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Missouriacupuncture.bizRenal Disease and Chinese Medicine
Written by: Travis Spire-Sweet, L.Ac. beta (TGF-Beta) which leads to a factor, glomerular filtration rate The United States, along with other cascade of inflammatory signals that increases causing hyper-filtration, developed nations, is succumbing to a further progresses to fibrosis and hypertrophy, and increased capillary drastic increase in renal failure. The glomerular sclerosis, thus decreasing hydrostatic pressure leading to hy- rate in increase of people reaching end- the number of nephrons, decreasing pertension. This is the start of dia- stage renal disease, (ESRD) glomerular kidney function, and leading to betic nephropathy and from here the filtration rate less than 20, is not pro- ESRD. Angiotensin, which is part disease process is the same as all portionate to quality of care or treat- of the renin angiotensin system others, just the starting off point is ment of the actual disease. To re- (RAS), is a polypeptide that circu- emphasize, there is no treatment for lates in the blood and causes vaso- the actual disease, only management of constriction. An increase in angio- How can acupuncture posi-
symptoms with dialysis, transplant, or tensin is often associated with CRF tively affect the disease mecha-
angiotensin converting enzyme (ACEi) because the damaged kidney does nism of renal failure?
therapy. ACEi, being the main form of not receive enough blood due to preventative medicine, does not stop fibrosis and sclerosis of kidney tissue Hiromi Yamamoto of Japan showed the progression of renal disease. or artery. In response the kidney that acupuncture on two points, one "Current treatments are, in general, excretes renin that activates angio- located below knee and the other poorly effective and new therapeutic tensin and leads to vasoconstriction medial posterior to ankle(KD-3 and strategies or adjunct therapies that en- and increased systemic blood pres- ST-36), decreased sympathetic hance the efficacy of current pharma- sure. This increased blood pressure nerve activity in the kidney22. Dr. ceutical agents are needed"1. This ex- creates a negative feedback loop that Brenner and Rector, leading neph- ponential growth will continue as long increases mean arterial pressure rologist in the United States wrote as there is a rise in diabetes and hyper- (MAP) in the capillary beds of the "evidence from experimental studies tension, the leading contributors to kidney. This increased pressure on indicated that sympathetic overac- the capillary beds expands the ves- tivity resulting from kidney disease sels and destroys more of the kid- may be accelerated in renal injury" The white flag has been raised in sur- and contributes to the progression render to the numbers with no hope of of renal disease8. Josne Paterno reinforcements. However, Traditional Not only does angiotensin increase showed that the same two acupunc- Chinese Medicine has not only a chance blood pressure, but it also activates ture points on the ankle and shin of helping but can slow down the pro- TGF-beta. The ability of ACEi to lowers serum creatinine, pro- gression of renal disease, improve lower blood pressure and reduce teinuria, glomerular sclerosis and erythropoietin resistant anemia10,11,12,13, one of the agonist of TGF-beta is tubulointerstitial fibrosis indices.23 improve sleep, fatigue, and depression one of the reasons why ACEi thera- A secondary effect of one of the in dialysis patients 5,14,15,, and comple- py is one of the first forms of treat- points studied above that may con- ments current ACEi and diabetes thera- ment of kidney disease4. tribute to the shown effectiveness of py16. Acupuncture and herbs can be acupuncture on CRF is the point effective because renal disease progress- Sympathetic nerve activity (SNA) in below the shin. Stomach 36 when es slowly and even a small improve- the kidney is 2.5x higher in a dis- stimulated with acupuncture needles ment over time provides years of bene- eased state than a normal and the lowers blood pressure by modulat- SNA leads to the progression of ing endothelial nitric oxide (eNOS) ESRD9,20. As the kidney tissue be- and neuronal nitric oxide Chronic renal disease, no matter the comes damaged proteinuria ap- cause, has the same histological changes pears. These proteins filter through and same disease progression19. From the glomerular capsule and then are The second hand of Chinese
the infancy of renal disease there is an reabsorbed later, increasing the rate medicine is herbal therapy.
