Master Healthcare Excellence in Natural Medicine and Wellness

Master Healthcare Excellence in Natural Medicine and Wellness Enhancing Immunity A Multi-Modality Approach Mark Shoring CMD ND Master Healthcare Practice Principle and Owner Registered Chinese Herbal Medicine Practitioner [CMRB H/1695] §Master of Acupuncture UWS §Master of Applied Science (Chinese Herbal Medicine) RMIT §Master of Health Science (Nutrition Medicine) UNE §Master of Health Science (Herbal Medicine) UNE §Graduate Certificate of Health Science (Human Nutrition – Sports Nutrition) Deakin §Graduate Certificate of Education (Higher Education) UQ §Bachelor of Health Science (Naturopathy) ACNM §Bachelor of Health Science (Acupuncture) ACNM §Bachelor of Health Science (Musculoskeletal Therapy) Endeavour §Certificate IV (Oriental Massage) ACNM §Traditional Chinese Medicine Hospital Internship Guangxi TCM University §Certificate IV (Assessment &Workplace Training) Russo Melbourne ANTA Seminar Master Healthcare 1

Hippocrates 460 -377 BC “If we could give every individual the right amount of nourishment and exercise, not to little and not too much, we would have found the safest way to health” (Field et al 2002) Melbourne ANTA Seminar Master Healthcare 2

Session Aims § Overview the role of some key therapies that may be included in the management/enhancement of the immune system function. § These therapies include: § Nutrition Medicine § Diet (Food Based Chemicals) § Nutraceuticals § Herbal Medicine § Chinese § Western § Acupuncture Melbourne ANTA Seminar Master Healthcare 3

Nutrition Medicine Melbourne ANTA Seminar Master Healthcare 4

Proposed Immune System Model Considerations Underlying Aetiological Considerations: § Physical/Neurological/Emotional Stress § Overworking § Dietary Insufficiencies (Substrates and Co-Factors) § Genetic Abnormalities § External Pathogenic Factor (Infectious/Environmental) § Other Treatment Considerations: § Meditation § Dietary § Adaptogens | Nervines | Qi Tonifying | Jing Tonifying § Immune Stimulating Melbourne ANTA Seminar Master Healthcare 5

Central Nervous System Vs Immune System Vitex | Melatonin Physical Stress Nervine Adaptogen (eg. Ren Shen) Physical Stress http: //www. endotext. org/adrenal 28/adrenal 28. htm Melbourne ANTA Seminar Master Healthcare 6

Cell Mediated (TH 1) Versus Humoral (TH 2) Humoral Immunity involves antibodies that are produced in B lymphocytes. This process is further aided by CD 4+ T-helper 2 cells, which provide co-stimulation. Released antibodies bind to an antigen which flags them for destruction. Cell-mediated immunity involves macrophages, natural killer cells (NK), antigenspecific cytotoxic Tlymphocytes, and cytokine release that is not mediated by antibodies. Melbourne ANTA Seminar Master Healthcare 7

Ascorbic Acid (Field et al 2002) § § § § Antioxidant; Reduces T cell death; Increase NK activity via up-regulation of protein kinase C; Increases intracellular cyclic nucleotide levels; Modulates prostaglandins synthesis; Increases intracellular cyclic nucleotide levels Antagonism of the immunosuppressive interaction between histamine and leukocytes. Dosage: 500 mg frequently throughout the day due to the water soluble nature of vitamin. Melbourne ANTA Seminar Master Healthcare 8

Retinoic Acid (Field et al 2002) § § Encourages epithelial cell differentiation through regulating keratin synthesis; Reduces IFN-g secretion by T cells; Stimulates glycoprotein synthesis, Lymphocyte proliferations; and Encourages a shift from Th 2 to Th 1 dominance through reducing INF-g and aiding production of IL-4, IL 5 and IL-10 cytokine production. Dosage: 24, 000 IU / day taken throughout the day (avoid in pregnancy) Melbourne ANTA Seminar Master Healthcare 9

PUFA Omega 3 (Field et al 2002) Immunomodulating Effects (Balancing Effect): § Enhances NK cell activity and lymphocyte activity (proliferation/activation); § Increases T cell proliferation; § Activates CD 8+ T cells, IFN-g, TNF-a (note), cytokine (IL-1, IL-2), production, macrophages; § Reduces cytokines (IL-1, IL-6), TNF-a (note), PGE 2; and § DHA may increase CD 4+ antigen expression. Further Activities Including: § Alteration of lipid membrane lipid composition § Modulation of eicosanoid synthesis § Alteration of signal transduction Dosage: 12 gm per day (Extreme caution with Anti-PAF medication) Melbourne ANTA Seminar Master Healthcare 10

