Alzheimer’s disease: The Pathogenesis and Treatment by Chinese
Medicine
Rong Zhu
CMD
Abstract: Alzheimer’s disease (AD) is a progressive and irreversible brain disorder that
is associated with comprehensive diffuse atrophy of cerebral cortex, therefore causes the
dysfunction of centre nervous system. At present, the cause of the disease remains
unknown and there is no effective treatment available. This article explains the
pathogenesis of AD based on the theory of Chinese medicine, the knowledge of modern
medicine, and combination of clinical observation and literature review. The author
believes that AD is caused by the essential depletion and vacuity of kidney, spleenstomach and Qi-Blood; by the tangle of phlegm-stasis thereby obstructs the path of brain
and clouds the mental activity. The treatment of AD should be focused on filling in the
essence of the body, invigorating the kidney, fortifying the spleen and heart to cultivate
the root, dispelling phlegm and relieving congestion, removing the stasis in the blood
vessel to govern the sign. The cure of AD would be possible if this fundamental and
incidental guideline is followed.
Keywords: Alzheimer’s disease, Chinese medicine, pathogenesis, treatment
Alzheimer's disease is a progressive, irreversible neurodegenerative disease of central
nervous system with no known cause or cure. The disease usually begins after age 60,
and its incidence increases as age advances. Although younger people also may get AD,
it is much less common. About 5 percent of men and women ages 65 to 74 have AD, and
nearly half of those age 85 and older may have the disease. The disease progresses
gradually, although sometimes symptoms seem to plateau for a while. The main
manifestations are irreversible progressive degeneration of the intelligence, the memory,
the ability of orientation, the judgment and the language ability. It becomes one kind of
disease which harms the senior citizens physically and mentally. The mortality is high.
So far there is no effective treatment or prevention of worsen development of AD in the
field of Western medicine. And the thoroughly permanently cure is out of the question.
Therefore discussing its pathogenesis and therapy methods from the angle of Chinese
medicine appears especially important. Based on the theory of Chinese medicine and
addition of clinical observation and the literature review, the author summarizes the
pathogenesis and treatment measure of AD as follows:
A. The Pathogenesis of Alzheimer’s Disease from Chinese Medicine Point of View
In Chinese Medicine Alzheimer's disease pertains to the categories of Dementia, Idiocy,
Depressive Psychosis, and Melancholia. It had already been recognized as early as in
Canon of medicine. The cause of the disease had been correlated to the dysfunction of
the five internal organs in addition to the brain vacuity. Zhang jingyue, a famous medical
journalist in the Ming dynasty compiled a monograph of The Jingyue Complete
Compendium, which had diagnosed the disease as "mania-depressive psychosis and
dementia”. In his Dialectical Record, Chen Shiduo, a famous doctor in Qing Dynasty,
had a special discussion of "dementia". Wang Qingren, another famous doctor of Qing
Dynasty, compiled Correction of the Errors in Medical World in which he elaborated
that the dementia pathogenesis has a lot to do with the dysfunction of the brain that has
been blocked by Qi-stagnation and blood-stasis. The brain is then gradually atrophied.
The following is the outline showing the AD pathogenesis in the view of Chinese
medicine.
1. Kidney-Essence Deficiency and Brain-Marrow Atrophy
The kidney stores the essence of life. It controls the bone and the bone marrow by
connecting them to the brain through Qi. The brain is the original place of human mental
activity. It governs human state of mind. Li Shizhen, a famous Doctor of Ming Dynasty,
pointed out that "brain is the house of mental activity". The function of brain directly
affects human’s intelligence and memory. The brain marrow is nourished by the Qi from
the strong essential kidney. It had been recorded that "The kidney engenders the marrow"
in The Natural Phenomena of Yin-Yang. In Ling-Shu Treatise of Sea the author
mentioned that "The brain is the sea of marrows”. Brain and marrow are different in
name, but they come from the same source. Both of them are formed from the kidneyessence. In his Summery of Chinese and Western Medicine Tang Rongchuan, a famous
Doctor in Qing Dynasty pointed out that "the kidney is in charge of the bone. The Qi of
kidney passes through the spinal cord. When the kidney essence is sufficient, it then
enters the spine, forms the marrow and goes up into the brain. This builds up the brain
marrow. It means that the marrow is the reservoir of the essence". In his The
Comprehension of Medicine, Cheng Guopeng, a famous doctor in Qing Dynasty, said
"Kidney hosts wisdom. If kidney is insufficient, the wisdom would decline, and the
memory of the past would be lost easily". In his Corrections of the Errors in Medical
World Wang Qingren further pointed out that, "The inspiration and memory are not
stored in heart, but in the brain." "Old people lost memory are because the brains are
gradually getting empty." So the brain essence is the material base and the fountain house
of the functional activity. If the kidney essence is sufficient, the brain would be active.