increase of transcription growth factor of kidney decline. If diabetes is a The first thing any doctor is going to CYTP450 enzyme system in the dry cough and astragalus limits the tell a patient with renal disease is liver and how herbs either interact amount of ACEi needed therefore DO NOT TAKE any Chinese sup- or effect the metabolism of other decreasing the severity and even the plements or herbs, they lead to kid- medications.9 Simple rule of thumb ney failure and possibly cancer. is formulas with Buplereum (Chai There is logical concern for this, hu) especially Xiao Chai Hu Tang, many over the counter Chinese pa- appear to be the strongest at being Notoginseng (San Qi) has been tent medicines in the 80's and 90's metabolized by the CYTP450 sys- shown to have the ability to prevent contained unlabeled medication, epithelial to myofibroblast transition heavy metals, and unspecified (EMT) in damaged kidney tissue. herbs.25,26,27 Aristolochia species, Knowing the worries of Chinese This is basically the conversion of like fang ji and mu tong, along with medicine and herbal therapy here function epithelial into a fibroblast aristolochic acid containing herbs are a few positives: extra cellular matrix (ECM) depos- like xi xin, are to be avoided in renal iting cell. So even though the kid- disease. Aristolochic acid can build Safflower, (Hong Hua) inhibits the ney may be damaged, San Qi pre- up in even a healthy kidney and SMAD2,3 inflammatory cascade by vents the epithelial cells from be- causes acute kidney failure. This activating smad7, the inhibitor of coming non-functional. This func- type of kidney failure is known as SMAD2,3, in the kidney. tion is achieved by inhibiting alpha aristolochic acid nephropathy and (SMAD2,3 are downstream activa- smooth muscle actin (alpha-SMA) before that its common name was tors for fibrosis and glomerular scle- positive myofibroblast. It is these Chinese herb nephropathy, hence rosis which are activated by TGF- alpha-SMA fibroblast that respond the idea that all Chinese herbs cause beta, so even if TGF-beta is high it to increased TGF-beta and deposit kidney failure.1 Then there is can't effect the kidney because the extra cellular matrix (ECM).35 ephedra (Ma Huang) which increas- downstream signals are blocked)28 These fibroblast go through apopto- es blood pressure and can cause kid- sis in the presence of San Qi.36 Re- ney stones.25,26,27 The amount of Angelica and Astragalus (Dang Gui active oxidative species (ROS) play ephdra being taken as a dietary sup- Bu Xue Tang), is cooked and dosed another role in tubulointerstitial plement for weight loss was close to in a 5:1 ratio. Any other ratio have damage by activating TGF-beta. San 40-50 times more than a normal shown to be significantly less bio- Qi inhibits nicotinamide adenine Chinese medicinal dose. Another chemically active than the 5:1 de- dinucleotide phosphate (NADPH) specific herb that comes up is lico- coction. These two herbs must also which is a major source of the ROS rice (Gan Cao) which can cause be cooked together, when added produced in the kidney.37 pseudoaldosteronism, increases separately after cooking the strength blood pressure, and can lead to of the formula is diminished. Dang Cordyceps Sinensis (Dong Chong hypokalemia.25,26,27 The metabolism Gui Bu Xue Tang lowers pro- Xia Cao) a parasitic fungus can be of herbs in renal failure is complete- teinuria, which has shown to be a given orally as a tea with protective ly different than a healthy individual, leading contributor to the progres- benefits against chronic renal fail- the duration the herbs are in the sion of renal failure. The formula ure.38 The pharmacological effects system is longer especially if the also improves microvascular insuffi- of cordycep lower serum creatinine herb is secreted in the urine. Just be ciency in a damaged kidney by in- (Scr), lower inflammatory cytokines aware that the metabolic imbalance creasing vascular endothelial growth like TGF-Beta, decrease BUN, pro- in the body changes what is ab- factor (VEGF) which decreases the teinuria, and inhibit mesangial cell sorbed in the intestines, and the first rate of capillary loss in kidney fail- proliferation.25,39 In a clinical study pass effect into the liver is modified. ure. The astragalus part of the for- of CRF a course of treatment with In general, depending on the GFR, mula when combined with ACEi, cordyceps was able to lower BUN dose in smaller doses. Another con- increases the ability the medication by 25% and improve anemia by in- cern that comes up is with has in lowering TGF-beta. ACEi creasing hemoglobin by 13%.40 often has the side effects of chronic Generally this is the first and fore- shown to improve quality of health ure. The strength of TCM has al- most used Chinese herb for renal in patients with renal failure. Chang ways been