Zinc (Field et al 2002) § § § Antioxidant and substrate for macrophage and neutrophil free radical function (peroxide superdismutase); Lymphocyte formation: Substrate for T (CD 4) and B cell formation; Thymulin production: Zinc is an essential substrate for this protein that leads to T cell formation and activity; Cytokine production: Increase INF-g, IL-2, TNF-a (Th 1 type) without changing production of IL-4, IL-6, IL-10 (Th 2 type); Apoptosis regulation: § Low RA intake increases CD 4 and 8 apoptosis § High RA intake decreases endonuclease and inhibits steriod binding to glucocorticoid receptors. Gene Regulation: Decrease NFk. B (decreasing IL-2 -IL-2 R) and thymidine kinase (delaying cell cycl and reducing cell growth). Dosage: 500 mg frequently throughout the day due to the water soluble nature of vitamin. Melbourne ANTA Seminar Master Healthcare 11

Nutrient Considerations – An Example Melbourne ANTA Seminar Master Healthcare 12

Herbal Medicine – Recent Research Isbaniah F, Wiyono WH, Yunus F, Setiawati A, Totzke U, Verbruggen MA. 2010. Echinacea purpurea along with zinc, selenium and vitamin C to alleviate exacerbations of chronic obstructive pulmonary disease: results from a randomized controlled trial. J Clin Pharm Ther. 2010 Nov 10 Introduction: Upper respiratory tract infections (URTI) frequently cause exacerbations of chronic-obstructive pulmonary disease (COPD). Stimulation of the innate immune system may provide an early defence against such infections. The objective of this study was to determine whether Echinacea purpurea (EP) along with micronutrients may alleviate COPD exacerbations caused by acute URTI. Methods:   This was a double-blind, randomized, placebo-controlled trial in COPD patients with acute URTI. Patients were given ciprofloxacin for 7 days and additionally one tablet per day of EP, of EP along with zinc, selenium and ascorbic acid (EP+), or of placebo until day 14. Serum levels of TNF α and interleukins 1β, 6 and 10 were measured before and after treatment. Until week 4 post-end of treatment, all patients had to daily report on COPD symptoms in diaries. Results and Discussion:   In total, 108 mostly male patients with a mean age of 65· 8 years (40 -81 years) were enrolled. Patients of the three treatment arms did not vary significantly in baseline characteristics. EP+, but not EP resulted in significantly less severe and shorter exacerbation episodes following URTI as compared with placebo suggesting a synergistic effect of Echinacea and micronutrients. Large variations in biomarkers in-between and within groups were unrelated to treatment. Study medication was safe and well tolerated with overall 15 adverse events one of which was serious. Among those, sleeping disorders were most frequent and likely related to the underlying disease. What is new and Conclusion:   The combination of EP, zinc, selenium and vitamin C may alleviate exacerbation symptoms caused by URTI in COPD. Further studies are warranted to investigate the interactions among Echinacea, zinc, selenium and vitamin C. Melbourne ANTA Seminar Master Healthcare 13

Immune Herbs Western Sedating: § Hemidesimus indicus radix Western Stimulating: § Andrographis paniculata folium § Astragalus membranaceus radix § Baptisia tinctoria radix § Uncaria tomentosa caulis § Echinacea purpurea radix § Phytolacca americana Western Modulating: § Echinacea purpurea radix § Withania somnifera radix § Eleutherococcus senticosus radix § Panax ginseng radix Melbourne ANTA Seminar Chinese (Tonify Qi) – Post EPF § Huang Qi | Astragalus membranaceus radix § Dang Shen | Codonopsis pilosula radix § Ren Shen | Panax ginseng radix § Si Jun Zi Tang Chinese (Release Exterior) – During EPF § Wind Cold (head cold without heat) § Gui Zhi Tang (stiff neck) § Ge Gen Tang (stiff body) § Wind Heat (ie. sore throat) § Yin Qiao San (no cough) § Sang Ju Yin (with cough) Master Healthcare 14

Thomsonian Herbalism – Acute Infection (Colby 1845) Treatment of a wind cold type infection: Method and dosage: Place in a teapot two teaspoon of cayene and then add as much bayberry, goldenseal as possible. Steep in one pint of water then take half a cup full every three hours till symptoms disappear. Avoid exposure to wind and cold Treatment of a cough: 4 oz Lobelia herb, 2 oz Hoarhound, 2 oz Comfrey, 2 oz Elecampane, 4 oz Boneset Method: Boil in three quarts of water to three pints, strain and add two pounds of white sugar and one pint holland gin. Dosage: Two to three teaspoons once an hour for asthma, croup, cough, whooping cough consumption. Melbourne ANTA Seminar Master Healthcare 15