On the other hand, if the kidney essence is insufficient, the brain would be idle; the
mental activity would be weaken and becomes apraxia. It has also been confirmed in
modern medicine that the cerebrum of AD appears moderate or heavier atrophy. There is
an increase in ditch and width of the brain, and expansion of the brain ventricles.
Obviously the kidney deficiency can cause the atrophy of brain. The clinical data also
demonstrated that the kidney-deficient patients showed some kind of decline of brain
function. If kidney can be strengthened, the brain would be nourished. It can be said that
the kidney essence is the root of brain function. Thus kidney deficiency addition to brain
marrow atrophy is the main reason of Alzheimer’s disease.
2. Heart-Spleen Vacuity and Qi-Blood Depletion
The heart is the monarch of all the organs and taking charge of mental activity. The brain
is the house of mental activity. Obviously the heart and the brain are inseparable. As The
Functions of Viscera and Bowels, a chapter of the medical classic Plain Questions
indicates, “The heart is the monarch. It governs all the vital functions of the whole body
including mental activities.” In The Essence of Sphygmology, a chapter of the Plain
Questions said, “The head is the house of mental activities.” Obviously the mental
activity is taking the brain as the carrier, but managed by the heart. If Qi-Blood of the
heart is sufficient, then the brain is nourished and mental activity is clear and bright.
Otherwise, the mental activity will lose its management and its nourishment, and
becomes clouded and unclear.
Spleen and stomach are providing the material supplies for the acquired constitution and
are the source of producing the Qi and Blood. The book Miraculous Pivot says in the
chapter of The Normal Individual Fasting: "Mental activity is from the essence of the
foods." If the weakness of the spleen and the stomach sustains, the transportation of foods
to the heart would be reduced and the heart would lose its source of nourishment; then the
spiritual activity decreases and wisdom getting weaker. This means that the kidney would
receive fewer nutrients as well. The consequences of it are the kidney would lose the
ability to regenerate its essence, the encephala atrophy would take place and nervous
system would be weaker. This would then injure the spiritual activity. Apparently the
spleen is providing the basic materials for the acquired constitution, while the kidney is
the foundation of the congenital constitution. The essence of life stored in the kidney can
only be plentiful when provided continuously with the nutrition transformed by the
spleen. In his The Medical Records, Chen xingxuan says: "The kidney regulates water
metabolism, and stores the essence of the five Zang-organs and six Fu-organs in it. It
means that the essence is stored in the kidney, but does not generate in the kidney. For
example, the money and grain store in the warehouse, however they are not produced by
warehouse. So we must constantly refill the spleen-stomach reservoir."
Moreover, the spleen is the main place where phlegm is produced. Insufficiency of the
spleen-Qi and dysfunction of the spleen transportation will lead to the retention of fluid.
Too much fluid will cause dampness and will ferment phlegm. Latter then moves along
with the Qi to the whole body, “accumulates in the chest, occupies the place outside the
heart, and clouds the spirit activity and causes dementia." (Chen Shiduo).