its preventative abilities. failure due to its ability to protect Chuan Chinese Medical College In the Yellow Emperor's Inner Can- the kidney, having near zero side used an enema with rhubarb to treat non, Suwen, Chapter 2 it states: effects, and being non-nephrotoxic 1,000 CRF patients with an effective "Treating an illness after it has begun at very high dosages. rate of 87.7%.44 is like suppressing a revolt after it has broken out. If someone digs a Chinese rhubarb root (Da Huang) Salvia mitiorrhiza (Dan Shen) is a well when thirsty, or forges weap- has been used for thousands of years very active and safe ACEi which ons after becoming engaged in bat- as the main way to treat kidney dis- contributes to its activity in amelio- tle, one cannot help but ask, "Are ease. The confusion between Amer- rating the progression of renal dis- not these actions too late?"51 ican rhubarb root, often seen in ease45,46. The inhibition of angioten- pies, compared to the Chinese rhu- sin II is what enables salvia to lower How can acupuncturist help in pre- barb root can be attributed to Chris- renal TGF-beta along with reducing venting Kidney disease? First we topher Columbus' eager ambition in blood pressure. The reduction in must go back to the leading causes believing he had landed in the east blood pressure appears to be two of CRF. Those being diabetes and Indies and had found the famous and fold. One acting as an ACEi and the high blood pressure. valuable Chinese medicinal rhu- second by activating renal arterial barb.41 Its strong cathartic action is eNOS, which is a vasodilator.47 Diabetic nephropathy is character- thought to detoxify the blood by Other researched renal protective ized by infiltration of glycoproteins increasing the excretion of waste mechanisms deal with its ability to in kidney tissue, increased oxidative products through the large and small lower protein urea, BUN, Scr, and stress caused by lipoperoxidation, intestine.25 In small doses, starting inhibit ROS by increasing SOD and decrease in free radical scavenging at 1g per day and increasing to the catalase.36,37,38,40 Lately salvia's abil- enzymes, vascular damage, advanced tolerance of the patient,39 rhubarb ity to act as an xanthine oxidase in- glycation end products (AGEs), lowers protein urea, lowers BUN (a hibitor has led to increased interest proteinuria, and polyuria. nitrogen by product that is supposed in its future role as an alternative to to be excreted by the kidney but allopurinol, a medication that causes Lipoperoxidation is when a unsatu- builds up in CKD), decreases glo- severe nephrotoxicity at normal rated lipid (cellular membrane) is merular sclerosis but not tubulinter- dosages in patients with current attacked by a free radical. The free stitial fibrosis, decrease mesangial renal failure.48,49,50 radical cleaves a H+ group and cre- cell proliferation, and lowers ates a lipid radical. The lipid radical methylguanidine (MG) and Overall the use of acupuncture and shortly thereafter comes into con- guanidoinosuccinic acid (GSA), two the herbs safflower, astragalus, an- tact with a water molecule and uremic toxins.25,39,42 The medicinal gelica, notoginseng, cordyceps, rhu- forms lipid peroxide. benefit of this root was observed in a barb, and salvia can significantly 151 patient control trail comparing (P>0.05) lower renal SNA, lower This cycle repeats itself over and captopril (ACEi) therapy in combi- TGF-beta, ameliorate renal fibrosis over very quickly if there are no free nation with rhubarb, without the and glomerular sclerosis, prevent radical scavengers such as SOD, root, and a control taking neither. EMT, inhibit SMAD2,3, and alpha- catalase, or glutathione to bind to The group receiving both captopril SMA, causes apoptosis of fibro- the free radical and break it down. and rhubarb showed significantly blasts, inhibit ROS and NADPH, The increase in need of antioxidants better serum parameters than the lower creatinine, BUN, decrease caused by hyperglycemia creates a other groups.43 Aqueous extract of proteinuria, inhibit xanthine oxi- low amount of those free scavengers rhubarb root have also been used in dase, and act as an ACEi. showing up in blood work because the form of an enema that func- they are bound to a free radical. It's tioned like dialysis before dialysis PREVENTION
these free radicals that cause vascu- was invented. These enemas were Acupuncture and herbs gives us the lar damage by bombarding cellular tools to combat chronic kidney fail- pancreatic sensitivity to glucose, the pancreas to insulin. Ear seeds membranes. AGEs are formed increase uptake of glucose by tissue placed on kidney, endocrine, and when a sugar (glucose) comes into and adipose cells, and by decreasing shenmen increase free radical scav- Visit the AAM website at
visual is better, for charts/graphs and references.
