What's if for? This blog is intended as a resource for acupuncturists, herbalists and medical doctors to learn about new research in the application of science based herbs to patient care. It'll also be useful to those laypeople out there who want to have a more involved hand in your care (and by the way kudos to you!). I'll go through recent studies both from Chinese and English sources that offer useful clinical nuggets, and investigate them in light of the classical wisdom on those herbs and formulas. I recognize and value the empirical wisdom of the thousands of years of knowledge in Chinese Medicine, but also recognize that modern experiments are valuable in understanding the nuances of the application of these herbs.
I guess a brief introduction is in order. I'm Kieran Jones. I'm an acupuncturist practicing in Washington State near Seattle. I attended Five Branches University in Santa Cruz, Ca, graduating in 2009. I'm currently applying to attend a Doctoral Program at Oregon College of Oriental Medicine.
Anyway, enough about me, lets get to the studies. To kick it off lets look at a promising herb called dan shen and it's use in the treatment of something we didn't hear about using it for in Chinese Medicine School.
Hopefully most of us know about the spontaneous fractures that occur as a result of taking the Biophosphonate drug Fosomax, and many of us probably know patients still taking Fosomax. I just saw one a few weeks ago. It leaves us wondering, how we can best treat these patients for their risk of fractures, without (hard to say this with a straight face) increasing their risk of fractures.
Well, enter the chinese herb Dan Shen. Categorized as a regulate blood herb in the Chinese Pharmacopeia, Dan Shen invigorates the blood, tonifies the blood and calms irritability due to blood heat. (source Materia Medica 3rd edition) Dan Shen has been long used to treat pain associated with what Chinese Medicine calls blood stagnation, and has a particular affinity (tropism we say in the herb nerdery) for the heart.
An exciting study came out back in 2004 looking at this amazing little herb's action in the treatment of Osteoporosis with pretty encouraging results. In this study by Liao et. al., rats were ovariectomized (ovaries removed) leaving them without the glands that make their estrogen. Without the protective effects of estrogen they began a made dash for osteoporosis, their bones thinning like pre weigh-in high school wrestlers. They were treated variously with estrogen, the dan shen extract (tanishonine) or a control injection of deionized water.
The results were that dan shen protected against bone loss almost as well as the estrogen did. Also the dan shen didn't have any significant effects on increasing the weight of the uterus as the estrogen did. (meaning the dan shen was not stimulating the estrogen receptors, but was working through another mechanism. This is important because as we know the use of Hormone Replacement Therapy can increase the risk of cancer, heart attack and stroke, so we want to avoid stimulating those receptors in this patient population.)
Note that this was a fat soluble extraction of Dan Shen, which is traditionally extracted in a water based decoction. This is key. The active ingredients in various dan shen preparations varies widely so the safest bet is to get the raw herb for your patients and either extract it yourself or send them home to decoct it. It isn't immediately clear to me how many of the fat soluble components are retained in the water decoction. If anybody has seen a detailed analysis of the constituents in a water extraction of dan shen, I'd love to see it.
The authors stated Dan Shen's ability to decrease the loss of bone mass as a result of its action on decreasing the actions of the osteoclasts, however, unlike estrogen it does this without decreasing the action of the osteoblasts. The constant back and forth action of the osteoblasts and osteoclasts ensure the bones remain both dense (enough material) and structurally strong (properly placed material). After all, anybody can carry a stack of two by fours into your living room, but unless they are placed strategically in the walls at the correct locations they won't increase the strength of your house. Here are the authors:
Unlike well-known antiresorptive agents estrogen, as shown in this study, which inhibit bone resorption accompanying with a subsequent decrease of bone formation through coupling mechanism[16], tanshinone treatment only decreased mineral apposition rate but not mineralizing surface at the PTM of OVX rats. In addition, all bone formation indices such as mineralizing surface, mineral apposition rate, and bone formation rates were not altered by tanshinone treatment at the LV in OVX rats. Furthermore, tanshinone also thickened the trabecula whereas estrogen did not have such effect as shown in the current study. These results indicate that tanshinone does not inhibit osteoblast bone formation occurred on bone surface while inhibiting bone resorption thus causes a positive bone balance resulting in bone gain.Add to that the benefits Dan Shen shows in preventing cardiac ischemia and it's a bit of a no brainer getting your elderly patients on this as a regular piece of their herbal supplementation!
Later till next time!
Great post Kieran! Thanks! I wonder what the tcm action is represented here by the study you reported on?
ReplyDeleteThanks for reading Harris. I hope I can keep enough coming to keep people's interest. You have an important question, and one that I regret not even mentioning.
DeleteI bet you've got some ideas Harris, and I'd love to hear them. For me I see overactive osteoclasts in the absence of healthy osteoblasts as empty heat at the xue level, which dan shen clears. (and sufficient estrogen would prevent) The fact that Dan Shen is used for inflammation in the marrow (pg 682 of the study, paragraph 1) indicates its ability to penetrate to that depth. Extracting the fat soluble constituents (tanishonine 2, cryptotanishonine, etc.) I think, guides it to the jing, allowing it to better address bone characteristics. Of course it would have to be in a balanced formula and depend on a correct TCM diagnosis.