3. Restrained Liver Qi and Tangled Phlegm-Stasis
Liver plays a vital role in the dementia. It can restrain the free movement of Qi. The
accumulation of stress from the family, the society and other fields in life will
emotionally affect aged people, causing depression. The body loses its balance. The liver
is then unable to flow its Qi easily in and out. Gradually, this stagnation of Qi will cause
the retention of dampness and form phlegm; will block the blood circulation and induce
blood stasis. The consequences of this stasis of Qi, blood and phlegm are heartache,
headache, spiritual disorientation and mental dysfunction. The modern medicine also
demonstrated that patients with Alzheimer's disease have a remarkable pathological
change in their cerebral and glial tissues. There is a deposition of an abnormal protein
(amyloid beta) outside nerve cells to form an amyloid. These diffuse plaques are called
senile or neuritic plaques. In addition, an accumulation of abnormal protein filaments
inside nerve cells is formed from the aggregation of tau-protein. This is the evidence
proved from a different angle that the phlegm-stasis is one of the characters of this
disease. Chen Shiduo, a famous doctor of Qi dynasty said in his book The Dialectical
Record “The dementia begins from the stagnation of the Qi in liver and ends up with an
exhaustion of the Qi in spleen-stomach. In the situation of liver-Qi stagnation, the wood
is overcoming soil as to unable to remove the phlegm; while in the situation of stomach
exhaustion, the soil can not control the water as to unable to digest the phlegm. In his
Corrections on the Errors of Medical World, Wang Qingren emphasized that the
ecchymosis is the important pathogenic factor. He thought that the blood stasis blocked
the meridian and disconnecting the Qi flow among brain and the internal organ. So the Qi
and blood can not go up to the head and nourish the brain as for damaging the spirit.
B. Treatment of Alzheimer’s Disease with Chinese Medicine
The fundamental root of Alzheimer’s disease is inside-deficient and outside-sufficient. In
clinical, most cases manifest complicated syndromes interweaving deficiency and excess.
The treatment should measure the actual situation of the deficiency-sufficiency and the
incidental-fundamental. Reinforcing the body deficiency and strengthening the body
resistance. Dispelling the excessive syndrome and eliminating the pathogenic factors; or
strengthening the body's natural resistance and eliminating the pathogenic factors at the
same time. This is the only way to have a better effect.
1. Tonifying the Kidney and Replenishing Essence, Supplementing the Bone
Marrow and Nourishing the Brain
The kidney essence deficiency and brain marrow atrophy are the main origin of
Alzheimer's disease. Therefore, invigorating the kidney and replenishing the essence
should be considered. The treatment should be given according to the syndrome of
deficiency if it’s in kidney, in Yin or in yang. In the situation of kidney deficiency,
replenishing the kidney essence is needed. Therefore the following Chinese herbal drugs
should be given. Most of these items are friendly in taste and in feelings. The are
Prepared Rehmannia Root, Wolfberry Fruit, Pilose Antler, Frost Pilose Antler, Dogwood
Fruit, Tortoise-Plastron etc. A fact should be pointed out that the Qi is from the same
origin as essence. So the smart way of replenishing essence should be companied with
replenishing Qi. Therefore these items are ought to be given as well. They are Ginseng,
Astragalus Root, Polygonatun Root etc. In the situation of Qi deficiency, boosting the
vital-Qi to restore the energy is needed. The drugs with sweat flavor and worm nature
should be used. Again boosting vital-Qi should be companied with drugs for essence as
well. These drugs are Ginseng, Astragalus Root, Plygonatun Root, Ginnamon Bark,
Liquorice etc. In the situation of Yin deficiency, enrich the yin is needed. Therefore these
drugs should be used, such as ripe Rehmannia Root, raw Rehmannia Root, Dogwood
Fruit, Wolfberry Fruit, Chinese Yam, Ophiopogon Root etc. They are belong to sweet,
soft, rich tasting in nature drugs to replenish the true yin. But Yang and Yin are
interdependence. So often combining Antler, Dodder Seed, Eucommia Bark etc. to warm
and tonifying nature. So the Yin obtains the Yang’s sublimation, its origin will not be
dry out. In the situation of yang deficiency, invigorating the Yang is needs. The drugs
with the nature of pungent-hot and sweet-warm are preferred since they can support the
Yang and preserve the Origin-Qi. They are including Prepared Lateral Root of Aconite,
Cinnamon Bark, Ginseng, Desertliving Cistanche, Dodder Seed, Eucommia Bark etc. At
the same time, some drugs that can enrich the Yin should also be used, such as Prepared
Rehmannia Root, Wolfberry Fruit, and Dogwood Fruit and so on. In this case, the Yang
obtains the help from Yin; its function will be more abundant. Modern famous doctor
Zhang Xichun already advocated invigorating the kidney to replenish the essence and
nourish the brain. He created a recipe to enriching the kidney to nourish the brain
including Walnut, the Antler and so on. The evidence from pharmacological research
proved that Ginseng, Wolfberry Fruit, Siberian Solomonseal Rhizome etc. has the effect
of anti-aging and improving brain function. Apparently, invigorating the kidney to fill in
the essence and strengthening the root to support the primordium is one of the basic
methods of treating the Alzheimer’s disease.