Eclectic Herbalism – Acute Infection (King 1866) Treatment of Fever: Tincture of Yellow Jessamine (Gelseminum sempervirens) Method: take fresh root yellow jessamine, cut into small pieces (roughly four ounces). Dilute in one pint of gin before macerating for 14 days, express and filter. Dosage: One teaspoon every three to four hours until effective. Treatment of Asthma, Bronchitis, Whooping Cough, Croup, Convulsions: Compound Tincture of Lobelia Method: Take lobelia, blood root, skunk-cabbage root, wild ginger rhizome and pleurisy root each in a moderately fine powder before mixing into one a total of one ounce. Then add one pint of water (or vinegar); Gin three pints; allow for maceration to take place, express and filter before dispensing. Dosage: one tablespoon every ten minutes until vomiting. Melbourne ANTA Seminar Master Healthcare 16

Proposed Formula – for Infant Male (10 month old 8 -8. 5 kg) presenting with acute bronchialitis with wheeze and cough. 40 m. L Pelargonium sidiodies 30 m. L Sambucus nigra 30 m. L Hydastis canadensis Dosage: 2 m. L (BID) 2 x/day Sang Ju Yin Dosage: 0. 25 teaspoon in warm water two times per day Vitamin C Dosage: 500 mg TDS in milk bottle NOTE THAT INFANT DOSAGE AND PRESCRIPTION IS DIFFERENT FOR EACH CHILD Melbourne ANTA Seminar Master Healthcare 17

TONIFY QI Huang Qi | Astragalus membranaceus radix (Hempen and Fischer 2009, p 706) http: //tcm. health-info. org/Herbology. Materia. Medica/huangqi-properties. htm – accessed 17/08/2010 @ 2: 09 pm Temperature: Warm Tendency Taste: Sweet Direction of Action: Ascending Site of Action: Spleen; Stomach; Middle Jiao; Lung Dosage: 10 -15 gm (standard 10 gm) Cooking time: 20 minutes Melbourne ANTA Seminar Actions: § Harmonize & tonifies qi § Raises collapsed yang § Stabilize the exterior § Restrains the sweating § Detoxifies and disinfects § Promotes urination § Stops bleeding Pharmacology: Promotes haematopoiesis; Immune stimulating; Anti-hypertensive; Hepatoprotective; Antibiotic; Analgesic; Sedative; Diuretic. Toxicology: Do not use past second trimester of pregnancy due to diuretic activity. Contraindications: Yin xu with heat/fire; Excess heat; damp-heat. Master Healthcare 18

TONIFY QI http: //www. aznhealth. com/herbs/h-dangshen. jpg – accessed 26/10/2010 @ 8: 41 am Temperature: Neutral Taste: Sweet Direction of Action: Ascending Site of Action: Spleen; Stomach; Middle Jiao; Lung Dosage: 3 -15 gm (standard 8 gm) Cooking time: 20 minutes Melbourne ANTA Seminar Dang Shen | Codonopsis pilosula radix (Hempen and Fischer 2009, p 710) Actions: § Harmonize and tonifies the qi § Raises the qi § Harmonizes and tonifies the spleen and stomach § Generates fluids Pharmacology: Adaptogen; Immune stimulating; Increases erythrocyte and macrophage counts; Reduces leucocytes and lymphocytes; Improves circulation. Toxicology: Nil noted. Contraindications: Damp-Heat; Ascendant Liver Yang. Caution: Pregnancy. Master Healthcare 19

TONIFY QI Ren Shen | Panax ginseng radix (Hempen and Fischer 2009, p 714) Actions: § Harmonize & tonifies qi and spleen § Raise the Qi § Generate fluid § Clams and anchors the shen Pharmacology: increases reaction and http: //tcm. health-info. org/Herb%20 Pictures/Ren%20 Shen%20. jpg – accessed endurance (adatogenic); stimulates 16/08/2010 @ 2: 55 pm Temperature: Warm immune function; lower serum cholesterol; lower serum blood glucose. Taste: Sweet | Bitter Toxicology: Excess use may lead to Direction of Action: Ascending headache, insomnia, palpitations, Site of Action: Spleen & Stomach; middle increased blood pressure, oedema and jiao; Lung diarrhoea; Over dose may lead to Dosage: 1 -10 gm (standard 3 gm) pruritis, dizziness, fever, rashes, Cooking time: In order to optimize haemorrhage, painful breasts and post extraction boil for three hours and then add menopausal bleeding. to the other prepared ingredients Contraindications: Yin xu with heat or fire; Melbourne ANTA Seminar Master Healthcare 20 damp-heat, ascendant liver yang with