ic patients and a intestinal absorption of glucose. control. The three ear points were making maple syrup. These AGEs Second line of defense is creating a massage 12 seconds a piece 3 times have receptors on the kidney called cellular environment that can handle per day for 20 days. By doing this receptor for advanced glycation end the increased oxidative stress in- the amount of serum catalase was products (RAGE). This binding duced by hyperglycemia. That can doubled and the amount of SOD causes inflammation in the kidney. be done by increasing the amount of was significantly increased52. We The kidney plays a role in the me- catalase, SOD, and glutathione be- have previously mentioned how St- tabolism and excretion of AGEs. ing produced by the body or by in- 36 and Kd-3 decreased renal sympa- This role is diminished in diabetic hibiting the formation of AGEs and thetic activity and inhibited TGF- disease. High renal concentrations of free radicals. Most secondary symp- glucose stimulates protein kinase c toms such as nephropathy, neuropa- (PKC). PKC activates TGF-beta thy, retinopathy from diabetes is Radix ginseng (Ren Shen), Scutellar- which stimulates cyclin-dependent related to this oxidative damage. ia baicalensis (Huang Qin), and kinase p27kip1. P27kip1 causes cell Rehmannia glutinosa (Shou Di arrest at the G1 phase in the cell Previous experiments with acupunc- Huang) increase insulin receptor cycle. This arrest leads to cellular ture and the pancreas has revealed substrate-2 (IRS2) which helps hypertrophy of mesangial and tubu- that the right spleen channel actually maintain beta cell function in the lar cells in the kidney. stimulates the pancreas while the pancreas. Beta cells are the cells left spleen channel stimulates the responsible for excretion of insulin. The first line of defense in treating spleen. Points such as Sp-3 and Sp-6 diabetes is lowering serum glucose on the right are effective at activat- by decreasing glycogenesis, increase ing and increasing the sensitivity of They also increases pancreas duodenum High proteinuria is often seen in diabetic lowers blood pressure in essential, 5/6 homeobox-1 (PDX-1) which is responsi- and non-diabetic nephropathies. The rate nephrectomized, and NaCl induced hy- ble for beta cell proliferation.53 When of GFR is closely predictable with the pertension by inhibiting ACEi and acting Huang Qin is combined with metformin it level of proteinuria. Showing that a pa- as a slight diuretic.64 It was also shown to increases the anti-diabetic effect by in- tient with low proteinuria would have a decrease BUN in the 5/6 nephrectomized creasing SOD, catalase, glutathione pe- slower progression of renal failure than a model. Bai Ji Li has a smooth muscle re- roxidase (GPx), and decreasing lipid pe- similar patient with a high level of pro- laxant effect, ACEi activity in the heart, teinuria. Cinnamon and Poria Decoction aorta, kidney, clipped kidney, lung, and (Gui Zhi Fu Ling Wan) when given in blood.65,55 Schisandra chinensis (Wu Wei Zi), Poria diabetes decreases kidney weight by pre- cocos (Fu Ling), Rhizoma alismatis (Ze venting renal hypertrophy, decreases TGF Other herbs such as Ligusticum (Chuan Xie), Dioscorea opposita (Shan Yao) in- -beta, fibronectin, AGEs and pro- Xiong), Gastrodia (Tian Ma), and Gyno- crease glucose absorption in the intestinal teinuria.60,61 Huang Qi also increases stemma (Jiao Gu Lan) are benefical at tract, Wu Wei Zi, Shan Zhu Yu, Ze Xie SOD, reduces proteinuria, and oxidative lowering blood pressure but they do not increase glucose uptake in adipose and renal damage.62 have a direct effect on the kidney. Hong fibroblast cells.54 Hua, even though it is great for kidney The next leading