2. Invigorating the Spleen and Replenishing the Qi, Tonifying the Blood and
Nourishing the Heart
The spleen provides the material basis for the acquired constitution and is the source of
the Qi and blood production. While as the heart is the house of the spiritual activity.
Human spiritual activity and consciousness depend on the nourishment of the Qi and
blood. Fortifying the spleen would enable the transformation of Qi-blood from the origin;
tonifying the blood would enable the maintenance of the heart to control the mental
activity being clearly and brightly. In the case of weakened spleen, restoring vital energy
and fortifying the spleen is needed. The drugs often used are: Ginseng, Dangshen,
Astragalus Root, Siberian Solomonseal Rhizome, Acanthopanax Root, and Poria, etc.
The prescriptions usually used are: Decoction of Six Noble Drugs, Decoction for
Reinforcing Middle-warmer and Replenishing Qi and so on. In the case of weakened
heart, boosting the Qi and relieving the mental stress is needed. The drugs often used are:
Ginseng, Prepared Rehmannnia Root, Chinese Angelica Root, Schisandra Fruit, FleeceFlowe Root, Poria, Longan Aril, Polygala Root, Arborvitae Seed, Red Sage Root,
Winter-worm Summer-herb etc. The recipes often used are: Decoction for Invigorating
the Spleen and Nourishing the Heart, Ginseng Nutrition Decoction, etc.
3. Soothing the Liver and Regulating the Circulation of Qi, Removing the Blood
Stasis and Resolving the Phlegm
Zhang Jingyue pointed out that the onset of the dementia was mostly because of the
stagnation of liver-Qi, dissatisfaction, over thinking and preoccupation or because of fear
and frightening. The Qi is then backflow to the heart or liver-gallbladder to become dirty
Qi. So in the case of liver Qi stagnation, smoothing the liver and rectifying the Qi is
needed. The drugs often used are: Bupleurum Root, Curcuma Root, Chuanxiong
Rhizome, White Peony Root, Tangerine Peel etc. The recipe is Bupleurum Powder for
Reliving Liver-Qi. However liver is the unyielding viscus. When Qi is stagnated for a
period of time, there is a chance that it can transform into fire. Therefore some drugs like
Moutan Bark, Capejasmine Fruit, Scutellaria Root and Coptis Root should be used. The
recipes often used are Decoction of Gentian for Purging Liver-fire; LiverTransforming Brew; Decoction of Silk Tree for Depression-Resolving (Silk Tree
Flower, Curcuma Root, Red Sage Root, Chinese Angelica Root, White Peony root,
Arborvitae Seed, Poria Root, Aquilaria , Candied Tangterine, Bupleurum Root,
Peppermint, Capejasmine Fruit, Jujube). As Prof. Ding Guangdi said, “The drugs for
liver disease should be used carefully. For regulating the flow of vital energy, it must
prevent consuming too much vital Qi to scorch the essence yin; for clearing the fire and
heat it must prevent injuring stomach and wounding spleen. If the stagnation of liver Qi
lasts for a long time, it will produce the phlegm-stasis. The latter will then obstruct the
life-light receiving entrance and cloud the spirit. In this situation, dissolving phlegm and
rectifying Qi is needed. In his Secret Record at Stone Chamber, Chen Shiduo, the doctor
of the Qing Dynasty said "There is no miracle method treating the dementia, only one
way is feasible, to treat the phlegm. The more phlegm is produced, the severe dementia
would be. It can not be cured by only using the common recipe Two Old Drugs
Decoction." The medications often used are Pinellia Tuber, Tangerine Peel, White
Mustard Seed, Poria, Grassleaved Sweetfkag Rhizome, Polygala Root, Curcuma Root
and Arisaema Root etc. The prescriptions are Phlegm-Abducting Decoction, NoForgetting Powder (Grassleaved Sweetfkag Rhizome, Poria, Poria Root, Ginseng,
Polygala Root) and Elixir of Cure Dementia (Ginseng, White Mustard Seed, Cuscuta
Seed, White Atractylodes Rhizome, Poria Root, Pinellia Tuber, Prepared Lateral Root of
Aconite, Cynanchum Root and Cinnabar).
