medicine, 1998; 4(4): 247–250.

May 2000

http://www.itmonline.org/arts/tortois2.htm

APPENDIX 2: Aplastic Anemia and Thrombocytopenia

Aplastic anemia refers to a deficiency in circulating red blood cells that occurs because the bone marrow is failing to produce the cells at an adequate rate. This type of anemia stands in opposition to iron deficiency anemia that might arise with inadequate intake or absorption of iron or an autoimmune anemia in which the red blood cells are removed from circulation too quickly. Aplastic anemia may occur with chemical damage to the bone-marrow stem cells that produce red blood cells; these chemicals may be intentionally introduced to the body as a treatment for disease, with aplastic anemia as a side effect. Other causes include viruses, chemical pollutants, genetic disorders, radiation, and leukemias.

In China, aplastic anemia is frequently treated by herbal therapies. There seems to be little agreement on the best formulations to use, as the number of published formulas that differ markedly from one to the next is large, but most of the prescriptions rely heavily on tonic therapies, as might seem appropriate to this disease characterized by a blood deficiency. From the traditional Chinese perspective, the blood is stored in the liver, and there are a group of “liver blood” tonics that are thought to promote the accumulation of blood; the spleen is the source of blood nutrients, so qi tonics are usually deemed important to producing more blood; and the kidney system, which includes the bone marrow, is the ultimate source of blood and is stimulated by a combination of yang tonics to invigorate its activity and yin nourishing herbs to provide essential substance. It is common for the herbal prescriptions recommended to patients with aplastic anemia to be large, incorporating three or four herbs from each of the tonic categories: qi, blood, yin, and yang.

Anemias are often accompanied by fever, and the traditional description is that the blood deficiency, a type of yin weakness, gives rise to a deficiency heat (the heat is not adequately controlled). Thus, some formulas for treatment of aplastic anemia include heat clearing herbs, with a focus on those that clear heat from the blood. Some anemias are accompanied by reduced production of platelets, a condition that can lead to spontaneous bleeding; therefore, some cases of aplastic anemia are treated with herbs that inhibit bleeding.

It has been proposed that as a focus of treatment, for red blood cell deficiency focus on tonifying qi and blood; for platelet deficiency tonify yin; and for leukocyte deficiency tonify yang. Integrated Chinese and Western medicine is sometimes applied, using androgens, such as testosterone or stanazolol, or stem cell growth factors (i.e., erythropoeiten: EPO).

Gelatins from tortoise, turtle, antler, or donkey skin are prescribed in some formulas for the treatment of aplastic anemia. One example is an evaluation that involved 300 patients recruited during a 27-year period and treated with Chinese herb formulas (35). There were four formulas administered, but all contained donkey skin gelatin, rehmannia, and licorice; in the case of hyperactivity of yang and deficiency of yin as a traditional diagnosis, the patients were also treated with tortoise shell, turtle shell, stellaria, picrorrhiza, and lycium bark. While the cure rates were relatively low (except for patients with simple yang deficiency diagnosis), the improvement rates were said to be high; in the case of yin deficiency and yang hyperactivity, 77% of patients were reported to respond to this treatment method.

Another example is the use of Buxue Tang (Blood Nourishing Decoction) plus Buxue San (Blood Nourishing Powder) used in a study of treatment for aplastic anemia (25). The decoction included turtle shell and tortoise shell, the blood cooling and nourishing group of raw rehmannia, moutan, peony; the qi tonics astragalus, atractylodes, dioscorea, and codonopsis; the blood nourishing ho-shou-wu and lycium; and the astringents schizandra, cirsium, and rubia. The powder contained donkey skin gelatin and deer antler, plus ginseng, eucommia, sanqi, and gallus. The decoction and powder were taken twice daily. Of 25 patients so treated, it was reported that 17 were essentially cured, 5 were in remission, and only 3 did not respond after a course of therapy lasting one month. These formulas, rich in gelatins from four animals, mainly focus on the traditional categories of tonifying qi and blood.

A version of this protocol, using Bushen Shengxue Yihao (Tonify Kidney, Generate Blood No. 1), has the main ingredients tortoise gelatin, donkey hide gelatin, rehmannia, and astragalus. This was tested in laboratory animals (32) and shown to increase plasma testosterone levels, an effect that has also been claimed for deer antler and its gelatin. Testosterone is sometimes given along with Chinese herbs to treat aplastic anemia; in one study (42), patients with chronic aplastic anemia were given large doses of testosterone by injection and a decoction of Chinese herbs according to constitution. For patients classified as having yin deficiency, the formula incorporated tortoise shell, tortoise shell gelatin, antler gelatin, lycium, eclipta, ligustrum, and ho-shou-wu. Among 13 of 22 patients who had good response to the combined therapy, 9 had no relapse for at least a year.

Thrombocytopenia, or platelet deficiency (usually due to bone marrow disorder), is treated similarly. For example, one of the versions of Bushen Shengxue Tang, containing tortoise shell gelatin, deer antler gelatin, rehmannia, astragalus, ho-shou-wu, codonopsis, tang-kuei, epimedium, salvia, rubia, ligustrum, and licorice, was given to 54 patients with thrombocytopenia (33). It was reported that all but 2 of the patients responded with increase in platelet counts and halt bleeding due to platelet deficiency.

Another example of treatment strategy is relayed in The Treatment of Difficult and Recalcitrant Diseases with Chinese Herbs (26), formulas listed for treating this disorder include Ciyhin Cangxue Fang, which is comprised of tortoise shell, oyster shell, and herbs to clear heat (phellodendron, lycium bark, gardenia), stop bleeding (bleeding is an effect of having low platelets; biota tops, sanguisorba, scute), and tonify deficiency (eucommia, lycium).

According to Pei Shen (40), when treating bone marrow deficiencies, one should tonify the yang to raise leukocytes, nourish the yin to raise platelets, and tonify qi and nourish blood to raise red blood cells. For raising platelets, he recommended tortoise shell gelatin, deer antler gelatin, and donkey skin gelatin, along with polygonatum, jujube, yu-chu, and raw rehmannia, as valuable ingredients.

Friday, May 5, 2006

11:55PM - Microcelluar CD 34 Etc.

http://www.bmtinfonet.org/newsletters/issue50/cd34.html - CD34 Treatment - Would this make sense for AA types? Wait til my cytometry results are in.

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