cause of CKD that can disease, only has minor hypertensive ef- Warm and Tonify the Spleen Decoction benefit from the preventative abilities of fect.28 (Wen Pi Tang) inhibit AGEs, and increase Chinese medicine is high blood pressure. AGE clearance. Da Huang, a chief herb With high blood pressure there is essen- These findings validate the long history of in Wen Pi Tang, was shown to be the tial and secondary hypertension. Essential use of traditional Chinese medicine in the most active in inhibiting AGEs by 98.1% hypertension is where the cause of the treatment and prevention of renal disease. at a dosage of 25ug/ml.55 increase in blood pressure is not known The multi-targeted approach that can be which accounts for over 90% of diagnosed taken with the combination of herbal Shou Di Huang decreases diabetic kidney hypertension. Secondary hypertension therapy and acupuncture is well beyond lesions, inhibit TBA-reactive substance are cases when the cause of high blood the current approach of western medicine which is a lipid peroxidation product, pressure is caused by another medical but does not undermine current pharma- decreases BUN, serum glucose, and renal condition. Examples of secondary hyper- ceutical therapy. Unfortunately the heavy glucose.56 Shou Di Huang also enhances tension are complications from diabetes, curtain of aristolochic acid species causing liver glucokinase which phosphoralates a polycystic kidney disease, renovascular Chinese herb nephropathy still lingers glucose molecule turning it into glucose-6 hypertension caused by stenosis of renal today. This combined with the patients -phosphate. It stimulates secretion of artery, Cushing's syndrome, thyroid frantic and desperate search for a quick insulin and decreases hepatic glycogen problems, and a long list of others. cure to their kidney disease online can lead to negative results. Just type in Acupuncture of St-36, Zusanli, is effective "kidney disease cure" on Google and you Eight Ingredient Pill with Rehmannia (Ba at lowering blood pressure by inducing will find days' worth of miracle herbal Wei Di Huang Wan) suppressed pro- eNos which dilates blood vessels.24 Kd-3, decoctions that you can conveniently buy. teinuria in a 25 week study, inhibited fi- Taixi, combined with St-36 lowers blood An informed licensed acupuncture and bronectin, TGF-beta, renal lipid peroxi- pressure, inhibits TGF-beta and attenu- herbalist does have the ability to help dation by lowering TBA-reactive sub- ates the progression of renal disease.23 KD those with chronic renal failure, to help stance, increased renal SOD, and was -3 combined St-36 decreases sympathetic those 30 million Americans who might shown to be able to prevent diabetic kid- nerve activity in the kidney thereby re- someday walk into your clinic and ask, ney damage by reducing renal oxidative ducing blood pressure.22 "Does Chinese medicine help kidney fail- When it comes to herbs there are three Radix astragali (Huang Qi) reduces fasting main players with renal disease. We have serum glucose, reduces albuminuria lev- already spoken of Dan Shen and its ACEi els, reverses glomerular hyper-filtration ability and renoprotective proper- rate, and ameliorates pathological changes ties.
36,37,38,40,48,49,50 Two other herbs are seen in early diabetic nephropathy.59 Herba apocyni veneti (Luo Bu Ma) and for the full article.
Tribulus terrestris (Bai Ji Li). Luo Bu Ma
Hospital Management Strengthening Program (HMSP) Checklist To Identify the Gaps in Minimum Service Standards Government of Nepal Ministry of Health and Population Contents Section 1: Governance Section 2: Organizational Management Section 3: Human Resource Management Section 4: Financial Management