In the case of blood stagnation, promoting blood circulation, removing blood stasis,
clearing the life-light entrance and raising the spirit are needed. However the Qi is the
commander of the blood, it should be equally considered to push the circulation of the Qi
at the same time of removing the blood stasis. The Chinese medications often used are
Peach Kernel, Safflower, Chuanxiong Rhizome, Red Peony Root, Red Sage Root,
Earthworm, Chinese Angelica Root, Grassleaved Sweetflag Rhizome, Musk and
Curcuma Root etc. The recipes are Decoction for Removing Blood Stasis in the Chest,
Decoction of Boost Qi- Remove Stasis and Rouse the Spirit (Dangshen, Astragalus
Root, Red Sage Root, Chuanxiong Rhizome, Peach Kernel, Safflower, Earthworm,
Grassleaved Sweetflag Rhizome, Polygala Root, Bamboo Sugar, Degelatinated Deer
Antler) and Powder for Fortify Brain (Ginseng, Chinese Angelica Root, Notoginseng,
Wingless Cockroach, Wolfberry Fruit, Prepared Nux Vomica, Prepared Frankincense,
Prepared Myrrh, Prepared Scorpion, Placenta, Membrane of Chicken’s Gizzard,
Dragon’s Blood, Liquorice).
In summary, the fundamental pathogenesis of Alzheimer's disease is the deficiency in
origin and excess in superficiality, i.e. the interior deficiency and the exterior sufficiency.
Although the main affected organ is brain, but it also has close relationship with the
kidney, spleen, heart, and liver. The main pathological factors are the deficiency, phlegm
and stasis. The syndrome primarily includes deficiency of kidney essence and weakness
of heart-spleen. As for phlegm and stasis, the two factors have the same pathological
origin and alternate growing each other. The muddy phlegm stagnates in the interior and
ties in the blood system. Later it transforms itself into ecchymosis. The blood stasis
obstructs interior, blocks the flow of the Qi and impede the Qi system. This helps
produce the phlegm. The two evils alternately damage the body system, obstruct the brain
vessel and cloud the spirit orifice. Clinically there are a lot cases showing deficiency
syndrome companied with sufficiency complex. The treatment should measure the
primary factor by diagnosing the phlegm from the stasis. There are several therapeutic
methods available. They are, to restore the deficiency and support the primary immunity
of the body; to dispel the exterior sufficiency and quell the pathogenic evil; to strengthen
the body's natural immunity and remove harmful pathogenic factors; finally to pursue
simultaneously both attacking and supplementing. In addition it should be addressed that
patients may bury different complex and drugs should be selected accordingly. Some
Chinese medications have already been proved effective clinically and experimentally,
such as: Ginseng, Dangshen, Notoginseng, Astragalus Root, Red Peony Root, Schisandra
Fruit, Gastrodia Tuber, Acanthopanax Root, Red Sage Root, Pilose Antler, Epimedium,
Fleece-flowe Root, Bitter Cardamon, Cynomorium, Poria, Pueraria Root, Grassleaved
Sweetflag Rhizome and Capejasmine Fruit etc. In general there is a bright future for
treating Alzheimer's disease with Chinese medicine. Nothing is impossible as long as the
diagnosing is accurate and the choice of medicine is appropriate.
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