Si Jun Zi Tang (Four Gentleman Decoction) Herb Latin Name Dosage Bai Zhu** Atractylodis macrocephala rhizoma Fu Ling*** Poria cocos Group Warm Sweet Bitter Tonify Qi 7. 5 gm Warm Bitter Sweet Tonify Qi 6 gm Panax ginseng radix Taste 9 gm Ren Shen* Temp Neutral Sweet Expel Damp TCM Indications: Strengthen the spleen and supplement qi Gan Cao Glycrrrhiza uralensis radix 6 gm Neutral Pungent Tonify Qi Biomedical Indications: • Enhance/regulate digestive function; and • strengthens immunity/resistance. Contraindications: See caution Caution: Early stage acute illness (eg cold/flu) Dosage: 8 -12 pills (up to every two hours) away from food where possible Melbourne ANTA Seminar Master Healthcare 21

Gui Zhi Tang (Cinnamon Twig Decoction) Herb Latin Name Dosage Temp Taste Group Gui Zhi* Cinnamomi cassiae ramulus 9 gm Warm Pungent Sweet Release Exterior Bai Shao** Paeonia lactiflora radix 9 gm Neutra l Bitter Sour Tonify Blood Sheng Jiang Zingiber officinale rhizoma 9 gm Warm Pungent Release Exterior Da Zao Zizyphus jujuba fructus 12 Warm Sweet Tonify Qi TCM Indications: Dispel wind from the exterior; balances relationship between pieces nutritive (ying) qi and defensive (wei) qi; harmonizes the spleen and stomach Zhi Gan 6 gm Warm Pungent Tonify Qi Biomedical Glycrrrhiza uralensis Indications: Mild Diaphoretic, Antispasmodic Cao radix Contraindications: Excess patterns, external cold with internal heat, wind heat, acute warm or damp heat, internal heat and yin deficiency Caution: Pregnancy Dosage: 8 -12 pills (up to every two hours) away from food Melbourne ANTA Seminar Master Healthcare 22

Yin Qiao San (Honeysuckle and Forsythia Powder) Herb Latin Name Dosage Temp Taste Group Jin Yin Hua* Lonicera japonica flos 30 gm Cold Sweet Clear Heat Lian Qiao* Forsynthia suspensa fructus 30 gm Cold Bitter Pungent Clear Heat Jie Geng** Platycodon grandifolium radix 18 gm Warm Pungent Bitter Transform Phlegm Niu Bang Zi** Arctium lappa fructus 18 gm Cold Pungent Release Exterior Bo He*** Mentha haplocalyx herba 18 gm Cold Pungent Aromatic Release Exterior Dan Dou Qi*** Glycine Max. semen praeparatum 15 gm Warm Pungent Sweet Release Exterior Jing Jie*** Schizonepeta tenuifolia herba 12 gm Warm Pungent Aromatic Release Exterior Dan Zhu Lophaterum gracile herba 12 gm Cold Sweet Clear Heat Melbourne ANTA Seminar Master Healthcare 23

Sang Ju Yin (Mulberry Leaf & Chrysanthemum Decoction) Herb Latin Name Dosage Temp Taste Group Sang Ye* Morus alba folium 15 gm Cold Bitter Sweet Release Exterior Ju Hua* Chrysanthemum morifolium flos 12 gm Cold Sweet Bitter Release Exterior Bo He** Mentha haplocalyx herba 18 gm Cold Pungent Aromatic Release Exterior Xing Ren** Prunus armeniaca semen 7. 5 gm Warm Bitter Sweet Eliminate Phlegm Jie Geng*** Platycodon grandifolium radix 10 gm Warm Pungent Bitter Transform Phlegm Lian Qiao*** Forsynthia suspensa fructus 10 gm Cold Bitter Pungent Clear Heat Lu Gen*** Lophaterum gracile herba 15 gm Cold Sweet Clear Heat Gan Cao Glycrrrhiza uralensis radix 5 gm Neutral Pungent Tonify Qi Melbourne ANTA Seminar Master Healthcare 24

Proposed Mechanism of Activity http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 442119/figure/f 1/ - accessed 22/11/2010 Melbourne ANTA Seminar Master Healthcare 25

Acupuncture Main Points: Co 4; Du 14; Lu 7; Ren 4; Ren 14; Sp 6; St 36 § Electro-stimulation (20 -30 minutes of stimulation): § St 36: Stimulate hypothalamus function (Jiang H et al 2010) and balances Th 1 and Th 2 cytokine function (Wang et al 2009) § Ren 4: T and B lymphocyte proliferation rates and IL-2 activity enhanced (Liu et al 2009) § Ren 14: T and B lymphocyte proliferation rates and IL-2 activity enhanced (Liu et al 2009) § Other Techniques: § Cupping over Ren 8 (Tang 2010) Melbourne ANTA Seminar Master Healthcare 26

In conclusion § This is just snap shot of data on this topic. § Don’t be afraid to consider the emerging science and contrast this with past practice (this is how we evolve). Thankyou Master Healthcare 71 Loftus Street Deagon QLD 4017 Email: mark@masterhealthcare. com. au Melbourne ANTA Seminar Master Healthcare 27